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Unpatchable
Living	with	a	vulnerable	implanted	device
@MarieGMoe
@SINTEF_Infosec
Marie	Moe,	PhD,	Research	Scientist	at	SINTEF
Hack	to	save	lives!
How	the	heart	works
3https://www.youtube.com/watch?v=d6RbN5lPqIU
Electrical	system	of	the	heart
4
Pacemaker
5
https://www.youtube.com/watch?v=-f2FKmMneXY
Leadless pacemaker
The	future?
The	Internet	of	Medical	”Things”	is	real,
and	my	heart	is	wired	into	it…
Pacemaker/ICD
Programmer
Home	monitoring
unit
Cellular	or	
Telephone	Network Web	portal
Inductive
near	field
communicationMICS/
ISM
POTS/SMS
Remote	monitoring
With	connectivity	comes	vulnerability…
10
Potential	threats
Device	is	vulnerable?
Access	point	is	vulnerable?
Mobile	network	is	compromised?
Server	at	vendor	is	compromised?
Web	site	that	doctor	logs	in	to	is	vulnerable?
Personal	Infrastructure
Your	reliance	on	an	infrastructure	is	inversely	
proportional	to	how	invisible	it	is	to	you.
We	all	rely	on	oxygen,	our	lungs,	and	our	hearts,	but	
how	often	to	we	think	about	them?
How	often	do	we	do	maintenance	or	debug	them?
“Tech	is	not	neutral	nor	value-free.”
Ben	Zevenbergen,	 Troopers16
The	stairs that almost killed me
Debugging	me
”We need to	be	able to	verify the software that
controls our lives”
Bruce	Schneier on	“Volkswagen	and	Cheating	Software”
Reflections on trusting machines
When	trust	is	broken
http://www.startribune.com/guidant-to-pay-a-fine-of-296m/113367264/
Previous	work
• Kevin	Fu	et	al:
– Pacemakers	and	implantable	cardiac	defibrillators:	Software	radio	attacks	and	
zero-power	defenses (2008)
– Mitigating	EMI	signal	injection	attacks	against	analog	sensors	(2013)
• Barnaby	Jack
• Hardcoded	credentials
• Medical	device	honeypots
• Drug	infusion	pumps
20
Hacking	can	save	lives!
21
http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm456815.htm
WTF	are you doing with my	data?
22
25
Research	needed
• Open	source	medical	devices
• Medical	device	cryptography
• Personal	area	network	monitoring
• Jamming	protection
• Forensics	evidence	capture
The	benefit	outweighs	the	risk
Credits
Éireann Leverett (@blackswanburst)
Tony	Naggs (@xa329)
Gunnar	Alendal (@gradoisageek)
Hugo	Campos	(@HugoOC)
Scott	Erven (@scotterven)
Alexandre Dulaunoy (@adulau)
Claus	Cramon Houmann (@ClausHoumann)
Joshua	Corman (@joshcorman)
Beau	Woods	(@beauwoods)
Suzanne	Schwartz	(US	FDA)
Family	&	Friends
Thank	you!
marie.moe @	sintef.no
www.infosec.sintef.no
www.iamthecavalry.org
@MarieGMoe
@SINTEF_Infosec

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