6 ms·

Prototype of clinical trials in an untrustworthy environment using blockchain

38 points by carbocation 7y ago

danghica 7y ago
Why not a government regulated database?
- JohnJamesRambo 7y ago
  Because centralized databases are prone to manipulation and censorship?
  - nosianu 7y ago
    So you also need to get rid of drug databases, PubMed, protein databases, etc. This makes no sense. If your government is in such bad shape you have far bigger problems than keeping track of drug trials. "Blockchain" just stores the same stuff lots and lots of times in as many places as possible. Extremely wasteful and expensive, with all the overhead of doing that (and updating hat "database"), plus the consensus algorithm which may or may not be reliable/crackable. Is it a sign of the times, and maybe in some countries more than in others, that there is a hype around mistrust? Trying to build a world where trust is not necessary? I bet that won't work. I think you need to fix the trust issue more directly, working around the trust requirement won't work. It just creates huge complexity and even more points of failure. Especially since you would have to go "all in": What's the point in taking just one thing into the trust-free solution? All those things depend on one another, you would have to do it with all or most of them to get the benefit you are looking for. It may look manageable if you only look at one particular thing, but imagine everything had to be stored in such a way, the incredible effort required, and the more distribution there is the harder it is to understand what's going on. You really think storing all kinds of data in as many places as possible and then trusting an algorithm to sort it all out, the "truth", works better than trust in a credible entity? At scale (in more than one dimension)?
    - hanniabu 7y ago
      > If your government is in such bad shape you have far bigger problems than keeping track of drug trials. I agree with the parent but I also agree with this, at the very least with the US government. If you think it's not in bad shape then you're living in a fantasy. All it takes is somebody with an agenda to start changing facts from being science based to being what you personally believe in or what corporations want. One such example of this is Pruitt at the EPA.
      - danghica 7y ago
        Yes, and this means that you do have far bigger problems than keeping track of drug trials.
    - lixtra 7y ago
      > "Blockchain" just stores the same stuff lots and lots of times in as many places as possible. Extremely wasteful and expensive, with all the overhead of doing that (and updating hat "database"), plus the consensus algorithm which may or may not be reliable/crackable. No. Blockchain doesn’t have to be wasteful. In general is enough to store the hash of the data in the blockchain and the data itself somewhere where it can be accessed. This prevents manipulation. If at least one trusted party has access to the data it also would not just vanished. If you had an permissioned blockchain signed by the top universities of the world it could be done for very little money.
      - tastroder 7y ago
        There seems little upside between what this paper proposes and everybody just sending all data to all stakeholders of figure 1. The blockchain itself does not conserve confidentiality of placebo placements outside of this process and "Regulatory agency" and "Data safety monitoring board" are presumably two trusted parties that could, post hoc, compare their two databases and draw the same conclusions. Adding a semi-public blockchain seems like a neat little tidbit but it mostly adds a formalization of the process (which would of course be a good thing) and buzzword-worthiness, thus warranting the "wasteful" label. > permissioned blockchain [...] for very little money Is that a solved problem yet?
  - ska 7y ago
    For the current clinical trial mechanism to work at all, you are relying on a deep level of trust and professionalism. If you don't have that, you're going to have to imagine a radical, nearly complete transformation of how this sort of science is being done. If you do have that, I don't see what tracking a small piece of it with a blockchain really buys you. Do you?
- carbocation 7y ago
  This is my current view, too. There is no "double spend" possibility. There is necessarily a trusted source. Why not get the benefit of that centralized source and have the government host a plain database?
notahacker 7y ago
Can't imagine the idea of a "trustless" medical trial really taking off tbh. Or indeed that the first resort of people trying to manipulate results of medical trials to achieve a particular outcome is post hoc database tampering...
- rscho 7y ago
  > post hoc database tampering You'd be very surprised, then. It has always been a mystery to me how people plugged most holes in the data that I extract for them.
- oaiey 7y ago
  There is fraud involved due to financial incentives to patients and especially doctors. But the industry is all based on audit trails etc. Tampering is not done on a technical level.
randaouser 7y ago
they mandate access through a web portal... this in itself is centralization. One can simply tamper with the website. You need to distribute a client software or use an open source dapp explorer type product to prevent data manipulation en-route to the blockchain
Canada 7y ago
A blockchain isn't necessary because there's no double spending to prevent. Just broadcasting signed assertions to a bunch of nodes who make all of the data available to the public should be enough for everyone to know who claimed what and when. Less like Bitcoin, more like Certificate Transparency.
- jasode 7y ago
  >A blockchain isn't necessary because there's no double spending to prevent. A "chaining of hashes of the previous blocks" has other uses than preventing double spending of currency. It also acts as a "incrementing clock" of record-keeping that's resistant to tampering. E.g. The "blockchain" started by Surety[1][2] in 1995 in The New York Times published hashes that depended on previous hashes. They could have published hashes that were independent of previous hashes but they didn't. It would not provide the same anti-tampering guarantees. (I'm only replying to your assertion about blockchain's "double spending" use case in isolation and not commenting on whether the thread's article is a good idea.) [1] https://www.vice.com/en_us/article/j5nzx4/what-was-the-first-blockchain https://www.vice.com/en_us/article/j5nzx4/what-was-the-first... [2] https://news.ycombinator.com/item?id=17865168 https://news.ycombinator.com/item?id=17865168
  - carbocation 7y ago
    To be nitpicky, isn't that a Merkle tree?
    - jasode 7y ago
      Yes. I put "blockchain" in airquotes. I also added Surety ex-CEO's comment that he also called it a Merkle Tree.
  - Canada 7y ago
    It seems like any distributed system that involves any cryptography these days is being called a blockchain. The Vice article is simply wrong. Yes, it's a great idea to use a chain of hashed timestamps+data to prevent data from being tampered with later. People have been doing this with logs for ages. The NYT timestamp system doesn't meet the blockchain definition, at least so long as the word has any real meaning. This point is often debated, but my take is that without also featuring some kind of consensus mechanism to order the writes in a specific manner, thus preventing double spending, then the protocol shouldn't be described as a blockchain at all. A timestamp service (as opposed to a blockchain) is good enough for the goals described in the article. There's no need to enforce strict ordering of transactions because there's no spending. It's just assertions of some fact at some time. So all that's needed are a few reliable servers run by different parties that will log the data. If one of them cheats, it is detectable. Knowing who is behind the private keys signing the assertions is a far more important problem in this kind of system, and blockchains don't help that one bit.
deleted 7y ago
[deleted]
Pneumaticat 7y ago
We're actually trying to do something very similar at https://delph.us https://delph.us. We also have operational encryption, multi-researcher studies, and soon an end-to-end encrypted chat system between researchers and participants using Matrix.
- carbocation 7y ago
  Why? Your website seems to explain the current problems with clinical research, but I didn't see an explanation of your solution. Can you share here?

38 points by carbocation 7y ago

danghica 7y ago

Why not a government regulated database?

JohnJamesRambo 7y ago
Because centralized databases are prone to manipulation and censorship?
- nosianu 7y ago
  So you also need to get rid of drug databases, PubMed, protein databases, etc. This makes no sense. If your government is in such bad shape you have far bigger problems than keeping track of drug trials. "Blockchain" just stores the same stuff lots and lots of times in as many places as possible. Extremely wasteful and expensive, with all the overhead of doing that (and updating hat "database"), plus the consensus algorithm which may or may not be reliable/crackable. Is it a sign of the times, and maybe in some countries more than in others, that there is a hype around mistrust? Trying to build a world where trust is not necessary? I bet that won't work. I think you need to fix the trust issue more directly, working around the trust requirement won't work. It just creates huge complexity and even more points of failure. Especially since you would have to go "all in": What's the point in taking just one thing into the trust-free solution? All those things depend on one another, you would have to do it with all or most of them to get the benefit you are looking for. It may look manageable if you only look at one particular thing, but imagine everything had to be stored in such a way, the incredible effort required, and the more distribution there is the harder it is to understand what's going on. You really think storing all kinds of data in as many places as possible and then trusting an algorithm to sort it all out, the "truth", works better than trust in a credible entity? At scale (in more than one dimension)?
  - hanniabu 7y ago
    > If your government is in such bad shape you have far bigger problems than keeping track of drug trials. I agree with the parent but I also agree with this, at the very least with the US government. If you think it's not in bad shape then you're living in a fantasy. All it takes is somebody with an agenda to start changing facts from being science based to being what you personally believe in or what corporations want. One such example of this is Pruitt at the EPA.
    - danghica 7y ago
      Yes, and this means that you do have far bigger problems than keeping track of drug trials.
  - lixtra 7y ago
    > "Blockchain" just stores the same stuff lots and lots of times in as many places as possible. Extremely wasteful and expensive, with all the overhead of doing that (and updating hat "database"), plus the consensus algorithm which may or may not be reliable/crackable. No. Blockchain doesn’t have to be wasteful. In general is enough to store the hash of the data in the blockchain and the data itself somewhere where it can be accessed. This prevents manipulation. If at least one trusted party has access to the data it also would not just vanished. If you had an permissioned blockchain signed by the top universities of the world it could be done for very little money.
    - tastroder 7y ago
      There seems little upside between what this paper proposes and everybody just sending all data to all stakeholders of figure 1. The blockchain itself does not conserve confidentiality of placebo placements outside of this process and "Regulatory agency" and "Data safety monitoring board" are presumably two trusted parties that could, post hoc, compare their two databases and draw the same conclusions. Adding a semi-public blockchain seems like a neat little tidbit but it mostly adds a formalization of the process (which would of course be a good thing) and buzzword-worthiness, thus warranting the "wasteful" label. > permissioned blockchain [...] for very little money Is that a solved problem yet?
- ska 7y ago
  For the current clinical trial mechanism to work at all, you are relying on a deep level of trust and professionalism. If you don't have that, you're going to have to imagine a radical, nearly complete transformation of how this sort of science is being done. If you do have that, I don't see what tracking a small piece of it with a blockchain really buys you. Do you?
carbocation 7y ago
This is my current view, too. There is no "double spend" possibility. There is necessarily a trusted source. Why not get the benefit of that centralized source and have the government host a plain database?

notahacker 7y ago

Can't imagine the idea of a "trustless" medical trial really taking off tbh. Or indeed that the first resort of people trying to manipulate results of medical trials to achieve a particular outcome is post hoc database tampering...

rscho 7y ago
> post hoc database tampering You'd be very surprised, then. It has always been a mystery to me how people plugged most holes in the data that I extract for them.
oaiey 7y ago
There is fraud involved due to financial incentives to patients and especially doctors. But the industry is all based on audit trails etc. Tampering is not done on a technical level.

randaouser 7y ago

they mandate access through a web portal... this in itself is centralization. One can simply tamper with the website. You need to distribute a client software or use an open source dapp explorer type product to prevent data manipulation en-route to the blockchain

Canada 7y ago

A blockchain isn't necessary because there's no double spending to prevent. Just broadcasting signed assertions to a bunch of nodes who make all of the data available to the public should be enough for everyone to know who claimed what and when. Less like Bitcoin, more like Certificate Transparency.

jasode 7y ago
>A blockchain isn't necessary because there's no double spending to prevent. A "chaining of hashes of the previous blocks" has other uses than preventing double spending of currency. It also acts as a "incrementing clock" of record-keeping that's resistant to tampering. E.g. The "blockchain" started by Surety[1][2] in 1995 in The New York Times published hashes that depended on previous hashes. They could have published hashes that were independent of previous hashes but they didn't. It would not provide the same anti-tampering guarantees. (I'm only replying to your assertion about blockchain's "double spending" use case in isolation and not commenting on whether the thread's article is a good idea.) [1] https://www.vice.com/en_us/article/j5nzx4/what-was-the-first-blockchain https://www.vice.com/en_us/article/j5nzx4/what-was-the-first... [2] https://news.ycombinator.com/item?id=17865168 https://news.ycombinator.com/item?id=17865168
- carbocation 7y ago
  To be nitpicky, isn't that a Merkle tree?
  - jasode 7y ago
    Yes. I put "blockchain" in airquotes. I also added Surety ex-CEO's comment that he also called it a Merkle Tree.
- Canada 7y ago
  It seems like any distributed system that involves any cryptography these days is being called a blockchain. The Vice article is simply wrong. Yes, it's a great idea to use a chain of hashed timestamps+data to prevent data from being tampered with later. People have been doing this with logs for ages. The NYT timestamp system doesn't meet the blockchain definition, at least so long as the word has any real meaning. This point is often debated, but my take is that without also featuring some kind of consensus mechanism to order the writes in a specific manner, thus preventing double spending, then the protocol shouldn't be described as a blockchain at all. A timestamp service (as opposed to a blockchain) is good enough for the goals described in the article. There's no need to enforce strict ordering of transactions because there's no spending. It's just assertions of some fact at some time. So all that's needed are a few reliable servers run by different parties that will log the data. If one of them cheats, it is detectable. Knowing who is behind the private keys signing the assertions is a far more important problem in this kind of system, and blockchains don't help that one bit.

deleted 7y ago

[deleted]

Pneumaticat 7y ago

We're actually trying to do something very similar at https://delph.us https://delph.us. We also have operational encryption, multi-researcher studies, and soon an end-to-end encrypted chat system between researchers and participants using Matrix.

carbocation 7y ago
Why? Your website seems to explain the current problems with clinical research, but I didn't see an explanation of your solution. Can you share here?