Regarding Paul Hochman's recent Fast Company article on prosthetics
, as both a consumer of prosthetic arms and an engineer working on the most ambitious prosthetic arm project in history, I have some significant problems with his portrayal of the clinical state of the art. The basic premise raised in the article, that we're anywhere close to "Super Human Prostheses You'll Envy" is laughable to those actually suffering from this problem, at least with respect to arms. Since I lost my arm in Iraq Jan 1, 2005, I can tell you that the US Government has spared no expense in giving me, and other military patients, the state of the art in prosthetic limbs. As I detailed in my article
in IEEE Spectrum magazine last year, that state of the art is simply nowhere close to what we imagine it to be, fueled by images from science fiction and the fictionalization of science in the popular press—the “Discovery Channel” problem.
This problem is by no means a new one. George Edwin Marks, in the 1896 edition of his Treatise on Prosthetics
"We are frequently amused by reading newspaper articles of artificial arms made by forgotten mechanics that are fully as good as natural arms. We frequently have to listen to the narration of some magical performances of men who wear artificial arms. We recall an article that appeared in a Canadian paper some years ago of a woman who had a pair adjusted to her person supplementary to her natural ones. She became so dexterous in manipulating them that when in a public conveyance she would hold a book in her artificial hands and while apparently reading would with her natural hands pick the pockets of those who sat next to her. We have read in the newspaper the story of a politician who lost his arm in the Rebellion and who had an ingenious artificial one applied that enabled him to shuffle a deck of cards, pick up a glass of beer and carry it to his mouth, and on one occasion when in a barroom brawl he liberated a spring and the arm immediately began its pugilistic movements with more vigor and with more deadly results than possible for a natural arm, and by this means he emptied a crowded barroom. We have read a great many newspaper articles equally as absurd as the above and being acquainted with every method used throughout the world for the construction of artificial limbs we brand all such stories as fabrications of poorly informed but highly imaginative newspaper correspondents."
In 1965, following the introduction of the first clinically available myoelectric hand, and the MIT research project that was to create the Boston Elbow, the New York Times delivered a similarly rosy prediction, under the headline, "New Process Will Help Amputee To Control Limb With Thought." The article noted that, "Scientists displayed today a development in the field of artificial limbs that enables an amputee to flex an elbow and control arm movement simply by thinking about it. ...[T]he work was still in the experimental stage and its practical use still a few years away.”
Indeed. While simply realistic assessments of the actual state of the art are described as morose
, they serve as a very low-volume counterpoint to the drumbeat of such "highly imaginative" accounts.
My response when someone says about my arm, “Wow, that's really cool,” is often the polar opposite of Mr. Hochman's claim: “No it's not. When it's good enough that you want an elective amputation, then it'll be cool. Trust me, we're no where close.” The problem, of course, is the media. We absolutely have a media bias, but it's not political. It's an entertainment bias. The meme
that Mr. Hochman bought into, that modern technology is righting the wounds of war and others, and that we can “[s]ave [our] tears for Tiny Tim,” is a happy ending that doesn't yet exist. So, by the way, is the other extreme; no one remembers that at the same time as he was pointing out the admittedly awful living conditions in quarters at Walter Reed, Specialist Jeremy Duncan mentioned
that he was getting outstanding medical care. Unfortunately, the truth lies somewhere in between the extremes that the press gravitates toward, and it's a little more complicated than a sound bite. My own experience being interviewed by 60 Minutes
was the same way: I talked for hours about the non-technical problems that we were facing just to imagine an advanced arm reaching the marketplace. What came out was about a minute and a half of very carefully worded quotes and voice over that, despite my efforts, left most people who watched it with the impression that thought-controlled arms were just around the corner, if not here already. I've taken to copying the producer whenever I have a particularly hard time breaking it to somebody that this is not the case.
What's the problem? It's the economics, stupid. Despite Mr. Hochman's rosy picture of the goldmine at the end of the amputation rainbow, no one loses arms from diabetes. There are only 193 servicemembers missing arms as of January, 2010 from service since conflict began in 2001 (Amputee Patient Care Service, Walter Reed Army Medical Center). Cancer and vehicle trauma don't add many more patients to the customer pool, which remains at between 50,000 and 100,000 in the US (a few per cent of the amputee total), and only increases by a couple of thousand a year. Add to this the reality that most insurance companies refuse to pay a minimum of $30,000 for the current state of the art--an “experimental” or “purely cosmetic” myoelectric arm that has failed to significantly evolve since the 1970s--and that doesn't add up to very many customers for one of the new arms, which would likely cost as much as $300,000. And by the way, the $300,000 arm may not be as useful as that puff piece made you think that it was.
So do I have an antidote for all of this? The Open Prosthetics Project is an answer
that we have proposed. Do I think it's the answer
? Absolutely not. I do
know that nothing that society has tried thus far, in any combination of public and private initiatives, has helped solutions to this problem keep pace with those in more common use—like telephones, cars and computers. I also know that we need to fix the total lack of transparency in the way our government conducts scientific research, and on our abysmal failure to translate the results of this basic research to the clinic in the absence of a clear economic incentive.
Most importantly, I know that if we keep letting people claim that these problems are solved, it will become increasingly difficult to ask for any more money to continue trying.