Category: News

Electronic brain implants are becoming increasingly common in both research and medicine but little attention has been paid to the digital security of these grey matter gateways. A new article in Neurosurgical Focus discusses their potential back doors and security weaknesses.

While there’s a small literature on hardware problems in implantable deep brain stimulators, little consideration has been give to data privacy, access control and crash protection for neural implants.

Many of these devices are designed to be surgically implanted and controlled, tuned or reprogrammed from outside the body by a wireless link but very few (if any) have an in-built authentication system that only allows access to people who are authorised to make the changes.

Currently, they work more like TV remote controls. Anyone with the correct remote control can change the settings on your TV, but it’s just assumed that no one except the owner would want to.

As these devices become more widespread, however, it leaves open the possibility that malicious attackers could alter the function of the brain by taking control of the device.

In fact the research group that wrote this article managed exactly this sort of remote pwnage on a commercial implantable heart defibrillator in 2003:

In our past research, we experimentally demonstrated that a hacker could wirelessly compromise the security and privacy of a representative implantable medical device: an implantable cardiac defibrillator introduced into the US market in 2003.

Specifically, our prior research [pdf] found that a third party, using his or her own homemade and low-cost equipment, could wirelessly change a patient’s therapies, disable therapies altogether, and induce ventricular fibrillation (a potentially fatal heart rhythm).

Although we only conducted our experiments using short-range, 10-cm wireless communications, and although we believe that the risk of an attack on a patient today is very low, the implications are clear: unless appropriate safeguards are in place, a hacker could compromise the security and privacy of a medical implant and cause serious physical harm to a patient.

We believe that some future hackers — if given the opportunity — will have no qualms in targeting neural devices.

It also seems that there is little concern for data privacy on these devices, so everything is broadcast ‘in the clear’. This means even if you didn’t own a legitimate controller, you could potentially intercept the data, learn its structure and create your own.

While information about an individual’s neural firing patterns are probably of little interest at the current time, we just don’t know enough about them to ‘reveal’ anything personal about the patient, their frequency and pattern could conceivably leave both the device and the patient open to side channel attacks – where the external behaviour of a system can give clues to its internal weaknesses.

For example, take a patient who has an implantable chip that detects when epileptic seizures are about to start and cools the disturbed part of the brain, a technology that is already in development.

It would be possible to know when the system kicks in by monitoring radio transmissions, giving the outside observer a reliable guide to what external conditions trigger seizures in the patient.

If transmitted, it might also be possible to read the exact frequency at which neural oscillations lead to seizures, giving clues as to how to trigger them with lights or sounds.

Another problem is the integrity of the devices. For example, the devices need to be resistant to interference from other radio signals, magnetic fields or even deliberate attempts to crash them.

This new article serves as both a warning and a plea to consider security when designing and deploying these increasingly common medical technologies.

By the way, the whole issue of Neurosurgical Focus is dedicated to brain-machine interfaces and is freely available online.

Link to ‘Neurosecurity: security and privacy for neural devices’.

Thanks to everyone who came along to the Troublemaker’s Fringe last night and I hope you all enjoyed the evening as much as I did.

The slides for my talk “Don’t touch that dial! Technology Scares and the Media” are online as a PowerPoint file and everything was captured as audio recordings so you should be able check out the evening’s events, including Ben and Petra’s excellent talks, as they appear online.

Apparently, they’ll be a discussion kicking off on badscience.net about some of the issues raised by the speakers, so I’ll keep you posted as the links appear.

If you’re in London Town Wednesday evening, don’t forget to come along to the Troublemaker’s Fringe, where we’ll be tackling the problems of science journalism and discussing how misleading, dangerous and inaccurate stories keep making the headlines.

Hilariously, we’ve already been slagged off by Steve Connor of The Independent who deals out some scorching criticism, calls us arrogant, and defends the accuracy of the mainstream media by saying:

The medics met in a pub in London last night to explain why the “mainstream media’s science coverage is broken, misleading, dangerous, lazy, venal and silly”.

Except we’re meeting tomorrow night, and there’s only one medic.

Ugh! Feel the heat!

Link to full details of the Troublemaker’s Fringe.
Link to Steve Connor in The Independent (I recommend the comments).

The arguments over the forthcoming revision of the psychiatrists’ diagnostic manual, the DSM-V, have just been heated up again by an unusually acerbic response from the American Psychiatric Association attacking their main critic.

The article that condemns the new diagnostic manual committee by ex-DSM chairman Allen Francis’ has just been officially published, alongside an interview where he furthers his damning criticism.

The American Psychiatric Association has apparently written a response which seems to have been leaked online, and it contains some robust responses to Francis’ points as well as a surprising ad hominem attack – suggesting he is motivated by losing money after the DSM-IV goes out of print.

The APA makes some good replies to the main criticisms, defending their record of openness, their reliance on the scientific data and their proposed changes to the diagnostic process based on current best practice, but the final paragraph is quite suprising:

Both Dr. Frances and Dr. Spitzer have more than a personal ‘pride of authorship’ interest in preserving the DSM-IV and its related case book and study products. Both continue to receive royalties on DSM-IV associated products. The fact that Dr. Frances was informed at the APA Annual Meeting last month that subsequent editions of his DSM-IV associated products would cease when the new edition is finalized, should be considered when evaluating his critique and its timing.

This line of criticism is perhaps most surprising for the fact that, as recently reported in USA Today, 68% of the DSM-V committee report financial ties with drug companies.

While the committee rules require that members cannot receive more than $10,000 in drug company payments while at work on the DSM, I can’t help but thinking that they are better off not opening the Pandora’s box of conflict-of-interest criticisms.

Link to Frances article in Psychiatric Times.
Link to Frances interview in Psychiatric Times.
Link to leaked alleged APA response (via Carlat blog).

The forthcoming revision of the psychiatrists’ diagnostic manual, the DSM-V, is controversially being written behind closed doors and has already sparked criticisms for its lack of openness to outside scrutiny. So far, critics have managed to raise little more than smoke signals but the tinderbox may well have just been ignited by an article of scorching criticism penned by the head of the last DSM committee.

The article, by psychiatrist Allen Frances, is apparently due to be published in Psychiatric Times but a pre-publication version seems to have found its way online as a pdf and is already being widely circulated.

Frances slams the new chairman, the process, and the ethos of secrecy behind the new manual saying that “The work on DSM-5 has, so far, displayed an unhappy combination of soaring ambition and remarkably weak methodology.”

He also cites the openness of previous revisions as key to their acceptance and validity, and criticises the supposedly impending diagnostic creep that would make mild disturbances diagnosable mental illnesses.

Such heavyweight criticism in one of American psychiatry’s main news publications signals that the shit has really hit the fan for what was already a controversial project.

The article was posted online by psychiatrist Doug Brenner who also described being kicked off the authors list for an academic paper and denounced to members of a DSM sub-committee for criticising conflicts of interest in the committee in an earlier blog post.

This spurred well-known psychiatrist and blogger Daniel Carlat to recount his own experience of being denounced to the DSM committee for nothing more than a critical comment on his site, left by a reader.

If these reports are to be believed, it seems the committee members are already becoming hot under the collar and the apparently forthcoming Psychiatric Times piece can only turn up the heat.

pdf of Allen Frances article for Psychiatric Times.

Next week the World Conference of Science Journalists will be coming to London. A few of us felt they might not adequately address some of the key problems in their profession, which has deteriorated to the point where they present a serious danger to public health, fail to keep geeks well nourished, and actively undermine the publics’ understanding of what it means for there to be evidence for a claim.

More importantly we fancied some troublemaking and a night in the pub.

As a result, you have the opportunity to come and see three angry nerds explain how and why mainstream media’s science coverage is broken, misleading, dangerous, lazy, venal, and silly. Join our angry rabble, and tell the world of science journalists exactly what you think about their work. All are welcome, admission is free. They may not come.

After the presentations (with powerpoint and everything, in a pub) we will attempt to collaboratively and drunkenly derive some best practise guidelines for health and science journalists, with your kind assistance.

Ben Goldacre has written the Guardian’s Bad Science column for 6 years, where he exposes misleading science journalism, health scare hoaxes, pill-pushing quacks and the crimes of the evil multinational pharmaceutical industry. He will talk about how the media promote the publics’ misunderstanding of evidence, focusing on health scares, journalists’ hoaxes, and their consequences, as well as cases where scientists have had their work misrepresented and failed to get satisfaction from newspapers.

Vaughan Bell is a neuropsychology researcher and clinician in the NHS, where he deals with disorders of the mind and brain, and is a writer for MindHacks.com, where he deals with disorders of the media. His talk will be called “Don’t touch that dial! Technology scares and the media” and will discuss how the media loves to tell us that new technology will give us brain damage and mental illness but is strangely adverse to discussing the research even when the science says there’s not a lot to be worried about.

Petra Boynton is a Social Psychologist and Lecturer in International Health Services Research. She specialises in researching sex and relationships health. For the past 7 years Petra has worked as as an Agony Aunt in print, online and broadcast media. She actively campaigns for free and accurate sexual health advice within the media both in the UK and Internationally. Petra will talk about the consequences of PR companies misusing surveys and formulas as a form of cheap advertising, the problem of unethical or untrained people posing as ‘media experts’, and what happens when journalists fail to fact check science and health stories.

www.badscience.net
www.mindhacks.com
www.drpetra.co.uk

Of note, attending the WCSJ will cost you £200 a day. You are welcome to come to our event entirely for free, beer/shrapnel in a bucket gratefully received. Journalists, corporate event organisers: welcome to the shits and giggles economy. Special thanks to Sid the Skeptic from Viz for booking the room at short notice.

What:

World Conference of Science Journalists 2009 – Troublemakers Fringe

Where:

Penderel’s Oak Pub, 286-288 High Holborn, London WC1V 7HJ, Holborn Tube.

Google Maps here

When:

1st July 7pm for 8pm – Midnight

Neuron Culture covers a new study on predictors of PTSD in deployed American combat troops. Predicting whether a soldier will break down through combat has been one of the Holy Grails of military psychiatry and the impressive results of this study suggest that this may be getting closer.

World War One was the crucible of military psychiatry as it became clear that even the bravest and best soldiers could break down due to combat stress.

When World War Two arrived, the British and American militaries invested a great deal in psychological screening to attempt to distinguish which soldiers would break down more quickly.

The project was widely regarded as a failure as the only reliably predictor seemed to be the duration and ferocity of the combat the soldier was exposed to.

However, as Dobbs notes, this new study finds that a simple measure of physical health could be a powerful way of preventing half of all PTSD cases in combat deployed troops.

The study found that the least healthy 15% of the troops in the study who saw combat accounted for well over half — 58% — of the post-combat PTSD cases, as indicated by either the study’s own criteria or by self-report of a PTSD diagnosis from the soldiers during follow-up.

This is a pretty stunning result. And it certainly suggests that, as the study put it, “more vulnerable members of the population could be identified and benefit from interventions targeted to prevent new onset PTSD.” The beauty of this finding is that fairly general measures of health are the indicators, so you can predict a lot from fairly simple and easy-to-collect data.

Obviously not all of the 15% who scored lowest on PTSD; but that bottom 15% accounted for more cases than do the entire remaining 85%. So at a time when we are much concerned with reducing PTSD in combat troops, it seems fairly plain that we could cut the PTSD rate by more than 50% simply by keeping the least healthy 15% — as measured by fairly simple health questionnaires we already have in any and — out of combat zones.

He also notes a curiosity that while the study was on US troops, the paper was published in the British Medical Journal, and wonders whether there were some PTSD politicking that meant it was rejected from American journals.

As we’ve discussed before, PTSD is perhaps the most politicised psychiatric diagnosis. It was originally called post-Vietnam syndrome and was created to allow the US healthcare system treat Vietnam veterans.

The direct effects of trauma where never previously thought to be a mental illness in itself, although it was known to be a risk factor for a number of conditions.

Psychologist Dave Grossman, author of On Killing, convincingly argues that Vietnam was particularly conducive to combat trauma for US troops, owing to the fact that US forces had no front line and hence no ‘safe’ areas to relax in, and that they often found themselves fighting a irregular army of civilians including women and children.

Link to Neuron Culture on predicting PTSD in combat troops.
Link to full-text of study from BMJ.

This week’s Nature has a feature article on how visual motion media impacts on young children. It’s an interesting article because it focuses largely on television.

This is notable for two reasons: the first is that numerous research studies have found that, as a generalisation, watching television negatively impacts on children’s concentration, increases the risk of obesity and interferes with play and communication. The second is that this rarely makes the headlines.

Despite studies appearing regularly in the medical literature, it simply isn’t fashionable to panic about television – that’s so last century.

In contrast, evidence-free panicking about computers or the internet gets broadcast across the world, because it’s something new to panic about, and that’s what the media does best.

It’s not all bad news about television and children though. There’s some evidence that it increases imaginative play and broadens knowledge.

You also may be interested to know that Sesame Street was developed with psychologists to specifically help children improve social attitudes and increase numeracy and literacy.

The programme has been carefully and scientifically evaluated, tweaked and re-evaluated and many of the studies appear in the academic literature. It was the first and most successful evidence-based children’s programme.

Link to Nature article ‘Media research: The black box’.

The latest edition of the neuroscience podcast Neuropod has just hit the tubes and has sections on stress, genetics and culture in birdsong, the ongoing debate about homo florensis and hearing.

One of the most interesting sections is the part on stress, and accompanies a special collection of articles on stress in Nature Reviews Neuroscience.

It also contains the phrase, ‘the frontal lobes are the goldilocks of the brain’, which I can’t help but love.

mp3 of latest Neuropod podcast.
Link to Neuropod homepage with audio stream.

The June issue of The Psychologist has been made freely available online and has articles on psychology in virtual worlds, sibling rivalry, the neuroscience of giftedness and Albert Bandura’s plan to apply psychology to global problems.

The interface is a little bit clunky (you need to click on a page to see it in readable size) but gives you the full layout of the magazine as it appears in print.

The main articles start here and kick off with one on psychology (and, indeed, psychologists) in virtual worlds, but I always turn to the news section first and it’s a great place for quick updates and summaries of interesting new studies from the last month.

Link to June edition of The Psychologist.

Full disclosure: I’m an occasional columnist and unpaid associate editor of The Psychologist and I want to look like Albert Bandura when I’m fully grown up. True.

One of the particular joys of psychiatry is the regular ritual where a small but determined group of researchers try and get their idea for a new diagnosis accepted into the DSM. The most recent outbreak has hit the LA Times where a short article notes the proposal for ‘posttraumatic embitterment disorder’.

The idea for the disorder, where people are impaired by feelings of bitterness after “a severe and negative life event”, is not new. A small group of German researchers have been proposing the disorder in the medical literature since 2003 and have recently released a psychometric scale which they argue can diagnose the condition.

The last incarnation of this debate to hit the mainstream press was discussion over whether extreme racism could or should be diagnosed as ‘racist personality disorder’.

The discussions are interesting because they cut to the heart of how we define an illness. This is usually discussed as if it is a problem specific to psychiatry, as if diagnoses in other areas of medicine are more obvious, but this is not the case.

Implicit in medical diagnoses is the concept that the change or difference in the person has a negative impact.

Importantly, the biological ‘facts’ have little to do with this, because whether something has a ‘negative impact’ is largely a value judgement.

An infectious disease is not defined solely on the basis that it is a bacteria or virus, as we have many bacteria or viruses in our bodies that cause no problems. It’s only when they cause us distress or impairment that they’re classified as an illness.

In fact, there are some bacteria or viruses that are completely harmless in certain areas of the body, but cause problems in others. Like in cases of viral encephalitis where otherwise benign viruses can cause problems when they get into brain tissue.

In some cases the definition is partly based on a comparison to what’s average for a person of this type. Differences in brain structure, such as some white matter lesions, may be considered medical problems in young people but normal in older people.

But there are many human characteristics that we could equally classify as being ‘not normal’ and ‘negative’ but we don’t currently accept as illnesses.

Being left-handed is clearly a statistical deviation from the average, has been associated with a greater risk of breast cancer, an increase in accidental injuries, and has been genetically linked to schizophrenia. But left-handedness is not considered an illness.

In other words, there is no definition of an illness which is divorced from a subjective interpretation of what counts as ‘negative’.

We also have some subjective and fairly fuzzy cultural ideas just about what sort of things count as medical conditions and require attention from doctors. Someone born with a missing thumb – yes, someone born left-handed – no.

Many of these assumptions are not about the properties of the ‘illness’ but about what we think doctors should be doing and what we feel the place of medicine in society should be.

Psychiatric disorders are just another instance of this. So when you hear proposals for seemingly wacky mental illnesses, think to yourself, why is this not an illness?

Importantly, we should do the same for widely accepted mental illnesses, such as schizophrenia or depression. Ask yourself, on what basis is this an illness?

It’s not that all new diagnoses are useful or all existing ones are nonsense, it’s just that the process of questioning highlights our assumptions regarding the relationship between normality, human distress, impairment and the role of medicine in society.

Link to LA Times piece on bitterness as a mental illness.
Link to brilliant Stanford Philosophy Encyclopaedia entry on mental illness.

PLoS Biology has an excellent article on the social factors behind how recent vaccination scares sparked off and continue, despite them having no scientific basis and having been repeatedly proved incorrect.

I’m morbidly fascinated by the autism scares because they are meeting of two very different forms of systems in which to think about knowledge.

Broadly, scientists think about how well a belief is supported by looking at its justifying evidence, whereas the antivaxxers decide on the conclusion often based on what they believe about their children and then bend or reject any evidence to fit the mould.

The piece focuses on the American antivaxxers and looks at how the US media amplified the scare story through focusing on personal stories and presenting them heavy weight scientific evidence.

Rachel Casiday, a medical anthropologist at the Centre for Integrated Health Care Research at Durham University, UK, who studied British parents’ attitudes toward MMR, says scientists should not underestimate the importance of narrative. People relate much more to a dramatic story‚Äî‚Äúhe got his vaccination, he stopped interacting, and he hasn’t been the same since‚Äù‚Äîthan they do to facts, risk analyses, and statistical studies.

‚ÄúIf you discount these stories, people think you have an ulterior motive or you’re not taking them seriously,‚Äù she explains. Casiday suggests providing an alternative, science-based explanation or relating emotionally compelling tales about counter-risk‚Äîsuch as helplessly watching a young child die of a vaccine-preventable disease‚Äîin the same narrative format.

While scientists have been (for years now) presenting the facts to people, it has really made very little difference and this is the first article I know of that suggests that science uses the power of the narrative to gets its vaccine safety message across.

UPDATE: I really recommend a post on the Providentia blog where psychologist Romeo Vitelli describes how the first life-saving smallpox vaccinations were opposed by a fledgling anti-vaccination movement that bear remarkable similarities to their modern day counterparts. The series on the historical antivaccination theme will continue, so look out for further posts on the same blog.

Link to PLoS Biology article (via @bengoldacre).

PsychCentral reports on the likely changes to appear in the DSM-V, the new version of the psychiatrist’s diagnostic manual, due out in 2012 and discussed in a recent presentation in last week’s American Psychiatric Association annual conference.

The most significant change proposed has to do with the inclusion of dimensional assessments for depression, anxiety, cognitive impairment and reality distortion that span across many major mental disorders. So a clinician might diagnose schizophrenia, but then also rate these four dimensions for the patient to characterize the schizophrenia in a more detailed and descriptive manner.

Despite the PR spin that “no limits” were placed on this revision of the DSM, the reality is that there will be very few significant changes from the existing edition of the DSM-IV. While virtually all disorders will be revised, the revisions will, for the most part, be incremental and small. Why? Because the APA recognizes that you can’t retrain 300,000 mental health professionals (not to mention the 500,000 general physicians) in the field to completely relearn their way of diagnosing common mental disorders such as depression, bipolar disorder, ADHD and schizophrenia. Changes are always incremental and tweak the existing system, nothing more.

The inclusion of dimensional ratings owes much to the role of psychometrics in the assessment of mental illness, but it remains to be seen how extensively this is implemented as it could just be a fancy label for sub-categories of degree (slight, moderate, severe etc) rather than the reliance on statistically sound measurements.

The post also mentions that there may be some moving of the diagnostic furniture with some additions and retractions but no major shakeups.

There’s more coverage on MedPage, but bear in mind that as we’re still three years away from publication so it’s worth bearing in mind that some of the final decisions have still to be made.

Link to PsychCentral post ‘Update: DSM-V Major Changes’.
Link to MedPage coverage.

I get the feeling that DARPA, the American military research agency, only ever select their research projects from sci-fi comics.

Wired reports that their latest multi-million dollar project is to create an EEG-based ‘telepathy’ communication system for the battlefield solder:

Forget the battlefield radios, the combat PDAs or even infantry hand signals. When the soldiers of the future want to communicate, they’ll read each other’s minds.

At least, that’s the hope of researchers at the Pentagon’s mad-science division Darpa. The agency’s budget for the next fiscal year includes $4 million to start up a program called Silent Talk. The goal is to “allow user-to-user communication on the battlefield without the use of vocalized speech through analysis of neural signals.” That’s on top of the $4 million the Army handed out last year to the University of California to investigate the potential for computer-mediated telepathy.

Before being vocalized, speech exists as word-specific neural signals in the mind. Darpa wants to develop technology that would detect these signals of “pre-speech,” analyze them, and then transmit the statement to an intended interlocutor. Darpa plans to use EEG to read the brain waves. It’s a technique they’re also testing in a project to devise mind-reading binoculars that alert soldiers to threats faster the conscious mind can process them.

It’s all getting a bit Rogue Trooper isn’t it?

Link to Wired on DARPA barmyness.

I seem to have accidentally written dialogue about the Capgras delusion for the 2008 psychological horror film The Broken.

The therapist in this clip says “Have you ever heard about the Capgras syndrome? It’s a rare disorder in which a person holds a belief that an acquaintance, usually a close family member or spouse has been replaced by an identical looking imposter.”

This is taken from the Wikipedia entry for the Capgras delusion, the first sentence of which I wrote in the first version way back in 2003.

The film, by the way, is excellent with a fantastic twist ending, although it stops at what I thought was perhaps the most interesting part when the character realises the truth and attempts to comprehend what this means about herself.

Anyway, my next project is to get a line from the schizophrenia article into a Madonna song.

Wish me luck.

Link to clip from The Broken.
Link to Wikipedia entry for the Capgras delusion.

A case study just out in CNS Spectrums describes an apparent case of ‘caffeine-induced psychosis’. The summary is below although the full paper is available online as a pdf.

If you’re a regular coffee drinker, I don’t think you should worry though. It’s impossible to say whether caffeine was the definite cause in this case, and the gentleman concerned was drinking about 36 cups of coffee a day.

Caffeine-induced psychosis

Hedges DW, Woon FL, Hoopes SP.

As a competitive adenosine antagonist, caffeine affects dopamine transmission and has been reported to worsen psychosis in people with schizophrenia and to cause psychosis in otherwise healthy people. We report of case of apparent chronic caffeine-induced psychosis characterized by delusions and paranoia in a 47-year-old man with high caffeine intake. The psychosis resolved within 7 weeks after lowering caffeine intake without use of antipsychotic medication. Clinicians might consider the possibility of caffeinism when evaluating chronic psychosis.

pdf of full-text article.
Link to PubMed entry for same.