Updated: Apr 19, 2022
Imagine you're walking down the street and your legs suddenly collapse beneath you. The neural stimulator implant on your spine has somehow malfunctioned, and now you're back to being paralyzed. Rushed to the emergency room, you learn that your implanted device is in failure. Calls to the company go unanswered, and soon you learn they're fighting bankruptcy and are no longer supporting your device. No upgrades, patches, or new equipment are available. There's just not enough money in it. Not only that, you hear that the company saved itself by merging with another company. There are still no plans to continue support as that department was liquidated. Sorry.
We've all had our technology grow obsolete. Products like game systems that are no longer supported by their manufacturers, smartwatches too old to accept the new upgrade, and cell phone models simply discontinued making way for the next generation. When a favorite device becomes obsolete it can be frustrating, but they're still relatively easy and cheap to replace
Now imagine that device is surgically implanted, healed over, and risky to remove. Not so trivial anymore. But there are safeguards in place to protect patients, right? People who receive long-established bionic medical assistance such as cochlear implants and pacemakers have the safety of a stable, cooperative system. When pacemakers first came out there were issues with needing to remove leads from the heart to replace or upgrade. Especially with multiple companies vying for a foothold. The need to undergo surgery and the risk of removing no longer compatible wires from the heart put the patient in danger. Things had to change. The industry moved to practices like using modular parts that make changing devices easier and based new builds as much as possible on earlier models, etc. These safer practices may have slowed innovation a touch, yet they saved lives and lowered complications.
But most newer technology comes from start-ups that barely have the capital to survive the initial prototype phase much less long-term care and maintenance. Small trials of just a few hundred people at a time are common so there's not a lot of stock for repairs and replacements. Most implants require new tools and techniques which are not widely available. Especially after the initial trial phase. What happens to those patients if something goes wrong?
People who lose the ability to walk, hear, and even see not because we don't have the technology to help patients but because there's no profit in it may sound like a cyberpunk dystopia, but it's already happening. Investigative Science Magazine, IEEE ran a story this month on patients in a retinal implant study who discovered their devices were no longer supported. The timing was horrible. It was when some of the patient's implants began to fail. The company, Second Sight, discontinued the program to survive bankruptcy.
So what's the solution? Medical ethicists propose safeguards such as technology that affects basic human function to be put in escrow for safekeeping. There are proposed changes to government funding to demand a candidate show they've built in long-term plans for product maintenance. Even possibly requiring that vital technology be open-sourced if a company goes under to allow for other manufacturers to continue care.
With advances like Neuralink and deep brain stimulators for Parkinson's and depression on the horizon, we must race to regulate because the most vulnerable are the poor and marginalized. Paying to remove obsolete implants is both dangerous and expensive. Something most people can't afford. In the event of an accident, defunct parts may make MRI and other tests difficult or impossible to conduct. Thus, affecting treatment.
My hope is that legislation steps in to protect the patient consumer while still allowing an ecosystem of innovation and funding to keep advancing. What do you think?
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