0:00:00.982,0:00:02.602
Nine years ago, I worked

0:00:02.602,0:00:04.799
for the U.S. government in Iraq,

0:00:04.799,0:00:07.928
helping rebuild the electricity infrastructure.

0:00:07.928,0:00:10.565
And I was there, and I worked in that job

0:00:10.565,0:00:12.415
because I believe that technology

0:00:12.415,0:00:15.064
can improve people's lives.

0:00:15.064,0:00:17.999
One afternoon, I had tea with a storekeeper

0:00:17.999,0:00:20.819
at the Al Rasheed Hotel in Baghdad,

0:00:20.819,0:00:23.558
and he said to me, "You Americans,

0:00:23.558,0:00:24.909
you can put a man on the moon,

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but when I get home tonight,

0:00:26.454,0:00:29.310
I won't be able to turn on my lights."

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At the time, the U.S. government had spent

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more than two billion dollars

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on electricity reconstruction.

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How do you ensure technology reaches users?

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How do you put it in their hands

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so that it is useful?

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So those are the questions that my colleagues and I

0:00:46.116,0:00:48.229
at D-Rev ask ourselves.

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And D-Rev is short for Design Revolution.

0:00:51.377,0:00:53.971
And I took over the organization four years ago

0:00:53.971,0:00:56.272
and really focused it on developing products

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that actually reach users,

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and not just any users,

0:00:59.946,0:01:04.001
but customers who live on[br]less than four dollars a day.

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One of the key areas we've been working on recently

0:01:05.909,0:01:08.422
is medical devices, and while it may not be obvious

0:01:08.422,0:01:10.554
that medical devices have something in common

0:01:10.554,0:01:13.120
with Iraq's electricity grid then,

0:01:13.120,0:01:15.249
there are some commonalities.

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Despite the advanced technology,

0:01:17.958,0:01:20.726
it's not reaching the people who need it most.

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So I'm going to tell you about one of[br]the projects we've been working on,

0:01:23.134,0:01:26.041
the ReMotion Knee, and it's a prosthetic knee

0:01:26.041,0:01:28.197
for above-knee amputees.

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And this project started when[br]the Jaipur Foot Organization,

0:01:31.497,0:01:34.091
the largest fitter of prosthetic limbs in the world,

0:01:34.091,0:01:35.560
came to the Bay Area and they said,

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"We need a better knee."

0:01:38.530,0:01:41.678
Chances are, if you're living on[br]less than four dollars a day,

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and you're an amputee,

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you've lost your limb in a vehicle accident.

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Most people think it's land mines,

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but it's a vehicle accident.

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You're walking by the side of the road

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and you're hit by a truck,

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or you're trying to to jump on a moving train,

0:01:53.889,0:01:57.873
you're late for work, and your pant leg gets caught.

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And the reality is that if[br]you don't have much money,

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like this young named Kamal right here,

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the option you really have

0:02:05.242,0:02:07.806
is a bamboo staff to get around.

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And how big a problem is this?

0:02:10.289,0:02:13.215
There's over three million amputees every year

0:02:13.215,0:02:16.504
who need a new or replacement knee.

0:02:16.504,0:02:18.373
And what are their options?

0:02:18.373,0:02:20.972
This is a high-end. This is[br]what we'd call a "smart knee."

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It's got a microprocessor inside.

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It can pretty much do anything,

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but it's 20,000 dollars,

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and to give you a sense of who wears this,

0:02:28.978,0:02:32.221
veterans, American veterans coming[br]back from Afghanistan or Iraq

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would be fit with something like this.

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This is a low-end titanium knee.

0:02:37.064,0:02:39.541
It's a polycentric knee, and all that that means

0:02:39.541,0:02:41.750
is the mechanism, is a four-bar mechanism,

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that mimics a natural human knee.

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But at 1,400 dollars, it's still too expensive

0:02:46.703,0:02:49.087
for people like Kamal.

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And lastly, here you see a low-end knee.

0:02:51.680,0:02:53.511
This is a knee that's been designed specifically

0:02:53.511,0:02:55.187
for poor people.

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And while you have affordability,

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you've lost on functionality.

0:02:58.915,0:03:01.566
The mechanism here is a single axis,

0:03:01.566,0:03:03.815
and a single axis is like a door hinge.

0:03:03.815,0:03:06.100
So you can think about how unstable that would be.

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And this is the type of mechanism

0:03:08.005,0:03:11.894
that the Jaipur Foot Organization was using[br]when they were looking for a better knee,

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and I just wanted to give you a sense[br]of what a leg system looks like,

0:03:14.251,0:03:15.590
because I'm showing you all these knees

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and I imagine it's hard to think [br]how it all fits together.

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So at the top you have a socket,

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and this fits over someone's residual limb,

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and everyone's residual limb is a little bit different.

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And then you have the knee,

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and here I've got a single axis on the knee

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so you can see how it rotates,

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and then a pylon, and then a foot.

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And we've been able to develop a knee,

0:03:35.634,0:03:37.996
a polycentric knee, so that type of knee

0:03:37.996,0:03:40.571
that acts like a human knee, mimics human gait,

0:03:40.571,0:03:43.314
for 80 dollars retail.

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(Applause)

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But the key is, you can have this great invention,

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you can have this great design, but how do you get it

0:03:51.418,0:03:53.190
to the people who most need it?

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How do you ensure it gets to them[br]and it improves their lives?

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So at D-Rev, we've done some other projects,

0:03:59.432,0:04:01.816
and we looked at three things that we really believe

0:04:01.816,0:04:05.788
gets technologies to customers, to users,

0:04:05.788,0:04:07.164
to people who need it.

0:04:07.164,0:04:09.885
And the first thing is that the product [br]needs to be world class.

0:04:09.885,0:04:11.536
It needs to perform on par

0:04:11.536,0:04:14.381
or better than the best products on the market.

0:04:14.381,0:04:16.527
Regardless of your income level,

0:04:16.527,0:04:18.065
you want the most beautiful,

0:04:18.065,0:04:20.753
the best product that there is.

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I'm going to show you a video now

0:04:24.242,0:04:25.888
of a man named Ash. You can see him walking.

0:04:25.888,0:04:27.800
He's wearing the same knee system here

0:04:27.800,0:04:29.406
with a single axis knee.

0:04:29.406,0:04:31.498
And he's doing a 10-meter walk test.

0:04:31.498,0:04:35.313
And you'll notice that he's struggling [br]with stability as he's walking.

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And something that's not obvious, that you can't see,

0:04:37.968,0:04:40.555
is that it's psychologically draining

0:04:40.555,0:04:44.337
to walk and to be preventing yourself from falling.

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Now this is a video of Kamal.

0:04:46.041,0:04:48.774
You remember Kamal earlier,[br]holding the bamboo staff.

0:04:48.774,0:04:51.482
He's wearing one of the earlier versions of our knee,

0:04:51.482,0:04:54.582
and he's doing that same 10-meter walk test.

0:04:54.582,0:04:57.998
And you can see his stability is much better.

0:04:59.849,0:05:02.968
So world class isn't just about[br]technical performance.

0:05:02.968,0:05:06.308
It's also about human performance.

0:05:06.308,0:05:08.166
And most medical devices, we've learned,

0:05:08.166,0:05:10.694
as we've dug in, are really designed for Westerners,

0:05:10.694,0:05:12.357
for wealthier economies.

0:05:12.357,0:05:15.619
But the reality is our users, our customers,

0:05:15.619,0:05:18.172
they do different things. They sit cross-legged more.

0:05:18.172,0:05:21.014
We see that they squat. They kneel in prayer.

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And we designed our knee to have[br]the greatest range of motion

0:05:23.762,0:05:27.846
of almost any other knee on the market.

0:05:27.846,0:05:29.576
So the second thing we learned, and this leads

0:05:29.576,0:05:31.836
into my second point, which is that we believe

0:05:31.836,0:05:34.553
that products need to be[br]designed to be user-centric.

0:05:34.553,0:05:37.153
And at D-Rev, we go one step further and we say

0:05:37.153,0:05:39.053
you need to be user-obsessed.

0:05:39.053,0:05:41.773
So it's not just the end user[br]that you're thinking about,

0:05:41.773,0:05:43.749
but everyone who interacts with the product,

0:05:43.749,0:05:46.463
so, for example, the prosthetist who fits the knee,

0:05:46.463,0:05:49.631
but also the context in which the knee is being fit.

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What is the local market like?

0:05:51.215,0:05:53.133
How do all these components get to the clinic?

0:05:53.133,0:05:55.455
Do they all get there on time? The supply chain.

0:05:55.455,0:05:57.558
Everything that goes into ensuring

0:05:57.558,0:05:59.541
that this product gets to the end user,

0:05:59.541,0:06:03.962
and it goes in as part of the system, and it's used.

0:06:03.962,0:06:05.828
So I wanted to show you some of the iterations

0:06:05.828,0:06:10.421
we did between the first version, the Jaipur Knee,

0:06:10.421,0:06:12.242
so this is it right here.

0:06:12.242,0:06:13.968
(Clicking)

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Notice anything about it?

0:06:16.186,0:06:18.747
It clicks.

0:06:18.747,0:06:21.613
We'd seen that users had actually modified it.

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So do you see that black strip right there?

0:06:25.125,0:06:28.117
That's a homemade noise dampener.

0:06:28.117,0:06:30.335
We also saw that our users had modified it

0:06:30.335,0:06:31.769
in other ways.

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You can see there that that particular amputee,

0:06:33.559,0:06:35.788
he had wrapped bandages around the knee.

0:06:35.788,0:06:37.512
He'd made a cosmesis.

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And if you look at the knee,

0:06:39.708,0:06:43.162
it's got those pointy edges, right?

0:06:43.162,0:06:45.365
So if you're wearing it under pants or a skirt

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or a sari, it's really obvious

0:06:47.625,0:06:49.221
that you're wearing a prosthetic limb,

0:06:49.221,0:06:53.413
and in societies where there's social[br]stigma around being disabled,

0:06:53.413,0:06:56.370
people are particularly acute about this.

0:06:56.370,0:06:58.686
So I'm going to show you some[br]of the modifications we did.

0:06:58.686,0:07:01.601
We did a lot of iterations, not just [br]around this, but some other things.

0:07:01.601,0:07:04.029
But here we have the version three, [br]the ReMotion Knee,

0:07:04.029,0:07:05.848
but if you look in here, you can see

0:07:05.848,0:07:10.566
the noise dampener. It's quieter.

0:07:10.566,0:07:14.219
The other thing we did is that[br]we smoothed the profile.

0:07:14.219,0:07:15.651
We made it thinner.

0:07:15.651,0:07:17.359
And something that's not obvious is that we

0:07:17.359,0:07:20.560
designed it for mass production.

0:07:20.560,0:07:22.256
And this goes into my last point.

0:07:22.256,0:07:24.227
We really, truly believe that if a product

0:07:24.227,0:07:26.564
is going to reach users at the scale that it's needed,

0:07:26.564,0:07:28.399
it needs to be market-driven,

0:07:28.399,0:07:31.644
and market-driven means that products are sold.

0:07:31.644,0:07:34.767
They're not donated. They're not heavily subsidized.

0:07:34.767,0:07:36.980
Our product needs to be designed to offer value

0:07:36.980,0:07:38.281
to the end user.

0:07:38.281,0:07:40.460
It also has to be designed to be very affordable.

0:07:40.460,0:07:42.634
But a product that is valued by a customer

0:07:42.634,0:07:44.345
is used by a customer,

0:07:44.345,0:07:46.518
and use is what creates impact.

0:07:46.518,0:07:48.277
And we believe that as designers,

0:07:48.277,0:07:51.507
it holds us accountable to our customers.

0:07:51.507,0:07:54.123
And with centralized manufacturing,

0:07:54.123,0:07:56.150
you can control the quality control,

0:07:56.150,0:07:57.878
and you can hit that $80 price point

0:07:57.878,0:08:00.368
with profit margins built in.

0:08:00.368,0:08:02.524
And now, those profit margins are critical,

0:08:02.524,0:08:04.193
because if you want to scale, if you want to reach

0:08:04.193,0:08:06.452
all the people in the world who possibly need a knee,

0:08:06.452,0:08:09.609
it needs to be economically sustainable.

0:08:09.609,0:08:12.205
So I want to give you a sense of where we are at.

0:08:12.205,0:08:15.781
We have fit over 5,000 amputees,

0:08:15.781,0:08:18.000
and one of the big indicators[br]we're looking at, of course,

0:08:18.000,0:08:19.913
is, does it improve lives?

0:08:19.913,0:08:21.649
Well, the standard is, is someone

0:08:21.649,0:08:24.174
still wearing their knee six months later?

0:08:24.174,0:08:26.877
The industry average is about 65 percent.

0:08:26.877,0:08:29.169
Ours is 79 percent,

0:08:29.169,0:08:32.113
and we're hoping to get that higher.

0:08:32.113,0:08:35.126
Right now, our knees are worn in 12 countries.

0:08:35.126,0:08:36.736
This is where we want to get, though,

0:08:36.736,0:08:38.254
in the next three years.

0:08:38.254,0:08:40.754
We'll double the impact in 2015,

0:08:40.754,0:08:43.872
and we'll double it each of[br]the following years after that.

0:08:43.872,0:08:45.705
But then we hit a new challenge,

0:08:45.705,0:08:47.724
and that's the number of skilled prosthetists

0:08:47.724,0:08:50.832
who are able to fit knees.

0:08:50.832,0:08:53.513
So I want to end with a story of Pournima.

0:08:53.513,0:08:55.160
Pournima was 18 years old

0:08:55.160,0:08:58.028
when she was in a car accident[br]where she lost her leg,

0:08:58.028,0:09:01.469
and she traveled 12 hours by train

0:09:01.469,0:09:03.896
to come to the clinic to be fit with a knee,

0:09:03.896,0:09:06.489
and while all of the amputees who wear our knees

0:09:06.489,0:09:08.665
affect us as the designers,

0:09:08.665,0:09:12.932
she's particularly meaningful to me [br]as an engineer and as a woman,

0:09:12.932,0:09:14.496
because she was in school,

0:09:14.496,0:09:17.220
she had just started school to study engineering.

0:09:17.220,0:09:19.375
And she said, "Well, now that I can walk again,

0:09:19.375,0:09:21.783
I can go back and complete my studies."

0:09:21.783,0:09:24.953
And to me she represents the next generation

0:09:24.953,0:09:27.985
of engineers solving problems

0:09:27.985,0:09:30.430
and ensuring meaningful technologies

0:09:30.430,0:09:32.214
reach their users.

0:09:32.214,0:09:34.252
So thank you.

0:09:34.252,0:09:38.056
(Applause)