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If you haven’t seen it yet, and you subscribe to Netflix, I suggest you watch The Social Dilemma. It’s about ninety minutes and attempts to explain how social media sucks up our time and manipulates susceptible people into accepting misinformation as true. Part interviews with knowledgeable people from the worlds of Facebook, Twitter, Mozilla, Firefox, Apple, Instagram, Uber, Pinterest, YouTube, and Google, and part docudrama, I found the show to be very informative.


It all boils down to the monetization of social networking platforms. There’s no free lunch. What you think is free is costing you your time and, if you don’t take responsibility for verifying information, your ability to know what is true. There are some pretty scary forces out there trying to hack our brains and, in many cases, succeeding.


Part of what I discuss below is in the Netflix movie, some isn’t. Likewise, not everything mentioned in the film is discussed below, so I recommend watching The Social Dilemma to learn about everything it covers.


Social networking started off as mainly a force for good. It kept people connected—united family members, helped bring attention to good causes, and kept people informed about local events. Monetization wasn’t important back in the good ol’ days. The turning point for that was 2012, when Facebook went public. It had many users hooked, and now was poised to make a lot of money.


In the 2010s, the biggest moneymakers in Silicon Valley have not been the hardware and software companies that garnered the area’s reputation for tech innovation and profit. The biggest profit centers in recent years have been the social networking platforms, the companies basically selling YOU, their users. More specifically, they are selling YOUR ATTENTION. To be clear, the people who use these platforms to connect with friends and search for the best deal on a laptop are the USERS, not the customers. The real customers are the advertisers.


As I see it, there are two main problems here: 1) the insinuation of these platforms into our lives, causing addictive behavior and wasting our time, and 2) the changes these platforms can produce in our view of the world.


In the movie, Jaron Lanier explained it best: “It’s the gradual, slight, imperceptible change in your own behavior and perception that is the product” using manipulation and persuasion techniques. Sounds like a slow form of brainwashing to me. What’s really scary is that as the companies gather more and more information on us by following our likes, the videos we watch, and how long we stay on a page, they constantly improve their algorithms, allowing them to “sell certainty” that a particular ad will get the attention of the users they target and therefore enhance their already substantial bottom line.


How do they draw us in, keep us engaged and coming back, inviting friends? A technique called positive intermittent reinforcement. In the case of social media, rewards are doled out unpredictably, on a variable-ratio schedule. By offering rewards (a notification, a like, an email, a news item you like) in an unpredictable fashion, it keeps you checking your phone and scrolling. A slot machine operates in the same manner – you never know when you’re going to come up with three cherries. Maybe with the next quarter . . . Having studied behavior modification in the past, I’m familiar with the power of intermittent reinforcement, especially if given in a variable-ratio schedule. It can be much stronger than a predictable reward, such as picking a certain number of apples for a predictable paycheck.


With so many users, companies are able to optimize manipulation using small changes in subsets of users which they can test, tweaking and continually improving their behavior modification techniques. Even people who work in these companies say they fall prey to the manipulation.


In the movie, some attention is given to the harmful effects social media has on children. I won’t go into that here, but will repeat that members of Gen Z, those born after 1996, are the first generation to use social media in middle school, and it’s probably not good for them.


Wasting your time and conning you to spend lots of time scrolling through junk is bad enough. The really scary aspect, however, is how social media has been hijacked by people and groups with a nefarious purpose. This has been easy because YouTube and Facebook are set up to present information to you based on your profile (gleaned by spying on you), the goal being to keep you engaged (in contrast to Wikipedia, where everyone sees the same content, and they don’t strive to keep you on their site).


For example, a search for climate change will give you different results depending on your interests. You may be directed to sites indicating it is a great hoax, or sites showing it to be a great threat. Whichever type of site you are led to, you can get a false sense that everyone agrees with you. Then you can easily fall prey to manipulation. When people are presented with different information they deem to be credible, they will come to different conclusions.


Interestingly, an MIT study concluded that fake news on Twitter spreads six times faster than accurate stories. The more outrageous the story, the more interesting it is, and the more it spreads. The Social Dilemma used Pizzagate as an example.


I remember first hearing about Pizzagate on the news, where it was described as a belief some people had that Hilary Clinton and other high-ranking Democrats were involved in a child sex ring working out of restaurants, including a Washington, D.C. pizzeria. I dismissed the story as being so ridiculous, nobody would believe it, but the facts show that I was wrong. According to Wikipedia, one poll showed that 9% of registered voters thought Hillary Clinton was involved in this child sex ring, and 19% weren’t sure.


The conspiracy theory, which was subsequently connected to Michael Flynn and his son, was spread by a number of right-wing news organizations. One man became so upset by the story, he drove to the pizzeria from his home in North Carolina and shot into the restaurant three times with his rifle.


You may wonder how so many people believed the story. Apparently, once the conspiracy groups popped up, Facebook started suggesting these groups to other users deemed susceptible to conspiracy theories, such as anti-vaxxers and believers in chemtrails. These malleable individuals were directed to social media platforms discussing Pizzagate, even though they had never searched for it. The ultimate goal of Facebook was to keep the users engaged, so they could be shown ads from paying customers. However, often those customers, paying for directed messaging, have perverse intentions.


Charging for directed ads has become sophisticated and lucrative. I first heard about this from my son who attended a conference where this was discussed. Platforms can have instant pricing where advertisers agree to spend a certain amount of money to reach a particular sort of user.


By targeting users who meet specific demographics, social media has been weaponized. People with a lot of money, or governments (Russia for example), can send out manipulative messages quickly and cheaply. In this way, a government can be destabilized. Right now, most countries targeted in this way run democratic elections. Russians don’t need to hack into our system – they just exploit our existing platforms to sow chaos and division.


How is this done? Facebook can find thousands of people who believe the earth is flat, for example. A nefarious actor can promote conspiracy theories and misinformation to these people, influencing their beliefs, and, ultimately, their vote.


If you have someone in your household who you know has very different opinions than you do, I suggest you do an experiment and see what shows up on your searches when you enter certain words, such as: Trump, Biden, the second amendment, Palestinians, fracking, the affordable care act, etc. You get my drift. I would be interested in finding out what happens.


At the core of the problem is the business model. There is little in terms of rules, regulation, and competition. All businesses need to be reined in. I think of them as like bacteria – they will seek the most profits they can get mindlessly, without regard to the ultimate outcome. Just as bacteria mutate to evade antibiotics, businesses hire lawyers to get around regulations. Governments must constantly adapt to keep companies in line, just as we do what we can to overcome bacterial infections. Our lawmakers have a new challenge – they need to come up with ways to prevent the manipulative techniques at play.


Facebook has promised to set up and oversight board to protect us from false information. That still hasn’t happened. Recently, a group of concerned citizens has organized the “Real Oversight Board” in an attempt to hold big tech accountable. Until a better way is found, we need to judge for ourselves what to believe and what not to believe.


Here’s my approach: look at reliable news sources from both the right and the left. Importantly, check things out. If something doesn’t seem reasonable, search for reliable information. Rely on trusted sources as well as your own common sense. The latter is very important. I present two falsehoods I’ve come across, one political, one not.


Political: In an ad funded by America First Action (a Trump super PAC), a video of Joe Biden is presented as “Defund the police?” is splashed on the screen. Joe Biden says, “Yes, absolutely.” If you are not paying attention, you might think Joe Biden said he wants to defund the police, while he actually might have been answering “Yes, absolutely,” to the question, “Would you like your bagel toasted?” In truth, Biden has never supported defunding the police. I remember listening very carefully to him after defunding the police became a popular topic of conversation. He immediately dismissed the idea and has consistently held that he is not in favor of it. If you don’t believe me, check out his website and try to find something about defunding the police.


Nonpolitical: My hairdresser informed me that she’d heard doctors have the cure for cancer, but don’t want to give it to people because they make more money treating cancer patients than they would by curing them. It’s surprising that anyone could believe this, especially since doctors die of cancer, just like non-doctors. The same is true of pharmaceutical executives who some people think are withholding cures to make more money on medications for patients who aren’t cured. There are so many reasons why this makes no sense – a doctor or pharmaceutical company with a cancer cure could charge a whole lot of money (some medications which don’t cure cancer cost over $100,000/year currently). Why would a doctor or pharmaceutical company waste their time finding a cure if they had no intention of using it? Wouldn’t you expect at least one egotistical or humanitarian doctor or person in the pharma industry to break with the others and divulge this information? Using a little common sense, anyone should be able to figure out that this idea is nonsense.


If we as a society continue as we are going, we run the risk of destroying civilization through willful ignorance. We need to take control of the situation before we reach the singularity – the point where we can’t outsmart the computers, and can no longer control our technology. Let’s not go there.


Start with watching The Social Dilemma if you haven’t seen it yet.


And now (I really hate doing this), I’m going to ask you to please visit my Facebook page at https://facebook.com/devengreeneauthor. I’m giving in to pressure to advertise my first novel on Facebook (remember, I said social media can be used for good). On my Facebook page you’ll find useful links to area 51, the alien autopsy, the Sandy Hook Elementary School hoax, and verified sightings the Loch Ness monster (if you think I might be lying, check out the site). If you like the site even a little, please give it a like.


Earlier this month, I read in a Wall Street Journal article that a research lab at UC San Diego and Abcam, a British biotech company, were contributing money to the Henrietta Lacks Foundation to support STEM higher education for descendants of Henrietta Lacks.


Henrietta Lacks was made famous posthumously by the book "The Immortal Life of Henrietta Lacks," a 2010 best-seller by Rebecca Skloot. I'm sure some of you reading this blog have read it, and some may have seen the 2017 movie. I became aware of the book in 2010 when I tuned in NPR and heard a narrator describe how cells taken from a woman's cervical malignancy were grown in a lab, the first time a scientist had successfully grown human cells in tissue culture indefinitely. I was immediately drawn to the story, having utilized tissue culture myself in experiments I ran in what I call "my previous life," when I was a biochemist (before I went to medical school and became a pathologist). I never used human cells in my research, but was quite familiar with HeLa cells, which were used in many other labs.


I had learned that HeLa cells were grown from the ovarian cancer of a middle-aged woman named Helen Lane. Listening to the narrative, I learned that the cells actually came from the cervical cancer of a thirty-year-old woman named Henrietta Lacks, who died less than a year after a sample of her cells was taken.


I became curious about the about the origin of the cell line, and since there was a book written about it, I thought the story might be interesting.


I read the book, and found the story of Henrietta Lacks and her descendants to be sad, yet unfortunately, not unique. Of more interest to me were descriptions of the history of tissue culture, where I recognized the names of some of the scientists mentioned. I would recommend the book to anyone interested in the subject matter, with a caveat to be wary of oversimplification of some aspects, probably due to the author's unfamiliarity with some facets of the discussion. The Immortal Life of Henrietta Lacks is not a suspenseful mystery, so my description below is not a spoiler.


Henrietta Lacks was a poor, uneducated black woman who suffered from more than her share of the usual economic and social inequities of the time. She had been diagnosed with neurosyphilis in the past but refused treatment. Two months before her cancer diagnosis, she visited a doctor, probably at Johns Hopkins (although it's not stated in the book), where "Tests showed areas of increased cellular activity in the cervix," according to Skloot. I cannot tell what test was done at the time. Perhaps a Pap smear, perhaps a Lugol's iodine stain. The author had the medical record, but her reporting is vague.


Ms. Lacks was referred to a specialist to rule out malignancy but failed to go. To her detriment, she probably had a general distrust of doctors, as did many in her ethnic group. After the birth of her fifth child, Ms. Lacks complained of discomfort and finally sought care at Johns Hopkins which, in addition to being a well-respected tertiary care medical center, was a charity hospital.


While Jim Crow was alive and well at Johns Hopkins at the time and Ms. Lacks was segregated in the colored area of the hospital, her treatment was state-of-the-art. She died less than a year later after suffering great pain, despite receiving pain medication at the end. This is a heart-rending story, not different from that of others with advanced cervical cancer at the time. What happened to Henrietta Lacks's cells removed during her treatment, and her family’s reaction, gives rise to the core of the book.


Upon admission to the hospital for treatment, Ms. Lacks signed a consent for surgery. During implantation of radium tubes in Ms. Lacks's cervix, the treating physician removed two pieces of tissue, one piece malignant, one benign. The specimens obtained at that time may not have been needed for Ms. Lacks's treatment, but the procedure wasn't harmful.


The specimens were given to a researcher at Johns Hopkins who had been procuring tissues obtained during surgery, hoping to grow human cells in tissue culture for research. Obtaining samples in this way was and is a common practice, generally using tissue that would be discarded otherwise. Permission to use such tissue is covered in the language of most surgery consent forms. Removal of additional tissue without the patient's permission, as may have happened in Ms. Lacks's case, would not be considered ethical currently. At the time, however, there were no regulations in place.


The Johns Hopkins researcher who received the tissue had tried to grow human cells many times. The cells obtained from Ms. Lacks were the first that continued to grow indefinitely. Additional tumor tissue was removed at autopsy (after a consent was signed) but wasn’t needed to establish the cell line, named HeLa. The cells were attributed to a fictional person named Helen Lane to protect the identity of Ms. Lacks, even though this was decades before HIPAA was implemented.


Unbeknownst to the Lacks family, the cells cultured from Ms. Lacks kept growing and dividing. The scientist who first grew them shared them with other labs in the hope of advancing scientific knowledge. He never sold the cells, and never made money from distributing them. The same was true of Johns Hopkins and other scientists who grew, used, and shared the cells.


HeLa cells were eventually used for the manufacture of the polio vaccine (which was never patented) and led to many significant investigations. A company, Microbiological Associates, and a non-profit agency that supplies labs with cell lines, the American Type Culture Collection (ATTC), began selling HeLa cells. The money ATTC collected for the cells covered the overhead cost of growing and mailing them. It is not stated in the book how much profit, if any, was made by Microbiological Associates.


At some time, members of the Lacks family became aware of the existence of HeLa cells. Skloot published parts of conversations she had with them. Unfortunately, she presents a rather unflattering picture of them. They come across as incapable of understanding what HeLa cells are, mad that the cells were attributed to Helen Lane instead of Henrietta Lacks (as if there had been a conspiracy to rob Ms. Lacks of credit due her), outraged that the cells were taken, and infuriated they hadn't gotten any money, being convinced others had profited wildly from the cells.


In truth, the success of HeLa cells depended upon the contributions of scientists who developed techniques to grow and ship the cells. Years later, when there was real money in biotech, large profits may have been made using HeLa cells in conjunction with information gleaned from many costly experiments. The author didn’t present evidence that large profits were made from HeLa cells themselves.


Due to contamination of other cell lines with HeLa cells in the 1970's, blood samples from Ms. Lacks's relatives were obtained to determine which lines were compromised. According to Skloot, the relatives didn’t know why their blood was taken then, although the researcher who spoke to them claimed she explained it to them and thought they understood. Skloot indicated it is unlikely they understood because they weren't capable of understanding much.


I'm sure each reader takes away something different from this book, but I believe the overall message promoted by the author is that the Lacks family has suffered from racism and profiteering in medicine. I don’t think that is an accurate interpretation of the events. I didn't see evidence of racism in the therapy Ms. Lacks received. There was no profiteering by the man who originally grew her cells. Others may have made money using her cells later, but it is unclear how much, and what per cent could be attributed to her cells vs scientific discoveries. Ms. Lacks's contribution was an unfortunate accident of nature coinciding with being at Johns Hopkins at the right time. (Many people, by comparison, make important contributions to society without renumeration. For instance, art dealers can make huge amounts of money from paintings made by people who made little money for themselves or their heirs.) Eventually, probably due to the book, the family has received recognition, and a foundation has been set up in Henrietta Lacks's name.


The book (but not the movie) discusses ethical issues that came up later, before today’s laws to protect patients from experimental treatments were instituted. An interesting ethical case discussed in the book involves the human cell line Mo (named for John Moore). John Moore was a white man whose spleen was removed at UCLA for treatment of leukemia in 1976. A researcher, Dr. David Golde, grew cells from his spleen and discovered they made a protein that could be used in research and treatment. Skloot inaccurately states Dr. Golde, an oncologist, removed the spleen, whereas of course another doctor, a surgeon, performed the splenectomy.


Dr. Golde regularly collected blood and other specimens from Mr. Moore (I'm not sure why, as his cells were already growing), leading the patient to think the painful procedures he routinely underwent were part of his treatment (they weren't). I remember learning about the case when I was a pathology resident at UCSF. By then, I knew that specimens removed during surgery were regularly routed to researchers with an interest in certain tumors or tissues. Again, the consent form allowed for this. Monetary returns were generally of no concern at the time, as there was little money in biotech.


My recollection of events differs somewhat from those described by Ms. Skloot, but not in a material way. Mr. Moore moved to Washington state, and decided he no longer wanted to fly to Los Angeles for testing. He asked Dr. Golde if someone local could take his samples. When Dr. Golde offered to pay his travel expenses and put him up at an upscale hotel, Mr. Moore became suspicious and discovered that Dr. Golde had patented his spleen cells and turned them into a very profitable enterprise. A suit and several appeals ensued. Ultimately, the court ruled in Dr. Golde's favor, and Mr. Moore wasn't compensated. He ultimately died in 2001 and, although not mentioned in the book, Dr. Golde committed suicide in 2004.


The case brings up a number of ethical issues. In my opinion, obtaining specimens from Mr. Moore, causing him pain but not benefitting him medically, was a giant breach. The matters of cell and gene patenting are messy, and have not yet been fully worked out. Technology outpaces legislation. At this time, most surgical consents include permission to use or discard tissue removed at the discretion of the institution. There is still no agreed-upon process for remuneration from profitable specimens. Don’t expect to make a lot of money from your appendix.

I was going to write about something else, but when this started popping up all over the media, I couldn’t let it go.


If you’ve been tuned into the news lately, you must have seen Donald Trump pathetically bragging about his outstanding performance on a cognitive test, reported as being the Montreal Cognitive Assessment, or MOCA.


Apparently, he was able to correctly identify pictures of a lion, a rhinoceros, and a camel. He said he didn’t think that part of the test was challenging. So far so good. He didn’t disclose whether or not he was able to draw a clock showing ten past eleven correctly, count backward from 100 by 7’s, or complete several other tasks included in the test.


The one thing he focused on, and repeatedly bragged about, was his ability to remember five words: person, woman, man, camera, and TV. He described the astonishment of his test giver(s) at his remarkable memory.


Here’s the problem (I’m surprised I haven’t seen this mentioned in reports): those five words are not part of the MOCA test. The actual words are: face, velvet, church, daisy, red. As I understand it, there are several variations of the test (which I haven’t seen) so repeat takers won’t be familiar with it. However, I doubt if person man, woman, camera, and TV appear on any. You may wonder why, and what difference it makes.


Let me explain why the exact composition of the word list is hugely important. Any reasonable test of useful memory would include five unrelated words, like those in the MOCA test which I listed above. Another such list might be: drum, river, nose, curtain, farmer.


However, person, woman, and man are closely related to each other and therefore easy to remember together. If the test-taker remembers person, then the two following associated words are easy to come up with. After that, the list requires recalling the word camera which is not as closely related to the previous three words, although one might think of a person, man or woman, holding a camera. The connection of camera to TV is obvious. This list would be analogous to memorizing the list: pitcher, bat, base, car, lock.


The real question is: was Donald Trump really asked to memorize the strange list as he claims? If so, did he indeed memorize it on the spot, or is he lying about it (we know he’s a serial liar)? It wouldn’t be a stretch to imagine he practiced and memorized this simple list after he took the test, unable to remember a more difficult one.


I think Mary Trump summed it up best on the Late Show with Stephen Colbert recently when she said, “His talking about it the way he’s talking about it is failing the test.”

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