[HN Gopher] Nuclear-Powered Cardiac Pacemakers
       ___________________________________________________________________
        
       Nuclear-Powered Cardiac Pacemakers
        
       Author : bookofjoe
       Score  : 346 points
       Date   : 2022-09-02 13:22 UTC (9 hours ago)
        
 (HTM) web link (osrp.lanl.gov)
 (TXT) w3m dump (osrp.lanl.gov)
        
       | bhaak wrote:
       | Wonder how I slided into the world of Fallout?
       | 
       | WTF!?! We have plutonium powered pacemakers?
       | 
       | http://large.stanford.edu/courses/2015/ph241/degraw2/
       | 
       | Ah, okay we _had_.
       | 
       | > Despite the often longer life-expectancies, nuclear pacemakers
       | quickly became a part of the past when lithium batteries were
       | developed. Not only did the technology improve, allowing for
       | lighter, smaller, and programmable pacemakers, but doctors began
       | to realize that this excessive longevity of nuclear pacemakers
       | was excessive. Lithium pacemakers often last 10-15 years allowing
       | for doctors to check in on their patients and replace either the
       | batteries or the pacemakers themselves with new and improved
       | technology as it is develops in those 10-15 year spans.
        
         | mysterydip wrote:
         | > allowing for doctors to check in on their patients and
         | replace either the batteries or the pacemakers themselves
         | 
         | I cynically read this as "we needed to get more money out of
         | these patients"
        
           | hwillis wrote:
           | You really should not. 60 beats per minute means that in ten
           | years the leads of a pacemaker will be bent *315 million*
           | times. That's an order of magnitude higher than we typically
           | test fatigue resistance, and even if we were that confident
           | about being able to produce flawless materials, there are
           | _millions_ of different enzymes and acids and temperature
           | fluctuations in the body. Any one of those could impact the
           | fatigue resistance.
           | 
           | Additionally, any kind of implanted device is _significantly_
           | prone to a wide range of problems that range from
           | inconvenient to devastating. The human body is very hostile
           | to foreign objects, often with few warning signs. Clots and
           | fibrous capsules (and eventually, calcified capsules) form
           | around ANY implant, and that 's the _best_ case problem.
           | 
           | Titanium is extremely biocompatible. It forms a thinner
           | capsule than most materials. It integrates with bones
           | beautifully, due to surface treatments that allow bone to
           | grow into microscopic surface cavities, with strong molecular
           | bonds. But also sometimes, for no apparent reason, all the
           | bone around a titanium implant will just start dying and
           | resorbing. It's rare, but if you get a hip replacement you
           | absolutely need to check on it regularly because if you don't
           | you'll lose use of the leg completely (and quickly, and
           | permanently).
           | 
           | In and around the heart is one of the most challenging places
           | to implant things, aside from maybe the brain. Any moving
           | part of the body will constantly stress any mechanical part,
           | and build up scar tissue around and rubbing spots. The only
           | reason the brain is worse is because its fragile and changes
           | size significantly when you sleep.
           | 
           | Recently we started using _leadless_ pacemakers. Even before
           | that pacemakers were continually getting smaller, and smaller
           | pacemakers are less irritating and experience less stress and
           | movement. Even if that weren 't true, it would _still_ be
           | worth checking in on pacemakers, because they 're doing
           | incredibly hard jobs and if they fail people can die faster
           | than they can get to a hospital.
           | 
           | EDIT: oh, and heart disease is the #1 cause of death in the
           | US, while heart surgery is one of the most difficult
           | specialties to get in to. They are absolutely never short on
           | patients, lol.
        
             | nousermane wrote:
             | > _315 million_ times. That 's an order of magnitude higher
             | than we typically test fatigue resistance
             | 
             | Nah, it's not that bad. Decent mechanical keyboard switch
             | is specified for 100 million clicks [1, or google for
             | "switch million actuations"]. Surely good engineering can
             | eek out another order of magnitude. Not to mention -
             | pacemaker leads ("wires"), the only part that bends, have
             | _way_ less stress on them (= larger bend radius) compared
             | to a keyboard switch. Oh, and technology of multi-strand
             | wire for redundancy is a very well established and
             | understood one.
             | 
             | [1] https://cdn-shop.adafruit.com/product-
             | files/4974/EN_CHERRY_M...
        
               | pixl97 wrote:
               | You're not counting failure rate over time. How many
               | people actually click a key 100M clicks? What does the
               | bathtub curve look like? What's the failure rates at
               | 1,10,100,200M clicks?
               | 
               | I'm going to assume those failure numbers are far higher
               | than you'd want for something keeping you alive.
        
               | [deleted]
        
               | cududa wrote:
               | The absolutely arrogance to assume a keyboard switch and
               | a pace maker are anywhere near the same thing...
        
               | tom_ wrote:
               | Indeed, the keyboard switch people have to produce a
               | device that's manufacturable at scale for pennies per
               | unit, and can be fitted in unforgiving environments by
               | the untrained.
        
               | macintux wrote:
               | They also make a product that, when it fails, doesn't
               | generally kill anyone.
        
               | melq wrote:
               | How is that comparable to a pacemaker in any way? They
               | aren't made for a similar scale, price, or 'environment',
               | and would only be installed/serviced/dealt with at all by
               | anyone aside from highly trained specialists.
        
               | monetus wrote:
               | Intentions aside, I read it as a very narrow comparison
               | of the relative durability - I'm guessing they weren't
               | trying to devalue pacemaker engineering.
        
               | [deleted]
        
               | ceeplusplus wrote:
               | I've had Cherry switches fail right as the keyboard's
               | warranty was up. The switch feels soft after wearing out,
               | it gets dust in it and starts double typing, etc.
               | Pacemakers need to be 100% reliable, not 99.9%.
        
               | formerly_proven wrote:
               | Seen way too many failed Cherry MX (OG, vintage and
               | third-party) switches to believe that.
        
             | R0b0t1 wrote:
             | > EDIT: oh, and heart disease is the #1 cause of death in
             | the US, while heart surgery is one of the most difficult
             | specialties to get in to. They are absolutely never short
             | on patients, lol.
             | 
             | This is still relevant to his concern, but from the other
             | end. They might be making the labor artificially scarce to
             | increase pay.
        
               | ampdepolymerase wrote:
               | > _This is still relevant to his concern, but from the
               | other end. They might be making the labor artificially
               | scarce to increase pay._
               | 
               | This is very much true. I find that a lot of people in
               | tech seem to put healthcare on a pedestal and believe
               | that the professionalisation and gatekeeping of the
               | industry create a better outcome than other engineering
               | fields. This is very much untrue, the healthcare field is
               | in need of massive disruption and lobbying to increase
               | labor supply. You are being downvoted because a lot of
               | tech people here hate to imagine that healthcare at the
               | highest level is still subject to market forces like
               | everything else. Medical training is being severely
               | gatekept and hindered via the current
               | apprenticeship/residency system. After all, we call the
               | worst medical student, doctor. If you want to improve
               | healthcare, tie medical school admission to the MCAT
               | score, and _only_ the MCAT score. You are not going to
               | get better doctors just because candidates spend their
               | summers building houses in some impoverished third world
               | country.
        
               | zaroth wrote:
               | I live near Boston which is known for its medical
               | centers, so this might skew things somewhat, but it seems
               | like every graduate I know is going into medicine of some
               | form (surgery, anesthesia, nursing, surgical tech,
               | hospice, etc. etc.)
               | 
               | I heard consistently that residency slots are extremely
               | competitive and a lot of qualified candidates get passed
               | over. The more I learn about the process the more insane
               | it seems.
               | 
               | From the student perspective you go from paying to work
               | one day and spending most your time working cases with
               | zero relevance to your actual specialty, to raking in
               | several hundred thousand a year.
               | 
               | It also seems like hospital systems seem to spend more
               | than half their capacity either dealing with patients
               | that don't need to be there but there's literally no
               | place to send them, or patients that are too far gone and
               | untreatable but there's literally no place to send them.
               | 
               | Healthcare is like a Gordian knot of terrible policies
               | cemented into place by trillions of dollars of government
               | spending.
        
               | Am4TIfIsER0ppos wrote:
               | More like deliberately increasing demand for the service.
        
               | zaroth wrote:
               | Are you positing a conspiracy between McDonalds and
               | Cardiothoracic Surgeons?
        
             | NikolaNovak wrote:
             | >>"changes size significantly when you sleep."
             | 
             | Wait,what??
        
               | fennecfoxen wrote:
               | Brain neurons going into sleep mode eject some of the
               | cell contents and shrink, which apparently also helps
               | flush waste because the cerebrospinal fluid can flow
               | better.
        
             | rudididdjdh wrote:
        
             | furyofantares wrote:
             | It's a weird argument, though, that we should be checking
             | in on the state of the patient & these devices, but we
             | don't do it unless we have the additional problem of
             | needing to replace a battery.
        
               | sgtnoodle wrote:
               | Modern devices provide a wealth of telemetry completely
               | autonomously. My pacemaker talks at least daily to a UFO
               | shaped brick on my night stand via BLE. The brick has an
               | integrated cell modem, and was given to me pre-
               | configured. It has a bright green light (that turns off
               | in the dark) to show that it's functional. It has a
               | single button I have never pressed, for if I think
               | something notable enough happened that my doctor's office
               | needs to be sent a report sooner than every 90 days or
               | so.
        
               | ethbr0 wrote:
               | I'd think cert expiration would have taught all of us
               | that out of sight and working is out of a busy,
               | multitasking mind.
        
             | sgtnoodle wrote:
             | It sounds like you have quite a bit of knowledge on the
             | subject. I had to get a pacemaker a couple years ago, and
             | am an embedded engineer. I hope to live another 50 years at
             | least, so this is an interesting subject for me.
             | 
             | Maybe my cardiologist is just trying to make me feel good,
             | but he says my leads will likely last 30-50 years.
             | Intuitively that seems unlikely, but we'll see. It's got to
             | be one of the most engineered cables in existence.
             | 
             | The leadless pacemakers are indeed a technical marvel, but
             | they aren't yet nearly as feature packed as shoulder
             | implanted devices. They'll keep your heart from stopping if
             | your nerves are flaky from time to time, but they don't
             | have the energy storage to do much more than that. Mine
             | monitors every single beat my heart takes, and
             | automatically reports issues to my doctor via BLE. (Is
             | bluetooth more or less scary than radioactive isotopes
             | mounted in your body?)
             | 
             | For about 8 months, my AV nerves were completely broken,
             | and the pacemaker paced my ventricles 100% of the time. It
             | was a nearly perfect drop-in replacement for the failed
             | nerves. A leadless pacemaker wouldn't have had nearly the
             | same performance. My nerves eventually started mostly
             | working again, and now I'm on track to have a battery life
             | pushing 15 years.
             | 
             | It would of course be great for the technology to advance
             | even more over the next decade. Since my nerves mostly
             | healed, a leadless device with a 30+ year battery life
             | would be a nice replacement. With a shorter battery life, I
             | don't really want to be collecting them in my heart (they
             | don't plan to remove leadless pacemakers when they die.)
             | I'm hoping by the time my current device is worn out, it
             | will have logged enough telemetry for me to convince my
             | cardiologist that I don't need a pacemaker at all, though.
        
               | guhidalg wrote:
               | My heart sank when you mentioned a BLE-enabled pacemaker.
               | Has technology gone too far? /s
        
               | melq wrote:
               | It sounds like the bluetooth functionality is only there
               | for telemetry.
        
               | samstave wrote:
               | An interesting thought would be to have a nano-lead down
               | the arterials to the wrist, where an external telemetry
               | relay-watch could read the signals, and have the BLE
               | device top dermal. (apple watch)
               | 
               | eliminating RF/BLE bullshit from talking to the
               | pacemaker.
        
               | sgtnoodle wrote:
               | Being pragmatic, that sounds way worse than just having a
               | little ceramic 2.4ghz antenna and some extra silicon
               | potted into the device!
        
               | samstave wrote:
               | https://www.dailymail.co.uk/news/article-2379009/Barnaby-
               | Jac...
               | 
               | -
               | 
               | Oops - I didnt realize you were same poster from other
               | comment
        
               | sgtnoodle wrote:
               | I don't think my particular pacemaker has the necessary
               | circuitry to generate more than 5V, in pulses less than a
               | few milliseconds. The voltage doesn't really matter much
               | to the muscle.
               | 
               | If you got in you could probably put the leads into
               | single-ended mode (so that there's more current path to
               | cause mayhem) and pace my atrium and ventricles at
               | 210bpm, and effectively give me a seizure. I can't
               | imagine it would kill me before an EMS arrived with a
               | magnet?
               | 
               | Perhaps a more nuanced attack would be to somehow use all
               | the configuration parameters to intentionally bias the
               | pulses so that there's net charge going into the muscle.
               | Over a long time that would cause tissue damage.
               | 
               | If someone wanted to kill me overtly, a gun would be less
               | work. A pacemaker malfunction that bad would be
               | thoroughly investigated, and would be fixed in new
               | devices within a year or two.
        
               | RavZterz wrote:
               | If they were able to cause the pacemaker to fire when
               | they wanted they could time it during the repolarization,
               | which could possibly cause a fatal arrhythmia even in a
               | heart that doesn't need a pacemaker. It's called R-on-T
               | phenomenon and it's usually caused by malfunctioning
               | pacemakers.
        
               | samstave wrote:
               | The crazy thing was that this was when there was a lot of
               | talk about Dick Cheney and how he was vuln to this attack
               | -- and there was a lot of spec around if barnaby was
               | silenced because it was the older, Cheney-esque
               | politicians that could be taken out by this vector...
               | 
               | Perhaps, he got the 'reverse bounty' on this bug...
        
               | sgtnoodle wrote:
               | It's not. It's a full diagnostic interface. Someone with
               | the right software and my serial number could reconfigure
               | it from across the room.
               | 
               | BLE replaces the previous diagnostic interface, which was
               | some form of near-field. You had to have a puck resting
               | within a few inches, going to a several decade old
               | toughbook. My device supports both. It's just in the last
               | couple years that UCLA got the BLE equipment, and
               | sometimes a doctor will whip out the old gear if they
               | feel more confident with it.
               | 
               | When I had the pacemaker first implanted, there was a
               | reliability problem they had to do a second operation to
               | fix it. The pacemaker failed to "capture" my ventricle a
               | few times when it should have. It turned out to be a
               | loose lead connection, but the device's impedance
               | diagnostics didn't make the issue immediately obvious. My
               | overall case was weird enough that UCLA did a case study
               | about it, so for the revision procedure they had a vendor
               | rep in the room to help out just in case. She was holding
               | a tablet and pushing buttons that would make my heart
               | temporarily stop.
               | 
               | Now my AV nerves mostly work again, so the pacemaker
               | can't stop my heart if it wanted to. It can only increase
               | my heart rate, and report unusual patterns to my doctor.
               | Also, if someone did somehow mess with it, holding a
               | strong magnet near it will force it into safe mode.
        
               | spicybright wrote:
               | That's fascinating, and very unfortunate how lax the
               | security likely is for an organ keeping you alive.
               | 
               | You would think if you can detect a strong magnet, you
               | could use that to turn the wireless on and off... Like
               | how holding a power button on a phone turns it off, but
               | holding longer can do a factory reset or what have you.
               | 
               | Glad you're doing better since then, though.
        
               | samstave wrote:
               | >> _I had to get a pacemaker a couple years ago, and am
               | an __embedded engineer__._
               | 
               | <3 -- This sounds like a badge of courage-type
               | Classification. I love this sentence.
               | 
               | -
               | 
               | Recall BARNABY JACK? (the guy who claimed he could build
               | a pacemaker killer and was to present at DEFCON and then
               | "suicided" over drugs (yes, I know he had a drug problem
               | - but he was lit going to give a talk at defcon about
               | this subject)
               | 
               | I am so fucking tired of people who downvote on HN
               | because they dont know their fucking internet history:
               | 
               | https://www.dailymail.co.uk/news/article-2379009/Barnaby-
               | Jac...
               | 
               | You shouldnt be able to downvote with at least a 140
               | character reason why.
               | 
               | READ THE FUCK UP. Barnaby was set to talk at defcon about
               | killing pacemakers remotely... and he was also able to
               | hack other medical devices.
               | 
               | ( _HN rules say you shouldnt complain about downvotes! -
               | screw that, should I have to give the full historical
               | context if someone doesnt know what I am talking about.
               | 
               | I almost NEVER downvote people. Its not helpful, because
               | a lot of downvoters may not have a deeper context of
               | connection..._)
        
               | sgtnoodle wrote:
               | Lol. I've certainly already made the joke that embedded
               | systems are dear to my heart. I'd consider working a few
               | years at a place like Medtronic just to see what I can
               | contribute, but on the other hand I hear there's roughly
               | a 2:1 ratio between requirements and lines of code.
               | 
               | Going through airport security is fun just because the
               | TSA agents overreact as if the metal detector is going to
               | kill me.
        
               | samstave wrote:
               | DYSTOPIAN OUTCOME:
               | 
               | /u/sgtnoodle has accepted a great job with MedTronic,
               | little does he know, that as a QA process embedded
               | engineer, his duties require him to monitor various labs
               | - including the PENTEST/AGGRESSIVE attack lab... but the
               | anechoic chamber contract was low bid - and has leaks...
               | 
               | As he walks by the lab, checking his tablet for his
               | various checklists... there is a leak.
               | 
               | A deadly leak... As he rounds Corridor-4A toward his
               | desk, the leak hits him.
               | 
               | As a Class-I Mk2 Embedded engineer, he was susceptible to
               | the RF attacks...
               | 
               | We only found him after the alarm sounded that he badged
               | through Door X1A, but never made it to Door TR3B where
               | his lab was...
               | 
               | Cardiac failure due to failed electro-stim documented as
               | cause of termination of employment.
        
               | LastTrain wrote:
               | You are getting downvoted for the conspiracy theory
               | aspect of your post and for throwing shade on a guy with
               | the pacemaker. If you care about being liked, say
               | likeable things.
        
               | samstave wrote:
               | You're getting a FU from me for even using the term
               | "conspiracy theory" as you adopt its MSM meaning...
               | 
               | You clearly did not grasp what I said.
               | 
               | Fucking think. (13 days vs >13 years)
        
               | alphaoverlord wrote:
               | If you have complete AV block, a leadless pacemaker is
               | less good than one with multiple leads, since it allows
               | pacing multiple chambers and maintaining synchrony
               | between A and V.
        
               | animatedb wrote:
               | There are now leadless devices that communicate with each
               | other using RF.
        
               | lake-view wrote:
               | > Maybe my cardiologist is just trying to make me feel
               | good, but he says my leads will likely last 30-50 years.
               | Intuitively that seems unlikely, but we'll see. It's got
               | to be one of the most engineered cables in existence.
               | 
               | One of my favorite learnings in school was about the
               | "Endurance limit".
               | 
               | Some materials, like aluminum, will eventually fail under
               | cyclic loading even at tiny, tiny loads. This was a big
               | problem when they built the first passenger jets. Other
               | materials, like steel, have a threshold at which they can
               | be cycled _indefinitely_ without issue.
               | 
               | For something like a pacemaker, I like to imagine they
               | dialed the materials and forces to be within such a
               | threshold so you can keep on ticking!
        
               | tengwar2 wrote:
               | Re passenger jets - I imagine you are thinking of the
               | Comet 1? That was a more complex failure than is
               | generally known. In brief, they did know about fatigue
               | life at the time, and had ways of retiring aircraft
               | before it was an issue (safe-life design, apparently
               | introduced in the 19C for steam engines despite their
               | being iron and steel). Ok, now you will be thinking
               | "square windows, stress concentrators". Almost all
               | pressurised aircraft use windows with angled corners in
               | the cockpit. There isn't an intrinsic bar to square
               | windows, and in fact the original design would probably
               | have been ok. That used glued installation, avoiding
               | stress concentrators. However a production engineer
               | changed the design to use riveted installation, which
               | caused the well-known problem with hull failure. Still,
               | that would have been discovered if DH had not managed to
               | resist government pressure to do fatigue testing on the
               | pressure hull (because they were racing Boeing to be
               | first to market, and fatigue testing takes time). They
               | actually had the apparatus for repeatedly pressurising
               | the hull in a bath, but only used it for testing static
               | pressure.
        
           | tomrod wrote:
           | Meh. Maintenance is a good thing when performed well and not
           | excessively.
           | 
           | Heart problems are funky.
        
           | konschubert wrote:
           | I read this as:
           | 
           | Most patients don't survive those 10 years anyways.
        
             | kristopolous wrote:
             | I'd rather live an extra 9 years than 0.
             | 
             | We're all going to die and an extra 9 years is not bad.
        
               | dghughes wrote:
               | My Dad was diagnosed with a fatal lung illness and was
               | given three years to live. He made it to ten years the
               | last six months were rough. But I can't imagine if he had
               | died after the predicted three years.
               | 
               | I see people Dad's age or older driving and walking
               | around and I find it amazing how older people are alive.
               | Elderly people are amazing as people and for their
               | knowledge.
               | 
               | Love every day you and your family are here and healthy!
        
               | konschubert wrote:
               | I did not mean to say that they are not worth it.
        
             | mlyle wrote:
             | A number don't. But as far as the number that needs some
             | kind of pacemaker tune-up or revision during that time--
             | it's a really big share.
        
               | sgtnoodle wrote:
               | If battery life doesn't improve much, I don't die
               | prematurely, and I continue to materially benefit from
               | having an implant, I personally could be realistically
               | looking at 3 replacement devices and at least one lead
               | replacement over the years. In the unlikely event that I
               | suffer from ventricle enlargement long term, I'd need two
               | more leads installed as well.
        
               | mlyle wrote:
               | Yup, there's definitely some patients that would benefit
               | from a nuclear battery.
               | 
               | > I personally could be realistically looking at 3
               | replacement devices and at least one lead replacement
               | over the years. In the unlikely event that I suffer from
               | ventricle enlargement long term, I'd need two more leads
               | installed as well.
               | 
               | This is the point I'm making, though: realistically, you
               | have a high chance of needing 2 additional procedures for
               | non-battery reasons, which are likely good times to
               | replace the device, too.
        
             | jjkaczor wrote:
             | My grandfather got a pacemaker in the late 1970's.
             | 
             | He died in 2014, not from heart-related issues.
             | 
             | I'd say that was a good return on medical investment.
        
             | WastingMyTime89 wrote:
             | The figures surrounding pacemakers are hard to interpret.
             | Most people are fitted extremely late in their life
             | following serious cardiac incidents.
             | 
             | My understanding is that people diagnosed with bradycardia
             | young can expect to survive a long time with the device.
        
               | konschubert wrote:
               | You are right. When you read the studies, they seem
               | gloom. But of course, most people who are fitted a
               | pacemaker are already very late in their life.
        
             | patrickserrano wrote:
             | Glad I'm not the only cynical one ;)
        
               | KerrAvon wrote:
               | Seems like maybe don't be cynical outside of your own
               | specialty might be a lesson here.
        
           | toss1 wrote:
           | A friend had one of these units that extended his life for
           | over a decade. He had it upgraded at least once, and the
           | programing updated several times, and noted improvements each
           | time (although he never got the one feature he really wanted
           | [0]). So active maintenance is definitely not spurious or
           | mercenary but is genuinely useful.
           | 
           | [0] When the pacemaker detected a problematic arrhythmia it
           | would give a couple of defibrillation shocks just like the
           | paddles but right on the heart muscle. He said this felt like
           | getting kicked in the chest by a horse and came completely
           | out of the blue with zero warning. So it could be quite
           | disruptive. He wanted a feature where it would tingle or beep
           | or something just a few seconds ahead of time so he could
           | mentally prepare; apparently the second one that was expected
           | was a lot less traumatic. Anyway, the docs thought it was a
           | good idea, and passed it up, but it never happened before he
           | passed.
        
             | WastingMyTime89 wrote:
             | That's an implantable cardiac defibrillator not a
             | pacemaker. Completely different things.
        
               | toss1 wrote:
               | It had both functions, at least according to my friend;
               | he was an engineer and he described both in some detail.
        
             | leeoniya wrote:
             | > He wanted a feature where it would tingle or beep or
             | something just a few seconds ahead of time so he could
             | mentally prepare; apparently the second one that was
             | expected was a lot less traumatic.
             | 
             | reminds me of the pre-safe sound prior to collision
             | 
             | https://www.mercedesbenzofnatick.com/new-features-
             | mercedes-b...
        
               | toss1 wrote:
               | Yes, it does -- Thx for reminding me of that!
        
             | bobbob1921 wrote:
             | I'm not clear on what he was supposed to do in response to
             | this. Is it a situation where if he were to sit down and
             | relax he could resolve the arrhythmia? Or is this a
             | notification mechanisms that he can then alert his doctors?
             | (My question is why was this designed to be an extreme
             | "notification ")?
        
               | toss1 wrote:
               | He just wanted some kind of warning to get himself
               | mentally prepared or braced for the kick - maybe take a
               | quick breath, pull out of the way a tool he's using,
               | whatever, or just reduce the surprise factor. As he said,
               | the second one that he knew was coming was not such a big
               | deal. It was definitely not to try to resolve it, that
               | was up to the pacemaker/defib.
        
           | happyopossum wrote:
           | There's not a single cardiac surgeon in the world who thinks
           | he's gonna get rich with once-every-10-years follow up
           | appointments. We produce enough new patients to keep them all
           | sufficiently busy.
        
             | robocat wrote:
             | A private surgery business that specialised in pacemakers
             | would surely care, because those 10yr repeat customers
             | would be part of the valuation (valued like SaaS with long
             | duration and high churn?). That would matter to a surgeon
             | with an ownership stake on retirement.
             | 
             | I agree that a surgeon at a general hospital probably
             | wouldn't care (little financial incentive).
        
               | Calavar wrote:
               | Private practice is quickly going extinct in the US. It's
               | generally not an option for US residency and fellowship
               | graduates these days unless they are in one of the
               | specialties that has cash payors (plastics, dermatology,
               | orthopedics, a small number of "concierge" primary care
               | docs and psychiatrists that cater to rich patients, and a
               | small number of ophthalmology practices that carved out a
               | good Lasik business).
               | 
               | The vast majority of pacemakers are placed by
               | cardiologists with an additional two years of training in
               | electrophysiology (not by cardiothoracic surgeons, who
               | prefer to do complicated open heart surgeries and
               | generally find things like pacemakers boring).
               | 
               | Contrary to the conspiratorial thinking all over this
               | thread, medical society guidelines have _scaled back_ the
               | indications for putting in pacemakers time and time
               | again, so the market has shrunk. Electrophysiologists
               | have to make up for the lost pacemaker volume by doing
               | newer procedures (ablations) that reimburse less per hour
               | of work. Even then, the volume at a lot of shops isn 't
               | enough to merit full time work. A lot of graduating
               | electrophysiologists have to take mixed
               | electrophysiology/general cardiology jobs where less than
               | 50% of the work is electrophysiology.
               | 
               | All that is to say, no, pacemakers are not a money making
               | scheme. While there is decent money to be made, it's a
               | shrinking market and those who got obscenely rich putting
               | in pacemakers in the 80s and 90s have mostly already
               | retired.
        
             | ecpottinger wrote:
             | Looked at my scales this morning, boy are you right.
        
           | citizenpaul wrote:
           | >longevity of nuclear pacemakers was excessive
           | 
           | Same. In what world can a lifesaving device run excessively
           | long? One with our health system is where...
        
           | hkgjjgjfjfjfjf wrote:
        
         | rwmj wrote:
         | Until now I assumed that _all_ pacemakers were nuclear powered,
         | since I read about this as a kid in some children 's science
         | book. It's come as a surprise to find out they're unusual.
        
         | afterburner wrote:
         | > Due to the extremely high risk and toxicity involved with
         | using plutonium, numerous layers and shields were woven into
         | these pacemakers resulting in larger and heavier devices.
         | Despite strong concern of radiation exposure, the actual risk
         | of exposure from these plutonium-powered pacemakers was almost
         | non-existent.
         | 
         | What a strange phrase. I would say it was _because_ of the
         | concern of the risk of radiation, not  "despite" it, leading to
         | the precautions built into the device, that the risk was
         | reduced to "almost non-existent".
         | 
         | Or is this a claim that the shielding was unnecessary?
        
           | michaelt wrote:
           | The claim here is "The risk was tiny due to the superb
           | shielding - but patients were still wary and preferred their
           | implants not have any nuclear material at all"
        
           | jerry1979 wrote:
           | I think it reads like:
           | 
           | Even though people might worry about radiation from the
           | device, the actual risk (due to all the shielding) is almost
           | non-existent.
        
       | ceejayoz wrote:
       | I'm just imaginging trying to explain to TSA that this is the
       | reason their radiological alarms are going off...
        
         | adenner wrote:
         | That already happens for other medical uses of isotopes.
        
       | bad416f1f5a2 wrote:
       | I think my step zero would be to pause and ask myself how I got
       | myself in a situation like this.
        
       | jakedata wrote:
       | The first thing I thought of when I saw the pacemaker photo was
       | to adapt the miniature RTG to power a digital watch. People have
       | Nixie tube watches, I want my RTG powered watch.
       | 
       | I'd use a capacitor to accumulate a charge which would power one
       | of the really old-school LED digital watches of the early 70s.
       | 
       | Totally impractical, dangerous and illegal? Sign me up!
        
       | aaaaaasss wrote:
        
       | bookofjoe wrote:
       | This is a new record for me: top of HN homepage 20 minutes after
       | submission
        
         | bookofjoe wrote:
         | Even more annoying to some: still there after two hours
        
           | bookofjoe wrote:
           | Make that three hours and counting
        
             | bookofjoe wrote:
             | Four
        
               | bookofjoe wrote:
               | 5
        
               | bookofjoe wrote:
               | 6
        
       | rob74 wrote:
       | So this is the same technology as used in various space probes
       | and the Curiosity and Perseverance Mars rovers
       | (https://en.wikipedia.org/wiki/Multi-
       | mission_radioisotope_the...), just miniaturized. Fascinating, but
       | not sure if I would want to have one inside my body...
        
         | tenebrisalietum wrote:
         | Well, if the other option is that your heart won't work without
         | one, and you are already elderly, why not?
        
       | acchow wrote:
       | Any chance we can get a nuclear-powered iPhone which lasts 4
       | years?
        
         | gurjeet wrote:
         | Please stop spreading unsubstantiated FUD. If you have the data
         | to prove otherwise, please share the links.
         | 
         | I have had an iPhone 7 for many years; yes, same device. I
         | don't remember the exact time when I got it, but it might've
         | been around 2017. So this device is over 5, if not 6, years
         | old. In all this time, I've had to replace only the screen due
         | to physical damage, but the phone is otherwise perfectly
         | functional. I've been told a few times that the battery needs
         | replacement, but that's primarily because the phone reports
         | battery's "Maximum Capacity" is 73%; but I'm reluctant to
         | replace the battery because I haven't had any problems with the
         | current battery.
         | 
         | Another data point: I bought an iPad Air 2 in November 2016 for
         | my kids, and it's been used by my kids, changing hands as the
         | older one grew out of it, and has had zero issues. Yes, it's
         | screen has got scratches, and it's got blemishes on the body.
         | But it's been running along just fine for over 7 years now.
         | It's getting OS updates, even though it's been discontinued for
         | over 5 years. I cannot say that for any of the Android devices
         | I had bought, not even the ones made by Google.
         | 
         | Before getting the iPhone, I was firmly in the "android is
         | best" camp, and I was almost against buying Apple devices,
         | primarily for the cost of the hardware. I have bought phones,
         | and a tablet, powered by Android, but none of them lasted long
         | enough for me to extract value out of my investment. Either
         | they died early because of some hardware failure, or because
         | the device stopped getting updates.
         | 
         | After trying iPhone, and Apple's other hardware, like MacBooks,
         | I have become a fan of the _quality_ of their products. Their
         | products may not give the customer the same freedoms (of
         | choice) and flexibilities that we've come to expect from Linux
         | and Android worlds, but their products serve the needs of their
         | customers for long durations, and in a way that no other
         | company possesses the ability to do.
         | 
         | If you are of the type who pines for products of a bygone era
         | where the products used to last decades, serving the customers
         | faithfully without much fuss, I think you should seriously
         | consider buying Apple devices.
        
           | lake-view wrote:
           | I think they meant the charge lasts for 4 years, not the
           | phone itself.
        
             | gurjeet wrote:
             | The comment complains about the device itself, and not any
             | specific components of it.
             | 
             | > Any chance we can get a nuclear-powered iPhone which
             | lasts 4 years?
        
               | acchow wrote:
               | I didn't complain about anything. I'm using an iPhone
               | from 2018, but I have to charge it every day. Would be
               | nice to not charge it at all from the time I buy it (like
               | a nuclear power source)
        
               | gurjeet wrote:
               | Your comment made it sound like you were unhappy with the
               | longevity of the device itself.
               | 
               | > iPhone that lasts 4 years
               | 
               | Sorry if that was not your intent.
        
           | macintux wrote:
           | > Please respond to the strongest plausible interpretation of
           | what someone says, not a weaker one that's easier to
           | criticize. Assume good faith.
           | 
           | From the site guidelines. The most plausible interpretation
           | by far is that the comment referred to the time between
           | charges; otherwise, what would nuclear power do to extend the
           | lifespan of a device?
        
       | drraj32 wrote:
       | Just got me thinking: What would it take for us to get to a point
       | where there are small, safe nuclear powered "batteries", that can
       | supply enough electricity for a building.
        
         | Gordonjcp wrote:
         | Far better would be a Pebble Bed Reactor, which more or less
         | fits into a couple of shipping containers and provides a
         | building's worth of power and heat for about ten years with a
         | similar level of maintenance as a diesel genny.
        
           | MichaelCollins wrote:
           | That doesn't sound like any PBR I've ever heard of. Which
           | design are you talking about?
        
         | fulafel wrote:
         | XKCD style what-if:
         | 
         | We'd need to have a lot of money, a disregard for return of
         | investment and a lot patience: Current RTGs can do that, but
         | they're rather expensive for heating houses and problematic
         | from the nuclear materials POV (waste / profileration), not to
         | mention the regulatory and licensing for using it a
         | neighbourhood - better budget the time and money for lobbying
         | for some legislation changes.
         | 
         | If by building we mean say 10 apartments, and each needs 10 kW,
         | the RTG would need hundreds of kg of Pu-238 plutonim dioxide
         | [1].
         | 
         | It's hard to cite the exact cost for that since it's not a
         | freely traded commodity but that's a lot of plutonium. Eg NASA
         | said that with a $75-90 million investment they can make 1.5-2
         | kg per year of it. [2]
         | 
         | [1] https://drinksavvyinc.com/blog/how-much-does-a-
         | radioisotope-... gives 2 kW per 5 kg [2]
         | https://www.space.com/20774-plutonium-spacecraft-fuel-nasa-b...
        
         | klodolph wrote:
         | It would take some kind of complete revolution. It's not
         | happening.
         | 
         | These batteries have very poor power density and are very
         | inefficient. The advantages of nuclear-powered batteries are:
         | 
         | - They generate power over a long time, decades,
         | 
         | - They generate some heat.
         | 
         | They don't generate much power. If you have a building, you
         | would definitely think of a nuclear RTG as a "very shitty
         | battery", and that's even if you don't care at all about
         | radioactivity.
         | 
         | Thinking of these as a "battery" is also a bit misleading, IMO.
         | These are really just small power plants, which generate heat
         | and turn the heat into electricity. The heat is powered by
         | radioactive decay of Pu-238, and then turned into electricity
         | with the extremely inefficient Seebeck effect. If you had a
         | source of heat you wanted to turn into electricity, it's much
         | more efficient to use that heat to turn a turbine which is
         | connected to a generator. And if you want an efficient, cost-
         | effictive turbine, you make it big. At that point, you have a
         | power plant.
        
           | adrian_b wrote:
           | While Pu-238 is an alpha emitter, so it is difficult to
           | capture the decay energy in any other way than by converting
           | heat into electrical energy, for the radioactive isotopes
           | that are beta emitters there is an alternative where the
           | nuclear batteries function in a way very similar to a
           | chemical battery.
           | 
           | The beta decaying substance is connected electrically to one
           | electrode of a capacitor, while the electrons emitted due to
           | the beta decay are able to pass through the insulating layer
           | of the capacitor, reaching the other electrode.
           | 
           | Thus the capacitor is charged directly by the beta-decay and
           | it can provide electrical energy to the external circuit.
        
           | drraj32 wrote:
           | Thanks for the insights. I was thinking if we can make
           | nuclear power generation small, it can avoid the stigma
           | associated with big nuclear power plants. At that point it
           | might become a viable source of energy to replace fossil
           | fuels.
        
         | srvmshr wrote:
         | Not related to nuclear, but the startup Bloom Energy was aiming
         | this by fuel cells. A small box could power a house for a year,
         | as they claimed. Trouble was the box internals run at very high
         | temperatures (800degC) and there was potential for things going
         | awry.
         | 
         | [1] https://en.wikipedia.org/wiki/Bloom_Energy
        
           | Danieru wrote:
           | This is established and commonly installed technology in
           | Japan. It's called EneFarm. Lots of newish houses connected
           | to natural gas have these largish boxes out front. The odd
           | name leaves most people confused.
           | 
           | The EneFarms used to be heavily subsidized by the japanese
           | government in a long term program to encourage fuel cell
           | development and manufacturing. Over time prices have
           | decreased such that the subsidy is either already expired or
           | could be soon expired.
           | 
           | The tech is near, and allows getting a bit more energy out if
           | natural gas. The gas companies hope it will allow them to
           | eventually reuse their pipes to send hydrogen. Personally I
           | think the combo of cheap solar panels and 400% efficiency
           | heat pumps will outcompete gas.
        
             | OJFord wrote:
             | Just because you pay a positive non-zero amount for less
             | than a quarter of the energy in, it does not mean that a
             | device has greater than 100% efficiency, which is not
             | possible.
             | 
             | If heat pumps are 400% efficient then log burners in cabins
             | in the woods are even better.
        
               | mminer237 wrote:
               | All energy from log burners comes from the fuel, and some
               | ashes remain unburnt. They're under 100% efficient at
               | converting fuel to heat. You put in x fuel and <x heat.
               | 
               | A heat pump takes heat from outside the system. You put
               | in x fuel and you get >x heat. Getting more energy than
               | you put in makes the efficiency over 100%.
        
               | bufferoverflow wrote:
               | > They're under 100% efficient at converting fuel to heat
               | 
               | I think only matter-antimatter reaction comes close to
               | 100%. Burning fuels isn't even 1% of that.
        
               | OJFord wrote:
               | I know. You can't just ignore the bulk of the input and
               | still call it 'efficiency' though.
               | 
               | Even manufacturers call this 'coefficient of
               | performance', not efficiency.
        
               | MichaelCollins wrote:
               | Since precise use of language is so important to you:
               | 
               | > _" You can't [...]"_
               | 
               | He did, so obviously he can. You mean _shouldn 't_, not
               | _can 't._
        
               | marshray wrote:
               | An implied qualification of "you can't [while remaining
               | logically consistent]" is common usage.
        
               | cedilla wrote:
               | Impossible in a closed system. Extremely common
               | elsewhere.
        
               | jackcarter wrote:
               | A heat pump warms a home more efficiently than using the
               | same amount of electricity for resistive heating. It can
               | do this because it's not generating the heat from
               | scratch; it's moving heat from outside to inside.
               | 
               | https://en.wikipedia.org/wiki/Heat_pump#Performance
        
               | xattt wrote:
               | A local company has developed a heat pump with a thermal
               | energy storage system. Not sure how they do this, but I
               | imagine there is some sort of insulated cinder blocks on
               | a secondary loop that shuttles heat/cold to where it
               | needs to go.
               | 
               | (1) https://stash.energy/en/product/
        
               | folmar wrote:
               | They try very hard not to be specific, but the industrial
               | heat accumulators are usually just water.
        
               | OJFord wrote:
               | I know. It's only >100% 'efficient' if you ignore the
               | input of 'outside heat'. That is not a normal
               | calculation, and not really called 'efficiency'.
               | 
               | It's desirable for multiple reasons, of course, but it's
               | not efficiency.
        
               | pmoleri wrote:
               | Unfortunately by that metric other electrical heaters
               | tend to 0% efficiency because they are not making use of
               | the virtually unlimited energy outside the buildings.
               | 
               | The 400% metric let's you compare with other heaters, the
               | 100% is kind of useless.
        
         | qbasic_forever wrote:
         | RTGs have been around since the 50's and 60's:
         | https://en.wikipedia.org/wiki/Radioisotope_thermoelectric_ge...
         | For example Russia used them to power lighthouses in super
         | remote parts of their coast. Space probes, mars rovers, etc.
         | use them too.
        
           | fortran77 wrote:
           | You can buy radioactive exit signs.
           | 
           | https://www.emergencylights.net/collections/self-
           | luminous?gc...
           | 
           | They aren't generating electricity though.
        
           | krisoft wrote:
           | Absolutely. And not without incidents:
           | https://en.wikipedia.org/wiki/Lia_radiological_accident
           | 
           | Short summary: Soviet engineers installed RTG powered radio
           | relays to support the construction of a damn in Georgia.
           | Political instability lead to the abandonment of the RTGs.
           | Someone scavenged the generators and removed the radioactive
           | cores from them.
           | 
           | Two of the radioactive sources were discovered by men
           | gathering firewood in the forest. They decided to bring them
           | to their camp(!) and cozy up to them to keep warm during the
           | night(!!). Despite showing symptoms of radiation poisoning
           | they kept the cores on their person while loading their
           | truck(!!!). They all suffered terrible radiation injuries.
           | 
           | There are more sources "lost" from the same batch which
           | remains unaccounted for to this day.
        
             | masklinn wrote:
             | Yeah the URSS made routine use of RTGs throughout their
             | territory (pretty logically as it's so vast and low-density
             | electrification can't reach everywhere), and those
             | routinely got misplaced. Things got worse after the fall of
             | the URSS too e.g. a helo dropped two RTGs from 50m while
             | airlifting them in 2004.
        
           | petre wrote:
           | Yes, there's a Russian movie with a guy that is guarding a
           | weather station in the North and playing games all day. He
           | somehow gets into a conflict with his supervisor,
           | dissasembles a RTG beacon and uses the Strontium 90 to poison
           | his supervisor's dried fish supply. They both get irradiated
           | and the military cleans up the mess.
           | 
           | https://m.imdb.com/title/tt1588875/
           | 
           | Only the Soviets were daft enough to build RTGs using
           | Strontium 90.
        
             | philipkglass wrote:
             | _Only the Soviets were daft enough to build RTGs using
             | Strontium 90._
             | 
             | The United States did too.
             | 
             | Oak Ridge National Laboratory technical report
             | "Strontium-90 Heat Sources"
             | 
             | https://technicalreports.ornl.gov/1971/3445605716035.pdf
             | 
             |  _Introduction_
             | 
             |  _Compact electrical generators powered by heat from
             | radioisotopes have been under development in the United
             | States since the early 1950s for space, marine, and
             | terrestrial uses. Essentially all the generators developed
             | for marine and terrestrial uses have been powered by 90 Sr.
             | This report summarizes the development work done by Oak
             | Ridge National Laboratory (ORNL), Hanford Atomic Products
             | Operation, and Martin Company, Nuclear Division, which led
             | to the production of 90 Sr heat sources for use in the
             | generators._
             | 
             | It was a natural choice since strontium 90 is an inevitable
             | byproduct of operating any fission reactor, and was readily
             | available as a coproduct from weapons plutonium production
             | reactors. Making better RTG isotopes like plutonium 238
             | required additional infrastructure.
        
             | masklinn wrote:
             | > Only the Soviets were daft enough to build RTGs using
             | Strontium 90.
             | 
             | I mean, Sr90 is super cheap, and as long as it stays inside
             | the RTG you're fine. The AEC actually tried Polonium RTGs
             | in the late 50s.
             | 
             | The shorter half-life of Sr compared to Pu also means it's
             | a bit less of an issue when you lose the source.
        
         | amelius wrote:
         | Nice in theory but what if they fall into the wrong hands?
        
           | zdragnar wrote:
           | People are why we can't have nice things.
        
           | Galaxeblaffer wrote:
           | It's already in the wrong hands
        
         | spacephysics wrote:
         | I saw a video about a recent advancement in nuclear diamond
         | batteries. Basically look like normal AA batteries but used
         | depleted uranium and lab diamonds to make them save and long
         | lasting
        
           | duffyjp wrote:
           | A phone I never have to charge would be rad.
        
             | jsmith45 wrote:
             | Sadly like most similar nuclear powered energy sources this
             | is very low density, and provides very little power,
             | despite lasting a long time. Think microwatts.
             | 
             | Only really viable in deployments that need very little
             | power, where no other energy harvesting method is
             | available, and periodically changing out batteries is not
             | an option.
        
         | atemerev wrote:
         | RTGs can't do that. Compact nuclear reactors, however, can.
         | 
         | The problem is that a nuclear reactor is a dynamic system, with
         | some moving parts. It requires thermal management. It requires
         | dynamic control. It is really hard to design a fully self-
         | contained nuclear power system which wouldn't require any human
         | intervention to operate.
         | 
         | And even if we could, there is also a problem of waste
         | management. Nuclear waste is not too dangerous, if you don't
         | touch it. It is, however, quite dangerous, if you grind it into
         | fine particles and spray a large city with it by a crop duster.
         | Our world is crazy. There are people like that out there, who
         | might be interested in it. It is relatively hard to obtain hot
         | nuclear waste from centralized large power plants. It will be
         | really easy in the case of small building-scale reactors.
        
       | bell-cot wrote:
       | The headline situation obviously needs an entry or two in the "If
       | I Was An Evil Overlord" List.
       | 
       | Best that you not discover that little detail when you're trying
       | to "seal the deal" with an ultra-powerful Eldritch Abomination,
       | which you summoned from Far Beyond Mortal Realms, and are pulling
       | the still-beating heart from your live human sacrifice for that
       | _kinda_ -critical part of the Horrific Ritual.
       | 
       | And it's clearly a detail which any Faithful Lieutenant should
       | check when "procuring" sacrifice victims. And yet another reason
       | for any survival-oriented members of the Evil Overlord's Legions
       | of Terror to request postings in distant and sleepy bits of the
       | EO's Empire - far from the glory and promotion opportunities...
        
       | tetsusaiga wrote:
       | I had no idea nuclear power had been miniaturized to this extent,
       | wow.
        
         | OJFord wrote:
         | AIUI there's not really anything to miniaturise beyond the rest
         | of the pacemaker (i.e. ignoring how it's powered) - there's no
         | 'control' or addition of material as in a big nuclear power
         | station, it's 'just' a decaying radioactive material -> heat ->
         | electricity (the inverse of Peltier effect heating, and
         | presumably just as inefficient (~30%?)).
        
           | mullen wrote:
           | Why not just draw heat from the person and convert it to
           | electricity?
        
             | jadt wrote:
             | Looks like there has been research done on that topic[1].
             | 
             | [1]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146093/
        
             | palmtree3000 wrote:
             | You need a heat difference, not just heat, to generate
             | electricity.
             | 
             | Now my sibling comment links to a paper where they say they
             | can find heat differences in the body that are sufficient
             | for their needs, so this is still a possibility! But it
             | does mean you need to be somewhere with a heat gradient:
             | the paper mentions just under the skin.
        
       | Linda703 wrote:
        
       | JoeDaDude wrote:
       | Err... could you make a nuclear reactor with the plutonium in
       | your backyard?
       | 
       | https://en.wikipedia.org/wiki/David_Hahn
        
       | blossomsflorals wrote:
        
       | Bakary wrote:
       | Tragically relevant story to accompany this article: the Goiania
       | accident.
       | 
       | https://en.wikipedia.org/wiki/Goi%C3%A2nia_accident
        
         | xtracto wrote:
         | Ooh, the Cobalt-60 incident in Mexico is also pretty crazy:
         | 
         | https://en.wikipedia.org/wiki/Ciudad_Ju%C3%A1rez_cobalt-60_c...
         | 
         | There were _houses_ built of contaminated rebar! The story gets
         | crazier the more you read about it.
        
           | pxeger1 wrote:
           | It seems like an amazing coincidence that they were able to
           | work out so much about how this happened. It makes you wonder
           | how often this happens and noone finds out.
        
             | clucas wrote:
             | Nah, I think it would be more surprising if you _couldn 't_
             | track this stuff down. In the industrial and construction
             | world, everything works off of POs and work orders. When a
             | company buys or sells anything, there's almost always a
             | paper trail, and usually some internal records showing what
             | material went where. If you have the money to spend on the
             | investigation (and an easy-to-detect signature in the
             | material itself, like radioactivity) you can probably trace
             | contamination all the way back to the hole in the ground it
             | came out of.
        
           | reaperducer wrote:
           | There are people in America who live in houses built out of
           | radioactive uranium mine tailings.
           | 
           | https://navajotimes.com/reznews/grand-canyon-gateway-
           | chapter...
           | 
           | They've been begging the EPA for help for decades.
        
           | joezydeco wrote:
           | It was a thing in the US too. My favorite coffee shop in the
           | suburbs of Chicago got a shipment of tables that had
           | contaminated metal from this incident.
           | 
           | https://www.upi.com/Archives/1984/04/02/Radioactive-
           | tables-r...
        
             | xtracto wrote:
             | Yes! apparently the only reason why this thing was
             | discovered and talked about was because a trailer taking
             | contaminated rebar to the US passed near a military airbase
             | that had reactive material detector and detected the
             | contaminated material. Then the US blew the whistle and
             | pushed Mexico to do a proper investigation.
             | 
             | Otherwise, Mexico (my country) being Mexico, I am sure
             | nobody would have known anything about it. Specially during
             | that time when we had a "soft dictatorship" that buried all
             | bad things under the ground (not that nowadays is that much
             | different...)
             | 
             | Anyway, thanks for the read, I have always found very
             | interesting to know the extent of the contamination.
        
           | corpMaverick wrote:
           | My father built our house in Chihuahua city around 1985. We
           | lived in that house for 25 years. I never thought about it
           | until we had a case of brain cancer in the family 3 years
           | ago.
        
           | orbital-decay wrote:
           | There were several incidents like this, ex. https://en.wikipe
           | dia.org/wiki/Kramatorsk_radiological_accide...
           | 
           | A caesium-137 source from an industrial sensor has been lost
           | and ended up inside a concrete wall of an apartment building;
           | four people died from it.
        
             | masklinn wrote:
             | There were also several incidents from the russian army
             | just up and leaving orphan sources in the wild when the
             | URSS failed e.g. Lilo and Lia (both in Georgia).
             | 
             | Lia was two RTGs, which the URSS used quite a lot, and
             | which regularly got lost or into accidents e.g. two
             | degraded RTGs were found in the north of russia in 2003,
             | one on the Cape of Navarin and one near Kola Bay, and two
             | got dropped by a helo transporting them in 2004.
             | 
             | Though from the Plainly Difficult channel, I feel like the
             | most frequent radiological accidents aren't even orphan
             | sources but either misused / defective radiological devices
             | (a la Therac 25), or commercial irradiation facilities
             | whose opsec degrades until fatal exposure occurs after a
             | jam.
        
           | eloisius wrote:
           | This also happened in Taiwan. A metalworks reused
           | Cobalt-60-contaminated rebar and then hundreds of apartment
           | buildings were constructed with it in the 80s. The government
           | tried to find and buy them, but it seems that some people
           | didn't want to sell because of the amount offered. There are
           | still some of them around.
        
         | dqpb wrote:
         | > stolen from an abandoned hospital site in the city
         | 
         | Is it "stealing" if it's abandoned?
        
           | lIl-IIIl wrote:
           | There was a security guard guarding the site, and the site
           | was broken into on the day the guard didn't show up for work.
        
             | dqpb wrote:
             | Ok, that does sound like stealing
        
           | baud147258 wrote:
           | Abandoned means at the time not in use, not that it's not
           | owned by anyone.
        
           | WastingMyTime89 wrote:
           | I think putting it this way absolves the Brazilian government
           | too much. What happened is 100% their fault.
           | 
           | The hospital moved to a new site but as there was
           | disagreement with their previous landlord they were prevented
           | to move equipments by the police despite trying to secure the
           | source which was later stolen and having repeatedly warned of
           | its danger.
        
           | gambiting wrote:
           | Yes.
        
           | zxexz wrote:
           | I would probably have used the word "scrapped".
           | 
           | This whole thing was a complete failure of bureaucracy from
           | that start and the only entities that deserve any blame are
           | those responsible for leaving nuclear waste in an abandoned
           | facility after being told about it.
        
         | saalweachter wrote:
         | It's the scary goldilocks of nuclear waste.
         | 
         | On the one extreme, you have the Elephant Foot at Chernobyl,
         | which even today will kill you if you, like, go up and lick it.
         | But it's not going to sneak up behind you, so just don't go
         | over there.
         | 
         | On the other extreme you have the release of radioactive water
         | from Fukushima, which instantly dilutes to nothing in the
         | vastness of the ocean. Meh.
         | 
         | In the middle, you have radiation sources like this, which are
         | small enough to be unnoticed and highly mobile, but clumpy
         | enough to still kill you dead if you get too close. Unless you
         | have a radiation detector, you could step on one on your way
         | home today and never know it.
         | 
         | Scary!
        
           | NotYourLawyer wrote:
           | There's another scary Goldilocks aspect too, which is what I
           | thought your comment was going to be about when I started
           | reading it.
           | 
           | Stuff with a really short half life is horribly radioactive,
           | but not for long. Stuff with a half life of millions of years
           | sticks around forever, but it's not throwing off that much
           | radiation. But stuff in the middle (a half life of perhaps
           | decades to a thousand years) can be very dangerous and remain
           | that way for a long time.
        
           | marcosdumay wrote:
           | > and never know it.
           | 
           | Nah... You will know it quite soon.
        
         | ssizn wrote:
         | Well, tragic... we are talking scavengers here.
        
           | foobiekr wrote:
           | The kids weren't scavengers.
           | 
           | There are so many things we could have if we actually could
           | somehow have faith that the required (for safety, pollution
           | mitigation, etc.) full lifecycle was actually honored.
           | 
           | Instead, everything is dominated by lazy jerks. The other
           | day, I noticed my neighbor's house painter digging a hole. I
           | said hello and asked what was up, and he said "Yes, I need to
           | dispose of the water and paint from my sprayer, so I dig
           | holes and pour it in. Don't worry, I will fill the hole back
           | in when I'm done." This was in the bay area.
           | 
           | People just will not do the right thing by default if it is
           | even remotely more work and for most people, thought is the
           | hardest work there is.
        
             | ethbr0 wrote:
             | What's the recommended method of disposing of paint waste
             | water in the Bay Area?
             | 
             | I'd assume soil sequestration (we're not talking lead paint
             | here, presumably) is preferable to storm drain dilution?
        
               | mh- wrote:
               | https://sfenvironment.org/article/household-hazardous-
               | waste-...
               | 
               | Paint is explicitly mentioned. SF even has free home
               | pickup for it via Recology.
               | 
               | https://sfenvironment.org/safe-disposal
        
               | ethbr0 wrote:
               | Is that for all paint? It looks like they only offer
               | pickup for oil-based paints, and latex/acrylic-based
               | should drop off:
               | https://sfrecycles.org/items?words=paint&address=all
               | 
               | I was curious, because I know SF has a high enough
               | population:water ratio that stricter treatment is
               | required, but on the other hand modern non-oil paints are
               | relatively chemically safe (at worst, probably the off-
               | gasing parts).
        
               | mh- wrote:
               | Not sure. I don't live in the city anymore but your
               | comment made me realize I didn't know either.
        
             | hutzlibu wrote:
             | "People just will not do the right thing by default if it
             | is even remotely more work and for most people, thought is
             | the hardest work there is. "
             | 
             | My theory is simply low education.
             | 
             | Since aeons we burried our garbage and it was never a
             | problem. It only started quite recently, that our
             | technology is so advanced, that it simply will not
             | decompose. But rather contaminate.
             | 
             | But only a very low percentage of people actualy
             | understands this.
             | 
             | So sure, that painter surely was "educated" at some point,
             | that doing this is bad. But they simply do not believe it.
             | "Not a big deal, you know". Same with plastic bags, same
             | with climate change.
             | 
             | Maybe we should start proper science education a lot
             | earlier?
        
             | triceratops wrote:
             | Should've reported him.
        
           | jcoder wrote:
           | Is something less tragic if the victims weren't fully
           | participating in capitalism at the time of injury? If they're
           | performing a societal function that you obviously think is
           | beneath you?
        
           | kergonath wrote:
           | Yeah, tragic. They are no less human than you are. They had
           | no clue what they were doing, like all of us in general. What
           | fraction of the population is aware of the effect of
           | radiation and the toxicity of medical sources? How would they
           | go about assessing the risk in this situation?
           | 
           | Uncontrolled contamination can also harm innocent bystanders,
           | in this case children.
        
             | ssizn wrote:
             | I know not to barge into buildings to steal stuff that
             | doesn't belong to me and that I know nothing about.
        
               | NoSorryCannot wrote:
               | That's right, and it's illegal for rich and poor alike.
               | That's how you know it's fair.
        
           | justusthane wrote:
           | That is an extremely cavalier take, especially considering:
           | 
           | > His six-year-old daughter, Leide das Neves Ferreira, later
           | ate an egg while sitting on this floor. She was also
           | fascinated by the blue glow of the powder, applying it to her
           | body and showing it off to her mother. Dust from the powder
           | fell on the egg she was consuming; she eventually absorbed
           | 1.0 GBq and received a total dose of 6.0 Gy, more than a
           | fatal dose even with treatment.
           | 
           | Maybe read the article before commenting?
        
             | ssizn wrote:
             | Oh I read it.
        
           | DonHopkins wrote:
           | Maybe so, and I admire the modesty of your proposal, but it's
           | just not safe to eat the children of poor people if they're
           | radioactive, you know.
        
           | poulpy123 wrote:
           | Are poor people really humans ?
        
           | toss1 wrote:
           | Right, they are so poor that they are using their what little
           | knowledge they have to scavenge an abandoned building for
           | scrap they can sell to feed themselves and their children.
           | 
           | If you had never been taught about radiation, you wouldn't
           | know what to do about it either. It is not like radioactive
           | materials are a common everyday occurrence for everyone.
           | 
           | What is wrong with you that you cannot see that they are also
           | humans just like us, and were born into horrible
           | circumstances that they never got the education to learn
           | about this, through no fault of their own whatsoever?
        
           | Bakary wrote:
           | I know that low-empathy privileged commenters are to be
           | expected on HN, but I nonetheless find it impressive that
           | such a short comment can illuminate so many biases in one go.
        
             | pxmpxm wrote:
             | Flip take : using social media to feign empathy for
             | abstract contexts - ones that you actually have zero
             | emotional connection to - is merely how left leaning people
             | signal their bona fides.
        
               | Bakary wrote:
               | I hear what you're saying but it's helpful to look at
               | this with an additional layer of abstraction.
               | 
               | This is not just virtue-signaling in combat with
               | edginess-signaling for their respective audience. It's
               | more importantly a testament to prevailing sub-ideologies
               | within portions of the population.
               | 
               | Edgy comments in tech forums like these are a signal of
               | larger-scale class warfare (a loaded term, but bear with
               | me). White collar techworkers think nothing of building
               | skinner boxes and ad services all day as they are
               | rewarded handsomely for it. In combination with all sorts
               | of other factors, you end up with worsening social
               | conditions across the board.
               | 
               | Some guy being nonchalant about dead Brazilian families
               | and taking pleasure in signaling it is just a
               | manifestation of overall societal nonchalance about
               | rights and negative externalities among high-skilled
               | workers and capital owners. These are real phenomenons
               | that have consequences regardless of whether I myself
               | might virtue signal about rejecting them.
        
       | prennert wrote:
       | (do not autoclave)
        
         | gilleain wrote:
         | Do not stare into laser with remaining eye
        
       | fallingfrog wrote:
       | If you have one of those, are you then a nuclear cyborg? Because
       | that's kind of awesome.
        
       | anfractuosity wrote:
       | Has anyone found the peak power output from the thermocouples,
       | for this pacemaker?
        
       | sgustard wrote:
       | Properly disposing of an EXIT sign is no picnic either.
       | 
       | https://www.nrc.gov/reading-rm/doc-collections/fact-sheets/f...
        
       | darwingr wrote:
       | Could I use it to power my iPhone? Frankly I'm fed up with the
       | need for charging.
        
         | jjk166 wrote:
         | For actual power, no it would be wildly impractical. However
         | there is a concept of a nuclear top-off battery which keeps
         | your main chemical battery from draining during long periods
         | when not it use. So you could throw a charged phone in a drawer
         | and come back months or years later and it's still good to go.
         | Good for applications like an emergency kit.
        
         | hwillis wrote:
         | It would take about 50,000 hours (5.7 years) to charge a 10 Wh
         | iPhone. A solar cell on the back of the iphone would take
         | roughly a full sunny day to charge an iPhone, with ~2 watts
         | peak output.
        
         | dale_glass wrote:
         | No. It lasts years because pacemakers have a really tiny power
         | draw.
         | 
         | There's not a miniature nuclear reactor in there, it's just a
         | RTG, which is simple but also very inefficient. So it doesn't
         | get the crazy amount of power from a tiny amount of material a
         | fission reactor does.
        
           | MichaelCollins wrote:
           | > _There 's not a miniature nuclear reactor in there, it's
           | just a RTG,_
           | 
           | I believe these are not RTGs (radioisotope _thermo_ electric
           | generators.) Rather they use radiovoltaic conversion,
           | probably alphavoltaic conversion judging by the use of
           | Pu-238. Such devices convert alpha or beta radiation directly
           | to electricity using semiconductors, not unlike photovoltaic
           | cells.
           | 
           | But your point still holds, these atomic batteries produce a
           | tiny amount of power.
        
         | julianlam wrote:
         | Probably, given the right modifications.
         | 
         | However I do not trust the public to dispose of recyclable
         | waste properly, let alone radioactive devices.
        
       | adultSwim wrote:
       | What happens when someone is cremated with one of these still
       | installed?
        
         | na85 wrote:
         | Standard practice is to remove pacemakers. If you don't:
         | 
         | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1279940/
        
       | bt1a wrote:
       | I feel like this PSA would be best suited for a different type of
       | hackers
        
         | kurupt213 wrote:
         | It's always the seemingly normal people with the weird hobbies
        
       | ToddWBurgess wrote:
       | If it is a dead body and it is being cremated you take it out so
       | it doesn't explode in the crematorium. I say this as a former
       | funeral director who had to remove them.
        
         | bookofjoe wrote:
         | >Pacemaker explosions in crematoria: problems and possible
         | solutions
         | 
         | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1279940/
        
           | inciampati wrote:
           | Fascinating read and a lovely example of a simple and
           | pragmatic socioscientific study. Cool!
        
         | masklinn wrote:
         | I assume it's mostly an issue with the li-ion battery
         | pacemakers? Plutonium wouldn't explode, though the casing may
         | crack which would be less than ideal.
        
         | Vaslo wrote:
         | Was just coming here to ask this - thanks for the info!
        
         | alasdair_ wrote:
         | "It was the day my grandmother exploded."
         | 
         | Thus begins one of my favorite Ian Banks novels, starting with
         | exactly this event.
        
         | mabbo wrote:
         | HackerNews truly does pull from a large swatch of interesting
         | people, doesn't it?
        
           | kierkegaard_s wrote:
           | boiling it down, what would you say is the link between most
           | common HNers?
        
             | MKais wrote:
             | Curiosity.
        
             | thomascgalvin wrote:
             | Internet access.
        
               | incognition wrote:
               | Reductio ad absurdum
        
             | ricardo81 wrote:
             | 'what if'
        
             | hathawsh wrote:
             | Even if HN mostly consists of people engaged in building or
             | maintaining technology, technology is in every industry, so
             | the discussion can credibly touch nearly every topic with
             | some interesting depth.
        
             | callalex wrote:
             | Taking the question literally? People who believe democracy
             | makes correct choices.
        
             | barrysteve wrote:
             | Desire for quality news
        
           | elromulous wrote:
           | Nit: the idiom is "large swath"
        
         | elliekelly wrote:
         | I'm curious whether it was standard practice for you to check
         | for a pacemaker prior to cremation or whether the process
         | relied on a family member informing you?
        
           | lucakiebel wrote:
           | The doctors that sign off the cremation have to provide info
           | on pacemakers/artificial joints and so on to the crematorium
        
             | landofredwater wrote:
             | > artificial joints
             | 
             | Would you have to remove the joints as well then? How are
             | you meant to properly dispose of something like a knee or a
             | hip?
        
               | lucakiebel wrote:
               | Make it a modern art piece? Titanium hips look pretty
               | dope
        
               | lucakiebel wrote:
               | But, for real, there's companies that recycle artificial
               | joints.
        
               | jrockway wrote:
               | Autoclave and sell for scrap?
        
             | klyrs wrote:
             | Vaguely related, the crematorium stole my grandpa's gold
             | fillings, much to my grandmother's dismay.
        
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