IEEE Technology and Society Magazine - September 2023 - 37

Commentary
The Role of Public Policy in the Adoption
of Prosthetic Limbs in the United States
Carolena Stephanie Larson and
Muhammad Salar Khan
Schar School of Policy and Government
George Mason University
Arlington, VA 22201 USA
 In the UnIted StateS, approximately 2 million
people live with limb loss [1] and that number
is expected to double by 2050 [2]. Although this is a
significant figure, it still does not represent a substantial
market size for the private sector to develop prosthetics
for this population. Mobility is highly crucial
for long-term health [3], [4], [5], [6], and prosthetic
limbs are vital in restoring mobility. Undoubtedly,
people with limb loss are among the most vulnerable
segments of society. Therefore, we contend that
their safety and care should be a high priority for
the government. In this article, we recap the public
policy landscape surrounding prosthetic limbs in
the United States before proposing ways to increase
access and adoption of prosthetic limbs.
In the United States, two federal departments are
involved in the creation, maturation, and diffusion
of prosthetic limbs. The first is the Food and Drug
Administration (FDA). The second, understandably,
is the Department of Veterans Affairs (VA), as
soldiers are at a high risk of losing limbs in combat
duty. For prosthetic researchers, funding from traditional
sources such as the National Institutes of
Health (NIH) and the National Science Foundation
(NSF) has become remarkably difficult to secure,
partly because of the competition from other projects
in those institutions [7]. Consequently, many
Digital Object Identifier 10.1109/MTS.2023.3306531
Date of current version: 21 September 2023.
September 2023
researchers have turned their attention to the VA.
In 2014-2015, the Congressionally Directed Medical
Research Program (CDMRP) at the Department
of Defense (DOD) funded 18 proposals in orthotics
and prosthetics outcomes. However, obtaining such
funding is also becoming more competitive, as 98
proposals were rejected [7].
In 1938, Congress gave the FDA the authority to
oversee the safety of food, drugs, medical devices,
and cosmetics through the Federal Food, Drug, and
Cosmetic Act (FFDCA). Consequently, the FDA uses
guidance documents to approve medical devices
and radiation-emitting products (including prosthetics)
for commercialization and distribution. While
the FDA stimulates the diffusion of medical devices
and prosthetics by ensuring they are safe for human
use, the VA has been a driving force behind the
invention and adoption of prosthetic limbs in service
members (and veterans) and civilian populations
alike.
The history of limb development dates back to
the second half of the 19th century. Starting in 1862,
Congress appropriated $15,000 for the purchase of
artificial limbs for soldiers and seamen disabled in
the line of service, to be expended under the direction
of the U.S. Surgeon General [8]. Four years later,
in 1866, the War Department (now the DOD) was
authorized to start a program which was to provide
union veterans with transportation to and from their
homes to a place where they could obtain their artificial
limbs or devices and furnish those veterans with
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37
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