The Future (43 page)

Even though the merger between people and machines may remain in the realm of science fiction for the foreseeable future, the introduction of mechanical parts as replacements for components of the human body is moving forward quickly. Prosthetics are now being used to
replace not only hips,
knees,
legs, and
arms,
but also eyes and other body parts that have not previously been
replaceable with artificial substitutes.
Cochlear implants, as noted, are used to restore hearing. Several research teams have been developing mechanical
exoskeletons to enable paraplegics to walk and to
confer additional strength on soldiers and others who need to carry heavy loads. Most
bespoke in-ear hearing aids are already made with 3D printers. The speed with which 3D printing is advancing makes it inevitable that many other prosthetics will soon be printed.

In 2012, doctors and technologists in the Netherlands used a 3D printer (described in
Chapter 1
) to fabricate a lower jaw out of titanium powder for an elderly
woman who was not a candidate for traditional reconstructive surgery. The jaw was designed in a computer with articulated joints that match a real jaw, grooves to accommodate the regrowth of veins and nerves, and precisely designed depressions for her muscles to be attached to it. And of course, it was sized to perfectly fit the woman’s face.

Then, the 3D digital blueprint was fed into the 3D printer, which laid down titanium powder, one ultrathin layer at a time (thirty-three layers for each millimeter), and fused them together with a laser beam each time, in a process that took just a few hours. According to the woman’s doctor, Dr. Jules Poukens of Hasselt University, she was able to use the printed jaw normally after awakening from her surgery, and one day later was able to swallow food.

The 3D printing of human organs is not yet feasible, but the emerging possibility has already generated tremendous excitement in the
field of transplantation because of the current shortage of organs. However, well before the 3D printing of organs becomes feasible, scientists hope to develop the ability to generate replacement organs in the laboratory
for transplantation into humans. Early versions of so-called exosomatic kidneys (and livers) are now being grown by
regenerative medicine scientists at Wake Forest University. This emerging potential for people to grow their own replacement organs promises to transform the field of transplantation.

Doctors at the Karolinska Institute in Stockholm have already created and successfully transplanted a replacement windpipe by inducing the patient’s own cells to regrow in a laboratory on a special plastic “scaffolding” that
precisely copied the size and shape of the windpipe it replaced. A medical team in Pittsburgh has used a similar technique to grow a quadriceps muscle for a soldier who lost his original thigh muscle to an explosion in Afghanistan, by implanting into his leg a scaffold made from a pig’s urinary bladder (stripped of living cells), which stimulated his stem cells to rebuild the muscle tissue as they
sensed the matrix of the scaffolding being broken down by the body’s immune system. Scientists at MIT are
developing silicon nanowires a thousand times smaller than a human hair that can be embedded in these scaffolds and used to monitor how the regrown organs are performing.

As one of the authors of the National Organ Transplant Act in 1984, I learned in congressional hearings about the problems of finding enough organ donors to meet the growing need for transplantation. And having sponsored the ban on buying and selling organs, I remain unconvinced by the argument that this legal prohibition (
which the U.S. shares with all other countries besides Iran) should be removed. The potential for abuse is already obvious in the disturbing black market trade in organs and tissues from people in poor countries for
transplantation into people living in wealthy countries.

Pending the development of artificial and regenerated replacement organs, Internet-based tools, including social media, are helping to address the challenge of finding more
organ donors and matching them with those who need transplants. In 2012,
The New York Times
’s Kevin Sack reported on a moving example of how sixty different people became part of “
the longest chain of kidney transplants ever constructed.” Recently, Facebook announced the addition of “organ donor” as one of the items to be updated on the profiles of its users.

Another 3D printing company, Bespoke Innovations of San Francisco, is using
the process to print more advanced artificial limbs. Other firms are
using it to make numerous medical implants. There is also a
well-focused effort to develop the capacity to
print vaccines and pharmaceuticals from basic chemicals on demand. Professor Lee Cronin of the University of Glasgow, who leads one of the teams focused on the 3D printing of pharmaceuticals, said recently that the process they are working on would place the molecules of common elements and compounds used to formulate pharmaceuticals into the equivalent of the cartridges that feed different color inks into a conventional 2D printer. With a manageably small group of such cartridges, Cronin said, “You can make any organic molecule.”

One of the advantages, of course, is that this process would make it possible to transmit the 3D digital formula for pharmaceuticals and vaccines to widely dispersed 3D printers around the world for the manufacturing of the pharmaceuticals on site with negligible incremental costs for the tailoring of pharmaceuticals to each individual patient.

The pharmaceutical industry relied historically on large centralized manufacturing plants because its business model was based on the idea of a mass market, within which large numbers of people were provided
essentially the same product. However, the digitization of human beings and molecular-based materials is producing such an extraordinarily high volume of differentiating data about both people and things that it will soon no longer make sense to lump people together and ignore medically significant information about their differences.

Our new prowess in manipulating the microscopic fabric of our world is also giving us the ability to engineer nanoscale machines for insertion into the human body—with some active devices the size of living cells that can coexist with human tissue. One team of nanotechnologists at MIT announced in 2012 that they have successfully built “nanofactories” that are theoretically capable of producing proteins while inside the human body when they are
activated by shining a laser light on them from outside the body.

Specialized prosthetics for the brain are also being developed. Alongside pacemakers for hearts, comparable devices can now be inserted into brains to compensate for damage and disorders. Doctors are already beginning to implant computer chips and
digital devices on the surface of the brain and, in some cases, deeper within the brain. By cutting a hole in the skull and placing a chip that is wired to a computer directly on the surface of the brain, doctors have empowered paralyzed patients with the ability to
activate and direct the movement of robots with their thoughts.
In one widely seen demonstration, a paralyzed patient was able to direct a robot arm to pick up a cup of coffee, move it close to her lips, and insert the straw between her lips so she could take a sip.

Experts believe that it is only a matter of time before the increased computational power and the reduction in size of the computer chips will make it possible to
dispense with the wires connecting the chip to a computer.
Scientists and engineers at the University of Illinois, the University of Pennsylvania, and New York University are working to develop a new form of interface with the brain that is flexible enough to stretch in order to fit the contours of the brain’s surface. According to the head of R&D at GlaxoSmithKline, Moncef Slaoui, “The sciences that underpin bioelectronics are proceeding at an amazing pace at academic centers around the world but it is all happening in separate places. The challenge is to integrate the work—in brain-computer interfaces, materials science,
nanotechnology, micro-power generation—to provide therapeutic benefit.”

Doctors at Tel Aviv University have equipped rats with an artificial cerebellum, which they have attached to the
rat’s brain stem to interpret information from the rest of the rat’s body. By using this information, doctors are able to stimulate motor neurons to move the rat’s limbs. Although the work is at an early stage, experts in the field believe that it is only a matter of time before artificial versions of entire brain subsystems are built. Francisco Sepulveda, at the University of Essex in the U.K., said that the complexity of the challenge is daunting but that scientists see a clear pathway to succeed. “It will likely take us several decades to get there, but my bet is that specific, well-organized brain parts such as the hippocampus or the visual cortex will have
synthetic correlates before the end of the century.”

Well before the development of a synthetic brain subsystem as complex as the hippocampus or visual cortex, other so-called neuroprosthetics are already being used
in humans, including prosthetics for bladder control,
relief of spinal pain, and the
remediation of some forms of blindness
and deafness. Other neuroprosthetics expected to be introduced in the near future will, according to scientists, be able to stimulate particular parts of the brain
to enhance focus and concentration, that with the flip of a switch will stimulate the neural connections associated with “practice” in order to enhance the ability of a stroke victim to learn how to walk again.

As implants, prosthetics, neuroprosthetics, and other applications in cybernetics continue to improve, the discussion about their implications has broadened from their use as therapeutic, remedial, and reparative devices to include the implications of using prosthetics that
enhance
humans. For example, the brain implants described above that can help stroke victims learn more quickly how to walk again, can also be used in healthy
people to enhance concentration at times of their choosing to help them learn a brand-new skill, or enhance their capacity for focus when they feel it is particularly important.

The temporary enhancement of mental performance through the use of pharmaceuticals has already begun, with an estimated 4 percent of college students routinely using attention-focusing medications like
Adderall, Ritalin, and Provigil to improve their test scores on exams. Studies at some schools found rates as high as 35 percent. After an in-depth investigation of the use of these drugs in high schools,
The New York Times
reported that there was “no reliable research” on which to base a national estimate, but that a survey of more than fifteen schools with high academic standards yielded an estimate from doctors and students that the percentage of students using these substances “
ranges from 15 percent to 40 percent.”

The
Times
went on to report, “One consensus was clear: users were becoming more common … and some students who would rather not take the drugs would be compelled to join them because of the competition over class rank and colleges’ interest.” Some
doctors who work with low-income families have started prescribing Adderall for children to help them compensate for the advantages that children from wealthy families have. One of them, Dr. Michael Anderson, of Canton, Georgia, told the
Times
he thinks of it as “evening the scales a little bit.… We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

A few years ago, almost 1,500 people working as research scientists at institutions in more than sixty countries responded to a survey on the use of brain-enhancing pharmaceuticals. Approximately 20 percent said that they had indeed used such drugs, with the majority saying they
felt they improved their memory and ability to focus. Although inappropriate use and dangerous overuse of these substances has caused doctors to warn
about risks and side effects, scientists are working on new compounds that carry
the promise of actually boosting intelligence. Some predict that the use of the improved intelligence-enhancement drugs now under development may well become commonplace and carry
as little stigma as cosmetic surgery does today. The U.S. Defense Advanced Research Projects Agency is experimenting with a different approach to enhance concentration and speed the learning of new skills, by using small electrical currents applied from outside the skull to the part of the brain
used for object recognition in order to improve the training of snipers.

At the 2012 Olympics, South Africa’s Oscar Pistorius made history as the
first double amputee track athlete ever to compete. Pistorius, who was born with no fibulas in his lower legs, both of which were amputated before he was one year old, learned to run on prosthetics. He competed in the 400-meter sprint, where he reached the semifinals, and the 4 × 400
relay, in which the South African team reached the finals.

Some of Pistorius’s competitors expressed concern before the games that the flexible blades attached to his prosthetic lower legs actually gave him an unfair advantage. The retired world record holder in the 400-meter sprint, Michael Johnson, said, “Because we don’t know for sure whether he gets an advantage from the prosthetics,
it is unfair to the able-bodied competitors.”

Because of his courage and determination, most were cheering for Pistorius to win. Still, it’s clear that we are already in a time of ethical debate over whether artificial enhancements of human beings lead to unfair advantages of various kinds. When Pistorius competed two weeks later in the Paralympics, he himself lodged a protest against one of the other runners whose prosthetic blades,
according to Pistorius, were too long compared to his height and gave him an unfair advantage.

In another example from athletics, the use of a hormone called erythropoietin
(EPO)—which regulates the production of red blood cells—can give athletes a significant advantage by
delivering more oxygen to the muscles for a longer period of time. One former winner of the Tour de France has already been stripped of his victory after he tested positive for elevated testosterone.
He has admitted use of EPO, along with other illegal enhancements. More recently, seven-time Tour de France winner
Lance
Armstrong was stripped of his championships and banned from cycling for life after the U.S. Anti-Doping Agency released a report detailing his
use of EPO, steroids, and blood transfusions, doping by other members of his team, and a complex cover-up scheme.