 Hello, welcome to our panel about why we need more open source hardware and software for health applications. I'm happy to have you all here and very grateful that FirstAsia gave us a chance to hold this panel. I'm very pleased to have all these engaged panelists here and I'm very happy and thank you so much for coming from all over the world here to our coming panel discussion. Okay, we want to speak about our work and I'm happy to introduce Ren-Ven Zang, who is Assistant Professor in the Department of Communication and New Media at the National University of Singapore, dedicated to building bridges across disciplines and solve big problems such as health care and social injustice. And Karan Sandler is Executive Director of the Software Freedom Conservancy, former Executive Director of the KnoM Foundation and much more she's going to introduce herself later, like all of us. And Daniel Wesolek, who is Tangible Interaction Designer and Electronic Artist and Co-initiator of the Open Source Prototype Fund Hardware. And Joel Murphy with a background in Kinetic Sculpture, Citizen Engineer and Carrier Hacker, now heading the Community Building and Commonization Teams of the OS Hearing Aid Hardware Prototype Timper and is also co-founder of OpenBCI Biosensing Boards and Pile SensorCon. And my name is Peggy Silop, I'm Computer Scientist, is Master of Public Policy and Artist, founder of Backlapstays and initiator of the Open Hearing Project, Open Source Hearing Aid Development. So I give the first introduction right to Ren-Ven, please introduce yourself, say a bit about your work. Hey everyone, thanks Peggy for the great introduction, it's a pleasure to be here and exchange ideas, have discussion with all the Stella panel members here. So my name is Ren-Ven Zhang, I'm currently Assistant Professor at National University of Singapore. So I got my PhD in Communication Studies from Northwestern University last year and my PhD work has largely focused on digital technologies for promoting well-being and mental health. So my research mainly focuses on designing and evaluating the use and effects of mobile health apps and social media for enhancing mental well-being. And I've worked closely with clinical psychologists and computer scientists and designers to design and evaluate a suite of mobile apps for treating depression and anxiety and also evaluated the effectiveness and efficacy of these apps. Among people with depression and anxiety both in the clinic and in the community. So it was through this research experience that I started thinking about the importance of open source data as well as open source software, especially in the field of mental wellness. So first of all, after I came to Singapore I started building collaborations with local hospitals and some psychiatrists and psychologists to develop mobile health apps for mental health like that can fit in any context and particularly the single context. And we went through the process of understanding other regulations governing the development of mobile health apps and then we realized that the local regulations are really strict. So if we want to develop something from scratch it can take a super long time and then sometimes it can take years for an app to be approved by the regulatory body. So I think this might be the case for many countries and not only for Singapore. So that prompted me to think about the importance of leveraging open source mobile health apps that can be tested and modified by developers so as to fit in local languages and local cultures. Especially in developing world as well as global south because a lot of existing mobile health apps are developed in developed countries in the western world. But these apps may not fit into the local culture and social context in other parts of the world. And also another fact I have is regarding the importance of having an open data repository for identifying biomarkers surrounding health and in particular mental health. And then this kind of open data repository can help us to build machine learning models that are more comprehensive, equitable and transparent. So that you're able to identify this biomarker associated with symptoms of depression and anxiety in a conservative group. So I have two thoughts I have and I look forward to learning more from other panelists and also exchange ideas. So that's all from me and I'll pass to Karen. Hi everybody. So I am Karen Sandler. I'm the executive director of the Software Freedom Conservancy and a lecturer in law at Columbia Law School. And I come at these issues from a perspective of a patient because I have a heart condition where I have a very thick heart. It's called hypertrophic cardiomyopathy. And I had a very high risk of suddenly dying but it's okay because I have an implanted device, a pacemaker defibrillator, and it monitors my heart and if I get into a dangerous rhythm it will shock me and deliver life-saving technology, which is fantastic. But being an engineer turned lawyer, as soon as I was prescribed with this device, I wanted to see the source code in my own body and that was a very difficult exercise to undertake. The manufacturers were not willing to share that with me. And so I went on this big journey where at first I thought that the issues were really important about self-transparency and that we should have the right to see the software in our bodies and we do. But as I live with my defibrillator, I learned that it's not just about transparency. When I was pregnant, my heart palpitated, which is super normal for women who are pregnant about a quarter to a third of all pregnant women have palpitations. And so I had palpitations, which was totally normal, except that because I had a defibrillator, my defibrillator thought that I was in danger and so it unnecessarily and inappropriately shocked me repeatedly to save my life, which I did not need. And the only way to reliably stop it from doing that was to take drugs to slow my heart rate down, but it was hard to walk up a flight of stairs. And so this was such an eye-opening, it was shocking, an eye-opening issue because it really underscored the fact that our technology may not be used in the ways that the manufacturers expect. When I think about it, only 15% of the people who get defibrillators are under the age of 65 and only about 42% total are women anyway. And so the number of people who are pregnant with defibrillators is a teeny tiny subset. Now, device manufacturers have no desire for pregnant ladies to get shocked. It's like literally their worst nightmare, but it stands for this proposition that despite all the best intentions, my use case wasn't anticipated. And the only way that our software will be safe and reliable in the long term is if we, the public, we as patients, we are able to take collective action and are able to control our technology. Because it's not a matter of if her software will fail, it's when it will fail, and what matters is what can we do about it when it does fail. So I work at Software Freedom Conservancy to help promote alternatives to proprietary software to enforce and stand up for copy-black licenses. So we have the tools to bring freedom to other people. And then also we run a diversity initiative where we do paid remote internships to people who are subject to systemic bias, nor impacted by underrepresentation and tech. Because if our tech is not made by everybody for everyone, then we're going to have these situations over and over again where we have use cases where we don't anticipate. And so I'm really passionate about these issues in Software Freedom, and I come at things from like a practical nonprofit. What can we do as the public and also from a legal perspective? And I'm so excited to talk to all of you. Oh, and I'm going to pass it to Daniel. Thank you. Yeah, I'm also super interested in this question because I'm an artist by training, but I'm doing like open hardware more and more and also quite active here in Germany to promote this prototype fund for hardware and was working in different projects like caribolds where we were trying to co-design solutions, individual solutions with people that needed that. And so I have a strong interest in designing these things. And I think innovation can go much faster, especially if one develops for the people directly and doesn't need to wait for certification and all these things and issues. So I think it's a very important thing that there are a lot of things that are open hardware. And I think on the other side, it's also difficult to figure out how, yeah, like other boundaries or something like, for example, a defibrillator. Like, of course, you don't want this not to work in the right, in the wrong moment or something. So maybe one could say, okay, it would be maybe wrong that people can change things in there. But at the same time, there's this example of this retina implant where the company went bankrupt and suddenly you have a device that got turned off or you can't do anything anymore and that would be super helpful if it was an open hardware device because then you could actually work with people to fix it and to still seize something with the implant that you already have in your body. So I think there are different sides to the story and in general, I'm more on the side that I think open hardware in this field has a lot of benefits and maybe there are some things where one should restrict it or something, but I'm not super sure about it and I think fighting for openness is good and then if there are things, then one needs to figure out solutions. Yeah, and I'll hand over to Joy. Thanks Daniel. Thanks Peggy for having us on the panel and my name is Joel Murphy and I am in the deep dark past, I was a kinetic sculptor, I'm an electronics design engineer and I have been working on building sustainable open source hardware companies. I make pulse sensor which is an optical heart rate monitor for Arduino which is not a medical device and I've co-founded OpenBCI which is an open source EEG device which is again not a medical device and I'm currently working on a project called TEMPEN which is funded by the National Institute of Health here in the US and the National Institute of Deafness and Communication Disorders which is a tool called a master hearing aid and that's the hardware that you run your hearing aid algorithms on for research and testing, user testing, this kind of stuff. That's called TEMPEN and that's been ongoing now since 2016-2017. That is also not a medical device. I'm sort of skirting the edges of the medical device hardware world. During the pandemic, here in New York when we had our first surge of sicknesses and deaths, there was a push to create hardware solutions, especially respirators. I was working with a team to create an open source respirator which never wound up being open source in the end because the regulatory hurdles are too high, the costs of making this thing are too high and in a lot of cases open source technology, actual microchips are not recommended for life-saving applications so you have to be really careful about how you make something if you want it to be used as a medical device. I'm very interested in this sort of line and this boundary between what regulations will require and how open can devices be for of course all the reasons that both Karen and Ren said. So I'm really fascinated about this conversation and I'm looking forward to discussing it with you. So thank you Charles, thank you Karen, Ren, Daniel, it's really interesting, all your work is really fascinating, absolutely interesting and I'm really happy that we have discussion here. So I wanted to introduce myself a bit, I have really lost myself and I come from sound art and I tried 2016 my first hearing aid not saying oh wow this sounds really bad. There's no interface, I have no control about my medical device. I'm suddenly, I have a problem suddenly and I'm patient and at that moment other people tell me what's good for me hearing. Nobody cares about when you go on streets and you listen to really loud music. Nobody cares but at the moment you need an aid. People tell you that's the right noise and that must be like this and for most people hearing aids are too loud and I thought I have to do something about it and I decided that we need self-adjustment of hearing aids and I started the first open-source citizen science project at Fraunhofer IT&T in Altenburg in Germany and what we did, we did actually put open-source hearing aid algorithms of the OpenMHA on a Raspberry Pi and put some interface on it and make sound walks which comes out from also sound art going on streets and actively listening to what you like, what you don't like and self-adjust the sound like you wish it looked like full control in the hands of the user and it came actually out and it's also, meanwhile I know there's other scientific studies say that most people think that hearing aids are too loud and they make it softer and in the end I'm still working at this project, the research projects stop but I have a new project, the open hearing project and we want to put this scientific research prototype on an Android app we are still looking for some support so if you feel like helping me just contact me and specifically the idea is to give the chance to have full control about hearing aid algorithms which is not possible on a normal hearing aid and yeah, why is it so important? because it is also a scientific studies in me while I also saying that the personal need of amplification is not relying so much on your ability on hearing so some people like it a bit louder, some like it a bit softer, some like it higher frequencies other like more like low frequencies it's one thing and I found also in my studies that every person has a very single way of adjusting the sound and this is also confirmed on one way and on the other way most hearing aid tests there are some sorts of hearing problems which can't be tested in a conventional hearing test so one thing is you test it in a laboratory only which has nothing to do with the real world and also the hearing aids are tested in a laboratory which has nothing to do with the real world and you get out and it's like wow, wow, it's too loud, too much meanwhile it's better but that time was really bad I have to say meanwhile I am just testing some quite cool hearing aids I have to say and the other thing is there is something like a sudden hearing loss which you get after you had a very loud sound and then you get hyperacusis which you get hypersensitive to hearing, to sounds and there is no hearing tests made for this for example and then in the moment you can adjust yourself, you're perfect you can do it in the loudness you like and you can stand and so I had this very simple hearing aid prototype and I was actually just for people with soft to moderate hearing loss like me and actually I have still like a very elderly fanboy who is using this big raspberry pi box in daily life and has really similar hearing loss why does he use it? it's because when you get hearing loss you don't hear softer sounds because you're not able to and when they're getting too loud, the ear is not dynamic it's really like crushing your brain easily so it must be the worst hearing is the less space you have in loudness which you can stand and on the other hand it's also so that the frequencies you still can perceive are getting less and less so it's perfectly if you can just like steer into that let's say area of hearing you still have and steer exactly there by self adjustment just the hearing aid so this is somehow already made but I tried all the by hearing manufacturers but not perfectly and I still think that open source is the right way so one makes this give more control to the user to the impaired person on one side and on the other side there's also one big issue of connectivity also connected with Bluetooth and hearing aids and I would think an open source would make it much more easy for example hearing aid have a special Bluetooth format most hearing aids are impossible to connect with a laptop for example for some video conferences and it makes it really complicated you have your headphones above your hearing aids and then they get into acoustical feedback and start to make strange noises there's a lot of usability and also basic needs which are very individual and also what I think Karen has also a similar addressing similar problem about how you feel with your individual problem and what do you think actually why it's so important to use open source to open this up it would be very interesting to hear more about it from you it's kind of funny because Joel is making this distinction between medical devices and wellness devices and Daniel is alluding to this as well about when is it right to be able to modify your own device and I'm in a funny situation with a heart device where I want to make sure that my device is very secure I want to make sure that no one can simply tamper with my device but at the same time there's real benefit when patients can engage in their own health care and currently the situation with most medical devices is that the manufacturers have total control over these devices and in fact in many cases you need a technician with that company in order to be able to modify even the settings on your devices and it varies across the different medical devices and the tools that they have to do that but what I found is that people conflate the issues of security with the issues around transparency openness and modifiability and so we are at this point where studies have long shown that security through obscurity that is security through not publishing your source code simply does not work right there's all software is vulnerable because the software has not been disclosed does not make your software less vulnerable to attack or to failure and so software through obscurity security through obscurity simply does not work and having free and open source software means that when there's a problem you don't have to first wait for a company to admit there's a problem and then make a change there's some actions that you can take you know independently or collectively and so even if I wouldn't want to modify the software to my device I would like to take collective action to work with whatever medical professional I want to I want to be in a situation where those those eye implants that I think Daniel was referring to a fascinating article company goes out of business it was like a startup amazing technology people were able to see who couldn't see before and it was like just amazing technology that is literally implanted into people's eyes and then the company goes out of business they start providing security updates they start providing updates and eventually one day people who could see could stop seeing I mean just this tragedy and it's one of those situations where the patients are just helpless there's nothing that they can do there's no one they can work with companies out of business they are out of luck if you have transparency if you have structures of open hardware and open source software you are in the situation if you have your software freedom and you can work with somebody else all those patients can get together pool their resources so that they can work on being able to see again and so these are not theoretical things I mean we've been talking about them a long time from a hypothetical perspective and we're only now starting to see the actual results of this and so you know I think like if we focus on things like the insulin pump space where kids who have diabetes are getting help from technical from their parents who are able to modify their insulin pumps to have more precise insulin delivery it's going off book with respect to the device manufacturers they strongly recommended against it but there's open APS has great data about kids who there was one kid who had to go to the doctor's office like almost every day he went to school and when he started using open APS it was reduced dramatically orders of magnitude where this kid had a much much healthier life and if you have better treatment early you're going to have a much better outcome for your life and so we have concrete situations where being able to take control of medical devices by patients or by parents or even just by having more flexibility with your medical professionals can make life or death change I agree totally I agree totally what do you think Daniel what can hardware development do to how you say to boost more medical devices to be done to be open and make them possible what kind of fields do you see as hardware developer what can you do for this idea yeah like in Karen's example I find it so staggering basically because you have this device you have to take medication in order to calm the device basically and that's totally absurd and I think there are a lot of like big and weird things that shouldn't be like this and I think open hardware can help but there's also this whole field of not life saving necessary devices that are just more like in the space of like helping you like there are things that are a problem when you have certain disabilities or something and it makes your life a pain and it's very good space also to develop these things necessarily be like medical aids or something but just help people in their specific situation individually and there's a lot of like co-design processes that we worked on in a project called Match My Maker and also in caribolds where it's about for example okay you're in the wheelchair you have like a backpack hanging there but you can't easily pull it so can there be a device that helps you to easily pull the backpack in front of you in order to then open it and take something out and put something in and then it slides away for example so there's a lot of things that really are helpful solutions and I think it's very great if there's a big repository of things where you can use these things and then modify it again and find solution for your personal needs and space basically and maybe another thought in the bigger industry is that also through this experimentation you can come up with new solutions that wouldn't be invented so quickly because like I don't know there is some braille device that maybe has been developed like 25 years ago or something and it has certification and it's being sold and so on so there's no need to change anything but like if you come up with something new now with other technology that's available now you could maybe create something better so I think it can also inspire bigger companies or people that are willing to go through all these certification processes to make better products. So you think open source prototyping can be an inspiration for let's say professional companies to create more creative and more like need I say need-related devices what do you think Joel you're working in that field quite a while what is your experience how much could you have what's your positive feedback you got from your engagement? Well I would say definitely that having open source tools accelerates innovation part of the original intent of projects like OpenBCI and the Timpin project are to lower the barrier of entry for people to engage with the technology outside of a laboratory or a medical situation or research situation if you have people in their garage for example measuring brain waves with novel hearing aid algorithms those people are going to ask questions that are different than what scientists and researchers ask so from the very beginning we're dealing with opening up the space and having sort of people engaging with questions or problems from a sideways angle or a different angle and that already creates innovation in the space now whether that leads to something or not there's always a question but so I of course a firm believer that open source tools will make things in a lot of ways better and you know when people have access to these kinds of tools then their lives become better just educating yourself about stuff about improvement I think that there's a really interesting edge that we're riding when we're talking about open source medical devices because when we say open source that means that you can see the code, you can see the hardware you can modify it you can repurpose it, you can retool it but if your tool is designed to give you a special shock or a drug dose or diagnose something and then you go around messing with it you may be destroying the ability for it to actually perform correctly according to whatever the research and the doctors really require it to do I would say that allowing allowing mods on people to interact with the tech and change settings could be useful that could be a useful way of opening up partially in a way that will make access that they need to make customized changes to suit themselves but when you open stuff up way too far by making things completely open you're inviting people to hurt themselves in some way I see you waving your hands around that's great and we also have a strata of technical ability someone's a software engineer maybe they can go through and write in some new source code to provide functionality that doesn't exist to a piece of medical hardware but what if someone has no skills at all and they're locked out from all of that by their inability to access we're talking about a lot of layers of complexity I'll hand it off why did you wave your hands thank you to all of you I would first like to hear Karen because she raised her hand I was just waving my hand but I can say afterwards I don't think it matters which of us speaks first I suspect we're getting to a similar point which is that I think that these issues are complicated as you say we need real security proper encryption proper security on our medical devices so they're not accidentally modified by people who don't know what they're doing people need to work with their medical professionals to make sure that they have the right treatment for them I have some heart medication that I take it's mostly preventative I take it every day I could easily and sometimes I do tweak the amount that I take now I do that I could easily take two or three or four times the amount of that drug and experiment with myself and there's no regulation on that nothing stopping me from doing that but I don't because it's my health and I work with a medical professional and I think that these issues are not necessarily unique to hardware and software but I think a lot of times we're so scared that people will inappropriately modify their devices that we forget that we have the ability to hurt ourselves in myriad ways in a variety of things across every moment that we live and that people to some extent have to live wisely and work in concert with their medical professionals and then make sure that our devices have the appropriate safeguards so that people who don't know what they're doing can't accidentally modify them Daniel I don't know if you were going in the same direction Yeah exactly I just think really a short anecdote for example if you're in a wheelchair and you have an electric wheelchair like friends of mine and then it's not your device because it's paid for by the health insurance so the health insurance owns it but you spend like 24 or minus the time you're sleeping you spend in this device so it's basically part of your body like it's body augmentation and then you have a request that you would like to have like a charger for your phone on there for example and then it's not possible because it's not your device, you can't do anything so it becomes very strange quickly and then there are these workarounds that of course it's easy to connect a cigarette lighter like these old electric cigarette lighters to a wheelchair because that's something that I don't know someone fought for one point in time and then you can take an adapter and then it's easy to solve the problem so I think the more freedom people have the better and I don't think that developers will be able to anticipate all the problems that might come up so I think from my perspective it's better to give people the possibility to look into this change this and if you change things that could hurt you then you probably won't do this unless you feel comfortable doing this you also don't open like your open source television and do things in there if you feel like you can't deal with it so I think it's I'm not sure if one needs to protect but I think it's an interesting question and I totally agree with Karen that there's a lot of importance in having the right security measures and avoiding that people accidentally do something that they shouldn't they don't do on purpose that they're just turning around knobs and suddenly it's not working anymore so the design should prevent that but nothing wrong with them saying okay like I want to change this actually and I'm aware of what I'm doing and yeah so that's also my view on it just find out about control and giving patients control okay how it's a moment when you're patient that other people care about you and suddenly you're not allowed to use a knife anymore because you could cut yourself and it's actually it's not what's happening for example with hearing aids people put it soft there and I said also to my clinician I said this is too loud for me you know what it tells me to use to it it's good for you and then I don't feel good with it but hearing aids hearing care doesn't care if I feel good with it because some technicians who never tried hearing aids by themselves and I think others it's really important stuff try the stuff you develop so I tell every developer whatever it is please try it for yourself one day two days a hearing aid to develop and immediately know what people who are using what the problem is with hearing aids you know because for example you can choose between two programs and say I do like more CIS program and like no CIS program but both of the programs I think they sound somehow the same and how can I choose then then I get the next samples and they are the same again there's a lot of like especially in interface and connectivity and in all these kind of things I think that patients could actually take care about themselves you know I agree with Karin but I think we can give much more responsibility to patients than we are likely to I don't know how it is with mental health do you have any experience about like the self-determination of life and how you work and when could help people to have more self-determination with like dealing with mental health definitely I echo what everyone said that giving users the ability to modify the devices to suit person needs can put users in the driver's seat and actually there's a bunch of research showing that engaging in customization can enhance user agency and a sense of control and this can ultimately lead to a higher level of self-determination and this has been also found in my previous research on mental health where we found that like engaging in customizing activities such as you know choosing preferred options or creating idiosyncratic content in this mental health apps can make people feel more fulfilled and satisfied and also increase their perceived autonomy but I want to say there's definitely some trade-offs because customization always comes at a cost of considerable time and cognitive investment and actually some of previous research shows that like users they may find that customization burdens on and thus favor just automated systems that demand leader user effort so like that's why a lot of people are quite lazy, I mean users they're quite lazy so that they don't touch the app itself and just go with whatever the app default suggests because that modifying and playing around these apps requires a lot of time investment as well as high level of digital literacy so yeah I think our previous research has actually found that users' attitudes towards this customization features are really dependent on their own level of digital literacy and self-efficacy so and this led me to think about the potential issues that this type of open source devices may risk perpetrating and amplifying some digital divide or digital inequality such that people who are well educated have higher level of digital literacy they're more likely and more capable of modifying these apps to like to suit their personal needs whereas people from low SES or like not poorly educated they may not have the capability of understanding the very complex algorithm or the features behind this open source data or open source repository and this also may apply to healthcare professionals for those who are older or have lower digital literacy these doctors they may hate these new technologies and they don't really want to work with the patients to modify this to their needs whereas doctors who are younger have higher literacy or they grew up with the technologies like they are more open minded and are more willing to embrace these opportunities we are talking about open source hardware software we might need to take into account these very complex issues around digital divide and digital inequality and be cautious of not perpetuating the existing digital divide so I would love to hear what you think about some of the solutions of encouraging and empowering people who are less probably from low SES and less educated have low digital literacy and how we can empower them to you know really reap the benefit of open source health apps yeah maybe just a quick thought that I think it's definitely a valid point but I think it shouldn't result in everyone having an equally bad experience or something so probably one should work on figuring out how to increase digital literacy and make interfaces that make it easy to make changes and so on this would be a quick thought from my side I always make a Karen joke about my heart device that I say who else but a Karen would ask to talk to the manager to see the source code in her defibrillator right like being able to ask these questions comes from a place of privilege I've come from a technical background people who have the privilege who have the luxury time to think about the technology they rely on are as patients in a much better position I think the questions you raise are so fundamental to the inequalities in our various societies that the execution of healthcare has exacerbated which has only been more exacerbated during the pandemic I might add that the issues around digital literacy are fundamentally connected to our issues around access to healthcare generally and how do we support people to make sure that they get the healthcare that they deserve despite the fact of whatever resources they're bringing to the table I think so too that is always something we think about so when I think about an open source hearing aid that's basically where I'm aiming to be working for still also in the open hearing project I think about what's about the hardware is it possible for people which are not in the western states to have access to the hardware I put my hearing aid on one thing the other thing is why should it be self adjustable because where in most countries you don't even have audiologists who should make the fitting where is the audiolaboratory to make fitting, don't exist so while we're thinking about regulations meanwhile there's a lot of people who anyway wouldn't have anything and it stops us from doing something to develop our hardware or software we need it's always a general problem about hardware for example I was in Brazil and I was saying let's make some prototype on a Raspberry Pi and Arduino and then I said Arduino is so expensive it's so hard to import because you have very high tax on it so I think there's still a lot of we have to learn about the different living situations we should also discuss much more about how you say production lines and distribution possibilities and get to in much more intense exchange with people in not western countries because we have everything here we don't have to complain it's actually just a luxury problem we have what do you think Joel you're nothing like you want to add something I mean I really think when you're writing and it's coming down to a user interface problem really and in terms of designing that user interface engineers and testers who are open to a broader cultural investigation as to what is the proper way to gauge in order to get the result you want so it's a big problem that is not being addressed we're still living in a world where most user interfaces are designed by engineers and are untested lots of assumptions go into the way people think people will be dealing with a phone interface or whatever the hell it is this is getting I think a little bit better but user testing is always the last thing that ever happens on a hardware project and then Peggy to get to address the point you made about accessibility global accessibility you know open source hardware and software is about as accessible as you can get because at least the design files and the code is all on the internet and you can get it but hardware is hard I spent some time before the pandemic working with a team of engineering students in Bangalore they were using my hardware designs for the Timpin project and they would make the hardware there with their local manufacturing base but the design that I made was I don't want to say too sophisticated but it relied on a higher level of resolution in the manufacturing process than their manufacturing base could provide so we worked within the limitations of the contract manufacturers in the region to redesign the hardware so that they could then have it made their local open hardware works open hardware is accessible but hardware is still hard you know so those kind of problems can be overcome but then I freely gave my time and my resources for reviewing their designs, giving them feedback all of this happening through github online the process is easier but still you need somebody like me who is willing to give away all the stuff and then help you that doesn't happen very often I wanted to bring up an example of an open source hardware project starting right now some engineering students at college are trying to design an autoacoustic emissions device this is a diagnostic tool it sends sound waves into your ear canal and then it waits for the echo coming back and you can get a really good indication of cochlear health based on the reflected sound coming back from your ear inside your ear canal they want to make an open source one and we talked last week for about an hour about how to plan for that and what to expect I told them that certainly they would probably want to open source all of the process and all of the prototyping work that they want to do because that gives people an opportunity to see the process to get some result that works that they can modify and work with all on open source hardware platforms all on open source software platforms so that it becomes more of like a global community can engage but their actual science or their actual medical device may not be able to be modified they might be able to show what their source code is they might be able to show what their hardware files are but they need to lock down enough of that because this is a diagnostic tool if you change the tone frequency, if you change the sound pressure level, you're going to get bad results and you're not going to have a good diagnosis so here in this case there's a medical device there are categories of medical devices where you really don't want to mess with them because you're relying on that tool at its settings to give you diagnostic information or results that would lead toward a diagnosis so as open source you can get in a lot of ways at the same time I understand the value of regulation and the value of maintaining a tool that does a thing that it says it's going to do if you want to break it and you want to avoid the warranty that's fine, that's great but you don't have that tool anymore you have a different tool and right to repair I think is really important and critical for humans globally to have but at the same time there has to come with it a lot of education about what does it mean to crack open that box, that case and poke around in what's going on inside you know what are your responsibilities that you're taking on when you're doing that and to address the point you made earlier Karen we just lived through like two years of some of the worst disinformation health wise ever I think at least that I've lived through people are taking drugs that clearly don't treat Covid based on bad information that they're getting because they don't trust good information so you know if you're going to go ahead and like dive into the wind there's not enough real support and real consensus for understanding what that actually means I'll shut up now thank you Charlie so I think we're coming to an end thank you all very much for your participation and I would say I would please everybody to say one short sentence about what they wish for their application for their work for the future from open source in health hardware or software so let's start with Daniel yeah I hope that regulation also gets more flexible and reflects the time better because I want everything in the world to be open hardware basically and also medical devices and then I think the world will be a better place to a big extent Karen I can't wait to see what you the audience think of all of these issues that we raised in the panel because you are the ones that will shape the way that our technology will be created you are the ones who are going to make these choices and you will all we're all in the process of becoming an unbecoming cyborgs these issues around what rights do we have with respect to our body it is all of our question and I'm so excited to see how this evolves and to each and every one of you get involved because there's a place for you in this field thank you very much Karen so Karen so well put so everything Karen said I agree with and also just want to reiterate that we are excited to hear what the audience think about this especially the sort of really tricky issues we talk about such as finding a delicate balance between open source and regulation to ensure the safety and effectiveness of medical devices and how we can find a sweet spot between like providing users with the capability of customizing as well as minimizing and reducing the potential issues of just so inequality so we're excited to hear your thoughts on this thank you very much yeah thank you guys so much for this panel it's really fascinating very vigorous discussion I love it I agree I think things should be more open things should be more open definitely and that's the way that we're going to be able to lift the whole world into a better place definitely thank you guys so I actually think that's like being in prayer having some issues, having some needs it's not something to be desperate or to wait somebody for the help of a creative to get your technology in your hands to ask for more like inclusion in the developing process to ask for more like shaping your device whatever you're dealing with and if it's because you like it or because I know you'll be seen from some people as prepared but actually you're not you're just having fun with nice devices so I'm also very curious on the question of our audience and yeah see you soon and thank you all very much and thanks again for inviting us to Foss Elshah it was big fun and really amazing exchange bye thanks everybody bye thank you