There's a day in the not-too-distant future when incorrigible smokers, having blackened their lungs beyond function, will have access to a shiny new artificial pair; when cancer patients will mobilize microscopic nanobots in their bloodstreams to eradicate disease; when diabetes will be nothing more than a bad memory on account of an effective blood-sugar management system. People who are alive today will be taking advantage of such medical developments—and wrestling with the dystopian conundrums aggressive life-extension practices present. S__o says science writer Eve Herold in her new book, Beyond Human, which captures the current state of these various "converging technologies" in medicine via the scientists developing them and the patients testing out their early iterations.
"As exciting as these possibilities sound, they could be extremely dangerous if human beings don't change the more belligerent side of their nature," Herold writes, going on to describe internecine wars and a gap between rich and poor that extends deep into our physiology and cognition. Amid her dark projections, though, are bright spots—about incredible feats underway in medicine and technology, and the inevitable human capacity to adjust and adapt. —Kate Lowenstein
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 40 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 65, 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 Victor asked his cardiologist whether he would live to see his new grandchild born, the answer was, "Probably not." His cardiologist disapproved of his 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 for 20 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 four 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 onto 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 60 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 as an intolerable stretch of years, perhaps decades, without his soulmate.
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 the severe loss of vision because of macular degeneration, which was destroying the light-sensitive cells of his retina. He soon got to the point that 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 felt 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. They not only restored Victor's vision to what it had been in his twenties, being able to see and get around again gave him a whole new lease on life. He wanted to not only watch life passing him by, but to be active and engaged once again. He had been retired for 20 years, but now he felt that reentering the work force 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 old codger he saw in the mirror?
There was a new anti-aging treatment that was being met with wild enthusiasm across the country. It sounded almost like science fiction, but doctors had devised an extremely "smart" nanotech 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, but should he be involved in a serious accident, his non-human 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.
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, these technologies 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.
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.
Most of the groundbreaking technologies it will take to get to this point are either in human clinical trials, in animal trials where they have already provided proof of principle, or already exist and simply await commercialization. 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.
From Beyond Human by Eve Herold. Copyright © 2016 by the author and reprinted by permission of Thomas Dunne Books, an imprint of St. Martin's Press, LLC.