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Jun 13

The Ethics of ChatGPT in Medicine and Healthcare: A Systematic Review on Large Language Models (LLMs)

With the introduction of ChatGPT, Large Language Models (LLMs) have received enormous attention in healthcare. Despite their potential benefits, researchers have underscored various ethical implications. While individual instances have drawn much attention, the debate lacks a systematic overview of practical applications currently researched and ethical issues connected to them. Against this background, this work aims to map the ethical landscape surrounding the current stage of deployment of LLMs in medicine and healthcare. Electronic databases and preprint servers were queried using a comprehensive search strategy. Studies were screened and extracted following a modified rapid review approach. Methodological quality was assessed using a hybrid approach. For 53 records, a meta-aggregative synthesis was performed. Four fields of applications emerged and testify to a vivid exploration phase. Advantages of using LLMs are attributed to their capacity in data analysis, personalized information provisioning, support in decision-making, mitigating information loss and enhancing information accessibility. However, we also identifies recurrent ethical concerns connected to fairness, bias, non-maleficence, transparency, and privacy. A distinctive concern is the tendency to produce harmful misinformation or convincingly but inaccurate content. A recurrent plea for ethical guidance and human oversight is evident. Given the variety of use cases, it is suggested that the ethical guidance debate be reframed to focus on defining what constitutes acceptable human oversight across the spectrum of applications. This involves considering diverse settings, varying potentials for harm, and different acceptable thresholds for performance and certainty in healthcare. In addition, a critical inquiry is necessary to determine the extent to which the current experimental use of LLMs is necessary and justified.

Beyond Memorization: Violating Privacy Via Inference with Large Language Models

Current privacy research on large language models (LLMs) primarily focuses on the issue of extracting memorized training data. At the same time, models' inference capabilities have increased drastically. This raises the key question of whether current LLMs could violate individuals' privacy by inferring personal attributes from text given at inference time. In this work, we present the first comprehensive study on the capabilities of pretrained LLMs to infer personal attributes from text. We construct a dataset consisting of real Reddit profiles, and show that current LLMs can infer a wide range of personal attributes (e.g., location, income, sex), achieving up to 85% top-1 and 95.8% top-3 accuracy at a fraction of the cost (100times) and time (240times) required by humans. As people increasingly interact with LLM-powered chatbots across all aspects of life, we also explore the emerging threat of privacy-invasive chatbots trying to extract personal information through seemingly benign questions. Finally, we show that common mitigations, i.e., text anonymization and model alignment, are currently ineffective at protecting user privacy against LLM inference. Our findings highlight that current LLMs can infer personal data at a previously unattainable scale. In the absence of working defenses, we advocate for a broader discussion around LLM privacy implications beyond memorization, striving for a wider privacy protection.

LLMs-in-the-Loop Part 2: Expert Small AI Models for Anonymization and De-identification of PHI Across Multiple Languages

The rise of chronic diseases and pandemics like COVID-19 has emphasized the need for effective patient data processing while ensuring privacy through anonymization and de-identification of protected health information (PHI). Anonymized data facilitates research without compromising patient confidentiality. This paper introduces expert small AI models developed using the LLM-in-the-loop methodology to meet the demand for domain-specific de-identification NER models. These models overcome the privacy risks associated with large language models (LLMs) used via APIs by eliminating the need to transmit or store sensitive data. More importantly, they consistently outperform LLMs in de-identification tasks, offering superior performance and reliability. Our de-identification NER models, developed in eight languages (English, German, Italian, French, Romanian, Turkish, Spanish, and Arabic) achieved f1-micro score averages of 0.966, 0.975, 0.976, 0.970, 0.964, 0.974, 0.978, and 0.953 respectively. These results establish them as the most accurate healthcare anonymization solutions, surpassing existing small models and even general-purpose LLMs such as GPT-4o. While Part-1 of this series introduced the LLM-in-the-loop methodology for bio-medical document translation, this second paper showcases its success in developing cost-effective expert small NER models in de-identification tasks. Our findings lay the groundwork for future healthcare AI innovations, including biomedical entity and relation extraction, demonstrating the value of specialized models for domain-specific challenges.

Trusted Machine Learning Models Unlock Private Inference for Problems Currently Infeasible with Cryptography

We often interact with untrusted parties. Prioritization of privacy can limit the effectiveness of these interactions, as achieving certain goals necessitates sharing private data. Traditionally, addressing this challenge has involved either seeking trusted intermediaries or constructing cryptographic protocols that restrict how much data is revealed, such as multi-party computations or zero-knowledge proofs. While significant advances have been made in scaling cryptographic approaches, they remain limited in terms of the size and complexity of applications they can be used for. In this paper, we argue that capable machine learning models can fulfill the role of a trusted third party, thus enabling secure computations for applications that were previously infeasible. In particular, we describe Trusted Capable Model Environments (TCMEs) as an alternative approach for scaling secure computation, where capable machine learning model(s) interact under input/output constraints, with explicit information flow control and explicit statelessness. This approach aims to achieve a balance between privacy and computational efficiency, enabling private inference where classical cryptographic solutions are currently infeasible. We describe a number of use cases that are enabled by TCME, and show that even some simple classic cryptographic problems can already be solved with TCME. Finally, we outline current limitations and discuss the path forward in implementing them.

Anonymizing Speech: Evaluating and Designing Speaker Anonymization Techniques

The growing use of voice user interfaces has led to a surge in the collection and storage of speech data. While data collection allows for the development of efficient tools powering most speech services, it also poses serious privacy issues for users as centralized storage makes private personal speech data vulnerable to cyber threats. With the increasing use of voice-based digital assistants like Amazon's Alexa, Google's Home, and Apple's Siri, and with the increasing ease with which personal speech data can be collected, the risk of malicious use of voice-cloning and speaker/gender/pathological/etc. recognition has increased. This thesis proposes solutions for anonymizing speech and evaluating the degree of the anonymization. In this work, anonymization refers to making personal speech data unlinkable to an identity while maintaining the usefulness (utility) of the speech signal (e.g., access to linguistic content). We start by identifying several challenges that evaluation protocols need to consider to evaluate the degree of privacy protection properly. We clarify how anonymization systems must be configured for evaluation purposes and highlight that many practical deployment configurations do not permit privacy evaluation. Furthermore, we study and examine the most common voice conversion-based anonymization system and identify its weak points before suggesting new methods to overcome some limitations. We isolate all components of the anonymization system to evaluate the degree of speaker PPI associated with each of them. Then, we propose several transformation methods for each component to reduce as much as possible speaker PPI while maintaining utility. We promote anonymization algorithms based on quantization-based transformation as an alternative to the most-used and well-known noise-based approach. Finally, we endeavor a new attack method to invert anonymization.

Boosting Digital Safeguards: Blending Cryptography and Steganography

In today's digital age, the internet is essential for communication and the sharing of information, creating a critical need for sophisticated data security measures to prevent unauthorized access and exploitation. Cryptography encrypts messages into a cipher text that is incomprehensible to unauthorized readers, thus safeguarding data during its transmission. Steganography, on the other hand, originates from the Greek term for "covered writing" and involves the art of hiding data within another medium, thereby facilitating covert communication by making the message invisible. This proposed approach takes advantage of the latest advancements in Artificial Intelligence (AI) and Deep Learning (DL), especially through the application of Generative Adversarial Networks (GANs), to improve upon traditional steganographic methods. By embedding encrypted data within another medium, our method ensures that the communication remains hidden from prying eyes. The application of GANs enables a smart, secure system that utilizes the inherent sensitivity of neural networks to slight alterations in data, enhancing the protection against detection. By merging the encryption techniques of cryptography with the hiding capabilities of steganography, and augmenting these with the strengths of AI, we introduce a comprehensive security system designed to maintain both the privacy and integrity of information. This system is crafted not just to prevent unauthorized access or modification of data, but also to keep the existence of the data hidden. This fusion of technologies tackles the core challenges of data security in the current era of open digital communication, presenting an advanced solution with the potential to transform the landscape of information security.

Fidelity and Privacy of Synthetic Medical Data

The digitization of medical records ushered in a new era of big data to clinical science, and with it the possibility that data could be shared, to multiply insights beyond what investigators could abstract from paper records. The need to share individual-level medical data to accelerate innovation in precision medicine continues to grow, and has never been more urgent, as scientists grapple with the COVID-19 pandemic. However, enthusiasm for the use of big data has been tempered by a fully appropriate concern for patient autonomy and privacy. That is, the ability to extract private or confidential information about an individual, in practice, renders it difficult to share data, since significant infrastructure and data governance must be established before data can be shared. Although HIPAA provided de-identification as an approved mechanism for data sharing, linkage attacks were identified as a major vulnerability. A variety of mechanisms have been established to avoid leaking private information, such as field suppression or abstraction, strictly limiting the amount of information that can be shared, or employing mathematical techniques such as differential privacy. Another approach, which we focus on here, is creating synthetic data that mimics the underlying data. For synthetic data to be a useful mechanism in support of medical innovation and a proxy for real-world evidence, one must demonstrate two properties of the synthetic dataset: (1) any analysis on the real data must be matched by analysis of the synthetic data (statistical fidelity) and (2) the synthetic data must preserve privacy, with minimal risk of re-identification (privacy guarantee). In this paper we propose a framework for quantifying the statistical fidelity and privacy preservation properties of synthetic datasets and demonstrate these metrics for synthetic data generated by Syntegra technology.