Stair-climbing wheelchair comes to a halt

[Guest guest]

Stair-climbing wheelchair comes to a halt

How much will society agree to pay for high-tech help for the disabled?

http://www.msnbc.msn.com/id/30929301/

The nation's first stair-climbing wheelchair hit the market with a bang but

disappeared with a whimper, a casualty of price that raises a big question: How

much will society agree to pay for high-tech help for the disabled?

& quietly sold the last iBOTs this spring, shuttering

manufacturing of a wheelchair that doctors had greeted five years ago as

potentially revolutionary for the freedom of movement it promised ¡ª but which

failed to sell more than a few hundred a year. Earlier this month, a veteran who

lost his legs in Iraq received the last known available iBOT, donated after its

initial owner died.

Now iBOT users who fear their chairs wearing out are joining high-profile

inventor Dean Kamen ¡ª best known for his Segways ¡ª in lobbying Congress for

reimbursement changes that they hope could revive a technology that left the

market with a $22,000 price tag but that Medicare deemed worth about $6,000.

Story continues below ¡ý

--------------------------------------------------------------------------------

advertisement | your ad here

--------------------------------------------------------------------------------

" If I ever had to get out of this chair, I really don't know if I'd want to live

anymore, to be honest with you, " says Alan T. Brown, 42, of Hollywood, Fla., who

is mostly paralyzed from the chest down and on his second iBOT. " Guys in these

chairs ... we might be disabled now, but then we'd really become disabled. "

Price wasn't the only factor in the iBOT's demise. Only a small fraction of the

paralyzed even were candidates because the high-tech chair required, among other

things, use of at least one arm and certain upper-body control.

Still, disability specialists say the iBOT saga has ramifications beyond one

gee-whiz but far-from-perfect wheelchair. It raises the issue of how the nation

handles different kinds of medical equipment.

Take this example from Dr. Boninger, who directs the University of

Pittsburgh Medical Center's rehabilitation institute: Medicare routinely pays

tens of thousands of dollars for hip replacements to keep the elderly walking

pain-free. But a 70-year-old who can't undergo that operation must become too

impaired to easily care for herself at home before being approved for a basic

electric wheelchair ¡ª when short stands in the kitchen are less of an issue

than going to the grocery store, Boninger says.

Medicare says that's how Congress wrote its rules.

Disability discrimination?

" The wheelchair is maybe the most enabling technology in medicine, period, "

Boninger says. " What it is, is discriminatory policy. "

The iBOT episode also sends a cautionary signal about pricey innovation. New

technology requires scientific evidence that it changes users' lives in ways

existing alternatives cannot, says Henry Claypool, the new director of the

federal Office on Disability, which advises the secretary of health and human

services.

" Innovative technology should be treated as something we need to embrace when we

really find it has a chance to advance a group's function and integration into

the community, " says Claypool, himself a wheelchair user.

Did the iBOT do that? It depends on who you ask.

The iBOT's wheels rotate up and over one another to go up and down steps, using

gyroscopes that sense and adjust to a person's center of gravity. The Department

of Veterans Affairs bought the chairs for a limited number of disabled soldiers.

Yet by the end of 2006, Medicare had concluded that the stair-climbing function

and other features ¡ª lifting users to standing height and powering over uneven

turf ¡ª weren't medically necessary for at-home care; it would pay only the

basic electric wheelchair price. Medicare does provide far pricier wheelchairs,

equipped for certain pressure-easing motions or to handle breathing equipment,

when doctors deem them required.

J & J blamed reimbursement in part for lack of a " sustainable market, " but pledged

to provide iBOT users repair service through 2013.

" Giving people independence and access and freedom and technology ought to be

something we do, " says Kamen, who argues that an iBOT might save money on home

modifications.

But today's emphasis is to expand access to health care rather than provide

pricier improvements, cautions University of Michigan business professor

Gordon, who tracks J & J. He just heard the venture capitalists who fund device

research warn industry that new designs must prove a better value than

alternatives.

'Breakthroughs we just can't afford'

" To a certain extent, there are breakthroughs we just can't afford, " Gordon

says.

Linfoot of sville, Tenn., illustrates the pros and cons. The Army

pilot was paralyzed in a helicopter crash in Iraq last year and found an iBOT

through the nonprofit Huey 091 Foundation ¡ª but switches between it and his

VA-provided manual wheelchair. The smaller, lightweight manual lets him drive a

car, not a van, to Fort , where he now oversees an aquatic training

facility. He installed an elevator in his house.

But he uses the iBOT at home, to reach high shelves or work under his car's

hood. He also uses it to visit friends whose houses have a step or two that " may

as well be Mount Everest, " says Linfoot. " You don't understand all the

accessibility issues until you find yourself in one and you're trying to

navigate the world yourself. "