[jacquesm]

There are a lot of people hacking on insulin pumps and they are lightyears ahead of commerce. If you want a very interesting rabbit hole to dive into try 'artificial pancreas hacking' as google feed.

One interesting link:

https://www.drugtopics.com/view/hacking-diabetes-the-diy-bio...

I would trust the people that hack on these systems to be even more motivated than the manufacturers to make sure they don't fuck up, it's the equivalent of flying a plane you built yourself.

[bitmasher9]

> it's the equivalent of flying a plane you built yourself

A great analogy because people die that way. I personally would never push code to another person’s insulin pump (or advertise code as being used for an insulin pump) because I couldn’t live with the guilt if my bug got someone else killed.

[jacquesm]

I know people die that way (GA). But someone is working for the companies that make insulin pumps and they are not as a rule equally motivated so I would expect them to do worse, not better.

And to the best of my knowledge none of the closed-loop people have died as a result of their work and they are very good at peer reviewing each others work to make sure it stays that way. And I'd trust my life to open source in such a setting long before I'd do it to closed source. At least I'd have a chance to see what the quality of the code is, which in the embedded space ranges from 'wow' all the way to 'no way they did that'.

[chii]

> I would expect them to do worse, not better.

which is why lots of systems and processes (sometimes called red tape) exist to try and prevent the undesired outcome, and dont rely on the competency of a single person as the weak link!

[firtoz]

There are more financial reasons to violate and cheat the red tape than there are incompetent open source hackers in the world.

[f1shy]

Anytime anybody does something himself, there is a risk. People die because of welding parts cleaned with break-cleaner, people die driving, diving, sky-diving, doing bungee jumping...

Advertising that code, IMHO would be as showing of you doing extreme sports, for example. I do not think is any bad. A good disclaimer should be enough to take away any guilt.

[RobotToaster]

I'm not aware of any deaths attributed to open source artificial pancreas systems. Meanwhile there have been multiple attributed to closed source glucose monitors.

[croemer]

Not attributed to. The FDA wording says "associated with" which is much weaker causally.

[UomoNeroNero]

I can guarantee you, from my personal experience of being diabetic for 30 years, that every day—and in the most incredible ways—I have managed to “almost kill myself.” Whether when I used finger-prick testing, sensors, injecting insulin with pens, or managing insulin with a pump. Our life is always a delicate balancing act between too little, too much, and way too much—the kind where this time I really kick the bucket

By personal choice I use a commercial CGM (if I could “touch it,” I’d be firmly on the side of certainty about killing myself through sheer stupidity), but reading something like “associated with” really makes me angry. Before making such subtle insinuations about the open-source world (the source of the revolution of the last 10 years in this field), regulatory bodies should open their eyes to what is actually happening with the quality of current sensors and the real problems they are causing.

[jacquesm]

Thank you.

And strength to you. I had a business partner for some time that was much like you and every time he'd be 10 minutes late for an appointment I'd get nervous and if it was more than an hour I'd be on the phone to his family to check up on him.

[fsflover]

https://news.ycombinator.com/item?id=46398414

[horsawlarway]

And yet someone IS pushing code to these devices. Every single one.

So the question really becomes - Are these people working on their own pumps with open source more or less invested than the random programmers hired by a company that pretty clearly can't get details right around licensing, and is operating with a profit motive?

More reckless as well? Perhaps. But at least motivated by the correct incentives.

[dullcrisp]

So flying in a plane you built yourself is in fact safer than flying commercial because the motivations line up. Got it.

[AnthonyMouse]

You, an engineer at a major aircraft manufacturer that isn't Boeing, have been working after hours with some of your colleagues on a hobby project to add some modern safety features to an older model of small private plane, because you regard it as unsafe even though it still has a government certification and you got into this field because you want to save lives.

Your "prototype" is a plane from the original manufacturer with no physical modifications but a software patch to use data from sensors the plane already had to prevent the computer from getting confused under high wind conditions in a way that has already caused two fatal crashes.

Now you have to fly somewhere and your options for a plane are the one with the history of fatal crashes or the same one with your modifications, and it's windy today. Which plane are you getting on?

[sarusso]

This example is so right. Including the parallel with what happened with those two aircrafts.

[amrocha]

Definitely not the untested code I wrote myself!

Are you kidding me? How many times have you unwillingly introduced bugs into a code base you didn’t fully understand? That’s basically table stakes for software engineering.

[AnthonyMouse]

> Definitely not the untested code I wrote myself!

Nobody said it was untested.

> How many times have you unwillingly introduced bugs into a code base you didn’t fully understand? That’s basically table stakes for software engineering.

Which applies just the same to the people the company hired to do it, and now we're back to "the people with a stronger incentive to get it right are the people who die if it goes wrong".

[mindslight]

Flying in a plane you built yourself is likely safer than flying in the same model of plane built by a company that assembled it for you using lowest-bid labor while making you sign a twenty page lawyer barf disclaiming liability.

[TylerE]

We have decades of data saying that isn’t true. Homebuilt aircraft have much worse accident rates than factory built aircraft.

[habinero]

Are you really comparing an amateur skillset to designs from paid engineers made on a company assembly line with QC?

Why on earth would you think an experimental aircraft made by a hobbyist would be safer?

[mindslight]

See my other follow up comment ("same model"). Medical device software development feels much closer to homegrown (or worse) than aeronautical engineering.

[f1shy]

Why do you think a random person, who is VERY passionate about something, as to invest all the free hours in life to do something, is less skilled that one who just does it because is needed to survive?

Sorry. I would be much more inclined to have something made by somebody passionate about it, as done by some guy that received hopefully some kind of instruction on how to do things and was then left alone.

In this context (GA) we are not comparing Airbus/Boeing with a garage build. We are comparing some small company making 2 seaters with your hangar and maybe 10 certified aircraft mechanics that will help you a lot on the process.

[jacquesm]

You write that as if you have ample experience with codebases of medical devices and I'm going to take a stab at this and say that you don't. Prove me wrong.

[amrocha]

You can’t honestly believe that or you wouldn’t be able to function in society.

[mindslight]

My comment rests on the fact that the types of planes you can build yourself are completely different models than the fully assembled models from the likes of Boeing etc. I do agree that a kit 737, if such a thing existed, would be less safe than one off the line.

[array_key_first]

You can believe it and simultaneously function in society.

We aren't all building our own planes because it's worse, but because it's time consuming. I don't have 20,000 hours to burn learning about how planes work to make my own.

If we magically beamed the knowledge straight into people's heads and also had a matter fabricator, I'd imagine yes - everyone would build their own plane. And it might be safer, I don't know.

Point is, the ideas are not mutually exclusive. You can believe both and still resolve it internally and with the world

[replyifuagree]

Those people on the boeing flights would have appreciated a little more of the correct motivations.

Instead they got McDonnell Douglas'd

As it turns out the motivations matter way more than you might think.

[socalgal2]

> I would trust the people that hack on these systems to be even more motivated than the manufacturers to make sure they don't fuck up

I would think it's the opposite. People that hack on this only risk their own life. Companies risk many people's lives and will get sued. Of course the person doing the hacking doesn't want to die but they're also willing to take the risk.

[tavavex]

The absolute worst-case scenario of messing this up as a company is that you get sued and they win, or you're forced to settle. You pay out some money, post a public apology, whatever. If things get really bad, the company goes under. But you're likely still far richer than the average person, and the blame is distributed enough that no one gets a criminal sentence - not that it was a realistic option to begin with.

The baseline worst-case scenario of messing this up on yourself is that you die.

[Dilettante_]

>People that hack on this only risk their own life

Yeah, only their own life, yknow, something not particularly valuable or motivating to conserve for them, as opposed to the companies financials!

[array_key_first]

Right, but getting sued is basically the least risky activity ever. Okay, a little dramatic but: you won't go to jail, and if you're rich and become less rich you're still better off than most people. In pure absolutionist terms, being a business owner is basically always less risky than being labor.

[wpm]

> People that hack on this only risk their own life.

Provided they do not risk anyone elses, that is entirely their right.

[rkomorn]

A lot of the other responses say something along the lines of "of course people have more incentive not to mess up, they care about their own lives more than corporations care about getting sued" and sure, that's true in general, but:

- people try to wingsuit through narrow obstacles and miss

- people try to build their own planes and helicopters and die

- people try to build submersible vehicles to go see the titanic and, uh, don't have a 100% success rate

- people try to build steam-powered rockets and die

"It's their life, they won't fuck it up" doesn't exactly cover a lot of behaviors.

I'd argue home-rolling your own medical device firmware is closer to daredevil/"hold my beer" behavior than normal.

[jacquesm]

None of these have anything to do with your average diabetic loop hacker. You are comparing people that live for the thrills with people that are just trying to live.

[rkomorn]

They're also people who had a lot of confidence in their own skills (including thinking they knew better than others) and ended up being wrong.

I would say that can have a lot to do with your average diabetic loop hacker.

[jacquesm]

I'd like some proof that the embedded programmers working for 'the man' at medical device companies are better and more motivated than those that are hacking on loop devices.

You're comparing people with a death wish in disguise with people that are extremely motivated to improve the QOL and they're very careful about how they do this, in fact if you read up on this you'd notice the insane attention to detail and the very rigorous process, on par with what I've seen in industry and in fact probably better than most.

All of this talk in this thread makes me think back to a time when people were laughing at that Finnish kid that was making his own OS with his buddies. Surely nobody would ever trust their business, their property or the lives to open source.

I checked and this is actually hacker news, not the BSA.

[rkomorn]

I'm arguing that "it's their life, so they'll be more careful than 'the man'" is tenuous.

There have been many people who "made informed decisions" about their medical treatments over the advice of professionals and ended up being wrong. They don't count as thrill seekers.

Even in other threads on HN, you'll find takes on this topic ranging from "I don't trust my device, so I do finger tests every day" to "I trust my vibes and my device and don't do finger tests anymore" which tells me there's a pretty wide spectrum along which hackers might fall.

I'm not at all arguing that it's impossible that someone would do a good job of hacking their device, let alone do better than pharma/med companies.

I just don't buy that everyone who hacks away at it will inherently do a better than said companies because their life is at stake. There are way too many examples of people taking their lives in their own hands and getting it wrong.