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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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#431412 3 Dangerous Ideas From Ray Kurzweil
Recently, I interviewed my friend Ray Kurzweil at the Googleplex for a 90-minute webinar on disruptive and dangerous ideas, a prelude to my fireside chat with Ray at Abundance 360 this January.
Ray is my friend and cofounder and chancellor of Singularity University. He is also an XPRIZE trustee, a director of engineering at Google, and one of the best predictors of our exponential future.
It’s my pleasure to share with you three compelling ideas that came from our conversation.
1. The nation-state will soon be irrelevant.
Historically, we humans don’t like change. We like waking up in the morning and knowing that the world is the same as the night before.
That’s one reason why government institutions exist: to stabilize society.
But how will this change in 20 or 30 years? What role will stabilizing institutions play in a world of continuous, accelerating change?
“Institutions stick around, but they change their role in our lives,” Ray explained. “They already have. The nation-state is not as profound as it was. Religion used to direct every aspect of your life, minute to minute. It’s still important in some ways, but it’s much less important, much less pervasive. [It] plays a much smaller role in most people’s lives than it did, and the same is true for governments.”
Ray continues: “We are fantastically interconnected already. Nation-states are not islands anymore. So we’re already much more of a global community. The generation growing up today really feels like world citizens much more than ever before, because they’re talking to people all over the world, and it’s not a novelty.”
I’ve previously shared my belief that national borders have become extremely porous, with ideas, people, capital, and technology rapidly flowing between nations. In decades past, your cultural identity was tied to your birthplace. In the decades ahead, your identify is more a function of many other external factors. If you love space, you’ll be connected with fellow space-cadets around the globe more than you’ll be tied to someone born next door.
2. We’ll hit longevity escape velocity before we realize we’ve hit it.
Ray and I share a passion for extending the healthy human lifespan.
I frequently discuss Ray’s concept of “longevity escape velocity”—the point at which, for every year that you’re alive, science is able to extend your life for more than a year.
Scientists are continually extending the human lifespan, helping us cure heart disease, cancer, and eventually, neurodegenerative disease. This will keep accelerating as technology improves.
During my discussion with Ray, I asked him when he expects we’ll reach “escape velocity…”
His answer? “I predict it’s likely just another 10 to 12 years before the general public will hit longevity escape velocity.”
“At that point, biotechnology is going to have taken over medicine,” Ray added. “The next decade is going to be a profound revolution.”
From there, Ray predicts that nanorobots will “basically finish the job of the immune system,” with the ability to seek and destroy cancerous cells and repair damaged organs.
As we head into this sci-fi-like future, your most important job for the next 15 years is to stay alive. “Wear your seatbelt until we get the self-driving cars going,” Ray jokes.
The implications to society will be profound. While the scarcity-minded in government will react saying, “Social Security will be destroyed,” the more abundance-minded will realize that extending a person’s productive earning life space from 65 to 75 or 85 years old would be a massive boon to GDP.
3. Technology will help us define and actualize human freedoms.
The third dangerous idea from my conversation with Ray is about how technology will enhance our humanity, not detract from it.
You may have heard critics complain that technology is making us less human and increasingly disconnected.
Ray and I share a slightly different viewpoint: that technology enables us to tap into the very essence of what it means to be human.
“I don’t think humans even have to be biological,” explained Ray. “I think humans are the species that changes who we are.”
Ray argues that this began when humans developed the earliest technologies—fire and stone tools. These tools gave people new capabilities and became extensions of our physical bodies.
At its base level, technology is the means by which we change our environment and change ourselves. This will continue, even as the technologies themselves evolve.
“People say, ‘Well, do I really want to become part machine?’ You’re not even going to notice it,” Ray says, “because it’s going to be a sensible thing to do at each point.”
Today, we take medicine to fight disease and maintain good health and would likely consider it irresponsible if someone refused to take a proven, life-saving medicine.
In the future, this will still happen—except the medicine might have nanobots that can target disease or will also improve your memory so you can recall things more easily.
And because this new medicine works so well for so many, public perception will change. Eventually, it will become the norm… as ubiquitous as penicillin and ibuprofen are today.
In this way, ingesting nanorobots, uploading your brain to the cloud, and using devices like smart contact lenses can help humans become, well, better at being human.
Ray sums it up: “We are the species that changes who we are to become smarter and more profound, more beautiful, more creative, more musical, funnier, sexier.”
Speaking of sexuality and beauty, Ray also sees technology expanding these concepts. “In virtual reality, you can be someone else. Right now, actually changing your gender in real reality is a pretty significant, profound process, but you could do it in virtual reality much more easily and you can be someone else. A couple could become each other and discover their relationship from the other’s perspective.”
In the 2030s, when Ray predicts sensor-laden nanorobots will be able to go inside the nervous system, virtual or augmented reality will become exceptionally realistic, enabling us to “be someone else and have other kinds of experiences.”
Why Dangerous Ideas Matter
Why is it so important to discuss dangerous ideas?
I often say that the day before something is a breakthrough, it’s a crazy idea.
By consuming and considering a steady diet of “crazy ideas,” you train yourself to think bigger and bolder, a critical requirement for making impact.
As humans, we are linear and scarcity-minded.
As entrepreneurs, we must think exponentially and abundantly.
At the end of the day, the formula for a true breakthrough is equal to “having a crazy idea” you believe in, plus the passion to pursue that idea against all naysayers and obstacles.
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#431371 Amazon Is Quietly Building the Robots of ...
Science fiction is the siren song of hard science. How many innocent young students have been lured into complex, abstract science, technology, engineering, or mathematics because of a reckless and irresponsible exposure to Arthur C. Clarke at a tender age? Yet Arthur C. Clarke has a very famous quote: “Any sufficiently advanced technology is indistinguishable from magic.”
It’s the prospect of making that… ahem… magic leap that entices so many people into STEM in the first place. A magic leap that would change the world. How about, for example, having humanoid robots? They could match us in dexterity and speed, perceive the world around them as we do, and be programmed to do, well, more or less anything we can do.
Such a technology would change the world forever.
But how will it arrive? While true sci-fi robots won’t get here right away—the pieces are coming together, and the company best developing them at the moment is Amazon. Where others have struggled to succeed, Amazon has been quietly progressing. Notably, Amazon has more than just a dream, it has the most practical of reasons driving it into robotics.
This practicality matters. Technological development rarely proceeds by magic; it’s a process filled with twists, turns, dead-ends, and financial constraints. New technologies often have to answer questions like “What is this good for, are you being realistic?” A good strategy, then, can be to build something more limited than your initial ambition, but useful for a niche market. That way, you can produce a prototype, have a reasonable business plan, and turn a profit within a decade. You might call these “stepping stone” applications that allow for new technologies to be developed in an economically viable way.
You need something you can sell to someone, soon: that’s how you get investment in your idea. It’s this model that iRobot, developers of the Roomba, used: migrating from military prototypes to robotic vacuum cleaners to become the “boring, successful robot company.” Compare this to Willow Garage, a genius factory if ever there was one: they clearly had ambitions towards a general-purpose, multi-functional robot. They built an impressive device—PR2—and programmed the operating system, ROS, that is still the industry and academic standard to this day.
But since they were unable to sell their robot for much less than $250,000, it was never likely to be a profitable business. This is why Willow Garage is no more, and many workers at the company went into telepresence robotics. Telepresence is essentially videoconferencing with a fancy robot attached to move the camera around. It uses some of the same software (for example, navigation and mapping) without requiring you to solve difficult problems of full autonomy for the robot, or manipulating its environment. It’s certainly one of the stepping-stone areas that various companies are investigating.
Another approach is to go to the people with very high research budgets: the military.
This was the Boston Dynamics approach, and their incredible achievements in bipedal locomotion saw them getting snapped up by Google. There was a great deal of excitement and speculation about Google’s “nightmare factory” whenever a new slick video of a futuristic militarized robot surfaced. But Google broadly backed away from Replicant, their robotics program, and Boston Dynamics was sold. This was partly due to PR concerns over the Terminator-esque designs, but partly because they didn’t see the robotics division turning a profit. They hadn’t found their stepping stones.
This is where Amazon comes in. Why Amazon? First off, they just announced that their profits are up by 30 percent, and yet the company is well-known for their constantly-moving Day One philosophy where a great deal of the profits are reinvested back into the business. But lots of companies have ambition.
One thing Amazon has that few other corporations have, as well as big financial resources, is viable stepping stones for developing the technologies needed for this sort of robotics to become a reality. They already employ 100,000 robots: these are of the “pragmatic, boring, useful” kind that we’ve profiled, which move around the shelves in warehouses. These robots are allowing Amazon to develop localization and mapping software for robots that can autonomously navigate in the simple warehouse environment.
But their ambitions don’t end there. The Amazon Robotics Challenge is a multi-million dollar competition, open to university teams, to produce a robot that can pick and package items in warehouses. The problem of grasping and manipulating a range of objects is not a solved one in robotics, so this work is still done by humans—yet it’s absolutely fundamental for any sci-fi dream robot.
Google, for example, attempted to solve this problem by hooking up 14 robot hands to machine learning algorithms and having them grasp thousands of objects. Although results were promising, the 10 to 20 percent failure rate for grasps is too high for warehouse use. This is a perfect stepping stone for Amazon; should they crack the problem, they will likely save millions in logistics.
Another area where humanoid robotics—especially bipedal locomotion, or walking, has been seriously suggested—is in the last mile delivery problem. Amazon has shown willingness to be creative in this department with their notorious drone delivery service. In other words, it’s all very well to have your self-driving car or van deliver packages to people’s doors, but who puts the package on the doorstep? It’s difficult for wheeled robots to navigate the full range of built environments that exist. That’s why bipedal robots like CASSIE, developed by Oregon State, may one day be used to deliver parcels.
Again: no one more than Amazon stands to profit from cracking this technology. The line from robotics research to profit is very clear.
So, perhaps one day Amazon will have robots that can move around and manipulate their environments. But they’re also working on intelligence that will guide those robots and make them truly useful for a variety of tasks. Amazon has an AI, or at least the framework for an AI: it’s called Alexa, and it’s in tens of millions of homes. The Alexa Prize, another multi-million-dollar competition, is attempting to make Alexa more social.
To develop a conversational AI, at least using the current methods of machine learning, you need data on tens of millions of conversations. You need to understand how people will try to interact with the AI. Amazon has access to this in Alexa, and they’re using it. As owners of the leading voice-activated personal assistant, they have an ecosystem of developers creating apps for Alexa. It will be integrated with the smart home and the Internet of Things. It is a very marketable product, a stepping stone for robot intelligence.
What’s more, the company can benefit from its huge sales infrastructure. For Amazon, having an AI in your home is ideal, because it can persuade you to buy more products through its website. Unlike companies like Google, Amazon has an easy way to make a direct profit from IoT devices, which could fuel funding.
For a humanoid robot to be truly useful, though, it will need vision and intelligence. It will have to understand and interpret its environment, and react accordingly. The way humans learn about our environment is by getting out and seeing it. This is something that, for example, an Alexa coupled to smart glasses would be very capable of doing. There are rumors that Alexa’s AI will soon be used in security cameras, which is an ideal stepping stone task to train an AI to process images from its environment, truly perceiving the world and any threats it might contain.
It’s a slight exaggeration to say that Amazon is in the process of building a secret robot army. The gulf between our sci-fi vision of robots that can intelligently serve us, rather than mindlessly assemble cars, is still vast. But in quietly assembling many of the technologies needed for intelligent, multi-purpose robotics—and with the unique stepping stones they have along the way—Amazon might just be poised to leap that gulf. As if by magic.
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#431238 AI Is Easy to Fool—Why That Needs to ...
Con artistry is one of the world’s oldest and most innovative professions, and it may soon have a new target. Research suggests artificial intelligence may be uniquely susceptible to tricksters, and as its influence in the modern world grows, attacks against it are likely to become more common.
The root of the problem lies in the fact that artificial intelligence algorithms learn about the world in very different ways than people do, and so slight tweaks to the data fed into these algorithms can throw them off completely while remaining imperceptible to humans.
Much of the research into this area has been conducted on image recognition systems, in particular those relying on deep learning neural networks. These systems are trained by showing them thousands of examples of images of a particular object until they can extract common features that allow them to accurately spot the object in new images.
But the features they extract are not necessarily the same high-level features a human would be looking for, like the word STOP on a sign or a tail on a dog. These systems analyze images at the individual pixel level to detect patterns shared between examples. These patterns can be obscure combinations of pixel values, in small pockets or spread across the image, that would be impossible to discern for a human, but highly accurate at predicting a particular object.
“An attacker can trick the object recognition algorithm into seeing something that isn’t there, without these alterations being obvious to a human.”
What this means is that by identifying these patterns and overlaying them over a different image, an attacker can trick the object recognition algorithm into seeing something that isn’t there, without these alterations being obvious to a human. This kind of manipulation is known as an “adversarial attack.”
Early attempts to trick image recognition systems this way required access to the algorithm’s inner workings to decipher these patterns. But in 2016 researchers demonstrated a “black box” attack that enabled them to trick such a system without knowing its inner workings.
By feeding the system doctored images and seeing how it classified them, they were able to work out what it was focusing on and therefore generate images they knew would fool it. Importantly, the doctored images were not obviously different to human eyes.
These approaches were tested by feeding doctored image data directly into the algorithm, but more recently, similar approaches have been applied in the real world. Last year it was shown that printouts of doctored images that were then photographed on a smartphone successfully tricked an image classification system.
Another group showed that wearing specially designed, psychedelically-colored spectacles could trick a facial recognition system into thinking people were celebrities. In August scientists showed that adding stickers to stop signs in particular configurations could cause a neural net designed to spot them to misclassify the signs.
These last two examples highlight some of the potential nefarious applications for this technology. Getting a self-driving car to miss a stop sign could cause an accident, either for insurance fraud or to do someone harm. If facial recognition becomes increasingly popular for biometric security applications, being able to pose as someone else could be very useful to a con artist.
Unsurprisingly, there are already efforts to counteract the threat of adversarial attacks. In particular, it has been shown that deep neural networks can be trained to detect adversarial images. One study from the Bosch Center for AI demonstrated such a detector, an adversarial attack that fools the detector, and a training regime for the detector that nullifies the attack, hinting at the kind of arms race we are likely to see in the future.
While image recognition systems provide an easy-to-visualize demonstration, they’re not the only machine learning systems at risk. The techniques used to perturb pixel data can be applied to other kinds of data too.
“Bypassing cybersecurity defenses is one of the more worrying and probable near-term applications for this approach.”
Chinese researchers showed that adding specific words to a sentence or misspelling a word can completely throw off machine learning systems designed to analyze what a passage of text is about. Another group demonstrated that garbled sounds played over speakers could make a smartphone running the Google Now voice command system visit a particular web address, which could be used to download malware.
This last example points toward one of the more worrying and probable near-term applications for this approach: bypassing cybersecurity defenses. The industry is increasingly using machine learning and data analytics to identify malware and detect intrusions, but these systems are also highly susceptible to trickery.
At this summer’s DEF CON hacking convention, a security firm demonstrated they could bypass anti-malware AI using a similar approach to the earlier black box attack on the image classifier, but super-powered with an AI of their own.
Their system fed malicious code to the antivirus software and then noted the score it was given. It then used genetic algorithms to iteratively tweak the code until it was able to bypass the defenses while maintaining its function.
All the approaches noted so far are focused on tricking pre-trained machine learning systems, but another approach of major concern to the cybersecurity industry is that of “data poisoning.” This is the idea that introducing false data into a machine learning system’s training set will cause it to start misclassifying things.
This could be particularly challenging for things like anti-malware systems that are constantly being updated to take into account new viruses. A related approach bombards systems with data designed to generate false positives so the defenders recalibrate their systems in a way that then allows the attackers to sneak in.
How likely it is that these approaches will be used in the wild will depend on the potential reward and the sophistication of the attackers. Most of the techniques described above require high levels of domain expertise, but it’s becoming ever easier to access training materials and tools for machine learning.
Simpler versions of machine learning have been at the heart of email spam filters for years, and spammers have developed a host of innovative workarounds to circumvent them. As machine learning and AI increasingly embed themselves in our lives, the rewards for learning how to trick them will likely outweigh the costs.
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