Philippa Garner is a self-described "gender-hacker."
In 1993 at the age of 51, she underwent sex reassignment surgery. That was just the beginning of her quest for self-improvement. She followed the sex change with more modification: brow reduction, cheek implants, breast implants, lip augmentation and a face-lift. And she'd happily sign up for more, she says.
"I would be inclined to go through with some pretty radical conceptual self-improvement procedures," Garner said. "I think of cosmetic surgery as collaborative art.... And when I next have disposable income, I'll be back in the O.R."
Garner is part of a tiny population of early adopters eager to test bionics by choice rather than out of need. Any company that comes out with, say, a bio implant for Wi-Fi connectivity or devices that interact directly with the brain, can put Garner on the waiting list, she said.
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Such desire for radical body transformation remains very much on the fringe, and represents behavior that many if not most people would consider taboo. But the distance between denial and acceptance could turn as much on what current machines can and can't do, as it does body image.
In science fiction, advanced bionics that not only replace but surpass human potential are often treated as a given. Although today's technologies come nowhere close to that ideal, it's increasingly tantalizing to ponder what-if scenarios.
To Garner, surgical enhancements fall right in line with her vocation. A freelance illustrator whose work includes monthly satire in Car & Driver magazine based on cheekily modified car concepts, she has also produced a stream of personal vehicle designs for more efficient transport of the human body.
Whether she's modifiying vehicles or her own body, it's all part of the same quest for improvement.
"I felt that my situation in general was screaming out for a monkey wrench in the works," she said. Will the day arrive when she might swap her legs for some that can attach directly to one of her modified vehicles? Scientists say the technology isn't there yet – and Garner may have quite a while to wait.
Control and reliability is a necessity in limb design. Researchers working on prosthetic limbs say the devices must be flawless before they can be seen as a desirable replacement to a biological arm or leg.
"If you try to replace something on the human body, you have to do it in the way that the individual will feel exactly that they have the full control of the mechanism," said Stephane Bedard, founder and chief operating officer of Quebec-based Victhom Human Bionics.
Victhom's Neurostep technology is in clinical trials. Components are implanted in a limb that has suffered nerve damage – the device detects normal nerve signals sent to move a muscle or joint, then relays them electronically to the target muscle. The goal is for the patient to regain abilities like flexing joints, balance and stability of movement. Even such sophisticated technology, however, won't get much use if it's not convenient, experts say.
"Give a person an absolute state-of-the-art prosthetic limb with all the robotics technology we have and all the sensors we have and see if they're still using it in six months," said biomedical engineer and neuroscientist James Patton. "Most of them don't even put it on in the morning."
Patton works in the Robotics Lab at the Sensory Motor Performance Program of the Rehabilitation Institute of Chicago. Patton said amputees often choose simpler prosthetics that emphasize realistic appearance over function – or the plain old "hook" – because they get more done with it.
One accidental poke in the eye is a deal-breaker for anyone trying a prosthetic. Any malfunction destroys a user's trust, Patton said.
And unless a prosthetic performs even better than a natural-born limb, it's not likely able-bodied customers will be lining up.
"If one day a bionic hand outperformed a biological hand just on sheer practical performance – like dexterity, strength and speed – I'd probably consider replacing my biological hand," said Kyle Peterson, a 21-year-old information science major at the University of North Florida in an e-mail.
A technology enthusiast in general, Peterson's imagination regarding prosthetic possibilities was first fostered by the development of the Cyberhand. In November 2005, European scientists presented their prototype Cyberhand. The user could feel and touch, as well as make the hand grasp and move in response to their own nerve signals. Nerves in the wearer's arm fire an intricate package of touch and temperature sensors, motors, articulated joints and controls.
The Cyberhand was designed for amputees. But the prototype caught the attention of imaginative gadget freaks. Some, including Peterson, have mused over whether they might ever consider buying their own. But first, he'd want a safety guarantee. "No crushing babies or poking my eyes out when trying to put in my contacts," he said.
Body-modification enthusiast Garner said she is more compelled by implanted communications or entertainment technology. "I'd like to turn myself on via a TV-style remote or perhaps a tongue-operated keypad in the roof of my mouth."
Inventor and author Ray Kurzweil, author of The Singularity Is Near: When Humans Transcend Biology, is an optimistic visionary when it comes to the potential for the human body to intertwine completely with technology. But he doesn't downplay the difficulties involved. "People find it daunting ... we're not going to get there in a single leap."
Other futurists agree. When looking forward at radical leaps in medicine and technology, there is sometimes a tendency to draw stark visions of radical change and to imagine crossing them in ways that seem unappealing from today's perspective. Imagining the line between needing and wanting these technologies is to forget how change happens, some researchers say.
"I don't think it's possible to create a distinction between need and want," said Steve Mann, a pioneer in wearable computing technology and electrical and computer engineering professor at the University of Toronto. "Do we really need clothing? It's hard to say," Mann said. "It becomes a technology that receives widespread acceptance because it provides a mixture of need and want."
Some of Mann's donnable devices creep toward early bionic-like complements, if not replacements, to human function. His wearable EyeTap is an always-on eye-cam that has been adapted for control via signals sent from the wearer's occipital lobe.
Nonetheless, whether people will want to surrender their natural limbs when they don't need to may be another story. Dr. Henrik Christensen, a professor at the Royal Institute of Technology in Stockholm, is on the steering committee of the Neurobotics project. The European Commission-sponsored initiative is led by Paolo Dario, the Italian researcher who also led the Cyberhand team.
Christensen said scientists can build in technical safeguards, such as the Neurobotics projects standards to secure human-to-machine communications – and prevent devices from being taken over maliciously, one ominous possibility. But some of the bigger questions of societal acceptance and rejection of man-machine convergence will certainly be influenced by society itself.
Kurzweil says the vision of permanence is incorrect, anyway. Invasive, permanent bionics are unlikely to be humanity's path into a bionic future. "Temporariness really changes the equation," Kurzweil said. "I think people will be hesitant to make an irreversible decision, unless there are very compelling advantages."
Temporariness was in fact the critical factor for Paris-based Brenda Nahon, another conventional example of a person who chose cosmetic surgical change because she simply wanted it: breast implants. As she pondered the operation, it was the possibility of later having the implants removed that clinched the deal.
"To me, it wasn't a permanent thing – even though it will be permanent," Nahon said. "I knew that if I didn't like it, I could go back to what I was."
Nahon's plastic surgeon, Dr. Pierre Nahon (also Nahon's brother-in-law) is rigorous about making sure a patient understands the psychological as well as physical impact of cosmetic surgery. Too many operations are performed, he said, without the doctor and patient being aware of the risks.
Nahon believes the questions will be the same when it comes to tomorrow's more advanced surgeries.
"Sometimes you do a very nice operation, but the patient was not expecting the psychological effects," Nahon said.
