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IEET > Life > Access > Enablement > Innovation > Contributors > Kyle Munkittrick

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A Tale of Two Prostheses


Kyle Munkittrick
By Kyle Munkittrick
Pop Transhumanism

Posted: Feb 3, 2010

Prosthetics are amazing. Aimee Mullins and Oscar Pistorius are living examples of how a disability can become an opportunity not just for success, but for super-human ability.

Our popular culture is packed with characters with enabling prostheses: Lt. Dan, Luke Skywalker, and Nina Sharp. Within the past decade, many have come to the realization that a prosthetic need not be a disturbing hook or peg leg. It need not be an impediment or an indicator of dysfunction. In fact, it can be a thing of beauty.

But there is a problem: cutting-edge prostheses are absurdly expensive. Fast Company has a great article on Hugo Herr, an M.I.T. professor, and Carrie Davis (pictured), both of whom have incredible, powerful prostheses. As I was coming down from my techno-fetish high after reading the article, I noticed the comments. They offered quite a different picture, pointing out the cost, first and foremost, as well as the rose-colored glasses the author and his interviewees seems to be wearing. One commenter wrote:

While Carrie may have a cool iLimb that makes a noise when she touches her wine glass — I would like to know what Carrie thinks when she wants to do something as simple as scratch her ass, or change her tampon, or touch her babies face.

The point is the prosthetics are still imperfect. The commenters note the failure rate of the technology, the problems of putting on the prosthetic itself, and the lack of options for many amputees. Their points are valid, but sadly both commenters veer in the opposite direction of the article, coming off as cynical and morose about the condition of those who need prostheses. Both the commenters and Hugo Herr discuss eyeglasses as a kind of prosthetic. The point Herr makes is that eyeglasses are so common that, in addition to being functional, many people incorporate them into their fashion sense. In fact, when given the option to wear contacts, get Lasik, or wear glasses, many still choose glasses. I am one of those people, but I believe Herr is over simplifying. Contacts dry out when you’re on the computer a lot (like me) and Lasik is only worth while to those with a very bad prescription (unlike me). Glasses, in addition to making me look rather dashing, are just the most functional of my options. But, and this is the important part, I have options. The problem with the limbs described by the Fast Company article is that they are a combination of Lasik and fashion glasses: expensive, top-of-the-line, and unnecessary for most people.

Which is where we come to the other side of the story. The carbon-fiber showpiece Carrie Davis adorns with a Tiffany ring and holds a wine glass is about as far from the Jaipur foot as one can get:

The beauty of the Jaipur foot is its lightness and mobility–those who wear it can run, climb trees and pedal bicycles–and its low price. While a prosthesis for a similar level of amputation can cost several thousand dollars in the U.S., the Jaipur foot costs only $28 in India. Sublimely low-tech, it is made of rubber (mostly), wood and aluminum and can be assembled with local materials. In Afghanistan craftsmen hammer the foot together out of spent artillery shells. In Cambodia, where roughly 1 out of every 380 people is a war amputee, part of the foot’s rubber components are scavenged from truck tires.

That is innovation of the best kind. The Jaipur foot was developed by Dr. Pramod Karen Sethi and Ram Chandra. The former is an orthopedic surgeon and member of the Royal College of Surgeons, the other, an artisan with barely an elementary school education. Their story is beautifully chronicled in Time’s “Heroes of Medicine” series. The Jaipur foot allows mobility, comfort, and is, thanks to Chandra’s skills, beautiful.

One one end of the spectrum, we have the hyper-expensive, power-assist, high-tech PowerFootOne by Hugo Herr, and on the other end, the Jaipur foot, $28 and made of recycled artillery shells and tires. So who is right? Is Herr right in trying to develop a foot that does more than any other prosthetic foot, pushing the limits of tech a little further out? Or are Sethi and Chandra right, to build a minimally expensive foot that restores basic function to those who need it? Are the commenters right, in pointing out the ridiculous attitude Herr and Davis have in regarding their prosthetics as positive, beautiful aspects of their selves? Which do we choose?

All three. The points and purposes are not mutually exclusive. The commenters, who represent skeptics at large, keep the tech and prosthetics developers honest: hooray, you’ve built a fancy, expensive, fashion piece that breaks easily and is only affordable to those in the highest tax brackets. Skeptics are the ones who turn our heads from the shiny show pieces to the practical inventions, like those of Sethi and Chandra. Yet there is no reason that the inventions of Herr (and of others, like Dean Kamen’s Luke Arm or the Cheetah Blades used by Aimee Mullins) cannot exist in the same world as the Jaipur foot. Let wealthy socialites like Carrie Davis wear a Tiffany ring on her liquid-black, high-fashion arm. In doing so, let her turn banal cocktail conversation towards the better purpose of normalizing prosthetics. If she can afford a “bag of hands worth more than [her] house,” good for her! It seems she is using that wealth to force the wealthy gaze onto the issue of prosthetics. Herr and Davis are on the same side as Sethi and Chandra; all are working to improve the lives and well-being of those with a need for prostheses.

For a farmer in India, the Jaipur foot lets daily life return to about normal, at least enough to keep bringing in the crops. For Davis, an arm that costs as much as a luxury sedan lets her mingle in high-society, get noticed, and come off as superior. The Jaipur foot sends the message, “If you have lost a limb, all is not lost. There is hope.” The work of Herr, Mullins, Davis and Pistorius says, “Just because I have a prosthetic does not mean I am disabled. In fact, I may be better off than you. I might be enhanced.” The combined message of both groups is, “A lost limb need not be permanent, disfiguring, or disabling. It is a common, real problem and it is one we can solve. And in that solution, there may be a better, empowering, improvement on what nature originally gave us.”


Kyle Munkittrick, IEET Program Director: Envisioning the Future, is a recent graduate of New York University, where he received his Master's in bioethics and critical theory.
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COMMENTS


Hello Kyle,

Carrie Davis here.  Interesting piece : though I’m not a wealthy socialite that mingles in high society, gets noticed and comes off as superior.  It may have seemed like that from the article in Fast Company Magazine, but let me assure you, I’m an average girl who has dedicated my life to helping others who have lost limbs.  My “Tiffany Ring” is a $10.00 sparkly gem on an elastic, stretchy band.  The seemingly ridiculous attitude that I have regarding my prosthesis as a positive, beautiful aspect of myself is not ridiculous at all.  In fact, it took me many years to get to a point where I was proud of the body that I came in, prosthesis and all.

Therefore, like I said, I have dedicated my whole life to helping others.  I am a National Patient Advocate for Upper Extremity Patients seeking assistance.  I have worked with kids, families, adults, soldiers, etc. to help them accept their bodies and work effectively with their prostheses.  I write letters to insurance companies to help patients get funding for prostheses and once they receive them, I’m there every step of the way to offer moral support and guidance.  When insurance doesn’t come through, I work to help try to find a way.

I also volunteer at a camp called Camp No Limits - a camp for kids with limb deficiencies.  My goal is to catch kids before they decide their self-image based on their body image or what they don’t have versus the gifts, talents and heart that they do have.  I’d invite you to check out the foundation www.nolimitfoundation.org. That “ridiculous positive attitude” and sense of pride in my body is one that I hope kids also grab on to, as well. 

I’m also the National Coordinator for a volunteer organization called Amputee Empowerment Partners; a group of over 500 trained volunteers nationwide who also want to assist new amputees navigate the road to recovery.  We just started a very unique e-community online specifically geared toward helping others. 

My “bag of arms” has been compiled over 20+ years.  I have an i-LIMB, yes, which I do think is pretty special, but I also have a cable operated hook that I wear regularly, as well.  Do people perceive me differently when they see the hook hanging out of my sleeve versus the hand?  Yes.  Do I care?  Not so much. 

What I do care about is that people see me for who I am and what I’m about versus what I’m missing.  The black i-LIMB starts conversations.  The hook repels them.  When I catch people staring at my hook, I invite a conversation, “Hey, I saw you were looking at my hook - do you have any questions?  Would you like to know more about it?”  Whether I want the attention or not, I get it and so I use it to benefit others, hopefully.

I thank you for noting that we are all working to improve the lives and well-being for those with the need for prostheses.  It truly is my mission in life.  I’m not a wealthy socialite.  I’m a single mom to two amazing sons, living in a modest home, moving through life the best I can, hoping I can help people along the way. 

My prosthesis and its price tag have very little to do with me.  However, having access to all kinds of prostheses has allowed me to accomplish anything that I have set my sights on.  Thanks to my prostheses and the great prosthetists that I have had the good fortune to work with in my life, I am able to do anything I want.  I’ve always said that if you don’t have a hand, you don’t have an excuse, because there is a prosthesis or a terminal device that will allow me to do anything I can set my mind to - even, as one commenter wondered : scratch my…

Cheers Kyle.





Carrie, I am so glad you found this post and set the record straight. We spoke via email, but I’d like to apologize publicly as well for my errors in the post. Your story is far more interesting than that Fast Company article, let alone what I wrote. I hope you write a post or two for IEET. Lord knows we need some people who live in the real world to remind us why we’re writing about all this transhumanist stuff in the first place. Thanks so much for commenting, I can’t wait read more from you.





Aimee Mullins and Oscar Pistorius are living examples of how a disability can become an opportunity for the very wealthy and/or sponsored.  How many of us fall into that category?  I’m a housewife in CO with two sons.  I have medical insurance through my husband’s job that we pay thousands of dollars per year in premiums and thousands of dollars in “deductible and out of pocket expenses” and I still have to fight for my prosthetics each time I need one.  The latest from the insurance company was when they decided to categorize the foot and socket on my prosthesis as ‘experimental’ even though they’d paid for the exact same type on my previous prosthesis.  They make us jump through hoops. 
I was lucky enough to have my insurance company approve a socket with suction, a newer development in prosthetics, which was the best thing to happen to me since I lost my leg in 1991.  I was able to do so much more than before I had that type of socket, and with almost zero pain.  I was able to join a gym and do cardio exercise for the first time in years, which led to me lose the 50 pounds I’d gained since losing my leg, hence the need for a new prosthesis, only this time what they approved a couple of years earlier was now “experimental” and not considered medically necessary.  After the insurance company received a ‘not so happy’ letter I’d written to my prosthetist detailing my weight-loss, activity increase, better, easier mobility, decreased cholesterol level and blood pressure, lack of need for pain meds, they decided to approve the suction pump as well as the foot they were denying.  They thought a foot that walked pretty much like a brick would be good enough.
I can’t imagine the companies that make these cutting edge, absurdly expensive prosthetics can be making much money on them, unless of course there are many extremely wealthy limb needing citizens that I’m not aware of.  I can’t afford the cutting edge.  Shoot, I can’t even afford the skin cover that would make my prosthesis look identical to my real leg as it costs approximately $23,000 for the skin alone, and the insurance company won’t touch that one!  That’s more than the prosthesis!  The prosthesis my insurance company will pay for anyway.  I’d love to be able to put on a dress and heels and feel like I did before I lost my leg.  My insurance company does not think that is ‘medically necessary.’
It makes zero sense to me that insurance companies will pay for total knee and hip replacements (those are prosthetics too) which are far more expensive than a prosthetic limb, but balk at paying for outer prosthetics, and want to cover just the bare minimums. 
It’s great to hear of all the breakthroughs and advancements in the prosthetic world, but I can’t help but wonder when I do who exactly is benefiting from them.  I lost my leg in ‘91 and have never had a running leg.  I would LOVE to be able to run again, but I can barely get my walking leg paid for, you know there’s different legs for different activities, right?  I also have a nearly 10 year old shower leg.  Even when I do manage to get the insurance company to approve a new prosthesis it still costs me thousands of dollars in out of pocket expenses.  Do I just not know the right people?  Do I just not have the right connections? 
I’m happy for Aimee Mullins and Carrie Davis.  I applaud their “ridiculous positive attitudes,” which are not only admirable, but necessary.  They deserve the prosthetics that they have, but so do I. 
Boy can I relate to Carrie when she catches people staring at her arm.  No matter how strong you are, it’s not fun when you see someone looking at you with what comes across as a repulsion.  It’s not fun when the loss of your limb seems to be what people identify you as.  I HATE the stares, especially the quick ‘look aways,’ when they realize they’ve been spotted.  I WELCOME the questions.  It’s different, it’s intriguing perhaps, and I understand and welcome the curiosity, yet I still view myself as a beautiful woman who appreciates, like any other woman, being seen and appreciated for who I am, and like Carrie stated, who I am is not what I’m missing. 
I would love to be a National Patient Advocate for Lower Extremity Patients seeking assistance.  I’m going to look into that, but in the meantime please remember that although all of the advancements in the prosthetic world make a great story, that’s all it’s really been for me as they are out of my league.





I also have a nearly 10 year old shower leg. Even when I do manage to get the insurance company to approve a new prosthesis it still costs me thousands of dollars in out of pocket expenses. Do I just not know the right people? Do I just not have the right connections?





I’m a 16 year old girl with a below-the-knee amputation. I don’t mind people staring really. What bugs me is when people are too worried about offending me to ask questions. I am very good humored about my leg and love to answer their questions.

That’s beside the point, though. I hate the question, “Are you able to do this?”. Of course I am! Would I let my parents pay thousands of dollars for a prosthetic if it won’t allow me to do what any other teen girl can do? No way! I’d rather limp, crawl, and hop my way through life than have a leg that won’t give me the mobility I need.





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