[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 Friday Five covers five stories in research that you may have missed this week. There are plenty of controversies and troubling ethical issues in science – and we get into many of them in our online magazine – but this news roundup focuses on scientific creativity and progress to give you a therapeutic dose of inspiration headed into the weekend.
Here are the promising studies covered in this week's Friday Five:
- Research on a "smart" bandage for wounds
- A breakthrough in fighting inflammation
- The pros and cons of a new drug for Alzheimer's
- Benefits of the Mediterranean diet - with a twist
- How to recycle a plastic that was un-recyclable
Sexually transmitted infections (STIs) are surging across the U.S. to 2.5 million cases in 2021 according to preliminary data from the CDC. A new prevention and treatment strategy now in clinical trials may provide a way to get a handle on them.
It's easy to overlook the soaring rates of gonorrhea, chlamydia, and syphilis because most of those infections have few or no symptoms and can be identified only through testing. But left untreated, they can lead to serious damage to nerves and tissue, resulting in infertility, blindness, and dementia. Infants developing in utero are particularly vulnerable.
Covid-19 played havoc with regular medical treatment and preventive care for many health problems, including STIs. After formal lockdowns ended, many people gradually became more socially engaged, with increases in sexual activity, and may have prioritized these activities over getting back in touch with their doctors.
A second blow to controlling STIs is that family planning clinics are closing left and right because of the Dobbs decision and legislation in many states that curtailed access to an abortion. Discussion has focused on abortion, but those same clinics also play a vital role in the diagnosis and treatment of STIs.
Routine public health is the neglected stepchild of medicine. It is called upon in times of crisis but as that crisis resolves, funding dries up. Labs have atrophied and personnel have been redirected to Covid, “so access to routine screening for STIs has been decimated,” says Jennifer Mahn, director of sexual and clinical health with the National Coalition of STD Directors.
A preview of what we likely are facing comes from Iowa. In 2017, the state legislature restricted funding to family health clinics in four counties, which closed their doors. A year later the statewide rate of gonorrhea skyrocketed from 83 to 153.7 cases per 100,000 people. “Iowa counties with clinic closures had a significantly larger increase,” according to a study published in JAMA. That scenario likely is playing out in countless other regions where access to sexual health care is shrinking; it will be many months before we have the data to know for sure.
A decades-old antibiotic finds a new purpose
Using drugs to protect against HIV, either as post exposure prophylaxis (PEP) or pre-exposure prophylaxis (PrEP), has proven to be quite successful. Researchers wondered if the same approach might be applied to other STIs. They focused on doxycycline, or doxy for short. One of the most commonly prescribed antibiotics in the U.S., it’s a member of the tetracycline family that has been on the market since 1967. It is so safe that it’s used to treat acne.
Two small studies using doxy suggested that it could work to prevent STIs. A handful of clinical trials by different researchers and funding sources set out to generate the additional evidence needed to prove their hypothesis and change the standard of care.
Senior researcher Victor Omollo, with the Kenya Medical Research Institute, noted, “These are prevention interventions that women can control on their own without having to seek or get consent from another person,” as is the case with condom use.
The first with results is the DoxyPEP study, conducted at two sexual health clinics in San Francisco and Seattle. It drew from a mix of transgender women and men who have sex with men, who had at least one diagnosed STI over the last year. The researchers divided the participants into two groups: one with people who were already HIV-positive and engaged in care, while the other group consisted of people who were on PrEP to prevent infection with HIV. For the active part of the study, a subset of the participants received doxy, and the rest of the participants did not.
The researchers intentionally chose to do the study in a population at the highest risk of having STIs, who were very health oriented, and “who were getting screened every three months or so as part of their PrEP program or their HIV care program,” says Connie Celum, a senior researcher at the University of Washington on the study.
Each member of the active group was given a supply of doxy and asked to take two pills within 72 hours of having sex where a condom was not used. The study was supposed to run for two years but, in May, it stopped halfway through, when a safety monitoring board looked at the data and recommended that it would be unethical to continue depriving the control group of the drug’s benefits.
Celum presented these preliminary results from the DoxyPEP study in July at the International AIDS Conference in Montreal. “We saw about a 56 percent reduction in gonorrhea, about 80 percent reduction in chlamydia and syphilis, so very significant reductions, and this is on a per quarter basis,” she told a later webinar.
In Kenya, another study is following a group of cisgender women who are taking the same two-pill regimen to prevent HIV, and the data from this research should become available in 2023. Senior researcher Victor Omollo, with the Kenya Medical Research Institute, noted that “these are prevention interventions that women can control on their own without having to seek or get consent from another person,” as is the case with condom use, another effective prevention tool.
Antibiotic resistance is a potentially big concern. About 25 percent of gonorrhea strains circulating in the U.S. are resistant to the tetracycline class of drugs, including doxy; rates are higher elsewhere. But resistance often is a matter of degree and can be overcome with a larger or longer dose of the drug, or perhaps with a switch to another drug or a two-drug combination.
Research has shown that an established bacterial infection is more difficult to treat because it is part of a biofilm, which can leave only a small portion or perhaps none of the cell surface exposed to a drug. But a new infection, even one where the bacteria is resistant to a drug, might still be vulnerable to that drug if it's used before the bacterial biofilm can be established. Preliminary data suggests that may be the case with doxyPEP and drug resistant gonorrhea; some but not all new drug resistant infections might be thwarted if they’re treated early enough.
“There are some tradeoffs” to these interventions, Celum says, and people may disagree on the cost of increased resistance balanced against the benefits of treating the STIs and reducing their spread within the community.
Resistance does not seem to be an issue yet for chlamydia and syphilis even though doxy has been a recommended treatment for decades, but a remaining question is whether broader use of doxy will directly worsen antibiotic resistance in gonorrhea, or promote it in other STIs. And how will it affect the gut microbiome?
In addition, Celum notes that we need to understand whether doxy will generate mutations in other bacteria that might contribute to drug resistance for gonorrhea, chlamydia or syphilis. The studies underway aim to provide data to answer these questions.
“There are some tradeoffs” to these interventions, Celum says, and people may disagree on the cost of increased resistance balanced against the benefits of treating the STIs and reducing their spread within the community. That might affect doctors' willingness to prescribe the drug.
Turning research into action
The CDC makes policy recommendations for prevention services such as taking doxy, requiring some and leaving others optional. Celum says the CDC will be reviewing information from her trial at a meeting in December, but probably will wait until that study is published before making recommendations, likely in 2023. The San Francisco Department of Public Health issued its own guidance on October 20th and anecdotally, some doctors around the country are beginning to issue prescriptions for doxy to select patients.
About half of new STIs occur in young people ages 15 to 24, a group that is least likely to regularly see a doctor. And sexual health remains a great taboo for many people who don't want such information on their health record for prying parents, employers or neighbors to find out.
“People will go out of their way and travel extensive distances just to avoid that,” says Mahn, the National Coalition director. “People identify locations where they feel safe, where they feel welcome, where they don't feel judged,” Mahn explains, such as community and family planning clinics. They understand those issues and have fees that vary depending on a person’s ability to pay.
Given that these clinics already are understaffed and underfunded, they will be hard pressed to expand services covering the labor intensive testing and monitoring of a doxyPEP regimen. Sexual health clinics don't even have a separate line item in the federal budget for health. That is something the National Association of STI Directors is pushing for in D.C.
DoxyPEP isn't a panacea, and it isn't for everyone. “We really want to try to reach that population who is most likely going to have an STI in the next year,” says Celum, “Because that's where you are going to have the biggest impact.”