From cases of people that can see with their ears to people functioning with bionic limbs, technology and science have afforded us a whole new era of metamorphosis, pushing the capacity of the human body to new heights. In this sometimes jaw-dropping interview, Piore walks us through a world where drug companies, scientists and courageous individuals are shaping this bioengineering revolution – a world where no disease is too great a challenge to cure or any disability too complex to overcome.

What does it mean to be human these days?

I don’t think technology has changed who we are at the core or what it means to be human. If you look at the Harvard Grant Study – perhaps the longest longitudinal study out there on how people grow and change over time – what really makes us happy, and I would extend that to say what makes us feel most human, is our relationships with other people, and whether we spend our time doing things that feel meaningful.

But I do think technology can enhance our ability to do the things that make us feel most human, like Hugh Herr who lost both legs below the knees. After losing his legs, he used to dream every night about running through corn fields with the wind in his hair. Then he’d wake up, see the stumps of his legs and remember doctors had told him he would never be able to run again. Today he jogs around Walden Pond every day on prosthetic legs.

I met a lady called Pat Fletcher. She loved nature, and then was blinded in a grenade explosion. Today she can “see” with her ears using a sensory substitution device, and she cried when she saw a mountain again for the first time in decades.

David Jayne started to lose the ability to speak from ALS. Then he got a new machine that allowed him to communicate again and clown around with his kids. The technologies behind Hugh’s legs can make exoskeletons for the able-bodied. Pat’s sensory substitution device can probably be transformed into something that would allow us all to have infrared vision. The technology that bioengineers are developing to try and give David Jayne the ability to speak again might one day be used by soldiers to communicate telepathically with a “thought helmet.”

The people and stories featured in this book are, as you said, almost ‘implausible’. Was there a particular technology or story that really amazed you?

I would say the effort to reach inside the human brain and decode imagined speech was pretty mind blowing. Scientists have discovered that when we imagine speaking, our brains send a copy of how the words should sound to our auditory cortex as an error correction mechanism. This is true even if we simply imagine speaking, but don’t say anything out loud. So, I visited a guy trying to decode these words and sentences from the patterns of neurons firing in the brains of people when people imagine them. The whole concept is pretty wild. They are not totally there yet because we have billions of neurons.
But at one point this researcher Gerwin Schalk sat me down in front of speakers and played me the sounds translated from neuronal firing patterns recorded from the auditory cortex of patients listening to music. It was Pink Floyd’s Another Brick in the Wall. I could make out the thumping base, and the echoing guitar solo. It sounded a little like it had been recorded under water, but it was the song. And it was the song reproduced and extracted basically from the patient’s brain waves. That blew my mind.

“After losing his legs, [Hugh Herr] used to dream every night about running through corn fields with the wind in his hair.”

Your research shows that science could eliminate physical disability as we know it. With innovations as far reaching as this in the field of bioengineering, can we be hopeful that disease will similarly be eliminated by science in the near future?

I agree with Peter Thiel that computational power will be used more and more as a tool to decode the mysteries of biology, in fact that is what my book is about. It’s already having a huge impact on people’s lives and allowing us to unlock untapped resilience in the body and mind to augment people. But there’s a second part of that quote. Thiel says we will be able to “reverse all human ailments in the same way that we can fix the bugs of a computer program” and that “death will eventually be reduced from a mystery to a solvable problem.” While it’s certainly possible, I doubt that will happen in the ‘near’ future. There are simply too many ways that things can wrong—too many things to reverse engineer.

Our best shot is to unlock the secrets of ageing itself, because cancer, strokes and heart attacks—so many diseases—are diseases of ageing. But that’s a tall order, and the question of what happens to our cells when we age is one of the most complex questions in biology. It’s a systemic failure which we are only just beginning to understand.

Why do you think humans are so obsessed with progress? Do you think it is right to eliminate our natural limitations?

It’s just hardwired through evolution. We like challenges, always pushing to be better. It’s for you and other readers to decide whether you think it is right to eliminate our natural limitations. The answer I have come to believe is “it depends”. I asked a military scientist whether he thought all these technologies were good or bad, and he said, “Is a baseball bat good or bad? It’s a good thing if you use it to play baseball. It’s a bad thing if you use it to club somebody over the head. It depends.”

Having said that, there are all sorts of frightening scenarios that could play out. When I was in China, the Beijing Genomics Institute is involved in this controversial project trying to decode the genetics of intelligence, and some people are really alarmed that will lead to a genetics arms race. I asked one of the people there what they thought and he said, ‘Well I think that all parents should have the option to make their children as intelligent as they want.’ I asked him if there was any prospect that alarmed him and he said, ‘Yeah, like if some really ambitious tiger mom wanted to give her child perfect intelligence and also give them sociopathic tendencies that make them immune from altruism and empathy, that’s a scary thought.’

“Imagine some really ambitious tiger mom wanted to give her child perfect intelligence and also give them sociopathic tendencies that make them immune from altruism and empathy, that’s a scary thought.” –  Adam Piore visits the Beijing Genomics Institute.

You’ve said, “Computers and medical technology have caught up to the point that we can look at things on the molecular level and hack the body.” What happens next, do you think there is a 5-10-15-20 year outcome plan?

I’d like to answer that question by telling you about the human leg. The human leg is like a giant network of springs. The human body itself has a little more than 200 bones, 350 joints, 700 muscles and 4,000 tendons, a couple hundred of which are in the leg. They form a complex web, capturing, juggling and recycling energy every time we walk or run. That allows us to reuse more than half the energy generated by a previous stride every time we take a new step. We now have the computing and sensing power to analyse how every constituent part of this web relates to one another – how a changing angle of the shin can affect the force with which the heel touches the ground, and how that changes when the knee moves back 3 cm. We can then put all that info into a mathematical formula on a computer chip and build robotic parts that behave the same way. This is allowing people to walk again.

But we don’t yet have the computing and signal processing power to instantly decode the interaction between billions of neurons in the brain multiple times a second, or the interaction between billions of nucleotides and environmental factors. Our ability to do this is improving every year. So, I don’t know how fast these technologies will go. Will it take 15-20 years to decode imagined speech, and hook us all up to a giant “hive” mind where we can all communicate over the internet just by thinking? Seems doubtful. But that is where we are headed.

People like the billionaire Paul G. Allen and Peter Thiel are part of this wealthy private sector funding these types of operations. Do you think the Silicon Valley elite etc. will change the course of these ventures?

Their contributions are significant and helpful but they are still far less than the money the government has traditionally provided. Where they help is in backing research that is outside the mainstream, bleeding edge explorations too risky for more conservative government grant writing panels. You see this especially in the area of efforts to reverse engineer the biology of ageing, but also in areas where the goal seems to be human augmentation. The effort I write about to try and invent a memory pill or “Viagra for the brain” is being funded by a billionaire Styrofoam magnate named Ken Dart. And they are giving grants to academics to study people with superior memory, something the NIH would be unlikely to fund because it’s not explicitly aimed at targeting a disease.

Do you think we’re starting to witness the end of diseases perhaps?

Some diseases. I’m sure as we knock old ones down, new ones will emerge for us to tackle. We have a lot of problems we didn’t have before because we have been so successful in extending human life.

But what about the big diseases like cancer, how far are we from eliminating it?

Yes sure, well the human immune system, theoretically, should be able to defeat cancer; it is designed to detect threats to the body and things that don’t belong there, then deal with them. T cells are basically this molecular level defence force of security guards that go through the body to find threats and neutralise them. When you get cancer, partially it’s a failure of the immune system, and when you get older your body gets more and more mutations, making you more likely to get cancer because mutations are likely to result in cancer being able to elude the immune system.

Until recently, people had always been trying to boost the immune system, turbo charge it to go after cancer for a long time, but with mixed results. There was a drug called Interferon in the 70s and 80s that everyone thought would be the new wonder drug but you gave it to people and it attacked their own body and they’d be really sick. Then in the 90s they discovered something called a checkpoint, which is basically like a circuit breaker, and they found that certain kinds of cancers have these mutations that allow them to flip a switch and turn off T cells. So if you could develop an antibody that would bind itself to the switches on the T cells preventing them from being turned off, then the immune system would continue to attack the cancer. It was amazing when they first tested it around 2000, they had 14 melanoma patients who were heading for hospice about to die, and 3 of those patients survived and are still around today. Now they’ve found that other cancers have mutations that hit different checkpoints, and if you try and bind those checkpoints, those cancers will be killed.

So it’s the same thing as the augmentation technologies, in that, as we develop new technologies to analyse and counteract this battle that is going on at a molecular level, we can find ways to overcome some of these mutations that the cancer is using to elude the immune system. So this molecular level battle that has been going on recently is much more sophisticated and has more promise than what we have had before. It is the biggest advance in fighting cancer since chemotherapy and has got a lot of attention in the US because Jimmy Carter, the former President, announced he was going to die from cancer and then he was treated with immunotherapy and survived.

“At deCODE they found a mutation seeming to protect people from Alzheimer’s, stopping the brain from creating the plaque build up that occurs in Alzheimer’s sufferers. Now they’re trying to find a drug to replicate that.”

You recently wrote an article on the opioids crisis and potential solutions with new engineered drugs. There seems to be such a large buffer between what treatment you would receive in a typical doctors surgery and the theoretical existence of future medications. What do you think will be the wall collapsing to allow us to access these types of developments?

I guess the biggest obstacle is that it is very difficult to convert some of these technologies into mass market products; there’s a lack of funding and it’s slow to get it there. But if you look at Hugh Herr and the prosthetics, just a couple of weeks ago a huge German company bought Hugh’s bionics company and they’ve been consolidating and buying up all sorts of prosthetics companies. So there is something definitely happening there commercially that will increase the economies of scale and hopefully make some of these prosthetics more available to people. If Donald Trump slashes the budget for everything that would also slow things down a lot in the United States. I feel like the technology is expanding at a pace and it will continue to expand so the biggest challenge is the funding to get these things to market. Genetic engineering is happening, it’s gradually moving towards market – some of the first genetic therapies have already been approved.

And what do they look like, these genetic therapies?

They’re simple, very expensive and they target single mutations, but the fact is that most of the diseases we deal with are based on a combination of environmental factors and genetic mutations. Everybody is talking about CRISPR, which is a huge advance that will allow us to do gene-editing at a much more refined and precise level. But I guess another answer to your question on what obstacles we are facing is the continued increase of computing power, which I mentioned before but it applies to genetic engineering. I went to BGI in Shenzhen, China, and they had more genetic sequencing power than any place on the planet. Every genome is billions of nucleotides, so in order to understand how a complex trait like intelligence is determined, we have to understand how hundreds of genes interact, and in order to do that you need the computer processing power because you’re looking at 3 billion nucleotide genomes to see what is correlated with high intelligence. This extends to the exciting area of Deep Brain Stimulation and using targeted electricity to influence when and how certain neurons fire in the brains of individuals with psychiatric disorders, instead of using drugs that globally expand neurotransmitters like seratonin and are much less precise.

So pharmaceutical companies must be biting at the heels to make some profit from these areas?

Well there are a couple of drug companies in the US, one for example called Amgen doing fascinating work around drugs in the area of genetics. Amgen recently bought a company in Iceland called deCODE which is basically gathering information on the genetics of the entire Icelandic population. Iceland has a very homogenised population with similar DNA, so when you look at the people who have a disease there, it is much easier to find the mutations with these people because there is less variability throughout the gene pool. So they’re looking for people with rare mutations that have a strong effect and then they are trying to replicate that with drugs. In deCODE they found a mutation seeming to protect people from Alzheimer’s, stopping the brain from creating the plaque build up that occurs in Alzheimer’s sufferers. Now they are trying to find a drug to replicate that, and since they know this mutation exists in people they don’t need to do so much testing because they already know it doesn’t have a deleterious effect. So that’s how genetics is going to have a huge impact on the generation of new drugs.

You’ve documented the metamorphosis of renowned thinker Hugh Herr. I see his transformation as 1.0. What do you think 2.0 or 3.0 look like?

Well, Hugh himself has stated that he hopes to end disability, and he has teamed up with Robert Langer, a regenerative medicine pioneer, and Ed Boyden, one of the inventors of ontogenetics, to found what they call the centre for “extreme” bionics. In this stage, they will hook the prosthetics up directly to the nervous system, so that you could move, say, a prosthetic toe just by thinking, but also feel the sensation if you stick that toe in a warm bathtub. Perhaps that would be prosthetic 1.5. Of course, I think the ultimate goal is to be able to regrow human limbs. And there’s a guy in my book named Michael Levin who is trying to understand how to do just that.

What would 3.0 look like?

Bionics with superior performance for the once disabled. And for the rest of us, I like what Hugh Herr said: “At some point in this century we’ll have a class of human mobility machine that augment the biology of the body, augment walking and running,” Herr says. Fifty years from now when you want to go to see your friend across town, you’re not going to go in a big metal box with four wheels. You’ll just strap on some wild exoskeleton structure and you’ll run there.

The Body Builders: Inside the Science of the Engineered Human is out now through Harpers Collins

Feature image by http://paulbarbera.com/