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Milos Prvulovic and Alenka Zajic. Credit: Allison Carter, Georgia Tech

Researchers at the Georgia Institute of Technology have gotten very good at eavesdropping — but not in the traditional sense. Recently, computer science professors Milos Prvulovic and Alenka Zajic discovered that they could steal encryption keys from a major mobile security package by listening in to smartphone vibrations and electromagnetic signals with a portable device.

Zajic told Healthcare Analytics News™ that the exploit takes less than one second to complete. The device, which can be bought for less than $1,000, analyzes signal variations around a given device’s processor clock — basically measuring when its signal is changing to accommodate for the added burden of running encryption &mdash; and then sorts them into zeroes and ones, using that to extrapolate the encryption key.

READ: Cybersecurity Is Undervalued. But That Might Change Soon

Their work, which was supported by the National Science Foundation, Defense Advanced Research Projects Agency and the U.S. Air Force Research Laboratory, was recently presented at the USENIX Security Symposium in Baltimore. The researchers notified software developers of the exploit before it was published, but Zajic said it’s unclear whether any malicious actors found and used the exploit before her team caught it.

“It is hard to tell since bad actors do not advertise their success,” Zajic said.

Side-channel exploits aren’t new, but the specific exploit the Georgia team found completely changes the game.

“What is unique about our finding is that only one recording of the signal is sufficient to recover the full key,” Zajic said.

Prior side-channel attacks on encryption needed “thousands of observations” of a device’s signals or key to extract it, a process that wasn’t as viable for hackers because encryption keys change frequently.

“By needing only one recording, it makes the attack more practical and dangerous,” Zajic said. “Both electronic designers and software engineers need to worry about this problem and try to minimize side-channel leakage.”

The researchers tested the exploit on Android devices, but Zajic said that Apple devices are also susceptible to the same vulnerability “in principle.”

Zajic said hackers using a side-channel exploit would only need the encryption key to perform more sophisticated crimes. The exploit can also extract actual data — the encrypted information itself &mdash; but Zajic said that would be largely unnecessary if a hacker has the user’s personal key.

“Once you have a key, there are probably better ways to steal the data or pretend you are someone else (since you have their private key) than side channels,” Zajic told 

in an email, “But it is possible to get data through side-channels too.”

In the healthcare system, Zajic said, encryption is often used to verify user identity and which data said user can access.

“If attackers obtain access to administrator's device, they could pretend to be an administrator and dispense the wrong medicine. Similarly, attackers could penetrate network protection (by having a key) and change many settings in a hospital network,” Zajic said. “We all operate under assumption that encryption will protect us from wrong persons having information about our identity or having our data, and this is mostly true, except when an unauthorized person gets the key to all that info.”

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Articles

Why the finding is significant in healthcare and elsewhere.

Researchers Stop Dramatic New Side-Channel Exploit That Cracks Encryption in 1 Second

For all the advancements of modern medicine, doctors still struggle to decipher the human brain. But a new machine-learning algorithm could drastically simplify the complicated calculus that psychiatrists go through to diagnose conditions such as bipolar disorder and major depressive disorder (MDD), giving them a far easier way to fine-tune medication and treatment.

Researchers at the Lawson Health Research Institute, the Mind Research Network and the Brainnetome Center recently designed an artificial intelligence (AI) system purpose-built to analyze brain scans and pick apart the subtle differences in mood disorders. The algorithm — 

— could help doctors prescribe and predict a patient’s response to a given medication, lessening the period of tortuous trial-and-error before a patient can get the help they need.

READ: mHealth Might Solve Our Prisons’ Mental Health Problem

The researchers used brain scans from 78 young adult patients at the London Health Sciences Center in Ontario, Canada. Of those, 66 patients had already been diagnosed and treated for either major depressive disorder or bipolar type 1. The researchers also used 33 participants with no history of mental illness as a control group for their data set, which was compiled using fMRI scans. Under an fMRI, brains exhibiting MDD and bipolar 1 look different next to each other and compared to the group with no history of mental illness, which the researchers designed the algorithm to identify. They set the AI loose on the data and checked its work based on the patients with an existing diagnosis. All told, the AI was promising — classifying illnesses correctly 92.4 percent of the time.

“The technique can always be improved, and we have lots of ideas there,” Vince Calhoun, Ph.D., president of the Mind Research Network and a professor of neuroscience, computer science and psychiatry at the University of New Mexico, told Healthcare Analytics News™ in an email. “But given the performance was very good for the current algorithm, I think the next steps include scaling up.”

Researchers want to scale the program up to see how it runs on different kinds of MRI machines, and to further automate how the AI processes data and comes to a conclusion (the “analysis pipeline,” as Calhoun put it). They also want to develop a protocol that can help human doctors to perform similar analysis to the algorithm, looking for the same distinctions that the computer does.

Down the line, the technique still needs much more data from additional studies, as well as some way of certifying imaging facilities to do the scans correctly. Calhoun said a widespread implementation would also need cloud-based tools to process the data.

For now, the program is still in its infancy.

“This is not ready for ‘prime time’ or routine clinical care yet,” Elizabeth Osuch, M.D., a clinician-scientist at Lawson Health Research Institute and medical director at the First Episode Mood and Anxiety Program (FEMAP) at the London Health Sciences Center, told HCA News in an email. “But advances in technology may lead to cheaper proxies for an fMRI scan.”

And in any case, Osuch said the AI is designed to be used in cases where traditional DSM diagnoses fails, not on every patient who comes through the door.

But, if implemented properly, it could make the difficult job of distinguishing a patient’s particular mood disorder much easier. The researchers said they already have algorithms that can differentiate bipolar disorders from schizophrenia and classify forms of dementia, and they are working toward applying the approach to everything from autism to ADHD — any disorder that the standard DSM diagnostic approach struggles to nail down.

, “suggests that we may one day have an objective measure of psychiatric illness through brain imaging that would make diagnosis faster, more effective and more consistent across health care providers."

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Photo: Abbas Furniturewalla, Rutgers University.

Over the past few years, wearable technology has become ubiquitous among fitness freaks and many other people, too. Having an easy piece of tech that monitors heart rate, calories burned and activities is useful, but the next generation of the technology could do a lot more than that.

Researchers at Rutgers University—New Brunswick are working on a new system of wearable tech that expands the smartwatch into a far more functional medical device. In new research published in 

the researchers described a smart wristband capable of diagnosing everything from blood cancers to toxins in the air around the wearer.

READ: Digital Health Isn’t a Technological Revolution. It’s a Cultural One.

The “smart wristband,” as it’s called, isn’t as sleek and polished as a Fitbit, but researcher Mehdi Javanmard, Ph.D., told Healthcare Analytics News™ that further miniaturization is the next step. Right now, it’s a wide wrap of circuitry and sensors that connects wirelessly to a smartphone via Bluetooth, like its commercial predecessors. The difference is, the new wristband packs a lot more hardware. With a standard lancet prick (the wristband doesn’t have needles embedded in it, yet), people can use the wearable technology to analyze their blood cell counts, test for certain blood cancers, quantify bacteria and analyze proteins.

Before that happens, though, researchers have more work to do.

“Extensive assessments need to be performed, testing the device on large numbers of patients,” Javanmard said, emphasizing that they must make the device “more rugged.”

The device’s uses are an interesting combination of clinical and commercial.

On one hand (literally), a commercial user could wear a bracelet to monitor insulin levels or check the air quality outdoors when stepping out of the house for a run.

On a clinical level, the device could be put on discharged patients who need further testing, to provide immediate, up-to-date information to doctors without another visit to the hospital. Blood samples are fed into a small plastic channel on the device that’s embedded with tiny gold electrodes and analyzed by a micro-controller.

The researchers tested and developed the device for Android phones, but there’s nothing stopping it from being adapted to iOS or other operating systems.

“Current wearables can measure only a handful of physical parameters such as heart rate and exercise activity,” said Abbas Furniturewalla, the study’s lead author and former undergraduate researcher in the Department of Electrical and Computer Engineering, said in a 

. “The ability for a wearable device to monitor the counts of different cells in our bloodstream would take personal health monitoring to the next level.”

Javanmard mentioned in the release that a whole host of professions could benefit from the device, which could become a next-generation canary for miners to measure poisonous gases in their environment. And, of course, they’d also let every fitness-focused consumer fine-tune their body’s chemistry as well.

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A few times a month, Johnny Kung, Ph.D., and his colleagues sit down with groups of people to tell them about all the different ways they could have been born. Kung works for Harvard University’s Personal Genetics Education Project (pgEd), an outreach group that talks to classrooms, churches and healthcare professionals about the potential of gene-editing technology — and about the ethical dilemmas it presents.

When Kung approaches a class, he can’t shy away from the transformative, and possibly transgressive, nature of his field. Gene editing could give doctors the ability to change the building blocks of human life, overhauling everything from our susceptibility to diseases to our physical strength and stamina. It promises cures for cancer, hereditary disease and any number of genetic flaws that cause hardships. But like our bodies, the world is an imperfect place, and some groups think altering our fundamental code is problematic, for many reasons.

READ: Handling the Headaches of At-Home Genetic Testing

Our understanding of the human genome, and what editing it might produce, remains far from complete, and opponents worry that beginning to change it will have unforeseen and disastrous side effects. Others worry that creating a system in which humans can enhance themselves will further societal divides between the haves and have-nots, allowing only the rich to change their genes and futures.  

Kung accepts this. But he also realizes that personal genetics are only going to play a larger role in personal health and society in the future — and the only way to maximize their potential and minimize their pitfalls is to empower the public to make thoughtful, informed decisions. Techniques like CRISPR/Cas9, short for clustered regularly interspaced short palindromic repeats, and chimeric antigen receptor T-cell (CAR T) therapy are still in their infancy but have already shown groundbreaking results in animal and human trials. As these innovations develop, healthcare providers must learn how to counsel patients, navigating the ethical intricacies of changing the human body among different groups, races and religions.

“For many of the communities we engage with, genetics is so closely tied to questions of health, identity, autonomy and privacy, informed consent and history,” Kung says. “We believe that having these difficult conversations early and frankly is important for our audience to be informed.”

Kung says his team’s goal is to “spark conversations about what ways these communities can ensure that current research in these areas can lead to benefits for their communities while preventing the negative history from repeating.” Usually, Kung goes into a classroom or a community center with a short lecture, orienting people to the basics of what gene editing is. After some PowerPoint slides, he likes to pose different scenarios or ethical dilemmas to the group and have them sort themselves into smaller groups based on their stance. This helps them solidify arguments and process why they hold their own views and why others might feel differently. Trying to decide the future of the human race can get thorny, and for many historically marginalized groups, the scientific advancements have often come at the expense of violence to their communities. Many communities just don’t trust scientists who promise miracles.

In 1932, the U.S. Public Health Service performed a 

nonconsensual study on hundreds of black syphilis patients in the South

, using them as a control population to examine the effects of the disease without treatment. The patients were not told they had syphilis or about the nature of the experiment.

In 2016, Kung met with a group of black pastors in Baltimore for a conference co-organized by the 

Minority Coalition for Precision Medicine

 and the Health Ministries Network to discuss religious and cultural objections to gene editing. Kung had high hopes for the meeting, and more than 100 prominent clergy had signed up to attend. But when the date arrived, after the conference was postponed during protests over a court’s decision to 

drop charges for the officers indicted in the killing of Baltimore resident Freddie Gray

, only a handful of clergy showed up. Kung asked why.

“One of the pastors who was in attendance told us bluntly that, to many of them, Harvard [where the pgEd is based] carries the same connotations as their local medical powerhouse, Johns Hopkins — a history of mistrust, the story of Henrietta Lacks,” Kung says.

Much of modern cancer treatment stems from the cell line of Lacks, a black woman whose biopsied cancerous cells were immortalized by doctors at Johns Hopkins in 1951. Lacks never consented to the procedure nor received any compensation for the invaluable research that resulted from her genetic material. Though her body has saved countless lives and changed the way we understand humanity’s most dangerous disease, she was effectively used as a laboratory specimen by doctors entrusted with her care. Lacks, the Tuskegee experiment and a 

long legacy of eugenics in the U.S. disproportionately targeting minorities

 have all left an indelible legacy in many communities, felt today in an entire demographic’s trepidation toward researchers who promise new cures.

Citing the history of eugenics, critics of gene editing warn that editing of individual human embryos could quickly become a tool of oppression. They fear that bad faith actors wielding complete control of the human genome could carry out genocide or systematic oppression on an unprecedented scale.

Even in a best-case scenario, the ability to edit embryos, like 

, would be reserved for those fortunate enough to afford it. This concern isn’t new — in the ’90s, when cloning first entered the scientific dialogue, 

Princeton microbiologist Lee Silver warned

 that specialized genetic selection could quickly widen the gap between rich and poor. In his book “Remaking Eden: Cloning and Beyond in the Brave New World

Silver explained that privileged classes would have the resources and ability to edit out undesirable traits at will.

Marcy Darnovsky, executive director of the Center for Genetics and Society and one of the most outspoken critics of gene editing of most forms, says that CRISPR technology and other epigenetic procedures could quickly make Silver’s dystopia possible.

READ: Forensic Genealogy Is Neat. Is It Ethical, Though?

This fear is particularly pronounced in one specific kind of epigenetics, a process called germline editing. Germline gene editing changes the genetic makeup of something while it is still in embryo, ensuring that the resultant life form will pass on those changes to their own offspring. In humans, germline editing immediately changes a person’s genome, and thus their life, before they are a conscious being capable of consent or awareness of what’s happening. With a germline change, doctors or scientists could, for example, eliminate the chance that a baby would be born with Huntington’s disease or another hereditary condition. But the fear is that things go further: that genetic treatments become an expensive luxury that one class of people can afford so that all children born to the wealthy will be stronger, taller, smarter and healthier than those who cannot afford treatments.

“This kind of thing could take us to some very ugly places,” Darnovsky says. “We already tolerate pretty huge levels of inequality and unfairness in this society that we have. And I think that to try to add to that, exacerbate that, just seems wrong.”

Make no mistake: Gene-editing technology is here. Public and private labs across the country are throwing money and resources into genetic research and CRISPR trials, and it’s inevitable that, eventually, many of the changes that critics worry about will become possible. But that doesn’t mean this scientific evolution has to play out the way that Darnovsky and others fear.

CRISPR technology can be used both for germline editing and somatic editing, which refers to changing the genes of living cells in a fully formed organism to fight cancer or genetic disease or to provide other enhancements.

Somatic gene editing with CRISPR most recently 

played a semiaccurate role in Dwayne Johnson’s summer blockbuster “Rampage

,” in which Johnson’s gorilla friend is juiced up with edited genes to become enormous and angry, and a gigantic wolf grows bat wings. This sort of Frankenstein-like power is not one of the chief concerns of gene-editing opponents, although Chinese researchers have managed to make 

several species of dogs extremely muscular

. In humans, somatic gene editing has the potential to cure or treat hundreds, if not thousands, of diseases and conditions.

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Germline and somatic editing are being widely researched in both humans and animals despite the ongoing debate. Even so, in 2015, the National Institutes of Health (NIH), a major government source of funding for scientific trials, announced that it would not fund germline gene-editing experiments on human embryos.

“The concept of altering the human germline in embryos for clinical purposes has been debated over many years from many different perspectives and has been viewed almost universally as a line that should not be crossed,” NIH Director Francis S. Collins, M.D., Ph.D., 

. “Advances in technology have given us an elegant new way of carrying out genome editing, but the strong arguments against engaging in this activity remain. These include the serious and unquantifiable safety issues, ethical issues presented by altering the germline in a way that affects the next generation without their consent and a current lack of compelling medical applications justifying the use of CRISPR/Cas9 in embryos.”

Germline editing of human embryos is legal but must be privately funded, a regulation that has been on the books well before CRISPR became prominent: The 1996 Dickey-Wicker Amendment prohibits the creation or destruction of human embryos during any research that uses federal funding. Other countries, such as the U.K. and China, have less restrictive laws: Chinese researchers reportedly used CRISPR to genetically modify human embryos as far back as 2015.

Still, experts say that it’s unlikely germline-editing techniques will make it into a clinical setting in the near future. 

, is an assistant professor at Columbia University who did his doctorate under Jennifer Doudna, one of the first scientists to propose that CRISPR could be used for gene editing. Sternberg says that modern research efforts in the U.S. are largely focused on somatic editing rather than germline editing, and even those studies are in their infancy.

“We don’t even know how well CRISPR is going to work as a way to treat disease in living patients, so it’s really too early to think about doing this clinically in embryos,” Sternberg says.

CRISPR technology is not without risks, and with a scarcity of human trials, it’s still too early to tell how soon they’ll be clinically viable. In June, two studies 

linked CRISPR treatments with an increased risk for cancer in edited cells

. This isn’t necessarily a deal breaker for the technology — it’s more of a risk to study or an eventual problem to fix &mdash; but findings like it will change the ethical risk calculations for doctors who are deciding whether to prescribe a somatic gene-editing procedure in the future. And Darnovsky says we can expect more side effects of gene editing down the line.

“We are at a very early stage of our understanding of how changing one genetic sequence might have biological and health consequences,” she says. “We just learned how to read the human genome a few years ago. If we try to rewrite it now, to rewrite the code, we’re likely to have some bugs.”

For doctors and scientists working on genetic treatments for disease, Sternberg explained that there’s an ethical difference between exposing a living patient to the risk of a procedure going wrong and exposing a future person to an unforeseen host of effects. A living patient may consent to a CRISPR treatment, knowing there’s a chance they’ll contract cancer, because they think it will give them the best shot at life. But an embryo and future offspring can’t consent to having their genetic code completely altered.

Fortunately, in our current medical system, germline editing is largely unnecessary to treat medical conditions.

“I think it’s going to be very rare that you’ll have medical needs that would justify germline editing,” Sternberg says. Instead, major companies pursuing CRISPR technologies on a clinical, commercial level — 

— will “completely avoid the germline issue,” Sternberg adds, bypassing the difficult ethics of modifying embryos to focus on somatic-editing therapies to treat medical conditions in living patients.

The solution to this, and to some of the more ideological critiques of gene editing, Sternberg says, is to treat gene editing as any other medical procedure.

READ: Lost in the CRISPR Hype, a Gene-Editing Giant Is Fighting Back

“I think it’s often mentioned in this way as being a very profound thing,” Sternberg notes. “I don’t actually see intervention at the genetic level as something we should do any more or less seriously than intervention at a surgical level or in a way that might modify the genome of certain cells. The question is, can some intervention address medical needs? Can it be offered in an equitable, socially responsible way, and are there any safety concerns that may be intended or unintended that we need to address?”

And right now, somatic gene editing shows great potential to help. Novartis’ 

groundbreaking CAR T cancer treatment, Kymriah

already met Food and Drug Administration approval

, and doctors and hospital administrators are starting to include it in their budget analyses. A single dose of the treatment is $475,000, which means the cost-benefit analysis for administrators is going to be heavily driven by how effective it really is — something we won’t know until it’s been used many, many more times.

What focusing on somatic, clinical applications of gene-editing technology doesn’t solve, however, is the social ethics component of the conversation. The applications for CRISPR tech are varied, from a cure to cancer to enhanced muscle tone. As the medical science community gains further understanding of the human genome, more solutions will present themselves and more cures will become available. Darnovsky worries that gene editing will become like cosmetic surgery, which was first proposed as a treatment for patients with disfiguring wounds but then became a luxury for those who could afford it. Except gene editing could create differences even more drastic than those of personal appearance — it could weed out diseases, improve life expectancies and change bodies. Those who will miss out on these advancements are the populations of people the existing medical system in the U.S. often overlooks: the uninsured or underinsured, the poor, ethnic minorities and rural populations living far from well-equipped, metropolitan healthcare networks.

Sternberg mentioned the case of sickle cell anemia, a chronic genetic condition that predominantly affects African-Americans. Sickle cell is virtually incurable, but there are treatments that have improved the life expectancy for many affected patients. And yet hydroxyurea, the most effective treatment for sickle cell, is 

 by doctors, and many patients in the developing world have no access to it at all.

“If that isn’t available today, then what is going to be the landscape with a new, highly priced drug named CRISPR that’s even more difficult for most of these people to access or pay for?” Sternberg asks. “None of that excitement [about CRISPR] addresses these underlying problems with access and insurance.”

Sickle cell is one of many diseases that 

CRISPR (combined with stem cell therapies) has the potential to cure,

 but Sternberg points out that its mere existence doesn’t guarantee the tech will get to where it needs to go.

Kung covered this on the second day of his meeting with church leaders last year. He was invited back to one of the pastors’ churches to speak more about the coming revolution of personal genetics. The pastors told Kung to focus on the technology’s potential to deliver patients from suffering rather than its comparisons to “playing God.” In Tuskegee, with Henrietta Lacks, researchers were playing God, with unwitting subjects unable to consent. With gene editing, that possibility is on the table, particularly if the technology is deployed in a way that only some have the means to use it.

Speaking to the pastors, Kung says, “showed us how wide the gap is between the biomedical research community and some of the communities it’s supposed to serve. And how much work still needs to be done to narrow this gap.”

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Jack Crosbie

Articles

Researchers Stop Dramatic New Side-Channel Exploit That Cracks Encryption in 1 Second

AI Can Help Doctors Diagnose Tricky Mood Disorders Like Bipolar 1

Next-Gen Smartwatches Could Measure Blood Cells and Environmental Hazards

The Complicated Ethics of Gene Editing