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The future of surgery in a world of human enhancement

By Rohit Talwar

Humanity’s technological reach has grown to a point where it is now possible to biologically and physically enhance healthy individuals so that they may obtain extreme characteristics and abilities. The human enhancement procedures already available to consumers offer a taste of what’s yet to come: in-eye cameras, computer chip implants, and do it yourself (DIY) gene editing are just a few examples already being implemented. So where might we go from here?

Here we look at ten human enhancements that are possible now, or could soon be, and discuss the possible implications of the rise in these different forms of “biohacking” for patients and the surgical profession.

Exoskeletons

Achieving superhuman strength and endurance might be possible with an exoskeleton suit of external body armour that turns any average person into Iron Man. Physical labour would be made easier with the addition robotic arms, legs, and a back which never tire or run low on energy. Whilst this would be great for work or recreational sports, there is potential adverse employment side-effect. With fewer exoskeleton-enhanced people required to do the work, it puts house movers, miners, farm labourers, warehouse staff, and construction workers at risk of being “replaced by cyborgs.”

Of all the enhancement procedures discussed here, the fitting of exoskeletons is the one most commonly in use today. Indeed, for many it might appear to be the safest and most likely to be adopted by the medical profession without serious concerns about the potential side effects or procedural risks.

Endoskeletons

The goal here is to help humans become stronger and fitter from the inside out, but without most of the requirement for exercise and healthy eating. Physical and genetic enhancements applied to bones and muscles would improve body mass index (BMI) and performance from the outset. Reinforced bones would improve tone and strength with no extra work needed.

Surgical attachments to the spinal cord are nothing new, but the materials involved in the enhanced endoskeleton would be nothing like those used in the past. In the future, spinal cords could be fitted with dynamic, shape-shifting, responsive, and potentially 4D printed materials. The would provide a custom created backbone which is stronger, self-healing or “smart” in the sense that it can gather, transmit, and receive information.

Becoming surgically transformed into a cyborg may cross ethical and psychological boundaries similar to the intricacies recognized in the use of transgender operations and drug treatments. The rise of new identities and changed sense of self as a result of human enhancements may complicate the evolution of such “biohacking”, and require mandatory therapy or other psychological preparation for potential patients.

Cosmetic Gene Editing

The genome editing technology known as CRISPR/ CAS introduced in 2012 has already made it inexpensive and relatively easy to alter DNA sequences and alter gene functions inside the body. The CRISPR system’s ease of use means it could be used for almost any gene-editing technique. While doctors could apply the technology as a targeted cancer treatment, we could also see the same approach used for cosmetic augmentation. For example, high street centres could provide services to change clients’ hair thickness, eye colour, and skin pigmentation, making CRISPR treatments as common as other beauty and lifestyle options. Could we see regular beauty parlours and tattoo shops offering such services in the future?

In 2017, a doctor made headlines by using CRISPR to become the first human to modify his own DNA, with the goal of gaining superhuman strength by removing a protein that limits muscle growth. What are the implications for the future of health care when such life-changing genetic modifications could be obtained or even self-administered on a whim?

Memory Implants

In 2017, a research team from the University of Southern California used neural implants to boost test subjects’ short-term memory by 15-25%. The hope is that neural implants, possibly in the form of a “neural lace” lattice of tiny sensors under or just above the skull, could improve memory and may ultimately also prevent Alzheimer’s disease. This would make sense for elderly patients who’ve not yet started showing signs of dementia and be appealing to the radical age-extenders and transhumanists. However, the authenticity of memories could come into question in a future where memory implants exist.

4D Printed Skin

4D printed materials are essentially “shape shifting” in the sense that they can change their form and properties based on external stimuli. So, wetness might prompt rapid drying or absorption, heat would trigger a cooling effect, and so forth. In the future, enhancements such as a skinsuit, an active skin covering, or a surgical skin implant could give humans the ability to adapt to their environment seamlessly. Clothing may become unnecessary; form-fitting shape-shifting material could adapt to look like clothes, skin, or whatever the wearer selects. 4D printed skin might be viewed as an essential adaptation in extreme climates.

Surgeons would clearly need to learn a range of these new skin enhancement techniques. They might also be at the forefront of research and experimentation in developing these different printed skin solutions.

Organ Regeneration

The ability to regenerate human organs could end the ravages of disease, aging, and even injury. By 2030, organ modification and regeneration may be singled out as the signature body transformations being taken up by those pursuing life-extension. Being able to regrow diseased organs would also signal a victory in the fight against numerous chronic and terminal diseases like diabetes and pancreatic cancer.

Organ regeneration would imply tremendous ethical and scientific paradigm shifts for society. A key issue this raises for the profession is whether it would eliminate the need for surgical transplants. A concern might be a growing perception of organs as a consumer good. For example, what kind of regulations might need to be in place to govern the giving of organs as gifts? Furthermore, there is also the risk that such readily available solutions could actually enable irresponsible behaviour. For example, alcoholics and drug addicts might increase their level of bodily abuse because the situation can be reversed easily with organ regeneration.

Catching the Rainbow

Gene therapy has cured colour blindness in monkeys; if clinical trials are allowed, colour blind humans may be next. Eventually, science may expand our colour vision to include all wavelengths of light, from gamma rays and ultraviolet through to radio waves. Humans might literally see the world in a whole new light.

Today, smart contact lenses and eye implants, potentially with built-in cameras, are evolving as both consumer devices and medical devices that can potentially detect disease. Could genetic therapy or wearables eventually replace the surgeon’s role in healing optical disorders and vision defects?

Beyond Sound

As humans age, we naturally lose the ability to hear higher frequencies. In the future, we may be able to reverse this, or even enhance human hearing beyond the normal range via aural implants directly connected to our brains.

Brain implants are one of the more common enhancement strategies being pursued by researchers in the field, although their practical use may be at least a decade away. When and if it does become normal, the surgical enhancement of different senses (smell, sight, sound) might spawn new surgical specialties, similar to today’s cosmetic surgery specializations but focused on extending our natural abilities, not meeting beauty ideals

Reputation Sleeve

One’s online reputation may become a valuable form of currency in the future, for example, becoming a key selection criterion on job or credit applications. Tattoos or embedded objects could change, grow, morph, and otherwise shape-shift depending on one’s fluctuating online reputation score. A score might be comprised of the number of social media contacts, shares, likes, or uploads.

This type of enhancement might lend itself to DIY experimentation, in the same ways as computer chip inserts and other implants have been self-administered by so-called “body hackers” and “grinders” who are willing to take enhancement procedures into their own hands. These fringe activists are known for embedding chips into their skin in private and unregulated labs, where personalized body hacks can be obtained. The surgical profession might have special concerns over the safety and future growth of body hacking, particularly the potential to be called in to repair self-inflicted damages among DIY cyborgs.

3D Printed Wings

Imagine customized 3D printed wings, perfectly designed to bring aerodynamic freedom and flight to human beings. Could such vanity appendages eventually be attached surgically and removed by a home-visiting robo-surgeon or with a DIY kit? On the one hand, the administration of such cosmetic enhancements could be an important additional revenue stream for clinics, hospitals, and individual surgeons. On the other, emergency rooms could find themselves over run with the consequences of unsafe and unsupervised attempts at self-enhancement.

The divide between the supporters and opponents of human enhancement grows by the day – with a range of ethical, safety, moral, access, and religious issues being debated. From a surgical perspective, every one of the potential enhancements or biohacks described here could lead to reckless and ethically questionable activity. Ultimately, medical professionals may have a significant say in defining the boundaries of safe and acceptable procedures to ensuring that human enhancement doesn’t become a future form of societal self-harm.

 

Image: https://pixabay.com/photos/book-landscape-nature-wind-weather-2929646/

 

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