So, I work in healthcare - as a doc, and at various times, as an admin in healthcare centers as well as in health insurance. I don't know how much of that experience relates to FB's behavior, but I have some idea of what it's like to work in a field and be either called a hero or a devil, depending on the day. I am neither.

Deep breath.

As an industry, we are often doing things that are perceived to be evil. I've noticed the following:

1. Some of that interpretation is just wrong. People from the outside tend to have a poor understanding of what we do (providers, centers, insurers) and draw conclusions based on highly imperfect information. This is compounded by the fact that journalists have a terrible comprehension of what we do and an incentive to dramatize and oversimplify it - resulting in people reading the news and walking away misinformed and wrongly feeling like they're now educated on the topic. This happens a lot.

2. We sometimes do things, or want to do things, that have potential harms and potential benefits - e.g., in health insurance, I'd love to have had the ability to twist people's arms into coming to get a flu shot. It would have been a huge net benefit to their health. It would have been a net reduction in our costs. It would have been great! If we'd had the ability to ignore patient autonomy and force it, or carrot-and-stick it, we probably would have. We would not have conceptualized it as "ignoring patient preference," we would have conceptualized it as "preventing a bunch of preventable hospitalizations and deaths and, for the elderly, permanent consequences of hospitalizations." And that would have been true! And would have allowed us to not think about the trade-off so much. It's not lying to yourself: it's looking at the grey, round-edged parts of a cost-benefit analysis and subjectively leaning it in your direction. My motivation there isn't even about the money - the money just gets it on the radar as something my employer would be willing to prioritize.

3. Resource scarcity. I only have so many resources to allocate. One may benefit a patient X; another may benefit them 10X. If X benefits my organization and the 10x choice doesn't, I'll probably choose X. By itself I'm not choosing to do harm - I'm choosing a win/win. Enough decisions like that, in enough contexts, probably do give rise to net harm. But the choice isn't to do harm.

4. Not every battle can be a "will I burn my career over this?" battle. If I'd ever been faced with a choice that I thought was harm > benefit to patients, I would have burnt the house down over it. But I haven't. I've been faced with lots of little grey questions with uncertain costs and uncertain benefits where there was, in fact, benefit, and usually not just to us but to the patients too. I imagine that's where most organizations go awry: a thousand decisions like this, shaking out under the pervasive organizational need for profit. Like a million million particles of sand moved by the tide, settling out into an overall pattern due to gravity. I think the badness is generally an emergent pattern, not a single person choosing to do evil, or choosing themselves over causing harm to many. I've never been in that position, ever, so either my career is highly anomalous, or that's just not how those choices present themselves in real life. I suspect it's the latter. (Or, I guess, my being amoral is a valid third possibility.)