Beyond Human: How Cutting-Edge Science Is Extending Our Lives

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When Humans and Technology Merge

Meet Victor, the future of humanity. He’s 250 years old but looks and feels 30. Having suffered from heart disease in his 50s and 60s, he now has an artificial heart that gives him the strength and vigor to run marathons. His type 2 diabetes was cured a century ago by the implantation of an artificial pancreas. He lost an arm in an accident, but no one would know that he has an artificial one that obeys his every thought and is far stronger than the original. He wears a contact lens that streams information about his body and the environment to his eye and can access the Internet anytime he wants through voice commands. If it weren’t for the computer chips that replaced the worn-out cells of his retina, he would have become blind countless years ago. Victor isn’t just healthy and fit, he’s much smarter than his forebears now that his brain has been enhanced through neural implants that expanded his memory, allow him to download knowledge, and even help him make decisions. While 250 might seem like a ripe old age, Victor has little worry about dying because billions of tiny nanorobots patrol his entire body, repairing cells damaged by disease or aging, fixing DNA mistakes before they can cause any harm, and destroying cancer cells wherever they emerge.

With all the advanced medical technologies Victor has been able to take advantage of, his life has not been a bed of roses. Many of his loved ones either didn’t have access to or opted out of the life-extending technologies and have passed away. He has had several careers that successively became obsolete due to advancing technology and several marriages that ended in divorce after he and his partners drifted apart after forty years or so.

His first wife, Elaine, was the love of his life. When they met in college, both were part of a movement that rejected all artificial biomedical interventions and fought for the right of individuals to live, age, and die naturally. For several decades, they bonded over their mutual dedication to the cause of natural living, and tried to raise their two children to have the same values. Then, one day, Victor unexpectedly had a massive heart attack. Having a near-death experience shook him to the core, and for several years he and Elaine both pursued every natural avenue of fending off heart disease. They exercised, ate only heart-healthy foods, and Victor took a cholesterol-lowering drug. However, his heart disease gradually worsened, and by the time he was sixty-five, he had prematurely entered end-stage heart failure. Victor’s heart had become grossly enlarged, and it was greatly weakened in the process. Day after day, he felt weak, dizzy, and had more and more trouble breathing. His feet and legs swelled up so much from water retention that he could barely walk. Then he could no longer sleep lying down because the fluid in his lungs made him feel like he was drowning. Being both ill and severely sleep-deprived made Victor’s quality of life miserable. Elaine, who was in much better health, remained completely devoted to caring for him.

Gradually it dawned on Victor that he was dying. After all the years of illness and disability, this should have come as no surprise, but he was deeply disturbed by the idea. He and Elaine had a loving marriage and had just welcomed their first grandchild, and Victor’s love and anticipation of seeing his granddaughter grow up was far more intense than anything he had ever imagined. Soon another grandchild was on the way, and he wanted desperately to be alive long enough to welcome and know this child. He took stock of his situation. By then, there were millions of people who had received artificial hearts and thereby been completely cured of heart disease. Although he had always thought that he did not want to live to an advanced old age, he couldn’t deny that he knew more and more people who had accepted some of the radically life-extending technologies becoming available, and had achieved far greater health and vitality than he and Elaine enjoyed. He had never accepted a pacemaker or an internal defibrillator, so his heart disease had proceeded unchecked and his health was rapidly deteriorating. Soon his cardiologist could do nothing more to assist him as long as he remained stubbornly attached to the worn-out heart he was born with. When he asked his cardiologist whether he would live to see his new grandchild born, the answer was, Probably not.

His cardiologist disapproved of Victor’s refusal to accept an artificial heart. Artificial hearts had completely replaced biological heart transplants because they could not be rejected by the body, were widely available, and were far more durable than biological hearts. So far, the earliest artificial heart transplants had already lasted more than eighty years, and the technology was constantly improving. Still, Victor was rather set in his ways and found the idea of having his natural heart removed and replaced by a metal and plastic electronic device deeply unsettling. Then one night, he woke Elaine up in a panic, telling her that he had severe chest pains and couldn’t breathe. Elaine immediately called 911, but in the meantime Victor stopped breathing.

The next thing Victor remembered, he was in the hospital emergency room with doctors, nurses, and emergency medical personnel swarming around him. They had revived him with repeated shocks from a heart defibrillator, but he felt his heart fluttering wildly and lost consciousness again. The next time he opened his eyes, his wife, son, and daughter were all gathered around him, their eyes red from crying, while his cardiologist was telling him something that he at first couldn’t understand. He caught the words terminal and surgery, being spoken with great urgency. Then he focused on the faces of his adult daughter and son as they leaned over him, their faces stricken and their eyes full of tears. The thought of never seeing these beloved faces again seemed utterly impossible to accept. With a weak, silent nod of his head, he agreed to the implantation of a permanent artificial heart. While Elaine signed the release form for Victor to have surgery, an anesthesiologist quickly administered an injection into his IV, and he drifted away again.

Victor’s life after the surgery was remarkable. He suddenly had more energy and mental clarity than he had enjoyed in twenty years. In fact, it was only then that he realized how terribly sick he had been. The fluid in his lungs and the swelling in his body completely disappeared, and he told Elaine that he felt like an entirely new man. His long-held ideology about aging and dying naturally suddenly seemed stubborn and irrational. He noticed that even though Elaine was relieved and grateful that he was still alive, she wasn’t changing her mind about her own dedication to allowing the aging process to proceed without any drastic intervention. He consoled himself with the secret belief that Elaine would change her mind when she faced her own serious health crisis. And he insisted that he still drew the line at getting one of the neural implants that so many people were hailing as a miracle cure for age-related memory problems, even Alzheimer’s disease. It seemed that he and Elaine still had plenty of time ahead of them to enjoy their growing family, including four grandchildren who were rapidly approaching their teen years. It was hard to believe, but soon they would be entering adulthood, getting married, and having children of their own. Victor noticed that he had more energy and vitality than Elaine, who now had several chronic health problems, but he felt sure that all she needed was a wake-up call via some health crisis to convince her that it was time to take advantage of some of the amazing new medical technologies that would rejuvenate her and drastically extend her life.

There was a turning point for Elaine. She developed sharp pains in her lower abdomen and felt tired all the time. Victor urged her to go to the doctor, but she only became cranky and stubborn in her insistence that it was only old age. She lost an alarming amount of weight and wanted to sleep seemingly all the time, so after a few months of Victor nagging her constantly, she finally went to see her gynecologist. There were a few tests that were swiftly followed by some devastating news. Elaine had stage 4 ovarian cancer, which had metastasized throughout her abdomen and had even entered her lungs and brain. Traditional approaches to treating cancer would do little to help her because the tumor in her brain was inoperable. However, her oncologist assured her that there was a good chance of curing the cancer by using specially engineered nano-sized particles that would seek out and destroy all the cancer cells in her body. Victor, who was with Elaine at this meeting with the oncologist, immediately latched on to the idea and heaved a huge sigh of relief. Then he couldn’t believe the words that came out of Elaine’s mouth. I’ve lived long enough, she said. I just want to go home to die. You can bring in hospice, but I don’t want anything else done to me. Just let me die in peace.

Elaine’s death was the hardest thing Victor had ever had to face. She stuck by her decision to accept only palliative care, and within three months, she had passed away at home with their children and grandchildren around her. Her death was peaceful, but Victor was anything but at peace. His last days with Elaine were greatly complicated not only by grief but by an irreconcilable anger at her. He was unable to accept her decision to reject the nanotech cure that had already saved millions of lives. After almost sixty years of marriage, he felt that he couldn’t go on without her by his side, and he fell into a deep depression. He then understood what it was like to want to die, and he even cursed the artificial heart that he felt had sentenced him to a long life without Elaine. He bitterly regretted that he had strayed from his original commitment to aging and dying naturally. If only he had allowed nature to run its course, he never would have had what now seemed to him an intolerable stretch of years, perhaps decades, without his soul mate.

In the years after Elaine’s death, Victor refused to entertain any possibility of marrying again, putting all his energy into their children and grandchildren. By then, one of his biggest problems was severe loss of vision due to macular degeneration, which was destroying the light-sensitive cells of his retina. He soon got to the point where he could no longer read, drive, or even watch a movie to ease his loneliness. He became more and more dependent on his daughter, and he felt guilty for the burden he believed he was becoming to her. He finally decided that he would embrace the microchip implants that would restore his vision, still telling himself that he was not artificially extending his life, only relieving his daughter of the burden of taking care of him. The microchips were miraculous. Not only did they restore Victor’s vision to what it had been in his twenties, but being able to see and get around again gave him a new lease on life. He wanted to stop watching life pass him by and become active and engaged once again. He had been retired for twenty years, but now he felt that reentering the workforce would give him a focus, and he longed for a new opportunity. However, with his newly restored vision, when he looked into the mirror he saw an old man. He had even started to think of having a new partner in life, but what employer or woman would be interested in the wrinkled-up, elderly codger he saw in the mirror?

There was a new antiaging treatment that was being met with wild enthusiasm across the country. It sounded almost like science fiction. Doctors had devised an extremely smart treatment that released tiny nanoparticles into the body, where they entered every cell and corrected just about any problem, including the ubiquitous DNA mistakes involved in aging. People were claiming that the nanobot treatment literally erased all signs of aging. Victor had seen before and after pictures that were almost impossible to believe. He felt guilty when he thought about his shared commitment with Elaine to age and die naturally, but that option had already been nullified the day he accepted his artificial heart. If he was going to live several more decades, why not look and feel as young and vital on the outside as he felt on the inside?

A hundred years later, Victor finds himself once again ambivalent about the wide array of technologies that he has accepted to keep him young, productive, and fit. His closest companion is a robot that caters to his every need, yet leaves him nostalgic for Elaine and longing for a more authentic relationship. At times he feels guilty for having lived so long in a radically unequal world, where not everyone can enjoy life-extending enhancements, but should he be involved in a serious accident, his nonhuman parts are almost sure to keep him alive. If he wanted to die, no doctor would turn off the technology that is keeping him alive since doing so would be considered homicide. His only option is to discontinue his dependence on constant rejuvenation, then to age and die a complicated death as his bionic implants gradually go bad, a process that will take many decades and possibly, great suffering. At several junctures in his life, he regarded the technologies he has relied on as massively liberating, but as he continues to live decade after decade, they are beginning to feel like a trap.

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While Victor’s story may sound like science fiction, the technologies extending and enhancing his life are in fact now in development, and some are already being tested in humans. These technologies will radically transform human health and extend our life spans far beyond what most of us have ever dreamed. Many people alive today will be able to take advantage of an array of medical technologies taking shape at the nexus of computing, microelectronics, engineering, gene therapies, cognitive science, nanotechnology, cellular therapies, and robotics. The combination of these technologies is a nascent but rapidly advancing field that many scientists refer to as converging technologies (CTs). Scientists predict that combining the powerful emerging discoveries of today will take medical science, and human life, to an entirely new plateau.

Rather than predicting the effects of nanotechnology, genetic engineering, and cognitive science in isolation, experts say that one can only glimpse the true potential of these fields by looking at their combined effect. The results of collaboration among various scientific specialists is not only leading to an entirely new multidisciplinary approach to medical research, but creating treatments and cures that are far beyond what we now consider to be on the cutting edge. The possibilities for life extension will soon transform not only individual lives, but society as well. At the same time, the technologies discussed in this book will almost surely introduce ethical quandaries and complications that we are ill prepared to navigate. With a multitude of technological blessings come complicated practical and ethical issues, some of which we can predict, but many we cannot. Artificial organs and other critical body parts, neural implants to enhance the brain, nanorobots that can cure disease and reverse aging, and direct interfaces between our bodies and machines will dramatically improve human health, but they also mean that the line between human and machine will become progressively more blurry.

This book will tap the minds of doctors, scientists, and engineers engaged in developing these new technologies while telling the stories of the patients testing the newest products entering the market. It will ask difficult questions of the scientists and bioethicists who seek to ensure that as our bodies and brains become ever more artificial, we can hold on to our humanity. Will everyone have access to technological miracles, or will we end up living in a world of radical disparities? Will our descendants live in a world radically liberated by technology, or will we end up merely serving the machines and devices that keep us healthy, smart, young, and alive?

With radically advanced technologies come questions we have never before faced. Consider the simple development of a gene therapy that eliminates the tendency to become overweight. Today millions of people suffer a multitude of disorders that are directly related to obesity, including diabetes and heart disease. Yet many researchers say this is by no means inevitable. Soon drugs and supplements will prevent the excess absorption of calories. Dr. Ron Kahn at the Joslin Diabetes Center in Boston has gone even further. He has identified a gene that acts as a fat insulin receptor and turns sugars into fat, and he has learned to block the expression of this gene in mice. As a result, the mice are able to eat as much food as they want while remaining lean and healthy. Not only do they not get fat, they live 18 percent longer than the control mice. Such a discovery, if carried over into humans, will open up unprecedented questions. Should parents have this gene deactivated at a child’s birth? Will we all choose to have the gene deactivated in our sex cells—eggs and sperm cells—so that the change will be automatically inherited by all of our offspring, changing the course of human evolution? Or will the gene deactivation be something that only each individual can decide for herself after having reached a certain age? The temptation to adopt this technology will be irresistible to just about everyone, yet there could be consequences that we haven’t dreamed of, simply because such a possibility has never existed before. And not everyone is comfortable with transcending the natural limits that God or nature has conferred upon us.

According to the science writer Ronald Bailey, Nothing could be more natural to human beings than striving to liberate ourselves from biological constraints.¹ But because we are human, that striving is poised to challenge our values and beliefs as never before. What is a reasonable life span for today’s generations that doesn’t adversely affect other generations? Is brain enhancement with drugs or neural implants cheating in the game of life? Who should receive advanced, expensive technology in the form of artificial organs and nanomedical interventions, and will everyone be equal in this new world of radical life extension? Or will the availability of advanced technologies create extreme disparities between those fortunate enough to live in modern, industrialized societies and those who don’t?

Both left-leaning and right-leaning bioethicists have strong criticisms of proposed human enhancements, and some predict consequences as dire as internecine wars between the enhanced and the unenhanced. Past experience has shown that new technologies don’t suddenly take over the world wholesale; technology adoption tends to come in waves, with the wealthy being the first beneficiaries while progressively cheaper forms of manufacturing make it available to all but the poorest poor. Yet this, too, is changing.

Advances in wireless computing, microelectronics, drugs, cell and gene therapies, nanotechnology, and robotics have reached a state in which all these fields are coming together in a new synthesis of treatments and technologies. The rate of change in these fields has become not just incremental, but exponential, as one technology builds upon another, extreme miniaturization occurs, and the cost of manufacturing plummets. As this process takes place, human life could extend for hundreds of years. Of course, in order to make such a long life meaningful, natural aging will have to be dramatically reduced so that those years are healthy, vital, and independent.

Already in use or in development is an array of artificial organs, including hearts, kidneys, pancreases, lungs, retinas, and parts of the brain. Those of us living today stand a good chance of someday being the beneficiaries of such advances. These human components are already saving and extending lives, but once nanotechnology, or the manufacture of tiny machines at the atomic level, becomes available, we will have entered an entirely new paradigm. At that point, microscopic nanoparts will be able to enter our bodies’ cells and repair just about any damage brought about by aging, disease, and genetic mutations.

The last few years have seen wireless computing technology being integrated into a huge array of products, including our bodies, our homes, our gadgets, and our clothes. The broad distribution of computing will make our lives easier and more convenient than ever. Yet with this technology comes a profusion of intimate information about our bodies and brains that is likely to be stored on the Internet. Who owns that data, and who will have access to it? Can this data be protected from insurance companies, employers, and the like? And what happens when we no longer wish to be monitored? Will our doctors be willing to turn off artificial organs, for example, when we are ready to embrace the end of life, or will they consider such actions euthanasia?

There’s also the possibility of a backlash against technologies that merge biology with technology, while many people continue to place a higher value on that which is natural. The key issue is that many new technologies don’t just cure disease—they go far beyond that and may end up enhancing almost every human ability. As these technologies advance beyond even current imagination, the changes to our lives, and the necessity to use them only for good, will require our best minds to literally rethink almost everything we currently know about being human.

Some people today have strong feelings against the quest for enhancement, but the pursuit of perfection goes back at least as far as the ancient Greeks, and arguably much further. Human beings have employed not only medicine, but cosmetic enhancement throughout history. Tattoos, piercings, cosmetics, and even some practices we would consider bodily mutilation have been common for centuries.

The search for the extreme enhancement of the human body and mind today fall under the rubric of transhumanism, a movement embracing the concept of the merging of humans and machines, that has been a marginalized system of thought in the scientific community for the past few decades. However, skepticism is giving way in the face of rapid breakthroughs in CTs, especially in light of rapid gains taking place in the private sector that are already in human trials. The strands of opposition from the right wing (especially religious conservatives) and the left wing (especially environmentalists and antiglobalists) have deep historical roots. Religious conservatives are especially concerned about what they see as hubris, a concern that also goes back at least as far as the ancient Greeks.

In ancient Greek mythology, the god Prometheus, who was thought to have created humanity from clay, made the error of sharing the ability to make fire with humans. As a result, humans became in a sense godlike, transcending their limits in ways that offended the gods. As a punishment for his crime, Zeus had Prometheus bound to a rock where every day an eagle would come and feed on his liver. Overnight his liver would regenerate itself, only to be eaten again the next day. Prometheus was condemned to an eternal, tormenting punishment for trying to raise mankind above its natural state. The message of this myth reflects a deep dread of catastrophic punishment should we attempt to transcend the natural limits of humanity. The theme that man would suffer some dreadful punishment if he attempts to better his lot has been reiterated endlessly throughout Western history and has numerous supporters even today. Bioconservatives today often invoke the charge of playing God in a whole array of medical and biotechnology issues and remain convinced that should humans, in their hubris, cross some line that enables them to develop godlike powers, the unintended results would be catastrophic.

Transhumanism has been so deeply intertwined with human history that the seeds of transhumanist thought can be seen since the beginning of time. The transhumanist trend also has deep roots in rational humanism and the Enlightenment, and its sweep seems to grow wider with each passing year, thanks to scientific innovation. The deep longing for perfection that gave rise to transhumanism can be seen in everything from Plato’s Dialogues to medieval Christianity to modern science fiction. However, the vast majority of doctors, researchers, and others in the field of developing and regulating CTs adamantly reject the label transhumanist because of its radical connotations.

The term transhuman was first coined in 1927 by Julian Huxley, a biologist and brother of author Aldous Huxley. Huxley used it to denote the human organism in transition from human to the next stage of existence, described as posthuman. In this book, I use it simply to signify humanity in an active process of profound change, and not necessarily in the strictest sense described by the World Transhumanist Association (WTA). The WTA represents the contemporary Transhumanist social movement, or Transhumanism with a capital T. This movement began to form in the 1960s and, although it might appear to have languished in the obscurity of a small community of unconventional thinkers, it’s gathering strength from the amazing trajectory of scientific discovery. This book is about transhumanism with a small t, i.e., concrete developments that are taking place today, embed human beings more deeply with technology than ever before, and call for a deeper examination of these changes.

The international nature of convergent technologies and the issues surrounding them is important because so many of the innovations are being developed not by governments but by private industry in nations that span the globe. New and convergent technologies are being commercialized and spread by companies that are themselves becoming global. However, regulatory and ethical policies differ from one country to the next. What is considered acceptable in China may not be acceptable in the United States or Britain, and vice versa. So far there is no all-encompassing system of regulation that recognizes a shared system of values, or that ensures that people throughout the world will have equal access to the best of