Monthly Archives: May 2021

Patient confidentiality in remote consultations

During the lockdown last year, I was asked by the International Psychoanalytic Association (IPA) to help them update their guidance on remote consultations. I spoke to a range of GPs, surgeons, psychologists and psychoanalysts about what they’d learned during the first lockdown about working over the phone, or over Skype or Zoom. The IPA has now published my report, on a web page that also has their guidance to members both before and after the exercise.

Before the pandemic, remote consultation did happen, but not all therapists offered it; and confidentiality concerns tended to focus on technical security measures such as whether the call was encrypted end-to-end. After everyone was forced online in March and April 2020, clinicians learned rapidly to focus on the endpoints. Patients often have problems finding a private space to talk; there may be a family member in earshot, whether by accident, or because they’re cooped up in a tiny apartment, or because they have a controlling partner or parent. A clinician may return a patient’s call and catch them in a supermarket queue. And the clinic too can be interrupted, if the clinician is practicing from home.

Technical endpoint compromise is occasionally an issue; a controlling family member could inspect a patient’s device and discover a therapeutic relationship that had not been disclosed. By far the worst endpoint compromise that happened during the study period was when the Vastaamo chain of clinics in Finland was hit by ransomware; 45,000 patients’ records were stolen, and some were put online by extortionists demanding bitcoin payments. (And now we face an even larger-scale issue in the UK as the government plans to hoover up all our GP records for sale to drug companies unless we opt out by June 25; see here for how to do that.)

Such horrors aside, the core problem is to establish a therapeutic space where both patient and clinician can interact effectively, which means being able to concentrate and also to relax. There’s more to this than just being comfortable trusting the endpoint environments, the devices, the communications medium and any record-keeping mechanism. Interaction matters too. Many clinician communities discovered independently that the plain old telephone system often works better than new-fangled stuff such as skype and zoom. Video calls add maybe half a second of latency for buffering, which destroys conversational turn-taking. A further advantage of the phone is that you’re not staring at someone’s face at an unnatural distance. You can walk around the room, or even walk around the park.

Since doing this work I’ve started to avoid zoom and teams in favour of phone calls when I can, and use end-to-end encrypted voice calls on WhatsApp or Signal where call costs or client confidentiality make it sensible.

Robots, manners and stress

Humans and other animals have evolved to be aware of whether we’re under threat. When we’re on safe territory with family and friends we relax, but when we sense that a rival or a predator might be nearby, our fight-or-flight response kicks in. Situational awareness is vital, as it’s just too stressful to be alert all the time.

We’ve started to realise that this is likely to be just as important in many machine-learning applications. Take as an example machine vision in an automatic driver assistance system, whose goal is automatic lane keeping and automatic emergency braking. Such systems use deep neural networks, as they perform way better than the alternatives; but they can be easily fooled by adversarial examples. Should we worry? Sure, a bad person might cause a car crash by projecting a misleading image on a motorway bridge – but they could as easily steal some traffic cones from the road works. Nobody sits up at night worrying about that. But the car industry does actually detune vision systems from fear of deceptive attacks!

We therefore started a thread of research aimed at helping machine-learning systems detect whether they’re under attack. Our first idea was the Taboo Trap. You raise your kids to observe social taboos – to behave well and speak properly – and yet once you send them to school they suddenly know words that would make your granny blush. The taboo violation shows they’ve been exposed to ‘adversarial inputs’, as an ML engineer would call them. So we worked out how to train a neural network to avoid certain taboo values, both of outputs (forbidden utterances) and intermediate activations (forbidden thoughts). The taboos can be changed every time you retrain the network, giving the equivalent of a cryptographic key. Thus even though adversarial samples will always exist, you can make them harder to find; an attacker can’t just find one that works against one model of car and use it against every other model. You can take a view, based on risk, of how many different keys you need.

We then showed how you can also attack the availability of neural networks using sponge examples – inputs designed to soak up as much energy, and waste as much time, as possible. An alarm can be simpler to build in this case: just monitor how long your classifier takes to run.

Are there broader lessons? We suspect so. As robots develop situational awareness, like humans, and react to real or potential attacks by falling back to a more cautious mode of operation, a hostile environment will cause the equivalent of stress. Sometimes this will be deliberate; one can imagine constant low-level engagement between drones at tense national borders, just as countries currently probe each others’ air defences. But much of the time it may well be a by-product of poor automation design coupled with companies hustling aggressively for consumers’ attention.

This suggests a missing factor in machine-learning research: manners. We’ve evolved manners to signal to others that our intent is not hostile, and to negotiate the many little transactions that in a hostile environment might lead to a tussle for dominance. Yet these are hard for robots. Food-delivery robots can become unpopular for obstructing and harassing other pavement users; and one of the show-stoppers for automated driving is the difficulty that self-driving cars have in crossing traffic, or otherwise negotiating precedence with other road users. And even in the military, manners have a role – from the chivalry codes of medieval knights to the more modern protocols whereby warships and warplanes warn other craft before opening fire. If we let loose swarms of killer drones with no manners, conflict will be more likely.

Our paper Situational Awareness and Machine Learning – Robots, Manners and Stress was invited as a keynote for two co-located events: IEEE CogSIMA and the NATO STO SCI-341 Research Symposium on Situation awareness of Swarms and Autonomous systems. We got so many conflicting demands from the IEEE that we gave up on making a video of the talk for them, and our paper was pulled from their proceedings. However we decided to put the paper online for the benefit of the NATO folks, who were blameless in this matter.

COVID-19 test provider websites and Cybersecurity: COVID briefing #22

This week’s COVID briefing paper (COVIDbriefing-22.pdf) resumes the Cybercrime Centre’s COVID briefing series, which began in July 2020 with the aim of sharing short on-going updates on the impacts of the pandemic on cybercrime.

The reason for restarting this series is a recent personal experience while navigating through the government’s requirements on COVID-19 testing for international travel. I observed great variation in the quality of website design and cannot help but put on my academic hat to report on what I found.

The quality of some websites is so poor that it hard to distinguish them from fraudulent sites — that is they have many of the features and characteristics that consumers have been warned to pay attention to. Compounded with the requirement to provide personally identifiable information there is a risk that fraudulent sites will indeed spring up and it will be unsurprising if consumers are fooled.

The government needs to set out minimum standards for the websites of firms that they approve to provide COVID-19 testing — especially with the imminent growth in demand that will come as the UK’s travel rules are eased.