Biohacking: medical promises or ethical perils?

What does the future of human­i­ty look like? Will we sur­vive the next few cen­turies with our descen­dants look­ing rough­ly as we do now, liv­ing out their three score years and ten? Or will biol­o­gy and tech­no­log­i­cal enhance­ment see us sport­ing stronger, faster mechan­i­cal limbs and genet­ic aug­men­ta­tion giv­ing us every­thing from enhanced cog­ni­tion to longer, health­i­er lives?

Advances in sci­ence, com­put­ing and biotech make this future, and the eth­i­cal chal­lenges it might throw up, worth con­sid­er­ing. But they also mean that those will­ing to do some extra leg­work (and some­times take sig­nif­i­cant risks) can try aug­ment­ing their own bod­ies at home. Let’s take a look at some of the pre­dic­tions, promis­es, per­ils and per­son­al­i­ties of bio­hack­ing, and see how they’ve panned out.

With an almost end­less sup­ply of head­lines sug­gest­ing that sci­en­tists have found the ‘gene for’ this and that, rang­ing from com­plex dis­eases to char­ac­ter traits, it’s hard to shake the sense that our des­tiny is writ­ten in our DNA. So, could we rewrite that DNA and improve every­thing from health to intelligence?

This idea took root in the ear­ly 20^th Cen­tu­ry, when using sim­i­lar breed­ing tech­niques to those that allowed us to opti­mise farm ani­mals and crops to do the same to human beings was shock­ing­ly wide­ly accept­ed. Eugenic poli­cies were pushed by politi­cians from Win­ston Churchill to William Bev­eridge and stud­ied by giants of sta­tis­tics and genet­ics like Fran­cis Gal­ton and even Fran­cis Crick, co-dis­cov­er­er of the struc­ture of DNA. While the hor­rif­ic crimes of the Nazis trashed the field’s rep­u­ta­tion, eugen­ics adapt­ed and sur­vived, down­play­ing overt ties to race and coer­cive birth con­trol, and empha­sis­ing indi­vid­ual lib­er­ty and the impor­tance of the wel­fare state to max­imise humans’ poten­tial by means oth­er than pure heredity.

Even as the polit­i­cal decline of eugen­ics con­tin­ued, how­ev­er, mod­ern sci­ence has shown us that the whole edi­fice was built on shaky foun­da­tions: most traits and dis­eases we might want to select for or against are incred­i­bly genet­i­cal­ly com­plex. Sad­ly, for those head­lines promis­ing a ‘gene for’ some­thing, most traits of inter­est are high­ly ‘poly­genic’, with hun­dreds or thou­sands of genes act­ing in con­cert with one-anoth­er and the envi­ron­ment to cre­ate a predisposition—not even a cer­tain­ty! —for a giv­en char­ac­ter­is­tic to manifest.

Screen­ing devel­op­ing babies for seri­ous genet­ic prob­lems is already common—but com­pa­nies are already appear­ing that offer more com­pre­hen­sive genet­ic testing.

Even eye colour, which we are taught in school has a very sim­ple pat­tern of inher­i­tance, is pre­dict­ed non-deter­min­is­ti­cal­ly by about 16 genes; height is explained by about 10,000 genet­ic vari­ants spread across around 30% of our DNA, plus diet and more in youth; and intel­li­gence is both hard­er to quan­ti­fy and, even if we take IQ as a good proxy, is genet­i­cal­ly less well-under­stood still. We may not even be able to selec­tive­ly breed for eye colour with certainty—let alone intelligence.

This hasn’t stopped com­pa­nies from offer­ing ser­vices that may allow par­ents to choose a future child based on genet­ic pre­dic­tions of brain­pow­er. Screen­ing devel­op­ing babies for seri­ous genet­ic prob­lems is already common—but com­pa­nies are already appear­ing that offer more com­pre­hen­sive genet­ic test­ing. Known as ‘pre-implan­ta­tion genet­ic diag­noses, or PGD, cou­ples under­go­ing IVF can have a sam­ple of just a few cells tak­en from a set of embryos devel­op­ing in a test-tube, and get their DNA test­ed for risk of dis­eases like can­cer and diabetes—and also intelligence.

US com­pa­ny Genom­ic Pre­dic­tion offers a num­ber of ser­vices under their ‘Life­View’ brand, up to and includ­ing a deluxe ver­sion called PGT‑P: T stands for ‘test­ing’, and the ‘P’ for ‘poly­genic’. Poly­genic risk scores are cal­cu­lat­ed using a sta­tis­ti­cal tech­nique that search­es for asso­ci­a­tions between changes in hun­dreds of places across our DNA and risk of spe­cif­ic con­di­tions. While this is fas­ci­nat­ing sci­ence at a pop­u­la­tion lev­el to under­stand how dis­eases devel­op, it has sev­er­al short­com­ings for pre­dict­ing the future health of unborn chil­dren. The main one is that these asso­ci­a­tions are pure­ly statistical—the genes used to pre­dict risk are often not causal­ly relat­ed to the con­di­tion of inter­est, mean­ing that even if the risk of, say, can­cer is less­er, you may be unin­ten­tion­al­ly select­ing an embryo with a high­er risk of some­thing else that isn’t mea­sured by the test.

The oth­er prob­lem is that prospec­tive par­ents will almost always end up forced into some kind of trade-off: even if you take the scores at face val­ue, per­haps the embryo pre­dict­ed to be most intel­li­gent will also have the high­est can­cer risk. Not only is this an impos­si­ble dilem­ma for mums and dads, but it illus­trates the oth­er prob­lem with genet­ic screen­ing as social pol­i­cy: even if the tests pro­vid­ed cer­tain­ty (which they don’t), we’d end up forced into decid­ing whether one dis­ease or trait is worth more than anoth­er, for future gen­er­a­tions who may not share our views—especially if we opt to low­er their risk of a dis­ease that’s cured in future at the expense of one that isn’t!

If we’re not com­fort­able choos­ing the DNA we start our lives with, per­haps we’d be hap­pi­er with alter­ing our genet­ic lot as con­sent­ing adults? CRISPR and oth­er gene-edit­ing tech­nolo­gies are mak­ing this process dra­mat­i­cal­ly easier—both for sci­en­tists and doc­tors, who are using first-gen­er­a­tion ther­a­pies to cure dead­ly genet­ic dis­eases, and for garage ‘bio­hack­ers’ look­ing to mod­i­fy their own biol­o­gy at home.

One exam­ple is bio­hack­er Josi­ah Zayn­er, who runs a com­pa­ny pro­vid­ing DNA-edit­ing kits—and once inject­ed him­self on cam­era with a sup­pos­ed­ly mus­cle-boost­ing gene edit using CRISPR tech­nol­o­gy. That this is even a plau­si­ble con­cern shows us how far the tech­nol­o­gy has come, but DIY DNA alter­ation comes with seri­ous risks. For a start, it may sim­ply not have done any­thing: get­ting DNA edit­ing machin­ery into enough cells to make a sig­nif­i­cant dif­fer­ence to the biol­o­gy of an adult human is a work in progress, and most gene edit­ing right now hap­pens out­side the human body, by extract­ing some cells and mod­i­fy­ing them in con­trolled con­di­tions in the lab. The biggest risk if it does work might be can­cer from ‘off-tar­get’ genet­ic edits. This kind of extreme bio­hack­ing is very risky, and any ben­e­fits are very hard to quantify—and, for what it’s worth, Zayn­er says that he regrets set­ting such an auda­cious example.

The sec­ond type of bio­hack­ing involves meld­ing human biol­o­gy with tech­no­log­i­cal implants. Elon Musk co-found­ed Neu­ralink, a com­pa­ny mak­ing brain–computer inter­faces, with the long-term goal of enabling a ‘merg­er of bio­log­i­cal intel­li­gence and machine intel­li­gence’. He hopes that this will be the solu­tion to align­ing arti­fi­cial intel­li­gence with human inter­ests, by giv­ing humans a direct inter­face to ensure that AI advances aug­ment rather than oppose our desires.

How­ev­er, despite big claims and even FDA approval for a clin­i­cal tri­al, Neu­ralink remains vapour­ware. Musk has promised ‘to address brain injuries or spinal injuries and make up for what­ev­er lost capac­i­ty some­body has with a chip’, but so far the company’s high­est-pro­file demo in 2021 was a mon­key play­ing com­put­er game ‘Pong’ with its mind.

Oth­er bion­ic implants seem to have gar­nered pub­lic­i­ty not through being huge tech­ni­cal advances, but more because they seem weird and under­whelm­ing. One com­pa­ny, Bio­hax Inter­na­tion­al, has implant­ed ID ‘biochips’ in a few thou­sand customers—but use-cas­es range from no longer hav­ing to ever wor­ry about los­ing your keys, to pay­ing for gro­ceries with a wave of your arm. It seems that most of us would rather leave a spare key with a neigh­bour or use our phone to pay than have a minor sur­gi­cal procedure.

Oth­er bio­hack­ers are try­ing to use more con­ven­tion­al med­ical inter­ven­tions to opti­mise them­selves. This ranges from using sup­ple­ments and off-label approved drugs like rapamycin to opti­mise health or cog­ni­tion. There are dozens of com­pa­nies offer­ing every­thing from sup­ple­ments with dubi­ous evi­dence to online phar­ma­cies that will ship you drugs with­out a prescription—or any easy way to check that they are what they say they are, cor­rect­ly dosed, and so on.

Whether from infec­tions from an implant gone wrong, or prob­lems from drug or sup­ple­ment side-effects, do-it-your­self med­i­cine def­i­nite­ly comes with a health warning.

Most ideas for human enhance­ment exist on a slid­ing scale (or per­haps a slip­pery slope, depend­ing on your out­look): as these tech­nolo­gies approach fea­si­bil­i­ty and wide­spread adop­tion, might they sim­ply cease to be con­sid­ered ‘bio­hack­ing’, and become reg­u­lar med­i­cine, or every­day tech?

When dis­miss­ing the prac­tice of hav­ing an ID chip embed­ded in your hand as dan­ger­ous and eccen­tric, it’s easy to for­get that human–technology inter­faces are already in use every day, like microchip-enabled mod­ern pace­mak­ers keep­ing hearts beat­ing, or cochlear implants wiring an exter­nal micro­phone to the brain and giv­ing some deaf peo­ple the abil­i­ty to hear. Sim­i­lar­ly, implantable glu­cose mon­i­tors, are becom­ing avail­able for dia­bet­ics as a more com­fort­able and con­ve­nient alter­na­tive than fin­ger-prick tests or exter­nal ‘CGM’ devices.

It’s easy to imag­ine the lines becom­ing blur­ri­er as tech­nol­o­gy advances.

It’s easy to imag­ine the lines becom­ing blur­ri­er as tech­nol­o­gy advances. Many of us already wear smart­watch­es that mon­i­tor our heart rate and count our steps—could implantable ver­sions sen­si­tive to blood chem­istry be diag­nos­ing dis­eases or pro­vid­ing diet and exer­cise tips in the next decade or two? Is this bio­hack­ing, or a con­tin­u­a­tion of mod­ern med­ical and tech­no­log­i­cal innovation?

Sim­i­lar­ly, the line between genet­ic treat­ments and enhance­ments isn’t hard and fast. Most peo­ple would agree that it’s OK to use gene ther­a­py to cor­rect a gene that caus­es a fatal genet­ic dis­ease, even if the dis­ease isn’t fatal in all cas­es. Is it OK to low­er risk of death from heart dis­ease by 50% in some­one at genet­i­cal­ly high risk? What about 10% in some­one with no overt genet­ic risk fac­tors? What about if it improves their ath­let­ic abil­i­ties a bit at the same time? Where does the line between treat­ment and enhance­ment lie, and how com­fort­able are we with the lat­ter? These are impor­tant ques­tions, and delin­eation will become increas­ing­ly com­pli­cat­ed as gene-edit­ing tech­nol­o­gy becomes safer and more powerful—maybe even safe enough that, one day, we’ll all be doing DNA mod­i­fi­ca­tion at home.