Implantable Medical Device Tells All

Implantable Medical Device Tells All: Uberveillance Gets to the Heart of the Matter

In 2015, I provided evidence at an Australian inquiry into the use of subsection 313(3) of the Telecommunications Act of 1997 by government agencies to disrupt the operation of illegal online services [1]. I stated to the Standing Committee on Infrastructure and Communications that mandatory metadata retention laws meant blanket coverage surveillance for Australians and visitors to Australia. The intent behind asking Australian service providers to keep subscriber search history data for up to two years was to grant government and law enforcement organizations the ability to search Internet Protocol–based records in the event of suspected criminal activity.

Importantly, I told the committee that, while instituting programs of surveillance through metadata retention laws would likely help to speed up criminal investigations, we should also note that every individual is a consumer, and such programs ultimately come back to bite innocent people through some breach of privacy or security. Enter the idea of uberveillance, which, I told the committee, is “exaggerated surveillance” that allows for interference [1] that I believe is a threat to our human rights [2]. I strongly advised that evoking section 313 of the Telecommunications Act 1997 requires judicial oversight through the process of a search warrant. My recommendations fell on deaf ears, and, today, we even have the government deliberating over whether or not they should relax metadata laws to allow information to be accessed for both criminal and civil litigation [3], which includes divorces, child custody battles, and business disputes. In June 2017, Australian Prime Minister Malcolm Turnbull even stated that “global social media and messaging companies” need to assist security services’ efforts to fight terrorism by “providing access to encrypted communications” [52].

Consumer Electronics Leave Digital Data Footprints

Of course, Australia is not alone in having metadata retention laws. Numerous countries have adopted these laws or similar directives since 2005, keeping certain types of data for anywhere between 30 days and indefinitely, although the standard length is somewhere between one and two years. For example, since 2005, Italy has retained subscriber information at Internet cafes for 30 days. I recall traveling to Verona in 2008 for the European Conference on Information Systems, forgetting my passport in my hotel room, and being unable to use an Internet cafe to send a message back home because I was carrying no recognized identity information. When I asked why I was unable to send a simple message, I was handed an antiterrorism information leaflet. Italy also retains telephone data for up to two years and Internet service provider (ISP) data for up to 12 months.

Similarly, the United Kingdom retains all telecommunications data for one to two years. It also maintains postal information (sender, receiver data), banking data for up to seven years, and vehicle movements for up to two years. In Germany, metadata retention was established in 2008 under the directive Gesetz zur Neuregelung der Telekommunikationsüberwachung und anderer verdeckter Ermittlungsmaßnahmen sowie zur Umsetzung der Richtlinie 2006/24/EG, but it was overturned in 2010 by the Federal Constitutional Court of Germany, which ruled the law was unconstitutional because it violated a fundamental right, in that correspondence should remain secret. In 2015, this violation was challenged again, and a compromise was reached to retain telecommunications metadata for up to ten weeks. Mandatory data retention in Sweden was challenged by one holdout ISP, Bahnhof, which was threatened with an approximately US$605,000 fine in November 2014 if it did not comply [4]. They defended their stance to protect the privacy and integrity of their customers by offering a no-logs virtual private network free of charge [5].

Some European Union countries have been deliberating whether to extend metadata retention to chats and social media, but, in the United States, many corporations voluntarily retain subscriber data, including market giants Amazon and Google. It was reported in The Guardian in 2014 that the United States records Internet metadata for not only itself but the world at large through the National Security Agency (NSA) using its MARINA database to conduct pattern-of-life analysis [6]. Additionally, with the Amendments Act in 2008 of the Foreign Intelligence Surveillance Act 1978, the time allotted for warrantless surveillance was increased, and additional provisions were made for emergency eavesdropping. Under section 702 of the Foreign Intelligence Surveillance Act of 1978 Amendments Act, now all American citizens’ metadata is stored. Phone records are kept by the NSA in the MAINWAY telephony metadata collection database [53], and short message service and other text messaging worldwide are retained in DISHFIRE [7], [8].

Emerging Forms of Metadata in an Internet of Things World

Figure 1. An artificial pacemaker (serial number 1723182) from St. Jude medical, with electrode, which was removed from a deceased patient prior to cremation. (Photo courtesy of wikimedia commons.)

The upward movement toward a highly interconnected world through the Web of Things and people [9] will only mean that even greater amounts of data will be retained by corporations and government agencies around the world, extending beyond traditional forms of telecommunications data (e.g., phone records, e-mail correspondence, Internet search histories, metadata of images, videos, and other forms of multimedia). It should not surprise us that even medical devices are being touted as soon to be connected to the Internet of Things (IoT) [10]. Heart pacemakers, for instance, already send a steady stream of data back to the manufacturer’s data warehouse (Figure 1). Cardiac rhythmic data is stored on the implantable cardioverter-defibrillator’s (ICD’s) memory and is transmitted wirelessly to a home bedside monitor. Via a network connection, the data find their way to the manufacturer’s data store (Figure 2).

The standard setup for an EKG. A patient lies in a bed with EKG electrodes attached to his chest, upper arms, and legs. A nurse oversees the painless procedure. The ICD in a patient produces an EKG (A) which can automatically be sent to a ICD manufacturer's data store (B). (Image courtesy of wikimedia commons.)

In health speak, the ICD set up in the patient’s home is a type of remote monitoring that happens usually when the ICD recipient is in a state of rest, most often while sleeping overnight. It is a bit like how normal computer data backups happen, when network traffic is at its lowest. In the future, an ICD’s proprietary firmware updates may well travel back up to the device, remote from the manufacturer, like installing a Windows operating system update on a desktop. In the following section, we will explore the implications of access to personal cardiac data emanating from heart pacemakers in two cases.

CASE 1: HUGO CAMPOS DENIED ACCESS TO HIS PERSONAL CARDIAC DATA

Figure 3. The conventional radiography of a single-chamber pacemaker. (Photo courtesy of wikimedia commons.)

In 2007, scientist Hugo Campos collapsed at a train station and later was horrified to find out that he had to get an ICD for his genetic heart condition. ICDs usually last about seven years before they require replacement (Figure 3). A few years into wearing the device, being a high-end quantifiedself user who measured his sleep, exercise, and even alcohol consumption, Campos became inquisitive over how he might gain access to the data generated by his ICD (Figure 4). He made some requests to the ICD’s manufacturer and was told that he was unable to receive the information he sought, despite his doctor having full access. Some doctors could even remotely download the patient’s historical data on a mobile app for 24/7 support during emergency situations (Figure 5). Campos’s heart specialist did grant him access to written interrogation reports, but Campos only saw him about once every six months after his conditioned stabilized. Additionally, the logs were of no consequence to him on paper, and the fields and layout were predominantly decipherable only by a doctor (Figure 6).

Figure 4. The Nike FuelBand is a wearable computer that has become one of the most popular devices driving the so-called quantified-self trend. (Photo courtesy of wikimedia commons.)

Dissatisfied by his denied access, Campos took matters into his own hands and purchased a device on eBay that could help him get the data. He also went to a specialist ICD course and then intercepted the cardiac rhythms being recorded [11]. He got to the data stream but realized that to make sense of it from a patient perspective, a patient-centric app had to be built. Campos quickly deduced that regulatory and liability concerns were at the heart of the matter from the manufacturer’s perspective. How does a manufacturer continue to improve its product if it does not continually get feedback from the actual ICDs in the field? If manufacturers offered mobile apps for patients, might patients misread their own diagnoses? Is a manufacturer there to enhance life alone or to make a patient feel better about bearing an ICD? Can an ICD be misused by a patient? Or, in the worst case scenario, what happens in the case of device failure? Or patient death? Would the proof lie onboard? Would the data tell the true story? These are all very interesting questions.

Figure 5. The medical waveform format encoding rule software on a Blackberry device. It displays medical waveforms, such as EKG (shown), electroencephalogram, and blood pressure. Some doctors have software that allows them to interrogate EKG information, but patients presently do not have access to their own ICD data. (Photo courtesy of wikimedia commons.)

Campos might well have acted to not only get what he wanted (access to his data his own way) but to raise awareness globally as to the type of data being stored remotely by ICDs in patients. He noted in his TEDxCambridge talk in 2011 [12]:

the ICD does a lot more than just prevent a sudden cardiac arrest: it collects a lot of data about its own function and about the patient’s clinical status; it monitors its own battery life; the amount of time it takes to deliver a life-saving shock; it monitors a patient’s heart rhythm, daily activity; and even looks at variations in chest impedance to look if there is build-up of fluids in the chest; so it is a pretty complex little computer you have built into your body. Unfortunately, none of this invaluable data is available to the patient who originates it. I have absolutely no access to it, no knowledge of it.

Doctors, on the other hand, have full 24/7 unrestricted access to this information; even some of the manufacturers of these medical devices offer the ability for doctors to access this information through mobile devices. Compare this with the patients’ experience who have no access to this information. The best we can do is to get a printout or a hardcopy of an interrogation report when you go into the doctor’s office.

Figure 6. An EKG chart. Twelve different derivations of an EKG of a 23-year-old japanese man. A similar log was provided to hugo campos upon his request for six months worth of EKG readings. (Photo courtesy of wikimedia commons.)

Campos decided to sue the manufacturer after he was informed that the data being generated from his ICD measuring his own heart activity was “proprietary data” [13]. Perhaps this is the new side of big data. But it is fraught with legal implications and, as far as I am concerned, blatantly dangerous. If we deduce that a person’s natural biometric data (in this instance, the cardiac rhythm of an individual) belong to a third party, then we are headed into murky waters when we speak of even more invasive technology like deepbrain stimulators [14]. It not only means that the device is not owned by the electrophorus (the bearer of technology) [15], [16], but quite possibly the cardiac rhythms unique to the individual are also owned by the device manufacturer. We should not be surprised. In Google Glass’s “Software and Services” section of its terms of use, it states that Google has the right to “remotely disable or remove any such Glass service from user systems” at its “sole discretion” [17]. Placing this in the context of ICDs means that a third party almost indelibly has the right to switch someone off.

CASE 2: ROSS COMPTON’S PACEMAKER DATA IS SUBPOENAED FOR CRIMINAL INVESTIGATIONS

Enter the Ross Compton case of Middletown, Ohio. M.G. Michael and I have dubbed it one of the first authentic uberveillance cases in the world, because the technology was not just wearable but embedded. The story goes something like this: On 27 January 2017, 59-year-old Ross Compton was indicted on arson and insurance fraud charges. Police gained a search warrant to obtain his heart pacemaker readings (heart and cardiac rhythms) and called his alibi into question. Data from Compton’s pacemaker before, during, and after the fire in his home broke out were disclosed by the heart pacemaker manufacturer after a subpoena was served. The insurer’s bill for the damage was estimated at about US$400,000. Police became suspicious of Compton when they traced gasoline to Compton’s shoes, trousers, and shirt.

In his statement of events to police, Compton told a story that misaligned and conflicted with his call to 911. Forensic analysts found traces of multiple fires having been lit in various locations in the home. Yet, Compton told police he had rushed his escape, breaking a window with his walking stick to throw some hastily packed bags out and then fleeing the flames himself to safety. Compton also told police that he had an artificial heart with a pump attached, a fact that he thought might help his cause but that was to be his undoing. In this instance, his pacemaker acted akin to a black box recording on an airplane [18].

After securing the heart pacemaker data set, an independent cardiologist was asked to assess the telemetry data and determine if Compton’s heart function was commensurate with the exertion needed to make a break with personal belongings during a life-threatening fire [19]. The cardiologist noted that, based on the evidence he was given to interpret, it was “highly improbable” that a man who suffered with the medical conditions that Compton did could manage to collect, pack, and remove the number of items that he did from his bedroom window, escape himself, and then proceed to carry these items in front of his house, out of harm’s way (see “Columbo, How to Dial a Murder”). Compton’s own cardio readings, in effect, snitched on him, and none were happier than the law enforcement officer in charge of the case, Lieutenant Jimmy Cunningham, who noted that the pacemaker data, while only a supporting piece of evidence, was vital in proving Compton’s guilt after gasoline was found on his clothing. Evidence-based policing has now well outstripped the more traditional intelligence-led policing approach, entrenched given the new realm of big data availability [20], [21].

Columbo, How to Dial a Murder [S1] Columbo says to the murderer:
“You claim that you were at the physicians getting your heart examined…which was true [Columbo unravels a roll of EKG readings]…the electrocardiogram, Sir. Just before three o’clock your physician left you alone for a resting trace. At that moment you were lying down in a restful position and your heart showed a calm, slow, easy beat [pointing to the EKG readout]. Look at this part, right here [Columbo points to the reading], lots of sudden stress, lots of excitement, right here at three o’clock, your heart beating like a hammer just before the dogs attacked…Oh you killed him with a phone call, Sir…I’ll bet my life on it. Very simple case. Not that I’m particularly bright, Sir…I must say, I found you disappointing, I mean your incompetence, you left enough clues to sink a ship. Motive. Opportunity. And for a man of your intelligence Sir, you got caught on a lot of stupid lies. A lot.” [S1] Columbo: How to Dial a Murder. Directed by James Frawley. 1978. Los Angeles, CA: Universal Pictures Home Entertainment, 2006. DVD.

Consumer Electronics Tell a Story

Several things are now of interest to the legal community: first and foremost, how is the search warrant for a person’s pacemaker data executed? In case 1, Campos was denied access to his own ICD data stream by the manufacturer, and yet his doctor had full access. In case 2, Compton’s own data provided authorities with the extra evidence they needed to accuse him of fraud. This is yet another example of seemingly private data being used against an individual (in this instance, the person from whose body the data emanated), but in the future, for instance, the data from one person’s pacemaker might well implicate other members of the public. For example, the pacemaker might be able to prove that someone’s heart rate substantially increased during an episode of domestic violence [22] or that an individual was unfaithful in a marriage based on the cross matching of his or her time stamp and heart rate data with another.

Of course, a consumer electronic does not have to be embedded to tell a story (Figure 7). It can also be wearable or luggable, as in the case of a Fitbit that was used as a truthdetector in an alleged rape case that turned out to be completely fabricated [23]. Lawyers are now beginning to experiment with other wearable gadgetry that helps to show the impact of personal injury cases from accidents (work and nonwork related) on a person’s ability to return to his or her normal course of activities [24] (Figure 8). We can certainly expect to see a rise in criminal and civil litigation that makes use of a person’s Android S Health data, for instance, which measure things like steps taken, stress, heart rate, SpO2, and even location and time (Figure 9). But cases like Compton’s open the floodgates.

Figure 7. A Fitbit, which measures calories, steps, distance, and floors. (Photo courtesy of wikimedia commons.)

Figure 8. A closeup of a patient wearing the iRhythm ZIO XT patch, nine days after its placement. (Photo courtesy of wikimedia commons.)

I have pondered on the evidence itself: are heart rate data really any different from other biometric data, such as deoxyribonucleic acid (DNA)? Is it perhaps more revealing than DNA? Should it be dealt with in the same way? For example, is the chain of custody coming from a pacemaker equal to that of a DNA sample and profile? In some way, heart rates can be considered a behavioral biometric [25], whereas DNA is actually a cellular sample [26]. No doubt we will be debating the challenges, and extreme perspectives will be hotly contested. But it seems nothing is off limits. If it exists, it can be used for or against you.

Figure 9. (a) and (b) The health-related data from Samsung's S Health application. Unknown to most is that Samsung has diversified its businesses to be a parent company to one of the world's largest health insurers. (Photos courtesy of katina michael.)

The Paradox of Uberveillance

In 2006, M.G. Michael coined the term uberveillance to denote “an omnipresent electronic surveillance facilitated by technology that makes it possible to embed surveillance devices in the human body” [27]. No doubt Michael’s background as a former police officer in the early 1980s, together with his cross-disciplinary studies, had something to do with his insights into the creation of the term [28]. This kind of surveillance does not watch from above, rather it penetrates the body and watches from the inside, looking out [29].

Furthermore, uberveillance “takes that which was static or discrete…and makes it constant and embedded” [30]. It is real-time location and condition monitoring and “has to do with the fundamental who (ID), where (location), and when (time) questions in an attempt to derive why (motivation), what (result), and even how (method/plan/thought)” [30]. Uberveillance can be used prospectively or retrospectively. It can be applied as a “predictive mechanism for a person’s expected behavior, traits, likes, or dislikes; or it can be based on historical fact” [30].

In 2008, the term uberveillance was entered into the official Macquarie Dictionary of Australia [31]. In research that has spanned more than two decades on the social implications of implantable devices for medical and nonmedical applications, I predicted [15] that the technological trajectory of implantable devices that were once used solely for care purposes would one day be used retrospectively for tracking and monitoring purposes. Even if the consumer electronics in question were there to provide health care (e.g., the pacemaker example) or convenience (e.g., a near-field-communication-enabled smartphone), the underlying dominant function of the service would be control [32]. The socioethical implications of pervasive and persuasive emerging technologies have yet to really be understood, but increasingly, they will emerge to take center stage in court hearings, like the emergence of DNA evidence and then subsequently global positioning system (GPS) data [33].

Medical device implants provide a very rich source of human activity monitoring, such as the electrocardiogram (EKG), heart rate, and more. Companies like Medtronics, among others specializing in implantables, have proposed a future where even healthy people carry a medical implant packed with sensors that could be life sustaining and detect heart problems (among others), reporting them to a care provider and signaling when assistance might be required [34]. Heart readings provide an individual’s rhythmic biometrics and, at the same time, can record increases and decreases in activity. One could extrapolate that it won’t be long before our health insurance providers are asking for the same evidence for reduced premiums.

Figure 10. A pacemaker cemetery. (Photo courtesy of wikimedia commons.)

The future might well be one where we all carry a black box implantable recorder of some sort [35], an alibi that proves our innocence or guilt, minute by minute (Figure 10). Of course, an electronic eye constantly recording our every move brings a new connotation to the wise words expressed in the story of Pinocchio: always let your conscience be your guide. The future black boxes may not be as forgiving as Jiminy Cricket and more like Black Mirror’s “The Entire History of You” [36]. But if we assume that these technologies are to be completely trusted, whether they are implantable, wearable, or even luggable, then we are wrong.

The contribution of M.G. Michael’s uberveillance is in the emphasis that the uberveillance equation is a paradox. Yes, there are near-real-time data flowing continuously from more points of view than ever [37], closed-circuit TV looking down, smartphones in our pockets recording location and movement, and even implantables in some of us ensuring nontransferability of identity [38]. The proposition is that all this technology in sum total is bulletproof and foolproof, omniscient and omnipresent, a God’s eye view that cannot be challenged but for the fact that the infrastructure and the devices, and the software, are all too human. And while uberveillance is being touted for good through an IoT world that will collectively make us and our planet more sustainable, there is one big crack in the utopian vision: the data can misrepresent, misinform, and be subject to information manipulation [39]. Researchers are already studying the phenomenon on complex visual information manipulation, how to tell whether data has been tampered with, a suspect introduced or removed from a scene of a crime, and other forensic visual analytics [40]. It is why Vladimir Radunovic, director of cybersecurity and e-diplomacy programs in the DiploFoundation, cited M.G. Michael’s contribution that “big data must be followed by big judgment” [41].

What happens in the future if we go down the path of constant bodily monitoring of vital organs and vital signs, where we are all bearing some device or at least wearing one? Will we be in control of our own data, or, as is seemingly obvious at present, will we not be in control? And how might selfincrimination play a role in our daily lives, or even worse, individual expectations that can be achieved by only playing to a theater 24/7 so our health statistics can stack up to whatever measure and cross-examination they are put under personally or publicly [42]? Can we believe the authenticity of every data stream coming out of a sensor onboard consumer electronics? The answer is no.

Having run many years of GPS data-logging experiments, I can say that a lot can go wrong with sensors, and they are susceptible to outside environmental conditions. For instance, they can log your location miles away (even in another continent), the temperature gauge can play up, time stamps can revert to different time zones, the speed of travel can be wildly inaccurate due to propagation delays in satellites, readings may not be at regular intervals due to some kind of interference, and memory overflow and battery issues, while getting better, are still problematic. The short and long of it is that technology cannot be trusted. At best, it can act as supporting evidence but should never replace eyewitness accounts. Additionally, “the inherent problem with uberveillance is that facts do not always add up to truth (i.e., as in the case of an exclusive disjunction T 1 T 5 F), and predictions based on uberveillance are not always correct” [30].

Conclusion

While device manufacturers are challenging the possibility that their ICDs are hackable in courts [43], highly revered security experts like Bruce Schneier are heavily cautioning about going down the IoT path, no matter how inviting it might look. In his acclaimed blog, Schneier recently wrote [44]:

All computers are hackable…The industry is filled with market failures that, until now, have been largely ignorable. As computers continue to permeate our homes, cars, businesses, these market failures will no longer be tolerable. Our only solution will be regulation, and that regulation will be foisted on us by a government desperate to “do something” in the face of disaster…We also need to reverse the trend to connect everything to the internet. And if we risk harm and even death, we need to think twice about what we connect and what we deliberately leave uncomputerized. If we get this wrong, the computer industry will look like the pharmaceutical industry, or the aircraft industry. But if we get this right, we can maintain the innovative environment of the internet that has given us so much.

The cardiac implantables market by 2020 is predicted to become a US$43 billion industry [45]. Obviously, the stakes are high and getting higher with every breakthrough implantable innovation we develop and bring to market. We will need to address some very pressing questions at hand, as Schneier suggests, through some form of regulation if we are to maintain consumer privacy rights and data security. Joe Carvalko, a former telecommunications engineer and U.S. patent attorney as well as an associate editor of IEEE Technology and Society Magazine and pacemaker recipient, has added much to this discussion already [46], [47]. I highly recommend several of his publications, including “Who Should Own In-the-Body Medical Data in the Age of eHealth?” [48] and an ABA publication coauthored with Cara Morris, The Science and Technology Guidebook for Lawyers [49]. Carvalko is a thought leader in this space, and I encourage you to listen to his podcast [50] and also to read his speculative fiction novel, Death by Internet, [51] which is hot off the press and wrestles with some of the issues raised in this article.

REFERENCES

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[16] K. Michael and M. G. Michael, “Homo electricus and the continued speciation of humans,” in The Encyclopedia of Information Ethics and Security, M. Quigley, Ed. Hershey, PA: IGI Global, 2007, pp. 312–318.

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[19] D. Smith. (2017, Feb. 4). Pacemaker data used to charge alleged arsonist. Jonathan Turley. [Online]. Available: https://jonathanturley .org/2017/02/04/pacemaker-data-used-to-charge-alleged-arsonist/

[20] K. Michael, “Big data and policing: The pros and cons of using situational awareness for proactive criminalisation,” presented at the Human Rights and Policing Conf,. Australian National University, Canberra, Apr. 16, 2013.

[21] K. Michael and G. L. Rose, “Human tracking technology in mutual legal assistance and police inter-state cooperation in international crimes,” in From Dataveillance to Überveillance and the Realpolitik of the Transparent Society (The Second Workshop on Social Implications of National Security), K. Michael and M. G. Michael, Eds. Wollongong, Australia: University of Wollongong, 2007.

[22] F. Gerry, “Using data to combat human rights abuses,” IEEE Technol. Soc. Mag., vol. 33, no. 4, pp. 42–43, 2014.

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[25] K. Michael and M. G. Michael, “The social and behavioural implications of location-based services,” J. Location Based Services, vol. 5, no. 3–4, pp. 121–137, Sept.–Dec. 2011.

[26] K. Michael, “The European court of human rights ruling against the policy of keeping fingerprints and DNA samples of criminal suspects in Britain, Wales and Northern Ireland: The case of S. and Marper v United Kingdom,” in The Social Implications of Covert Policing (Workshop on the Social Implications of National Security, 2009), S. Bronitt, C. Harfield, and K. Michael, Eds. Wollongong, Australia: University of Wollongong, 2010, pp. 131–155.

[27] M. G. Michael and K. Michael, “National security: The social implications of the politics of transparency,” Prometheus, vol. 24, no. 4, pp. 359–364, 2006.

[28] M. G. Michael, “On the ‘birth’ of uberveillance,” in Uberveillance and the Social Implications of Microchip Implants, M. G. Michael and K. Michael, Eds. Hershey, PA: IGI Global, 2014.

[29] M. G. Michael and K. Michael, “A note on uberveillance,” in From Dataveillance to Überveillance and the Realpolitik of the Transparent Society (The Second Workshop on Social Implications of National Security), M. G. Michael and K. Michael, Eds. Wollongong, Australia: University of Wollongong, 2007.

[30] M. G. Michael and K. Michael, “Toward a state of uberveillance,” IEEE Technol. Soc. Mag., vol. 29, pp. 9–16, 2010.

[31] M. G. Michael and K. Michael, “Uberveillance,” in Fifth Edition of the Macquarie Dictionary, S. Butler, Ed. Sydney, Australia: Sydney University, 2009.

[32] A. Masters and K. Michael, “Lend me your arms: The use and implications of humancentric RFID,” Electron. Commerce Res. Applicat., vol. 6, no. 1, pp. 29–39, 2007.

[33] K. D. Stephan, K. Michael, M. G. Michael, L. Jacob, and E. P. Anesta, “Social implications of technology: The past, the present, and the future,” Proc. IEEE, vol. 100, pp. 1752–1781, 2012. [34] E. Strickland. (2014, June 10). Medtronic wants to implant sensors in everyone. IEEE Spectrum. [Online]. Available: http://spectrum.ieee .org/tech-talk/biomedical/devices/medtronic-wants-to-implant-sensorsin-everyone

[35] K. Michael, “The benefits and harms of national security technologies,” presented at the Int. Women in Law Enforcement Conf., Hyderabad, India, 2015. [36] J. A. Brian Welsh. (2011). The entire history of you,” Black Mirror, C. Brooker, Ed. [Online]. Available: https://www.youtube.com/watch?v= Sw3GIR70HAY

[37] K. Michael, “Sousveillance and point of view technologies in law enforcement,” presented at the Sixth Workshop on the Social Implications of National Security: Sousveillance and Point of View Technologies in Law Enforcement, University of Sydney, Australia, 2012.

[38] K. Albrecht and K. Michael, “Connected: To everyone and everything,” IEEE Technology and Soc. Mag., vol. 32, pp. 31–34, 2013.

[39] M. G. Michael, “The paradox of the uberveillance equation,” IEEE Technol. Soc. Mag., vol. 35, no. 3, pp. 14–16, 20, 2016.

[40] K. Michael, “The final cut—tampering with direct evidence from wearable computers,” presented at the Fifth Int. Conf. Multimedia Information Networking and Security (MINES 2013), Beijing, China, 2013.

[41] V. Radunovic, “Internet governance, security, privacy and the ethical dimension of ICTs in 2030,” IEEE Technol. Soc. Mag., vol. 35, no. 3, pp. 12–14, 2016.

[42] K. Michael. (2011, Sept. 12). The microchipping of people and the uberveillance trajectory. Social Interface. [Online]. Available: http:// socialinterface.blogspot.com.au/2011/08/microchipping-of-people-and .html

[43] O. Ford. (2017, Jan. 12). Post-merger Abbott moves into 2017 with renewed focus, still faces hurdles. J.P. Morgan Healthcare Conf. 2017. [Online]. Available: http://www.medicaldevicedaily.com/servlet/com .accumedia.web.Dispatcher?next=bioWorldHeadlines_article& forceid=94497

[44] B. Schneier. (2017, Feb. 1). Security and the Internet of Things: Schneier on security. [Online]. Available: https://www.schneier.com/ blog/archives/2017/02/security_and_th.html

[45] IndustryARC. (2015, July 30). Cardiac implantable devices market to reach $43 billion by 2020. GlobeNewswire. [Online]. Available: https://globenewswire.com/news-release/2015/07/30/756345/10143745/ en/Cardiac-Implantable-Devices-Market-to-Reach-43-Billion-By-2020 .html

[46] J. Carvalko, The Techno-Human Shell: A Jump in the Evolutionary Gap. Mechanicsburg, PA: Sunbury Press, 2013.

[47] J. Carvalko and C. Morris, “Crowdsourcing biological specimen identification: Consumer technology applied to health-care access,” IEEE Consum. Electron. Mag., vol. 4, no. 1, pp. 90–93, 2014.

[48] J. Carvalko, “Who should own in-the-body medical data in the age of ehealth?” IEEE Technol. Soc. Mag., vol. 33, no. 2, pp. 36–37, 2014.

[49] J. Carvalko and C. Morris, The Science and Technology Guidebook for Lawyers. New York: ABA, 2014.

[50] K. Michael and J. Carvalko. (2016, June 20). Joseph Carvalko speaks with Katina Michael on his non-fiction and fiction pieces. [Online]. Available: https://www.youtube.com/watch?v=p4JyVCba6VM

[51] J. Carvalko, Death by Internet. Mechanicsburg, PA: Sunbury Press, 2016.

[52] R. Pearce. (2017, June 7). “No-one’s talking about backdoors” for encrypted services, says PM’s cyber guy. Computerworld. [Online]. Available: https://www.computerworld.com.au/article/620329/no-onetalking-about-backdoors-says-pm-cyber-guy/

[53] M. Ambinder. (2013, Aug. 14). An educated guess about how the NSA is structured. The Atlantic. [Online]. Available: https://www .theatlantic.com/technology/archive/2013/08/an-educated-guess-abouthow-the-nsa-is-structured/278697/

Acknowledgment

A short form of this article was presented as a video keynote speech for the Fourth International Conference on Innovations in Information, Embedded and Communication Systems in Coimbatore, India, on 17 March 2017. The video is available at https://www.youtube.com/watch?v=bEKLDhNfZio.

Keywords

Metadata, Electrocardiography, Pacemakers, Heart beat, Telecommunication services, Implants, Biomedical equipment, biomedical equipment, cardiology, criminal law, medical computing, police data processing, transport protocols, implantable medical device, heart, Australian inquiry, government agencies, illegal online services,mandatory metadata retention laws, government organizations, law enforcement organizations, Internet protocol

Citation: Katina Michael, 2017, "Implantable Medical Device Tells All: Uberveillance Gets to the Heart of the Matter", IEEE Consumer Electronics Magazine, Vol. 6, No. 4, Oct. 2017, pp. 107 - 115, DOI: 10.1109/MCE.2017.2714279.

 

Are You Addicted to Your Smartphone, Social Media, and More?

Abstract

Back in 1998, I remember receiving my first second-generation (2G) mobile assignment at telecommunications vendor Nortel: a bid for Hutchison in Australia, a small alternate operator. At that time, I had already grown accustomed to modeling network traffic on traditional voice networks and was beginning to look at the impact of the Internet on data network dimensioning. In Australia, we were still relying on the public switched telephone network to dial up the Internet from homes, the Integrated Services Digital Network in small-to-medium enterprises, and leased lines for larger corporates and the government. But modeling mobile traffic was a different affair.

Figure 1. Russia’s Safe-Selfie campaign flyer.

Back in 1998, I remember receiving my first second-generation (2G) mobile assignment at telecommunications vendor Nortel: a bid for Hutchison in Australia, a small alternate operator. At that time, I had already grown accustomed to modeling network traffic on traditional voice networks and was beginning to look at the impact of the Internet on data network dimensioning. In Australia, we were still relying on the public switched telephone network to dial up the Internet from homes, the Integrated Services Digital Network in small-to-medium enterprises, and leased lines for larger corporates and the government. But modeling mobile traffic was a different affair.

I remember thinking: how will we begin to categorize subscribers, and what kinds of network patterns could we expect in mobility? I recall beginning to define the market segments into four categories, which included security (low-end users), road warriors (high-end corporate users), socialites (youth market), and everyday users (average users). Remember, this was even before the rise of the Wireless Application Protocol. As naysayers said that the capital expenditure spent on 2G networks would be prohibitive and that investments would never be recouped for decades, subscribers’ usage rapidly increased with devices like the Research in Motion Blackberry, which allowed for mobile e-mail.

Fast-forward to 2000. I was already knee-deep in thirdgeneration (3G) mobile bids, predicting the cost of 3G spectrum in emerging and developed markets, increasing my categories of subscriber types from four to nine segments, and calculating upload and download rates for top mobile apps like gaming, images (photos and imaging), and e-mail with chunky PowerPoint attachments and other file types. We knew what was coming was big, but perhaps we ourselves sitting on the coalface didn’t realize what a big impact it would actually have on our lives and the lives of our children. Our models showed average revenues per user of US$120 per month for corporates. At the time, most of us believed the explosion that would take place in the coming decade (but not as big as it turned out to be), despite preaching the mantra that voice is now just another bit of data. In calculating pricing models, we brainstormed with one another: who would spend over 100 min on a mobile? Or who would spend hours gaming on a handset rather than a larger gaming console?

Enter social media, enabled by this wireless Internet protocol (IP) revolution and the rapid increase in diverse mobile hardware from netbooks to tablets to smartphones and smartwatches. Then things rapidly changed again. LinkedIn, Facebook, Twitter, Instagram, Snapchat, and WeChat are all enjoyed by social media users (consumers and professionals) around the globe today, and it is estimated that there will be 2.67 billion social network users by 2018 [1]. Over one-third of consumers worldwide, more than 2.56 billion people, will have a mobile phone by 2018, and more than half of these will have smartphone capability, making feature phones the minority [2].

The Social Media Boom

When Google announced that a staggering 24 billion selfies were uploaded to its servers alone in 2015, consuming 13.7 petabytes of storage space, I stopped and contemplated the meaning of these statistics [3]. What about the zillions of selfies uploaded to Apple’s iCloud, posted to Facebook, Instagram, Snapchat, and Twitter? It means that in one’s average lifetime, most people are taking at least one selfie a day and sharing their image publicly. This figure is much higher for the impressionable teen market, with a 2015 Google study reporting that youth take, on average, 14 selfies and 16 photos or videos, check social media 21 times, and send 25 text messages per day [4]. This number continues to grow steadily, according to fresh evidence by Pew Internet Research [5], and is now even impacting workplace productivity [6]. In the same year that Google announced the selfie statistics, Russia’s Ministry of Internal Affairs began a Safe-Selfie campaign [7], stating: “When you take a selfie, make sure that you are in a safe place and your life is not in danger!” (Figure 1). This was followed, of course, by the acknowledged deaths that had occurred while younger and older individuals were in the process of taking selfies, and the rate of frequency outnumbered shark attacks in 2015 [8]. One cannot fathom.

Noticeable is the adoption of high-tech gadgetry, especially in the childhood to youth markets, with an even greater penetration by teenagers and individuals younger than 34 years. It is rather disturbing to read that 24% of U.S. teens go online “almost constantly” [5], facilitated by the widespread penetration of smartphones and increasing requirement of tablets in the secondary education system. The sheer affordability of tech gear and its increasing multifunctionality now means that most people have digital Swiss Army knives at their disposal with a smartphone. By accessing the Internet via your phone, you can upload pictures, browse websites, navigate locations on maps, and be reachable any time of the day. The allure of how to kill time while waiting for appointments or in public transportation means that most people are frequently engaged in some form of interaction through a screen. The short-lived Google Glass was a hands-free solution that would have brought the screen right up to the eye [9], but while momentarily halted, one can envisage a future where we are seeing everything through filtered lenses. Google Glass Enterprise edition is now on sale [35]!

The Rise of Internet Addiction

Experts have tried to quantify the amount of time being spent on screens, specific devices (smartphones), and even particular apps (e.g., Facebook), and have identified guidelines for various age groups for appropriate use. Most notable is the work started by Dr. Kimberly Young in 1995 when she established her website netaddiction.com and clinical practice, the Center for Internet Addiction. She has been conducting research on how the Internet changes people’s behavior. Her guideline “3-6-9-12 Screen Smart Parenting” has gained worldwide recognition [10].

Increasingly, we are hearing about social media addiction stories (see “Social Media Addiction” [11] and “Mental Health and Social Media” [36]). We have all heard about the toddler screaming for his or her iPad before breakfast and gamers who are reluctant to come to dinner with the rest of the family (independent of gender, age, or ethnicity) unless they are instant messaged. There is a growing complexity around the diagnosis of various addiction behaviors. Some suffer from Internet addiction broadly, while others are addicted to computer gaming, smartphones, and even social media. It has been postulated by some researchers that most of these modern technology-centric addictions are age-old causes, such as obsessive-compulsive disorder, but they have definitely been responsible for triggering a new breed of what I consider to be yet-to-be-defined medical health issues.

In the last five years, especially, much research has begun in the area of online addiction. Various scales for Internet addiction have been developed by psychologists, and there are even scales for specific technologies now, like smartphones. The South Koreans have developed the Smartphone Addiction Scale, Smartphone Addiction Proneness Scale, and the KS-scale, a method for Koreans to self-report Internet addiction using a short-form scale. Unsurprisingly, these scales are significant for the South Korean market, given it is the world leader in Internet connectivity, having the world’s fastest average Internet connection speed with roughly 93% of citizens connected. It therefore follows that the greater the penetration of highspeed Internet in a market, the greater the propensity for a subscriber to suffer from some form of online addiction. There are even scales for social media applications, e.g., the Bergen Facebook Addiction Scale (BFAS) developed by Dr. Cecile Andraessen at the University of Bergen in Norway in 2012 (see “BFAS Survey Statements” [12]).

Accessible Internet Feeds the Addiction

Despite its remoteness to the rest of the world, Australia surprisingly does not lag far behind the South Korean market. According to the Australian Bureau of Statistics, in 2013, 94% of Australians were Internet users, but regional areas across Australia do not enjoy the same high-speed access as in South Korea, despite the National Broadband Network initiative that was founded in 2009, with the actual rollout beginning in 2015. Yet, alarmingly, one recognized industry report, “Digital Down Under,” stated that 13.4 million Australians spent a whopping 18.8 h a day online [13]. This statistic has been contested but commensurately backed by Lee Hawksley, managing director of ExactTarget Australia, who oversaw the research. She has gone on record saying, “...49% of Australians have smartphones, which means we are online all the time…from waking to sleep, when it comes to e-mail, immersion, it’s even from the 18–65s; however, obviously with various social media channels the 18–35s are leading the charge.”

According to the same study, roughly one-third of women living in New South Wales are spending almost two-thirds of their day online. And it is women who are 30% more likely to suffer anxiety as a result of participating in social media than men [14]–[16]. This is even greater than the Albrecht and Michael deduction of 2014, which estimated that people in developed nations are spending an average of 69% of their waking life behind the screen [17]. That is about 11 h behind screens out of 16 waking hours. But, no doubt, people are no longer sleeping 8 h with access to technology at arm’s reach within the bedroom, and, as a result, cracks are appearing in relationships, employment, severe sleep deprivation, and other areas as a result of screen dependencies [18].

It is difficult to say what kinds of specific addictions exist in relation to the digital world, and various countries identify market-relevant scales and measures. While countries like China, Taiwan, and South Korea acknowledge there is something called “Internet addiction” as a diagnosed medical condition, other countries, e.g., the United States, prefer not to be explicit about the condition, such as in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) [19]. Instead, a potential new diagnosis, Internet gaming disorder, is dealt with in an appendix of the DSM-V [20], [21]. Generally, Internet addiction is defined as “the inability of individuals to control their Internet use, resulting in marked distress and/or functional impairment in daily life” [22]. Some practitioners have likened online addiction as being akin to substance-based addiction. Usually it manifests predominantly in one of three quite separate but sometimes overlapping subtypes in an individual: excessive gaming, sexual preoccupations [23], and e-mail/text/social media messaging [24].

Shared Data and the Need to Know

For now, what has been quantified and is well known is the amount of screen time spent by individuals in front of multiple platforms: Internet-enabled television (e.g., Netflix), play stations (for video games), desktops (for browsing), tablets (for pictures and editing), and smartphones (for social media messaging). Rest assured, the IP-enabled devices we are enjoying are passing on our details to corporations, who in the name of billing now accurately know about our family’s every move, digitally chronicling our preferences and habits. It is a form of pervasive social and behavioral biometrics, allowing big business to know app-by-app your individual thoughts. What is happening to all this metadata? Of course, it is being repurposed to give you more of the same, generating even more profit for interested businesses. For some capitalists, there is nothing wrong with this calculated engineering. Giving you more of what you want is the new mantra, but it does have its side effects, obviously.

The Australian Psychological Society issued its “Stress and Wellbeing in Australia” report last year, which included a section on social media fear of missing out (FOMO) [25]. Alongside FOMO, we also now have a fear of being off the grid, or FOBO, and the fear of no mobile, or NoMo [26]. I personally know adults who will not leave their homes in the morning unless they have watched the top ten YouTube videos of the day or won’t go to sleep until every one of those last e-mails has been answered and placed in the appropriate folder and actioned. Screen times are forever increasing, and this has come at the expense of physical exercise and one-toone time with loved ones.

There are reports of men addicted to video games who cannot keep a nine-to-five job, there are women suffering from depression and anxiety because they compare their online status with that of their peers, there are children who message on Instagram throughout the night, and there are those who are addicted to their work at the expense of all physical relationships around them. Perhaps most disturbingly are the increasing cases of online porn exposure by children between the ages of 9 and 13 years in particular [27], cybersexual activities in adolescence, or extreme social-media communities that spread disinformation. If it’s being conducted virtually, then it must not be real, with no physical repercussions; but far from it, online addictions generate a guilt that remains and is hard to rid. This is particularly true of misdemeanors published to the websphere that can be played back, disallowing individuals to forget about their prior actions or break out of stereotypes [28].

A New Tool: The AntiSocial App

FIGURE 2. The app AntiSocial measures the number of unlocks. (Image courtesy of BugBean.)

Endless pings tend to plague smartphone users if their settings have not been tweaked for anything but a default [29]. Notifications and alerts are checked while users are driving (even if it is against the law to text and drive), in the middle of a conversation, in bed while being intimate, while using the restroom, or even while taking a shower. But no one has ever measured the end-to-end use through actual surveying of digital instrumentation in an open market setting. It has been left to self-reporting mechanisms or applications that  have run on a desktop that might monitor how long workers use various work applications or are on e-mail or closed surveying of populations participating in trials. But manual voluntary audit logs are often incomplete or underreport actual usage, and closed trials are not often representative of reality. At best, we can point to the South Korean smartphone verification and management system that has helped to raise awareness that such a system is needed for intervention [30]. And yet, the concern is so high that we can say with some confidence that it won’t take long for companies to come out with socially responsible technologies and software to help us remain in the driver’s seat with some confidence.

FIGURE 3. AntiSocial measures app usage in minutes, allowing the user to limit or block certain apps based on a predefined consumption. (Image courtesy of BugBean.)

Enter the new app called AntiSocial, created by Melbourne, Australia, software company BugBean, which has consumer interests at heart [31]. Antisocial.io has taken the world by storm and has been downloaded on GooglePlay by individuals in over 150 countries within just a few months. The fact that it ranked number three on the U.K. GooglePlay downloads after only a few days demonstrates the need for it. It will not only accurately record usage in multiple application contexts but also encourage mindfulness about usage. AntiSocial does not tell users to stop using social media or stop video gaming for entertainment, but it reminds people to consider their digital calorie intake by comparing their behaviors with other anonymous users in their age group, occupation, and location. It is not about shaming users but raising individual awareness and wasting less time. We say we are too busy for this or that, and yet we don’t realize we are getting lost and absorbed in online activities. How do we reclaim some of this time [32]?

It may well be as simple as switching off the phone in particular settings, deliberately not taking it with you on a given outing, or having a digital detox day once a week or once a month. It might be taking responsibility for the length of screen time you have when you are away from the office or using AntiSocial to block certain apps after a self-determined amount of time has been spent on the app on any given day [33]. Whatever your personal solution, taking the AntiSocial challenge is about empowering you, and letting you exploit the technology at your fingertips without it exploiting you.

The AntiSocial App will Help

FIGURE 4. AntiSocial benchmarks smartphone app usage against others in the same age group, occupation, and location. (Image courtesy of BugBean.)

Some of the social problems that arise from smartphone and/ or social media addiction in particular include sleep depravity, anxiety, depression, a drop in grades, and anger management issues. AntiSocial provides a count of the number of unlocks you perform on your handset (Figure 2) and tells you in minutes how long you use each application (Figure 3), including cameras, Facebook and Instagram, and your favorite gaming app. It will help you to compare yourself against others and take responsibility for your use (Figure 4). You might choose to replace that time spent on Facebook, e.g., with time walking the dog, helping your kids with their homework, or even learning to cook a new recipe [34]. There is also a paired version that can be shared between parents and their children or even colleagues and friends. You might like to set yourself a challenge to detox digitally, just like you might do at your local gym in terms of fitness and weight loss. Have fun within a two-week timeframe, declaring yourself the biggest loser (of mobile minutes, that is) and report back to family and friends on what you feel you have gained. You might be surprised how liberating this actually feels.

You’ll come away appreciating the digital world and its conveniences a great deal more. You’ll also likely have a clearer head and not be tempted to snap back a reply online that might hurt another or inadvertently hurt yourself. And you’ll be able to use the AntiSocial app to become more social and start that invaluable conversation with those loved ones around you in the physical space.

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Keywords

Social network services, Facebook, Mobile communication, Australia, Telecommunication services, smart phones, social networking (online), telephone networks, smartphone, social media, antisocial app, second-generation mobile assignment, 2G mobile assignment, Nortel telecommunications vendor, Hutchison, Australia, network traffic, voice networks, Internet, data network dimensioning, public switched telephone network, integrated services digital network, small-to-medium enterprises

Citation: Katina Michael, "Are You Addicted to Your Smartphone, Social Media, and More?: The New AntiSocial App Could Help", IEEE Consumer Electronics Magazine, Vol. 6, No. 4, Oct. 2017, pp. 116 - 121, DOI: 10.1109/MCE.2017.2714421

The Dark Side of Video Games

Are you addicted?

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What is it with us today? We are giving over control to the machine and losing touch with the physical world around us [1]. We are witnessing the decay of our meaningful relationships— sucked into electronic vectors of nothingness—right before our very eyes [2]. Sometimes we are at a loss to describe this phenomenon, reflecting on how members of our own family have been duped by the promise of a Second Life.

It is true that some people are predisposed to different types of addictions—e.g., drugs, alcohol, and gambling—all of which act to curb an underlying condition, usually obsessive-compulsive disorder, depression, and/or anxiety. However, we are now confident that a compulsion toward excessive playing of video games will be added to that suite of newly defined behavioral addictions that need our urgent attention.

This article is dedicated to video game addiction, given its widespread reach, but we would be the first to admit that this is simply one of a dozen types of computer applications that can trigger deep-seated dependencies [3]. Although video game addiction was not included in U.S. Diagnostic and Statistical Manual of Mental Disorders (DSM-V) for 2012, there was an appendix on further research into Internet use disorder [4]. In contrast, the Chinese have already defined the disorder, and some studies have claimed that as many as one-third of mentally ill patients who stay at home are addicted to the Internet [5], [52].

Nintendo Game & Watch: Donkey Kong Jr. [Photo courtesy of Wikimedia Commons/Francis Bijl (Frenkieb).]

We can point to the increasing number of video game and online Internet detoxification clinics around the world that have been in existence since at least 2005, especially in China [6], [54], South Korea, and Taiwan [7]. From PSs and DSs to Wiis and Zappers, from iPods and iPads to Xboxes, our high tech gaming toys are enslaving children, grandchildren, nephews, nieces, partners, friends, parents, and teachers [8].

Are you addicted to video games?

If you do not wish to admit to the possibility that there is such a thing as video game addiction, then you can just log into one of your avatars in your favorite massively multiplayer online game (MMOG), and, while your terminal is booting, ask yourself a few of the following questions.

▼ How long do you spend on your favorite MMOG each day? [9]

▼ Are you preoccupied by your favorite video game when you are not playing? Is it all you can think about, even at the expense of your closest relationships?

▼ Over the last 12 months, have you put on weight as a result of your gaming habits?

▼ Do you have any friends outside those connected to your online avatar(s)?

▼ Are your grades at school slipping, or is your employment suffering as a result of playing games day and night? Are you suffering from sleep deprivation as a result?

▼ When you are on the computer engrossed in a session of play, do you lose track of time and forget about basic needs like eating, sleeping, or going to the restroom?

Moths are positively phototactic. Cockroaches are negatively phototactic, which means they search for dark spots and crevices. Humans are like moths—they are drawn to the light. But video games can change that. Many gamers who are addicted don't know the difference between light and dark, save for the light emitting from their screen. (Photo courtesy of Wikimedia Commons/Accassidy.)

We visited the Xbox homepage and were confronted with the following message: “A new generation has begun.” Yes, indeed it has. It is the generation drawn to the screen culture, like the moth is drawn to the light. But as soon as the moth touches the artificial light, it is no more. We can say that humans are also prone to the “moth effect.” Like moths, humans are naturally drawn to the light during the day, as opposed to cockroaches, which scurry into dark corners and crevices to avoid detection. We investigate what transforms the gamer—analogously from light to dark phototaxis—and what the ensuing social implications are for him or her and his or her close relationships [10]. How is it, you ask, that the screen emits bright light but the gamer is enveloped in visual and persistent perceptive darkness? Curtains drawn and lights out, the gamer retreats to his or her bedroom to play, and, if engaged in a first-person shooter MMOG, he or she continues to hide in the crevices to avoid being shot. There is a significant body of literature that needs to be studied in relation to target fixation [11] and video gaming. What is it that draws gamers to the console when they know that what they are attracted to has no real tangible benefit?

Just to set the record straight, this generation is not really “new,” as Xbox would have us believe, but about 40 years in the making. It is little wonder that the average gamer is a 35-year-old male [12].

In the beginning was Pong, then came MMOG

Pong interface—the instructions were simple: "Avoid missing the ball for a high score." Pong was akin to a game of ping-pong, but play was electronic in style and versus a computer.

We started off with Atari’s launch of Pong in 1972. The graphics could not be simpler, and, on first viewing, Pong is an innocuous game compared to today’s standards. The instructions were simple: “Avoid missing the ball for a high score” [13]. But what was it about Pong that brought millions of players to the TV screen? Psychologists point to the feedback loop, the anticipation of the response from the terminal, a sense of achievement at gaining high scores, a mastery of sorts over the game, the chance to fill the void with some fun, and a momentary escape from the realities and responsibilities of life.

Then, arcade games for just a nickel a game came into prominence at the same time that video-based poker machines surfaced to draw gamblers [14]. It used to be that Space Invaders (1978), Pac-Man (1980), Donkey Kong (1981), and Mario Bros. (1983) ruled—you used a laser canon to ward off the aliens, you got to eat the pellets and fight off the ghosts and monsters, you gathered ammunition to defend yourself against anthropomorphic enemies, and, as Mario, you got to exterminate the pests threatening to rise from the sewers below New York. But something happened to the nature of the gaming industry after personal computers were introduced into homes. Space Invaders gave way to DOOM (1993), Pac-Man to Grand Theft Auto (1997), and Mario Bros. to Manhunt (2003). Unsurprisingly, the promise of flight- and car-simulator games gave way to war and debauchery. The impact of the rise of the Internet was no different to that which followed the printing press for the production of propaganda and pornography [15].

Sergeant Shane Perry of the 401st Military Police Company displays his new Call of Duty: Ghosts game during the midnight release at the Clear Creek Post Exchange GameStop. (Photo courtesy of Sergeant Cody Barber, 11th Public Affairs Detachment.)

The defining point in the history of video gaming, however, came in 2003 with the introduction of Call of Duty, when a cinematic experience was introduced, tending away from traditional robotic-like behavior by personas. Call of Duty also provided the illusion of a more organic and dynamic game made possible by some clever programming, despite the fact that it still relied on linear scripting. It was much less formulaic than what gamers had experienced with previous first-person shooters. In the same year, massively multiplayer online gaming was touted as having well and truly arrived, as Financial Times measured the per-capita gross domestic product in the EverQuest game to be equatable to that of the 77th-wealthiest nation in the world. This was followed by a large number of subscriptions in the millions with Happy Farm and hundreds of millions with World of Warcraft and, more recently, Minecraft.

On the dark side of the…

The video gaming scene really came of age when the social networking elements of instant messaging, chat, video conferencing features, and presence information were added to the real-world-like online environment. All of a sudden, gaming became a fusion of unified communications that, if misused, could easily appeal to the darker side of the human instinct. Again, we contend that this medium is no different than other entertainment—such as movies with dark themes, music with dark lyrics, or even books with dark messages [16]. But there is something about MMOGs that differs from books, music, and movies [17]. The latter have a beginning and an end, whereas MMOGs seemingly go on forever—a little like the continuous pieces of music on each side of Pink Floyd’s famous album The Dark Side of the Moon (1973). Is there something in this distinction? The flesh is mortal, yet MMOGs carry with them a seeming infinity. You can die a million times over and spawn back to life in a game like UberStrike (2010), but on Earth you only have one life.

We contend that killing people in a game, no matter whether the characters are just animations, cannot be good for the human spirit, that is, the spiritual and mental part of our humanity. Spending a great deal of time, many hours per day, transfixed by high-impact violence (gross and unrelenting), high levels of gore (decapitations, dismemberments, and excessive blood-letting), offensive depictions of cruelty, and prostitution and heavy sexual themes means that we cannot break free from the endless loop. The same argument can be made for any video game that begins to impede our ability to be productive or that affects our ability to take care of fundamental personal hygiene needs [18]. We should be focusing our time toward positive and constructive play with long-term benefits as opposed to spending copious time building a world that does not exist when the power goes off.

We know what some of you are thinking: Not all video games are bad for you. Support your positions with real evidence and scientific studies [53]. Just because I maim and kill online, virtually, it doesn’t mean I’ll do it in the real world, and, if I have virtual sex every so often or even rape a prostitute in a game, it’s not like committing a real physical act. It’s all just make-believe… Who are you fooling? We are building games today in our society that are not only distasteful but are extolling what are generally labeled in the legal domain as cyber crimes against the person [19]. The worrying part is that these violent depictions of everyday life are becoming more callous and entering the mainstream. Are you going to tell us that when you perform these vile acts online that you are actually feeling true love, peace, and joy? Whatever happened to extolling morals and values in our society and to ethical codes of conduct in the game-development industry? It is not even a question of traditional ethics anymore but of plain old common sense.

Yes, yes, having an online affair has naught to do with the real world and has no real-world repercussions. Poof! Smokescreen! What is your heart telling you? What is your body saying to you? Are these acts just our imagination, or are they real, with real-world repercussions? When I spend more time online than with the person with whom I share a bed in the physical world, isn’t there something wrong? [20] When your first thought when you awake is to make contact with your favorite gaming community so that you can go out on another mission and pick off a few more fraggers, you need to reassess your behavior [21]. Things and people around you will start to suffer—how can they not if you are spending 10–15 h glued behind the screen playing? [22] Something must give [23].

Consider the Korean couple who, in 2010, let their threemonth-old baby girl die from starvation as they spent hours devoted to raising a virtual character of a young girl named Anima in the game Prius Online [24]. Think about the case of a young Korean man who collapsed at an Internet café in 2005 and went into cardiac arrest after playing Starcraft (1998) for 50 h straight, of a young Chinese man in 2007 who suffered a heart attack after spending almost seven straight days behind a computer screen (save for restroom breaks) [25], and of two Taiwanese men in separate incidents in 2012 who also collapsed in Internet cafés playing Diablo (1996) and League of Legends (2008) without a break for 40 and 23 h, respectively [26]. Consider the number of wives and husbands who have divorced their spouses over their gaming behaviors [27], especially for infidelity in Second Life and World of Warcraft [28]. And ponder the number of people who have lost their jobs because they cannot work and play video games simultaneously, later moving in with friends and relatives as a result of losing their income [29], [30].

Yes, we know what you’re thinking yet again—that these are just one-off tragic stories, and they’ll never happen to you or your kids [31]. To respond to this, we ask, “really?” It is not difficult to come to the same conclusions we hold. Do your own field observations on your way to work or the next time you are at a coffee shop or on a school campus. How many people, young and old, are absorbed by their mobile phone— immersed in the screen [32]? Parents, it’s time to admit it— there’s a problem with how technology has taken over your family, your workplace, and your headspace. What are you going to do about it? Will you keep believing that resistance is futile? Do you think that you cannot change because you fear that little Johnny will make life hell for you if he doesn’t get his 8 or 9 h online?

Don’t we realize as a technology-reliant community that we are keeping these gaming companies alive by logging in for our kids on 17+ games when they are barely ten years old? What are we willingly exposing them to? We shudder in horror when African dictators enlist ten-year-olds to fight in wars, but we turn around and buy our ten-year-olds the experience of killing far more virtual people than any real war would ever make possible.

When we give in to the demands of our children for yet another video game, we are feeding the darkness in their imaginations and sullying their spirits [33]. What happens when we get so entangled and lost in this virtual world that we do not even see what is happening to our household?

Ask the difficult questions

Stop and ask yourself: Where are your kids? What activity are they engaged in? Are they outside or inside, sleeping or awake? Chances are that every single one of them is behind a console of one form or another, for one reason or another. Now go and do a physical reconnaissance—how many of them are playing games? That has to say something about what we’ve become, and what we hope to become is a question for an entirely different article.

Games like Grand Theft Auto: Vice City promote a host of vices that are contrary to positive societal values

There’s an epidemic of parents failing to care for their kids, to feed them when they are hungry, to change their diapers, make sure they’ve brushed their teeth and gotten enough sleep for the day ahead. There’s also an epidemic of people failing to take care of themselves because they are addicted to electronic gaming or, more precisely, addicted to Wi-Fi. Why is everyone so bent on walking around and deceiving themselves that technology has not pervaded their life with a whole lot of ugly negatives? [34] Why are we all so scared to admit that what we are potentially creating is a road to nowhere? [35] For some, gaming has become a pathological addiction, and they cannot break free from the screen. Is the problem that we, too, are so engrossed by the screen that we cannot lend a hand?

We each know people who treat Facebook (or Instagram, Twitter, or Tumblr) as if they were online games. What’s the difference? Instead of shooting a character in a videogame, we can just like or Tweet some news. It is all “button pushing” and “screen scrolling,” reactionary, and stimulating to the prefrontal cortex, is it not [51]?

Enter locked-in syndrome, a medical term used to describe “a condition in which a patient is aware and awake but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for the eyes” [36]. Similarly, being in a persistent vegetative state is defined as “a wakeful unconscious state that lasts longer than a few weeks” [37]. We borrow the terms here to question whether society at large is presently undergoing some kind of locked-in technology scenario. In our analysis, addicted gamers go into a comatose state of affairs, where their heart is pumping blood, they are clinically alive, but they are barely conscious. Only their fingers around the console are moving spasmodically, showing us, the bystanders, signs of life in the form of a reflex action. Some even ceremoniously prepare with food and beverage beside them before choosing the addictive stance within which to use the social media elements of gaming.

Have you noticed when you try to talk to an addicted gamer that his or her gaze does not leave the screen, remaining transfixed? If he or she happens to make a mistake while you are trying to talk to him or her, you get blamed for the error in the most extreme way [38]. In the end, that is what the creators of these games want from us: a mind-numbing sense that what they are feeding us is good for our spirit [39]. Many of us, however, would not wish to believe that the primary driver of the gamedevelopment companies is to get us addicted from the start because it means more revenue for them [40]. These games have a spirit behind them, but it’s not one that lifts our souls or causes us to reach for greater things. It is the spirit of the times, that pervasive, uneasy feeling that things are not going so well toward the goodness and natural inclination of life.

This spirit of anarchy or nihilism is leading gamers of violent virtual realities to see and to dream of hells in the games they play as opposed to goodness, to be influenced by the images they see in strange visitations called nightmares, and to ponder demonic thoughts. We do not need to provide you with our evidence, which would only act to pollute your minds. Most players of these abhorrent games will not go out and conduct a massacre in the physical space [41], but surely there are other ways to spend one’s time—outside playing games with the children, admiring natural beauty with a sense of awe, going for a surf or a hike? Why do we choose a psychological prison, trapped not only inside but within ourselves? Those versed in the writings of Carl Jung can take much from here in the context of the “shadow aspect” of our personalities.

The next time you walk past your child’s door (whether he or she is a teenager or an adult living in your home), why don’t you spend ten full minutes together looking at how he or she is interacting with the virtual world through the computer device. In addition, ask about the music your child listens to and the movies he or she gets a buzz from. It is all one and the same: lyrics (auditory), multimedia (visual), consoles (touch and feel) enveloping the faculties of the human body. Immersing oneself in a whole lot of bad stuff is like immersing oneself in a cesspool. The problem with our life today is that we are swimming in the cesspool, surrounded by soft e-waste, and cannot see it for what it is. It is enveloping us on all sides and suffocating our freedom. We can only see things more clearly if we decide to get out of it, wash afresh, and then look with open eyes at what is before us. Yes, this does mean limiting our screen time.

Enacting change

When was the last time you embraced your children or told them you love them in the real world, not just over SMS or e-mail? There’s your challenge—get up off your chair right now, let go of that iDevice, and go searching in the physical space to reach out to that family member right now who is absorbed by their favorite high-tech gadget. It won’t be easy to get him or her to stop and to make eye contact with you, but that’s just the first step [41]. Be patient. It may take several weeks, or even months, but try detoxing the whole family from the dreaded technology that has bound them hand, foot, and mouth [42]. At first, try taking the family away to a location that is a complete dead zone—without even mobile connectivity [43]. Go away for at least a week. When you return, tell yourself you will not go back to your old ways and will hold your ground [44].

The screen is coming closer and closer, and it now seeks entry into the subdermal. Consider it this way: in the last 60 years, we have seen the advent of television, the computer, the Internet, the mobile phone, and now the wearable device that can distort and augment reality itself. What will come next? Will it be a translucent contact lens that completely replaces our actual field of view with another in a pervasive gaming environment? When we cannot make the distinction between fantasy and reality, are we really living? [45]

We must do better [56]. There is still a chance to resist. We can recapture our human rights and our dignity, reaffirm the rights of our children to have undistracted parents, and get back to a time when our children looked us in the eye clearly and brightly when we spoke to them [47]. We still have time to reaffirm the value of reality. We can change. We can do better. We have to remain in charge of the “screen” so that we can not only enjoy the great innovations of our times but also put them to good use.

Conclusions

There are people out there who are not slaves to technology and who are able to play games casually without any ill effect to their health. We are not asking people to live the life of an Amish community [48] but to consider how technology is impacting their home life and start drawing some lines. Children are especially vulnerable [49], but parents are struggling with the same addiction and the same detachment from the real world, staring into a screen instead of sharing real hugs, real smiles, real conversations, real activities, and reality itself with their kids. And it’s not just video games. Answering e-mails, talking on the mobile, texting, Facebook, web surfing, YouTube, all can be equally draining if misused [50].

We would be remiss not to point out the downsides that everyone around us is experiencing. It’s the elephant in the room, the emperor parading naked down the street, the skeleton in nearly every family’s closet. We are calling for people to wake up and admit that, collectively, we have a very big problem on our hands and to begin a thoughtful discussion of how we want to handle it. And lest you think we speak from some lofty, technology-free form of purity, we assure you that, one way or another, we have been down the ugly road we are describing. If we were not challenged by these matters ourselves, we would not be able to speak of them with such passion.

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Acknowledgments

This article was adapted from “The Dark Side of Online Gaming,” written by Katherine Albrecht, Katina Michael, and M.G. Michael for the International Conference on Cyber Behavior, 18–20 June 2014, Taipei, Taiwan; it was awarded best paper at the conference.

Citation: Katherine Albrecht, Katina Michael, M. G. Michael, "The Dark Side of Video Games: Are you addicted?", IEEE Consumer Electronics Magazine, 2016, Vol. 5, No. 1, pp. 107 - 113.