Wii Balance Board Gives $18,000 Medical Device a Run For Its Money

Gizmodo highlights a very cool repurposing effort for the Wii's Balance Board accessory. Rather than the specialized force platforms used to quantify patients' ability to balance after a trauma like stroke, doctors at the University of Melbourne thought that a Balance Board might serve as well. Says the article: "When doctors disassembled the board, they found the accelerometers and strain gauges to be of 'excellent' quality. 'I was shocked given the price: it was an extremely impressive strain gauge set-up.'" Games controllers you'd expect to be durable and at least fairly accurate; what's surprising is just how much comparable, purpose-built devices cost. In this case, the Balance Board (just under $100) was compared favorably with a test platform that costs just a shade less than $18,000.

Comments

"Not for ________ use"

[LostCluster]

What determines the price of a scale is not just its equipment or accuracy.. but also the insurance the manufacturer has to carry in case something goes wrong. That's why medical devices are more expensive... you're also paying for the liability of somebody being misdiagnosed by a technical malfunction. Highly unlikely, but the money that has to be paid when that happens and gets proven is huge.

Re:"Not for ________ use"

[Anonymous Coward]

What determinds the price is production, and demand. The wiimote is mass produced, which makes the price even less. And its in high demand.
Medical equipment? There is a certain number of hospitals involved ordering X amount of copies, and the demand is static. They will also pay for it. Basically its overpriced, but the question is how much its overpriced.

Re:"Not for ________ use"

[MightyMartian]

What determined the price was the word "medical". It's a word, like "marine" which denotes adding zeros to the price of an item that costs only a moderate amount to actually manufacture.

Re:"Not for ________ use"

[LostCluster]

Yep. The word "medical" means lots of requirements for the device on it's way to being used... Nintendo gets around those by saying they're not selling a medical device.

Re:"Not for ________ use"

[ThogScully]

Those companies are only abusing their monopoly if someone new comes in and is pressured out of the market by anti-competitive tactics. If no one else wants to take advantage of the opportunity to compete in a market, you're looking for a different reason why. Off the top of my head, perhaps there's too much government regulation making it too difficult to get into that field. Too much insurance costs because of liability concerns in an overly litigious society. Perhaps just no one realized how much of an opportunity there was here because no one really has a clue how much healthcare costs these days since no one using it looks at the bills anymore - they just have their insurance cover it and complain when there's a problem. How do you expect competition in a market to lower prices when the consumer doesn't decide what features to invest in and compare based on price?

In other words, the answer you're looking for is not "more government" - that is the problem.
-N

Re:"Not for ________ use"

[vlm]

What determines the price of a scale is not just its equipment or accuracy.. but also the insurance the manufacturer has to carry in case something goes wrong. That's why medical devices are more expensive...

You're missing a couple other issues:

1) Provably sterile out of the box. If the patient has an open foot ulcer, and some Chinese dude sneezed on the board before he wrapped it up, and then the patient dies of infection...

2) Bodily fluid proof, if not disposable or autoclave-able. The board is too expensive to toss and too weak to autoclave, furthermore god only knows what it'll do electrically when a patient pees on it. Or if not pee, some highly conductive cleaning fluid. Or blood.

3) Intrinsically safe. In the unlikely event of using or storing the board in an atmosphere contaminated by flammable anesthetics, it won't blow up. Closely related to oxygen proof plastics. No great achievement to make a plastic that does not support combustion in plain ole air, but I have no idea what plastics (if any) will not continue to burn in pure oxygen. And you know some heart patient is going to drop their oxy mask on the wii board and the batteries will spark at the same time. Also if the patient collapses and you need to use the crash cart, you don't want the electronics inside to catch fire. Would be unfortunate to restart a patients heart only to have the patient die of infected burns.

4) Proven EMC/EMI compatibility. Last thing you want is for the board to interfere with the patients portable EKG machine or whatever.

5) There are all kinds of allergen related issues. For example, no latex (rubber bands) used internally for any part at any time during construction. Peanut oil sounds like a "green" lubricant for metal machining, etc, until you run into someone with an allergy.

6) Connected. It needs to be sold by the current collection of booth-babe saleswomen with open purchase order accounts at the hospital. Its possible the hospital has no pre-existing relationship with any place that sells wii balance boards... Literally no way for purchasing to buy one...

7) Software licensing which probably prohibits this kind of activity, along with controlling nuclear power plants and air traffic control. "Lean forward to lower the control rods, lean back to raise the control rods. Lean left and right to control primary circulation pumps. Walk in place as if running away to declare a SCRAM."

Theres a bunch of other "EE" related medical device rules that are pretty interesting, especially as regards AC power supplies, until it gets too creepy realizing a bunch of folks died before they figured the rules out.

Its not so hard to follow the rules, its just HARDER to prove someone in China followed the rules...

Re:"Not for ________ use"

[DJRumpy]

There is no justification for an $18,000 price difference for what amounts to the same fundamental technology. I don't need a formula, or theories as to why this is. The medical industry is full of a bunch of crooked greedy bastards. They use the same basic technology to accomplish the same result, probably with the very same components, all of which can obviously be had for very cheap. Costs are applied at the component level. If you can buy the same components for a Wii as in this other piece of equipment, their prices should be a bit closer. Our medical system has been gamed so badly for so many years, that a hospital doesn't even blink when they see $18,000 for a piece of equipment. They will happily pass the costs on to the patient, and the patients health insurance.

If this isn't a case of price fixing then I don't know what is.

What we really need is transparency is pricing for all medical costs. Force manufacturer's to provide their component costs for everything like eqiupment, drugs, and consumables, so that the consumer can see exactly what kind of markup their paying for.

Re:"Not for ________ use"

[LtGordon]

To make sure that only the official cable was used, there would be loop-back configurations built into unused pins at each end of the cable, so that a connector patched up from twenty-five core cable and a couple of RS232 snap connectors wouldn't work.

Kind of like how Apple charges $35 for an iPod USB wall charger, and makes sure that my generic USB wall chargers / powered USB hub won't work.

Re:"Not for ________ use"

[Anonymous Coward]

You have obviously never worked in an industry with high quality control standards. The price of some product isn't the sum of its individual components. You have to pay people to design it, and people to test it, and then pay insurance on it. For small markets, this means that the price is very steep for even simple things. What would you price this device if the parts cost $100 per unit, but the R&D cost (2 doctors and 2 engineers for 1 year) was $1 million, the insurance cost was $500,000/yr, the customer support cost was $100,000/yr, and the market size was 100/yr?

Re:"Not for ________ use"

[Miamicanes]

> I guess we were paying $99 for the QC sticker they put on it before they sent it off through the supply system.

Actually, there's a very good real-world example of a cheap electronic component that nevertheless can be very expensive when its quality is absolutely certified: electrolytic capacitors. Today, in 2010, brand new devices are STILL being manufactured with electrolytic capacitors that have substandard electrolyte. This is a problem that was supposed to have gone away YEARS ago. Why is it still around? Because the bad electrolyte is a tiny, tiny bit cheaper to make... and the capacitors tend to work just fine for at least a few months. In other words, they fail prematurely... but not immediately.

If you're building something that absolutely, positively, must NEVER use an electrolytic capacitor with bad electrolyte, you have no real option besides buying only capacitors that are certified (and can be audited) all the way from you (the company building the device that uses them) to the chemicals used to make the electrolyte itself. It's not enough to buy "a good brand". To get that level of certification, every party along the way -- distributor, wholesaler, supplier -- has to be certified capable of keeping them secure and properly stored. Otherwise, an employee (or manager, or higher) at the supplier could substitute counterfeit capacitors, then sell the genuine ones elsewhere.

The point is, that degree of auditing and handling is insanely expensive, because it involves SO MANY different parties (all of whom want to be reimbursed for the extra trouble). It's made more expensive by the fact that there are (fortunately) very few things that really NEED that kind of quality control. Life support equipment and nuclear power plant control systems are obvious excamples where it's justified, costs be damned.

That said, this particular device isn't life support equipment, regardless of how hard someone might try to make it sound like the tiniest malfunction would lead to death or injury. I think it's safe to say that this particular device's price is all but guaranteed to come down a few thousand dollars if they want to keep selling it.

Re:"Not for ________ use"

[Skuld-Chan]

Again, you're paying for the sticker and the insurance that covers the lawsuit should that piece break and irradiate an entire shipyard.

Are you though? Because I bet if that did happen they still wouldn't assume liability.

Re:"Not for ________ use"

[rtb61]

I get it. So what you are saying is that governments would be far better off manufacturing all this stuff themselves rather than contracting it out. Not only are you eliminating wasteful profits but also enormous insurance costs because the governments can readily self insure.

Now lets have a little bit of fun with the insurance lie. If insurance costs are so high, then the private medical manufacturers must really, really crap, because that is what drives high insurance premiums, lots of failures (no failures, low premiums), so get rid of the private corporations because just like insurance companies, the government should also recognise them as being high risk. The quality control systems in all medical manufacturing facilities must be so bad, that no insurance companies give any of them a discount.

I would love to see some of the warranties on medical equipment, from the sounds of the marketing trolls it must be decades but I bet a lot of that junk comes out with nothing better than 90 days (now that's a big insurance risk, ha ha). The underlying reality is that all this low manufacturing run custom equipment should be manufactured by government, because no matter how inefficient they are, it well still be way cheaper than paying for inflated profit margins at the manufacturers, oh yeah and the insurance companies. Especially the insurance companies because according the medical manufacturing trolls, the very, very expensive quality control system means absolutely no failures.

Re:"Not for ________ use"

[Anonymous Coward]

Production and demand are sufficient to determine price only when the market is perfect.

This is not true for medical equipment, because the market is highly regulated.

I work in the field of medical devices, so I see this every day. We have to keep copious records of the design process of the hardware, the testing to validate and demonstrate perormance, and each device has a record kept of every periodic maintenance call and every service call for a performance problem (e.g. breakdown).

All this adds to the cost to bring a product to market, and then adds to the cost of keeping a device running.

And on top of all that, the health "systems" that provide patient care in the USA are an extemely imperfect market...

I have seen many instances in the North Eastern states of extreme over-capacity. Great, in that if you need an X-Ray or an MRI you can get it done within fifteen minutes (which is three sets of paperwork to prove you can pay). But that means that a device is sitting around 80% of its time unused. But other posters will point out, "you can't put a price on your health", so people will cough up to $3200 for a simple abdominal X-Ray that takes, literally, 45 seconds of device time. The same X-Ray costs (I'm told) around $800 in Japan, and less in France or the UK. But in France and the UK, you turn up for your appointment, fill out no extra paperwork, but wait for maybe 90 to 120 minutes to go under the device, because it is utilised at 90% to 100% of the time.

Finally, even though you state that "demand is static", this is not quite true. There is relatively little growth in the number of hospital beds places in the USA,Europe and Japan, but the demand for every increasing resolution in imaging, ever faster turnaround, every simpler interfaces so that less qualified (i.e., cheaper) staff can operate the device for more qualified staff (i.e. doctors) to spend more time doing diagnoses... And that is in the mature, saturated markets of the world... then we can talk about BRICS...

AC

Re:"Not for ________ use"

[BronsCon]

I'm not talking about IR. Hell, I have a $90 vid cam that does IR imaging. The Sony cam had a thermal imaging mode and yes, if aimed at a window, it would fail; but if aimed at a poorly insulated wall, you could make out the outlines of your neighbors.

People were worried about being recorded doin' the naughty, when it was easily foiled by properly insulating your walls. Not to mention that the quality was... well... quality isn't the right word for the image it would give through even the thinnest of drywall, let alone studs and siding...

Re:"Not for ________ use"

[timonak]

I can honestly tell you that you have no idea of what you are speaking. I work for a small medical device manufacture as a software architect/engineer. There are many reasons why a medical device is expensive. I'll enumerate the two that I have experience with. The first, and biggest is the FDA. We are a class 2 medical device, much like the piece of equipment mentioned in the article. So what does this mean? It means reams and reams of paperwork. Not nearly as much paperwork his required for a class 2 as a class 3 (pace maker and other implantable devices) device, but still reams of paper. We sent almost a WHOLE box of paper to the FDA when we submitted our paperwork. If I had to add up the cost to produce the paperwork, given the cost of lawyers, and staff time, my guess would be >$250k. Thats just the initial cost. We now have to get ready for an FDA compliance audit in the next few months. We have also have to overhaul how we develop the software. We have to be able to trace every line of code back to reams of paperwork, that adds an additional burden to the bottom line. Next are lawyers. We spent a TON of money on lawyers while doing our FDA 510K. Competent lawyers who are also knowledgable about the FDA 510K process are NOT cheap. ONE of the lawyers we used cost $600/hr. You also have to remember that the medical market is quiet limited. How is a small medical device company supposed to survive if they sell the device for a couple of hundred dollars into a very limited market? When you see our product, you might be tempted to think $5000? I'm not paying that much for a metal frame, a hardened PC w/ a touch screen and some software. Its not worth that much. And when you do, I want you to tell that to me personally, to my face. I also want you to tell me that my family doesn't deserve to eat.

Re:"Not for ________ use"

[wvmarle]

We're talking about a diagnostic device. Not a life saving device. Not even for internal use. It is quantifying balance: we know the patient has balance, we just want to know how much of it. It is not even diagnosing whether a patient has a disease or not, or what disease a patient has.

If it is faulty, the doctors will know. Either it doesn't work, or the values do not make sense. A doctor with a little bit of experience will know from looking at the test about where the number should end up, and if out of expectations can take another device to test again. They're cheap, so you can have more than one on hand.

Sterility is not even an issue here (beyond basic cleanliness of course), it is not for use in an OR.

The main reason these things are/were so expensive I think is because of the very small product runs. Really small: hundreds, maybe a few thousand. There was no other use for these sensors, so development cost has to be shared over a few thousand pieces at most. Come the Wii with its gadges using basically the same tech, and both production cost and development cost per unit drop enormously. It matters a lot if you share costs between 1000 or 100,000 units.

Then probably the medical version is much stronger and sturdier, lasting longer, but the price difference is too big to make up for that.

What have we here?

[tonycheese]

Wii parts replacing 18,000 dollar medical equipment... PS3s replacing 10,000 dollar supercomputers... clearly the video game industry knows something we don't.

Re:What have we here?

[lanner]

It's all BS. Forget all of the posts regarding FDA, documentation, testing, and that crap.

It's just a matter of how many units get sold, like microprocessors.

If you design, make, and sell one, it's $500 million. If you design one, make 500 million, and sell 500 million, they cost $1 each. Profit is the same either way.

Not a lot of people buy medical devices, with some exceptions.

Nintendo can't make them and start with high prices, then drop them later. They have to assume how many they will make, sell, and guess a good price before their first unit is sold.

And yes, I have worked in medical device manufacturing, and I currently work in non-profit cancer research. We have numerous genetic sequencers around, like ones from Illumina. They cost like $750K each, but it's really surprising how little materials is actually in them. A $500 laptop is technologically 10,000 times more advanced than one of those Illumina boxes.

It's true that medical devices are more expensive, and I'd be the first person crying foul about it, but they often really really do have good reasons to justify the higher costs... usually.

If you want to talk about price rape, look no further than Cisco.

$2000 card
http://www.cdw.com/shop/products/default.aspx?EDC=1352161

$13,0000 card
http://www.cdw.com/shop/products/default.aspx?edc=1424619

They are the SAME EXACT CARD, with a little tiny firmware tweak. We have a couple of these in the 5580 series firewalls.

Perception

[jlb.think]

It is all just people's perception. A videogame can't be too expensive, but it damn well better work so the market pushes high quality at low prices. In the medical world we expect devices to cost out of the ass and be complex. That is the exact opposite of the videogame, or rather, the general technology world. It is about time there is direct market competition with the medical device manufactures who rip us off and overcharge for clunky hard to use equipment that doesn't work that well in the first place.

Re:This is not a shock...

[Big Boss]

I've started purchasing my own CPAP machine and accessories as well. Far cheaper than dealing with the home medical place locally (owned by my insurance company no less), even with insurance coverage picking up part of the bill. For less money, I get a better machine and direct support. And I can run the purchase through my FSA, so it's tax free. :)

FWIW, nebulizers are the same way. I bought a very nice machine online for about half the cost of the local place, and the local place wanted to give me a gigantic POS. I bought a very compact unit that has much nicer features.

Has Little to Do with Lawsuits

[Comatose51]

The reason medical devices are so expensive has little to do with lawsuits when compared with the number one reason: the market for health care is distorted because the decision maker (doctor) is not the person paying for the decision (the patient or insurance). Medical device companies just market directly to doctors. Medical conferences are like industry paid vacations for doctors. Even if you tell your doctor that your Wii balance board does the same thing as the $18,000 device, he's still not going to prescribe it because he has no incentive to. He doesn't bear the cost of paying for it. You do or most likely your insurance do. You see the exact same thing in the textbook industry. The professors make the decision and the students pay for it. When the two entities are not the same, you have a market that's distorted and normal mechanisms of capitalism don't lead to lower costs and greater efficiency like they do in other areas. Of course FDA approval definitely plays into this by making it easier for doctors to have support for their decisions.

You miss the point here - cost is irrelevant

[tg123]

There is no justification for an $18,000 price difference for what amounts to the same fundamental technology. I don't need a formula, or theories as to why this is. The medical industry is full of a bunch of crooked greedy bastards........

I think your missing the point here.

It's not how much it costs or if there ripping us off .

"The how much it costs" argument is irrelevant.

Its the fact that we are now getting devices, which are used to play games, in our homes which are comparable to highly sensitive medical devices.

WOW !!!

The doctors in this melbourne hospital should also be congratulated for looking at alternative ways of doing things.