Here is the 72 page workshop report
What is meant by Human Enhancement (for this report)
The term ‘human enhancement’ encompasses a range of approaches that may be used to improve aspects of human function (e.g. memory, hearing, mobility). This may either be for the purpose of restoring an impaired function to previous or average levels, or to raise function to a level considered to be ‘beyond the norm’ for humans.
This is often achieved through technological means, with examples including the following:
• The use of cognitive enhancing drugs to improve memory and concentration.
• The use of hearing aids and retinal implants to improve sensory perception.
• The use of bionic limbs to restore mobility.
These examples demonstrate that new enhancement techniques arise from a range of disciplines including biotechnology, engineering, neuroscience and computing. The social, political, ethical, economic and regulatory issues raised by their use further highlight the interdisciplinary nature of this topic.
Key messages identified by participants at a workshop in March 2012 included:
* Enhancement technologies could change how people work. Work will evolve over the next decade, with enhancement technologies potentially making a significant contribution. Widespread use of enhancements might influence an individual’s ability to learn or perform tasks and perhaps even to enter a profession; influence motivation; enable people to work in more extreme conditions or into old age, reduce work-related illness; or facilitate earlier return to work after illness.
* The cost of technologies will be crucial. Cost and cost–benefit analysis are clearly key factors in determining who funds provision, which in turn will impact on equality and justice. Cost also drives investment decisions and will therefore be important in determining commercialization opportunities.
* The availability of enhancements will be influential. Although the cost of some enhancement technologies will render them inaccessible to all but the very few, raising questions of equality and justice, other technologies such as pharmacological cognition enhancers, are already readily available through the internet—posing imminent challenges for effective regulation. Likewise, digital devices and services with the potential to influence cognition are emerging continuously with little research into the risks and benefits.
* Interdisciplinary approaches will be key to moving forward. In developing new technologies, whether they are cognitive training or bionic limbs, interdisciplinary approaches will facilitate better understanding of how best to proceed. This also applies to implementation: if any enhancement is seen as valuable, scientists need to work together with social scientists, philosophers, ethicists, policy-makers and the public to discuss the ethical and moral consequences of enhancement, and thus to harness maximum benefit with minimal harm.
In considering the application of human enhancement to work, much discussion at the workshop focused on its potential role in increasing the access of disabled people to work. The Department of Work and Pensions has estimated that there are over 10 million disabled people in the UK. Over 6 million report significant problems with mobility, a similar number with lifting and carrying, and over 2 million report problems with dexterity and/or coordination. Of the people living with disabilities, about 50% are of working age.
There are several ways to enhance cognition in humans. Education and physical exercise are two well-established cognition enhancers not considered in detail here. Over the next decade, the ageing population will render efforts to restore and maintain cognition increasingly important. Emerging approaches include the following:
•Cognition enhancing drugs used to treat individuals with neuropsychiatric disorders could also improve mental faculties such as memory and concentration in healthy individuals, enabling them to work more efficiently or for longer.
•Drugs could also facilitate cognitive maintenance, which could be particularly beneficial to the ageing workforce. Revealing the optimal timing of treatment onset, as well as the risk factors that could facilitate cognitive decline, will be invaluable.
•Cognitive training delivered by computer may be able to improve learning, and research into the ways in which the brain responds to training is beginning to inform software design. Cognitive training will be most useful if it can provide transferable improvements, rather than just better performance on specific tasks.
• Brain stimulation, particularly non-invasive techniques, might facilitate improved learning and training outcomes, but further research will be needed to reveal how it should be used.
• Collective cognition could also facilitate enhanced performance at work. The rise in ubiquitous communications technologies over the past decade has changed how we work and is likely to improve efficient and inexpensive coordination and knowledge-sharing. This brings new opportunities to harness technology to boost the power of a collective network to solve complex problems. Individuals will in turn use the outputs of collective efforts to enhance their individual performance.
Examples of cognitive enhancers currently in common use
Methylphenidate (Ritalin) increases the synaptic concentration of the neurotransmitters dopamine and noradrenaline by blocking their reuptake.
Atomoxetine (Strattera) is a relatively selective noradrenaline reuptake inhibitor. Although Ritalin has low abuse potential when prescribed correctly, its action on the dopaminergic system brings a risk of substance misuse. By not acting on dopamine, Atomoxetine is not accompanied by such risks.
Modafinil (Provigil) is an atypical stimulant. Its cognitive enhancing effects are likely to be due to effects on noradrenaline and possibly dopamine.
Some cognitive-enhancing drugs do not produce extreme changes in mood that usually accompany recreational use, such as a ‘high’ or ‘rush’, and do not lead to obvious physical dependence. This applies to drugs such as atomoxetine and modafinil.
Non-invasive brain stimulation
Non-invasive brain stimulation could be a more applicable technique (than invasive deep brani stimulation which is used to treat Parkisons now) and of widespread use in the next years. The most used non-invasive transcranial stimulation methods are transcranial magnetic stimulation, in which a magnetic coil is placed above part of the skull to deliver magnetic pulses to the brain area beneath the skull, and to induce action potentials; and transcranial electrical stimulation, in which low electrical currents are applied to the skull through one or more electrodes, to modulate neuronal excitability in brain areas beneath the skull.
To date, physical enhancement has been developed primarily with a focus on restoration, although over the next decade we are likely to see this extend to applications in healthy individuals. Developments include the following:
• As the average age of the working population rises, individuals are likely to seek to maintain or restore declines in sensory perception. Better-quality devices like hearing aids will support prolonged auditory abilities, but could also be useful to individuals with normal hearing in challenging situations, such as in the military. Equally, new techniques to restore and maintain vision are in development, such as retinal implants, gene transfer and replacing photoreceptors in the eye.
• Technologies external to the body can support restoration of mobility and limb function, and future applications in healthy individuals might include those whose jobs involve manual labour. Design of devices like bionic limbs and exoskeletons must overcome the traditional challenges of user control, energy efficiency and usability if they are to become more automated and easy-to-use, and thus more accurately mimic or surpass the functionality of human limbs.
• Tissue engineering and regenerative medicine are offering new opportunities to replace degenerating tissues. Less complex applications, such as bone and joint tissues, are entering clinical trials and we are seeing progress in more complex tissues like tracheas. The most complex cases will produce entire organs, but less involved techniques that target specific parts of an organ might turn out to be sufficiently effective. Research to integrate stem cell work with cardiac pumps is another avenue, which might also be applied to other organs.
• Good nutrition is clearly vital to health and wellbeing, and there may be particular nutritional approaches that benefit specific aspects of performance, such as stamina, strength and recovery time. Future applications could be improved by determining the neuronal basis of overcoming fatigue.
• Cosmetic enhancement could be appealing to some members of an ageing workforce, in which younger appearance might be believed to have implications for one’s employment prospects.
Enhancements could have many applications to work in the future, which might benefit both employees and employers, but the potential implications may well be complex, unpredictable or divisive.
• Enhancement could benefit employee efficiency and even work–life balance, but there is a risk that it will be seen as a solution to increasingly challenging working conditions, which could have implications for employee wellbeing.
• Work to identify the potential harms of new technologies should be pursued to support decisions by users – both employees and employers – but data are currently lacking and difficult to collect.
• The usefulness of technologies will vary with context. Enhancements will benefit different occupations in different ways and, importantly, every user will exist in unique circumstances. To benefit fully from enhancement technologies, integration must therefore focus on the individual.
• There are few data on the current and potential use of enhancements or on how publics view the use of enhancements at work. Ongoing dialogue will be vital in developing an understanding in these areas.
• Particularly complex questions are raised by the use of enhancements in occupations where work is related to responsibilities to others, for example surgeons performing lengthy operations or passenger coach drivers.
• The use of enhancements could widen access to certain occupations. However, access to the enhancements themselves may be restricted by cost, thus raising questions over who funds provision.
• If technologies enter mainstream use at work, there is a risk that individuals will feel coerced into using them, with consequences for individual freedom.
• The use of restorative technologies could enable disabled individuals to enter, or return to, work and might lead to a blurring of the boundary between those considered disabled and those not. This could have significant implications for individuals who do not wish to make use of such technologies and for any decisions over funding that are related to whether a technology is defined as enhancement or restoration.
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