Entries Tagged "medicine"
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Wired has a detailed story about the ransomware attack on a Dusseldorf hospital, the one that resulted in an ambulance being redirected to a more distant hospital and the patient dying. The police wanted to prosecute the ransomware attackers for negligent homicide, but the details were more complicated:
After a detailed investigation involving consultations with medical professionals, an autopsy, and a minute-by-minute breakdown of events, Hartmann believes that the severity of the victim’s medical diagnosis at the time she was picked up was such that she would have died regardless of which hospital she had been admitted to. “The delay was of no relevance to the final outcome,” Hartmann says. “The medical condition was the sole cause of the death, and this is entirely independent from the cyberattack.” He likens it to hitting a dead body while driving: while you might be breaking the speed limit, you’re not responsible for the death.
So while this might not be an example of death by cyberattack, the article correctly notes that it’s only a matter of time:
But it’s only a matter of time, Hartmann believes, before ransomware does directly cause a death. “Where the patient is suffering from a slightly less severe condition, the attack could certainly be a decisive factor,” he says. “This is because the inability to receive treatment can have severe implications for those who require emergency services.” Success at bringing a charge might set an important precedent for future cases, thereby deepening the toolkit of prosecutors beyond the typical cybercrime statutes.
“The main hurdle will be one of proof,” Urban says. “Legal causation will be there as soon as the prosecution can prove that the person died earlier, even if it’s only a few hours, because of the hack, but this is never easy to prove.” With the Düsseldorf attack, it was not possible to establish that the victim could have survived much longer, but in general it’s “absolutely possible” that hackers could be found guilty of manslaughter, Urban argues.
And where causation is established, Hartmann points out that exposure for criminal prosecution stretches beyond the hackers. Instead, anyone who can be shown to have contributed to the hack may also be prosecuted, he says. In the Düsseldorf case, for example, his team was preparing to consider the culpability of the hospital’s IT staff. Could they have better defended the hospital by monitoring the network more closely, for instance?
Researchers are synthesizing squid proteins to create a face mask that better survives cleaning. (And you thought there was no connection between squid and COVID-19.) The military thinks this might have applications for self-healing robots.
As usual, you can also use this squid post to talk about the security stories in the news that I haven’t covered.
Read my blog posting guidelines here.
Seems like thermal imaging is the security theater technology of today.
These features are so tempting that thermal cameras are being installed at an increasing pace. They’re used in airports and other public transportation centers to screen travelers, increasingly used by companies to screen employees and by businesses to screen customers, and even used in health care facilities to screen patients. Despite their prevalence, thermal cameras have many fatal limitations when used to screen for the coronavirus.
- They are not intended for medical purposes.
- Their accuracy can be reduced by their distance from the people being inspected.
- They are “an imprecise method for scanning crowds” now put into a context where precision is critical.
- They will create false positives, leaving people stigmatized, harassed, unfairly quarantined, and denied rightful opportunities to work, travel, shop, or seek medical help.
- They will create false negatives, which, perhaps most significantly for public health purposes, “could miss many of the up to one-quarter or more people infected with the virus who do not exhibit symptoms,” as the New York Times recently put it. Thus they will abjectly fail at the core task of slowing or preventing the further spread of the virus.
I was quoted in BuzzFeed:
“My problem with contact tracing apps is that they have absolutely no value,” Bruce Schneier, a privacy expert and fellow at the Berkman Klein Center for Internet & Society at Harvard University, told BuzzFeed News. “I’m not even talking about the privacy concerns, I mean the efficacy. Does anybody think this will do something useful? … This is just something governments want to do for the hell of it. To me, it’s just techies doing techie things because they don’t know what else to do.”
I haven’t blogged about this because I thought it was obvious. But from the tweets and emails I have received, it seems not.
This is a classic identification problem, and efficacy depends on two things: false positives and false negatives.
- False positives: Any app will have a precise definition of a contact: let’s say it’s less than six feet for more than ten minutes. The false positive rate is the percentage of contacts that don’t result in transmissions. This will be because of several reasons. One, the app’s location and proximity systems — based on GPS and Bluetooth — just aren’t accurate enough to capture every contact. Two, the app won’t be aware of any extenuating circumstances, like walls or partitions. And three, not every contact results in transmission; the disease has some transmission rate that’s less than 100% (and I don’t know what that is).
- False negatives: This is the rate the app fails to register a contact when an infection occurs. This also will be because of several reasons. One, errors in the app’s location and proximity systems. Two, transmissions that occur from people who don’t have the app (even Singapore didn’t get above a 20% adoption rate for the app). And three, not every transmission is a result of that precisely defined contact — the virus sometimes travels further.
Assume you take the app out grocery shopping with you and it subsequently alerts you of a contact. What should you do? It’s not accurate enough for you to quarantine yourself for two weeks. And without ubiquitous, cheap, fast, and accurate testing, you can’t confirm the app’s diagnosis. So the alert is useless.
Similarly, assume you take the app out grocery shopping and it doesn’t alert you of any contact. Are you in the clear? No, you’re not. You actually have no idea if you’ve been infected.
The end result is an app that doesn’t work. People will post their bad experiences on social media, and people will read those posts and realize that the app is not to be trusted. That loss of trust is even worse than having no app at all.
It has nothing to do with privacy concerns. The idea that contact tracing can be done with an app, and not human health professionals, is just plain dumb.
EDITED TO ADD: This Brookings essay makes much the same point.
EDITED TO ADD: This post has been translated into Spanish.
This one isn’t even related to contact tracing:
On March 17, 2020, the federal government relaxed a number of telehealth-related regulatory requirements due to COVID-19. On April 3, 2020, California Governor Gavin Newsom issued Executive Order N-43-20 (the Order), which relaxes various telehealth reporting requirements, penalties, and enforcements otherwise imposed under state laws, including those associated with unauthorized access and disclosure of personal information through telehealth mediums.
Lots of details at the link.
The trade-offs are changing:
As countries around the world race to contain the pandemic, many are deploying digital surveillance tools as a means to exert social control, even turning security agency technologies on their own civilians. Health and law enforcement authorities are understandably eager to employ every tool at their disposal to try to hinder the virus even as the surveillance efforts threaten to alter the precarious balance between public safety and personal privacy on a global scale.
Yet ratcheting up surveillance to combat the pandemic now could permanently open the doors to more invasive forms of snooping later.
I think the effects of COVID-19 will be more drastic than the effects of the terrorist attacks of 9/11: not only with respect to surveillance, but across many aspects of our society. And while many things that would never be acceptable during normal time are reasonable things to do right now, we need to makes sure we can ratchet them back once the current pandemic is over.
Cindy Cohn at EFF wrote:
We know that this virus requires us to take steps that would be unthinkable in normal times. Staying inside, limiting public gatherings, and cooperating with medically needed attempts to track the virus are, when approached properly, reasonable and responsible things to do. But we must be as vigilant as we are thoughtful. We must be sure that measures taken in the name of responding to COVID-19 are, in the language of international human rights law, “necessary and proportionate” to the needs of society in fighting the virus. Above all, we must make sure that these measures end and that the data collected for these purposes is not re-purposed for either governmental or commercial ends.
I worry that in our haste and fear, we will fail to do any of that.
More from EFF.
The TSA is allowing people to bring larger bottles of hand sanitizer with them on airplanes:
Passengers will now be allowed to travel with containers of liquid hand sanitizer up to 12 ounces. However, the agency cautioned that the shift could mean slightly longer waits at checkpoint because the containers may have to be screened separately when going through security.
Won’t airplanes blow up as a result? Of course not.
Would they have blown up last week were the restrictions lifted back then? Of course not.
It’s always been security theater.
The TSA can declare this rule change because the limit was always arbitrary, just one of the countless rituals of security theater to which air passengers are subjected every day. Flights are no more dangerous today, with the hand sanitizer, than yesterday, and if the TSA allowed you to bring 12 ounces of shampoo on a flight tomorrow, flights would be no more dangerous then. The limit was bullshit. The ease with which the TSA can toss it aside makes that clear.
All over America, the coronavirus is revealing, or at least reminding us, just how much of contemporary American life is bullshit, with power structures built on punishment and fear as opposed to our best interest. Whenever the government or a corporation benevolently withdraws some punitive threat because of the coronavirus, it’s a signal that there was never any good reason for that threat to exist in the first place.
The world is racing to contain the new COVID-19 virus that is spreading around the globe with alarming speed. Right now, pandemic disease experts at the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), and other public-health agencies are gathering information to learn how and where the virus is spreading. To do so, they are using a variety of digital communications and surveillance systems. Like much of the medical infrastructure, these systems are highly vulnerable to hacking and interference.
That vulnerability should be deeply concerning. Governments and intelligence agencies have long had an interest in manipulating health information, both in their own countries and abroad. They might do so to prevent mass panic, avert damage to their economies, or avoid public discontent (if officials made grave mistakes in containing an outbreak, for example). Outside their borders, states might use disinformation to undermine their adversaries or disrupt an alliance between other nations. A sudden epidemic — when countries struggle to manage not just the outbreak but its social, economic, and political fallout — is especially tempting for interference.
In the case of COVID-19, such interference is already well underway. That fact should not come as a surprise. States hostile to the West have a long track record of manipulating information about health issues to sow distrust. In the 1980s, for example, the Soviet Union spread the false story that the US Department of Defense bioengineered HIV in order to kill African Americans. This propaganda was effective: some 20 years after the original Soviet disinformation campaign, a 2005 survey found that 48 percent of African Americans believed HIV was concocted in a laboratory, and 15 percent thought it was a tool of genocide aimed at their communities.
More recently, in 2018, Russia undertook an extensive disinformation campaign to amplify the anti-vaccination movement using social media platforms like Twitter and Facebook. Researchers have confirmed that Russian trolls and bots tweeted anti-vaccination messages at up to 22 times the rate of average users. Exposure to these messages, other researchers found, significantly decreased vaccine uptake, endangering individual lives and public health.
Last week, US officials accused Russia of spreading disinformation about COVID-19 in yet another coordinated campaign. Beginning around the middle of January, thousands of Twitter, Facebook, and Instagram accounts — many of which had previously been tied to Russia — had been seen posting nearly identical messages in English, German, French, and other languages, blaming the United States for the outbreak. Some of the messages claimed that the virus is part of a US effort to wage economic war on China, others that it is a biological weapon engineered by the CIA.
As much as this disinformation can sow discord and undermine public trust, the far greater vulnerability lies in the United States’ poorly protected emergency-response infrastructure, including the health surveillance systems used to monitor and track the epidemic. By hacking these systems and corrupting medical data, states with formidable cybercapabilities can change and manipulate data right at the source.
Here is how it would work, and why we should be so concerned. Numerous health surveillance systems are monitoring the spread of COVID-19 cases, including the CDC’s influenza surveillance network. Almost all testing is done at a local or regional level, with public-health agencies like the CDC only compiling and analyzing the data. Only rarely is an actual biological sample sent to a high-level government lab. Many of the clinics and labs providing results to the CDC no longer file reports as in the past, but have several layers of software to store and transmit the data.
Potential vulnerabilities in these systems are legion: hackers exploiting bugs in the software, unauthorized access to a lab’s servers by some other route, or interference with the digital communications between the labs and the CDC. That the software involved in disease tracking sometimes has access to electronic medical records is particularly concerning, because those records are often integrated into a clinic or hospital’s network of digital devices. One such device connected to a single hospital’s network could, in theory, be used to hack into the CDC’s entire COVID-19 database.
In practice, hacking deep into a hospital’s systems can be shockingly easy. As part of a cybersecurity study, Israeli researchers at Ben-Gurion University were able to hack into a hospital’s network via the public Wi-Fi system. Once inside, they could move through most of the hospital’s databases and diagnostic systems. Gaining control of the hospital’s unencrypted image database, the researchers inserted malware that altered healthy patients’ CT scans to show nonexistent tumors. Radiologists reading these images could only distinguish real from altered CTs 60 percent of the time — and only after being alerted that some of the CTs had been manipulated.
Another study directly relevant to public-health emergencies showed that a critical US biosecurity initiative, the Department of Homeland Security’s BioWatch program, had been left vulnerable to cyberattackers for over a decade. This program monitors more than 30 US jurisdictions and allows health officials to rapidly detect a bioweapons attack. Hacking this program could cover up an attack, or fool authorities into believing one has occurred.
Fortunately, no case of healthcare sabotage by intelligence agencies or hackers has come to light (the closest has been a series of ransomware attacks extorting money from hospitals, causing significant data breaches and interruptions in medical services). But other critical infrastructure has often been a target. The Russians have repeatedly hacked Ukraine’s national power grid, and have been probing US power plants and grid infrastructure as well. The United States and Israel hacked the Iranian nuclear program, while Iran has targeted Saudi Arabia’s oil infrastructure. There is no reason to believe that public-health infrastructure is in any way off limits.
Despite these precedents and proven risks, a detailed assessment of the vulnerability of US health surveillance systems to infiltration and manipulation has yet to be made. With COVID-19 on the verge of becoming a pandemic, the United States is at risk of not having trustworthy data, which in turn could cripple our country’s ability to respond.
Under normal conditions, there is plenty of time for health officials to notice unusual patterns in the data and track down wrong information — if necessary, using the old-fashioned method of giving the lab a call. But during an epidemic, when there are tens of thousands of cases to track and analyze, it would be easy for exhausted disease experts and public-health officials to be misled by corrupted data. The resulting confusion could lead to misdirected resources, give false reassurance that case numbers are falling, or waste precious time as decision makers try to validate inconsistent data.
In the face of a possible global pandemic, US and international public-health leaders must lose no time assessing and strengthening the security of the country’s digital health systems. They also have an important role to play in the broader debate over cybersecurity. Making America’s health infrastructure safe requires a fundamental reorientation of cybersecurity away from offense and toward defense. The position of many governments, including the United States’, that Internet infrastructure must be kept vulnerable so they can better spy on others, is no longer tenable. A digital arms race, in which more countries acquire ever more sophisticated cyberattack capabilities, only increases US vulnerability in critical areas such as pandemic control. By highlighting the importance of protecting digital health infrastructure, public-health leaders can and should call for a well-defended and peaceful Internet as a foundation for a healthy and secure world.
This essay was co-authored with Margaret Bourdeaux; a slightly different version appeared in Foreign Policy.
EDITED TO ADD: On last week’s squid post, there was a big conversation regarding the COVID-19. Many of the comments straddled the line between what are and aren’t the the core topics. Yesterday I deleted a bunch for being off-topic. Then I reconsidered and republished some of what I deleted.
Going forward, comments about the COVID-19 will be restricted to the security and risk implications of the virus. This includes cybersecurity, security, risk management, surveillance, and containment measures. Comments that stray off those topics will be removed. By clarifying this, I hope to keep the conversation on-topic while also allowing discussion of the security implications of current events.
Thank you for your patience and forbearance on this.
Sidebar photo of Bruce Schneier by Joe MacInnis.