What happens when AI is your therapist?

By Adriel Bettelheim

THE ROAD TO WELLVILLE?: AI-powered health apps are proliferating. We’re not ready for them.

The mental stresses of the pandemic have fueled a boom in wellness devices that track speech, facial expressions and even eye blinks to assess emotional states. This kind of “affective computing” can replicate therapy or detect depression when in-person care isn’t available — and even remotely monitor workers and children.

But the burst of interest is heightening concerns about whether there’s enough government oversight of the technology, known as “emotion AI”. Future Pulse spoke about the tension points with Alexandrine Royer , a doctoral candidate studying the field and the digital economy at the University of Cambridge and a student fellow at the Leverhulme Centre for the Future of Intelligence. The conversation was edited for length and clarity.

Emotion AI is in its infancy and can only capture a limited range of human emotions, at best. Does it have any constructive use right now?

Emotion AI might be beneficial when it is used for the day-to-day management of symptoms. It can also encourage individuals to take further steps towards improving their mental well being, and the wide availability of tools can reduce the stigma surrounding mental health treatment. But it remains a supplementary tool and not a cure.

It’s also worth noting the wide pool of devices that fall under affective computing and mental health. Sensor-equipped virtual reality devices can help expose patients to stress-inducing scenarios within the safety of their home or psychologist’s office. The essential element is that there is ultimately some form of clinical oversight over these self-guided treatments.

You’ve written the wellness industry is eager to profit on the digitization of health care and that people who can’t afford in-person therapy may be referred to bot-powered counseling. Where should the government set guardrails?

The government doesn’t require that digital tool providers have a “duty of care” towards their users. More stringent regulation on the safety and reliability of these digital mental health solutions would allow for gimmicky apps to be removed from app stores.

The FDA should reconsider how it classifies AI-powered therapies as “minimal risk” and ask that such digital tools provide accurate information on how to reach other person-based resources. Some applications do not have any protocols in place if the user is at risk of suicidal thoughts. Prolonged clinical testing of the application, and peer-reviewed findings, should be required before these chatbot therapists are released onto the market. Users should also be made aware how the credentials of digital tool providers compare to those of licensed professionals.

Our personal devices already track the way we sleep, exercise and eat. Why the concern over tracking people’s emotions?

We have yet to achieve a scientific consensus on how to recognize human emotions. Not only is the information at risk of being inaccurate, but it can also be tinged with certain biases. Emotion AI systems that incorporate facial-recognition have been found to poorly identify the emotions of people of color. Digital tracking can have far-reaching consequences for individuals as employers are increasingly looking to integrate mood analysis software into recruitment strategies and monitoring of daily worker performance.

You argue the push for affective computing can widen health disparities. How so, and what can be done to avoid that?

Digital tools are attractive as they are cheaply sourced, infinitely scalable, always available, and cannot experience the emotional exhaustion that overworked therapists face. For health insurance providers and employers, it can be tempting to limit coverage to digital solutions.

It’s estimated that 100 million people reside in communities in the U.S. that suffer from shortages in mental health professionals. As the cost of affordable therapy remains a barrier to many, health care providers may look to gradually replace in-person mental health care in favor of automated therapists. Digital solutions can thus appear as a panacea rather than encouraging further investments into early interventions and preventative measures in vulnerable communities.

Welcome back to Future Pulse, where we explore the convergence of health care and technology. Share your news and feedback: @dariustahir, @ali_lev, @abettel, @samsabin923, @_BenLeonard.

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Paul Kedrosky @pkedrosky “Was chatting with someone in concierge medicine today who sets up specialist appointments for large company execs. I asked, out of curiosity, which speciality has the longest/shortest wait times in SoCal.

Shortest: Dermatology (< week)

Longest: Migraines (~2-3 mos)”

RITE AID RAPPED ON VAX SCHEDULING SITE: As regular Future Pulse readers know, scheduling vaccine appointments online has been a particularly difficult task for patients with disabilities. This week, the Justice Department stepped in, striking an agreement with Rite Aid Corp. to update its booking site and make it accessible to people who use screen reader software and have a hard time operating a mouse.

Under the pact, the pharmacy chain agreed to make content about Covid vaccines, including the forms for scheduling appointments, conform to the Web Content Accessibility Guidelines — a set of voluntary industry standards for making information on a website accessible to users with disabilities. Rite Aid will have to regularly test the scheduling and information pages and promptly fix any problems that keep people with disabilities from accessing them.

“The internet is where people gain access to information about Covid-19 vaccines and schedule vaccination appointment,” Bruce Brandler, acting U.S. Attorney for the Middle District of Pennsylvania, said in a statement.

The settlement highlights a pattern stretching back to the beginning of the vaccine rollout, when advocates argued that scheduling sites weren’t sufficiently user-friendly. Some lacked adequate non-English language options while others were confusing to older Americans. But as with so many things Covid, the trend was there all along: health tech developers have long overlooked disability issues in designing their software, prompting some clinicians to sue medical records companies over screen-reader deficiencies.

EQUIPPED FOR BATTLE?: A surge of data breaches in health care exposed 12 billion pieces of protected health information last year, according to some estimates. But about two-thirds of health care organizations say they have access to the appropriate information security and tools and resources, the highest rate of any industry, according to a recent survey from information security company Shred-it.

The survey nonetheless found that 42 percent of health care organizations don’t have an incident response plan. And just a third undergo vulnerability assessments.

Sean Gallup/Getty

An overwhelming majority of organizations — 85 percent — have cyber insurance to mitigate losses from security breaches, according to the survey, which also found that 56 percent of organizations have suffered a data breach.

Health information breaches have climbed in recent years, according to data from HHS' Office of Civil Rights , with tens of millions of people now being affected by breaches every year. Shred-it says there was a 73 percent increase in the number of confirmed data breaches in health care in 2020.

TRANSPARENCY AND ONLINE DRUG SALES: The Senate Judiciary Committee this week signaled a willingness to strengthen safeguards shielding consumers from counterfeit or unsafe goods sold online, an issue that's gained prominence with more illegal sales of prescription drugs.

Lawmakers see a vehicle in the INFORM Consumers Act, which aims to provide more transparency by mandating online marketplaces verify and disclose information about high-volume third-party vendors. The legislation — which could make it more difficult for sellers of illegal and potentially counterfeit drugs — is backed by both committee Chair Dick Durbin (D-Ill.) and ranking member Chuck Grassley (R-Iowa).

About 95 percent of online pharmacies are selling substandard products, operating unlicensed or otherwise engaged in illegal activity, according to the National Association of Boards of Pharmacy. Polling from the ASOP Global Foundation has shown that more Americans have turned to online marketplaces for medications during the pandemic.

Advocates for crackdowns on rogue online pharmacies have pushed for further action, including reforming Section 230 of the Communications Decency Act, which shields platforms from liability for how they police user content.

The FDA recently pressured social media sites and internet service providers to crack down on rogue pharmacies. In an ASOP Global roundtable Tuesday, Dan Burke, division chief of cyber operations for FDA's criminal investigations office, reiterated calls for social media companies to be proactive.

NEW TECH FOR HOME-BASED DIALYSIS: The Centers for Medicare and Medicaid Services is making a series of changes aimed at expanding at-home dialysis for socioeconomically vulnerable populations. And it envisions a prominent role for new technology.

For the first time, the agency has qualified a device under a program that awards enhanced payments for innovative tools deemed to improve the clinical experience. The device, a hemodialysis machine from Outset Medical, is cloud-connected and allows for remote patient monitoring so doctors can oversee at-home care. The company says it’s an alternative to more complicated machines that, along with extended preparation time, hinder at-home services.

Last year, CMS said that more than 85 percent of Medicare fee-for-service patients who had end-stage renal disease had to leave the home to get dialysis for a minimum of three times weekly.

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How closely have you followed recent health-tech headlines? (Answers below)

1) Digital Covid-19 vaccine credentials, sometimes called vaccine passports, are now available to more than this many Americans:
A) 50 million. B) 100 million. C) 150 million. D) 200 million.

2) Researchers recently were able to transplant a kidney from this animal into a human without triggering immediate rejection.
A) Pig. B) Baboon. C) Rabbit. D) Cow.

3) The FDA just teamed with the National Institutes of Health to evaluate these products in order to speed up federal reviews:
A) Covid-19 antiviral pills. B) Covid-19 at-home tests. C) Wearable devices to track virus-like symptoms. D) New telemedicine apps.

4) Moderna is delaying its bid for a kids Covid shot in the U.S. so it can:
A) Expand manufacturing. B) Donate more doses abroad. C) Study the optimal dosage. D) Study the heart risk in teens.

5) The federal government last finalized standards for collecting race and ethnicity data in public health programs to track disparities in:
A) 1997. B) 2008. C) 2011. D) 2020.

Vaccine-related coinages dominate the Oxford English Dictionary’s words of the year, The Washington Post reports.

Googler and former HHS official Karen DeSalvo considers the next era in public health in the American Journal of Public Health.

And a cyberattack at one San Diego-area hospital displaced patients and overcrowded neighboring emergency departments, a new study discussed in MedPage Today says.

Answers to Pop Quiz: 1) C. 2) A. 3) B. 4) D. 5) C.

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