Caveat emptor: Privacy could turn UK’s genomic dream into a nightmare

Raise your hand if, over the past couple of years, you have not heard of whole genome sequencing (usually abbreviated as WGS), or at least read a sensational headline or two about how fast its costs are dropping. In a nutshell, WGS is used to determine an organism’s complete DNA sequence. But it is actually not the only way to analyze our DNA — in fact, genetic testing has been used in clinical settings for decades, e.g., to diagnose patients with known genetic conditions. Seven-time Wimbledon champion Pete Sampras is a beta-thalassemia carrier – a condition that affects the formation of beta-globin chains, ultimately leading to red blood cells not being formed correctly. Testing for thalassemia, usually triggered by family history or a blood test showing low mean corpuscular volume, is done with a number of simple in-vitro techniques.

The availability of affordable whole genome sequencing not only prompts new hopes toward the discovery and diagnosis of rare/unknown genetic conditions, but also enables researchers to better understand the relationship between the genome and predisposition to diseases, response to treatment, etc. Overall, progress makes it increasingly feasible to envision a not-so-distant future where individuals will undergo sequencing once, making their digitized genome easily available for doctors, clinicians, and third-parties. This would also allow us to use computational algorithms to analyze the genome as a whole, as opposed to expensive, slower, targeted in-vitro tests.

Along these lines is last week’s announcement by Prof. Dame Sally Davies, UK’s Chief Medical Officer, calling the NHS to deliver her “genomic dream” within five years, with whole genome sequencing becoming “as standard as blood tests and biopsies.” As detailed in her annual report, a large number of patients in the UK already undergo genetic testing at least once in their life, and for a wide range of reasons, including the aforementioned thalassemia diagnosis, screening for cancer predisposition triggered by high family incidence, or determining the best course of action in cancer treatment. So wouldn’t it make sense to sequence the genome once and keep the data available for life? My answer is yes, but with a number of bold and double underlined caveats.

The first one is with respect to the security concerns prompted by the need to store data of extreme sensitivity like genomic data. The genome obviously contains information about ethnic heritage and predisposition to diseases/conditions, possibly including mental disorders. Data breaches of sensitive information, including health and medical data, sadly happen on a daily basis. But certain security threats are actually specific to genomic data and much more worrisome. For instance, due to its hereditary nature, access to a genome essentially implies access to that of close relatives as well, including offspring, so one’s decision to publish/donate their genome is also being made for their siblings, kids/grandkids, etc. So sensitivity does not degrade over time, but persists long after a patient’s death. In fact, it might even increase, as new aspects of the genome are studied and discovered. As a consequence, Prof. Dame Davies’ dream could easily turn into a nightmare without adequate investments toward sound security measures, that involve both technical tools (such as upgrading of obsolete hardware) as well as education, awareness, and practices that do not simply shift burden onto clinicians and practitioners, but incorporate security in their design and not as an after-the-fact.

Another concern is with allowing researchers to use the genomic data collected by the NHS, along with medical history, for research purposes – e.g., to discover genetic mutations that are responsible for certain traits or diseases. This requires building a meaningful trust relationship between the NHS/Government and patients, which cannot happen without healing the wounds from recent incidents like the care.data debacle or Google DeepMind’s use of personal NHS records. Instead, the annual report seems to include security/anonymity promises we cannot realistically maintain, while, worse yet, promoting a rhetoric of greater good trumping privacy concerns, as well as seemingly pushing a choice between donating data and access to the best care. It is misleading to use terms like “de-identification” of genomic data as an effective protection tool, while proper anonymization is inherently impossible due to its peculiar combination of unique and hereditary features, as demonstrated by a wide array of scientific results. Rather, we should make it clear that data can never be fully anonymized, or protected with 100% guarantees.

Overall, I believe that patients should not be automatically enrolled in sequencing programs. Even if they are given an option to later withdraw, once the data is out there it is impossible to delete all copies of it. Rather, patients should voluntarily decide to join through an effective informed consent mechanism. This proves to be challenging against a background in which information that can be extracted/inferred from genomes may rapidly change: what if in the future a new mutation responsible for early on-set Alzheimer’s is discovered? What if the NHS is privatized? Encouraging results with respect to education and informed consent, however, do exist. For instance, the Personal Genome Project is a good example of effective strategies to help volunteers understand the risks and could be used to inform future NHS-run sequencing programs.

 

An edited version of this article was originally published on the BMJ.

Preventing phishing won’t stop ransomware spreading

Ransomware is in the news again, with Reckitt Benckiser reporting that disruption caused by the NotPetya ransomware could have cost them up to £100 million. In response to this news, just as every previous ransomware incident, the security industry started giving out advice – almost universally emphasising the importance of not opening phishing emails.

The problem is that this advice won’t work. Putting aside the fact that such advice is often so vague as to be impossible to put into action, the cause of recent ransomware outbreaks is not people opening phishing emails:

  • WannaCry, which notably caused severe disruption to the NHS, spread by automated scanning of computers vulnerable to an NSA-developed exploit. Although the starting point was initially assumed to be a phishing email, this was later debunked – only network scanning was used.
  • The Mole Ransomware attack that hit many organisations, including UCL, was initially thought to be spread by employees clicking on links in phishing emails. Subsequent analysis found this was incorrect and most likely the malware spread through malicious advertisements on legitimate websites.
  • NotPetya was initially thought to have been spread through Russian or Ukrainian phishing emails (explaining why that part of the world was so badly affected). It turned out to have not involved phishing at all, but the outbreak started through a tampered software update to the MEDoc tax accounting software mandated by the Ukranian government. Once inside an organisation, NotPetya then spread using the same exploit as WannaCry or by compromising administrative credentials.

Here are three major incidents, making international news, and the standard advice to “be vigilant” when opening emails or clicking links would have been useless. Is it any surprise that security advice gets ignored?

Not only is common anti-phishing advice unhelpful but it shifts blame to individuals (who are not in a position to prevent or mitigate most attacks) away from the IT industry and staff (who are). It also misleads management into thinking that they can “blame-and-train” their employees rather than investing in well engineered preventative security mechanisms and IT systems that can recover from compromise.

And there are things that can be done which have been shown to be effective, not just against the current outbreaks but many in the past and likely future. WannaCry would have been prevented by applying software updates, but the NotPetya outbreak was caused by a software update. The industry needs to act promptly to ensure that software updates are safe and reliable before customers become even more wary about installing them.

The spread of WannaCry and NotPetya within companies could have been prevented or slowed through better operational practices such as segmenting networks and limiting the use of administrative privilege. We’ve known this approach to be effective, but better tools and practices are needed to avoid enhanced security mechanisms being a drag on an organisation’s productivity.

Mole could have been prevented by ad-blocking browser extensions. The advertising industry is in open war against ad-blocking because it harms their income stream, but while they keep on spreading malware through their networks I have limited sympathy.

Well maintained and protected backups are essential to allow recovery, whether from ransomware, purely destructive attacks, or hardware failure. The security techniques above are effective, but these measures will not prevent every attack so mechanisms are needed to efficiently deal with the aftermath.

Most importantly we need move away from security being a set of traditions passed from generation to generation with little or no reason to believe they are effective (so called “best practice”) to well engineered systems following rigorous, evidence-based guidance on state of the art cybersecurity principles, standards and practices.

EPFL blockchain summer school

This year EPFL hosted a Blockchain Summer School from the 21st to the 24th of June. UCL was well represented with Sarah Meiklejohn presenting two talks whilst Sarah Azouvi, Patrick McCorry, Mustafa Al-Bassam and Alexander Hicks also attended. This blog post is a joint effort from the four of us, aimed at highlighting the talks presented last week.

Patrick, Sarah, Sarah, Mustafa, Rebekah (UCL alumni) and Alex. Credit: Emin Gün Sirer

The Summer School featured talks on several aspects of blockchain technology ranging from classical distributed computing, security of smart contracts in Ethereum and proving the security of proof of work/stake. Here, we will provide a small summary for each of the talks. Slides can be found by clicking on each talk on the school’s program page.

TLS-N: Non-repudiation over TLS Enabling Ubiquitous Content Signing for Disintermediation by Arthur Gervais: Gervais’ talk highlights that a slight modification to TLS can allow a smart contract to verify the authenticity of data received from website.  Essentially, at the end of the TLS session the server signs evidence of the TLS session if requested by the client. This evidence is verified and stored by the smart contract. It is also worth mentioning that the protocol relies on redactable signatures that ensures private data isn’t revealed.

Town Crier: An Authenticated Data Feed for Smart Contracts – Ari Juels: Juel’s talk highlights that trusted execution environments can be leveraged to build authenticated data feeds. This trusted hardware communicates with the website before sending the data to the smart contract.  It is responsible for setting up a HTTPS session and fetching data from a website before sending the data to the smart contract. TownCrier is currently implemented using Intel SGX and is currently released for testing.

It is also worth mentioning that Juels beautifully provided a good definition for a smart contract:

“A smart contract is a trusted third party with public state.”

This is one of the reasons why cryptography and smart contracts are a great combination. The contract can ensure the cryptography is faithfully executed, whereas the cryptography can provide integrity and confidentiality for data used by the contract.

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