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The Future of Your Body Is Electric
In the television series Star Trek: The Next Generation, the blind Lieutenant Commander Geordi La Forge wore futuristic goggles called a VISOR (for Visual Instrument and Sensory Organ Replacement). With the VISOR, La Forge enjoyed vision better than humans do with normal eyes.
Today, in the real world, a company called Second Sight is selling an FDA-approved artificial retinal prosthetic, the Argus II. The Argus II provides very limited but functional vision to people who have lost their sight due to retinitis pigmentosa, a retinal ailment that presently afflicts about 1.5 million people worldwide. The Argus II captures images in real time with a video camera and processor mounted on eyeglasses. A wireless chip in the eyeglass rim beams the images to an ocular implant that uses sixty electrodes to stimulate remaining healthy retinal cells, and those cells then send visual information to the optic nerve. The Argus II lets people detect light and motion but not much more; users cannot recognize faces or detect colors, for example. And its cost is prohibitive, at $100,000.
In August 2018, a team of researchers at the University of Minnesota demonstrated a fully 3-D–printed array of light receptors on a hemispherical surface that achieved a 25 percent level of efficiency in converting light into electricity. They said this discovery marked a significant step toward creating a “bionic eye” that could someday help blind people see or sighted people see better.116
It will take many such breakthroughs, but on a Moore’s Law curve, the time from a product such as Argus II to the Star Trek: The Next Generation character La Forge’s fully functional VISOR system should be about twelve years. Still, to think that hundreds of patients already walk the face of the Earth with a direct interface between a video camera and their eye is stunning. The question this raises in my mind is why, as systems such as these become cheaper and better, we wouldn’t proactively replace our eyes with more powerful prosthetics.
The case of the Argus II illustrates how the digitization of everything will have profound positive effects on our world. Vision is fragile; the miraculous biological mechanism that converts light to nerve impulses all too commonly breaks down with age or injury. For example, age-related macular degeneration (AMD) of the retina—a thin layer of light-sensing tissue on the inner eye—presently hobbles as many as two million Americans.
Addressing a broad range of ailments that affect our legs, our eyes, our hearing, and our sense of smell, the pieces are coming together to extend, replace, or improve on the human form. What will be even more shocking is the speed and low cost with which we will be able to build truly personalized, highly customized medical systems that are designed specifically to fit our bodies, our blood chemistry, our environments, and our genes.
Printing Body Parts, Saving Lives
Garrett Peterson’s parents noticed from the day he was born that he frequently stopped breathing and turned blue. Garrett had an exceptionally weak trachea that collapsed frequently, cutting off his air. This is a rare condition, and one that can be fatal. Any stress, including diaper changes or crying, could result in Garrett’s near asphyxiation.117
Garrett was sixteen months old and on the verge of dying from lung damage. His parents approached Scott Hollister, a biomedical engineer at the University of Michigan who had designed many plastic implants. Hollister designed a plastic splint to fit perfectly into Garrett’s throat and hold his windpipe open. He printed the implant with a 3-D printer. The surgery was a success. The splint held Garrett’s trachea open and saved his life. No longer starved for air, he quickly strengthened. Hollister designed the splint to expand as Garrett grows and to eventually dissolve, when the trachea is strong enough to support itself. “He’s being more interactive and more alert and reaching more for his toys. He’s just starting to be more like a normal child,” Garrett’s father, Jake Peterson, told National Public Radio in March 2014. Rather than wait for months or years for a medical-device company to build an implant and run it through the approval process, the Petersons and Hollister built it themselves, and the design and 3-D–printing process took a week and cost less than $10,000. This touching story is only one of many describing how do-it-yourself 3-D printing and other do-it-faster or -cheaper techniques are transforming previously costly tasks into quick, easily replicable exercises. One can readily envision a company emerging in China or the United States that specializes in experimental artificial implants machined with 3-D printers, charging only a few hundred dollars. The implants could be delivered overnight. Or you might print them on your own 3-D printer.
This pairing of personalized 3-D printing with medical prosthetics or enhancement is happening in many places. For example, Ekso Bionics designs and makes robotic exoskeletons to help the paralyzed walk again. Many of Ekso’s customers now pair the exoskeleton with 3-D–printed interface parts to make using the computerized, robotic legs easier and more comfortable.
The new legs have not only freed some Ekso users from wheelchairs but also taken them to places that would have seemed unreachable using older generations of technology. On February 27, 1992, Amanda Boxtel had a freak skiing accident in Colorado.118 An expert skier, she crossed the tips of her skis on an intermediate slope and flipped over, landing on her back on the frozen ground. The spill shattered four vertebrae, leaving her legs paralyzed. In 2012, she received access to an early prototype of Ekso Bionics’s exoskeleton. The first time she stood up and walked, tentatively, heel to toe across the room, she wept. And she knew that in her lifetime she would be able to walk on her favorite beach, hike in the mountains, and maybe, just maybe, even ski again. The computers that coordinate her legs are getting smarter and better; the exoskeletons, stronger, lighter, and less intrusive: software and hardware advancing together at an accelerating rate, like a skier gathering speed for a free and easy downhill run.
The $6,000 Man (and Woman): The Inevitable Progress from Human to Superhuman
The 1970s television series The Six-Million Dollar Man was a favorite of mine. Its lead character, Steve Austin, was an astronaut who had suffered a catastrophic accident. The government experimentally rebuilt him, giving him legs with which he could run at sixty miles per hour, a telescopic eye that could magnify human vision by twenty times, and an arm with the strength of a bulldozer. The procedures cost the U.S. government $6 million. That’s probably close to $350 million today, adjusting for inflation. But what if, in a little over a decade, we could build him for a thousandth of that cost? That is what I believe will be possible.
The body parts need not be made of plastic; 3-D printers can already print out biological materials. Called bioprinting, the process uses so-called bio-ink, a term that describes multi-cellular building blocks and materials that can serve as a scaffolding.
The tissue designer suits the scaffolding design to the target tissue, using inert gels to support fragile cell structures or to create gaps, channels, or void spaces that reproduce physical features of natural tissue, and develops the bioprocess protocols to create from the appropriate cells a bio-ink from which the body will make the target tissue. After designing and testing the bio-ink mixture, the designer can load up the bioprinter and, layer by layer, build the desired tissue structure.
In a paper released in April 2014, Wake Forest University scientists and regenerative-medicine expert Anthony Atala described several successful trials to create de novo vaginas for young girls whose vaginas had been missing or malformed at birth.119 According to the trial results, the implanted vaginas, built using 3-D printing and bio-ink, worked quite well.
Atala has also bio-printed bladders in clinical trials, and is working toward creating more-complex organs with detailed vascular structures, such as kidneys and livers. Adding the blood vessels necessary to feed the tissues or organs that metabolize or process nutrients and toxins remains elusive; that could be decades away. But, within the next decade, any relatively simple structure that you might need replaced—heart valve, bone, ear, or nose—will likely be grown using a mixture of bio-ink and, to minimize risk of rejection, your own stem cells. There are now nearly a dozen companies working toward bioprinting real body materials; and industrial design giants such as Autodesk, led by its visionary CEO, Carl Bass, are researching the fabrication of biological materials through additive printing.
Of course, we will need doctors and surgeons to do all this; it is not like printing and installing a spare part in your car. But these are the technologies that our medical practitioners will commonly use.
As we gain the ability to grow tissues and print organs, we also gain an unprecedented ability to create hybrid materials and weave together biology and chemistry. Nanomaterials are of particular interest in this regard; for example, researchers are studying bone regeneration with nanostructured calcium phosphate biomaterials. The calcium phosphate acts as scaffolding and mimics crystallographic properties of inorganic components of bone. Early findings have shown that these nanostructured materials, when combined with stem cells, can accelerate bone regeneration.
Alongside better-than-human materials will come sensor systems with miniature electronics that turn our bodies into minutely measured machinery. In August 2013, the United States Patent and Trademark Office issued Endotronix a patent for its wireless sensor reader for continuous monitoring of pulmonary-artery pressure. The tiny implanted biosensor is delivered to the artery via routine, minimally invasive, low-cost catheterization. The implant requires no batteries and does not necessitate puncturing patients’ vessels in order to place leads. Instead, patients can hold a smartphone up to their chests, take the measurements, and send the results off to their doctors. Till now, measuring pulmonary-artery pressure—a key indicator of congestive heart failure—on a continuous basis has been difficult and highly invasive.
The movie Fantastic Voyage and its novelization by Isaac Asimov, in 1966, painted a picture of the promise of wireless sensors floating in our bodies and beaming back data. The Endotronix system is one of the very first to start delivering on this promise, and it will be viewed as crude by future researchers. They are already building tiny sensor systems that will allow for true in vivo measurement of many key biological functions. In chapter 7 we discussed pills carrying cameras and other sensors that we can swallow. They are in use already. In effect, we will be wired up with an early-warning system to continuously assess our physical condition, preempt serious health problems, and enable prescription of proactive behaviors and therapies. We will also finally gain deep insights into the validity of many deeply held but unproven assumptions underpinning the systems theory that doctors use to describe our bodies, such as the effect of systemic inflammation on our overall health.
As we wire up our bodies, biohacking becomes a branch of computer hacking, and the sensors that help keep us alive may become a means by which to kill us. Concerned security researchers have already demonstrated that it is possible to hack into the circuitry of pacemakers. As our bodies and their electronic extensions and implants become more intertwined, cyberattacks both on our physical beings and on the information that these sensors generate will become a genuine concern.
Some will ask why we would replace parts of our body with our own cells when, in many cases, a better, longer-lasting, more durable digital alternative exists. Why replace our nose with the same old one, when we could replace it with one that is resistant to sunburn and maybe has additional nerve cells that can better detect smell and enhance our sense of taste? Why simply replace a broken bone with a replica, when we could replace it with a strong bone laced with graphene and bearing wireless sensors to track the healing process along with micro-capsules of anti-inflammatories to reduce swelling around the joint? Why replace a cornea with another one, when we could replace it with a high-resolution camera offering us perfect sight? Why just be human, when we could be superhuman? We are going to be faced with some very interesting choices.
Even as Ekso Bionics, the company that produced Amanda Boxtel’s exoskeleton, continues to improve its product, dozens of companies in different disciplines are attacking problems that, if addressed, could allow Ekso to slash the price of its system and shrink it in size. New robotics components could make it much faster to build Ekso-like systems and shrink to iPhone-size the clunky backpack of wires and silicon that Amanda carries.
Speculation about digital enhancement has extended even into the realm of the brain. Recent articles have called into question the value of rote learning, asking whether we should bother memorizing material that we can easily look up via Google. And some of the staunchest advocates for transhumanism often cite Google and search technology as an extension of our brains, a way to make it far easier for us to store, parse, and recall information as needed.
To date, there has always been a relatively clear line between what was human and what was technology. Even sophisticated technology, such as cochlear implants and pacemakers, sought to work with our existing tools, not necessarily to supplant them with a more powerful version. In the late 2020s, we will have not only crossed that line but sprinted past it.
If we become entirely dependent on these electronic crutches, will they degrade our inherent evolutionarily hard-won capabilities so far that we could no longer recoup them should the figurative plug be pulled on our extended being?
On the other hand, as we learn to create digital proxies for biological and biophysical processes, could our ability to permanently cure or mitigate the most debilitating ailments give us the digital keys to something akin to the fountain of youth?
Does the Technology Foster Autonomy Rather Than Dependence?
For paraplegics or people who would otherwise die or become blind without the help of innovative new technology, clearly the new “body electric” represents a tremendous leap forward in autonomy without any measurable accompanying increase in dependency. In these cases, the body electric can replace the broken and the dysfunctional with something that is better and that may eventually be even better than the original human editions.
Where we start to cross into territory that is less obvious is in incorporating technologies for enhancement that is more cosmetic or merely desirable rather than necessary. This can be particularly troubling if the artificial component replaces the human component—a digital eye for an analog eye, for example. This would be a one-way journey, for the most part: a one-way journey that might increase autonomy in some ways but, by and large, will make us most intimately dependent on our devices. That dependency should be carefully considered, because converting our sensory organs and limbs and muscles and even our brains to digital extensions, while incredibly enticing, opens us up to many new risks (some discussed in earlier chapters). For digital devices, there are bits and bytes, software, and many, many failure states. Sudden failure, we should remember, could be catastrophic.
No doubt, some athletes will do this, and the doping scandals of today will become the bionics scandals of tomorrow. Some people will want the enhancements that Steve Austin had so they can climb mountains and observe nature more closely. Whether this is good or bad is what we will be debating in the late 2020s and 2030s.
And, of course, on the technologies just emerging, there are no long-term studies that tell us what will happen many years in the future. We are taking big risks. And we are becoming entirely dependent on electronic crutches that could degrade our inherent evolutionary capabilities so far that we couldn’t recover them.
So we will be making trade-offs and upgrading ourselves with technologies that make us less and less human. But is that really different than the medical choices we make today? When we get eyeglasses, we commit ourselves to a lifetime of medical enhancement. When I had my heart attack in 2002, I chose to have surgery and had drug-eluting stents placed in my arteries. These slowly release a drug to block cell proliferation. My cardiologist warned me that this was new technology and there were no very-long-term studies of their efficacy yet. He said that he believed that these stents were substantially better than the older bare-metal stents, but that I would have to take blood thinners to prevent sudden stent closure due to clotting—perhaps for the rest of my life. I chose the risk and accepted the fact that I would be taking a regimen of heart medications for as long as I lived. It was the trade-off that has allowed me to live a healthy and more-or-less normal life.
These are the types of choices, for better health and for longer lives, that we will all be facing.