Device stopped working because your medical prescription has expired | Hacker News Reader

Device stopped working because your medical prescription has expired

olympicophthalmics.com

48 pointsdavikr55 comments

At what point does dependence on insurance become a liability for medical approval? I would have thought we passed that threshold decades ago but the industry appears to have the full throated endorsement of the state for some reason.

I don't see how expiring prescriptions are caused by insurance?

Prescriptions are tied to billing. The main party with the incentive to withhold treatment is the party expecting a direct payment from the patient.

I might see some concern if there's concern about abuse of the treatment, but that seems like a fundamental mischaracterization of the concept of prescription.

Then to rephrase the question:

  >At what point does [the poors dying in the gutter when they can't afford care] become a liability?

Never.

That's a feature (arguably the feature) of for-profit healthcare, not a bug.

> That's a feature (arguably the feature) of for-profit healthcare, not a bug.

Ok, at what point can we cull the rich in a comparable way?

I assume you meant "expecting a direct payment TO the patient"?

My understanding is that prescriptions are required for medications that carry risk, so a doctor needs to evaluate if it is appropriate for the patient, and at what dose.

This avoids people self diagnosing and taking random doses of various medications.

Pharmacies are happy to sell you medications that aren't covered by insurance at full price.

> This avoids people self diagnosing and taking random doses of various medications.

This is such a non-issue it's impossible to take seriously. People do this regardless of prescriptions and the danger of the substances they're intaking (think: alcohol). What is the risk entailed by the device described in the original post that a prescription guardrail might prevent?

I need to order supplemental nutrition for my son. I usually just pay out of pocket, but I contacted a company that can deliver the product and have it billed though my insurance. It would end up costing me about the same but would at least count towards my deductible. They delivered monthly. After the second delivery I got the first bill. It was much higher than they said the per unit cost was.

After a lot of Byzantine exploration of billing codes, I discovered they were billing a daily charge for infusion. A lot of angry phone calls just reached the conclusion that they add this charge because they are allowed to by the insurance.

I'm guessing this is a similar thing. They can keep charging a daily charge so long as they are able to control that the device is active.

> iTEAR®100 does not run out during its 30 day prescription so you do not have to conserve therapy or worry about wasted practice drops or sprays.

> Q: How long does this last?

> A: The iTEAR®100 device prescription lasts 30 days at which time it turns off and you will need a new prescription from your doctor for further treatment. After 30 days, the device will be inactive.

Alas, medical device DRM.

The iTEAR 100 is not generally reimbursed by insurance. If you have an HSA or FSA, you might be able to get it through that. This whole medical device lifetime thing is because it’s regulated for its medical claims by FDA. Given some of the side effects noted here https://itear100.com/clinical-data.html, and how it changes the kind of tears that the user produces, I think it’s reasonable on its face to require a medical professional to review whether it’s working and needs more time with you every month.

But is it a medical professional reviewing its use, or the device maker repeatedly demanding payment for a device they already sold?

This should be illegal. Its just anti consumer and anti competitive practices abusing the regulatory system to seek rent.

Maybe, but it's also a bigger philosophical debate between positive and negative freedoms. Do you want the freedom for businesses to operate how they want, or do you want the freedom from unfair business practices? You can't really have both.

Do you want freedom from extortion and racketeering? If you do, are you not against free market?

Do you want collusion and cartels to be legal? If you do, are you not against free market?

It seems the entire distinction of negative vs positive freedom is fictitious.a negative freedom can be a positive freedom when looked at from another perspective

It's philosophy all the way down, wikipedia style.

What? Unchecked capitalism doesn't ensure our freedoms. Quite the opposite, unless you're talking about freedom of the rich to screw over others.

Capitalism looks like game theory, where instead of universal cooperation you have every actor working to restrict or steal information from other actors and generally finding ways to insulate yourself to a point where you can just keep hitting the defect button.

If businesses operated the way they want, they would take 100% of everyone's money and provide nothing of value. Everything else they do is just an inconvenient step on the way to the goal.

If businesses operated the way they want...they would nit be businesses, they would be cartels....or governments!

Businesses operate like the customers want unless the govt tells them to do otherwise. In this case the paying customer is an insurance company who could care less if the medical device was deprecated, or not, after its expected value was delivered

> Businesses operate like the customers want

Like feeding cows chucked poop, and then selling meat of cows infected with bird flu directly to consumers.

I can't wait for repo men to rip the artificial heart out of my body after I can't make the monthly payments.

PS They did this shtick for Repo Men (2010) w/ Jude Law.

I was a big fan of the first part in the Repo series: https://en.wikipedia.org/wiki/Repo!_The_Genetic_Opera

This looks awesome, thanks for sharing!

Sometimes I wonder if humanity would be better off if us computer engineers were "real" engineers with licenses and an ethics standard?

Yes

It drives me mad that computer programmers call themselves engineers without ever getting any engineering training

In many cases with no tertiary qualifications at all

Then there are "software architects".

So dishonest.

No wonder our industry has such a well deserved reputation for producing very bad products

Once upon a time bridge builders built bad bridges, so engineering as an actual discipline was created.

We desperately need that. We need to be held to account for what we do, just like bridge builders are

They are probably doing it in an attempt to get coverage by insurance (even if that is now not available). They can then raise the price manyfold.

See this discussion of prescription-only smartphone apps. https://www.astralcodexten.com/p/welcome-to-the-terrible-wor...

> If your device stopped working, it could be because your prescription has expired, and the device has been deactivated. Talk to your doctor about getting another refill prescription for iTEAR®100. Or you can request a telehealth appointment and the company will assign a doctor to you.

So, a Prescription is the new Subscription model?

Here is a migraine headache therapy that works on the same principle.

https://www.gammacore.com/

It’s really difficult to get prescription and insurance to line up and then they mail you a RFID card that you scan to “refill” the device.

https://www.djoglobal.com/products/regeneration/ol1000 uses magnetic fields to stimulate bone growth. After the appropriate number of treatments, the device bricks itself

What is the device for? Genuine ignorance and curiosity. Are there folks who cannot produce tears, and do the tears serve an important health function that makes it important to stimulate tears in this way?

https://en.wikipedia.org/wiki/Dry_eye_syndrome

https://en.wikipedia.org/wiki/Schirmer's_test - this test is used in the clinical trials for the device to determine if your eyes produce enough tears

Website has stopped working... because it has been posted on HN?

I wonder if there will ever be an 'iBreathe' device = life DRM?

Sadly, I think this is already a thing.

A medical device should not require a subscription

What about a prescription though? If someone invented a device that could synthesize opiates and dispense them on demand, surely that should require a prescription?

That's some unrelated fairy tale that makes this company look no better.

I don’t think it’s unrelated. The title of this post is “prescription required,” not “subscription required.” Whether or not the device should be so regulated as to require a prescription is one question. But if the FDA has determined that it’s required (and thus you must get a prescription from your doctor), then why should you be able to use it after your prescription has expired? If your doctor prescribes you 1000mg of opiates, you don’t get more opiates when you run out of them unless you renew your prescription with your doctor.

The problem in this case seems to be that the device requires a prescription in the first place. But since it does, I don’t see an issue with enforcing it.

If the use of the device genuinely needs continued supervision of a doctor, that's fine. But that's no reason for the device maker to demand eternal payment, which I'm guessing is the case here? If that indeed is the case, then "prescription" is just some corporate lawyer word game.

There are far better analogies than opiates though.

There's no reason why a treatment that is working and is expected to continue to be effective indefinitely should be withheld because a doctor's appointment didn't happen during the scheduled window one month, any more than my glasses should stop working because I didn't see my opthalmologist this year.

Freedom to choose suboptimal outcomes is not a bad thing.

No device should require a subscription

Own a Tesla?

Noone really does

Well, at least it’s not a pacemaker. We haven’t reached end-stage capitalism, yet.

Beyond that there's still some way to go - https://en.wikipedia.org/wiki/In_Time

  "a society that uses time from one's lifespan as its primary currency"

That's just wages with fewer steps.

People trading their time for money?? What an inconceivable future society! :D

I was going to suggest something closer to https://en.wikipedia.org/wiki/Repo!_The_Genetic_Opera

Isn't that just Michael Ende's Momo but with extra steps?

What is end-stage capitalism? Under the nomenclature of "late-stage capitalism" the next stage is revolution, not "end-state".

"End-stage" is when there is no revolution because greed has killed everyone already.

the revolution option has expired and cannot be enabled anynmore

I bet they sell pitchforks wholesale.

Revolution is what the would-be proletariat persistently, but perhaps delusionally, assumes it will win (despite the 1% being able to afford more than enough bullets)… end-stage is when the cancer has gone past the point of fighting and you just have to resolve yourself to (in this case human-societal) death. A good sign it’s too late to seize the means of production is when the workers have medical devices that require an active and paid up subscription.

> Revolution is what the would-be proletariat persistently, but perhaps delusionally, assumes it will win

Occasionally, it does win. I think Marx tends to have a point about the inevitability of this given persistent class conflict, but this could play out over centuries rather than something we'll ever see.

And we never will!

Dunno, Elon and Bezos seem to be doing their damndest to push past the red line. A pacemaker with an LLM you can chat with would also be a good sign we’ve passed the point of no return.

In the same way there is Rule 34, I think there applies a similar rule for capitalism: At least it's not a pacemaker, yet, but I'm sure someone is working on it.

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