Protecting Patients with GANs

Generative adversarial networks are just one of the many ways to digitally create or alter images. While a lot of discussion has focused on what a horrible mess they may make of our political life and a smaller amount on how they could be used to sabotage imaging AI, it's worth remembering they are just a tool that can be used positively or negatively. In addition to providing synthetic data for medical imaging informatics, I stumbled onto thinking deeply about another use recently.

Someone in my circles who is an artist published an online photo essay about people spending time in a psychiatric ward. The patients, some of whom obviously had little capacity to consent to anything, were photographed including shots that included their faces, and put online. When I contacted the artist, and explained that many psychiatric patients might have little capacity to consent to being photographed, and just as importantly might not realize the implications of these pictures to the rest of their lives, I got a load of condescension. In addition to being told about my lack of knowledge in medical issues (as he perceived it), I was told that the institute director agreed to having the patients photographed.

While legally a signature from a director might hold water (I'm not sure), I am so sadly disappointed at the artist's failure of imagination on so many fronts. An artist should have enough imagination if not empathy to understand that being photographed as an institutionalized psychiatric patient might have bad consequences for someone and/or their family. Either empathy or imagination would make a decent person at least hesitate to publish the faces or any identifying feature of psychiatric patients. The final decision to put up such pictures could be weighted with other concerns- for example if the institution was abusing patients then bringing the unforgiving light of the camera onto the situation might do more good than harm. But a modern artist should know there are ways to treat patients or any subjects to protect their confidentiality.

Apparently, unbeknownst to some, we live in an age where we no longer need that corny black box over the eyes of patient's pictures. We live in an age where digital image data can be augmented in numerous ways. Synthetic faces can be made to show the same emotions, but with different facial features anonymizing the patients; or the opposite. As someone worked as an artist, I don't consider digital image processing less important than darkroom techniques. In medical photography, traditionally little black boxes over the eyes were how an image was manipulated to conceal patient's identities. Slowly in some areas a few different techniques came in, but none were really satisfactory. My sincere hope is that we will soon see people trying new techniques with GANs (generative adversarial networks) and other new tools. GANs not only present a way to simply anonymize but an interesting way to synthesize knowledge about patients while obscuring their identities. Representing dysmorphology or other pathology that is in any way visible, even if through somewhat complex motions over time, can become less of an art, and more of a science.

The truth is, I'm always angry when I see people from weak populations photographed in ways that may come back to hurt them. I was thrilled when recently in refugee camps in Greece photographs were banned. Nonetheless that didn't stop certain people who had shown up for a few days of volunteering from taking selfies with other people in the background- including ironically local healthcare professionals, people involved in the issue for the long haul, who mocked these literal posers for their self-aggrandizing insensitivity. Refugees are an extreme case. Some of these people are literally in hiding from maniacal governments that have a price on their head. But many other people would have legitimate reasons for not wanting their pictures online, whether they are aware of it or not. It doesn't take a medical degree for anyone shooting pictures to just ask themselves- if this were me or someone I deeply care about in this position- would I want them to have their picture published in this way?

So here I am metaphorically howling at the wind trying to move the moon.If artists aren't going to learn digital image manipulation techniques to improve their art for anything other than aesthetic reasons and never think about sensitivity to the subjects...well, who is? At least I personally can digitally move and modify a picture of the moon....

Secretly, I still believe artists must lead the way. The supposed great leaps froward in imaging informatics some people hint came out of nowhere, or academia, came from areas many scientists might consider superfluous. Computer games, digital design...it's easy to parody fine artists and their lunatic babbling about thier works...but if there is a group even these folks condescend, it might be the people doing things like art for computer games, and graphic designers of all stripes. But it isn't just haughty supercilious artists who look down on digital designers. I'll never forget when I was working as one, and a close friend who I attended university with that had gone on into medicine, stated that by working in digital design I was doing "stupid work" that could be done by anyone who could type. Perhaps he inspired me to leave art and become a doctor. Now I can say from experience anyone can be a commercially viable digital artist in the same sense anyone can be a surgeon. Both professions actually take some level of skill, even if graphics and digital communication will forever occupy the last and most marginal area in both art and science. Yet from these very un-elite margins where people labor intensively over the images consumed commercially came the demand for better hardware, and innovation in software, that slowly brought on all kinds of changes in what is possible in art, and now medicine. In a better world, everyone will understand a vision about the numbers that run underneath digital images, whether MRIs or pictures, can not only be used to help people elucidate reality, but in some cases,for the good of humanity, obscure it.