Neuromancer 2022

The collapse of a startup leaves implanted medical devices in > 700 people

The unavailability of the proprietary SW needed to recalibrate the devices and maintain its effectiveness, and the draining of batteries, will leave them without treatment and with HW implanted in their bodies

They have to hack their own implants

And it is not an isolated case but a trend

https://www.nature.com/immersive/d41586-022-03810-5/index.html

Abandoned: the human cost of neurotechnology failure

When the makers of electronic implants abandon their projects, people who rely on the devices have everything to lose.

@pheras medical devices should not be proprietary at all.. that is criminal.

@pherasMöllmann-Bohle, meanwhile, turned to skills he developed as an electrical engineer. In the past three years, he has repaired a faulty charging port on the hand-held portion of his device and replaced its inbuilt battery several times. This battery was never intended to be accessible to the user, and it turned out to be unusual. Möllmann-Bohle scoured the Internet and eventually found suitable replacements made by a firm in the United States. When he returned for more, however, he learnt that the company had stopped making them. His most recent replacement came from a Chinese company that custom made what he needed.

this not only says a lot about Intellectual Property™®© and its lack of ethics, but also about how hard preserving right to repair is anyway… society still has a long way to learn

@xerz @pheras I wouldn't sleep at night implanting something lifelong into someone that can't be serviced. These companies don't care about the user, just money. Once the initial transaction is over, it's the customer's problem.
@pheras
Yet another area. #Diabetes got it's #WeAreNotWaiting movement with managing devices themselves, and I heard similar stories about pacemakers.

@pheras this reminded me of some of the talks that @conservancy gives about this very subject. @karen gave this talk.

https://invidious.fdn.fr/watch?v=qW1h1s_ojpM

Freedom in My Heart - Lessons from a Cyborg Lawyer by Karen Sandler of Software Freedom Conservancy

In her keynote at SeaGL 2014, Conservancy's Karen Sandler explains why software freedom is essential for all devices, and in particular medical devices. She also points out that security through obscurity not only doesn't work, but is extremely dangerous for medical devices.

Software Freedom Conservancy | Invidious
@onepict @conservancy @karen Oh, good to know. It's so scary. There should be some regulation requiring the automatic conversion to Free/Libre SW in these cases.
@pheras this is both frightening and fascinating
@pheras software should be deposited with authorities, and conditions such as bankruptcy should make it public domain immediately. Experience shows you can't expect the private sector to keep people healthy out of good will alone.
@pheras why do we always get the "capitalism ruins everything" timeline and not the hopeful future of advancements in technology just making people's lives better?
@pheras absolutely incredible read. Thank you for sharing.
@pheras We have engineers that can inspect a building before we put people in them. We should use engineers to inspect the code before we put things into people.
@webkris @pheras we do it for example in the aeroespacial sector. It is incredible that the heath sector can develop software as if it was running in a toaster.

@pheras

Cory Doctorow @doctorow full-on predicted this years ago: What happens when the companies providing healing meds/tech abandon their miracle cures?

We're all cyborgs or will increasingly become ones as we age. Between them, my parents have bionic knees, eyes, ears, hearts, & livers.

Shouldn't these devices have SLAs (service level agreements) that extend beyond the life of the corporations that built them? And barring that, they MUST be open source.

@eff

@pheras The cyberpunk dystopias were utopic in that they did not envision how we would be struck down by intellectual property laws and marginally profitable, but vital, ventures.

@pheras There's also the point that many of these devices are *quite* hackable. And programmable via radio.

Pacemakers programmable by radio with weak to no security. Implanted insulin pumps programmable by radio with weak to no security.

Look up some DefCon talks on medical implants if you want reduced sleep quality.

@pheras @ZaneSelvans

Chilling. If I ever need one I hope there will be an open source option.

"Peckham plans to make the design specifications and supporting documentation of new implantable technologies developed by his team freely available. “Then people can just cut and paste,” he says."

@judell "It's like Stack Overflow, but for your liver."
@ZaneSelvans I'm also reminded of an old joke about biometrics: "The problem is that if your identity is stolen, you need to have surgery."
@pheras @mmasnick who knew that proprietary software dongles were a harbinger of medical disaster?
@pheras @jferg The FDA and the Euro equivalent should require plans for this situation as a prerequisite for approval!

@pheras "The human cost of neurotechnology failure" .. why is that in the title, it is about companies failing, not technology. The technology was probably going to need maintenance anyway.

Open source might have mitigated, but only solves it if the know-how and resources to use that information is there.. (and as it mentions, insurers are likely to not co-operate with non-institutional sources)

@jasper being Free/Libre software would enable alternatives such as associations of patients paying developers to maintain the SW controlling their implants.

A new company could maintain this SW profesionally and co-operate with insurers.

There are many companies providing professional service to Free/Libre SW in other areas.

@jasper @pheras

It just turns out that technology does *not* end at product design and manufacturing.

It is a technological failure because engineers didn't incorporate ways to address this predictable issues.

@jcast @pheras continuity of organisations is *definitely* not in the job description of engineers.

It *does* end there ..by definition.. but of course definitions or job descriptions don't mean those people shouldn't point out organizational problems, or blindly work with people who ostensibly it's job it is to run orgs responsibly, but don't..

@jasper @pheras

Absolutely agree that engineers should in principle not be blamed for managerial decisions.

But in the XXI century, not considering the full product cycle in a technological project, in particular a health device, is at best short sighted. It's a technical fault. Technology cannot be considered outside its social context.

@jasper @pheras

It's not accidental that engineers without borders shifted to focusing on social skills once they started analyzing their failures systematically.

@pheras Like Doctrow's Authorized Bread, but amazingly, worse!
@pheras this happened to one of my best friends. She died in 2020. I don’t know if the abandoned, nonfunctional implant had anything to do with it, but it couldn’t have helped.

@pheras Wait! I thought this was the premise of a movie and your post was a review.

I’m not shitting you! I’m blown away that this is reality!

Abandoned: the human cost of neurotechnology failure

When the makers of electronic implants abandon their projects, people who rely on the devices have everything to lose.

@pheras as a chronic migraineur I feel this so acutely. Omg…
@pheras That’s one might be wise to avoid the new sleep apnea implant, Inspire, that’s being heavily advertised on US TV right now. More convenient than wearing a CPAP when it works no doubt, but when it reaches EOL, or the company goes under, then what?

@pheras there was a largish report about this last year or so, including a huge black market for used parts, regarding a pixelated vision solution for some kinds of blindness whose vendor vanished as well

complete with video documentary

but I don’t recall where or how it was named

@pheras fabulous read. thank you for sharing.
@pheras @VickiWoodward anyone else get the feeling medical device companies should be required to provide the means for ongoing support for their products if they fail? (even better, open source their stuff, but somehow I don't think that'll happen). Needs to be written into their legal obligations somewhere that their patients wont be at risk.
@pheras … always interesting …
@pheras Wow, what a nightmare. Thanks for sharing.
@pheras When I read this I immediately think of this film: https://framatube.org/w/9mLheCcHa19bW2Qv2AJjhQ
#foss
FSF-Rewind-720p

PeerTube

@pheras this has got me thinking about my mom and the experimental treatment she went through for her Parkinson's.

While the treatment was still supported, it wasn't easy to get info to the nursing home about how to get the battery charged when she suddenly needed 24/7 skilled nursing care.

@pheras Similar story in IEEE Spectrum recently about obsolete “bionic eyes.”

https://spectrum.ieee.org/bionic-eye-obsolete

Their Bionic Eyes Are Now Obsolete and Unsupported

These early adopters found out what happened when a cutting-edge marvel became an obsolete gadget... inside their bodies.

IEEE Spectrum
@pheras I'm in strong favor of requiring escrow software for medical devices, or maybe even require open source.
@pheras I really thought this was a fiendishly evil story hook for a cyberpunk game until I saw the article attached. Oof, much as I am ready to retire this meat suit, knowing I could be shut down because a manufacturer won’t release a firmware update is terrifying.

@pheras I made provisions to address this problem with my software-only solution for functional vision that runs on commodity (replaceable, affordable) hardware https://twitter.com/seeingwithsound/status/1507083141437136899 #The_vOICe sensory substitution

Edit for when Twitter vanishes: https://web.archive.org/web/20211225143619/https://www.seeingwithsound.com/webvoice/webvoice.htm

The vOICe vision 😎 on Twitter

“Long-term availability of The vOICe is guaranteed https://t.co/GVjXhUFNdX Internet Archive; #bionic #ethics”

Twitter
@pheras When I read the start of your post, I thought it was the description of a dystopian future novel so a link at the end of your post to Nature was just a bit puzzling. I suppose that tells me a lot about what I think about this.
@pheras scary, but this is kind of how i perceived and imaginated the world of the sprawl created by @GreatDismal back then. Fascinating and tempting, but also scary.
@pheras I suppose my first thought was escrow. But then also a seed bank. Paid membership of an organisation that holds the code for in the event of and carries out research/ updates. I think though this touches upon the ownership of medicine and whether something devised from and built upon research we perhaps all contribute to should be hived off. The result here is one small aspect of viewing medicine as discrete boxes of cures for sale to individual patients.

LB which is why you'll never catch me using Musk's "neuralink" or anything else. I've got zero interest in elective cybernetics or bionics of any kind.

Even something like a pacemaker I'd want to research the device manufacturer and support to make sure I'm not signing up for an implant that can go out of support leaving me with a malfunctioning device inside my body.

@pheras it’s criminal to exist even the possibility of a so called startup in the medical field.

@pheras Holy shit I don't think I realized this was already a thing...

and it's the sort of thing that's really only going to keep happening unless the government takes steps to force these companies to make their stuff open.

@pheras See also "Their Bionic Eyes Are Now Obsolete and Unsupported

Second Sight left users of its retinal implants in the dark"
https://spectrum.ieee.org/bionic-eye-obsolete

Their Bionic Eyes Are Now Obsolete and Unsupported

These early adopters found out what happened when a cutting-edge marvel became an obsolete gadget... inside their bodies.

IEEE Spectrum
@pheras cyborgs having to scavenge for parts to stay alive after their parts fall out of service sure is a weird dystopia like step.