My time serving as Chief Information Officer for the FDA impressed upon me the clear and present threats that cybercrime posed, not just to our medical infrastructure, but to some of the most vulnerable members of society-patients. Similarly, cyber threats to the stability of medicine have already resulted in harm – yet the field of medicine as a whole has been slow to respond. As unthinkable as it may be, targeting of aid workers and humanitarian medical missions has become far too common. I have taken part in promotions of the #NotATarget initiative to protect my humanitarian colleagues working in the field in conflict zones. More recently, however, a number of tragic events have greatly changed our understanding of the risks facing us. The idea of person or organization deliberately seeking to harm vulnerable patients was difficult to comprehend, even a few decades ago. The enemies of medicine historically have been disease and ignorance. This lack of understanding is perhaps understandable. But despite these and other efforts, the medical world typically has been slow to understand cyber threats, cyber security, and the important distinctions between ethical “white hat” hackers versus malicious or criminal “black hat” hackers. One important example is #WeHeartHackers, a collaboration spanning the federal government, (and the FDA in particular), the medical device industry, and security research communities that works to advance patient safety for internet-connected devices and organizations. The field of medicine has directly benefited from this adaptive strengthening in many ways. Behind the Curve: Medicine’s Lagging Response to Cyber Risk This distinction is made especially clear in the viral TED Talk given by cybersecurity Keren Elazari titled “ Hackers: the internet’s immune system.” In this talk, Elazari argues that hackers make the internet stronger by testing its defenses, which forces the internet to adapt, improve, and strengthen, not unlike the body’s adaptive immune system. Given how pervasive this image is, it may surprise some to learn that there are many “good” hackers. The term hacker often brings to mind a faceless, hooded figure that is ubiquitously linked to crime. Marcus Hutchins’ story is notably complex, but there is no denying that his actions greatly decreased the global harm that likely would have otherwise occurred. In addition to greatly slowing WannaCry’s spread, this kill switch also prevented infected computers from being encrypted and their data locked. Shortly after 15:00 UTC on May 13, the infection was halted when information security researcher and hacker Marcus Hutchins discovered and exploited a “kill switch” embedded in the malware’s code. Within a day, it was raging worldwide and had infected tens of thousands of computers and electronic devices belonging to the United Kingdom’s National Health Service, causing severe disruptions to hospital operations. On May 12, 2017, a ransomware cyberattack known as WannaCry was launched.
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