mental health and the government

[Biff Tannen 45497]

Take it to another thread you goons.  This is for the fat tub of shit that is tanking the economy via twitter today.

[BradInATX 9208]

Yes, instituting the appropriate human subjects research protections and oversight procedures is a pre-requisite to the conduct of human subjects research. This is basic and fundamental to biomedical research. If your baseline assumption is that research conducted within the context of public-private-academic partnerships engaged by a department of DHS, such as the one proposed by the Suzanne Wright Foundation, will not be conducted according to these principles and the regulations of DHS, than I guess that is your rhetorical prerogative.  I am operating under the expectation that these protections and procedures will be in place, as is required by law and the ethical guidelines driven into the head of healthcare researchers from day 1 of their training.   

So today we trust the benevolent government to treat PII and incredibly sensitive information ethically and with proper care. And we of course know they'd never overreach or violate the constitution.

Anastasis, sudden lover of government's ever-expanding and totally cool surveillance state.

C'mon now.

[hayden_horn 11360]

i may splinter this discussion into a discrete thread, but i have one question for everyone: do you want the government to have unfettered access to your google search history, and possibly have the power to commit you to an institution because of that?

[Mojo Hand 4580]

6 minutes ago, Anastasis said:

OK, let's shift gears @Mojo Hand.  What kind of research into gun violence would you find acceptable?  You don't want the government engaged if it involves "advanced analytics" such as a large multi-modal dataset and machine learning analysis techniques. I assume that this excludes a broad range of data analysis techniques and cutting edge methods of data collection. What exactly is acceptable to you in terms of research into gun violence? I think that you rhetorically confuse advanced analytic methods such as machine learning with something scary sounding like an "artificial intelligence systems designed to spy on you through your echo".  I don't think that leap is supported by what I read in the article, but I am curious as to what type of research into gun violence you think should be conducted that would not have potential for abuse by rogue government entities such as the NSA.    

Statistical analysis, for one thing.   The kinds of things that got shut down at CDC a couple decades ago were studies on the increased risk of gun violence in homes that had a gun and the like. That's perfectly fine.  Mental health can be a component of those kinds of analysis.  For example, how many gun crimes were caused by people with a history of diagnosed mental illness. 

That kind of data is perfect for crafting legislative responses to the gun violence problem.   Would fewer guns help?   That can be informed by data.  Would mental health funding help?  Same.

The question I don't think the government should be looking into is "Can we develop software algorithms to identify future shooters, who haven't yet done anything, from the information pulled from their smart devices."    It's too easy to deploy that information for dangerous purposes, and not entirely clear what a legitimate purpose would be.   

What positive do you think can come out of it?   Per the document, the proposal is to develop "Advanced analytical tools based on artificial intelligence and machine learning" that can "be applied to the data."  The data is information collected from "Apple Watches, Fitbits, Amazon Echo and Google Home," along with data "collected by health-care provides like fMRIs, tractography and image analysis."  And the end goal is "to develop a 'sensor suite' using advanced artificial intelligence to try to identify changes in mental status that could make an individual more prone to violent behavior." 

So the government creates this "sensor suite" that can sift through data from personal smart devices and find markers that can predict a risk of violent behavior.   What then?   What do you do when you have a way to roughly predict violent people from web searches and certain words overheard by your Echo?   I guess in theory you can use the markers to try to find those same people through non-invasive ways, like by giving psychiatrists ideas to focus on in therapy.   But how many shooters would that actually stop?   It's much easier to have computers spit out some names for surveillance. 

[Ted Lange 16052]

13 minutes ago, hayden_horn said:

i may splinter this discussion into a discrete thread, but i have one question for everyone: do you want the government to have unfettered access to your google search history, and possibly have the power to commit you to an institution because of that?

If it means people can still buy assault rifles, even though I don’t own one or have any intention of buying one, YES!

-brainwashed Trumpkin 

[hayden_horn 11360]

ok, @Anastasis and @Mojo Hand and anyone else that wants to talk mental health and government, i made a new thread. i think i got most of the post on the topic. 

it deserves its own space and discussion, imo

 

[Anastasis 23394]

I don't know if it was the splintering or my browser, but I lost a response in drafting.

[Anastasis 23394]

55 minutes ago, Mojo Hand said:

Statistical analysis, for one thing. 

What do you think machine learning is?  It is a statistical analysis procedure suited particularly to examining large data sets to identify patterns. And it is increasingly being used in sophisticated healthcare research. 

 

56 minutes ago, Mojo Hand said:

What positive do you think can come out of it? 

Any number of potential public health initiative focused on education, public identification of at-risk family members, informing policy, etc.  There are lot of potential positives from conducting this type of research.  That you cannot imagine them reflects only a lack of imagination on your part. Are there potential risks that any variety of the research conducted by the CDC, or the NIH, or the NIMH, or any other alphabet agency you want could be misappropriated by bad actors in the IC?  Sure.  We should address that problem.

If you are worried about the power of our rogue surveillance state, we should do something that. There are about a 1000 examples based in actual reality, today, that need to be addressed. If the IC wanted to develop an "artificial intelligence system" to identify pre-crime, they would do it, and you would never know about it, save some leak from someone like Snowden. 

The stuff being discussed in that article is the same types of shit being discussed among health care researchers all the time.  360 data inputs, wearables, social and behavioral determinants of health, social media inputs, biomarkers, etc.  Advanced analytic techniques and diverse datasets to address drug safety, identification and treatment of chronic disease, informing population health initiatives and interventions, blah blah blah at every methods heavy conference I attend. Biden's cancer institute lead has discussed a similar approach to tackling cancer. The government has been conducting and funding this type of research in health care for a while now. I don't find a discussion along the same lines related to a serious population health issue of the day , i.e. gun violence, to be particularly "chilling".  I think that it is quite natural in fact. I do think that there is probably more value is oncology and other serious issues such as neurodegenerative disorders. Would you have a problem if the HARPA concept carved out gun violence research?  If not, fine throw that shit in the circular file and focus on areas where the resources would be better spent anyways.

[Biff Tannen 45497]

1 hour ago, hayden_horn said:

ok, @Anastasis and @Mojo Hand and anyone else that wants to talk mental health and government, i made a new thread. i think i got most of the post on the topic. 

it deserves its own space and discussion, imo

 

confused the hell out of me.  now my post just makes me look like an idiot.  like most of them do I guess.

[Js1 85110]

3 hours ago, henrygandorf said:

rounding up 4th and 5th graders because of alarming trends in their drawings and handwriting analysis that could eventually lead them to take part in mass shootings, then bringing them all in to some blacksite and running tests on them, should be the plot of an episode of black mirror next season.

fuck it, i'll just write it.

Damnit, we could have caught it before it was too late!

[Js1 85110]

dp

Edited August 23, 2019 by Js1

[Anastasis 23394]

1 hour ago, BradInATX said:

So today we trust the benevolent government to treat PII and incredibly sensitive information ethically and with proper care. And we of course know they'd never overreach or violate the constitution.

Anastasis, sudden lover of government's ever-expanding and totally cool surveillance state.

C'mon now.

Yes, the CDC, NIH, NIMH, DHS, etc.  All part of the intelligence community surveillance apparatus. Researchers from academia, public and private sector, working in open and transparent collaboration, conducting human subjects research with volunteers under informed consent and with appropriate oversight to address the major healthcare challenges of the day. Deep State!  

 

[Js1 85110]

tp

god damnit aggy, what have you done to this site? 

Edited August 23, 2019 by Js1

[immortal13 4059]

They should start with the Cloak Room

[JimmyJames 12271]

17 minutes ago, Biff Tannen said:

confused the hell out of me.  now my post just makes me look like an idiot.  like most of them do I guess.

Yes the splintering was very unfair to you.

Oh well. Off to the institution with you anyway. 

[BradInATX 9208]

17 minutes ago, Anastasis said:

Yes, the CDC, NIH, NIMH, DHS, etc.  All part of the intelligence community surveillance apparatus. Researchers from academia, public and private sector, working in open and transparent collaboration, conducting human subjects research with volunteers under informed consent and with appropriate oversight to address the major healthcare challenges of the day. Deep State!  

 

https://wwwnc.cdc.gov/eid/article/8/10/02-0400_article

I know how you roll. It's Friday bourbon time, not Friday let's be intentionally obtuse time.

Edited August 23, 2019 by BradInATX

[henrygandorf 29177]

1 hour ago, Anastasis said:

I don't know if it was the splintering or my browser, but I lost a response in drafting.

thx, @hayden_horn

[Mojo Hand 4580]

1 minute ago, Anastasis said:

What do you think machine learning is?  It is a statistical analysis procedure suited particularly to examining large data sets to identify patterns. And it is increasingly being used in sophisticated healthcare research. 

 

Any number of potential public health initiative focused on education, public identification of at-risk family members, informing policy, etc.  There are lot of potential positives from conducting this type of research.  That you cannot imagine them reflects only a lack of imagination on your part. Are there potential risks that any variety of the research conducted by the CDC, or the NIH, or the NIMH, or any other alphabet agency you want could be misappropriated by bad actors in the IC?  Sure.  We should address that problem.

If you are worried about the power of our rogue surveillance state, we should do something that. There are about a 1000 examples based in actual reality, today, that need to be addressed. If the IC wanted to develop an "artificial intelligence system" to identify pre-crime, they would do it, and you would never know about it, save some leak from someone like Snowden. 

The stuff being discussed in that article is the same types of shit being discussed among health care researchers all the time.  360 data inputs, wearables, social and behavioral determinants of health, social media inputs, biomarkers, etc.  Advanced analytic techniques and diverse datasets to address drug safety, identification and treatment of chronic disease, informing population health initiatives and interventions, blah blah blah at every methods heavy conference I attend. Biden's cancer institute lead has discussed a similar approach to tackling cancer. The government has been conducting and funding this type of research in health care for a while now. I don't find a discussion along the same lines related to a serious population health issue of the day , i.e. gun violence, to be particularly "chilling".  I think that it is quite natural in fact. I do think that there is probably more value is oncology and other serious issues such as neurodegenerative disorders. Would you have a problem if the HARPA concept carved out gun violence research?  If not, fine throw that shit in the circular file and focus on areas where the resources would be better spent anyways.

I know what machine learning is.  The problem I have is applying it in the specific way proposed, rather than the kind of statistical analysis in my example.   There's plenty of gun violence research that can be done, even using AI, that doesn't involve harvesting information from personal devices to determine a person's thoughts and intentions. 

Yes, I'd still have a problem with this if gun violence were carved out.   My concern isn't with the policy need driving the research, but with the particular tool that would be developed, its dataset, the means of capturing that data, and that it's the government doing it. 

Yes, the IC could develop something like this on its own, in theory.  That doesn't justify doing it openly for them, or publicly blessing the project for cooperation by research minds and tech companies, or for a public that might want to deploy something like this as a response to a crime wave.   If it comes down to it, I'd rather have an IC system that the public doesn't know about but would be horrified by than an equivalent system that the public has already tacitly accepted. 

Yes, leveraging the wealth of information captured by our personal electronic devices is all the rage.   That only heightens the importance of considering the implications and unintended consequences.   Your position is like someone saying in 2009 that online data-based voter targeting is no big deal because Obama's campaign and many others do it harmlessly.   Yeah, then Cambridge Analytica had some ideas about that, and now we're rethinking everything after the cat is out of the bag.  Only, it's even more serious when the government has the tools and the data and the policy need to address. 

[Anastasis 23394]

2 minutes ago, BradInATX said:

https://wwwnc.cdc.gov/eid/article/8/10/02-0400_article

I know how you roll. It's Friday bourbon time, not Friday let's be intentionally obtuse time.

LOL. The CDC sent some lab techs to assist in investigating an anthrax attack.  One step away from the CDC collaborating with the NSA pre-crime division to lock people up in mental facilities based on their artificial intelligence system created to identify the undesirables. Public Health Deep State! 

[Judge Roybeanbag 11810]

16 minutes ago, Anastasis said:

LOL. The CDC sent some lab techs to assist in investigating an anthrax attack.  One step away from the CDC collaborating with the NSA pre-crime division to lock people up in mental facilities based on their artificial intelligence system created to identify the undesirables. Public Health Deep State! 

Interestingly, and I’m not taking sides on this issue, but do you know who involved with that coordinated effort?

Quote

On August 3, 2001, Azar was confirmed to be the General Counsel of the United States Department of Health and Human Services.^[14][15] Azar played an important role in responding to the 2001 anthrax attacks.

 

[Anastasis 23394]

 

33 minutes ago, Mojo Hand said:

The problem I have is applying it in the specific way proposed, rather than the kind of statistical analysis in my example.

2 hours ago, Mojo Hand said:

The kinds of things that got shut down at CDC a couple decades ago were studies on the increased risk of gun violence in homes that had a gun and the like. That's perfectly fine.  Mental health can be a component of those kinds of analysis.  For example, how many gun crimes were caused by people with a history of diagnosed mental illness. 

 

None of your examples address in a meaningful way research that would help us understand and address, from a population health perspective, the mass shooting problem. You are hamstringing efforts to understand the problem in a robust way because you are worried about the boogeyman sending the brown shirts around to lock people up in mental institutions for pre-crimes.  

Edited August 23, 2019 by Anastasis

[Anastasis 23394]

Curious what you think of the Sentinel Initiative @Mojo Hand?

This is a national initiative conducted under the auspices of the FDA to carry out drug safety surveillance. It involves the development of a national distributed database network consisting of the health utilization (medical, lab, rx, enrollment) records of most Americans, reflecting approximately 300 million person-years of observation. The system is run as a collaborative public-private-academic research initiative under the FDA. It is used to monitor for safety signals, and to conduct safety evaluations for vaccines, biologicals, and pharmaceuticals. They have developed a variety of methods to query these data. In the hands of a nefarious intelligence agency with sophisticated re-identification capabilities it easily be used to target individuals for institutionalization by the brown shirts.

Do you think that the government should shut down this public health initiative, underway since 2008, because the surveillance apparatus in this country has gone off the rails and could potentially use this tool against Americans?

https://www.sentinelinitiative.org/background

 

[Mojo Hand 4580]

3 minutes ago, Anastasis said:

 

 

None of your examples address in a meaningful way research that would help us understand and address, from a population health perspective, the mass shooting problem. You are hamstringing efforts to understand the problem in a robust way because you are worried about the boogeyman sending the brown shirts around to lock people up in mental institutions for pre-crimes.  

Maybe.  And maybe you would hamstring our ability to stop the next 9/11 by opposing some of the programs Snowden exposed, simply because of some boogeyman using the info in a way that hasn't yet really materialized.   That's literally the argument for our government surveillance programs and why nobody from either party has done much about it.  There's always some compelling justification. 

But every society has mentally disturbed people.  Every society has violent people.   Every western country has video games and everything else we have.   Only we have a mass shooting problem of this magnitude.   I don't see why developing a robust understanding of what drives mass shooters is worth handing the government a tool to create mental profiles from data captured from personal electronics.  The bigger problem is the availability of weapons that enable a single person to inflict so much damage.   

[Celery Man 20886]

i just can't decide which rights are more important - guns' rights, or human rights.

[Mojo Hand 4580]

5 minutes ago, Anastasis said:

Curious what you think of the Sentinel Initiative @Mojo Hand?

This is a national initiative conducted under the auspices of the FDA to carry out drug safety surveillance. It involves the development of a national distributed database network consisting of the health utilization (medical, lab, rx, enrollment) records of most Americans, reflecting approximately 300 million person-years of observation. The system is run as a collaborative public-private-academic research initiative under the FDA. It is used to monitor for safety signals, and to conduct safety evaluations for vaccines, biologicals, and pharmaceuticals. They have developed a variety of methods to query these data. In the hands of a nefarious intelligence agency with sophisticated re-identification capabilities it easily be used to target individuals for institutionalization by the brown shirts.

Do you think that the government should shut down this public health initiative, underway since 2008, because the surveillance apparatus in this country has gone off the rails and could potentially use this tool against Americans?

https://www.sentinelinitiative.org/background

 

I don't know enough about it to draw that conclusion, but the absence of the collection of personal communications data from your summary makes it seem less problematic to me.   Just as with the cholesterol example I mentioned earlier, there are significant privacy considerations involved, but nowhere near the level of a program that uses AI to analyze data captured on someone's Amazon Echo.  The particular features of HARPA that bother me are that they are analyzing thoughts and using data captured by personal smart devices. 

Does the Sentinel program include a database of psychiatrist notes among those medical records and an AI system to sift through those notes for certain markers?  That would be the kind of thing that would raise similar concerns to me. 

[Js1 85110]

5 minutes ago, Celery Man said:

i just can't decide which rights are more important - guns' rights, or human rights.

I believe it was Hillary who famously said “guns’ rights are human rights and human rights are guns’ rights”

[Anastasis 23394]

2 hours ago, Mojo Hand said:

Maybe.  And maybe you would hamstring our ability to stop the next 9/11 by opposing some of the programs Snowden exposed,

The difference being, of course, public health research conducted by a consortium operating under the auspices of DHS, with voluntary subjects who have been appropriately consented, and with the proper oversight, does not violate any principles of biomedical ethics or Constitution protections.  OTOH, mass surveillance of law abiding American citizens, and the other various actions of the IC, including obfuscation and outright lying to our congressional representatives, violates all sorts of ethical principles and the Constitution. I can't believe that we are equivocating this shit on this thread. 

If you have a problem with the surveillance state, and you should, let's fucking address those problems, not hamstring our ability to do public health research because the boogeyman exists. Let's dismiss with the boogeyman.    

1 hour ago, Mojo Hand said:

 The particular features of HARPA that bother me are that they are analyzing thoughts and using data captured by personal smart devices.

JFC.  If home assistant data is your real sticking point we could have worked out a resolution to this exchange hours ago by agreeing that the results of the research could be useful, and minor tweaks to the data inputs (i.e., excluding personal home assistants) would better balance the risk/benefits of the study. BTW, I didn't catch the thought analysis component in the article. Keyword search didn't catch anything, but maybe you will clarify.

1 hour ago, Mojo Hand said:

Does the Sentinel program include a database of psychiatrist notes among those medical records and an AI system to sift through those notes for certain markers?  That would be the kind of thing that would raise similar concerns to me. 

To answer your question, the core system does not include EHR data; however a variety of different groups are working on extending the model to consider both structured and unstructured EHR data. Simply a matter of time.

What I really find curious is that your concerns regarding notes in EHRs and lab values, and Brad's concerns related to PII and sensitive information (presumably medical information and PHI would be included here).  You guys argue that DHS cannot be trusted with sensitive information related to public health research related to gun violence, but in the course of the various debates on this board regarding a national healthcare plan, I don't recall any y'all piping up about the concentration of sensitive healthcare information under DHS under such a system.  You know very well that EHR data, lab data, and a variety of extremely sensitive health care data would be collected and analyzed within DHS. Hold your breath for a second. There would be researchers using that data to develop predictive models using...gasp...advanced analytic techniques such as machine learning and rich data to develop public health interventions to target almost any health outcome you can think of and many you could not.

Strange that I haven't previously heard such a full throated expression of concern regarding the consolidation of such sensitive information under DHS from you guys.  Those data, consisting of the most sensitive medical information of all Americans, pose a substantially greater risk in terms of breaches of privacy, confidentially, and nefarious government action, than do the results of a research study conducted involving consented volunteers under appropriate independent oversight. Strange that I haven't heard any concerns out of you guys in the course of that debate, just this one now, flushed out when the topic of gun violence research is brought up. Curious.  I am sure that you guys will find your voice on this aspect as the debate further evolves.    

 

Edited August 24, 2019 by Anastasis

[JimmyJames 12271]

Since this has become an apparent official privacy thread think we all need to realize that for the most part privacy, at least in the good old USA when it comes to the government, is at this point in time just about dead. 

Google knows more about you than you know about yourself. And the only thing really separating the government from knowing everything about you that Google knows is for the most part, the government don’t give a shit about you personally. Once you get in their crosshairs, however, they can find out whatever they need or want to know. Getting a warrant is very easy and doesn’t take much.

When it comes to medical information, including mental health, there still remains some semblance of privacy however due to HIPPA and other laws. And so while Anastasis’s position may be right that concerns at this point may be overblown, that doesn’t mean that this couldn’t be the first step to eliminating this as well. 

But every time you Google “symptoms of a heart attack,” that information is not private and can be discovered and then possibly cross checked with other readily available information. 

The first step in fixing a problem is always recognizing that it actually exists. 

[Anastasis 23394]

Yes. If you want to lose your mind over something, consider all the research being conducted under cover of darkness with zero IRB oversight by companies like google.  If I want to crunch some number using your medical claims data to determine if exposure to medication X increases your risk for AMI or stroke, I have to jump through a hole series of regulatory hoops, operating in a de-identified data environment, subject to regulatory audit and black listing. As it absolutely should be. Now google, if they want to use your sensitive medical information derived from search terms, social media platforms, and a variety of other data feeds at their disposal, welp, wild wild west. If you want to talk about problems and data privacy, there are much better places to start that discussion than public health research being considered for implementation in a regulatory controlled environment at DHS.   

[Pam Cummings 9582]

Oh look, the fascist enabler wants to enable some more fascism. What a surprise.

[Anastasis 23394]

Oh, look, the people who whine the most about mass shootings want to find every excuse to avoid conducting research that could provide meaningful insights related to mass shootings. What a surprise. 

Edited August 24, 2019 by Anastasis

[JimmyJames 12271]

3 minutes ago, Anastasis said:

Yes. If you want to lose your mind over something, consider all the research being conducted under cover of darkness with zero IRB oversight by companies like google.  If I want to crunch some number using your medical claims data to determine if exposure to medication X increases your risk for AMI or stroke, I have to jump through a hole series of regulatory hoops, operating in a de-identified data environment, subject to regulatory audit and black listing. As it absolutely should be. Now google, if they want to use your sensitive medical information derived from search terms, social media platforms, and a variety of other data feeds at their disposal, welp, wild wild west. If you want to talk about problems and data privacy, there are much better places to start that discussion than public health research being considered for implementation in a regulatory controlled environment at DHS.   

Gagree and correct.

But don’t minimize the cooperation that large corporations and our government sometimes engage in “synergy” over what they want to accomplish, despite having different motivations. You scratch my back and I’ll scratch yours. Hell the entire military industrial complex is completely based on that. Different motivations with different definitions of “profit.” 

[JimmyJames 12271]

Just now, Anastasis said:

Oh, look, the people who whine the most about mass shootings want to find every excuse to avoid conducting research that could provide meaningful insights related to mass shootings.

The answer to less mass shootings is more gun control. It don’t take a genius to figure that out and it doesn’t even have to violate the second amendment either, despite NRA propaganda to the contrary. 

[sidis 9754]

fewer /stannis 

[Anastasis 23394]

Just now, JimmyJames said:

The answer to less mass shootings is more gun control. It don’t take a genius to figure that out and it doesn’t even have to violate the second amendment either, despite NRA propaganda to the contrary. 

I think that it is part of the solution.  My thoughts on gun controls measures are in another thread.  In addition, I think that it is also part of the answer to develop a robust understanding of the influences and factor associated with specific cases mass violence.  There will always be millions of semi auto rifles and 30 rd mags in circulation for those that seek to obtain them, under any form of gun control legislation. We need to understand the problem beyond the mechanical tools used to carry them out.   

[BradInATX 9208]

38 minutes ago, Anastasis said:

I think that it is part of the solution.  My thoughts on gun controls measures are in another thread.  In addition, I think that it is also part of the answer to develop a robust understanding of the influences and factor associated with specific cases mass violence.  There will always be millions of semi auto rifles and 30 rd mags in circulation for those that seek to obtain them, under any form of gun control legislation. We need to understand the problem beyond the mechanical tools used to carry them out.   

"Wiretapping bad" - You

"Mining recorded audio from devices that sit in someone's house good" - Also you

You are not truly naive enough to believe that there's some mythical wall between the DHS or CDC and the rest of the government including law enforcement, the NSA, etc. I'm not even going to entertain that debate with you. I know you know better. You are being inconsistent and you know it.

My two biggest issues with Obama were his expansion of the use of wiretapping/FISA, and leaving Guantanamo open. Other than that, I thought he was a very good president. And yet, for those two reasons, I voted elsewhere after voting for him in 2008. I also think this proposal is terrible, and Trump will not get my vote next time.

This is Brad. He is ideologically consistent. Be more like Brad.

[Mojo Hand 4580]

33 minutes ago, Anastasis said:

The difference being, of course, public health research conducted by a consortium operating under the auspices of DHS, with voluntary subjects who have been appropriately consented, and with the proper oversight, does not violate any principles of biomedical ethics or Constitution protections.  OTOH, mass surveillance of law abiding American citizens, and the other various actions of the IC, including obfuscation and outright lying to our congressional representatives, violates all sorts of ethical principles and the Constitution. I can't believe that we are equivocating this shit on this thread. 

If you have a problem with the surveillance state, and you should, let's fucking address those problems, not hamstring our ability to do public health research because the boogeyman exists. Let's dismiss with the boogeyman.    

JFC.  If home assistant data is your real sticking point we could have worked out a resolution to this exchange hours ago by agreeing that the results of the research could be useful, and minor tweaks to the data inputs (i.e., excluding personal home assistants) would better balance the risk/benefits of the study. BTW, I didn't catch the thought analysis component in the article. Keyword search didn't catch anything, but maybe you will clarify.

To answer your question, the core system does not include EHR data; however a variety of different groups are working on extending the model to consider both structured and unstructured EHR data. Simply a matter of time.

What I really find curious is that your concerns regarding notes in EHRs and lab values, and Brad's concerns related to PII and sensitive information (presumably medical information and PHI would be included here).  You guys argue that DHS cannot be trusted with sensitive information related to public health research related to gun violence, but in the course of the various debates on this board regarding a national healthcare plan, I don't recall any y'all piping up about the concentration of sensitive healthcare information under DHS under such a system.  You know very well that EHR data, lab data, and a variety of extremely sensitive health care data would be collected and analyzed within DHS. Hold your breath for a second. There would be researchers using that data to develop predictive models using...gasp...advanced analytic techniques such as machine learning and rich data to develop public health interventions to target almost any health outcome you can think of and many you could not.

Strange that I haven't previously heard such a full throated expression of concern regarding the consolidation of such sensitive information under DHS from you guys.  Those data, consisting of the most sensitive medical information of all Americans, pose a substantially greater risk in terms of breaches of privacy, confidentially, and nefarious government action, than do the results of a research study conducted involving consented volunteers under appropriate independent oversight. Strange that I haven't heard any concerns out of you guys in the course of that debate, just this one now, flushed out when the topic of gun violence research is brought up. Curious.  I am sure that you guys will find your voice on this aspect as the debate further evolves.    

 

It's not much of a difference when you consider that the current surveillance state isn't version 1.0, and version 1.0 of this program is not, in itself, problematic.  I guess we should just let it happen and worry about what it could be used for after it's too late. 

I do have a problem with the broader surveillance state, but there's nothing you or I can do to dismantle it.  Snowden released what he released and the public yawned.  Neither party does anything of significance.   All we can do is speak up every time and maybe avoid helping it grow. 

By thought analysis, I mean analyzing what people are thinking based on the data collected.    The stated purpose of the program is to "identify changes in mental status that could make an individual more prone to violent behavior."   If data captured from home assistants is useful in that endeavor, it's by analyzing whether the person is engaging in violent thinking based on things like web searches and who knows what else an Echo hears. 

Sure, excluding home assistants and other things that capture private communications would largely solve my problem with the program.   I don't think we have control of the parameters here, though, do we? 

And I don't know why you would find it strange that I haven't raised similar concerns in connection with government health care, given that I've already said at least twice why I view this kind of information as more dangerous.   No doubt, we need strong privacy protections to protect health data, and there are plenty of advocates fighting for that already.   But I see anything designed to listen in on people's smart devices and analyze the data captured as far more ripe for abuse and societal harm.  Particularly when it can easily be deployed under the justification of "stopping crime."

Maybe it's just that I lack imagination, as you've said, but it's an opinion I hold honestly. 

[Anastasis 23394]

1 hour ago, BradInATX said:

"Wiretapping bad" - You

"Mining recorded audio from devices that sit in someone's house good" - Also you

"Mass data collection involving the communications of Americans by the government, bad" - Me

"Voluntary and consented participation in public health research conducted by a public-private-academic collaboration under the auspices of the Health Department, good" - Me

"Equivocating the two, bad" - Me.

"Mining involuntarily recorded audio captured by the government to profile individuals, bad" - Also me. 

This really isn't that complex. But keep trying to frame your gotcha.     

1 hour ago, BradInATX said:

This is Brad. He is ideologically consistent. Be more like Brad.

 

And yet not a peep of concern regarding the consolidation of vast amounts of sensitive health care information under Health and Human Services administering a national healthcare plan. In your own words, any firewalls protecting those data are "mythical". We are yet to hear a sound on that, despite lengthy discussions of the subject on this board. Loud noises and call outs when it comes to voluntary participation in gun violence research. Not a sounds when it comes to collection of vast amounts of sensitive health information for all Americans. Oh wait, I suppose that silence is the sound of ideological consistency.  

56 minutes ago, Mojo Hand said:

Sure, excluding home assistants and other things that capture private communications would largely solve my problem with the program.   I don't think we have control of the parameters here, though, do we? 

In the context of a discussion on an internet discussion board, the point is kinda to have a thoughtful exchange of ideas. But yes, nothing discussed here really matters. This program won't be implemented. They were trying to increase the relevance of the broader proposal by finding a gun violence angle to pitch to the Administration. Some people appear to have decided based on 1300 words in WaPo, less than 50 from the actual proposal, that this was tantamount to developing a pre-crime division within the Health Department to institutionalize unsavories.  So it will go away, and we won't have an honest vetting of novel ways to approach research on public health priorities such as cancer and alzheimer's disease and yes, gun violence. Cheers I guess.  

56 minutes ago, Mojo Hand said:

And I don't know why you would find it strange that I haven't raised similar concerns in connection with government health care, given that I've already said at least twice why I view this kind of information as more dangerous.

You suggested that lab data and physician notes issued a similar level of concern in your view. That will all be collected under Health and Human Services in administering M4A benefits.  Second, this specific discussion deals with a study proposal involving a wide rang of data sources, one of which being considered was home assistant data, collected from willing volunteers. Your position appears to be that individuals contributing their own data, under informed consent and in a voluntary fashion, poses a greater threat to the principles of autonomy and privacy than patient level lab and physician data collected for all Americans as part of standard practice in implementing a national healthcare system.  I mean, I guess you are free to hold that opinion, but it doesn't make much sense.

 

Under the position that you guys are staking out here, we are effectively barring the conduct of any research on psychological, environmental, and behavioral factors associated with potentially sensitive subjects such as mental illness and gun violence because an unaccountable intelligence apparatus that nobody is able to control may misuse the results of that research against us.  Seems to me maybe we should reel in the IC rather than shrug off research on these important issues, but perhaps y'all's approach is the right one.     

 

Edited August 24, 2019 by Anastasis

[BradInATX 9208]

5 minutes ago, Anastasis said:

"And yet not a peep of concern regarding the consolidation of vast amounts of sensitive health care information under Health and Human Services administering a national healthcare plan. In your own words, any firewalls protecting those data are "mythical". We are yet to hear a sound on that, despite lengthy discussions of the subject on this board. Loud noises and call outs when it comes to voluntary participation in gun violence research. Not a sounds when it comes to collection of vast amounts of sensitive health information for all Americans. Oh wait, I suppose that silence is the sound of ideological consistency. 

You don't see the difference between EMR and 24/7 coilection of every single word that you and every member of your family says?

You do though. I probably misframed the discussion earlier when I mentioned PII. Regardless the distinction between the two things I just mentioned are night and day.

Edited August 24, 2019 by BradInATX

[Anastasis 23394]

2 minutes ago, BradInATX said:

You don't see the difference between EMR and 24/7 coilection of every single word that you and every member of your family says?

You do though.

Who is advocating for the involuntary collection by the government of every single word that you and every member of your family says in this thread?

Edited August 24, 2019 by Anastasis

[Anastasis 23394]

4 minutes ago, BradInATX said:

I probably misframed the discussion earlier when I mentioned PII.

I know, you see the problem with your framing of the gotcha now.

[Mojo Hand 4580]

7 minutes ago, Anastasis said:

"Mass data collection involving the communications of Americans by the government, bad" - Me

"Voluntary and consented participation in public health research conducted by a public-private-academic collaboration under the auspices of the Health Department, good" - Me

"Equivocating the two, bad" - Me.

"Mining involuntarily recorded audio captured by the government to profile individuals, bad" - Also me. 

This really isn't that complex. But keep trying to frame your gotcha.     

 

And yet not a peep of concern regarding the consolidation of vast amounts of sensitive health care information under Health and Human Services administering a national healthcare plan. In your own words, any firewalls protecting those data are "mythical". We are yet to hear a sound on that, despite lengthy discussions of the subject on this board. Loud noises and call outs when it comes to voluntary participation in gun violence research. Not a sounds when it comes to collection of vast amounts of sensitive health information for all Americans. Oh wait, I suppose that silence is the sound of ideological consistency.  

In the context of a discussion on an internet discussion board, the point is kinda to have a thoughtful exchange of ideas. But yes, nothing discussed here really matters. This program won't be implemented. They were trying to increase the relevance of the broader proposal by finding a gun violence angle to pitch to the Administration. Some people appear to have decided based on 1300 words in WaPo, less than 50 from the actual proposal, that this was tantamount to developing a pre-crime division within the Health Department to institutionalize unsavories.  So it will go away, and we won't have an honest vetting of novel ways to approach research on public health priorities such as cancer and alzheimer's disease and yes, gun violence. Cheers I guess.  

You suggested that lab data and physician notes issued a similar level of concern in your view. That will all be collected under Health and Human Services in administering M4A benefits.  Second, this specific discussion deals with a study proposal involving a wide rang of data sources, one of which being considered was home assistant data, collected from willing volunteers. Your position appears to be that individuals contributing their own data, under informed consent and in a voluntary fashion, poses a greater threat to the principles of autonomy and privacy than patient level lab and physician data collected for all Americans as part of standard practice in implementing a national healthcare system.  I mean, I guess you are free to hold that opinion, but it doesn't make much sense.

 

Under the position that you guys are staking out here, we are effectively barring the conduct of any research on psychological, environmental, and behavioral factors associated with potentially sensitive subjects such as mental illness and gun violence because an unaccountable intelligence apparatus that nobody is able to control may misuse the results of that research against us.  Seems to me maybe we should reel in the IC rather than shrug off research on these important issues, but perhaps y'all's approach is the right one.     

 

The proposal is already dead?   I hadn't seen that.   Sounds like you are personally involved or something? 

To be clear, I didn't say lab data and physician notes; I said psychiatrist notes would be comparable information.   You know, the notes of what people tell a shrink during therapy.   A system to digitize them in a central government database and analyze them to predict violent behavior would worry me for the same reasons as home assistant data analysis.  I don't think that would exist under MFA, but if it would, I would strongly oppose it. 

I wouldn't bar all research by any stretch.  Just the development of government systems to predict behavior from data captured from personal devices as to which we have some expectation of privacy.   I don't see why that would be so dramatically stifling to medical research. 

[BradInATX 9208]

12 minutes ago, Anastasis said:

Who is advocating for the involuntary collection by the government of every single word that you and every member of your family says in this thread?

What do you think the devices they're proposing they gain access to do?

[Anastasis 23394]

2 minutes ago, BradInATX said:

What do you think the devices they're proposing they gain access to do?

You mean the devices that study subjects would be voluntarily consenting for the researchers to gain access to?

[Mojo Hand 4580]

7 minutes ago, Anastasis said:

You mean the devices that study subjects would be voluntarily consenting for the researchers to gain access to?

Yes.  They are identical to millions of devices in other people's homes.   What works on one works on all. 

[ndawg 1242]

Anyone else ever try to imagine what kind of worldview @Anastasis actually holds? Or, rather, what kind of worldview he'd actually espouse, if he had the courage to relate one, rather than just cowardly bait people with hypercontextualized drivel?

[Anastasis 23394]

26 minutes ago, Mojo Hand said:

The proposal is already dead?   I hadn't seen that.   Sounds like you are personally involved or something? 

To be clear, I didn't say lab data and physician notes; I said psychiatrist notes would be comparable information.   You know, the notes of what people tell a shrink during therapy.   A system to digitize them in a central government database and analyze them to predict violent behavior would worry me for the same reasons as home assistant data analysis.  I don't think that would exist under MFA, but if it would, I would strongly oppose it. 

I wouldn't bar all research by any stretch.  Just the development of government systems to predict behavior from data captured from personal devices as to which we have some expectation of privacy.   I don't see why that would be so dramatically stifling to medical research. 

LOL, no.  Not personally involved. Just reading the tea leaves. 

A psychiatrist is a physician. I am willing to wager any amount you wish that a US-based nationalized healthcare system will involve utilization management programs that will require physician notes, lab data, and other supporting documentation be provided to adjudicate coverage appeals.  Just as current Medicare FFS requires clinical justification for treatment coverage in certain situations. "In fact, I would go further in that I would wager that within 5 years the lab companies are feeding their data right into CMS, just like they do today with other payers.

You are very hung up on the Amazon Echo thing in this. Something that is not even a direct quote used in the WaPo article. It would probably be helpful to this discussion if we actually had the proposal, as it is hard to discuss beyond concept level without a very fleshed out proposal. As I said, between you and me, I would agree that removing that data source would mitigate potential risks associated with unintended use of the results.  So drop them and move on. You are acting like it is THE pivotal aspect of the overall proposal. From my perspective is a minor data source detail that would be more fully vetted as the study progressed from concept document to protocol development.  There would be a scientific process. Discussion along the lines of that taking place here would be part of that process.     

Edited August 24, 2019 by Anastasis

[Anastasis 23394]

5 minutes ago, Mojo Hand said:

Yes.  They are identical to millions of devices in other people's homes.   What works on one works on all. 

Once again, who is actually advocating the involuntary collection of these data?

[Mojo Hand 4580]

1 minute ago, Anastasis said:

Once again, who is actually advocating the involuntary collection of these data?

The NSA, probably. 

[Anastasis 23394]

Just now, Mojo Hand said:

The NSA, probably. 

We should stop that.