It’s not on the radar screen of your obstetrician quite yet, but the US Food and Drug Administration (FDA) and technology security people have been pondering cyber threats to implanted medical devices for at least the past four years. An increasing number of people depend on implanted medical devices, which could be hacked, not as easily as your phone or other internet-dependent devices, but with more dire consequences.
The aim here is not to scare, but to promote a sense of reasonable vigilance as medicine moves into the future. Articles are accumulating with increasing references to an approaching age of “medjacking”. I have found nobody describing any actual cases of malicious hacking of implantable device, but we seem to be in an era of warnings. Last October, Johnson and Johnson announced that there’s low but real risk that implanted insulin pumps could be hacked. An increasing number of diabetics –including some diabetic pregnant women—use these devices, because they provide more precise insulin and blood sugar control, compared with self monitoring of blood glucose and self insulin administration. The pumps can do this, because of little computers that exchange data through radio links with other devices. These linkups are enabling capabilities that are expected to save lives, but medical technology experts cited in a BBC story have pointed out that security measures are lagging behind the developing therapeutic capabilities.
Insulin pumps have been at center stage of the discussions, because it’s fairly easy to explain the risk in terms of what the pumps do. In endocrinology, the decision on giving insulin therapy is generally straightforward, while tweaking the dosage and timing always constitutes the bigger challenge. Thus, if somebody could access the radio link exchanging information on blood glucose levels and pump rates, the potential danger is clear. Somebody with access could command pumps to increase insulin doses to kill people, or a bunch of people at once. While such nefarious pump hacking is still hypothetical, a story last year –popularized in Popular Science Magazine— described how a tech savvy woman with Type 1 diabetes hacked her own insulin pump. She did this to improve insulin delivery, but also to expose the vulnerability of such devices.
Along with insulin pumps, there are other implanted devices with electromagnetic signals and functions that are critical to life. Many people have implanted cadioverter-defibrillators (ICDs), for instance, devices that deliver and electrical jolt to the heart should it develop a dangerous rhythm. This includes some women who become pregnant, and investigators have found that the device poses no major risk to the fetus. That’s assuming, that nobody hacks into it, but there actually is a hacking possibility with these devices too, since they also put out an electromagnetic signal.
Of course, security is the initial and principal concern when we talk about devices that interface with life-critical functions. However, the case in the Popular Science story also suggests that we are entering an age of people hacking their own bodies through medical devices, gene therapy, and other means. Ultimately, could this lead to a society of biological casts, characterized by the tech- and biotech savvy having not just better health interventions, but even biological enhancements that simply are not accessible to those lacking the technical capability?