The Internet Is Making Us Lose Trust In Our Doctors

How well do you trust your doctor?

Is seems that, at least for parents, a level of trust might be impacted by exposure to on-line medical information.  A study presented at the 2017 Pediatric Academic Societies suggests that doctor / patient trust and the drive to a second opinion–in a digital age–might be more fragile than we thought.  In this study, 1,374 parent participants were presented with a vignette of a child who ‘has had a rash and worsening fever for 3 days.’ The participants were divided into three groups and the first two were presented with information related to the symptoms as computer screen shots.

  • Group one was presented with screen shots of clinical information on scarlet fever.
  • Group two was presented with screen shots of clinical information on Kawasaki Disease (a condition that causes inflammation in the walls of blood vessels).
  • Group three received no internet screenshots.

After which, all three groups were informed that that physician had diagnosed the child with scarlet fever and then asked to rate their level of trust in the diagnosis from 1 (Not at all) to 7 (Completely). Parents were also asked to rate their likelihood of seeking a second opinion regarding the diagnosis, from 1 (Extremely Unlikely) to 7 (Extremely Likely).

Physician and Patient Trust

With permission. Ruth Malanaik

Source: Ruth Malaniak MD

The results suggest that prior exposure to information can ‘prime’ a parent to have a unique bias. This bias can impact the trust that has been established with a physician and even change the care pathway.  And this result was supported statistically–the three cohorts significantly differed in reported trust in the doctors’ diagnosis (p < .001) and reported likelihood of seeking a second opinion.  The authors concluded:

After reading online search results, parents were more inclined to trust their doctor’s Dx (diagnosis) when online information supported their doctor Dx and less inclined when information contradicted the doctor. Parents were also more likely to seek a SO (second opinion) if internet results contradicted the doctor Dx. Although it is imperative that parents participate in the medical decision-making process, conflicting online information could in some cases delay necessary medical treatment. Physicians must be aware of the influence the internet may have on parents and ensure adequate parental education to address any possible concerns.

While this ‘artificial’ scenario may not accurately reflect everyday life or clinical practice, the results seem to indicate that exposure to clinical information on-line may ‘prime’ parents to particular point of view and predisposition to action. I’m reminded of work done by John Bargh, a social psychologist who studied how people, given prior exposure to information, can have that point of view reflected in their subsequent opinion or actions. This concept was popularized by Malcolm Gladwell in his best selling book Blink.

In this study, we can see how information obtained on-line can directly impact the caregivers’ perceptions of decisions and recommendations of a physician.  Dr. Ruth Milaniak MD, the lead investigator of this study, supports this observation and offers some important advice.

Every time I speak with my patients, I always have in the back of my mind what on-line influence may have already impacted our dialogue.  The internet is emerging as ‘the elephant exam room’ and we as clinicians need to understand this and communicate with patients and caregivers accordingly.

In an era where doctor / patient communication can be time-limited, the role of on-line support may play and increasing role. And as more and more, patients look to Dr. Google as a primary source of medical information, the key question that emerges is if that ‘digital information’ helps or hurts clinical care.

Follow me @JohnNosta for a more informed and healthy future.

 

How Congress dismantled federal Internet privacy rules

Congressional Republicans knew their plan was potentially explosive. They wanted to kill landmark privacy regulations that would soon ban Internet providers, such as Comcast and AT&T, from storing and selling customers’ browsing histories without their express consent.

So after weeks of closed-door debates on Capitol Hill over who would take up the issue first — the House or the Senate — Republican members settled on a secret strategy, according to Hill staff and lobbyists involved in the battle. While the nation was distracted by the House’s pending vote to repeal Obamacare, Senate Republicans would schedule a vote to wipe out the new privacy protections.

On March 23, the measure passed on a straight party-line vote, 50 to 48. Five days later, a majority of House Republicans voted in favor of it, sending it to the White House, where President Trump signed the bill in early April without ceremony or public comment.

“While everyone was focused on the latest headline crisis coming out of the White House, Congress was able to roll back privacy,” said former Federal Communications Commission chairman Tom Wheeler, who worked for nearly two years to pass the rules.

The process to eliminate them took only a matter of weeks. The blowback was immediate.

Constituents heckled several of the lawmakers at town halls. “You sold my privacy up the river!” one person yelled at Sen. Jeff Flake (R-Ariz.) — lead sponsor of the Senate bill — at a gathering in April. Several late-night comedians roasted congressional Republicans: “This is what’s wrong with Washington, D.C. I guarantee you there is not one person, not one voter of any political stripe anywhere in America who asked for this,” Stephen Colbert said.

The quick undoing of the Internet privacy rules has prompted lawmakers in more than a dozen states to propose local laws to restore privacy protections to their constituents.

The FCC privacy rules were among the first of more than a hundred regulations and laws being targeted for elimination or massive overhaul by Trump and Republican members of Congress who want to dismantle Obama-era regulations they view as burdensome.

How the privacy rules came to be undone helps to explain and inform the strategies behind the broader range of Republican initiatives in the works. The rollback of privacy, for example, was the first step by the Republican-led FCC to overhaul Obama-era net neutrality rules .

The rolling crises within Trump’s administration and Republican infighting has slowed Republican lawmakers’ work on Capitol Hill. But they remain positioned to capi­tal­ize on their control of the White House and both chambers of Congress, a power structure that has not existed in more than a decade.

“Trump and the Republicans are doing so many different things on parallel tracks, the news media and activists can’t follow it all,” said Trump adviser and former House speaker Newt Gingrich. “This is by design.”

Maybe the Internet Isn’t Tearing Us Apart After All

 

VIKINGMAIDEN88 IS TWENTY-SIX years old. She enjoys reading history and writing poetry. Her signature quote is from Shakespeare. I gleaned all this from her profile and posts on Stormfront.org, America’s most popular online hate site. I also learned that Vikingmaiden88 has enjoyed the content on the site of the newspaper I work for, the New York Times. She wrote an enthusiastic post about a particular Times feature. I recently analyzed tens of thousands of such Stormfront profiles, in which registered members can enter their location, birth date, interests, and other information.

Stormfront was founded in 1995 by Don Black, a former Ku Klux Klan leader. Its most popular “social groups” are “Union of National Socialists” and “Fans and Supporters of Adolf Hitler.” Over the past year, according to Quantcast, roughly 200,000 to 400,000 Americans visited the site every month. A recent Southern Poverty Law Center report linked nearly one hundred murders in the past five years to registered Stormfront members.

Stormfront members are not whom I would have guessed. They tend to be young, at least according to self-reported birth dates. The most common age at which people join the site is nineteen. And four times more nineteen-year-olds sign up than forty-year-olds. Internet and social network users lean young, but not nearly that young. Profiles do not have a field for gender. But I looked at all the posts and complete profiles of a random sample of American users, and it turns out that you can work out the gender of most of the membership: I estimate that about 30 percent of Stormfront members are female. The states with the most members per capita are Montana, Alaska, and Idaho. These states tend to be overwhelmingly white. Does this mean that growing up with little diversity fosters hate?

Mary Meeker’s Internet Trends Report Highlights Gaming’s Cultural Influence

 

Venture capitalist Mary Meeker released on Wednesday her highly anticipated annual report on Internet trends, capturing the tech world’s state of play. This year’s biggest insights include: the sprawling growth of the gaming industry, slowing mobile phone shipments, and online ad dollars surpassing that of TV.

Meeker considers gaming the most engaging form of social media, and suggests that early interactive gaming paved the way for much of the contemporary web. She points to how notable features of gaming, including interactive storytelling, messaging, and novel camera angles have been adopted by other forms of popular media and technology. Mobile messaging apps, car companies, streaming services, and sports media have all taken a page from the world of video games. Perhaps, she said, gaming has helped prime society for the development of human-computer interaction.

She tallies the global revenue for interactive gaming at $100 billion (6,44,962 crores) globally, with a 9 percent increase from 2015. And when gaming is compared to other digital media, it beats out other popular platforms in the amount of time users spend with it. People spend an average of 51 minutes playing console games every day, edging out Facebook (50 minutes), Snapchat ( 30 minutes), and Instagram (21 minutes), according to her report.

Like many other industries with an international presence, tech faces a shifting political landscape. Meeker seized on the national debate over immigration, where many of technology’s biggest names have clashed with the Trump administration over the president’s travel ban and broader immigration policy. Attracting talent from overseas is key to job creation in the tech industry, Meeker said. According to the report, 60 percent of the most highly valued tech companies in the US were founded by immigrants or the children of immigrants. In 2016, those companies staffed 1.5 million employees.Mary Meeker's Internet Trends Report Highlights Gaming's Cultural Influence

One notable first for the report came in the advertising section. The money spent on US mobile advertising has eclipsed that of the desktop, marking the flow of ad dollars and attention toward phones. Online advertising in general, which combines phones and computers, is up 22 percent from last year, totaling $73 billion (roughly Rs. 4,70,862 crores). The report pins the growth of online ads on improved methods to measure their efficacy, and more dollars chasing the rapid rise in phone usage.
Just as mobile has finally bested the desktop in advertising cash, Meeker predicts that in the next six months, the amount of money spent on online ads globally will surpass that of TV advertising. In 2016, TV and Internet advertising each totaled just under $200 billion.

Google and Facebook continue to dominate the US market for Internet advertising. Their combined revenue and growth tower above the rest of the industry. Google’s revenue for 2016 was over $35 billion (roughly Rs. 2,25,807 crores) and is up 22 percent from last year, the report said. Facebook took in roughly $14 billion (roughly Rs. 90,296 crores) from online ads in the US and saw a whopping 62 percent boost from 2015. Meanwhile, every other online advertiser, which Meeker lumped into a category called “others”, took in more than $20 billion, with a 9 percent increase, compared to last year. The report attributed the growth in Internet advertising to firms finding better ways of targeting audiences and measuring their engagement.

And while more of the world is coming online, something approaching universal connectivity remains elusive. The number of Internet users around the world, now at around 3.4 billion, continues to climb, but the level of growth remains flat, at 10 percent.

More smartphones are being shipped too, but growth is slowing down. Whereas global smartphone shipment numbers jumped by 24 percent in 2014, and 10 percent in 2015, that figure dwindled to 3 percent in 2016.

 

The prime minister has laid out a comprehensive plan of internet restrictions if she wins the election

Theresa May has refused to rule out censoring the internet like China.

The prime minister has looked to introduce sweeping and deep changes to the way the internet works, in what she claims is a necessary move to prevent terror. Those have included restricting the kinds of things people can post online and forcing internet companies to weaken security so that intelligence agencies can read their messages.

Many of those plans have been criticised by internet companies, who argue that such undertakings would require them to put their customers safety in danger and undermine their businesses. It might not even be possible to comply with such rules, they have argued, since laws in other countries explicitly prohibit such measures.

“I think what we need to do is see how we can regulate,” she told the Evening Standard, in response to a question on restrictions on the internet.

The prime minister was then asked if she would rule out “Chinese-style cyber-blocking action”.

She only said that she would “work with the companies” and gave no explicit commitment that she wouldn’t introduce censorship and restriction regimes like the ones that operate in China.

 

Title II: The Internet’s Commercial Firewall

 

In 2015, Tom Wheeler’s Federal Communications Commission (FCC) proposed that the Title II provision of the 1934 Communications Act applied to the internet. In short, the FCC considered the internet a public monopoly and, by extension, should be subject to the 80-year-old policies designed to regulate the telephone monopoly, Ma Bell.

Colloquially, we refer to this invocation of Title II as “net neutrality,” the FCC’s official position since 2015.

The rationale behind this policy is rather elegant in its simplicity: that internet service providers shouldn’t be permitted to discriminate against content owners by leveraging their ability to speed up or slow down consumer internet speeds.

The U.S. is now more than two decades removed from its last substantive overhaul of policies governing the nation’s communications infrastructure and resources. The 1996 Telecommunications Act, signed into law by President Bill Clinton, paved the way for the access, innovation and spectrum optimization necessary to bring us to the modern user-value economy.

But few lawmakers in 1996 could have grasped the enormity of a 2017 internet. An internet capable of serving billions of latent-free 4K UHD streams wirelessly to VR goggles on our faces. An internet, in fact, whose spectrum is today almost entirely consumed by video.

And lawmakers most certainly couldn’t have envisioned such scale in 1934, which is why this lack of clarity serves in tentative support of Title II as a modern standard of regulation.

Enter Ajit Pai, the new Republican sheriff at the FCC. If you’ve ever wondered what modernized laissez-faire looks like, you’re about to see it.

Related: FCC’s Ajit Pai Launches Effort to Repeal Title II

Pai has not minced words when it comes to reversing net neutrality in pursuit of an “open and free” internet. You need look no further than the Netflix-Comcast relationship to understand what an “open and free” internet will look like.

This could substantially augment the business of network carriage, positioning ISPs as industry toll booths across rapidly expanding lanes of traffic. Audiences that once “tuned” to TV programming in a “one-to-any” broadcast feed are finding their ways into the “one-to-device” economy of unicast streaming through connected TVs and linear streaming apps.

Simply put, a metered internet provides content distributors—specifically, content distributors that own the “last mile” of spectrum to the consumer—with leverage against the carriage fees the programmer currently collects from the distributor. This is an enormous chunk of most people’s $200-plus monthly cable bill.

In an “open and free” internet, the distributor can theoretically charge the programmer for dedicated bandwidth to ensure a satisfactory streaming experience, which in turn makes content cost-neutral to the distributor. That is, of course, if the distributor happens to also be the ISP.

If we look to the pre-network-neutrality precedent set by that Netflix and Comcast deal, where Netflix was able to structure a better consumer streaming experience across the Comcast footprint, the model suggests that an environment capable of supporting true a la carte may be knocking on the door.

A profound shift in the balance of power between content and distribution will be the necessary consequence of eliminating Title II’s governance of the internet. For better or worse, three sectors of the media landscape will be affected:

  • First, this is a boon to traditional cable operators who also serve as most people’s ISP, via coax, fiber or wireless spectrum—the incumbent Multichannel Video Programming Distributors (MVPDs). They are content gateways through which consumers’ access, cost and quality of content engagement will be determined by the content originator’s metered internet terms, payable to the ISP/MVPD.

Such cost-neutralization of carriage for the traditional MVPD represents enormous advantages over virtual MVPDs, an industry effectively created by the FCC in 2014 when it reclassified the definition of MVPD to exclude any physical distribution infrastructure.

While virtual MVPDs may offer content access rivaling the incumbent MVPDs, they too would be subject to the costs of a metered internet, again, payable to the ISPs. No doubt, this would be a margin-crusher that would favor the incumbent MVPDs in a content price war. The FCC has yet to comment on how exactly this promotes competition.

Finally, there are the programmers whose very existence depends on bundled carriage revenues. Without the ability to offset the neutralization of carriage revenue with robust monetization of audience, the elimination of net neutrality may very well thin the herd of linear programmers. Who’s got time for bad TV anymore?

In the end, Ajit Pai’s vision for an open and free internet will likely result in outcomes marginally favorable to consumers. Content distribution is democratizing at an unbelievable rate, while audiences continue to balkanize across platforms and devices.  So while consumers will soon be able to price shop providers in earnest, diversity in programming itself may be the first casualty of a new, open and free internet. 

Randy Cooke is VP of programmatic TV at video ad inventory marketplace SpotXchange.

 

Microsoft Agrees to Buy US-Israeli Cyber-Security Firm Hexadite

 

Microsoft said on Thursday it has agreed to acquire Hexadite, a US-Israeli provider of technology to automate responses to cyber-attacks.

Financial terms were not disclosed.

In May, Israeli financial news website Calcalist said Microsoft would pay $100 million (roughly Rs. 643 crores) for Hexadite, which is headquartered in Boston with its research and development centre in Israel.

Hexadite says its technology increases productivity and reduces costs for businesses.Microsoft Agrees to Buy US-Israeli Cyber-Security Firm Hexadite
Terry Myerson, executive vice president of Windows and Devices Group at Microsoft, said Hexadite will enable the company to add new tools and services to Microsoft’s enterprise security offerings.

Investors in Hexadite include Hewlett Packard Ventures, and venture capital firms TenEleven and YL Ventures.

Microsoft said in January it plans to continue to invest more than $1 billion (roughly Rs. 6,428 crores) annually on cyber-security research and development in the coming years. Israel has already benefited from that investment.

 

The Guardian view on securing the internet: collective action needed

 

‘The attack serves, among other things, as a warning that nothing and nowhere is really secure.’ Photograph: Yui Mok/PA

Europol and the NHS are both warning people going back to work after the weekend to start up their computer with care. The cyber-attack on the UK health service, which also brought down systems in at least 150 countries, is an illustration of the vulnerability of the networks and software on which societies and economies now depend. In an ironical twist, it appears that the unknown writers of the “WannaCry” malware had themselves left a security holein their creation, which allowed the attack to be halted once their mistake was discovered.

We do not yet know how much damage WannaCry caused. People may have died; trauma units have been shut down and operations postponed. The attack serves, among other things, as a warning that nothing and nowhere is really secure.

The crucial weakness in Microsoft Windows that allowed the infection to spread had been identified years ago by the National Security Agency in Washington (and no doubt shared with Britain’s surveillance agency GCHQ). It seems to have informed no one else. Had it seen its duty primarily as defending friendly computer networks, as Edward Snowden has suggested it does, it might have issued a warning. It did not. Only when the hacking toolkit was itself stolen and published on the web did Microsoft respond with a patch that offered protection.A patient appointment letter from a London NHS hospital, next to a virus and spyware warning message on a laptop screen at a home in London,

Up-to-date computer systems were safe, but many others were not. The NHS, which has tens of thousands of computers running the obsolete Windows XP system, had not renewed its support contract with Microsoft. Despite the demand of the national data guardian, Dame Fiona Caldicott, they had not been upgraded. It’s clear from Dame Fiona’s letter that some of the system’s insecurities are the results of its users working their way around measures they find obstructive; but some must also be the result of financial pressure, which does not just affect the cost of software licences but the enormous expense of retraining and supporting users. The blame for software failures is thus widely distributed.

However, the costs fall entirely on the victims. In no other industry could the manufacturers take so little legal responsibility for the safety and reliability of the goods they sell. If the NHS had bought a fleet of ambulances whose only flaw was that the left front wheel fell off every time it hit a pothole, the makers would be sued. But if the manufacturer were a software company, it would simply charge extra for upgrading the wheels.

Computer software is difficult and complex. In the case of some neural networks, not even the programmers can trace, still less understand, how the conclusions emerge from the inputs. Yet we live in a world that depends on it. The connectivity that makes us vulnerable also knits the economy together. The strong encryption that is used to lock the files so that a ransom can be paid also underlies the security of a properly administered banking system.

The assault on the NHS is part of a growing pattern of international lawlessness that shows how optimistic were the libertarian dreams of the early internet culture. What has emerged instead is a kind of feudal system, where not just individuals but even powerful companies, banks and government agencies in their operations in cyberspace are no more than unarmed peasants dependent on Microsoft, Google or the other great baronies to protect them from the robbers and bandits waiting to exploit weakness. In exchange for this vital protection, they own our virtual lives. All of the obvious measures to guard us against the next attack – which is certainly coming – must be taken.

This is not the first ransomware attack on the NHS but it must be the last one that is successful. Though it will cost money, it is essential that the government takes digital security as seriously as it takes hygiene in hospitals. In the long run, however, we must also work for democratic control over the wider system of digital feudalism.

 

Microsoft Said to Plan Sales Reorganisation Focused on Cloud

 

HIGHLIGHTS
Microsoft is planning to announce a reorganisation as early as next week
Job cuts are likely to result from the changes
There may be other smaller personnel changes in company’s other parts
Microsoft Corp. is planning a global sales reorganisation to better focus on selling cloud software, according to people familiar with the matter.

The restructuring is scheduled to be announced as soon as next week and will impact the Worldwide Commercial Business under Judson Althoff and Jean-Philippe Courtois’ global sales and marketing group, the people said.Microsoft Said to Plan Sales Reorganisation Focused on Cloud

Job cuts are likely to result from the changes, said the people, who asked not to be identified speaking about unannounced plans. The shifts will be some of the most significant in the sales force in years and will also impact local marketing efforts in various countries, said one of the people. There may be other smaller personnel changes in other parts of the company too, one of other people said. A Microsoft spokesman declined to comment.

The company’s sales force has been trained for years to sell software for use on desktops and servers. Now it’s more important to convince customers to sign up for cloud services hosted in Microsoft’s datacenters. The Redmond, Washington-based company wants to accelerate this switch to add more revenue and catch cloud market leader Amazon.com.
Friday is the end of Microsoft’s fiscal year, the first in which Althoff and Courtois have run the sales and marketing organisations, taking over from Kevin Turner who left in 2016.

The Puget Sound Business Journal reported earlier than the company planned a companywide reorganisation around the cloud.

 

Apple reportedly plans to perform 5G internet tests in Cupertino

Apple is planning to test next-generation wireless internet technology near its California headquarters, according to a experimental application signed today by the iPhone maker and disclosed by the FCC. The application, obtained by Business Insider, details Apple’s plans to test 5G internet speeds achievable only with what’s known as millimeter wave technology, or mmWave. This is the same type of technology that internet startup Starry uses to try and deliver gigabit Wi-Fi to homes.

“Apple Inc. seeks to assess cellular link performance in direct path and multi-path environments between base station transmitters and receivers using this spectrum,” reads the application, according to BI. “These assessments will provide engineering data relevant to the operation of devices on wireless carriers’ future 5G networks.”

Though 5G remains a somewhat nebulous concept because standards organizations have yet to formally classify it, the successor to LTE is broadly understood to be capable of gigabit speeds that rely on mmWave tech. Because mmWave transmits data at a higher frequency, and thus a smaller wavelength of between 30 GHz and 300 GHz, the technology is capable of reducing latency and expanding data transmission capacity. It also opens up possibilities for cutting down on antenna size and for packing more powerful multi-band antennas into a single device.

Generally speaking, we’re talking about internet speeds that are orders of magnitude higher than standard LTE. Of course, there are big technically challenges with mmWave that need to be solved, primarily that the signal has trouble traveling great distances and through a great many surface materials, including glass. Still, Apple seems intent on testing the technology for itself:

Apple intends to transmit from two fixed points located at Apple-controlled facilities in Cupertino and Milpitas, CA. These transmissions will be consistent with the parameters and equipment identified in Apple’s accompanying Form 442, and will include the use of a horn antenna with a half-power beamwidth of 20 degrees in the E-plane and H-plane and a downtilt between 20 – 25 degrees. Apple anticipates that it will conduct its experiments for a period not to exceed 12 months.

Apple would be handling only the hardware side of testing with relation to the construction of new iPhones — perhaps the company is also looking at a different smartphone modem supplier given its ongoing legal dispute with Qualcomm. On the other end, there’s still a significant amount of network infrastructure work that has to be completed on behalf of telecoms, chipmakers, and standards organizations before your next smartphone sports a new logo in the upper left corner. That might not happen for an other two or three years.

AT&T, Verizon, Sprint, and T-Mobile have all announced plans to start testing faster versions of 4G LTE that should, in theory, help lay the groundwork for true 5G in the future. On the chip side, Samsung, Qualcomm, and Intel have all announced new hardware to support 5G speeds, while telecom standards organization 3GPP is working to release the first official 5G standards in the second half of 2017 with full-scale tests and deployments slated for 2019.