Dozens of companies — large and small, foreign and domestic — have received grants to invent and improve prostheses for use, first by wounded warriors and eventually by the much larger number of civilian amputees. Wars typically yield such advancements because those who have sacrificed limbs often demand replacements that push the limits of prosthetic technology. Because today's war amputees account for only a tiny fraction of the people living with limb loss, leaders of the US $900 million prosthetics industry say the government's investment will be seen less on their balance sheets than in the sophistication of newfangled prostheses. "That is, in my mind, almost like what the space programme did," said Thomas Kirk, president of Hanger Orthopedic Group Inc., the largest provider of prosthetic patient services in the US. Of course, the military and the Veteran Administration (VA), which provides lifelong care for veterans, are buying more prosthetic products and services. For example, the VA said it spent $1.1 million last year on prosthetic devices and services, compared with about $529,000 in 2000. "The military expenditure on prosthetics is obviously booming, and it represents a more and more significant part of our business, but it is still only a small part of our business," said Ian Fothergill, clinical marketing manager for the North American division of Iceland-based Ossur hf., the world's second-largest prosthetics manufacturer. North American sales of all products by publicly traded Ossur in 2006 totaled $156 million, or 62 per cent of its worldwide sales, the company reported. That was up from 52 per cent of worldwide sales in 2002, the year before the US-led invasion of Iraq. Ossur said sales of prosthetics grew by 12 per cent worldwide and 17 per cent in North America last year. Still, the company's growth strategy relies more heavily on orthotics — braces and other assistive devices — to serve an aging population. Wounded warriors historically have helped push the boundaries of prosthetic technology by demanding ever more functional, durable, comfortable devices. These days, the military aims to restore functionality to the point that some troops have returned to battle — something virtually unheard of until now. "We no longer have to be content just getting them on their feet; we can do more," said Kirk, of Bethesda-based Hanger. Hanger, with nearly a quarter of the US 2,700 prosthetic and orthotic patient care centres, had 2006 sales of $599 million. Its share price hit a nearly three-year high of $12.40 in April, and the company recently reported that sales at patient care centres open more than a year were growing at an annual rate of more than 2.5 per cent. The company was founded in 1861 by a Civil War amputee, James E. Hanger of Virginia, who fashioned an improved artificial leg out of whittled barrel staves, rubber, wood, and metal components and started selling them to other Confederate veterans. Germany's Otto Bock healthcare, the world's biggest manufacturer of prostheses, also has wartime roots. The company's founder and namesake "was considered a little bit like the Henry Ford of the prosthetic industry" for mass-producing devices for World War I veterans, said Brad Ruhl, vice-president of sales at the company's North American headquarters in Minneapolis. The privately held firm now has annual sales of about $500 million, but Ruhl would not reveal detailed financial data. Bock's C-Leg, a microprocessor-controlled knee joint introduced in the late 1990s, is the standard prosthesis issued to US fighters who have lost a leg above the knee, according to the American Orthotics and Prosthetics Association. Celebrated by "Doonesbury" maker Garry Trudeau, who gave one to a wounded Iraq War veteran, it costs $30,000 to $40,000 delivered and fitted by a certified prosthetist and equipped with a socket, liner and foot. Otto Bock is also the commercial partner in the $30.4 million project at Johns Hopkins University in Baltimore to develop a thought-controlled arm by 2009. The project is funded by the Defense Department through its Defense Advanced Research Projects Agency (DARPA). The current standard for upper-extremity amputees is the myoelectric arm, like Sgt. Salzman's Utah Arm. Because far more people lose legs than arms — roughly three times as many, according to the Amputee Coalition of America — fewer private research dollars are devoted to replacing them. That is where the DARPA programme comes in; without government help, "the potential demand is so small that the significant investment required to bring these types of devices to market would be insurmountable," Ruhl said. Motion Control, the small, privately held maker of the Utah Arm, also bid on the DARPA project as part of a competing group. President Harold Sears expressed disappointment his firm lost, but was ecstatic about his latest success, a hook called the Electric Terminal Device (ETD), that weighs several ounces less than Otto Bock's competing Greifer device. Dear Egyptian Mail readers, Your comments and/or contributions are welcome. We promise to publish whatever is deemed publishable at the end of each series of articles. [email protected]
