In a chilling episode of "Homeland" last year, a terrorist killed the vice president with a fiendishly clever weapon: a remote-control device that attacked the computerized defibrillator implanted in his chest.
For former Vice President Dick Cheney, it was all too realistic.
Mr. Cheney, who had heart disease for decades before receiving a transplant last year, had such an implant to regulate his heart rate and shock his heart back into life, if necessary. The defibrillator could be reprogrammed wirelessly from a short distance away. In 2007, he had the wireless feature disabled.
About the "Homeland" scenario, Mr. Cheney said on the Oct. 20 episode of "60 Minutes": "I found it credible. It was an accurate portrayal of what was possible."
But was it really? Medical experts say the answers are surprisingly complicated.
Mr. Cheney's cardiologist, Dr. Jonathan Reiner of George Washington University, said in the "60 Minutes" interview that he agreed with his patient.
An assassin "on a rope line or in a hotel room next door" could have instructed the defibrillator to kill Mr. Cheney, he said, adding that a wireless programmable device "seemed to me a bad idea for the vice president of the United States."
Other experts say the scenario is highly unlikely, though they couch their answers carefully.
The devices, used by millions of Americans, transmit data from a patient's home to a doctor's office, alerting the doctor of a malfunction. But the remote communication goes only one way; the devices being used today cannot be reprogrammed remotely.
Instead, patients must go to a doctor's office. With some devices, they must be within inches of the reprogramming machine. Other devices can be reprogrammed from about 30 feet away, but a wand must be held close to patients' collarbones to identify them to the machine.
"My opinion is it is probably unlikely that a remote attack of this nature could happen today," said Kevin Fu, a University of Michigan expert on computer security.
But he emphasized the word "probably," adding that he would never say something is impossible. "There can always be a flaw we are unaware of," he said.
In fact, a precedent for the "Homeland" episode was a 2008 paper by Dr. Fu and other security experts, who reported that they had managed to change the settings on an implantable defibrillator so it would release deadly electric shocks.
Of course, Dr. Fu noted, the experiment required almost a dozen people in a lab full of Ph.D.s. And the investigators had to be as close as two inches from the defibrillator to do their work.
Still, the experiment became known as a proof of principle. It originated a decade ago, when Dr. Fu noticed that the Food and Drug Administration had issued a recall for software on an implanted heart device. He began to wonder about software updates and the security of medical devices. So he started calling cardiologists, trying to get more information.
Many of the doctors hung up on him, Dr. Fu said, adding, "They thought I was crazy to worry about the security of a device in the chest."
Finally, he got together with a colleague, Tadayoshi Kohno, a computer security researcher at the University of Washington. The two investigators and their colleagues set to work seeing if they could breach the security of a defibrillator that had been removed from a patient's chest.
The defibrillator and the device used to program it communicated in their own language from a distance no greater than a few inches, Dr. Kohno said. The group figured out the language by turning various therapy commands on and off.
"We would intercept the communications," Dr. Kohno said. "Aha — this is the command that means 'turn on,' this is the command that means 'turn off.' " After they learned the communication language, "we could generate the commands ourselves."
At that time, "security was not on the radar yet for the medical device community," Dr. Fu said. "But there was a rapid trend toward wireless communication and Internet connectivity. We definitely raised awareness."
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