Peter G, Neumann
Computer-Related Risks in Healthcare [10-minute summary]
CCS 2024 conference HealthSec workshop.

The paper is on my website, in part derived from recent RISKS issues,
with lots of editorial additions:
  https://www.csl.sri.com/users/neumann/health.pdf
HealthSec 2024, Salt Lake City, 14 Oct 2024

The 10-minute summary that I was going to present at the workshop is
on my website:
  https://www.csl.sri.com/users/neumann/healthsec.txt
There were several screwups and logistic problems (bandwidth
with muliple workshops) that prevented my zooming in, so I wound up with two
minutes after a lovely introduction from William Yurcik, the
program chair (head of information technology, Dept. of
Health and Human Services), who had invited my paper.  I
thank him most heartily.

Here are my notes for my intended summary:

I regret not being able to be with you all -- for pressing health
reasons.  Here's an abbreviated summary of the paper.

0. I am very grateful to Kaiser Permanente for multiple decades of
   keeping me at work at SRI at 92, and to Stanford Hospital for its
   emergency treatment of my heart attack over a year ago.  My paper
   is a countercultural analysis of what has gone wrong and what might
   need to be done in the future to dramatically improve the
   situation.

1. Many problems in healthcare require holistic approaches, because
   many factors are often interrelated, Thinking out of the box is a
   poor metaphor, because there actually is no box.  Albert Einstein
   said, ``Everything should be made as simple as possible, *but no
   simpler.*'' Unfortunately, violating *but no simpler* often causes
   crises, and requires some total-system thinking.  Also, medical
   best practices tend to be overly simplified, driven in part by
   avoiding law suits.

2. Certain medical devices have been poorly designed and implemented,
   lacking in assurance, monitoring, and oversight.  Research and
   development in medical devices needs to be much more holistic and
   evidence-based.  In an incident in Houston just after my paper was
   finalized , a student died when the defibrillator failed.  When the
   authorities checked, all of Houston's 150 school devices failed to
   operate correctly.  Self-checking failed miserably.
   
3. In the spirit of this workshop, technological solutions often are
   not sufficiently trustworthy -- especially if they rely on
   artificial intelligence that has no evidence that it will give
   sound results.  However, we note that nontechnological problems
   generally cannot be solved by technology alone.

4. Throughout the medical profession, money and greed are often the
   driving force, whether for making profits or surviving as a
   non-profit, cutting corners wherever possible.  Political and
   government problems abound, especially relating to insurance and
   vaccinations.  Healthcare is a worldwide concern, but the U.S. has
   its own problems.

5. Artificial intelligence can be helpful, but in systems demanding
   real-time life-critical trustworthiness, it urgently needs serious
   evidence-based assurance.  I have an Inside Risks article (the
   255th column) in the November 2024 CACM on that subject.  a preview
   of which is also on my website, along with most of the other
   more recent columns since my book came out:
     https://www.csl.sri.com/users/neumann/cacm255.pdf

6. Dealing with rampant disinformation has become pandemic.

7. Overall, some serious rethinking is required throughout, along with
   stringent oversight.  Functional rather than allopathic medicine is
   almost completely disregarded by conventional healthcare, that is,
   treating the underlying causes rather than just the symptoms. This
   fact seems to be strongly influenced by pharmaceutical companies,
   overly narrow best practices, and big money.

8. The meaning if my school pledge of allegiance seems to have been
   lost -- one nation, under God, with liberty and justice for all.

Please read the entire paper, which has ample examples for all of
these points -- and lots more.  And this inroductory list is also on
my website.  I seem to be the only Peter G Neumann, although I know
three other Peter Neumanns.

Once you have read my paper based on recent items in the ACM Risks
Forum (http://www.risks.org), with extensive personal opinions, read
Bernie Sanders new book, It's OK To Be Angry About Capitalism.
Chapter 5 is titled Ending Greed in the Health Care System: Health
Care is a Human Right, not a Privilege.  It is comprehensive.

Also, read the very constructive HealthSec 2024 paper by John McHugh
and William Yurcik, on John's personal experience abouthow caregiving
institutions can be done humanely.  I prefer hospice care where
possible, which may be where I am eventually headed.