By Luis Kun
The 2018 IEEE International Symposium on Technology and Society (ISTAS) took place in Washington, D.C., at the George Washington University hosted by the School of Engineering and Applied Science during November 13 and 14, 2018. This is the flagship conference for Technology and Society and the IEEE Society for Social Implications of Technology (SSIT).
ISTAS 2018 – LSTC SESSION Workshop and Panel Discussion
Health and Public Health Delivery Challenges and Ethics in the Information Age
We live in a planet where two very different realities coexist. One is a world where Internet, cell phones, computers, iPhones, iTunes, iPads, iPods, High Definition TV, the Global Economy, medications a la carte for: depression, cholesterol, high blood pressure or erectile dysfunction are available. The other reality, however shows that over 71% of the World lives with less than 10 dollars a day. Also according to the United Nations: 884 million people don’t have access to clean water; 2.5 billion lack proper sanitation facilities; 21.000 persons die every day from malnutrition. In this “other” reality thousands of daily deaths are caused by tuberculosis, AIDS and Malaria (to name a few). Most of these deaths, due to: dirty water, lack of food and medications / vaccines for infectious diseases, are preventable. In the mid-90’s a discussion ensued regarding a potential “digital divide” between these two groups. The call for attention was based on the great social inequities that could be produced based on the possibilities between having or not, access to the Internet and communication technologies. Today, 25 years later, new advances, new hurdles and several ethical questions arose. Shifting from a disease centric system to one that focuses on wellness, requires a strategy on prevention. This strategy may require: silencing, activating or editing genes; disactivate cancer cells; correcting genetic defects; neutralizing mosquitos of Malaria, Dengue or Yellow Fever; neutralizing cancer cells; neutralizing infections, virus, HIV, etc. If our goal is to improve the quality of life by avoiding disease while decreasing the associated healthcare costs, many ethical questions will occur regarding Genetically Modified Organisms (GMO)/ humans in particular. While genetic enhancement for a healthier life may be acceptable, what about the following features: stronger, better looking, smarter, or even creating someone as a super human or a super villain? These characteristics could generate errors / horrors, discrimination responsibility toward the future generations, banalization and human dignity challenges to Society. Life expectancy has increased because of advances in science and technology. In the developed world, expenses related to the elderly (non-communicable diseases / chronic conditions) are mounting daily. It is expected for example that the US over 65 population will more than double by 2030. The US already spends 19% of the GDP in health expenses. If we consider that the last year of life is the most expensive one, then this expense will not only be staggering but unsustainable. In parallel, the world population grew from a 6 to 7.6 billion, from 1995 to 2017. It is expected to reach 8.2 B by 2030, 9.7 B by 2050 and 11.2 billion in 2100, according to a UN report. These population increases will be mainly felt in Africa and Asia, where already 75% of the world population resides. The increases in population density will increase the potential for transmission of communicable (infectious) diseases throughout the world. Advances in computing, information and communications technology provide a unique opportunity to provide mechanisms that may lower the cost of healthcare through prevention while improving the quality of life. Cybercare / homecare through fast access Internet offers such possibilities, however new “digital” challenges such as access to medical information, privacy and security of our information and the interdependence of all of the world’s Critical Infrastructures is a new paradigm.
“The Cybercare model shifts health care provision from hospital to home; from specialist to generalist; and from treatment to prevention. Cybercare uses seven “pillars” of technology to provide medical care: genomics; telemedicine; robotics; simulation, including virtual and augmented reality; artificial intelligence (AI), including intelligent agents; the electronic medical record (EMR); and smartphones. All these technologies are evolving and blending. The technologies are integrated functionally because they underlie the Cybercare network, and/or form part of the care for patients using that distributed network. Moving health care provision to a networked, distributed model will save money, improve outcomes, facilitate access, improve security, increase patient and provider satisfaction, and may mitigate the international global burden of disease.” From the “Future Delivery of Healthcare”1
- C. Koop, Robyn Mosher, Luis Kun, Jim Geiling, Eliot Grigg, Sarah Long, Christian Macedonia, Ronald Merrell, Richard Satava, Joseph Rosen (2008). Future delivery of health care: Cybercare. IEEE Engineering in Medicine and Biology Magazine, 27(6), 29-38. DOI: 10.1109/MEMB.2008.929888 http://www.academia.edu/20121023/Future_delivery_of_health_care_Cybercare
Health and Public Health Delivery Challenges in the Information Age: Prevention a Key
Luis Kun, Ph.D, Distinguished Professor Emeritus of National Security Affairs, CHDS/NDU – Washington DC
Cybercare / homecare through fast access Internet links patients and primary care providers to tertiary medical providers via telemedicine. This decentralization could reduce costs and as a dual system, better protect a country’s resources in an event of biological terror, or natural disasters. A large ransomware cyberattack in May 2017 crippled computer systems at hospitals across Britain with appointments cancelled, phone lines down and patients turned away. Malware infected and locked computers while the attackers demanded a (small) ransom. The ransomware attack however, not only hit 16 National Health System hospitals in the UK but up to 70,000 devices across 74 countries using a leaked exploit first discovered by the NSA and included Banks (China), telephone companies, Federal Express (US), etc. In an interconnected digital world economy, a cyberattack to any industry, anywhere, can have consequences everywhere. Conversely an attack to any other industry can have consequences in the healthcare delivery system. Estonia is the first 100% digital country. In 2007 Russia through a denial of service attack, closed all of this country’s critical infrastructures. With the adoption of the Aadhaar system in India (collection of biometrics) 1.4 billion people’s privacy and security is at risk. Our (electronic) health records are islands of information not fully accessible, integrated or interoperable. In the US, currently 440.000 people die every year because of preventable medical errors.
Opportunities for applying artificial intelligence in medicine to benefit underserved populations
Sameer Antani, PhD – National Library of Medicine, National Institutes of Health, Bethesda, MD
Some of the world’s deadliest but curable diseases afflict under-resourced and populations of the world. For example, comorbidities of HIV and TB, Malaria, and Uterine cervical cancer are all treatable, or manageable diseases. Yet, these scourges kill millions every year. Recently, the role of artificial intelligence in medicine and other automation and the potential for their introducing cost and labor efficiencies has been extensively discussed in the research literature and popular press. Extending these ideas to under-resourced regions presents an opportunity to apply meaningful research outcomes to serve the afflicted and perhaps even eradicate some of these. At the National Library of Medicine and various other institutes within the National Institutes of Health, computer scientists and biomedical researchers are working toward studying and developing solutions that could make that dream a reality. These solutions are interdisciplinary involving the clinical sciences, computer sciences, and engineering and communication between relevant information systems. This talk will highlight some of the projects led by Dr. Antani that apply image data analytics, machine learning, and AI techniques toward this goal.
Standardization for Life Sciences Technologies: Why Do Standards Matter?
Carole Carey, M.S. – IEEE Engineering in Medicine and Biology Society, Private Consulting, Washington DC
Life Sciences in the 21st century encompasses industry sectors in many fields, such as biotechnology, biomedical technologies, medical devices, environmental, pharmaceuticals, food processing and so on. Innovation and advances in life sciences technologies have significantly change healthcare and healthcare systems. It is shifting the landscape to more “Personalized Healthcare and Wearables.” Whether the use of life science technologies is for clinical application or consumer wearables, the need for standardization is evident in order to produce quality, safe, reliable products at lower costs. This presentation will be a perspective on the value of standards at any stage: research, development, technology transfer or commercialization, of multi-disciplines and inter-disciplines.
Technology is Not Above All. People and Their Needs Are!
Nahum Gershon, Ph.D., Senior Principal Scientist, MITRE, Washington D.C. Metro Area
Our addiction to mobile devices and the occasional disregard of technology to how people would like to conduct their lives are only two examples of an array of potential ill effects of technology on humans (in addition to its positive effects). Having the slogan of “Advancing technology for the benefit of humanity”, it is of utmost importance for IEEE to become knowledgeable and actionable about the disadvantages of technology. The IEEE Life Sciences Community relies on its Life Sciences & technology practitioners to study the positive as well as the negative effects of technology on users and organizations. It thus works to formulate guidelines and methods that will help people & organizations take advantage of the positive aspects of technology use while avoiding its potential pitfalls.
Luis Kun, Dr.
Distinguished Prof. Emeritus,
National Defense University,