Implantable Smart Technologies (IST): Defining the ‘Sting’ in Data and Device

In a world surrounded by smart objects from sensors to automated medical devices, the ubiquity of ‘smart’ seems matched only by its lack of clarity. In this article, we use our discussions with expert stakeholders working in areas of implantable medical devices such as cochlear implants, implantable cardiac defibrillators, deep brain stimulators and in vivo biosensors to interrogate the difference facets of smart in ‘implantable smart technologies’, considering also whether regulation needs to respond to the autonomy that such artefacts carry within them. We discover that when smart technology is deconstructed it is a slippery and multi-layered concept. A device’s ability to sense and transmit data and automate medicine can be associated with the ‘sting’ of autonomy being disassociated from human control as well as affecting individual, group, and social environments.

[1]  G. Thomas,et al.  Reinventing grounded theory: some questions about theory, ground and discovery , 2006 .

[2]  Frédéric Gilbert,et al.  Lessons from the past , 2021, Nature.

[3]  Pim Haselager,et al.  Did My Brain Implant Make Me Do It? Questions Raised by DBS Regarding Psychological Continuity, Responsibility for Action and Mental Competence , 2010, Neuroethics.

[4]  A. Kalache,et al.  The greying world: a challenge for the twenty-first century. , 2000, Science progress.

[5]  John Haugeland,et al.  Artificial intelligence - the very idea , 1987 .

[6]  G. Snow,et al.  The role of radiotherapy , 1980, The Journal of Laryngology & Otology.

[7]  Emil Jovanov,et al.  Issues in wearable computing for medical monitoring applications: a case study of a wearable ECG monitoring device , 2000, Digest of Papers. Fourth International Symposium on Wearable Computers.

[8]  E. Racine,et al.  Responding Ethically to Patient and Public Expectations About Psychiatric DBS , 2012 .

[9]  R. Sciacca,et al.  Psychosocial Outcome after ICD Implantation: A Current Perspective , 1998, Pacing and clinical electrophysiology : PACE.

[10]  M. Schalij,et al.  Psychosocial impact of implantable cardioverter defibrillators (ICD) in young adults with Tetralogy of Fallot , 2012, Clinical Research in Cardiology.

[11]  Kevin Fu,et al.  Security and Privacy Qualities of Medical Devices: An Analysis of FDA Postmarket Surveillance , 2012, PloS one.

[12]  C. Vassy,et al.  From a genetic innovation to mass health programmes: the diffusion of Down's Syndrome prenatal screening and diagnostic techniques in France. , 2006, Social science & medicine.

[13]  S Smith,et al.  Development of a miniaturised drug delivery system with wireless power transfer and communication. , 2006, IET nanobiotechnology.

[14]  Geoff Delaney,et al.  The role of radiotherapy in cancer treatment , 2005, Cancer.

[15]  J. Dammeyer.  Psychosocial development in a Danish population of children with cochlear implants and deaf and hard-of-hearing children. , 2010, Journal of deaf studies and deaf education.

[16]  E. Rynning.  The ageing populations of Europe--implications for health systems and patients' rights. , 2008, European journal of health law.

[17]  Geoff Delaney M.B.B.S.,et al.  The role of radiotherapy in cancer treatment , 2005 .

[18]  Robert Langer,et al.  Small-scale systems for in vivo drug delivery , 2003, Nature Biotechnology.

[19]  M. White.  Psychosocial Impact of the Implantable Cardioverter Defibrillator: Nursing Implications , 2002, The Journal of cardiovascular nursing.

[20]  Randi Markussen,et al.  Bjørn & Markussen: Cyborg Heart: The Affective Apparatus of Bodily Production of ICD Patients , 2013 .

[21]  Gill Haddow,et al.  New risks inadequately managed: the case of smart implants and medical device regulation , 2015, Law, innovation and technology.

[22]  Luthfi Ramadani,et al.  Preliminary Investigation , 2015, 2015 Second International Conference on Computing Technology and Information Management (ICCTIM).

[23]  Fiona A. Stewart,et al.  Strategies to improve radiotherapy with targeted drugs , 2011, Nature Reviews Cancer.

[24]  Stuart S Blume,et al.  The Rhetoric and Counter-Rhetoric of a "Bionic" Technology , 1997, Science, technology & human values.

[25]  Emily A. Kuhl,et al.  The ICD Shock and Stress Management Program: A Randomized Trial of Psychosocial Treatment to Optimize Quality of Life in ICD Patients , 2007, Pacing and clinical electrophysiology : PACE.

[26]  Jeffrey G. Andrews,et al.  In-vivo communication using blood vessels as the transport channel , 2009, 2009 Conference Record of the Forty-Third Asilomar Conference on Signals, Systems and Computers.

[27]  B. Withell.  Patient consent and implantable cardioverter defibrillators: some palliative care implications. , 2006, International journal of palliative nursing.

[28]  M. Dorman,et al.  A Sensitive Period for the Development of the Central Auditory System in Children with Cochlear Implants: Implications for Age of Implantation , 2002, Ear and hearing.

[29]  E. Gisquet.  Cerebral implants and Parkinson's disease: a unique form of biographical disruption? , 2008, Social science & medicine.

[30]  A. Peñaranda,et al.  Parents' narratives on cochlear implantation: reconstructing the experience of having a child with cochlear implant , 2011, Cochlear implants international.

[31]  J. Tagney.  Can nurses in cardiology areas prepare patients for implantable cardioverter defibrillator implant and life at home? , 2004, Nursing in critical care.

[32]  Shawn H E Harmon,et al.  Medical research data-sharing: the 'public good' and vulnerable groups. , 2012, Medical law review.

[33]  J. Borenstein,et al.  Medicine by micromachine , 2009, IEEE Spectrum.

[34]  B P Tucker,et al.  Deaf culture, cochlear implants, and elective disability. , 1998, The Hastings Center report.

[35]  Jean Baudrillard,et al.  The System of Objects , 1968 .

[36]  T. Kohno,et al.  Improving the security and privacy of implantable medical devices. , 2010, The New England journal of medicine.

[37]  Kevin Fu,et al.  Security and Privacy for Implantable Medical Devices , 2008, IEEE Pervasive Comput..

[38]  Gill Haddow,et al.  Cyborgs in the Everyday: Masculinity and Biosensing Prostate Cancer , 2015, Science as culture.

[39]  Kevin Fu,et al.  Pacemakers and Implantable Cardiac Defibrillators: Software Radio Attacks and Zero-Power Defenses , 2008, 2008 IEEE Symposium on Security and Privacy (sp 2008).

[40]  Clive Seale,et al.  Researching Society and Culture , 2017 .

[41]  D. Bowers,et al.  Deep Brain Stimulation and the Role of the Neuropsychologist , 2007, The Clinical neuropsychologist.

[42]  A. Strauss,et al.  The discovery of grounded theory: strategies for qualitative research aldine de gruyter , 1968 .

[43]  S S Blume,et al.  Histories of cochlear implantation. , 1999, Social science & medicine.

[44]  M. Foucault,et al.  The Order of Things , 2017 .

[45]  G. S. Wilson,et al.  Biosensors for real-time in vivo measurements. , 2005, Biosensors & bioelectronics.

[46]  Robert James Sparrow,et al.  Defending Deaf Culture: The Case of Cochlear Implants* , 2005 .

[47]  J. Christiansen,et al.  Correlates of psychosocial adjustment in deaf adolescents with and without cochlear implants: a preliminary investigation. , 2009, Journal of deaf studies and deaf education.

[48]  Raghu Garud,et al.  A Socio-Cognitive Model of Technology Evolution: The Case of Cochlear Implants , 2015 .

[49]  R. Hauer,et al.  ICD: a qualitative study of patient experience the first year after implantation. , 2004, Journal of clinical nursing.