Amputee rights

The New York Times and USA Today had stories on amputees and prostheses today. The front-page Times piece (Debate on Amputee Sprinter: Is He Disabled or Too-Abled?) chronicles the story of a South African who’s been legless from infancy and wants to run in the Olympics. His high-tech carbon fiber Cheetah prostheses, made by Ossur enable him to reach Olympic speeds. Unsurprisingly the track and field governing body wants to ban him for having an unfair advantage, while he and his supporters say he doesn’t have an unfair advantage and should be allowed to compete. The points on each side are interesting as far as they go.

Too bad the article doesn’t mention the cost and general availability of the prosthetics, which is the subject of the USA Today’s piece (Amputees’ reality is out of step with ‘Dancing’), which appears in the Life Section. Without providing any hard statistics, the thrust of the article is that amputees are being denied coverage for prosthetics. Heather Mills, “the estranged wife of former Beatle Paul McCartney” is shown on the TV show Dancing With the Stars, but according to Amputee Support Team of Central Pennsylvania’s Dick Nickle (try saying that name five times fast):

“It’s an inspirational thing she’s doing, but it sometimes creates a false sense of being able to do the same thing based on your income and insurance.”

The article describes the C-Leg, “a limb containing a microprocessor and hydraulics” that is seen by some amputees as a godsend, but costs $60,000, an amount insurers are reportedly often unwilling to pay. Meanwhile Medicare does cover the devices.

We’ll be hearing a lot more about amputees and prostheses; Iraq and Afghanistan veterans will make sure of that. But there’s a great opportunity to demonstrate that medical technology doesn’t have to drive up costs, rather it can drive them down. Nobody can make me believe that the cost of the device can’t fall radically with scale-up. Sure, some of the materials are expensive but hydraulics and especially microprocessors can benefit from experience curve effects that drive costs down over time. That leaves the labor costs associated with the prostheses, especially the time of physicians and other medical personnel. Those costs can be driven down, too, by more efficient deployment in the US or outsourcing to high-skill, low cost facilities in places like India and Thailand. India’s more or less on the way home from Afghanistan anyway.

And let’s not forget about the many more amputees in poorer countries. Seems to me that low cost, high quality prostheses would be a lot more useful technology than the cheap laptops that some are so excited about.

May 15, 2007

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