Redesigning People: How Medtech Could Expand Beyond the Injured

By David Ewing Duncan

Radical human modification is coming, like it or not, by the end of this century—if not earlier. How much are you willing to alter yourself?

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This is my first column on TheAtlantic.com, which will regularly cover the interface between new discoveries in the life sciences and how it impacts people and society -- and other random topics.

Last fall at the TEDMED meeting in San Diego I watched a man walk who was paralyzed from the waist down. Injured a year earlier, Paul Thacker hadn't been able to stand since breaking his back in a snowmobile accident. Yet here he was walking, thanks to an early-stage exoskeleton device attached to his legs.

This wasn't exactly on the level of "exos" we've seen in sci-fi films like Avatar and Aliens, which enable people to run faster, carry heavier loads, and smash things better. But Thacker's device, called eLEGS -- manufactured by Ekso Bionics in Berkeley, California -- is one harbinger of what's coming in the next decade or two to treat the injured and the ill with radical new technologies.

Other portents include first-generation machines and treatments that range from deep brain implants that can stop epileptic seizures to stem cells that scientists are using experimentally to repair damaged retinas.

No one would deny that these technologies, should they fulfill their promise, are anything but miraculous for Paul Thacker and others who need them. Yet none of this technology is going to remain exclusively in the realm of pure therapeutics. Even now some are breaking through the barrier between remedies for the sick and enhancements for the healthy.

Would you take a daily pill that not only stimulated your brain to help you do your best on a test, but also boosted memory?

Take the drug Adderall. A highly addictive pharmaceutical prescribed for patients with Attention Deficit Hyperactivity Disorder (ADHD), the drug works as a stimulant in people without ADHD -- and is now used by at least one out of five college students to bump up their energy and attention when they want to perform well on tests or pull all-nighters.

Saying that college students are popping pills is like Claude Rains in Casablanca saying to Humphrey Bogart: "I'm shocked, shocked to find that gambling is going on in here." Yet the widespread use -- and acceptance -- of Adderall and other stimulants by students to enhance their academic performance is bumping up against something new. It's pushing us into a realm where taking powerful pharmaceuticals that boost, say, attention or memory is becoming acceptable beyond pure recreation.

Can we be too far from a greater acceptance of surgically implanted devices that increase our ability to hear or see? Or new legs that allow us to run like cheetahs and scramble up walls like geckos?

Or that allow us to run in the Olympics like Oscar Pistorius, the South African sprinter who may qualify for the games in London this year despite missing his lower legs? He runs using two sleek, metallic "legs" that combine with his natural speed and skill to do far more than overcome a disability.

Which leads us to the crucial question for the approaching age of human enhancement: How far would you go to modify yourself using the latest medtech?

Would you replace perfectly good legs with artificial ones if they made you faster and stronger?

Would you take a daily pill that not only stimulated your brain to help you do your best on a test, but also bumped up your memory?

Would you sign up for a genetic alteration that would make you taller and stronger?

Let's up the ante and declare that these fixes had no deleterious side effects, and were deemed safe by a newly appointed U.S. Agency for Human Augmentation. Would this change your mind? (As an aside, I'm trying to imagine what the candidates now vying for the Republican nomination for president would say about an Agency for Human Augmentation.)

And what if everyone else at work -- or all of the rest of the kids in your child's class at school -- were taking advantage of these enhancements?

Currently, none of these hypothetical modifications would be ethical, and most are illegal. Yet one doesn't need to spend too much time delving into the world of near-future medtech to understand that each of these possibilities are likely to occur in one form or another in the lifetime of those college kids now swallowing Adderall.

For now, the device attached to Paul Thacker's legs is clunky. The apparatus is little more than a pair of sophisticated braces with whirring mechanics attached to a computer he wears on his back -- which is guided by a technician walking behind him, holding a control box attached to the computer with a wire. But it won't be too long until this 37-year-old former champion snowmobile jumper will be walking with ease using an advanced exoskeleton.

In a few more years, you might be wearing your own eLEGS to carry heavy loads around the house, or as a soldier on patrol in some distant corner of the world (assuming we aren't using only drones). Flash forward a few more years, and you may have the option of permanently implanting in your legs the "eLEGS LXII," an endo-skeletal implant that stays with you like a futuristic hip or knee implant does today.

Back at TEDMED, Paul Thacker wasn't thinking about anything nearly as grandiose as this. When I asked him what he wishes for most using the new eLEGS technology, he smiled and said something refreshingly mundane considering he is a herald of the future.

"Right now I'd like to be able to stand up and pee," he said. "I really miss being able to do that."

Image: Ekso Bionics.

This article available online at:

http://www.theatlantic.com/health/archive/2012/02/redesigning-people-how-medtech-could-expand-beyond-the-injured/253236/