One Sensational Hand

A decade ago, Dennis Aabo Sørensen lost his hand in an accident.  Now, thanks to an international team of physicians and technicians, he can feel objects once again, this time through the use of a bionic hand that is directly connected to the nerve cells in his arm. 

Sørensen is the world's first amputee able to use his bionic hand to experience the sensation of feeling.  Because he can feel what he touches, he is able to use his bionic hand with far more agility than other amputees, knowing instantly when he is squeezing something too hard and likely to crush or harm it.

Photo Credit: Sensory feedback enabled prosthesis, close-up.  Credit: LifeHand 2/Patrizia Tocci.  LINK to Video. 

 

“The sensory feedback was incredible,” reports the 36 year-old amputee from Denmark according to a press release from the Ecole Polytechnique Fédérale de Lausanne.  “I could feel things that I hadn’t been able to feel in over nine years.” In a laboratory setting wearing a blindfold and earplugs, Sørensen was able to detect how strongly he was grasping, as well as the shape and consistency of different objects he picked up with his prosthetic. “When I held an object, I could feel if it was soft or hard, round or square.”

 

The bionic hand, of course, is equipped with touch sensors.  But the real key is the bi-directional or two-way connection between the hand's electronics and the brain's neurons.  Tiny, cell-size links between electrodes and nerve endings were implanted into Sørensen's arm.  Then his new hand was attached and the wires connected. 

 

Over time and with a little practice, he could feel different shapes and degrees of hardness.  The sensation was as fast as normal touch.  Signals passed from the bionic fingers to the brain and then from the brain to the hand, controlling its movements.

 

For those in need of bionic hands, this work marks a real milestone.  Ordinarily we take two-way processing for granted.  But the way things feel helps us use our hands with versatility and skill. 

 

What this means in broader terms is a little less clear.  Bionic restoration is a key frontier in today's medicine.  But the technologies of healing or restoration can quickly become the technologies of enhancement.  Perhaps someday, we will look back at Sørensen's hand as a kind of evolutionary advance, bringing not just the restoration of touch but the extension of power. 

 

The paper, entitled "Restoring NaturalSensory Feedback in Real-Time Bidirectional Hand Prostheses," is the work of an international team largely based in Italy and Switzerland.  It appears in the 5 February 2014 issue of Science Translational Medicine. 

Enhancing Healthy Kids: A Warning, But Who's Listening?

The American Academy of Neurology (AAN) has just issued new guidelines calling on doctors to stop prescribing cognitive-enhancing drugs to healthy kids.

Drugs like Ritalin and Adderal are widely used, not just by adults and university students, but increasingly by children, and not just those who are appropriately diagnosed as experience difficulites with attention or focus, such as Attention Deficit Disorder. 

PHOTO: Ritalin SR (a brand-name sustained-release formulation of methylphenidate, from Wikimedia, 16 June 2006, created by Sponge. 

Perviously, the AAN raised concerns drug enhancement by adults.  It concluded that there is no moral basis for objecting, provided that the patient is acting autonomously in requesting the prescription.  But when it comes to prescribing for healthy children, the AAN report makes this claim:  "Pediatric neuroenhancement remains a particularly unsettled and value-laden practice, often without appropriate goals or justification."  

The Report notes that enhancing children is fundamentally different from enhancing adults.  For doctors, it raises concerns for "the fiduciary responsibility of physicians caring for children, the special integrity of the doctor–child–parent relationship, the vulnerability of children to various forms of coercion, distributive justice in school settings, and the moral obligation of physicians to prevent misuse of medication."

Based on these concerns, the AAN Report advises that "the prescription of neuroenhancements is inadvisable because of numerous social, developmental, and professional integrity issues."

The primary objection raised by the AAN is that children lack the competency to act as autonomous moral agents.  If they were competent, then their request for enhancement would be honored.  Sure, children can be coerced, manipulated, confused, and ambivalent about their needs.  Kind of like the rest of us. 

Whether age brings moral competence is a good question.  But perhaps what this report shows us once again is that when secular bioethics meets enhancement technology, about all it can say is this: If you want it and if you can prove your competence, you can have it. 

The AAN report, “Pediatric neuroenhancement: Ethical, legal,social, andneurodevelopmental implications,” is published in the March 13, 2013 issue of Neurology.

Enhancement at Work: A New Report

A new report on human enhancement and its growing impact on the workplace has just been released by top-level British science and policy groups. The Royal Society, the Academy of Medical Science, the British Academy, and the Royal Academy of Engineering collaborated on a research project throughout 2012, resulting in the November 2012 report.

Image from the cover of Human Enhancement and the Future of Work.

Among the conclusions: "Advances in a range of areas in science and engineering such as neuroscience, regenerative medicine and bionics are already enhancing, or could in the next decade enhance, the physical and cognitive capacity of individuals in the workplace." The report is entitled Human Enhancement and the Future of Work.

Even the advocates of human enhancement find something uniquely troubling about the prospect of enhancement technologies in the workplace. Will employers coerce their workers? Will use of enhancement technology be a non-negotiable prerequisite for success in an increasingly competitive work environment? Will employees have full access to information about potential side-effects?

The report notes the following: "Cognitive-enhancing drugs present the greatest immediate challenge...They are already available without prescription through internet purchasing, are relatively cheap and are increasinly being used by healthy individuals."

In response to these challenges, the report does not recommend sanctions or bans, but it does press the case urgently for widening the dialogue and reforming policies and regulations.

Human Germline Modification: A Step Closer?

Human germline modification—often described as "designer babies—has come a step closer. It has been shown that in nonhuman primates, it is possible to transplant specialized cells that produce sperm. When combined with other steps, this may make germline modification feasible and safe for human use.

The new research involves nonhuman primates. Its purpose is to set the stage for clinical trials in human beings. The goal for using this technique in human beings is to overcome infertility, especially for cancer survivors who were treated with radiation or chemotherapy. In men, that treatment may destroy the ability to produce sperm. If the cancer treatment occurs after puberty, sperm can be stored in advance. But if the treatment occurs before a young boy's body produces sperm, permanent infertility may result.

"Men can bank sperm before they have cancer treatment if they hope to have biological children later in their lives," according to University of Pittsburgh researcher Kyle Orwig, lead researcher. "But that is not an option for young boys who haven't gone through puberty, can't provide a sperm sample, and are many years away from thinking about having babies," Orwig said according to a press release from the university.

Photo by Bertrand Devouard, 2006, available at Wikimedia

No medical solution is now available, but the report published today opens the possibility that in the future, young male cancer survivors will be transplanted with cells that can restore their ability to produce sperm and to become fathers. To be clear: Orwig's group did not work with human subjects. But by showing that the technique works in rhesus monkeys, they help make the case that it could work in humans and should be tried.

"This is the first study to demonstrate that transplanted spermatogonial stem cells can produce functional sperm in higher primates," Orwig said. "This is an important step toward human translation." The study is published in the November 2012 issue of the journal, Cell Stem Cell.

The cells that were transplanted into the rhesus monkeys are called "spermatogonial stem cells" or SSCs. Researchers used frozen or cryopreserved SSCs.

In the future, one possibility is that SSCs might be produced from stem cells, such as induced pluripotent stem cells. In addition, the SSCs might be genetically modified before they are transplanted. In nonhuman animals, this would provide a new way to create transgenic animals for research.

Another possibility is that this technique, if used to restore fertility to men who cannot produce sperm, might also be used for human germline modification. In a 2006 article, Hiroshi Kubota and Ralph L. Brinster (a pioneer in developing this technique) suggested that SSC transplantation may be used for precisely this purpose. "Another potential clinical application using human SSCs is GERMLINE GENE THERAPY" (Capital letters in original). They suggest that "germline gene therapy using SSCs will become a promising and feasible approach, although considerable ethical concerns exist."

What makes all this especially interesting is that by transplanting SSCs, researchers may make it possible for fertility to be restored without the use of in vitro fertilization. The Orwig paper suggests this quite clearly: SSC transplantation may be capable of "enabling the recipient male to father his own genetic children, possibly through normal coitus." If the SSCs are genetically modified first, we would have germline modification without IVF.

When human germline modification is suggested, many find the idea frightening. It is generally assumed that religious people will be universally opposed. That is not true, not even among Catholics.

What the official Catholic position opposes is the destruction of human embryos or even their creation outside the human body, which IVF requires. The Vatican is not opposed to using high tech medicine to create healthy babies.

In 2004, this is what a Vatican commission had to say: “Germ line genetic engineering with a therapeutic goal in man would in itself be acceptable were it not for the fact that is it is hard to imagine how this could be achieved without disproportionate risks especially in the first experimental stage, such as the huge loss of embryos and the incidence of mishaps, and without the use of reproductive techniques. A possible alternative would be the use of gene therapy in the stem cells that produce a man’s sperm, whereby he can beget healthy offspring with his own seed by means of the conjugal act.”

It almost sounds here like the Vatican was suggesting the technique that is being developed. It should be noted that this statement was released while John Paul II was pope. It was drafted by a commission headed by Cardinal Ratzinger, who is now Benedict XVI.

One should not expect Catholics or any other religious community to lead a chorus of praise for human germline modification. At most, one might expect guarded comments from religious leaders, coupled with the demand that this technology be limited to therapy and not used for enhancement. But the key point is this: if human germline modification technology is developed, religious leaders may actually be open to its use.

But if it is developed for therapy, who really thinks it will be limited in that way? If it works to create a healthy baby, why not use it to create a better baby?

The article, entitled "Spermatogonial stem cell transplantation into Rhesus testes regenerates spermatogenesis producing functional sperm," appears in the November 2012 issue of the journal, Cell Stem Cell.

Resveratrol and Enhancement? Not So Fast

Does resveratrol help healthy people become even healthier? Does it improve metabolic health and possibly even help us live longer?

A new study casts doubts on these hopes. In the October 25 issue of Cell Metabolism, researchers at Washington University School of Medicine publish the results of their study involving 29 healthy middle-aged women. They asked whether resveratrol boosts metabolic health. When they ran the tests and collected the evidence, the answer was simple: No.

The study divided the women into two groups. Fifteen were given 75 milligrams of resveratrol each day, the same as they would get in 8 liters (more than 10 bottles) of red wine. The other fourteen received a sugar-pill placebo.

Researchers measured the women's sensitivity to insulin and the rate of the glucose uptake. The result, according to Samuel Klein, senior investigator, is that "we were unable to detect any effect of resveratrol. In addition, we took small samples of muscle and fat tissue from these women to look for possible effects of resveratrol in the body's cells, and again, we could not find any changes in the signaling pathways involved in metabolism," Klein said in a press release issued by Washington University School of Medicine.

Photo Credit: Robert Boston. No usage restrictions.

This study is small, but what makes it interesting is that it involves healthy human beings. In nonhuman trials, resveratrol seems to enhance the health of healthy animals. And in human trials involving people with metabolic problems, resveratrol seems beneficial.

According to Klein, "Few studies have evaluated the effects of resveratrol in people," Klein explains. "Those studies were conducted in people with diabetes, older adults with impaired glucose tolerance or obese people who had more metabolic problems than the women we studied. So it is possible that resveratrol could have beneficial effects in people who are more metabolically abnormal than the subjects who participated in the study."

That point goes right to the heart of the human enhancement debate. Often, "enhancement" is distinguished from therapy. While therapy improves the health of the sick, enhancement improves the health of the healthy. This study seems to suggest that resveratrol may be therapeutic, but it is not an enhancement.

Right now, however, the picture is not completely clear. Those who drink red wine in moderation are less likely than others to develop heart disease and diabetes? Is it the resveratrol, the wine, or the interactions between them?

According to Klein, "We were unable to detect a metabolic benefit of resveratrol supplementation in our study population, but this does not preclude the possibility that resveratrol could have a synergistic effect when combined with other compounds in red wine."

The article, entitled "Resveratrol Supplementation Does Not Improve Metabolic Function in Nonobese Women with Normal Glucose Tolerance," appears in the October 25 issue of Cell Metabolism.