0:00:00.000,0:00:01.500 [Jon Kuniholm - Good Design by Design[br]May 2nd, 2014[ 0:00:01.500,0:00:03.000 MICHAEL WEISS-MALIK:[br]Hi, everybody. 0:00:03.000,0:00:03.530 Hear me OK? 0:00:03.529,0:00:04.029 OK. 0:00:04.030,0:00:05.770 So I think we're[br]going to get going. 0:00:05.769,0:00:07.919 My name's Michael Weiss-Malik. 0:00:07.919,0:00:11.769 Our guest today,[br]Jonathan Kuniholm. 0:00:11.769,0:00:14.769 I met him in, we[br]think, 2007 as far 0:00:14.769,0:00:17.719 as we can piece back together[br]at a SciFoo conference. 0:00:17.719,0:00:19.390 And he had some pretty[br]cool tech that he 0:00:19.390,0:00:22.199 was demoing on some open[br]source robotics stuff 0:00:22.199,0:00:24.390 related to prosthetics. 0:00:24.390,0:00:26.660 And I was impressed[br]enough that I said, hey, 0:00:26.660,0:00:29.120 you should come and give a[br]talk at Google some time. 0:00:29.120,0:00:31.200 And he took that to heart. 0:00:31.199,0:00:33.240 And about four or[br]five years later, 0:00:33.240,0:00:35.800 emailed me and said, hey, you[br]offer that talk at Google. 0:00:35.799,0:00:38.000 Now would be a great time. 0:00:38.000,0:00:40.000 So we're hosting him today. 0:00:40.000,0:00:43.640 Jonathan is the president and[br]founder of the Open Prosthetics 0:00:43.640,0:00:44.530 Project. 0:00:44.530,0:00:47.670 He's also a founder of[br]StumpworX, a startup that 0:00:47.670,0:00:49.987 focuses on prosthetic[br]technology. 0:00:49.987,0:00:52.320 He's also presidential appointee[br]to the National Council 0:00:52.320,0:00:53.810 on Disability. 0:00:53.810,0:00:56.150 And the stuff he has[br]to say is pretty cool. 0:00:56.149,0:00:57.750 So please put your[br]hands together 0:00:57.750,0:00:58.750 and help me welcome Jon. 0:00:58.750,0:01:03.230 (Applause) 0:01:03.229,0:01:06.899 JON KUNIHOLM: Thanks[br]very much, Michael. 0:01:06.900,0:01:11.219 Let me first just offer[br]a disclaimer with respect 0:01:11.219,0:01:12.140 to my government job. 0:01:12.140,0:01:14.180 They encourage us to do this. 0:01:14.180,0:01:16.540 That everything that[br]I'm going to say today 0:01:16.540,0:01:19.560 is-- are my personal[br]views and not 0:01:19.560,0:01:22.769 reflective of any position[br]of the government. 0:01:25.609,0:01:29.109 So what I would like[br]to talk about today 0:01:29.109,0:01:36.760 is, how we can design good[br]design to solve problems 0:01:36.760,0:01:40.480 that society has, for[br]the most part, neglected. 0:01:40.480,0:01:44.290 And I came across[br]one of those problems 0:01:44.290,0:01:48.200 personally after I[br]lost my arm in 2005 0:01:48.200,0:01:51.310 and discovered that[br]prosthetic arms were 0:01:51.310,0:01:53.609 an orphan medical device. 0:01:53.609,0:01:56.219 And in thinking[br]a little bit more 0:01:56.219,0:02:02.609 about why prosthetic arms lagged[br]so far behind other technology 0:02:02.609,0:02:06.349 that we use every day,[br]I started to realize 0:02:06.349,0:02:10.719 that prosthetic arms and[br]orphan medical devices 0:02:10.719,0:02:16.039 are part of a larger[br]group of those problems 0:02:16.039,0:02:20.310 that society has[br]tended to neglect 0:02:20.310,0:02:22.590 which can be solved by[br]something that we're beginning 0:02:22.590,0:02:25.479 to call public interest design. 0:02:25.479,0:02:28.310 And the question[br]that I'd really like 0:02:28.310,0:02:31.449 to talk about today--[br]and I would actually 0:02:31.449,0:02:33.979 like it to be the[br]beginning of the discussion 0:02:33.979,0:02:36.280 because it's something[br]that, by no means, 0:02:36.280,0:02:40.169 I claim to have[br]even begun to solve. 0:02:40.169,0:02:47.159 --is, how can we marshal all of[br]the tools at our disposal to, 0:02:47.159,0:02:49.509 trying to better[br]solve those problems. 0:02:49.509,0:02:54.129 Because very much now I believe[br]that most of those problems 0:02:54.129,0:02:58.019 are solved in kind[br]of a haphazard way. 0:02:58.020,0:03:02.600 Government-funded projects,[br]philanthropy, side 0:03:02.599,0:03:07.210 projects from industry,[br]you name the way 0:03:07.210,0:03:11.770 that people happen upon these[br]issues and try to solve them. 0:03:11.770,0:03:16.409 But in general, you can[br]be sure that the resources 0:03:16.409,0:03:18.799 and attention that we[br]devote toward solving 0:03:18.800,0:03:20.930 these underserved[br]needs are going 0:03:20.930,0:03:24.689 to lag far behind[br]those problems which 0:03:24.689,0:03:29.210 are very obvious from every[br]other standpoint need solving, 0:03:29.210,0:03:31.349 very profitable things. 0:03:31.349,0:03:34.500 There was no question[br]that cellphone technology 0:03:34.500,0:03:39.599 was going to improve over the[br]last 10 years, for example. 0:03:39.599,0:03:47.139 So in the summer of 2005, I[br]took leave from graduate school 0:03:47.139,0:03:48.639 at Duke University. 0:03:48.639,0:03:53.539 And I was deployed as a Marine[br]to Iraq in Anbar Province. 0:03:56.560,0:04:00.719 And I was the platoon commander[br]for an engineer platoon 0:04:00.719,0:04:01.840 of 50 Marines. 0:04:01.840,0:04:07.180 And we were doing[br]mostly what everybody 0:04:07.180,0:04:09.770 was doing over there which[br]is sustainment and stability 0:04:09.770,0:04:15.460 operations, patrolling, guarding[br]convoys, that sort of thing. 0:04:15.460,0:04:21.259 On New Year's today[br]of 2005, I was 0:04:21.259,0:04:24.469 on a foot patrol[br]that was ambushed 0:04:24.470,0:04:27.050 by improvised explosive device. 0:04:27.050,0:04:34.180 And the blast took off[br]most of my forearm. 0:04:34.180,0:04:39.509 And I found myself back[br]in the States and learning 0:04:39.509,0:04:42.349 about prosthetic arm technology. 0:04:45.430,0:04:48.889 I managed to get[br]myself back to school 0:04:48.889,0:04:52.649 and get involved with a[br]research project sponsored 0:04:52.649,0:04:55.109 by DARPA called the[br]Revolutionizing Prosthetics 0:04:55.110,0:04:56.280 2009 Project. 0:04:56.279,0:04:59.799 It was one of two that DARPA[br]was funding which is really 0:04:59.800,0:05:05.670 the first serious prosthetic[br]arm research effort that 0:05:05.670,0:05:10.189 at occurred in the United[br]States since-- there was 0:05:10.189,0:05:15.129 a small one in the '70s but[br]really since World War II. 0:05:15.129,0:05:22.170 And the goal was a[br]really ambitious one. 0:05:22.170,0:05:25.610 The goal was to[br]create in four years 0:05:25.610,0:05:30.460 in 2007 an arm using[br]commercially-available 0:05:30.459,0:05:35.909 technology that could go to[br]market in that year, in 2007. 0:05:35.910,0:05:38.840 And then, more[br]ambitiously, to create 0:05:38.839,0:05:41.279 an arm that had more[br]degrees of freedom, 0:05:41.279,0:05:43.639 was fully neurally integrated. 0:05:43.639,0:05:47.919 So nearly the same articulation[br]as a native human arm 0:05:47.920,0:05:50.210 and full strength. 0:05:50.209,0:05:56.339 And an incredibly[br]ambitious project. 0:05:56.339,0:05:59.029 What I think is[br]important to understand, 0:05:59.029,0:06:02.779 there's been an enormous-- and[br]this picture is up here not 0:06:02.779,0:06:04.449 too brag that I[br]was on "60 Minutes" 0:06:04.449,0:06:09.240 but to show the[br]kind of attention 0:06:09.240,0:06:11.090 that these projects got. 0:06:11.089,0:06:13.959 For whatever reason,[br]prosthetic arms 0:06:13.959,0:06:17.959 tend to really capture[br]the popular imagination. 0:06:17.959,0:06:20.359 People love robotics. 0:06:20.360,0:06:24.490 They love thinking about the[br]barriers, the singularity 0:06:24.490,0:06:26.850 and the barriers between man[br]and machine disappearing. 0:06:26.850,0:06:29.850 And it becomes a vehicle for[br]all kinds of philosophical 0:06:29.850,0:06:32.379 and science fiction interest. 0:06:32.379,0:06:38.209 I think the takeaway[br]about these projects which 0:06:38.209,0:06:42.159 is important to remember[br]is, first of all, 0:06:42.160,0:06:45.689 that we-- despite the[br]amazing things that both 0:06:45.689,0:06:49.529 of these research[br]efforts accomplished, 0:06:49.529,0:06:54.339 we still have not, 10[br]years, more than 10 years 0:06:54.339,0:07:01.549 since the war began Afghanistan,[br]actually pushing 15 now 0:07:01.550,0:07:05.210 --still do not have any[br]commercially-available device 0:07:05.209,0:07:09.039 that has resulted from any[br]of this government-funded 0:07:09.040,0:07:10.640 research. 0:07:10.639,0:07:14.099 We're still waiting[br]for the first one. 0:07:14.100,0:07:17.420 It has remained, as always,[br]just around the corner. 0:07:17.420,0:07:23.290 And I'm told that we're waiting[br]on FDA approval for the DECA RP 0:07:23.290,0:07:27.189 '07 project to[br]receive FDA approval. 0:07:27.189,0:07:29.949 And it has been in[br]some clinical trials. 0:07:29.949,0:07:32.699 But we still haven't[br]seen a device. 0:07:32.699,0:07:38.060 The other one is-- I think[br]that's important to understand. 0:07:38.060,0:07:40.769 It's my belief that[br]we have a media bias. 0:07:40.769,0:07:44.310 It's not a political[br]conservative media bias. 0:07:44.310,0:07:46.240 But it's one towards[br]entertainment. 0:07:46.240,0:07:50.660 And so there-- the word[br]bionic is used a lot. 0:07:50.660,0:07:54.250 The words dexterous[br]and manipulation 0:07:54.250,0:07:58.290 are also used a lot which[br]have very specific meanings 0:07:58.290,0:07:59.490 in robotics. 0:08:03.310,0:08:10.589 And there are some[br]caveats that I could give. 0:08:10.589,0:08:15.189 You could call a trigger[br]grip, for example, 0:08:15.189,0:08:18.350 where one part of[br]the hand is grasping 0:08:18.350,0:08:21.650 a handle of a cordless[br]drill, and the finger 0:08:21.649,0:08:24.219 is pulling the trigger. 0:08:24.220,0:08:27.814 That tends toward a[br]sort of manipulation. 0:08:27.814,0:08:30.230 It's at lease a compound grasp[br]where one part of your hand 0:08:30.230,0:08:32.220 is doing one thing[br]and one doing another. 0:08:32.220,0:08:37.548 But of course, the slide that[br]I'm showing here right now 0:08:37.548,0:08:42.860 gives you some insight into what[br]the human hands are capable of. 0:08:42.860,0:08:45.269 This pair of hands[br]is doing a card trick 0:08:45.269,0:08:50.860 where four cuts of the[br]deck are being controlled 0:08:50.860,0:08:53.370 by different parts[br]of the two hands. 0:08:53.370,0:08:55.070 And it's a dynamic movement. 0:08:55.070,0:08:58.990 And so I guarantee[br]you that there 0:08:58.990,0:09:02.799 isn't a robotic hand[br]of any kind that 0:09:02.799,0:09:05.039 could do these card[br]tricks right now. 0:09:05.039,0:09:10.409 But based on the popular press[br]presentation of all this, 0:09:10.409,0:09:13.089 you would think that it can. 0:09:13.090,0:09:16.000 You would think that[br]these problems are solved. 0:09:16.000,0:09:20.690 So while I think it's important[br]to acknowledge the strides that 0:09:20.690,0:09:23.040 were made by these[br]research projects, 0:09:23.039,0:09:24.829 it's also very[br]important to understand 0:09:24.830,0:09:26.150 that we are not there yet. 0:09:26.149,0:09:30.860 And we do not have[br]bionic people. 0:09:30.860,0:09:36.700 And these hands are,[br]for most part right now, 0:09:36.700,0:09:40.440 I think that it would be fair[br]to say, at least in terms 0:09:40.440,0:09:45.780 of prosthetic control, that even[br]these highly articulated hands 0:09:45.779,0:09:48.089 are really only[br]capable of grasping. 0:09:48.090,0:09:50.840 And the difference between[br]grasping and manipulation, 0:09:50.840,0:09:55.129 you can use a Rubik's[br]cube to illustrate. 0:09:55.129,0:09:59.500 Manipulation is a[br]speed cuber solving 0:09:59.500,0:10:02.169 a Rubik's cube in a few minutes. 0:10:02.169,0:10:06.029 And grasping is not dropping it. 0:10:06.029,0:10:08.689 And grasping a Rubik's[br]cube is actually something 0:10:08.690,0:10:12.360 that I can do with[br]the hook that I 0:10:12.360,0:10:17.460 wear when I do wear a prosthetic[br]arm, which is the Dorrance 0:10:17.460,0:10:21.840 5x named after the guy[br]who patented it in 1912. 0:10:21.840,0:10:28.620 And you can see that since[br]then, it's evolved a little bit. 0:10:28.620,0:10:33.700 There's some rubber grip on[br]the fingers, a cigarette notch, 0:10:33.700,0:10:38.000 and I think it's[br]called a pen notch now. 0:10:38.000,0:10:42.794 But this remains, despite[br]everything that's happened, 0:10:42.794,0:10:47.360 the most used prosthetic[br]terminal device in America. 0:10:47.360,0:10:51.539 And were you to go to the[br]Myoelectric Conference 0:10:51.539,0:10:54.939 in New Brunswick in[br]Canada this August, 0:10:54.940,0:10:59.800 it would be a fair bet to make[br]that the majority of amputees 0:10:59.799,0:11:02.409 attending the conference, at[br]least the ones who weren't paid 0:11:02.409,0:11:04.860 to be there by a[br]prosthetic company, 0:11:04.860,0:11:06.919 would be wearing[br]one of these devices 0:11:06.919,0:11:10.429 and not any of the[br]robotic prosthetic hands 0:11:10.429,0:11:11.819 that are available. 0:11:11.820,0:11:14.280 The other thing that's[br]important to note about this 0:11:14.279,0:11:17.919 is that there's another[br]choice which actually beats 0:11:17.919,0:11:20.839 all of them which is the[br]one that I'm wearing today 0:11:20.840,0:11:22.230 which is nothing. 0:11:22.230,0:11:26.120 And about half of[br]all arm amputees 0:11:26.120,0:11:29.470 choose most times not to[br]wear a prosthesis at all. 0:11:29.470,0:11:31.966 And it's mostly because[br]of weight and comfort 0:11:31.966,0:11:32.549 in suspension. 0:11:32.549,0:11:35.019 And I'm going to talk about[br]that a little bit later. 0:11:40.205,0:11:48.989 So now, why is all of that? 0:11:48.990,0:11:55.590 This is by no means an[br]attack on any the folks 0:11:55.590,0:11:58.879 who were generous enough[br]to fund that project 0:11:58.879,0:12:00.809 and try to make some progress. 0:12:00.809,0:12:03.429 The real problem is[br]that there simply 0:12:03.429,0:12:06.500 isn't a market for these things. 0:12:06.500,0:12:11.279 The market for powered[br]arms is just barely noise 0:12:11.279,0:12:13.990 compared to these[br]other large markets. 0:12:13.990,0:12:17.450 And even though the government[br]has accomplished quite a bit 0:12:17.450,0:12:19.670 in some of these[br]research projects, what 0:12:19.669,0:12:23.929 we call the valley of death[br]which is the bridge that one 0:12:23.929,0:12:28.019 of these products must cross[br]in order to get from the lab 0:12:28.019,0:12:31.740 into becoming a clinical[br]product, is really significant. 0:12:31.740,0:12:41.529 And without a market to drive[br]further funding, that gap which 0:12:41.529,0:12:43.500 is estimated by[br]people in the industry 0:12:43.500,0:12:47.600 to be something like[br]90% of the R&D remaining 0:12:47.600,0:12:50.480 on a medical product once[br]a proof of principle device 0:12:50.480,0:12:55.470 is finished, there's just simply[br]nowhere for those resources 0:12:55.470,0:12:58.759 to come from and make it happen. 0:12:58.759,0:13:02.590 And so correspondingly,[br]the amount 0:13:02.590,0:13:06.710 of effort that's actually put[br]into solving this problem is 0:13:06.710,0:13:11.290 also very small, compared[br]to-- I cherry-picked 0:13:11.289,0:13:14.409 a few really large[br]government-sponsored 0:13:14.409,0:13:16.149 engineering projects. 0:13:16.149,0:13:20.259 Some of which have been compared[br]to the DARPA prosthetics 0:13:20.259,0:13:22.580 project. 0:13:22.580,0:13:24.639 This is all in 2006 dollars. 0:13:24.639,0:13:27.730 The Manhattan Project comes[br]in at over $20 billion, 0:13:27.730,0:13:33.399 the moon race over $120 billion,[br]and just the R&D for the Joint 0:13:33.399,0:13:36.659 Strike Fighter at[br]over $40 billion. 0:13:36.659,0:13:41.779 And so the $100[br]million, well more than 0:13:41.779,0:13:47.199 anybody had spent on prosthetic[br]arms in half a century. 0:13:47.200,0:13:50.870 The DARPA spend is basically[br]just noise compared to this. 0:13:50.870,0:13:57.659 And I would argue that the[br]task that they set out to solve 0:13:57.659,0:14:01.329 rivals some of these in[br]terms of the engineering 0:14:01.330,0:14:02.060 effort required. 0:14:02.059,0:14:08.379 It's a small project[br]instead of a large one. 0:14:08.379,0:14:15.080 But nevertheless, an enormous[br]portion of our brains, 0:14:15.080,0:14:21.190 for example, is devoted to[br]the control of our hands 0:14:21.190,0:14:21.940 in manipulations. 0:14:21.940,0:14:23.315 I don't know if[br]you all have ever 0:14:23.315,0:14:25.148 seen-- I don't have a[br]slide of it here here, 0:14:25.148,0:14:28.870 but the homunculus that neural[br]researchers use to represent, 0:14:28.870,0:14:33.299 they take a human figure and[br]adjust him proportionally, 0:14:33.299,0:14:35.259 based on the number[br]of nerve endings 0:14:35.259,0:14:36.549 in some studies of the brain. 0:14:36.549,0:14:41.209 So this little figure has[br]gigantic lips, gigantic hands, 0:14:41.210,0:14:44.519 and, depending on whether you're[br]looking at the censored version 0:14:44.519,0:14:46.980 or not, gigantic[br]genitalia, reflecting 0:14:46.980,0:14:48.529 how much of our[br]brains are devoted 0:14:48.529,0:14:52.089 to control these various[br]parts of our body. 0:14:52.090,0:14:55.370 And this is true both in[br]terms of motor control 0:14:55.370,0:14:56.269 and sensory control. 0:14:56.269,0:14:57.490 I works both ways. 0:14:57.490,0:15:01.799 And as you can see from that[br]slide of the card trick, 0:15:01.799,0:15:04.129 feedback, sensory[br]feedback is certainly 0:15:04.129,0:15:09.850 a huge part of our hands[br]being able to do what we do. 0:15:09.850,0:15:18.879 So what we have is a[br]three-way market failure 0:15:18.879,0:15:24.870 to solve this problem- Industry,[br]government, and academia. 0:15:24.870,0:15:28.950 All doing their parts, but all[br]unable to solve this problem. 0:15:28.950,0:15:33.970 And so -- so 0:15:33.970,0:15:36.019 But of course, it's[br]completely understandable. 0:15:36.019,0:15:39.990 And that's why we[br]call a prosthetic arms 0:15:39.990,0:15:40.970 an orphan device. 0:15:40.970,0:15:47.310 The orphan drug law[br]that was passed in 1983 0:15:47.309,0:15:57.029 defined patients in need of a[br]drug as being medical orphans 0:15:57.029,0:16:02.240 if their patient population[br]was less than 250,000. 0:16:02.240,0:16:04.690 So prosthetic arms[br]in the United States 0:16:04.690,0:16:07.750 are about, a couple[br]years ago, 43,000 0:16:07.750,0:16:11.129 so fewer than 50,000 patients[br]in the United States. 0:16:11.129,0:16:17.570 So that's 1/6 of the maximum[br]threshold for being an orphan. 0:16:17.570,0:16:21.920 Course, the orphan drug law[br]covers pharmaceuticals and not 0:16:21.919,0:16:22.620 medical devices. 0:16:22.620,0:16:27.669 So we don't have a companion[br]regulation or law or anything 0:16:27.669,0:16:31.329 that covers the creation[br]of medical devices. 0:16:31.330,0:16:35.060 And another peculiarity,[br]of course, of that 0:16:35.059,0:16:39.619 is, how we pay for medical[br]devices in the United States. 0:16:39.620,0:16:43.470 And I will get to that[br]a little bit later. 0:16:43.470,0:16:47.690 So as I mentioned before, all[br]of these medical orphans-- 0:16:47.690,0:16:50.440 and the NIH-- and[br]this includes all 0:16:50.440,0:16:56.990 of the drug, the orphan drug[br]patient populations and others. 0:16:56.990,0:17:00.269 The NIH lists something like[br]10,000 orphaned conditions 0:17:00.269,0:17:01.429 on its website. 0:17:01.429,0:17:05.500 And because I happened to be[br]interested in prosthetic arms, 0:17:05.500,0:17:09.240 I searched for limb[br]absence, arm absence. 0:17:09.240,0:17:12.279 And so my particular[br]orphan condition 0:17:12.279,0:17:15.098 is actually not one of the ones[br]that's listed on that site. 0:17:15.098,0:17:18.932 So I would say that[br]there are probably more. 0:17:18.932,0:17:24.250 And so the question is-- and[br]this gets back to the graphs 0:17:24.250,0:17:25.970 that I showed before. 0:17:25.970,0:17:28.304 Because there's obviously[br]no market for it, 0:17:28.304,0:17:29.720 it doesn't necessarily[br]make sense. 0:17:29.720,0:17:33.180 I wouldn't argue, for example,[br]that it's a travesty that DARPA 0:17:33.180,0:17:37.590 didn't invest $100 billion into[br]solving this prosthetic arm 0:17:37.589,0:17:40.329 problem because the[br]same could be said 0:17:40.329,0:17:41.755 for any of these other orphans. 0:17:41.756,0:17:43.130 We simply can't[br]afford to do that 0:17:43.130,0:17:45.810 from a public health standpoint. 0:17:45.809,0:17:48.960 It's just not an effective[br]way to spend our resources. 0:17:48.960,0:17:51.630 So nevertheless,[br]feeling like this 0:17:51.630,0:17:55.130 is a problem that we'd[br]like for society to solve 0:17:55.130,0:18:00.070 and that it's not the only[br]one, this is the question. 0:18:00.069,0:18:02.750 How can we attacked[br]these problems 0:18:02.750,0:18:04.259 and solve some of them? 0:18:04.259,0:18:06.980 And it's clear that[br]we probably need 0:18:06.980,0:18:11.130 to think about them a little bit[br]different way than we are now. 0:18:11.130,0:18:13.810 My friend Chuck[br]Messer described this 0:18:13.809,0:18:16.480 as using your geek[br]powers for good. 0:18:16.480,0:18:21.140 The Cooper-Hewitt Design[br]Museum, in referencing 0:18:21.140,0:18:24.110 the 90% of the world[br]that doesn't benefit 0:18:24.109,0:18:27.419 from our consumer culture,[br]they had a design exhibit 0:18:27.420,0:18:32.061 several years ago called Design[br]for the Other 90% in reference 0:18:32.060,0:18:32.559 to that. 0:18:32.559,0:18:36.049 And there's another movement[br]here in the Bay Area. 0:18:36.049,0:18:40.440 For example, you have[br]a designer and engineer 0:18:40.440,0:18:43.150 named Ralf Hotchkiss[br]who makes a wheelchair. 0:18:43.150,0:18:45.585 Whirlwind Wheelchair[br]is their organization. 0:18:45.585,0:18:49.559 And they make appropriate[br]technology wheelchairs 0:18:49.559,0:18:54.259 that have larger balloon[br]tires on the front 0:18:54.259,0:18:57.970 to deal with uneven terrain[br]and broken sidewalks 0:18:57.970,0:18:59.710 that you're more[br]likely to encounter, 0:18:59.710,0:19:02.850 if there are sidewalks all, in[br]a lot of the developing world. 0:19:02.849,0:19:06.099 And they have a cool[br]model where they 0:19:06.099,0:19:10.519 try to set up factories as[br]a profitable businesses, 0:19:10.519,0:19:13.129 a social enterprise, to[br]manufacture this wheelchair 0:19:13.130,0:19:16.440 design in the area where[br]they might be used. 0:19:16.440,0:19:21.080 And this in contrast[br]to sometimes 0:19:21.079,0:19:23.259 what gets done in the[br]wheelchair space, for example, 0:19:23.259,0:19:29.029 is to send a kind of[br]rickety hospital wheelchair 0:19:29.029,0:19:30.690 over to that environment[br]where at last, 0:19:30.690,0:19:32.730 like a lot of medical[br]technology over there, 0:19:32.730,0:19:35.120 about 10 minutes[br]before it breaks. 0:19:35.119,0:19:37.869 And then, somebody has trouble[br]finding a part to fix it, 0:19:37.869,0:19:40.769 and it ends up getting junked. 0:19:40.769,0:19:47.690 So there's-- whereas I'm arguing[br]that prosthetic arm users 0:19:47.690,0:19:50.450 in the United States are[br]an underserved population, 0:19:50.450,0:19:52.100 they're not[br]disadvantaged, certainly, 0:19:52.099,0:19:56.689 to the same degree that patients[br]in the developing world are. 0:19:56.690,0:19:59.610 But all of these[br]patients are underserved 0:19:59.609,0:20:03.259 in some way or another. 0:20:03.259,0:20:05.700 So a good phrase[br]that's been used 0:20:05.700,0:20:10.269 to describe all of these[br]problems and the design 0:20:10.269,0:20:12.059 that we can use to[br]try to attack them 0:20:12.059,0:20:15.490 is public interest design,[br]design in the public interest. 0:20:15.490,0:20:18.589 And so really what[br]I'd like to talk 0:20:18.589,0:20:22.179 about is, what are[br]the ways besides-- I 0:20:22.180,0:20:25.580 will start off with[br]government-sponsored research 0:20:25.579,0:20:28.409 because that's a lot of[br]what's happening currently. 0:20:28.410,0:20:32.500 But what is our[br]whole quiver of tools 0:20:32.500,0:20:35.829 that we might use to try to[br]solve some of these problems? 0:20:35.829,0:20:38.619 And-- yeah. 0:20:38.619,0:20:41.059 Sorry about that. 0:20:41.059,0:20:44.859 So what are the[br]collection of tools 0:20:44.859,0:20:48.049 that we could use to try to[br]better solve these problems? 0:20:48.049,0:20:50.460 And I, like lots of[br]people do, I think 0:20:50.460,0:20:55.329 I'll probably come down on there[br]being some combination of all 0:20:55.329,0:20:57.490 of these that are necessary. 0:20:57.490,0:21:00.490 But just to brush over[br]them all, to begin 0:21:00.490,0:21:03.809 with government-sponsored[br]research and commercialization, 0:21:03.809,0:21:10.369 then DIY and the maker culture,[br]potentially an orphan device 0:21:10.369,0:21:15.319 law to service as a companion[br]to the orphan drug law 0:21:15.319,0:21:19.299 that we've had in this[br]country since 1983. 0:21:19.299,0:21:22.669 And then, what other[br]regulatory or policy changes 0:21:22.670,0:21:27.610 might be made under[br]our existing structure. 0:21:27.609,0:21:31.729 But by program managers[br]who fund, for example, some 0:21:31.730,0:21:34.569 of this government-sponsored[br]research, what things might 0:21:34.569,0:21:41.490 they do to try to raise the[br]impact of the research funding 0:21:41.490,0:21:43.370 that they're[br]currently giving out. 0:21:43.369,0:21:46.739 And then secondly, what can[br]we do in the private sector? 0:21:46.740,0:21:50.839 Are there ways that folks[br]in the private sector 0:21:50.839,0:21:52.689 might be able to[br]contribute in ways 0:21:52.690,0:21:56.240 that don't impact[br]their own bottom line? 0:21:56.240,0:22:00.200 And they can[br]potentially even have 0:22:00.200,0:22:07.710 a win-win in serving[br]these underserved folks. 0:22:07.710,0:22:12.220 So to start off with,[br]these are the three-- 0:22:12.220,0:22:15.470 these are icons that represent[br]the three major engineering 0:22:15.470,0:22:17.750 research efforts that[br]I showed the funding 0:22:17.750,0:22:20.829 levels for- the moon[br]shot, at the atomic bomb, 0:22:20.829,0:22:22.439 and the Joint Strike Fighter. 0:22:22.440,0:22:26.700 And it's certainly clear[br]that there are some problems 0:22:26.700,0:22:30.509 that government has[br]to solve if they're 0:22:30.509,0:22:32.220 going to get it solved for us. 0:22:32.220,0:22:37.329 While we do have SpaceX in[br]a commercial space effort 0:22:37.329,0:22:41.939 right now, it only exists[br]because the government 0:22:41.940,0:22:43.850 is choosing to create[br]that capability. 0:22:43.849,0:22:46.379 And the funding's coming[br]from the government. 0:22:46.380,0:22:49.140 So that's an example, actually,[br]of spreading this stuff 0:22:49.140,0:22:50.320 around a little bit. 0:22:50.319,0:22:56.220 But it was clear that[br]sending a man to the moon 0:22:56.220,0:22:59.160 or building the bomb,[br]however you feel about 0:22:59.160,0:23:01.970 that having done, these[br]were certainly projects that 0:23:01.970,0:23:06.120 would never have happened[br]had not one of the largest 0:23:06.119,0:23:07.750 and wealthiest[br]governments in the world 0:23:07.750,0:23:09.708 decided that they were[br]going to make it happen. 0:23:09.708,0:23:13.550 And they happen[br]because, in at least two 0:23:13.549,0:23:15.980 in these cases, the first[br]two that I mentioned, 0:23:15.980,0:23:19.049 the results were non-negotiable. 0:23:19.049,0:23:21.490 We were going to[br]get to the moon, 0:23:21.490,0:23:24.549 no matter how much it costs[br]and how dangerous it was. 0:23:24.549,0:23:28.700 And those who were[br]in charge of the bomb 0:23:28.700,0:23:32.660 viewed it as a response[br]to an existential threat. 0:23:32.660,0:23:34.830 And that failure[br]was not an option. 0:23:34.829,0:23:39.389 It's probably-- the[br]government probably 0:23:39.390,0:23:46.120 would have spent anything[br]to achieve these ends. 0:23:46.119,0:23:51.369 Now, a lot of times,[br]some these very programs 0:23:51.369,0:23:53.379 and the other basic[br]science research 0:23:53.380,0:23:55.950 that the government[br]does are cited 0:23:55.950,0:24:00.250 as having intangible[br]benefits that spin off, 0:24:00.250,0:24:06.210 that we would be without were[br]it not for these other efforts. 0:24:06.210,0:24:10.120 And so Tang, Teflon,[br]and Velcro are three. 0:24:10.119,0:24:12.109 And there's actually[br]a myth-busting page 0:24:12.109,0:24:15.169 on NASA's website that I[br]have up there on the slide. 0:24:15.170,0:24:18.300 Says that, in fact, none[br]of these three products 0:24:18.299,0:24:21.279 were created by NASA[br]or NASA-funded research 0:24:21.279,0:24:24.839 although the space program did[br]take advantage of all of those. 0:24:24.839,0:24:27.959 So while they used Tang,[br]Teflon, and Velcro, 0:24:27.960,0:24:29.380 they did not create it. 0:24:29.380,0:24:35.920 And I would argue that even[br]if they had, building a bomb, 0:24:35.920,0:24:40.850 sending somebody to the moon,[br]or building a high-tech fighter 0:24:40.849,0:24:44.069 jet are not the most efficient[br]ways to create things 0:24:44.069,0:24:46.099 like Tang, Teflon, and Velcro. 0:24:46.099,0:24:50.619 So if what you want[br]is a prosthetic arm 0:24:50.619,0:24:56.639 or to put somebody on the moon[br]or to build a fighter jet, 0:24:56.640,0:24:59.110 that is what you do. 0:24:59.109,0:25:03.639 And this really comes[br]down to a difference 0:25:03.640,0:25:06.750 between engineering[br]and basic science. 0:25:06.750,0:25:10.740 So the point is that[br]whatever efforts there 0:25:10.740,0:25:12.759 are that are devoted to[br]solving this problem, 0:25:12.759,0:25:16.390 it really needs to be dedicated[br]to solving the problem. 0:25:16.390,0:25:18.950 And there needs to be[br]some agreement on actually 0:25:18.950,0:25:21.160 what the problem is. 0:25:21.160,0:25:25.759 A significant component[br]of at least the four year 0:25:25.759,0:25:30.369 DARPA effort was based on the[br]creation of a neural brain 0:25:30.369,0:25:31.819 machine interface. 0:25:31.819,0:25:36.599 And it is-- well,[br]in the long term, 0:25:36.599,0:25:40.469 it's certainly true that[br]that represents potentially 0:25:40.470,0:25:43.680 a holy grail of prosthetic arms. 0:25:43.680,0:25:50.000 It's not clear that that is[br]a necessary component of it, 0:25:50.000,0:25:53.220 particularly given the state[br]of the technology that most 0:25:53.220,0:25:57.809 people are using every day. 0:25:57.809,0:26:05.679 So then-- so I was-- at the[br]time when I met Michael in 2007, 0:26:05.680,0:26:09.600 we had a version of[br]this hardware board 0:26:09.599,0:26:12.189 that we were showing[br]Google SciFoo. 0:26:12.190,0:26:18.090 And this is-- Tim Hanson[br]is now post-doc at UCSF. 0:26:18.089,0:26:21.230 And he created, when he[br]was at the Nicolelis Lab 0:26:21.230,0:26:24.620 at Duke University, the[br]signal processing board which 0:26:24.619,0:26:33.445 is capable of processing 16[br]EMG, electromyogram, signals 0:26:33.445,0:26:34.819 from the surface[br]of the skin that 0:26:34.819,0:26:37.129 can detect muscle movements. 0:26:37.130,0:26:39.830 And we designed it to have as[br]many interfaces as possible. 0:26:39.829,0:26:42.939 Because are our goal[br]in this DIY space 0:26:42.940,0:26:45.809 was to try to encourage[br]experimentation 0:26:45.809,0:26:48.960 and to try to benefit[br]from the maker 0:26:48.960,0:26:53.934 culture and the huge[br]video game industry in -- 0:26:55.089,0:26:59.769 And hope that some of[br]those resources and efforts 0:26:59.769,0:27:02.849 and interests could rub off[br]and make some improvements 0:27:02.849,0:27:04.959 in prosthetic arms. 0:27:04.960,0:27:11.779 What we learned is the[br]downside to DIY maker 0:27:11.779,0:27:16.720 and open source culture was[br]that, these projects sometimes 0:27:16.720,0:27:19.670 require-- well first, they[br]can't be done completely 0:27:19.670,0:27:21.890 without resources. 0:27:21.890,0:27:24.960 And then secondly,[br]there's activation energy 0:27:24.960,0:27:27.980 to any kind of[br]collaborative effort. 0:27:27.980,0:27:30.710 Which if you don't[br]cross, you have 0:27:30.710,0:27:33.130 a lot of difficulty[br]making anything happen. 0:27:33.130,0:27:35.140 So this project is still alive. 0:27:35.140,0:27:36.540 I looked. 0:27:36.539,0:27:40.369 There were commits this week. 0:27:40.369,0:27:44.179 But they're primarily-- but all[br]of those, as far as I'm aware, 0:27:44.180,0:27:48.240 are coming from the two[br]labs at UCSF and Duke 0:27:48.240,0:27:49.799 that are using the hardware. 0:27:49.799,0:27:54.379 So the schematics-- all[br]this is open source and GPL 0:27:54.380,0:27:59.180 to the extent that it[br]actually applies to all of it. 0:27:59.180,0:28:03.590 The schematics are up there,[br]all of the masks, the firmware 0:28:03.589,0:28:05.119 for the board,[br]everything is there. 0:28:05.119,0:28:08.399 But as far as I'm aware, nobody[br]has actually made one of these, 0:28:08.400,0:28:11.444 except for those two[br]labs that are using 0:28:11.443,0:28:12.609 and are active contributors. 0:28:12.609,0:28:15.659 And Tim made a pretty[br]complicated board. 0:28:15.660,0:28:20.490 It's like six layers and has[br]these tiny little vias and some 0:28:20.490,0:28:22.220 04 components on it. 0:28:22.220,0:28:24.600 We had some-- we made[br]this thing in a toaster 0:28:24.599,0:28:29.519 and had some horrible moments[br]where somebody breathed on it 0:28:29.519,0:28:32.019 or-- And then, you can't[br]tell what any of those things 0:28:32.019,0:28:34.150 are anymore, et cetera. 0:28:34.150,0:28:39.100 So as far as I know, nobody from[br]the larger DIY or maker culture 0:28:39.099,0:28:41.240 has participated[br]in this project. 0:28:41.240,0:28:43.680 Now, there's also-- there's[br]another part of the project. 0:28:43.680,0:28:48.519 We have functioning pattern[br]recognition software in MATLAB 0:28:48.519,0:28:50.309 which is not open source. 0:28:50.309,0:28:52.849 And again, this is[br]another barrier. 0:28:52.849,0:28:57.179 In order to use the open source[br]software that we have up there, 0:28:57.180,0:28:59.100 you need to have[br]access to something 0:28:59.099,0:29:02.319 like $20,000 worth[br]of MATLAB tool boxes 0:29:02.319,0:29:05.189 which you're only going to have[br]if you're either an industry 0:29:05.190,0:29:08.220 or you're in academia somewhere. 0:29:08.220,0:29:10.789 So these, again, are[br]some of the barriers. 0:29:10.789,0:29:16.859 But beyond that,[br]this hasn't really 0:29:16.859,0:29:19.619 had the impact[br]that we really hope 0:29:19.619,0:29:21.729 that it would have[br]when we started. 0:29:21.730,0:29:25.440 Although I'm certainly[br]proud we tried, 0:29:25.440,0:29:29.048 and it's a pretty cool[br]piece of hardware. 0:29:29.048,0:29:29.839 Here's another one. 0:29:29.839,0:29:32.419 We had a little project on[br]the open prosthetics project 0:29:32.420,0:29:35.490 to recreate a[br]prosthetic hook that 0:29:35.490,0:29:41.930 was designed in the '20s which[br]has been out of production 0:29:41.930,0:29:45.799 for something like[br]35 or 40 years. 0:29:45.799,0:29:49.480 And most of the guys,[br]and it is mostly 0:29:49.480,0:29:53.860 guys, who use this hook[br]are now 80, 90 years old. 0:29:53.859,0:29:55.409 And I live in the Midwest. 0:29:55.410,0:29:59.080 I think there are some[br]demographic particular areas 0:29:59.079,0:30:00.889 about where this[br]thing was prescribed 0:30:00.890,0:30:02.620 or what people[br]wanted to use it for. 0:30:02.619,0:30:05.829 And I still get calls from[br]people who find-- very few, 0:30:05.829,0:30:06.730 it's a trickle. 0:30:06.730,0:30:09.710 --who find this thing[br]on the web and want one. 0:30:09.710,0:30:14.809 And you can see here, this[br]is a picture-- somebody, 0:30:14.809,0:30:18.559 Bre Pettis put it[br]in the Thingiverse. 0:30:18.559,0:30:21.267 And a bunch of[br]people-- I got bunches 0:30:21.267,0:30:22.600 of people who want to volunteer. 0:30:22.599,0:30:25.079 They were offering to print[br]as many of these things 0:30:25.079,0:30:28.409 as they could on there first[br]generation MakerBots, which 0:30:28.410,0:30:32.850 is where I think this[br]printed hook came from, 0:30:32.849,0:30:33.719 to help the project. 0:30:33.720,0:30:38.670 But unfortunately, even[br]the latest generation 0:30:38.670,0:30:43.750 MakerBot 2-- which which[br]I have and really enjoy. 0:30:43.750,0:30:46.509 --it doesn't print[br]in a material that's 0:30:46.509,0:30:51.849 appropriate for actual use,[br]at least in this design. 0:30:51.849,0:30:56.269 This is made to be a[br]metal, a metal hook. 0:30:56.269,0:31:00.650 And you can see that the[br]resolution is really not 0:31:00.650,0:31:01.570 fantastic there. 0:31:01.569,0:31:05.970 So and what we discovered,[br]that one in the lower right 0:31:05.970,0:31:08.440 was printed using[br]a selective laser 0:31:08.440,0:31:11.090 centering rapid[br]prototyping process. 0:31:11.089,0:31:14.159 And we had some tolerance[br]problems with that 0:31:14.160,0:31:19.210 until the service bureau[br]actually printed the thing out 0:31:19.210,0:31:23.141 on a plate and then[br]machined off the plate. 0:31:23.141,0:31:26.279 The two jaws of the hook[br]did not fit together. 0:31:26.279,0:31:30.160 So we had something like more[br]than 50,000ths off on that 0:31:30.160,0:31:32.180 thing. 0:31:32.180,0:31:32.680 and. 0:31:32.680,0:31:34.580 I bring this up[br]just to point out 0:31:34.579,0:31:38.059 the limitations of[br]some of these things. 0:31:38.059,0:31:42.879 And you see this--[br]just a loop back 0:31:42.880,0:31:47.406 for a moment to the[br]breathless enthusiasm 0:31:47.405,0:31:49.029 of the press for a[br]lot of these things. 0:31:49.029,0:31:50.769 I can't tell you the[br]number of stories 0:31:50.769,0:31:53.529 that I've seen in[br]the last two years 0:31:53.529,0:31:57.769 about a high school[br]student who has 3D printed 0:31:57.769,0:32:01.769 a prosthetic hand that is[br]supposedly better than, you 0:32:01.769,0:32:05.440 pick the price point, of[br]some commercially-available 0:32:05.440,0:32:06.640 prosthetic hand. 0:32:06.640,0:32:09.730 And when you-- there's[br]really no scrutiny 0:32:09.730,0:32:14.509 at all that's applied[br]to these claims. 0:32:14.509,0:32:16.890 Very often, there are[br]completely externally-powered. 0:32:16.890,0:32:24.270 Like motors with strings or[br]maybe they're not even powered. 0:32:24.269,0:32:28.160 In any case, nobody really[br]closely examines the claim 0:32:28.160,0:32:33.290 that some kid has bested[br]a $40,000 prosthetic 0:32:33.289,0:32:36.180 hand in his bedroom[br]with a RepRap machine. 0:32:36.180,0:32:43.170 And while I consider[br]myself to be a part of 0:32:43.170,0:32:44.670 and fully embrace[br]the maker culture, 0:32:44.670,0:32:48.400 I think we also need to be[br]very realistic about what we've 0:32:48.400,0:32:50.970 actually accomplished[br]and try not 0:32:50.970,0:32:55.430 to run victory laps before[br]we've actually done it. 0:32:55.430,0:32:58.519 And I think that this probably[br]is one of those cases. 0:32:58.519,0:33:01.720 Now, the happy[br]ending to this story 0:33:01.720,0:33:05.190 is that there actually is[br]a prosthetic company called 0:33:05.190,0:33:10.930 ToughWare that re-engineer--[br]they re-engineered this 0:33:10.930,0:33:13.430 and fixed some of the[br]problems that we had actually 0:33:13.430,0:33:15.745 identified with the[br]original design. 0:33:15.744,0:33:17.119 I think you could[br]actually see it 0:33:17.119,0:33:22.419 in the-- that's an original hook[br]from many decades ago up there. 0:33:22.420,0:33:25.210 And you can see the[br]places it has been welded. 0:33:25.210,0:33:30.598 And so this company fixed[br]some of the problems 0:33:30.598,0:33:32.139 and where these[br]things were breaking. 0:33:32.140,0:33:36.380 And I do believe that[br]you can actually now 0:33:36.380,0:33:39.710 purchase a version of this[br]hook commercially again. 0:33:39.710,0:33:44.960 So I consider that[br]to be a success even 0:33:44.960,0:33:46.809 if we weren't the[br]ones who did it. 0:33:49.359,0:33:54.839 So lastly-- and there is[br]some bleed across here. 0:33:54.839,0:33:59.569 Michael did reference the[br]company that I've started. 0:33:59.569,0:34:02.700 I also decided to[br]back up a little bit 0:34:02.700,0:34:07.610 and solve one of the problems[br]about prosthetic arms that 0:34:07.609,0:34:10.806 may be, in fact, the most[br]vexing and least address, 0:34:10.806,0:34:13.114 which is how we attach[br]them to people's bodies. 0:34:15.579,0:34:18.759 This is traditionally done[br]with a hard carbon fiber 0:34:18.760,0:34:23.000 or fiberglass socket,[br]a rubber liner, 0:34:23.000,0:34:27.250 and maybe a plastic[br]socket there. 0:34:27.250,0:34:30.650 And I would liken a[br]lot of these designs 0:34:30.650,0:34:34.039 to wearing wooden[br]shoes and rubber socks. 0:34:34.039,0:34:37.489 And it does pretty horrible[br]things to your skin 0:34:37.489,0:34:40.599 when there's moisture[br]and friction involved. 0:34:40.599,0:34:44.190 And heat, moisture, weight,[br]and perceived weight 0:34:44.190,0:34:47.190 is really related to[br]all of these things 0:34:47.190,0:34:50.027 because people will tolerate[br]hanging less off of your body 0:34:50.027,0:34:51.360 when it doesn't really fit well. 0:34:51.360,0:34:54.599 It feels like it's heavier[br]if it's uncomfortable. 0:34:54.599,0:35:00.179 So we decided that[br]the way to solve this 0:35:00.179,0:35:02.799 was to go back to what[br]prosthetic arms used 0:35:02.800,0:35:04.660 to be like in the[br]'40s before the VA did 0:35:04.659,0:35:08.309 all the research that created[br]these composite sockets. 0:35:08.309,0:35:12.799 And consider making prosthetics[br]sockets more like shoes, 0:35:12.800,0:35:14.592 like athletic shoes. 0:35:14.592,0:35:16.550 Prosthetics sockets used[br]to be made of leather. 0:35:16.550,0:35:19.325 And I've been told[br]by old guys who 0:35:19.324,0:35:20.699 wear leather[br]sockets that they're 0:35:20.699,0:35:22.000 the most comfortable[br]thing in the world. 0:35:22.000,0:35:23.860 And they'd never[br]wear anything else. 0:35:23.860,0:35:26.111 But you can't find anybody[br]to make one of these things 0:35:26.110,0:35:27.900 now because they're[br]really labor intensive. 0:35:27.900,0:35:29.980 And the VA actually did[br]a whole bunch of research 0:35:29.980,0:35:31.355 in the '40s, trying[br]to figure out 0:35:31.355,0:35:35.079 how to make them not stink[br]because of they're basically 0:35:35.079,0:35:37.500 like shoes. 0:35:37.500,0:35:42.019 So we now have a pending[br]research proposal 0:35:42.019,0:35:46.110 that we should hear[br]from the Army and DARPA 0:35:46.110,0:35:53.260 from any day now to use current[br]athletic shoe technology to try 0:35:53.260,0:35:57.140 to make a flexible, variable[br]compliance socket that's 0:35:57.139,0:36:00.319 stiff in some places[br]and flexible and others, 0:36:00.320,0:36:02.230 breathable everywhere. 0:36:02.230,0:36:04.389 That basically solves[br]all the same problems 0:36:04.389,0:36:06.989 that your running shoes do. 0:36:06.989,0:36:10.359 And this would address[br]the number one reason 0:36:10.360,0:36:13.320 that people abandon[br]prosthetic arms. 0:36:13.320,0:36:17.720 And that, by the way, actually[br]includes, for example, 0:36:17.719,0:36:22.709 one of the DARPA arms that[br]was tested in VA clinics 0:36:22.710,0:36:27.760 among transradial[br]patients like me. 0:36:27.760,0:36:31.460 Comfort was actually[br]one of the major reasons 0:36:31.460,0:36:34.409 that I think about[br]half of those patients 0:36:34.409,0:36:36.839 said that they might not[br]be interested in having 0:36:36.840,0:36:37.800 one of those new arms. 0:36:37.800,0:36:40.490 So if we solve that[br]problem, then we 0:36:40.489,0:36:43.399 could potentially make a[br]lot of the other technology 0:36:43.400,0:36:45.112 more effective because[br]we'll be better 0:36:45.112,0:36:46.570 at attaching it to[br]people's bodies. 0:36:46.570,0:36:50.030 So that's what we're[br]up to right now. 0:36:50.030,0:36:51.530 An orphan device law. 0:36:51.530,0:36:55.480 So at the time that the orphan[br]drug law was passed in 1983, 0:36:55.480,0:36:59.949 we had a bipartisan Congress. 0:36:59.949,0:37:05.379 And I think that to imagine[br]in the current legislative 0:37:05.380,0:37:10.300 environment that we[br]can get anything done, 0:37:10.300,0:37:12.539 may be over optimistic. 0:37:12.539,0:37:15.980 Although, perhaps,[br]in an ideal world, 0:37:15.980,0:37:21.784 we would consider a law that[br]could increase innovation 0:37:21.784,0:37:24.519 and competition in this space. 0:37:24.519,0:37:28.300 Now, for those of you who[br]are unfamiliar with it, what 0:37:28.300,0:37:35.100 the orphan drug law does is, it[br]extends exclusivity for a drug 0:37:35.099,0:37:38.429 company who has[br]developed a product 0:37:38.429,0:37:42.919 but who believes that[br]the further investment 0:37:42.920,0:37:46.730 necessary to actually bring[br]a proven drug to market 0:37:46.730,0:37:50.675 is not worth the investment[br]because their patent, 0:37:50.675,0:37:53.049 the exclusivity available to[br]them on the original patent, 0:37:53.050,0:37:53.660 has expired. 0:37:53.659,0:37:57.420 Drug development is often[br]a really long process. 0:37:57.420,0:38:03.760 And it's a race against[br]the sundown on the patents. 0:38:03.760,0:38:06.630 Now unfortunately,[br]I'm not convinced 0:38:06.630,0:38:12.289 that a similar model in the this[br]even much smaller orphan device 0:38:12.289,0:38:13.730 spaces would[br]actually do anything 0:38:13.730,0:38:18.840 because exclusivity in[br]prosthetic arm patents 0:38:18.840,0:38:22.230 is often abandoned[br]when people decide 0:38:22.230,0:38:24.809 to stop paying the maintenance[br]on their process arm patents 0:38:24.809,0:38:26.690 after seven or 15 years. 0:38:26.690,0:38:29.950 So they're leaving exclusivity[br]on the table with regard 0:38:29.949,0:38:31.819 to patents in the space already. 0:38:31.820,0:38:34.630 So would extending it[br]actually do anything? 0:38:34.630,0:38:37.170 And I'm not convinced[br]that it would. 0:38:37.170,0:38:39.380 So Yeah? 0:38:43.884,0:38:45.810 AUDIENCE: [INAUDIBLE]. 0:38:54.981,0:38:55.690 JON KUNIHOLM: OK. 0:38:55.690,0:38:58.019 So since we're not[br]miked in the audience, 0:38:58.019,0:39:02.579 the question is, is the approval[br]process for medical devices, 0:39:02.579,0:39:06.400 prosthetic arm[br]specifically, similarly long 0:39:06.400,0:39:08.909 as it is for drugs. 0:39:08.909,0:39:10.450 That's sort of a[br]complicated question 0:39:10.449,0:39:13.164 because it depends on[br]which class of devices 0:39:13.164,0:39:14.039 you're talking about. 0:39:14.039,0:39:18.059 The FDA it has three classes[br]of medical devices- I, II, 0:39:18.059,0:39:19.846 and III. 0:39:19.846,0:39:26.480 The DARPA neural sensing[br]system would be a Class III 0:39:26.480,0:39:28.539 medical device[br]because it actually 0:39:28.539,0:39:31.190 involves an internal implant. 0:39:31.190,0:39:35.869 Most prosthetic devices[br]right now are Class I. 0:39:35.869,0:39:37.410 And they're not only[br]Class I, they're 0:39:37.409,0:39:40.469 Class I Exempt which means that[br]there are exempt from-- there's 0:39:40.469,0:39:43.149 something like seven or eight[br]requirements for Class I 0:39:43.150,0:39:44.079 devices. 0:39:44.079,0:39:48.090 And all but three[br]of those are ignored 0:39:48.090,0:39:53.120 for this group of[br]Class I Exempt devices. 0:39:53.119,0:39:57.210 So in fact-- and this[br]is something actually 0:39:57.210,0:40:02.070 that there's been some--[br]some of the folks who've 0:40:02.070,0:40:04.960 been pursuing these new[br]things have been assuming-- 0:40:04.960,0:40:07.320 and they may be right.[br]--that the FDA is seeking 0:40:07.320,0:40:12.250 to regulate prosthetic arm[br]stuff more rigorously than they 0:40:12.250,0:40:14.400 have in the past. 0:40:14.400,0:40:18.180 So even though you[br]could bring-- there 0:40:18.179,0:40:21.909 are articulated[br]myoelectric hands 0:40:21.909,0:40:25.929 that have been brought to[br]market in the last five years 0:40:25.929,0:40:30.109 that were brought to market. 0:40:30.110,0:40:32.574 All you have to do basically[br]is announced to the FDA 0:40:32.574,0:40:34.990 that you're going to start[br]selling these things and do it. 0:40:34.989,0:40:37.405 And if you're going to test[br]it, you stamp it experimental. 0:40:37.405,0:40:39.929 And you're good to go. 0:40:39.929,0:40:44.489 But nobody wants to invest[br]hundreds of millions of dollars 0:40:44.489,0:40:46.334 in the creation of[br]a device unless they 0:40:46.335,0:40:49.190 are sure that they're going[br]to get away with that. 0:40:49.190,0:40:51.670 And the FDA had[br]been making noises 0:40:51.670,0:40:53.470 that they were going[br]to try to bump up 0:40:53.469,0:40:55.619 the classification of[br]some of these things. 0:40:55.619,0:41:01.619 And they also have a requirement[br]for orthopedic devices 0:41:01.619,0:41:02.710 which is reasonable. 0:41:02.710,0:41:06.690 It's based on-- so a screw[br]in an orthopedic implant 0:41:06.690,0:41:10.289 is a Class I device that's a[br]component of a Class III device 0:41:10.289,0:41:11.699 which is the implant. 0:41:11.699,0:41:16.539 And there was a bad[br]failure in the '80s because 0:41:16.539,0:41:19.789 of the changing of[br]these Class I devices. 0:41:19.789,0:41:24.349 And so the FDA requires[br]each Class I component 0:41:24.349,0:41:27.271 be separately recertified[br]with the Class III system. 0:41:27.271,0:41:29.480 And if somebody did something[br]like that, for example, 0:41:29.480,0:41:35.670 with, say, there's a bolt[br]that can go through your skin 0:41:35.670,0:41:36.302 into the bone. 0:41:36.302,0:41:37.510 It's called osseointegration. 0:41:37.510,0:41:39.620 A titanium bolt. 0:41:39.619,0:41:43.529 And the bolt, of course,[br]is a Class III device 0:41:43.530,0:41:47.040 because it goes inside the body. 0:41:47.039,0:41:51.539 And if they required you[br]to separately certify 0:41:51.539,0:41:54.670 every prosthetic hand[br]or foot that you attach 0:41:54.670,0:41:57.150 to one of these systems,[br]it would effectively 0:41:57.150,0:41:59.519 mean that there wouldn't be[br]any available because nobody 0:41:59.519,0:42:00.840 would bother to do it. 0:42:00.840,0:42:06.650 So the whole-- so actually, you[br]bring up a really great point 0:42:06.650,0:42:09.789 which is that the FDA is a[br]really important part of this. 0:42:09.789,0:42:14.650 And some orphan device law, a[br]hypothetical orphan device law 0:42:14.650,0:42:19.450 or revisions of regulations that[br]might really impact the space, 0:42:19.449,0:42:23.139 should try to remove[br]some of those barriers 0:42:23.139,0:42:26.349 that actually the[br]FDA could potentially 0:42:26.349,0:42:29.759 create in trying to[br]better protect us. 0:42:29.760,0:42:33.700 And there are humanitarian[br]exemptions available. 0:42:33.699,0:42:35.759 And so it's something[br]that I think 0:42:35.760,0:42:37.980 bares further consideration. 0:42:37.980,0:42:39.730 So that leads into[br]the next group 0:42:39.730,0:42:42.099 of things which[br]are beyond new law. 0:42:42.099,0:42:45.900 What about the interpretation of[br]existing laws and regulations? 0:42:45.900,0:42:51.430 The Bayh-Dole Act[br]is the law from 1980 0:42:51.429,0:42:53.379 that governs the[br]government-funded creation 0:42:53.380,0:42:54.487 of intellectual property. 0:42:54.487,0:42:57.070 And the part that most of us are[br]familiar with, if you've ever 0:42:57.070,0:42:59.195 received a government grant,[br]is that the government 0:42:59.195,0:43:02.400 has royalty-free nonexclusive[br]license to anything 0:43:02.400,0:43:04.740 that they pay you to create. 0:43:04.739,0:43:08.009 But then, in order to[br]encourage economic activity, 0:43:08.010,0:43:12.560 anybody who creates this[br]stuff has the permission 0:43:12.559,0:43:14.630 to go off and license it. 0:43:14.630,0:43:17.440 Do whatever they want, exploit[br]that intellectual property 0:43:17.440,0:43:20.789 on their own, as long as they[br]don't charge any royalties back 0:43:20.789,0:43:22.094 to the government. 0:43:22.094,0:43:24.219 In practice, I think some[br]of this actually goes on. 0:43:24.219,0:43:27.389 Because if they fund,[br]particularly weapon systems 0:43:27.389,0:43:31.297 and stuff like that, it's[br]not like they segment off 0:43:31.297,0:43:33.380 what the intellectual[br]property component of it is. 0:43:33.380,0:43:36.490 It's not like anybody else can[br]make some of these fighter jets 0:43:36.489,0:43:38.939 or tanks or whatever. 0:43:38.940,0:43:41.900 So the least popular[br]provision of this law 0:43:41.900,0:43:44.036 is what are called[br]march-in rights. 0:43:44.036,0:43:46.159 Which means that if the[br]government-- if there are-- 0:43:46.159,0:43:48.117 there are four criteria[br]that could be met where 0:43:48.117,0:43:49.739 the government can[br]come in and say, 0:43:49.739,0:43:55.089 you are not making use of this[br]intellectual property the way 0:43:55.090,0:43:55.990 we intended you to. 0:43:55.989,0:43:59.549 We're going to take it from you[br]and give it to somebody else. 0:43:59.550,0:44:05.730 And people-- it has been[br]exercised very few times, 0:44:05.730,0:44:06.710 if ever. 0:44:06.710,0:44:09.110 And it's a very unpopular,[br]as you can imagine, 0:44:09.110,0:44:12.990 provision with people who get[br]a lot of government funding. 0:44:12.989,0:44:14.030 How much time do we have? 0:44:17.119,0:44:26.880 So while this law[br]exists, it is something 0:44:26.880,0:44:29.920 that could be made use of[br]that's on the books already. 0:44:29.920,0:44:35.010 And so people, program[br]managers could say, OK, 0:44:35.010,0:44:37.100 so it's been 15 years. 0:44:37.099,0:44:40.739 You haven't-- you created[br]a product where we're going 0:44:40.739,0:44:43.750 to find somebody who will[br]because our goal is to bring 0:44:43.750,0:44:45.599 something like this to market. 0:44:45.599,0:44:47.529 And another one that[br]I referenced earlier 0:44:47.530,0:44:50.710 is the Center for Medicare[br]and Medicaid Services. 0:44:50.710,0:44:54.559 So all these devices, and many[br]medical devices are like this, 0:44:54.559,0:44:59.549 are reimbursed as durable[br]medical equipment- 0:44:59.550,0:45:04.140 canes, walkers, CPAP machines,[br]and prosthetic devices. 0:45:04.139,0:45:05.909 And the weirdness[br]that this creates 0:45:05.909,0:45:07.849 is that the whole[br]cost of supporting 0:45:07.849,0:45:09.799 the device for something[br]like five years 0:45:09.800,0:45:12.240 in between replacements[br]has to be captured just 0:45:12.239,0:45:15.319 in the provision of the product[br]at the beginning of its life 0:45:15.320,0:45:15.957 cycle. 0:45:15.956,0:45:17.539 All of the appointment[br]and everything. 0:45:17.539,0:45:22.630 So a prosthetist needs to be[br]able to function based on that. 0:45:22.630,0:45:24.820 The other thing that's[br]weird about this 0:45:24.820,0:45:26.820 is that there's a perverse[br]incentive, of course, 0:45:26.820,0:45:29.150 to provide more[br]of these products. 0:45:29.150,0:45:34.305 Because if you give[br]somebody a myoelectric arm, 0:45:34.304,0:45:39.119 it reimburses at[br]$30,000, $35,000. 0:45:39.119,0:45:44.069 A body-powered[br]arm may be $8,000. 0:45:44.070,0:45:46.680 And the other thing is that the[br]way that these reimbursement 0:45:46.679,0:45:49.109 codes are created is[br]that a company has 0:45:49.110,0:45:50.700 to demonstrate efficacy. 0:45:50.699,0:45:53.429 And then, they petition CMS. 0:45:53.429,0:45:57.853 And so that they have to[br]basically outlay all of the R&D 0:45:57.853,0:45:59.769 ahead before they know[br]if they're going to get 0:45:59.769,0:46:00.269 reimbursed. 0:46:00.269,0:46:02.960 Then, there have been[br]some recent cases 0:46:02.960,0:46:06.625 where people get the wrong[br]answer back from CMS. 0:46:06.625,0:46:07.769 And it kills the company. 0:46:07.769,0:46:10.599 A good example is[br]the iBot wheelchair 0:46:10.599,0:46:13.440 which everybody agrees is[br]pretty impressive technology. 0:46:13.440,0:46:16.530 That came back as being[br]excluded to a very 0:46:16.530,0:46:21.490 few pretty serious[br]disabilities and not 0:46:21.489,0:46:25.539 reimbursable at a rate that[br]could sustain its manufacturer. 0:46:25.539,0:46:28.079 And the company has[br]closed it doors. 0:46:28.079,0:46:29.559 And so it's actually[br]up in the air 0:46:29.559,0:46:31.509 what's going to happen[br]to that technology. 0:46:31.510,0:46:34.510 Hopefully, DEKA, which[br]is the creator of it, 0:46:34.510,0:46:36.800 will figure something out. 0:46:36.800,0:46:39.610 So one thing that I[br]think people might do 0:46:39.610,0:46:43.200 would be to create incentives[br]in reimbursement codes. 0:46:43.199,0:46:46.369 You could create a code[br]for the performance 0:46:46.369,0:46:49.000 of a particular device without[br]knowing that it exists. 0:46:49.000,0:46:54.599 And so I could say, a 15 degree[br]of freedom prosthetic hand 0:46:54.599,0:46:58.009 and wrist that's capable of[br]all these performance criteria 0:46:58.010,0:47:02.010 will reimburse at this rate,[br]$150,000, whatever it is. 0:47:02.010,0:47:05.480 And then, a company[br]would know ahead of time 0:47:05.480,0:47:07.610 that they have a[br]payday ahead of them 0:47:07.610,0:47:09.829 if they're capable of[br]meeting the criteria. 0:47:09.829,0:47:14.110 And so it would be much more[br]clear that this was possible. 0:47:14.110,0:47:15.780 Then, contract language. 0:47:15.780,0:47:21.150 There's a bunch of open source[br]and open architectural language 0:47:21.150,0:47:25.000 that the Navy, for one,[br]still has on kind of dead 0:47:25.000,0:47:26.250 website that's still up there. 0:47:26.250,0:47:29.320 But it's sample program[br]manager language 0:47:29.320,0:47:32.309 to put in RFPs to[br]ensure that you 0:47:32.309,0:47:36.519 can get what you[br]want out of them. 0:47:36.519,0:47:38.480 And those are tools[br]that could be used. 0:47:38.480,0:47:41.510 And then lastly, the DARPA[br]has made really good use 0:47:41.510,0:47:44.590 of challenges and contests. 0:47:44.590,0:47:48.450 And I think this sort of thing,[br]in partnership with industry, 0:47:48.449,0:47:50.519 might be very helpful. 0:47:50.519,0:47:52.585 So I guess in some[br]sense, my graphic here 0:47:52.585,0:47:54.092 of somebody cutting[br]red tape, maybe 0:47:54.092,0:47:55.550 I'm actually talking[br]about creating 0:47:55.550,0:47:57.180 some more in some cases. 0:47:57.179,0:47:59.629 But you get the picture. 0:47:59.630,0:48:03.160 So what about industry? 0:48:03.159,0:48:07.429 And that's you guys[br]here at Google. 0:48:07.429,0:48:11.279 I think that Google has done[br]some really creative things 0:48:11.280,0:48:15.040 in terms of business model in[br]creating great products that 0:48:15.039,0:48:18.889 solve problems in ways[br]that people hadn't before 0:48:18.889,0:48:22.589 by focusing the[br]business model in sort 0:48:22.590,0:48:24.960 of unexpected parts of it. 0:48:24.960,0:48:28.829 And so I think both Android,[br]both the Android operating 0:48:28.829,0:48:31.079 system and Gmail are[br]good examples of that. 0:48:31.079,0:48:34.119 In a recent acquisition of[br]yours, the nest company that 0:48:34.119,0:48:39.829 makes these thermostats[br]and the smoke detector, 0:48:39.829,0:48:42.420 those are examples[br]of products where 0:48:42.420,0:48:44.539 people would have said[br]the innovation is-- 0:48:44.539,0:48:45.889 these are commodities. 0:48:45.889,0:48:47.190 You can't improve on this. 0:48:47.190,0:48:47.920 It is what it is. 0:48:47.920,0:48:49.409 Everybody has to have one. 0:48:49.409,0:48:51.739 And you're going to buy[br]the $8.95 one instead 0:48:51.739,0:48:55.919 of the $9.95 one because it just[br]does whatever it needs to do. 0:48:55.920,0:49:01.570 And I think the way that that[br]company was able to really pay 0:49:01.570,0:49:07.980 attention to consumers[br]represents creative thinking 0:49:07.980,0:49:10.130 which is the way that[br]probably everybody needs 0:49:10.130,0:49:12.898 to attack challenging markets. 0:49:12.898,0:49:14.440 And these ones that[br]I've talked about 0:49:14.440,0:49:17.720 are certainly some of them. 0:49:17.719,0:49:20.079 So you guys have[br]also been in the news 0:49:20.079,0:49:24.849 recently for, by count,[br]something like nine, 0:49:24.849,0:49:27.119 counting the drone company,[br]robotic acquisitions 0:49:27.119,0:49:29.549 over the last year or so. 0:49:29.550,0:49:31.890 And one of these[br]is Redwood Robotics 0:49:31.889,0:49:36.440 which I think involves a part[br]of a Willow Garage spin-off. 0:49:36.440,0:49:38.480 And I looked a little[br]bit-- I'd never 0:49:38.480,0:49:41.059 seen this hand picture before. 0:49:41.059,0:49:42.570 It looks to me like a rendering. 0:49:42.570,0:49:45.539 I don't know if it[br]represents a real product. 0:49:45.539,0:49:48.329 I think that it's[br]interesting that, in terms 0:49:48.329,0:49:54.360 of a manipulation and[br]terminal device, a hand 0:49:54.360,0:49:56.980 acquisition that you[br]guys chose to acquire, 0:49:56.980,0:50:00.670 Redwood and not any[br]of the companies 0:50:00.670,0:50:04.630 that were involved in the[br]DARPA prosthetic arms, 0:50:04.630,0:50:11.320 the-- there's an interesting[br]companionship between robot 0:50:11.320,0:50:15.519 teleoperation and prosthetics. 0:50:15.519,0:50:21.789 Myron Diftler, who runs the[br]robonaut program for NASA 0:50:21.789,0:50:26.134 at Johnson Space Center, said[br]that when he thought about it, 0:50:26.135,0:50:29.630 the prosthetic[br]problem is basically 0:50:29.630,0:50:31.400 a teleoperation problem. 0:50:31.400,0:50:33.880 You just happened to be[br]attached to the device you're 0:50:33.880,0:50:35.230 trying to teleoperate. 0:50:35.230,0:50:39.480 So in some sense, when you[br]take away video latency 0:50:39.480,0:50:44.679 to the moon or whatever, the[br]prosthetic control problem 0:50:44.679,0:50:47.919 might be, in some sense, easier. 0:50:47.920,0:50:51.710 Although the way that[br]these things are usually 0:50:51.710,0:50:57.590 performed right now is[br]with a haptic armature. 0:50:57.590,0:51:00.059 And in the prosthetic[br]case, obviously, you're 0:51:00.059,0:51:03.440 trying to control a limb that's[br]absent, so you don't have 0:51:03.440,0:51:05.740 access to those[br]fingers to tell you, 0:51:05.739,0:51:07.869 to tell those digits[br]where to move. 0:51:07.869,0:51:10.759 Anyway, my point[br]in bringing this up 0:51:10.760,0:51:15.280 is that there is some[br]great companionship 0:51:15.280,0:51:16.200 to these problems. 0:51:16.199,0:51:21.059 And in fact, while[br]it is not clear 0:51:21.059,0:51:26.159 right now who in America is[br]ready to buy, for example, 0:51:26.159,0:51:30.299 a personal assistance[br]robot or some other things 0:51:30.300,0:51:31.920 that one might[br]imagine as products 0:51:31.920,0:51:36.000 that could come out of companies[br]like these down the road. 0:51:36.000,0:51:38.739 There are prosthetic[br]customers who 0:51:38.739,0:51:40.739 can, according to the[br]current reimbursement 0:51:40.739,0:51:44.409 system, in some[br]cases, pay in excess 0:51:44.409,0:51:47.429 of $100,000 for one[br]of these devices. 0:51:47.429,0:51:52.549 So it might be possible to[br]create a synergy of interest 0:51:52.550,0:51:58.289 where you're solving problems[br]for the future of home 0:51:58.289,0:52:02.409 and mass-produced[br]robotics at the same time 0:52:02.409,0:52:06.039 as you are serving prosthetic[br]customers in the near term. 0:52:06.039,0:52:10.150 Even though they don't represent[br]the huge revenue stream 0:52:10.150,0:52:15.510 that we all would if everybody[br]has a Jetsons-style maid 0:52:15.510,0:52:16.575 in their home. 0:52:19.550,0:52:22.660 This is a picture[br]of my friend Kevin 0:52:22.659,0:52:27.769 who was born without[br]both of his legs. 0:52:27.769,0:52:31.300 I throw his picture up there[br]because he is, in some ways, 0:52:31.300,0:52:36.490 represents an orphan of an even[br]smaller community than my own. 0:52:36.489,0:52:40.479 Without any hip joints, when[br]he was about 10 years old, 0:52:40.480,0:52:42.769 they tried to put[br]prosthetic legs on him. 0:52:42.769,0:52:46.230 And they weren't really[br]anything but another couple 0:52:46.230,0:52:49.590 of extra crutches for him[br]to sort of haul around. 0:52:49.590,0:52:52.542 And he very quickly decided[br]that he wanted no part of that. 0:52:52.541,0:52:54.510 And he gets around[br]on a skateboard. 0:52:56.739,0:53:01.429 Now, that said, if[br]you were to envision-- 0:53:01.429,0:53:04.429 and that's a way to[br]stay active, too. 0:53:04.429,0:53:07.909 But if you were to envision a[br]robotic prosthetic device that 0:53:07.909,0:53:10.119 might help him, it[br]could look something 0:53:10.119,0:53:15.429 like Boston Robotics,[br]Boston Dynamics-- I forget 0:53:15.429,0:53:18.719 the name of the[br]company. --in Cambridge. 0:53:18.719,0:53:20.648 They have the big[br]dog, walking bot 0:53:20.648,0:53:22.940 and those others where they[br]pretty famously kicked them 0:53:22.940,0:53:27.619 over in the video. 0:53:27.619,0:53:31.460 A pair of those walking legs,[br]controlled like the Segway, 0:53:31.460,0:53:38.530 is by leaning, could[br]do a pretty fair bit 0:53:38.530,0:53:41.440 towards replacing legs. 0:53:41.440,0:53:47.340 And so that's another case where[br]one of these robotics companies 0:53:47.340,0:53:51.690 might hold, in currently[br]available technology, the keys 0:53:51.690,0:53:54.409 to making a change[br]in somebody's life. 0:53:54.409,0:54:00.059 And my hope in[br]mentioning industry-- 0:54:00.059,0:54:04.539 and I think, again, none of[br]these are mutually exclusive. 0:54:04.539,0:54:09.440 I do believe that[br]the only way that we 0:54:09.440,0:54:11.710 are going to solve these[br]extremely vexing problems 0:54:11.710,0:54:16.099 to society is by throwing nearly[br]everything that we have at it 0:54:16.099,0:54:18.650 and seeing what sticks. 0:54:18.650,0:54:23.079 And so really my purpose[br]in talking to you today 0:54:23.079,0:54:27.799 is to try-- I want to start[br]this conversation because it's 0:54:27.800,0:54:31.439 pretty clear to me that there[br]are some things that we could 0:54:31.438,0:54:33.730 do better about how we're[br]responding to these problems. 0:54:33.730,0:54:38.990 And I'd very much like some help[br]in figuring out how to do it. 0:54:38.989,0:54:42.559 So I used up more time[br]than I had intended to. 0:54:42.559,0:54:45.289 But if you all[br]have any questions, 0:54:45.289,0:54:47.900 I'd certainly like to[br]try and answer them. 0:55:04.519,0:55:08.880 So the question is-- I mentioned[br]that most arm amputees still 0:55:08.880,0:55:13.970 use hooks vise the[br]more complicated 0:55:13.969,0:55:19.359 electrical externally-powered[br]prostheses and why. 0:55:19.360,0:55:21.460 I think cost is part of it. 0:55:21.460,0:55:24.199 The Affordable Care Act[br]has changed some of that. 0:55:24.199,0:55:33.239 Before January, a lot of[br]people with medical insurance 0:55:33.239,0:55:37.500 had lifetime caps of, in[br]some cases, just more, 0:55:37.500,0:55:41.050 like $1,500 lifetime cap on[br]prosthetics services which 0:55:41.050,0:55:45.060 isn't even enough to[br]get a single prosthesis. 0:55:45.059,0:55:50.750 And beyond the[br]expansion of coverage, 0:55:50.750,0:55:57.760 the removal of the lifetime[br]caps and pre-existing conditions 0:55:57.760,0:56:00.670 are huge for the[br]prosthetic community. 0:56:00.670,0:56:04.760 So to the extent[br]that it is monetary, 0:56:04.760,0:56:09.390 the Affordable Care Act[br]should change some of that. 0:56:09.389,0:56:14.039 I, anecdotally, I don't[br]think that there's 0:56:14.039,0:56:17.179 any great data on this. 0:56:17.179,0:56:23.059 But I think that a lot[br]of common complaints 0:56:23.059,0:56:29.329 about the myoelectric[br]prostheses are latencies, 0:56:29.329,0:56:34.269 unintended movements, the speed[br]with which the motors move, 0:56:34.269,0:56:35.570 the weight. 0:56:35.570,0:56:38.380 And then, I think you[br]hit on it, function 0:56:38.380,0:56:41.630 is probably the primary reason. 0:56:41.630,0:56:48.260 The hook has been famously[br]described in TED Talks 0:56:48.260,0:56:51.790 as a rubber band and a[br]hook on the end of a stick. 0:56:51.789,0:56:54.420 But I believe that[br]the bar is actually 0:56:54.420,0:56:55.630 quite a bit higher than that. 0:56:55.630,0:56:59.190 The Dorrance hook is really[br]kind of a marvel of design. 0:56:59.190,0:57:02.760 It's got a bunch of[br]affordances built into it. 0:57:02.760,0:57:05.330 You can pick something[br]up, use it as a hook, 0:57:05.329,0:57:07.679 and as a split hook,[br]you can open it up 0:57:07.679,0:57:10.469 and use the individual[br]fingers for different things. 0:57:10.469,0:57:14.079 The little thumb that[br]has the cable on it--- 0:57:14.079,0:57:16.590 I'll put that back up. 0:57:16.590,0:57:21.820 The little thumb that[br]has the cable on it 0:57:21.820,0:57:24.230 can be used to push things. 0:57:24.230,0:57:29.050 And is the part of[br]the device that's 0:57:29.050,0:57:31.330 used to wedge a[br]knife and a fork. 0:57:31.329,0:57:33.549 Actually that's[br]a perfect example 0:57:33.550,0:57:35.120 is eating with a knife and fork. 0:57:38.076,0:57:41.039 With cosmetic coverings[br]on the myoelectric hands, 0:57:41.039,0:57:42.150 they tend to be slippery. 0:57:42.150,0:57:46.720 And it's hard to get a knife and[br]a fork to sit securely in them. 0:57:46.719,0:57:49.069 And this thing is designed[br]to do exactly that. 0:57:49.070,0:57:51.059 It's got a chisel[br]tang in the middle, 0:57:51.059,0:57:54.670 so you can stick[br]a tool in there. 0:57:54.670,0:57:56.720 Or you can wedge either[br]a knife or a fork 0:57:56.719,0:57:59.389 in between the fingers[br]and over the thumb. 0:57:59.389,0:58:02.250 So I think function[br]is a lot of it. 0:58:04.880,0:58:07.179 Any other questions? 0:58:10.900,0:58:11.400 Yeah? 0:58:11.400,0:58:12.316 AUDIENCE: [INAUDIBLE]. 0:58:22.809,0:58:23.600 JON KUNIHOLM: Yeah. 0:58:23.599,0:58:26.400 So well, first of all,[br]it's selfish of me, right? 0:58:26.400,0:58:27.220 That's my problem. 0:58:27.219,0:58:30.189 So that's what I spend a[br]lot of time thinking about. 0:58:30.190,0:58:32.414 But there are other[br]complications. 0:58:32.414,0:58:38.680 So there are something like[br]50 times more leg amputees 0:58:38.679,0:58:43.719 in America than arm amputees[br]because of peripheral vascular 0:58:43.719,0:58:45.774 disease secondary diabetes. 0:58:48.119,0:58:50.559 And that's the major[br]cause of leg amputation. 0:58:50.559,0:58:54.170 So there are more than[br]two million leg amputees 0:58:54.170,0:58:55.000 in America. 0:58:55.000,0:58:59.670 And most of-- and is an[br]easier problem to solve, too. 0:58:59.670,0:59:03.489 When you're looking at--[br]well, Oscar Pistorius 0:59:03.489,0:59:04.280 is a great example. 0:59:04.280,0:59:08.550 The cheetah legs make somebody[br]capable of running close to 10 0:59:08.550,0:59:10.920 second 100. 0:59:10.920,0:59:12.980 Although knees are a problem. 0:59:12.980,0:59:18.010 And Oscar Pistorius is[br]a below knee amputee. 0:59:18.010,0:59:21.040 But then, among the[br]powered devices, 0:59:21.039,0:59:23.289 control engineers[br]who work on legs 0:59:23.289,0:59:27.699 have told me that it's possible[br]to do reasonable approximations 0:59:27.699,0:59:31.359 of gate with the individual[br]components not even talking 0:59:31.360,0:59:32.700 to each other. 0:59:32.699,0:59:35.009 Where they just respond[br]to the external forces, 0:59:35.010,0:59:39.010 and they're capable of doing[br]a pretty good job walking. 0:59:39.010,0:59:43.260 And contrast that to[br]an arm where just, 0:59:43.260,0:59:45.470 forget the manipulation[br]stuff, just 0:59:45.469,0:59:47.859 reach to grasp with a[br]whole arm for somebody 0:59:47.860,0:59:50.570 up to the shoulder level[br]involves the coordination 0:59:50.570,0:59:52.920 of all of the joints together. 0:59:52.920,0:59:57.639 So I like to say that if you[br]imagine that these are legs, 0:59:57.639,1:00:00.489 the arm problem has five of[br]them on the end of a sixth. 1:00:00.489,1:00:02.439 And they all have to[br]dance together in order 1:00:02.440,1:00:04.970 to do the most basic task[br]that an arm has to do. 1:00:07.000,1:00:07.500 Yeah. 1:00:07.500,1:00:13.039 And so the economics are--[br]legs are a lot bigger business. 1:00:13.039,1:00:16.090 So there is a real incentive. 1:00:16.090,1:00:20.650 Although there are[br]some new leg companies, 1:00:20.650,1:00:26.710 because of the high cost of[br]additional degrees of freedom, 1:00:26.710,1:00:28.414 there are some[br]leg companies that 1:00:28.414,1:00:30.080 are going to be in[br]trouble if they don't 1:00:30.079,1:00:33.690 get the reimbursements that[br]they want on powered ankles, 1:00:33.690,1:00:35.090 for example. 1:00:35.090,1:00:40.675 And so in that sense they[br]share exactly the same problem. 1:00:45.250,1:00:47.489 Anything else? 1:00:49.335,1:00:52.433 Any questions from our[br]remote rooms? 1:00:59.150,1:00:59.950 All right. 1:00:59.949,1:01:01.189 Well, listen. 1:01:01.190,1:01:04.139 Thank you very much for taking[br]the time to check it out. 1:01:04.139,1:01:07.069 And I don't if there's a way for[br]me to post contact information 1:01:07.070,1:01:07.570 or whatever. 1:01:07.570,1:01:12.000 But if anybody's interested[br]in further talking about this, 1:01:12.000,1:01:15.849 please get with[br]Michael Weiss-Malik. 1:01:15.849,1:01:19.360 And he'll put you[br]in touch with me. 1:01:19.360,1:01:21.170 Thanks very much. 1:01:21.170,1:01:25.032 (Applause)