The future of healthcare is deep

I'm on my way to give a blood sample. It's not something I enjoy. At all. After a nasty experience with the removal of a cannula as a child, I've tried to avoid needles wherever possible. Though I grin and bear it and do my best to look brave for all my jabs in front of the kids.Just writing about it, I'm getting squeamish. I have a physical reaction where I don't even like the sensation of my fingers touching each other. I have to splay them out for a few seconds until it subsides. I'm doing this in between typing sentences.So if i hate it so much, why am I getting an entirely voluntary blood test?

Our Future Health

It's for a programme called Our Future Health. This is a private initiative running the UK's largest ever health research programme. The goal is to better understand some of the key diseases that blight our health - cancer, diabetes, heart disease etc - by screening huge numbers of people down to a genetic level. Its goal is to reach five million volunteers, and it has already crossed the 100,000 threshold.Right now some people are screaming at the screen. "Why are you giving your personal health data to a private company?" "What about privacy?" etc. These are all valid concerns and ones that I have weighed up, alongside my squeamishness, before I decided to volunteer. So why did I do it?Because I believe that our current models of healthcare are unsustainable. We need to radically reinvent the way we manage lifelong health if we are not to regress. What we need, is Deep Healthcare.

A Growing Problem

Most healthcare interventions today start with a symptom. That might lead us into an acute care pathway (if the symptom is that you just lopped your finger off with a chainsaw) or a chronic care pathway (if the symptom leads to tests and a bad diagnosis). Or a different type of pathway altogether - for example, prenatal care. The largest expenditure today in terms of treated conditions is mental health, including dementia.Exactly what we spend on health and care is somewhat hard to calculate. Each country breaks things down differently, and has different systems. Totting up all the chunks of central and local government spending along with private spending across sports, medicines, care and treatment is time consuming. People can debate what should (a packet of painkillers?) and should not (gym membership?) be included. What we can say is that government spending is typically over 10% of GDP and in some cases closer to 20%. Add in private spending and it's a very large number indeed.Not only is that number large, it's growing. In spite of - in fact, because of - many advances, we now live longer lives. Things that would have cut our lives short in the past can now be treated or at least their symptoms can be ameliorated. In developed economies, our populations are ageing and population growth is slowing. In the second half of the century, it will decline. This will undermine the economics of many healthcare systems and leave us with critical issues around staffing, unless we can find a new way to deal with disease. An approach that extends everyone's healthy, happy lives at a cost that we can afford to bear.

Deep Healthcare

The idea that prevention is better than cure is not new. The debate about shifting investment towards preventative measures has been raging for a long time, with much debate about whether it would actually save money, or whether we ought to do it anyway for other reasons (life improvement). For example, one preventative measure is screening: catch an illness early and its treatment can be both more effective and much cheaper. But screening can be expensive - potentially costing more than the savings from the early treatment. So is it right to direct a limited health budget towards screening when there are always other demands? This is where we get into utilitarian arguments about the value of life and units like 'qualys' - quality-adjusted life years.Deep Healthcare is what happens when these arguments intersect with one great pressure and an incoming trend.The pressure comes from our ageing population, as mentioned above. Not a new phenomenon globally but one that is going to become increasingly acute for a growing percentage of countries over the rest of this century.The trend is technological. In the next few years, our ability to screen for health issues, and create targeted programmes of treatment, will increase dramatically. It will be driven by multiple scientific and technological advances:

• The application of our growing understanding of genetics
• Low-cost, high resolution, connected sensors
• Rapid processing of vast data sets
• Machine learning systems that can extract and present answers
• Rich, personalised digital communications

Deep Healthcare is a lifelong approach to maintaining your good health. It will be based on your unique genetics and your environment, and be tailored throughout your life based on physiological monitoring. It should mean fewer trips to the doctors. It should mean fewer hospital visits and less chronic illness. It should mean people can be healthy and active later into their lives. And that those lives should be extended.

Signs To Look For

What signals might we see that Deep Healthcare is coming?One to watch for is increasing investment in public health campaigns. As government concern about ageing and persistent issues like obesity, you will see more information campaigns and more nudge measures like taxes to try to change population behaviour. Alcohol will be a likely target.You will see more rich sensing technology aimed at consumers. I've been talking about smart sensing toilets for years now, and sure enough, one of the biggest names in consumer health electronics launched something along those lines at CES this year. There will be more to come.And you'll see more experimental screening programmes like the one I'm taking part in, enriching our understanding at a population level and helping to finesse the maths of where screening money will be best spent.

Problems With Deep Healthcare

The challenge to Deep Healthcare programmes come from issues of privacy and liberty. In the US particularly, you're likely to see very negative reactions to a system that seeks to monitor you, and to government attempts to change our behaviour. There will be lots of problems around insurance. And difficult questions about where the data goes and who owns the value in it, if private companies are involved - as they are with Our Future Health.Nonetheless, I think this is the obvious direction of travel. There will be problems along the way. But we need a new approach, and I'm willing to support the experiment.

Halfway between a stranger and a friend

Insularity is one of the biggest risk factors. The more we isolate ourselves from the views and expertise of others, the more we are blind to the challenges that might affect us. Worse, we begin to blame those who disturb our comfortable world view for the realities they proffer. It’s all too easy to shoot the messenger bearing bad news.It’s why I’m always so delighted to find organisations and individuals who seek to challenge their own perspectives. At a strategy day for a large company this week, I found myself one of a few external contributors, giving the board a range of perspectives.One of the other contributors was Maff Potts, founder of the Association of Camerados. Camerados is an organisation devoted to creating the space for people to communicate and support each other in times of hardship, not as professionals but as peers. It’s about a sense of solidarity. Potts describes the relationships between Camerados using a phrase coined by one of its users: ‘halfway between a stranger and a friend’.This phrase came back to me when speaking at a dinner later in the week. Around the table were the legal counsels of a range of large organisations. As I talked to them about the future, I scared a few (as usual). The inevitable questions arose: ‘what should we be teaching our kids?’, and ‘what will people do in the future?’I gave my stock answers about the three Cs, and the resurgent value of craft. But I was also thinking about what Potts said: part of the answer must be that we will be supporting each other.No-one can have missed the demographic shift facing our country. In some parts, the ratio between those receiving pensions and those of working age will be approaching 1:1 within 25 years. There’s no sign of dramatic service increases and investment in these areas to support the challenges that presents. We face a crumbling infrastructure and over-stretched services. So what do we do?Increasing engagement in our communities is not an answer. We probably need a radical rethink of our beliefs about what drives national success and growth – if growth, in the traditional sense, is even a valid objective anymore. A new approach to tax, spending and welfare should ultimately emerge*. But this will take a very long time.Between now and then we may have to grow our sense of solidarity and appetite for co-operation and mutual support. In a wider sense, maybe we all need to be camerados.*Before anyone thinks I am calling for some form of communist revolution here, let me point you to this post. In short, if you think markets can solve everything, you’re an idiot. But if you think states can solve everything, you’re just as much of an idiot.

Will a robot hold your hand? Technology in the future of care

This week I gave a short address at a panel debate on the future of care, hosted by frequent client, the rather forward-thinking Freeths solicitors. Here’s what I said. Or at least, what I intended to say when I wrote my script.When you’re looking to the future, you need to understand two factors. Firstly, what are the pressure points that the sector you are examining is facing today? In my experience, these are always the points of failure or opportunity where change happens first. Secondly, you need to understand what is causing that change. What are the major trends?For me, the best way to understand those trends is to look at technology. Technology is the means by which we enact change. Described in the broadest terms, technology the application of our understanding of the world. From the first rock a caveman or woman sharpened, through language, to the modern smartphone.

Pressure Points

You’re all familiar with the pressure points facing the care sector today. Rising demand, declining budgets, and a catastrophic lack of skilled permanent staff. The demographic changes we’re facing mean the areas with the most demand often have the least access to staff.Throughout history, technology has been deployed to address issues like this. If you can mechanise a process, you can repeat it at lower cost and higher frequency with fewer staff. It doesn’t matter if it’s a steam powered loom or a computerised call centre. But can we really apply technology to replace skilled people in care? For me, the answer is a very strongly qualified ‘yes’.First of all, let me tell you what we won’t see, which is some form of robot nurse, capable of all the things a person can do. Human beings are extraordinarily adaptable, both physically and mentally, and this flexibility is enormously challenging — and expensive — to try to replicate.Rather, what we will see is a much more distributed and pervasive suite of technologies designed to help people support themselves better, for longer. To smooth their entry into more formal care settings. And to assist them in overcoming their challenges throughout.

Monitoring

I’ll start with the first category — what we might loosely term remote monitoring.Have all heard the buzzphrase, the internet of things? How about Moore’s Law? What this really means is that the price of adding computing power and connectivity to just about anything has collapsed over the last fifty years — even the last decade. And at the same time, the accessibility of the devices and the knowledge to do this has dramatically increased. You can now, with really only a junior school education, programme a machine to monitor basic environmental factors such as temperature and humidity, and send that information off over the Internet. That device might cost you five pounds.Scale this up and add some grown-up intelligence, and you can start to monitor more things: activity, energy consumption, carbon dioxide levels, doors opening and closing. You can know if someone is active and what sort of conditions they’re living in.None of this is new, you might say. We’ve been able to get this information over a phone line for years. Sure. But two things have changed. Firstly, the cost: it now costs less than £5 a month to monitor basic environment factors and activity in someone’s home. The hardware is so cheap that there is no up-front cost. And it’s all battery powered so you don’t even need a specialist installer. It can just be stuck to a wall or ceiling, just like the fire brigade installs smoke alarms.Secondly, intelligence. Computing power is so cheap now that we can throw enormous amounts at monitoring and interpreting this data for very little money. To find the exceptions, the behaviour changes. To identify the risk factors and intervene early — and cheaply — rather than later when the issue is acute.Over the next few years I think we will see a massive expansion in the application of home monitoring technologies, not just by concerned children but by the state in a bid to manage the costs of care.

Robots

The second class of technology I want to talk about is robots. This is perhaps the area that has caused most consternation when its application in the care sector is discussed. People don’t like the idea of a warm nurse being replaced by a cold machine. And I understand that, but we shouldn’t leap to the conclusion that all automata in a care setting are bad.I have a sideline reviewing gadgets for the BBC, and before Christmas I got sent a Cozmo to play with. Did anyone’s kids get one of these for Christmas? Lucky kids. This is a tiny toy that looks a little bit like a cross between Wall-E and a forklift truck. It borrows the incredible processing power of your smartphone to approximate an artificial intelligence. It can recognise your face and play a series of games with you, using some special cubes that come with it.The most interesting thing about this toy for me was not the level of tech packed into its tiny shell, but the way that my children projected an identity onto it. This shouldn’t have surprised me. It’s a very human trait: we anthropomorphise everything. Just look how much intelligence and personality we ascribe to our pets, or kids do to totally inanimate dolls.In a very short space of time my kids created a connection to Cozmo and clearly felt a real sense of reward from interactions with it. The same behaviour has been witnessed in adults interacting with automata in a care setting.Machines can’t care. But they can provide mental support and stimulation. They can answer questions, guide people, control the environment and entertainment, and increasingly, chat. We can even project a level of love and companionship onto them — even when we know deep down that they are not capable of reciprocating. Because this is clearly what the human brain does. We shouldn’t reject that possibility out of hand.

Augmentation: Physical and mental

What these robots can also do is collect information, store it, and replay it. This is something that we all struggle with, particularly as we age or if our mental faculties are starting to decline. There’s a serious opportunity for us to start to augment our minds with technology. In fact I’ve been arguing for a few years that the process has already started: we are all bionic now.How many people used a smartphone to get here, looking up the time or location, using GPS and maps? I was born with a terrible memory and basically without a sense of direction, so the advent of such technology has been an absolute boon for me.Imagine if you could make the interface to this information even more natural. So low friction that you barely notice where you end, and the machine begins. Take these inserts for the sole of your shoe, for example, which vibrate to tell you when to turn left or right. Imagine a verbal prompt through a bone-conducting earpiece. Imagine a digital overlay on your vision.All of these things are real today or within a few years. They are still both expensive and a little rough around the edges, but that Moore’s Law I talked about will make them widely accessible. I’m betting that this technology is what ultimately replaces the smartphone.This doesn’t help those with physical frailty of course, but here again, Moore’s Law is our friend. Just ten years ago, strength augmenting suits were the stuff of science-fiction and military fantasies. Now they are commercially available, both in commercial contexts and to help the paralysed to walk again. In another decade or two, as battery and motor technology continues to improve, it’s easy to see articulated walking frames helping people to recover mobility. We’ve already seen such a revolution happen: how many mobility scooters do you remember seeing 20 years ago?

Summary

Technology is not the answer to our care crisis. That requires political intervention to raise funding and wages, improve conditions, overcome the looming threat that Brexit presents, and to address the threat to employment and employment quality that technology also so clearly presents. But whether or not these interventions are made, technology represents an opportunity to improve care. To give people more self-sufficient lives for longer, to ensure earlier interventions when they are needed, and even to provide a level of companionship to those who need it. I’d argue that we need to overcome our squeamishness and embrace it.

Future humans sleep more

We are not who we could be. Our minds and bodies are capable of much more than we have yet achieved.If you’re anything like me, you have already raised a sceptical eyebrow reading this. It sounds like the beginning of a woo-laden pitch for whatever the latest fad is in new-age treatments.It’s not.In the realm of real science, we are constantly uncovering new information about the operation and optimisation of our brains and bodies. Applying that information could lead to a dramatic change in our capability and longevity.One of the most fascinating areas of research right now is around sleep. I was directed to this by my friend David Turner, founder of TweakSleep, who told me an array of horrifying statistics last week. I was drinking beer rather than taking notes, but suffice to say most of us don’t get enough good sleep and it is killing us.Prompted by our conversation I hit play on a recent episode of the RSA Events podcast, a talk given by Matthew Walker, director of the Centre for Sleep Science. He didn’t reassure, packing his presentation with stat after stat about the damaging effect of sleep deprivation on our bodies and minds, starting with a shocking piece of information about how sleep ages testicles.Shocking as this all was, it was also extremely positive. Because what we understand, we can start to address. Fixing our sleep problems might help us to tackle everything from mental illness to cancer, accelerate our learning, and even boost our economy.The ways to do this also sound interesting and novel. This isn’t just about early nights. For example, Walker is experimenting with direct current stimulation to the brain to amplify positive effects, such as the laying down of memories. It’s a technology that could help students to learn but it could also be applied to tackling the onset of dementia.Sleep is just one of many areas of human physiology about which we still have so much to learn. As we do, and as we apply that knowledge, we can improve. It’s vital to remember this when looking to the future. The limits of human capability are far from set. Whether you are looking at population, economy, work or any other factor, you have to remember that tomorrow’s humans may well be much more capable and robust than we are today.

Robots are companions, not carers

I trust that the TV and radio producers I deal with are adept at gauging public interest in the stories on which they ask me to comment. So I’m sure there must be great interest in the concept of the care robot, a topic on which I was asked to comment three times yesterday, ending with a debate with The Guardian’s Michele Hanson on BBC Ulster.Michele and I were positioned slightly apart in our opinions, though perhaps not as far as it may have seemed to the listener. For while I think robots most definitely have a role to play in the care sector, I’m loathe to accept that they are in any way a suitable replacement for a human being.

Love technology, respect people

Any reader of this blog will know that I love technology. It has been my obsession from near-birth. But I also feel we are too appreciative of our own brilliance when compared to the spectacular complexity of our own bodies. We can’t yet understand nearly half of what we our bodies and minds can do, let alone replicate it. Rarely are those uniquely human characteristics more important than in a caring environment.For this reason we are a long way from having a robot that can ‘care’, however rapid the rate of technological progress. The revolution we require is not one of technology but of economics and social policy, properly valuing care work and creating a system to reward it appropriately. It’s hard to see how this will be achieved without radical political intervention in the economic system, something that might be decades away.What fits today’s system is an answer based on capital investment in technologies that can — if only in part — offset the lack of proper investment in humans in a care setting.This is where Michele and I differ. We agree that robots can’t care. But we disagree about whether robots can be useful companions.

Plug-in pets

I am not a pet person. Animals make me sneeze. Dogs scare me. And frankly it’s hard enough tidying up after myself and my kids, let alone adding an even less self-controlled creature into the mix.But I get it. I understand the appeal. I’ve seen the joy that animal companions bring to others. A joy that has been quantified by research. As the US Center for Disease Control, an organisation not prone to woo, puts it:“Pets can decrease your: Blood pressure, Cholesterol levels, Triglyceride levels, feelings of loneliness…”Now, what proportion of each of these benefits do you think is down to the innate capabilities of the animal? And what proportion is down to what happens in our heads through our interactions? The studies, though small so far, suggest that robot companions can offer the same benefits as living companions.Robots may not yet be even as smart as our pets. But they can be much better adapted to the needs of those they are designed to interact with. For a start, they can speak, tell stories, show films, control lights and heating, and clean floors rather than dirty them.Between these enhanced capabilities and our own propensity to anthropomorphise everything around us, it seems obvious to me that robot companions can be a useful supplement to human interaction.

Companionship is not care

This though, is the limit of their capabilities with today’s technology. Robots cannot replace humans in a care setting and nor should we accept that as a proposition. We have a major under-employment problem amongst the young, an ageing population and historical undervaluation of care work: one solution could hit the trifecta.If and when these problems are solved though, robots will remain useful and valid additional companions.

Future superhumans: from microchips to microdoses

What would you do to augment yourself? Over the last 24 hours I’ve found myself discussing three very different approaches to making us future superhumans.

Conscious Control

First, I met Simon Fox of BfB Labs, a London-based start-up building ‘emotionally responsive games’. The company’s first game, Champions of the Shengha, will be launched on 27th September 2016 on Indiegogo. It uses a Bluetooth connected heart-rate monitor to bring a different dimension to a classic style: the trading card/duel, in the style of Yu-Gi-Oh. By following instructions to control your breathing, and so moderate your heart rate, you can enhance your power-ups.

Adding this sort of gamification to what is fundamentally a meditatory technique for managing your mind state is really interesting. Imagine a whole generation of kids who grow up associating calmness and with power. Kids who have a well-trained ability to consciously control their body’s natural responses to stress and anxiety.

This is just the company’s first game. You can imagine how many of the most beneficial components of ancient techniques of self-control could be brought bang up to date in a game environment.

Basic Bionics

The second stimulus for this blog post was a conversation with Danny Kelly on BBC WM about the latest people to insert RFID chips into their hands and call themselves transhuman. This isn’t anything new: people have been attracting publicity through this approach for a few years now. Every time it seems to startle a few people, even though the technology is pretty rudimentary — no different to tagging a pet.

It does open up some interesting possibilities, even if it is very much a technology for today. In the future machines will be able to recognise us from our faces or our heart beat signature. No need for internal electronics.

Meanwhile though, opening doors at work with a wave of your hand is one thing. Being able to pay for a pint as if by magic is quite another.

I can see how that would appeal to future superhumans with a taste for beer.

Microdosing

The third spur was a brilliant piece by Wired’s Olivia Solon on ‘microdosing’ of psychoactive substances as a means of improving at work performance. Tiny amounts of LSD or psilocybin (magic mushrooms) are taken every few days to maintain a low-level boost to focus and mood.

As Solon notes, this is not a new phenomenon, but it is one with a growing number of adherents. I don’t mind admitting that if I were both younger and braver, I might give it a go. But having watched a few people on bad trips in the 90s, illicit pills and powders have always terrified me.

Future Superhumans: Train, Augment, Enhance

These three ideas present three glimpses of ways that we might make all of us into future superhumans. Mind and body training so subtly integrated into games that we just don’t notice the improvements we’re making in our own capabilities. Electronic devices inserted subcutaneously to give us access to systems and services. And drugs to extract the maximum potential from our own minds.

TEDxManchester: You Are All Bionic Now

I gave the opening talk at TEDxManchester yesterday. It was a cracking event with a great range of speakers, covering everything from parenting in war zones, to freestyle dance, to online dating and musical coding.

Normally when I do a talk like TEDx I post my full script afterwards. But the reality is that my script for this talk ended up quite some way from the words I actually said. In this case the script was really just the bones of a talk against which I planned the slide deck. What I actually said when I got on stage added a lot more detail that only really fell into place during the couple of days before.

So rather than posting my script to accompany the slide deck, I thought I’d post a summary and a few interesting quotes from my research material. You can see the full slide deck here: TEDxManchester — You Are All Bionic Now

Navigate with arrow keys (or just scroll on devices that don’t support the javascript behind it). And read on for the thoughts behind it.

We Are All Bionic Now

The central argument of my talk was that we are all bionic now. All cyborgs enhanced by the power of pocket and remote computers to which we have happily outsourced the augmentation of our mental functions. Satnav for our sense of direction. Shared photo and video stores for memories. Calendars and digital assistants. Search engines increasing our knowledge and aiding our recall.

Because our mental image of a cyborg has been defined as the direct interface of man and machine at a physical level — the Terminator, the CyberMen, the Borg — we have missed the fact that technology has overcome the issues that obliged this physical melding when the term ‘cyborg’ was first created back in the Cold War. We now have very high performance interfaces to and between our machines. Not only can they accept rich data from a range of inputs, but they can use their processing power to make assumptions to fill in the blanks. And when they need more power they can access it on demand over fast Internet connections.

Today you no longer need to have a chip in your head or your brain directly connected to mechanical body parts in order to be a cyborg.

And that’s good because the challenges we are facing now are very different to the ones that scientists faced back in the Cold War. In a stable, developed economy like the UK our challenges are much more mental than physical. The places we need augmentation are not primarily in lifting heavy objects or surviving harsh extra-terrestrial environments. Or for that matter, war zones (though this issue drives the continued research of more physical cyborg applications).

We use our cyborg powers today to filter the morass of content that comes our way. To navigate a world that is changing ever faster. And to inform and enrich ourselves with knowledge and media, for pleasure or to help us tackle the challenges of our work.

The next step is for portions of our personality to break off from the physical whole and become semi-autonomous in the cloud and in other devices. In a total reverse of the original idea of a human brain in a robot body, fragments of human thoughts, experiences, preferences and needs will be encapsulated in code and allowed to roam across the Internet doing our bidding.

A limited micro-clone of you will be in your self-driving car, remembering your address, preferences and even preferred driving style.

Another micro-clone will handle mundane shopping tasks, ensuring that not only do you never run out of toilet paper, but that when your preferred brand isn’t available you get the next best thing based on an understanding of you.

Perhaps there should have been a moral debate about whether we want to be cyborgs. But the reality is that we are now. The question we have to address is how far we want it to go. And what we will all do with our cyborg powers.

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Research

I found these excerpts from academic papers/books looking at the subject of cyborgs really useful — and fascinating,

“The use of the term ‘cyborg ‘ to describe a human-machine amalgam originated during the Cold War. It was coined by Manfred Clynes and Nathan Kline in Astronautics (1960) for their imagined man-machine bybrid who could survive in extraterrestrial environments. NASA, which needed an enhanced man for space exploration, sponsored their work. According to the original conception, the cybernetic organisms would remain human in a Cartesian sense; their bodies (like machines) would be altered, whilst their minds could continue their scientific research.”TechnoFeminism, By Judy Wajcman 2004

“By including gender [in the Turing Test], Turing implied that renegotiating the boundary between human and machine would involve more than transforming the question of “who can think” into “what can think”. It would also necessarily bring into question other characteristics of the liberal subject, for it made the crucial move of distinguishing between the enacted body, present in the flesh on one side of the computer screen, and the represented body, produced through the verbal and semiotic markers constituting it in an in electronic environment. This construction necessarily makes the subject into a cyborg, for the enacted and represented bodies are brought into conjunction through the technology that connects them.”How We Became Posthuman: Virtual Bodies in Cybernetics, Literature and Informatics, N Katherine Hayles, 1999

“I believe that these figures embody the libidinal-political dynamics of the consumerist ethos to which young peoplehave been systematically habituated during the contemporary period. …the Cyborg has incorporated the machineries of consumption into its juvenescent flesh.”Rob Latham, Consuming Youth: Vampires, Cyborgs and the Culture of Consumption, 2002

Three Things I Want from Engineered Evolution

At the How To Change the World conference this week we heard from a range of speakers who talked in one way or another about the control we will soon have over our own physical development. It included the application of stem cells and other techniques in the regeneration of human tissue and organs — even to defeat ageing. And the use of psychedelic drugs to consciously expand our own thinking and change our brain plasticity to enhance learning. The options are many.

Whether through biology or technology — and frankly the boundaries between the two are blurry, given the importance of quantum physics in both — we are now in control of our own evolution. Natural selection is no longer the force it was. What traits we want to select, we have to choose, or even design. At the conference, Professor Julian Savulescu termed this ‘evolution under reason’, but you could equally call it ‘rational selection’ or ‘engineered evolution’.

This throws up a number of ethical dilemmas, particularly around the prospects for inequality, as today’s debate around gene editing is highlighting.

Assuming we can address those to the satisfaction of most — at least the rational portion — the prospects are rather exciting.

I’ve always been rather squeamish about human modification. Tattoos and piercings are not for me. And no, I’m not interested in the spam adverts for other forms of male enhancement. But there are certainly aspects of my abilities over which I would like greater control. Particularly the mental ones.

Here are three examples that are top of my wishlist.

Focus

Like most people there are particular times of the day when I am at my best. The exact hours change between summer and winter but it’s always first thing in the morning. It’s not always possible, or desirable to be at my desk by 7. And if I miss my window, which may only be three or four hours at most, then my day can be deeply unproductive. I might still plough through some expenses or achieve the rare feat of clearing my inbox, but I likely won’t create anything, and that’s largely what I get paid for.

There are other periods in the day when I get bursts of creativity, but these are less predictable. Even the usual methods of seeking distraction, or inspiration, or just letting my brain freewheel on a walk, often don’t give me more than a few minutes of renewed focus.

But what if I could turn this mind state on and off. With a switch or a pill? What could I achieve then?

There are a few options here today for this. I could try drugs like Adderall and Ritalin, but these are both illegal without prescription and have serious potential side effects. Similar drugs pop up as ‘legal highs’ but these carry all the same risks and more. If I were going to pop a pill I’d want it to be very well tested and regulated.

I could also try Transcranial Direct Current Stimulation or tDCS, an increasing popular alternative to drugs for DIY brain hackers. But again the science on this is in its early days. While there are enthusiastic proponents, my natural scepticism leads me to want some solid trials before I start to experiment.

The answers aren’t there yet, but there are clear opportunities.

More RAM

Computers have a neat way to deal with a shortage of short-term memory. They dump a chunk of it into long-term memory and then retrieve it when it’s needed.

Humans do something similar. Some can do this with their own minds, with pretty reliable recall. I am not one of those people. Instead I rely on tools: notebooks, apps, my calendar, photos.

I once tried to replicate the computer’s process more precisely. I maintained what I grandly called a ‘livepad’. A single cloud-stored document, always open, on which I could record notes, ideas, my todo list, unfinished blog posts. It worked for a while but my limited interface to it (the keyboard), unreliable connectivity, and simple lack of discipline meant that I dropped it after a while.

Imagine something similar, with a better interface, and a level of intelligence to it. A place where you could record ideas that could be replayed back to you at the right time. The added intelligence in the pad may even help you to find coherence and commonality in those ideas, as well as assisting you with more mundane tasks, like remembering where to be and when.

High Bandwidth Interface

I think in words, more than pictures. Language is my preferred interface, and the way that I record and share language most frequently is via the keyboard.

The keyboard has proven to have incredible longevity. It is perhaps three hundred years old, based on the earliest patents. But it has limitations. I can only communicate words with it (for the most part). It is not that fast — certainly not in my hands.

I could try to learn to touch type, but even then I am limited to a relatively cumbersome interface. I can’t capture my thoughts on the move (though I do a decent job of writing blogs with my thumb while travelling on packed Tube trains). I could use a voice interface, but this isn’t exactly private and could be very annoying for those around me: I talk loud.

Instead I want the words to flow straight from my brain to the page, or the storage system.

This is some way off unfortunately. Though we are reaching the point where we can control artificial limbs with thoughts, the understanding of the brain on which this incredible achievement is based remains limited. For all our comprehension it is still largely a black box to us.

Evolution in Our Control

These are examples of what we might be able to add to human physiology in the years ahead. Even the drugs could be added to new glands as they are in Iain M Banks’ Culture novels. But they are elective and trivial compared to some of the choices we will have to make soon. We will have the capability to eliminate some genetically-carried diseases by selectively editing people’s genomes.

With that sort of power in our hands, we all need to think about the implications*.

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* If you want to make a start, you could do worse than to watch this video from Professor Julian Savulescu: