You may still be gnawing on the bones of Terry’s November 26th Acumen blog post on the QPP Final Rule impact on Advanced Alternative Payment Models, but Thanksgiving is in the history books and it is the December holiday season! Did you join the millions of shoppers on Cyber Monday? I did, and I expect that somewhere north of 80% of my Christmas shopping will be online this year. It’s hard to beat shopping from my couch, especially when it’s 35 degrees Fahrenheit in Boston.
I’m shopping for family gifts and also keeping an eye out for goodies to add to my handy Amazon “wish list.” It is so easy to add one item to my Amazon shopping cart and one item to my “wish list,” just in case Santa is filling up his sleigh for a trip to the Maddux house. I’m hunting for some high-tech gadgets like Bose noise-cancelling headphones and iRobot Roomba.
The iRobot Roomba replaces old fashioned vacuuming, but what about new technology that can really change your life? Human enhancements are defined as, “any kind of genetic, biomedical, or pharmaceutical intervention aimed at improving human dispositions, capacities, or well-being, even if there is not pathology to be treated.” A lot has been written about human enhancement ethical and moral issues in the past 10 years and the Chinese researcher announcement about using CRISPR to alter the genes of 2 babies to render them HIV resistant has rekindled this discussion. Publications on the subject note arguments that medicine should be focused on restoring health to the natural human condition, a “return to health,” but others argue that the human condition is about change and making people “better.”
This year AARP published survey results on “U.S. Public Opinion and Interest on Human Enhancements Technology” examining public acceptance of theoretical enhancements for vision, mobility, cognition, and gene editing. Results show that most adults believe that technology advancements have a positive impact for individuals and society. People favor the use of technology to restore lost human function such as joint replacement or cognitive ability due to dementia. Generally, there is support for individual choice about human enhancements if they don’t harm others, but there are concerns about disparities for those who can afford new technology and those who can’t.
The Hastings Center recently published an overview of the technology surrounding “Enhancing Humans.” Enhancement with good and bad aspects has always been present in society. The printing press made the written word widely available and progressive enhancements since the Gutenberg printing press support modern social media platforms. Artificial intelligence is a human enhancement that is leading to self-driving cars and drones, both of which still require human control, but may become entirely autonomous in the future. An example of a common healthcare-related human enhancement is vaccination, which enhances the immune system.
Human enhancement in the next decade
According to the multimedia Big Think website, here are some human body enhancements we may be able to add to our gift lists over the next 10 years:
- Personal radio-frequency identification (RFID) microchip implantation that carries credit card and identification that eliminates the need for a wallet and/or keys.
- Exoskeletons that provide mobility for people with paralysis and can be used to augment normal human walking and running ability. The Defense Advanced Research Projects Agency (DARPA) is exploring wearable exoskeletons as a way for soldiers to hike long distances carrying more weight.
- Real-time language translation such as using Pixel earbuds coupled with the AI of Google Translate.
- Augmented vision starting with “bionic eyes” for blindness utilizing a camera with retina electrodes providing an image for the brain. Ocumetrics Technology Corp claims to have developed an implantable lens that provides superhuman vision, better than 20/20. A contact lens that monitors glucose levels in tears for diabetes management is currently in development.
- 3D-printed body parts started with relatively simple tasks like printing skin and ears, but advancements are being made to print vascular structures and complex vital organs like hearts, lungs, and kidneys.
Making human enhancements human
Hugh Herr, MIT professor and researcher, gave an amazing talk at TED2018 about building body parts for human augmentation. He talks about his bilateral lower limb protheses that have computers responsive to his thoughts about movement and subsequent nervous system muscle stimulation initiating movement. He notes that today he is “not a cyborg”; he signals movement to the computer of his prothesis, but he does not receive nervous system stimulation back reflecting the experience and sensation of walking or running. He does not experience his prosthetic limbs as “self.” The future of bidirectional communication between the human nervous system and synthetic prosthetic body parts is coming and will result in blending of the biological body with the “built-design world” beginning an era of true human enhancement.
Human enhancement using nanotechnology, biotechnology, information technology, and cognitive sciences may make us “better than well,” moving healthcare beyond restoring health to providing general well-being. In a review of ethical issues raised by human enhancement, author Andy Miah notes that enhancements that seemingly affect only individuals may ultimately impact the larger society. Improving individual abilities to work longer, live longer, and play harder affects the workplace, retirement plans, and healthcare services, not to mention communities and families. Healthcare may move beyond treatment for a health problem to helping people live desired life styles.
Some human enhancements seem excellent and I think I’ll keep them on my “Wish List” for now. We’ll have to wait and see how human enhancement works out for individuals and for humans collectively. How do you feel about disrupting the “natural balance” of the human condition through human enhancements? Is augmentation a natural part of ever-changing human nature? Send a comment about the human enhancements on your gift list.
Dugan Maddux, MD, FACP, is the Vice President for CKD Initiatives for FMC-NA. Before her foray into the business side of medicine, Dr. Maddux spent 18 years practicing nephrology in Danville, Virginia. During this time, she and her husband, Dr. Frank Maddux, developed a nephrology-focused Electronic Health Record. She and Frank also developed Voice Expeditions, which features the Nephrology Oral History project, a collection of interviews of the early dialysis pioneers.
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