The week before E3 2016 the Team behind the upcoming game Deus Ex: Mankind Divided made a peculiar announcement. They announced that they would be working with a company called Open Bionics on a project they call “Augmented Future.” In short, the project was designed to use the commercial success of the Deus Ex video game franchise and the marketing power of Eidos Montreal (the game’s developer) and Square Enix (the game’s publisher) to help Open Bionics create less costly prosthetics for amputees.
This is a goal that is very much in keeping with the theme of Deus Ex. This is a game that explores Transhumanism and the potential societal issues that will come about as more and more people begin to alter themselves using machine parts. I couldn’t help but wonder whether or not this project itself was a “good thing.”
So, in order to help answer that question I reached out to William Gibbs. He is a board certified Prosthetist and is also a gaming expert which is very familiar with transhumanism and the way Deus Ex explores it. I sent him the press release I received along with the video and asked for his comments on the topic. Take a look below to see what he says.
A Prosthetist’s Commentary
I should start with an introduction. My name is William Gibbs and I am a Board Certified Prosthetist. My background is BSE Biomedical Engineering, Masters in Prosthetics, and American Board Certification in Prosthetics. I am a published researcher in the field of Prosthetics and I have been in clinical practice in New York for about 6 years. I have treated hundreds if not thousands of amputee patients. I state these credentials because I think a lot of what I am about to say is going to be seen as the guy raining on the parade.
The topic of transhumanisim is a fascinating one and I am personally of the belief that a future where the lines between biology and technology is not just inevitable but necessary for humanity to overcome the challenges of the next century. I am an avid gamer, writer, and aspiring game developer and a huge fan of the Deus Ex series. So with all that in mind I have been asked to comment on the “Augmented Future”.
I see these things all the time on social media. Friends post videos of “Dad made $200.00 prosthesis in his shed” and the like all the time. They say “isn’t that so cool”? The thing is, it isn’t. I know that sounds harsh but let me explain. Most of those things you see have major anatomical and biomechanical flaws. Long term use of those devices runs a lot of risk of injury. The part of a prosthesis which is worn is called a “socket” and sockets have to be carefully molded for both comfort and force distribution. Getting that wrong leads to skin problems, bruising, and muscular dysfunction. Hobbyists without the proper training can make a prosthesis that looks amazing with today’s 3D printing tech but the functionality and safety leaves a lot to be desired. When your child gets sick you bring them to the doctor. Prosthetics is no different. That’s what a prosthetist is for. People make the mistake of thinking that because there is a physical technological device that prosthetics is somehow not medicine. That if you could somehow get the device yourself, you don’t need the medical professional.
In addition current 3D printing materials do not have the strength and durability for pediatric, let alone prosthetic applications. Prosthetic sockets are usually made from lightweight but extra strong composite materials. The most common is laminated carbon fiber, the same material that the bodies of sports cars are made from. 3D printed plastics such as ABS and PLA do not have the kind of cross sectional loading strength needed for these applications. They break apart within weeks.
Which brings me to Augmented Future. The good news is their partnership with Open Bionics means that some of the usual issues with these projects are being addressed because they have clinical professionals involved in the design. That said, the heavy reliance on cosmetic rather than function is contrary to the accepted clinical practice of prosthetics. The project focuses on reducing price and advancing 3D printing which are good goals, but given the current state of the technology this work does not belong on patients, not without a clinically acceptable prosthesis hiding under the admittedly cool cosmetic cover.
That’s the thing. It’s not the idea of making prosthetics cheaper or visually appealing that is the issue. The problem is tossing aside clinically acceptable treatment in favor of these devices. The project makes no reference to current advanced but fully available prosthetic technology. Robotic hands are clinically available now, and have been for years. Projects like Open Bionics and Augmented Future fail in that they perpetuate the idea that existing technological options are limited when in fact we live in the 21st century and I assure you the technology at my disposal in my clinic reflects this. I welcome readers to google “Bebionic 3” or “iLimb” if they wish to see for themselves.
Upper limb (hand, arm, etc) amputees often don’t use a prosthesis. The main reason for this isn’t a lack of technology. Studies have shown that it has much more to do with the effort needed to learn to use a prosthesis for manual tasks and the fact that if a new upper limb amputee doesn’t begin using a prosthesis of some sort within 21 days of the amputation then their brain gets used to doing things with one hand. The longer a patient goes without a prosthesis the less likely they are to become a successful prosthetic user later on. In addition to these barriers there are problems with insurance and healthcare delivery which while outside the scope of this conversation are largely responsible for the delays in treatment that a lot of patients run into.
“So wouldn’t making prosthetic devices cheaper help that?” Well, maybe in time, but the reality is our healthcare system still needs a lot of work and there is only so inexpensive you can make a prosthesis. Without getting into the politics of it, prosthetic devices fall under something called “Durable Medical Equipment”. What that means is prosthetists can not bill insurance for their time, only the final finished prosthesis. That means all the pre-prosthetic care, the measurements, castings, fabrication, fittings, training, therapy…it is all rolled into the price of the prosthesis. So when an article says “dad made a robot hand that would have cost 100k” what it is actually saying is “man with no medical training made device without postoperative medical care, several fitting and adjustment appointments, and lifetime follow up care”. I am all for maker culture and do-it-yourself projects, but not with my health, and not with the health of my loved ones.
Which brings me to the final thing I have to touch on which is the plan to make all of their designs available for hobbyists. The so called “open source” aspect of most 3D printing projects. Giving away the designs for the cosmetic applications is awesome. Encouraging hobbyists to make prosthetic sockets or hands or implying that people can skip out on seeking trained medical attention when it comes to prosthetic use is not just an issue to me; it is irresponsible.
In summary, Open Bionics and Augmented Future have the potential to do great things to advance the material science of 3D printing and create some awesome cosmetic options for patients. I think that’s awesome. However the approach, like most projects I have seen in prosthetics that come from outside the medical community, ignores proper clinical practice and perpetuates false information about the real costs of prosthetic devices and the reality of just how much therapy, work, and training patients have to go through to become successful prosthetic users. I encourage readers to visit http://www.amputee-coalition.org for more information especially if you or a loved one is an amputee or is facing amputation in the future.
William B. Gibbs, CP
Board Certified Prosthetist