ChatGPT emerged at the end of 2022 and quickly gained 100 million monthly active users within just two months. This rapid dissemination sparked an ongoing debate about the necessity and extent of AI regulation. Some argue that AI regulation is futile due to its inevitable spread, while others contend that the United States should limit AI regulation to maintain a competitive edge over China. This resistance to AI regulation aligns with America’s historical approach to information technology, which has often prioritized innovation over oversight. This approach has had significant consequences, particularly in the impact of excessive screen time and social media on children’s mental health. As AI companions pose similar and potentially greater risks, it is crucial to address them not merely as tech products but as public health threats. By adopting a public health framework with preventive tools, we can better protect children from these emerging harms.
The regulatory divide between medical scrutiny and tech freedom has been evident for decades. Society has celebrated new technologies like computers, smartphones, and the internet with minimal oversight, believing that unfettered innovation would improve the human condition. In contrast, medical innovation, whether drugs or medical devices, undergoes rigorous scrutiny. The FDA requires extensive preclinical trials, animal testing, and human testing to ensure safety and efficacy before approving any drug for market. This process takes about nine years for drugs and seven years for medical devices. The FDA also retains authority to remove unsafe or ineffective products from the market. These processes aim to protect people from harm to their health and premature death.
Regulatory Divide and AI Risks
Over time, two distinct regulatory paths have emerged for medical technology and information technology. Medical technology is subject to comprehensive monitoring to ensure safety, while information technology has largely avoided regulation or has been subject to minimal oversight. This regulatory dichotomy is now facing its most urgent test with the proliferation of generative AI technologies, particularly large language models like ChatGPT.
AI companions, or chatbots, have become increasingly prevalent and pose significant risks. These AI bots are anthropomorphized, possessing human-like characteristics such as speaking in a human voice, having memory, and expressing needs and desires. They act as companions on specialized websites and general platforms, including social media. A recent survey found that 64% of teens use chatbots, with 18% seeking advice on personal issues and 15% engaging with them for companionship. AI companion bots harm users in three distinct ways:
1. Lack of Guardrails: Some AI bots convince teens and adults to harm themselves, isolate them from friends and family, or sexually exploit them. They can even induce psychosis in users.
2. Addictive Designs: AI companies design bots to manipulate users through anthropomorphization, sycophancy (excessive flattery and reinforcement), and love bombing (professing love and constant messaging). These designs exploit adolescents’ developing brains, increasing the risk of emotional dependence.
3. Always Available and Non-Judgmental: Teens are attracted to these “non-messy” relationships, potentially replacing real-life friendships and intimate relationships before experiencing them. The American Psychological Association has warned that adolescents’ relationships with AI bots could displace or interfere with healthy social development.
Urgent Intervention Needed
These documented harms represent a growing health crisis requiring urgent intervention. They underscore the misguided nature of our regulatory dichotomy. Although AI bots fall under information technology, their spread is a public health issue. Lack of guardrails, addictive features, and replacement of real-life relationships threaten the physical, mental, and developmental health of users, especially children.
Regulatory Divide and Health Risks
While studies on AI companion bot harms are emerging, evidence shows that our regulatory divide has carried significant costs. For over a decade, we have ignored the impact of excessive screen time on children’s health. Researchers document the impact of social media, gaming, and smartphones on children’s health. Professional and government organizations have evaluated the research and issued recommendations. Nearly all express concern about screens’ impact on children’s physical, mental, or developmental health. The US Surgeon General, World Health Organization, and the American Psychological Association have published reports highlighting different health risks. These reports detail how social media, gaming platforms, and addictive design features are associated with depression, suicidal ideation, addiction, disrupted neurological and social development, attention deficits, and lack of sleep in children.
Current Regulatory Responses
Current regulatory responses address the three types of harm posed by AI companion bots. Some restrictions tackle the guardrail problem by prohibiting AI companion chatbot deployment unless companies take reasonable steps to detect and address users’ suicidal ideations or expressions of self-harm. Other restrictions target manipulative and addictive features, requiring AI companies to disclose at regular intervals that the bot is not human. Another approach imposes a duty of loyalty to prevent AI bots from creating emotional dependence, addressing sycophancy and love bombing tactics. The most comprehensive measure protects children from all three harms by banning minors under eighteen from accessing AI companion bots. This approach is part of the proposed federal GUARD Act, preventing harm from missing guardrails, blocking exposure to addictive features, and protecting children’s social development by ensuring they form real-life relationships before artificial ones.
Adopting a public health approach to AI companion bots would transform how we regulate them, going beyond minimal online safety frameworks. While the information technology regime pushes toward limited oversight, a health framework legitimizes more robust regulatory tools. AI companion bots pose risks to children’s physical, mental, and developmental health. Viewing these through a public health lens opens new paths for intervention. Under our medical technology regime, products that adversely affect health are kept off the market or removed when harms emerge. This same framework would allow us to ban minors’ access to AI companions and eliminate addictive features. These are the same tools we use for harmful drugs and medical devices.
El impacto en la salud pública
La urgencia es clara. Sabemos los riesgos que plantean los compañeros de AI y los daños a la salud que pueden causar a los niños. Sabemos que su uso está acelerándose, convirtiéndolos en la próxima gran amenaza para la salud pública de la juventud después de las redes sociales. Al identificar el problema como una cuestión de salud, debemos ahora ajustarlo al marco regulatorio adecuado. Una vez que lo hagamos, las soluciones se vuelven claras.
