Can Good Standards Propel Unethical Technologies?

Between 2010 and 2016 I accepted a voluntary post representing the Consumers Federation of Australia (CFA) on the standardization of the forensic analysis process [1]. The CFA represents most major Australian national consumer organizations that work together to represent consumer rights.

The committee I was on was Standards Australia's “CH041 — Forensic Analysis” focused on the collection, analysis, and storage of materials as well as interpretation and reporting of results for forensic purposes (Figure 1). The Committee's scope included digital forensics, DNA, soil examination, toxicology, document examination, audio and video analysis, drug analysis, blood alcohol examination, chemical trace evidence, clandestine laboratory investigations, fire and explosion investigation, ballistics, forensic biology, forensic botany, crime scene investigation, fingerprint identification, vehicle examination, shoe and tire impressions, toolmarks, evidence recovery, exhibit storage, bloodstain pattern interpretation, forensic anthropology, forensic entomology, forensic odontology, and forensic pathology. Over a period of six years, six standards were created in the Australia and New Zealand landscape [2] (Table 1).

Figure 1. Bus drivers across the West Midlands were equipped with mini DNA kits in 2012 to help police track anyone who spit at them or fellow passengers.“Spit kits”—which feature swabs, gloves and hermetically sealed bags—allow staff to take saliva samples and protect them from contamination before being sent for forensic analysis. Samples are stored in a refrigerator before being sent for forensics analysis, with arrest plans put in place should returning DNA results point to a suspect already known to police.Date: Nov. 23, 2012, 16:03. Courtesy of Palnatoke, West Midlands Police.

Figure 1. Bus drivers across the West Midlands were equipped with mini DNA kits in 2012 to help police track anyone who spit at them or fellow passengers.“Spit kits”—which feature swabs, gloves and hermetically sealed bags—allow staff to take saliva samples and protect them from contamination before being sent for forensic analysis. Samples are stored in a refrigerator before being sent for forensics analysis, with arrest plans put in place should returning DNA results point to a suspect already known to police.Date: Nov. 23, 2012, 16:03. Courtesy of Palnatoke, West Midlands Police.

All of the meetings I attended were very well organized, and provided adequate materials with enough time to digest documentation. Queries were dealt with in a very professional manner both via email and in person. The location of these standards meetings happened at the Australia New Zealand Policing Advisory Agency (ANZPAA) in Melbourne Victoria — perhaps a non-neutral location, but regardless important as a hub for our gatherings. There was adequate funding provided to allow people to come together several times a year to discuss the development of the standards and the rest was achieved via email correspondence. Of course, there were a number of eminent leaders in the group with a discernible agenda that dominated discussions, but for all intents and purposes, these folks were well-meaning, fair, and willing to listen. It was obvious that the standardization process was paramount to those using forensic data on a day-to-day basis.

Representatives who served on that committee had diverse backgrounds: police officers, analysts from forensic laboratories, lawyers, statisticians, consumer representatives, and academics in the broad area. I never felt like I was ever asking a redundant question, people spent time explaining things no matter how technical or scientific the content. Members of the committee were willing to hear about consumer perspectives when key points had to be raised, but for some the importance of the topic was circumvented by the need to get the forensics right in order for criminals to be brought to justice.

In March of 2010, I graduated with my Masters of Transnational Crime Prevention degree in the Faculty of Law at the University of Wollongong. My major project was a study of the European Court of Human Rights ruling S. and Marper v. The United Kingdom [3], under the supervision of former British law enforcement officer, Associate Professor Clive Harfield. The European Court of Human Rights sitting as a Grand Chamber was led by President Jean-Paul Costa. S. and Marper complained under Articles 8 and 14 of the European Convention on Human Rights [4] that the authorities had continued to retain their fingerprints and cellular samples and DNA profiles after the criminal proceedings against them had ended with an acquittal or had been discontinued. Both applicants had asked for their fingerprints and DNA samples to be destroyed, but in both cases the police refused [5]. My involvement in the enactment of forensic standards in the Australian landscape was to ensure that Australia did not end up with blanket coverage surveillance of the populace, as has happened in the United Kingdom where about 6 million people (1 in 11) have their DNA stored on the national DNA database (NDNA), and over 37% of black ethnic minorities (BEM) are registered on the database with indefinite DNA retention of samples or profiles [6].

I learned a lot about standards setting through the Forensic Analysis project. Although I had studied the theoretical importance of standards in the process of innovation, and I had spent some time in an engineering organization during a peak period of telecommunications standards and protocol developments, I never quite realized that a standard could propel a particular product or process further than was ever intended. Of course the outcome of the BETAMAX versus VHS war has gone down in engineering folklore [7], but when standards have human rights implications, they take on a far greater importance.

Although international standards usually take a long time to bring into existence (at least 2 years), at the national level if there is monetary backing, and a large enough number of the right kind of people in a room with significant commercial or government drivers, a standard can be defined in a fairly straightforward manner within about 1 year. No matter the query, issues can usually be addressed or abated by industry representatives if you can spend the time necessary on problem solving and troubleshooting. Consumer representatives on standards panels, however, unlike paid professionals, have very limited resources and bandwidth when it comes to innovation. They usually have competing interests; a life outside the standards environment that they are contributing to, and thus fall short from the full impact they could make in any committee that they serve if there was financial support. In the commercial world, the greater the opportunity cost of forgoing the development of a standard, the greater the driver to fulfil the original intent.

And thus, I was asked at the completion of my CFA role by the convenor Regina Godfredson, Standards Co-ordinator of the CFA Standards Projects, whether or not I had any thoughts about future standards because “standards” were one thing that the CFA received funding for, in terms of the voluntary contributions of its representatives and membership being seconded to standards committees.

Table 1. Forensic analysis — Australian standards.

Table 1. Forensic analysis — Australian standards.

As Regina and I brainstormed, I described a few projects pertaining to emerging technologies that required urgent attention from the consumer perspective. But the one that stuck out in my mind as requiring standardization was non-medical implants in humans (Figure 2). I kept thinking about the event report I cited in 2007 published on the MAUDE database of the Food and Drug Administration (FDA) web site, for the “removal of an implant” that acted as a personal health record (PHR) unique ID [8]. In 2004, the company VeriChip had an implant device approved by the FDA for use in humans [9]. The device was to be inserted in the right tricep, but as applications for access control and electronic payment were trialled, the device soon found itself in people's wrists and hands for usability [10]. Still that event report had got me thinking. How could a company (or for that matter a government administration) be so inept in creating a device for implantation with no removal process? Of course, had the VeriChip device not been related to any health application, it would not have required any FDA approval whatsoever, which is equally problematic when ethical questions are considered.

7563959-fig-2-small.gif

Figure 2.

A surgeon implants British scientist Dr. Mark Gasson in his left hand with an RFID microchip (Mar. 16, 2009). Mark's Ph.D. scholarship with Prof. Kevin Warwick was sponsored by the author's former employer Nortel Networks. Photo taken: March 16, 2009, 14:44:22. Photo courtesy of Paul Hughes.

The questions that stem from this mini case are numerous. But perhaps the most important one is: does a standard set by a standards or regulatory body open the floodgates to propelling a given innovation forward, even if that innovation is controversial or even viewed as risky or unethical by the community at large? I had to ask myself the pros and cons of spearheading such a standard into Australia and New Zealand. Standards at the local level begin to gather momentum when they are recognized by the Australian Standards organization, but more so when they are picked up and highlighted by the International Standards Organisation (ISO). There are also no commensurate “ethics applications” accompanying the submission of human augmentation devices, as noted by Joe Carvalko, a U.S.-based patent attorney and implant recipient [11].

Did I really wish to be involved in such a process when I believe deeply, for anything other than therapeutics and prosthesis, there should not be a standard? Do I think this is the future of e-payments being sold to us? There have been countless campaigns by VISA to show us the “mini-Visa” [12] or the contactless VISA “tap and go” system or the VISA embedded in our phone or e-wallet or even smartwatch. Do I think we should believe the companies pushing this next phase? No, I do not. As consumers we do have a choice of whether or not to adopt. As a technology professional do I wish to be the one to propel this forward? Absolutely not. Does it mean it will never happen? No, it doesn't.

As I continued my conversation with Regina Godfredson, I realized deeply, that while CFA would get some major attention in funding for being leaders in this space, the negative would be that we would also be heavily responsible and accountable for what would come out of the group as we would be the driving force behind it. The consumer side of me says “get in there quick to contribute to the discussion and push the importance of ethics within an information technology implant scenario.” The academic side of me says sit back and let someone else do it, but make sure to be ready for when this may take place (and it is taking place right now). Just yesterday, I received a telephone call from one of Japan's leading games suppliers who wants to integrate the human augmentation scenario into Deus Ex's, “Mankind Divided” game, to be launched in Australia in the last week of August with an implants shopfront.

The conversation with the publicist went something like this: “Hello Katina. I note you are one of the leading researchers on the topic of the socio-legal-ethical implications of implants. Look, I want to know, if there are any legal issues with us launching a campaign for our new game that includes an implantation shop. I've rung everyone I can think of, and everyone keeps passing me on to someone else and cannot give me a direct answer. I've tried the Therapeutic Goods Administration here, but they say they don't care because it is not a medical device. I've looked up laws, and I can't seem to find anything on implants for non-medical applications. I've spoken to police, and ditto they don't seem to care. So what do you think?” It goes without saying that that 50 minute conversation ended up being one of the most stimulating non-academic discussions I've had on the topic. But also, I finished by saying read Katherine Albrecht's Bodily Integrity Act in draft since 2007. The publicist kept stating: “I hope from this engagement to put forward a framework allowing for human implants.”

My concern with going forward has naught to do with my ability to answer very complex biomedical ethical questions as I've thought about them for over 20 years. My concern has much to do with whether or not we should even be dabbling with all of this, knowing what we know of the probable uberveillance trajectory. I am sure I could create some very good standards to some very unethical value-laden technologies.

I will not say much about what is an ethical or unethical technology. I will simply say that pervasive technologies have an intentionality, and they have inherent qualities that can be used positively or negatively. Talking to social shaping of technology experts, I would be labeled as a follower of the technological determinist school of thought. But clearly here, when we investigate the piercing of the skin, we have a complexity that we've never before faced in the non-medical commercial space. It crosses the boundaries of negligence, consent, and human rights, which we cannot ignore or treat as just another run-of-the-mill technological innovation.

References

1. Consumers Federation of Australia, [online] Available: http://consumersfederation.org.au/.

2. CH-041 - Forensic Analysis, [online] Available: http://www.sdpp.standards.org.au/ActiveProjects.aspx?CommitteeNumber=CH-041&CommitteeName=forensic%20Analysis.

3. Case of S. and Marper v. The United Kingdom, 2008, [online] Available: https://www.coe.int/t/dghl/standardsetting/dataprotection/Judgrnents/S.%20AND%20MARPER%20v.%20THE%20UNITED%20KING-DOM%20EN.pdf.

4. Article 8 ECHR, 2016, [online] Available: http//echr-online.into/article-8-echr/.

5. K. Michael, , "The road from S and Marper to the Prum Treaty and the implications on human rights" in Cross-Border Law Enforcement: Regional Law Enforcement Cooperation - European Australian and Asia-Pacific Perspectives, Routledge, pp. 243-258, 2012.

6. K. Michael, "The legal social and ethical controversy of the collection and storage of fingerprint profiles and DNA samples in forensic science", pp. 48-60, 2010.

7. A.R. Dennis, B.A. Reinicke, "Beta versus VHS and the acceptance of electronic brainstorming technology", MIS Quart, vol. 28, pp. 1-20, 2004.

8. MAUDE Adverse Event Report VeriChip Corporation - VeriMed Patient Identificator - VeriChip Implant, July 2007, [online] Available: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CfM?MDRFOI_ID=962453.

9. 21 CFR Part 880 [Docket No. 2004N-0477] Medical Devices; General Hospital and Personal Use Devices; Classification of Implantable Radiofrequency Transponder System for Patient Identification and Health Information, [online] Available: http://www.fda.gov/ohrms/dockets/98fr/04-27077.htm.

10. A. Masters, K. Michael, "Lend me your arms: The use and implications of humancentric RFID", Electronic Commerce Research and Applications, vol. 6, pp. 29-39, 2007.

11. J. Carvalko, K. Michael, "Crossing The Evolutionary Gap", Joseph Carvalko Speaks With Katina MichaelOn His Fiction Piece, July 2016, [online] Available: https//www.youtube.com/watch?v=p4JyVCba6VM.

12. "Visa introduces contactless mini card making payments faster and more convenient than ever", Business Wire, Aug. 2006, [online] Available: http://www.businesswire.com/news/home/20060316005263/en/Visa-Introduces-Contactless-Mini-Card-Making-Payments.

Citation: Katina Michael, Can Good Standards Propel Unethical Technologies? IEEE Technology and Society Magazine, Volume: 35, Issue: 3, Sept. 2016, pp. 6 - 9.

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.

5. T. Denison, "Building a bionic nervous system: Smart neural stimulators sense and respond to the body's fluctuations", IEEE Spectrum, pp. 28-35, Feb. 2015.

6. W. Glannon, "Stimulating brains altering minds", J. Medical Ethics, vol. 35, pp. 289-292, 2009.

7. T. Schlaepfer, J. Fins, "Deep brain stimulation and the neuroethics of responsible publishing: when one is not enough", JAMA, vol. 303, pp. 775-776, 2010.

8. B. Aouizerate, "Deep brain stimulation for OCD and major depression", Amer. J. Psychiatry, vol. 162, pp. 2192, 2005.

9. P. Moore, "Enhancing Me: The Hope and the Hype of Human Enhancement" in , Wiley, 2008.

10. C. Ch, "Hypomania with hypersexuality following bilateral anterior limb stimulation in obsessive-compulsive disorder", J. Neurosurg., vol. 112, pp. 1299-1300, 2010.

11. S. Na, "Panic and fear induced by deep brain stimulation", J. Neurol. Neurosurg Psychiatry, vol. 77, pp. 410-12, 2006.

12. J. Carvalko, "The Techno-Human Shell: A Jump in the Evolutionary Gap" in , Sunbury, 2013.

13. J. Carvalko, "Who should own in-the-body medical data in the age of ehealth?" in IEEE Technology & Society Mag., Summer, pp. 36-37, 2014.

14. J. Fins, "Misuse of the FDA's humanitarian device exemption in deep brain stimulation for obsessive-compulsive disorder", Health Aff. (Millwood), vol. 30, pp. 302-311, 2011.

15. C. Blue, "Medical Policy: Implantable Eletrical Nerve Stimulators (Vagus Autonomic Nerve and Peripheral Nerve Stimulators)", 2014, [online] Available: https://www.capbluecross.com/wps/wcm/connect/73f7fba6-65df-4f7f-a35c-acc4d805a066/Implantable_Electrical_Nerve_Stimulators_3-25-14.pdf?MOD=AJPERES.

16. G. J. Diefenbach, "Portrayal of lobotomy in the popular press: 1935–1960", J. History of the Neurosciences, vol. 8, pp. 60-70, 1999.

17. C. M. DeGiorgio, "Pilot study of trigeminal nerve stimulation (TNS) for epilepsy: A proof-of-concept trial", Epilepsia, vol. 47, pp. 1213-1215, 2006.

18. A. Schulze-Bonhage, V. Coenen, "Treatment of epilepsy: peripheral and central stimulation techniques", Nervenartz, vol. 84, pp. 517-528, 2013.

19. E. Strickland, "How brain pacemakers treat parkinson's disease", IEEE Spectrum, Apr. 2015, [online] Available: http://spectrum.ieee.org/tech-talk/biomedical/devices/new-clues-how-does-a-brain-pacemaker-control-parkinsons-symptoms.

20. K. Michael, Microchipping People, 2012.

21. E. Strickland, "Medtronic wants to implant sensors in everyone", IEEE Spectrum, Jun. 2014, [online] Available: http://spectrum.ieee.org/tech-talk/biomedical/devices/medtronic-wants-to-implant-sensors-in-everyone.

22. "Google director Regina E. Dugan pushing RFID microchips", 2014, [online] Available: https://www.youtube.com/watch?v=RvYnWBdmcQk.

23. K. Michael, M. G. Michael, The Social Cultural Religious and Ethical Implications of Automatic Identification, 2004.

24. M. G. Michael, K. Michael, "Towards a state of Uberveillance", IEEE Technology & Society Mag., vol. 29, pp. 9-16, 2010.

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

Predicting the socioethical implications of implanting people with microchips

Privacy, security, trust, control and human rights are all concerns that need to be addressed before widespread diffusion of advanced identification technologies. Implants for humans are not new... Today we have even realised the potential for microchip implants to be embedded inside the human body for the purpose of acting as unique lifetime identifiers (ULIs).

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