When I read the headline “Lawsuit: AbbVie Used Kickbacks and Nurse Ambassadors to Boost Humira Sales,” I was mortified. My initial thought? This could be a result of work my team did, in an attempt to help patients. After all, my team has frequently suggested to clients that they get more involved with patients and providers. What if this sort of “ambassadorship” was being seen as pushing a drug, rather than joining the conversation?
As it turns out, I was wrong. The lawsuit alleges that Humana “used a network of registered nurses to mislead patients about the risks associated with the drug,” which is most definitely not a recommendation that my team has ever made to any client. But it got me thinking about the UX ethics of the situation.
Where is the line between providing a benefit and pushing a product?
The Idyllic, Ethical UX World
At UX agencies we can live in a sweet, idyllic world, in which we pretend that profit is not a motivating factor. We create extensive user journeys and consider the user’s needs and barriers, and we look for opportunities to connect with them. We seek to impact behavior change, and help people make smart decisions to improve their health and financial wellbeing.
Often we discuss the business needs as well, but this is always secondary. So when a pharmaceutical company asks us, a UX agency, to help them connect to patients who would benefit from their medication, we see the challenge through the lens of the ideal.
- First we learn more about the patients who tend to take this sort of medication. This involves user research, ethnographic interviews, and surveys.
- Next, we sketch out the scenarios in which patients are currently getting support (both via medication and other means). We identify when medication is mostly likely to be needed, and what the opportunities for awareness are just before that point.
- Typically we make recommendations to our client on how they can interact with patients. This involves some content marketing, some engagement strategies, and yes, some medication sales. And typically our clients are open to these suggestions – particularly the ones that expand their role beyond selling medication.
It’s that sort of work that leads to suggestions such as creating “nurse ambassadors.” In an ideal world, ambassadors remain objective and help the patient. In a worst case scenario, they become glorified salespeople, or even provide misinformation.
UX Ethics in the Real World
As a sidenote, I personally believe it is wrong that Pharmaceutical companies charge what they do for medications. Also, I believe our system is broken, and healthcare should not be bankrupting people. As a UX practitioner, I believe my job is to do what I can to improve the system. If I can help a few more people understand they medical bills in advance, that’s better. And if I can help a pharmaceutical company become less about sales and more about support, that’s better too.
But I’m also lucky. Clients who come to Mad*Pow tend to be people whose jobs are not about profit alone. They see themselves as people who can help their target audience. For example, they don’t want to gouge patients on prices and further harm those with chronic conditions.
Unfortunately, our clients don’t control everything in the world, or even everything in their organizations. So in order to create ethical programs and systems, we need to leave our idyllic world. We need to plan for the worst case scenario.
Plan for the Ethical Worst Case Scenario
As I said, it turned out that our ambassador program was not the one referenced in the lawsuit. But it could have been, and other recommendations we make could someday be misused.
With that in mind, here are questions to consider, to protect your UX solution from misuse:
- How could someone misuse this? What would the ramifications be?
- What are the core elements of this plan?
- How does this plan help the end user?
- What is the “MVP” of this plan – in other words, if the company strips it down, what can they not touch?
Knowledge is power. When you know the worst, you can plan for the best.