[HN Gopher] Spinal implants allow paralysed people to walk, swim...
       ___________________________________________________________________
        
       Spinal implants allow paralysed people to walk, swim and cycle
       again
        
       Author : helsinkiandrew
       Score  : 404 points
       Date   : 2022-02-09 06:45 UTC (16 hours ago)
        
 (HTM) web link (www.economist.com)
 (TXT) w3m dump (www.economist.com)
        
       | smm11 wrote:
       | Good. Now cure cancer, and grow hair back on my head.
        
       | Cthulhu_ wrote:
       | My main criticism and cynicism from articles like these (related:
       | prosthetics) is that they help the few people that are lucky,
       | popular, or rich; lucky to have a doctor or to find a program and
       | get into it; popular because they end up in social media 'feel
       | good' posts and articles; rich because it's experimental, low-
       | volume tech or treatments that require going abroad. Popular can
       | also translate to being able to afford it, but it's shameful that
       | people have to post their stories online to raise money.
       | (shameful to society that is, not the people who are driven by
       | desperation).
       | 
       | But I guess things like this will eventually trickle down to
       | general and widespread availability, just technological
       | advancements like cochlear implants and pacemakers did.
        
         | huhtenberg wrote:
         | Oh, knock it off.
         | 
         | What these people did is nothing short of amazing.
         | 
         | Yet, here we are - a completely generic and trivial "critique"
         | comment is the highest upvoted sentiment. On the HN of all
         | places. Jesus.
         | 
         | The same "complaint" can be lodged against ANY novel treatment
         | before it's fully productized for mass adoption.
        
           | Jaruzel wrote:
           | > _Yet, here we are - a completely generic and trivial
           | "critique" comment is the highest upvoted sentiment. On the
           | HN of all places. Jesus._
           | 
           | And 26 minutes later it's now downvoted. HN is working as
           | intended, you just have to wait and let the community do it's
           | job.
        
           | benjamir wrote:
           | I waited for this.
           | 
           | I agree with you and always have to think about "Everything
           | is amazing and nobody is happy": https://youtu.be/nUBtKNzoKZ4
           | 
           | -- and I don't care it's Louis C.K. saying it. Like I don't
           | care if a songs from Michael Jackson is playing. Still true.
        
         | twayt wrote:
         | You don't have to worry about that. If it's possible, the
         | market will solve that. Think of this as a proof of concept
         | that viable tech and a potential market exists.
        
         | germandiago wrote:
         | We all want the biggest amount of people have something that
         | improves their life.
         | 
         | However, I am yet to see a single service or product or
         | improvement that all humanity took at the same instant. It
         | simply does not or won't ever exist.
         | 
         | These things need work, feedback, improvement. It is literally
         | impossible to deliver things at the same time to everyone.
         | Besides that, if that happened, but cannot, you would also make
         | exactly the same mistakes with almost everyone. So tak e for
         | granted that people that come later are granted to take
         | improved versions of these techniques.
         | 
         | Economy in the sense of scarcity and availability, was, is and
         | will be always like this. If you wanted everyone to have this
         | at the same time the only reality is these people would have to
         | wait until general availability, things would probably be
         | slower bc of the loop feedback and noone would get this
         | benefit, just these three people would not get ir. So noone
         | wins this way, except your feeling of fairness. But it is notba
         | rational choice.
         | 
         | What we need is massification and learning of these tecniques
         | as they are certified as safe and to lower its price as much as
         | it is possible to spread its availability.
         | 
         | I think your negativity comes from the frustration that you
         | cannot accept reality as it is. We all want what you say. It is
         | just not how things work, unfortunately.
        
         | jillesvangurp wrote:
         | That's generally how things with new tech. Initially expensive;
         | it gets cheaper over time. Eventually patents run out and
         | everybody gets in on the action.
        
         | [deleted]
        
         | greatpatton wrote:
         | Please this is public research from a public University, what
         | do you expect? That they can scale it to 1000 of people? This
         | is research as intended, now commercial products may be built
         | out of this but it will take time again.
        
         | resonious wrote:
         | Do you have any ideas or advice on how these products should be
         | developed instead?
         | 
         | Sorry if that came off as antagonistic. I think I actually
         | agree with the overall sentiment that luck and popularity
         | shouldn't be barriers to healthcare, but experimentation is a
         | necessary part of the process. And at the very least, luck is
         | inherent to experimentation.
        
           | thaumasiotes wrote:
           | Obviously, medical experiments should only be done on the
           | poorest and neediest segment of the population. There's no
           | way to spin THAT as exploitative. ;D
        
         | DeWilde wrote:
         | I see it differently, I think articles like are important by
         | making people aware of solutions like these which will speed up
         | the time needed to get them to people not as fortunate to have
         | access to them now. More awareness means more people will work
         | towards making the solution, lowering their cost.
        
           | BelleOfTheBall wrote:
           | I'd agree with this sentiment. These articles make people
           | excited and bring awareness plus, if you allow me to
           | speculate, I bet someone with paralysis who at least sees
           | these articles and realizes they might have a chance to walk
           | in the future will feel better than someone who doesn't see
           | them. Knowing there is a chance makes it easier to cope with
           | problems. Or maybe I'm wrong, tell me if I am, I fully
           | understand my perspective may be skewed.
        
             | DeWilde wrote:
             | I have a few medical problems that aren't solvable with
             | current technology, seeing articles like these related to
             | my issue gets me excited and hopeful that I'll be cured one
             | day.
             | 
             | And as an engineer it brings attention to me that there are
             | companies solving these problems that I could work for to
             | speed up the effort.
        
       | mgreb wrote:
       | Walk, swim, cycle? Are we talking about pre-recorded neural
       | commands, "modes" in implant? Or they actually managed to restore
       | connectivity in nerves, bypassing damaged part?
        
         | unnouinceput wrote:
         | No.
         | 
         | Quote from article: "Dr Courtine and Dr Bloch have developed a
         | wafer-thin device with electrodes that could target the dormant
         | nerves. Once implanted into Mr Roccati's back, the device sent
         | in pulses of electricity that mimicked those normally present
         | in the nerves of an uninjured person as they walk.
         | 
         | By doing this, the device acted like an amplifier for any
         | electrical signals coming from Mr Roccati's brain. Those brain
         | signals would normally be blocked by his damaged spinal tissue
         | and be incapable of activating the nerves in his lower back.
         | But with the stimulation device in place, Mr Roccati was able
         | to voluntarily control those once-dormant nerves, allowing him
         | to move his legs and walk."
         | 
         | It's his brain, the device is only used as amplifier. The fact
         | that article talks about "Walk, swim, cycle" in its title is
         | only a part of what people fitted with devices can do. It said
         | he can also sit and talk to friends at bar.
        
           | eps wrote:
           | It's NOT his brain. The article is 100% wrong.
           | 
           | Read the Nature article linked at one of top comments. It is
           | also mentioned in every interview the researchers gave
           | recently. The muscles are controlled with the software only,
           | the brain doesn't participate at all.
           | 
           | "... the first implant specifically designed to control
           | movement by _mimicking the signals the lower body usually
           | receives from the brain and upper spinal cord._ "
           | 
           | https://www.nature.com/articles/d41586-022-00367-1
        
           | vba wrote:
           | Why is this post downvoted? Is it inaccurate.
        
             | wizzwizz4 wrote:
             | It's best not to speculate too much on voting. Who knows
             | how many bots and trolls there are?
        
             | eps wrote:
             | Yes, it is inaccurate to the point of being the reverse.
             | 
             | Muscles are controlled through the software, with pattern
             | of activation uploaded from an iPad via Bluetooth and
             | generally managed by am accompanying person. The patients
             | absolutely do NOT control the muscles with their brain.
        
               | snovv_crash wrote:
               | So basically it's just a DAC + amplifier, not an ADC or
               | with any kind of passthrough.
        
           | clsec wrote:
           | The methods used in this study sound almost exactly like a
           | TENS unit (1). As someone with a spinal cord injury that
           | almost left me a quadriplegic, and who has serious neuropathy
           | as a result, I have found that TENS units do very little to
           | help me. I hope this can help people though,
           | 
           | (1) https://en.wikipedia.org/wiki/Transcutaneous_electrical_n
           | erv...
        
         | huhtenberg wrote:
         | They hooked up trodes to the bottom section of the nerves,
         | enabling patients to activate, selectively, respective muscles.
         | Chain those activations together in sequence and you got a
         | walk.
         | 
         | It's described in the Nature article linked from another
         | comment - https://www.nature.com/articles/d41586-022-00367-1
         | 
         | Also I heard authors give an interview on the radio and they
         | mention that while walking is impressive, a more practical
         | outcome is an ability to control muscles on the back, because
         | these allow for bending and controlling the balance while
         | sitting on a chair.
        
           | cjmcqueen wrote:
           | As the partner of a complete paraplegic, sitting up and
           | providing trunk control would be a huge benefit to newly
           | injured patients. My partner had titanium rods but in their
           | back 20+ years ago and the connections and bones are now
           | wearing down. Allowing the muscles to provide trunk control
           | would likely improve quality of life, increase mobility, and
           | remove the challenges with arthritis from implants they put
           | in spinal cord injury patients currently.
        
             | Tabular-Iceberg wrote:
             | Reading in detail what it actually entails to be completely
             | paraplegic is quite an eye-opening experience.
             | 
             | I think a lot of people don't really see past the
             | wheelchair, I certainly didn't for a long time. Some people
             | try as an educational experience to live for a day in a
             | wheelchair, but that's easy, spending a whole day sitting
             | down is something desk workers do anyway. It's a completely
             | different thing if you don't get to use any core muscles. I
             | wanted to try that, but couldn't go even ten seconds
             | without cheating. Even with all kinds of assistive
             | technology it's extremely hard. Also the lack of bowel
             | control must be a total nightmare.
             | 
             | The whole "paraplegics can do anything, they're just like
             | you and me" schtick that normal people are fed is a nice
             | coping mechanism, but I think it may be holding back
             | funding for research into real solutions.
        
         | MayeulC wrote:
         | Probably pre-recorded, according to the nature article:
         | 
         | > _Once the implant was in place, each person could control the
         | pattern of electrical stimulation, using buttons and a tablet
         | to raise or lower each leg, for example [...] using the device
         | to guide their muscles through preprogrammed movements._
        
       | twayt wrote:
       | I wonder if this could be used for a truly immersive vr
       | experience.
       | 
       | 1. Hook up said implant, convert analog impulse to digital 2.
       | Chemically induce paralysis of the peripheral motor neurons (??)
       | 3. Truly immersive VR experience where participant controls
       | embodied avatar
        
         | amatic wrote:
         | For the full experience you might also need some touch
         | feedback. Maybe vibration gloves or some sort of pressure
         | actuator to mimic touch.
        
         | plutonorm wrote:
         | yeah, I've been thinking about this for a while. You can do a
         | kind of tomographic reconstruction of neural impulses in the
         | spinal column. By the same token you can induce electric fields
         | within the spinal column.
         | 
         | You need an incredibly high density of electrodes arranged
         | around the spinal column. Then you need to construct in real
         | time an image of the internal spinal column down to the level
         | of fibre bundles, in real time. Then when you want to stimulate
         | something you can apply the correct voltages to the huge
         | numbers of electrodes and induce firing in the target neuron
         | bundles.
         | 
         | Oh and you need to understand how neurons relay information -
         | not actually a solved problem.
         | 
         | It's all possible. Just good luck getting this to work before
         | the year 2100.
         | 
         | But in the back of my mind I have a plan involving flex pcbs...
        
           | pharke wrote:
           | Might be a bit sooner than 2100
           | 
           | https://www.roadtovr.com/neuralink-brain-interface-limb-
           | trac...
        
         | mwcampbell wrote:
         | The sequel to the novel Ready Player One, predictably called
         | Ready Player Two, begins by introducing an OASIS Neural
         | Interface (ONI) headset, which paralyzes the body and directly
         | connects the brain to the OASIS VR. To develop this technology
         | in secret, the creator of the OASIS set up an "Accessibility
         | Research Lab" to develop implants for various categories of
         | disabled people, then moved on to develop the headset.
         | 
         | As a disabled (legally blind) person myself, I had mixed
         | feelings about this. On the one hand, it felt like we (well,
         | the disabled people in the fictional world) were being used as
         | means to an end. On the other hand, one of my unanswered
         | questions from the first book was what the rise of a VR like
         | the OASIS would mean for people like us; I felt that the second
         | book provided a satisfying answer (in the fictional world, if
         | not in the real one).
         | 
         | To be clear, the sequel was panned, for good reasons IMO. I
         | chose to read it before looking at the reviews. I don't
         | recommend it, but this comment reminded me of it.
        
         | jcun4128 wrote:
         | SAO
         | 
         | Wonder if you use your mind vs. a display, then are the visuals
         | as good as real life. Or maybe you feed the image and your mind
         | upscales it.
        
           | eps wrote:
           | What's "SAO"?
        
             | jcun4128 wrote:
             | It's an older RPG anime about people laying in bed playing
             | a game in a virtual world via a BCI head set. It wasn't
             | like today's VR, their eyes were closed.
        
           | twayt wrote:
           | The number of bits needed for visual input far outweigh that
           | needed for motor output so I'm not optimistic that it can
           | improve the immersiveness of the experience.
        
         | [deleted]
        
       | goldenkey wrote:
       | Seems incredibly risky. If a muscle is stimulated too greatly
       | without the user's ability to feel it cramp or be overworked, it
       | could potentially rip, rupture, etc.. and now the user will be
       | dealing with rhabdomyolysis without even having any notice.
        
         | cjmcqueen wrote:
         | True risk. My partner is a paraplegic and their are things to
         | watch out for all the time. Hot items on paralyzed skin, bed
         | sores, muscle atrophy. I don't know if this is common, but my
         | partner has developed a heightened sense of awareness for many
         | of these things. Not to say that muscle tears couldn't happen,
         | but there are other senses that do kick in with practice and
         | awareness to keep people safe.
        
         | adingus wrote:
         | I'm sure folks who get this treatment will be willing to stick
         | to activities less strenuous than an intense CrossFit workout.
        
           | viraptor wrote:
           | You don't need to do crossfit to get injured. You're
           | perfectly capable of injury by pushing your arm back, walking
           | too slowly, and many other "normal" movements if you ignore
           | the pain or are not able to feel it. This is basically a one-
           | way interface and as far as I understand it, the patients
           | don't get the sensations coming back.
        
       | benjamir wrote:
       | I think I would cry tears of joy even seeing _anyone_ even just
       | wiggle their toes after not being able to do so. How awesome that
       | most be to witness somebody who could only recently dream of
       | doing this, really accomplish this?
       | 
       | _This_ is infinitely more amazing than any crypto shit, saving-
       | the-world with Lomi blah blah blah and senseless techno-garbage
       | some wanna-be-rich-thanks-to-an-exit-strategy creeps propagate on
       | HN.
        
         | allisdust wrote:
         | Or the ad industry that keeps peddling more material shit on
         | all of humanity. They ensure that the brightest minds are
         | occupied by only one thought: how to maximise clicks.
        
       | lotophage wrote:
       | So they can complete a triathlon?
        
       | spupe wrote:
       | This builds upon some solid research in rodents and humans, which
       | had showed very promising results. It is very likely to become a
       | therapeutic option within the next 10 years, in my opinion.
        
         | sschueller wrote:
         | Yes, a tremendous amount of research and animal testing. The
         | exact opposite of what Elon is promising and doing after taking
         | over nural link.
        
       | eerikkivistik wrote:
       | I have a colleague who could benefit from this type of new
       | treatment. Since HN is a wonderful place with a multitude of
       | experts in various fields, I'll throw a question in the air:
       | 
       | Who and how would I contact, if I wanted to know more about these
       | kinds of clinical trials and participation?
        
         | pakitan wrote:
         | This is the company from the article:
         | 
         | https://www.neurorestore.swiss/join-our-programs
        
         | paledot wrote:
         | As a sibling comment noted, the vast majority of
         | "breakthroughs" are hot air and your discovery of a way to
         | "fix" your colleague may not be received as warmly as you
         | expect. I don't know anything about your colleague or your
         | relationship with them, but I strongly advise careful
         | consideration before broaching the subject. (In fact, I
         | strongly advise against bringing it up at all. "I found a cure
         | for you" is up there with "what's wrong with you" and "I'll
         | just push your wheelchair without your consent" on the list of
         | ways to really, really piss off someone with a disability.)
        
       | Proven wrote:
        
       | rosege wrote:
       | Just a couple of days ago there was an article about Israeli
       | scientists using stem cells to fix the spine:
       | https://scitechdaily.com/human-spinal-cord-implants-breakthr...
        
       | neonate wrote:
       | http://web.archive.org/web/20220209151817/https://www.econom...
       | 
       | https://archive.is/3rCen
        
       | _Microft wrote:
       | There is an article in Nature on this which in my opinion is even
       | better than the submission:
       | https://www.nature.com/articles/d41586-022-00367-1
       | 
       | Here is the actual paper:
       | https://www.nature.com/articles/s41591-021-01663-5 (paywall)
        
       | ineedasername wrote:
       | Growing up, this sort of thing was speculated about with almost
       | the same level of "sci fi" around it as things like stopping
       | aging, instant cures for new diseases, and video phones.
       | 
       | Just another example of how I slowly ended up living in the
       | future without fully realizing it. Now, where's my flying car and
       | Rosie, my robot maid?
        
         | pharke wrote:
         | Futurists and sci-fi authors always focus on the destination,
         | we're the ones that get to experience the journey.
        
         | felipemnoa wrote:
         | Not a flying car but close enough:
         | https://www.autocar.co.uk/car-news/move-electric/meet-jetson...
        
         | beaconstudios wrote:
         | Flying cars, despite being a symbol of a scifi future, are
         | actually a pretty bad idea. Driving on wheels is much more
         | energy efficient than flying, and without the risk of acting
         | like a kinetic weapon if the battery cuts out.
         | 
         | I'm all for innovation, but I do think it's easy to get the
         | wrong end of the stick with scifi and focus on the aesthetic
         | over the social conditions.
        
         | T-A wrote:
         | https://www.dw.com/en/slovakia-certifies-flying-car-as-airwo...
         | 
         | https://www.theverge.com/2021/11/19/22791267/alphabet-google...
        
         | wizzwizz4 wrote:
         | https://en.wikipedia.org/wiki/Autogyro is your flying car. Your
         | "robot maid" lives on your smartphone, probably called Alexa or
         | Siri or Mycroft.
        
       | abhayhegde wrote:
       | For those who are not able to access this:
       | 
       | https://12ft.io/proxy?q=https%3A%2F%2Fwww.economist.com%2Fsc...
        
         | dotancohen wrote:
         | > For those who are not able to access this
         | 
         | We are now at the technological level where the paralyzed can
         | walk, but still at the legal level where information regarding
         | such achievements is best shared surreptitiously.
        
       | kvetching wrote:
       | Better hope you have insurance or are a part of a study. Spinal
       | Cord injuries are among the most expensive injuries to treat.
       | Totals up into the millions pretty quick.
        
       | bitfhacker wrote:
       | Can this help people with ALS?
        
         | moffkalast wrote:
         | I thought ALS was already treatable by pouring a bucket full of
         | ice onto yourself daily /s
        
       | cjmcqueen wrote:
       | As a partner of a person with a complete spinal cord injury, I
       | appreciate these articles and the science being done by these
       | researchers, it is truly a big and complex and worthwhile problem
       | to solve.
       | 
       | For most of us, I do want to suggest being careful when and how
       | you mention research and articles like this to people in
       | wheelchairs. Just be aware there are lots of different reasons
       | why someone might be in a wheelchair and what can and can't be
       | done for a given illness. It can be really taxing to get
       | suggestions or shares of articles like this from well-meaning
       | friends and family that don't actually understand the realities
       | of living with an injury or medical issue that puts someone in a
       | wheelchair.
       | 
       | Obviously people should know work is being done. And obviously
       | people might be excited to hear about breakthrough research. If
       | you're inspired by articles like this, consider donating to the
       | institutions funding the research. But, be aware that articles
       | like this come out every year and for the vast majority of spinal
       | cord injury patients it won't be available to them soon or ever.
       | 
       | If you really want to support those in the accessibility needs
       | community, support local building code changes and adaptive
       | sports and outdoors programs. Making buildings, sports, and
       | wilderness accessible will impact more people positively in the
       | near term. The science is cool and amazing, but 100k people are
       | limited by a few stairs to enjoy life and experiences with
       | family.
        
         | steve76 wrote:
        
         | willmadden wrote:
         | I completely agree. My mother has been a partial quadriplegic
         | since 1992 after a car accident. The moment there are broad
         | cures for injury related paralysis, it'll be front page news.
         | 
         | The most impactful thing you can do to help people with
         | paralysis is push for better wheelchair accessibility where you
         | live. It's amazing how much of the world is not accessible to
         | someone in a wheelchair.
        
         | tarboreus wrote:
         | I'm blind with a retinal disease and it's a similar dynamic.
         | Not all breakthroughs will help a given person. Additionally,
         | most breakthroughs seem to be some version of vaporware, and it
         | might be 10 or 15 years, or never, for most people in that
         | category to benefit. I go through phases of catching up on
         | research, but mostly try not to think about it.
        
         | Archelaos wrote:
         | Whenever I come across an article about walking robots for the
         | military, I am asking myself: What about walking-chairs as a
         | replacement for wheelchairs? Could that be a realistic solution
         | to the access problematic? I am an absolute layperson regarding
         | robotics. Can perhaps anybody with some background explain,
         | what to expect here in the next few years?
        
           | paledot wrote:
           | No. My wife is paraplegic and we did in fact test a
           | rudimentary exoskeleton at one point.
           | 
           | The reason they don't work is because the mobility she misses
           | the most is the ability to transport a cup of coffee from the
           | coffee maker to her desk, or the ability to go for a jog.
           | It's the little things that have the biggest impact, and no
           | one is going to don an exoskeleton to wear around the house.
           | 
           | Furthermore, the drive to overengineer mobility solutions
           | crashes headlong into the world of manual wheelchairs. Manual
           | wheelchairs are like road bikes: the best ones are the
           | smallest, lightest-weight ones (often made from the same
           | parts and materials). They have as few parts as possible, can
           | turn on a dime, and can be lifted one-handed into the
           | passenger seat of a car.
           | 
           | A walking device of some sort might be a better equivalent to
           | an electric wheelchair for someone with quadriplegia,
           | hemiplegia, muscle spasms, or generalized weakness, but here
           | you have the problem that many electric wheelchair users are
           | at high risk of pressure sores. There's a reason that
           | electric wheelchairs have all sorts of fancy recliner
           | features: sit in any chair for 16 hours a day without the
           | ability to shift around and you're going to do some pretty
           | serious damage to whatever your weight is resting on. An
           | exoskeleton necessarily holds you in a more upright position,
           | putting more weight on fewer body parts.
           | 
           | The solution to the access problem is to build ramps and
           | lifts.
        
           | ska wrote:
           | It's not exactly my area but I have some related experience.
           | I suspect the big problem with this is power use.
           | 
           | A standard issue wheelchair is very efficient on reasonably
           | smooth and flat surfaces. Beyond the obvious problems with
           | e.g. stairs, you can get around ok using just arm muscle
           | power in lots of places.
           | 
           | This efficiency helps also if you can't use your arms or the
           | slopes are more challenging. Reasonably sized and weighted
           | batteries can extend your scope a huge amount in very
           | practical ways.
           | 
           | As soon as you get away from wheeled locomotion though, the
           | power needs become much more problematic. Not to mention the
           | system complexity is orders of magnitude higher than a basic
           | chair, with all that entails.
           | 
           | So short story, I wouldn't expect any significant impact in
           | the next few years. It's possible that for some very specific
           | use cases you'll see a bit more robotics in assistive
           | technology. It's also possible that we'll learn some good
           | tricks from robots about negotiating particular obstacles
           | (e.g. curbs) which can be retrofitted to "dumb" conveyances
           | and improve things...
        
         | kspacewalk2 wrote:
         | To your last point, it's worth pointing out that making your
         | built environment more easily traversible and usable for people
         | with accessibility needs will pretty much always make it more
         | easily traversible and usable for _everyone_. It 's hard to
         | appreciate this until you visit a country where they _haven 't_
         | spent decades making sure their elevators and hallways are wide
         | enough, there are no unnecessary stupid steps, the sidewalks
         | don't have curbs at crossing points, etc. etc. This is just
         | general societal progress, it makes all of our lives easier and
         | we're so used to it we don't even notice it anymore.
        
           | oalders wrote:
           | I only truly appreciated this once I had was a pedestrian in
           | a big city with a baby stroller. If a wheelchair can get
           | somewhere, generally the stroller can do it as well. (At
           | least a single wide stroller). Making places more accessible
           | can have a positive impact on large parts of the population.
        
             | tomrod wrote:
             | I've learned to take this approach with software as well.
             | It just makes sense. While he's not universally accepted,
             | Nassim Taleb makes compelling behavioral arguments for why
             | this is better overall (in the context things like kosher
             | salt and such)
             | 
             | https://medium.com/incerto/the-most-intolerant-wins-the-
             | dict...
        
           | paledot wrote:
           | Canada is unexpectedly one of those countries. Accessibility
           | here is a nightmare, especially in big cities. As another
           | partner of a person with limited mobility, I always notice
           | and appreciate the difference that 40 years of ADA has
           | brought to construction in the US.
           | 
           | (I'd take universal health care over improved building codes
           | any day, but both would be nice.)
        
         | verisimi wrote:
        
           | helsinkiandrew wrote:
           | Unless I've misread the articles about this story this is
           | about a company using electrical stimulation to try to get
           | people with spinal injuries to walk again. Not government
           | using foetuses for some deeper purpose.
        
           | mattkrause wrote:
           | You may be happy to learn that a lot of recent stem cell work
           | does not actually use foetal tissue. Instead, there are
           | methods for reverting adult cells from a blood sample back
           | into stem cells (IPSCs, or induced pluripotent stem cells).
           | This is exciting for a number of reasons: not only does it
           | sidestep ethical concerns, but it introduces the possibility
           | of making stem cells--and thus, other cells--that precisely
           | match an individual patient!
           | 
           | On the other hand, I'd encourage you to think about the
           | motivations of medical researchers. Nobody is _actually_
           | looking for any excuse to work with embryonic tissues (or
           | animals, placebo-controlled trials, etc): it 's slow,
           | annoying and expensive and everyone I've ever met would
           | vastly prefer to use yeast + computational models. People do
           | actually want to help the sick and helpless, but the tools
           | aren't there yet to do so with nothing but yeast and
           | computational models.
        
         | londons_explore wrote:
         | I guess the real question is, will a dollar spent on wheelchair
         | ramps in buildings across the USA give a greater quality of
         | life improvement to the average american than a dollar spent on
         | medical research that tries to repair spinal nerves?
         | 
         | Obviously "average american" is not intended to reflect the
         | 'typical american', but instead be an average across all
         | people, including those with mobility requirements.
        
           | paledot wrote:
           | And spina bifida, and cerebral palsy, and strokes, and
           | diabetes, and broken bones, and arthritis, and being
           | pregnant, and just getting old, and literally hundreds of
           | other disorders that cause temporary or permanent impairment.
           | 
           | By the time you're finished fixing the reasons people
           | encounter mobility issues, we'll be darn near immortal - and
           | you still won't have magicked away the reasons that able-
           | bodied people benefit from universal design.
        
           | SamoyedFurFluff wrote:
           | > will a dollar spent on wheelchair ramps in buildings across
           | the USA give a greater quality of life improvement to the
           | average american than a dollar spent on medical research that
           | tries to repair spinal nerves?
           | 
           | Yes, I don't know why this is even a question. Ramps support
           | people who will never need spinal nerve repair. They support
           | strollers, wheeled luggage, canes, crutches, fall risk folks,
           | furniture movers, bike/scooters, etc.
        
             | londons_explore wrote:
             | But medical research leads to treatments which may have far
             | better quality of life improvements than ramps. And when
             | discovered, those treatments can be used forever, whereas
             | ramps require constant spending for every new or renovated
             | building.
             | 
             | Both are 'obviously' better than the other, depending on
             | what you look at. Therefore the decision really should be
             | made with more data.
        
               | mwcampbell wrote:
               | > But medical research leads to treatments which may have
               | far better quality of life improvements than ramps. And
               | when discovered, those treatments can be used forever,
               | whereas ramps require constant spending for every new or
               | renovated building.
               | 
               | I think you make a good point here. Likewise, making
               | software accessible, e.g. to blind people, requires
               | effort for every GUI toolkit and non-trivial application.
               | In the short term, that work has to be done, because it
               | would be wrong to just leave blind people without a way
               | to independently access software that might be critical
               | to jobs, education, etc. But if we started funding
               | research into curing or preventing all of the various
               | causes of blindness now, then we could eventually solve
               | the problem permanently. I'd have to find a different
               | problem domain to work in, but I might be retired by then
               | anyway.
        
               | paledot wrote:
               | Just like universal design in the physical world,
               | universal design in software has knock-on benefits for
               | everyone. A website that can be properly parsed by a
               | screen reader can be scraped by search engines and
               | archived efficiently. An application with proper tab
               | indexes can be easily navigated by someone with a laptop
               | rather than forcing them to reach for the trackpad.
               | 
               | > curing or preventing all of the various causes of
               | blindness
               | 
               | All of them? Got a list?
        
               | krisoft wrote:
               | > But medical research leads to treatments which may have
               | far better quality of life improvements than ramps.
               | 
               | There is so much wrong with what you say. Just look at
               | the person in the very article. He doesn't walk with a
               | hippity-hoppity bouncy gait. He walks with the help of a
               | wheeled walking frame. He needs the ramps and the
               | handholds to get to places. Do you have a proposal on how
               | to spend all the ramp money to "medical research" that
               | away?
               | 
               | Look at any person who broke their leg and walks with a
               | crutch, or a mother-to-be who is wobbly from all the
               | extra weight of the baby, or an old person who needs a
               | walking frame. Do you think if we just spend more money
               | on medical research these conditions will go away?
               | 
               | How are you proposing to medical research away the need
               | for a baby stroller?
        
               | SamoyedFurFluff wrote:
               | It's not obviously better because you're solving for one
               | case when a ramp solves for multiple. At no point does
               | solving nerve damage fix the fact a baby in a stroller
               | has a better time on a ramp, unless you're proposing a
               | new technology that obviates wheels. But that just makes
               | it the new ramp in its utility.
        
           | Tsiklon wrote:
           | The distinction is that the quality of life improvement can
           | be done now, and can make peoples' lives better immediately.
           | It's not just wheelchair users that can make use of
           | accessible infrastructure, the elderly, and young children
           | can more readily make use of it too.
           | 
           | I don't discount the promise or effect of such research, but
           | the utilitarian in me says that this can make a tangible
           | improvement now, and to more people and not at an
           | indeterminate point in the future.
        
             | londons_explore wrote:
             | There are plenty of such tradeoffs... For example, the
             | government could start a helicopter service to help people
             | cross a river today, or they could build a bridge across
             | the river, which will help far more people, but won't be
             | ready for 5 years.
             | 
             | I assume governments have models to make decisions about
             | utility now vs utility later, and the way that trades off
             | with cost now vs cost later.
             | 
             | I don't see why this decision shouldn't just use those
             | models and spend the money on whatever the models say makes
             | sense.
        
               | afarrell wrote:
               | > I assume governments have models to make decisions
               | about utility now vs utility later, and the way that
               | trades off with cost now vs cost later.
               | 
               | I'm curious where this assumption comes from. It seems
               | more likely that it would be made on intuition of what
               | story will seem most defensible to voters or avoid the
               | angry scrutiny of a legislator.
               | 
               | If decisions were made with the high level of rationality
               | you point to, it seems unlikely that the US would have
               | problems like this:
               | 
               | - https://pittsburgh.cbslocal.com/2022/02/07/pittsburgh-
               | warnin...
               | 
               | - https://www.marketwatch.com/story/it-is-a-challenge-
               | the-irs-...
               | 
               | - https://www.irs.gov/newsroom/irs-announces-transition-
               | away-f...
               | 
               | ----------------
               | 
               | Looking at your username lets consider a question such as
               | "Should we pay additional money to design London's new
               | Elizabeth Line with step-free access at all stations?"
               | 
               | for such a model to answer such questions, we would need
               | a way to accurately count costs. If could do that, then
               | the line would already be open.
        
           | dundarious wrote:
           | Given perfect hindsight that we have now, at any point in the
           | 20th century you would have to respond "yes, you should also
           | fund accessibility right away" . The answer today is almost
           | certainly the same. Never mind that there are reasons to need
           | accessibility beyond spinal injuries.
        
       | kazinator wrote:
       | "Spinal implants allow geeks to stand up to their bosses!"
       | 
       | https://dilbert.com/strip/1994-07-24
        
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