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AANS Neurosurgeon | Volume 28, Number 2, 2019


Science-functional: Cosmetic Neurosurgery, Transhumanism and the Future of Surgical Neuroenhancement Part 2

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Neurosurgery Skepticism

Neurosurgery’s greatest contemporary growth niche – functional neurosurgery – is the only subspecialty consistently adding new diagnoses to its practice. Indeed, enthusiasm for finding new pathologies that can be treated with neurostimulation has been robust, and regularly leads to major discoveries and developments. By contrast, few individuals within the neurosciences have explored the potential for mobilizing these and related technologies as a form of augmentation in healthy individuals.

Indeed, the default position taken by the neurosurgical community has rightly been marked by skepticism and even a degree of anxiety regarding the potential risks of neurosurgical devices and procedures for elective augmentation – independent of procedural complications, infections, or other sequelae of foreign body implantation.

1. Numerous hardware and software issues are familiar to any computer user; however, the neurological implications with neuroaugmentation are difficult to anticipate, particularly without a frame of reference.

2. Digital systems are vulnerable to exploitation and even assault, leaving users at considerable risk for unwelcome monitoring or even manipulation by the manufacturer, potential hackers, state agents, or other bad actors.

3. Early neuroenhancement technologies are unlikely to be widely available, at least initially. The resulting fear of concerned citizens, sci-fi writers, and social activists is a scenario in which only a small, elite segment of the population will have access to these technologies, rendering them a privileged, immortal, hyper-intelligent, and disease-free subspecies, positioned to effectively abandon or subjugate the underclass.

A Neurosurgical Champion for Transhumanism

Eric C Leuthardt, MD, FAANS, of Washington University in St. Louis, has been an early neurosurgical champion of transhumanism. In an extended interview with The Guardian, he emphasized that augmentation technologies are steadily creeping closer to mainstream acceptance and application. He also states that they should not be feared, particularly given that the vast majority will mirror existing applications of technology that are widely accepted, well-understood, and closely regulated.

The employment of DBS for hypothalamic stimulation in obesity is a particularly exciting and potentially impactful practice undergoing active study in clinical trials. In contrast to stimulation for Parkinson’s disease (abnormal nigrostiatal pathway) or essential tremor (cerebellothalamocortical pathway), these trials do not target an area of specific pathology. Rather, the stimulation suppresses of appetite, resultiong in reduced caloric intake, weight loss and decreased risk of medical complications – a much more transhumanistic approach to neuromodulation.

Given the many health risks associated with obesity and its sequelae, this neuroenhancement has been more accepted by mainstream medicine. Dr. Leuthardt argues that this differential sense of social approval can and should shift in the near future. If we endorse the benefits of reducing the drive to eat among obese individuals, would we not also support memory enhancement in the forgetful or elderly? Or allow a struggling student a cognitive boost? And from there, the leap to broader applications of proactive neural augmentation feels far less psychologically threatening. When combined with the remarkable prevalence and sophistication of medically indicated devices, widespread acceptance of practical neuroenhancement may indeed be far closer than we might otherwise imagine.

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

Economic Drivers

While the neuroenhancements discussed are likely to have lasting societal impact, they may be the last to achieve widespread dissemination. In most historical moments tied to technological advances, such as transoceanic seafaring in early cultures, the agricultural and industrial revolutions, or globalization, it has economic forces rather than scientific or social forces that have precipitated discovery and development. Technological evolution can be unpredictable; however, once a promising profit-to-risk ratio is established, market forces often rule the day. As such, cognitive enhancements and life-extending technologies are likely to lag behind those related to entertainment:

  • Implanted audio transmitters;
  • Pleasure stimulators;
  • Immersive virtual reality generators; or
  • Other as-of-yet-unimagined delight.

Neuroenhancements may be the tattoos of tomorrow – a former taboo, that is now more prevalent and widely embraced in western culture than anyone would have thought imaginable mere decades in the past.

Also quite pertinent to the economic future of transhumanism are niches separate from device development:

  • CRISPR-based genome editing;
  • More effective nootropic pharmacology; and
  • The hypothesized rise of the “singularity” – a projected near-future development of self-actualizing, self-propagating, artificial super-intelligence.

Taken together, it is easy to imagine how rapidly the boundaries between humanity and our technologic creations may begin to blur – or how quickly that synergy might move beyond the point of reversibility.

Will 2030 begin the decade of neurosurgical transhumanism? Will the revolution of cosmetic plastic surgery see an equal or perhaps superlative revolution in neuroenhancement? And if it does, will those neurosurgeons who continue to provide emergency care, intervention for tumors, degenerative spine procedures, and work in pediatrics be eclipsed by the economic boon of an expanding frontier? Given the rapid expansion of the neuromodulatory device niche and the projections for several commercially viable markets outside the sphere of disease treatment, that calculus is anticipated to shift in the decades ahead – whether by patient interest, market forces, or as a consequence of unanticipated technical advances. Regardless of what form and function augmentation may find in neurosurgery, our ultimate responsibilities will remain unchanged: to rigorously and continuously maintain our education, to embrace change with an open but skeptical mind and, foremost, to advocate for the needs of our patients above all else.

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