5 ms·

I imagine reviewing a pull request for a repo like this and shudder in horror. I've never understood a significant piece of software in my life to the degree th

I imagine reviewing a pull request for a repo like this and shudder in horror. I've never understood a significant piece of software in my life to the degree that I'd be confident having it control the contents of someone's bloodstream. I know many programmer's don't have the luxury of having only bugs that can't kill people. I'm just glad I'm not one of them. With the best of my intentions and skills, every app I've written has ultimately been a house of cards, supportable only by extensive testing, that can and does fall over at a stern thought. I'd like to write truly robust software but it doesn't look like one of my practical options at the moment.

walterbell 5y ago
If my life depended on a piece of software, I would choose the programmer who understood the impossibility of their task.
alexmcc81 5y ago
There are standards they likely have to follow, e.g. IEC 62304.
twobitshifter 5y ago
Standards must be followed and testing can add a great deal of safety. And for an individual contributor, there could be potential liability if standards weren't followed. Even so, I think in terms of social value per line of code, you'd feel much better spending your time on a project like this. We should understand that the alternative is very imprecise: poking yourself and trying to time the right delivery of insulin doses, based on your current blood sugar, exercise levels, meals, etc. It's a guessing game with diabetics, so this is a giant leap forward in making them healthier, even if the tech wasn't 100% perfect. My dad had been lethargic as he ages, the doctors just told him that the level he was maintaining his blood sugar at was much lower than he should be at for his age. They also gave him an in-arm blood sugar reader. The difference from these small changes has been enormous. He seems more alert and healthier than he has in the last couple of years and he keeps more on top of the sugar levels with the new reader. My point here is that people risk their own lives trying to manage their own blood sugar, and even the smallest tech add, like a device that suggests the right insulin dose can be life altering. Diabetics who fail to manage their blood sugar properly can lose limbs and go blind. Given the choice of going it alone or using a technology used by many others, I know what I'd choose.
- heisenzombie 5y ago
  Yes it's always worth remembering the alternative. In this case, the algorithm insulin_dose(blood_glucose, activity, carbohydrate, fat, protein, time_of_day, time_of_month, is_saturn_in_retrograde, **kwargs) has to get run: Either a microcontroller does it or a person (tired? hungry? intoxicated? distracted?) has to do do it in their head.
  - nwallin 5y ago
    Sure, but a tired/hungry/drunk/distracted human failure mode is "fuck it, it was 22 units 12 this morning, 22 units yesterday evening, 22 units yesterday morning, I'll just do 22 units." A tired/drunk/hungry/distracted human isn't going to calculate a dose of -1 units of insulin and inject 4,294,967,295 units.
    - ThalesX 5y ago
      What would stop a tired/drunk/hungry/distracted human from overdosing as they sometimes do?
      - Aloha 5y ago
        or underdosing. Like, software can have failsafes and error handling, but at some point any healthcare product may require user intervention.
        khuey 5y ago
        In this particular use case, overdosing is a far worse failure mode than underdosing.
    - icehawk 5y ago
      Exactly, a human won't won't dose 4,294,967,295 units, but dosing 4 units instead of 2 units is still a thing can drop you to 30mg/dl, as has happened with my SO.
    - 5y ago
the_d3f4ult 5y ago
Don't forget that if you miss an edge case lawyers will take your house and your life savings. Welcome to medicine = )
go_elmo 5y ago
Theres also the possibility to verify things, which is at least as much effort as to write it in the first place but then you know it wont kill anyone.
tsol 5y ago
I think one of the considerations with open source medical software like this is price-- for many who can't afford anything better its a suitable risk, perhaps with excess monitoring by the user. The ideal situation is for everyone to have easy access to the best equipment, but in some countries that just isn't possible. Not to 'shoo' away your concerns, I do think the still need to be accounted for, but I don't think they represent a roadblock for such an initiative
- pimeys 5y ago
  Also there is nothing comparable to AndroidAPS available in the market that allows you to keep crazy good balance. The price is the learning curve, but the documentation is good.

walterbell 5y ago

If my life depended on a piece of software, I would choose the programmer who understood the impossibility of their task.

alexmcc81 5y ago

There are standards they likely have to follow, e.g. IEC 62304.

twobitshifter 5y ago

Standards must be followed and testing can add a great deal of safety. And for an individual contributor, there could be potential liability if standards weren't followed. Even so, I think in terms of social value per line of code, you'd feel much better spending your time on a project like this. We should understand that the alternative is very imprecise: poking yourself and trying to time the right delivery of insulin doses, based on your current blood sugar, exercise levels, meals, etc. It's a guessing game with diabetics, so this is a giant leap forward in making them healthier, even if the tech wasn't 100% perfect. My dad had been lethargic as he ages, the doctors just told him that the level he was maintaining his blood sugar at was much lower than he should be at for his age. They also gave him an in-arm blood sugar reader. The difference from these small changes has been enormous. He seems more alert and healthier than he has in the last couple of years and he keeps more on top of the sugar levels with the new reader. My point here is that people risk their own lives trying to manage their own blood sugar, and even the smallest tech add, like a device that suggests the right insulin dose can be life altering. Diabetics who fail to manage their blood sugar properly can lose limbs and go blind. Given the choice of going it alone or using a technology used by many others, I know what I'd choose.

heisenzombie 5y ago
Yes it's always worth remembering the alternative. In this case, the algorithm insulin_dose(blood_glucose, activity, carbohydrate, fat, protein, time_of_day, time_of_month, is_saturn_in_retrograde, **kwargs) has to get run: Either a microcontroller does it or a person (tired? hungry? intoxicated? distracted?) has to do do it in their head.
- nwallin 5y ago
  Sure, but a tired/hungry/drunk/distracted human failure mode is "fuck it, it was 22 units 12 this morning, 22 units yesterday evening, 22 units yesterday morning, I'll just do 22 units." A tired/drunk/hungry/distracted human isn't going to calculate a dose of -1 units of insulin and inject 4,294,967,295 units.
  - ThalesX 5y ago
    What would stop a tired/drunk/hungry/distracted human from overdosing as they sometimes do?
    - Aloha 5y ago
      or underdosing. Like, software can have failsafes and error handling, but at some point any healthcare product may require user intervention.
      - khuey 5y ago
        In this particular use case, overdosing is a far worse failure mode than underdosing.
  - icehawk 5y ago
    Exactly, a human won't won't dose 4,294,967,295 units, but dosing 4 units instead of 2 units is still a thing can drop you to 30mg/dl, as has happened with my SO.
  - 5y ago

the_d3f4ult 5y ago

Don't forget that if you miss an edge case lawyers will take your house and your life savings. Welcome to medicine = )

go_elmo 5y ago

Theres also the possibility to verify things, which is at least as much effort as to write it in the first place but then you know it wont kill anyone.

tsol 5y ago

I think one of the considerations with open source medical software like this is price-- for many who can't afford anything better its a suitable risk, perhaps with excess monitoring by the user. The ideal situation is for everyone to have easy access to the best equipment, but in some countries that just isn't possible. Not to 'shoo' away your concerns, I do think the still need to be accounted for, but I don't think they represent a roadblock for such an initiative

pimeys 5y ago
Also there is nothing comparable to AndroidAPS available in the market that allows you to keep crazy good balance. The price is the learning curve, but the documentation is good.