*4.2.2.1 i-Limb by Touch Bionics, UK*

Touch Bionics is one of the top companies in producing prostheses for transradial, wrist disarticulation, and finger amputees. A finger of i-Limb consists of four-bar mechanism driven by a DC motor via worm gears. The latest model i-Limb Quantum weighs 470 g for the ultrasmall model and 630 g for the large model. The four sizes of i-Limb Quantum are shown in **Figure 6** [17].

The new i-Limb Quantum has four different modes of control:


4.Grip chips proximity control: this is the unique programmable feature introduced in i-Limb quantum; whenever the user moves his/her hand near the grip chip, the pre-programmed grip will be enabled, allowing the user to quickly use that specific grip.

Although the Touch Bionics has developed a state-of-the-art prosthesis, there is always a room for improvement. Lack of sensory feedback to control the grip limits the performance of the i-Limb. Also, the user must select from the defined grips available with the model and preprogram them. Another factor that limits the amputee to get the i-Limb prostheses is the high price tag [18].

#### *4.2.2.2 Bebionics by Ottobock, Germany*

The Ottobock company has a wide variety of prostheses, including both upper limb and lower limb solutions. For consistency, the upper limb hand myoelectric prosthesis of Ottobock, i.e., Bebionics, is discussed in this section.

The Bebionic is available in three sizes and weighs between 390 and 600 g, as shown in **Figure 7** [19]. Each finger of Bebionics is driven by a custom linear actuator through four-bar mechanism. Similar to i-Limb quantum, the Bebionic has an FSM-based control scheme to select among the 14 different grip patterns and hand positions [20].

The structure of the Bebionic is developed using aerospace industry grade aluminum, which gives it a robust structure and is lightweight. The Bebionic suffer from the same constraints as of i-Limb due to unavailability of the sensory feedback, pre-programmed grip pattern, and high cost.

#### *4.2.2.3 Vincent Hand by Vincent Systems GmbH, Germany*

The Vincent Systems GmbH is specialized in producing the myoelectric prosthesis hand. Currently, Vincent Evolution 3 has been released with four different sizes, i.e., extra small, small, medium, and large. The extra-small size of Vincent Evolution 3 is the lightest myoelectric prosthesis hand, which weighs only 386 g with the transcarpal wrist [21] (**Figure 8**).

Each finger of Vincent Evolution 3 comprises of a DC motor that drives the four-bar mechanism with the help of worm gear to achieve the flexion-extension of the finger. The control scheme of Vincent Hand is a specialized type of FSM, which senses two EMG signals and can attain five different grip groups directly from the central hand position. Another advantage of the Vincent FSM is that you can jump to the central hand position from any grip by a long "open" signal. The "open," "close," and "trigger" are customizable and the user may choose any other unique signal instead of co-contraction [22].

Similar to Bebionics and i-Limb, Vincent Evolution 3 lacks the sensory feedback essential to control the grip force. Therefore, Vincent Evolution 3 has preprogrammed grips and fingers are coupled with open/close function.

#### *4.2.2.4 Modular prosthetic limb by John Hopkins Applied physics Lab, USA*

The modular prosthetic limb (MPL) is the most advanced prosthesis hand developed by the John Hopkins Applied Physics Lab, USA, under the umbrella of Revolutionizing Prosthetics 2009 (RP 2009) [23]. Unlike the commercially available prostheses, MPL contains motor at each joint of the finger. The MPL has 26 degrees of freedom (DOF) including wrist, elbow, and shoulder movements.

**17**

*Impact of Medical Advancement: Prostheses DOI: http://dx.doi.org/10.5772/intechopen.86602*

1.32 kg as shown in **Figure 9**.

**Figure 7.**

**Figure 6.**

cially available yet.

for a person who lost a major portion of his/her limb.

*The Bebionics V3 by Ottobock, from left to right: small, medium, and large.*

*i-Limb Quantum by Touch Bionics, from left to right: extra small, small, medium, and large.*

*4.2.2.5 Vanderbilt hand by Vanderbilt University, USA*

The MPL is customizable and can be used for all major upper limb amputation. The overall weight of the MPL is 3.5 kg, and the hand with wrist weighs around

The MPL is tested on human subjects who underwent targeted muscle reinnervation (TMR) surgery [24]. The TMR surgery is the process of connecting the residual motor nerves of lost muscle into the nearest large muscle, so that, the intentions of moving the lost muscle can be detected. This technique is quite useful

The recent development in targeted sensory reinnervation (TSR) technique [25] allows the MPL to send the sensory feedback directly to the nerves of the lost limbs. This is the major limitation of the commercial prostheses that MPL has overcome [26]. In TSR surgery, the residual sensory nerves are connected or reinnervate at the nearest large muscle, so that, the sensory feedback of the prostheses can be sensed via the electrode. The MPL is the most advanced prostheses, and it is not commer-

The researchers at the Center for Intelligent Mechatronics Lab at Vanderbilt University, USA, have developed a 9 DOF prosthesis hand with 4 degrees of control (DOC). The Vanderbilt hand uses four motors with a tendon-spring mechanism to achieve essential grips to perform ADL. Instead of using a single motor for each finger, Vanderbilt hand uses one motor for the index finger, two motors for thumb, and one motor for remaining three fingers (i.e., middle, ring, and pinky). The adult human hand-sized Vanderbilt hand weighs around 546 g as shown in **Figure 10** [27]. *Impact of Medical Advancement: Prostheses DOI: http://dx.doi.org/10.5772/intechopen.86602*

**Figure 6.**

*Computer Architecture in Industrial, Biomechanical and Biomedical Engineering*

amputee to get the i-Limb prostheses is the high price tag [18].

prosthesis of Ottobock, i.e., Bebionics, is discussed in this section.

back, pre-programmed grip pattern, and high cost.

with the transcarpal wrist [21] (**Figure 8**).

signal instead of co-contraction [22].

*4.2.2.3 Vincent Hand by Vincent Systems GmbH, Germany*

use that specific grip.

*4.2.2.2 Bebionics by Ottobock, Germany*

positions [20].

4.Grip chips proximity control: this is the unique programmable feature introduced in i-Limb quantum; whenever the user moves his/her hand near the grip chip, the pre-programmed grip will be enabled, allowing the user to quickly

Although the Touch Bionics has developed a state-of-the-art prosthesis, there is always a room for improvement. Lack of sensory feedback to control the grip limits the performance of the i-Limb. Also, the user must select from the defined grips available with the model and preprogram them. Another factor that limits the

The Ottobock company has a wide variety of prostheses, including both upper limb and lower limb solutions. For consistency, the upper limb hand myoelectric

The Bebionic is available in three sizes and weighs between 390 and 600 g, as shown in **Figure 7** [19]. Each finger of Bebionics is driven by a custom linear actuator through four-bar mechanism. Similar to i-Limb quantum, the Bebionic has an FSM-based control scheme to select among the 14 different grip patterns and hand

The structure of the Bebionic is developed using aerospace industry grade aluminum, which gives it a robust structure and is lightweight. The Bebionic suffer from the same constraints as of i-Limb due to unavailability of the sensory feed-

The Vincent Systems GmbH is specialized in producing the myoelectric prosthesis hand. Currently, Vincent Evolution 3 has been released with four different sizes, i.e., extra small, small, medium, and large. The extra-small size of Vincent Evolution 3 is the lightest myoelectric prosthesis hand, which weighs only 386 g

Each finger of Vincent Evolution 3 comprises of a DC motor that drives the four-bar mechanism with the help of worm gear to achieve the flexion-extension of the finger. The control scheme of Vincent Hand is a specialized type of FSM, which senses two EMG signals and can attain five different grip groups directly from the central hand position. Another advantage of the Vincent FSM is that you can jump to the central hand position from any grip by a long "open" signal. The "open," "close," and "trigger" are customizable and the user may choose any other unique

Similar to Bebionics and i-Limb, Vincent Evolution 3 lacks the sensory feedback

The modular prosthetic limb (MPL) is the most advanced prosthesis hand developed by the John Hopkins Applied Physics Lab, USA, under the umbrella of Revolutionizing Prosthetics 2009 (RP 2009) [23]. Unlike the commercially available prostheses, MPL contains motor at each joint of the finger. The MPL has 26 degrees of freedom (DOF) including wrist, elbow, and shoulder movements.

essential to control the grip force. Therefore, Vincent Evolution 3 has prepro-

*4.2.2.4 Modular prosthetic limb by John Hopkins Applied physics Lab, USA*

grammed grips and fingers are coupled with open/close function.

**16**

*i-Limb Quantum by Touch Bionics, from left to right: extra small, small, medium, and large.*

**Figure 7.**

*The Bebionics V3 by Ottobock, from left to right: small, medium, and large.*

The MPL is customizable and can be used for all major upper limb amputation. The overall weight of the MPL is 3.5 kg, and the hand with wrist weighs around 1.32 kg as shown in **Figure 9**.

The MPL is tested on human subjects who underwent targeted muscle reinnervation (TMR) surgery [24]. The TMR surgery is the process of connecting the residual motor nerves of lost muscle into the nearest large muscle, so that, the intentions of moving the lost muscle can be detected. This technique is quite useful for a person who lost a major portion of his/her limb.

The recent development in targeted sensory reinnervation (TSR) technique [25] allows the MPL to send the sensory feedback directly to the nerves of the lost limbs. This is the major limitation of the commercial prostheses that MPL has overcome [26]. In TSR surgery, the residual sensory nerves are connected or reinnervate at the nearest large muscle, so that, the sensory feedback of the prostheses can be sensed via the electrode. The MPL is the most advanced prostheses, and it is not commercially available yet.

#### *4.2.2.5 Vanderbilt hand by Vanderbilt University, USA*

The researchers at the Center for Intelligent Mechatronics Lab at Vanderbilt University, USA, have developed a 9 DOF prosthesis hand with 4 degrees of control (DOC). The Vanderbilt hand uses four motors with a tendon-spring mechanism to achieve essential grips to perform ADL. Instead of using a single motor for each finger, Vanderbilt hand uses one motor for the index finger, two motors for thumb, and one motor for remaining three fingers (i.e., middle, ring, and pinky). The adult human hand-sized Vanderbilt hand weighs around 546 g as shown in **Figure 10** [27].

**Figure 8.** *Vincent evolution 3 by Vincent Systems GmbH.*

**Figure 9.** *The modular prosthetic limb by John Hopkins Applied Physics Laboratory, USA.*

The FSM of Vanderbilt hands is shown in **Figure 11** [28]. The Vanderbilt hand uses two onsite EMG signals for switching between the states of the machine. The co-contraction will be used for thumb reposition and opposition states. The contraction of the forearm flexor is associated with the upward movement, and contraction of the forearm extensor is associated with the downward movement as shown in the state diagram of the Vanderbilt hand.

The Vanderbilt hand has a unique mechanism and control scheme, but it lacks the functionality and features offered by the MPL. However, the price estimation of the Vanderbilt hand is much lower as compared to the MPL.

**19**

in **Figure 13** [30].

the commercial prostheses.

*Impact of Medical Advancement: Prostheses DOI: http://dx.doi.org/10.5772/intechopen.86602*

*4.2.2.6 Hero Arm by Open Bionics, UK*

**Figure 10.**

of the Hero Arm can be found at [29].

*4.2.2.7 Tact Hand by University of Illinois, USA*

actuated with a single motor in a three-motor version.

*Third-generation Vanderbilt hand by the Center for Intelligent Mechatronics.*

The Open Bionics has released multiple open source 3D printed prostheses including, Dextrus Hand, Ada Hand, Brunel hand, and Hero Arm. The latest and most advance among all, i.e., the Hero Arm is shown in **Figure 12**. The Hero Arm is designed for a person with transradial amputation. There are two versions of the Hero Arm, one with four-motor-drive mechanism and other with three-motordrive mechanism. The only difference is that the index and middle fingers are

The Hero Arm has tendon-flexure-based mechanism for flexion extension of the finger. The control scheme of the Hero Arm consists of FSM that utilizes the contraction of wrist flexion and extension muscles. The trigger signal for switching the grip is open signal, pause, and then holds the open signal for 1 s. Further details

The main advantages of the 3D printed prostheses are low cost, easy modification, and customization. On the other hand, 3D printed prostheses mostly lack the

performance and robustness offered by the commercial prostheses [16].

The Tact Hand is another open source prosthesis hand developed by the researchers at the University of Illinois. Each finger of the Tact Hand is driven by a DC motor through the string. The string is attached with the underactuated fourbar mechanism of the finger. As the motor rotates clockwise, it winds up the string on the spool, creating tension in the string, which in turn flexes the finger. The rubber band attached at the back of the finger assists in the extension of the finger when the motor rotates anticlockwise, releasing the tension in the spring as shown

Tact Hand is the cheapest 3D printed prostheses as claimed by the author [30]. However, it lacks the esthetic look, robustness, and durability, offered by most of

**Table 1** summarizes the characteristics of the commercial and 3D printed hand prostheses discussed in this section. All the prostheses use an underactuated mechanism to reduce the complexity of the hand design. Underactuated mechanism not only reduces the requirement of the actuators at each joint, but also simplifies the control scheme of the hand, which in turn reduces the weight of the prosthetic

*Impact of Medical Advancement: Prostheses DOI: http://dx.doi.org/10.5772/intechopen.86602*

**Figure 10.**

*Computer Architecture in Industrial, Biomechanical and Biomedical Engineering*

The FSM of Vanderbilt hands is shown in **Figure 11** [28]. The Vanderbilt hand uses two onsite EMG signals for switching between the states of the machine. The co-contraction will be used for thumb reposition and opposition states. The contraction of the forearm flexor is associated with the upward movement, and contraction of the forearm extensor is associated with the downward movement as

The Vanderbilt hand has a unique mechanism and control scheme, but it lacks the functionality and features offered by the MPL. However, the price estimation of the

shown in the state diagram of the Vanderbilt hand.

Vanderbilt hand is much lower as compared to the MPL.

*The modular prosthetic limb by John Hopkins Applied Physics Laboratory, USA.*

**18**

**Figure 9.**

**Figure 8.**

*Vincent evolution 3 by Vincent Systems GmbH.*

*Third-generation Vanderbilt hand by the Center for Intelligent Mechatronics.*

#### *4.2.2.6 Hero Arm by Open Bionics, UK*

The Open Bionics has released multiple open source 3D printed prostheses including, Dextrus Hand, Ada Hand, Brunel hand, and Hero Arm. The latest and most advance among all, i.e., the Hero Arm is shown in **Figure 12**. The Hero Arm is designed for a person with transradial amputation. There are two versions of the Hero Arm, one with four-motor-drive mechanism and other with three-motordrive mechanism. The only difference is that the index and middle fingers are actuated with a single motor in a three-motor version.

The Hero Arm has tendon-flexure-based mechanism for flexion extension of the finger. The control scheme of the Hero Arm consists of FSM that utilizes the contraction of wrist flexion and extension muscles. The trigger signal for switching the grip is open signal, pause, and then holds the open signal for 1 s. Further details of the Hero Arm can be found at [29].

The main advantages of the 3D printed prostheses are low cost, easy modification, and customization. On the other hand, 3D printed prostheses mostly lack the performance and robustness offered by the commercial prostheses [16].

#### *4.2.2.7 Tact Hand by University of Illinois, USA*

The Tact Hand is another open source prosthesis hand developed by the researchers at the University of Illinois. Each finger of the Tact Hand is driven by a DC motor through the string. The string is attached with the underactuated fourbar mechanism of the finger. As the motor rotates clockwise, it winds up the string on the spool, creating tension in the string, which in turn flexes the finger. The rubber band attached at the back of the finger assists in the extension of the finger when the motor rotates anticlockwise, releasing the tension in the spring as shown in **Figure 13** [30].

Tact Hand is the cheapest 3D printed prostheses as claimed by the author [30]. However, it lacks the esthetic look, robustness, and durability, offered by most of the commercial prostheses.

**Table 1** summarizes the characteristics of the commercial and 3D printed hand prostheses discussed in this section. All the prostheses use an underactuated mechanism to reduce the complexity of the hand design. Underactuated mechanism not only reduces the requirement of the actuators at each joint, but also simplifies the control scheme of the hand, which in turn reduces the weight of the prosthetic

**Figure 11.** *The finite state machine of the Vanderbilt hands.*

hand. The Hero Arm is the lightest among the studied prostheses with weight as low as 280 g. The actuator used by the commercial and 3D printing prostheses is DC motor. The most common configuration is to use DC motor with worm gear, lead screw or spool, and tendon to translate the motor rotation into the finger flexion

**21**

to fit younger subjects.

**Hand/ developer**

**Figure 13.**

Tact/ University of Illinois [30]

Ada V1.1/ Open Bionics [31]

Hero Arm/ Open Bionics [29]

i-Limb/ Touch Bionics [17]

Bebionic V2/ RSL Steeper [32]

Vincent Hand/ Vincent System [21]

**Table 1.**

extension through the four-bar mechanism. This mechanism is housed inside each finger/thumb with the dimension as close as the dimension of a normal healthy adult for large size prosthesis and relatively smaller for medium and small versions

— — 11/6 6 DC motor-

Owing to the technological boom in the twenty-first century, the healthcare industry has also advanced considerably. This progress is evident in all subfields of the healthcare systems. Surgical procedures have moved on from bone drillings to

**5. Impact of advancement in prostheses and medical devices**

*Impact of Medical Advancement: Prostheses DOI: http://dx.doi.org/10.5772/intechopen.86602*

> **Mass (g)**

*Tact: an open source hand prosthesis.*

280– 346

450– 615

495– 539

*\*Exclusive of motors and circuit cost.*

*Characteristic comparison of the prosthesis hand.*

**Size (L × W × H) (mm)**

180–182 × 75–80 × 35–41

> 190–200 × 84–92 × 50

**Joints/ DOF**

350 200 × 98 × 27 11/6 6 DC motor-

380 215 × 178 × 58 10/5 5 Linear

— 10/3–4 3–4 DC motor

11/6 6 DC motor-

11/6 5 DC motor-

**No. of actuators** **Actuation method**

tendons

actuator tendons

tendons

worm gear

lead screw

worm gear

**Joint coupling**

Linkage spanning MCP to PIP

Tendon linking to MCP to the fingertip

Tendon linking to MCP to the fingertip

Tendon linking to MCP to PIP

Linkage spanning MCP to PIP

Linkage spanning MCP to PIP

**Cost (USD)**

250\*

1200

—

40,000

35,000

—

*Impact of Medical Advancement: Prostheses DOI: http://dx.doi.org/10.5772/intechopen.86602*

#### **Figure 13.**

*Computer Architecture in Industrial, Biomechanical and Biomedical Engineering*

hand. The Hero Arm is the lightest among the studied prostheses with weight as low as 280 g. The actuator used by the commercial and 3D printing prostheses is DC motor. The most common configuration is to use DC motor with worm gear, lead screw or spool, and tendon to translate the motor rotation into the finger flexion

**20**

**Figure 12.**

**Figure 11.**

*The Hero Arm from Open Bionics.*

*The finite state machine of the Vanderbilt hands.*

*Tact: an open source hand prosthesis.*


#### **Table 1.**

*Characteristic comparison of the prosthesis hand.*

extension through the four-bar mechanism. This mechanism is housed inside each finger/thumb with the dimension as close as the dimension of a normal healthy adult for large size prosthesis and relatively smaller for medium and small versions to fit younger subjects.

### **5. Impact of advancement in prostheses and medical devices**

Owing to the technological boom in the twenty-first century, the healthcare industry has also advanced considerably. This progress is evident in all subfields of the healthcare systems. Surgical procedures have moved on from bone drillings to

innovations like robotic surgeries, MARVEL (multiangle rear-viewing endoscopic tool), and surgical glasses. The field of biomedical imaging has advanced from x-ray imaging to molecular imaging. Likewise, rehabilitation engineering has moved on from wooden dentures and minimalist crutches to cyborg body prostheses. Pharmaceutics has now headed toward immunotherapy, pharmacogenetic testing, and RNA therapeutics.

It is now a common notion that such rapid advancement in biomedical innovation and research is the leading cause of improvement in the quality of human life and longevity [33]. A number of studies credit this increase in longevity to the pharmaceutical innovations, which has appeared to be the most research-intensive subfield of the healthcare industry. Lichtenberg has proved time and again that pharmaceutical innovations have a profound effect on health and longevity [34–41]. By his research, he cemented the notion that drug innovations decrease mortality rate, hospitalization rate, and improve the general well-being of the society.

Through similar studies, authors have linked the advancement in biomedical innovations to increase the longevity and general betterment of health. For example, Cutler et al. concluded that the ultimate determinant of health is scientific advancement and progress, which in turn is influenced by economic and academic growth [42]. Another study considering the USA population found that the improved health of genial Americans is owing to the advancement in medical technologies [43]. Fuchs also asserts that the primary cause of increased longevity is the fruit of biomedical innovations after the Second World War [44]. Furthermore, the National Institutes of Health (NIH) claims that their research has enabled average Americans to live 30 years more (in 2012) than they did in 1900 [45]. The variables, inspected the most in such studies, are the medical services and procedures prevalent in the population and the availability of drugs and healthcare artifacts for the people. Lichtenberg studied medical care and behavioral risk factors in increasing or decreasing longevity [46].

While the outcome variable that is usually inspected in these studies is longevity, defined as "a long duration of individual life" or "the length of life" by Merriam-Webster Dictionary [47], another important outcome measure is the performance of activities of daily living (ADLs) under the influence of medical interventions.

The effects of biomedical innovations other than pharmaceutical innovations on health and longevity are comparatively more difficult to gauge as there are fewer researches on this topic. As evident from the fact that more than 50% of the research on biomedical innovations is provided by pharmaceutical companies, other researches take a back seat [48].

In most of the cases, the biomedical technological advancements are not easy to gauge. An extensive amount of data is required to measure the availability of healthcare facilities, and even more difficult is to quantify the qualitative nature of the healthcare facilities. In order to solve this problem, a surrogate measure is taken for the biomedical advancement that is the per capita income of the population in consideration. The reliability of gross domestic product (GDP) as an indicator of biomedical advancement is asserted by the World Health Organization (WHO) when it continuously lauds France for its excellent biomedical system, with a GDP per capita of USD 46732 in 2019. Furthermore, the Organization for Economic Co-operation and Development (OECD), in its official magazine, the OECD Observer, reports that a 10% increase in life expectancy makes up an annual 0.3–0.4% growth in the economy, proving that the relationship is bidirectional [49]. On the other hand, the countries with lower GDP have been reported to have a life expectancy rate by a study that analyzed the 213 years' worth of data [50]. One obvious reason for this relationship is the fact that people with less economic stability tend to avoid getting treatment for "minor" health issues such as malaria,

**23**

**Figure 14.** *R2*

*Impact of Medical Advancement: Prostheses DOI: http://dx.doi.org/10.5772/intechopen.86602*

countries were retrieved from Geobase [52].

logarithm to GDP values. The resultant R2

economy further.

**6. Data acquisition**

**7. Regression analysis**

life of the individuals.

**8. Quartile mapping**

 *values for cross-sectional regressions by years.*

flu, and infections. This leads to worsening of the symptoms and eventually casualties that would otherwise have been easily avoided. Also, if there is an endemic in the country like Ebola, tourism and foreign visits tend to dry up, setting back the

Taking this into consideration, we attempted to find a relationship between the GDP of the countries of the world with the expected life in years for the year 2018.

In order to analyze the annual per capita income of the countries, the World Economic Outlook database of the International Monetary Fund (IMF) was accessed, as provided freely by the Gapminder Foundation [51]. The data from 183 countries for 10 years (2009–2018) were filtered to match the available data of the life expectancy rate of different countries. The estimated lifespans of the

For statistical analysis of the data, we performed regression analysis via IBM SPSS Statistics. The regression analyses are performed taking GDP as the independent variable and life expectancy as the dependent variable. We used the natural

It is evident from the graph that over the decade, the GDP alone explains 47–69% of the cross-country variation in life expectancy. This strengthens the notion that GDP per capita income is an important contributor in prolonging the

For the sake of ease, we mapped the GDP per capita income and life expectancy for 2018 on the world map, see **Figures 15** and **16**. The mapping is done by first defining four quartiles of each variable. The cutoff points for each quartile are mentioned in the captions of these two figures. By keeping the color coding same for

values are plotted in **Figure 14**.

The methodology and results are stated in the following sections.

*Impact of Medical Advancement: Prostheses DOI: http://dx.doi.org/10.5772/intechopen.86602*

flu, and infections. This leads to worsening of the symptoms and eventually casualties that would otherwise have been easily avoided. Also, if there is an endemic in the country like Ebola, tourism and foreign visits tend to dry up, setting back the economy further.

Taking this into consideration, we attempted to find a relationship between the GDP of the countries of the world with the expected life in years for the year 2018. The methodology and results are stated in the following sections.

## **6. Data acquisition**

*Computer Architecture in Industrial, Biomechanical and Biomedical Engineering*

and RNA therapeutics.

or decreasing longevity [46].

other researches take a back seat [48].

innovations like robotic surgeries, MARVEL (multiangle rear-viewing endoscopic tool), and surgical glasses. The field of biomedical imaging has advanced from x-ray imaging to molecular imaging. Likewise, rehabilitation engineering has moved on from wooden dentures and minimalist crutches to cyborg body prostheses. Pharmaceutics has now headed toward immunotherapy, pharmacogenetic testing,

It is now a common notion that such rapid advancement in biomedical innovation and research is the leading cause of improvement in the quality of human life and longevity [33]. A number of studies credit this increase in longevity to the pharmaceutical innovations, which has appeared to be the most research-intensive subfield of the healthcare industry. Lichtenberg has proved time and again that pharmaceutical innovations have a profound effect on health and longevity [34–41]. By his research, he cemented the notion that drug innovations decrease mortality rate, hospitalization rate, and improve the general well-being of the society. Through similar studies, authors have linked the advancement in biomedical innovations to increase the longevity and general betterment of health. For example, Cutler et al. concluded that the ultimate determinant of health is scientific advancement and progress, which in turn is influenced by economic and academic growth [42]. Another study considering the USA population found that the improved health of genial Americans is owing to the advancement in medical technologies [43]. Fuchs also asserts that the primary cause of increased longevity is the fruit of biomedical innovations after the Second World War [44]. Furthermore, the National Institutes of Health (NIH) claims that their research has enabled average Americans to live 30 years more (in 2012) than they did in 1900 [45]. The variables, inspected the most in such studies, are the medical services and procedures prevalent in the population and the availability of drugs and healthcare artifacts for the people. Lichtenberg studied medical care and behavioral risk factors in increasing

While the outcome variable that is usually inspected in these studies is longevity, defined as "a long duration of individual life" or "the length of life" by Merriam-Webster Dictionary [47], another important outcome measure is the performance of activities of daily living (ADLs) under the influence of medical interventions. The effects of biomedical innovations other than pharmaceutical innovations on health and longevity are comparatively more difficult to gauge as there are fewer researches on this topic. As evident from the fact that more than 50% of the research on biomedical innovations is provided by pharmaceutical companies,

In most of the cases, the biomedical technological advancements are not easy to gauge. An extensive amount of data is required to measure the availability of healthcare facilities, and even more difficult is to quantify the qualitative nature of the healthcare facilities. In order to solve this problem, a surrogate measure is taken for the biomedical advancement that is the per capita income of the population in consideration. The reliability of gross domestic product (GDP) as an indicator of biomedical advancement is asserted by the World Health Organization (WHO) when it continuously lauds France for its excellent biomedical system, with a GDP per capita of USD 46732 in 2019. Furthermore, the Organization for Economic Co-operation and Development (OECD), in its official magazine, the OECD Observer, reports that a 10% increase in life expectancy makes up an annual 0.3–0.4% growth in the economy, proving that the relationship is bidirectional [49]. On the other hand, the countries with lower GDP have been reported to have a life expectancy rate by a study that analyzed the 213 years' worth of data [50]. One obvious reason for this relationship is the fact that people with less economic stability tend to avoid getting treatment for "minor" health issues such as malaria,

**22**

In order to analyze the annual per capita income of the countries, the World Economic Outlook database of the International Monetary Fund (IMF) was accessed, as provided freely by the Gapminder Foundation [51]. The data from 183 countries for 10 years (2009–2018) were filtered to match the available data of the life expectancy rate of different countries. The estimated lifespans of the countries were retrieved from Geobase [52].

#### **7. Regression analysis**

For statistical analysis of the data, we performed regression analysis via IBM SPSS Statistics. The regression analyses are performed taking GDP as the independent variable and life expectancy as the dependent variable. We used the natural logarithm to GDP values. The resultant R2 values are plotted in **Figure 14**.

It is evident from the graph that over the decade, the GDP alone explains 47–69% of the cross-country variation in life expectancy. This strengthens the notion that GDP per capita income is an important contributor in prolonging the life of the individuals.

**Figure 14.**

*R2 values for cross-sectional regressions by years.*

#### **8. Quartile mapping**

For the sake of ease, we mapped the GDP per capita income and life expectancy for 2018 on the world map, see **Figures 15** and **16**. The mapping is done by first defining four quartiles of each variable. The cutoff points for each quartile are mentioned in the captions of these two figures. By keeping the color coding same for

#### **Figure 15.**

*Mapping of the world according to the four quartiles of the GDP per capita income of the countries. Where quartile 1 is 0 to 2297.5 USD, quartile 2 is 2297.6 to 5874 USD, quartile 3 is 5874.1 to 17617.5 USD, and quartile 4 is 17617.6 to 129,710 USD.*

#### **Figure 16.**

*Mapping of the world according to the four quartiles of the longevity of the countries. Where quartile 1 is 0 to 67.25 years, quartile 2 is 67.3 to 74.15 years, quartile 3 is 74.2 to 78.125 years, and quartile 4 is 78.2 to 84.2 years.*

the quartiles of both the variables, we attempted to make the comparison of both variables making it apparent. Quartiles were calculated with the help of the buviltin QUARTILE function of MS excel for each of the two data groups. The mapping was performed using the online tool provided by www.mapchart.net.

#### **9. Discussion**

In this chapter, we first had an overview of the biomedical innovations of the current times. We then hypothesized that these innovations may have a profound effect on the life expectancy and general health of the population. For this, we revisited the relationship of GDP per capita income to the life expectancy, taking GDP as the surrogate measure of the health facilities provided in the country. Our analyses included data for the past 10 years (2009–2018) for 183 countries.

**25**

**Author details**

Pakistan

Samreen Hussain\*, Sarmad Shams and Saad Jawaid Khan

provided the original work is properly cited.

\*Address all correspondence to: samreen.hussain18@gmail.com

Faculty of Engineering Science and Technology, Ziauddin University, Karachi,

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Impact of Medical Advancement: Prostheses DOI: http://dx.doi.org/10.5772/intechopen.86602*

and worse quality of life of their citizens.

will create more employment options in developing countries.

This positive impact will improve the longevity of the people.

increasing income?

**10. Conclusion**

These analyses targeted one key question: does life expectancy increase with

Overall, the analysis of the GDP and life expectancy data of the past 10 years suggests a considerable correlation between income level and life expectancy. It is to be noted that biomedical innovations are more likely to be bought and utilized in countries with stronger economies and higher income levels. Hence, the longevity of their citizens increases. In contrast, the countries with poorer economies are unable to possess the latest biomedical innovation and hence have shorter lifespans

As a future direction, the research and development (R&D) of biomedical technology should weigh in the factor of affordability and mass production. For this, the researches may opt for cheaper and locally available materials while building the end product. Also, the outsourcing of R&D and production of these technologies

The results of our analyses showed that there exists a direct positive relationship between per capita income and the expected years of life across countries. These results support our hypothesis that growth in the biomedical industry and a resultant growth in the healthcare industry will have a positive impact on the economy.

#### *Impact of Medical Advancement: Prostheses DOI: http://dx.doi.org/10.5772/intechopen.86602*

These analyses targeted one key question: does life expectancy increase with increasing income?

Overall, the analysis of the GDP and life expectancy data of the past 10 years suggests a considerable correlation between income level and life expectancy. It is to be noted that biomedical innovations are more likely to be bought and utilized in countries with stronger economies and higher income levels. Hence, the longevity of their citizens increases. In contrast, the countries with poorer economies are unable to possess the latest biomedical innovation and hence have shorter lifespans and worse quality of life of their citizens.

As a future direction, the research and development (R&D) of biomedical technology should weigh in the factor of affordability and mass production. For this, the researches may opt for cheaper and locally available materials while building the end product. Also, the outsourcing of R&D and production of these technologies will create more employment options in developing countries.
