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#431899 Darker Still: Black Mirror’s New ...

The key difference between science fiction and fantasy is that science fiction is entirely possible because of its grounding in scientific facts, while fantasy is not. This is where Black Mirror is both an entertaining and terrifying work of science fiction. Created by Charlie Brooker, the anthological series tells cautionary tales of emerging technology that could one day be an integral part of our everyday lives.
While watching the often alarming episodes, one can’t help but recognize the eerie similarities to some of the tech tools that are already abundant in our lives today. In fact, many previous Black Mirror predictions are already becoming reality.
The latest season of Black Mirror was arguably darker than ever. This time, Brooker seemed to focus on the ethical implications of one particular area: neurotechnology.
Emerging Neurotechnology
Warning: The remainder of this article may contain spoilers from Season 4 of Black Mirror.
Most of the storylines from season four revolve around neurotechnology and brain-machine interfaces. They are based in a world where people have the power to upload their consciousness onto machines, have fully immersive experiences in virtual reality, merge their minds with other minds, record others’ memories, and even track what others are thinking, feeling, and doing.
How can all this ever be possible? Well, these capabilities are already being developed by pioneers and researchers globally. Early last year, Elon Musk unveiled Neuralink, a company whose goal is to merge the human mind with AI through a neural lace. We’ve already connected two brains via the internet, allowing one brain to communicate with another. Various research teams have been able to develop mechanisms for “reading minds” or reconstructing memories of individuals via devices. The list goes on.
With many of the technologies we see in Black Mirror it’s not a question of if, but when. Futurist Ray Kurzweil has predicted that by the 2030s we will be able to upload our consciousness onto the cloud via nanobots that will “provide full-immersion virtual reality from within the nervous system, provide direct brain-to-brain communication over the internet, and otherwise greatly expand human intelligence.” While other experts continue to challenge Kurzweil on the exact year we’ll accomplish this feat, with the current exponential growth of our technological capabilities, we’re on track to get there eventually.
Ethical Questions
As always, technology is only half the conversation. Equally fascinating are the many ethical and moral questions this topic raises.
For instance, with the increasing convergence of artificial intelligence and virtual reality, we have to ask ourselves if our morality from the physical world transfers equally into the virtual world. The first episode of season four, USS Calister, tells the story of a VR pioneer, Robert Daley, who creates breakthrough AI and VR to satisfy his personal frustrations and sexual urges. He uses the DNA of his coworkers (and their children) to re-create them digitally in his virtual world, to which he escapes to torture them, while they continue to be indifferent in the “real” world.
Audiences are left asking themselves: should what happens in the digital world be considered any less “real” than the physical world? How do we know if the individuals in the virtual world (who are ultimately based on algorithms) have true feelings or sentiments? Have they been developed to exhibit characteristics associated with suffering, or can they really feel suffering? Fascinatingly, these questions point to the hard problem of consciousness—the question of if, why, and how a given physical process generates the specific experience it does—which remains a major mystery in neuroscience.
Towards the end of USS Calister, the hostages of Daley’s virtual world attempt to escape through suicide, by committing an act that will delete the code that allows them to exist. This raises yet another mind-boggling ethical question: if we “delete” code that signifies a digital being, should that be considered murder (or suicide, in this case)? Why shouldn’t it? When we murder someone we are, in essence, taking away their capacity to live and to be, without their consent. By unplugging a self-aware AI, wouldn’t we be violating its basic right to live in the same why? Does AI, as code, even have rights?
Brain implants can also have a radical impact on our self-identity and how we define the word “I”. In the episode Black Museum, instead of witnessing just one horror, we get a series of scares in little segments. One of those segments tells the story of a father who attempts to reincarnate the mother of his child by uploading her consciousness into his mind and allowing her to live in his head (essentially giving him multiple personality disorder). In this way, she can experience special moments with their son.
With “no privacy for him, and no agency for her” the good intention slowly goes very wrong. This story raises a critical question: should we be allowed to upload consciousness into limited bodies? Even more, if we are to upload our minds into “the cloud,” at what point do we lose our individuality to become one collective being?
These questions can form the basis of hours of debate, but we’re just getting started. There are no right or wrong answers with many of these moral dilemmas, but we need to start having such discussions.
The Downside of Dystopian Sci-Fi
Like last season’s San Junipero, one episode of the series, Hang the DJ, had an uplifting ending. Yet the overwhelming majority of the stories in Black Mirror continue to focus on the darkest side of human nature, feeding into the pre-existing paranoia of the general public. There is certainly some value in this; it’s important to be aware of the dangers of technology. After all, what better way to explore these dangers before they occur than through speculative fiction?
A big takeaway from every tale told in the series is that the greatest threat to humanity does not come from technology, but from ourselves. Technology itself is not inherently good or evil; it all comes down to how we choose to use it as a society. So for those of you who are techno-paranoid, beware, for it’s not the technology you should fear, but the humans who get their hands on it.
While we can paint negative visions for the future, though, it is also important to paint positive ones. The kind of visions we set for ourselves have the power to inspire and motivate generations. Many people are inherently pessimistic when thinking about the future, and that pessimism in turn can shape their contributions to humanity.
While utopia may not exist, the future of our species could and should be one of solving global challenges, abundance, prosperity, liberation, and cosmic transcendence. Now that would be a thrilling episode to watch.
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#431427 Why the Best Healthcare Hacks Are the ...

Technology has the potential to solve some of our most intractable healthcare problems. In fact, it’s already doing so, with inventions getting us closer to a medical Tricorder, and progress toward 3D printed organs, and AIs that can do point-of-care diagnosis.
No doubt these applications of cutting-edge tech will continue to push the needle on progress in medicine, diagnosis, and treatment. But what if some of the healthcare hacks we need most aren’t high-tech at all?
According to Dr. Darshak Sanghavi, this is exactly the case. In a talk at Singularity University’s Exponential Medicine last week, Sanghavi told the audience, “We often think in extremely complex ways, but I think a lot of the improvements in health at scale can be done in an analog way.”
Sanghavi is the chief medical officer and senior vice president of translation at OptumLabs, and was previously director of preventive and population health at the Center for Medicare and Medicaid Innovation, where he oversaw the development of large pilot programs aimed at improving healthcare costs and quality.
“How can we improve health at scale, not for only a small number of people, but for entire populations?” Sanghavi asked. With programs that benefit a small group of people, he explained, what tends to happen is that the average health of a population improves, but the disparities across the group worsen.
“My mantra became, ‘The denominator is everybody,’” he said. He shared details of some low-tech but crucial fixes he believes could vastly benefit the US healthcare system.
1. Regulatory Hacking
Healthcare regulations are ultimately what drive many aspects of patient care, for better or worse. Worse because the mind-boggling complexity of regulations (exhibit A: the Affordable Care Act is reportedly about 20,000 pages long) can make it hard for people to get the care they need at a cost they can afford, but better because, as Sanghavi explained, tweaking these regulations in the right way can result in across-the-board improvements in a given population’s health.
An adjustment to Medicare hospitalization rules makes for a relevant example. The code was updated to state that if people who left the hospital were re-admitted within 30 days, that hospital had to pay a penalty. The result was hospitals taking more care to ensure patients were released not only in good health, but also with a solid understanding of what they had to do to take care of themselves going forward. “Here, arguably the writing of a few lines of regulatory code resulted in a remarkable decrease in 30-day re-admissions, and the savings of several billion dollars,” Sanghavi said.
2. Long-Term Focus
It’s easy to focus on healthcare hacks that have immediate, visible results—but what about fixes whose benefits take years to manifest? How can we motivate hospitals, regulators, and doctors to take action when they know they won’t see changes anytime soon?
“I call this the reality TV problem,” Sanghavi said. “Reality shows don’t really care about who’s the most talented recording artist—they care about getting the most viewers. That is exactly how we think about health care.”
Sanghavi’s team wanted to address this problem for heart attacks. They found they could reliably determine someone’s 10-year risk of having a heart attack based on a simple risk profile. Rather than monitoring patients’ cholesterol, blood pressure, weight, and other individual factors, the team took the average 10-year risk across entire provider panels, then made providers responsible for controlling those populations.
“Every percentage point you lower that risk, by hook or by crook, you get some people to stop smoking, you get some people on cholesterol medication. It’s patient-centered decision-making, and the provider then makes money. This is the world’s first predictive analytic model, at scale, that’s actually being paid for at scale,” he said.
3. Aligned Incentives
If hospitals are held accountable for the health of the communities they’re based in, those hospitals need to have the right incentives to follow through. “Hospitals have to spend money on community benefit, but linking that benefit to a meaningful population health metric can catalyze significant improvements,” Sanghavi said.
Darshak Sanghavi speaking at Singularity University’s 2017 Exponential Medicine Summit in San Diego, CA.
He used smoking cessation as an example. His team designed a program where hospitals were given a score (determined by the Centers for Disease Control and Prevention) based on the smoking rate in the counties where they’re located, then given monetary incentives to improve their score. Improving their score, in turn, resulted in better health for their communities, which meant fewer patients to treat for smoking-related health problems.
4. Social Determinants of Health
Social determinants of health include factors like housing, income, family, and food security. The answer to getting people to pay attention to these factors at scale, and creating aligned incentives, Sanghavi said, is “Very simple. We just have to measure it to start with, and measure it universally.”
His team was behind a $157 million pilot program called Accountable Health Communities that went live this year. The program requires all Medicare and Medicaid beneficiaries get screened for various social determinants of health. With all that data being collected, analysts can pinpoint local trends, then target funds to address the underlying problem, whether it’s job training, drug use, or nutritional education. “You’re then free to invest the dollars where they’re needed…this is how we can improve health at scale, with very simple changes in the incentive structures that are created,” he said.
5. ‘Securitizing’ Public Health
Sanghavi’s final point tied back to his discussion of aligning incentives. As misguided as it may seem, the reality is that financial incentives can make a huge difference in healthcare outcomes, from both a patient and a provider perspective.
Sanghavi’s team did an experiment in which they created outcome benchmarks for three major health problems that exist across geographically diverse areas: smoking, adolescent pregnancy, and binge drinking. The team proposed measuring the baseline of these issues then creating what they called a social impact bond. If communities were able to lower their frequency of these conditions by a given percent within a stated period of time, they’d get paid for it.
“What that did was essentially say, ‘you have a buyer for this outcome if you can achieve it,’” Sanghavi said. “And you can try to get there in any way you like.” The program is currently in CMS clearance.
AI and Robots Not Required
Using robots to perform surgery and artificial intelligence to diagnose disease will undoubtedly benefit doctors and patients around the US and the world. But Sanghavi’s talk made it clear that our healthcare system needs much more than this, and that improving population health on a large scale is really a low-tech project—one involving more regulatory and financial innovation than technological innovation.
“The things that get measured are the things that get changed,” he said. “If we choose the right outcomes to predict long-term benefit, and we pay for those outcomes, that’s the way to make progress.”
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