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Jon Kuniholm, "Good Design by Design" | Talks at Google

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    [Jon Kuniholm - Good Design by Design
    May 2nd, 2014[
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    MICHAEL WEISS-MALIK:
    Hi, everybody.
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    Hear me OK?
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    OK.
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    So I think we're
    going to get going.
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    My name's Michael Weiss-Malik.
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    Our guest today,
    Jonathan Kuniholm.
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    I met him in, we
    think, 2007 as far
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    as we can piece back together
    at a SciFoo conference.
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    And he had some pretty
    cool tech that he
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    was demoing on some open
    source robotics stuff
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    related to prosthetics.
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    And I was impressed
    enough that I said, hey,
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    you should come and give a
    talk at Google some time.
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    And he took that to heart.
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    And about four or
    five years later,
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    emailed me and said, hey, you
    offer that talk at Google.
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    Now would be a great time.
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    So we're hosting him today.
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    Jonathan is the president and
    founder of the Open Prosthetics
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    Project.
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    He's also a founder of
    StumpworX, a startup that
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    focuses on prosthetic
    technology.
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    He's also presidential appointee
    to the National Council
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    on Disability.
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    And the stuff he has
    to say is pretty cool.
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    So please put your
    hands together
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    and help me welcome Jon.
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    (Applause)
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    JON KUNIHOLM: Thanks
    very much, Michael.
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    Let me first just offer
    a disclaimer with respect
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    to my government job.
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    They encourage us to do this.
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    That everything that
    I'm going to say today
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    is-- are my personal
    views and not
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    reflective of any position
    of the government.
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    So what I would like
    to talk about today
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    is, how we can design good
    design to solve problems
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    that society has, for
    the most part, neglected.
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    And I came across
    one of those problems
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    personally after I
    lost my arm in 2005
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    and discovered that
    prosthetic arms were
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    an orphan medical device.
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    And in thinking
    a little bit more
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    about why prosthetic arms lagged
    so far behind other technology
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    that we use every day,
    I started to realize
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    that prosthetic arms and
    orphan medical devices
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    are part of a larger
    group of those problems
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    that society has
    tended to neglect
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    which can be solved by
    something that we're beginning
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    to call public interest design.
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    And the question
    that I'd really like
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    to talk about today--
    and I would actually
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    like it to be the
    beginning of the discussion
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    because it's something
    that, by no means,
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    I claim to have
    even begun to solve.
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    --is, how can we marshal all of
    the tools at our disposal to,
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    trying to better
    solve those problems.
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    Because very much now I believe
    that most of those problems
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    are solved in kind
    of a haphazard way.
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    Government-funded projects,
    philanthropy, side
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    projects from industry,
    you name the way
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    that people happen upon these
    issues and try to solve them.
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    But in general, you can
    be sure that the resources
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    and attention that we
    devote toward solving
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    these underserved
    needs are going
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    to lag far behind
    those problems which
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    are very obvious from every
    other standpoint need solving,
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    very profitable things.
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    There was no question
    that cellphone technology
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    was going to improve over the
    last 10 years, for example.
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    So in the summer of 2005, I
    took leave from graduate school
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    at Duke University.
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    And I was deployed as a Marine
    to Iraq in Anbar Province.
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    And I was the platoon commander
    for an engineer platoon
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    of 50 Marines.
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    And we were doing
    mostly what everybody
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    was doing over there which
    is sustainment and stability
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    operations, patrolling, guarding
    convoys, that sort of thing.
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    On New Year's today
    of 2005, I was
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    on a foot patrol
    that was ambushed
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    by improvised explosive device.
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    And the blast took off
    most of my forearm.
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    And I found myself back
    in the States and learning
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    about prosthetic arm technology.
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    I managed to get
    myself back to school
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    and get involved with a
    research project sponsored
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    by DARPA called the
    Revolutionizing Prosthetics
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    2009 Project.
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    It was one of two that DARPA
    was funding which is really
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    the first serious prosthetic
    arm research effort that
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    at occurred in the United
    States since-- there was
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    a small one in the '70s but
    really since World War II.
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    And the goal was a
    really ambitious one.
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    The goal was to
    create in four years
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    in 2007 an arm using
    commercially-available
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    technology that could go to
    market in that year, in 2007.
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    And then, more
    ambitiously, to create
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    an arm that had more
    degrees of freedom,
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    was fully neurally integrated.
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    So nearly the same articulation
    as a native human arm
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    and full strength.
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    And an incredibly
    ambitious project.
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    What I think is
    important to understand,
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    there's been an enormous-- and
    this picture is up here not
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    too brag that I
    was on "60 Minutes"
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    but to show the
    kind of attention
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    that these projects got.
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    For whatever reason,
    prosthetic arms
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    tend to really capture
    the popular imagination.
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    People love robotics.
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    They love thinking about the
    barriers, the singularity
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    and the barriers between man
    and machine disappearing.
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    And it becomes a vehicle for
    all kinds of philosophical
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    and science fiction interest.
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    I think the takeaway
    about these projects which
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    is important to remember
    is, first of all,
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    that we-- despite the
    amazing things that both
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    of these research
    efforts accomplished,
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    we still have not, 10
    years, more than 10 years
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    since the war began Afghanistan,
    actually pushing 15 now
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    --still do not have any
    commercially-available device
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    that has resulted from any
    of this government-funded
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    research.
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    We're still waiting
    for the first one.
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    It has remained, as always,
    just around the corner.
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    And I'm told that we're waiting
    on FDA approval for the DECA RP
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    '07 project to
    receive FDA approval.
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    And it has been in
    some clinical trials.
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    But we still haven't
    seen a device.
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    The other one is-- I think
    that's important to understand.
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    It's my belief that
    we have a media bias.
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    It's not a political
    conservative media bias.
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    But it's one towards
    entertainment.
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    And so there-- the word
    bionic is used a lot.
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    The words dexterous
    and manipulation
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    are also used a lot which
    have very specific meanings
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    in robotics.
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    And there are some
    caveats that I could give.
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    You could call a trigger
    grip, for example,
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    where one part of
    the hand is grasping
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    a handle of a cordless
    drill, and the finger
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    is pulling the trigger.
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    That tends toward a
    sort of manipulation.
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    It's at lease a compound grasp
    where one part of your hand
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    is doing one thing
    and one doing another.
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    But of course, the slide that
    I'm showing here right now
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    gives you some insight into what
    the human hands are capable of.
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    This pair of hands
    is doing a card trick
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    where four cuts of the
    deck are being controlled
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    by different parts
    of the two hands.
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    And it's a dynamic movement.
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    And so I guarantee
    you that there
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    isn't a robotic hand
    of any kind that
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    could do these card
    tricks right now.
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    But based on the popular press
    presentation of all this,
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    you would think that it can.
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    You would think that
    these problems are solved.
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    So while I think it's important
    to acknowledge the strides that
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    were made by these
    research projects,
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    it's also very
    important to understand
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    that we are not there yet.
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    And we do not have
    bionic people.
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    And these hands are,
    for most part right now,
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    I think that it would be fair
    to say, at least in terms
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    of prosthetic control, that even
    these highly articulated hands
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    are really only
    capable of grasping.
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    And the difference between
    grasping and manipulation,
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    you can use a Rubik's
    cube to illustrate.
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    Manipulation is a
    speed cuber solving
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    a Rubik's cube in a few minutes.
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    And grasping is not dropping it.
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    And grasping a Rubik's
    cube is actually something
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    that I can do with
    the hook that I
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    wear when I do wear a prosthetic
    arm, which is the Dorrance
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    5x named after the guy
    who patented it in 1912.
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    And you can see that since
    then, it's evolved a little bit.
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    There's some rubber grip on
    the fingers, a cigarette notch,
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    and I think it's
    called a pen notch now.
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    But this remains, despite
    everything that's happened,
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    the most used prosthetic
    terminal device in America.
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    And were you to go to the
    Myoelectric Conference
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    in New Brunswick in
    Canada this August,
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    it would be a fair bet to make
    that the majority of amputees
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    attending the conference, at
    least the ones who weren't paid
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    to be there by a
    prosthetic company,
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    would be wearing
    one of these devices
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    and not any of the
    robotic prosthetic hands
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    that are available.
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    The other thing that's
    important to note about this
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    is that there's another
    choice which actually beats
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    all of them which is the
    one that I'm wearing today
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    which is nothing.
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    And about half of
    all arm amputees
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    choose most times not to
    wear a prosthesis at all.
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    And it's mostly because
    of weight and comfort
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    in suspension.
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    And I'm going to talk about
    that a little bit later.
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    So now, why is all of that?
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    This is by no means an
    attack on any the folks
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    who were generous enough
    to fund that project
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    and try to make some progress.
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    The real problem is
    that there simply
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    isn't a market for these things.
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    The market for powered
    arms is just barely noise
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    compared to these
    other large markets.
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    And even though the government
    has accomplished quite a bit
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    in some of these
    research projects, what
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    we call the valley of death
    which is the bridge that one
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    of these products must cross
    in order to get from the lab
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    into becoming a clinical
    product, is really significant.
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    And without a market to drive
    further funding, that gap which
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    is estimated by
    people in the industry
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    to be something like
    90% of the R&D remaining
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    on a medical product once
    a proof of principle device
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    is finished, there's just simply
    nowhere for those resources
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    to come from and make it happen.
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    And so correspondingly,
    the amount
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    of effort that's actually put
    into solving this problem is
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    also very small, compared
    to-- I cherry-picked
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    a few really large
    government-sponsored
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    engineering projects.
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    Some of which have been compared
    to the DARPA prosthetics
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    project.
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    This is all in 2006 dollars.
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    The Manhattan Project comes
    in at over $20 billion,
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    the moon race over $120 billion,
    and just the R&D for the Joint
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    Strike Fighter at
    over $40 billion.
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    And so the $100
    million, well more than
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    anybody had spent on prosthetic
    arms in half a century.
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    The DARPA spend is basically
    just noise compared to this.
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    And I would argue that the
    task that they set out to solve
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    rivals some of these in
    terms of the engineering
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    effort required.
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    It's a small project
    instead of a large one.
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    But nevertheless, an enormous
    portion of our brains,
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    for example, is devoted to
    the control of our hands
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    in manipulations.
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    I don't know if
    you all have ever
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    seen-- I don't have a
    slide of it here here,
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    but the homunculus that neural
    researchers use to represent,
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    they take a human figure and
    adjust him proportionally,
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    based on the number
    of nerve endings
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    in some studies of the brain.
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    So this little figure has
    gigantic lips, gigantic hands,
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    and, depending on whether you're
    looking at the censored version
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    or not, gigantic
    genitalia, reflecting
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    how much of our
    brains are devoted
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    to control these various
    parts of our body.
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    And this is true both in
    terms of motor control
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    and sensory control.
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    I works both ways.
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    And as you can see from that
    slide of the card trick,
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    feedback, sensory
    feedback is certainly
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    a huge part of our hands
    being able to do what we do.
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    So what we have is a
    three-way market failure
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    to solve this problem- Industry,
    government, and academia.
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    All doing their parts, but all
    unable to solve this problem.
  • 15:29 - 15:34
    And so -- so
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    But of course, it's
    completely understandable.
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    And that's why we
    call a prosthetic arms
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    an orphan device.
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    The orphan drug law
    that was passed in 1983
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    defined patients in need of a
    drug as being medical orphans
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    if their patient population
    was less than 250,000.
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    So prosthetic arms
    in the United States
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    are about, a couple
    years ago, 43,000
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    so fewer than 50,000 patients
    in the United States.
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    So that's 1/6 of the maximum
    threshold for being an orphan.
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    Course, the orphan drug law
    covers pharmaceuticals and not
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    medical devices.
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    So we don't have a companion
    regulation or law or anything
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    that covers the creation
    of medical devices.
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    And another peculiarity,
    of course, of that
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    is, how we pay for medical
    devices in the United States.
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    And I will get to that
    a little bit later.
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    So as I mentioned before, all
    of these medical orphans--
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    and the NIH-- and
    this includes all
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    of the drug, the orphan drug
    patient populations and others.
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    The NIH lists something like
    10,000 orphaned conditions
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    on its website.
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    And because I happened to be
    interested in prosthetic arms,
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    I searched for limb
    absence, arm absence.
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    And so my particular
    orphan condition
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    is actually not one of the ones
    that's listed on that site.
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    So I would say that
    there are probably more.
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    And so the question is-- and
    this gets back to the graphs
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    that I showed before.
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    Because there's obviously
    no market for it,
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    it doesn't necessarily
    make sense.
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    I wouldn't argue, for example,
    that it's a travesty that DARPA
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    didn't invest $100 billion into
    solving this prosthetic arm
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    problem because the
    same could be said
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    for any of these other orphans.
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    We simply can't
    afford to do that
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    from a public health standpoint.
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    It's just not an effective
    way to spend our resources.
  • 17:49 - 17:52
    So nevertheless,
    feeling like this
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    is a problem that we'd
    like for society to solve
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    and that it's not the only
    one, this is the question.
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    How can we attacked
    these problems
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    and solve some of them?
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    And it's clear that
    we probably need
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    to think about them a little bit
    different way than we are now.
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    My friend Chuck
    Messer described this
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    as using your geek
    powers for good.
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    The Cooper-Hewitt Design
    Museum, in referencing
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    the 90% of the world
    that doesn't benefit
  • 18:24 - 18:27
    from our consumer culture,
    they had a design exhibit
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    several years ago called Design
    for the Other 90% in reference
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    to that.
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    And there's another movement
    here in the Bay Area.
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    For example, you have
    a designer and engineer
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    named Ralf Hotchkiss
    who makes a wheelchair.
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    Whirlwind Wheelchair
    is their organization.
  • 18:46 - 18:50
    And they make appropriate
    technology wheelchairs
  • 18:50 - 18:54
    that have larger balloon
    tires on the front
  • 18:54 - 18:58
    to deal with uneven terrain
    and broken sidewalks
  • 18:58 - 19:00
    that you're more
    likely to encounter,
  • 19:00 - 19:03
    if there are sidewalks all, in
    a lot of the developing world.
  • 19:03 - 19:06
    And they have a cool
    model where they
  • 19:06 - 19:11
    try to set up factories as
    a profitable businesses,
  • 19:11 - 19:13
    a social enterprise, to
    manufacture this wheelchair
  • 19:13 - 19:16
    design in the area where
    they might be used.
  • 19:16 - 19:21
    And this in contrast
    to sometimes
  • 19:21 - 19:23
    what gets done in the
    wheelchair space, for example,
  • 19:23 - 19:29
    is to send a kind of
    rickety hospital wheelchair
  • 19:29 - 19:31
    over to that environment
    where at last,
  • 19:31 - 19:33
    like a lot of medical
    technology over there,
  • 19:33 - 19:35
    about 10 minutes
    before it breaks.
  • 19:35 - 19:38
    And then, somebody has trouble
    finding a part to fix it,
  • 19:38 - 19:41
    and it ends up getting junked.
  • 19:41 - 19:48
    So there's-- whereas I'm arguing
    that prosthetic arm users
  • 19:48 - 19:50
    in the United States are
    an underserved population,
  • 19:50 - 19:52
    they're not
    disadvantaged, certainly,
  • 19:52 - 19:57
    to the same degree that patients
    in the developing world are.
  • 19:57 - 20:00
    But all of these
    patients are underserved
  • 20:00 - 20:03
    in some way or another.
  • 20:03 - 20:06
    So a good phrase
    that's been used
  • 20:06 - 20:10
    to describe all of these
    problems and the design
  • 20:10 - 20:12
    that we can use to
    try to attack them
  • 20:12 - 20:15
    is public interest design,
    design in the public interest.
  • 20:15 - 20:19
    And so really what
    I'd like to talk
  • 20:19 - 20:22
    about is, what are
    the ways besides-- I
  • 20:22 - 20:26
    will start off with
    government-sponsored research
  • 20:26 - 20:28
    because that's a lot of
    what's happening currently.
  • 20:28 - 20:32
    But what is our
    whole quiver of tools
  • 20:32 - 20:36
    that we might use to try to
    solve some of these problems?
  • 20:36 - 20:39
    And-- yeah.
  • 20:39 - 20:41
    Sorry about that.
  • 20:41 - 20:45
    So what are the
    collection of tools
  • 20:45 - 20:48
    that we could use to try to
    better solve these problems?
  • 20:48 - 20:50
    And I, like lots of
    people do, I think
  • 20:50 - 20:55
    I'll probably come down on there
    being some combination of all
  • 20:55 - 20:57
    of these that are necessary.
  • 20:57 - 21:00
    But just to brush over
    them all, to begin
  • 21:00 - 21:04
    with government-sponsored
    research and commercialization,
  • 21:04 - 21:10
    then DIY and the maker culture,
    potentially an orphan device
  • 21:10 - 21:15
    law to service as a companion
    to the orphan drug law
  • 21:15 - 21:19
    that we've had in this
    country since 1983.
  • 21:19 - 21:23
    And then, what other
    regulatory or policy changes
  • 21:23 - 21:28
    might be made under
    our existing structure.
  • 21:28 - 21:32
    But by program managers
    who fund, for example, some
  • 21:32 - 21:35
    of this government-sponsored
    research, what things might
  • 21:35 - 21:41
    they do to try to raise the
    impact of the research funding
  • 21:41 - 21:43
    that they're
    currently giving out.
  • 21:43 - 21:47
    And then secondly, what can
    we do in the private sector?
  • 21:47 - 21:51
    Are there ways that folks
    in the private sector
  • 21:51 - 21:53
    might be able to
    contribute in ways
  • 21:53 - 21:56
    that don't impact
    their own bottom line?
  • 21:56 - 22:00
    And they can
    potentially even have
  • 22:00 - 22:08
    a win-win in serving
    these underserved folks.
  • 22:08 - 22:12
    So to start off with,
    these are the three--
  • 22:12 - 22:15
    these are icons that represent
    the three major engineering
  • 22:15 - 22:18
    research efforts that
    I showed the funding
  • 22:18 - 22:21
    levels for- the moon
    shot, at the atomic bomb,
  • 22:21 - 22:22
    and the Joint Strike Fighter.
  • 22:22 - 22:27
    And it's certainly clear
    that there are some problems
  • 22:27 - 22:31
    that government has
    to solve if they're
  • 22:31 - 22:32
    going to get it solved for us.
  • 22:32 - 22:37
    While we do have SpaceX in
    a commercial space effort
  • 22:37 - 22:42
    right now, it only exists
    because the government
  • 22:42 - 22:44
    is choosing to create
    that capability.
  • 22:44 - 22:46
    And the funding's coming
    from the government.
  • 22:46 - 22:49
    So that's an example, actually,
    of spreading this stuff
  • 22:49 - 22:50
    around a little bit.
  • 22:50 - 22:56
    But it was clear that
    sending a man to the moon
  • 22:56 - 22:59
    or building the bomb,
    however you feel about
  • 22:59 - 23:02
    that having done, these
    were certainly projects that
  • 23:02 - 23:06
    would never have happened
    had not one of the largest
  • 23:06 - 23:08
    and wealthiest
    governments in the world
  • 23:08 - 23:10
    decided that they were
    going to make it happen.
  • 23:10 - 23:14
    And they happen
    because, in at least two
  • 23:14 - 23:16
    in these cases, the first
    two that I mentioned,
  • 23:16 - 23:19
    the results were non-negotiable.
  • 23:19 - 23:21
    We were going to
    get to the moon,
  • 23:21 - 23:25
    no matter how much it costs
    and how dangerous it was.
  • 23:25 - 23:29
    And those who were
    in charge of the bomb
  • 23:29 - 23:33
    viewed it as a response
    to an existential threat.
  • 23:33 - 23:35
    And that failure
    was not an option.
  • 23:35 - 23:39
    It's probably-- the
    government probably
  • 23:39 - 23:46
    would have spent anything
    to achieve these ends.
  • 23:46 - 23:51
    Now, a lot of times,
    some these very programs
  • 23:51 - 23:53
    and the other basic
    science research
  • 23:53 - 23:56
    that the government
    does are cited
  • 23:56 - 24:00
    as having intangible
    benefits that spin off,
  • 24:00 - 24:06
    that we would be without were
    it not for these other efforts.
  • 24:06 - 24:10
    And so Tang, Teflon,
    and Velcro are three.
  • 24:10 - 24:12
    And there's actually
    a myth-busting page
  • 24:12 - 24:15
    on NASA's website that I
    have up there on the slide.
  • 24:15 - 24:18
    Says that, in fact, none
    of these three products
  • 24:18 - 24:21
    were created by NASA
    or NASA-funded research
  • 24:21 - 24:25
    although the space program did
    take advantage of all of those.
  • 24:25 - 24:28
    So while they used Tang,
    Teflon, and Velcro,
  • 24:28 - 24:29
    they did not create it.
  • 24:29 - 24:36
    And I would argue that even
    if they had, building a bomb,
  • 24:36 - 24:41
    sending somebody to the moon,
    or building a high-tech fighter
  • 24:41 - 24:44
    jet are not the most efficient
    ways to create things
  • 24:44 - 24:46
    like Tang, Teflon, and Velcro.
  • 24:46 - 24:51
    So if what you want
    is a prosthetic arm
  • 24:51 - 24:57
    or to put somebody on the moon
    or to build a fighter jet,
  • 24:57 - 24:59
    that is what you do.
  • 24:59 - 25:04
    And this really comes
    down to a difference
  • 25:04 - 25:07
    between engineering
    and basic science.
  • 25:07 - 25:11
    So the point is that
    whatever efforts there
  • 25:11 - 25:13
    are that are devoted to
    solving this problem,
  • 25:13 - 25:16
    it really needs to be dedicated
    to solving the problem.
  • 25:16 - 25:19
    And there needs to be
    some agreement on actually
  • 25:19 - 25:21
    what the problem is.
  • 25:21 - 25:26
    A significant component
    of at least the four year
  • 25:26 - 25:30
    DARPA effort was based on the
    creation of a neural brain
  • 25:30 - 25:32
    machine interface.
  • 25:32 - 25:37
    And it is-- well,
    in the long term,
  • 25:37 - 25:40
    it's certainly true that
    that represents potentially
  • 25:40 - 25:44
    a holy grail of prosthetic arms.
  • 25:44 - 25:50
    It's not clear that that is
    a necessary component of it,
  • 25:50 - 25:53
    particularly given the state
    of the technology that most
  • 25:53 - 25:58
    people are using every day.
  • 25:58 - 26:06
    So then-- so I was-- at the
    time when I met Michael in 2007,
  • 26:06 - 26:10
    we had a version of
    this hardware board
  • 26:10 - 26:12
    that we were showing
    Google SciFoo.
  • 26:12 - 26:18
    And this is-- Tim Hanson
    is now post-doc at UCSF.
  • 26:18 - 26:21
    And he created, when he
    was at the Nicolelis Lab
  • 26:21 - 26:25
    at Duke University, the
    signal processing board which
  • 26:25 - 26:33
    is capable of processing 16
    EMG, electromyogram, signals
  • 26:33 - 26:35
    from the surface
    of the skin that
  • 26:35 - 26:37
    can detect muscle movements.
  • 26:37 - 26:40
    And we designed it to have as
    many interfaces as possible.
  • 26:40 - 26:43
    Because are our goal
    in this DIY space
  • 26:43 - 26:46
    was to try to encourage
    experimentation
  • 26:46 - 26:49
    and to try to benefit
    from the maker
  • 26:49 - 26:54
    culture and the huge
    video game industry in --
  • 26:55 - 27:00
    And hope that some of
    those resources and efforts
  • 27:00 - 27:03
    and interests could rub off
    and make some improvements
  • 27:03 - 27:05
    in prosthetic arms.
  • 27:05 - 27:12
    What we learned is the
    downside to DIY maker
  • 27:12 - 27:17
    and open source culture was
    that, these projects sometimes
  • 27:17 - 27:20
    require-- well first, they
    can't be done completely
  • 27:20 - 27:22
    without resources.
  • 27:22 - 27:25
    And then secondly,
    there's activation energy
  • 27:25 - 27:28
    to any kind of
    collaborative effort.
  • 27:28 - 27:31
    Which if you don't
    cross, you have
  • 27:31 - 27:33
    a lot of difficulty
    making anything happen.
  • 27:33 - 27:35
    So this project is still alive.
  • 27:35 - 27:37
    I looked.
  • 27:37 - 27:40
    There were commits this week.
  • 27:40 - 27:44
    But they're primarily-- but all
    of those, as far as I'm aware,
  • 27:44 - 27:48
    are coming from the two
    labs at UCSF and Duke
  • 27:48 - 27:50
    that are using the hardware.
  • 27:50 - 27:54
    So the schematics-- all
    this is open source and GPL
  • 27:54 - 27:59
    to the extent that it
    actually applies to all of it.
  • 27:59 - 28:04
    The schematics are up there,
    all of the masks, the firmware
  • 28:04 - 28:05
    for the board,
    everything is there.
  • 28:05 - 28:08
    But as far as I'm aware, nobody
    has actually made one of these,
  • 28:08 - 28:11
    except for those two
    labs that are using
  • 28:11 - 28:13
    and are active contributors.
  • 28:13 - 28:16
    And Tim made a pretty
    complicated board.
  • 28:16 - 28:20
    It's like six layers and has
    these tiny little vias and some
  • 28:20 - 28:22
    04 components on it.
  • 28:22 - 28:25
    We had some-- we made
    this thing in a toaster
  • 28:25 - 28:30
    and had some horrible moments
    where somebody breathed on it
  • 28:30 - 28:32
    or-- And then, you can't
    tell what any of those things
  • 28:32 - 28:34
    are anymore, et cetera.
  • 28:34 - 28:39
    So as far as I know, nobody from
    the larger DIY or maker culture
  • 28:39 - 28:41
    has participated
    in this project.
  • 28:41 - 28:44
    Now, there's also-- there's
    another part of the project.
  • 28:44 - 28:49
    We have functioning pattern
    recognition software in MATLAB
  • 28:49 - 28:50
    which is not open source.
  • 28:50 - 28:53
    And again, this is
    another barrier.
  • 28:53 - 28:57
    In order to use the open source
    software that we have up there,
  • 28:57 - 28:59
    you need to have
    access to something
  • 28:59 - 29:02
    like $20,000 worth
    of MATLAB tool boxes
  • 29:02 - 29:05
    which you're only going to have
    if you're either an industry
  • 29:05 - 29:08
    or you're in academia somewhere.
  • 29:08 - 29:11
    So these, again, are
    some of the barriers.
  • 29:11 - 29:17
    But beyond that,
    this hasn't really
  • 29:17 - 29:20
    had the impact
    that we really hope
  • 29:20 - 29:22
    that it would have
    when we started.
  • 29:22 - 29:25
    Although I'm certainly
    proud we tried,
  • 29:25 - 29:29
    and it's a pretty cool
    piece of hardware.
  • 29:29 - 29:30
    Here's another one.
  • 29:30 - 29:32
    We had a little project on
    the open prosthetics project
  • 29:32 - 29:35
    to recreate a
    prosthetic hook that
  • 29:35 - 29:42
    was designed in the '20s which
    has been out of production
  • 29:42 - 29:46
    for something like
    35 or 40 years.
  • 29:46 - 29:49
    And most of the guys,
    and it is mostly
  • 29:49 - 29:54
    guys, who use this hook
    are now 80, 90 years old.
  • 29:54 - 29:55
    And I live in the Midwest.
  • 29:55 - 29:59
    I think there are some
    demographic particular areas
  • 29:59 - 30:01
    about where this
    thing was prescribed
  • 30:01 - 30:03
    or what people
    wanted to use it for.
  • 30:03 - 30:06
    And I still get calls from
    people who find-- very few,
  • 30:06 - 30:07
    it's a trickle.
  • 30:07 - 30:10
    --who find this thing
    on the web and want one.
  • 30:10 - 30:15
    And you can see here, this
    is a picture-- somebody,
  • 30:15 - 30:19
    Bre Pettis put it
    in the Thingiverse.
  • 30:19 - 30:21
    And a bunch of
    people-- I got bunches
  • 30:21 - 30:23
    of people who want to volunteer.
  • 30:23 - 30:25
    They were offering to print
    as many of these things
  • 30:25 - 30:28
    as they could on there first
    generation MakerBots, which
  • 30:28 - 30:33
    is where I think this
    printed hook came from,
  • 30:33 - 30:34
    to help the project.
  • 30:34 - 30:39
    But unfortunately, even
    the latest generation
  • 30:39 - 30:44
    MakerBot 2-- which which
    I have and really enjoy.
  • 30:44 - 30:47
    --it doesn't print
    in a material that's
  • 30:47 - 30:52
    appropriate for actual use,
    at least in this design.
  • 30:52 - 30:56
    This is made to be a
    metal, a metal hook.
  • 30:56 - 31:01
    And you can see that the
    resolution is really not
  • 31:01 - 31:02
    fantastic there.
  • 31:02 - 31:06
    So and what we discovered,
    that one in the lower right
  • 31:06 - 31:08
    was printed using
    a selective laser
  • 31:08 - 31:11
    centering rapid
    prototyping process.
  • 31:11 - 31:14
    And we had some tolerance
    problems with that
  • 31:14 - 31:19
    until the service bureau
    actually printed the thing out
  • 31:19 - 31:23
    on a plate and then
    machined off the plate.
  • 31:23 - 31:26
    The two jaws of the hook
    did not fit together.
  • 31:26 - 31:30
    So we had something like more
    than 50,000ths off on that
  • 31:30 - 31:32
    thing.
  • 31:32 - 31:33
    and.
  • 31:33 - 31:35
    I bring this up
    just to point out
  • 31:35 - 31:38
    the limitations of
    some of these things.
  • 31:38 - 31:43
    And you see this--
    just a loop back
  • 31:43 - 31:47
    for a moment to the
    breathless enthusiasm
  • 31:47 - 31:49
    of the press for a
    lot of these things.
  • 31:49 - 31:51
    I can't tell you the
    number of stories
  • 31:51 - 31:54
    that I've seen in
    the last two years
  • 31:54 - 31:58
    about a high school
    student who has 3D printed
  • 31:58 - 32:02
    a prosthetic hand that is
    supposedly better than, you
  • 32:02 - 32:05
    pick the price point, of
    some commercially-available
  • 32:05 - 32:07
    prosthetic hand.
  • 32:07 - 32:10
    And when you-- there's
    really no scrutiny
  • 32:10 - 32:15
    at all that's applied
    to these claims.
  • 32:15 - 32:17
    Very often, there are
    completely externally-powered.
  • 32:17 - 32:24
    Like motors with strings or
    maybe they're not even powered.
  • 32:24 - 32:28
    In any case, nobody really
    closely examines the claim
  • 32:28 - 32:33
    that some kid has bested
    a $40,000 prosthetic
  • 32:33 - 32:36
    hand in his bedroom
    with a RepRap machine.
  • 32:36 - 32:43
    And while I consider
    myself to be a part of
  • 32:43 - 32:45
    and fully embrace
    the maker culture,
  • 32:45 - 32:48
    I think we also need to be
    very realistic about what we've
  • 32:48 - 32:51
    actually accomplished
    and try not
  • 32:51 - 32:55
    to run victory laps before
    we've actually done it.
  • 32:55 - 32:59
    And I think that this probably
    is one of those cases.
  • 32:59 - 33:02
    Now, the happy
    ending to this story
  • 33:02 - 33:05
    is that there actually is
    a prosthetic company called
  • 33:05 - 33:11
    ToughWare that re-engineer--
    they re-engineered this
  • 33:11 - 33:13
    and fixed some of the
    problems that we had actually
  • 33:13 - 33:16
    identified with the
    original design.
  • 33:16 - 33:17
    I think you could
    actually see it
  • 33:17 - 33:22
    in the-- that's an original hook
    from many decades ago up there.
  • 33:22 - 33:25
    And you can see the
    places it has been welded.
  • 33:25 - 33:31
    And so this company fixed
    some of the problems
  • 33:31 - 33:32
    and where these
    things were breaking.
  • 33:32 - 33:36
    And I do believe that
    you can actually now
  • 33:36 - 33:40
    purchase a version of this
    hook commercially again.
  • 33:40 - 33:45
    So I consider that
    to be a success even
  • 33:45 - 33:47
    if we weren't the
    ones who did it.
  • 33:49 - 33:55
    So lastly-- and there is
    some bleed across here.
  • 33:55 - 34:00
    Michael did reference the
    company that I've started.
  • 34:00 - 34:03
    I also decided to
    back up a little bit
  • 34:03 - 34:08
    and solve one of the problems
    about prosthetic arms that
  • 34:08 - 34:11
    may be, in fact, the most
    vexing and least address,
  • 34:11 - 34:13
    which is how we attach
    them to people's bodies.
  • 34:16 - 34:19
    This is traditionally done
    with a hard carbon fiber
  • 34:19 - 34:23
    or fiberglass socket,
    a rubber liner,
  • 34:23 - 34:27
    and maybe a plastic
    socket there.
  • 34:27 - 34:31
    And I would liken a
    lot of these designs
  • 34:31 - 34:34
    to wearing wooden
    shoes and rubber socks.
  • 34:34 - 34:37
    And it does pretty horrible
    things to your skin
  • 34:37 - 34:41
    when there's moisture
    and friction involved.
  • 34:41 - 34:44
    And heat, moisture, weight,
    and perceived weight
  • 34:44 - 34:47
    is really related to
    all of these things
  • 34:47 - 34:50
    because people will tolerate
    hanging less off of your body
  • 34:50 - 34:51
    when it doesn't really fit well.
  • 34:51 - 34:55
    It feels like it's heavier
    if it's uncomfortable.
  • 34:55 - 35:00
    So we decided that
    the way to solve this
  • 35:00 - 35:03
    was to go back to what
    prosthetic arms used
  • 35:03 - 35:05
    to be like in the
    '40s before the VA did
  • 35:05 - 35:08
    all the research that created
    these composite sockets.
  • 35:08 - 35:13
    And consider making prosthetics
    sockets more like shoes,
  • 35:13 - 35:15
    like athletic shoes.
  • 35:15 - 35:17
    Prosthetics sockets used
    to be made of leather.
  • 35:17 - 35:19
    And I've been told
    by old guys who
  • 35:19 - 35:21
    wear leather
    sockets that they're
  • 35:21 - 35:22
    the most comfortable
    thing in the world.
  • 35:22 - 35:24
    And they'd never
    wear anything else.
  • 35:24 - 35:26
    But you can't find anybody
    to make one of these things
  • 35:26 - 35:28
    now because they're
    really labor intensive.
  • 35:28 - 35:30
    And the VA actually did
    a whole bunch of research
  • 35:30 - 35:31
    in the '40s, trying
    to figure out
  • 35:31 - 35:35
    how to make them not stink
    because of they're basically
  • 35:35 - 35:38
    like shoes.
  • 35:38 - 35:42
    So we now have a pending
    research proposal
  • 35:42 - 35:46
    that we should hear
    from the Army and DARPA
  • 35:46 - 35:53
    from any day now to use current
    athletic shoe technology to try
  • 35:53 - 35:57
    to make a flexible, variable
    compliance socket that's
  • 35:57 - 36:00
    stiff in some places
    and flexible and others,
  • 36:00 - 36:02
    breathable everywhere.
  • 36:02 - 36:04
    That basically solves
    all the same problems
  • 36:04 - 36:07
    that your running shoes do.
  • 36:07 - 36:10
    And this would address
    the number one reason
  • 36:10 - 36:13
    that people abandon
    prosthetic arms.
  • 36:13 - 36:18
    And that, by the way, actually
    includes, for example,
  • 36:18 - 36:23
    one of the DARPA arms that
    was tested in VA clinics
  • 36:23 - 36:28
    among transradial
    patients like me.
  • 36:28 - 36:31
    Comfort was actually
    one of the major reasons
  • 36:31 - 36:34
    that I think about
    half of those patients
  • 36:34 - 36:37
    said that they might not
    be interested in having
  • 36:37 - 36:38
    one of those new arms.
  • 36:38 - 36:40
    So if we solve that
    problem, then we
  • 36:40 - 36:43
    could potentially make a
    lot of the other technology
  • 36:43 - 36:45
    more effective because
    we'll be better
  • 36:45 - 36:47
    at attaching it to
    people's bodies.
  • 36:47 - 36:50
    So that's what we're
    up to right now.
  • 36:50 - 36:52
    An orphan device law.
  • 36:52 - 36:55
    So at the time that the orphan
    drug law was passed in 1983,
  • 36:55 - 37:00
    we had a bipartisan Congress.
  • 37:00 - 37:05
    And I think that to imagine
    in the current legislative
  • 37:05 - 37:10
    environment that we
    can get anything done,
  • 37:10 - 37:13
    may be over optimistic.
  • 37:13 - 37:16
    Although, perhaps,
    in an ideal world,
  • 37:16 - 37:22
    we would consider a law that
    could increase innovation
  • 37:22 - 37:25
    and competition in this space.
  • 37:25 - 37:28
    Now, for those of you who
    are unfamiliar with it, what
  • 37:28 - 37:35
    the orphan drug law does is, it
    extends exclusivity for a drug
  • 37:35 - 37:38
    company who has
    developed a product
  • 37:38 - 37:43
    but who believes that
    the further investment
  • 37:43 - 37:47
    necessary to actually bring
    a proven drug to market
  • 37:47 - 37:51
    is not worth the investment
    because their patent,
  • 37:51 - 37:53
    the exclusivity available to
    them on the original patent,
  • 37:53 - 37:54
    has expired.
  • 37:54 - 37:57
    Drug development is often
    a really long process.
  • 37:57 - 38:04
    And it's a race against
    the sundown on the patents.
  • 38:04 - 38:07
    Now unfortunately,
    I'm not convinced
  • 38:07 - 38:12
    that a similar model in the this
    even much smaller orphan device
  • 38:12 - 38:14
    spaces would
    actually do anything
  • 38:14 - 38:19
    because exclusivity in
    prosthetic arm patents
  • 38:19 - 38:22
    is often abandoned
    when people decide
  • 38:22 - 38:25
    to stop paying the maintenance
    on their process arm patents
  • 38:25 - 38:27
    after seven or 15 years.
  • 38:27 - 38:30
    So they're leaving exclusivity
    on the table with regard
  • 38:30 - 38:32
    to patents in the space already.
  • 38:32 - 38:35
    So would extending it
    actually do anything?
  • 38:35 - 38:37
    And I'm not convinced
    that it would.
  • 38:37 - 38:39
    So Yeah?
  • 38:44 - 38:46
    AUDIENCE: [INAUDIBLE].
  • 38:55 - 38:56
    JON KUNIHOLM: OK.
  • 38:56 - 38:58
    So since we're not
    miked in the audience,
  • 38:58 - 39:03
    the question is, is the approval
    process for medical devices,
  • 39:03 - 39:06
    prosthetic arm
    specifically, similarly long
  • 39:06 - 39:09
    as it is for drugs.
  • 39:09 - 39:10
    That's sort of a
    complicated question
  • 39:10 - 39:13
    because it depends on
    which class of devices
  • 39:13 - 39:14
    you're talking about.
  • 39:14 - 39:18
    The FDA it has three classes
    of medical devices- I, II,
  • 39:18 - 39:20
    and III.
  • 39:20 - 39:26
    The DARPA neural sensing
    system would be a Class III
  • 39:26 - 39:29
    medical device
    because it actually
  • 39:29 - 39:31
    involves an internal implant.
  • 39:31 - 39:36
    Most prosthetic devices
    right now are Class I.
  • 39:36 - 39:37
    And they're not only
    Class I, they're
  • 39:37 - 39:40
    Class I Exempt which means that
    there are exempt from-- there's
  • 39:40 - 39:43
    something like seven or eight
    requirements for Class I
  • 39:43 - 39:44
    devices.
  • 39:44 - 39:48
    And all but three
    of those are ignored
  • 39:48 - 39:53
    for this group of
    Class I Exempt devices.
  • 39:53 - 39:57
    So in fact-- and this
    is something actually
  • 39:57 - 40:02
    that there's been some--
    some of the folks who've
  • 40:02 - 40:05
    been pursuing these new
    things have been assuming--
  • 40:05 - 40:07
    and they may be right.
    --that the FDA is seeking
  • 40:07 - 40:12
    to regulate prosthetic arm
    stuff more rigorously than they
  • 40:12 - 40:14
    have in the past.
  • 40:14 - 40:18
    So even though you
    could bring-- there
  • 40:18 - 40:22
    are articulated
    myoelectric hands
  • 40:22 - 40:26
    that have been brought to
    market in the last five years
  • 40:26 - 40:30
    that were brought to market.
  • 40:30 - 40:33
    All you have to do basically
    is announced to the FDA
  • 40:33 - 40:35
    that you're going to start
    selling these things and do it.
  • 40:35 - 40:37
    And if you're going to test
    it, you stamp it experimental.
  • 40:37 - 40:40
    And you're good to go.
  • 40:40 - 40:44
    But nobody wants to invest
    hundreds of millions of dollars
  • 40:44 - 40:46
    in the creation of
    a device unless they
  • 40:46 - 40:49
    are sure that they're going
    to get away with that.
  • 40:49 - 40:52
    And the FDA had
    been making noises
  • 40:52 - 40:53
    that they were going
    to try to bump up
  • 40:53 - 40:56
    the classification of
    some of these things.
  • 40:56 - 41:02
    And they also have a requirement
    for orthopedic devices
  • 41:02 - 41:03
    which is reasonable.
  • 41:03 - 41:07
    It's based on-- so a screw
    in an orthopedic implant
  • 41:07 - 41:10
    is a Class I device that's a
    component of a Class III device
  • 41:10 - 41:12
    which is the implant.
  • 41:12 - 41:17
    And there was a bad
    failure in the '80s because
  • 41:17 - 41:20
    of the changing of
    these Class I devices.
  • 41:20 - 41:24
    And so the FDA requires
    each Class I component
  • 41:24 - 41:27
    be separately recertified
    with the Class III system.
  • 41:27 - 41:29
    And if somebody did something
    like that, for example,
  • 41:29 - 41:36
    with, say, there's a bolt
    that can go through your skin
  • 41:36 - 41:36
    into the bone.
  • 41:36 - 41:38
    It's called osseointegration.
  • 41:38 - 41:40
    A titanium bolt.
  • 41:40 - 41:44
    And the bolt, of course,
    is a Class III device
  • 41:44 - 41:47
    because it goes inside the body.
  • 41:47 - 41:52
    And if they required you
    to separately certify
  • 41:52 - 41:55
    every prosthetic hand
    or foot that you attach
  • 41:55 - 41:57
    to one of these systems,
    it would effectively
  • 41:57 - 42:00
    mean that there wouldn't be
    any available because nobody
  • 42:00 - 42:01
    would bother to do it.
  • 42:01 - 42:07
    So the whole-- so actually, you
    bring up a really great point
  • 42:07 - 42:10
    which is that the FDA is a
    really important part of this.
  • 42:10 - 42:15
    And some orphan device law, a
    hypothetical orphan device law
  • 42:15 - 42:19
    or revisions of regulations that
    might really impact the space,
  • 42:19 - 42:23
    should try to remove
    some of those barriers
  • 42:23 - 42:26
    that actually the
    FDA could potentially
  • 42:26 - 42:30
    create in trying to
    better protect us.
  • 42:30 - 42:34
    And there are humanitarian
    exemptions available.
  • 42:34 - 42:36
    And so it's something
    that I think
  • 42:36 - 42:38
    bares further consideration.
  • 42:38 - 42:40
    So that leads into
    the next group
  • 42:40 - 42:42
    of things which
    are beyond new law.
  • 42:42 - 42:46
    What about the interpretation of
    existing laws and regulations?
  • 42:46 - 42:51
    The Bayh-Dole Act
    is the law from 1980
  • 42:51 - 42:53
    that governs the
    government-funded creation
  • 42:53 - 42:54
    of intellectual property.
  • 42:54 - 42:57
    And the part that most of us are
    familiar with, if you've ever
  • 42:57 - 42:59
    received a government grant,
    is that the government
  • 42:59 - 43:02
    has royalty-free nonexclusive
    license to anything
  • 43:02 - 43:05
    that they pay you to create.
  • 43:05 - 43:08
    But then, in order to
    encourage economic activity,
  • 43:08 - 43:13
    anybody who creates this
    stuff has the permission
  • 43:13 - 43:15
    to go off and license it.
  • 43:15 - 43:17
    Do whatever they want, exploit
    that intellectual property
  • 43:17 - 43:21
    on their own, as long as they
    don't charge any royalties back
  • 43:21 - 43:22
    to the government.
  • 43:22 - 43:24
    In practice, I think some
    of this actually goes on.
  • 43:24 - 43:27
    Because if they fund,
    particularly weapon systems
  • 43:27 - 43:31
    and stuff like that, it's
    not like they segment off
  • 43:31 - 43:33
    what the intellectual
    property component of it is.
  • 43:33 - 43:36
    It's not like anybody else can
    make some of these fighter jets
  • 43:36 - 43:39
    or tanks or whatever.
  • 43:39 - 43:42
    So the least popular
    provision of this law
  • 43:42 - 43:44
    is what are called
    march-in rights.
  • 43:44 - 43:46
    Which means that if the
    government-- if there are--
  • 43:46 - 43:48
    there are four criteria
    that could be met where
  • 43:48 - 43:50
    the government can
    come in and say,
  • 43:50 - 43:55
    you are not making use of this
    intellectual property the way
  • 43:55 - 43:56
    we intended you to.
  • 43:56 - 44:00
    We're going to take it from you
    and give it to somebody else.
  • 44:00 - 44:06
    And people-- it has been
    exercised very few times,
  • 44:06 - 44:07
    if ever.
  • 44:07 - 44:09
    And it's a very unpopular,
    as you can imagine,
  • 44:09 - 44:13
    provision with people who get
    a lot of government funding.
  • 44:13 - 44:14
    How much time do we have?
  • 44:17 - 44:27
    So while this law
    exists, it is something
  • 44:27 - 44:30
    that could be made use of
    that's on the books already.
  • 44:30 - 44:35
    And so people, program
    managers could say, OK,
  • 44:35 - 44:37
    so it's been 15 years.
  • 44:37 - 44:41
    You haven't-- you created
    a product where we're going
  • 44:41 - 44:44
    to find somebody who will
    because our goal is to bring
  • 44:44 - 44:46
    something like this to market.
  • 44:46 - 44:48
    And another one that
    I referenced earlier
  • 44:48 - 44:51
    is the Center for Medicare
    and Medicaid Services.
  • 44:51 - 44:55
    So all these devices, and many
    medical devices are like this,
  • 44:55 - 45:00
    are reimbursed as durable
    medical equipment-
  • 45:00 - 45:04
    canes, walkers, CPAP machines,
    and prosthetic devices.
  • 45:04 - 45:06
    And the weirdness
    that this creates
  • 45:06 - 45:08
    is that the whole
    cost of supporting
  • 45:08 - 45:10
    the device for something
    like five years
  • 45:10 - 45:12
    in between replacements
    has to be captured just
  • 45:12 - 45:15
    in the provision of the product
    at the beginning of its life
  • 45:15 - 45:16
    cycle.
  • 45:16 - 45:18
    All of the appointment
    and everything.
  • 45:18 - 45:23
    So a prosthetist needs to be
    able to function based on that.
  • 45:23 - 45:25
    The other thing that's
    weird about this
  • 45:25 - 45:27
    is that there's a perverse
    incentive, of course,
  • 45:27 - 45:29
    to provide more
    of these products.
  • 45:29 - 45:34
    Because if you give
    somebody a myoelectric arm,
  • 45:34 - 45:39
    it reimburses at
    $30,000, $35,000.
  • 45:39 - 45:44
    A body-powered
    arm may be $8,000.
  • 45:44 - 45:47
    And the other thing is that the
    way that these reimbursement
  • 45:47 - 45:49
    codes are created is
    that a company has
  • 45:49 - 45:51
    to demonstrate efficacy.
  • 45:51 - 45:53
    And then, they petition CMS.
  • 45:53 - 45:58
    And so that they have to
    basically outlay all of the R&D
  • 45:58 - 46:00
    ahead before they know
    if they're going to get
  • 46:00 - 46:00
    reimbursed.
  • 46:00 - 46:03
    Then, there have been
    some recent cases
  • 46:03 - 46:07
    where people get the wrong
    answer back from CMS.
  • 46:07 - 46:08
    And it kills the company.
  • 46:08 - 46:11
    A good example is
    the iBot wheelchair
  • 46:11 - 46:13
    which everybody agrees is
    pretty impressive technology.
  • 46:13 - 46:17
    That came back as being
    excluded to a very
  • 46:17 - 46:21
    few pretty serious
    disabilities and not
  • 46:21 - 46:26
    reimbursable at a rate that
    could sustain its manufacturer.
  • 46:26 - 46:28
    And the company has
    closed it doors.
  • 46:28 - 46:30
    And so it's actually
    up in the air
  • 46:30 - 46:32
    what's going to happen
    to that technology.
  • 46:32 - 46:35
    Hopefully, DEKA, which
    is the creator of it,
  • 46:35 - 46:37
    will figure something out.
  • 46:37 - 46:40
    So one thing that I
    think people might do
  • 46:40 - 46:43
    would be to create incentives
    in reimbursement codes.
  • 46:43 - 46:46
    You could create a code
    for the performance
  • 46:46 - 46:49
    of a particular device without
    knowing that it exists.
  • 46:49 - 46:55
    And so I could say, a 15 degree
    of freedom prosthetic hand
  • 46:55 - 46:58
    and wrist that's capable of
    all these performance criteria
  • 46:58 - 47:02
    will reimburse at this rate,
    $150,000, whatever it is.
  • 47:02 - 47:05
    And then, a company
    would know ahead of time
  • 47:05 - 47:08
    that they have a
    payday ahead of them
  • 47:08 - 47:10
    if they're capable of
    meeting the criteria.
  • 47:10 - 47:14
    And so it would be much more
    clear that this was possible.
  • 47:14 - 47:16
    Then, contract language.
  • 47:16 - 47:21
    There's a bunch of open source
    and open architectural language
  • 47:21 - 47:25
    that the Navy, for one,
    still has on kind of dead
  • 47:25 - 47:26
    website that's still up there.
  • 47:26 - 47:29
    But it's sample program
    manager language
  • 47:29 - 47:32
    to put in RFPs to
    ensure that you
  • 47:32 - 47:37
    can get what you
    want out of them.
  • 47:37 - 47:38
    And those are tools
    that could be used.
  • 47:38 - 47:42
    And then lastly, the DARPA
    has made really good use
  • 47:42 - 47:45
    of challenges and contests.
  • 47:45 - 47:48
    And I think this sort of thing,
    in partnership with industry,
  • 47:48 - 47:51
    might be very helpful.
  • 47:51 - 47:53
    So I guess in some
    sense, my graphic here
  • 47:53 - 47:54
    of somebody cutting
    red tape, maybe
  • 47:54 - 47:56
    I'm actually talking
    about creating
  • 47:56 - 47:57
    some more in some cases.
  • 47:57 - 48:00
    But you get the picture.
  • 48:00 - 48:03
    So what about industry?
  • 48:03 - 48:07
    And that's you guys
    here at Google.
  • 48:07 - 48:11
    I think that Google has done
    some really creative things
  • 48:11 - 48:15
    in terms of business model in
    creating great products that
  • 48:15 - 48:19
    solve problems in ways
    that people hadn't before
  • 48:19 - 48:23
    by focusing the
    business model in sort
  • 48:23 - 48:25
    of unexpected parts of it.
  • 48:25 - 48:29
    And so I think both Android,
    both the Android operating
  • 48:29 - 48:31
    system and Gmail are
    good examples of that.
  • 48:31 - 48:34
    In a recent acquisition of
    yours, the nest company that
  • 48:34 - 48:40
    makes these thermostats
    and the smoke detector,
  • 48:40 - 48:42
    those are examples
    of products where
  • 48:42 - 48:45
    people would have said
    the innovation is--
  • 48:45 - 48:46
    these are commodities.
  • 48:46 - 48:47
    You can't improve on this.
  • 48:47 - 48:48
    It is what it is.
  • 48:48 - 48:49
    Everybody has to have one.
  • 48:49 - 48:52
    And you're going to buy
    the $8.95 one instead
  • 48:52 - 48:56
    of the $9.95 one because it just
    does whatever it needs to do.
  • 48:56 - 49:02
    And I think the way that that
    company was able to really pay
  • 49:02 - 49:08
    attention to consumers
    represents creative thinking
  • 49:08 - 49:10
    which is the way that
    probably everybody needs
  • 49:10 - 49:13
    to attack challenging markets.
  • 49:13 - 49:14
    And these ones that
    I've talked about
  • 49:14 - 49:18
    are certainly some of them.
  • 49:18 - 49:20
    So you guys have
    also been in the news
  • 49:20 - 49:25
    recently for, by count,
    something like nine,
  • 49:25 - 49:27
    counting the drone company,
    robotic acquisitions
  • 49:27 - 49:30
    over the last year or so.
  • 49:30 - 49:32
    And one of these
    is Redwood Robotics
  • 49:32 - 49:36
    which I think involves a part
    of a Willow Garage spin-off.
  • 49:36 - 49:38
    And I looked a little
    bit-- I'd never
  • 49:38 - 49:41
    seen this hand picture before.
  • 49:41 - 49:43
    It looks to me like a rendering.
  • 49:43 - 49:46
    I don't know if it
    represents a real product.
  • 49:46 - 49:48
    I think that it's
    interesting that, in terms
  • 49:48 - 49:54
    of a manipulation and
    terminal device, a hand
  • 49:54 - 49:57
    acquisition that you
    guys chose to acquire,
  • 49:57 - 50:01
    Redwood and not any
    of the companies
  • 50:01 - 50:05
    that were involved in the
    DARPA prosthetic arms,
  • 50:05 - 50:11
    the-- there's an interesting
    companionship between robot
  • 50:11 - 50:16
    teleoperation and prosthetics.
  • 50:16 - 50:22
    Myron Diftler, who runs the
    robonaut program for NASA
  • 50:22 - 50:26
    at Johnson Space Center, said
    that when he thought about it,
  • 50:26 - 50:30
    the prosthetic
    problem is basically
  • 50:30 - 50:31
    a teleoperation problem.
  • 50:31 - 50:34
    You just happened to be
    attached to the device you're
  • 50:34 - 50:35
    trying to teleoperate.
  • 50:35 - 50:39
    So in some sense, when you
    take away video latency
  • 50:39 - 50:45
    to the moon or whatever, the
    prosthetic control problem
  • 50:45 - 50:48
    might be, in some sense, easier.
  • 50:48 - 50:52
    Although the way that
    these things are usually
  • 50:52 - 50:58
    performed right now is
    with a haptic armature.
  • 50:58 - 51:00
    And in the prosthetic
    case, obviously, you're
  • 51:00 - 51:03
    trying to control a limb that's
    absent, so you don't have
  • 51:03 - 51:06
    access to those
    fingers to tell you,
  • 51:06 - 51:08
    to tell those digits
    where to move.
  • 51:08 - 51:11
    Anyway, my point
    in bringing this up
  • 51:11 - 51:15
    is that there is some
    great companionship
  • 51:15 - 51:16
    to these problems.
  • 51:16 - 51:21
    And in fact, while
    it is not clear
  • 51:21 - 51:26
    right now who in America is
    ready to buy, for example,
  • 51:26 - 51:30
    a personal assistance
    robot or some other things
  • 51:30 - 51:32
    that one might
    imagine as products
  • 51:32 - 51:36
    that could come out of companies
    like these down the road.
  • 51:36 - 51:39
    There are prosthetic
    customers who
  • 51:39 - 51:41
    can, according to the
    current reimbursement
  • 51:41 - 51:44
    system, in some
    cases, pay in excess
  • 51:44 - 51:47
    of $100,000 for one
    of these devices.
  • 51:47 - 51:53
    So it might be possible to
    create a synergy of interest
  • 51:53 - 51:58
    where you're solving problems
    for the future of home
  • 51:58 - 52:02
    and mass-produced
    robotics at the same time
  • 52:02 - 52:06
    as you are serving prosthetic
    customers in the near term.
  • 52:06 - 52:10
    Even though they don't represent
    the huge revenue stream
  • 52:10 - 52:16
    that we all would if everybody
    has a Jetsons-style maid
  • 52:16 - 52:17
    in their home.
  • 52:20 - 52:23
    This is a picture
    of my friend Kevin
  • 52:23 - 52:28
    who was born without
    both of his legs.
  • 52:28 - 52:31
    I throw his picture up there
    because he is, in some ways,
  • 52:31 - 52:36
    represents an orphan of an even
    smaller community than my own.
  • 52:36 - 52:40
    Without any hip joints, when
    he was about 10 years old,
  • 52:40 - 52:43
    they tried to put
    prosthetic legs on him.
  • 52:43 - 52:46
    And they weren't really
    anything but another couple
  • 52:46 - 52:50
    of extra crutches for him
    to sort of haul around.
  • 52:50 - 52:53
    And he very quickly decided
    that he wanted no part of that.
  • 52:53 - 52:55
    And he gets around
    on a skateboard.
  • 52:57 - 53:01
    Now, that said, if
    you were to envision--
  • 53:01 - 53:04
    and that's a way to
    stay active, too.
  • 53:04 - 53:08
    But if you were to envision a
    robotic prosthetic device that
  • 53:08 - 53:10
    might help him, it
    could look something
  • 53:10 - 53:15
    like Boston Robotics,
    Boston Dynamics-- I forget
  • 53:15 - 53:19
    the name of the
    company. --in Cambridge.
  • 53:19 - 53:21
    They have the big
    dog, walking bot
  • 53:21 - 53:23
    and those others where they
    pretty famously kicked them
  • 53:23 - 53:28
    over in the video.
  • 53:28 - 53:31
    A pair of those walking legs,
    controlled like the Segway,
  • 53:31 - 53:39
    is by leaning, could
    do a pretty fair bit
  • 53:39 - 53:41
    towards replacing legs.
  • 53:41 - 53:47
    And so that's another case where
    one of these robotics companies
  • 53:47 - 53:52
    might hold, in currently
    available technology, the keys
  • 53:52 - 53:54
    to making a change
    in somebody's life.
  • 53:54 - 54:00
    And my hope in
    mentioning industry--
  • 54:00 - 54:05
    and I think, again, none of
    these are mutually exclusive.
  • 54:05 - 54:09
    I do believe that
    the only way that we
  • 54:09 - 54:12
    are going to solve these
    extremely vexing problems
  • 54:12 - 54:16
    to society is by throwing nearly
    everything that we have at it
  • 54:16 - 54:19
    and seeing what sticks.
  • 54:19 - 54:23
    And so really my purpose
    in talking to you today
  • 54:23 - 54:28
    is to try-- I want to start
    this conversation because it's
  • 54:28 - 54:31
    pretty clear to me that there
    are some things that we could
  • 54:31 - 54:34
    do better about how we're
    responding to these problems.
  • 54:34 - 54:39
    And I'd very much like some help
    in figuring out how to do it.
  • 54:39 - 54:43
    So I used up more time
    than I had intended to.
  • 54:43 - 54:45
    But if you all
    have any questions,
  • 54:45 - 54:48
    I'd certainly like to
    try and answer them.
  • 55:05 - 55:09
    So the question is-- I mentioned
    that most arm amputees still
  • 55:09 - 55:14
    use hooks vise the
    more complicated
  • 55:14 - 55:19
    electrical externally-powered
    prostheses and why.
  • 55:19 - 55:21
    I think cost is part of it.
  • 55:21 - 55:24
    The Affordable Care Act
    has changed some of that.
  • 55:24 - 55:33
    Before January, a lot of
    people with medical insurance
  • 55:33 - 55:38
    had lifetime caps of, in
    some cases, just more,
  • 55:38 - 55:41
    like $1,500 lifetime cap on
    prosthetics services which
  • 55:41 - 55:45
    isn't even enough to
    get a single prosthesis.
  • 55:45 - 55:51
    And beyond the
    expansion of coverage,
  • 55:51 - 55:58
    the removal of the lifetime
    caps and pre-existing conditions
  • 55:58 - 56:01
    are huge for the
    prosthetic community.
  • 56:01 - 56:05
    So to the extent
    that it is monetary,
  • 56:05 - 56:09
    the Affordable Care Act
    should change some of that.
  • 56:09 - 56:14
    I, anecdotally, I don't
    think that there's
  • 56:14 - 56:17
    any great data on this.
  • 56:17 - 56:23
    But I think that a lot
    of common complaints
  • 56:23 - 56:29
    about the myoelectric
    prostheses are latencies,
  • 56:29 - 56:34
    unintended movements, the speed
    with which the motors move,
  • 56:34 - 56:36
    the weight.
  • 56:36 - 56:38
    And then, I think you
    hit on it, function
  • 56:38 - 56:42
    is probably the primary reason.
  • 56:42 - 56:48
    The hook has been famously
    described in TED Talks
  • 56:48 - 56:52
    as a rubber band and a
    hook on the end of a stick.
  • 56:52 - 56:54
    But I believe that
    the bar is actually
  • 56:54 - 56:56
    quite a bit higher than that.
  • 56:56 - 56:59
    The Dorrance hook is really
    kind of a marvel of design.
  • 56:59 - 57:03
    It's got a bunch of
    affordances built into it.
  • 57:03 - 57:05
    You can pick something
    up, use it as a hook,
  • 57:05 - 57:08
    and as a split hook,
    you can open it up
  • 57:08 - 57:10
    and use the individual
    fingers for different things.
  • 57:10 - 57:14
    The little thumb that
    has the cable on it---
  • 57:14 - 57:17
    I'll put that back up.
  • 57:17 - 57:22
    The little thumb that
    has the cable on it
  • 57:22 - 57:24
    can be used to push things.
  • 57:24 - 57:29
    And is the part of
    the device that's
  • 57:29 - 57:31
    used to wedge a
    knife and a fork.
  • 57:31 - 57:34
    Actually that's
    a perfect example
  • 57:34 - 57:35
    is eating with a knife and fork.
  • 57:38 - 57:41
    With cosmetic coverings
    on the myoelectric hands,
  • 57:41 - 57:42
    they tend to be slippery.
  • 57:42 - 57:47
    And it's hard to get a knife and
    a fork to sit securely in them.
  • 57:47 - 57:49
    And this thing is designed
    to do exactly that.
  • 57:49 - 57:51
    It's got a chisel
    tang in the middle,
  • 57:51 - 57:55
    so you can stick
    a tool in there.
  • 57:55 - 57:57
    Or you can wedge either
    a knife or a fork
  • 57:57 - 57:59
    in between the fingers
    and over the thumb.
  • 57:59 - 58:02
    So I think function
    is a lot of it.
  • 58:05 - 58:07
    Any other questions?
  • 58:11 - 58:11
    Yeah?
  • 58:11 - 58:12
    AUDIENCE: [INAUDIBLE].
  • 58:23 - 58:24
    JON KUNIHOLM: Yeah.
  • 58:24 - 58:26
    So well, first of all,
    it's selfish of me, right?
  • 58:26 - 58:27
    That's my problem.
  • 58:27 - 58:30
    So that's what I spend a
    lot of time thinking about.
  • 58:30 - 58:32
    But there are other
    complications.
  • 58:32 - 58:39
    So there are something like
    50 times more leg amputees
  • 58:39 - 58:44
    in America than arm amputees
    because of peripheral vascular
  • 58:44 - 58:46
    disease secondary diabetes.
  • 58:48 - 58:51
    And that's the major
    cause of leg amputation.
  • 58:51 - 58:54
    So there are more than
    two million leg amputees
  • 58:54 - 58:55
    in America.
  • 58:55 - 59:00
    And most of-- and is an
    easier problem to solve, too.
  • 59:00 - 59:03
    When you're looking at--
    well, Oscar Pistorius
  • 59:03 - 59:04
    is a great example.
  • 59:04 - 59:09
    The cheetah legs make somebody
    capable of running close to 10
  • 59:09 - 59:11
    second 100.
  • 59:11 - 59:13
    Although knees are a problem.
  • 59:13 - 59:18
    And Oscar Pistorius is
    a below knee amputee.
  • 59:18 - 59:21
    But then, among the
    powered devices,
  • 59:21 - 59:23
    control engineers
    who work on legs
  • 59:23 - 59:28
    have told me that it's possible
    to do reasonable approximations
  • 59:28 - 59:31
    of gate with the individual
    components not even talking
  • 59:31 - 59:33
    to each other.
  • 59:33 - 59:35
    Where they just respond
    to the external forces,
  • 59:35 - 59:39
    and they're capable of doing
    a pretty good job walking.
  • 59:39 - 59:43
    And contrast that to
    an arm where just,
  • 59:43 - 59:45
    forget the manipulation
    stuff, just
  • 59:45 - 59:48
    reach to grasp with a
    whole arm for somebody
  • 59:48 - 59:51
    up to the shoulder level
    involves the coordination
  • 59:51 - 59:53
    of all of the joints together.
  • 59:53 - 59:58
    So I like to say that if you
    imagine that these are legs,
  • 59:58 - 60:00
    the arm problem has five of
    them on the end of a sixth.
  • 60:00 - 60:02
    And they all have to
    dance together in order
  • 60:02 - 60:05
    to do the most basic task
    that an arm has to do.
  • 60:07 - 60:08
    Yeah.
  • 60:08 - 60:13
    And so the economics are--
    legs are a lot bigger business.
  • 60:13 - 60:16
    So there is a real incentive.
  • 60:16 - 60:21
    Although there are
    some new leg companies,
  • 60:21 - 60:27
    because of the high cost of
    additional degrees of freedom,
  • 60:27 - 60:28
    there are some
    leg companies that
  • 60:28 - 60:30
    are going to be in
    trouble if they don't
  • 60:30 - 60:34
    get the reimbursements that
    they want on powered ankles,
  • 60:34 - 60:35
    for example.
  • 60:35 - 60:41
    And so in that sense they
    share exactly the same problem.
  • 60:45 - 60:47
    Anything else?
  • 60:49 - 60:52
    Any questions from our
    remote rooms?
  • 60:59 - 61:00
    All right.
  • 61:00 - 61:01
    Well, listen.
  • 61:01 - 61:04
    Thank you very much for taking
    the time to check it out.
  • 61:04 - 61:07
    And I don't if there's a way for
    me to post contact information
  • 61:07 - 61:08
    or whatever.
  • 61:08 - 61:12
    But if anybody's interested
    in further talking about this,
  • 61:12 - 61:16
    please get with
    Michael Weiss-Malik.
  • 61:16 - 61:19
    And he'll put you
    in touch with me.
  • 61:19 - 61:21
    Thanks very much.
  • 61:21 - 61:25
    (Applause)
Title:
Jon Kuniholm, "Good Design by Design" | Talks at Google
Description:

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Video Language:
English
Team:
Captions Requested
Duration:
01:01:26
  • Thank you so much for subtitling this video, Dennis. It's a long one - do you want to subtitle it alone, or would it be OK if others joined?

  • No, definitely happy for others to join in. Pretty new to Amara, so I'm not sure what the normal process is for dividing up larger files.

    I'm done for the night anyway, so very happy to have someone continue on from where I got up to. :)

  • Thanks, Dennis, so I did, but just a little bit for now because my connection is slow. I marked the point reach in the last sub - 12:58 - because it makes it easier to launch the video at the right point. I also added some "(check)" for bits I'm not sure of - they can wait until we do the syncing.

    Best,

    Claude

  • Thanks, Dennis, so I did, but just a little bit for now because my connection is slow. I marked the point reach in the last sub - 12:58 - because it makes it easier to launch the video at the right point. I also added some "(check)" for bits I'm not sure of - they can wait until we do the syncing.

    Best,

    Claude

  • Hi, Connie and Dennis,

    So now "Talks at Google" has captioned the original video: per se, that's great, but I hope you're not too peeved about the time you spent on the subtitles here? Sorry about that: they didn't use to caption these talks. I'll now upload their subtitles over ours: this way if people want to translate them, they can do it here.

    Best,

    Claude

English subtitles

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