Is Finding Out Your Baby’s Genetics A New Responsibility of Parenting?
Hours after a baby is born, its heel is pricked with a lancet. Drops of the infant's blood are collected on a porous card, which is then mailed to a state laboratory. The dried blood spots are screened for around thirty conditions, including phenylketonuria (PKU), the metabolic disorder that kick-started this kind of newborn screening over 60 years ago. In the U.S., parents are not asked for permission to screen their child. Newborn screening programs are public health programs, and the assumption is that no good parent would refuse a screening test that could identify a serious yet treatable condition in their baby.
Learning as much as you can about your child's health might seem like a natural obligation of parenting. But it's an assumption that I think needs to be much more closely examined.
Today, with the introduction of genome sequencing into clinical medicine, some are asking whether newborn screening goes far enough. As the cost of sequencing falls, should parents take a more expansive look at their children's health, learning not just whether they have a rare but treatable childhood condition, but also whether they are at risk for untreatable conditions or for diseases that, if they occur at all, will strike only in adulthood? Should genome sequencing be a part of every newborn's care?
It's an idea that appeals to Anne Wojcicki, the founder and CEO of the direct-to-consumer genetic testing company 23andMe, who in a 2016 interview with The Guardian newspaper predicted that having newborns tested would soon be considered standard practice—"as critical as testing your cholesterol"—and a new responsibility of parenting. Wojcicki isn't the only one excited to see everyone's genes examined at birth. Francis Collins, director of the National Institutes of Health and perhaps the most prominent advocate of genomics in the United States, has written that he is "almost certain … that whole-genome sequencing will become part of new-born screening in the next few years." Whether that would happen through state-mandated screening programs, or as part of routine pediatric care—or perhaps as a direct-to-consumer service that parents purchase at birth or receive as a baby-shower gift—is not clear.
Learning as much as you can about your child's health might seem like a natural obligation of parenting. But it's an assumption that I think needs to be much more closely examined, both because the results that genome sequencing can return are more complex and more uncertain than one might expect, and because parents are not actually responsible for their child's lifelong health and well-being.
What is a parent supposed to do about such a risk except worry?
Existing newborn screening tests look for the presence of rare conditions that, if identified early in life, before the child shows any symptoms, can be effectively treated. Sequencing could identify many of these same kinds of conditions (and it might be a good tool if it could be targeted to those conditions alone), but it would also identify gene variants that confer an increased risk rather than a certainty of disease. Occasionally that increased risk will be significant. About 12 percent of women in the general population will develop breast cancer during their lives, while those who have a harmful BRCA1 or BRCA2 gene variant have around a 70 percent chance of developing the disease. But for many—perhaps most—conditions, the increased risk associated with a particular gene variant will be very small. Researchers have identified over 600 genes that appear to be associated with schizophrenia, for example, but any one of those confers only a tiny increase in risk for the disorder. What is a parent supposed to do about such a risk except worry?
Sequencing results are uncertain in other important ways as well. While we now have the ability to map the genome—to create a read-out of the pairs of genetic letters that make up a person's DNA—we are still learning what most of it means for a person's health and well-being. Researchers even have a name for gene variants they think might be associated with a disease or disorder, but for which they don't have enough evidence to be sure. They are called "variants of unknown (or uncertain) significance (VUS), and they pop up in most people's sequencing results. In cancer genetics, where much research has been done, about 1 in 5 gene variants are reclassified over time. Most are downgraded, which means that a good number of VUS are eventually designated benign.
While one parent might reasonably decide to learn about their child's risk for a condition about which nothing can be done medically, a different, yet still thoroughly reasonable, parent might prefer to remain ignorant so that they can enjoy the time before their child is afflicted.
Then there's the puzzle of what to do about results that show increased risk or even certainty for a condition that we have no idea how to prevent. Some genomics advocates argue that even if a result is not "medically actionable," it might have "personal utility" because it allows parents to plan for their child's future needs, to enroll them in research, or to connect with other families whose children carry the same genetic marker.
Finding a certain gene variant in one child might inform parents' decisions about whether to have another—and if they do, about whether to use reproductive technologies or prenatal testing to select against that variant in a future child. I have no doubt that for some parents these personal utility arguments are persuasive, but notice how far we've now strayed from the serious yet treatable conditions that motivated governments to set up newborn screening programs, and to mandate such testing for all.
Which brings me to the other problem with the call for sequencing newborn babies: the idea that even if it's not what the law requires, it's what good parents should do. That idea is very compelling when we're talking about sequencing results that show a serious threat to the child's health, especially when interventions are available to prevent or treat that condition. But as I have shown, many sequencing results are not of this type.
While one parent might reasonably decide to learn about their child's risk for a condition about which nothing can be done medically, a different, yet still thoroughly reasonable, parent might prefer to remain ignorant so that they can enjoy the time before their child is afflicted. This parent might decide that the worry—and the hypervigilence it could inspire in them—is not in their child's best interest, or indeed in their own. This parent might also think that it should be up to the child, when he or she is older, to decide whether to learn about his or her risk for adult-onset conditions, especially given that many adults at high familial risk for conditions like Alzheimer's or Huntington's disease choose never to be tested. This parent will value the child's future autonomy and right not to know more than they value the chance to prepare for a health risk that won't strike the child until 40 or 50 years in the future.
Parents are not obligated to learn about their children's risk for a condition that cannot be prevented, has a small risk of occurring, or that would appear only in adulthood.
Contemporary understandings of parenting are famously demanding. We are asked to do everything within our power to advance our children's health and well-being—to act always in our children's best interests. Against that backdrop, the need to sequence every newborn baby's genome might seem obvious. But we should be skeptical. Many sequencing results are complex and uncertain. Parents are not obligated to learn about their children's risk for a condition that cannot be prevented, has a small risk of occurring, or that would appear only in adulthood. To suggest otherwise is to stretch parental responsibilities beyond the realm of childhood and beyond factors that parents can control.
Facial Recognition Can Reduce Racial Profiling and False Arrests
[Editor's Note: This essay is in response to our current Big Question, which we posed to experts with different perspectives: "Do you think the use of facial recognition technology by the police or government should be banned? If so, why? If not, what limits, if any, should be placed on its use?"]
Opposing facial recognition technology has become an article of faith for civil libertarians. Many who supported the bans in cities like San Francisco and Oakland have declared the technology to be inherently racist and abusive.
The greatest danger would be to categorically oppose this technology and pretend that it will simply go away.
I have spent my career as a criminal defense attorney and a civil libertarian -- and I do not fear it. Indeed, I see it as positive so long as it is appropriately regulated and controlled.
We are living in the beginning of a biometric age, where technology uses our physical or biological characteristics for a variety of products and services. It holds great promises as well as great risks. The greatest danger, however, would be to categorically oppose this technology and pretend that it will simply go away.
This is an age driven as much by consumer as it is government demand. Living in denial may be emotionally appealing, but it will only hasten the creation of post-privacy world. If we do not address this emerging technology, movements in public will increasingly result in instant recognition and even tracking. It is the type of fish-bowl society that strips away any expectation of privacy in our interactions and associations.
The biometrics field is expanding exponentially, largely due to the popularity of consumer products using facial recognition technology (FRT) -- from the iPhone program to shopping ones that recognize customers.
But the privacy community is losing this battle because it is using the privacy rationales and doctrines forged in the earlier electronic surveillance periods. Just as generals are often accused of planning to fight the last war, civil libertarians can sometimes cling to past models despite their decreasing relevance in the current world.
I see FRT as having positive implications that are worth pursuing. When properly used, biometrics can actually enhance privacy interests and even reduce racial profiling by reducing false arrests and the warrantless "patdowns" allowed by the Supreme Court. Bans not only deny police a technology widely used by businesses, but return police to the highly flawed default of "eye balling" suspects -- a system with a considerably higher error rate than top FRT programs.
Officers are often wrong and stop a great number of suspects in the hopes of finding a wanted felon.
A study in Australia showed that passport officers who had taken photographs of subjects in ideal conditions nonetheless experienced high error rates when identifying them shortly afterward, including 14 percent false acceptance rates. Currently, officers stop suspects based on their memory from seeing a photograph days or weeks earlier. They are often wrong and stop a great number of suspects in the hopes of finding a wanted felon. The best FRT programs achieve an astonishing accuracy rate, though real-world implementation has challenges that must be addressed.
One legitimate concern raised in early studies showed higher error rates in recognitions for certain groups, particularly African American women. An MIT study finding that error rate prompted major improvements in the algorithms as well as training changes to greatly reduce the frequency of errors. The issue remains a concern, but there is nothing inherently racist in algorithms. These are a set of computer instructions that isolate and process with the parameters and conditions set by creators.
To be sure, there is room for improvement in some algorithms. Tests performed by the American Civil Liberties Union (ACLU) reportedly showed only an 80 percent accuracy rate in comparing mug shots to pictures of members of Congress when using Amazon's "Rekognition" system. It recently showed the same 80 percent rate in doing the same comparison to members of the California legislators.
However, different algorithms are available with differing levels of performance. Moreover, these products can be set with a lower discrimination level. The fact is that the top algorithms tested by the National Institute of Standards and Technology showed that their accuracy rate is greater than 99 percent.
The greatest threat of biometric technologies is to democratic values.
Assuming a top-performing algorithm is used, the result could be highly beneficial for civil liberties as opposed to the alternative of "eye balling" suspects. Consider the Boston Bombing where police declared a "containment zone" and forced families into the street with their hands in the air.
The suspect, Dzhokhar Tsarnaev, moved around Boston and was ultimately found outside the "containment zone" once authorities abandoned near martial law. He was caught on some surveillance systems but not identified. FRT can help law enforcement avoid time-consuming area searches and the questionable practice of forcing people out of their homes to physically examine them.
If we are to avoid a post-privacy world, we will have to redefine what we are trying to protect and reconceive how we hope to protect it. In my view, the greatest threat of biometric technologies is to democratic values. Authoritarian nations like China have made huge investments into FRT precisely because they know that the threat of recognition in public deters citizens from associating or interacting with protesters or dissidents. Recognition changes conduct. That chilling effect is what we have the worry about the most.
Conventional privacy doctrines do not offer much protection. The very concept of "public privacy" is treated as something of an oxymoron by courts. Public acts and associations are treated as lacking any reasonable expectation of privacy. In the same vein, the right to anonymity is not a strong avenue for protection. We are not living in an anonymous world anymore.
Consumers want products like FaceFind, which link their images with others across social media. They like "frictionless" transactions and authentications using faceprints. Despite the hyperbole in places like San Francisco, civil libertarians will not succeed in getting that cat to walk backwards.
The basis for biometric privacy protection should not be focused on anonymity, but rather obscurity. You will be increasingly subject to transparency-forcing technology, but we can legislatively mandate ways of obscuring that information. That is the objective of the Biometric Privacy Act that I have proposed in recent research. However, no such comprehensive legislation has passed through Congress.
The ability to spot fraudulent entries at airports or recognizing a felon in flight has obvious benefits for all citizens.
We also need to recognize that FRT has many beneficial uses. Biometric guns can reduce accidents and criminals' conduct. New authentications using FRT and other biometric programs could reduce identity theft.
And, yes, FRT could help protect against unnecessary police stops or false arrests. Finally, and not insignificantly, this technology could stop serious crimes, from terrorist attacks to the capturing of dangerous felons. The ability to spot fraudulent entries at airports or recognizing a felon in flight has obvious benefits for all citizens.
We can live and thrive in a biometric era. However, we will need to bring together civil libertarians with business and government experts if we are going to control this technology rather than have it control us.
[Editor's Note: Read the opposite perspective here.]
The Case for an Outright Ban on Facial Recognition Technology
[Editor's Note: This essay is in response to our current Big Question, which we posed to experts with different perspectives: "Do you think the use of facial recognition technology by the police or government should be banned? If so, why? If not, what limits, if any, should be placed on its use?"]
In a surprise appearance at the tail end of Amazon's much-hyped annual product event last month, CEO Jeff Bezos casually told reporters that his company is writing its own facial recognition legislation.
The use of computer algorithms to analyze massive databases of footage and photographs could render human privacy extinct.
It seems that when you're the wealthiest human alive, there's nothing strange about your company––the largest in the world profiting from the spread of face surveillance technology––writing the rules that govern it.
But if lawmakers and advocates fall into Silicon Valley's trap of "regulating" facial recognition and other forms of invasive biometric surveillance, that's exactly what will happen.
Industry-friendly regulations won't fix the dangers inherent in widespread use of face scanning software, whether it's deployed by governments or for commercial purposes. The use of this technology in public places and for surveillance purposes should be banned outright, and its use by private companies and individuals should be severely restricted. As artificial intelligence expert Luke Stark wrote, it's dangerous enough that it should be outlawed for "almost all practical purposes."
Like biological or nuclear weapons, facial recognition poses such a profound threat to the future of humanity and our basic rights that any potential benefits are far outweighed by the inevitable harms.
We live in cities and towns with an exponentially growing number of always-on cameras, installed in everything from cars to children's toys to Amazon's police-friendly doorbells. The use of computer algorithms to analyze massive databases of footage and photographs could render human privacy extinct. It's a world where nearly everything we do, everywhere we go, everyone we associate with, and everything we buy — or look at and even think of buying — is recorded and can be tracked and analyzed at a mass scale for unimaginably awful purposes.
Biometric tracking enables the automated and pervasive monitoring of an entire population. There's ample evidence that this type of dragnet mass data collection and analysis is not useful for public safety, but it's perfect for oppression and social control.
Law enforcement defenders of facial recognition often state that the technology simply lets them do what they would be doing anyway: compare footage or photos against mug shots, drivers licenses, or other databases, but faster. And they're not wrong. But the speed and automation enabled by artificial intelligence-powered surveillance fundamentally changes the impact of that surveillance on our society. Being able to do something exponentially faster, and using significantly less human and financial resources, alters the nature of that thing. The Fourth Amendment becomes meaningless in a world where private companies record everything we do and provide governments with easy tools to request and analyze footage from a growing, privately owned, panopticon.
Tech giants like Microsoft and Amazon insist that facial recognition will be a lucrative boon for humanity, as long as there are proper safeguards in place. This disingenuous call for regulation is straight out of the same lobbying playbook that telecom companies have used to attack net neutrality and Silicon Valley has used to scuttle meaningful data privacy legislation. Companies are calling for regulation because they want their corporate lawyers and lobbyists to help write the rules of the road, to ensure those rules are friendly to their business models. They're trying to skip the debate about what role, if any, technology this uniquely dangerous should play in a free and open society. They want to rush ahead to the discussion about how we roll it out.
We need spaces that are free from government and societal intrusion in order to advance as a civilization.
Facial recognition is spreading very quickly. But backlash is growing too. Several cities have already banned government entities, including police and schools, from using biometric surveillance. Others have local ordinances in the works, and there's state legislation brewing in Michigan, Massachusetts, Utah, and California. Meanwhile, there is growing bipartisan agreement in U.S. Congress to rein in government use of facial recognition. We've also seen significant backlash to facial recognition growing in the U.K., within the European Parliament, and in Sweden, which recently banned its use in schools following a fine under the General Data Protection Regulation (GDPR).
At least two frontrunners in the 2020 presidential campaign have backed a ban on law enforcement use of facial recognition. Many of the largest music festivals in the world responded to Fight for the Future's campaign and committed to not use facial recognition technology on music fans.
There has been widespread reporting on the fact that existing facial recognition algorithms exhibit systemic racial and gender bias, and are more likely to misidentify people with darker skin, or who are not perceived by a computer to be a white man. Critics are right to highlight this algorithmic bias. Facial recognition is being used by law enforcement in cities like Detroit right now, and the racial bias baked into that software is doing harm. It's exacerbating existing forms of racial profiling and discrimination in everything from public housing to the criminal justice system.
But the companies that make facial recognition assure us this bias is a bug, not a feature, and that they can fix it. And they might be right. Face scanning algorithms for many purposes will improve over time. But facial recognition becoming more accurate doesn't make it less of a threat to human rights. This technology is dangerous when it's broken, but at a mass scale, it's even more dangerous when it works. And it will still disproportionately harm our society's most vulnerable members.
Persistent monitoring and policing of our behavior breeds conformity, benefits tyrants, and enriches elites.
We need spaces that are free from government and societal intrusion in order to advance as a civilization. If technology makes it so that laws can be enforced 100 percent of the time, there is no room to test whether those laws are just. If the U.S. government had ubiquitous facial recognition surveillance 50 years ago when homosexuality was still criminalized, would the LGBTQ rights movement ever have formed? In a world where private spaces don't exist, would people have felt safe enough to leave the closet and gather, build community, and form a movement? Freedom from surveillance is necessary for deviation from social norms as well as to dissent from authority, without which societal progress halts.
Persistent monitoring and policing of our behavior breeds conformity, benefits tyrants, and enriches elites. Drawing a line in the sand around tech-enhanced surveillance is the fundamental fight of this generation. Lining up to get our faces scanned to participate in society doesn't just threaten our privacy, it threatens our humanity, and our ability to be ourselves.
[Editor's Note: Read the opposite perspective here.]