AANS Neurosurgeon | Volume 28, Number 4, 2019


Science-functional: Cosmetic Neurosurgery, Transhumanism and the Future of Surgical Neuroenhancement Part 1

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Primer of Transhumanism

Is “transhumanism” in neurosurgery’s future? This complex question first requires a definition. Known casually as cosmetic neurosurgery or more formally as surgical neuroenhancement and falling under the more general heading of transhumanism, this largely theoretical field is essentially exploratory at present; however it has the potential to integrate discoveries in human-computer interface, nanotechnology, artificial intelligence (AI), augmented reality (AR), virtual reality (VR), and genome editing, among others. Indeed, seemingly limitless applications have already been imagined, ranging from cognitive augmentation to entertainment and beyond.

Can we predict the future? Doing so is an endeavor in which humans in general, and doctors in particular, have rarely succeeded. While there is widespread agreement that the rapid pace of technological advancement will only continue to accelerate, anticipating specific niches where novel discoveries will significantly impact clinical neurosurgery remains challenging.

Attention has primarily been paid to disease-specific medical applications of these high-impact developing technologies. While these therapeutic and educational strategies are promising, a growing interest has emerged in neurosurgical augmentation beyond the traditional scope of disease.

Cyborgs and Beyond

Cyborgs may be well known within the subcultures of gaming or graphic novels, but have not entered into mainstream consciousness. The concept is that the embrace of technology extends human evolution. Integration of technological devices into the human body falls under this umbrella and is of particular interest to neurosurgeons.The hope is that as scientific discoveries empower individuals with new abilities, the human species will move closer to transcending the limitations of the body, and in doing so conquer not just medical threats to longevity, but also many of the social, political and economic forces that drive inequality and human suffering.

A large community of biohackers is already at work, including:

  • A DIY movement of device implantation;
  • Unconventional nootropic pharmacology (e.g., drugs and supplements for cognitive enhancement); and
  • Genetic modifications.

All of these attempt to bring about personal unification with technology. Perhaps the most recognized and high-profile biohacker is Dr. Kevin Warwick (Coventry University, United Kingdom), a professor of engineering with a history of pioneering work in artificial intelligence. His Project Cyborg includes a:

  • Sub-dermal RFID transmitter for data storage and personal identification;
  • Electrode array overlying the median nerve which converts motor action potentials into movement in an electric wheelchair or a robotic arm; and
  • Paired set of sensor/stimulator chips implanted in his and his wife’s wrists which effectively enable a rudimentary form of radiotelegraphy.

Cosmetic versus Transhumanism

While augmentation through cosmetic plastic surgery is now the norm, neuroenhancement research and application remains controversial. While there are enthusiastic individual scientists attempting to make progress, and a small but supportive community of potential users, interest at the level of large-scale funding bodies or medical device manufacturers has been relatively limited.

At least two chief concerns likely underlie the lack-of-enthusiasm from the traditional scientific establishment:

  • Despite interest, neuroscientists are primarily motivated to contribute to patient care – the socioeconomic payoff to society of such augmentation is likely far in the future.
  • In a climate of scarce scientific funding, both individual researchers and funding institutions are under unprecedented pressure to emphasize projects that are expected to yield meaningful, near-future patient benefits, or corporate profits – neither of which is clear in the current trajectory for exploratory neuroenhancement technologies.

More elusive is the sense of cultural skepticism regarding neuroenhancement, which either directly or indirectly gives many scientists and funding bodies pause. New technologies have historically been met with trepidation, even when they have fit within an accepted social space. Technologies that imply a radical philosophical departure from the status quo, such as reproductive endocrinology or the Internet, meet even greater resistance. Popular culture has done little to assuage these fears by presenting brain-computer interfaces or cyborgs through gruesome sci-fi imagery. While most proponents of neuroenhancement would reject the suggestion that machines are liable to subjugate humanity, or that humans and computers are destined to merge and leave a post-human race of cyborgs in their wake, those extreme extensions of transhumanist logic highlight a number of important questions regarding the risks, benefits, and ethics of surgical neuroenhancement.

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