Do you have a cochlear implant? An intraocular lens in your eye? A prosethetic leg with microservos? You may not realize it, but you're standing on the front line of a new age of medical augmentation, one that's raising a host of complex questions.
Who owns the expensive implant that allows you to hear or see better or the sleek thin blades that let you sprint faster? How are upgrades to your device handled? What happens to you and your device if that company goes out of business? Do the answers change if the procedure is elective rather than life-saving?
No one has easy answers, or even much beyond informed speculation -- certainly not the doctors we spoke to for this article or the medical students who addressed medical augmentation at a Defcon 20 session last month in Las Vegas. But all agree on one thing: A new frontier of medical augmentation isn't just coming sooner than you think. It's already here, as society moves from medically necessary augmentation to elective procedures. Call it human hacking.
--Dr. Daniel Kraft, executive director, FutureMed
"Hackers break down systems to build them up better," Jeff "r3plicant" Tully said at Defcon. The Defcon audience ate up the compliment. For the bulk of their session, Tully and Christian "Quaddi" Dameff -- both third-year med students at a U.S. school they declined to identify -- outlined the idea that the human body is just another system people can separate into its component parts and put together better than before.
"There are three reasons to augment: to impress chicks, to get titanium abs, and because we can," Dameff said, tongue planted firmly in cheek.
Daniel Kraft, a physician-researcher who trained at Harvard and Stanford universities, didn't address the chick-impressing motivation. But he agrees that electronic and chemical augmentation are becoming inseparable from modern medicine.
"I think one way to frame this is how "hacking" is moving from enabling the disabled to becoming super-enabled," Kraft told CNET. Executive director for FutureMed and the Medicine and Neuroscience Chair at Singularity University, Kraft said this shift marks the democratization of medical technology. "There's a point coming where you can hack DNA in your garage."
Take Trevor Prideaux, an amputee with a vision for adding a smartphone to his prosthetic appendage -- and the persistence to find the right people to make it happen. Now he can hold his arm up to his ear to make and receive calls or hit the speakerphone button more easily. There's Jerry Jalava, who thought up a prosthetic finger with a USB device attached. And Wafaa Bilal, an arts professor who had a digital camera implanted in the back of his head so he could take photos of what was going on behind his back.
"[Medicine is] generally riding exponential trends of smaller devices, connected computing, and big data," Kraft said.
So, just what is modern "medical augmentation"? Dameff and Tully define it as the administration of drugs to alter body or brain chemistry; surgical replacement of limbs or organs with mechanical ones; or introduction of electrical devices into the human body, such as neuroprosthetic electrodes that can be implanted in the brain to prevent seizures.
The medical students said their definition of a new age of medical augmentation coincides with the birth of 20th century medicine. While basic prosthetics came into use in the 1500s, they argued, it wasn't until the first human electroencephalograph (EEG) in 1924 that electronics were used to analyze the body. Only three years later, amphetamines were first used for chemical augmentation.
'Blade Runner's' artificial legs controversial at Olympics
There is, however, a huge chasm between medically necessary augmentation and similar procedures or devices uses electively, said Peter Weber, a neurosurgeon at San Francisco's California Pacific Medical Center who specializes in surgical treatments for spine and brain disorders like epilepsy. While the kinds of neuroprostheses that Weber uses can have a real, measurable impact on people with these conditions, he says there's little real data as to how similar techniques might work in basically healthy individuals.
"Can we make your memory function better by stimulation? Or taking it a step further, can we use stimulation to enhance permanent storage systems? We don't have the data yet, but we would like to ask that question at some point," he said.
Others raise serious concerns about how far elective medical modifications should go. Such worries, however, don't faze enthusiasts like Dameff and Tully, who sketched out a path to casual augmentation in their Defcon session. The two laid out some of the central issues people will face as elective modification enters the mainstream -- not to mention some of the problems those looking to hack their own bodies will likely encounter.
Choosing the kind of mod will cover three basic categories: chemical modifications, such as the attention deficit disorder drug Adderol; mechanical mods, such as artificial limbs; and electronic mods, such as the aforementioned neuroprosthetics.
Choosing materials will be another critical issue. Today, material choice is often limited by a combination of what your medical insurance will pay for and what's available to patients. But these choices are expanding rapidly. Some metals currently in use in implants include chromium, nickel, molybdenum, titanium, magnesium-based alloys, iron, and cobalt. Polymers, the medical students said, cover a wider range, from spider silk and polyethylene to polyglycolic acid and polysulfone.
Choosing a location on your body for the mod is important, if a bit obvious. For many applications -- particularly those involving drugs or biochemical sensors -- subdermal implants will likely be popular for early elective modifications. Such devices are relatively non-invasive, since they can be placed under the skin in a simple procedure, after which the skin heals over the incision. In fact, some people use inert implants already for aesthetic modifications such as piercings.
Implanting your modification will require surgery, which means finding a doctor and surgical team to open you up and suture your new device in place. It's safe to assume most doctors aren't about to cut off your arm to give you Inspector Gadget-style powers, no matter how cool you think that would be. But what about putting magnets under your skin to hold your iPod nano in place?
Weber said the idea of such mods is more common than people realize. "When we do a breast augmentation, we do it at the request of the individual to be prettier," he said. "The principle of buying something medical to be a better person is not unheard of."
Connecting your mod is the next step, and one that's distinct from implantation, Dameff explained. Getting mods to work with the human nervous system can be an incredibly complex challenge. "It's a whole different realm between something you strap on, like a hearing aid or vision aid or exoskeleton, to something that you integrate with your physiology," Kraft said.
Supplying power to modifications has proven to be a difficult challenge, said Tully. One recent innovation -- the spring-based SPARKy system for a self-powering prosthetic leg -- could offer a solution to many energy-source problems, at least for prosthetics.
The cost of modifying your body will likely be an enormous deterrent. (Steve Austin wasn't called the Six Million Dollar Man for nothing, even if he'd be the Sixty Million Dollar Man today.) Medically necessary enhancements are often covered by insurance; not so for elective surgeries. Lasik vision correction, which reshapes the cornea, is generally considered elective in the U.S. and runs more than $2,000. Breast augmentation is close to double that. The current cost of a pacemaker is around $22,000; leg prostheses are in the ballpark of $36,000 per leg; and a cochlear implant rounds out at nearly $40,000 per ear.
So in addition to paying for the modification and its ancillary pieces, such as the power source, you'll have to fork over bucks for the surgical team, for the operating room, anesthesia if required, and potential hospital stay for recovery.
Tully and Dameff also brought up three ethical issues concerning body hacks: who gets access to the mods, how to build a community for people with mods, and the medical consequences of your body rejecting foreign materials.
A fourth major concern Dameff and Tully noted only briefly is security. While it's unlikely that you risk having somebody run off with your bionic arm, a growing number of new devices are shipping with Wi-Fi chips to help doctors monitor patients without invasive wires.
While security concerns about electronic medical devices may sound a little too sci-fi to some, they've already become a reality with insulin pump hacks. What happens if President Obama or Facebook's Mark Zuckerberg has an IP address-enabled pacemaker that can be hacked?
"This is a crimes of the future issue," said Kraft, alluding to a TED talk by futurist and security consultant Marc Goodman. While there's a lot of thought going into how to secure implantable medical systems, it appears that tech-driven body hacks, not unlike nuclear weapons program hacks, will one day become just another security frontier.