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Comment by RL_Quine | Hacker News Reader

I have a rather specific condition that I’ve seen YouTube advertisements for the drugs for, despite not even searching for the details of it except through an anonymizer. I’ve always wondered what the cost per click for an advertisement for a $100,000/yr drugs is.

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That’s so messed up. What do you think of advertisements for drugs in general? Have they been helpful finding treatment for your condition ? They are illegal where i’m from i believe (i’ve never seen one myself except in the us).

Btw, this reminds of this absolutely hilarious story i think i first heard of here on HN: https://ghostinfluence.com/the-ultimate-retaliation-pranking...

There’s basically one treatment, and one only that any specialist would recommend at this point, so it’s effectively moot other than the question of it being covered by whatever healthcare or insurance you can muster up.

The alternative and older drugs tend to have some rather horrific side effects (detaching your retinas, making your skin detach in some cases) but are very cheap, nobody would choose them if they had the better option.

I’m sort of confused in general what advertising for these sort of drugs actually achieves. It’s not like the patient really has a deciding ability (other than live or die if they can’t afford it), so all it does is act as a constant reminder of how financially screwed you are.

I’m betting these advertisements are for healthcare providers.

There's basically some segment of the population who will demand $SOME_DRUG_THEY_SAW_ADS_FOR and will change doctors repeatedly until they can get a prescription for it, even if there are better alternatives that were recommended by the previous doctors. Eliminating direct advertisement won't completely avoid that since there will always be blogs full of crazy nonsense or whatever, but I don't think there's any reason that consumers should be getting targeted for ads for things they can't even legally buy.

It's illegal to do that in the UK and therefore we have no (major) issues like you describe.

One of those regulations that is a net good to society.

Interesting video https://www.youtube.com/watch?v=ic_FpRG7Z_k

Here are some ideas:

- If you have a call with your doctor that probably is specialized in that specific condition, that metadata would be good enough to guess that condition.

- Some doctors send appointment reminders via email, if you use gmail that would explain the youtube ad

- If you use the wifi/gps at that doctor office, and some other patient also uses the wifi/gps and they use google to search for those conditions, that would be enough to link you with them. This could be any website making the link and tying all those people as similar.

- Close friends and family that research about your condition, would also point to you having that condition. Would probably use google to research, that would explain ads on youtube. They would also see ads for that and actually even might click on them because they would be interested on it.

>Some doctors send appointment reminders via email, if you use gmail that would explain the youtube ad

Google stopped mining Gmail for ad targeting years ago: https://www.nytimes.com/2017/06/23/technology/gmail-ads.html

While this may be true, recently I started using Google Flights and couple of days later I started receiving email ads (ads in Gmail) about flight cancelation insurance.

So the link is there.

That's entirely different to what we're discussing. You will still be targeted based on sites your visited, but not based on emails you receive.

Language is not clear enough, scan is different from metadata. I can see a lawyer defining scan as checking every word of the content and metadata being account Foo sends email to account Bar. That would be enough to make the connection. Foo account later uses google to search about topic A then topic A is presented to account Bar.

Those are all very plausible, but I'm surprised you didn't guess the most obvious:

His healthcare information was not transmitted through technical means. His insurer and/or doctor sold the information.

It’s also possible it was stolen. Though a FOI request against my hospital I was able to find the URLs where they store documents (they printed them and sent them to me, with the URLs at the top), which appear (though I obviously didn’t try) to be vulnerable to enumeration attacks. The files I was supplied with have sequential identifiers.

Assuming they live in the US, that is against HIPAA and in my experience it is taken very seriously since what you described is crime punished by a fine of up to $250,000 and up to 10 years in jail.

None of these sound reasonably ethical to me. I think we all agree that medical information shouldn't be sold. If you disagree then what do we do about HIPPA? Get rid of it? I feel like the things you listed above basically skirt around HIPPA. Legal, but definitely violates the spirit of the law.

That's how Google operates, all they see is bits flowing one way and another and the algorithm makes the connection. That's the problem, there is no safeguards or way of saying don't make those connections since they leak personal info.

Are there any alternatives? It often gets very weird at the high end of drug prices, but usually in a way that inverts normal economic logic - this story from a few years ago blew my mind https://news.ycombinator.com/item?id=13995249#13996448

> I’ve always wondered what the cost per click for an advertisement for a $100,000/yr drugs is.

I doubt it's very much. The reason the price of the drug is so high is that there's zero competition. CPC in auction-style ads is driven upwards by competitive pressure.

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