Thousands of Third-Party Library Flaws Put Pacemakers at Risk

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Researchers have conducted a detailed analysis of pacemaker systems from four major vendors and discovered many potentially serious vulnerabilities.

The fact that implantable cardiac devices such as pacemakers and defibrillators are vulnerable to hacker attacks has been known for years, and while steps have been taken to address issues, security experts still report finding flaws in these products.

WhiteScope, a company founded by Billy Rios, one of the first security researchers to analyze medical devices, recently conducted an analysis of the implantable cardiac device ecosystem architecture and implementation interdependencies, with a focus on pacemakers.

The analysis covered home monitoring systems, implantable devices, pacemaker programmers, and the patient support networks of four vendors. Researchers investigated each type of device and the communications between them.

Tests conducted on devices acquired from eBay showed that reverse engineering their firmware is made easy by the fact that many of them use commercial, off-the-shelf microprocessors.

In the case of home monitoring devices, researchers discovered data sheets publicly available on the Internet, allowing attackers to determine how they work and how they can be manipulated. Firmware reverse engineering is also made easy by the lack of packing, obfuscation and encryption.

Debugging functionality present in implanted devices also exposes firmware. Malicious actors could leverage these features to gain privileged access to home monitoring devices and the pacemaker programmers used by physicians to diagnose and program the actual cardiac devices.

WhiteScope has analyzed four pacemaker programmers and found that they use more than 300 third-party libraries. Of these components, 174 are known to have a total of more than 8,000 vulnerabilities.

“Despite efforts from the FDA to streamline routine cybersecurity updates, all programmers we examined had outdated software with known vulnerabilities,” Rios said in a blog post. “We believe that this statistic shows that the pacemaker ecosystem has some serious challenges when it comes to keeping systems up-to-date. No one vendor really stood out as having a better/worse update story when compared to their competitors.”

In some cases, researchers found unencrypted patient data stored on the programmers, including SSNs, names, phone numbers and medical information. Since these programmers typically use removable storage drives, it’s easy for a local attacker to mount the drive and extract the entire file system.

Another potential problem is the fact that programmers do not require any type of authentication for programming implantable cardiac devices.

The list of security holes found by experts in home monitoring devices includes the failure to map the firmware to protected memory, firmware updates not digitally signed or protected against man-in-the-middle (MitM) attacks, hardcoded credentials, unsecured external USB connections, and the usage of universal authentication tokens for pairing with the implanted device.

The vendors have not been named and the details of the vulnerabilities found by WhiteScope have not been disclosed to the public, but they have been reported to ICS-CERT, which will likely alert affected companies.

Related: Sobering Thoughts When a Connected Medical Device Is Connected to You

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Eduard Kovacs is an international correspondent for SecurityWeek. He worked as a high school IT teacher for two years before starting a career in journalism as Softpedia’s security news reporter. Eduard holds a bachelor’s degree in industrial informatics and a master’s degree in computer techniques applied in electrical engineering.

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