Bio Hacking Village - Employ Cybersecurity Techniques against the Threat of Mediacal Misinformation
CC Attribution 3.0 Unported:
You are free to use, adapt and copy, distribute and transmit the work or content in adapted or unchanged form for any legal purpose as long as the work is attributed to the author in the manner specified by the author or licensor.
Perakslis, Eric D
Medical misinformation has been labeled as one of the greatest public health threats of our time. Previously eradicated diseases, such as measles are occurring in clusters and causing deaths. The problem is complex with a mixture of private individuals and nation state actors all working to undermine the credibility of doctors and the US health system. In this piece, I will discuss our JAMA piece that calls for the use of an ethical cyber response to the threat of medical misinformation.
 So our first speaker, Eric Pradixlis, sorry if I put your dot, is a Rubenstein fellow at Duke University where he focuses on data science that spans medicine, policy, information technology, and security. Eric is also lecturer in biomedical informatics at Harvard Medical School and Strategic Innovations Advisor to Mendicine Suns Frontieres. And now without further ado, please welcome Eric Pradixlis. Thank you. Thanks everybody for coming. How's it going? Here you go. Can you hear me OK? Usually I'm too short to stand in front of podiums. So Nina asked me not to wear my jacket. She's a little stiff for this crowd. It's like she's going to halfway through this talk. I bet she asked me to put the jacket on. So anyway, I'm going to start off. I'm going to talk about medicine. I'm going to talk about infectious diseases. I'm going to talk about medical misinformation. And I want to start off and say if you can actually be dispassionate about medicine, which is something scientists and clinicians are taught to try to do, is be dispassionate, then medicine actually starts to look a lot like math in some ways while you're being dispassionate. So you all are coders and hackers. You want a little math in the morning. We'll do a little math. What's one in 100,000? Odds of death from getting a measles vaccine. One in 3,000. Odds by hitting by being hit by lightning. One in 250. Odds to have an identical twins. One in 50 children is me. I have a peanut allergy. Three out of 300. Odds of catching the measles of exposure after getting the vaccine, but the case will be much more mild. Odds of catching measles if you're unvaccinated, rare. That's side effects. Just so you know, I'm actually not in love with these numbers and I'm going to pick on this a little bit. And so I don't think that telling somebody something is rare is that helpful when you're a sleep deprived new parent with a baby and you're really worried about something that you're at, right? So I think, you know, everything is benefit risk. So whether it was my time as a drug developer, my time at FDA or whatever it was, there's always a calculus in this. And it's actually really hard to do, but you know, you've probably done it. If you ever tweaked your knee and had your ACL done, the, you know, the anesthesia is like, well, there's a one in 20,000 chance you're going to react to this thing. And you know what? It really sucks if you're the one in 20,000. And so I wrote a paper in JAMA about using cyber techniques against medical misinformation. And I got a lot of shade and a lot of hate for it. But I read through them. And of course, I found at least one of the email that I knew I would get and that I wanted to talk to. And that's the poor guy whose child had a really horrible reaction. He lost his child. So to that one person, that one child, that one in 200,000, that really sucks. And I could see how that could change and color your opinion for the whole rest of your life. How many of you have ever seen what malnourished babies with measles look like? Okay, so we'll get to that in a second. So these are all about numbers. You know what the odds of 10 out of 10 are? Going online saying something and meeting an asshole. Because guaranteed you're going to meet an asshole online if you go online. It's not only that, it's actually an asshole who's probably willing to do you harm or happy to see you come to harm if you don't agree with their ideology. And I think this is kind of the basis of what we're talking about here. You know, keyboard courage can be a really dangerous thing, especially to, you know, unknowing and unwilling folks. Now that said, there are different types of misinformation. I'm going to be really careful about this, right? So I may say this 10 times. I actually have no problem with individual citizens, even if they're whacked sharing their opinion, that's their right. I actually have no problem with Gwyneth's Paltrow being an idiot. I have no issue with that, right? What I'm talking about organized, anti-science, anti-population misinformation and malinformation. This is how they're described. So I spent September on Rohingya service with Dr. Laubborders. And, you know, these people were mowed down because they were updating their status on Facebook. Someone was looking for one of them. I'm okay. Where's this going on? And next thing you know, the government was using Facebook to target this population. Somali population in Minnesota was targeted by anti-vaxxers and had an outbreak because their marginalized population and they're vulnerable. So I'm going to talk a little bit about that. But 2015, I'm working with Partners in Health, my last Ebola mission in West Africa, and we're looking for the last patients. And it was actually something kind of new because no space suits. One of the first times we went into the village is why? Because you walk into the village in space suits and you take away sick people and they die. People run from people in space suits, right? This isn't good. Remember, a lot of these cultures are actually get it. They're actually used to what we're learning. That governments can be overtly corrupt and overtly self-interested. Because if you grew up in Africa, that was your reality, depending on where you lived. Is that anybody with power would use it to hurt you and for their own gain. We're just starting to see that here in this country, but it's real. So these people are really happy to talk to me, right? And in this particular village, there was a man who had a stroke. He didn't have Ebola. We got him transported. But we found a lot of kids with measles. We found a lot of cholera, right? Because there was a full quarantine. Schools were closed. Everything was closed. The hospitals had been shut down because of all the workers who had been infected with Ebola. And so the idea here is that messaging really matters. And trust me, I'm a doctor. No. Trust me, I'm a scientist. No. And the really thing about this is that a lot of scientists and doctors don't get that. They don't get the fact that a lot of people don't realize that are we kind of part of this issue. So just a few pictures of babies with measles. I'm only putting this up for one reason. And that's that. It was an interesting study that I was watching. So New England Journal published this thing a few weeks ago. It's all about measles. It's fine. This person asked some really good questions. And really detailed questions like, where did you get your safety data? Did you get it out of airs? Which is the FDA virus adverse event reporting system. If you got it out of airs, everybody thinks airs is wrong. Did you apply the multiplier that Harvard Medical School says you should apply? Blah, blah, blah. Funny thing is I was previewing this. I'm going to tease him with former FDA commissioner Rob Kaliff before I flew in. And he got all hot about this. He was like, well, you know, if you share data, they just attack the data. I'm like, then don't share bad data. But you have to answer the gift. At least try to answer the question. If they pile on and they don't, then you back off. You don't have to re-answer again. Now, in fairness, I actually looked yesterday and the author did put up the answers to these questions. So good for them. Good for the New England Journal. These were fair questions. And they stuck their neck back out and answered them regardless. The other thing about this is the idea of public health. The idea of public health is that you're protecting the public more so than the individual. Right? So herd immunity matters. Here's a really sad story of a young man with leukemia who died because he was exposed to measles. So we're in a room right now. We're all together. We're all breathing the same air. You know, you kind of, if you knew you were like dripping flu, sneezing and blowing, would you come in and sit down next to everybody? Probably not. So there is an idea here. Now, public health, you know this. Why were we, when we come back during the last Ebola outbreak, why were they allowed us to put us in jail for three weeks every time we came back? Because it was a mandatory evacuation order for the countries we went to. We broke the law by going. And so it was their right to imprison us when we came back and we did. They were nice. They put me on house arrest. I had friends that went through a lot worse for three weeks every time. But you know, we knew it when we went. So I think the idea here, public health and that were people who need to help people and also, you know, you don't want to hurt somebody on accident. And so I get the whole, well, it's my body. I'm going to do whatever. But, you know, you get schools being closed in New York right now with little kids and stuff like that. So it's a tough issue. Interestingly, medical charlatanism is as old as it gets. So everybody's heard of caveat emptor, buyer beware. The first known case, 1603 in England, with somebody basically selling an intestinal stone that allegedly had magical powers called a bazaar stone. Shanla versus Lewis. This is fascinating. It actually was medical charlatanism. And basically what they decided was because there was no warranty and because the buyer couldn't prove that it wasn't a magical bazaar stone, they found for the plaintiff. So the other thing to think about here is that, is that in medicine, the customer isn't right, you know, and that you have to watch out for. It's caveat emptor. So when we're looking at what goes on in healthcare, self-educating, making your own decisions, these aren't easy things because not everybody's going to understand the science or even the beginnings of the science. The other thing is that medicine is always playing catch up. You can't regulate something bad if it's not illegal yet. So I was at the FDA for this. How many people remember the New England compound and pharmacy thing? These people committed mass murder, right? They really did, right? They had basically dirty drugs that get injected right in your spinal column and people died. Here's the thing. Being on the inside of the FDA, when this is going on, a reporter of the commissioner actually knew the inside story on this. And what was killing them about the inside story is, of course, as soon as this happened, FDA, what are you doing about it? The FDA had actually tried to sue these people multiple times on anything they could think of because they were pretty sure they were doing bad stuff and they lost every lawsuit they filed. And then after this, and then as you can see from eventually after this bad thing happens, well, maybe you should regulate compounding pharmacies. In 1910, people were selling belts with radiation on them as a cure for diabetes and stuff like that. So there's always been charlatanism, you know, the vaping stuff today. If it was really about anti, if it really about smoking secession, why was the first, why was the first flavor bubble gum or one of the first flavors if you weren't trying to attract kids? So people have to beware and they've got to watch what they're doing. But if something isn't illegal yet, is it illegal? Right? So if is targeting a community on Facebook, going into that community with pamphlets, talking them into, talking them out of doing medical care that leads to injury, illness or death, a crime. Today, not yet. Should it be? Good news, I'm not a lawyer. I don't want to know. I know what I personally think that I see a lot of sick people, I've seen a lot of sick people and I prefer that people don't get sick. But at the same time, it's a tough thing to do. But is it harm? Is it harm like yelling fire in a theater? Or is it harm like plowing your car into those same Somalis in Minnesota that were targeted? Something to think about when people go in and you drop vaccine rates like this into marginalized community and then have people get very, very sick. What do you do? And again, I'm not talking about my aunt who may want to say, do not brush your teeth with that water if it has chlorine in it. She can tell anybody she wants about that. She can advertise anything she wants. I'm talking about organized campaigns of disinformation and malice information. Here's the thing. So as somebody who's a faculty at Duke School in Harvard, we're a big part of the problem. That whole rare reaction is rare. What does that mean? How rare? I mean, are we giving people? So I really like the line that what we have is a medical problem with immediate dimension, not an information problem. That trust in medicine, trust in science has flagged over time. And sometimes for good reason, who knows if it's really smart and healthy to eat eggs? Dietetic epidemiology, are you kidding me? I'm 52 years old, at least 10 times in my life I've been told the opposite of what I have been told. Now, the fact that science changes that we learn and grow doesn't make science bad. It does make it imperfect. It does open it to criticism. So living in an open society where it's okay to challenge whether or not eat eggs, I think that's fine. But I do think that we have to understand, the public has to understand that the World Health Organization leads patient harm as the 14th leading cause of illness and disease on the planet. There's a study out of Johns Hopkins a few years ago that said it might be as high as third leading cause of death in hospitals. So people do get hurt in healthcare. So we in medicine have to be better. We have to figure this stuff. We've got to own part of it and not just discount people out of hand. Now, what I like about this is I love the Facebook post from BCH, not just some faculty there too. On the right here, because what the mom really says is, you know, they treat us intelligently. That's what we like about this place. They listen to us and our voices matter. They're not talking at us. So I do think that even scientists and doctors can learn how to do this stuff. So spent most of my time. I was a change A for 20 years. I was an FDA and went to doctors above borders and places like that forever. And I've worked on a lot of compliance. CIO would change. I was a CIO at FDA. So I've worked on a lot of compliance. You know what happens when things go wrong? At least this is my opinion, is that most of the time it's a mistake and then sometimes there's a few bad guys. Right? Most of you work at device companies. You know, some things go wrong. Some forget something. There's a slip. There's a faulty part. Whatever. There's a breach. Someone wasn't trained well. They made a mistake. I mean, when I was, I worked on the harvesting organs and tissues when I was an undergrad. And I actually shipped off expired tissue one day. I had to reread the SOP and do that, figure it out. Right? You make mistakes. You make bad guys. So what I want to talk about the rest of the talk is what you'll be doing about the bad guys. I know they're in the minority, but they might be really bad. So can you do it by a counter messaging? This is an interesting thing, right? You know, in general, and I'm no expert on this stuff. I'll be the first one to say it. If we're in any or someone else's field, there's better experts on this. Most people actually say the counter messaging isn't that effective. A lot of people will say, and actually some of you all that were in the device thing yesterday, we said it, right? Don't answer question number two because it validates the question if you try to answer it, right? So you back away from that. But you know, the best study that I think on this has actually been anti-terrorism. How do people become radicalized? So counter marriage messaging, we know because we've seen really good people try to do it. And I spent three years going back and forth in Arabia building a cancer center in a 2010 timeframe for the only large cancer center in the Arab world that imams getting up and saying violence is bad and hasn't stopped extremists from doing violence. As much as they respect their moms, it hasn't happened. So counter messaging, what appears to work is more like alternative messaging. You tell a different story instead, but don't directly go at what's going on. So credible voices, all of these types of things are somewhat difficult. My favorite headline in a while, read the two tweets, it's the best. A lady posting on an anti-vax site, what do I do to protect my child now that there's a measles outbreak? And then I don't think this, while this gentleman's response is funny, I don't know that it's all that useful for this poor lady who's now worried about her kid. And by the way, still deserves to get to protect her kid. Even if she is on a different website. And you know, what really is going on here is like everything else, it's also polarized that anybody that wants to be in the middle and be normal or be smart and be reasonable, they get shouted down by the two extremes that are trying to fight it. So how do we get kind of towards the middle? So positive case studies work, learning by history and role model tend to work. Alternative messaging work, if any of you followed on Twitter, there was a great piece that was put up by the Hunger Games Cast in 2015 that I put up. You can look at my Twitter and you can find it. What was awesome about it was they basically just said how they're trying to calm down all the hype. They're going to close the airports, they're going to close the port. You know, there was a story of like an Ohio of someone who came back and went into a wedding dress shop for a bridesmaid dress and that shop actually went out of business because nobody would shop there because somebody who had done a bowl of service had been there. And the whole thing, so the Hunger Games Cast put out this kind of cool message. What was really cool about it and what was first about it for me is one, Paul Farmer, my boss at P I H was in it. More importantly, my daughter was 12 and couldn't tell anybody in her school, middle school where I was. Can you imagine what playground talk was like when all that hype was going on on the table? She couldn't say a word to anybody. Her best friend's parents knew. We knew. So that video was awesome. Gender-faith ideology-based messaging and need for specificity. This last one, the second and last one is really important. How do we match the volume and velocity? You know, because I've seen this. I have colleagues that will get an article in JAMA saying, look, at the end of the day your statins are probably good for you and they get 5,000 people banging on them. You know, what are you, one person, what do you do? I think we need to troll army and med students, but I'll talk about that in a few minutes. There they are. How to accomplish better messaging. So at this point, the rest of this talk is my shameless ask for your help. You people know this stuff better than I do, right? I am looking for, I'm going to be running some experiments. We need to try some things. There's a lot of people like me, academics, getting up and saying why this shit is terrible and find anybody actually doing something besides saying it's terrible, right? And I think the cyber community can be one of the communities that can actually do something that can make a difference. Oops, sorry. So how do you fix it? You know, how should patient groups convey their concern? I was looking at Andrea here. How do they convey their concern? How do they communicate? How do they do things like that? How do you know when it's going on? So one of the experiments we're going to run is a great guy, colleague of mine at Boston Children's Hospital named John Brownstein, built something called the vaccine centimeter. It measures a centimeter about vaccines on all social media platforms. Built it in 2014, shared it, nobody would fund it. So if you looked at my little chart about measles has gone up, I wish the CDC had funded it or FDA or somebody had funded it, but we'll fund it. So go into these communities, measure what's going again. Not so much to say this community is bad or good because of sentiment. I want to understand signals. I want to understand that if I sort the social media by communities, am I seeing targeting? Am I seeing ethnic groups being picked out? Am I seeing that's what I want to see? I want to know if that's going on because that's a signal that's maybe worth managing. You know, what's the correct oversight? Who watches this stuff? One of the things, one of the comments Jim had took out of my paper was say, so how does the AMA deal with the KGB if it happens to be state sponsored? That's a one-sided fight, isn't it? How does that really happen? So there's that. So we're going to do consistent messaging pilots, counter-messaging, trolling, and adaptive pilots, and then measurement to see how things go on. And I'm looking for people to help with that. I'm looking for people to teach for that. I will put you in rooms full of med students that want to do that. So do we need a CVE list for healthcare? Right? If Chris is here, he's been helpful to explain this. Chris from MITRE explained the CVE list to me and how it works. It's not exactly, but do we need to know? Especially again, I'm talking about the bad guys. I'm talking about targeting of groups. So if you look at the breakout in the Orthodox Jewish community in New York, you look at the Somalis in Minnesota, while they weren't targeted online, those were low tech. That was pamphlets, that was talks, that was phone calls. How do you think the people organized to do it? That was online. So you would have seen, should have seen, leading indications into it. So this concept, how would you do it? So this is one of the pilots I'd like to talk to people. How do we set, what would you do? What would you watch? What would you change? You know? We've got the epidemiology side. People have mapped the whole ethnography of some of these groups. How do you know when it's going on? What if it does look like it's state sponsored? Right? I mean, Commissioner Califf has said, look, if you want to kill Americans, you know, talking them out of their statins will be a certain way to kill a lot of older Americans. You know, you're going to win an election that way? Maybe. I don't know. But if we see it, do we recognize it? And then once in a while, you've got to hack somebody. So if we find something's really, really bad, right, what do we do? If we see a community's being targeted by a group, what do we do? I actually have no problem dreaming of a world where their websites go off for 24 hours. And I have no problem dreaming of that world. They have their right to do whatever, but if I see targeting or something like that, I don't have any issue with that. Let's talk about it. So there is the idea of saying, what do you actually do? We are doing honeypot experiments, working with some experts and honey tokens. If anybody wants to see that, we're going to put up data. We're going to see where the data goes. Anybody that has expertise and wants to see that, we got to do it. So right now, everything I'm talking about is diagnostic. I'm not talking about any retaliation. I'm not talking about hacking about it. I'm not talking about any of that stuff. That's for law enforcement to decide. I'm talking about as a scientist, I want to diagnose and I want to figure stuff out. So because we don't learn our lesson, we've got a bowl again, right? Really bad. So guess where I'll be heading in a couple of weeks? So I'm gone again. I got to say bye to my wife and kids because we don't learn lessons we should have learned two years ago. It's not easy to think about infectious diseases. My mentor was my great uncle. Graduate Harvard Medical School in 1943. We shipped right to the Battle of Britain. We was there at 48 concentration camps, came back, practiced 50 years, grew up right after Spanish flu, thought the world was going to be taken up by an epidemic. This little guy, we're trained not to touch people. That's not me. That's my friend Tim Holt and that guy. Because the ambulance drivers were the first ones to go, Anabola, put the people in the back of the car, closed the door. Nobody opens it until it gets to the clinic and we can take them out. That little guy was with his mother, his father, a cousin, and a grandmother. And when we opened that ambulance, he was the only one who was alive. And all that happened during the six-hour ride. So we need to work on these problems and the world is a lot smaller than people say it is. And by the way, stuff works when it works. So here we are going over to help Africa with Ebola and you've got places like Rwanda where cervical cancer is the second leading cause of cancer death and they're killing it with campaigns. We know the HPV vaccine is a huge success. So anyway, there's that. I love this tweet. I haven't met Jenny. I'm stealing this tweet. I do think y'all are the immune system of healthcare. Thank you. Uh-oh. Are there any questions? Complaints, criticisms. So I'm going to practice a very practical story. Okay. We got into a really interesting meeting about an infant who was there where she realized that as a leader, she shut people up. Her question to me that indicates how do you, I really love some of the NTAs who are just proposing, but how do we do that from kind of the ground up? It's a great question. I don't have a definitive answer. All I can say is, I'll do it with a microphone. The question is in the conversations with people, how do you meet people in common ground when you've got somebody who has strong opinions and they're trying to manage a lot of stuff, right? So it's a great question. My answer is what I've used as patients and I think that's why we need an army, a troll. You literally need an army of people and trust me, just so you know, I'm absolutely not the phenotype for some of these conversations, but I've got friends and colleagues that are. You can't get sucked in and you can't take forever with it, but you've really got to look at it and be very fact-basic. This is what I think and this is kind of where it is. You also have to try to conduct something outside. If somebody is like, if somebody, I had no idea if I was going to have someone call me out in the first five minutes of this talk, but if they did, I would have answered two questions and asked them to shut up so I could finish my talk and then I would have bought them lunch, but you know, just, just, but I can do that. You can do that one-on-one when you're managing group of 20,000, you can't necessarily do that, but I do think people have to get there because again, that one voice can cause a lot of trouble and it really amplifies. So it's a great question, sir. This is more of a question about the campaign, we see issues in modern US medicine at a peer-to-peer level, especially when we're looking at areas that are underserved. If we can get other physicians to agree and to come along with modern messaging and evidence-based on moderately educated society. Yeah, that's a great question. So the question was, is that it's hard to change everybody's mind, even experienced doctors, and how do you do it? And I think, I actually think we have to land in a different place. That's why I like the idea of medicine is medicine is a medical problem with immediate dimension. I don't think, I don't think 10 years post the internet where anybody has the authority they used to have as a professional anymore. I don't care what your profession is. You can be an architect, you can be whatever. And so I think a lot of people aren't used to dealing with that, but I do think it's more of a conversation now and that it's gonna be a mixture of what people are doing. And the next generation of clinicians as we train them, have to figure that out, because they're not gonna have that white code authority. And I don't know that that's a bad thing. But to that point, they're being trained by the ones who do swim secret, next to his residence fellows coming through the program, having the same traditional values in a world that's changing outside of them. There's a lot, but I mean, at least what I see in the classes, I work on, so for example, at HMS, we did a computationally medicine medical class where we actually had med students rotate into a pharma company and figure out value and pricing. I do think it's gonna, I do think it's gonna take stuff like that. I think we have to change the way we're medicine. I actually think that we should be more selective and opportunistic about what med students do in their third year. I think physician scientists get this all the way through. But I think that third year is just a prime spot to go work with me at MSF, do whatever is your passion, figure it out and find it. It's a great question. Any other questions? Thanks guys, see ya. Thank you.
 So our first speaker, Eric Pradixlis, sorry if I put your  dot, is a Rubenstein fellow at Duke University where he  focuses on data science that spans medicine, policy,  information technology, and security.  Eric is also lecturer in biomedical informatics at  Harvard Medical School and Strategic Innovations Advisor  to Mendicine Suns Frontieres.  And now without further ado, please welcome Eric Pradixlis.  Thank you.  Thanks everybody for coming.  How's it going?  Here you go.  Can you hear me OK?  Usually I'm too short to stand in front of podiums.  So Nina asked me not to wear my jacket.  She's a little stiff for this crowd.  It's like she's going to halfway through this talk.  I bet she asked me to put the jacket on.  So anyway, I'm going to start off.  I'm going to talk about medicine.  I'm going to talk about infectious diseases.  I'm going to talk about medical misinformation.  And I want to start off and say if you can actually be  dispassionate about medicine, which is something scientists  and clinicians are taught to try to do, is be dispassionate,  then medicine actually starts to look a lot like math in some  ways while you're being dispassionate.  So you all are coders and hackers.  You want a little math in the morning.  We'll do a little math.  What's one in 100,000?  Odds of death from getting a measles vaccine.  One in 3,000.  Odds by hitting by being hit by lightning.  One in 250.  Odds to have an identical twins.  One in 50 children is me.  I have a peanut allergy.  Three out of 300.  Odds of catching the measles of exposure after getting the  vaccine, but the case will be much more mild.  Odds of catching measles if you're unvaccinated, rare.  That's side effects.  Just so you know, I'm actually not in love with these numbers  and I'm going to pick on this a little bit.  And so I don't think that telling somebody something is rare  is that helpful when you're a sleep deprived new parent with  a baby and you're really worried about something that you're  at, right?  So I think, you know, everything is benefit risk.  So whether it was my time as a drug developer, my time at FDA  or whatever it was, there's always a calculus in this.  And it's actually really hard to do, but you know, you've  probably done it.  If you ever tweaked your knee and had your ACL done, the, you  know, the anesthesia is like, well, there's a one in 20,000  chance you're going to react to this thing.  And you know what?  It really sucks if you're the one in 20,000.  And so I wrote a paper in JAMA about using cyber techniques  against medical misinformation.  And I got a lot of shade and a lot of hate for it.  But I read through them.  And of course, I found at least one of the email that I knew  I would get and that I wanted to talk to.  And that's the poor guy whose child had a really horrible  reaction.  He lost his child.  So to that one person, that one child, that one in 200,000,  that really sucks.  And I could see how that could change and color your opinion  for the whole rest of your life.  How many of you have ever seen what malnourished babies  with measles look like?  Okay, so we'll get to that in a second.  So these are all about numbers.  You know what the odds of 10 out of 10 are?  Going online saying something and meeting an asshole.  Because guaranteed you're going to meet an asshole online  if you go online.  It's not only that, it's actually an asshole  who's probably willing to do you harm or happy to see you  come to harm if you don't agree with their ideology.  And I think this is kind of the basis of what we're talking  about here.  You know, keyboard courage can be a really dangerous thing,  especially to, you know, unknowing and unwilling folks.  Now that said, there are different types of misinformation.  I'm going to be really careful about this, right?  So I may say this 10 times.  I actually have no problem with individual citizens,  even if they're whacked sharing their opinion,  that's their right.  I actually have no problem with Gwyneth's Paltrow being an idiot.  I have no issue with that, right?  What I'm talking about organized, anti-science,  anti-population misinformation and malinformation.  This is how they're described.  So I spent September on Rohingya service with Dr.  Laubborders.  And, you know, these people were mowed down because they were  updating their status on Facebook.  Someone was looking for one of them.  I'm okay.  Where's this going on?  And next thing you know, the government was using Facebook  to target this population.  Somali population in Minnesota was targeted by anti-vaxxers  and had an outbreak because their marginalized population  and they're vulnerable.  So I'm going to talk a little bit about that.  But 2015, I'm working with Partners in Health,  my last Ebola mission in West Africa,  and we're looking for the last patients.  And it was actually something kind of new because no space suits.  One of the first times we went into the village is why?  Because you walk into the village in space suits  and you take away sick people and they die.  People run from people in space suits, right?  This isn't good.  Remember, a lot of these cultures are actually get it.  They're actually used to what we're learning.  That governments can be overtly corrupt  and overtly self-interested.  Because if you grew up in Africa, that was your reality,  depending on where you lived.  Is that anybody with power would use it to hurt you  and for their own gain.  We're just starting to see that here in this country,  but it's real.  So these people are really happy to talk to me, right?  And in this particular village, there was a man  who had a stroke.  He didn't have Ebola.  We got him transported.  But we found a lot of kids with measles.  We found a lot of cholera, right?  Because there was a full quarantine.  Schools were closed.  Everything was closed.  The hospitals had been shut down  because of all the workers who had been infected with Ebola.  And so the idea here is that messaging really matters.  And trust me, I'm a doctor.  No. Trust me, I'm a scientist.  No.  And the really thing about this is that a lot of scientists  and doctors don't get that.  They don't get the fact that a lot of people don't realize  that are we kind of part of this issue.  So just a few pictures of babies with measles.  I'm only putting this up for one reason.  And that's that.  It was an interesting study that I was watching.  So New England Journal published this thing a few weeks ago.  It's all about measles.  It's fine.  This person asked some really good questions.  And really detailed questions like,  where did you get your safety data?  Did you get it out of airs?  Which is the FDA virus adverse event reporting system.  If you got it out of airs, everybody thinks airs is wrong.  Did you apply the multiplier that Harvard Medical School  says you should apply?  Blah, blah, blah.  Funny thing is I was previewing this.  I'm going to tease him with former FDA commissioner Rob Kaliff  before I flew in.  And he got all hot about this.  He was like, well, you know, if you share data,  they just attack the data.  I'm like, then don't share bad data.  But you have to answer the gift.  At least try to answer the question.  If they pile on and they don't, then you back off.  You don't have to re-answer again.  Now, in fairness, I actually looked yesterday  and the author did put up the answers to these questions.  So good for them.  Good for the New England Journal.  These were fair questions.  And they stuck their neck back out and answered them regardless.  The other thing about this is the idea of public health.  The idea of public health is that you're protecting the public  more so than the individual.  Right?  So herd immunity matters.  Here's a really sad story of a young man with leukemia  who died because he was exposed to measles.  So we're in a room right now.  We're all together.  We're all breathing the same air.  You know, you kind of, if you knew you were like dripping flu,  sneezing and blowing, would you come in and sit down next to everybody?  Probably not.  So there is an idea here.  Now, public health, you know this.  Why were we, when we come back during the last Ebola outbreak,  why were they allowed us to put us in jail for three weeks  every time we came back?  Because it was a mandatory evacuation order  for the countries we went to.  We broke the law by going.  And so it was their right to imprison us when we came back  and we did.  They were nice.  They put me on house arrest.  I had friends that went through a lot worse for three weeks every time.  But you know, we knew it when we went.  So I think the idea here, public health and that were people who need  to help people and also, you know, you don't want to hurt somebody on accident.  And so I get the whole, well, it's my body.  I'm going to do whatever.  But, you know, you get schools being closed in New York right now  with little kids and stuff like that.  So it's a tough issue.  Interestingly, medical charlatanism is as old as it gets.  So everybody's heard of caveat emptor, buyer beware.  The first known case, 1603 in England, with somebody basically selling  an intestinal stone that allegedly had magical powers called a bazaar stone.  Shanla versus Lewis.  This is fascinating.  It actually was medical charlatanism.  And basically what they decided was because there was no warranty  and because the buyer couldn't prove that it wasn't a magical bazaar stone,  they found for the plaintiff.  So the other thing to think about here is that, is that in medicine,  the customer isn't right, you know, and that you have to watch out for.  It's caveat emptor.  So when we're looking at what goes on in healthcare, self-educating,  making your own decisions, these aren't easy things because not everybody's  going to understand the science or even the beginnings of the science.  The other thing is that medicine is always playing catch up.  You can't regulate something bad if it's not illegal yet.  So I was at the FDA for this.  How many people remember the New England compound and pharmacy thing?  These people committed mass murder, right?  They really did, right?  They had basically dirty drugs that get injected right in your spinal column  and people died.  Here's the thing.  Being on the inside of the FDA, when this is going on,  a reporter of the commissioner actually knew the inside story on this.  And what was killing them about the inside story is, of course,  as soon as this happened, FDA, what are you doing about it?  The FDA had actually tried to sue these people multiple times on anything  they could think of because they were pretty sure they were doing bad stuff  and they lost every lawsuit they filed.  And then after this, and then as you can see from eventually after this bad thing happens,  well, maybe you should regulate compounding pharmacies.  In 1910, people were selling belts with radiation on them  as a cure for diabetes and stuff like that.  So there's always been charlatanism, you know, the vaping stuff today.  If it was really about anti, if it really about smoking secession,  why was the first, why was the first flavor bubble gum or one of the first flavors  if you weren't trying to attract kids?  So people have to beware and they've got to watch what they're doing.  But if something isn't illegal yet, is it illegal?  Right? So if is targeting a community on Facebook,  going into that community with pamphlets, talking them into,  talking them out of doing medical care that leads to injury, illness or death, a crime.  Today, not yet.  Should it be? Good news, I'm not a lawyer.  I don't want to know.  I know what I personally think that I see a lot of sick people,  I've seen a lot of sick people and I prefer that people don't get sick.  But at the same time, it's a tough thing to do.  But is it harm?  Is it harm like yelling fire in a theater?  Or is it harm like plowing your car into those same Somalis in Minnesota  that were targeted?  Something to think about when people go in and you drop vaccine rates like this  into marginalized community and then have people get very, very sick.  What do you do?  And again, I'm not talking about my aunt who may want to say,  do not brush your teeth with that water if it has chlorine in it.  She can tell anybody she wants about that.  She can advertise anything she wants.  I'm talking about organized campaigns of disinformation and malice information.  Here's the thing.  So as somebody who's a faculty at Duke School in Harvard,  we're a big part of the problem.  That whole rare reaction is rare.  What does that mean?  How rare?  I mean, are we giving people?  So I really like the line that what we have is a medical problem with immediate dimension,  not an information problem.  That trust in medicine, trust in science has flagged over time.  And sometimes for good reason, who knows if it's really smart and healthy to eat eggs?  Dietetic epidemiology, are you kidding me?  I'm 52 years old, at least 10 times in my life I've been told the opposite of what I have been told.  Now, the fact that science changes that we learn and grow doesn't make science bad.  It does make it imperfect.  It does open it to criticism.  So living in an open society where it's okay to challenge whether or not eat eggs, I think that's fine.  But I do think that we have to understand, the public has to understand that the World Health Organization  leads patient harm as the 14th leading cause of illness and disease on the planet.  There's a study out of Johns Hopkins a few years ago that said it might be as high as third leading cause of death in hospitals.  So people do get hurt in healthcare.  So we in medicine have to be better.  We have to figure this stuff.  We've got to own part of it and not just discount people out of hand.  Now, what I like about this is I love the Facebook post from BCH, not just some faculty there too.  On the right here, because what the mom really says is, you know, they treat us intelligently.  That's what we like about this place.  They listen to us and our voices matter.  They're not talking at us.  So I do think that even scientists and doctors can learn how to do this stuff.  So spent most of my time.  I was a change A for 20 years.  I was an FDA and went to doctors above borders and places like that forever.  And I've worked on a lot of compliance.  CIO would change.  I was a CIO at FDA.  So I've worked on a lot of compliance.  You know what happens when things go wrong?  At least this is my opinion, is that most of the time it's a mistake and then sometimes  there's a few bad guys.  Right?  Most of you work at device companies.  You know, some things go wrong.  Some forget something.  There's a slip.  There's a faulty part.  Whatever.  There's a breach.  Someone wasn't trained well.  They made a mistake.  I mean, when I was, I worked on the harvesting organs and tissues when I was an undergrad.  And I actually shipped off expired tissue one day.  I had to reread the SOP and do that, figure it out.  Right?  You make mistakes.  You make bad guys.  So what I want to talk about the rest of the talk is what you'll be doing about the bad  guys.  I know they're in the minority, but they might be really bad.  So can you do it by a counter messaging?  This is an interesting thing, right?  You know, in general, and I'm no expert on this stuff.  I'll be the first one to say it.  If we're in any or someone else's field, there's better experts on this.  Most people actually say the counter messaging isn't that effective.  A lot of people will say, and actually some of you all that were in the device thing yesterday,  we said it, right?  Don't answer question number two because it validates the question if you try to answer  it, right?  So you back away from that.  But you know, the best study that I think on this has actually been anti-terrorism.  How do people become radicalized?  So counter marriage messaging, we know because we've seen really good people try to do it.  And I spent three years going back and forth in Arabia building a cancer center in a 2010  timeframe for the only large cancer center in the Arab world that imams getting up and  saying violence is bad and hasn't stopped extremists from doing violence.  As much as they respect their moms, it hasn't happened.  So counter messaging, what appears to work is more like alternative messaging.  You tell a different story instead, but don't directly go at what's going on.  So credible voices, all of these types of things are somewhat difficult.  My favorite headline in a while, read the two tweets, it's the best.  A lady posting on an anti-vax site, what do I do to protect my child now that there's  a measles outbreak?  And then I don't think this, while this gentleman's response is funny, I don't know that it's  all that useful for this poor lady who's now worried about her kid.  And by the way, still deserves to get to protect her kid.  Even if she is on a different website.  And you know, what really is going on here is like everything else, it's also polarized  that anybody that wants to be in the middle and be normal or be smart and be reasonable,  they get shouted down by the two extremes that are trying to fight it.  So how do we get kind of towards the middle?  So positive case studies work, learning by history and role model tend to work.  Alternative messaging work, if any of you followed on Twitter, there was a great piece  that was put up by the Hunger Games Cast in 2015 that I put up.  You can look at my Twitter and you can find it.  What was awesome about it was they basically just said how they're trying to calm down  all the hype.  They're going to close the airports, they're going to close the port.  You know, there was a story of like an Ohio of someone who came back and went into a wedding  dress shop for a bridesmaid dress and that shop actually went out of business because  nobody would shop there because somebody who had done a bowl of service had been there.  And the whole thing, so the Hunger Games Cast put out this kind of cool message.  What was really cool about it and what was first about it for me is one, Paul Farmer,  my boss at P I H was in it.  More importantly, my daughter was 12 and couldn't tell anybody in her school, middle school  where I was.  Can you imagine what playground talk was like when all that hype was going on on the  table?  She couldn't say a word to anybody.  Her best friend's parents knew.  We knew.  So that video was awesome.  Gender-faith ideology-based messaging and need for specificity.  This last one, the second and last one is really important.  How do we match the volume and velocity?  You know, because I've seen this.  I have colleagues that will get an article in JAMA saying, look, at the end of the day  your statins are probably good for you and they get 5,000 people banging on them.  You know, what are you, one person, what do you do?  I think we need to troll army and med students, but I'll talk about that in a few minutes.  There they are.  How to accomplish better messaging.  So at this point, the rest of this talk is my shameless ask for your help.  You people know this stuff better than I do, right?  I am looking for, I'm going to be running some experiments.  We need to try some things.  There's a lot of people like me, academics, getting up and saying why this shit is terrible  and find anybody actually doing something besides saying it's terrible, right?  And I think the cyber community can be one of the communities that can actually do something  that can make a difference.  Oops, sorry.  So how do you fix it?  You know, how should patient groups convey their concern?  I was looking at Andrea here.  How do they convey their concern?  How do they communicate?  How do they do things like that?  How do you know when it's going on?  So one of the experiments we're going to run is a great guy, colleague of mine at Boston  Children's Hospital named John Brownstein, built something called the vaccine centimeter.  It measures a centimeter about vaccines on all social media platforms.  Built it in 2014, shared it, nobody would fund it.  So if you looked at my little chart about measles has gone up, I wish the CDC had funded  it or FDA or somebody had funded it, but we'll fund it.  So go into these communities, measure what's going again.  Not so much to say this community is bad or good because of sentiment.  I want to understand signals.  I want to understand that if I sort the social media by communities, am I seeing targeting?  Am I seeing ethnic groups being picked out?  Am I seeing that's what I want to see?  I want to know if that's going on because that's a signal that's maybe worth managing.  You know, what's the correct oversight?  Who watches this stuff?  One of the things, one of the comments Jim had took out of my paper was say, so how does  the AMA deal with the KGB if it happens to be state sponsored?  That's a one-sided fight, isn't it?  How does that really happen?  So there's that.  So we're going to do consistent messaging pilots, counter-messaging, trolling, and adaptive  pilots, and then measurement to see how things go on.  And I'm looking for people to help with that.  I'm looking for people to teach for that.  I will put you in rooms full of med students that want to do that.  So do we need a CVE list for healthcare?  Right?  If Chris is here, he's been helpful to explain this.  Chris from MITRE explained the CVE list to me and how it works.  It's not exactly, but do we need to know?  Especially again, I'm talking about the bad guys.  I'm talking about targeting of groups.  So if you look at the breakout in the Orthodox Jewish community in New York, you look at  the Somalis in Minnesota, while they weren't targeted online, those were low tech.  That was pamphlets, that was talks, that was phone calls.  How do you think the people organized to do it?  That was online.  So you would have seen, should have seen, leading indications into it.  So this concept, how would you do it?  So this is one of the pilots I'd like to talk to people.  How do we set, what would you do?  What would you watch?  What would you change?  You know?  We've got the epidemiology side.  People have mapped the whole ethnography of some of these groups.  How do you know when it's going on?  What if it does look like it's state sponsored?  Right?  I mean, Commissioner Califf has said, look, if you want to kill Americans, you know,  talking them out of their statins will be a certain way to kill a lot of older Americans.  You know, you're going to win an election that way?  Maybe.  I don't know.  But if we see it, do we recognize it?  And then once in a while, you've got to hack somebody.  So if we find something's really, really bad, right, what do we do?  If we see a community's being targeted by a group, what do we do?  I actually have no problem dreaming of a world where their websites go off for 24 hours.  And I have no problem dreaming of that world.  They have their right to do whatever, but if I see targeting or something like that,  I don't have any issue with that.  Let's talk about it.  So there is the idea of saying, what do you actually do?  We are doing honeypot experiments, working with some experts and honey tokens.  If anybody wants to see that, we're going to put up data.  We're going to see where the data goes.  Anybody that has expertise and wants to see that, we got to do it.  So right now, everything I'm talking about is diagnostic.  I'm not talking about any retaliation.  I'm not talking about hacking about it.  I'm not talking about any of that stuff.  That's for law enforcement to decide.  I'm talking about as a scientist, I want to diagnose and I want to figure stuff out.  So because we don't learn our lesson, we've got a bowl again, right?  Really bad.  So guess where I'll be heading in a couple of weeks?  So I'm gone again.  I got to say bye to my wife and kids because we don't learn lessons we should have learned  two years ago.  It's not easy to think about infectious diseases.  My mentor was my great uncle.  Graduate Harvard Medical School in 1943.  We shipped right to the Battle of Britain.  We was there at 48 concentration camps, came back, practiced 50 years, grew up right after  Spanish flu, thought the world was going to be taken up by an epidemic.  This little guy, we're trained not to touch people.  That's not me.  That's my friend Tim Holt and that guy.  Because the ambulance drivers were the first ones to go, Anabola, put the people in the  back of the car, closed the door.  Nobody opens it until it gets to the clinic and we can take them out.  That little guy was with his mother, his father, a cousin, and a grandmother.  And when we opened that ambulance, he was the only one who was alive.  And all that happened during the six-hour ride.  So we need to work on these problems and the world is a lot smaller than people say it  is.  And by the way, stuff works when it works.  So here we are going over to help Africa with Ebola and you've got places like Rwanda where  cervical cancer is the second leading cause of cancer death and they're killing it with  campaigns.  We know the HPV vaccine is a huge success.  So anyway, there's that.  I love this tweet.  I haven't met Jenny.  I'm stealing this tweet.  I do think y'all are the immune system of healthcare.  Thank you.  Uh-oh.  Are there any questions?  Complaints, criticisms.  So I'm going to practice a very practical story.  Okay.  We got into a really interesting meeting about an infant who was there where she realized  that as a leader, she shut people up.  Her question to me that indicates how do you, I really love some of the NTAs who are  just proposing, but how do we do that from kind of the ground up?  It's a great question.  I don't have a definitive answer.  All I can say is, I'll do it with a microphone.  The question is in the conversations with people, how do you meet people in common ground  when you've got somebody who has strong opinions and they're trying to manage a lot of stuff,  right?  So it's a great question.  My answer is what I've used as patients and I think that's why we need an army, a troll.  You literally need an army of people and trust me, just so you know, I'm absolutely not the  phenotype for some of these conversations, but I've got friends and colleagues that are.  You can't get sucked in and you can't take forever with it, but you've really got to  look at it and be very fact-basic.  This is what I think and this is kind of where it is.  You also have to try to conduct something outside.  If somebody is like, if somebody, I had no idea if I was going to have someone call me  out in the first five minutes of this talk, but if they did, I would have answered two  questions and asked them to shut up so I could finish my talk and then I would have bought  them lunch, but you know, just, just, but I can do that.  You can do that one-on-one when you're managing group of 20,000, you can't necessarily do  that, but I do think people have to get there because again, that one voice can cause a lot  of trouble and it really amplifies.  So it's a great question, sir.  This is more of a question about the campaign, we see issues in modern US medicine at a peer-to-peer  level, especially when we're looking at areas that are underserved.  If we can get other physicians to agree and to come along with modern messaging and evidence-based  on moderately educated society.  Yeah, that's a great question.  So the question was, is that it's hard to change  everybody's mind, even experienced doctors,  and how do you do it?  And I think, I actually think we have to land  in a different place.  That's why I like the idea of medicine is medicine  is a medical problem with immediate dimension.  I don't think, I don't think 10 years post the internet  where anybody has the authority they used to have  as a professional anymore.  I don't care what your profession is.  You can be an architect, you can be whatever.  And so I think a lot of people aren't used to dealing  with that, but I do think it's more of a conversation now  and that it's gonna be a mixture of what people are doing.  And the next generation of clinicians as we train them,  have to figure that out, because they're not gonna have  that white code authority.  And I don't know that that's a bad thing.  But to that point, they're being trained by the ones  who do swim secret, next to his residence fellows  coming through the program, having the same traditional  values in a world that's changing outside of them.  There's a lot, but I mean, at least what I see  in the classes, I work on, so for example, at HMS,  we did a computationally medicine medical class  where we actually had med students rotate into a  pharma company and figure out value and pricing.  I do think it's gonna, I do think it's gonna take stuff  like that.  I think we have to change the way we're medicine.  I actually think that we should be more selective  and opportunistic about what med students do  in their third year.  I think physician scientists get this all the way through.  But I think that third year is just a prime spot  to go work with me at MSF, do whatever is your passion,  figure it out and find it.  It's a great question.  Any other questions?  Thanks guys, see ya.  Thank you.
Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_0_815.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_816_863.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_864_911.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_912_971.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_972_1031.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_1032_1115.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_1116_1379.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_1380_2255.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_2256_2423.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_2424_2639.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_2640_2771.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_2772_5447.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_5448_6767.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_6768_8675.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_8676_8987.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_8988_10175.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_10176_11903.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_11904_13151.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_13152_14951.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_14952_16127.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_16128_16847.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_16848_20771.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_20772_22427.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_22428_23483.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_23484_25799.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_25800_26555.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_26556_28823.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_28824_30659.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_30660_31931.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_31932_33563.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_33564_34079.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_34080_34943.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_34944_34991.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_34992_35327.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_35328_35951.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_35952_37691.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_37692_37751.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_37752_37799.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_37800_40835.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_40836_40907.png Eric_D_Perakslis_-_Employ_Cybersecurity_Techniques_OKrdzv9Yx54_40908_40929.png