All posts in “Policy”

All that glitters is not gold: How healthtech startups can achieve true value

Healthtech is apparently in a golden age. Just a few weeks ago, Livongo and Health Catalyst raised a combined $500 million through IPOs with a joint valuation reaching $3.5 billion. Deals such as these are catalyzing a record-breaking 2019, with digital health deal activity expected to surpass the $8.1 billion invested in 2018.

Amidst such abundance, the digital health ecosystem is thriving: as of 2017, greater than 300,000 mobile applications and 340 consumer wearable devices existed—with 200 new mobile applications added daily. No theme has been more important to this fundraising than artificial intelligence and machine learning (AI/ML), a space which captured more than one-quarter of healthtech funding in 2018.

Yet, how many of these technologies will prove valuable in medical, ethical, or financial terms?

Our research group at Stanford addressed this question by taking a deeper dive into the saying that, in AI/ML, “garbage in equals garbage out.” We did this by distinguishing digital health algorithms leveraging AI/ML from their underlying training data, documenting the numerous consequences to the outputs of these technologies should the inputs resemble, well, “garbage.”

For example, the utility of genetic risk scores provided by companies such as 23andMe and AncestryDNA (which have estimated valuations of $1.75 and $2.6 billion, respectively) may be limited due to diagnostic biases stemming from the underrepresentation of diverse populations.

Responding to such observations, we provide a variety of recommendations to the developers, inventors, and founders spearheading the advancement of digital health—as well as the funders supporting this charge forward—to ensure that their innovations are valuable to the stakeholders they target.

Healthtech startups still have to prove their value for patients

How ‘ghost work’ in Silicon Valley pressures the workforce, with Mary Gray

The phrase “pull yourself up by your own bootstraps” was originally meant sarcastically.

It’s not actually physically possible to do — especially while wearing Allbirds and having just fallen off a Bird scooter in downtown San Francisco, but I should get to my point.

This week, Ken Cuccinelli, the acting Director of the United States Citizenship and Immigrant Services Office, repeatedly referred to the notion of bootstraps in announcing shifts in immigration policy, even going so far as to change the words to Emma Lazarus’s famous poem “The New Colossus:” no longer “give me your tired, your poor, your huddled masses yearning to breathe free,” but “give me your tired and your poor who can stand on their own two feet, and who will not become a public charge.”

We’ve come to expect “alternative facts” from this administration, but who could have foreseen alternative poems?

Still, the concept of ‘bootstrapping’ is far from limited to the rhetorical territory of the welfare state and social safety net. It’s also a favorite term of art in Silicon Valley tech and venture capital circles: see for example this excellent (and scary) recent piece by my editor Danny Crichton, in which young VC firms attempt to overcome a lack of the startup capital that is essential to their business model by creating, as perhaps an even more essential feature of their model, impossible working conditions for most everyone involved. Often with predictably disastrous results.

It is in this context of unrealistic expectations about people’s labor, that I want to introduce my most recent interviewee in this series of in-depth conversations about ethics and technology.

Mary L. Gray is a Fellow at Harvard University’s Berkman Klein Center for Internet and Society and a Senior Researcher at Microsoft Research. One of the world’s leading experts in the emerging field of ethics in AI, Mary is also an anthropologist who maintains a faculty position at Indiana University. With her co-author Siddharth Suri (a computer scientist), Gray coined the term “ghost work,” as in the title of their extraordinarily important 2019 book, Ghost Work: How to Stop Silicon Valley from Building a New Global Underclass. 

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Image via Mary L. Gray / Ghostwork / Adrianne Mathiowetz Photography

Ghost Work is a name for a rising new category of employment that involves people scheduling, managing, shipping, billing, etc. “through some combination of an application programming interface, APIs, the internet and maybe a sprinkle of artificial intelligence,” Gray told me earlier this summer. But what really distinguishes ghost work (and makes Mary’s scholarship around it so important) is the way it is presented and sold to the end consumer as artificial intelligence and the magic of computation.

In other words, just as we have long enjoyed telling ourselves that it’s possible to hoist ourselves up in life without help from anyone else (I like to think anyone who talks seriously about “bootstrapping” should be legally required to rephrase as “raising oneself from infancy”), we now attempt to convince ourselves and others that it’s possible, at scale, to get computers and robots to do work that only humans can actually do.

Ghost Work’s purpose, as I understand it, is to elevate the value of what the computers are doing (a minority of the work) and make us forget, as much as possible, about the actual messy human beings contributing to the services we use. Well, except for the founders, and maybe the occasional COO.

Facebook now has far more employees than Harvard has students, but many of us still talk about it as if it were little more than Mark Zuckerberg, Cheryl Sandberg, and a bunch of circuit boards.

But if working people are supposed to be ghosts, then when they speak up or otherwise make themselves visible, they are “haunting” us. And maybe it can be haunting to be reminded that you didn’t “bootstrap” yourself to billions or even to hundreds of thousands of dollars of net worth.

Sure, you worked hard. Sure, your circumstances may well have stunk. Most people’s do.

But none of us rise without help, without cooperation, without goodwill, both from those who look and think like us and those who do not. Not to mention dumb luck, even if only our incredible good fortune of being born with a relatively healthy mind and body, in a position to learn and grow, here on this planet, fourteen billion years or so after the Big Bang.

I’ll now turn to the conversation I recently had with Gray, which turned out to be surprisingly more hopeful than perhaps this introduction has made it seem.

Greg Epstein: One of the most central and least understood features of ghost work is the way it revolves around people constantly making themselves available to do it.

Mary Gray: Yes, [What Siddarth Suri and I call ghost work] values having a supply of people available, literally on demand. Their contributions are collective contributions.

It’s not one person you’re hiring to take you to the airport every day, or to confirm the identity of the driver, or to clean that data set. Unless we’re valuing that availability of a person, to participate in the moment of need, it can quickly slip into ghost work conditions.

Local governments are forcing the scooter industry to grow up fast

Gone are the days when tech companies can deploy their services in cities without any regard for rules and regulations. Before the rise of electric scooters, cities had already become hip to tech’s status quo (thanks to the likes of Uber and Lyft) and were ready to regulate. We explored some of this in “The uncertain future of shared scooters,” but since then, new challenges have emerged for scooter startups.

And for scooter startups, city regulations can make or break their businesses across nearly every aspect of operations, especially two major ones: ridership growth and ability to attract investor dollars. From issuing permits to determining how many scooters any one company can operate at any one time to enforcing low-income plans and impacting product roadmaps, the ball is really in the city’s court.

US legislator, David Cicilline, joins international push to interrogate platform power

US legislator David Cicilline will be joining the next meeting of the International Grand Committee on Disinformation and ‘Fake News’, it has been announced. The meeting will be held in Dublin on November 7.

Chair of the committee, the Irish Fine Gael politician Hildegarde Naughton, announced Cicilline’s inclusion today.

The congressman — who is chairman of the US House Judiciary Committee’s Antitrust, Commercial, and Administrative Law Subcommittee — will attend as an “ex officio member” which will allow him to question witnesses, she added.

Exactly who the witnesses in front of the grand committee will be is tbc. But the inclusion of a US legislator in the ranks of a non-US committee that’s been seeking answers about reining in online disinformation will certainly make any invitations that get extended to senior executives at US-based tech giants much harder to ignore.

Naughton points out that the addition of American legislators also means the International Grand Committee represents ~730 million citizens — and “their right to online privacy and security”.

“The Dublin meeting will be really significant in that it will be the first time that US legislators will participate,” she said in a statement. “As all the major social media/tech giants were founded and are headquartered in the United States it is very welcome that Congressman Cicilline has agreed to participate. His own Committee is presently conducting investigations into Facebook, Google, Amazon and Apple and so his attendance will greatly enhance our deliberations.”

“Greater regulation of social media and tech giants is fast becoming a priority for many countries throughout the world,” she added. “The International Grand Committee is a gathering of international parliamentarians who have a particular responsibility in this area. We will coordinate actions to tackle online election interference, ‘fake news’, and harmful online communications, amongst other issues while at the same time respecting freedom of speech.”

The international committee met for its first session in London last November — when it was forced to empty-chair Facebook founder Mark Zuckerberg who had declined to attend in person, sending UK policy VP Richard Allan in his stead.

Lawmakers from nine countries spent several hours taking Allan to task over Facebook’s lack of accountability for problems generated by the content it distributes and amplifies, raising myriad examples of ongoing failure to tackle the democracy-denting, society-damaging disinformation — from election interference to hate speech whipping up genocide.

A second meeting of the grand committee was held earlier this year in Canada — taking place over three days in May.

Again Zuckerberg failed to show. Facebook COO Sheryl Sandberg also gave international legislators zero facetime, with the company opting to send local head of policy, Kevin Chan, and global head of policy, Neil Potts, as stand ins.

Lawmakers were not amused. Canadian MPs voted to serve Zuckerberg and Sandberg with an open summons — meaning they’ll be required to appear before it the next time they step foot in the country.

Parliamentarians in the UK also issued a summons for Zuckerberg last year after repeat snubs to testify to the Digital, Culture, Media and Sport committee’s enquiry into fake news — a decision that essentially gave birth to the international grand committee, as legislators in multiple jurisdictions united around a common cause of trying to find ways to hold social media giants to accounts.

While it’s not clear who the grand committee will invite to the next session, Facebook’s founder seems highly unlikely to have dropped off their list. And this time Zuckerberg and Sandberg may find it harder to turn down an invite to Dublin, given the committee’s ranks will include a homegrown lawmaker.

In a statement on joining the next meeting, Cicilline said: “We are living in a critical moment for privacy rights and competition online, both in the United States and around the world.  As people become increasingly connected by what seem to be free technology platforms, many remain unaware of the costs they are actually paying.

“The Internet has also become concentrated, less open, and growingly hostile to innovation. This is a problem that transcends borders, and it requires multinational cooperation to craft solutions that foster competition and safeguard privacy online. I look forward to joining the International Grand Committee as part of its historic effort to identify problems in digital markets and chart a path forward that leads to a better online experience for everyone.”

Multiple tech giants (including Facebook) have their international headquarters in Ireland — making the committee’s choice of location for their next meeting a strategic one. Should any tech CEOs thus choose to snub an invite to testify to the committee they might find themselves being served with an open summons to testify by Irish parliamentarians — and not being able to set foot in a country where their international HQ is located would be more than a reputational irritant.

Ireland’s privacy regulator is also sitting on a stack of open investigations against tech giants — again with Facebook and Facebook owned companies producing the fattest file (some 11 investigations). But there are plenty of privacy and security concerns to go around, with the DPC’s current case file also touching tech giants including Apple, Google, LinkedIn and Twitter.

Ajit Pai formally recommends T-Mobile/Sprint merger approval

Ajit Pai has long signaled that he would approve a T-Mobile/Sprint merger, but today the FCC Chairman made it official. In spite of widespread opposition suggesting that the combining of the country’s third and fourth largest carriers would reduce competition in the marketplace, Pai takes the stance that such a move would actual promote competition.

“After one of the most exhaustive merger reviews in Commission history, the evidence conclusively demonstrates that this transaction will bring fast 5G wireless service to many more Americans and help close the digital divide in rural areas,” Pai said in a statement. “Moreover, with the conditions included in this draft Order, the merger will promote robust competition in mobile broadband, put critical mid-band spectrum to use, and bring new competition to the fixed broadband market. I thank our transaction team for the thorough and careful analysis reflected in this draft Order and hope that my colleagues will vote to approve it.”

Pai’s statement echoes that of many conservatives on the topic. While T-Mobile and Sprint are third and fourth place, respectively, AT&T and Verizon are significantly ahead in terms of subscriber bases. Pai and other have suggested that combining the two under the T-Mobile umbrella would help the carriers get a leg up when it comes to competing on a 5G roll out.

Consumers will directly benefit from improvements in network quality and coverage, which in turn will foster innovation in a wide variety of sectors and services (itself creating significant public interest benefits),” Pai’s team writes.Moreover, the transaction will help to close the digital divide by bringing robust 5G deep into rural areas, with enforceable conditions in the draft Order requiring coverage of at least 99% of Americans within six years.”

Last month, the proposed merger was given the go-ahead by the U.S. Department of Justice on the condition that Sprint sell its prepaid assets (including Boost) to Dish network. A growing number of states attorneys general, meanwhile, have opposed the merger. Oregon joined the lawsuit yesterday, bringing the total up to 15 states and the District of Columbia.

“If left unchallenged, the current plan will result in reduced access to affordable wireless service in Oregon — and higher prices,” Oregon AG Ellen Rosenblum said at the time. “Neither is acceptable.”

Pai noted earlier this year that he planned to approve the $26.5 billion deal, which would knock the country’s premium carriers down to three. No word yet on when the Commission will formally vote on the deal.