Reflecting on the Contribution of T&S Magazine to the IEEE

Introduction

It's always important to stop, take a breath, and reflect on the activities one is engaged in. Sometimes we do this reflection willingly, and at other times there are formal structures within which we have to work that trigger the requirement periodically. It is always a good sign when a Committee knocks on your door asking for certain bits of data, and you are more than willing to share your learnings, with enthusiasm, and not just for the sake of the least amount of effort required to respond to a standard pro-forma.

This March, the IEEE Periodicals Review and Advisory Committee (PRAC) requested detailed data about the periodicals of the IEEE Society on Social Implications of Technology (IEEE-SSIT), providing three months for a written report to be submitted. The PRAC Review happens every five years and is an opportunity for IEEE to consider the contribution and validity of all its periodicals. For the Society in question, it is a chance to receive valuable feedback from experienced colleagues, look for areas to improve, consolidate, or expand, consider what was done well, and brainstorm on the opportunities that lie ahead.

The PRAC report that was submitted to IEEE in Fall 2015 was about 50 pages long. Katina Michael, Terri Bookman, Joe Herkert (by teleconference), Greg Adamson, and Lew and Bobbi Terman met with the PRAC Committee in New Jersey. We managed all the questions put to us by PRAC, and later received written feedback on our report, and responded accordingly to queries and clarifications.

It is now time to look at the next five years of IEEE Technology and Society Magazine, but before doing so let us celebrate the milestones we've achieved together, and also spell out what we need to do better to keep growing and developing, as well as some of the measures we've put in place to overcome some significant issues as we've gone through a rapid expansion phase.

Content

Figure 1. Concept map of IEEE Technology and Society Magazine article headings (March 2010–July 2015) generated using Leximancer.

Figure 1. Concept map of IEEE Technology and Society Magazine article headings (March 2010–July 2015) generated using Leximancer.

The first thing we would like to do is thank all the authors who have published their research with us in the last five years. It is such a privilege to work with professionals who sincerely care about how technology is impacting the world around them. We conducted a content analysis of paper titles since 2010 and generated the concept map in Figure 1. It is so encouraging to see diagrammatically that we are fulfilling the mission of our Society, with papers published in humanitarian engineering, engineering education, engineering ethics, sustainability, social implications, the interplay between technology and society, the role of government, and the development of systems to enrich our everyday lives with adequate energy. Privacy, security, and trust are prevalent themes also addressed in the digital data age of the Internet, as is acceptable use and user behavior with respect to smart applications.

Articles and Authors

During the study period, 272 individual articles were published with 452 author instances. Popular entry types included peer-reviewed articles (131), Commentaries (13), Book Reviews (35), Leading Edge columns (14), Opinion pieces (13), Viewpoint columns (5), Editorials (16) and Guest Editorials (6), as well as interviews, fiction, letters to the editor, news, policy and trends, Memoria, and Last Word columns. For a magazine that publishes only four times a year on a limited page budget, most recently of 80 pages per issue, we have really maximized space well. Particularly encouraging is the work toward internationalization that Keith Miller spearheaded and is still going strong. There has been a visible redistribution of author region location as can be seen in the pie chart in Figure 2, although we still require further expansion and outreach activities in Canada and Central/South America.

Figure 2. Authors by region IEEE-TSM 2010-2015.

Figure 2. Authors by region IEEE-TSM 2010-2015.

The caliber of our author affiliations are exceptional. A representative list of affiliations include: Arizona State University, Australian National University, Carnegie Mellon University, Copenhagen Business School, Cornell University, Delft University of Technology, Erasmus University Rotterdam, ESADE, ETH Zurich, Harvard University, Imperial College London, Kyoto University, M.I.T. Media Lab, Stanford University, Georgia Institute of Technology, The Pennsylvania State University, Tilburg University, University of Melbourne, University of New South Wales, Nanjing University, University of Sydney, University of Tokyo, University of Toronto, Virginia Tech, Zhejiang University.

Equally impressive are entries that have been affiliated with a variety of stakeholders, not just academia. These included for example:

  1. Applied industry submissions by employees of large technology corporations such as, Google, Accenture, Siemens Corporate Technology, Toshiba Research, Tata Consultancy, InfoSys Technologies, Fraunhofer Institute for Systems and Innovation Research, Telecom ParisTech, Acconite Solutions, Vodafone, and IBM.
  2. Applied government and defence submissions by employees of various international ministries and commissions both in defence and non-defence institutions such as the Defence Science and Technology Corporation (DSTO), European Commission, Virginia Military Institute, West Point Military Academy, Ontario Privacy Commissioners Office, and Greek Ministry of Economy and Finance.
  3. Small-to-medium company submissions such as BRP Renaud & Partner, KVC Consultancy, Illuminating Concepts, Xylem Technologies, Modern Combatives, StartPage, Oxford Systematics, Xamax Consultancy, Trans Technology Group, Salinger Privacy, Lockstep Consulting, Iran Nanotechnology Business Network, Orica Mining Chemicals, and Socca INC.
  4. Non-government organizational submissions such as from the American Civil Liberties Union, and the Australian Privacy Foundation.

Mission

IEEE-SSIT's Technology and Society Magazine is the only periodical that specializes in the social implications of technology – and on the interplay of technology and societal implications – from the perspective of a technical engineering society.

In the international publishing arena Technology and Society Magazine is considered as follows:

  1. an engineering periodical with a focus on societal implications of technology (privacy, security, affective, addictive, predictive, anticipatory, pervasive, invasive, ubiquitous, access, universal obligation, equity, borders, convenience, openness, value proposition, control, care, prosthetic, robotic, adaptive, surveillance, enforcement, employment, consumerism, innovation, human rights, gender, sustainability, and freedom and choice)
  2. a multidisciplinary periodical that includes perspectives from a variety of disciplines (legal, regulatory, philosophical, ethical, theological, cultural, anthropological, sociological, new media, economic, environmental, technological, scientific, health, medical, and policing)
  3. a diverse stakeholder reaching periodical that is relevant to entities along an upstream and downstream supply/value chain (business, raw material producers, designers, makers, manufacturers, distributors, retailers, content providers, handset/wearable providers, operators and service providers, industry bodies, standards-setting organizations, non-government organizations, advocates, and users).

Table 1. Thematic “Technology” snapshot by volume and issue

Table 2. Thematic “Society” snapshot by volume and issue.

 

Breadth of Topic Coverage

The content we have received for publication is mostly two-pronged. On the one hand are the organizational and/or societal issues raised by each paper, and on the other hand is the technology that overcomes those stated problems. In addition, from the interplay of technology and society come positive and negative socio-economic impacts, social implications, and technical shortcomings that are important to discuss.

Special Sections and Special Issues

We have continued to host an annual special issue on select papers emanating from SSIT's International Symposium on Technology and Society (ISTAS). In 2015 we also published a special issue on Norbert Wiener. Special section themes have also served as the basis for dialogue around emerging technologies. Some of these have included: the “Social Impacts of National Security Technologies” (vol. 31, no. 1), “Privacy in the Information Age” (vol. 31, no. 4), “Smart Grids and Social Networks” (vol. 33, no. 1), “Technology for Collective Action” (vol. 33, no. 3), “Social and Economic Sustainability” (vol. 34, no. 1). Co-locating like themed material has provided a richness for enjoying a single issue as a whole unit of evidence to ponder. At times articles submitted for review may “jump the queue” if they are immediately relevant to a socio-technical matter being addressed in that given issue, or in the media more broadly.

Online Social Media

As well as the IEEE Technology and Society Magazine there are several other ways to publish content relevant to the SSIT. These include the IEEE SSIT E-Newsletter (email DeepakMathur@ieee.org), and several social media portals listed here:

  1. IEEESSIT Facebook (4991 members) that can be found here: https://www.facebook.com/groups/324644704262132/?fref=nf
  2. IEEE-SSIT LinkedIN (3610 members) https://www.linkedin.com/groups/IEEE-Society-on-Social-Implications-1790357
  3. IEEESSIT Twitter (515 followers) https://twitter.com/ieeessit

What's New??

Two major changes recently have been made to IEEE T&S Magazine: the way the Magazine looks in terms of creative design; and how articles are submitted to the editor for review. A lot of effort was expended by the Publications Committee around these two items, and when prospective funding became available, we responded accordingly.

New Format Creative Design

The Magazine has a new look and feel – everything from presentation, to the way that content is laid out, to the spacing and accompanying images. We have defined “new entry” types and enhanced existing ones. A stronger emphasis on varying stylistic contributions has been adopted to ensure a mixture of peer review and non-peer review perspectives—from Opinion, to Leading Edge technology insights, to Interviews, Commentaries and Last Word columns.

Acquiring and Implementing a New Workflow in Scholarone's Manuscript Central

We have acquired the IEEE standard for submission of Magazine/Journal manuscripts. This meant that an online workflow had to be defined for T&S Magazine that would align with ScholarOne. By year-end we will have reduced our accepted article backlog to include only outstanding Book Reviews. Beginning in 2016, our review time will decrease substantially, as will time until the final result for accept, major revision, minor revision, or reject status. We are confident with this measure, given the streamlining we have implemented. It is important to underscore however, that our goals do also hinge on the availability of reviewers and their timely feedback.

Future

As T&S Magazine continues to grow, there are any number of opportunities we could investigate as future options. So far we are doing a solid job with our online downloads for articles published with 48 K papers being downloaded in 2014, placing us at about a 150/338 rank for IEEE publications.

Our impact factor is at the highest it has been over the last five years, at 0.56 which is so very encouraging. Although we are not solely about impact factor, we are widely considered the number 1 publication outlet for the specific overlap of technology and society. When we consider that IEEE Spectrum's impact factor is 0.22, Emerald Insight's IT & People is 0.530, Elsevier's Technology in Society is 0.271, John Hopkins University's Technology and Culture is 0.321, and Ethics and Information Technology is 0.520, it is exceptional that with merely 24–28 peer reviewed papers per year we are increasing our citations, and more. We are also not heavy on self-citations in our Magazine of our own contributors, but I would encourage more of us to cite IEEE Technology and Society Magazine articles in other outlets.

We would like to spread the word about the recent excellent results and development of IEEE T&S Magazine. We would like to do this by creating a new and enhanced user-friendly T&S Magazine front end website portal that may drive more traffic to paid elements of the Magazine, but also to contributors and reviewers, with additional multimedia content. We expect this new site will help drive increased membership in our Society on Social Implications of Technology (SSIT) and T&S subscriptions. The new portal also will allow more interactive feedback from readers. A reminder also, that T&S Magazine is still available in print medium.

As the reputation of IEEE Technology and Society Magazine grows, we will need to recruit more reviewers, invite key contributions from major stakeholders, and enlist more full-time and associate members from regions like South America and Africa as well as key representatives from government, all while assuring gender balance.

Acknowledgement

Katina Michael would like to thank Terri Bookman, Managing Editor, and Joe Herkert, Publications Chair, for their edits and additions to this editorial and their support throughout her editorship. She would also like to acknowledge the work of Keith Miller when he was editor for his foresight and vision.

Citations: Katina Michael, "Reflecting on the Contribution of T&S Magazine to the IEEE", IEEE Technology and Society Magazine, Volume: 34, Issue: 4, Dec. 2015, pp. 9 - 14, DOI: 10.1109/MTS.2015.2494238

Gamifying precision-guided firearms

Gamifying precision-guided firearms: Bugs and daffy wouldn't stand a chance

If you were born before 1985, then there is a good chance you watched Looney Tunes on a Saturday morning and followed the exploits of the Elmer Fudd, Bugs Bunny, and Daffy Duck hunting episodes with anticipation but no element of surprise. Poor old Daffy Duck, at times disguised as a rabbit, just couldn't outwit Bugs during rabbit season! And Elmer Fudd was one of those hunters you felt sorry for—a thousand shots fired, some on target, but he never really could finish off his rival.

When the crosshairs in the heads-up display are centered on the tagged target, a squeeze of the trigger will deliver a TrackingPoint proprietary round with great precision.
A modern-day remake of an Elmer Fudd cartoon might feature a precision-guided firearm, such as those in the TrackingPoint XactSystem series [1], making Fudd's rifle in Looney Tunes look like something out of ancient history. The modern cartoon might also be a little boring, with a short and predictable ending: shoot to kill the rabbit, and that's it—dead. There would be no great chase necessary, no teasing the target animal out. Daffy would be annihilated with pin-point accuracy the first time he came into Fudd's field of view.

The Rifle

The three TrackingPoint bolt-action rifles released in 2013 at the International Consumer Electronics Show in Las Vegas were developed with sport in mind rather than combat or law enforcement. The rifles (Figure 1) contain a computerized and networked tracking scope and nonvolatile storage space to record everything seen with the optics. Looking through the scope presents the shooter with a computerized heads-up display (HUD) that is similar to the sort you might find in a first-person-shooter video game. There is also the ability to “tag” a target, which is then tracked by the rifle's built-in software. When the crosshairs in the HUD (Figure 2) are centered on the tagged target, a squeeze of the trigger will deliver a proprietary TrackingPoint round with great precision.

Figure 1. A TrackingPoint precision-guided firearm. (Photo courtesy of Oren Schauble.)

Figure 2. A screenshot from the HUD of a TrackingPoint precision-guided firearm. (Photo courtesy of Oren Schauble.)

The TrackingPoint rifles have a Wi-Fi server on board, allowing them to be paired up with an external iOS device. In this way, an iPad app can mirror the rifle's HUD, allowing a spotter to assist with shots while looking at a bigger screen. TrackingPoint has a guided trigger, ballistic calculator, tracking engine, and integral laser range finder, with the ability to hit a target from about 900 m away.

Game Hunting, or Hunting Game?

With the addition of a computerized HUD and the ability to mirror the view from the rifle's optics on an iPad, hunting game is becoming ever more like a hunting video game. As one SIMHQ forum user wrote: “Might as well mount [a TrackingPoint rifle] on a drone and go nail Bambi from hundreds of miles away without the horrible inconvenience of all that going outside!” [2]

The similarities with video games continue with the ability to upload photos and videos of your kill, captured by the rifle to share with members of your social networks—a feature found in many current video games [3]. It's not hard to imagine a hunting-game craze with repercussions not only in the virtual world but in the physical. We could also point to the potential for cruelty to animals. Users might feel compelled to create an interesting clip that could go viral, and a single clean shot might look somewhat uninteresting to everyday YouTube viewers (despite the fact that hunters boast of quick kills). Using a TrackingPoint rifle is about more than sport. Hunting has been gamified.

There is nothing to stop these kinds of “sports” from becoming even more successful than the online games played by South Koreans and watched by more than a million people on television [4]. Because a living thing has been killed, we are creating our own reality-show-style scenes that are glorifying the kill. This cannot be healthy. Would we take a camera into a slaughterhouse and film the actual end-to-end process and put it on the Internet for comments or even “likes”?

Virtual and Real-World Hunting

TrackingPoint has a guided trigger, ballistic calculator, tracking engine, and integral laser range finder, with the ability to hit a target from about 900 m away.
The TrackingPoint rifles seem to create a game-like experience reminiscent of real-world, location-based, role-playing games (RPGs) where one fights virtual monsters with real-world personas in a given neighborhood. In 2011, YD Online [5], a Korean mobile gaming company, launched GEO Hunters [6], a location-based iPhone RPG app that sets gamers to fight monsters in their vicinity. What's of particular interest is that special “hidden monsters” appear based on current world news. The CEO of YD Online, Dr. Hyun Oh Yoo, believes the influence of real-life elements makes the game “even more relevant and engaging.” Yoo added, “Location-based technology has revolutionized game mechanics, and GEO Hunters takes this type of experience one step further by using Google Maps to create a fun, addictive gaming environment…We wanted to create a mobile game that combines actual geography with fantasy, while creating a community of engaged competitive players.”

Figure
ALL-FREE-DOWNLOAD.COM

My fear is that the line between violence in the real world and virtual world is starting to blur because of the location-based element that fixes monsters (as well as yourself and other gamers) to a physical location on the Earth's surface. Your feet might be touching the ground, but your head is in a virtual world as you move around trying to capture, tame, feed, and build your own army to protect the world. I can envisage people feeling trapped by virtual monsters surrounding them and not knowing which way to turn to maintain their position in the game. The longer you are in the game, the higher the stakes, after all. So despite knowing it is just a game, a gamer might accidentally step into traffic in the physical world to avoid capture in the overlapping virtual world, risking—at best—serious injury. Gamers may also become suspicious of people around them and fear the close-up tap on the shoulder that means “game over.” The separation between the part of the game conducted virtually and the part of the game relevant to a physical location begins to melt away.

Implications

With modern-day rifles like those in the TrackingPoint series, real-world violence (such as shooting at game) is being presented as it might be in a video game. It could be easy to dismiss the impact of the death of the target animal as something less significant if you're watching that death through an HUD or on an iPad. While there is much research still to be done in this area, it surely warrants concern. No doubt, we will have to rethink what it means to pull the trigger in the future—someone who selects a graphic on an iPad app might well plead that he or she were simply engaged in a game that went too far.

All of this comes even before augmented reality hits the mainstream gaming scene. Users might recant that it “felt like they were taking a photograph” or “they were just playing an iPhone app” and that they weren't actually holding a gun when the round was fired. We may be raising a generation of gamers who are good at real-world hunting, but we might also be raising gamers that won't know the difference between virtual and real shooting [7], [8].

I wonder if the TrackingPoint rifles come with a sophisticated security system—no one seems to have mentioned this just yet. What might happen if one was able to take control of someone's weapon wirelessly?

Thankfully, at about US$17,000, these precision-guided firearms don't come cheap. The price tag minimizes the risk that the guns will be seen as children's toys for creative play. That said, there's now an iOS app that allows kids to fire virtual NERF guns in an augmented-reality game that looks a lot like TrackingPoint.

Yes, TrackingPoint guns promise exciting technology, but, as a Looney Tunes character might put it, “That's not all, folks!”

ACKNOWLEDGMENTS

This article was adapted from Katina Michael, “TrackingPoint Bolt-Action Rifles Are Game-Changers, Not a Game,” The Conversation, February 2013, https://theconversation.com/trackingpoint-bolt-action-rifles-are-game-changers-not-a-game-11592.

Keywords: Games, Target tracking, Weapons, Tablet computers, Computer bugs, weapons, computer games, precision-guided firearms, TrackingPoint XactSystem series, Daffy Duck hunting episodes, Bugs Bunny, Elmer Fudd, Looney Tunes

Citation:  Katina Michael, 2016, IEEE Consumer Electronics Magazine, 5(1), Jan. 2016, pp. 99 - 101.

 

Mental Health, Implantables, and Side Effects

Then I was 8 years of age my older sister who was 8 years my senior was diagnosed with paranoid schizophrenia. As a result, my family spent quite a few years visiting hospitals and mental health facilities on a daily basis. It is painful to reflect on that period, as our whole world was rocked by this illness. My once vibrant, skilful, dynamic, energetic, extremely kind, and top-of-her-class sister was plagued by a disease process of schizophrenia that would have her attempting to take her own life on several occasions, battle with hearing voices, go into a state of catatonia for long periods of time, and suffer severe bouts of anxiety and depression.

The onset of my sister's schizophrenia was spontaneous, during what should have been the most carefree years of her life. We will never know what triggered her illness but for whatever reason that this “thing” landed in our household, we learned to come to terms with its impact. I grew up with an understanding that, in life, there are some things we can fix, and some things we cannot. There are some things we can explain, and some things we cannot. Sometimes medical science has the answers, and sometimes it does not. It does not mean I give up on the potential for a cure or therapy for various forms of mental illness, but I am more wary than most about silver bullet solutions.

In the 30 years my sister has lived with schizophrenia there have been numerous incremental innovations that have been beneficial to some sufferers. First, there have been advancements in pharmacology and in the composition of antidepressants so that they are more effective. But pharmaceutical treatments have not helped everyone, especially those sufferers who do not take their medication on a regular basis. Many persons living with depression who come on and off antidepressants without seeking medical advice are at an increased risk of suicide.

Cognitive behavior therapy (CBT), an empirically-based psychotherapy, has also aided increasing numbers of patients to better cope with their condition. Yet CBT is not given the same media attention as the new range of dynamic neural stimulators, commonly dubbed “brain implants,” now on the market [1].

For sufferers who are diagnosed with major depressive disorder (MDD), and for whom antidepressants and CBT simply do not work, doctors have turned to the prospect of somatic therapies. These include: electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS). If an individual does not respond to ECT (and only fifty per cent do), they are said to have treatment-resistant depression (TRD) [2].

In plain language, ECT is when electricity is applied to the scalp generally over a treatment period of between 2-4 weeks, several sessions per week. rMTS treatment goes for 4-6 weeks, of 5 sessions per week and uses a fluctuating magnetic field from electromagnetic coil placed outside the skull sending an electrical current to the brain.

VNS and DBS are more intrusive procedures targeting specific parts of the brain [3]. In VNS, an electrode is wrapped around the left vagus nerve in the neck and stimulation occurs about every 5 minutes for about 30 seconds. The battery packs sit under the skin of the chest in both VNS and DBS, but in the DBS procedure, one or more leads are implanted in the brain, targeted through burr holes in the skull, and locked into place [2].

VNS and DBS were unavailable techniques when my sister first became ill, but I do recollect vividly the results of ECT upon her. Post the treatments, we lost her well and truly into a dark space one cannot reach she was placed on higher dosages of antidepressants for the weeks to follow, and it was apparent to us she was not only in mental anguish but clearly in physical difficulties as well. Doctors claimed clinically that she “did not respond to the treatment,” but never acknowledged that the ECT process might have caused her any short-term distress whatsoever. In fact, we were told: “There is no change in her condition. She continues to be as she was before the treatment.” That was debatable in my eyes. Even though I was just a kid, I observed it took a good three months to get my sister back to where she was before the ECT treatment. But she was only one participant among many in clinical trials, and in no way do I generalize her outcomes to be the outcomes of all ECT patients.

VNS and DBS are again very different techniques, and while VNS is used as an adjunct therapy for major depression, DBS is mainly reserved for treating Parkinson's disease and has had only limited approval for combatting intractable obsessive compulsive disorder (OCD). However, what I gained from those childhood experiences is that human life is precious and experimentation can have some very adverse side effects without any direct benefits to the individual sufferer. Doctors need to be held accountable, caregivers and patients with MDD must be told clearly about the risks, and VNS patients must be monitored closely into the longer-term. I am alarmed at the lack of qualitative research being conducted across the spectrum of implantable devices in the health sector. And that is an area I intend to personally address in my own research in years to come.

To this day, I believe my sister was in no condition to consent to the treatment she received. At the time she intermittently thought I was Brooke Shields and that my siblings were other television personalities. She was delusional and completely unaware of herself. Prior to the trial my sister participated in, my parents had no real idea what ECT was, save for what they had heard anecdotally. As my sister's “guardians,” my parents did not understand how ECT would be administered and were not given the option to accompany her during the actual treatment. They were simply told that my sister would wear something on her head and have an electrical current travel all around it to hopefully “zap” her back to normal. They were not informed of what the risks might be to their beloved daughter, although they were clear it was all “experimental.” It was also emphasized, that this “electro-shock treatment” was the only other alternate route of exploration to help my sister get better. I remember their expectations being raised so high, only to be dashed after each treatment [4]. My parents had to rely on an interpreter as my father did not speak English and my mother only broken English. When one was not available my brother and sisters and I would do the translation.

In the end, when all other routes failed, my family turned to God for help. Alongside an excellent medical and health team (psychiatrist, social worker, general practitioner), and a loving home environment, it was faith that gave my family the will to go on facing everyday issues, as my sister slowly regained parts of herself to become functional again, such as her mobility and speech. As the saying goes “prayer works,” and while it might not make rational sense to believe in miracles, I remember witnessing these on at least a few occasions.

A few months ago, the cover of the February 2015 issue of IEEE Spectrum was graced with the title: “Hot-wiring the nervous system: implanted in the brain, smart-systems are defeating neurological disorders” (pp. 28) [5]. As someone who has spent the greater part of their academic career studying surveillance, risk, privacy and security, trust, and control, I have long reckoned that if we can “defeat” neurological disorders using implantable devices, then we can also “construct” and “trigger” them willingly, as well. But the point of my editorial is not to discuss the future of dynamic neural stimulators; we can debate that in another issue of T&S Magazine. Rather my point is to try to generate discussion about some of the fundamental issues surrounding the socio-ethical implications of penetrating the brain with new technologies, especially those that are remotely triggerable [6].

While the early studies for VNS with respect to MDD look promising, we need to acknowledge we are still at the very beginning of our investigations. I am personally more circumspect about published figures that simply categorize subjects post implantation using minimal labels like “non-responders,” “responders” and “achieved remission” [7]. Longitudinal data will give us a clearer picture of what is really happening. DBS, on the other hand, has been used to treat well over 75 000 persons, mostly suffering from movement disorders [2], but it is increasingly being piloted to treat OCD [8]. This is a call to the research community, to publish more widely about some of the complications, side effects, and resultant social life changes that implantees (of all kinds) are faced with post-surgery.

I am not referring here to issues related to surgical implantation (e.g., symptomatic haemorrhage after electrode placement), or even device failure or hardware-related complications (of which I have great concerns that there will be severe hacking problems in the future). Rather, I am referring to the resultant effect of “artificially constructed” dynamic stimulation on the human brain and its impact on an individual. In short, these are the unintended consequences, that range in scope from psychotic symptoms post stimulation (e.g., for epilepsy, or for patients presenting with auditory hallucinations for the first time), to modifications in sleep patterns, uncontrolled and accidental stimulation of other parts of body function [9], hypersexuality, hypomania [10], changes to heart and pulse rates, and much more.

Many implantees resort to social media to share their pre-and post-operative experiences. And while this is “off the record” self-reporting, clearly some of these discussions warrant further probing and inquiry. My hope is that the copious note-taking that occurs during pilots and clinical trials, specifically with respect to side effects, will be more accessible in the form of peer reviewed publication for doctors, engineers, government officials, standards organizations, regulatory approval bodies, and of course, the general public, so that we can learn more about the short-term and long-term effects of neural stimulation devices.

One patient, as a result of a particular procedure in a DBS pilot study described a sensation of feeling hot, flushed, fearful, and “panicky.” “He could feel palpitations in his chest, and when asked indicated he had an impending sense of doom. The feelings were coincident and continuous with the stimulator ‘on’ setting and they rapidly dissipated when switched ‘off'” [11]. Surely, this kind of evidence can be used to inform stakeholders towards what works and what does not, and the kinds of risks a patient may be exposed to if they opt-in, even if we know the same state will not be experienced by every patient given the complexity of the brain and body. In the more mature heart pacemaker industry, it is device manufacturers who tend to wish to hoard the actual physiological data being recorded by their devices [12], [13]; the brain implant industry will likely follow suit.

To conclude this editorial, at the very least, I would like to echo the sentiments of Fins et al., that deep brain stimulation is a “novel surgical procedure” that is “emerging,” and should presently be considered a last resort for people with neuropsychiatric disorders [14]. There needs to be some tempering of the hype surrounding the industry and we need to ensure that rigor is reintroduced back into trials to minimize patient risk. Exemptions like that granted by the U.S. Food and Drug Administration (FDA) on the grounds of a “humanitarian device” allow implant device manufacturers to run trials that are not meaningful because the size of the trial is inappropriate, lacking commensurate statistical power [14]. The outcomes from such trials cannot and should not be generalized.

I would go one step further, calling not only for adherence to more careful research requirements during clinical trials, but also urging the medical community in general to really think about the direction we are moving. If medical policies like these [15] exist, clearly stating that “there is insufficient evidence to support a conclusion concerning the health outcomes or benefits associated with [vagus nerve stimulation] … for depression” then we must introduce major reforms to the way that consent for the procedure is gained.

Between 1935 and 1960, thanks to a rush of media (and even academic coverage), lobotomies were praised for the possibilities they gave patients and their relatives [16]. Although I am not putting lobotomies on the same level as VNS and DBS, I am concerned about placing embedded devices at the site of the most delicate organ in the human body. If we can “switch on” certain functions through the brain, we can also “switch them off.”

It is clear to anyone studying emerging technologies, that the future trajectory is composed of brain implants for medical and non-medical purposes. Soon, it won't be just people fighting MDD, or OCD, epilepsy [17], [18], Parkinson's disease [19] or Tourette's Syndrome who will be asking for brain implants, but everyday people who might wish to rid themselves of memory disorders, aggression, obesity, or even headaches. There is also the potential for a whole range of amplified brain technologies that make you feel better – diagnostic devices that pick up abnormalities in physiological patterns “just-in-time,” and under-the-skin secure identification [20]. And while the current costs for brain implants to fight mental illness are not cheap, at some $25 000 USD each (including the end-to-end surgical procedure), the prices will ultimately fall [1]. Companies like Medtronics are talking about implanting everyone with a tiny cardiac monitor [21]; it won't take long for the same to be said about a 24×7 brain monitor, and other types of daily “swallowable” implants [22].

Fears related to embedded surveillance devices of any type may be informed by cultural, ethical, social, political, religious concerns that must be considered during the patient care process [23]. Fully-fledge uberveillance, whether it is “surveillance for care” or “surveillance for control” might well be big business in the future [24], but for now academicians and funding bodies should be less interested in hype and more interested in hope.

References

1. S. Upson, "A difficult time for depression devices", IEEE Spectrum, pp. 14, May 2008.

2. W. K. Goodman, R. L. Alterman, "Deep brain stimulation for intractable psychiatric disorders", Annu. Rev. Med., vol. 63, pp. 511-524, 2012.

3. P. Kotagal, "Neurostimulation: Vagus nerve stimulation and beyond", Seminars in Pediatric Neurology, vol. 18, pp. 186-194, 2011.

4. V. Johansson, "Beyond blind optimism and unfounded fears: Deep brain stimulation for treatment resistant depression", Neuroethics, vol. 6, pp. 457-471, 2013.

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Citation: Katina Michael, "Mental Health, Implantables, and Side Effects", IEEE Technology and Society Magazine, Volume: 34, Issue: 2, June 2015, pp. 5 - 17, 19 June 2015, DOI: 10.1109/MTS.2015.2434471

Social and Economic Sustainability

Back in 1997, Katina would use International Telecommunications Union (ITU) estimates of incoming and outgoing voice and data teletraffic tables for her work in strategic network engineering. She was particularly amazed when viewing these figures in global thematic maps, as thick arrows would always flow in and out from developed nations, and yet significantly thinner arrows would be flowing from developing nations, despite the difference in population counts [1]. That image has stuck with her as a depiction of how the world is, no doubt, related to historical events. Efforts required to bring those arrows into equilibrium at a country level seem somewhat impossible, given the digital divide.

As initiatives like Project Loon attempt to grant all peoples Internet access [2], there are still many places on Earth that have limited or no connectivity whatsoever. Some of these places reject services, believing that they will bring with them even greater harm, such as deforestation or a destabilization of culture and religious practice. And yet, developed nations uphold that they are in fact educating, providing, and allowing for longer-term economic and social sustainability through their technological solutions. For example, Jason has recently returned from the eastern part of the Maharashtra state of India where the use of technology in remote villages such as Jamnya appears at first glance to be at direct odds to the subsistence way of traditional village life. However, on second glance, the benefits of technology offer endless possibilities from education to weather station assistance with crop plantings. See also, Khanjan's projects in Africa [3].

But what about long-term stability in developing nations? For example, as we strive to mainstream alternate energy sources and make them accessible in resource poor communities [4], how do we think beyond the technological and economic dimensions and ensure respect for social, political, and environmental imperatives? Computers, including the tiny but powerful ones on cell phones can be game-changers, but they will not save lives directly. They cannot be eaten by a starving population. And then, they need to be serviced and maintained. Jason, along with Katina's husband Michael, visited and taught Karen refugee students in camps and remote villages on the Thai-Burma border [5]. They quickly realized that computers work only if they are connected to electricity. Someone has to pay the bill. Computers can thereafter continue to work, if no parts go missing, and they are fully enclosed within a shelter that has windows, and are not damaged. Computers can be operated by people who have received some training and where there is some connectivity. It is hopeless to want to share files or use remote applications if bandwidth is lower than 56 kbps. For example, Martin Murillo et al.'s article in this special section emphasizes that leading humanitarians have identified data communications for remote health offices as one of the top three tools that will contribute to the fulfilment of the Millennium Development Goals (MDGs).

Today, as many as 80% of the world's citizens reside in areas with mobile phone coverage [6]. Increasing access to computers and cellular devices has allowed telemedicine systems to flourish in developing countries. But these devices can only really work if technologies are integrated into local communities in bottom-up socialization practices. They can work if they are embraced by locals, and harnessed for good by local companies, NGOs, elders, and other stakeholders. While the number of mHealth and telemedicine systems is growing, the benefits of these technologies are yet to be fully realized. Many mHealth ventures in resource-constrained environments suffer from “pilotitis” – an inability to expand beyond the initial pilot and ultimately become sustainable ventures. Khanjan has led the design and execution of a cash-positive telemedicine venture in central Kenya that now has seven full-time employees. His students recently conducted a study of the failure modes that plague the growth of mHealth pilots in the developing world. This study of over 50 projects in Africa and Asia uncovered a wide range of barriers including financial challenges, business structures, technological limitations, and cultural misalignments. Once again, some of the greatest challenges were related to bottom-up socialization, melding Western and indigenous knowledge, and integration of new technologies, approaches, and business models into traditional ways of life. Khanjan has captured the nuts and bolts of “how things work” and why projects fail in a series of short stories called The Kochia Chronicles: Systemic Challenges and the Foundations of Social Innovation. These narratives take readers headlong into the lives of people in a quintessential African village as they usher in an era of design, innovation, and entrepreneurship.

It is difficult not to be cynical about initiatives such as Zuckerberg's hopes to wire the world [7]. These technological initiatives sound good, but with computing also will come social implications. Not all of these implications will be positive.

But back now to getting those inflows and outflows to look more alike, as newly industrialized countries have experienced growth since the inception of the mobile phone (e.g., India), broadband (e.g., Singapore), and manufacturing machinery (e.g., Thailand). The bottom line is that to overcome the endemic failures that inhibit the sustainability and scalability of well-meaning projects, a truly systemic and participatory approach is essential. Rather than dwelling on the problems caused by, or that might result from, the digital divide, let us preoccupy ourselves with considering digital inclusion as a primary aim. Digital inclusion is not just about offering equity but about making substantial self-determined improvements to the lives and livelihoods of people in resource-poor settings. The digital divide will never be entirely bridged, but inclusion can be propelled through social innovation, concerted time, and effort supported by multi-lateral funding from local and global stakeholders who not only understand the need for change but are passionate about the human need and its interdependence with global peace and sustainability.

IEEE Keywords: Special issues and sections, Investments, Communication Services, Internet, Government policies,Social factors, Social network services, Economics, Sustainable development, Environmental factors

Citation: Jason Sargent, Khanjan Mehta, Katina Michael, "Social and Economic Sustainability", IEEE Technology and Society Magazine, 34(1), March 2015, pp. 17 - 18