1
00:00:00,080 --> 00:00:02,430
The following content is
provided under a Creative

2
00:00:02,430 --> 00:00:03,810
Commons license.

3
00:00:03,810 --> 00:00:06,060
Your support will help
MIT OpenCourseWare

4
00:00:06,060 --> 00:00:10,150
continue to offer high quality
educational resources for free.

5
00:00:10,150 --> 00:00:12,690
To make a donation, or to
view additional materials

6
00:00:12,690 --> 00:00:16,600
from hundreds of MIT courses,
visit MIT OpenCourseWare

7
00:00:16,600 --> 00:00:17,260
at ocw.mit.edu.

8
00:00:31,680 --> 00:00:36,210
PROFESSOR: So welcome
everybody, and I actually

9
00:00:36,210 --> 00:00:38,830
used to be at MIT in the
'90s, so it's good to be back.

10
00:00:38,830 --> 00:00:41,540
And so we're going to talk
today about a different kind

11
00:00:41,540 --> 00:00:42,170
of security.

12
00:00:42,170 --> 00:00:44,550
It's going to be less on the
technical mechanism side,

13
00:00:44,550 --> 00:00:46,200
and more on the,
well, what happens

14
00:00:46,200 --> 00:00:48,492
when all this technology gets
put in place in something

15
00:00:48,492 --> 00:00:49,824
where there's high consequences?

16
00:00:49,824 --> 00:00:52,060
Not quite so high-consequence
as, say, an airplane in

17
00:00:52,060 --> 00:00:55,290
the sky, but getting
pretty close.

18
00:00:55,290 --> 00:00:57,470
Just to let you know
where I'm coming from.

19
00:00:57,470 --> 00:00:59,680
So I used to be part of the
midnight coffeehouse club

20
00:00:59,680 --> 00:01:02,299
myself, but this is
Michigan, actually.

21
00:01:02,299 --> 00:01:04,090
We're not quite as big
as your campus here.

22
00:01:04,090 --> 00:01:06,895
But a short while
ago somebody decided

23
00:01:06,895 --> 00:01:09,700
to put a hot tub on our
computer science building,

24
00:01:09,700 --> 00:01:11,364
so they're doing
research inside there.

25
00:01:11,364 --> 00:01:13,030
But what we're going
to talk about today

26
00:01:13,030 --> 00:01:16,016
is some of the research
that bubbled out of that.

27
00:01:16,016 --> 00:01:17,640
So we're going to
talk about everything

28
00:01:17,640 --> 00:01:23,010
from exploding defibrillators
to other issues of privacy

29
00:01:23,010 --> 00:01:24,667
in medical devices.

30
00:01:24,667 --> 00:01:26,250
And this mainly is
going to be related

31
00:01:26,250 --> 00:01:29,460
to just one thread of research
from one of my former graduate

32
00:01:29,460 --> 00:01:32,880
students here, who is
actually at this point

33
00:01:32,880 --> 00:01:36,020
sanitizing explanted pacemakers.

34
00:01:36,020 --> 00:01:38,540
But we're going to mostly
talk about the security

35
00:01:38,540 --> 00:01:41,210
of medical devices today.

36
00:01:41,210 --> 00:01:43,670
Got a bunch of acknowledgements.

37
00:01:43,670 --> 00:01:44,510
There it is on tape.

38
00:01:47,030 --> 00:01:49,370
This work is by tons
of people, and I'm

39
00:01:49,370 --> 00:01:51,480
going to try to
summarize for you some

40
00:01:51,480 --> 00:01:54,400
of the modern bits about
medical device security

41
00:01:54,400 --> 00:01:56,530
through all sorts of places.

42
00:01:56,530 --> 00:01:58,620
I'm also required to
put up this boilerplate

43
00:01:58,620 --> 00:02:01,580
slide of my potential
conflict of interest,

44
00:02:01,580 --> 00:02:03,860
so now you can know about
any potential biases

45
00:02:03,860 --> 00:02:05,080
on my thinking.

46
00:02:05,080 --> 00:02:06,740
But I'd like to
think that I am less

47
00:02:06,740 --> 00:02:08,820
biased than the average person.

48
00:02:08,820 --> 00:02:11,360
OK.

49
00:02:11,360 --> 00:02:12,580
So moving on.

50
00:02:12,580 --> 00:02:15,256
So an interesting thing
happened about a year ago,

51
00:02:15,256 --> 00:02:17,130
when FDA-- the Food and
Drug Administration--

52
00:02:17,130 --> 00:02:19,540
released a draft document
saying they are now

53
00:02:19,540 --> 00:02:22,580
going to be expecting
manufacturers to consider cyber

54
00:02:22,580 --> 00:02:24,814
security-- or as we call
it, security and privacy--

55
00:02:24,814 --> 00:02:27,480
not only in their implementation
of the medical device software,

56
00:02:27,480 --> 00:02:29,560
but in their design
of their software.

57
00:02:29,560 --> 00:02:31,970
Before a single line of
code has been written.

58
00:02:31,970 --> 00:02:33,744
And so we're going
to talk about how

59
00:02:33,744 --> 00:02:35,910
this has affected the
thinking in the medical device

60
00:02:35,910 --> 00:02:37,340
manufacturing community.

61
00:02:37,340 --> 00:02:40,040
Their final guidance came
out just a couple weeks ago,

62
00:02:40,040 --> 00:02:42,330
and we just held
a conference call.

63
00:02:42,330 --> 00:02:44,730
FDA held a conference
call, and over 650 people

64
00:02:44,730 --> 00:02:46,922
decided to join
the teleconference.

65
00:02:46,922 --> 00:02:49,380
So there's a lot of interest
in the manufacturing community

66
00:02:49,380 --> 00:02:51,838
about how to take some of the
concepts you're learning here

67
00:02:51,838 --> 00:02:54,760
in your class and actually apply
it to the medical community.

68
00:02:54,760 --> 00:02:55,640
But it's really hard.

69
00:02:55,640 --> 00:02:58,864
And I noticed one of the
questions up on the website

70
00:02:58,864 --> 00:03:01,530
was about how to get the culture
change in the medical community

71
00:03:01,530 --> 00:03:03,080
to understand security.

72
00:03:03,080 --> 00:03:05,260
And this slide illustrates that.

73
00:03:05,260 --> 00:03:08,010
So, who washed their
hands this morning?

74
00:03:08,010 --> 00:03:08,635
OK.

75
00:03:08,635 --> 00:03:11,250
Oh, this is not MIT, everybody.

76
00:03:11,250 --> 00:03:15,520
So actually about
164, 165 years ago,

77
00:03:15,520 --> 00:03:18,670
there was a famous
physician, Ignaz Semmelweis,

78
00:03:18,670 --> 00:03:21,130
who was looking into something
called childbed fever.

79
00:03:21,130 --> 00:03:23,650
And he discovered that
his medical students

80
00:03:23,650 --> 00:03:26,150
who were working in the morgue
in the morning who later went

81
00:03:26,150 --> 00:03:27,941
to work with patients,
well, those patients

82
00:03:27,941 --> 00:03:29,320
tended to die more often.

83
00:03:29,320 --> 00:03:32,260
And he discovered if you washed
your hands, then statistically

84
00:03:32,260 --> 00:03:35,740
you were less likely to pass
on some kind of probability

85
00:03:35,740 --> 00:03:38,220
of not living longer.

86
00:03:38,220 --> 00:03:41,435
So he recommended that
physicians wash their hands.

87
00:03:41,435 --> 00:03:43,310
And the reaction from
the physician community

88
00:03:43,310 --> 00:03:45,290
was, doctors are
gentleman, and therefore

89
00:03:45,290 --> 00:03:48,190
their hands are always clean.

90
00:03:48,190 --> 00:03:50,487
And to some extent
we're seeing some

91
00:03:50,487 --> 00:03:52,570
of those kinds of attitudes
toward security today,

92
00:03:52,570 --> 00:03:53,780
so it's not too surprising.

93
00:03:53,780 --> 00:03:55,490
But I'll try to
draw some parallels

94
00:03:55,490 --> 00:03:56,960
with that throughout the talk.

95
00:03:59,452 --> 00:04:00,910
I've got a lot of
material to cover

96
00:04:00,910 --> 00:04:02,618
so I'm going to whip
through some things.

97
00:04:02,618 --> 00:04:04,930
But first thing I'm going
to do-- anyone a physician?

98
00:04:04,930 --> 00:04:05,430
No?

99
00:04:05,430 --> 00:04:07,040
OK, well you're all
going to be able to have

100
00:04:07,040 --> 00:04:08,740
some good material
for cocktail parties

101
00:04:08,740 --> 00:04:10,320
with your doctor friends.

102
00:04:10,320 --> 00:04:11,210
We're going to talk
a little bit about

103
00:04:11,210 --> 00:04:12,500
implantable medical devices.

104
00:04:12,500 --> 00:04:14,221
Actually I'll pass
this guy around.

105
00:04:14,221 --> 00:04:15,470
You can feel free to touch it.

106
00:04:15,470 --> 00:04:16,386
It's been de-dangered.

107
00:04:16,386 --> 00:04:17,779
Just don't lick it.

108
00:04:17,779 --> 00:04:21,790
This is a defibrillator
from a former patient.

109
00:04:21,790 --> 00:04:25,241
And actually this is a device
here-- about 50 years ago,

110
00:04:25,241 --> 00:04:27,740
some of the first pacemakers
started to appear on the scene.

111
00:04:27,740 --> 00:04:28,531
They were external.

112
00:04:28,531 --> 00:04:31,420
You had to have a burly
nurse to cart it around.

113
00:04:31,420 --> 00:04:34,440
And then as the
decades wore on, they

114
00:04:34,440 --> 00:04:36,160
became small enough
to be implanted,

115
00:04:36,160 --> 00:04:37,790
completely implanted
in the body.

116
00:04:37,790 --> 00:04:39,290
And here you see a
picture of what's

117
00:04:39,290 --> 00:04:42,060
called a wand that's
using inductive coupling.

118
00:04:42,060 --> 00:04:43,300
It's technically wireless.

119
00:04:43,300 --> 00:04:44,091
There are no wires.

120
00:04:44,091 --> 00:04:47,634
To wirelessly program the device
to be 60 beats per minute.

121
00:04:47,634 --> 00:04:49,550
But interesting to me
as a security researcher

122
00:04:49,550 --> 00:04:51,720
was that in around
2003 or so, we

123
00:04:51,720 --> 00:04:53,870
began to see defibrillators,
such as the one I'm

124
00:04:53,870 --> 00:04:58,890
passing around, that started to
embrace wireless technologies

125
00:04:58,890 --> 00:05:00,950
and networking that
you'd be more used to

126
00:05:00,950 --> 00:05:03,440
as sort of general computation.

127
00:05:03,440 --> 00:05:06,470
And I was thinking what
could possibly go wrong?

128
00:05:06,470 --> 00:05:08,650
Luckily there are a lot
of engineers also thinking

129
00:05:08,650 --> 00:05:12,480
that same question in
companies, but security, it

130
00:05:12,480 --> 00:05:13,564
takes a different mindset.

131
00:05:13,564 --> 00:05:15,563
And I'm going to tell you
a little bit about how

132
00:05:15,563 --> 00:05:16,774
that mindset is changing.

133
00:05:16,774 --> 00:05:18,940
So if you were to open up
one of those devices, what

134
00:05:18,940 --> 00:05:21,716
you find inside are vast
resource constraints.

135
00:05:21,716 --> 00:05:23,340
If you want a hard
engineering problem,

136
00:05:23,340 --> 00:05:25,630
pop open one of these devices.

137
00:05:25,630 --> 00:05:28,070
So about half of the
device is just a battery.

138
00:05:28,070 --> 00:05:29,500
A very high quality battery.

139
00:05:29,500 --> 00:05:33,330
These cost about $40,000
a pop on the market.

140
00:05:33,330 --> 00:05:34,530
Silver vanadium oxide.

141
00:05:34,530 --> 00:05:36,613
And you've got little
microcontrollers at the top.

142
00:05:36,613 --> 00:05:38,270
Typically you have
some antennas where

143
00:05:38,270 --> 00:05:40,769
you can do your communication
for your control of the device

144
00:05:40,769 --> 00:05:41,760
as well.

145
00:05:41,760 --> 00:05:44,917
This is all hermetically
sealed, implanted in your body.

146
00:05:44,917 --> 00:05:47,250
We're talking one of the
harshest environments possible.

147
00:05:47,250 --> 00:05:49,541
You want to recharge a battery
in your body, good luck.

148
00:05:49,541 --> 00:05:52,230
Did you know that batteries
give off heat and gas?

149
00:05:52,230 --> 00:05:54,745
So there are very
challenging constraints

150
00:05:54,745 --> 00:05:56,330
to engineering the device.

151
00:05:56,330 --> 00:06:00,000
When you want to add security,
it gets just a little bit hard.

152
00:06:00,000 --> 00:06:02,260
So there is, however,
a very good reason

153
00:06:02,260 --> 00:06:06,000
for having a wirelessly
controlled medical device.

154
00:06:06,000 --> 00:06:08,390
There are good reasons, but
there are these subtle risks.

155
00:06:08,390 --> 00:06:10,600
So to illustrate
that, I want you

156
00:06:10,600 --> 00:06:13,440
to see what pacemakers
used to look like.

157
00:06:13,440 --> 00:06:15,630
So this is a pacemaker
from the Medtronic Museum

158
00:06:15,630 --> 00:06:17,000
up in Minneapolis.

159
00:06:17,000 --> 00:06:19,590
And can anyone guess what
that little piece of metal

160
00:06:19,590 --> 00:06:21,760
is on the right hand side?

161
00:06:21,760 --> 00:06:24,630
What its function is?

162
00:06:24,630 --> 00:06:25,300
Antenna?

163
00:06:25,300 --> 00:06:26,870
Control?

164
00:06:26,870 --> 00:06:27,936
Control is very close.

165
00:06:27,936 --> 00:06:28,685
Any other guesses?

166
00:06:31,650 --> 00:06:34,730
So this is a device before
there was wireless communication

167
00:06:34,730 --> 00:06:35,772
to control a pacemaker.

168
00:06:35,772 --> 00:06:37,980
In the old days, when you
want to change the settings

169
00:06:37,980 --> 00:06:40,320
on your device, the
physician says, "Patient,

170
00:06:40,320 --> 00:06:41,470
please lift up your arm.

171
00:06:41,470 --> 00:06:43,720
I'm going to put a needle
through your armpit to twist

172
00:06:43,720 --> 00:06:45,890
the dial to change
your heart rate. "

173
00:06:45,890 --> 00:06:48,300
So one of the great
reasons for wireless

174
00:06:48,300 --> 00:06:50,260
is that it actually
reduces infection rates,

175
00:06:50,260 --> 00:06:53,350
because the more you put
foreign objects in your body,

176
00:06:53,350 --> 00:06:56,040
the more likely you are
to contract an infection.

177
00:06:56,040 --> 00:06:57,350
It is a serious risk.

178
00:06:57,350 --> 00:07:01,840
Actually, 1% of implantations
have major complications,

179
00:07:01,840 --> 00:07:03,870
and of those,
about 1% are fatal.

180
00:07:03,870 --> 00:07:06,370
So controlling infection is one
of the most important things

181
00:07:06,370 --> 00:07:10,440
you can do in the implantation
and changing of the device.

182
00:07:10,440 --> 00:07:13,140
Of course, if you go the
other extreme and just say,

183
00:07:13,140 --> 00:07:14,740
I want to put
wireless everywhere,

184
00:07:14,740 --> 00:07:16,601
you'll get different
kinds of risks.

185
00:07:16,601 --> 00:07:18,975
So I've sort of dubbed this
the bacon theory of wireless.

186
00:07:21,725 --> 00:07:23,100
Now my mother's
from the Midwest,

187
00:07:23,100 --> 00:07:25,920
so she used to say bacon
makes everything better.

188
00:07:25,920 --> 00:07:28,390
And I've noticed there are
some device manufacturers who

189
00:07:28,390 --> 00:07:30,460
seem to be putting wireless
everywhere without necessarily

190
00:07:30,460 --> 00:07:31,751
thinking through all the risks.

191
00:07:31,751 --> 00:07:33,970
It does have its
benefits, but you

192
00:07:33,970 --> 00:07:36,290
need to very strategically
think before you add this

193
00:07:36,290 --> 00:07:37,732
to a safety critical device.

194
00:07:37,732 --> 00:07:39,606
What are the security
risks for instance that

195
00:07:39,606 --> 00:07:41,580
are going to be opening up?

196
00:07:41,580 --> 00:07:43,820
Oops, I had one
misplaced slide, but I

197
00:07:43,820 --> 00:07:45,410
guess I'll just say it anyway.

198
00:07:45,410 --> 00:07:47,534
I'm not going to talk a
whole lot about networking,

199
00:07:47,534 --> 00:07:50,740
but I thought this quote was
just too good not to mention.

200
00:07:50,740 --> 00:07:53,230
Does anyone remember the
ship off the coast of Italy?

201
00:07:53,230 --> 00:07:55,020
The captain says,
"These days, everything

202
00:07:55,020 --> 00:07:58,980
is much safer, thanks to modern
instruments and the internet."

203
00:07:58,980 --> 00:08:02,830
And there's his ship
that turned over there.

204
00:08:02,830 --> 00:08:04,887
So you add internet
connectivity and wireless

205
00:08:04,887 --> 00:08:07,220
to your medical device, there
are going to be new risks.

206
00:08:07,220 --> 00:08:08,720
And you don't need
to be afraid of them,

207
00:08:08,720 --> 00:08:10,770
but you just need to have
appropriate mitigating

208
00:08:10,770 --> 00:08:12,796
controls.

209
00:08:12,796 --> 00:08:13,920
So I'm flying through this.

210
00:08:13,920 --> 00:08:15,730
But what I want to
give you is paint

211
00:08:15,730 --> 00:08:19,920
a picture of what's a typical
day in a medical device,

212
00:08:19,920 --> 00:08:22,140
and how it's used
in clinical care,

213
00:08:22,140 --> 00:08:23,740
and how that might
change your mindset

214
00:08:23,740 --> 00:08:25,420
if you come from a
security background,

215
00:08:25,420 --> 00:08:27,360
and how you think about risk.

216
00:08:27,360 --> 00:08:29,620
So first going to
talk about the world

217
00:08:29,620 --> 00:08:34,000
where there aren't real threats,
just unsafe practices and some

218
00:08:34,000 --> 00:08:35,490
carelessness.

219
00:08:35,490 --> 00:08:39,470
So the FDA maintains a database
of near misses, malfunctions,

220
00:08:39,470 --> 00:08:40,539
injuries, and deaths.

221
00:08:40,539 --> 00:08:41,330
This is all public.

222
00:08:41,330 --> 00:08:42,705
You can go look
this up yourself.

223
00:08:42,705 --> 00:08:43,820
It's called MAUDE.

224
00:08:43,820 --> 00:08:47,630
And one of the devices was
called this volumetric infusion

225
00:08:47,630 --> 00:08:48,130
pump.

226
00:08:48,130 --> 00:08:51,660
This is a device that
infuses drugs into your body

227
00:08:51,660 --> 00:08:53,970
through an IV mechanically.

228
00:08:53,970 --> 00:08:55,900
And this patient died.

229
00:08:55,900 --> 00:08:59,030
And if you look carefully,
it says one of the causes

230
00:08:59,030 --> 00:09:01,356
was a buffer overflow.

231
00:09:01,356 --> 00:09:03,105
I think you learned
about buffer overflows

232
00:09:03,105 --> 00:09:04,490
in your first lecture.

233
00:09:04,490 --> 00:09:07,950
So they are very real and they
happen and in every sector.

234
00:09:07,950 --> 00:09:11,270
So in this particular case when
the buffer overflow occurred,

235
00:09:11,270 --> 00:09:14,880
it was actually caught in their
error checking in the software,

236
00:09:14,880 --> 00:09:17,450
but the action it took
was to shut the pump down.

237
00:09:17,450 --> 00:09:19,630
To bring it down to a safe mode.

238
00:09:19,630 --> 00:09:22,080
What they didn't realize
was that for some patients,

239
00:09:22,080 --> 00:09:24,440
shutting down the pump is
basically a death sentence.

240
00:09:24,440 --> 00:09:28,030
So this patient died
after the increase

241
00:09:28,030 --> 00:09:32,740
in intracranial pressure,
followed by brain death because

242
00:09:32,740 --> 00:09:35,750
of the buffer overflow.

243
00:09:35,750 --> 00:09:38,730
So there's nothing really
complicated here, right?

244
00:09:38,730 --> 00:09:40,595
You all know you don't
want to have buffer

245
00:09:40,595 --> 00:09:41,720
overflows in your software.

246
00:09:41,720 --> 00:09:43,670
There's no adversary
at this point.

247
00:09:43,670 --> 00:09:47,600
So this kind of illustrates
the state of software, at least

248
00:09:47,600 --> 00:09:49,195
for this particular device.

249
00:09:49,195 --> 00:09:51,700
It's very challenging.

250
00:09:51,700 --> 00:09:53,940
The other challenging
part that doesn't come up

251
00:09:53,940 --> 00:09:56,520
a whole lot in a security
course is the human side.

252
00:09:56,520 --> 00:09:59,150
So there are few
universities that

253
00:09:59,150 --> 00:10:02,600
focus on the human element, but
I think there ought to be more.

254
00:10:02,600 --> 00:10:05,240
So I set out on some life
experience of my own.

255
00:10:05,240 --> 00:10:07,290
My wife asked to
remain anonymous,

256
00:10:07,290 --> 00:10:10,460
so she said as long as
I don't reveal her name.

257
00:10:10,460 --> 00:10:13,530
So that's me, that's our
infusion pump in the back,

258
00:10:13,530 --> 00:10:15,600
and that's our baby in there.

259
00:10:15,600 --> 00:10:18,920
And for us luckily the
pump worked just fine.

260
00:10:18,920 --> 00:10:23,080
But pumps are great for
delivering medical care,

261
00:10:23,080 --> 00:10:28,250
but they have resulted in over
500 deaths due to various forms

262
00:10:28,250 --> 00:10:29,930
of malfunctions.

263
00:10:29,930 --> 00:10:34,010
So I'm going to tell you
about one more malfunction.

264
00:10:34,010 --> 00:10:35,990
There's also an
implantable kind of pump.

265
00:10:35,990 --> 00:10:37,770
They're not just
bedside pumps, the kind

266
00:10:37,770 --> 00:10:41,090
you see on daytime
hospital dramas.

267
00:10:41,090 --> 00:10:43,330
But here's an implantable
pump, and it's

268
00:10:43,330 --> 00:10:45,080
got this semipermeable
membrane where

269
00:10:45,080 --> 00:10:46,890
you can replenish the drugs.

270
00:10:46,890 --> 00:10:49,610
And this is a user interface
that the nurse or the clinician

271
00:10:49,610 --> 00:10:52,070
uses to change the dosage rate.

272
00:10:52,070 --> 00:10:55,670
So does anyone see where you
type in the quantity of drug?

273
00:10:58,660 --> 00:11:00,246
You've got to kind
of squint, right?

274
00:11:00,246 --> 00:11:02,310
So you squint really closely.

275
00:11:02,310 --> 00:11:04,600
And one thing you'll notice
is here by number six

276
00:11:04,600 --> 00:11:07,060
it says we're going to
dose this bolus-- bolus

277
00:11:07,060 --> 00:11:11,061
is a quantum of drug-- over
20 minutes and 12 seconds.

278
00:11:11,061 --> 00:11:12,810
We're going to dose
this into the patient.

279
00:11:12,810 --> 00:11:14,643
And this is implanted,
so you don't feel it.

280
00:11:14,643 --> 00:11:16,450
There's no nerve.

281
00:11:16,450 --> 00:11:18,860
And this user
interface is actually

282
00:11:18,860 --> 00:11:21,830
after an FDA recall
went into effect

283
00:11:21,830 --> 00:11:23,720
for the software quality.

284
00:11:23,720 --> 00:11:28,960
So what was missing before the
recall were eight key elements.

285
00:11:28,960 --> 00:11:34,442
In particular HH:MM:SS.

286
00:11:34,442 --> 00:11:38,650
So what do you think happens,
or what you think could happen,

287
00:11:38,650 --> 00:11:41,690
if that label were missing?

288
00:11:41,690 --> 00:11:46,120
It's really easy to
get the units wrong.

289
00:11:46,120 --> 00:11:48,410
Make an order of
magnitude error.

290
00:11:48,410 --> 00:11:52,390
So unfortunately for this
patient, who later expired,

291
00:11:52,390 --> 00:11:56,654
he or she had his or
her pump reprogrammed,

292
00:11:56,654 --> 00:11:58,320
and the health care
professional noticed

293
00:11:58,320 --> 00:12:01,370
that the bolus was given over
20 minutes instead of 20 hours

294
00:12:01,370 --> 00:12:02,670
after the fact.

295
00:12:02,670 --> 00:12:05,710
Unfortunately the patient
left the facility,

296
00:12:05,710 --> 00:12:07,650
got into a motor
vehicle accident,

297
00:12:07,650 --> 00:12:10,870
and then later died after the
family removed life support.

298
00:12:10,870 --> 00:12:14,920
But if you look at this from
a technical perspective,

299
00:12:14,920 --> 00:12:16,810
the problem is
pretty simple, right?

300
00:12:16,810 --> 00:12:19,050
In terms of you didn't
have the label there.

301
00:12:19,050 --> 00:12:21,670
But human factors is
very easy to overlook.

302
00:12:21,670 --> 00:12:23,590
It's not always right
there, front and center,

303
00:12:23,590 --> 00:12:24,395
in the engineering process.

304
00:12:24,395 --> 00:12:26,580
Do you have a human factors
part in this lecture?

305
00:12:26,580 --> 00:12:27,480
See what I mean?

306
00:12:27,480 --> 00:12:29,730
Blame Nickolai.

307
00:12:29,730 --> 00:12:30,940
No, Nickolai is great.

308
00:12:30,940 --> 00:12:33,620
But it's a very
important element

309
00:12:33,620 --> 00:12:36,350
of improving the
trustworthiness of devices

310
00:12:36,350 --> 00:12:38,330
that rely on software.

311
00:12:38,330 --> 00:12:41,170
So I encourage you to think
about better human elements

312
00:12:41,170 --> 00:12:43,440
and human factors
for your software,

313
00:12:43,440 --> 00:12:46,760
even if it's on
something non-critical.

314
00:12:46,760 --> 00:12:49,260
So that should begin
to paint a picture

315
00:12:49,260 --> 00:12:53,710
of the typical problems
in medical device failures

316
00:12:53,710 --> 00:12:55,710
post [INAUDIBLE] 25.

317
00:12:55,710 --> 00:12:57,640
And the other thing
I want to talk about

318
00:12:57,640 --> 00:12:59,840
is the exciting
world of management.

319
00:12:59,840 --> 00:13:02,320
Management, exciting.

320
00:13:02,320 --> 00:13:05,634
I used to collect all these
little dialogue boxes whenever

321
00:13:05,634 --> 00:13:07,300
my computer would get
a software update,

322
00:13:07,300 --> 00:13:09,520
but this all happens
in the background now.

323
00:13:09,520 --> 00:13:11,390
Like my iPhone's
constantly getting updates

324
00:13:11,390 --> 00:13:13,530
and drawing more power.

325
00:13:13,530 --> 00:13:15,990
But now it just sort of happens.

326
00:13:15,990 --> 00:13:20,160
But medical devices also
take software updates.

327
00:13:20,160 --> 00:13:23,540
They're not really
fundamentally different from

328
00:13:23,540 --> 00:13:25,430
traditional computing devices.

329
00:13:25,430 --> 00:13:28,869
They just happen to control
vital functions of your body.

330
00:13:28,869 --> 00:13:30,160
So there's an interesting case.

331
00:13:30,160 --> 00:13:31,920
It's now been about four years.

332
00:13:31,920 --> 00:13:35,010
So McAfee-- there are a
number of antivirus companies

333
00:13:35,010 --> 00:13:37,210
that produce products
that hospitals use--

334
00:13:37,210 --> 00:13:40,040
and in this particular case,
McAfee had this software

335
00:13:40,040 --> 00:13:42,350
update that actually
misclassified

336
00:13:42,350 --> 00:13:44,266
a critical Windows
DL as malicious,

337
00:13:44,266 --> 00:13:46,015
and then decided to
quarantine the system.

338
00:13:49,280 --> 00:13:52,947
So when it
quarantined, let's see.

339
00:13:56,617 --> 00:14:00,370
[COMPUTER SOUND]

340
00:14:00,370 --> 00:14:01,980
That always happens, right?

341
00:14:01,980 --> 00:14:02,480
OK.

342
00:14:02,480 --> 00:14:05,650
So, ha ha ha.

343
00:14:05,650 --> 00:14:08,030
In this particular
case with McAfee,

344
00:14:08,030 --> 00:14:10,770
when they quarantined
this critical Windows DL

345
00:14:10,770 --> 00:14:14,690
as malicious, the machine
just started rebooting.

346
00:14:14,690 --> 00:14:16,430
Blue Screen of
Death and cycling.

347
00:14:16,430 --> 00:14:17,969
And in Rhode Island,
they basically

348
00:14:17,969 --> 00:14:19,760
stopped admitting
patients at one hospital,

349
00:14:19,760 --> 00:14:22,200
except for severe cases
like gunshot wounds,

350
00:14:22,200 --> 00:14:24,800
because their admission systems
weren't working properly.

351
00:14:24,800 --> 00:14:30,270
So clinical care depends heavily
on the function of software,

352
00:14:30,270 --> 00:14:34,650
and we sometimes forget
about the role of security.

353
00:14:34,650 --> 00:14:38,990
On the topic of depending
on other people's software,

354
00:14:38,990 --> 00:14:42,275
Microsoft has one of the largest
footprint of operating systems.

355
00:14:42,275 --> 00:14:44,650
And believe it or not, there
are a lot of medical devices

356
00:14:44,650 --> 00:14:46,730
that run on Windows XP.

357
00:14:46,730 --> 00:14:48,230
Windows XP, in case
you didn't hear,

358
00:14:48,230 --> 00:14:51,694
went out of service
half a year ago.

359
00:14:51,694 --> 00:14:53,610
So you should not be
using this, because there

360
00:14:53,610 --> 00:14:56,680
are no more updates, security
updates, function updates.

361
00:14:56,680 --> 00:14:58,340
It's antiquated software.

362
00:14:58,340 --> 00:15:00,660
But there are still medical
devices today being shipped

363
00:15:00,660 --> 00:15:03,140
brand new with Windows XP.

364
00:15:03,140 --> 00:15:06,424
The software life cycles
are a little bit misaligned.

365
00:15:06,424 --> 00:15:08,840
If you're used to downloading
updates for your open source

366
00:15:08,840 --> 00:15:12,100
software on a daily basis, well,
think about medical devices.

367
00:15:12,100 --> 00:15:14,760
You might not be able to
get to it, say, for a year.

368
00:15:14,760 --> 00:15:16,860
It might be in the
field for 20 years.

369
00:15:16,860 --> 00:15:18,970
So it's very difficult
to locate software

370
00:15:18,970 --> 00:15:21,420
that's appropriate for
a 20-year life cycle.

371
00:15:21,420 --> 00:15:24,280
It's basically flying in space.

372
00:15:24,280 --> 00:15:26,210
So the Food and
Drug Administration

373
00:15:26,210 --> 00:15:29,190
has now released some
guidance-- actually,

374
00:15:29,190 --> 00:15:33,120
this was just
exactly a month ago--

375
00:15:33,120 --> 00:15:35,666
on what they expect to
see from manufacturers.

376
00:15:39,060 --> 00:15:40,590
Think of it as a design project.

377
00:15:40,590 --> 00:15:43,100
As you're writing down
all the requirements

378
00:15:43,100 --> 00:15:45,640
of your medical device,
they're asking manufacturers

379
00:15:45,640 --> 00:15:48,082
how have they thought through
the security problems.

380
00:15:48,082 --> 00:15:50,290
How have they thought through
all the security risks?

381
00:15:50,290 --> 00:15:51,760
How are they mitigating it?

382
00:15:51,760 --> 00:15:53,850
What risks are they
accepting as what

383
00:15:53,850 --> 00:15:56,630
they call residual risk,
things that they don't solve?

384
00:15:56,630 --> 00:15:59,590
But they expect them to least
be aware of all the risks

385
00:15:59,590 --> 00:16:02,080
and ideally mitigate them.

386
00:16:02,080 --> 00:16:04,230
So with the management
of software,

387
00:16:04,230 --> 00:16:06,430
when no one person
is accountable,

388
00:16:06,430 --> 00:16:08,400
all sorts of crazy
things happen.

389
00:16:08,400 --> 00:16:11,280
But there is some
guidance now that's

390
00:16:11,280 --> 00:16:14,570
beginning to emerge to help
the manufacturing community

391
00:16:14,570 --> 00:16:18,740
to better integrate security
into their products.

392
00:16:18,740 --> 00:16:21,480
So I think we're making
some pretty good time.

393
00:16:21,480 --> 00:16:22,170
All right.

394
00:16:22,170 --> 00:16:25,050
So now we're going to be able
to go into the security side.

395
00:16:25,050 --> 00:16:26,840
I wanted to get the
non-security stuff out

396
00:16:26,840 --> 00:16:29,040
of the way for the context.

397
00:16:29,040 --> 00:16:33,770
So let's put on our gray
hats and black hats.

398
00:16:33,770 --> 00:16:36,200
Before I begin this,
though, I guess

399
00:16:36,200 --> 00:16:39,280
what I want to say is this
is a very challenging area

400
00:16:39,280 --> 00:16:42,240
to do research, because
there are patients.

401
00:16:42,240 --> 00:16:48,140
And if I were given a medical
device, for instance, today,

402
00:16:48,140 --> 00:16:50,480
I'd still take it even if
the security problems weren't

403
00:16:50,480 --> 00:16:52,560
all worked out, because
I know I'm much better

404
00:16:52,560 --> 00:16:54,690
off with that medical device.

405
00:16:54,690 --> 00:16:56,500
But that said, of
course, I'd prefer

406
00:16:56,500 --> 00:16:58,920
to have medical devices
that are more secure.

407
00:16:58,920 --> 00:17:02,610
So there is the emergence of
more and more secure devices,

408
00:17:02,610 --> 00:17:05,750
but today, if you have to choose
between a device and no device,

409
00:17:05,750 --> 00:17:07,500
I'd strongly
recommend taking it,

410
00:17:07,500 --> 00:17:10,069
because you're going to be
in a much better position.

411
00:17:10,069 --> 00:17:12,460
But that said, let's
take a look now.

412
00:17:12,460 --> 00:17:15,220
If we consider the adversary,
and if the adversary

413
00:17:15,220 --> 00:17:17,790
wants to cause problems
to a medical device.

414
00:17:17,790 --> 00:17:21,578
So who's got the
defibrillator at the moment?

415
00:17:21,578 --> 00:17:22,619
Oh, it's right over here.

416
00:17:22,619 --> 00:17:24,413
Good.

417
00:17:24,413 --> 00:17:26,329
So I'd like to tell you
a little bit about how

418
00:17:26,329 --> 00:17:28,380
these defibrillators
are implanted.

419
00:17:28,380 --> 00:17:31,130
This is a very special device
because, well, number one,

420
00:17:31,130 --> 00:17:33,930
it's implanted, therefore
it's very high risk.

421
00:17:33,930 --> 00:17:36,310
It's life sustaining.

422
00:17:36,310 --> 00:17:38,660
If it's pacing your heart,
for instance, and it fails,

423
00:17:38,660 --> 00:17:40,110
the results can be catastrophic.

424
00:17:40,110 --> 00:17:42,485
So it's very interesting from
an engineering perspective.

425
00:17:42,485 --> 00:17:45,680
It needs to work
24/7 for many years.

426
00:17:45,680 --> 00:17:48,635
So this is a programmer.

427
00:17:48,635 --> 00:17:49,780
Not a person, but a device.

428
00:17:49,780 --> 00:17:52,230
It's basically a ruggedized
computer, and attached to it

429
00:17:52,230 --> 00:17:53,320
is a little wand.

430
00:17:53,320 --> 00:17:54,340
That's not a mouse.

431
00:17:54,340 --> 00:18:00,040
That's a transmitter/receiver
speaking a proprietary wireless

432
00:18:00,040 --> 00:18:02,210
signal over a licensed spectrum.

433
00:18:02,210 --> 00:18:04,220
We're not talking
802.11, we're talking

434
00:18:04,220 --> 00:18:06,640
specially-licensed
spectrum there.

435
00:18:06,640 --> 00:18:09,630
And what happens is it
takes about 90 minutes.

436
00:18:09,630 --> 00:18:11,510
The patient is
awake, just slightly

437
00:18:11,510 --> 00:18:14,540
sedated to remain calm, and
there's a local anesthetic.

438
00:18:14,540 --> 00:18:17,640
A small incision is made
beneath the clavicle.

439
00:18:17,640 --> 00:18:19,560
And then the team--
typically it's

440
00:18:19,560 --> 00:18:24,930
a team of about six people--
will weave electrodes

441
00:18:24,930 --> 00:18:27,420
through a sacrificed
blood vessel that then

442
00:18:27,420 --> 00:18:28,760
terminates inside the heart.

443
00:18:28,760 --> 00:18:31,150
And actually I have
one of them right here.

444
00:18:31,150 --> 00:18:34,550
This was not previously used.

445
00:18:34,550 --> 00:18:35,750
You can pass this around.

446
00:18:35,750 --> 00:18:37,960
You see the little
tines on the end.

447
00:18:37,960 --> 00:18:41,650
And on some of the devices
there's both a sensor,

448
00:18:41,650 --> 00:18:43,215
so it can sense
your cardiac rhythm,

449
00:18:43,215 --> 00:18:44,340
and there's also actuation.

450
00:18:44,340 --> 00:18:47,410
You can send shocks,
both small and large,

451
00:18:47,410 --> 00:18:51,430
to either pace the heart or
to basically reboot the heart

452
00:18:51,430 --> 00:18:53,100
if there's a chaotic rhythm.

453
00:18:53,100 --> 00:18:54,740
It's a very highly
advanced device.

454
00:18:54,740 --> 00:18:57,100
It's a steroid-tipped
piece of metal on the end,

455
00:18:57,100 --> 00:18:59,200
so it doesn't bind
to the tissue.

456
00:18:59,200 --> 00:19:02,390
You can pass that around.

457
00:19:02,390 --> 00:19:05,870
It's basically a
USB cable, right?

458
00:19:05,870 --> 00:19:10,090
So after that's
implanted into the body,

459
00:19:10,090 --> 00:19:11,660
the patient is sewn up.

460
00:19:11,660 --> 00:19:12,617
They do some testing.

461
00:19:12,617 --> 00:19:14,200
And typically the
patient will receive

462
00:19:14,200 --> 00:19:16,710
what looks like a
little base station.

463
00:19:16,710 --> 00:19:18,380
Like a little access point.

464
00:19:18,380 --> 00:19:20,410
It's very proprietary.

465
00:19:20,410 --> 00:19:23,725
Typically they speak a
proprietary RF to the implant

466
00:19:23,725 --> 00:19:25,700
so it can gather
all the telemetry,

467
00:19:25,700 --> 00:19:29,320
so that it can send it back up
through the cloud-- typically

468
00:19:29,320 --> 00:19:31,825
through a private cloud,
for whatever private means--

469
00:19:31,825 --> 00:19:34,182
so that the health care
professionals can keep tabs

470
00:19:34,182 --> 00:19:34,890
on their patient.

471
00:19:34,890 --> 00:19:36,830
So for instance, if
you notice that there's

472
00:19:36,830 --> 00:19:40,060
some odd measurement
coming from patient Mary,

473
00:19:40,060 --> 00:19:41,620
you might call up
Mary and say, "You

474
00:19:41,620 --> 00:19:42,540
should really make
an appointment

475
00:19:42,540 --> 00:19:44,706
and come in, because I'd
like to see what's going on

476
00:19:44,706 --> 00:19:45,770
with your defibrillator."

477
00:19:45,770 --> 00:19:47,603
So one of the nice
things about the wireless

478
00:19:47,603 --> 00:19:49,670
is they're able to have
more continuous care

479
00:19:49,670 --> 00:19:51,580
rather than come back in a year.

480
00:19:54,280 --> 00:19:56,440
We had a team of students
at several universities

481
00:19:56,440 --> 00:19:59,490
get together, and I gave them
one of these defibrillators

482
00:19:59,490 --> 00:20:01,080
and an oscilloscope,
and they went off

483
00:20:01,080 --> 00:20:02,895
into a cave for
about nine months.

484
00:20:02,895 --> 00:20:06,390
And they came back and
said, "Look what we found!"

485
00:20:06,390 --> 00:20:11,640
So this is a screenshot of the
communication between a device

486
00:20:11,640 --> 00:20:12,860
and the programmer.

487
00:20:12,860 --> 00:20:15,890
And what you can see is first
of all, it's in the clear.

488
00:20:15,890 --> 00:20:18,500
There's no cryptography, at
least none that we could find.

489
00:20:18,500 --> 00:20:21,190
You'll find inside here the name
of the implanting physician,

490
00:20:21,190 --> 00:20:23,210
the diagnosis, the hospital.

491
00:20:23,210 --> 00:20:25,380
Basically a complete
electronic health record.

492
00:20:25,380 --> 00:20:28,585
This is an older device,
from about 10 years ago.

493
00:20:28,585 --> 00:20:31,080
But that was the state of
the art about 10 years ago.

494
00:20:31,080 --> 00:20:33,170
There didn't appear to
be any use of encryption,

495
00:20:33,170 --> 00:20:36,550
at least for the privacy
of the health information.

496
00:20:36,550 --> 00:20:38,430
So when we noticed
this, we thought,

497
00:20:38,430 --> 00:20:41,110
well then, we definitely need
to look at the security side

498
00:20:41,110 --> 00:20:42,670
about how the device
is controlled.

499
00:20:42,670 --> 00:20:44,980
How do they ensure the
authenticity of the control?

500
00:20:44,980 --> 00:20:46,780
The integrity?

501
00:20:46,780 --> 00:20:50,180
And that's when we decided to
do the following experiment.

502
00:20:50,180 --> 00:20:53,060
So we started learning how to
use something called a software

503
00:20:53,060 --> 00:20:53,610
radio.

504
00:20:53,610 --> 00:20:55,735
Probably some of you have
played around with these.

505
00:20:55,735 --> 00:20:57,130
There are a bunch of them now.

506
00:20:57,130 --> 00:20:59,330
About 10 years ago,
the most popular one

507
00:20:59,330 --> 00:21:02,740
was the USRP and
GNU radio software.

508
00:21:02,740 --> 00:21:08,050
So we took an antenna from a
pacemaker that we didn't need,

509
00:21:08,050 --> 00:21:12,150
created a little antenna, and
we recorded the RF communication

510
00:21:12,150 --> 00:21:14,700
of inducing a
fatal heart rhythm.

511
00:21:14,700 --> 00:21:17,640
And then we replayed
that communication back.

512
00:21:17,640 --> 00:21:19,810
And then the device
happily emitted

513
00:21:19,810 --> 00:21:23,160
a large-- something on the
order of a 500-volt shock.

514
00:21:23,160 --> 00:21:27,270
On the order of about 32 joules
in one millisecond, which

515
00:21:27,270 --> 00:21:30,062
I'm told if you were
to get that on you,

516
00:21:30,062 --> 00:21:32,020
it's like being kicked
in the chest by a horse.

517
00:21:32,020 --> 00:21:36,090
So it's a rather powerful shock.

518
00:21:36,090 --> 00:21:38,840
And the interesting thing
was how we discovered this.

519
00:21:38,840 --> 00:21:41,500
So I was in the operating
room, and recall back,

520
00:21:41,500 --> 00:21:43,880
I said that when
you're a patient

521
00:21:43,880 --> 00:21:47,240
and the procedure is
ending, the health care

522
00:21:47,240 --> 00:21:51,030
team tests if the defibrillator
is working properly.

523
00:21:51,030 --> 00:21:55,830
So how do you end-to-end
test if a defibrillator's

524
00:21:55,830 --> 00:21:59,860
working properly if the
heart is beating normally?

525
00:21:59,860 --> 00:22:00,590
Right?

526
00:22:00,590 --> 00:22:03,580
So what's built into
the defibrillator

527
00:22:03,580 --> 00:22:06,160
is a command to induce
the very fatal heart

528
00:22:06,160 --> 00:22:10,200
rhythm that the defibrillator
is designed to restore you from.

529
00:22:10,200 --> 00:22:12,890
It's called a command shock.

530
00:22:12,890 --> 00:22:15,130
So when I asked the
physicians about that,

531
00:22:15,130 --> 00:22:18,047
they didn't seem to understand
the concept of authentication.

532
00:22:18,047 --> 00:22:19,630
And that's when we
decided we'd really

533
00:22:19,630 --> 00:22:22,672
need to look more deeply into
how to solve these problems.

534
00:22:22,672 --> 00:22:24,130
So in this particular
case, we were

535
00:22:24,130 --> 00:22:25,980
able to send the
command to the device,

536
00:22:25,980 --> 00:22:32,130
and we weren't authenticated,
and we could induce that shock.

537
00:22:32,130 --> 00:22:35,810
The good news is
these devices have

538
00:22:35,810 --> 00:22:38,450
been able to solve these
problems through some software

539
00:22:38,450 --> 00:22:39,010
updates.

540
00:22:39,010 --> 00:22:40,968
And they've been aware
of it for quite a while,

541
00:22:40,968 --> 00:22:42,660
so they're able to
spin out devices

542
00:22:42,660 --> 00:22:44,600
that now take into
account some of these more

543
00:22:44,600 --> 00:22:47,010
adversarial conditions.

544
00:22:47,010 --> 00:22:48,510
Where are those
tines going around?

545
00:22:48,510 --> 00:22:49,300
Over there?

546
00:22:49,300 --> 00:22:52,000
OK, great.

547
00:22:52,000 --> 00:22:53,357
So that's the implant side.

548
00:22:53,357 --> 00:22:55,190
There's a huge amount
of innovation going on

549
00:22:55,190 --> 00:22:56,680
with implants.

550
00:22:56,680 --> 00:22:59,070
It's not really science
fiction anymore,

551
00:22:59,070 --> 00:23:01,660
but there are real people
and patients behind it.

552
00:23:01,660 --> 00:23:05,340
And most people care deeply
about delivering quality health

553
00:23:05,340 --> 00:23:07,080
care.

554
00:23:07,080 --> 00:23:11,030
But sometimes they just don't
realize how to fit security

555
00:23:11,030 --> 00:23:13,060
into their designing process.

556
00:23:13,060 --> 00:23:16,760
So it's a challenge culturally.

557
00:23:16,760 --> 00:23:18,540
Another stakeholder
are the people

558
00:23:18,540 --> 00:23:20,380
who provide health care
in the first place.

559
00:23:20,380 --> 00:23:22,560
Hospitals, primarily,
or small clinics.

560
00:23:22,560 --> 00:23:24,620
If you want to find
malware, go to a hospital.

561
00:23:24,620 --> 00:23:27,090
You're going to find
some interesting malware.

562
00:23:27,090 --> 00:23:28,350
And here's why.

563
00:23:28,350 --> 00:23:32,550
So here's a screenshot
from a colleague who

564
00:23:32,550 --> 00:23:34,850
used to work at Beth Israel
Deaconess Medical Center

565
00:23:34,850 --> 00:23:36,040
here in Boston.

566
00:23:36,040 --> 00:23:38,440
And he gave a map of his
network architecture.

567
00:23:38,440 --> 00:23:40,610
There's nothing particularly
earth-shattering

568
00:23:40,610 --> 00:23:41,770
about the architecture.

569
00:23:41,770 --> 00:23:43,490
What was interesting,
though, was

570
00:23:43,490 --> 00:23:46,030
he listed the
number of operating

571
00:23:46,030 --> 00:23:48,530
systems in his
hospital on what were

572
00:23:48,530 --> 00:23:50,710
considered medical devices.

573
00:23:50,710 --> 00:23:53,490
And I looked at him-- I like
to add up numbers and insanity

574
00:23:53,490 --> 00:23:55,880
check things-- and I
said, "Well, you've

575
00:23:55,880 --> 00:23:58,720
got Service Pack one, two,
three of Windows XP, zero

576
00:23:58,720 --> 00:24:00,310
15 plus one.

577
00:24:00,310 --> 00:24:01,460
That equals 16.

578
00:24:01,460 --> 00:24:02,630
That doesn't equal 600.

579
00:24:02,630 --> 00:24:04,580
Your addition's wrong."

580
00:24:04,580 --> 00:24:06,910
And he looked at me and he
said, "No, Kevin, that's

581
00:24:06,910 --> 00:24:11,020
600 Service Pack zero
machines in the hospital."

582
00:24:11,020 --> 00:24:12,580
So these are medical
devices where

583
00:24:12,580 --> 00:24:14,880
they've been unable to
get the manufacturer

584
00:24:14,880 --> 00:24:17,910
to provide patches and update
it to the modern software.

585
00:24:17,910 --> 00:24:20,202
Which means it's
that old software,

586
00:24:20,202 --> 00:24:22,410
vulnerable to all the old
malware that's been hitting

587
00:24:22,410 --> 00:24:26,140
Windows XP for 15 years.

588
00:24:26,140 --> 00:24:29,260
So it's very difficult
in the clinical setting

589
00:24:29,260 --> 00:24:32,197
to keep yourself protected,
because the product life cycles

590
00:24:32,197 --> 00:24:33,530
are just completely out of sync.

591
00:24:33,530 --> 00:24:36,350
They think in terms of
decades in health care,

592
00:24:36,350 --> 00:24:39,350
but in the fast hockey stick
world of Silicon Valley,

593
00:24:39,350 --> 00:24:43,110
we think about days, weeks, or
months for software updates.

594
00:24:43,110 --> 00:24:45,700
You can see down here in
their clinical systems,

595
00:24:45,700 --> 00:24:47,830
average time to infection
is about 12 days

596
00:24:47,830 --> 00:24:51,020
when they don't have any kind
of protection against malware.

597
00:24:51,020 --> 00:24:52,762
And they can get
almost up to a year

598
00:24:52,762 --> 00:24:54,970
if they're able to get an
antivirus product on there.

599
00:24:54,970 --> 00:24:56,510
But even that's not perfect.

600
00:24:59,422 --> 00:25:01,380
And feel free to ask
questions too, by the way,

601
00:25:01,380 --> 00:25:02,421
if you want to know more.

602
00:25:02,421 --> 00:25:04,180
Go deeper dive on any
of these incidents.

603
00:25:04,180 --> 00:25:06,900
But one of the
interesting things I found

604
00:25:06,900 --> 00:25:11,030
was that one relatively
common source of infection

605
00:25:11,030 --> 00:25:12,209
is the vendor themselves.

606
00:25:12,209 --> 00:25:13,750
Sometimes they don't
even realize it.

607
00:25:13,750 --> 00:25:15,208
So I'm going to go
over a few cases

608
00:25:15,208 --> 00:25:18,240
where the vendor has
sort of accidentally

609
00:25:18,240 --> 00:25:20,145
been the carrier of the malware.

610
00:25:20,145 --> 00:25:23,420
I was talking with the
chief field security

611
00:25:23,420 --> 00:25:26,330
officer for the Veterans
Administration, the VA.

612
00:25:26,330 --> 00:25:29,790
They have about 153 clinics
in the United States.

613
00:25:29,790 --> 00:25:32,750
And one day there was
a vendor showing up

614
00:25:32,750 --> 00:25:35,540
to do software updates on
some of their clinical medical

615
00:25:35,540 --> 00:25:36,660
devices.

616
00:25:36,660 --> 00:25:38,390
And her intrusion
detection software

617
00:25:38,390 --> 00:25:39,870
was just chirping
away everywhere--

618
00:25:39,870 --> 00:25:41,411
I think his name
was Bob-- everywhere

619
00:25:41,411 --> 00:25:43,790
Bob was walking and
plugging in his USB drive

620
00:25:43,790 --> 00:25:45,050
to update the software.

621
00:25:45,050 --> 00:25:47,410
He was infecting the machines
with malware by accident,

622
00:25:47,410 --> 00:25:50,380
because somehow malware
got onto his USB drive.

623
00:25:50,380 --> 00:25:52,660
So there's a
perception out there

624
00:25:52,660 --> 00:25:54,619
that if you're not
networked, you're safe.

625
00:25:54,619 --> 00:25:56,160
But if you think
about it for moment,

626
00:25:56,160 --> 00:25:58,220
very few people used the
internet 20 years ago

627
00:25:58,220 --> 00:25:59,940
and there were still
computer viruses.

628
00:25:59,940 --> 00:26:02,520
So in a hospital, a
common infection vector

629
00:26:02,520 --> 00:26:04,290
is the USB drive.

630
00:26:04,290 --> 00:26:06,410
I'm even aware of
two manufacturers--

631
00:26:06,410 --> 00:26:11,360
I can't tell you their
names-- but they almost

632
00:26:11,360 --> 00:26:13,480
shipped malware-infected
medical devices.

633
00:26:13,480 --> 00:26:15,900
And they caught it
by chance, by luck,

634
00:26:15,900 --> 00:26:18,440
before it went out
into the product line.

635
00:26:21,440 --> 00:26:23,730
Who's done any work
on the programming

636
00:26:23,730 --> 00:26:26,980
with the cloud or
software distribution?

637
00:26:26,980 --> 00:26:28,180
A few of you.

638
00:26:28,180 --> 00:26:33,050
So the medical community is
also embracing the cloud.

639
00:26:33,050 --> 00:26:35,420
It gives them more
distributive control.

640
00:26:35,420 --> 00:26:37,020
But it also comes
with risks that

641
00:26:37,020 --> 00:26:40,300
are qualitatively different
from your typical software.

642
00:26:40,300 --> 00:26:44,100
If you want to get the
newest word processor,

643
00:26:44,100 --> 00:26:45,450
that's one thing.

644
00:26:45,450 --> 00:26:47,680
But if you want to get an
update for your ventilator,

645
00:26:47,680 --> 00:26:49,070
completely different.

646
00:26:49,070 --> 00:26:51,560
So I noticed there was
a recall on the firmware

647
00:26:51,560 --> 00:26:52,600
for a ventilator.

648
00:26:52,600 --> 00:26:56,410
And the manufacture sent out
a handy dandy website where

649
00:26:56,410 --> 00:26:58,729
you could download an update.

650
00:26:58,729 --> 00:27:00,770
Now I was going to go
check their PGP signatures.

651
00:27:00,770 --> 00:27:02,670
Couldn't find those,
but what I did find

652
00:27:02,670 --> 00:27:04,000
was a little link down here.

653
00:27:04,000 --> 00:27:06,180
It says, "Click here for
your software update."

654
00:27:06,180 --> 00:27:09,590
I thought, oh, goody,
let's go do that.

655
00:27:09,590 --> 00:27:13,050
So I did that and up
popped this dialogue box.

656
00:27:13,050 --> 00:27:14,960
It says, "Warning--
Visiting this site may

657
00:27:14,960 --> 00:27:16,130
harm your computer.

658
00:27:16,130 --> 00:27:20,710
This website you are visiting
appears to contain malware."

659
00:27:20,710 --> 00:27:24,290
Has anyone seen this before?

660
00:27:24,290 --> 00:27:26,390
Do you know what
it was what it is?

661
00:27:26,390 --> 00:27:27,478
What's going on?

662
00:27:27,478 --> 00:27:30,894
AUDIENCE: So that's probably
your antivirus software,

663
00:27:30,894 --> 00:27:31,870
correct?

664
00:27:31,870 --> 00:27:32,980
PROFESSOR: Close.

665
00:27:32,980 --> 00:27:35,140
It's not my antivirus
software, but it's

666
00:27:35,140 --> 00:27:36,755
sort of a similar concept.

667
00:27:36,755 --> 00:27:37,630
In the back, I heard.

668
00:27:37,630 --> 00:27:39,270
AUDIENCE: I would
bet this is Chrome.

669
00:27:39,270 --> 00:27:41,020
PROFESSOR: Chrome.

670
00:27:41,020 --> 00:27:43,500
Yeah, so in this case I
believe I was using Chrome.

671
00:27:43,500 --> 00:27:45,690
But effectively
what's going on is

672
00:27:45,690 --> 00:27:50,640
Google has something they call
the Safe Web Browsing service.

673
00:27:50,640 --> 00:27:53,440
So actually, the guy who did
this is Neil [INAUDIBLE].

674
00:27:53,440 --> 00:27:56,100
He's one of the lead programmers
for, I believe, OpenSSH.

675
00:27:56,100 --> 00:27:58,060
He's actually from Michigan.

676
00:27:58,060 --> 00:27:59,820
But he created this
service at Google

677
00:27:59,820 --> 00:28:01,380
that goes around
the internet just

678
00:28:01,380 --> 00:28:05,400
downloading random executables
and then running them.

679
00:28:05,400 --> 00:28:07,550
And what's interesting is
they create a whole bunch

680
00:28:07,550 --> 00:28:08,540
of virtual machines.

681
00:28:08,540 --> 00:28:09,609
This is my understanding.

682
00:28:09,609 --> 00:28:11,650
I may be misrepresenting
it, but my understanding

683
00:28:11,650 --> 00:28:13,691
is they create a whole
bunch of virtual machines,

684
00:28:13,691 --> 00:28:15,540
download those executables,
and just run it

685
00:28:15,540 --> 00:28:17,680
and then see if the virtual
machine gets infected.

686
00:28:17,680 --> 00:28:19,470
And if the virtual
machine gets infected,

687
00:28:19,470 --> 00:28:22,509
you flag that website
as distributing malware.

688
00:28:22,509 --> 00:28:24,300
They don't know the
intentions necessarily,

689
00:28:24,300 --> 00:28:26,535
but it's a participant in
the malware distribution.

690
00:28:29,552 --> 00:28:31,510
This is what you might
call drive-by downloads.

691
00:28:31,510 --> 00:28:33,860
It's a very common
way of getting malware

692
00:28:33,860 --> 00:28:37,190
to you on the internet,
especially with the spammers,

693
00:28:37,190 --> 00:28:40,164
and some of the organized crime.

694
00:28:40,164 --> 00:28:42,705
But in this case their website
appears have been infiltrated,

695
00:28:42,705 --> 00:28:45,195
and instead of sending me the
ventilator software update,

696
00:28:45,195 --> 00:28:46,850
they were giving me malware.

697
00:28:46,850 --> 00:28:50,270
And at least according
to the Google website,

698
00:28:50,270 --> 00:28:54,310
it says that over
the past 90 days,

699
00:28:54,310 --> 00:28:56,570
that's what the website
was resulting in.

700
00:28:56,570 --> 00:28:58,610
So all I could think
was, all right,

701
00:28:58,610 --> 00:29:00,365
so if there's an FDA
recall, and you're

702
00:29:00,365 --> 00:29:02,920
a biomedical engineer
working for a hospital,

703
00:29:02,920 --> 00:29:04,820
and your job is to
keep your hospital

704
00:29:04,820 --> 00:29:06,760
medical devices
safe and effective.

705
00:29:06,760 --> 00:29:08,510
You're going to go
download that software.

706
00:29:08,510 --> 00:29:11,770
So which box do you
think they clicked?

707
00:29:11,770 --> 00:29:17,680
Do you think they
clicked close or ignore?

708
00:29:17,680 --> 00:29:18,180
Right?

709
00:29:18,180 --> 00:29:22,770
I am sure, I would bet you
dollars to donuts, 99% of them

710
00:29:22,770 --> 00:29:23,820
clicked ignore.

711
00:29:23,820 --> 00:29:24,320
Right?

712
00:29:24,320 --> 00:29:26,200
And so all I'm
imagining now is we've

713
00:29:26,200 --> 00:29:28,074
got thousands of
clinical engineers

714
00:29:28,074 --> 00:29:30,240
and biomedical engineers
walking around with malware

715
00:29:30,240 --> 00:29:32,710
on their laptops in hospitals.

716
00:29:32,710 --> 00:29:35,320
Hopefully not on the
ventilator, but most likely

717
00:29:35,320 --> 00:29:36,490
on their local computer.

718
00:29:39,490 --> 00:29:42,310
So other fun things
you can do is

719
00:29:42,310 --> 00:29:45,330
you can go search the
MAUDE database for keywords

720
00:29:45,330 --> 00:29:48,010
like computer virus and
see what's in there.

721
00:29:48,010 --> 00:29:49,990
And these are all
narratives submitted

722
00:29:49,990 --> 00:29:51,350
by hospitals and manufacturers.

723
00:29:51,350 --> 00:29:53,440
One of the more
interesting ones is

724
00:29:53,440 --> 00:29:55,670
something called a compounder.

725
00:29:55,670 --> 00:29:57,210
So I have one of
these in my lab.

726
00:29:57,210 --> 00:29:58,920
It's kind of hard to get.

727
00:29:58,920 --> 00:30:00,550
But it makes liquid drugs.

728
00:30:00,550 --> 00:30:04,560
So it has I think on the
order of 16 ports on the top,

729
00:30:04,560 --> 00:30:06,450
where you can have
the little serums,

730
00:30:06,450 --> 00:30:09,689
and then it deposits
it into a saline bag.

731
00:30:09,689 --> 00:30:11,980
And then you can use IV
delivery to deliver it directly

732
00:30:11,980 --> 00:30:13,210
to your veins.

733
00:30:13,210 --> 00:30:16,750
So many hospitals will
have these for custom, just

734
00:30:16,750 --> 00:30:19,290
in time drug delivery,
special cocktails of drugs

735
00:30:19,290 --> 00:30:20,660
for patients.

736
00:30:20,660 --> 00:30:22,200
And what was
interesting is here,

737
00:30:22,200 --> 00:30:23,783
there was a report
that the compounder

738
00:30:23,783 --> 00:30:25,440
was infected with a virus.

739
00:30:25,440 --> 00:30:26,140
OK?

740
00:30:26,140 --> 00:30:28,650
So we bought that
compounder, and we found

741
00:30:28,650 --> 00:30:30,640
it runs Windows XP embedded.

742
00:30:30,640 --> 00:30:31,880
Surprise.

743
00:30:31,880 --> 00:30:34,282
And so it was
vulnerable to malware,

744
00:30:34,282 --> 00:30:35,990
all the malware that
any other Windows XP

745
00:30:35,990 --> 00:30:37,700
box would be vulnerable to.

746
00:30:37,700 --> 00:30:39,450
But what was a little
bit surprising to me

747
00:30:39,450 --> 00:30:41,522
was manufacturer
response at the time.

748
00:30:41,522 --> 00:30:43,480
I hope they changed their
tune, but at the time

749
00:30:43,480 --> 00:30:45,810
they said, "Well,
we do not regularly

750
00:30:45,810 --> 00:30:49,100
install operating system
updates or patches."

751
00:30:49,100 --> 00:30:51,320
This struck me as whoa, what?

752
00:30:51,320 --> 00:30:52,720
What do you mean?

753
00:30:52,720 --> 00:30:55,260
I said maybe they
had a bit flip.

754
00:30:55,260 --> 00:30:58,850
But there's a huge
misunderstanding

755
00:30:58,850 --> 00:31:01,474
about expectations
of software updates.

756
00:31:01,474 --> 00:31:02,140
Let me be clear.

757
00:31:02,140 --> 00:31:07,240
FDA expects manufacturers to
keep the software up to date.

758
00:31:07,240 --> 00:31:09,990
But many manufacturers
will claim

759
00:31:09,990 --> 00:31:13,090
that they are not able to do
updates because of some FDA

760
00:31:13,090 --> 00:31:14,680
nonexistent rules.

761
00:31:14,680 --> 00:31:16,930
So if you ever run into a
medical device manufacturer,

762
00:31:16,930 --> 00:31:19,260
and they claim that the
FDA rules prevent them

763
00:31:19,260 --> 00:31:20,860
from doing software
updates, just

764
00:31:20,860 --> 00:31:23,180
tell them, no,
actually that's untrue.

765
00:31:23,180 --> 00:31:26,360
And Professor Freeman
created a poster for this.

766
00:31:26,360 --> 00:31:27,370
So here we go.

767
00:31:27,370 --> 00:31:29,560
"Homework prevents me
from passing class,

768
00:31:29,560 --> 00:31:31,490
eHarmony prevents me
from getting dates,

769
00:31:31,490 --> 00:31:33,760
and yes, FDA rules
prevent software updates.

770
00:31:33,760 --> 00:31:34,550
Yeah, right.

771
00:31:34,550 --> 00:31:36,260
Bull."

772
00:31:36,260 --> 00:31:40,310
So it is true that issuing a
software update takes effort.

773
00:31:40,310 --> 00:31:41,670
It takes engineering time.

774
00:31:41,670 --> 00:31:43,090
It's not a simple process.

775
00:31:43,090 --> 00:31:45,790
It's not like-- I don't know
what course it's called these

776
00:31:45,790 --> 00:31:49,300
days, 6.170, what it's
become-- but it's not as simple

777
00:31:49,300 --> 00:31:52,540
as typing "make" and then
submit to the auto-grader.

778
00:31:52,540 --> 00:31:54,940
There's a huge amount of
verification and validation

779
00:31:54,940 --> 00:31:55,890
that goes on.

780
00:31:55,890 --> 00:31:57,660
But that's what
you're expected to do

781
00:31:57,660 --> 00:31:59,800
if you're in the medical
device manufacturing game.

782
00:31:59,800 --> 00:32:01,925
If you're in that industry,
that's the expectation.

783
00:32:05,240 --> 00:32:07,890
So a question that
often comes up

784
00:32:07,890 --> 00:32:10,160
is, do we need to
worry about this?

785
00:32:10,160 --> 00:32:12,750
And are there any intentional
malicious malfunctions?

786
00:32:12,750 --> 00:32:14,720
How significant are these?

787
00:32:14,720 --> 00:32:18,020
And the good news is, I'm not
aware of any specific instance

788
00:32:18,020 --> 00:32:19,970
where there's been
a targeted attack,

789
00:32:19,970 --> 00:32:21,940
and I hope none ever happens.

790
00:32:21,940 --> 00:32:23,500
But I think it'd be
foolish to assume

791
00:32:23,500 --> 00:32:26,040
that bad people don't exist.

792
00:32:26,040 --> 00:32:29,070
So if you look back in
history, in 1982, actually,

793
00:32:29,070 --> 00:32:31,730
there was an incident in
Chicago where somebody

794
00:32:31,730 --> 00:32:34,020
deliberately tampered with
extra-strength Tylenol

795
00:32:34,020 --> 00:32:38,020
on the shelves of pharmacies
and inserted cyanide.

796
00:32:38,020 --> 00:32:41,340
A number of people
ingested it and died.

797
00:32:41,340 --> 00:32:42,902
A short time later,
at the funeral,

798
00:32:42,902 --> 00:32:44,985
additional members of
family used the same bottle.

799
00:32:44,985 --> 00:32:46,560
They also died.

800
00:32:46,560 --> 00:32:50,710
Within days, the US
had pulled Tylenol

801
00:32:50,710 --> 00:32:52,460
from all the shelves
in the United States.

802
00:32:52,460 --> 00:32:55,650
You could not find Tylenol
in the United States.

803
00:32:55,650 --> 00:32:58,270
And within one year, Congress
had passed new legislation

804
00:32:58,270 --> 00:33:01,295
requiring tamper-evident
packaging and physical security

805
00:33:01,295 --> 00:33:03,020
of over-the-counter drugs.

806
00:33:03,020 --> 00:33:05,530
This incident is the reason
when you open up your medicine,

807
00:33:05,530 --> 00:33:07,610
you see a little metal foil.

808
00:33:07,610 --> 00:33:10,790
So we know bad people exist.

809
00:33:10,790 --> 00:33:14,620
The cases that we are aware
of are more about tomfoolery,

810
00:33:14,620 --> 00:33:15,950
but still dangerous.

811
00:33:15,950 --> 00:33:18,590
So this woman said she had
one of the worst seizure she's

812
00:33:18,590 --> 00:33:20,210
ever experienced
when somebody decided

813
00:33:20,210 --> 00:33:22,900
to post flashing animations
on an epilepsy support group

814
00:33:22,900 --> 00:33:24,090
website.

815
00:33:24,090 --> 00:33:25,497
So quite malicious.

816
00:33:25,497 --> 00:33:27,955
It was probably someone who
didn't realize the ramification

817
00:33:27,955 --> 00:33:30,410
of their actions,
because you can actually

818
00:33:30,410 --> 00:33:34,140
severely harm a patient who's
sensitive to those kinds

819
00:33:34,140 --> 00:33:35,180
of things.

820
00:33:35,180 --> 00:33:37,900
But again, bad people do exist.

821
00:33:37,900 --> 00:33:41,150
So one of the problems
with the culture gap

822
00:33:41,150 --> 00:33:43,600
is that much of medical
device manufacturing

823
00:33:43,600 --> 00:33:46,150
thinks statistically,
and they think

824
00:33:46,150 --> 00:33:48,960
about past performance
of a device predicting

825
00:33:48,960 --> 00:33:50,430
future performance.

826
00:33:50,430 --> 00:33:52,610
So in the security world,
we know that actually,

827
00:33:52,610 --> 00:33:55,110
if you see no security problems,
that might be because there

828
00:33:55,110 --> 00:33:56,780
are a bunch more to come soon.

829
00:33:56,780 --> 00:33:59,030
So if you take a look at the
Mac, for instance, right?

830
00:33:59,030 --> 00:34:03,030
Before two years ago, basically
no malware was on the Mac.

831
00:34:03,030 --> 00:34:05,400
But then one night over
half a million Macs

832
00:34:05,400 --> 00:34:07,840
got infected by Flashback.

833
00:34:07,840 --> 00:34:10,840
So one of the problems is
bridging that culture gap.

834
00:34:10,840 --> 00:34:12,299
To move from,
well, there haven't

835
00:34:12,299 --> 00:34:13,840
been any reported
problems yet, so we

836
00:34:13,840 --> 00:34:17,010
don't need to worry about it,
to explaining more about how

837
00:34:17,010 --> 00:34:19,170
to fit security into
the risk management

838
00:34:19,170 --> 00:34:22,380
thinking of medical
device manufacturing.

839
00:34:22,380 --> 00:34:24,520
So hopefully we can
avoid this, and keep

840
00:34:24,520 --> 00:34:29,980
that to be on the Weekly World
News, but it could happen.

841
00:34:29,980 --> 00:34:32,620
So trying to bring
that analogy home now.

842
00:34:32,620 --> 00:34:35,909
Before we get into a little
bit more on the solutions here,

843
00:34:35,909 --> 00:34:39,060
is that way back when,
there was a lot of denial

844
00:34:39,060 --> 00:34:40,690
that hand washing was a problem.

845
00:34:40,690 --> 00:34:42,840
But there was a real
reason for that.

846
00:34:42,840 --> 00:34:45,699
In the 1800s, running
water was not exactly

847
00:34:45,699 --> 00:34:47,710
common in hospitals.

848
00:34:47,710 --> 00:34:49,449
Latex gloves did not exist yet.

849
00:34:49,449 --> 00:34:53,110
So to ask someone to merely wash
their hands for each procedure

850
00:34:53,110 --> 00:34:55,389
was actually a
pretty tall order.

851
00:34:55,389 --> 00:34:57,990
And the same thing can be
said of security today,

852
00:34:57,990 --> 00:34:59,290
in almost any context.

853
00:34:59,290 --> 00:35:01,970
There's no magic pixie
dust you can sprinkle.

854
00:35:01,970 --> 00:35:05,150
There are no magic latex
gloves you can put to somehow

855
00:35:05,150 --> 00:35:06,870
magically add security.

856
00:35:06,870 --> 00:35:09,710
So when you ask a
manufacturer or clinician

857
00:35:09,710 --> 00:35:11,580
to, say, keep your
device secure,

858
00:35:11,580 --> 00:35:12,700
it's a pretty tall order.

859
00:35:12,700 --> 00:35:14,534
So it's going to take
some time, I think.

860
00:35:14,534 --> 00:35:15,950
But if they were
alive today, they

861
00:35:15,950 --> 00:35:17,840
might be saying medical
devices should be secure,

862
00:35:17,840 --> 00:35:20,131
and doctors are gentleman
and therefore their computers

863
00:35:20,131 --> 00:35:21,550
are secure.

864
00:35:21,550 --> 00:35:24,810
But I'm optimistic we're
going to get there,

865
00:35:24,810 --> 00:35:27,430
because most manufacturers
I talk to now realize it's

866
00:35:27,430 --> 00:35:28,772
a real problem.

867
00:35:28,772 --> 00:35:30,980
They're just not necessarily
sure on what to do next.

868
00:35:30,980 --> 00:35:33,730
So maybe they'll be hiring
you people for the future,

869
00:35:33,730 --> 00:35:36,250
to help them solve
these security problems.

870
00:35:36,250 --> 00:35:38,340
But what it all
boils down to is it's

871
00:35:38,340 --> 00:35:40,460
very difficult to add
security on after the fact.

872
00:35:40,460 --> 00:35:42,330
Bolting it on is
very challenging.

873
00:35:42,330 --> 00:35:45,070
It's possible in some
cases, but it's really hard,

874
00:35:45,070 --> 00:35:46,620
and often very expensive.

875
00:35:46,620 --> 00:35:48,953
And you've really got to
design it in from the beginning

876
00:35:48,953 --> 00:35:49,760
to get it right.

877
00:35:49,760 --> 00:35:51,774
So FDA is expecting
manufacturers

878
00:35:51,774 --> 00:35:53,190
to get it right
when they're still

879
00:35:53,190 --> 00:35:55,160
working with pen and
paper, on whiteboards,

880
00:35:55,160 --> 00:35:56,660
before they've
actually manufactured

881
00:35:56,660 --> 00:35:59,950
the medical device.

882
00:35:59,950 --> 00:36:04,570
So how are we doing on time?

883
00:36:04,570 --> 00:36:06,400
Oh, quite a bit?

884
00:36:06,400 --> 00:36:07,690
40 minutes, awesome.

885
00:36:07,690 --> 00:36:09,187
OK.

886
00:36:09,187 --> 00:36:10,520
I'm going faster than I thought.

887
00:36:10,520 --> 00:36:12,871
Sorry if you're taking notes.

888
00:36:12,871 --> 00:36:16,211
I'll talk slower now.

889
00:36:16,211 --> 00:36:18,730
I want to talk a little
bit about technology

890
00:36:18,730 --> 00:36:22,010
to make a medical devices
actually more trustworthy.

891
00:36:22,010 --> 00:36:25,380
So I'm going to try to
blow your mind, all right?

892
00:36:25,380 --> 00:36:32,450
So why do you trust the sensor
on, let's say, your smartphone?

893
00:36:32,450 --> 00:36:33,782
You've got a smartphone there.

894
00:36:33,782 --> 00:36:35,781
Do you know what sensors
are on that smartphone?

895
00:36:38,547 --> 00:36:39,340
AUDIENCE: GPS.

896
00:36:39,340 --> 00:36:40,298
PROFESSOR: There's GPS?

897
00:36:42,510 --> 00:36:44,339
Accelerometer, I heard.

898
00:36:44,339 --> 00:36:45,130
Any other thoughts?

899
00:36:45,130 --> 00:36:47,380
What else would we
find on a phone?

900
00:36:47,380 --> 00:36:48,350
AUDIENCE: Compass.

901
00:36:48,350 --> 00:36:49,280
PROFESSOR: Compass?

902
00:36:49,280 --> 00:36:50,111
Light?

903
00:36:50,111 --> 00:36:51,955
AUDIENCE: [INAUDIBLE].

904
00:36:51,955 --> 00:36:54,737
PROFESSOR:
Electromagnetic field?

905
00:36:54,737 --> 00:36:56,195
Everything's
temperature-sensitive.

906
00:36:59,000 --> 00:37:01,197
Camera's technically
got a CCD sensor.

907
00:37:01,197 --> 00:37:02,780
So there's sensors
all over the place.

908
00:37:02,780 --> 00:37:04,380
Medical devices
have sensors, too.

909
00:37:04,380 --> 00:37:06,170
Now, why do you trust
what the sensor's

910
00:37:06,170 --> 00:37:07,140
telling your processor?

911
00:37:07,140 --> 00:37:10,180
If you write software
and your sensor

912
00:37:10,180 --> 00:37:15,210
tells you it's 77 degrees
today, or 25 Celsius,

913
00:37:15,210 --> 00:37:17,960
why do you believe that?

914
00:37:17,960 --> 00:37:20,650
So at least in my lab, we
do a lot of work on sensors.

915
00:37:20,650 --> 00:37:22,580
So I try to pass
this one around.

916
00:37:22,580 --> 00:37:25,980
This is a batteryless sensor.

917
00:37:25,980 --> 00:37:29,482
It's got an MSP430
microcontroller.

918
00:37:29,482 --> 00:37:30,440
But there's no battery.

919
00:37:30,440 --> 00:37:32,700
It actually runs off a
10 microfarad capacitor,

920
00:37:32,700 --> 00:37:35,876
and it harvests RF energy to
power up that microprocessor.

921
00:37:35,876 --> 00:37:39,300
I'll pass it up
this side, I guess.

922
00:37:39,300 --> 00:37:41,030
And it's got all the
fun little things

923
00:37:41,030 --> 00:37:43,870
like a 3D accelerometer,
temperature sensors, light,

924
00:37:43,870 --> 00:37:45,470
all that fun stuff.

925
00:37:45,470 --> 00:37:48,029
But it's really
hard to power up.

926
00:37:48,029 --> 00:37:49,820
But again, how do you
trust what's actually

927
00:37:49,820 --> 00:37:51,110
coming into that sensor?

928
00:37:51,110 --> 00:37:54,530
Something's translating it from
all these physical phenomena

929
00:37:54,530 --> 00:37:56,390
to little electrical pulses.

930
00:37:56,390 --> 00:38:00,534
So one thing I want
to highlight is

931
00:38:00,534 --> 00:38:02,117
why you might not
want to trust what's

932
00:38:02,117 --> 00:38:03,460
coming out of that sensor.

933
00:38:03,460 --> 00:38:05,890
So this is work from one of
my post-docs, Denis Foo Kune

934
00:38:05,890 --> 00:38:08,369
here, who's kiteboarding
on Lake Michigan.

935
00:38:08,369 --> 00:38:09,910
But in his other
spare time, he likes

936
00:38:09,910 --> 00:38:11,700
to interfere with sensors.

937
00:38:11,700 --> 00:38:14,370
So let me tell you about--
forget security for a moment,

938
00:38:14,370 --> 00:38:17,295
to safety-- there was a
gentleman in 2009 who reported

939
00:38:17,295 --> 00:38:19,420
that every time his cell
phone rang in his kitchen,

940
00:38:19,420 --> 00:38:21,214
his oven turned on.

941
00:38:21,214 --> 00:38:23,130
So you can go find this
in the New York Times.

942
00:38:23,130 --> 00:38:26,460
It just happened to be that
that resonant frequency was just

943
00:38:26,460 --> 00:38:30,100
perfect to get that ignition
to go off in the over.

944
00:38:30,100 --> 00:38:32,360
So there's interference
all over the place.

945
00:38:32,360 --> 00:38:35,950
It's a constant battle, because
we have different devices

946
00:38:35,950 --> 00:38:37,720
speaking in the same spectrum.

947
00:38:37,720 --> 00:38:41,090
But there are technologies
to reduce that interference.

948
00:38:41,090 --> 00:38:44,260
The problem is, what happens
when the interference is

949
00:38:44,260 --> 00:38:45,740
in the baseband?

950
00:38:45,740 --> 00:38:47,990
I'm going to go a little bit
analog on you for moment.

951
00:38:47,990 --> 00:38:51,110
So does 6.003 still exist?

952
00:38:51,110 --> 00:38:51,610
It does?

953
00:38:51,610 --> 00:38:52,370
OK, good.

954
00:38:52,370 --> 00:38:54,411
So I encourage you all to
take it if you haven't.

955
00:38:54,411 --> 00:38:56,850
It's one of the most awesome
courses for a CS person,

956
00:38:56,850 --> 00:39:00,250
because you don't have to
go too deep into the circus.

957
00:39:00,250 --> 00:39:02,112
So what was
interesting to me was,

958
00:39:02,112 --> 00:39:04,070
I was trying to understand
why I should believe

959
00:39:04,070 --> 00:39:05,510
what a sensor's telling me.

960
00:39:05,510 --> 00:39:07,740
And so I started to look
at the block diagram.

961
00:39:07,740 --> 00:39:11,154
And so for instance, if you've
got a Bluetooth headset,

962
00:39:11,154 --> 00:39:13,570
what you're going to find
inside that Bluetooth headset is

963
00:39:13,570 --> 00:39:18,260
a microphone, piece of wire,
an amplifier-- right, 003--

964
00:39:18,260 --> 00:39:21,335
some more wire, or
some traces on a PCB.

965
00:39:21,335 --> 00:39:22,960
It goes to an
analog/digital converter.

966
00:39:22,960 --> 00:39:24,750
There might be some filtering.

967
00:39:24,750 --> 00:39:27,000
And then it goes to
your microprocessor.

968
00:39:27,000 --> 00:39:29,590
But there's all this other
stuff that gets in the way

969
00:39:29,590 --> 00:39:31,320
before it gets to your software.

970
00:39:31,320 --> 00:39:33,160
And for some reason,
your software

971
00:39:33,160 --> 00:39:36,820
just believes anything
this wire says.

972
00:39:36,820 --> 00:39:39,247
So what was interesting to
me was, well, you know what?

973
00:39:39,247 --> 00:39:41,580
That piece of wire from the
microphone to the amplifier,

974
00:39:41,580 --> 00:39:42,350
it has a length.

975
00:39:42,350 --> 00:39:44,750
It also has a
resonant frequency.

976
00:39:44,750 --> 00:39:48,650
So what would happen if somebody
generates custom electromagnet

977
00:39:48,650 --> 00:39:51,580
interference that's
optimized to latch

978
00:39:51,580 --> 00:39:53,820
onto that resonant frequency
of that piece of wire?

979
00:39:53,820 --> 00:39:55,319
Well, it would go
into the amplifier

980
00:39:55,319 --> 00:39:57,140
and it would get amplified.

981
00:39:57,140 --> 00:39:59,670
And then it would go into
that analog/digital converter,

982
00:39:59,670 --> 00:40:02,140
and you'd pass onto
the microprocessor.

983
00:40:02,140 --> 00:40:05,280
One of the questions we had
was, was this possible at all?

984
00:40:05,280 --> 00:40:07,560
And if so, how hard would it be?

985
00:40:07,560 --> 00:40:10,050
What kind of power
would you need to do it?

986
00:40:10,050 --> 00:40:12,840
And what would be the quality
of the signal that actually

987
00:40:12,840 --> 00:40:15,020
reaches the microprocessor?

988
00:40:15,020 --> 00:40:18,460
So the fundamental reason
why this is even possible

989
00:40:18,460 --> 00:40:21,780
is because we're talking
about intentional, as opposed

990
00:40:21,780 --> 00:40:23,520
to accidental
interference, we're

991
00:40:23,520 --> 00:40:24,770
throwing it into the baseband.

992
00:40:24,770 --> 00:40:27,320
So here's an example.

993
00:40:27,320 --> 00:40:29,040
Imagine that your
medical device is

994
00:40:29,040 --> 00:40:32,140
designed to accept physiologic
signals in the low hertz.

995
00:40:32,140 --> 00:40:34,330
Like your heart
doesn't beat that fast.

996
00:40:34,330 --> 00:40:37,180
We're talking a
few hertz or less.

997
00:40:37,180 --> 00:40:39,712
So if your electrodes were to
pick up some high frequency

998
00:40:39,712 --> 00:40:41,670
signals, you'd just put
in some analog filters.

999
00:40:41,670 --> 00:40:43,566
You'd say, that
cannot be real, right?

1000
00:40:43,566 --> 00:40:44,982
If your heart's
beating that fast,

1001
00:40:44,982 --> 00:40:48,370
you're probably just
picking up something

1002
00:40:48,370 --> 00:40:52,630
like an electric mixer while
you're making your lunch.

1003
00:40:52,630 --> 00:40:55,630
So similarly you can filter out
pulses in the high frequency.

1004
00:40:55,630 --> 00:40:58,450
But if you send interference
that's in the baseband,

1005
00:40:58,450 --> 00:41:00,520
those filters are going
to be meaningless.

1006
00:41:00,520 --> 00:41:02,730
Because those analog
filters cannot get rid

1007
00:41:02,730 --> 00:41:08,750
of if it's in the same frequency
area as what you're expecting.

1008
00:41:08,750 --> 00:41:11,970
So it's hard to
filter in the analog.

1009
00:41:11,970 --> 00:41:13,890
So I'm going to go
through a couple examples.

1010
00:41:13,890 --> 00:41:15,806
We're going to start
with a Bluetooth headset,

1011
00:41:15,806 --> 00:41:18,440
and then work our way
up to a medical device.

1012
00:41:18,440 --> 00:41:21,750
So Denis, he built a bunch
of homebrew dipole antennas

1013
00:41:21,750 --> 00:41:23,770
and transmitters and amplifiers.

1014
00:41:23,770 --> 00:41:28,282
Now what he's got up here is
you can see he's got a webcam.

1015
00:41:28,282 --> 00:41:30,490
I guess not too many of us
need to buy these anymore,

1016
00:41:30,490 --> 00:41:31,820
because they're built in.

1017
00:41:31,820 --> 00:41:36,100
But that webcam
has a microphone,

1018
00:41:36,100 --> 00:41:38,060
and then it's got
a little USB cable

1019
00:41:38,060 --> 00:41:40,445
to deliver the audio
to the computer.

1020
00:41:40,445 --> 00:41:42,320
So what he's done is
he's set up the computer

1021
00:41:42,320 --> 00:41:45,790
to record the video and
audio and then play it back.

1022
00:41:45,790 --> 00:41:51,230
So what's interesting
is-- you'll see this now.

1023
00:41:51,230 --> 00:41:52,750
He was in a completely
silent room.

1024
00:41:52,750 --> 00:41:53,958
It sort of sounded like this.

1025
00:41:53,958 --> 00:41:57,260
All you could hear was
the ventilation system.

1026
00:41:57,260 --> 00:41:58,230
He's got the camera.

1027
00:41:58,230 --> 00:42:00,021
He removed the housing,
just so it's easier

1028
00:42:00,021 --> 00:42:03,630
to tap in and measure
the interference.

1029
00:42:03,630 --> 00:42:06,045
And then he's got a
software radio about a meter

1030
00:42:06,045 --> 00:42:09,110
away, generating custom
electromagnetic interference.

1031
00:42:09,110 --> 00:42:13,950
He writes it in Python, and
then sends over his signals.

1032
00:42:13,950 --> 00:42:17,210
So here's what the
computer on the left

1033
00:42:17,210 --> 00:42:20,259
thought it heard, even
in this silent room.

1034
00:42:20,259 --> 00:42:21,257
[AUDIO PLAYBACK]

1035
00:42:21,257 --> 00:42:22,756
[MUSIC WEEZER, "ISLAND IN THE
 SUN"]

1036
00:42:30,310 --> 00:42:31,230
[END PLAYBACK]

1037
00:42:31,230 --> 00:42:32,370
PROFESSOR: So yeah.

1038
00:42:32,370 --> 00:42:34,286
The last time I did that,
somebody in the back

1039
00:42:34,286 --> 00:42:37,000
actually started dancing.

1040
00:42:37,000 --> 00:42:39,765
So it's actually
relatively high fidelity.

1041
00:42:39,765 --> 00:42:43,020
And it actually turns out that
in the manufacturing community,

1042
00:42:43,020 --> 00:42:43,990
they're so cheap.

1043
00:42:43,990 --> 00:42:46,880
They use really
cheap microphones

1044
00:42:46,880 --> 00:42:48,240
with poor frequency responses.

1045
00:42:48,240 --> 00:42:50,010
So we actually got
higher quality audio

1046
00:42:50,010 --> 00:42:53,520
through interference than
going to the microphone.

1047
00:42:53,520 --> 00:42:55,520
So if you ever don't like
your Bluetooth headset

1048
00:42:55,520 --> 00:42:57,150
and you want to play
classical music,

1049
00:42:57,150 --> 00:42:58,500
just do it with interference.

1050
00:42:58,500 --> 00:43:02,010
But don't tell the FCC
I told you to do that,

1051
00:43:02,010 --> 00:43:03,370
because you're not supposed to.

1052
00:43:03,370 --> 00:43:06,820
But the point is
if you're talking

1053
00:43:06,820 --> 00:43:08,950
intentional magnetic
interference,

1054
00:43:08,950 --> 00:43:11,330
it's kind of outside
the security model.

1055
00:43:11,330 --> 00:43:13,840
And so your processor
just trusts it.

1056
00:43:13,840 --> 00:43:16,160
So some interesting
things you can do.

1057
00:43:16,160 --> 00:43:18,510
Let's say your office
mate decides to call up

1058
00:43:18,510 --> 00:43:21,135
his bank to make some deposits.

1059
00:43:21,135 --> 00:43:23,170
Well, you can insert DTMF tones.

1060
00:43:23,170 --> 00:43:24,900
That's kind of fun.

1061
00:43:24,900 --> 00:43:26,849
So we were just playing around.

1062
00:43:26,849 --> 00:43:28,640
You can change the
language as the person's

1063
00:43:28,640 --> 00:43:31,274
trying to make deposits
from account to account.

1064
00:43:31,274 --> 00:43:32,690
But there's all
just interference.

1065
00:43:32,690 --> 00:43:35,310
And actually the person
on the Bluetooth headset

1066
00:43:35,310 --> 00:43:36,220
didn't hear it.

1067
00:43:36,220 --> 00:43:42,124
Because remember it's
coming from the person,

1068
00:43:42,124 --> 00:43:44,290
so that it doesn't actually
get echoed back to them.

1069
00:43:44,290 --> 00:43:48,250
But the bank heard it and
made all the transactions.

1070
00:43:48,250 --> 00:43:51,020
So there are ways to do this.

1071
00:43:51,020 --> 00:43:54,070
It doesn't take a whole
bunch of analog skills.

1072
00:43:54,070 --> 00:43:55,800
We're mostly
computer scientists.

1073
00:43:55,800 --> 00:43:59,140
But you do need
to somehow convert

1074
00:43:59,140 --> 00:44:01,505
the signal you want to have
appear at the microprocessor

1075
00:44:01,505 --> 00:44:04,980
into something else
that's easier to transmit.

1076
00:44:04,980 --> 00:44:08,240
So the first thing
you can do is think

1077
00:44:08,240 --> 00:44:09,727
about just
overwhelming the thing

1078
00:44:09,727 --> 00:44:10,810
with a very strong signal.

1079
00:44:10,810 --> 00:44:12,150
That's the brute force approach.

1080
00:44:12,150 --> 00:44:14,922
It doesn't work so well,
but it works a little bit.

1081
00:44:14,922 --> 00:44:16,630
So if you send something
out that matches

1082
00:44:16,630 --> 00:44:18,950
the resonant frequency of
that little piece of wire,

1083
00:44:18,950 --> 00:44:22,110
yeah, that'll get the
job done to some extent.

1084
00:44:22,110 --> 00:44:26,010
The problem is a lot of these
signals are low frequency,

1085
00:44:26,010 --> 00:44:28,880
and it's more
difficult to transmit.

1086
00:44:28,880 --> 00:44:30,172
It's got less power, basically.

1087
00:44:30,172 --> 00:44:32,088
So it's going to be
harder to send the signal.

1088
00:44:32,088 --> 00:44:35,170
So what you really want to do is
send a higher frequency signal,

1089
00:44:35,170 --> 00:44:37,620
and it's going to be easier
to deliver the power.

1090
00:44:37,620 --> 00:44:40,280
But if you send a really
high frequency signal, that's

1091
00:44:40,280 --> 00:44:42,065
going to be outside
the baseband,

1092
00:44:42,065 --> 00:44:44,270
so all the filters
are going to go at it.

1093
00:44:44,270 --> 00:44:47,130
So here's what you do instead.

1094
00:44:47,130 --> 00:44:51,840
You treat this circuit as an
unintentional demodulator.

1095
00:44:51,840 --> 00:44:54,554
So what you do is, we had
that original sine wave

1096
00:44:54,554 --> 00:44:55,470
we wanted to transmit.

1097
00:44:55,470 --> 00:44:58,995
Instead we modulate it onto
a higher frequency sine wave.

1098
00:44:58,995 --> 00:45:02,160
And we send it in
to the amplifier,

1099
00:45:02,160 --> 00:45:04,520
and eventually it's going
to work its way in because

1100
00:45:04,520 --> 00:45:05,530
of sampling theory.

1101
00:45:05,530 --> 00:45:07,960
You can think about
Nyquist and all that.

1102
00:45:07,960 --> 00:45:12,370
So up on the top is
the interfering signal

1103
00:45:12,370 --> 00:45:14,580
we're actually sending,
and then on the bottom

1104
00:45:14,580 --> 00:45:16,240
is what the microprocessor sees.

1105
00:45:16,240 --> 00:45:18,370
Because remember the
analog-to-digital converter

1106
00:45:18,370 --> 00:45:20,390
is not continuously sampling.

1107
00:45:20,390 --> 00:45:22,020
There's an interrupt
on the processor.

1108
00:45:22,020 --> 00:45:24,560
Wake up, take a reading,
wake up, take a reading.

1109
00:45:24,560 --> 00:45:25,935
So it's actually
going to sample,

1110
00:45:25,935 --> 00:45:27,812
and then try to
infer the signal.

1111
00:45:27,812 --> 00:45:29,770
So as we're sending out
our really fast signal,

1112
00:45:29,770 --> 00:45:32,170
it takes a sample,
it takes a sample,

1113
00:45:32,170 --> 00:45:35,180
it takes a sample,
et cetera, et cetera.

1114
00:45:35,180 --> 00:45:37,750
Your microprocessor thinks it
got this nice low frequency

1115
00:45:37,750 --> 00:45:40,180
sine wave, but we actually
used a high frequency one,

1116
00:45:40,180 --> 00:45:44,151
because that allowed us
to transmit more easily.

1117
00:45:44,151 --> 00:45:46,400
So I'm not going to go through
all the nitty-gritties,

1118
00:45:46,400 --> 00:45:49,250
but one another kind
of cool way to do

1119
00:45:49,250 --> 00:45:54,320
this is to muck around with
the non-linear components

1120
00:45:54,320 --> 00:45:55,590
of the circuit.

1121
00:45:55,590 --> 00:45:58,160
But this is all about violating
security models, right?

1122
00:45:58,160 --> 00:46:00,860
So we're completely violating
what the circuit designer

1123
00:46:00,860 --> 00:46:02,760
had intended.

1124
00:46:02,760 --> 00:46:06,650
It turns out that
if you send in, say,

1125
00:46:06,650 --> 00:46:09,440
in this case you're
sending in 826 megahertz

1126
00:46:09,440 --> 00:46:12,540
is the resonant
frequency of our wire.

1127
00:46:12,540 --> 00:46:15,780
But I can't speak that fast.

1128
00:46:15,780 --> 00:46:21,220
So what we do is we modulate
our voice on an 826 megahertz

1129
00:46:21,220 --> 00:46:22,130
carrier.

1130
00:46:22,130 --> 00:46:24,690
Problem is it's going to
get, for instance, all

1131
00:46:24,690 --> 00:46:27,294
this replication of the signal.

1132
00:46:27,294 --> 00:46:28,710
You're going to
see the frequency.

1133
00:46:28,710 --> 00:46:30,334
Here we're looking
at frequency domain.

1134
00:46:30,334 --> 00:46:31,590
It gets repeated.

1135
00:46:31,590 --> 00:46:33,490
But it turns out because
of the filters built

1136
00:46:33,490 --> 00:46:35,240
into most of these
devices, it's actually

1137
00:46:35,240 --> 00:46:37,531
going to chop off
the repeated copies.

1138
00:46:37,531 --> 00:46:39,655
So the end of the day, what
the microprocessor sees

1139
00:46:39,655 --> 00:46:41,900
is our original 1
kilohertz signal

1140
00:46:41,900 --> 00:46:43,070
we were trying to send in.

1141
00:46:43,070 --> 00:46:47,800
It's been unintentionally
demodulated.

1142
00:46:47,800 --> 00:46:49,530
So that's the easiest
example that I've

1143
00:46:49,530 --> 00:46:51,030
been able to come
up with to explain

1144
00:46:51,030 --> 00:46:54,370
the idea of this
intentional interference.

1145
00:46:54,370 --> 00:46:56,950
And now we're going to try
to apply it to defibrillators

1146
00:46:56,950 --> 00:46:58,680
and medical devices.

1147
00:46:58,680 --> 00:47:02,090
So again, the defibrillator's
implanted into the clavicle.

1148
00:47:02,090 --> 00:47:05,520
And it has these electrodes--
you can kind of see them here--

1149
00:47:05,520 --> 00:47:07,640
that go into the
chambers of the heart,

1150
00:47:07,640 --> 00:47:11,190
and it's used for both
sensing and actuation.

1151
00:47:11,190 --> 00:47:13,190
So it's just a signal.

1152
00:47:13,190 --> 00:47:18,310
So this is the time domain, and
this is the Fourier transform,

1153
00:47:18,310 --> 00:47:19,750
effectively.

1154
00:47:19,750 --> 00:47:23,780
So this is a single
heartbeat, and the heartbeat

1155
00:47:23,780 --> 00:47:26,110
is actually quite intricate.

1156
00:47:26,110 --> 00:47:27,860
The physicians have
actually labeled

1157
00:47:27,860 --> 00:47:29,660
the different components
of the heart rate.

1158
00:47:29,660 --> 00:47:31,560
You've got the
QRS complex, which

1159
00:47:31,560 --> 00:47:33,990
is typically what you would
think of as the heartbeat.

1160
00:47:33,990 --> 00:47:36,970
The actual beat is
this giant R here.

1161
00:47:36,970 --> 00:47:38,890
That's the one you'll feel.

1162
00:47:38,890 --> 00:47:41,370
But there are also these
other smaller waves,

1163
00:47:41,370 --> 00:47:46,110
as your tissue is
energizing and relaxing.

1164
00:47:46,110 --> 00:47:49,030
So if do a Fourier transform
on your cardiac rhythm,

1165
00:47:49,030 --> 00:47:51,060
you're going to end up
with most of the signal

1166
00:47:51,060 --> 00:47:53,890
in the tens of hertz.

1167
00:47:53,890 --> 00:47:55,680
You're not going to
see things a whole lot

1168
00:47:55,680 --> 00:47:59,120
beyond 100 hertz in a
typical cardiac signal.

1169
00:47:59,120 --> 00:48:01,531
So most of these
devices are designed

1170
00:48:01,531 --> 00:48:04,030
to filter out things that are
really low frequency or really

1171
00:48:04,030 --> 00:48:05,340
high frequency.

1172
00:48:05,340 --> 00:48:07,865
But if you choose to insert
intentional electromagnetic

1173
00:48:07,865 --> 00:48:09,940
interference on the
baseband, then it

1174
00:48:09,940 --> 00:48:12,840
gets through all the
analog circuit filters.

1175
00:48:12,840 --> 00:48:14,580
And now the only
approach to [INAUDIBLE]

1176
00:48:14,580 --> 00:48:18,010
that would be things more on
the computer science side.

1177
00:48:18,010 --> 00:48:20,270
So this is where
my students began

1178
00:48:20,270 --> 00:48:22,890
to have a little bit of fun.

1179
00:48:22,890 --> 00:48:27,075
So we wanted to test this
in as realistic a situation

1180
00:48:27,075 --> 00:48:27,790
as we could.

1181
00:48:27,790 --> 00:48:30,290
We couldn't get volunteers.

1182
00:48:30,290 --> 00:48:34,030
So instead we discovered there's
actually a national standard.

1183
00:48:34,030 --> 00:48:34,850
This is a body.

1184
00:48:34,850 --> 00:48:35,835
This is you.

1185
00:48:35,835 --> 00:48:38,279
It turns out that we're all
just bags of saline solution.

1186
00:48:38,279 --> 00:48:40,570
And so if you have a highly
calibrated saline solution,

1187
00:48:40,570 --> 00:48:44,740
that's the best way to
simulate human tissue.

1188
00:48:44,740 --> 00:48:48,360
The other thing we've done is
we used the synthetic cadaver.

1189
00:48:48,360 --> 00:48:50,900
She's actually
anatomically correct.

1190
00:48:50,900 --> 00:48:52,400
She's got all the
same vital organs

1191
00:48:52,400 --> 00:48:53,930
as anyone else
would have inside,

1192
00:48:53,930 --> 00:48:55,630
and a working
circulatory system.

1193
00:48:55,630 --> 00:48:57,880
So it has all the surface
properties of the RF.

1194
00:48:57,880 --> 00:49:01,730
So here we're doing
radiation fluoroscopy

1195
00:49:01,730 --> 00:49:04,890
to do 3D imaging-- 4D.

1196
00:49:04,890 --> 00:49:07,716
We see light imaging as we're
implanting the electrodes

1197
00:49:07,716 --> 00:49:08,840
into our synthetic cadaver.

1198
00:49:12,062 --> 00:49:13,770
So what we're going
to do now is generate

1199
00:49:13,770 --> 00:49:15,145
some electromagnetic
interference

1200
00:49:15,145 --> 00:49:17,520
and then try to see what
the device is perceiving

1201
00:49:17,520 --> 00:49:19,610
as a trustworthy signal.

1202
00:49:19,610 --> 00:49:21,010
So a couple ways we did this.

1203
00:49:21,010 --> 00:49:25,710
In the saline solution, we used
just a spool of magnet wire.

1204
00:49:25,710 --> 00:49:28,815
Here we have the wand that's
reading out the telemetry

1205
00:49:28,815 --> 00:49:30,565
to see what the device
thinks it's seeing,

1206
00:49:30,565 --> 00:49:32,240
and then another
experimental case.

1207
00:49:32,240 --> 00:49:34,660
So I had some leftover
pipes from plumbing,

1208
00:49:34,660 --> 00:49:36,760
so we created a dipole antenna.

1209
00:49:36,760 --> 00:49:39,080
And on the back there
on that poster board,

1210
00:49:39,080 --> 00:49:41,190
we created a 2D
version of a patient.

1211
00:49:41,190 --> 00:49:43,890
You can see that's the curvature
of the electrode, that's

1212
00:49:43,890 --> 00:49:46,000
the electrode, and
then the pacemaker

1213
00:49:46,000 --> 00:49:48,300
is right underneath the tape.

1214
00:49:48,300 --> 00:49:50,700
And we're transferring to it.

1215
00:49:50,700 --> 00:49:52,457
So here's what the
device thought it saw,

1216
00:49:52,457 --> 00:49:53,790
even though it wasn't happening.

1217
00:49:53,790 --> 00:49:56,460
So keep in mind this should have
been a flat line, because there

1218
00:49:56,460 --> 00:49:57,100
is no patient.

1219
00:49:57,100 --> 00:49:58,600
There is no heart beating.

1220
00:49:58,600 --> 00:50:01,970
So we tried a couple different
signals of interest are we

1221
00:50:01,970 --> 00:50:03,680
pulsed a sinusoid.

1222
00:50:03,680 --> 00:50:06,020
So that's really a
sine wave, but it's

1223
00:50:06,020 --> 00:50:07,295
so fast you can't quite tell.

1224
00:50:07,295 --> 00:50:09,670
But we pulsed it
like a heart beat.

1225
00:50:09,670 --> 00:50:12,470
So every one second
we sent out a pulse.

1226
00:50:12,470 --> 00:50:15,380
And then we also did
one that's modulated.

1227
00:50:15,380 --> 00:50:17,430
That's a little bit noisier.

1228
00:50:17,430 --> 00:50:21,020
So this is a screenshot of
the pacemaker programmer

1229
00:50:21,020 --> 00:50:24,100
which tells us live what
telemetry is going out.

1230
00:50:24,100 --> 00:50:27,220
And it's hard to read, but
the little green up there,

1231
00:50:27,220 --> 00:50:30,870
VP, says that the device sent
out the ventricular pace.

1232
00:50:30,870 --> 00:50:33,520
This is the pacemaker sending
an artificial heartbeat,

1233
00:50:33,520 --> 00:50:36,449
basically, to make
the tissue contract.

1234
00:50:36,449 --> 00:50:37,990
What's interesting
is when we started

1235
00:50:37,990 --> 00:50:40,320
sending our interference,
it got what's

1236
00:50:40,320 --> 00:50:42,330
called a VS, a
ventricular sense.

1237
00:50:42,330 --> 00:50:44,520
The little purple VS,
there's three of them.

1238
00:50:44,520 --> 00:50:46,400
So the pacemaker thought
that the heart was

1239
00:50:46,400 --> 00:50:48,710
beating on its own, so it
chose to inhibit the pacing

1240
00:50:48,710 --> 00:50:50,446
to save power.

1241
00:50:50,446 --> 00:50:52,320
And then when we turned
off the interference,

1242
00:50:52,320 --> 00:50:54,240
the pacing began again.

1243
00:50:54,240 --> 00:50:57,840
Similarly over here you see
where the interference starts,

1244
00:50:57,840 --> 00:51:00,130
and it's sensing
ventricular sense.

1245
00:51:00,130 --> 00:51:03,140
It says, oh, the body's
pacing itself naturally.

1246
00:51:03,140 --> 00:51:05,840
I don't need to waste my
energy pacing the heart.

1247
00:51:05,840 --> 00:51:08,070
So we're able to induce
that interference,

1248
00:51:08,070 --> 00:51:09,910
and then trick
the microprocessor

1249
00:51:09,910 --> 00:51:13,560
into believing the long state.

1250
00:51:13,560 --> 00:51:15,030
There is a silver
lining, though.

1251
00:51:15,030 --> 00:51:18,900
The good news is, that
only works in vitro.

1252
00:51:18,900 --> 00:51:21,800
Whenever we would do
this in saline solution

1253
00:51:21,800 --> 00:51:23,920
or in anything that
approximated the body,

1254
00:51:23,920 --> 00:51:25,400
it basically didn't work.

1255
00:51:25,400 --> 00:51:26,900
And that's because
your body absorbs

1256
00:51:26,900 --> 00:51:30,800
a lot of that RF energy,
and it doesn't actually

1257
00:51:30,800 --> 00:51:31,750
get to the sensor.

1258
00:51:31,750 --> 00:51:34,010
So the closest we were
able to get this to work

1259
00:51:34,010 --> 00:51:39,180
was, with the saline,
like three centimeters.

1260
00:51:39,180 --> 00:51:41,540
So that basically
means there's no worry

1261
00:51:41,540 --> 00:51:44,370
for this particular kind of
interference from an implant.

1262
00:51:44,370 --> 00:51:47,610
However, an externally
worn device, we don't know.

1263
00:51:47,610 --> 00:51:50,600
We hadn't done any tests
on insulin pumps yet.

1264
00:51:50,600 --> 00:51:52,100
There are plenty
of different kinds.

1265
00:51:52,100 --> 00:51:53,683
There's glucose
sensors, for instance,

1266
00:51:53,683 --> 00:51:57,970
that are percutaneous.

1267
00:51:57,970 --> 00:52:00,010
I wouldn't be surprised
if someone here has one.

1268
00:52:00,010 --> 00:52:01,610
They're pretty common.

1269
00:52:01,610 --> 00:52:04,540
But we just don't know yet.

1270
00:52:04,540 --> 00:52:10,210
But one of the approaches
we're taking to solve this

1271
00:52:10,210 --> 00:52:12,630
follows the end-to-end
principle to some extent.

1272
00:52:12,630 --> 00:52:14,607
A lot of these, I
just don't think

1273
00:52:14,607 --> 00:52:16,190
the analog is able
to distinguish good

1274
00:52:16,190 --> 00:52:17,520
from bad signal.

1275
00:52:17,520 --> 00:52:20,340
And so you have to do it closer
to the application layer.

1276
00:52:20,340 --> 00:52:27,440
So one of the defenses that we
tried out was the following.

1277
00:52:27,440 --> 00:52:30,694
It has its own limitations,
but here's the basic idea.

1278
00:52:30,694 --> 00:52:32,860
So imagine you're a pacemaker,
and you want to know,

1279
00:52:32,860 --> 00:52:35,000
are you getting a
trustworthy signal?

1280
00:52:35,000 --> 00:52:37,370
So what you do is
you selectively

1281
00:52:37,370 --> 00:52:41,930
choose to send test pulses every
now and then, to basically keep

1282
00:52:41,930 --> 00:52:43,100
the adversary in check.

1283
00:52:43,100 --> 00:52:45,890
So here's the interesting thing
we discovered when we worked

1284
00:52:45,890 --> 00:52:47,440
with electrophysiologists.

1285
00:52:47,440 --> 00:52:49,340
We learned that if you
send a pacing pulse

1286
00:52:49,340 --> 00:52:52,830
to a heart that recently was
beating, within about 200

1287
00:52:52,830 --> 00:52:55,750
milliseconds, that cardiac
tissue is physically

1288
00:52:55,750 --> 00:52:57,360
incapable of beating again.

1289
00:52:57,360 --> 00:53:00,110
It's also physically
incapable of sending out

1290
00:53:00,110 --> 00:53:01,800
an electrical
response, just because

1291
00:53:01,800 --> 00:53:05,300
of the polarization-- the way
that cardiac tissue works.

1292
00:53:05,300 --> 00:53:08,360
So we said, so what would happen
if we send an extra pacing

1293
00:53:08,360 --> 00:53:11,230
pulse right after a
ventricular sense?

1294
00:53:11,230 --> 00:53:14,700
He said, oh, well,
if the heart actually

1295
00:53:14,700 --> 00:53:17,310
had beat, as your
sensor told you,

1296
00:53:17,310 --> 00:53:18,950
then you should get no response.

1297
00:53:18,950 --> 00:53:21,400
Because it would be incapable
of sending a response.

1298
00:53:21,400 --> 00:53:23,860
So therefore, if we
saw the heart send us

1299
00:53:23,860 --> 00:53:26,160
an electrical signal
back, we knew-- then

1300
00:53:26,160 --> 00:53:28,190
that proves to us
that we were fooled

1301
00:53:28,190 --> 00:53:29,720
on the previous heartbeat.

1302
00:53:29,720 --> 00:53:32,910
And there we raise
our warning signs

1303
00:53:32,910 --> 00:53:34,450
that it appears to
be we're getting

1304
00:53:34,450 --> 00:53:36,550
intentional electromagnetic
interference.

1305
00:53:36,550 --> 00:53:38,760
So the basic idea is,
again, we probe it,

1306
00:53:38,760 --> 00:53:40,450
and we make use
of some of what we

1307
00:53:40,450 --> 00:53:42,740
know about the
physiology of the body

1308
00:53:42,740 --> 00:53:45,020
to have better trustworthiness.

1309
00:53:45,020 --> 00:53:48,170
Another approach we didn't
look into too deeply

1310
00:53:48,170 --> 00:53:50,223
was looking at
propagation delay.

1311
00:53:50,223 --> 00:53:52,440
Because if you have
electromagnetic interference

1312
00:53:52,440 --> 00:53:54,620
coming at you, it's
basically light, right?

1313
00:53:54,620 --> 00:53:55,810
Speed of light.

1314
00:53:55,810 --> 00:53:59,370
And if it's hitting you all at
once, if you have two sensors,

1315
00:53:59,370 --> 00:54:02,240
and you simultaneously see
the same cardiac signal

1316
00:54:02,240 --> 00:54:04,890
at the same time,
something's wrong.

1317
00:54:04,890 --> 00:54:07,480
Because there's an
electrochemical propagation

1318
00:54:07,480 --> 00:54:10,115
delay from your vagus nerve
as the electrical signal

1319
00:54:10,115 --> 00:54:12,390
is traveling down
through your heart.

1320
00:54:12,390 --> 00:54:14,430
So there are other ways
to try to tease out

1321
00:54:14,430 --> 00:54:18,050
whether the physiologic
signal is trustworthy,

1322
00:54:18,050 --> 00:54:19,960
but this is new ground.

1323
00:54:19,960 --> 00:54:22,610
There's not a lot going
on in this space yet.

1324
00:54:22,610 --> 00:54:25,191
A lot of fun projects for
graduate and undergraduate

1325
00:54:25,191 --> 00:54:25,690
research.

1326
00:54:29,300 --> 00:54:33,070
We end at-- oh, 25?

1327
00:54:33,070 --> 00:54:33,830
Oh.

1328
00:54:33,830 --> 00:54:38,095
So I want to tell you
about another project,

1329
00:54:38,095 --> 00:54:41,350
and that is detecting
malware at power outlets.

1330
00:54:41,350 --> 00:54:47,030
So a few years ago, one of
my students, Shane, he said,

1331
00:54:47,030 --> 00:54:50,160
hey, I built this power
outlet, and I can tell

1332
00:54:50,160 --> 00:54:52,630
what website you're browsing.

1333
00:54:52,630 --> 00:54:57,530
So he put a little
sense resistor in here,

1334
00:54:57,530 --> 00:54:59,810
and he measures what's
called the phase

1335
00:54:59,810 --> 00:55:01,850
shift in the reactive power.

1336
00:55:01,850 --> 00:55:05,980
It's basically a proxy for
the load on your computer.

1337
00:55:05,980 --> 00:55:08,980
And he can basically tell
how your computer-- how

1338
00:55:08,980 --> 00:55:11,670
your processor is
changing the load as it's

1339
00:55:11,670 --> 00:55:14,570
going out onto the
AC power system.

1340
00:55:14,570 --> 00:55:15,560
This is not new.

1341
00:55:15,560 --> 00:55:17,539
Has anyone heard of Tempest?

1342
00:55:17,539 --> 00:55:18,330
Tempest protection?

1343
00:55:18,330 --> 00:55:19,130
A few of you.

1344
00:55:19,130 --> 00:55:22,230
So Tempest has been
around for years.

1345
00:55:22,230 --> 00:55:25,620
Basically signals leak
all over the place,

1346
00:55:25,620 --> 00:55:27,750
and so there's a whole fine
art to stopping signals

1347
00:55:27,750 --> 00:55:29,730
from leaking.

1348
00:55:29,730 --> 00:55:31,310
What was interesting
to me was, I

1349
00:55:31,310 --> 00:55:33,143
like to keep all my old
computers-- actually

1350
00:55:33,143 --> 00:55:35,670
I have an exokernel machine.

1351
00:55:35,670 --> 00:55:39,307
And it's an old-- I
think it's a Pentium 4.

1352
00:55:39,307 --> 00:55:41,640
And this was before there was
advanced power management.

1353
00:55:41,640 --> 00:55:44,139
So if you measured the power
coming out of this old Pentium,

1354
00:55:44,139 --> 00:55:44,942
it was constant.

1355
00:55:44,942 --> 00:55:46,900
Just doesn't matter if
you were doing anything.

1356
00:55:46,900 --> 00:55:49,950
If you have a spin while
loop, doesn't matter.

1357
00:55:49,950 --> 00:55:53,600
It's the same thing as
actually doing processing.

1358
00:55:53,600 --> 00:55:56,440
But if you buy a modern
computer, whether it be desktop

1359
00:55:56,440 --> 00:56:00,150
or phone, your workload is
being revealed over the power

1360
00:56:00,150 --> 00:56:02,240
line in subtle ways.

1361
00:56:02,240 --> 00:56:08,789
And so what he discovered was
that what's going on here.

1362
00:56:08,789 --> 00:56:10,330
If you have an
embedded system that's

1363
00:56:10,330 --> 00:56:13,740
very difficult to change, and
you want to retrofit security

1364
00:56:13,740 --> 00:56:19,560
onto it, what you can do is
put in basically a power strip.

1365
00:56:19,560 --> 00:56:21,400
An intelligent power strip.

1366
00:56:21,400 --> 00:56:25,581
And it uses machine learning
classification of the frequency

1367
00:56:25,581 --> 00:56:26,080
domain.

1368
00:56:26,080 --> 00:56:27,650
Actually looking at the
frequency components

1369
00:56:27,650 --> 00:56:28,733
of your power consumption.

1370
00:56:28,733 --> 00:56:31,010
It's not looking at how
much power you consume.

1371
00:56:31,010 --> 00:56:34,530
Instead it's looking at how
often do you consume it.

1372
00:56:34,530 --> 00:56:36,960
So let me give you
some intuition here.

1373
00:56:36,960 --> 00:56:38,870
So imagine you have
a medical device that

1374
00:56:38,870 --> 00:56:41,020
gets infected by malware.

1375
00:56:41,020 --> 00:56:44,960
Let's say this malware is going
to wake up every few minutes

1376
00:56:44,960 --> 00:56:46,060
to send out spam.

1377
00:56:46,060 --> 00:56:49,058
How might that change
the power consumption?

1378
00:56:54,220 --> 00:56:55,108
Yeah.

1379
00:56:55,108 --> 00:56:56,024
AUDIENCE: [INAUDIBLE].

1380
00:56:58,535 --> 00:57:00,660
PROFESSOR: Yeah, every few
minutes that interrupt's

1381
00:57:00,660 --> 00:57:02,910
going to go off, and the
processor's going to wake up.

1382
00:57:02,910 --> 00:57:05,850
It's probably going to
power up its memory.

1383
00:57:05,850 --> 00:57:09,400
It's going to do some
cycling, or it might actually

1384
00:57:09,400 --> 00:57:11,490
insert a few extra
cycles in what

1385
00:57:11,490 --> 00:57:14,540
used to be a very constant
set of instructions.

1386
00:57:14,540 --> 00:57:17,527
Medical devices generally
do a small set of things,

1387
00:57:17,527 --> 00:57:19,235
as opposed to a general
purpose computer.

1388
00:57:19,235 --> 00:57:21,290
So it's a very regular pattern.

1389
00:57:21,290 --> 00:57:23,610
So when you suddenly
have malware getting in,

1390
00:57:23,610 --> 00:57:27,510
it just changes the behavior of
its power consumption patterns.

1391
00:57:27,510 --> 00:57:28,510
So you can pick that up.

1392
00:57:28,510 --> 00:57:29,635
You do a Fourier transform.

1393
00:57:29,635 --> 00:57:32,640
You do some other magic
involving machine learning.

1394
00:57:32,640 --> 00:57:34,080
The devil's in the details.

1395
00:57:34,080 --> 00:57:36,820
But you can basically
use the machine learning

1396
00:57:36,820 --> 00:57:40,670
to identify with very high
precision, very high accuracy,

1397
00:57:40,670 --> 00:57:42,850
low false positive,
low false negative,

1398
00:57:42,850 --> 00:57:45,840
the presence of malware
and other anomalies.

1399
00:57:45,840 --> 00:57:47,880
And so that's a project
he had been working

1400
00:57:47,880 --> 00:57:49,870
on for a number of years.

1401
00:57:49,870 --> 00:57:52,130
He initially created
this project, though,

1402
00:57:52,130 --> 00:57:54,819
to identify what website
you were browsing.

1403
00:57:54,819 --> 00:57:57,360
And unfortunately, he submitted
it to a bunch of conferences,

1404
00:57:57,360 --> 00:58:01,860
and they all said, well, why
would you ever want to do that?

1405
00:58:01,860 --> 00:58:04,410
But it's kind of interesting,
because he picked the top 50

1406
00:58:04,410 --> 00:58:05,870
Alexa websites.

1407
00:58:05,870 --> 00:58:07,890
And then he profiled
his computer,

1408
00:58:07,890 --> 00:58:10,700
used that as a training set
for the machine learning,

1409
00:58:10,700 --> 00:58:13,520
and then again, with very high
accuracy, very high precision,

1410
00:58:13,520 --> 00:58:16,350
was able to identify which
website you were going to.

1411
00:58:16,350 --> 00:58:19,060
And we were really confused
why it worked at all.

1412
00:58:19,060 --> 00:58:21,370
And we still don't
know exactly why,

1413
00:58:21,370 --> 00:58:22,703
but we have some strong hunches.

1414
00:58:22,703 --> 00:58:26,540
And [INAUDIBLE] Drupal.

1415
00:58:26,540 --> 00:58:29,020
So there's been a movement
over the last 10 years

1416
00:58:29,020 --> 00:58:33,396
on websites to move from-- who
still writes in Emacs HTML?

1417
00:58:33,396 --> 00:58:35,045
All right, me too.

1418
00:58:35,045 --> 00:58:37,170
That's why I have all these
mistakes on my website.

1419
00:58:37,170 --> 00:58:40,190
But there has been a
large movement, especially

1420
00:58:40,190 --> 00:58:43,025
in institutions, to have
code automatically generate

1421
00:58:43,025 --> 00:58:47,340
a web content file that follows
a very regular structure.

1422
00:58:47,340 --> 00:58:49,525
So can you imagine
if you go to CNN.com,

1423
00:58:49,525 --> 00:58:52,290
and they always have an ad in
the upper right-hand corner,

1424
00:58:52,290 --> 00:58:55,860
with flash animation that
lasts exactly 22 seconds?

1425
00:58:55,860 --> 00:58:59,500
So your GPU might kick in
at a very regular rate.

1426
00:58:59,500 --> 00:59:01,740
So some very interesting
things bleed through

1427
00:59:01,740 --> 00:59:04,790
into the power consumption
patterns from the web browser,

1428
00:59:04,790 --> 00:59:06,820
and from other things in
your operating system,

1429
00:59:06,820 --> 00:59:09,670
as a result of your activity.

1430
00:59:09,670 --> 00:59:12,726
The only website we couldn't
classify too well was GoDaddy.

1431
00:59:12,726 --> 00:59:16,230
We still don't know
why, but we don't care.

1432
00:59:21,406 --> 00:59:23,530
So this is going to branch
a little bit further out

1433
00:59:23,530 --> 00:59:26,156
from the security side.

1434
00:59:26,156 --> 00:59:27,530
But one of the
things you find is

1435
00:59:27,530 --> 00:59:31,500
that when you're helping your
colleagues in the hospital

1436
00:59:31,500 --> 00:59:34,002
system, they often ask
back for some of your help.

1437
00:59:34,002 --> 00:59:35,460
And one of the
interesting projects

1438
00:59:35,460 --> 00:59:37,376
that we got involved
with, purely by accident,

1439
00:59:37,376 --> 00:59:40,640
from some of the
pacemaker security work

1440
00:59:40,640 --> 00:59:43,800
was in some humanitarian
aid in developing countries,

1441
00:59:43,800 --> 00:59:47,010
especially Ghana, to
give patients new life.

1442
00:59:47,010 --> 00:59:48,955
Literally new life,
because it turns out

1443
00:59:48,955 --> 00:59:50,580
if you don't have a
health care system,

1444
00:59:50,580 --> 00:59:52,730
it's very difficult
to, say, get a $40,000

1445
00:59:52,730 --> 00:59:54,910
pacemaker plus
the surgical team.

1446
00:59:54,910 --> 00:59:56,499
Very challenging.

1447
00:59:56,499 --> 00:59:58,040
So what they've been
doing is they've

1448
00:59:58,040 --> 01:00:01,690
been recovering discarded
pacemakers and defibrillators,

1449
01:00:01,690 --> 01:00:02,835
and then sterilizing them.

1450
01:00:02,835 --> 01:00:04,210
It's actually
pretty interesting.

1451
01:00:04,210 --> 01:00:06,001
You have to use-- well,
you don't have to--

1452
01:00:06,001 --> 01:00:10,260
but what's typically
used is ethylene oxide.

1453
01:00:10,260 --> 01:00:12,685
It's a gas chamber to
sterilize and remove

1454
01:00:12,685 --> 01:00:15,680
all the pyrogens,
things that cause fever.

1455
01:00:15,680 --> 01:00:17,130
But these devices
are sterilized,

1456
01:00:17,130 --> 01:00:18,650
and then reimplanted
in patients.

1457
01:00:18,650 --> 01:00:19,810
So here's a gentleman.

1458
01:00:19,810 --> 01:00:22,010
I believe he was suffering
from a slow heart

1459
01:00:22,010 --> 01:00:25,050
rate, which was basically
a death sentence for him.

1460
01:00:25,050 --> 01:00:27,200
But because he was able
to get a pacemaker,

1461
01:00:27,200 --> 01:00:29,670
it gave him extra years of life.

1462
01:00:29,670 --> 01:00:32,470
So the problem they
came to us with was,

1463
01:00:32,470 --> 01:00:35,100
how do they know if the
devices are still safe?

1464
01:00:35,100 --> 01:00:36,990
They weren't even used.

1465
01:00:36,990 --> 01:00:39,370
So obviously you can
look at the battery life.

1466
01:00:39,370 --> 01:00:40,620
So that's one thing you do.

1467
01:00:40,620 --> 01:00:42,430
And if the battery
is too low, you

1468
01:00:42,430 --> 01:00:46,276
would not reimplant it, because
that wouldn't last too long.

1469
01:00:46,276 --> 01:00:48,150
But then what about some
of the other things?

1470
01:00:48,150 --> 01:00:49,887
Has some of the metal corroded?

1471
01:00:49,887 --> 01:00:52,220
How do we do an end-to-end
check to see if you can still

1472
01:00:52,220 --> 01:00:54,200
detect arrhythmias properly?

1473
01:00:54,200 --> 01:00:58,360
So the students in my lab
created a special tester

1474
01:00:58,360 --> 01:01:02,770
that sends out
what you would see

1475
01:01:02,770 --> 01:01:08,860
from the electrical components
of cardiac arrhythmias.

1476
01:01:08,860 --> 01:01:10,220
Things other than sinusoid.

1477
01:01:10,220 --> 01:01:12,470
Cardiac rhythms that you
wouldn't want to have, right?

1478
01:01:12,470 --> 01:01:13,640
So, anomalies.

1479
01:01:13,640 --> 01:01:16,000
And it replays these
against the pacemaker leads.

1480
01:01:16,000 --> 01:01:18,590
The pacemaker thinks it's
connected to the patient,

1481
01:01:18,590 --> 01:01:19,530
and then it responds.

1482
01:01:19,530 --> 01:01:21,030
And so we check
that response to see

1483
01:01:21,030 --> 01:01:23,960
if it's actually diagnosing
the cardiac arrhythmias,

1484
01:01:23,960 --> 01:01:26,350
and whether it's actually
sending out the lifesaving

1485
01:01:26,350 --> 01:01:28,080
shocks properly.

1486
01:01:28,080 --> 01:01:33,280
So they're now starting to
test this through the whole FDA

1487
01:01:33,280 --> 01:01:35,760
process to get their blessing.

1488
01:01:35,760 --> 01:01:37,220
And that's a work in progress.

1489
01:01:37,220 --> 01:01:39,660
But it's called the My
Heart Your Heart program.

1490
01:01:39,660 --> 01:01:42,110
You can go look it up if
you're curious about it.

1491
01:01:42,110 --> 01:01:45,000
And then we also
interact quite a bit

1492
01:01:45,000 --> 01:01:47,060
with the medical device
manufacturing community.

1493
01:01:47,060 --> 01:01:50,720
We bring them in each
summer out to Ann Arbor,

1494
01:01:50,720 --> 01:01:54,930
and we have the
manufacturers sit down,

1495
01:01:54,930 --> 01:01:58,230
while some of the persons
who are in charge of running

1496
01:01:58,230 --> 01:01:59,980
hospitals sit down
next to them, and they

1497
01:01:59,980 --> 01:02:05,740
start sharing their gripes and
problems with medical devices.

1498
01:02:05,740 --> 01:02:09,270
We had one company come in and
just reveal all the problems

1499
01:02:09,270 --> 01:02:11,507
that none of the
people would respond to

1500
01:02:11,507 --> 01:02:12,965
at the medical
device manufacturer.

1501
01:02:12,965 --> 01:02:16,550
And one guy in the corner
was like, that's my team.

1502
01:02:16,550 --> 01:02:18,899
And so they decided to go
out for lunch, have a beer,

1503
01:02:18,899 --> 01:02:20,190
and just work out the problems.

1504
01:02:20,190 --> 01:02:21,950
So a lot of it is cultural.

1505
01:02:21,950 --> 01:02:26,070
So I don't know if anyone here
has done any security analysis

1506
01:02:26,070 --> 01:02:27,890
work, or reverse engineering.

1507
01:02:27,890 --> 01:02:29,618
Anyone here?

1508
01:02:29,618 --> 01:02:30,710
Couple people.

1509
01:02:30,710 --> 01:02:32,610
So it's really delicate.

1510
01:02:32,610 --> 01:02:34,710
It's almost an
art, because you're

1511
01:02:34,710 --> 01:02:37,430
dealing with the social elements
of the manufacturing side.

1512
01:02:37,430 --> 01:02:39,680
And it's even more so in
medical device manufacturing,

1513
01:02:39,680 --> 01:02:41,940
because lives are at stake.

1514
01:02:41,940 --> 01:02:43,900
And so it can be
very, very tricky

1515
01:02:43,900 --> 01:02:46,740
to share these kinds of
problems with the people who

1516
01:02:46,740 --> 01:02:48,630
are most able to fix it.

1517
01:02:48,630 --> 01:02:51,450
So it often results
in in-person meetings

1518
01:02:51,450 --> 01:02:55,810
and actually going
to their facilities.

1519
01:02:55,810 --> 01:02:58,010
So I want to save
some more time here.

1520
01:02:58,010 --> 01:02:59,510
Hopefully we'll
have some questions,

1521
01:02:59,510 --> 01:03:02,930
because I think we have
five or 10 minutes.

1522
01:03:02,930 --> 01:03:07,020
But I want to dispel
a couple of myths.

1523
01:03:07,020 --> 01:03:10,630
You'll hear a lot of newspaper
headlines and TV shows

1524
01:03:10,630 --> 01:03:14,290
talking about hackers
breaking into medical devices.

1525
01:03:14,290 --> 01:03:18,037
Let me say it is a problem,
but it's not the problem.

1526
01:03:18,037 --> 01:03:19,870
It's not the only
problem, and it's probably

1527
01:03:19,870 --> 01:03:22,124
not the most
significant problem.

1528
01:03:22,124 --> 01:03:24,040
And it's hard to say
that, especially when you

1529
01:03:24,040 --> 01:03:25,952
enjoy doing security analysis.

1530
01:03:25,952 --> 01:03:27,910
It's hard to say that,
because there's actually

1531
01:03:27,910 --> 01:03:29,900
two problems that I
think are more important.

1532
01:03:29,900 --> 01:03:34,200
One is preventing wide-scale
unavailability of patient care.

1533
01:03:34,200 --> 01:03:36,080
Because forget adversaries--
what if you just

1534
01:03:36,080 --> 01:03:37,990
have malware that
accidentally breaks

1535
01:03:37,990 --> 01:03:40,254
into a medical device
in a monoculture

1536
01:03:40,254 --> 01:03:42,420
where they're all running
the same operating system?

1537
01:03:42,420 --> 01:03:44,860
What happens when you
lose 50,000 infusion

1538
01:03:44,860 --> 01:03:46,470
pumps all at once?

1539
01:03:46,470 --> 01:03:49,970
It's very difficult to
deliver patient care.

1540
01:03:49,970 --> 01:03:55,120
One of my colleagues wrote to me
saying that his cath labs were

1541
01:03:55,120 --> 01:03:55,780
shut down.

1542
01:03:55,780 --> 01:03:58,949
Catheterization lab is a
relatively new specialization.

1543
01:03:58,949 --> 01:04:00,490
It's a special kind
of operating room

1544
01:04:00,490 --> 01:04:02,600
for minimally invasive surgery.

1545
01:04:02,600 --> 01:04:05,620
And at his hospital,
they had to shut down

1546
01:04:05,620 --> 01:04:08,060
the cath lab, because
turned out a nurse

1547
01:04:08,060 --> 01:04:10,480
had accidentally
brought in a USB stick.

1548
01:04:10,480 --> 01:04:12,960
Something about transferring
family photos up to Yahoo.

1549
01:04:12,960 --> 01:04:14,770
And somehow malware
had gotten in

1550
01:04:14,770 --> 01:04:17,300
and infected their cath labs.

1551
01:04:17,300 --> 01:04:20,360
So they had to shut
the thing down.

1552
01:04:20,360 --> 01:04:22,190
So if you're waiting
to get an angioplasty,

1553
01:04:22,190 --> 01:04:24,106
that particular center's
not available to you.

1554
01:04:24,106 --> 01:04:26,520
You'll have to use one
of the backup centers.

1555
01:04:26,520 --> 01:04:29,940
So availability is, I think, one
of the key things that is often

1556
01:04:29,940 --> 01:04:32,640
forgotten about in security.

1557
01:04:32,640 --> 01:04:35,820
Second one is the
integrity of the sensor.

1558
01:04:35,820 --> 01:04:38,340
So if your medical
device gets infected

1559
01:04:38,340 --> 01:04:43,240
by malware, or any kind
of malicious software,

1560
01:04:43,240 --> 01:04:44,490
things are going to change.

1561
01:04:44,490 --> 01:04:45,948
Things are going
to change in a way

1562
01:04:45,948 --> 01:04:47,980
that the designers
didn't anticipate.

1563
01:04:47,980 --> 01:04:50,240
So a very simple example.

1564
01:04:50,240 --> 01:04:53,670
Let's say some malware
gets in, and adds a timer

1565
01:04:53,670 --> 01:04:58,440
to every now and then wake
up, send some network packets,

1566
01:04:58,440 --> 01:05:00,630
and send out some spam.

1567
01:05:00,630 --> 01:05:01,980
This took some time.

1568
01:05:01,980 --> 01:05:04,697
Well, what happens if your
medical device assumed

1569
01:05:04,697 --> 01:05:07,030
that it had complete control
over the interrupt handler,

1570
01:05:07,030 --> 01:05:09,700
and suddenly now it's
missing interrupts?

1571
01:05:09,700 --> 01:05:12,720
Maybe the sensor has
some data to supply

1572
01:05:12,720 --> 01:05:14,940
to the medical device, but
because of the malware,

1573
01:05:14,940 --> 01:05:16,990
it missed the interrupt.

1574
01:05:16,990 --> 01:05:19,420
You may actually start
misdiagnosing patients now,

1575
01:05:19,420 --> 01:05:22,977
because that device is going
to be getting bad data.

1576
01:05:22,977 --> 01:05:24,685
So I'm very concerned
about the integrity

1577
01:05:24,685 --> 01:05:25,780
of the medical sensors.

1578
01:05:25,780 --> 01:05:29,210
There was actually a reported
case of a high-risk pregnancy

1579
01:05:29,210 --> 01:05:30,900
monitor getting
infected with malware

1580
01:05:30,900 --> 01:05:33,400
and giving out
incorrect readings.

1581
01:05:33,400 --> 01:05:36,770
The good news is a
highly-trained clinician

1582
01:05:36,770 --> 01:05:40,800
can look at the device and
say, that makes no sense.

1583
01:05:40,800 --> 01:05:44,300
That's not a sane number coming
out of my medical device.

1584
01:05:44,300 --> 01:05:47,990
But we're basically cutting
down the safety margins

1585
01:05:47,990 --> 01:05:52,859
when we can't have the integrity
of our medical sensors.

1586
01:05:52,859 --> 01:05:54,775
As I mentioned, very
difficult to bolt on this

1587
01:05:54,775 --> 01:05:57,570
stuff after the fact.

1588
01:05:57,570 --> 01:06:00,100
You think changing software's
hard on an internet scale?

1589
01:06:00,100 --> 01:06:01,690
Try it on a medical device.

1590
01:06:01,690 --> 01:06:06,070
So I met a guy from one
hospital where his MRI is still

1591
01:06:06,070 --> 01:06:08,840
running on Windows 95.

1592
01:06:08,840 --> 01:06:14,040
I have a pacemaker
programmer that runs on OS/2.

1593
01:06:14,040 --> 01:06:17,440
And they recently
upgraded to Windows XP.

1594
01:06:17,440 --> 01:06:21,100
So they have some really old
stuff out there, so changing

1595
01:06:21,100 --> 01:06:25,410
things for security after the
fact is going to be difficult.

1596
01:06:25,410 --> 01:06:28,700
Not impossible, but difficult.
And the other reason

1597
01:06:28,700 --> 01:06:31,380
is the interruption
of clinical workflow.

1598
01:06:31,380 --> 01:06:32,880
If you ever go off
and want to start

1599
01:06:32,880 --> 01:06:35,585
implementing medical
devices or doing something

1600
01:06:35,585 --> 01:06:36,960
security related
for health care,

1601
01:06:36,960 --> 01:06:39,050
I encourage you to go off
and call up some people,

1602
01:06:39,050 --> 01:06:41,050
and say, hey, can I go
into your operating room?

1603
01:06:41,050 --> 01:06:43,630
That's what we did.

1604
01:06:43,630 --> 01:06:45,850
Because you'll see some
weird things happen.

1605
01:06:45,850 --> 01:06:49,360
I took all my students to live
surgery, pediatric surgery.

1606
01:06:49,360 --> 01:06:52,040
And as they were
watching the surgery,

1607
01:06:52,040 --> 01:06:55,626
they were watching one
clinician checking Gmail

1608
01:06:55,626 --> 01:06:57,385
on one of the medical devices.

1609
01:06:57,385 --> 01:07:01,780
And they're like, oh OK, so,
drive-by downloads, check.

1610
01:07:01,780 --> 01:07:04,940
At the same time, they
wanted to calm the patient,

1611
01:07:04,940 --> 01:07:10,290
so they logged into
Pandora to play music.

1612
01:07:10,290 --> 01:07:12,290
Actually I was just at
my dentist the other day,

1613
01:07:12,290 --> 01:07:13,900
and she was playing Pandora.

1614
01:07:13,900 --> 01:07:18,290
And these ads for various beers
started coming up on the screen

1615
01:07:18,290 --> 01:07:19,915
as she was looking
at my dental x-rays.

1616
01:07:19,915 --> 01:07:22,825
And I was trying to figure
why Dos Equis was on my-- I

1617
01:07:22,825 --> 01:07:26,191
was like, did I drink that much?

1618
01:07:26,191 --> 01:07:27,940
She's like, no, we
just play Pandora here.

1619
01:07:27,940 --> 01:07:31,080
It's the same web browser,
and just click here.

1620
01:07:31,080 --> 01:07:34,440
So there's a lot
of mixing going on.

1621
01:07:34,440 --> 01:07:37,730
Maybe it's not malicious,
but it's opening cracks.

1622
01:07:37,730 --> 01:07:39,450
It's out of sight, out of mind.

1623
01:07:39,450 --> 01:07:41,870
The hand washing
sterile technique

1624
01:07:41,870 --> 01:07:44,630
is driven into the mindset
of anyone who's a clinician.

1625
01:07:44,630 --> 01:07:45,560
Wash your hands.

1626
01:07:45,560 --> 01:07:47,470
Don't touch the gloves
after you put them on.

1627
01:07:47,470 --> 01:07:49,170
But when it comes
to security hygiene,

1628
01:07:49,170 --> 01:07:51,000
it's really out of
sight, out of mind.

1629
01:07:51,000 --> 01:07:52,602
It's not part of
the culture yet.

1630
01:07:52,602 --> 01:07:54,060
They don't even
realize they should

1631
01:07:54,060 --> 01:07:55,260
be asking these questions.

1632
01:07:55,260 --> 01:07:57,680
Should I be running Pandora
on the same device that's

1633
01:07:57,680 --> 01:08:00,657
controlling my x-rays?

1634
01:08:00,657 --> 01:08:02,740
So but the important thing
is on the designer side

1635
01:08:02,740 --> 01:08:04,480
is not to interrupt
the clinical workflow.

1636
01:08:04,480 --> 01:08:05,920
Because that's when
mistakes happen.

1637
01:08:05,920 --> 01:08:07,540
You want to keep the
clinical workflow

1638
01:08:07,540 --> 01:08:11,960
regular, predictable, easy
for them to make decisions.

1639
01:08:11,960 --> 01:08:16,202
And if you add a new dialogue
box to enter a password, what

1640
01:08:16,202 --> 01:08:18,410
do you think a problem could
be in the operating room

1641
01:08:18,410 --> 01:08:20,620
if you ask the clinician
to enter a password, say,

1642
01:08:20,620 --> 01:08:21,640
every ten minutes?

1643
01:08:28,540 --> 01:08:29,689
Distractions?

1644
01:08:29,689 --> 01:08:31,640
You're sitting there,
doing this, right?

1645
01:08:31,640 --> 01:08:32,700
Scalpel.

1646
01:08:32,700 --> 01:08:34,695
Oh, yeah, let me walk
over here and type in my

1647
01:08:34,695 --> 01:08:36,250
pass-- oh, no, I
got my gloves on.

1648
01:08:36,250 --> 01:08:37,580
Let me take those off.

1649
01:08:37,580 --> 01:08:39,390
Oh, I've got to resterilize now.

1650
01:08:39,390 --> 01:08:40,630
Nurse!

1651
01:08:40,630 --> 01:08:43,050
So if you're a
security engineer,

1652
01:08:43,050 --> 01:08:45,020
you have to take into
account all the rather

1653
01:08:45,020 --> 01:08:48,380
special conditions of the
clinical setting with infection

1654
01:08:48,380 --> 01:08:49,170
control.

1655
01:08:49,170 --> 01:08:51,361
Which, surprisingly, not
everybody knows about.

1656
01:08:51,361 --> 01:08:53,569
There are definitely some
very talented engineers who

1657
01:08:53,569 --> 01:08:57,826
know about it, but not enough.

1658
01:08:57,826 --> 01:08:59,670
The other big problem
is I've noticed

1659
01:08:59,670 --> 01:09:06,689
that security people tend to
specialize in the mechanisms

1660
01:09:06,689 --> 01:09:08,130
to control security.

1661
01:09:08,130 --> 01:09:09,330
You can wield crypto.

1662
01:09:09,330 --> 01:09:12,790
I know CBC mode this, and I
know public key crypto this.

1663
01:09:12,790 --> 01:09:14,370
That's great.

1664
01:09:14,370 --> 01:09:16,330
And you know how to
prevent the problems.

1665
01:09:16,330 --> 01:09:18,609
You know how to
detect the problems.

1666
01:09:18,609 --> 01:09:20,240
The issue is from
the medical world.

1667
01:09:20,240 --> 01:09:21,740
Most people in the
medical world are

1668
01:09:21,740 --> 01:09:23,510
coming from a very
different mindset, one

1669
01:09:23,510 --> 01:09:25,720
that's called risk management.

1670
01:09:25,720 --> 01:09:27,580
Let me try to explain it.

1671
01:09:27,580 --> 01:09:29,960
In risk management, you
look at risks and benefits,

1672
01:09:29,960 --> 01:09:31,910
and you ask yourself,
do they balance?

1673
01:09:31,910 --> 01:09:35,609
If I take an action, does that
improve my risk management

1674
01:09:35,609 --> 01:09:36,318
outlook?

1675
01:09:36,318 --> 01:09:38,109
So if you're going to
decide, for instance,

1676
01:09:38,109 --> 01:09:41,920
am I going to deploy
a password system

1677
01:09:41,920 --> 01:09:43,765
on all my medical devices.

1678
01:09:43,765 --> 01:09:46,259
A security person
might say, duh,

1679
01:09:46,259 --> 01:09:48,050
of course you're going
to deploy passwords,

1680
01:09:48,050 --> 01:09:49,819
because you need
to authenticate.

1681
01:09:49,819 --> 01:09:52,500
The safety person might
say, well, wait a minute.

1682
01:09:52,500 --> 01:09:56,310
If I required we have
passwords on every system,

1683
01:09:56,310 --> 01:09:58,910
we're going to worry
about sterilization.

1684
01:09:58,910 --> 01:10:00,900
How do we know how
often to time out?

1685
01:10:00,900 --> 01:10:02,710
And what about emergency access?

1686
01:10:02,710 --> 01:10:04,300
What if we forget the password?

1687
01:10:04,300 --> 01:10:07,459
We want to make sure we can get
a response time in 30 seconds.

1688
01:10:07,459 --> 01:10:09,500
So they might actually
make a different decision.

1689
01:10:09,500 --> 01:10:12,280
They might actually decide
not to have passwords at all.

1690
01:10:12,280 --> 01:10:14,930
Actually many hospitals
don't have passwords.

1691
01:10:14,930 --> 01:10:18,190
Excuse me, many hospitals
don't have access control

1692
01:10:18,190 --> 01:10:19,030
on medical records.

1693
01:10:19,030 --> 01:10:21,610
Instead they have what's called
audit-based access control.

1694
01:10:21,610 --> 01:10:23,860
After the fact, if you look
at something you shouldn't

1695
01:10:23,860 --> 01:10:25,860
look at, they come get you.

1696
01:10:25,860 --> 01:10:28,540
Because they know that it's
very difficult to predict what

1697
01:10:28,540 --> 01:10:30,040
you're going to
need in your routine

1698
01:10:30,040 --> 01:10:32,390
of your clinical workflow.

1699
01:10:32,390 --> 01:10:35,560
So the risk
management kind of way

1700
01:10:35,560 --> 01:10:39,120
will depend upon deploying
the security controls

1701
01:10:39,120 --> 01:10:40,822
and all the technology
learn about.

1702
01:10:40,822 --> 01:10:42,280
But in the risk
management picture,

1703
01:10:42,280 --> 01:10:44,530
you might actually decide
not to deploy something,

1704
01:10:44,530 --> 01:10:48,120
because it could cause
harm somewhere else.

1705
01:10:48,120 --> 01:10:49,770
But trustworthy
medical device software

1706
01:10:49,770 --> 01:10:52,880
is going to require both.

1707
01:10:52,880 --> 01:10:54,857
So I'll just finish up here.

1708
01:10:54,857 --> 01:10:56,940
I think there's a lot of
interesting things to do.

1709
01:10:56,940 --> 01:10:59,104
So you're taking this
cool security course.

1710
01:10:59,104 --> 01:11:01,020
I encourage you to go
out and use those tools.

1711
01:11:01,020 --> 01:11:03,280
But as you're thinking about
where to go afterwards,

1712
01:11:03,280 --> 01:11:05,060
whether it's industry
or graduate school,

1713
01:11:05,060 --> 01:11:07,435
think about medical devices,
because they need your help.

1714
01:11:07,435 --> 01:11:09,430
They need a lot of
smart people there.

1715
01:11:09,430 --> 01:11:12,080
And so there's just one
thing missing-- you are.

1716
01:11:12,080 --> 01:11:14,410
And I think there's a
lot of interesting stuff

1717
01:11:14,410 --> 01:11:15,590
still to be done.

1718
01:11:15,590 --> 01:11:17,932
So I think we have five
or 10 minutes or so.

1719
01:11:17,932 --> 01:11:19,390
I'd be glad to take
some questions.

1720
01:11:19,390 --> 01:11:20,640
Or I could go more into depth.

1721
01:11:20,640 --> 01:11:22,730
I got some fun
videos I could show.

1722
01:11:22,730 --> 01:11:25,810
But I think I'll at least
take a break for a moment

1723
01:11:25,810 --> 01:11:28,628
to see if you have
any questions.

1724
01:11:28,628 --> 01:11:29,128
Yes?

1725
01:11:29,128 --> 01:11:31,096
AUDIENCE: So that
pacemaker or whatever

1726
01:11:31,096 --> 01:11:35,086
it was that you were passing
around, does that [INAUDIBLE].

1727
01:11:35,086 --> 01:11:36,460
PROFESSOR: Oh,
the defibrillator.

1728
01:11:36,460 --> 01:11:37,085
AUDIENCE: Yeah.

1729
01:11:37,085 --> 01:11:41,448
How does that
interact with the fact

1730
01:11:41,448 --> 01:11:44,370
that they are [INAUDIBLE]
these kind of things.

1731
01:11:44,370 --> 01:11:46,132
PROFESSOR: OK so
a couple things.

1732
01:11:46,132 --> 01:11:48,340
So there are defibrillators
and there are pacemakers.

1733
01:11:48,340 --> 01:11:50,650
They're very related.

1734
01:11:50,650 --> 01:11:51,850
This is a defibrillator.

1735
01:11:51,850 --> 01:11:53,320
It sends out large shocks.

1736
01:11:53,320 --> 01:11:55,570
Pacemakers send
out small shocks.

1737
01:11:55,570 --> 01:11:59,020
But in the US, it's
illegal to reimplant these.

1738
01:11:59,020 --> 01:12:01,110
So it doesn't matter if you can.

1739
01:12:01,110 --> 01:12:02,670
It's just illegal.

1740
01:12:02,670 --> 01:12:05,720
But in many developing
countries it's not illegal.

1741
01:12:05,720 --> 01:12:08,150
And if you look from--
let me back up a slide.

1742
01:12:10,730 --> 01:12:14,110
If you look from not the
control mechanism, but the risk

1743
01:12:14,110 --> 01:12:16,840
management side of
equation, it might actually

1744
01:12:16,840 --> 01:12:19,750
lead to better public
health outcomes

1745
01:12:19,750 --> 01:12:22,750
to allow reimplantation and
reuse in developing countries

1746
01:12:22,750 --> 01:12:25,646
where they have no other choice.

1747
01:12:25,646 --> 01:12:26,890
And this is not my project.

1748
01:12:26,890 --> 01:12:29,600
This is just a project
we're assisting on.

1749
01:12:29,600 --> 01:12:32,280
But in that particular case, the
patients really have no choice.

1750
01:12:32,280 --> 01:12:34,670
It's basically a death sentence.

1751
01:12:34,670 --> 01:12:36,804
To sterilize it
is pretty tricky.

1752
01:12:36,804 --> 01:12:38,720
There's a whole lot of
science and engineering

1753
01:12:38,720 --> 01:12:40,970
that goes into how
to properly sterilize

1754
01:12:40,970 --> 01:12:44,020
to get rid of the pathogens.

1755
01:12:44,020 --> 01:12:48,560
Because these were in blood,
so first abrasive cleaner,

1756
01:12:48,560 --> 01:12:50,710
but the ethylene
oxide is one way

1757
01:12:50,710 --> 01:12:52,974
to destroy most, if not
all, of the pathogens.

1758
01:12:52,974 --> 01:12:54,390
There's a whole
testing procedure.

1759
01:12:54,390 --> 01:12:58,155
You actually put
special little-- I

1760
01:12:58,155 --> 01:12:59,280
forgot what they're called.

1761
01:12:59,280 --> 01:13:02,610
They're little wafers-- with
known quantities of pathogens.

1762
01:13:02,610 --> 01:13:05,120
And you put it in alongside
some of the devices

1763
01:13:05,120 --> 01:13:08,200
as it's going into the chamber,
and when you pull it out,

1764
01:13:08,200 --> 01:13:12,710
you test to see if all those
organisms have been killed.

1765
01:13:12,710 --> 01:13:14,220
Did that answer
all your questions?

1766
01:13:14,220 --> 01:13:16,610
You had a follow up.

1767
01:13:16,610 --> 01:13:17,180
OK.

1768
01:13:17,180 --> 01:13:17,680
Yes?

1769
01:13:17,680 --> 01:13:20,224
AUDIENCE: So what you're
saying, integrity of sensors

1770
01:13:20,224 --> 01:13:22,190
is a bigger risk
for hacker attack,

1771
01:13:22,190 --> 01:13:26,776
because most of the examples of
sensory interference you showed

1772
01:13:26,776 --> 01:13:28,240
are intentional interference.

1773
01:13:28,240 --> 01:13:29,916
So it's kind of [INAUDIBLE].

1774
01:13:29,916 --> 01:13:31,290
PROFESSOR: Oh, so
the question is

1775
01:13:31,290 --> 01:13:36,070
why focus on integrity of
sensors rather than hacking,

1776
01:13:36,070 --> 01:13:38,220
because everything I
showed was about hacking?

1777
01:13:38,220 --> 01:13:40,340
That's selection bias.

1778
01:13:40,340 --> 01:13:42,460
I selected those cases,
but that doesn't mean

1779
01:13:42,460 --> 01:13:45,300
that's statistically relevant.

1780
01:13:45,300 --> 01:13:48,850
I divided up into two
cases-- maybe three.

1781
01:13:48,850 --> 01:13:50,890
The past, the present,
and the future.

1782
01:13:50,890 --> 01:13:54,805
So at the present,
most of the problems

1783
01:13:54,805 --> 01:13:58,145
we're seeing from malware in our
very rudimentary surveillance

1784
01:13:58,145 --> 01:14:01,090
of medical devices has to do
with malware that accidentally

1785
01:14:01,090 --> 01:14:05,280
gets in, and then causes
near misses and malfunctions.

1786
01:14:05,280 --> 01:14:06,470
But we're no dummies.

1787
01:14:06,470 --> 01:14:08,830
We know that there could
be an intentional adversary

1788
01:14:08,830 --> 01:14:09,800
in the future.

1789
01:14:09,800 --> 01:14:11,570
They just haven't
materialized yet.

1790
01:14:11,570 --> 01:14:15,480
The closest example
would be-- this

1791
01:14:15,480 --> 01:14:16,750
is just from the news reports.

1792
01:14:16,750 --> 01:14:18,125
I don't know if
it's true, but it

1793
01:14:18,125 --> 01:14:20,720
was from I believe
the New York Times--

1794
01:14:20,720 --> 01:14:23,150
that there was a hospital.

1795
01:14:23,150 --> 01:14:25,586
CHS, I think, was
the hospital, Where

1796
01:14:25,586 --> 01:14:27,460
they brought in a security
company, Mandiant.

1797
01:14:27,460 --> 01:14:32,000
And they believe that a nation
state had actually come in

1798
01:14:32,000 --> 01:14:33,540
to steal the medical records.

1799
01:14:33,540 --> 01:14:36,710
They don't know exactly
why, but nation states.

1800
01:14:36,710 --> 01:14:38,900
And nation states are
powerful adversaries, right?

1801
01:14:38,900 --> 01:14:40,441
If you run up against
a nation state,

1802
01:14:40,441 --> 01:14:43,995
you might as well just give up,
because none of these controls

1803
01:14:43,995 --> 01:14:45,490
are going to help you.

1804
01:14:45,490 --> 01:14:47,024
But here's my concern.

1805
01:14:47,024 --> 01:14:48,440
If the nation
state, for instance,

1806
01:14:48,440 --> 01:14:51,350
is very dedicated on getting
one piece of information,

1807
01:14:51,350 --> 01:14:53,897
what if they make--
they're human too, right?

1808
01:14:53,897 --> 01:14:55,605
What if they make a
mistake along the way

1809
01:14:55,605 --> 01:14:57,146
and accidentally
hit a medical device

1810
01:14:57,146 --> 01:15:00,340
as they're trying to extract
whatever kind of information

1811
01:15:00,340 --> 01:15:02,210
they're trying to get at?

1812
01:15:02,210 --> 01:15:05,890
And that could
affect the integrity.

1813
01:15:05,890 --> 01:15:09,440
In the future, there could be
instances of custom malware,

1814
01:15:09,440 --> 01:15:16,050
but I think it takes that
one more step of someone

1815
01:15:16,050 --> 01:15:19,952
really wanting to cause harm.

1816
01:15:19,952 --> 01:15:21,660
And I'm hoping that
there aren't too many

1817
01:15:21,660 --> 01:15:23,030
of those kinds of people.

1818
01:15:23,030 --> 01:15:24,960
But there are people
who write malware

1819
01:15:24,960 --> 01:15:26,600
who don't realize
that malware gets

1820
01:15:26,600 --> 01:15:28,216
into medical devices
in hospitals,

1821
01:15:28,216 --> 01:15:31,020
and it's still causing problems.