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Ashraf AR, Mackey TK, Fittler A. Search Engines and Generative Artificial Intelligence Integration: Public Health Risks and Recommendations to Safeguard Consumers Online. JMIR Public Health Surveill 2024; 10:e53086. [PMID: 38512343 PMCID: PMC10995787 DOI: 10.2196/53086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/27/2023] [Accepted: 01/04/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The online pharmacy market is growing, with legitimate online pharmacies offering advantages such as convenience and accessibility. However, this increased demand has attracted malicious actors into this space, leading to the proliferation of illegal vendors that use deceptive techniques to rank higher in search results and pose serious public health risks by dispensing substandard or falsified medicines. Search engine providers have started integrating generative artificial intelligence (AI) into search engine interfaces, which could revolutionize search by delivering more personalized results through a user-friendly experience. However, improper integration of these new technologies carries potential risks and could further exacerbate the risks posed by illicit online pharmacies by inadvertently directing users to illegal vendors. OBJECTIVE The role of generative AI integration in reshaping search engine results, particularly related to online pharmacies, has not yet been studied. Our objective was to identify, determine the prevalence of, and characterize illegal online pharmacy recommendations within the AI-generated search results and recommendations. METHODS We conducted a comparative assessment of AI-generated recommendations from Google's Search Generative Experience (SGE) and Microsoft Bing's Chat, focusing on popular and well-known medicines representing multiple therapeutic categories including controlled substances. Websites were individually examined to determine legitimacy, and known illegal vendors were identified by cross-referencing with the National Association of Boards of Pharmacy and LegitScript databases. RESULTS Of the 262 websites recommended in the AI-generated search results, 47.33% (124/262) belonged to active online pharmacies, with 31.29% (82/262) leading to legitimate ones. However, 19.04% (24/126) of Bing Chat's and 13.23% (18/136) of Google SGE's recommendations directed users to illegal vendors, including for controlled substances. The proportion of illegal pharmacies varied by drug and search engine. A significant difference was observed in the distribution of illegal websites between search engines. The prevalence of links leading to illegal online pharmacies selling prescription medications was significantly higher (P=.001) in Bing Chat (21/86, 24%) compared to Google SGE (6/92, 6%). Regarding the suggestions for controlled substances, suggestions generated by Google led to a significantly higher number of rogue sellers (12/44, 27%; P=.02) compared to Bing (3/40, 7%). CONCLUSIONS While the integration of generative AI into search engines offers promising potential, it also poses significant risks. This is the first study to shed light on the vulnerabilities within these platforms while highlighting the potential public health implications associated with their inadvertent promotion of illegal pharmacies. We found a concerning proportion of AI-generated recommendations that led to illegal online pharmacies, which could not only potentially increase their traffic but also further exacerbate existing public health risks. Rigorous oversight and proper safeguards are urgently needed in generative search to mitigate consumer risks, making sure to actively guide users to verified pharmacies and prioritize legitimate sources while excluding illegal vendors from recommendations.
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Affiliation(s)
- Amir Reza Ashraf
- Department of Pharmaceutics, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Tim Ken Mackey
- Global Health Program, Department of Anthropology, University of California, La Jolla, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research, San Diego, CA, United States
| | - András Fittler
- Department of Pharmaceutics, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
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2
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Le N, McMann TJ, Cui M, Cuomo RE, Yang JS, Mackey TK. Tobacco Product Marketing Orders and Online Marketing and Sale of Unauthorized ENDS Products. JAMA Intern Med 2023; 183:1170-1172. [PMID: 37669043 PMCID: PMC10481318 DOI: 10.1001/jamainternmed.2023.3101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/20/2023] [Indexed: 09/06/2023]
Abstract
This study characterizes online marketing of unauthorized electronic nicotine delivery systems (ENDS).
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Affiliation(s)
- Nicolette Le
- Global Health Program, Department of Anthropology, University of California San Diego
| | - Tiana J. McMann
- Global Health Program, Department of Anthropology, University of California San Diego
| | - Mandy Cui
- Global Health Program, Department of Anthropology, University of California San Diego
| | - Raphael E. Cuomo
- Department of Anesthesiology, School of Medicine, University of California San Diego
| | - Joshua S. Yang
- Department of Public Health, California State University, Fullerton
| | - Tim Ken Mackey
- Global Health Program, Department of Anthropology, University of California San Diego
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3
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Mamudu HM, Nwabueze CA, Yang JS, Mackey TK, Ahuja M, Smith A, Weierbach FM, McNabb M, Minnick C, Jones A. Social media and use of electronic nicotine delivery systems among school-going adolescents in a rural distressed Appalachian community. Prev Med Rep 2022; 29:101953. [PMID: 36161107 PMCID: PMC9501989 DOI: 10.1016/j.pmedr.2022.101953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 11/28/2022] Open
Abstract
Social media use to discuss ENDS among youth in distressed areas is understudied. Nearly 1 in 3 and 1 in 8 of youth were ever and current ENDS users, respectively. Nearly 1 in 5 of the youth reported using social media to talk about ENDS. Social media increased current and ever ENDS use by 4 and 3 times, respectively. Social media engagement may lead to ENDS uptake among youth in distressed areas.
Electronic nicotine delivery systems (ENDS) are the most used tobacco products among middle and high schoolers in the United States (U.S.). Familial relations and access play a major role in uptake among adolescents; yet the role of social media in this phenomenon in the context of communities impacted by tobacco-related health disparities is understudied. In Spring 2019, data were collected from adolescents in 8th and 9th grades in a school located in a rural distressed county in Tennessee to assess social media’s role in ENDS uptake. Descriptive and multivariable statistical analyses were performed to delineate factors associated with ENDS use. Of a total of 399 respondents, 12.5 % reported current ENDS use and 22.1 % indicated having ever discussed ENDS on social media. Closed messaging platforms (Snapchat) and video platforms (Facebook/Instagram/You Tube) were the most reported form of social media used (8.31 % and 8.31 % respectively). Social media use was positively associated with both ever ENDS use (odds ratio [OR] = 2.9) and current ENDS use (OR = 3.98). Parental advice against ENDS use was positively associated with ever ENDS use. In conclusion, social media use was positively associated with both ever and current ENDS use, and Snapchat was the most popular platform among this population of students. The results indicate that youth social media engagement may lead to exposure that can influence ENDS uptake. Future studies are needed to further examine these associations among distressed communities.
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Affiliation(s)
- H M Mamudu
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson, City, TN, USA
- College of Public Health, East Tennessee State University, Johnson, City, TN, USA
| | - C A Nwabueze
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson, City, TN, USA
| | - J S Yang
- Department of Public Health, California State University, Fullerton, KHS 161 A, 800 N. State College Blvd, Fullerton, CA, 92831, USA
| | - T K Mackey
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, USA
| | - M Ahuja
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson, City, TN, USA
- College of Public Health, East Tennessee State University, Johnson, City, TN, USA
| | - A Smith
- College of Public Health, East Tennessee State University, Johnson, City, TN, USA
| | - F M Weierbach
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson, City, TN, USA
- College of Nursing, East Tennessee State University, Johnson City, TN, USA
| | - M McNabb
- Northeast Regional Office of Tennessee Department of Health, Johnson City, TN, USA
| | - C Minnick
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson, City, TN, USA
- College of Public Health, East Tennessee State University, Johnson, City, TN, USA
| | - A Jones
- Department of Sociology & Department of Epidemiology, Milken School Institute of Public Health, The George Washington University, Washington, DC, USA
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Cuomo RE, Mackey TK. Examining the association between international migration and colorectal cancer among multiple ancestry groups in the United States. Ethn Health 2022; 27:275-283. [PMID: 31679393 DOI: 10.1080/13557858.2019.1685652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 10/08/2019] [Indexed: 06/10/2023]
Abstract
Objectives: Prior research has not adequately examined the relationship between international migration and colorectal cancer (CRC) by cultural regions in the US. The purpose of this exploratory study was to determine how annual CRC incidence varied with US annual international migrant inflow in ten different regions, corresponding to dominant ancestry group.Design: County-level international migrant inflow and dominant ancestry type were obtained from the American Community Survey, and age-adjusted CRC incidence was obtained from the National Cancer Institute. A linear regression model was tested for each ancestry region to assess the relationship between migrant inflow and CRC incidence.Results: Higher international migrant inflow was associated with lower CRC incidence among counties where the dominant ancestry group was African American (p = 0.0207), British (p = 0.0212), Hispanic (p = 0.0001), and Native American (p = 0.0056).Conclusions: These findings suggest that US residents in certain ancestry groups are at higher risk for CRC.
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Affiliation(s)
| | - T K Mackey
- Global Health Policy Institute, San Diego, CA, USA
- Department of Anesthesiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
- Division of Global Public Health, School of Medicine, University of California, San Diego, San Diego, CA, USA
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Xu Q, Nali MC, McMann T, Godinez H, Li J, He Y, Cai M, Lee C, Merenda C, Araojo R, Mackey TK. Unsupervised Machine Learning to Detect and Characterize Barriers to Pre-exposure Prophylaxis Therapy: Multiplatform Social Media Study. JMIR Infodemiology 2022; 2:e35446. [PMID: 37113799 PMCID: PMC10014091 DOI: 10.2196/35446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/18/2022] [Accepted: 03/07/2022] [Indexed: 04/29/2023]
Abstract
Background Among racial and ethnic minority groups, the risk of HIV infection is an ongoing public health challenge. Pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV when taken as prescribed. However, there is a need to understand the experiences, attitudes, and barriers of PrEP for racial and ethnic minority populations and sexual minority groups. Objective This infodemiology study aimed to leverage big data and unsupervised machine learning to identify, characterize, and elucidate experiences and attitudes regarding perceived barriers associated with the uptake and adherence to PrEP therapy. This study also specifically examined shared experiences from racial or ethnic populations and sexual minority groups. Methods The study used data mining approaches to collect posts from popular social media platforms such as Twitter, YouTube, Tumblr, Instagram, and Reddit. Posts were selected by filtering for keywords associated with PrEP, HIV, and approved PrEP therapies. We analyzed data using unsupervised machine learning, followed by manual annotation using a deductive coding approach to characterize PrEP and other HIV prevention-related themes discussed by users. Results We collected 522,430 posts over a 60-day period, including 408,637 (78.22%) tweets, 13,768 (2.63%) YouTube comments, 8728 (1.67%) Tumblr posts, 88,177 (16.88%) Instagram posts, and 3120 (0.6%) Reddit posts. After applying unsupervised machine learning and content analysis, 785 posts were identified that specifically related to barriers to PrEP, and they were grouped into three major thematic domains: provider level (13/785, 1.7%), patient level (570/785, 72.6%), and community level (166/785, 21.1%). The main barriers identified in these categories included those associated with knowledge (lack of knowledge about PrEP), access issues (lack of insurance coverage, no prescription, and impact of COVID-19 pandemic), and adherence (subjective reasons for why users terminated PrEP or decided not to start PrEP, such as side effects, alternative HIV prevention measures, and social stigma). Among the 785 PrEP posts, we identified 320 (40.8%) posts where users self-identified as racial or ethnic minority or as a sexual minority group with their specific PrEP barriers and concerns. Conclusions Both objective and subjective reasons were identified as barriers reported by social media users when initiating, accessing, and adhering to PrEP. Though ample evidence supports PrEP as an effective HIV prevention strategy, user-generated posts nevertheless provide insights into what barriers are preventing people from broader adoption of PrEP, including topics that are specific to 2 different groups of sexual minority groups and racial and ethnic minority populations. Results have the potential to inform future health promotion and regulatory science approaches that can reach these HIV and AIDS communities that may benefit from PrEP.
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Affiliation(s)
- Qing Xu
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
| | - Matthew C Nali
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
- Global Health Program, Department of Anthropology University of California La Jolla, CA United States
| | - Tiana McMann
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
- Global Health Program, Department of Anthropology University of California La Jolla, CA United States
| | | | - Jiawei Li
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
| | - Yifan He
- S-3 Research San Diego, CA United States
| | - Mingxiang Cai
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
| | - Christine Lee
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration Silver Spring, MD United States
| | - Christine Merenda
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration Silver Spring, MD United States
| | - Richardae Araojo
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration Silver Spring, MD United States
| | - Tim Ken Mackey
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
- Global Health Program, Department of Anthropology University of California La Jolla, CA United States
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Platt M, Hasselgren A, Román-Belmonte JM, Tuler de Oliveira M, De la Corte-Rodríguez H, Delgado Olabarriaga S, Rodríguez-Merchán EC, Mackey TK. Test, Trace, and Put on the Blockchain?: A Viewpoint Evaluating the Use of Decentralized Systems for Algorithmic Contact Tracing to Combat a Global Pandemic. JMIR Public Health Surveill 2021; 7:e26460. [PMID: 33727212 PMCID: PMC8108567 DOI: 10.2196/26460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/20/2021] [Accepted: 03/08/2021] [Indexed: 01/29/2023] Open
Abstract
The enormous pressure of the increasing case numbers experienced during the COVID-19 pandemic has given rise to a variety of novel digital systems designed to provide solutions to unprecedented challenges in public health. The field of algorithmic contact tracing, in particular, an area of research that had previously received limited attention, has moved into the spotlight as a crucial factor in containing the pandemic. The use of digital tools to enable more robust and expedited contact tracing and notification, while maintaining privacy and trust in the data generated, is viewed as key to identifying chains of transmission and close contacts, and, consequently, to enabling effective case investigations. Scaling these tools has never been more critical, as global case numbers have exceeded 100 million, as many asymptomatic patients remain undetected, and as COVID-19 variants begin to emerge around the world. In this context, there is increasing attention on blockchain technology as a part of systems for enhanced digital algorithmic contact tracing and reporting. By analyzing the literature that has emerged from this trend, the common characteristics of the designs proposed become apparent. An archetypal system architecture can be derived, taking these characteristics into consideration. However, assessing the utility of this architecture using a recognized evaluation framework shows that the added benefits and features of blockchain technology do not provide significant advantages over conventional centralized systems for algorithmic contact tracing and reporting. From our study, it, therefore, seems that blockchain technology may provide a more significant benefit in other areas of public health beyond contact tracing.
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Affiliation(s)
- Moritz Platt
- Department of Informatics, King's College London, London, United Kingdom
| | - Anton Hasselgren
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Juan Manuel Román-Belmonte
- Department of Physical Medicine and Rehabilitation, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain
| | | | | | | | - E Carlos Rodríguez-Merchán
- Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Tim Ken Mackey
- Department of Anesthesiology, Division of Infectious Diseases and Global Public Health, School of Medicine, UC San Diego, La Jolla, CA, United States
- BlockLAB, San Diego Supercomputer Center, UC San Diego, La Jolla, CA, United States
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Mackey TK, Miyachi K, Fung D, Qian S, Short J. Combating Health Care Fraud and Abuse: Conceptualization and Prototyping Study of a Blockchain Antifraud Framework. J Med Internet Res 2020; 22:e18623. [PMID: 32909952 PMCID: PMC7516680 DOI: 10.2196/18623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/02/2020] [Accepted: 07/26/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND An estimated US $2.6 billion loss is attributed to health care fraud and abuse. With traditional health care claims verification and reimbursement, the health care provider submits a claim after rendering services to a patient, which is then verified and reimbursed by the payer. However, this process leaves out a critical stakeholder: the patient for whom the services are actually rendered. This lack of patient participation introduces a risk of fraud and abuse. Blockchain technology enables secure data management with transparency, which could mitigate this risk of health care fraud and abuse. OBJECTIVE The aim of this study is to develop a framework using blockchain to record claims data and transactions in an immutable format and to enable the patient to act as a validating node to help detect and prevent health care fraud and abuse. METHODS We developed a health care fraud and abuse blockchain technical framework and prototype using key blockchain tools and application layers including consensus algorithms, smart contracts, tokens, and governance based on digital identity on the Ethereum platform (Ethereum Foundation). RESULTS Our technical framework maps to the claims adjudication process and focuses on Medicare claims, with the US Centers for Medicare and Medicaid Services (CMS) as the central authority. A prototype of the framework system was developed using the blockchain platform Ethereum (Ethereum Foundation), with its design features, workflow, smart contract functions, system architecture, and software implementation outlined. The software stack used to build the system consisted of a front-end user interface framework, a back-end processing server, and a blockchain network. React was used for the user interface framework, and NodeJS and an Express server were used for the back-end processing server; Solidity was the smart contract language used to interact with a local Ethereum blockchain network. CONCLUSIONS The proposed framework and the initial prototype have the potential to improve the health care claims process by using blockchain technology for secure data storage and consensus mechanisms, which make the claims adjudication process more patient-centric for the purposes of identifying and preventing health care fraud and abuse. Future work will focus on the use of synthetic or historic CMS claims data to assess the real-world viability of the framework.
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Affiliation(s)
- Tim Ken Mackey
- UC San Diego - School of Medicine, Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, La Jolla, CA, United States.,San Diego Supercomputer Center, BlockLAB, La Jolla, CA, United States.,Global Health Policy and Data Institute, San Diego, CA, United States.,UC San Diego - Extension, Department of Healthcare Research and Policy, La Jolla, CA, United States
| | - Ken Miyachi
- San Diego Supercomputer Center, BlockLAB, La Jolla, CA, United States.,LedgerSafe Corporation, San Diego, CA, United States.,Institute of Electrical and Electronics Engineers, San Diego, CA, United States
| | - Danny Fung
- San Diego Supercomputer Center, BlockLAB, La Jolla, CA, United States
| | - Samson Qian
- San Diego Supercomputer Center, BlockLAB, La Jolla, CA, United States
| | - James Short
- San Diego Supercomputer Center, BlockLAB, La Jolla, CA, United States
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Mackey TK, Li J, Purushothaman V, Nali M, Shah N, Bardier C, Cai M, Liang B. Big Data, Natural Language Processing, and Deep Learning to Detect and Characterize Illicit COVID-19 Product Sales: Infoveillance Study on Twitter and Instagram. JMIR Public Health Surveill 2020; 6:e20794. [PMID: 32750006 PMCID: PMC7451110 DOI: 10.2196/20794] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/17/2020] [Accepted: 08/03/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic is perhaps the greatest global health challenge of the last century. Accompanying this pandemic is a parallel "infodemic," including the online marketing and sale of unapproved, illegal, and counterfeit COVID-19 health products including testing kits, treatments, and other questionable "cures." Enabling the proliferation of this content is the growing ubiquity of internet-based technologies, including popular social media platforms that now have billions of global users. OBJECTIVE This study aims to collect, analyze, identify, and enable reporting of suspected fake, counterfeit, and unapproved COVID-19-related health care products from Twitter and Instagram. METHODS This study is conducted in two phases beginning with the collection of COVID-19-related Twitter and Instagram posts using a combination of web scraping on Instagram and filtering the public streaming Twitter application programming interface for keywords associated with suspect marketing and sale of COVID-19 products. The second phase involved data analysis using natural language processing (NLP) and deep learning to identify potential sellers that were then manually annotated for characteristics of interest. We also visualized illegal selling posts on a customized data dashboard to enable public health intelligence. RESULTS We collected a total of 6,029,323 tweets and 204,597 Instagram posts filtered for terms associated with suspect marketing and sale of COVID-19 health products from March to April for Twitter and February to May for Instagram. After applying our NLP and deep learning approaches, we identified 1271 tweets and 596 Instagram posts associated with questionable sales of COVID-19-related products. Generally, product introduction came in two waves, with the first consisting of questionable immunity-boosting treatments and a second involving suspect testing kits. We also detected a low volume of pharmaceuticals that have not been approved for COVID-19 treatment. Other major themes detected included products offered in different languages, various claims of product credibility, completely unsubstantiated products, unapproved testing modalities, and different payment and seller contact methods. CONCLUSIONS Results from this study provide initial insight into one front of the "infodemic" fight against COVID-19 by characterizing what types of health products, selling claims, and types of sellers were active on two popular social media platforms at earlier stages of the pandemic. This cybercrime challenge is likely to continue as the pandemic progresses and more people seek access to COVID-19 testing and treatment. This data intelligence can help public health agencies, regulatory authorities, legitimate manufacturers, and technology platforms better remove and prevent this content from harming the public.
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Affiliation(s)
- Tim Ken Mackey
- Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States
- Department of Healthcare Research and Policy, University of California, San Diego, La Jolla, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research LLC, San Diego, CA, United States
| | - Jiawei Li
- Department of Healthcare Research and Policy, University of California, San Diego, La Jolla, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research LLC, San Diego, CA, United States
| | - Vidya Purushothaman
- Global Health Policy and Data Institute, San Diego, CA, United States
- Masters in Public Health Program, Department of Family Medicine and Public Health, University of California, San Diego - School of Medicine, La Jolla, CA, United States
| | - Matthew Nali
- Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research LLC, San Diego, CA, United States
| | - Neal Shah
- Department of Healthcare Research and Policy, University of California, San Diego, La Jolla, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
| | - Cortni Bardier
- Masters Program in Global Health, Department of Anthropology, University of California, San Diego, La Jolla, CA, United States
| | - Mingxiang Cai
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research LLC, San Diego, CA, United States
| | - Bryan Liang
- Global Health Policy and Data Institute, San Diego, CA, United States
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Abstract
Surgical data recording technology has great promise to generate patient safety and quality data that can be utilized to potentially reduce medical errors. Variations of these systems aim to improve surgical technique, develop better training simulation, and promote adverse event investigation similar to the aims of black box technology utilized in other industries. However, many unknowns remain for surgical data recording utilization in operating rooms and clinical settings in the United States. This includes the need to appropriately design systems so they collect meaningful and useful data that can be discussed by surgical team members in an open and safe environment to optimize clinical care processes. In order to better understand the clinical and regulatory environment for surgical data recording systems, we conducted an interdisciplinary review to identify key technology approaches, and assess legal and regulatory implications associated with this potentially disruptive technology. We found technology ranging from audio and visual data, to systems utilizing mobile applications, and kinematic data capture. The data collected present legal questions over ownership of information and privacy, along with regulatory issues at the federal and state levels. The benefits of these data should be balanced with the need to develop appropriate policies and regulations that protect the interests of both clinicians and patients in order to encourage further innovation and better realize the potential of surgical data recording technology to improve clinical decision making and patient safety outcomes.
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Affiliation(s)
- Jessica Jue
- University of California San Diego, School of Medicine, La Jolla, CA, USA
| | - Neal A Shah
- University of California San Diego, School of Medicine, La Jolla, CA, USA
| | - Tim Ken Mackey
- University of California San Diego, School of Medicine, La Jolla, CA, USA.,University of California San Diego, Extension, Department of Healthcare Research and Policy, La Jolla, CA, USA.,Global Health Policy Institute, San Diego, CA, USA
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Maroulis J, Mackey TK. State Health Care Reform: Waivers, Single-Payer, and the Need for Alternative Pathways. Ann Intern Med 2019; 171:281-282. [PMID: 31330538 DOI: 10.7326/m19-0509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- James Maroulis
- University of California San Diego, San Diego, California (J.M.)
| | - Tim Ken Mackey
- Global Health Policy Institute and University of California, San Diego School of Medicine, San Diego, California (T.K.M.)
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Katsuki T, Mackey TK, Cuomo R. Establishing a Link Between Prescription Drug Abuse and Illicit Online Pharmacies: Analysis of Twitter Data. J Med Internet Res 2015; 17:e280. [PMID: 26677966 PMCID: PMC4704982 DOI: 10.2196/jmir.5144] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 10/28/2015] [Accepted: 11/11/2015] [Indexed: 11/13/2022] Open
Abstract
Background Youth and adolescent non-medical use of prescription medications (NUPM) has become a national epidemic. However, little is known about the association between promotion of NUPM behavior and access via the popular social media microblogging site, Twitter, which is currently used by a third of all teens. Objective In order to better assess NUPM behavior online, this study conducts surveillance and analysis of Twitter data to characterize the frequency of NUPM-related tweets and also identifies illegal access to drugs of abuse via online pharmacies. Methods Tweets were collected over a 2-week period from April 1-14, 2015, by applying NUPM keyword filters for both generic/chemical and street names associated with drugs of abuse using the Twitter public streaming application programming interface. Tweets were then analyzed for relevance to NUPM and whether they promoted illegal online access to prescription drugs using a protocol of content coding and supervised machine learning. Results A total of 2,417,662 tweets were collected and analyzed for this study. Tweets filtered for generic drugs names comprised 232,108 tweets, including 22,174 unique associated uniform resource locators (URLs), and 2,185,554 tweets (376,304 unique URLs) filtered for street names. Applying an iterative process of manual content coding and supervised machine learning, 81.72% of the generic and 12.28% of the street NUPM datasets were predicted as having content relevant to NUPM respectively. By examining hyperlinks associated with NUPM relevant content for the generic Twitter dataset, we discovered that 75.72% of the tweets with URLs included a hyperlink to an online marketing affiliate that directly linked to an illicit online pharmacy advertising the sale of Valium without a prescription. Conclusions This study examined the association between Twitter content, NUPM behavior promotion, and online access to drugs using a broad set of prescription drug keywords. Initial results are concerning, as our study found over 45,000 tweets that directly promoted NUPM by providing a URL that actively marketed the illegal online sale of prescription drugs of abuse. Additional research is needed to further establish the link between Twitter content and NUPM, as well as to help inform future technology-based tools, online health promotion activities, and public policy to combat NUPM online.
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Affiliation(s)
- Takeo Katsuki
- Kavli Institute for Brain and Mind, University of California, San Diego, La Jolla, CA, United States
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Mackey TK, Liang BA, Kohler JC, Attaran A. Health domains for sale: the need for global health Internet governance. J Med Internet Res 2014; 16:e62. [PMID: 24598602 PMCID: PMC3961808 DOI: 10.2196/jmir.3276] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 11/29/2022] Open
Abstract
A debate on Internet governance for health, or “eHealth governance”, is emerging with the impending award of a new dot-health (.health) generic top-level domain name (gTLD) along with a host of other health-related domains. This development is critical as it will shape the future of the health Internet, allowing largely unrestricted use of .health second-level domain names by future registrants, raising concerns about the potential for privacy, use and marketing of health-related information, credibility of online health content, and potential for Internet fraud and abuse. Yet, prospective .health gTLD applicants do not provide adequate safeguards for use of .health or related domains and have few or no ties to the global health community. If approved, one of these for-profit corporate applicants would effectively control the future of the .health address on the Internet with arguably no active oversight from important international public health stakeholders. This would represent a lost opportunity for the public health, medical, and broader health community in establishing a trusted, transparent and reliable source for health on the Internet. Countries, medical associations, civil society, and consumer advocates have objected to these applications on grounds that they do not meet the public interest. We argue that there is an immediate need for action to postpone awarding of the .health gTLD and other health-related gTLDs to address these concerns and ensure the appropriate development of sound eHealth governance rules, principles, and use. This would support the crucial need of ensuring access to quality and evidence-based sources of health information online, as well as establishing a safe and reliable space on the Internet for health. We believe, if properly governed, .health and other domains could represent such a promise in the future.
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Affiliation(s)
- Tim Ken Mackey
- Department of Anethesiology, University of California, San Diego, San Diego, CA, United States.
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Kohler JC, Mackey TK, Ovtcharenko N. Why the MDGs need good governance in pharmaceutical systems to promote global health. BMC Public Health 2014; 14:63. [PMID: 24447600 PMCID: PMC3909282 DOI: 10.1186/1471-2458-14-63] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 01/16/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Corruption in the health sector can hurt health outcomes. Improving good governance can in turn help prevent health-related corruption. We understand good governance as having the following characteristics: it is consensus-oriented, accountable, transparent, responsive, equitable and inclusive, effective and efficient, follows the rule of law, is participatory and should in theory be less vulnerable to corruption. By focusing on the pharmaceutical system, we explore some of the key lessons learned from existing initiatives in good governance. As the development community begins to identify post-2015 Millennium Development Goals targets, it is essential to evaluate programs in good governance in order to build on these results and establish sustainable strategies. This discussion on the pharmaceutical system illuminates why. DISCUSSION Considering pharmaceutical governance initiatives such as those launched by the World Bank, World Health Organization, and the Global Fund, we argue that country ownership of good governance initiatives is essential but also any initiative must include the participation of impartial stakeholders. Understanding the political context of any initiative is also vital so that potential obstacles are identified and the design of any initiative is flexible enough to make adjustments in programming as needed. Finally, the inherent challenge which all initiatives face is adequately measuring outcomes from any effort. However in fairness, determining the precise relationship between good governance and health outcomes is rarely straightforward. SUMMARY Challenges identified in pharmaceutical governance initiatives manifest in different forms depending on the nature and structure of the initiative, but their regular occurrence and impact on population-based health demonstrates growing importance of addressing pharmaceutical governance as a key component of the post-2015 Millennium Development Goals. Specifically, these challenges need to be acknowledged and responded to with global cooperation and innovation to establish localized and evidence-based metrics for good governance to promote global pharmaceutical safety.
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Affiliation(s)
- Jillian Clare Kohler
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto M5S 3 M2, ON, Canada
| | - Tim Ken Mackey
- Department of Anesthesiology, University of California San Diego School of Medicine, 200 West Arbor Drive, San Diego, CA 92103 USA
| | - Natalia Ovtcharenko
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto M5S 3 M2, ON, Canada
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Mackey TK, Liang BA. Global reach of direct-to-consumer advertising using social media for illicit online drug sales. J Med Internet Res 2013; 15:e105. [PMID: 23718965 PMCID: PMC3668613 DOI: 10.2196/jmir.2610] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 04/20/2013] [Accepted: 05/07/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Illicit or rogue Internet pharmacies are a recognized global public health threat that have been identified as utilizing various forms of online marketing and promotion, including social media. OBJECTIVE To assess the accessibility of creating illicit no prescription direct-to-consumer advertising (DTCA) online pharmacy social media marketing (eDTCA2.0) and evaluate its potential global reach. METHODS We identified the top 4 social media platforms allowing eDTCA2.0. After determining applicable platforms (ie, Facebook, Twitter, Google+, and MySpace), we created a fictitious advertisement advertising no prescription drugs online and posted it to the identified social media platforms. Each advertisement linked to a unique website URL that consisted of a site error page. Employing Web search analytics, we tracked the number of users visiting these sites and their location. We used commercially available Internet tools and services, including website hosting, domain registration, and website analytic services. RESULTS Illicit online pharmacy social media content for Facebook, Twitter, and MySpace remained accessible despite highly questionable and potentially illegal content. Fictitious advertisements promoting illicit sale of drugs generated aggregate unique user traffic of 2795 visits over a 10-month period. Further, traffic to our websites originated from a number of countries, including high-income and middle-income countries, and emerging markets. CONCLUSIONS Our results indicate there are few barriers to entry for social media-based illicit online drug marketing. Further, illicit eDTCA2.0 has globalized outside US borders to other countries through unregulated Internet marketing.
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Affiliation(s)
- Tim Ken Mackey
- Institute of Health Law Studies, California Western School of Law, San Diego, CA, USA.
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Mackey TK, Liang BA. Separating online piracy from counterfeit medicines: The need for policy reform and a call to action. Health Policy and Technology 2012. [DOI: 10.1016/j.hlpt.2012.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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