How to Build a Bionic Human

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Speaker 8 Hello, I'm Robin Ince.

Speaker 9 And I'm Brian Cox. The title of today's episode is How to Build a Bionic Human, something Robin is particularly interested in, given the state of him.

Speaker 1 Yeah, because unlike Brian, I'm actually made of organic material, not merely a kind of dream that Philip K. Dick had.
Anyway, so

Speaker 9 this cardigan's not made of natural fibre, though, is it?

Speaker 1 This actually, it's not entirely made of some of this cardigan, is my kind of, because I was bitten by a radioactive librarian. It's

Speaker 1 partly made out of fibre optics as well, which means that it gives me a superpower of being able to do the dewy decimal system in half a time of normal.

Speaker 10 So, yeah.

Speaker 9 Right, and what's the classification for bleak house?

Speaker 1 823.8.

Speaker 1 Look it up, it is

Speaker 10 why

Speaker 1 800 for literature, and then 2030 it's English fiction, and the three represents an old man.

Speaker 1 We've definitely wandered off topic.

Speaker 11 I think we've wandered off topic.

Speaker 1 How many librarians do we have in?

Speaker 6 1. 17.

Speaker 6 Oh, wasn't that beautiful?

Speaker 1 What I loved is also how quiet they were. You know, it's a.

Speaker 1 If someone had gone, woo, you'd go, you're not a real librarian, but the silent librarian.

Speaker 9 Can you confirm that 800 is literature, yeah? All the way through?

Speaker 1 He's right.

Speaker 1 A true superpower. Anyway, today we're going to be talking, well, some of the ideas that we both grew up in the 1970s were children's TV, a lot of fantastic science fiction there.

Speaker 1 There were things like the idea that a nuclear explosion on the moon would send it across the universe and meet various different aliens. That's in space 1999.

Speaker 9 We had a discussion about this, by the way, because Robin actually thought when we were writing the script that it was just a piece of the moon that blew off and went across the universe.

Speaker 9 And I had to correct him. It was a whole moon, wasn't it? So, you know, scientific accuracy.

Speaker 1 Yeah, because that's far more, it's far more believable that it was the whole moon meeting aliens that could transmogrify, as opposed to a bit of the moon traveling across the universe.

Speaker 1 One of them is supposedly scientifically less effective. Overdosing on gamma radiation apparently turns you into a superhero.

Speaker 1 And one of, I suppose, our favorite shows actually is one that maybe does have some truth to it: the six million dollar man about the enhancement by implementation of bionic limbs.

Speaker 1 So, perhaps not so fanciful, to help us understand the possibilities of bionic enhancement and repair, we're joined by a space doctor, a super vet, and the incredible hull.

Speaker 1 And sorry, someone from the incredible hull.

Speaker 6 And they are.

Speaker 8 I am Dr. Kevin Fong, and I'm an aesthetist and intensive care doctor.
I also work for Kent Surrey, Sussex Air Ambulance. So if any of you ever see me again, you'll probably be having a really bad day.

Speaker 8 And

Speaker 8 for me, the most exciting possibility in bionics, and I think I had to choose bionic eye, bionic heart.

Speaker 8 I think I've got to go for bionic eye, partly because our mate Steve Austin had one, and partly because I think that's a wonderful idea to be able to, you know, plumb some electronics into the back of your retina and give people the power of sight who haven't had sight before.

Speaker 10 So, bionic eye.

Speaker 7 I am Lucy Beaumont.

Speaker 7 Some people know me as a comedian, apart from taxi drivers.

Speaker 7 They don't think I am when I tell them. They say I don't look like Michael McIntyre.

Speaker 7 And when we create our bionic human, us five, I'm very excited about the accessories a bionic human could have.

Speaker 7 So like, you know, like anything a Swiss Army knife had, like bottle openers,

Speaker 7 pou uh pouches as well.

Speaker 7 I I thought we would have evolved to have pouches by now.

Speaker 12 A marsupial bottle.

Speaker 11 Pockets.

Speaker 7 Yeah.

Speaker 8 Bionic pockets.

Speaker 10 Well, yeah.

Speaker 7 But

Speaker 7 this will come in time, won't it?

Speaker 12 It's kind of a mixture of Terminator and a kangaroo.

Speaker 6 You'll get used to it.

Speaker 7 Yeah, eventually.

Speaker 9 So your bionic thing, pocket.

Speaker 6 Yes, yes.

Speaker 12 So I'm Noel Fitzpatrick. I am a neuro-orthopedic veterinary specialist, and I run a team of specialists in Surrey called Fitzpatrick Referrals, and we do cancer and surgery and all kinds of animals.

Speaker 12 I'm also professor of orthopedics at the University of Surrey.

Speaker 12 And I think the most exciting development in bionics is actually figuring out how to make skin seamlessly and forever stick to metal and how to make nerves communicate to the outside as if a bionic limb were your own.

Speaker 12 But more importantly, or as importantly,

Speaker 12 I would wonder whether the monkey cage needs to be infinite, or in fact, can we get a better plan than having monkey cages at all?

Speaker 6 And this is our panel!

Speaker 1 It's a hard choice, isn't it, between having nerve-ending skin with metal on it and pockets? I'm not sure which one I'm going to go.

Speaker 6 I go with a pocket on the bottom.

Speaker 1 I think the two read each. I think they meet really, don't they?

Speaker 12 Well, it's actually quite interesting because marsupialization, which is the pocketization of skin around metal, is the biggest single reason that bionic limbs fail because bacteria colonize the area where the skin invaginates.

Speaker 12 Because it's not a normal body orifice, let's face it. Sticking metal through your skin.
I mean,

Speaker 12 the bionic man is definitely going to need that, but pockets may be deleterious to his or her future. So

Speaker 12 after this show, you're going to be the bionics expert of Hull.

Speaker 7 Well, I did have a, we used to call my Nana, we used to call her bionic Nana, but obviously obviously she wasn't, but she had a lot like both a hip replaced shoulder, kneecap.

Speaker 7 She'd a metal plate somewhere, but we don't really know where.

Speaker 1 But I like the idea, there's a point where you go, I think now so much of Nana's been replaced, she's no longer Nana. There's only a little bit of her left.

Speaker 7 Yeah, in more ways than one.

Speaker 9 I want to get into that after

Speaker 9 a definition.

Speaker 9 Because first of all, we like definitions. So, Kevin, could you define what we mean by bionics? And also, maybe refer to the history of bionics.

Speaker 8 Well, if you're looking up in the dictionary, bionics is the use of mechanical systems or devices to replace the function of organic systems,

Speaker 8 particularly in the human body. And most of us know it through, you know, for those of us who lived through the 1970s,

Speaker 8 through Steve Austin. I mean, that was what I grew up with.
This is a perfect, perfect 70s sci-fi superhero for me. He was an astronaut.
He had a bionic, was it two bionic legs or one?

Speaker 8 Two bionic legs. Two bionic legs, one bionic arm and a bionic eye.

Speaker 8 And so that idea that you could be that badly injured and yet you could be rebuilt and you could be better than you were before.

Speaker 8 In general,

Speaker 8 if we're talking about the history of this, you know, if you ignore sort of like just replacing amputated limbs with like long Jean-Silver style with just

Speaker 8 a post to replace the absent limb,

Speaker 8 we really don't get into building what we would accept as something that looks vaguely bionic really until the middle of the the 20th century.

Speaker 8 And I guess for me, at least in medicine, we don't really understand how to replace the artificial function or the function of real organs with machines really until then, until the birth of intensive care.

Speaker 9 This is interesting, because I think often we think of bionics as a bionic arm, bionic legs, you know, so not internal organs.

Speaker 9 But of course, I suppose a lot of the progress has been in artificial hearts, which you would call a bionic object.

Speaker 8 Yeah, no, absolutely.

Speaker 8 And, you know, although I guess because of popular sci-fi we think of bionic limbs, actually, you know, certainly from a medical point of view, replacing the function of vital organs with mechanical systems is all essential.

Speaker 8 And it's the thing that preoccupies us most in medicine.

Speaker 8 And so we start off really in the history of it with in the 1950s after the Copenhagen polio epidemic when people's lungs and chest walls were paralyzed by the polio virus with replacing that with ventilator systems, so so using artificial ventilators.

Speaker 8 And then after that we use drug support hardware.

Speaker 9 So, that's actually external. That's that's a and it's all external.

Speaker 8 And the irony is that, although you think of bionics as a thing that makes you better and you're running around at super speed with super strength, actually, the bionics that were created in the middle of the 20th century does the opposite.

Speaker 8 It confines you to a bed and puts you next to a bunch of machines that are running into your body and they're just barely maintaining you.

Speaker 8 And it's everything you can do to maintain this pale imitation of being alive with artificial kidneys, you know, dialysis machines, or pumps that reproduce the heart or

Speaker 8 indeed, you know, lungs. And the total artificial heart, for example, has been this holy grail, and we've not yet quite got there.
You know, we are close, but we haven't quite yet got there.

Speaker 8 And I say that out of personal experience.

Speaker 8 When I was a junior doctor working at a small hospital, in the middle of the night, I was sitting there, in the middle of a night shift, about two o'clock in the morning.

Speaker 8 Charge nurse comes up with a letter, and the letter says, What do you think of this?

Speaker 8 And the letter says, the bearer of this letter has an artificial heart should that artificial heart cease to function they've been instructed an alarm will sound and they should operate their manual pump and I said why are you showing me this letter I said because he's outside in the ambulance and the alarm's going off

Speaker 8 and I ran outside and opened the doors and there's two people inside there's this bloke with the artificial heart saying, hello, and this alarm going off, and there's his son with the pump in his hand going, hello, only long enough, you know, getting his hand off the pump long enough to keep pumping.

Speaker 8 And

Speaker 8 I thought, what am I going to do?

Speaker 8 So I closed the doors and I went round the front of the ambulance and I said, do you know where the heart hospital is across town? And the ambulance driver said, yes. I said, drive as fast as you can.

Speaker 8 And yet, still, after all this time, after half a century of chasing artificial hearts, they're still not a reliable replacement.

Speaker 8 We still rely on transplantation of human hearts and these total artificial hearts, as they're called, are still only a bridge to transplantation.

Speaker 12 And one of the things that occurs to me there is how very annoying it is in the press to have people say bionic this and bionic that or somebody's running on a bionic limb and in fact it's just a stump socket prosthesis that's stuck to the outside of your body and it's not bionic because it's not attached physically to your end or skeleton or in your case in in your thorax so people use the word bionic wrong all the time which really annoys me So your definition would be something that's physically attached to your skin.

Speaker 12 Well it needs it. No, it needs to be

Speaker 12 replacing or enhancing a bodily function as an integral part of the anatomy of the creature in my view, as opposed to, for example, a Paralympian running in a race has a stump socket prosthesis put onto a stump.

Speaker 12 Is that bionic? It's not attached directly to your skeleton. So by definition,

Speaker 12 probably not.

Speaker 12 People say in the press, you know, he's got pins in his his legs, so he must be, or your granny who had the various bits, is she bionic?

Speaker 12 Well, we're reaching an era where we can actually replace body parts, particularly in my area, which is the spine and the skeleton.

Speaker 12 So we can grow and replace body parts, but they're only bionic if they're actually replacing the function of. And I don't think that we've got to the point where

Speaker 12 we're not going to rebuild them faster, stronger, better. At this point, that's a myth.

Speaker 12 because we haven't really created a hedgehog with springs on its legs that can leap over a house except if you're in Wallace and Grommet territory.

Speaker 12 But when I first became interested in this, and it's similar to your story, I was fishing with my Uncle Paul on the River Shannon in Ireland, and I was 11.

Speaker 12 And it was probably the only hot day in Ireland I remember as a child.

Speaker 12 And Uncle Paul was getting sweatier and sweatier and sweater, and I didn't know why he was sometimes grumpy, and sometimes he was really grumpy.

Speaker 12 And he rolled up his trouser leg and took off his wooden leg. And of course, I'd never seen his wooden leg, which was effectively like Long John Silver.

Speaker 12 And he took it off and I saw this horrible scabby stump and I went

Speaker 12 as you do if you're an 11-year-old and you've just seen your Uncle Paul's stumpy leg covered in scabs. Unfortunately for me, I was rowing and knocked his wooden leg off the side of the boat.

Speaker 12 So we spent three and a half hours going downstream on the River Shannon chasing a wooden leg to finally have an American tourist hold it aloft in a bed of reeds and go, anyone's leg, anyone's leg.

Speaker 12 So I'm with Steve Austin. I thought at that moment we should rebuild him stronger, faster, better.
And I'm still trying.

Speaker 1 But that's that's a fun. When you said about faster, stronger, I was thinking this when you were talking as well.

Speaker 1 With something like six million dollar man, where you have he's lost his legs and he's now got these legs that go super fast, but he hasn't had his lungs replaced.

Speaker 12 There still is all Robocop had

Speaker 1 we'll move on to Robocop. We'll start in the 70s, move on to the 80s, and then we'll.

Speaker 1 But so if that was possible, wouldn't there be ramifications? Like, for instance, when he lifts up something really heavy, the rest of his body is still just a normal human body.

Speaker 1 Wouldn't it just be Oscar Goldman going his arms come off again because he tried to lift up something too heavy? Or when you're running at that speed, because it's not connected to the rest of the

Speaker 1 actual circulatory system, does it not mean he'd become wheezy? Surely he'd become wheezy that his legs are going at that speed.

Speaker 10 Well,

Speaker 8 only if his heart and lungs are driving the power of the legs, and this is the central problem.

Speaker 8 So, so Noel talks about it's not bionic unless you can integrate it into the the body as a whole but but the the problem with most of these mechanisms that require some sort of power and particularly the heart is that we're rubbish with batteries aren't we and so you can build these things you can build them small enough and reliable enough to insert in the body so they don't need you know servicing again

Speaker 8 but then the battery always sits outside you you know i've seen i've met a bloke with a total artificial heart and he sits there and the heart's in his chest but he's got this thing that looks like a little briefcase in which the pumping pumping mechanism, the power is, and it makes enough noise that in a quiet room you can't really have a conversation.

Speaker 8 And so, until we conquer that, you're not going to get to that, you know, that holy grail of bionics whereby you stick the thing in and you forget about it because it has an everlasting power source.

Speaker 8 We don't have that power.

Speaker 12 It's a myth if you think it's going to be stronger, faster, better, until, in the case of moving parts, we have an integral power source that is renewable. And I think that's possible.

Speaker 12 It's possible in the next foreseeable future.

Speaker 12 But I think it's important to differentiate internal moving parts from internal parts that are more static and that need to be moved by levers like muscle.

Speaker 12 So in my case, I only deal with the skeleton musculotendanous system. In your case, you deal with the heart and the lungs.
Different things entirely.

Speaker 12 And the same with the eyeball, different things entirely. But bionic, I think.
Are we agreeing that the definition is that it needs to be integral to the body?

Speaker 10 No, no, we're not agreeing.

Speaker 6 What are we agreeing on that definition?

Speaker 8 Otherwise, I'm out of a bionic job. I'd like to think that I just do bionics all the time.
No,

Speaker 8 I suppose that's fair.

Speaker 8 I think

Speaker 8 to honour Steve Austin in all his glory, it has to be integral, doesn't it?

Speaker 8 But I see a problem in that fundamentally in that then paint you into corner that I just can't see it happening for most of my important organs because most of the important organs that I want to replace require quite big power systems.

Speaker 12 So you see them as outside the body?

Speaker 8 Well, I see it.

Speaker 8 So, how can you say a bloke who's, and this bloke standing there with a total artificial heart in his chest, is pumping blood around his body, depends every moment of his life on this thing.

Speaker 8 The fact that the power source is in a sort of small briefcase-type thing outside his body, and he's got tubes running through the front of his chest. I mean, that's pretty bionic to me still.

Speaker 8 Now, you want to get that shrunk down so you can put that in the body, but I don't think he's less bionic for it.

Speaker 7 I think a big pocket.

Speaker 6 Yeah, yeah, yeah, yeah. There you go.

Speaker 12 Can we agree that the holy grail would be to make it integral?

Speaker 8 Yes, I can. And you know, some of the most exciting things for me in the current era of bionics that you could really see as being that.

Speaker 8 Meeting those criteria is some of the work that's done at the Royal National Orthopedic Hospital and by one of my collaborators at University College London, Professor Rebecca Shipley, and her group, is these

Speaker 8 bits of replacement bone that they put into children that have little motors in them that grow as the child grows, which is incredible and something that transforms the light.

Speaker 8 So these are children who usually, as a result of cancer, have had to have parts of their

Speaker 8 long bones resected, so

Speaker 8 in the leg or in the arm. And then as they grow up,

Speaker 8 you have to commit them to further operations to lengthen that bone as they grow. Except now, and you'll know more about this than I, Noel.
Now, they have these bits of replacement bone that have this

Speaker 8 motor mechanism in them. So, as the child grows, it senses that tension on this prosthesis and the bone grows.
And so, the child has to have just, well, hopefully, one, maybe two operations.

Speaker 1 Well, I just want to find out from Lucy because that my jaw did properly drop at that point when you were talking about the bones, that artificial bones that can grow.

Speaker 1 I mean, when you're first hearing, like me, you're hearing a lot of these ideas for the first time.

Speaker 8 How do you feel about

Speaker 9 these possibilities?

Speaker 7 I'm five foot one

Speaker 7 and a and a half,

Speaker 7 and I'd just like to be five foot three,

Speaker 7 to be honest. I couldn't, um, I wasn't able to it sort of changed my life really

Speaker 7 because I wanted to be Mickey Mouse at Disneyland. And I got down to the final audition and I was just too too small.
You have to be five foot three for the costume.

Speaker 1 So, this is the kind of world we can imagine. If bionic technology works, there's people who could work for Disneyland who'd never imagined they could before.

Speaker 12 If I could chip in there,

Speaker 12 that is a reality now. So, if you realize, oh yeah, oh, yeah, well, tonight, ladies and gentlemen, for the first time, Lucy, the Labrador.

Speaker 12 No, it's a reality now, and coming back to what you just said, the grower, which is an endoprosthesis. So, let's make a few definitions here.

Speaker 12 An endoprosthesis is something that's internal to the body and you can't see it. An exoprosthesis is something that's external and you can see it, and it's sometimes attached to an endoprosthesis.

Speaker 12 But the grower, which you were referring to, which is a femur, for example, that you can make grow inside an electromagnet, that was initially developed at University College London, Royal National Orthopedic Hospital, by Professor Gordon Blunt and his co-workers.

Speaker 12 And they did indeed create a bone that would grow within the child as they grew. And at that time, osteosarcoma was a very difficult disease to treat.

Speaker 12 And now it can be cut out, and of course, treatment with chemotherapy for the spread of the cancer. But you can replace this bone in dogs or in humans with these implants.

Speaker 12 And the holy grail for me, and for my entire life's purpose, is to try and get animals and humans treated side by side so that we all win.

Speaker 8 But right now...

Speaker 7 It's not on the same ward, though.

Speaker 12 Not in the same ward as it is.

Speaker 6 You're not going to be subjected to that.

Speaker 7 It's the little ones.

Speaker 6 But people do make humans grow, and it's not Daxon's.

Speaker 9 So you wouldn't mind big dogs on the ward, it's just the little ones.

Speaker 10 No, you know,

Speaker 7 they must drive you mad as well. Surely, yap, the yap.
Do you know, no, what I was thinking, have you seen, you know, you're saying about the bionic, um, it's not the right term.

Speaker 7 Have you seen Inspector Gadget?

Speaker 12 Yes, he has lots of pockets.

Speaker 7 But the, but it's sort of what you're saying, maybe they're not bionic, maybe they are gadgets at the moment.

Speaker 12 Oh, so we're going to call Kevin's bionic person gadget man.

Speaker 6 Yeah.

Speaker 6 When you get admitted to my ITU, I'll be in big trouble.

Speaker 6 Which is going to be before the end of this show, mate.

Speaker 6 Yeah, we don't want any of that.

Speaker 9 So you're suggesting that Lucy could have

Speaker 9 now

Speaker 9 the bones in her legs modified such that they can gradually grow and take her to five foot three.

Speaker 12 This is real life right now. You can insert growing endoprosthesis in humans, and in fact, it is done.

Speaker 9 You wouldn't suggest it is a cosmetic procedure, though.

Speaker 12 Well, I am no one to comment on this, but it is being done.

Speaker 7 With a cardache,

Speaker 12 in the world today.

Speaker 6 I am not going to be able to do that.

Speaker 11 So, it's not either.

Speaker 9 So, it's an optional

Speaker 9 procedure.

Speaker 12 I'm sure you'll agree, Kim, that this is happening in the world.

Speaker 8 Yeah, it is happening. I'm not sure I'd recommend it.

Speaker 8 Well, yes,

Speaker 8 and this is the thing:

Speaker 8 the important thing we're touching upon here is for me, the thing that we're calling bionics here is life-saving intervention, it is bridge to survival intervention.

Speaker 8 I think there's not a problem with that because, with all of these interventions, there is always risk, and you balance that risk against a potential benefit.

Speaker 8 And then, when you get into that, I'd like to be a bit taller, sorry, Lucy, but you know, or

Speaker 8 and it's the same, I guess we talk about this with

Speaker 8 you know, gene therapies, et cetera, et cetera. Where is the point at which you say, look,

Speaker 8 these are the cards you're dealt with?

Speaker 8 To what extent do you want to enhance yourself further with these bioprostheses? Because that will become possible in the future. And so there's a big discussion to be had about that.

Speaker 12 Yeah, the big decision for both human and animal medicine right now is ethics. Because just because we can do something, something does not mean we should do it.

Speaker 12 And I think it's absolutely critical for tonight's conversation, because as more and more things become possible, it absolutely does not mean that we have the right as a veterinary surgeon or a human medical surgeon to do that procedure.

Speaker 12 In my view, and certainly in my career as a veterinary surgeon, it needs to be in the patient's best interest and it needs to be to alleviate pain and suffering and so on.

Speaker 12 Now, I am not in the realm of cosmetics because, fortunately, that hasn't come into my world quite yet.

Speaker 12 Although it is legal in the United States, I believe, to put in testicles after they are removed with plastic ones. I'm not entirely sure if that's

Speaker 12 bionic balls, I'm not sure, but it does happen, and that is real life. Not my bag, and we would never.

Speaker 1 Another pouch gag! That has been the first punt for three weeks, and they have been starved of them. You could see this.

Speaker 11 We're on the subject of pouches all night.

Speaker 12 No, no, it's very, very important that we emphasize that from a medical perspective, there's a big difference between an act of recognized human medical practice or an act of recognized veterinary practice and an experiment.

Speaker 12 They are two entirely different things.

Speaker 9 This idea of enhancement will come into the bionic debate, though, and I suppose with many medical technologies, it will be developed initially as a treatment.

Speaker 9 But you can see that, for example, you talked about your introduction, that the eye, you know,

Speaker 9 and you said, you know, an eye that can have different functions like the six million dollar man, could have see different wavelengths, infrared and ultraviolet, whatever it is.

Speaker 9 But that that will come once we can build artificial eyes and integrate them into the body. And I suppose later we'll talk about the problems there.

Speaker 9 But once we can do that, the pressure will mount, won't it, for enhancement through bionics?

Speaker 8 Yes, I mean,

Speaker 8 as with everything, if you can buy it, people will want it.

Speaker 8 I mean, we already know, as we've said, we already know that people pay to have themselves artificially lengthened so they can be taller, and so it won't stop there, will it?

Speaker 10 Do adults do that?

Speaker 9 I was fascinated you said that. It's really so.
So, as an adult, if you put one of these devices, these growing bones, and it stretches slowly

Speaker 9 in a controlled way, then you do get longer legs.

Speaker 12 You cut the bone through what's called a corticotomy, you put the extended nail in there, and it's grown inside an electromagnet. It's quite painful.
It's not without pain.

Speaker 12 But as you say, people do pay to have this done.

Speaker 8 So it will eventually come if it is possible. I think the question for me is, is there some fundamental reason why it isn't possible?

Speaker 8 Because we're talking, you know, slightly as if it's not a problem just to wire into your optic nerve and reproduce all of the functions that the back of your eye has artificially.

Speaker 8 But actually, the most cutting-edge artificial rest, now artificial eye that we have now, really only gives you a marginal advantage over not having any sight at all.

Speaker 8 And that's the cutting edge at the moment. So it basically allows an individual who is without

Speaker 8 any ability to see to have a better than average chance of seeing changes in the light field around them. This is not then suddenly they're not up there reading war and peace in their bed at night.

Speaker 8 And so we're underplaying the complexity of the organs we're trying to replace here. The lungs are not just a pair of bellows, the heart is not just a two-stroke pump, the eye is not just a camera.

Speaker 8 And the problem is that I guess in this discussion we reduce human organ systems as it as if they are these sort of quasi-mechanical devices when they have there's so much more complex than that.

Speaker 8 So it is possible that we don't ever achieve these things.

Speaker 9 It's the difficulty in

Speaker 9 the object itself, the retina in that case.

Speaker 9 It seems to me that the interface between that and the rest of the body must be an extremely challenging problem for many reasons, just wiring the nerves onto the back of it.

Speaker 12 Well, and it's not just the retina.

Speaker 12 I mean, the most common perception for people about the bionic man or the bionic woman is limbs, and we share similar challenges, albeit potentially less complex than the retina.

Speaker 12 But one of the holy grails in the projects that I'm trying to help with in both animals and in humans is to provide bionic limbs that help both dogs and humans to have much better function because they've been amputated for whatever reason.

Speaker 12 And of course, you see on newspapers people powering their hand and lifting this and lifting that, but the reality is the nuances of movement are really not there for most of even the most advanced, really expensive exoprostheses, which are these bits that fit on the outside.

Speaker 12 And we'll come back back to the end all later.

Speaker 12 But to come to the point on nerves, transmitting what is, you know, what nature has created into a bionic beast is way more complex than popular literature or even news media would lead you to believe.

Speaker 12 Way more complex.

Speaker 12 Having said that, there are many projects going on, one of which you alluded to at the RNOH, whereby people can put microarray transmitters into nerves and into myofibrils, which are in muscles, and transmit those signals to microprocessors that can then transmit the signal from your brain into a bionic limb, and they're being refined all the time.

Speaker 9 So, we know how to decode those messages to an extent. We know what the

Speaker 9 clench your fist is.

Speaker 8 But that's the thing.

Speaker 8 So, we're so used to taking the outside world and transducing the signal of the outside world into something our phone can understand and spit out in a different way that you think, well, we must be nearly there.

Speaker 8 But actually, turning that into something that a human body can deal with and process is actually a next-level complexity.

Speaker 8 You know, the eye is not just a camera, it's attached to an optic nerve, which itself

Speaker 8 molds itself, the nerve, the actual nerve that leads from the back of the retina through to your brain, molds itself according to what you see in early life.

Speaker 8 And then on the back of that is the visual cortex, the part of the brain that deals with those images.

Speaker 8 Really, what you see is not really in your eye, it's in your brain, it's all at the level of perception. And so at that level of complexity,

Speaker 8 it's much, much, much more challenging than just slapping a C C D camera in the back of your eye.

Speaker 1 Well, I wanted to ask something, I'll ask you, Lucy, about the psychological effect as well, which is when we talk about having something replaced, say for you know, in the hand,

Speaker 1 we've seen there have been hand transplants, and the difference between the replacement of someone else's hand, you know, of course, in the hands of all, like it always turns out, it's a murderer and you go on a killing spree, but I think that's very much a 1935 universal horror film.

Speaker 1 But

Speaker 1 the difference between that and having something that is an artificial,

Speaker 1 you know, that, Lucy, do you feel, you know,

Speaker 1 if you can imagine the difference between you knew that your hand had been someone else's hand and you knew that, but, or you have a hand that has been manufactured to replace your hand, psychologically, there must be different things that you deal with.

Speaker 7 But the sit, I was talking to a guy in a public had a pig's valve put in and he went off park.

Speaker 12 But that's actually been scientifically established. If you have a heart transplant from somebody else, that you may feel different emotions, hasn't it?

Speaker 10 But that's what I wonder.

Speaker 1 You know, that's I love the idea though that the valve is actually more like a Nicorette patch.

Speaker 1 That it's like you've got a patch of ham inside you, and you go, I don't need to have it on the outside world now.

Speaker 9 I just say it's the best answer to one of your long and convoluted questions I've ever heard in.

Speaker 9 I'm going to remember that one, and I'm going to say that to you often.

Speaker 8 But that's an interesting point, isn't it? Because you're talking about the difference between transplantation of someone else's organ or limb onto you and how you would feel about that.

Speaker 8 But what you're doing there is getting around the problem that we've been talking about, which is all of that complexity that you're trying to interface with.

Speaker 8 When you transplant an organ, you're just borrowing the complexity from someone else and saying, here, it's ready-made. Why don't you stick it in?

Speaker 8 So, however hard it is to transplant a hand, it's probably easier to get that hand functioning like a real hand than it is to get an artificially built hand to work.

Speaker 9 Noel, I realize that coming towards the end of the show, I didn't ask the first question to contextualise,

Speaker 9 which is why did we ask a vet onto a programme about

Speaker 12 humans?

Speaker 10 Why? Night out.

Speaker 12 So my lifetime goal is to reunite 250 years of divergence of animal medicine and human medicine.

Speaker 12 Back in 1637 in Bologna in Italy in the Theatrum Anatomicum, dogs and humans were looked at side by side and

Speaker 12 we developed an era of medicine where there was a lot of cooperation and vets and human doctors kind of stood side by side. They were medicine people.

Speaker 12 And then over the last 250, 275 years, we grew apart. And I'm not saying in any way that

Speaker 12 we

Speaker 12 should be doing experiments in everyday life. That's not what I'm saying.
I'll give you one example just to illustrate what I mean.

Speaker 12 So, you heard me say about Uncle Paul, and I was really thought, this is stupid. Why does Uncle Paul have a wooden leg just strapped onto his bottom?

Speaker 12 Why doesn't he have a piece of metal sticking out of his leg? And since then, I saw lots of dogs and cats that didn't have legs.

Speaker 12 And I thought, well, why are we not working together with the human surgeons who are trying to do the same thing for humans?

Speaker 12 And then I found out that, in fact, the precedent is that the animal model always has to be experimental and the end point generally is death.

Speaker 12 And I realized that we're at a crossroads in medicine where for the first time in human history we have diagnostic imaging such as CT scans, high-resolution CT scans, where we can look at these interfaces between metal and bone without killing the patient.

Speaker 12 And it's not in any way, shape or form, and I want to emphasise that, that we would ever have an animal model that is a clinical patient, but I'm talking about collaboration and cooperation.

Speaker 12 So right now at the Royal National Orthopaedic Hospital and at some other centres in the United Kingdom, for the first time in the UK, we're working together as collaborative colleagues.

Speaker 12 So, there are humans that have stumps because they've had their leg chopped off or their arm chopped off, and there are dogs that need a new leg. And together, we're trying to unlock these mysteries.

Speaker 12 And to come to the real crux of your point, which is we know how to make metal and bone join together. We've done it in hip replacements and knee replacements for years.

Speaker 12 What we don't know is how to make the perfect seal between

Speaker 12 the metal and the outside. If you look inside your mouth, your tooth grows out of your gum.
And if you look at that, it's a miracle because bacteria could get in there every day.

Speaker 12 If you look at a deer antler, that's bone coming through the skin. And in the rotting season, the antler comes off, and bone grows through again, and it doesn't get infected.

Speaker 12 And that inspired Professor Blana at UCL to study the interface between the deer antler and the skin. And that's when I became interested.
And he worked with Dr.

Speaker 12 Catherine Pendergas and they looked at metal bonding to skin and for the last 12 to 15 years we've been trying to understand what makes the perfect seal and we are not there yet.

Speaker 12 There are those that would say well a bionic leg is just a piece of metal that sticks through the I know I'm going off on one now because I'm nerd I'm a nerd and

Speaker 12 and this is my

Speaker 12 it's one of the most important things I think because people underestimate the complexity of biology.

Speaker 12 There are those that think you can stick a piece of metal through skin, the skin will form around it like your gum around a tooth, and that's just not true.

Speaker 12 The skin has to stick to something to prevent the pouch, which to come full circle is where the bacteria get in. It's called marsupialization.

Speaker 12 And there are a lot of proponents of the two different types of bionic legs that are available now.

Speaker 12 One is where the skin is attached to the lining of the bone, and the second is where the skin is attached to the metal itself.

Speaker 12 And for us, we're looking for the perfect seal between the the metal and the skin so that it lasts forever.

Speaker 12 And our feeling is: if you can get that seal in the first 21 days, we're in business and we could be in business for the rest of life.

Speaker 12 That's the holy grail. If you don't, and if bacteria colonize, we lose limbs and we can lose life.
And that's the price we pay for bionics.

Speaker 12 You can't imagine for one second that any of us can sit here and say that a bionic human or a bionic animal is ethically or morally right without taking the moral responsibility that we lose life is when we lose limbs.

Speaker 12 And I think it's really important to say that because we're not God and nature will take its course and we live in harmony with bugs all around us and their job is to colonize.

Speaker 12 And I heard one of your shows where you said, well are we just receptacles for bugs? Well I'll tell you what, if a bug gets into an amputation prosthesis, we sure are.

Speaker 12 a receptacle for a bug and that can mean the difference between being able to have a stump socket where you can walk around or being in a wheelchair for the rest of your life.

Speaker 12 Or in a dog's case, it can mean the difference between life and death. And I think that's what we're dealing with here: life and death.
So we can't take bionics lightly.

Speaker 12 It's a real big ethical responsibility.

Speaker 7 What do you think of fat dogs?

Speaker 12 So this is a left-field question, isn't it?

Speaker 7 But does it annoy you? Because I've just

Speaker 7 moved to the countryside and where everyone's got a dog. And I kept thinking, why are all these? They look so thin.

Speaker 7 And then I realised in Hull, everyone's got fat dogs, and I thought that's what a dog was meant to look like.

Speaker 7 Well, I can't comment on the geographic diversity of the canine kingdom, but because I know a few people, as a treat, they buy their dog a Chinese takeaway.

Speaker 7 One had been, had had a tumour removed, and as a treat, she got it a takeaway when they got home.

Speaker 7 I mean, but what I'm saying is, you do all this bionic thing, and then there's people they'll get them home.

Speaker 7 You'll do give them a new leg, they'll get them home and give them, you you know, a meat pie.

Speaker 12 You actually have inadvertently stumbled on one of our biggest problems with infection, which is subcutaneous fat.

Speaker 6 Oh, that's what I meant.

Speaker 12 Genius, genius, you are the bionics expert of Hull.

Speaker 12 Because subcutaneous fat does not have good blood supply. And when we are trying to get skin to adhere to a bionic implant,

Speaker 12 that's that's the single biggest problem. We do not have a problem getting the metal to adjoin to the bone, as we've already told you.
We have a problem getting the skin to stick down.

Speaker 12 And you're quite right. Obesity is one of the biggest enemies of blood supply to the skin of the next bionic woman or man.
So it is a challenge.

Speaker 1 We're near the end now.

Speaker 1 Kevin, I want one more question for you, which is, are we really, when we were talking a little bit earlier about the ethics and the ethics that may well occur as advanced goals, is this the debate where we end up whether it's replacement or enhancement?

Speaker 8 That's where we find the problems will arise?

Speaker 8 Yes, I think that's true. And of course, the first goal, certainly in medicine, will be replacement as it is at the current time.

Speaker 8 It's all about replacement, bridge to survival, bridge to cure, or bridge to

Speaker 8 the abatement of a disease process.

Speaker 8 When you get good at some of this stuff, and I don't think this is true of all organ systems, but some organ systems, you'll get to the point where you can do better than what exists already.

Speaker 8 And then, yes, you will get into that.

Speaker 8 Do you want that for a medical reason, or do you want that for an enhancement? But, you know, this is something that's not that new in medicine. We have that sort of discussion going on

Speaker 8 at the current time in much lesser ways. I mean, whether it's cosmetic surgery or

Speaker 8 areas like that.

Speaker 8 But I think with bionics, or what we're calling bionics here,

Speaker 8 if you ever achieve your holy grail of body replacements, then of course, yes, you'll be able to, you know, it is then possible to make a replacement that is better than the real thing.

Speaker 8 And then you'll have a question: there'll always be someone who'll pay, and there'll always be someone who'll do it.

Speaker 9 I mean, are we heading towards

Speaker 9 a form of immortality here? I mean,

Speaker 9 let's project 100 years into the future. It's a final sort of idea.

Speaker 7 It's a climate change, though, isn't it?

Speaker 7 What matters would be floating, won't we?

Speaker 10 Well, Well, we could have to make it light.

Speaker 7 Gills,

Speaker 9 like the man from Atlantis.

Speaker 1 Lucia, apart from human civilization ending in 100 years, do you feel optimistic?

Speaker 7 No, I don't. I feel I don't feel optimistic about anything, to be honest with you.
We've got 12 years till most places flood, haven't they?

Speaker 7 And then we're going to see sort of mass destruction like we've never seen before.

Speaker 7 And some people don't.

Speaker 12 People out there are just not going to put it.

Speaker 7 Most people, all they're doing is just, oh, I've got paper straws now. And then they think that's all right.

Speaker 7 I've got friends, you know, they don't recycle, they eat meat three, four times a day, but they've got paper straws.

Speaker 7 But when we were talking, like, I just don't understand how

Speaker 7 the body can be, it's so complex, and the things you learn take,

Speaker 7 you know, 60, 70 years to let.

Speaker 7 And then, like, but it can take people like five times to pass the driving lesson.

Speaker 7 How can the body be so complex and the brain be so dim?

Speaker 7 It doesn't make sense, does it?

Speaker 1 Brian's got an idea to fuse himself with a pteropin. That's how he's going to survive.

Speaker 6 That's why I'm so interested in that.

Speaker 7 Do you think we're going to get things are going to be okay?

Speaker 8 That's what I tell my patients.

Speaker 1 Well, we've covered a lot of ground in that last five minutes, so we're

Speaker 1 little to do with this.

Speaker 1 So we asked the audience, what part of your body would you most like to make bionic and why? And we added that we go out at 4.30. So

Speaker 1 eyes, so I could see where my boyfriend has hidden his secret hoard of chocolate. That's from Helen.

Speaker 9 Sheila says bionic liver so I can drink more Prosecco.

Speaker 9 Carl says my throat so I can successfully swallow Brexit.

Speaker 1 My chin, it's otherwise dull but could be usefully employed as a torch if I could illuminate it at will.

Speaker 9 All these are mainly these are about alcohol.

Speaker 9 The renal system to fulfill my dream of becoming the world's greatest whiskey taster.

Speaker 1 Brian Cox's brain, then all his talk would make sense. Well that fitted in well up to your last bit.

Speaker 1 Bladder to relive my bygone night of undisturbed slumber.

Speaker 9 Oh, this is one for legs. I'd finally have enough pockets for all my useless scraps of paper.

Speaker 9 I like this one from Andrea. It's at stomach.
She wants it, the stomach converted so that excess calories get converted to electricity to recharge her phone instead of expanding her hips.

Speaker 6 Nice.

Speaker 1 Thank you very much to our panel, Lucy Beaumont, Kevin Fong, and Noel Fitzpatrick.

Speaker 9 Next week, we're talking about how to measure the universe.

Speaker 1 523.121.

Speaker 9 What

Speaker 9 has that got to do with the universe?

Speaker 1 Dewey Decimal System, Brief History of Time. Check it.
That is correct.

Speaker 1 Thank you very much. Bye-bye.

Speaker 1 In the infinite monkey cage.

Speaker 6 In the infinite monkey cage.

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