TRYING FOR THE TRIFECTA TELEHEALTH MEETS AI MEETS CYBERSECURITY

By Thomas P. Keenan

he social disruption of the COVID- and chest X-rays, after about five or six world—things like Wikipedia and so on— 19 pandemic has accelerated he’s getting tired, and after ten he’s “ready and used that data to learn how to answer Ttwo powerful trends in health to go the bar.” By contrast, the machine questions about the real world.”6 care—telemedicine (TM) and artificial treats each case with unbiased, fresh eyes, Today, we think nothing of saying, “Hey intelligence/machine learning (AI/ML). giving consistent results. “It [PUFF] also Google, turn off all the lights” or “Alexa, tell Advocates of digital transformation let out knows things I haven’t a clue about,” he me a joke about rabbits,” confident that our of collective “Yes!” as long-awaited changes added. One of the many experts who AI-enabled speakers will understand and happened almost overnight in early 2020. contributed knowledge to PUFF was a obey us. Because their knowledge base and Then, the ants of cybersecurity came along tropical medicine specialist. This contri- ML functionality reside in a remote com- to spoil the picnic! bution enabled the system to spot a rare puter, our virtual assistants will keep getting First, the good news. lung problem caused by breathing bat smarter and better informed. Perhaps • Suddenly, it became acceptable to guano in Central American caves. Alexa will have a joke about “one-legged “see” your doctor electronically; PUFF was an example of a rule-based rabbits” the next time I ask “her.”7 you could even send a picture of expert system. It sifted through care- AI is already embedded in many aspects that wart on your foot, though per- fully formatted symptoms and lab results, of today’s medicine, including surgery. haps not that rash in your groin.1 then spewed out a result like “THE LOW According to trade publication Robot- Health insurers, including Medi- DIFFUSING CAPACITY, IN COMBI- ics Online, “AI can determine patterns care, that had frowned upon NATION WITH OBSTRUCTION AND within surgical procedures to improve telemedicine suddenly decided it A HIGH TOTAL LUNG CAPACITY IS best practices and to improve a surgical was a great idea. CONSISTENT WITH A DIAGNOSIS robots’ control accuracy to submillimeter • The success of countries like South OF EMPHYSEMA.”4 Impressive for its precision.”8 Korea in “stopping the virus in time, but PUFF would feel like a dummy How about chest X-rays? In the almost its tracks”2 demonstrated that a (if programs could feel—a fascinating legal forty years since PUFF premiered, have technology-based, data-driven question5) beside one of today’s $40 smart we figured out how to automate that? approach to a major health prob- speakers. The answer is a qualified yes. In a study lem could actually work. It also Expert systems like PUFF had their day, published in 2019,9 Giovanni Montana raised troubling issues of pri- but real progress in AI required two more and colleagues used 470,388 adult chest vacy as some countries enforced things: massive computing power and new X-rays that had been analyzed by human quarantine with mandatory smart- approaches. radiologists to train a neural network. They phone apps, license plate readers, We got the first, in 1997, when IBM’s then gave the system an independent set even tracking of people through Deep Blue program stunned the world by of 15,887 X-rays to review. The program cell phone pings and credit card defeating human chess champion Garry called true positives “positive” seventy- transactions. Kasparov. It used specialized hardware and three percent of the time and identified true a brute force approach that could evalu- negatives ninety-four percent of the time. ARTIFICIAL INTELLIGENCE AND ate 200 million chess positions per second, While that isn’t perfect, it could certainly MACHINE LEARNING applying rules like working out the value of help to unclog the X-ray reading backlogs. High hopes for AI in medicine go back having your king in a safe position. The authors conclude that “we have dem- decades. In the 1980s I interviewed one Of even greater relevance is the 2011 onstrated the feasibility of AI for triaging of the early adopters of PUFF, an expert victory of the same company’s Watson chest radiographs.”10 system for the diagnosis of lung disease.3 over human Jeopardy! champs Brad Rut- One of the problems with AI in medi- I asked this doctor if PUFF was any good. ter and Ken Jennings. According to AI cine is that it can be too observant, finding “It’s a better diagnostician than I am,” he expert Murray Campbell, that system patterns that are not clinically meaning- laughed. The doctor further explained “used a machine-learning-based system ful. Speaking to Science, neurosurgeon Eric that, when given a stack of patient files that took a lot of data that existed in the Oermann noted that many of his hospital’s

10 TheSciTechLawyer FALL 2020 Published in The SciTech Lawyer, Volume 17, Number 1, Fall 2020. © 2020 American Bar Association. Reproduced with permission. All rights reserved. This information or any portion thereof may not be copied or disseminated in any form or by any means or stored in an electronic database or retrieval system without the express written consent of the American Bar Association. Published in The SciTech Lawyer, Volume 17, Number 1, Fall 2020. © 2020 American Bar Association. Reproduced with permission. All rights reserved. This information or any portion thereof may not be copied or disseminated in any form or by any means or stored in an electronic database or retrieval system without the express written consent of the American Bar Association. sickest patients had their X-rays done with by the appointment lasting over fifteen one example, it is now possible to buy portable machines. The hospital’s AI algo- minutes. There was some suggestion that a “medical-grade six lead EKG” from rithm started to incorrectly associate the doctors were being sloppy in tracking this, Amazon for $149.19 mere use of a portable unit with greater or even trying to “game” the system. With Millions of people wear fitness track- illness.11 telemedicine, data are collected automati- ers religiously, even to bed. This led to the No technology is perfect. Even Ama- cally and accurately. wonderful Gizmodo headline “Your Fuel- zon’s Alexa, which has been trained on TM can also make services available to band Knows When You’re Having Sex.”20 billions of interactions with millions of a wider population than traditional deliv- If you burn 100 calories in the middle of voices, can spew out some honkers. In a ery models. In the U.S., Congresswoman the night while taking zero steps, it knows YouTube video, an innocent toddler asks Robin Kelly (D-Illinois) has introduced what you’re doing. The only question is— Alexa to “Play Twinkle Twinkle.” The sys- a bill in the House of Representatives to who is it going to tell? tem hears this as “pussyanaldildo” and study the effects on the sudden move to Being ratted out by your wearable is begins to reply to that query, to the hor- doctors at a distance. She believes that not just a hypothetical risk. According to rified shouts of the adults in the room.12 technology can act as an “equalizer” in one news report, “a woman caught her Perhaps it was no accident. Alexa uses healthcare delivery.15 boyfriend cheating when his Fitbit activ- past interactions and machine learning It can also be a great compromiser of ity spiked at 4 a.m.”21 to tailor her responses to individual user personal privacy. While that data dump may not have preferences. One commentator on that When COVID-19 struck, Zoom rap- been in the boyfriend’s best interest, many video made this terse observation—“Dad’s idly became the most popular of the experts believe that collecting health data browser history!” videoconference platforms and was on a mass scale, and analyzing it with AI/ adopted by schools, businesses, and, of ML, may produce the greatest boon medi- TELEHEALTH AND course, healthcare providers. Part of its cine has ever seen. Projects like Columbia TELEMEDICINE appeal was simplicity. You could just send University–based OHDSI (ohdsi.org) are Canada, where I live, has a long history someone a link and they were in your pioneering a big data approach to medi- of using communications technology video meeting. You didn’t even need to cal research. for healthcare delivery. This is largely bother with a pesky password. A 2019 OHDSI-enabled paper pub- driven by geography, given the size of This quickly led to “Zoombombing,” lished in The Lancet “used insurance claim the country. It makes little economic where uninvited guests dropped into data and electronic health records from sense to fly a patient 1,000 km each way video sessions, disrupting them with 4.9 million patients across nine obser- from Churchill to Winnipeg, Manitoba, their comments or, often, their nudity. In vational databases, making it the most to have a toenail fungus checked. Also, addition, Zoom’s naming convention for comprehensive one ever on first-line Canada’s single-payer healthcare system stored recordings was easy to guess. The antihypertensives.”22 It also produced makes the decision to use technol- Washington Post reported “Thousands of a surprising result—“the most popu- ogy much simpler than in a world with Zoom Video Calls Left Exposed on Open lar hypertension drug isn’t the most HMOs and insurance companies and Web,” and said these included therapy ses- effective.”23 private and public providers. sions, conversations with children, even AI can be problematic when it can’t In our most populous province, the an explicit demonstration of how to do a “explain” how it reached a conclusion. Ontario Telemedicine Network (OTN, Brazilian wax job.16 This surfaced in Canada in a legal con- now part of Ontario Health) reported Simon Woodside, co-founder of Med- text when reporters from the Ottawa over 1,000,000 eVisits in 2018–19, serv- Stack, has advised healthcare providers Citizen discovered they could learn the ing almost 300,000 patients.13 In some against using Zoom for patient visits.17 court-protected name of a sexual assault cases, the link was from a local healthcare He says the company misstated its use of victim by viewing “related searches” on facility, often with a nurse alongside the encryption and “has broken trust.” He also Google.24 Google officials responded that patient. Other eVisits were done from the points to a Citizen Lab report18 showing they hadn’t deliberately violated the court’s patient’s home computer or smartphone. information was routed through servers publication ban; however, it was certainly OTN even tested a Virtual Palliative Care in China—a potential threat to data sov- possible that their algorithm, combined program that served 118 patients and gar- ereignty and user privacy. with the pattern of user queries, made it nered an eighty-seven percent positive possible to see the protected names. approval rating from them.14 HEALTH DATA: PRIVACY Google also had to pull back on the There are some fascinating conse- AND POTENTIAL planned release of more than 100,000 quences of telemedicine. One is the Data are the fuel of AI and ML, includ- “de-identified” chest X-rays. The National generation of precise information about ing in healthcare, and we are generating Institutes of Health, a partner in the proj- healthcare delivery. There are jurisdictions more data than ever, with dozens of sen- ect, notified Google that some of the in Canada (e.g., Alberta) where doctors sors surrounding every hospital patient images contained personally identifi- are paid more for “complex” patient con- and petabytes of self-generated data able information, such as the presence sultations. This is typically determined from consumer medical devices. As just of distinctive jewelry. According to the

12 TheSciTechLawyer FALL 2020 Published in The SciTech Lawyer, Volume 17, Number 1, Fall 2020. © 2020 American Bar Association. Reproduced with permission. All rights reserved. This information or any portion thereof may not be copied or disseminated in any form or by any means or stored in an electronic database or retrieval system without the express written consent of the American Bar Association. Washington Post, “Google’s lawyers location. At last count, the ABTraceTo- companies honest by pointing out flaws began raising concerns that possess- gether app had over 200,000 downloads, in their systems, although sometimes the ing and reviewing sensitive health data so many people see this as a civic duty.30 companies are slow to fix the bugs that could create liabilities for the company.”25 However, privacy advocates fear that the hackers find.36 Google bowed out of this project but con- citizen movement data from tracking apps The clear implication for heathcare tinues to have a keen interest in healthcare will be so attractive that governments may technology is that we should try to be technology. be hesitant to see them go away. smarter than the hackers, and also learn In the U.S. the HIPAA standard for There are other looming threats from from them as quickly as possible. Fortu- de-identification of protected health AI/ML systems to healthcare privacy, such nately, most of the ones I have met are information is that “there is no reason- as pills that verify when you take them. driven by curiosity and are eager to help. able basis to believe that the information Abilify MyCite® dissolves in your stom- This follows the famous “hacker ethic,” can be used to identify an individual.”26 As ach and sends a signal to a skin patch, which states, “it’s not doing what you’re the “distinctive jewelry” example showed, which then reports that you took your not supposed to do—it’s doing what you’re small artifacts can yield personal identity medicine. To whom? Well, perhaps the not supposed to be able to do.” information. An even greater risk is that insurance company that paid for your pills There certainly are “black hat” hackers “de-identified” health data sets could be wants to make sure that you’re not flush- who try to exploit stolen data and mon- subjected to a technique called “data jig- ing them down the toilet or selling them etize zero-day vulnerabilities, and that’s sawing”—combining multiple databases on the street. what law enforcement should be for. In to deduce personal information. In a talk my experience, most hackers would rather at the DEFCON hacker conference, I CYBERSECURITY: ALL YOU have a round of applause from their peers showed how Open Government systems REALLY NEED TO KNOW at DEFCON than the $1,000 they might could be “tortured” to reveal informa- I taught Canada’s first computer security get from selling your medical records. tion that was never intended to be made course on October 14, 1977.31 In many public.27 decades of watching this field mature, ETHICAL MEDICAL TECHNOLOGY Aside from the liability of data breach I have concluded that cybersecurity Medical ethics is generally acknowl- class action suits, of which they are many, problems stem largely from a failure of edged to have four key principles: healthcare organizations worry about the imagination on the part of technology increasing value of healthcare data on designers, and very excellent imagina- • Beneficence (trying to help the the dark web. According to credit bureau tion on the part of hackers. patient). Experian, hackers will pay up to $1,000 Systems have gone “haywire” because • Nonmaleficence (not hurting for full medical records because they typi- a program expected a nine-digit num- someone; e.g., stealing a kidney to cally contain date of birth, place of birth, ber and some joker typed in 200 digits, save another patient). credit card details, Social Security number, causing a “buffer overflow.” Y2K, largely • Autonomy (respecting the person address, and email addresses in addition a nonevent, brought the lack of program- and obtaining informed consent). to diagnoses. In other words, they are an mer foresight into the public eye. And, • Justice (providing a fair distribu- identify thief’s dream.28 of course, the designers of Zoom never tion of medical care). Applications to help track the spread expected people would share meeting of COVID-19 have raised vexing data links on Twitter, virtually inviting Zoom- TM would seem to be quite positive privacy issues. China used mandatory bombers to crash the party. in each of these dimensions. After all, its red/yellow/green status QR codes on One of the highlights of hacker con- very purpose is to help the patient, and smartphones to restrict movement, and ferences like DEFCON, Black Hat, and medical professionals are expected to do even deployed creepy talking drones to Germany’s Chaos Communication this in a fair and respectful way. However, patrol lockdowns. “Yes, Auntie, this is the Congress is the revealing of new digital inequities can arise. Perhaps some of those drone speaking to you. You shouldn’t walk exploits. I have seen a Black Hat hacker earlier-discussed Northern Canadians around without a mask.”29 make a demonstration ATM machine seen on video could actually benefit from Western countries generally provided spew out $20 bills!32 In 2011, a DEFCON a personal trip to a major medical center.37 voluntary smartphone apps that could speaker took a photo of a “copy proof” Is it unjust to make them use technology track your contacts, as long as other peo- Medeco key and reproduced it in plastic.33 instead of receiving in-person healthcare? ple’s phones also had the app installed. At the 2014 Chaos meeting, a hacker called Certainly if the video session is hacked, a Even then, there was considerable varia- Starbug used a photograph of the German person’s privacy could be harmed. In Can- tion in how different jurisdictions treated Defense Minister to reverse-engineer her ada, a victim may even have a cause of privacy. fingerprint.34 Another demonstrated that action based on the increasingly popular In Utah, the voluntary tracking app those built-in smartphone cameras could tort of intrusion upon seclusion.38 recorded the GPS location of the user’s compromise passwords by reading reflec- The use of healthcare AI and ML smartphone. The Canadian province of tions in your eyes!35 White hat hackers raises many complicated ethical issues, as Alberta opted for a system that didn’t track play a vital role in keeping technology explained by the American Association

FALL 2020 TheSciTechLawyer 13 Published in The SciTech Lawyer, Volume 17, Number 1, Fall 2020. © 2020 American Bar Association. Reproduced with permission. All rights reserved. This information or any portion thereof may not be copied or disseminated in any form or by any means or stored in an electronic database or retrieval system without the express written consent of the American Bar Association. for Clinical Chemistry (AACC) in a recent The magic word here is “iterative.” No 3. Janice S. Aikins et al., PUFF: An Expert publication.39 They note that the risk to computer system of any complexity has System for Interpretation of Pulmonary beneficence comes from ancillary use of ever worked perfectly. Even if the initial Function Data (Stan. Univ., Report No. STAN- data collected. Why are tech giants like results looked right, something like a leap CS-82-931, Sept. 1982), http://i.stanford.edu/ Google and Apple so interested in get- year or typing 300 digits into a nine-digit pub/cstr/reports/cs/tr/82/931/CS-TR-82-931. ting into this field? A large part of their field can trip it up.45 This is the reason pdf. enthusiasm may relate to what Shoshana Microsoft has a “patch Tuesday” to fix 4. Id. Zuboff calls “surveillance capitalism”40 software glitches (and sometimes intro- 5. At the 2003 International Bar Association as they envision more ways to make a duce new bugs in the process). Conference in San Francisco, participants healthy profit. Legislators and lawyers will need to held a mock trial in which a computer named Nonmaleficence could be violated if play a vital role in this evolution, as pri- BINA48, upon learning of plans to shut “her” health data sets are used to actually harm vacy and other technology-relevant laws down and reuse her components, seeks a individuals, including by combining them evolve and are tested in court. preliminary injunction to stop the termination. with other identifying data sources. There’s also a social side—we want to See Seo-Young Chu, Do Metaphors Dream For autonomy, patients may be asked make sure our technology doesn’t creep of Literal Sleep? (Harv. Univ. Press 2010). to trust an AI algorithm that they (or even us out! 6. Larry Greenemeier, 20 Years After the creators) cannot fully understand. A decade ago, I wrote about Toto’s Deep Blue: How AI Has Advanced Since So the concept of “informed consent” “smart toilet” that “weighs you when Conquering Chess, Sci. Am. (June 2, 2017), becomes problematic. The AACC recom- you sit down, checks your body temper- https://www.scientificamerican.com/ mends banning “black box” algorithms ature and does on-the-spot urinalysis.”46 article/20-years-after-deep-blue-how-ai-has- whose results cannot be understood and Today’s possibilities—from tattling pills advanced-since-conquering-chess (interview checked by humans. However, as AI pro- to smartphones that track your loca- with Murray Campbell). gresses, it may be hard to find a human tion—make that scenario seem almost 7. While PUFF was genderless, almost all who is smart enough to understand all the benign. consumer-oriented AI devices have feminine nuances of the system. A trifecta is picking the first, second, names and voices by default. Apparently, stud- Finally, the ethical principle of justice and third place finishers in a horse race. ies have shown the “female voices are perceived can be violated if technologies like AI- It’s hard—but it can result in a huge payoff as more cordial.” See Hannah Schwär & enabled medical care are only available to the bettor. We’re facing the same kind of Ruqayyah Moynihan, Companies Like Amazon to the rich—like those $5,000 “executive challenge as we work to bring healthcare May Give Devices Like Alexa Female Voices to physical” perks given to some CEOs.41 safely into its next evolution. That’s what Make Them Seem “Caring,” Bus. Insider (Apr. Reasonable pricing models for this tech- makes it so exciting! 5, 2020), https://www.businessinsider.com/ nology should be developed. The AACC theres-psychological-reason-why-amazon- states that “[o]ne way to mitigate this Thomas P. Keenan, EdD, is an award- gave-alexa-a-female-voice-2018-9. It’s also risk might be for health systems and winning journalist, public speaker, worth noting that HAL 9000, the sentient but patient interest groups to insist on rea- professor in the School of Architecture, rather unhelpful computer in the 1968 movie sonable pricing and distribution clauses Planning and Landscape at the University 2001: A Space Odyssey, had a male name and in exchange for sharing the patient data of Calgary in Alberta, Canada, and author voice. needed to develop AI systems.”42 Other of Technocreep: The Surrender of Privacy 8. Robotics Online Mktg. Team, Robotic experts suggest that the concept of health and the Capitalization of Intimacy. He Surgery: The Role of AI and Collaborative data ownership should be completely is a Fellow of the Canadian Information Robots, Robotics Online (July 9, 2019), abandoned and replaced with “an obli- Processing Society and the Canadian https://www.robotics.org/blog-article.cfm/ gation to ensure that the data are used Global Affairs Institute, serves as Chair Robotic-Surgery-The-Role-of-AI-and- for the benefit of future patients and of the Information and Communications Collaborative-Robots/181. society.”43 Technology Council of Canada, and has 9. Mauro Annarumma et al., Automated been an expert witness in a number of Triaging of Adult Chest Radiographs with Deep DESIGN THINKING technology-related civil and criminal cases. Artificial Neural Networks, 291 Radiology TO THE RESCUE 272 (2019). While the problems set out here seem ENDNOTES 10. Id. daunting, we do have a powerful tool 1. Tom Keenan, Would Men Show Their 11. Jennifer Couzin-Frankel, Medicine to achieve our goals—design thinking. Privates on Telemedicine?, Calgary Herald, Contends with How to Use Artificial Intelligence, It’s defined in one source as “an iterative May 9, 2020. 364 Science 1119 (2019). process in which we seek to under- 2. Derek Thompson, What’s Behind 12. BrotherVBrother, Hilarious Amazon stand the user, challenge assumptions, South Korea’s COVID-19 Exceptionalism?, Alexa Fail!!!!, YouTube (Dec. 31, 2016), https:// and redefine problems in an attempt The Atlantic (May 20, 2020), https://www. www.youtube.com/watch?v=-HmAYclRf4g. to identify alternative strategies and theatlantic.com/ideas/archive/2020/05/ 13. Ontario Telemedicine Network, solutions.”44 whats-south-koreas-secret/611215/Fbrazian. Annual Report 2018–2019, https://www.otn.

14 TheSciTechLawyer FALL 2020 Published in The SciTech Lawyer, Volume 17, Number 1, Fall 2020. © 2020 American Bar Association. Reproduced with permission. All rights reserved. This information or any portion thereof may not be copied or disseminated in any form or by any means or stored in an electronic database or retrieval system without the express written consent of the American Bar Association. ca/wp-content/uploads/2020/01/OTNAnnual- 25. Douglas MacMillan & Greg car rental agencies to see if they had applied Report-1819-final.pdf. Bensinger, Google Almost Made 100,000 the fix for these possibly life-threatening 14. Id. Chest X-rays Public—Until It Realized vulnerabilities. Most said, “No, we’re waiting 15. Kat Jercich, New Bill Would Mandate Personal Data Could Be Exposed, Wa s h . for the cars to come in for their next scheduled Research on Telehealth Regs After Coronavirus, Post (Nov. 15, 2019), https://www. maintenance.” Healthcare IT News (June 2, 2020), washingtonpost.com/technology/2019/11/15/ 37. Anecdotally, many requests for city https://www.healthcareitnews.com/news/ google-almost-made-chest-x-rays-public-until- medical visits from remote Canadians seem new-bill-would-mandate-research-telehealth- it-realized-personal-data-could-be-exposed/. to occur during the pre-Christmas shopping regs-after-coronavirus. 26. Guidance Regarding Methods for De- period, which has led to providers disallowing 16. Drew Harwell, Thousands of Zoom identification of Protected Health Information shopping trips disguised as medical visits. Video Calls Left Exposed on Open Web, in Accordance with the Health Insurance 38. Heather Gardiner, Welcome to the New Wash. Post (Apr. 3, 2020), https://www. Portability and Accountability Act (HIPAA) Tort of “Intrusion upon Seclusion,” Can. Law. washingtonpost.com/technology/2020/04/03/ Privacy Rule, U.S. Dep’t of Health & Human (Jan. 20, 2012), https://www.canadianlawyer- thousands-zoom-video-calls-left-exposed- Servs. (Nov. 6, 2015), https://www.hhs.gov/ mag.com/practice-areas/privacy-and-data/ open-web. hipaa/for-professionals/privacy/special-topics/ welcome-to-the-new-tort-of-intrusion-upon- 17. Simon Woodside, Why We Should Stop de-identification/index.html#rationale. seclusion/271204. Using Zoom in Healthcare, Medstack (Apr. 27. Tom Keenan, How I Torture Open 39. Brian Jackson, Ethics of Al and Big 10, 2020), https://medstack.co/blog/why-we- Government Systems for Fun, Profit and Time Data in Laboratory Medicine, AACC: Jan./ should-stop-using-zoom-in-healthcare. Travel, DEFCON 21 (Aug. 1, 2013), https:// Feb. (Jan. 1, 2020), https://www.aacc.org/ 18. B. Marczak & J. Scott-Railton, Move www.youtube.com/watch?v=eJgTZeUKkhs. publications/cln/articles/2020/janfeb/ethics- Fast and Roll Your Own Crypto: A Quick 28. Brian Stack, Here’s How Much Your of-al-and-big-data-in-laboratory-medicine. Look at the Confidentiality of Zoom Meetings, Personal Information Is Selling for on the Dark 40. Shoshana Zuboff, The Age of Citizen Lab (Apr. 3, 2020), https://citizenlab. Web, Experian: Cybersecurity (Dec. 6, Surveillance Capitalism: The Fight for ca/2020/04/move-fast-roll-your-own-crypto- 2017), https://www.experian.com/blogs/ a Human Future at the New Frontier of a-quick-look-at-the-confidentiality-of-zoom- ask-experian/heres-how-much-your-personal- Power (2019). meetings. information-is-selling-for-on-the-dark-web. 41. Mark Hendricks, Executive Physicals: 19. See AliveCor, https://www.alivecor. 29. TRT World, China Uses Drones to Warn Can a $5,000 Exam Help Improve Your com/kardiamobile6l. There’s a cheaper version Its Citizens About Coronavirus, YouTube (Feb. Health and Business?, Am. Express: if you only value your heart at $89. You can 3, 2020), https://youtu.be/3-eM4IM-PfY. Trends & Insights (Jan. 27, 2014), even email your results to your doctor. I’m sure 30. Tom Keenan, Contact Tracing Comes https://www.americanexpress.com/en-us/ they can hardly wait to hear from hundreds of of Age—But Where Is It Going?, Calgary business/trends-and-insights/articles/ hypochondriacs. Herald, June 12, 2020. executive-physicals-can-a-5000-exam-help- 20. A.C. Estes, Your Fuelband Knows When 31. Computer Control and Security, improve-your-health-and-business. You’re Having Sex, Gizmodo (July 12, 2013), Edmonton, AB (Oct. 13, 1977). The likelihood 42. Jackson, supra note 38. https://gizmodo.com/your-fuelband-knows- of anyone challenging this claim decreases 43. David B. Larson et al., Ethics of Using when-youre-having-sex-755620844. continuously from an actuarial perspective. and Sharing Clinical Imaging Data for Artificial 21. Gabby Landsverk, A Woman 32. SecurityWeek, ATM Spits Out Cash at Intelligence: A Proposed Framework, 2020. 295 Caught Her Boyfriend Cheating When His Black Hat—Barnaby Jack ATM Hacking Demo, Radiology 675 (2020). Fitbit Activity Spiked at 4 a.m., Insider BlackHat (2010), https://www.youtube.com/ 44. Rikke F. Dam & Teo Y. Siang, What Is (Dec. 11, 2019), https://www.insider.com/ watch?v=fS3Z8Xv-vUc. Design Thinking and Why Is It So Popular?, woman-caught-boyfriend-cheating-fitbit- 33. Christiaan008, Open in 30 Seconds: Interaction Design Found. (June 2020), fitness-tracker-sex-2019-12. Cracking One of the Most Secure Locks in https://www.interaction-design.org/literature/ 22. Craig Sachson, Lancet Paper Shows America, YouTub e at 1:22:39, DEFCON 16 article/what-is-design-thinking-and-why-is- Most Popular Hypertension Drug Isn’t Most (Jan. 22, 2011), https://www.youtube.com/ it-so-popular. Effective, Per OHDSI’s LEGEND Study, OHDSI watch?v=iOIRZnafgQk. 45. It is provably impossible to predict (Oct. 24, 2019), https://ohdsi.org/lancet-paper- 34. Alex Hern, Hacker Fakes German Min- what a program will do with every pos- shows-most-popular-hypertension-drug-isnt- ister’s Fingerprints Using Photos of Her Hands, sible input without running it on every most-effective-per-ohdsis-legend-study. The Guardian (Dec. 30, 2014), https://www. possible input. Computer scientists know 23. Id. theguardian.com/technology/2014/dec/30/ a variant of this as the “Halting Problem.” 24. Andrew Duffy, Searching for hacker-fakes-german-ministers-fingerprints- Undefined Behavior, Impossible Programs News on Google Can Return Victim and using-photos-of-her-hands. (The Halting Problem), YouTube (Nov. Offender Names Under Strict Pub Ban, 35. Id. 14, 2016), https://www.youtube.com/ Ottawa Citizen (Sept. 25, 2017), https:// 36. Even if technology companies fix their watch?v=wGLQiHXHWNk. ottawacitizen.com/news/local-news/ bugs, they may not reach consumers. Months 46. Thomas P. Keenan, Technocreep: scope-of-potential-ban-breaches-of-secret- after presenters at DEFCON showed how The Surrender of Privacy and the Capi- identities-through-google-search-broadens. certain vehicles could be easily hacked, I called talization of Intimacy (2014).

FALL 2020 TheSciTechLawyer 15 Published in The SciTech Lawyer, Volume 17, Number 1, Fall 2020. © 2020 American Bar Association. Reproduced with permission. All rights reserved. This information or any portion thereof may not be copied or disseminated in any form or by any means or stored in an electronic database or retrieval system without the express written consent of the American Bar Association.