This is a long and well-written piece that presents a lot of ideas that I think are often absent in #prosthetics discussions online. Allow me to summarize some of these below. https://features.propublica.org/diabetes-amputations/black-american-amputation-epidemic/

1. Lower-limb amputation is far more common than upper-limb amputation (about 9-to-1), and is overwhelmingly a consequence of infection resulting from vascular diseases including diabetes.

2. Preventative treatment for diabetes includes exercise. However, when someone has a dysvascular amputation, exercise can become more difficult as mobility is impaired. Thus, people with dysvascular amputation have a high incidence of subsequent contralateral amputation.

3. The US healthcare system does a poor job with preventative healthcare. Healthcare costs for diabetes are high, but the lifetime costs of amputation are higher. The cost of surgery, yes, but also the costs of prostheses, which must be repaired and replaced periodically.

As an aside, the high cost of prostheses is largely because these are medical-grade devices that must be FDA-approved, and must be fitted by certified prosthetists trained in fitting sockets to provide the most comfort and function, and the lowest risk of complications.

4. These high costs can be covered by Workman's Compensation in the case of traumatic amputation, but persons with dysvascular amputation are at the mercy of their insurance and their access to medical care. Thus the struggles of poverty compound.

This is obviously not to say there is no place for research on high-end prostheses. Expanding the capacity of bionic prostheses through increasingly biomimetic developments is an exciting and worthy pursuit. However, we must consider who can access the outcomes of our research.

Many people choose to use simple mechanical prostheses because it is their preference. But many others are limited by what they can afford or their insurance will pay for. We must develop prostheses that are functional and accessible to everyone, regardless of economic status.

But also, the US healthcare system needs to change, like, yesterday.