Having worked in IT for several decades, it is always interesting how past tech choices have come back to thwart us, showing weaknesses in our infrastructure and how the word legacy is often used pejoratively in our field. Consider the lowly fax machine, which many of us have not thought about in years.

In the early 1990s if my memory serves me, we had plug-in modem cards for PCs that also supported sending and receiving faxes. These were eventually replaced with technologies that could be used to transmit faxes across the Internet. (That link is woefully outdated and many of those vendors have gone away. Sorry! But at least you have some historical record to understand the context.) Why am I talking about faxes?

The NY Times recently posted this story about how the fax machines located in many public health offices is the latest bottleneck in our response to the pandemic. There is a photo included in the post of a pile of faxes taller than I am produced by one of these machines, located in a Houston office. This shows how we can have all the latest and greatest digital technology we want, but then things break with something that we have since forgotten about, like the fax machine. Humans will have to review all these faxes and try to sort things out, often re-enter the data and search for missing elements, such as details on the actual patient who is tested.

As someone who has had my own health challenges (although not Covid-related, at least not yet and hopefully not ever) over the past few months, I have come across a few digital bottlenecks myself. At my last hospital visit, I had to wait around for more than hour for my appointment for a very frustrating reason: my appointment wasn’t entered correctly “into the system” and the only way I could be seen and treated was for the staff to get hold of someone at Epic support to clear my appointment and then have it re-entered. No one at the hospital IT department could do this, apparently. Epic is the electronic medical record (EMR) provider of my hospital and for reference their motto is “the patient at the heart.” Yes indeed.

Let me tell you another digital bottleneck that I experienced. I was very careful to pick my treatment with a doctor that had experience with the particular surgery that I required and that I could communicate with readily using the Epic messaging portal, which they brand as MyChart. Often he answered my inquiries within minutes after I posted them to the portal. As a result, I have gotten very familiar with the MyChart portal and have used it frequently during my treatment over the past several months.

I have learned over the years that doctors who are digital natives, or at least comfortable with the technologies that I use (email and the web), are those doctors that I want to treat me. But when I had complications from surgery that required other doctors to get involved in my treatment, I was really at their mercy. Often all I had was a phone number that would page someone on call, if I had a problem that needed help in off-hours. I wasn’t prepared for that at all. It was frustrating because I went from a position where I was quite comfortable with the level of communication with my primary surgeon to going back to the pre-Internet1960s-era tools for my care. It was almost as if we were faxing each other.

These problems and bottlenecks have a simple root cause — we as a country have made some bad decisions on how patient data is stored, protected, and disseminated years ago. While it is true that few of us could have foreseen the pandemic, these past decisions have had a long shadow. In our rush to spread blame about what is happening with the virus now, some of these past decisions could have been made differently to lessen the impact today.

When fax tech was going out of style in the late 2000’s, I wrote this post for Baseline Magazine about some of the lessons learned from the fax machine. There are four important ones that bear repeating:

• Interoperability matters.
• Simplicity matters.
• Real-time communication matters.
• Privacy matters.

If we examine the fax breakdown during the pandemic, we can see these four lessons are still very much relevant. I ended my column by saying, “So the next time you have to build a new application, consider the lowly fax machine and what it does right. Take these lessons to heart, and you will have a leg up on building better and more useful applications.” Maybe we can finally learn these lessons to be prepared for the next pandemic.

For more than two years, a team of civil rights activists have been examining Facebook’s actions under a microscope. They have issued various interim reports: this week they produced their final report, which evaluates how well Facebook has done in implementing their extensive recommendations. The short answer: not very well.

The report covers a wide scope of activities, including eliminating hate speech, policing posts that are threatening democratic elections and the collection of US Census data, changes in advertising policies and algorithmic bias, inciting violence, and policies promoting diversity and inclusion. It would be a tall order for many tech companies to resolve all of these issues, but for business the size and scope of Facebook, I would expect to see more coherent and definitive progress.

At first glance, Facebook seems to be trying — maybe. “Facebook is in a different place than it was two years ago,” as the report mentions. The company has begun several initiatives towards making amends on some of their most reprehensible actions, including:

• Setting up better screening of posts that encourage hate speech or promote misinformation or harassment. The auditors mention that while there have been improvements during the study period, specific recommendations haven’t been implemented.
• Prohibiting ads that mention negative perceptions of immigrants, asylum seekers or refugees.
• Creating new policies prohibiting threats of violence relating to voting and elections outcomes.
• Expanding diversity and inclusion efforts, although in interviews with Facebook staff the auditors feel there is still plenty of room for improvement and could do a lot more.
• Eliminating explicit bias in targeting housing, employment and credit application ads by age, gender or Zip code.
• Making changes to its Ad Library to make it easier and more transparent for researchers to search for bias and to determine if Facebook is making progress in implementation of these policies.

But when you read the entire 90-page report, you get to see that while the company has moved (and is continuing to move) towards a more equitable and appropriate treatment, they have just begun to move the needle. “It is taking Facebook too long to get it right.” they state.

Megan Squire, a CS professor at Elon University, wrote to me with her reaction. “The report highlights the same kinds of inconsistencies and persistent failures to act that I have experienced as a researcher studying the hate groups. These groups still routinely use Facebook’s platform to recruit, train, organize, and plan violence. Onboarding civil rights expertise is something they have yet to do in the white supremacist and domestic terror space, but I hope they strongly consider something like this in the future.” Squire refers to hiring civil rights specialists to round out various teams. The final report mentions this hiring in several contexts, but doesn’t touch on it when it comes to the sections on fighting hate speech and improving Facebook’s content moderation.

One thing that occurred to me as I was reading the report is how many of the issues mentioned have to do with the actions of our President and his campaign staff. Many of his statements, on Twitter and Facebook and in his campaign advertising, violate the auditors’ recommended actions. They auditors mention a trio of Trump posts in May which contained false claims on mail-in voting and an attempt at voter suppression. The posts were removed by Twitter but left online by Facebook. “These political speech exemptions [justifying keeping them online] constitute significant steps backward that undermine the company’s progress and call into question the company’s priorities,” the auditors say. “For many users who view false statements from politicians or viral voting misinformation on Facebook, the damage is already done without knowing that the information they’ve seen is false.” The auditors mention civil rights advocates’ claims that Trump’s content is “troubling because it reflects a seeming impassivity towards racial violence.”

The auditors specifically address this, saying “powerful politicians do not have to abide by the same rules that everyone else does, so a hierarchy of speech is created that privileges certain voices over less powerful voices.” They mention how Facebook has reined in anti-vax proponents but ironically has been “far too reluctant to adopt strong rules to limit misinformation about voting.” They go on to state, “If politicians are free to mislead people about official voting methods (by labeling ballots illegal) and are allowed to use not-so-subtle dog whistles with impunity to incite violence against groups advocating for racial justice, this does not bode well for the hostile voting environment that can be facilitated by Facebook in the United States.”

Facebook has tried to blunt the auditors’ criticism, saying that from January to March 2020, they removed 4.7M pieces of hate speech-related content, which is more than twice what was removed in the prior three months. That’s progress, but just the tip of the hate-speech iceberg. Earlier this week, Zuck once again promised to address the auditors’ issues. And last week, the company announced they are trying to still lock down API access to private data, after yet another revealing breach of private user data was discovered. Clearly, they could do a better job.”Facebook has a long road ahead on its civil rights journey.” I agree. It is time we see progress over promises.

The past month has seen some interesting developments in the fight against online disinformation and hate speech. First was the K-Pop campaign that diluted the impact of white nationalists by filling the various social media channels with fan videos using their hashtags. The K-Pop fans were also initially credited for buying up tickets to the Trump Tulsa rally. While we know only about six thousand people attended the rally, it is hard to state with any certainty who really got those tickets in the end.

This is an effective way to blunt the impact of hate groups, because you are using the crowd to counter-program their content. What hasn’t worked until now is forcing different social media platforms to ban these groups entirely. This is because a ban will only shift the haters’ efforts to another platform, where they can regroup. As a result many new social platforms are popping up that are decentralized and unmoderated.

Megan Squire, a computer science professor whom I am distantly related, has studied these hate groups and documents how their members know how to push the limits of social media. For example, one group uses You Tube for its live streaming and real-time comments, then deletes the recorded video file at the end of their presentation and uploads the content to other sites that are less vigilant about their hate speech moderation.

Part of the problem is politics: tech companies are viewed as supporting mostly liberal ideologies and target conservative voices. This has resulted in a number of legal proposals. Squire says that these proposals are “naive and focused on solving yesterday’s problems. They don’t acknowledge the way the social media platforms are actually being gamed today nor how they will be abused tomorrow.”

Another issue is how content is recommended by these platforms. “The issue of content moderation should focus not on content removal but on the underlying algorithms that determine what is relevant and what we see, read, and hear online. It is these algorithms that are at the core of the misinformation amplification,” says Hany Farid, a computer science professor in his Congressional testimony this past week about the propagation of disinformation. He suggests that the platforms need to tune their algorithms to value trusted, respectful and universally accepted information over the alternatives to produce a healthier ecosystem.

But there is another way to influence the major tech platforms: through their pocketbooks. In the past month, more than 100 advertisers have pulled their ads from Facebook and other social sites. CNN is keeping track of this trend here. Led by civil rights organizations such as the NAACP and the ADL, the effort is called Stop Hate for Profit. They have posted a ten-point plan to improve things on Facebook/s various properties. It has been called a boycott, although that is not completely accurate: many advertisers have said they will return to Facebook in a few weeks. One problem is that the majority of Facebook business is from smaller businesses. Still, it is noteworthy how quickly this has happened.

Perhaps this effort will move the needle with Facebook and others. It is too soon to tell, although Facebook has announced some very small steps that will probably prove to be ineffective, if history is any predictor.

Whatever your position on childhood vaccinations, a new report provides very solid documentation of the role played by various antivax pressure groups to sway public opinion using a variety of online social media platforms. The report is a joint effort of two non-profit organizations, the Sabin Vaccine Institute and the Aspen Institute. I haven’t read the entire report, “Meeting the Challenge of Vaccination Hesitancy,” (a copy linked to at the end of this post) but want to focus on its last chapter, a paper written by Renée DiResta and Claire Wardle. DiResta is a cybersecurity researcher at Stanford, Wardle is a TED fellow and US director of First Draft. Their paper examines the changing policies of Facebook, Instagram, Twitter and other online platforms towards the antivax movement.

There is no doubt that this movement has created a global health crisis, even before Covid appeared. Doubts about polio and measles vaccines have created new outbreaks of this disease in places such as Brooklyn, Samoa and Italy, among other places. Both of these diseases were considered cured just a few years ago and rarely seen anywhere. That all has changed as a result of increasing opposition to vaccinating children.

Part of the problem is the asymmetric relationship between pro- and antivax groups: the provax folks use mostly medical literature and poorly designed public health websites; the antivax folks use well-thought out videos, catchy Internet memes and powerful personal anecdotes to make their points. Having just a few global social media platforms means the antivaxxers can spread their message more easily too. The antivaxxers also give the impression that they are the sole trusted source of information about vaccines, which isn’t helped by the several missteps over Covid over the past few months from the CDC and WHO. It also helps that several celebrities have been pushing the antivax message, which gets further amplified by mainstream media.

The authors wrote: “To counter online misinformation, we must understand how the rumors, conspiracy theories, and misleading content that we see in digital spaces intersects with existing barriers to vaccination in different countries.” The researchers took screenshots of how people searched for vaccine information in different countries and compared those results with the official policies of the social media platforms. Not surprisingly, things didn’t line up. There are “real concerns which still exist about whether these promised changes to vaccine-related policies are having the desired effect.” For example, a search for the term “vaccines” on Instagram in February 2020  produced top results that were disproportionately pushing antivax positions, even though Instagram instituted changes to reduce this misinformation almost a year earlier.

“Anti-vaccination activists have gained a deep understanding of how to communicate
effectively on social platforms and have developed techniques to take advantage of their unique characteristics, such as groups, ads, and trending topics,” they wrote. That is a depressing situation.

Another problem is that the state health departments are largely in charge of vaccination programs, and the antivaxxers are very organized at the state level to pressure their legislators to enact laws supporting their point of view. “The ability of the pro-vaccine community to tell a more compelling story more persuasively and to spread its evidence-based message to broader audiences online is an imperative for public health,” conclude the researchers.

https://www.sabin.org/sites/sabin.org/files/sabin-aspen-report-2020_meeting_the_challenge_of_vaccine_hesitancy.pdf