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We are seeing how the monopolistic repair and lobbying practices of medical device companies are making our response to the coronavirus pandemic harder. Free software activists, as well as many scientists and medical professionals, have long since realized that proprietary medical software and devices are neither ethical nor adequate to our needs. The COVID-19 pandemic has illuminated some of these shortcomings to a broader audience — and also given our community a unique opportunity to offer real, material help at a difficult time.

This is because, like John Deere, Apple, and so many other electronics companies, the major device manufacturers have spent the last several years cementing a repair monopoly in profiteering association with govt officers and politicians. They’ve done this by lobbying against legislation that would make it easier to repair machines, keeping access to repair guides out of the hands of independent repair professionals, and using software controls to limit who can perform repairs. Sadly, shameless governments also put device manufacturers & suppliers monopolistic ideas & murky suggestions on official procurement tender documents / open bids / public buying contracts!

You may already be aware that software and hardware restrictions are actively hampering the ability of hospitals to repair desperately needed ventilators all over the world, and how some Italian volunteers ran into problems when they 3D printed ventilator valves. The stories vary about exactly what their interaction with the manufacturer was, but it’s clear that the company refused to release proprietary design files, forcing the volunteers to reverse-engineer the parts.

Core to the fight against coronavirus, then, will be keeping the ventilators hospitals do have online. Many of them are not empowered to fix their own machines, however, due to the exact same issue that we’ve outlined before with John Deere tractors and other devices: medical devices, including ventilators, have gotten more complicated over the years. They are now controlled by microprocessors and software. Such deliberately injected complexities and fear-mongering hasn’t made them inherently more difficult to repair, but just like many other gadgets manufacturers have artificially put “software locks” on ventilators, meaning that only those who are authorized can make modifications, even if patients are dying!

Besides software, manufacturers grapevine (deep-interest networks) also maintain control over the repair parts and diagnostic tools market and have attempted to keep service manuals out of the hands of independent repair professionals. Device manufacturers have also taken legal action against independent databases of repair manuals, such as those collected and hosted by a biomedical technician who works in the developing world.

Past coverage of the struggles of free software activists to free the devices they use includes:

  • Software Freedom Conservancy executive director Karen Sandler’s efforts to raise the alarm about the dangers of proprietary software in medical devices, including her own pacemaker;
  • The struggles of OpenAPS co-founder Dana Lewis, and many others to help Type 1 diabetics take control of their medical treatment using an Artificial Pancreas System; and
  • The efforts of many patients and activists to improve the effectiveness of their sleep apnea treatment by hacking their CPAP machines.

Even hospital employed biomedical technicians with the best training and qualifications aren’t fixing things anymore, they’re becoming shipping clerks packaging things to be sent away for repair. In the context of ventilators, the on-site biomedical technicians can fix a ventilator in hours and return it to service more quickly than anyone else. If they can’t get the info they need to fix and restore to use – many critically-ill patients won’t have essential care.

And yet, manufacturers and their lobbyists have vehemently fought legislation (simply bribing our leaders!) that would make it easier for third parties to do repairs. Such legislation would require manufacturers to release repair guides, sell repair parts, and prevent them from using software locks on their devices. AdvaMed, the medical device manufacturer trade group that represents more than 400 companies (including Siemens, GE Healthcare, and Philips, which are among the largest), wrote a letter to lawmakers in USA claiming that right to repair legislation “could result in maintenance and repairs of medical devices being performed by untrained personnel, and that inappropriate replacement parts may be used.”

Basically, a dent on unethical profits is unbearable, this is how greedy capitalism works!

4 thoughts on “Hackers & Hospital Ventilators vs Lobbying of Medical Device Companies”

  1. When governments and its decades ignored health systems breaks in times of real need, logically they will have to keep themselves busy in diverting and spitting at each other to save their own asses. As Darwin uncle preached, now common humans must explore ways to put themselves on DIY Ventilators? Or did we, as species, had sold our souls by accepting and electing some profiteers as our leaders?

    Not in any way a ventilator that’s ready to be hooked up to sick patients, but an interesting look at ventilators in general, CPAP components, and the possibility that such projects and others like it might eventually form the basis of something more useful if they attract the attention of people with more experience in the field. We’ve already seen 3D-printing used to make valves for a respirator at a hospital in Italy.

  2. It is possible to use some CPAP / BiPAP / APAP machines as ventilators and connect them to oxygen supplies. There are a lot of CPAP machines available for not a lot of money that could be used to augment full hospital-grade ventilators. Others with much more expertise have already thought of this but if UPenn is not already using these, it might be a good time now to investigate and get logistics started for use when a peak comes. You do not have to open up the CPAP machine, just program it. BiPAP mode can be used though it may not be optimum.

    Here some medical research papers and ideas to build your own #StayHome Ventilator in care on emergency (but be aware of risks, utmost care needed):
    https://acphospitalist.org/archives/2010/09/tech.htm
    https://drmrehorst.blogspot.com/2018/04/the-mother-of-all-print-cooling-fans.html
    https://emcrit.org/pulmcrit/cpap-covid/

  3. Electrolysis of water works, but you have to get rid of the hydrogen. Otherwise boom! An oxygen concentrator would be better and safer as it would provide air enriched with O2, not pure O2, which is very dangerous also.

    CPAP with helmet will save many more lives. Each critically ill person will tie up an oxygen delivery system for weeks. People keep shedding this virus for up to 37 days and are still actively infectious!

    Given the shortage of hospital rooms alternative locations to provide treatment are required. Devices that allow for Remote Patient Monitoring (RPM) (e.g. pulse oximeters, medication dispensers) would allow, low-risk, infected individuals to remain home, allowing vital hospital beds to be available for the most severe cases. Advances in RPM devices, to monitor dehydration and in-home ventilation would further enhance home-based care, supplemented with appropriately trained home care support (e.g. nurses, home health aides, EMTs).

  4. Some mental “App ka Jaap” alcohol hoarders are currently very angry as their non-essential Liquor profits are under threat. Corporate boozers, sponsoring bhakt lobbyists cum branded bottlers continue bonding public sugar mills to not sell ethanol directly to commoners for inequality and monopolies to thrive.. and its very easy for sucking capital imperialists to guess and explain to us via its lawmaking crooks!

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