Ready For Cyborgization?

In yesterday’s newsletter, we asked you for your views on Brain-Computer Interfaces (BCIs), such as the Utah Array and Neuralink’s chips on/in brains that allow direct communication between brains and computers, so that (for example) a paralysed person can use a device to communicate, or manipulate a prosthetic limb or two.

We didn’t get as many votes as usual; it’s possible that yesterday’s newsletter ended up in a lot of spam filters due to repeated use of a word in “extra ______ olive oil” in its main feature!

However, of the answers we did get…

• About 54% said “It’s bad enough that our phones spy on us, without BCI monitoring our thoughts as well!”
• About 23% said “Sounds great in principle, but I don’t think we’re there yet safetywise”
• About 19% said “Sign me up for technological telepathy! I am ready for assimilation”
• One (1) person said “Electrode outside the skull are good; chips on the brain are bad”

But what does the science say?

We’re not there yet safetywise: True or False?

True, in our opinion, when it comes to the latest implants, anyway. While it’s very difficult to prove a negative (it could be that everything goes perfectly in human trials), “extraordinary claims require extraordinary evidence”, and so far this seems to be lacking.

The stage before human trials is usually animal trials, starting with small creatures and working up to non-human primates if appropriate, before finally humans.

• Good news: the latest hot-topic BCI device (Neuralink) was tested on animals!
• Bad news: to say it did not go well would be an understatement

The Gruesome Story of How Neuralink’s Monkeys Actually Died

The above is a Wired article, and we tend to go for more objective sources, however we chose this one because it links to very many objective sources, including an open letter from the Physicians’ Committee for Responsible Medicine, which basically confirms everything in the Wired article. There are lots of links to primary (medical and legal) sources, too.

Electrodes outside the skull are good; chips on/in the brain are bad: True or False?

True or False depending on how they’re done. The Utah Array (an older BCI implant, now 20 years old, though it’s been updated many times since) has had a good safety record, after being used by a few dozen people with paralysis to control devices:

How the Utah Array is advancing BCI science

The Utah Array works on the same general principle as Neuralink, but the mechanics of its implementation are very different:

• The Utah Array involves a tiny bundle of microelectrodes (held together by a rigid structure that looks a bit like a nanoscale hairbrush) put in place by a brain surgeon, and that’s that.
• The Neuralink has a dynamic web of electrodes, implanted by a little robot that acts like a tiny sewing machine to implant many polymer threads, each containing its own a bunch of electrodes.

In theory, the latter is much more advanced. In practice, so far, the former has a much better safety record.

I am right to be a little worried about giving companies access to my brain: True or False?

True or False, depending on the nature of your concern.

For privacy: current BCI devices have quite simple switches operated consciously by the user. So while technically any such device that then runs its data through Bluetooth or WiFi could be hacked, this risk is no greater than using a wireless mouse and/or keyboard, because it has access to about the same amount of information.

For safety: yes, probably there is cause to be worried. Likely the first waves of commercial users of any given BCI device will be severely disabled people who are more likely to waive their rights in the hope of a life-changing assistance device, and likely some of those will suffer if things go wrong.

Which on the one hand, is their gamble to make. And on the other hand, makes rushing to human trials, for companies that do that, a little more predatory.

Take care!

Cosmetic Surgery: What’s The Truth?

In Tuesday’s newsletter, we asked you your opinion on elective cosmetic surgeries, and got the above-depicted, below-described, set of responses:

• About 48% said “Everyone should be able to get what they want, assuming informed consent”
• About 28% said “It can ease discomfort to bring features more in line with normalcy”
• 15% said “They should be available in the case of extreme disfigurement only”
• 10% said “No elective cosmetic surgery should ever be performed; needless danger”

Well, there was a clear gradient of responses there! Not so polarizing as we might have expected, but still enough dissent for discussion

So what does the science say?

The risks of cosmetic surgery outweigh the benefits: True or False?

False, subjectively (but this is important).

You may be wondering: how is science subjective?

And the answer is: the science is not subjective, but people’s cost:worth calculations are. What’s worth it to one person absolutely may not be worth it to another. Which means: for those for whom it wouldn’t be worth it, they are usually the people who will not choose the elective surgery.

Let’s look at some numbers (specifically, regret rates for various surgeries, elective/cosmetic or otherwise):

• Regret rate for elective cosmetic surgery in general: 20%
• Regret rate for knee replacement (i.e., not cosmetic): 17.1%
• Regret rate for hip replacement (i.e., not cosmetic): 4.8%
• Regret rate for gender-affirming surgeries (for transgender patients): 1%

So we can see, elective surgeries have an 80–99% satisfaction rate, depending on what they are. In comparison, the two joint replacements we mentioned have a 82.9–95.2% satisfaction rate. Not too dissimilar, taken in aggregate!

In other words: if a person has studied the risks and benefits of a surgery and decides to go ahead, they’re probably going to be happy with the results, and for them, the benefits will have outweighed the risks.

Sources for the above numbers, by the way:

• What is the regret rate for plastic surgery?
• Decision regret after primary hip and knee replacement surgery
• A systematic review of patient regret after surgery—a common phenomenon in many specialties but rare within gender-affirmation surgery

But it’s just a vanity; therapy is what’s needed instead: True or False?

False, generally. True, sometimes. Whatever the reasons for why someone feels the way they do about their appearance—whether their face got burned in a fire or they just have triple-J cups that they’d like reduced, it’s generally something they’ve already done a lot of thinking about. Nevertheless, it does also sometimes happen that it’s a case of someone hoping it’ll be the magical solution, when in reality something else is also needed.

How to know the difference? One factor is whether the surgery is “type change” or “restorative”, and both have their pros and cons.

• In “type change” (e.g. rhinoplasty), more psychological adjustment is needed, but when it’s all over, the person has a new nose and, statistically speaking, is usually happy with it.
• In “restorative” (e.g. facelift), less psychological adjustment is needed (as it’s just a return to a previous state), so a person will usually be happy quickly, but ultimately it is merely “kicking the can down the road” if the underlying problem is “fear of aging”, for example. In such a case, likely talking therapy would be beneficial—whether in place of, or alongside, cosmetic surgery.

Here’s an interesting paper on that; the sample sizes are small, but the discussion about the ideas at hand is a worthwhile read:

Does cosmetic surgery improve psychosocial wellbeing?

Some people will never be happy no matter how many surgeries they get: True or False?

True! We’re going to refer to the above paper again for this one. In particular, here’s what it said about one group for whom surgeries will not usually be helpful:

❝There is a particular subgroup of people who appear to respond poorly to cosmetic procedures. These are people with the psychiatric disorder known as “body dysmorphic disorder” (BDD). BDD is characterised by a preoccupation with an objectively absent or minimal deformity that causes clinically significant distress or impairment in social, occupational, or other areas of functioning.

For several reasons, it is important to recognise BDD in cosmetic surgery settings:

Firstly, it appears that cosmetic procedures are rarely beneficial for these people. Most patients with BDD who have had a cosmetic procedure report that it was unsatisfactory and did not diminish concerns about their appearance.

Secondly, BDD is a treatable disorder. Serotonin-reuptake inhibitors and cognitive behaviour therapy have been shown to be effective in about two-thirds of patients with BDD❞

~ Dr. David Castle et al. (lightly edited for brevity)

Which is a big difference compared to, for example, someone having triple-J breasts that need reducing, or the wrong genitals for their gender, or a face whose features are distinct outliers.

Whether that’s a reason people with BDD shouldn’t be able to get it is an ethical question rather than a scientific one, so we’ll not try to address that with science.

After all, many people (in general) will try to fix their woes with a haircut, a tattoo, or even a new sportscar, and those might sometimes be bad decisions, but they are still the person’s decision to make.

And even so, there can be protectionist laws/regulations that may provide a speed-bump, for example:

Thinking about cosmetic surgery? New standards will force providers to tell you the risks and consider if you’re actually suitable

Take care!