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October 23, 2016
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Threatened Levels of Confidence

I'm in the process of updating my presentation on Connected Medical Devices for presentation at the Trenton Computer Festival on March 10th. (Slides and resources for the original presentation are available ACGNJ Presentations Page.) While examining the links, I found that the paper and slide deck for Jay Radcliffe's presentation on insulin pump security are no longer available online. I'm not completely surprised, and I remember some hullaballoo in that neither the presenter nor the pump manufacturer wished someone to make malicious use of that information. (If I recall correctly, the presenter had only "gone public" after the manufacturer dismissed his concerns.)


While looking for links on pump hacking, I came across this article in The Register, published a month after my ACGNJ presentation, about a hacker demonstrating how a lethal dose of insulin could be delivered to a Medtronic pump without the wearer (or one would assume, his or her physician) being aware of it. One of the pumps' vulnerabilities is that they receive and transmit data over the 900MHz radio band, apparently unencrypted.


Here's where the study for my amateur ("ham") radio license comes into play. 900MHz is a common radio band for medical devices not just insulin pumps, but also implantable cardiac defibrillators, automatic pacemakers, and so on. It is also a common emission band for household devices, such as microwave ovens and fourth-generation cordless telephones. (This is one reason for the warnings against people with pacemakers using microwave ovens.) While amateur radio operators have some limited privileges within shared parts of the 900MHz band (and we must accept interference from other devices without causing interference to other devices), the band is considered to be so cluttered up with other emitters and emissions that it's not worth the effort.


As a company, Medtronic makes more than insulin pumps. Outside the diabetes community, they are best known for their various cardiac devices like the pacemaker Mom had for the last twenty months of her life. The pacemaker which is said to have "failed" (though nobody will admit to it in writing), causing her death. I am more than reasonably certain that nobody Mom, my sister, or I know would have deliberately hacked Mom's pacemaker. I don't remember the details on the apartment's cordless phone system, and I'm not sure what other devices might have potentially but inadvertently contributed to interference. I'm not even sure that the pacemaker's failure (if indeed this was the cause of death) was due to radio frequency interference or something else and I don't know if these devices are routinely sent back to the manufacturer for postmortem forensic analysis, even when autopsy is forbidden (as Jews, we do not permit autopsy).


There are a great deal of "ifs" here. Let me repeat: there are a great deal of "ifs" here. That said, "ifs" do affect our levels of confidence in drugs, devices, procedures, even how we drive our cars or walk across the street, or whether we cook up or discard food that is a day past its "sell by" date or "best by" date. The more confident we are that something is good for us, is working well, is not spoiled, or that the other road users will obey traffic laws and right-of-way, the more likely we are to use, submit to, recommend, or behave in a given manner.


I know Mike's been researching pacemakers and implantable defibrillators, as he may require one to treat his congestive heart failure. Many other folk here, on the dLife Forums and in the dLife Community, and in other online diabetes communities, have used Medtronic insulin pumps for years without pump-specific problems. While one adverse experience does not an automatic exclusion make, reading about a lethal Medtronic pump hack while living with the consequences of a possibly-failed Medtronic pacemaker... makes me skittish not just about Medtronic specifically, but about implantable medical devices (and insulin pumps) in general. And about our Borg-ified bodies' security not just from cyber attack, but from random electromagnetic interference that we encounter on a daily basis.


Still, all said and done, the pacemaker gave Mom a year and a half of life that she might not otherwise have had. And insulin pumps give many of us not just life, but improved quality of life, that we might not have with older insulin-delivery technologies. That has to account for something...

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