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News Briefs March 2023

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Recent Articles, News, Stories & Press Releases

Some interesting reading to inform or stimulate ideas or further exploration in various topics

JMIR Medical Education is launching a new theme issue focused on ChatGPT, Generative Language Models, and Generative AI in Medical Education.

The objective of this theme issue is to explore how generative language models can be used to advance medical education. Areas of interest include but are not limited to applications of generative artificial intelligence (AI) in medical education, creating intelligent tutoring systems, using natural language processing technologies in medical education, and exploring how chatbots can improve patient-physician communication.

The deadline for submissions is July 31, 2023. All accepted manuscripts will be published as part of the JMIR Medical Education Special Issue on ChatGPT: Generative Language Models & Generative AI in Medical Education. Manuscripts should be prepared according to the journal’s guidelines and can be submitted at https://mededu.jmir.org/author.

LAMP Platform, originally developed specifically for mental health, has the potential for a broader application of the system’s data analysis tools across other medical specialties and care settings.

The program (Learn, Assess, Manage, Prevent) or LAMP, is designed to make psychiatric care possible whenever and wherever it’s needed most. It was developed for neuropsychiatric research purposes under the direction of Dr. John Torous at Beth Israel Deaconess Medical Center/Harvard, but its use has expanded to help augment clinical care according to software engineer and medical student Aditya Vaidyam with the team at Harvard.

The LAMP Platform is part of a new approach that combines asynchronous telemedicine with digital phenotyping. It takes virtual medicine to the next level, allowing patients to report changes or symptoms as they happen outside the clinical encounter. ‘Digital phenotyping’ tracks patient biomarkers (heart rate, sleep patterns, etc.) and interactions with mobile devices and cognitive games to yield vast amounts of data that can be analyzed to help predict relapse or even to suggest personalized interventions to fit the patient.

Vaidyam, who is at the University of Illinois Urbana-Champaign, Carle Health, CI MED, foresees broad application of the system’s data analysis tools across other medical specialties and care settings. “It has the potential to help triage care needs; maybe urgent care physicians or telehealth physicians use the data to lessen the load on ERs, or maybe primary care providers use the data to dynamically reschedule their patient load based on estimated patient health risks.”

For more information on LAMP visit the Harvard website [Link] [Source]

School systems sue social media platforms

A number of school districts across the country are increasingly taking on social media. They are filing lawsuits that argue that Instagram, Snapchat, TikTok and YouTube have helped create the nation’s surging youth mental health crisis and should be held accountable.

The focus of the litigation filed in a California federal court last week, alleges that social media companies used advanced artificial intelligence and machine learning technology to create addictive platforms that cause young people harm. “The results have been disastrous,” the filing asserts, saying more children than ever struggle with their mental health amid excessive use of the platforms. “There is simply no historic analog to the crisis the nation’s youth are now facing,” it said.

School administrators have observed a spike in mental health emergencies during the school day. There have been “very serious” cyberbullying incidents related to social media — with content “nearly impossible” to get the companies to take down — and school threats that have kept students at home.

Marisol Garcia, a staff therapist at the Family Institute at Northwestern University, said social media can be a powerful means of connection but the downsides are significant too. She was not surprised schools have begun filing lawsuits, saying they want to do what they think is good for their students’ mental and physical health.

The long-term ramifications of social media use — on attention span, social skills, mental health — are unclear, she said. The legal action, she said, “could be a positive thing.”

New Data from the Centers for Disease Control and Prevention

A new report from the CDC adds urgency to the lawsuits.

According to federal researchers who released data last week, teen girls across the United States are “engulfed in a growing wave of violence and trauma.” The CDC findings show that nearly 1 in 3 high school girls reported in 2021 that they seriously considered suicide — up nearly 60 percent from a decade ago.

Almost 3 in 5 teenage girls reported feeling so persistently sad or hopeless almost every day for at least two weeks in a row during the previous year that they stopped regular activities — a figure that was double the share of boys and the highest in a decade, CDC data showed. Girls fared worse on other measures, too, with higher rates of alcohol and drug use than boys and higher levels of being electronically bullied, according to the 89-page report. Thirteen percent had attempted suicide during the past year, compared with 7 percent of boys.

[Source – Washington Post], [Link to CDC Report Youth Risk Behavior Survey]

Physicians And Other Clinicians Should Screen Youth For Cyberbullying & Social Media Use

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An article published in the journal Primary Care Clinical Office Practice by physicians from Florida Atlantic University’s Schmidt College of Medicine recommend that primary care physicians and other clinicians need to screen adolescents and young adults for inappropriate or misuse of social media and cyberbullying.

Most adolescents and young adults have experienced bullying in some form, with about one-third of them experiencing cyberbullying, contributing to mental health concerns. Cyberbullying involves electronic communication such as texts, emails, online videos and social media, which has become increasingly problematic over the last few decades. Several reasons include the anonymity it allows, the fact that it is not as easily monitored, and that adolescents and young adults have easier access to devices.

Bullying is nothing new, but teens these days must also navigate the challenges of the digital landscape. Parents and teachers who grew up in a different generation may struggle to understand the many nuanced forms that online bullying, or cyberbullying, can take.

Any form of bullying is hurtful, but cyberbullying can be especially damaging because of the nature of the digital world. With cell phones and laptops, students carry their bullies in their backpacks, meaning that they cannot even escape their tormentors at home.

What’s more, because of the sneaky nature of cyberbullying, parents and teachers may be completely unaware that a problem is happening unless they are closely monitoring their children’s social media usage. And, teens may be reluctant to open up about cyberbullying for fear of losing access to the digital world.

Screening and Screening Tools

According to the article authors, “It is staggering that only 23 percent of students who were cyberbullied reported it to an adult at their school, which shows that many incidences go unreported. This is another crucial reason why we need to screen patients as well as educate parents.”

Screening tools are available and can be worked into the work-flow of healthcare visits to ensure that screening is consistently done and results are addressed in a timely manner.

Current screening tools include:

  • Revised Olweus Bully/Victim Questionnaire (R-OBVQ) [Link]
  • California Bullying Victimization Scale (CBVS) [Link]
  • Child Adolescent Bullying Scale (CABS) [Link]
  • Massachusetts Aggression Reduction Center (MARC) [Link & Ressources]

Another resource is a “Cyberbullying: Top Ten Tips for Health Care Providers,” pamphlet developed by the Cyberbullying Research Center, which is part of the FAU School of Criminology and Criminal Justice. [Link]

Source: Caceres J, Holley A. Perils and Pitfalls of Social Media Use: Cyber Bullying in Teens/Young Adults. Primary Care: Clinics in Office Practice. Volume 50, Issue 1, March 2023, Pages 37-45. [Link]

The Sale of American’s Mental Health Data

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Millions of Americans have been using health tracking apps for for the last few years and since the pandemic, numerous apps for mental health issues like depression and anxiety have proliferated. We have become used to our private medical information from the usual medical settings being protected by HIPAA (the Health Insurance Portability and Accountability Act). But unfortunately, HIPAA wasn’t designed for the modern digital world, with its new technologies. Most apps—including health, mental health, and biometric tracking devices—don’t fall under HIPAA rules, meaning that these companies can sell your private health data to third parties, with or without your consent.

A new research report published by Duke University’s Technology Policy Lab reveals that data brokers are selling huge datasets full of identifiable personal information—including psychiatric diagnoses and medication prescriptions, as well as many other identifiers, such as age, gender, ethnicity, religion, number of children, marital status, net worth, credit score, home ownership, profession, and date of birth—all matched with names, addresses, and phone numbers of individuals.

Data brokers are selling massive lists of psychiatric diagnoses, prescriptions, hospitalizations, and even lab results, all linked to identifiable contact information.

Researcher Joanne Kim began by searching for data brokers online. She contacted 37 of them by email or a form on their website (Kim identified herself as a researcher in the initial contact). None of those she contacted via email responded; some of those she contacted via form referred her to other data brokers. A total of 26 responded in some way (including some automated responses). Ultimately, only 10 data brokers had sustained contact by call or virtual meeting with Kim, so they were included in the study.

The 10 most engaged data brokers asked about the purpose of the purchase and the intended use cases for the data; however, after receiving that information (verbally or in writing) from the author, those companies did not appear to have additional controls for client management, and there was no indication in emails and phone calls that they had conducted separate background checks to corroborate the author’s (non-deceptive) statements.

Data Brokers reported conditions for selling data:

  • emphasized that the requested data on individuals’ mental health conditions was “extremely restricted” and that their team would need more information on intended use cases—yet continued to send a sample of aggregated, deidentified data counts.
  • confirmed that the author was not part of a marketing entity, the sales representative said that as long as the author did not contact the individuals in the dataset, the author could use the data freely.
  • implied they may have fully identified patient data, but said they were unable to share this individual-level data due to HIPAA compliance concerns. Instead, the sales representative offered to aggregate the data of interest in a deidentified form.
  • one was most willing to sell data on depressed and anxious individuals at the author’s budget price of $2,500 and stated no apparent, restrictive data-use limitations post-purchase.
  • another advertised highly sensitive mental health data to the author, including names and postal addresses of individuals with depression, bipolar disorder, anxiety issues, panic disorder, cancer, PTSD, OCD, and personality disorder, as well as individuals who have had strokes and data on those people’s races and ethnicities.
  • two data brokers, mentioned nondisclosure agreements (NDAs) in their communications, and one indicated that signing an NDA was a prerequisite for obtaining access to information on the data it sells.
  • one often made unsolicited calls to the author’s personal cell. If the author was delayed in responding to an email from the data broker, the frequency of calls seemed to increase.

Conclusions

The author concludes that additional research is critical as more depressed and anxious individuals utilize personal devices and software-based health-tracking applications (which are not protected by HIPAA), often unknowingly putting their sensitive mental health data at risk. This report finds that the industry appears to lack a set of best practices for handling individuals’ mental health data, particularly in the areas of privacy and buyer vetting. It finds that there are data brokers which advertise and are willing and able to sell data concerning Americans’ highly sensitive mental health information.

This research concludes by highlighting that the largely unregulated and black-box nature of the data broker industry, its buying and selling of sensitive mental health data, and the lack of clear consumer privacy protections in the U.S. necessitate a comprehensive federal privacy law or, at the very least, an expansion of HIPAA’s privacy protections alongside bans on the sale of mental health data on the open market.

[Link]

APA Psychology Chief Scientist @ Senate Judiciary Committee: Potential Harms, Benefits of Social Media for Kids

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Association calls for more research, regulation, better messaging to parents and teens

Additional research is needed to better understand how certain features and content inherent in social media, as well as user behavior, may be affecting our children for both good and bad, APA Chief Science Officer Mitch Prinstein, PhD, told the Senate Judiciary Committee.

The age at which children begin to use social media is an area of great concern, he said. “Developmental neuroscientists have revealed that there are two highly critical periods for adaptive neural development. One of these is the first year of life. The second begins at the outset of puberty and lasts until early adulthood (i.e., from approximately 10 to 25 years old). This latter period is highly relevant, as this is when a great number of youths are offered relatively unfettered access to devices and unrestricted or unsupervised use of social media and other online platforms.”

Recent research shows over 50% of teens reporting at least one symptom of clinical dependency on social media. He also outlined several additional areas of concern that have emerged from scientific research. Social media sites ostensibly exist to foster social connections, he said. But many youth use the sites to compare themselves to others, seeking “likes” and other metrics rather than healthy, successful relationships.

Social media sites ostensibly exist to foster social connections, he said. But many youth use the sites to compare themselves to others, seeking “likes” and other metrics rather than healthy, successful relationships.

In other words, social media offers the ‘empty calories of social interaction’ that appear to help satiate our biological and psychological needs, but do not contain any of the healthy ingredients necessary to reap benefits,

Social media also heightens the risk for negative peer influence among adolescents, as well as for addictive social media use and stress, he added, citing research showing that many young people use social media more than they intend to and that they have difficulty stopping its use.

Recent studies have revealed that technology and social media use is associated with changes in structural brain development (i.e., changing the size and physical characteristics of the brain). This highlights the risks associated with young people accessing social media sites that glamorize disordered eating, cutting and other harmful behaviors. Filtering or removing this type of content is often not done or warnings are not triggered. So vulnerable youth are not sheltered from the effects that exposure to this content can have on their own behavior. “This underscores the need for platforms to deploy tools to filter content, display warnings, and create reporting structures to mitigate these harms.”

Another area of concern is what young people are missing out on by spending so many hours on social media—especially sleep, which they need for healthy development. “Research suggests that insufficient sleep is associated with poor school performance, difficulties with attention, stress regulation, and increased risk for automobile accidents,” he said.

But it is not all bad news. Some research demonstrates that social media use is linked with positive outcomes that can benefit youth mental health, according to Prinstein. “Perhaps most notably, psychological research suggests that young people form and maintain friendships online. These relationships often afford opportunities to interact with a more diverse peer group than offline, and the relationships are close and meaningful and provide important support to youth in times of stress,” he said. This can be especially important for youth with marginalized identities, including racial, ethnic, sexual and gender minorities.

Dr. Prinstein made several recommendations for what Congress can do to address many of the risks social media may pose to youth. These include:

  • Allocating at least $100 million to study social media and adolescent mental health;
  • Mandating that data from algorithms be made public, along with other internal research conducted by social media companies;
  • Requiring social media platforms to develop tools to mitigate the harm to youth, such as disabling particularly addictive features and enabling users to opt out of certain algorithms;
  • Mandating protections for marginalized and LGBTQ+ kids, while retaining their ability to connect with others in such groups for social support;
  • Passing the Kids Online Safety Act and previously proposed legislative fixes such as updates to the Children Online Privacy and Protection Act.

Source: APA.org Press Release

Senate Judiciary Committee (PDF, 355KB).

**Update Article – 02/16/23 Published by National Public Radio – “10 things to know about how social media affects teens’ brains” discusses in more depth the important takeaway messages from Dr Prinstein’s presentation to the US Judiciary Committee [Link to article]