Meet Your Child’s New Nanny: A Robot
Would you leave your small child in the care of a robot for several hours a day? It may sound laughable at first, but think carefully.
"Given the huge amounts of money we pay for childcare, a [robot caregiver] is a very attractive proposition."
Robots that can care for children would be a godsend to many parents, especially the financially strapped. In the U.S., 62 percent of women who gave birth in 2016 worked outside the home, and day care costs are often exorbitant. In California, for instance, the annual cost for day care for a single child averages over $22,000. The price is lower in some states, but it still accounts for a hefty chunk of the typical family's budget.
"We're talking about the Holy Grail of parenting," says Zoltan Istvan, a technology consultant and futurist. "Imagine a robot that could assume 70 percent to 80 percent of the caregiver's role for your child. Given the huge amounts of money we pay for childcare, that's a very attractive proposition."
Both China and Japan are on the leading edge of employing specially designed social robots for the care of children. Due to long work schedules, shifting demographics and China's long-term (but now defunct) one-child policy, both countries have a severe shortage of family caregivers. Enter the iPal, a child-sized humanoid robot with a round head, expressive face and articulated fingers, which can keep children engaged and entertained for hours on end. According to its manufacturer, AvatarMind Robot Technology, iPal is already selling like hotcakes in Asia and is expected to be available in the U.S. within the next year. The standard version of iPal sells for $2,499, and it's not the only robot claimed to be suitable for childcare. Other robots being fine-tuned are Softbank's humanoid models Pepper and NAO, which are also considered to be child-friendly social robots.
iPal talks, dances, plays games, reads stories and plugs into social media and the internet. According to AvatarMind, over time iPal learns your child's likes and dislikes, and can independently learn more about subjects your child is interested in to boost learning. In addition, it will wake your child up in the morning and tell him when it's time to get dressed, brush his teeth or wash his hands. If your child is a diabetic, it will remind her when it's time to check her blood sugar. But iPal isn't just a fancy appliance that mechanically performs these functions; it does so with "personality."
iPal robot interacting with a boy.
The robot has an "emotion management system" that detects your child's emotions and mirrors them (unless your child is sad, and then it tries to cheer him up). But it's not exactly like iPal has the kind of emotion chip long sought by Star Trek's android Data. What it does is emotional simulation--what some would call emotional dishonesty--considering that it doesn't actually feel anything. But research has shown that the lack of authenticity doesn't really matter when it comes to the human response to feigned emotion.
Children, and even adults, tend to respond to "emotional" robots as though they're alive and sentient even when we've seen all the wires and circuit boards that underlie their wizardry. In fact, we're hardwired to respond to them as though they are human beings in a real relationship with us.
The question is whether the relationships we develop with robots causes social maladaptation, especially among the most vulnerable among us—young children just learning how to connect and interact with others. Could a robot in fact come close to providing the authentic back-and-forth that helps children develop empathy, reciprocity, and self-esteem? Also, could steady engagement with a robot nanny diminish precious time needed for real family bonding?
It depends on whom you ask.
Because iPal is voice-activated, it frees children to learn by interacting in a way that's more natural than interacting with traditional toys, says Dr. Daniel Xiong, Co-founder and Chief Technology Officer at AvatarMind. "iPal is like a "real" family member with you whenever you need it," he says.
Xiong doesn't put a time limit on how long a child should interact with iPal on a daily basis. He sees the relationship between the child and the robot as healthy, though he admits that the technology needs to advance substantially before iPal could take the place of a human babysitter.
It's no coincidence that many toymakers and manufacturers are designing cute robots that look and behave like real children or animals, says Sherry Turkle, a Professor of Social Studies and Science at MIT. "When they make eye contact and gesture toward us, they predispose us to view them as thinking and caring," she has written in The Washington Post. "They are designed to be cute, to provide a nurturing response" from the child. "And when it comes to sociable AI, nurturance is the killer app: We nurture what we love, and we love what we nurture."
What are we saying to children about their importance to us when we're willing to outsource their care to a robot?
The problem is that we get lulled into thinking that we're in an actual relationship, when a robot can't possibly love us back. If adults have these vulnerabilities, what might such lopsided relationships do to the emotional development of a small child? Turkle notes that while we tend to ascribe a mind and emotions to a socially interactive robot, "Simulated thinking may be thinking, but simulated feeling is never feeling, and simulated love is never love."
Still, is active, playful engagement with a robot for a few hours a day any more harmful than several hours in front of a TV or with an iPad? Some, like Xiong, regard interacting with a robot as better than mere passive entertainment. iPal's manufacturers say that their robot can't replace parents or teachers and is best used by three- to eight-year-olds after school, while they wait for their parents to get off of work. But as robots become ever more sophisticated, they're expected to become more and more captivating, and to perform more of the tasks of day-to-day care.
Some studies, performed by Turkle and fellow MIT colleague Cynthia Breazeal, have revealed a darker side to child-robot interaction. Turkle has reported extensively on these studies in The Washington Post and in her 2011 book, Alone Together: Why We Expect More from Technology and Less from Each Other. Most children love robots, but some act out their inner bully on the hapless machines, hitting and kicking them and otherwise trying to hurt them. The trouble is that the robot can't fight back, teaching children that they can bully and abuse without consequences. Such harmful behavior could carry over into the child's human relationships.
And it turns out that communicative machines don't actually teach kids good communication skills. It's well known that parent-child communication in the first three years of life sets the stage for a child's intellectual and academic success. Verbal back-and-forth with parents and caregivers is like food for a child's growing brain. One article published in JAMA Pediatrics showed that babies who played with electronic toys—like the popular robot dog AIBO—show a decrease in both the quantity and quality of their language skills.
Anna V. Sosa of the Child Speech and Language Lab at Northern Arizona University studied 26 ten- to 16-month-old infants to compare the growth of their language skills after they played with three types of toys: Electronic toys like a baby laptop and talking farm; traditional toys like wooden puzzles and building blocks; and books read aloud by their parents.
The play that produced the most growth in verbal ability was having books read to them, followed by play with traditional toys. Language gains after playing with electronic toys came dead last. This form of play involved the least use of adult words, the least conversational turn-taking with parents, and the least verbalizations from the children. While the study sample was small, it's not hard to extrapolate that no electronic toy or even more abled robot could supply the intimate responsiveness of a parent reading stories to a child, explaining new words, answering the child's questions, and modeling the kind of back-and-forth interaction that promotes empathy and reciprocity in human relationships.
Most experts acknowledge that robots can be valuable educational tools, but they can't make a child feel truly loved, validated, and valued.
Research suggests that the main problem of leaving children in the care of robots on a regular basis is the risk of their stunted, unhealthy emotional development. In Alone Together, Turkle asks: What are we saying to children about their importance to us when we're willing to outsource their care to a robot? A child might be superficially entertained by the robot while her self-esteem is systematically undermined.
Two of the most vocal critics of robot nannies are researchers at the University of Sheffield in the U.K., Noel and Amanda Sharkey. In an article published in the journal Interaction Studies, they claim that the overuse of childcare robots could have serious consequences for the psychological and emotional wellbeing of children.
They acknowledge that limited use of robots can have positive effects like keeping a child safe from physical harm, allowing remote monitoring and supervision by parents, keeping a child entertained, and stimulating an interest in science and engineering. But the Sharkeys see the overuse of robots as a source of emotional alienation between parents and children. Just regularly plopping a child down with a robot for hours of interaction could be a form of neglect that panders to busy parents at the cost of a child's emotional development.
Robots, the Sharkeys argue, prey upon a child's natural tendency to anthropomorphize, which sucks them into a pseudo-relationship with a machine that can never return their affection. This can be seen as a form of emotional exploitation—a machine that promises connection but can never truly deliver. Furthermore, as robots develop more intimate skills such as bathing, feeding and changing diapers, children will lose out on some of the most fundamental and precious bonding activities with their parents.
Critics say that children's natural ability to bond is prime territory for exploitation by toy and robot manufacturers, who ultimately have a commercial agenda. The Sharkeys noted one study in which a state-of-the-art robot was employed in a daycare center. The ten- to 20-month-old children bonded more deeply with the robot than with a teddy bear. It's not hard to see that starting the robot-bonding process early in life is good for robot business, as babies and toddlers graduate to increasingly sophisticated machines.
"It is possible that exclusive or near exclusive care of a child by a robot could result in cognitive and linguistic impairments," say the Sharkeys. They cite the danger of a child developing what is called in psychology a pathological attachment disorder. Attachment disorders occur when parents are unpredictable or neglectful in their emotional responsiveness. The resulting shaky bond interferes with a child's ability to feel trust, pleasure, safety, and comfort in the presence of the parent. Unhealthy patterns of attachment include "insecure attachment," a form of anxiety that arises when a child cannot trust his caregiver with meeting his emotional needs. Children with attachment disorders may anxiously avoid attachments and may not be able to experience empathy, the cornerstone of relationships. Such patterns can follow a child throughout life and infect every other relationship they have.
An example of the inadequacy of robot nannies rests on the pre-programmed emotional responses they have in their repertoires. They're designed to detect and mirror a child's emotions and do things like play a child's favorite song when he's crying or in distress. But such a response could be the height of insensitivity. It discounts and belittles what may be a child's authentic response to an upsetting turn of events, like a scraped knee from a fall. A robot playing a catchy jingle is a far cry from having Mom clean and dress the wound, and perhaps more importantly, kiss it and make it better.
Most experts acknowledge that robots can be valuable educational tools. But they can't make a child feel truly loved, validated, and valued. That's the job of parents, and when parents abdicate this responsibility, it's not only the child that misses out on one of life's most profound experiences.
So consider buying a robot to entertain and educate your little one—just make sure you're close by for the true bonding opportunities that arrive so fast and last so fleetingly in the life of a child.
Opioid prescription policies may hurt those in chronic pain
Tinu Abayomi-Paul works as a writer and activist, plus one unwanted job: Trying to fill her opioid prescription. She says that some pharmacists laugh and tell her that no one needs the amount of pain medication that she is seeking. Another pharmacist near her home in Venus, Tex., refused to fill more than seven days of a 30-day prescription.
To get a new prescription—partially filled opioid prescriptions can’t be dispensed later—Abayomi-Paul needed to return to her doctor’s office. But without her medication, she was having too much pain to travel there, much less return to the pharmacy. She rationed out the pills over several weeks, an agonizing compromise that left her unable to work, interact with her children, sleep restfully, or leave the house. “Don’t I deserve to do more than survive?” she says.
Abayomi-Paul’s pain results from a degenerative spine disorder, chronic lymphocytic leukemia, and more than a dozen other diagnoses and disabilities. She is part of a growing group of people with chronic pain who have been negatively impacted by the fallout from efforts to prevent opioid overdose deaths.
Guidelines for dispensing these pills are complicated because many opioids, like codeine, oxycodone, and morphine, are prescribed legally for pain. Yet, deaths from opioids have increased rapidly since 1999 and become a national emergency. Many of them, such as heroin, are used illegally. The CDC identified three surges in opioid use: an increase in opioid prescriptions in the ‘90s, a surge of heroin around 2010, and an influx of fentanyl and other powerful synthetic opioids in 2013.
As overdose deaths grew, so did public calls to address them, prompting the CDC to change its prescription guidelines in 2016. The new guidelines suggested limiting medication for acute pain to a seven-day supply, capping daily doses of morphine, and other restrictions. Some statistics suggest that these policies have worked; from 2016 to 2019, prescriptions for opiates fell 44 percent. Physicians also started progressively lowering opioid doses for patients, a practice called tapering. A study tracking nearly 100,000 Medicare subscribers on opioids found that about 13 percent of patients were tapering in 2012, and that number increased to about 23 percent by 2017.
But some physicians may be too aggressive with this tapering strategy. About one in four people had doses reduced by more than 10 percent per week, a rate faster than the CDC recommends. The approach left people like Abayomi-Paul without the medication they needed. Every year, Abayomi-Paul says, her prescriptions are harder to fill. David Brushwood, a pharmacy professor who specializes in policy and outcomes at the University of Florida in Gainesville, says opioid dosing isn’t one-size-fits-all. “Patients need to be taken care of individually, not based on what some government agency says they need,” he says.
‘This is not survivable’
Health policy and disability rights attorney Erin Gilmer advocated for people with pain, using her own experience with chronic pain and a host of medical conditions as a guidepost. She launched an advocacy website, Healthcare as a Human Right, and shared her struggles on Twitter: “This pain is more than anything I've endured before and I've already been through too much. Yet because it's not simply identified no one believes it's as bad as it is. This is not survivable.”
When her pain dramatically worsened midway through 2021, Gilmer’s posts grew ominous: “I keep thinking it can't possibly get worse but somehow every day is worse than the last.”
The CDC revised its guidelines in 2022 after criticisms that people with chronic pain were being undertreated, enduring dangerous withdrawal symptoms, and suffering psychological distress. (Long-term opioid use can cause physical dependency, an adaptive reaction that is different than the compulsive misuse associated with a substance use disorder.) It was too late for Gilmer. On July 7, 2021, the 38-year-old died by suicide.
Last August, an Ohio district court ruling set forth a new requirement for Walgreens, Walmart, and CVS pharmacists in two counties. These pharmacists must now document opioid prescriptions that are turned down, even for customers who have no previous purchases at that pharmacy, and they’re required to share this information with other locations in the same chain. None of the three pharmacies responded to an interview request from Leaps.org.
In a practice called red flagging, pharmacists may label a prescription suspicious for a variety of reasons, such as if a pharmacist observes an unusually high dose, a long distance from the patient’s home to the pharmacy, or cash payment. Pharmacists may question patients or prescribers to resolve red flags but, regardless of the explanation, they’re free to refuse to fill a prescription.
As the risk of litigation has grown, so has finger-pointing, says Seth Whitelaw, a compliance consultant at Whitelaw Compliance Group in West Chester, PA, who advises drug, medical device, and biotech companies. Drugmakers accused in National Prescription Opioid Litigation (NPOL), a complex set of thousands of cases on opioid epidemic deaths, which includes the Ohio district case, have argued that they shouldn’t be responsible for the large supply of opiates and overdose deaths. Yet, prosecutors alleged that these pharmaceutical companies hid addiction and overdose risks when labeling opioids, while distributors and pharmacists failed to identify suspicious orders or scripts.
Patients and pharmacists fear red flags
The requirements that pharmacists document prescriptions they refuse to fill so far only apply to two counties in Ohio. But Brushwood fears they will spread because of this precedent, and because there’s no way for pharmacists to predict what new legislation is on the way. “There is no definition of a red flag, there are no lists of red flags. There is no instruction on what to do when a red flag is detected. There’s no guidance on how to document red flags. It is a standardless responsibility,” Brushwood says. This adds trepidation for pharmacists—and more hoops to jump through for patients.
“I went into the doctor one day here and she said, ‘I'm going to stop prescribing opioids to all my patients effective immediately,” Nicolson says.
“We now have about a dozen studies that show that actually ripping somebody off their medication increases their risk of overdose and suicide by three to five times, destabilizes their health and mental health, often requires some hospitalization or emergency care, and can cause heart attacks,” says Kate Nicolson, founder of the National Pain Advocacy Center based in Boulder, Colorado. “It can kill people.” Nicolson was in pain for decades due to a surgical injury to the nerves leading to her spinal cord before surgeries fixed the problem.
Another issue is that primary care offices may view opioid use as a reason to turn down new patients. In a 2021 study, secret shoppers called primary care clinics in nine states, identifying themselves as long-term opioid users. When callers said their opioids were discontinued because their former physician retired, as opposed to an unspecified reason, they were more likely to be offered an appointment. Even so, more than 40 percent were refused an appointment. The study authors say their findings suggest that some physicians may try to avoid treating people who use opioids.
Abayomi-Paul says red flagging has changed how she fills prescriptions. “Once I go to one place, I try to [continue] going to that same place because of the amount of records that I have and making sure my medications don’t conflict,” Abayomi-Paul says.
Nicolson moved to Colorado from Washington D.C. in 2015, before the CDC issued its 2016 guidelines. When the guidelines came out, she found the change to be shockingly abrupt. “I went into the doctor one day here and she said, ‘I'm going to stop prescribing opioids to all my patients effective immediately.’” Since then, she’s spoken with dozens of patients who have been red-flagged or simply haven’t been able to access pain medication.
Despite her expertise, Nicolson isn’t positive she could successfully fill an opioid prescription today even if she needed one. At this point, she’s not sure exactly what various pharmacies would view as a red flag. And she’s not confident that these red flags even work. “You can have very legitimate reasons for being 50 miles away or having to go to multiple pharmacies, given that there are drug shortages now, as well as someone refusing to fill [a prescription.] It doesn't mean that you’re necessarily ‘drug seeking.’”
While there’s no easy solution. Whitelaw says clarifying the role of pharmacists and physicians in patient access to opioids could help people get the medication they need. He is seeking policy changes that focus on the needs of people in pain more than the number of prescriptions filled. He also advocates standardizing the definition of red flags and procedures for resolving them. Still, there will never be a single policy that can be applied to all people, explains Brushwood, the University of Florida professor. “You have to make a decision about each individual prescription.”
This article is part of the magazine, "The Future of Science In America: The Election Issue," co-published by LeapsMag, the Aspen Institute Science & Society Program, and GOOD.
When COVID-19 cases were surging in New York City in early spring, Chitra Mohan, a postdoctoral fellow at Weill Cornell, was overwhelmed with worry. But the pandemic was only part of her anxieties. Having come to the United States from India on a student visa that allowed her to work for a year after completing her degree, she had applied for a two-year extension, typically granted for those in STEM fields. But due to a clerical error—Mohan used an electronic signatureinstead of a handwritten one— her application was denied and she could no longerwork in the United States.
"I was put on unpaid leave and I lost my apartment and my health insurance—and that was in the middle of COVID!" she says.
Meanwhile her skills were very much needed in those unprecedented times. A molecular biologist studying how DNA can repair itself, Mohan was trained in reverse transcription polymerase chain reaction or RT-PCR—a lab technique that detects pathogens and is used to diagnose COVID-19. Mohan wanted to volunteer at testing centers, but because she couldn't legally work in the U.S., she wasn't allowed to help either. She moved to her cousin's house, hired a lawyer, and tried to restore her work status.
"I spent about $4,000 on lawyer fees and another $1,200 to pay for the motions I filed," she recalls. "I had to borrow money from my parents and my cousin because without my salary I just didn't have the $7,000 at hand." But the already narrow window of opportunity slammed completely shut when the Trump administration suspended issuing new visas for foreign researchers in June. All Mohan's attempts were denied. In August, she had to leave the country. "Given the recent work visa ban by the administration, all my options in the U.S. are closed," she wrote a bitter note on Twitter. "I have to uproot my entire life in NY for the past 6 years and leave." She eventually found a temporary position in Calcutta, where she can continue research.
Mohan is hardly alone in her visa saga. Many foreign scholars on H- and J-type visas and other permits that let them remain employed in America had been struggling to keep their rights to continue research, which in certain cases is crucial to battling the pandemic. Some had to leave the country, some filed every possible extension to buy time, and others are stuck in their home countries, unable to return. The already cumbersome process of applying for visas and extensions became crippled during the lockdowns. But in June, when President Trump extended and expanded immigration restrictions to cut the number of immigrant workers entering the U.S., the new limits left researchers' projects and careers in limbo—and some in jeopardy.
"We have been a beneficiary of this flow of human capacity and resource investment for many generations—and this is now threatened."
Rakesh Ramachandran, whose computational biology work contributed to one of the first coronavirus studies to map out its protein structures—is stranded in India. In early March, he had travelled there to attend a conference and visit the American consulate to stamp his H1 visa for a renewal, already granted. The pandemic shut down both the conference and the consulates, and Ramachandran hasn't been able to come back since. The consulates finally opened in September, but so far the online portal has no available appointment slots. "I'm told to keep trying," Ramachandran says.
The visa restrictions affected researchers worldwide, regardless of disciplines or countries. A Ph.D. student in neuroscience, Morgane Leroux had to do her experiments with mice at Gladstone Institutes in America and analyze the data back home at Sorbonne University in France. She had finished her first round of experiments when the lockdowns forced her to return to Paris, and she hasn't been able to come back to resume her work since. "I can't continue the experiments, which is really frustrating," she says, especially because she doesn't know what it means for her Ph.D. "I may have to entirely change my subject," she says, which she doesn't want to do—it would be a waste of time and money.
But besides wreaking havoc in scholars' personal lives and careers, the visa restrictions had—and will continue to have—tremendous deleterious effects on America's research and its global scientific competitiveness. "It's incredibly short-sighted and self-destructing to restrict the immigration of scientists into the U.S.," says Benjamin G. Neel, who directs the Laura and Isaac Perlmutter Cancer Center at New York University. "If they can't come here, they will go elsewhere," he says, causing a brain drain.
Neel in his lab with postdocs
(Courtesy of Neel)
Neel felt the outcomes of the shortsighted policies firsthand. In the past few months, his lab lost two postdoctoral researchers who had made major strides in understanding the biology of several particularly stubborn, treatment-resistant malignancies. One postdoc studied the underlying mechanisms responsible for 90 percent of pancreatic cancers and half of the colon ones. The other one devised a new system of modeling ovarian cancer in mice to test new therapeutic drug combinations for the deadliest tumor types—but had to return home to China.
"By working around the clock, she was able to get her paper accepted, but she hasn't been able to train us to use this new system, which can set us back six months," Neel says.
Her discoveries also helped the lab secure about $900,000 in grants for new research. Losing people like this is "literally killing the goose that lays the golden eggs," Neel adds. "If you want to make America poor again, this is the way to do it."
Cassidy R. Sugimoto at Indiana University Bloomington, who studies how scientific knowledge is produced and disseminated, says that scientists are the most productive when they are free to move, exchange ideas, and work at labs with the best equipment. Restricting that freedom reduces their achievement.
"Several empirical studied demonstrated the benefits to the U.S. by attracting and retaining foreign scientists. The disproportional number of our Nobel Prize winners were not only foreign-born but also foreign-educated," she says. Scientific advancement bolsters the country's economic prowess, too, so turning scholars away is bad for the economy long-term. "We have been a beneficiary of this flow of human capacity and resource investment for many generations—and this is now threatened," Sugimoto adds—because scientists will look elsewhere. "We are seeing them shifting to other countries that are more hospitable, both ideologically and in terms of health security. Many visiting scholars, postdocs, and graduate students who would otherwise come to the United States are now moving to Canada."
It's not only the Ph.D. students and postdocs who are affected. In some cases, even well-established professors who have already made their marks in the field and direct their own labs at prestigious research institutions may have to pack up and leave the country in the next few months. One scientist who directs a prominent neuroscience lab is betting on his visa renewal and a green card application, but if that's denied, the entire lab may be in jeopardy, as many grants hinge on his ability to stay employed in America.
"It's devastating to even think that it can happen," he says—after years of efforts invested. "I can't even comprehend how it would feel. It would be terrifying and really sad." (He asked to withhold his name for fear that it may adversely affect his applications.) Another scientist who originally shared her story for this article, later changed her mind and withdrew, worrying that speaking out may hurt the entire project, a high-profile COVID-19 effort. It's not how things should work in a democratic country, scientists admit, but that's the reality.
Still, some foreign scholars are speaking up. Mehmet Doğan, a physicist at University of California Berkeley who has been fighting a visa extension battle all year, says it's important to push back in an organized fashion with petitions and engage legislators. "This administration was very creative in finding subtle and not so subtle ways to make our lives more difficult," Doğan says. He adds that the newest rules, proposed by the Department of Homeland Security on September 24, could further limit the time scholars can stay, forcing them into continuous extension battles. That's why the upcoming election might be a turning point for foreign academics. "This election will decide if many of us will see the U.S. as the place to stay and work or whether we look at other countries," Doğan says, echoing the worries of Neel, Sugimoto, and others in academia.
Dogan on Zoom talking to his fellow union members of the Academic Researchers United, a union of almost 5,000 Academic Researchers.
(Credit: Ceyda Durmaz Dogan)
If this year has shown us anything, it is that viruses and pandemics know no borders as they sweep across the globe. Likewise, science can't be restrained by borders either. "Science is an international endeavor," says Neel—and right now humankind now needs unified scientific research more than ever, unhindered by immigration hurdles and visa wars. Humanity's wellbeing in America and beyond depends on it.
[Editor's Note: To read other articles in this special magazine issue, visit the beautifully designed e-reader version.]
Lina Zeldovich has written about science, medicine and technology for Popular Science, Smithsonian, National Geographic, Scientific American, Reader’s Digest, the New York Times and other major national and international publications. A Columbia J-School alumna, she has won several awards for her stories, including the ASJA Crisis Coverage Award for Covid reporting, and has been a contributing editor at Nautilus Magazine. In 2021, Zeldovich released her first book, The Other Dark Matter, published by the University of Chicago Press, about the science and business of turning waste into wealth and health. You can find her on http://linazeldovich.com/ and @linazeldovich.