Twindemic, SIM Jacking, Childhood Police Interactions and AI Systems
Written by Dr Nick on November 7, 2022
This month’s episode of “News you can Use” on HealthcareNOWRadio features news from the month of October 2022
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners.
We review the current state of public health in the context of the rising number of cases of COVID-19, the looming flu season, and the emerging increase in Respiratory Syncytial Virus (RSV) cases. As we discuss the guidance is clear on getting vaccinated for the first two with the updated vaccines and staying vigilant against RSV which does not have any available vaccine.
We talk about my recent SIM Jacking of my phone and attempt to take over my bank accounts. Despite both of us believing we are relatively well protected there are still things we should or could be doing and there are plenty of lessons for you to learn from my experiences that are documented in the accompanying link to the details on my blog and on LinkedIn.
Listen in to hear us review the recent paper Adverse Childhood Experiences and Adolescent Police Contact in the United Kingdom which discusses the impact of Adverse Childhood events in early life and the impact on adolescents and wee talk about AI systems and the difficulty in getting the design right even with lots of resources and good intent.
You can read more about the series here and the concept of keeping up with innovation in healthcare. Please send me your suggestions on topics you’d like to see covered. You can reach out direct via the contact form on my website, send me a message on LinkedIn or on my Facebook page (DrNickvT), or on Twitter by tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
And today as I am each and every month, I’m delighted to welcome Dr. Craig Joseph. He’s the chief medical officer at Nordic consulting partners, Craig, thanks for joining me.
Craig Joseph
Thank you for having me once
Nick van Terheyden
again. So, in our news, you can use continue trending and buried in the name of the virus 19. That was the year 2019. Here we are almost at the end of 2022. And we continue to discuss it, but it seems like it ain’t over yet. What’s going on?
Craig Joseph
It’s, it’s back. And it’s better than ever. So here’s the good news. The good news is that deaths from COVID, 19, are down, right down in the US and they’re down throughout most of the world. And that’s probably because most of us have either had the had the disease, or had a vaccine for the disease. And we have we understand it more. So we have new medications that can help treat the disease. Plus, even if we didn’t have that we know much more than we did. So we know what works in the ICU and what doesn’t work in the ICU. So. So that’s great news. And undeniably fewer people are dying in the United States and around the world. The bad news is that the virus continues to mutate. And, and changes changes the spike proteins especially, which is where most of our vaccines and our natural immunity tried to attack keep changing. And so it seems like it’s always one step ahead of us in terms of vaccine, you know, vaccine, manual design and manufacture. And so that’s the bad news. Plus Winter’s coming. Which also seems to be bad news, because we know it’s a
Nick van Terheyden
new series of Game of Thrones.
Craig Joseph
It’s not that winter. It’s it’s although it might be one never knows really.
Nick van Terheyden
Nice walk among us.
Craig Joseph
It Hey, scary things have happened. There’s a there’s a new prequel, which I highly recommend also for Game of Thrones, but I think we might be that’s a different.
Nick van Terheyden
No spoilers here. So I’ve got it,
Craig Joseph
the different different podcasts. So Winter is coming, getting back to what I was saying earlier. And so we know all respiratory viruses tend to be more common, because we tend to be inside more, which means we’re on other people more. And so that’s that’s our thing. And so certainly COVID-19 We are worried that it’s going to be back and we know that well, I shouldn’t say back, it never left us but that it might become more serious, fewer people are getting the vaccine, the booster, which is optional, available for everyone in the United States, I think over age five, as long as there’s been two months since your last vaccine, you are eligible for a booster vaccine. And this one is based on a lot of the Omicron. Signature. And so it’s more up to date, which is it ready for the virus that we’re seeing today? No, it takes us months and months to get up to that. However, it’s closer. And so I think something like 7% of eligible US citizens have or residents have gotten the booster. And that is not a good thing. Everyone should be should get this and now is the time to do it.
Nick van Terheyden
It is kind of shocking that that’s the case. I mean, we here we have readily available. I do believe that there’s some challenges around the cost of this because the rules that were in acted as part of the pandemic. And the response said, All of this would be free, including the COVID testing, and the vaccinations. Now, I don’t know if this is quite rolled into this point, but it feels like there is some challenges that, you know, I come from a system where, you know, this is freely accessible at the point of care. I think, you know, we should be doing that, particularly with preventative. And you know, I certainly recall through most of the years that I’ve been here that I see adverts in almost all of the places that offer vaccination, that flu vaccination is free in many of the places that offer it. That’s the part of the twin demic that people are talking about. I’m not sure and I don’t know it’s I’d be interested to hear if you have any thoughts around the cost issue. But there’s another one. People call it RSV and that’s probably because they hate pronouncing respiratory You sing city or virus and I know I said that wrong because I probably get the respiratory piece wrong, as I’ve been doing for years, but it took years for somebody to actually tell me that I was pronouncing it wrong, and I can’t change at this point. But can we do something about that? And you know, so what are your thoughts?
Craig Joseph
So first of all, you need to learn English. So it’s respiratory syncytial virus but it’s still RSV, you got the you pronounce the three letters correctly. So Oh, thank God, kudos to you on that. So as a pediatrician, I’m very aware of RSV. It’s something that pretty much every human gets. And generally, I would see it in, under two or three, by the time you’re two or three years old, you’ve probably had RSV, and it’s like the common cold, it’s a typically a minor virus. However, for little young little lungs, it can be it can be bad also for people who are immunocompromised or elderly who most likely have had it, but maybe don’t have the ability to fight it off. It can be it can be a problem. And so certainly I’ve hospitalized my fair share of, of healthy kids, young kids under two or three, typically with with RSV. And so what’s happening today is that we are seeing RSV in numbers that are requiring hospitalization for children that we don’t normally see this early in the season. And so that worries us because we’re seeing a lot of kids being hospitalized for RSV. Now, what happens in peak season, and the thought process to why this is happening is COVID. So for the last two years, these kids who were born during the pandemic, they were never exposed to RSV. Why? Because they were hardly exposed to any viruses because we were doing such a good job of trying to mitigate people. We’re not going into large groups, people were wearing masks and doing that kind of thing that helps decrease all respiratory viruses. And so so now we’re stuck Kitt, what can we do for RSV, precious little, it’s supportive care. For the vast majority, we do have antibodies that we can give to very premature kids during RSV season, but that’s few and far between. So for most kids, it’s simply supportive therapy. And again, the vast majority of children will come in to the pediatrician and will say, Oh, you’ve got most likely RSV, we could test but since there’s no medicine for it, we generally don’t test unless you’re very sick and end up in the emergency room or the hospital. And if you do, you generally end up with bronchitis, which is some wheezing. Again, we give supportive therapy for those kids, sometimes they need oxygen, sometimes they need even more support, but there’s no specific medication for RSV. So we’re we’ve been worried about that the two viruses, we’ve been worried about SARS Cove to the virus that causes COVID 19. And we’ve been worried about the flu. And now we have a third that no one really I think anticipated, which was RSV. So now all of those are happening at the same time. And so what can you do? Anyone who’s six months or older can get a flu shot. And remember a flu shot, you need a new one every year because it’s again, trying to predict the variants that we’re going to see. And I think everyone who’s five or older could get a COVID-19 booster shot. Again, those are different Vax. That’s a slightly different vaccine than the primary series that we’ve we’ve all had, or many of most of us have had. And the one key thing that people who have listened to us already know, but I think it bears repeating, is the goal of both of these vaccines is not to prevent you from getting sick, that would be awesome. It would be awesome. If you got a flu shot, and then you could not get the flu, that would be great. That is not how this vaccine works. Nor is it how the COVID-19 vaccine works. Both of them are meant to prevent you from ending up in the hospital or dying if you get those two diseases, right. And so So what that means is if you get the flu shot doesn’t mean you can’t get the flu No, but what it means is it significantly decreases your chances of ending up in the emergency department if you get the flu. And that’s the goal. And that’s what we’re trying to prevent. And by that measure, these are both are highly successful vaccines and so people need to set their expectations appropriately still might get the flu still might get COVID however, it should be a minor thing and less chances of you being very sick and for long COVID to we think that your decrease your chances by 30 to 40% of having long COVID If you’re if you’re properly vaccinated, so lots of benefits. And so that’s what people can do about it can’t do anything about RSV at this point.
Nick van Terheyden
So I I think, you know, great guidance there. I would just only reaffirm that I think, you know, the position from both of us has been pretty clear. Get the appropriate vaccination I have I have the double dose, I got flu in one side COVID. In the other interesting experience, this time, it was the least painful. And you know, for the most part not problematic for me, generally, but I didn’t even notice it. Maybe because I’ve had so many vaccinations in the last several months, as a result of COVID-19. I’m not sure but and my post reaction was, you know, very mild, and ideal, from my perspective, so fully vaccinated, best for protection. And in the case of RSV, that’s supportive therapy, as you’ve carefully described, but I think being aware, and, you know, obviously monitoring that that’s going to be important. So I think, good advice, and as clear as it can be. Moving on our next topic, talking about security, and you know, from my own personal experience, I was unfortunate enough to get sim jacked in the past several weeks. And people ask, what is Sim jacking? Well, briefly, it’s taking over your cell phone number. So somebody impersonated or fraudulently managed to transfer my cell phone number over to themselves, they also held themselves to a nice brand new Samsung Galaxy, I think it’s an s 20. I’m not in that domain. So I don’t know them well, that he charged to my account. Nice and fun, which I have to deal with as well. But the important thing was he actually took over my phone number and you go, Oh, great. He can carry on doing all my work and do all of those things. But actually, this is a very sophisticated attack that allows him then to go after accounts that I own, where those accounts have two factor authentication. So I have a user ID and password. And then when I try and log in the system says, are we not sure that this is you let us send you a text message to confirm that this is you. And typically it’s a six digit code. Although there is one exception, I’m trying to think off the top of my head, I can’t remember, I think I won’t even name them. It’d be unfair, because if I get it wrong, but they insist on an eight digit code, which is actually quite difficult for us to remember. And then type in the six digit code is more than sufficient, because it changes every 30 to 60 seconds. So it’s not repeatable. But anyway, side issue. And very quickly, after obtaining my cell phone number, and my phone stopped working, he then proceeded to attack my bank account, obtained my user ID and then attempted to reset my password. And as part of the post, I’ll post a link to a full forensic detail of this, but I was about three minutes away from losing control of my bank account. And it was, I’ve got to say, and I feel reasonably experienced in security issues, I talk about it extensively, I think I understand a fair amount of this. And I think I do most of the things that I should do. But I was a little bit shaken by the whole experience. And it certainly blue, a good three or four days of activity that I’ve now had to subsequently follow up and change things and take a number of other steps. But it was very concerning.
Craig Joseph
While it was not only concerning to you, you you posted it and went through almost minute by minute what happened and I became concerned and I thought that I was in a pretty good position understood some of these things. And yeah, it’s a scary scary thing. And I think it’s, it’s a worthwhile it’s a worthwhile event to talk about so that people can be become aware we’re, we’re generally not here cybersecurity experts. However, I think there’s some basic things that you can do to help minimize the chances of this happening. And, boy, if someone wants to create a fake driver’s license, with information that you know, is yours, but they’ve just put their face on it. They’re serious and they’re there, they’re coming for you. And so to do everything you can do to make that as difficult as possible is make sense and so, you know, adding those set that second factor to all of your all of your financial accounts or any any on Line account that you think is important. And then ideally, that second factor, as you just pointed out, should not be a text message because it’s so easy to, to steal your phone number, it’s not supposed to be, but it is. And so using a piece of software to authenticate is a much safer thing. And as you said, it gives you a different code every 30 seconds, at least the ones off us. So every 30 seconds, you get a six digit code, and it’s tied to the time and to your user ID. And so then that person actually needs to have your phone, not your phone, number, your phone. And and it’s generally pretty difficult to get your phone from you. And once even if they get your physical phone, they would still need a bunch of pieces of, of your username, password and other kinds of identifying features to get into that app. And so certainly, it’s it’s super scary. And I’m so glad that you were able to catch this thing as it was happening as it was happening.
Nick van Terheyden
Yeah, that I think was probably the most scary part of it from my perspective was, it would be a small step away for a very brief period of time, which happens fairly frequently for me, and I wouldn’t have been aware. For those of you just joining, I’m Dr. Nick the incrementalist and today I’m talking to Dr. Jay, Craig Joseph, he’s the Chief Medical Officer at an audit consulting partners, we’re focusing on news you can use in this particular case, it’s a little bit of news about me and my sim jacking experience. And I would say, primary guidance throughout all of this is to make sure you have two factor authentication and preferably two factor authentication, where you have the choice, that’s an app on your phone, as in authenticator, which I think people are probably familiar with that was the Google thing, it still exists. But there are a number of actually better improved versions of it, improve, because they allow you to flip over to a new phone, which people do fairly frequently. And it can be a bit of a pain in the neck to actually go back, as I discovered when I had this very early on, but certainly most concerning, and I think, you know, worthwhile for folks to really pay attention to moving on. Let’s talk a little bit about the pediatric report that came out. Just recently, adverse childhood experiences and adolescent police contact. And in summary, what they said in a survey, this was out of the United Kingdom, it was published in the American Academy of Pediatrics, but they looked at about 11,000 or so more adolescents, who they weren’t, essentially to measure what was happening in their childhood, and they categorize this as adverse childhood experiences, you ask, well, what’s that? That’s traumatic events, abuse, neglect, you know, household dysfunction. I’m not sure how broad that is. But essentially, the more of that, that you had, the much higher chance you had, as you moved into adolescent is of having interactions with police. And in this case, police stops, which included not just being stopped, but you know, being stopped, questioned, warned, cautioned, and indeed, even arrested. And there’s a part of me that says, Well, I guess that’s not surprising, but why would you know, at the age of five or so, those traumatic events lead to that. I’m curious about your thoughts?
Craig Joseph
Well, like you said, I It’s, it’s, it’s not surprising, yet, it’s horribly surprising and disappointing. You know, it’s, I think it’s a bunch of these little things. And so just having contact with, with the police with in a negative way, at a very young age over over multiple years. Ultimately, scientifically, now we know shows that you’re going to be at greater risk for being involved in the in the, in the with police in a negative way. And the, the conclusion of the article is, Hey, we should do everything that we can to intervene when kids are very young, like before adolescence, to make sure that they’re that both they are not looking at the police in an overly negative way but also to make sure that the police understand that every interaction that they have is a potential. Negative A can have a potentially negative effect a decade later and and And, you know, something such as a frisk or a search, even without force, you know, can can cause, understandably problems, years and years later. And so I think this is one of those things where Yeah, makes sense. But no one’s ever really shown that it happens, and that, that it’s got negative long term consequences. Well, now we have some of that some of that evidence. And so these things that seem on the outside as well, it’s not that, you know, I’m thinking about in New York with the stop and frisk, right rules that used to be in place. Well, you know, these people are in the wrong place at the wrong time, and, and doesn’t hurt to just talk to them a little bit. Well, that’s, that’s actually not what’s what’s happening. And, and, and we’re starting to see some some evidence that the deleterious effects again, as you mentioned, this was in in the UK, not in the US, but I think it makes sense to extrapolate and say that, yep, that’s a that’s a similar thing.
Nick van Terheyden
Right? I, you know, it’s hard not to sort of emphasize the point, but you know, interactions with people in an official capacity in a uniform, all of that is not just, hey, it’s like meeting somebody on the street, it’s just not the same. And I think the importance is to understand that and then start to mitigate that as much as possible, because, you know, we need to improve that overall. So let’s talk a little bit about epic, and the AI. They have the sepsis AI that’s been trending, we’ve, you know, seeing some challenges, and, you know, overall, obviously, good intent here trying to find sepsis and, but it’s proving not to be quite as helpful or as good as they thought. And, you know, there’s a real sense that perhaps we should be, you know, there should be some oversight, maybe there’s, you know, something to it there.
Craig Joseph
Well, so let’s just kind of dig a little deeper. So Epic is a big vendor of electronic health records. And we should note that I used to work there, so just want to call that out. Yeah, so the attempt from lots of different groups is to is to be able to help doctors take care of patients better. And as you mentioned, sepsis, which is a major infection in your body, and often leads to death, to be able to predict that earlier than we can, currently would be great. And so to try to apply artificial intelligence and other types of, of tools to that to say, hey, hear, you got a lot of sick people in your hospital, you don’t get in the hospital without being sick. Nowadays, you got a lot of sick people in the hospital. But we think these five, we the aI think these five are the have the highest likelihood of being sick, and you really want to pay more attention to them. And seems straightforward. But it’s it’s complicated. And so what epic and others who are struggling in this area to try to be successful, have found is that those they’re giving you more than five, right? So they’re giving you a lot of patience. And there’s really no advice about what are you supposed to do? Okay, well, so the AI says this patient is in high risk, they’re already being monitored, should I start them on antibiotics or different antibiotics earlier? What? And so that’s one of the major problems, I think, is that hey, thanks for that insight. Oftentimes, you can’t tell me why because you’re an AI. And it’s very complicated. So you don’t really know why we think there’s patients at high risk, but you think they are, and what can I do there? If they’re already in the ICU, they’re already being monitored as closely as possible. So, so one, one scholar wrote, I think over the weekend, bully of epic who’s been around for three or four decades and has a very good quality system in play is struggling, boy, for groups that are starting out, who don’t really understand healthcare, and don’t really understand workflows don’t understand how patients are taken care of. Yeah, that’s going to be a big, big struggle for them as well. It’s it’s hard. It’s hard.
Nick van Terheyden
Yeah, I think great point. It’s, this is this is not easy to do. We, you know, ultimately good intent, you know, find people before they get sick play some intervention. I think we all want to see that not just for sepsis, but, you know, multiple other instances, but it’s not just a Hey, throw all this data in result comes out. We’ve got it nailed. And I think, as you rightly say, and they have gargantuan amounts of data, and even with all of that, it became, I think what I was reading was it needed to be customized down to the individual level, you know, per site or you know, so I How you generalize AI has been a recurring theme and a recurring problem. And I think that’s one that we really need a lot of focus on. Unfortunately, as we do each week we’ve run out of time so just remains for me to thank you, as always for joining me. And I will look forward to next month Craig, thanks for joining me.
Craig Joseph
It was great. Can’t wait till the next time
