The Infinite Monkey Cage - How to Build a Bionic Human

Episode Date: February 4, 2019

How to Build a Bionic Human.Brian Cox and Robin Ince are joined on stage by "supervet" Noel Fitzpatrick, Dr Kevin Fong and comedian Lucy Beaumont to learn how to build a bionic human. They'll be looking at the development of artificial limbs and organs that have been pioneered during times of war and at the extreme end of emergency medicine, and find out how Noel Fitzpatrick is developing new techniques and bionic devices at his veterinary practice, that could eventually be used on humans.

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or stroke. Know your risks. Visit heartandstroke.ca. BBC Sounds. Music, radio, podcasts. Hello, I'm Robin Ince. And I'm Brian Cox. The title of today's episode is How to Build a Bionic Human, something Robin is particularly interested in, given the state of him. Yeah, because unlike Brian, I'm actually made of organic material, not merely a kind of dream that Philip K. Dick had. Anyway, so... This cardigan's not made of natural fibre, though, is it? Actually, it's not entirely made of... Some of this cardigan is my kind of...

Because I was bitten by a radioactive librarian. It's partly made out of fibre optics as well, which gives me a superpower of being able to do the Dewey Decimal System in half the time of normal. So, yeah. What's the classification for Bleak House? 823.8. Look it up! It is! Why?

800 for literature, and then 238, it's English fiction, and the three represents an old man. This is very Radio 4, isn't it? We've definitely wandered off topic. How many librarians do we have in? One! and the three represents an old man. This is very Radio 4, isn't it? We've definitely wandered off topic. I think we've wandered off topic. How many librarians do we have in? One.

One? 17. Oh, wasn't that... What I loved is also how quiet they were. You know it to... If someone had gone, woo, you'd go, you're not a real librarian,

but the silent librarian, yes. Can you confirm that 800 is literature? Yeah. All the way through? He's right. A true superpower. Well, anyway, today we're going to be talking, well, some of the ideas that we both grew up in the 1970s

were children's TV, a lot of fantastic science fiction there. There were things like the idea that a nuclear explosion on the moon would send it across the universe and meet various different aliens. That's in Space 1999. We had a discussion about this, by the way, because Robin actually thought when we were writing the script would send it across the universe and meet various different aliens. That's in Space 1999. We had a discussion about this, by the way, because Robin actually thought, when we were writing the script, that it was just a piece of the moon that blew off and went across the universe.

And I had to correct him. It was a whole moon, wasn't it? So, you know, scientific accuracy. Yeah. It's far more believable that it was the whole moon meeting aliens that could transmogrify, as opposed to a bit of the moon travelling across the universe. One of them is supposedly scientifically less effective. Overdosing on gamma radiation apparently turns you into a superhero.

And one of, I suppose, our favourite shows, actually, is one that maybe does have some truth to it, The Six Million Dollar Man, about the enhancement by implementation of bionic limbs. So, perhaps not so fanciful, to help us understand the possibilities of bionic enhancement and repair, we're joined by a space doctor, a super vet, and the Incredible Hull. Sorry, someone from the Incredible Hull. And they are... I am Dr Kevin Fong, and I'm an anaesthetist and intensive

care doctor. I also work for Kent Surrey Sussex Air Ambulance, so if any of you ever see me again, you'll probably be having a really bad day. And for me, the most exciting possibility in bionics, I think I had to choose bionic eye, bionic heart. I think I've got to go for bionic eye, partly because our mate Steve Austin had one and partly because I think that's a wonderful idea to be able to plumb some electronics into the back of your retina and give people the power of sight who haven't had sight before.

So, bionic eye. I am Lucy Beaumont. Some people know me as a comedian. Apart from taxi drivers, they don't think I am when I tell them. They say I don't look like Michael McIntyre and when we create our bionic human us five I'm very excited about the accessories

a bionic human could have anything a Swiss army knife had bottle openers. Pouches as well. I thought we would have evolved to have pouches by now. A marsupial bionic. Pockets, yeah.

Bionic pockets? Well, yeah. But this will come in time, won't it? It's kind of a mixture of Terminator and a kangaroo. You'll get used to it. Yeah, eventually. So your bionic thing, pocket. Yes, yes.

So I'm Noel Fitzpatrick. I am a neuro-orthopaedic veterinary specialist, and I run a team of specialists in Surrey called Fitzpatrick Referrals, and we do cancer and surgery in all kinds of animals. I'm also a professor of orthopaedics at the University of Surrey. And I think the most exciting development in bionics is actually figuring out how to make skin seamlessly and forever stick to metal and how to make nerves communicate to the outside

as if a bionic limb were your own. But more importantly, or as importantly, I would wonder whether the monkey cage needs to be infinite or, in fact, can we get a better plan than having monkey cages at all? And this is our panel! APPLAUSE cages at all. And this is our panel! It's a hard choice, isn't it, between having nerve-ending skin with metal on it

and pockets. I'm not sure which one I'm going for. I go with the pocket if I were you. I think they'd meet, really, don't they? Well, it's actually quite interesting, because marsupialisation, which is the pocketisation of skin around metal, is the biggest single reason that bionic limbs fail, because bacteria colonise the area where the skin invaginates, because it's not a normal body orifice, let's face it.

Sticking metal through your skin, I mean, the bionic man is definitely going to need that, but pockets may be a deleterious to his or her future. So after this show, you're going to be the bionics expert of Hull. Well, I did have a... We used to call my Nana... We used to call her Bionic Nana, but obviously she wasn't, but she had a lot, like, both her hip replaced,

shoulder, kneecap. She had a metal plate somewhere, but we don't really know where. I like the idea there's a point where you go, I think now so much of Nana's been replaced, she's no longer nana there's only a little bit of her left yeah in more ways than one i want to get into that after a definition because first of all we like definitions so kevin could you define what we mean by bionics and also maybe refer to the history of bionics?

Well, if you look it up in the dictionary, bionics is the use of mechanical systems or devices to replace the function of organic systems, particularly in the human body. And most of us know it, for those of us who lived through the 1970s, through Steve Austin. I mean, that was what I grew up with. This is a perfect, perfect 70s sci-fi superhero for me.

He was an astronaut. He had a bionic... Was it two bionic legs or one? Two bionic legs, one bionic arm and a bionic eye. And so that idea that you could be that badly injured and yet you could be rebuilt and you could be better than you were before. In general, if we're talking about the history of this you know if you ignore sort of like just replacing amputated limbs with like long john silver style with just with just

uh you know a post to replace the absent limb uh we really don't get into building what we would accept as something that looks vaguely bionic really until the middle of the 20th century. And I guess, for me, at least in medicine, we don't really understand how to replace the artificial function or the function of real organs with machines really until then, until the birth of intensive care. This is interesting, because I think often we think of bionics

as bionic arm, bionic legs, you know, not internal organs. But of course, I suppose a lot of the progress has been in artificial hearts, which you would call a bionic object. Yeah, no, absolutely. And, you know, although I guess because of popular sci-fi, we think of bionic limbs, actually, you know, certainly from a medical point of view,

replacing the function of vital organs with mechanical systems is all essential, and it's the thing that preoccupies us most in medicine. And so we start off, really, in the history of it, in the 1950s, after the Copenhagen polio epidemic, when people's lungs and chest walls were paralysed by the polio virus, with replacing that with ventilator systems, so using artificial ventilators.

And then after that, we use drug support, hearts. So that's external. And the irony is that although you think of bionics as a thing that makes you better and you're running around at super speed with super strength, actually, the bionics that we created in the middle of the 20th century does the opposite. It confines you to a bed and puts you next to a bunch of machines

that are running into your body, and they're just barely maintaining you and it's everything you can do to maintain this pale imitation of being alive with with artificial kidneys you know dialysis machines or pumps that reproduce the heart or or um or indeed you know lungs and the total artificial heart for example has been this holy grail and we've not yet quite got there you know we we are close but we haven't quite yet got there and and i say that out of personal experience and when i was when i was a junior doctor working at a small hospital in the middle of the night i was sitting there in the middle of a night shift about two o'clock in the morning charge nurse comes up with a letter and the letter says what do you think of this and the letter says the bearer of this letter has an artificial heart

should that artificial heart cease to function they've been instructed that an alarm will sound and they should operate their manual pump and i said why are you showing me this letter i said because he's outside in the ambulance and the alarm's going off. And I ran outside and opened the doors and there's two people inside. There's this bloke with the artificial heart saying, hello, and this alarm going off. And there's his son with the pump in his hand going, hello, only long enough, you know,

getting his hand off the pump long enough to keep pumping. And I thought, what am I going to do? So I closed the doors and I went round the front of the ambulance and I said, do you know where the heart hospital is across town? And the ambulance driver said, yes. I said, drive as fast as you can. And yet still, after all this time, after half a century of chasing artificial hearts,

they're still not a reliable replacement. We still rely on transplantation of human hearts and these total artificial hearts as they're called are still only a bridge to transplantation and one of the things that that occurs to me there is is how very annoying it is in the press to have people say bionic this and bionic that or somebody's running on a bionic limb and in fact it's just a stump socket prosthesis that's stuck to the outside of your body. And it's not bionic because it's not attached physically to your endoskeleton, or in your case, in your thorax.

So people use the word bionic wrong all the time, which really annoys me. So your definition would be something that's physically attached? Well, no, it needs to be replacing or enhancing a bodily function as an integral part of the anatomy of the creature, in my view, as opposed to, for example, a Paralympian running in a race has a stump socket prosthesis put onto a stump. Is that bionic?

It's not attached directly to your skeleton, so by definition, probably not. People say in the press, you you know he's got pins in his legs so he must be or your granny who had the various bits is she bionic well we're reaching an era where we can actually replace body parts particularly in my area which is the spine and the skeleton so we can grow and replace body parts but they're only bionic if they're actually replacing the function of and i don't think that we've got to the point where we can, we're not going to rebuild them faster, stronger, better.

At this point, that's a myth, because we haven't really created a hedgehog with springs on its legs that can leap over a house, except if you're in Wallace and Gromit territory. But when I first became interested in this, and it's similar to your story, I was fishing with my Uncle Paul on the River Shannon in Ireland, and it's similar to your story, I was fishing with my Uncle Paul on the River Shannon in Ireland, and I was 11. And it was probably the only hot day in Ireland I

remember as a child. And Uncle Paul was getting sweatier and sweatier and sweatier. And I didn't know why he was sometimes grumpy, and sometimes he was really grumpy. And he rolled up his trouser leg and took off his wooden leg. And of course, I'd never seen his wooden leg, which is effectively like Long John Silver. And he took it off and I saw this horrible scabby stump. And I went, ah! As you do if you're an 11-year-old and you've just seen your Uncle Paul's stumpy leg covered in scabs.

Unfortunately for me, I was rowing and knocked his wooden leg off the side of the boat. So we spent three and a half hours going downstream on the River Shannon, chasing a wooden leg, to finally have an American tourist haul it aloft in a bed of reeds and go, anyone's leg, anyone's leg.

So I'm with Steve Austin. I thought at that moment, we should rebuild him stronger, faster, better, and I'm still trying. But that's, when you said about faster, stronger, I was thinking this when you were talking as well. With something like Six Million Dollar Man, where you have, he's lost his legs,

and he's now got these legs that go super fast, but he hasn't had his lungs replaced. Robocop had. We'll move on to Robocop. We'll start in the 70s, move on to the 80s, and then we'll get... So, if that was possible wouldn't there be ramifications like for instance when he lifts up something really

heavy the rest of his body is still just a normal human body wouldn't it just be oscar goldman going his arms come off again because he tried to lift up something too heavy or when you're running at that speed because it's not connected to the rest of the uh um the actual circulatory system does it not mean he become wheezy surely he become wheezy that his legs are going at that speed well only only if his heart and lungs are driving the power of the legs and this is the central problem so so noel talks about it's not bionic unless you can integrate it into the the body as a whole but but the the problem with most of these uh mechanisms that require some sort of power and particularly the heart is

that we're rubbish with batteries aren't we and so you can build these things you build them small enough and reliable enough to insert in the body so they don't need uh you know servicing again but then the battery always sits outside you you know i've seen i've met a bloke with a total artificial heart and he sits there and the heart's in his chest but he's got this thing that looks like a little briefcase in which the pumping mechanism, the power is and it makes enough noise that in a quiet room you can't really have a conversation.

And so until we conquer that, you're not going to get to that, you know, that holy grail of bionics whereby you stick the thing in and you forget about it because it has an everlasting power source. We don't have that power. It's a myth if you think it's going to be stronger faster better until in the case of moving parts we have a an integral power source that is renewable and i think that's possible it's possible in the next foreseeable future but i think it's important to differentiate

internal moving parts from internal parts that are more static and that need to be moved by levers like muscles so in my case i only deal with the skeleton musculotendinous system in your case you deal with the heart and the lungs different things entirely and the same with the eyeball different things entirely but bionic by i think are we agreeing that the definition is that it needs to be integral to the body no No, no, we're not agreeing at all. What are we agreeing on the definition? Otherwise I'm out of a bionic job. I'd like to think that I just do bionics all the time.

No, I suppose that's fair. I think to honour Steve Austin in all his glory, it has to be integral, doesn't it? But I see a problem in that fundamentally, in that that then pates you into a corner that I just can't see it happening for most of my important organs because most of the important organs that i want to replace require quite big power systems you see them as outside the body well i see it so how can you say a bloke who's and this this bloke standing there with not

total artificial heart in his chest it's pumping pumping blood around his body. He depends every moment of his life on this thing. The fact that the power source is in a sort of small briefcase type thing outside his body and he's got tubes running through the front of his chest, I mean that's pretty bionic to me still. Now, you want to get that shrunk down

so you can put that in the body, but I don't think he's less bionic for it. What about a big pocket? Yeah, yeah, yeah, yeah. There you go. Well, can we agree that the Holy Grail would be to make it integral? Yes, I can. And do you know, some of the most exciting things for me

in the current era of bionics that you could really see as being that, meeting those criteria, is some of the work that's done me in the current era of bionics that you could really see as meeting those criteria is some of the work that's done at the Royal National Orthopaedic Hospital and by one of my collaborators at University College London, Professor Rebecca Shipley and her group, is these bits of replacement bone that they put into children that have little motors in them that grow as the child grows, which is

incredible and and something that transforms the light so these are children who usually as a result of cancer have had to have parts of their their bone long bones resected so uh in the in the in the leg or in the arm and then as they grow up uh you have to commit them to further operations to lengthen that bone as they grow except now uh and you'll know more about this than I know, now they have these bits of replacement bone that have this motor mechanism in them. So as the child grows, it senses that tension on this prosthesis and the bone grows.

And so the child has to have just, well, hopefully one, maybe two operations. Well, I just want to find out from Lucy, because my jaw did properly drop at that point when you were talking about the bones, the artificial, maybe two operations. Well, I just want to find out from Lucy, because my jaw did properly drop at that point when you were talking about the bones, the artificial bones that can grow. I mean, when you're first hearing, like me, you're hearing a lot of these ideas for the first time.

How do you feel about, you know, these possibilities? Because, well, I mean, I'm five foot one. And a half. And I'd just like to be five foot three, to be honest. I wasn't able to change my life, really, because I wanted to be Mickey Mouse at Disneyland, and I got down to the final audition, and I was just too small.

You had to be five foot three for the costume. So this is the kind of world we can imagine. If bionic technology works, there's people who could work for Disneyland who'd never imagined they could before. If I could chip in there, that is a reality now. To be me.

Oh yeah. Tonight, ladies and gentlemen, for the first time, Lucy, the Labrador. No, it's a reality now. And coming back to what you just said, the grower, which is an endoprosthesis. Let's make a few definitions here. An endoprosthesis is something that's internal to the body and you can't see it. An exoprosthesis is something that's external and you can see it, and it's sometimes attached to an endoprosthesis. But the grower, which you were referring to, which is a femur,

for example, that you can make grow inside an electromagnet, that was initially developed at University College London Royal National Orthopaedic Hospital by Professor Gordon Blunt and his co-workers. And they did indeed create a bone that would grow within the child as they grew. And at that time, osteosarcoma was a very difficult disease to treat. And now it can be cut out. And of course, treatment with chemotherapy for spread of the cancer. But you can replace this bone in dogs or in humans with these implants. And the holy grail for me and for my entire life's purpose is to try and get animals and humans treated side by side

so that we all win. But not in the same ward, though. Not in the same ward, Lizzie. You're not going to be subjected to that. It's the little ones that yap, don't they? But people do make humans grow, and it's not Dachshunds. So you wouldn't mind big dogs on the ward? It's just the little ones that you don't like?

Oh, no, you know, they must drive you mad as well. Charlie, yap the yap. Do know what what i was thinking have you seen you know you're saying about the bionic um it's not the right term have you seen inspector gadget yes he has lots of pockets but the but it's sort of what you're saying maybe they're not bionic maybe they are gadgets at the moment oh so we're going to call ke're not bionic, maybe they are gadgets at the moment. So we're going to call Kevin's bionic person Gadget Man. Yeah. When you get admitted

to my ICU... I'll be in big trouble. You come at me with that. Which is going to be before the end of this show, mate, if you carry on. Yeah, we don't want any of that. So you're suggesting that Lucy could have now the bones in her legs modified such that they can gradually Yeah, we don't want any of that. So you're suggesting that Lucy could have, now, the bones in her legs modified such that they can gradually grow

and take her to five foot three? This is real life right now. You can insert growing endoprosthesis in humans, and in fact it is done. You wouldn't suggest it is a cosmetic procedure, though? Well, I am no one to comment on this but it is being done with the kardashians in the world today um i am not going to comment on that either so it's an optional so it's an optional procedure there are i'm sure you'll agree here that this is happening in the

world yeah it is happening i'm not sure i'd recommend it but uh but yeah well yes and this is the thing is is that the important thing we Well, yes, and this is the thing, is that the important thing we're touching upon here is, for me, the thing that we're calling bionics here is life-saving intervention. It is bridge-to-survival intervention, and I think there's not a problem with that because with all of these interventions, there is always risk,

and you balance that risk against a potential benefit. And then when you get into that, I'd like to be a bit taller. Sorry, Lucy. And it's the same, i guess we talk about this with with uh you know gene therapies etc etc when is the point at which you say look these these these are the cards you're dealt with to what extent do you want to enhance yourself further with these bioprocesses because that will become possible in the future and And so there's a big discussion to be had about that. Yeah, the big decision for both human and animal medicine right now is ethics.

Because just because we can do something, something does not mean we should do it. And I think it's absolutely critical for tonight's conversation, because as more and more things become possible, it absolutely does not mean that we have the right as a veterinary surgeon or a human medical surgeon to do that procedure. In my view, and certainly in my career as a veterinary surgeon, it needs to be in the patient's best interest, and it needs to be to alleviate pain and suffering and so on. Now, I am not in the realm of cosmetics, because fortunately that hasn't come into my world

quite yet, although it is legal in the United States, I believe, in the realm of cosmetics, because fortunately that hasn't come into my world quite yet, although it is legal in the United States, I believe, to put in testicles after they are removed with plastic ones. I'm not entirely sure if that's bionic. Bionic balls? I'm not sure. But it does happen, and that is real life. Not my bag, and we would never... Another pouch gag That has been the first pun for three weeks

and they have been starved of them You could see We're on the subject of pouches all night It's very very important that we emphasise that from a medical perspective there's a big difference between an act of recognised human medical practice or an act of recognised human medical practice

or an act of recognised veterinary practice and an experiment. They are two entirely different things. This idea of enhancement will come into the bionic debate, though, won't it? And I suppose with many medical technologies, it will be developed initially as a treatment. But you can see that, for example, you talked about your introduction, the eye. And you said an eye that can have different functions like the six million dollar man could have see different wavelengths infrared and ultraviolet whatever it is but that that will come once we can build artificial eyes and integrate them into the body and i suppose

later we'll talk about the problems there but once once we can do that, the pressure will mount, won't it, for enhancement through bionics? Yes. I mean, as with everything, if you can buy it, people will want it. I mean, we already know, as we've said, we already know that people pay to have themselves artificially lengthened so they can be taller, and so it won't stop there, will it? Do adults do that? I was fascinated when you said that.

So as an adult, if you put one of these devices, these growing bones, and it stretches slowly in a controlled way, then you do get longer legs. You cut the bone through what's called a corticotomy. You put the extended nail in there, and it's grown inside an electromagnet. It's quite painful. It's not without pain. But as you say, people do pay to have this done. So it will eventually come if it is possible. I think the question for me is, is there some fundamental reason why it isn't possible? Because we're talking,

you know, slightly as if it's not a problem just to wire into your optic nerve and reproduce all of the functions that the back of your eye has artificially. But actually, the most cutting-edge artificial rest and artificial eye that we have now really only gives you a marginal advantage over not having any sight at all. And that's the cutting edge at the moment. So it basically allows an individual who is without any ability to see to have a better than average chance of seeing changes in the light field around them. This is not then suddenly,

they're not out there reading, you know, War and Peace in their bed at night. And so we're underplaying the complexity of the organs we're trying to replace here. The lungs are not just a pair of bellows. The heart is not just a two-stroke pump. The eye is not just a camera. And the problem is that i guess in

this discussion we reduce human organ systems as if they are these sort of quasi-mechanical devices when they have there's so much more complex than that so it is possible that we don't ever achieve these things it's the difficulty in the the the object itself the retina in that case so it seems to me that the interface between that and the rest of the body must be an extremely challenging problem for many reasons just wiring the nerves onto the back of it well it's not just the the retina i mean the most common perception for people about the bionic man or the bionic woman is limbs and we share similar challenges albeit potentially less complex than the retina but one one of the holy grails in the

projects that I'm trying to help with in both animals and in humans is to provide bionic limbs that help both dogs and humans to have much better function because they've been amputated for whatever reason. And of course, you see on newspapers, people powering their hand and lifting this and lifting that. But the reality is the nuances of movement are really not there for most of even the most advanced, really expensive exoprostheses, which are these bits that fit on the outside. And we'll come back to the end later. But to come to the point on nerves, transmitting what nature has created into a bionic beast is way more complex than popular literature or even news media would lead you to believe. Way more complex.

Having said that, there are many projects going on, one of which you alluded to at the RNOH, whereby people can put microarray transmitters into nerves and into myofibrils which are in muscles and transmit those signals to microprocessors that can then transmit the signal from your brain into a bionic limb and they're being refined all the time so we know how to decode those messages to an extent we know what the you know to clench your fist but that's the thing so so we're so used to taking the outside world and transducing the signal of the outside world into something our phone can understand and spit out in a different way

that you think, well, we must be nearly there. But actually turning that into something that a human body can deal with in process is actually a next-level complexity. The eye is not just a camera. It's attached to an optic nerve, which itself moulds itself. The nerve, the actual nerve

that leads from the back of the retina through to your brain molds itself according to what you see in early life and then and then on the back of that is the visual cortex that the part of the brain that deals with those images really what you see is not really in your eye it's in it's in your brain it's all at the level of perception and so at that level of complexity it's it's it's pretty it's much much much, much more challenging than just slapping a CCD camera in the back of your eye. Well, I wanted to ask something. I'll ask you, Lucy, about the psychological effect as well,

which is when we talk about having something replaced, say, in the hand, when we've seen there have been hand transplants, and the difference between the replacement of someone else's hand... Of course, in the hands of all, it always turns out it's a murderer and you go on a killing spree, but I think that's very much a 1935 universal horror film. But the difference between that and having something that is an artificial...

Lucy, do you feel... If you can imagine the difference between you knew that your hand had been someone else's hand or you have a hand that has been manufactured to replace your hand, psychologically, there must be different things that you deal with. But I was talking to a guy in a pub and he had a pig's valve put in and he went off park. But that's actually been scientifically established. If you have a heart transplant from somebody else,

that you may feel different emotions, hasn't it? Yeah. But that's what I wonder. I love the idea, though, that the valve is actually more like a Nicorette patch. It's like you've got a patch of ham inside you and you go i don't need to have it on the outside world now it's uh i just say it's the best answer to one of your long and convoluted questions i've ever heard i'm going to remember that one and i'm going to say that

to you often but that's an interesting point isn't it because you're talking about the difference between transplantation of someone else's organ or limb onto you and how you would feel about that. But what you're doing there is getting around the problem that we've been talking about, which is all of that complexity that you're trying to interface with. When you transplant an organ, you're just borrowing the complexity from someone else and saying, here, it's ready-made. Why don't you stick it in? why don't you stick it in so however hard it is to transplant a hand it's probably easier to get that hand functioning like a real hand than it is to get an artificially built hand to work no i realized that um coming towards the end of the show i didn't ask the first question to contextualize which is why did we ask a vet onto a programme about humans? No idea.

Why? A night out. So my lifetime goal is to reunite 250 years of divergence of animal medicine and human medicine. Back in 1637 in Bologna in Italy, in the Theatrum Anatomicum, dogs and humans were looked at side by side, and we developed an era of medicine where there was a lot of cooperation and vets and human doctors kind of stood side by side.

They were medicine people. And then over the last 250, 275 years, we grew apart. And I'm not saying in any way that we should be doing experiments in everyday life. That's not what I'm saying. I'll give you one example just to illustrate what I mean. So you heard me say about Uncle Paul, and I really thought, this is stupid. Why does Uncle Paul have a wooden leg that's strapped onto his bottom? Why doesn't he have a piece of metal sticking out of his leg? And since then, I saw lots of dogs and cats that didn't have legs. And I thought, well, why are we not working together with the human surgeons who are trying to do the same thing for humans? And then I found out that, in fact, in medicine where for the first time in human history,

we have diagnostic imaging such as CT scans, high-resolution CT scans, where we can look at these interfaces between metal and bone without killing the patient. And it's not in any way, shape or form, and I want to emphasise that, that we would ever have an animal model that is a clinical patient.

But I'm talking about collaboration and cooperation. So right now at the Royal National Orthopaedic Hospital and at some other centres in the United Kingdom, for the first time in the UK, we're working together as collaborative colleagues. So there are humans that have stumps because they've had their leg chopped off or their arm chopped off, and there are dogs that need a new leg.

And together, we're trying to unlock these mysteries. And to come to the real crux of your point, which is we know how to make metal and bone join together. We've done it in hip replacements and knee replacements for years. What we don't know is how to make the perfect seal between the metal and the outside. If you look inside your mouth, your tooth grows out of your gum. And if you look at

that, it's a miracle because bacteria could get in there every day. If you look at a deer antler, that's bone coming through the skin. And in the rutting season, the antler comes off and bone grows through again and it doesn't get infected. And that inspired Professor Blahn at UCL to study the interface between the deer antler and the skin, and that's when I became interested. And he worked with Dr Catherine Pendergast, and they looked at metal bonding to skin. And for the last 12 to 15 years, we've been trying to understand what makes the perfect seal,

and we are not there yet. There are those that would say, well, a bionic leg is just a piece of metal that sticks through. I know I'm going off on one now because I'm a nerd. leg is just a piece of metal that sticks through. I know I'm going off on one now because I'm a nerd. And this is one of the most important things, I think, because people underestimate the complexity of biology. There are those that think you can stick a piece of metal through skin, the skin will form around it like your gum around a tooth. And that's just not true. The skin has to stick to something to prevent the pouch, which to come full circle, is where the bacteria get in.

It's called marsupialization. And there are a lot of proponents of the two different types of bionic legs that are available now. One is where the skin is attached to the lining of the bone. And the second is where the skin is attached to the metal itself. And for us, we're looking for the perfect seal between the metal and the skin so that it lasts forever. And our feeling is, if you can get that seal in the first 21 days, we're in business, and we could be in business for the rest of life.

That's the holy grail. If you don't, and if bacteria colonize, we lose limbs and we can lose life. And that's the price we pay for bionics. You can't imagine for one second that any of us can sit here and say that a bionic human or a bionic animal is ethically or morally right

without taking the moral responsibility that we lose life and we lose limbs. And I think it's really important to say that because we're not God and nature will take its course and we live in harmony with bugs all around us and their job is to colonize. And I heard one of your shows where you said, well, are we just receptacles for bugs? Well, I'll tell you what, if a bug gets into an amputation

prosthesis, we sure are a receptacle for a bug. And that can mean the difference between being able to have a stump socket where you can walk around or being in a wheelchair for the rest of your life. Or in a dog's case, it can mean the difference between life and death. And I think that's what we're dealing with here, life and death. So we can't take bionics lightly. It's a real big ethical responsibility. What do you think of fat dogs?

So this is a left-field question, isn't it? But does it annoy you because I've just moved to the countryside and where everyone's got a dog and I kept thinking why are all these, they look so thin and then I realised in Hull everyone's got fat dogs

and I thought that's what a dog was meant to look like. Well I can't comment on the geographic diversity of the canine kingdom, but... Because I know a few people, as a treat, they buy their dog a Chinese takeaway. One had been... had a tumour removed,

and as a treat, she got it a takeaway when they got home. But what I'm saying is, you do all this bionic thing, and then there's people, they'll get them home. You'll give them a new leg. They'll get them home and give them you know, a meat pie. You actually have inadvertently stumbled on one of our biggest

problems with infection which is subcutaneous fat. Oh, that's what I meant, yes. Genius. Genius. You are the bionics expert of Hull um because subcutaneous fat does not have a good blood supply and when we are trying to get skin to adhere to a bionic implant that's that's the single biggest problem we we do not have a problem getting the metal to it joined to the bone as we've already told you we have a problem getting the skin to stick down,

and you're quite right. Obesity is one of the biggest enemies of blood supply to the skin of the next bionic woman or man, so it is a challenge. We're near the end now. Kevin, I wanted one more question from you, which is, when we were talking a little bit earlier about the ethics and the ethics that may well occur as advanced,

is this the debate where we end up whether it's uh replacement or enhancement that's where we find the problems will arise yes i think that's true and of course the first goal certainly in medicine will be replacement uh as it is at the current time it's all about replacement, bridge to survival, bridge to cure, or bridge to the abatement of a disease process. When you get good at some of this stuff, and I don't think this is true of all organ systems, but some organ systems, you'll get to the point where you can do better

than what exists already. And then, yes, you will get into that. Do you want that for a medical reason, or do you want that for an enhancement reason or do you want that for an enhancement but you know this is something that's not that new in medicine we have that sort of discussion going on um you know at the current time in much lesser ways i mean whether it's cosmetic surgery or or areas like that but um but i think with bionics or what we're calling bionics here if you ever achieve your holy grail of body replacements,

then of course, yes, you'll be able to, you know, it is then possible to make a replacement that is better than the real thing. And then you'll have a question of, there'll always be someone who'll pay, and there'll always be someone who'll do it. I mean, are we heading towards, you know, a form of immortality here?

I mean, if we project, let we project 100 years into the future, the final sort of idea... Climate change, though, isn't it? What matter? Because we'll be floating, won't we? We have to make it light. Gills. Gills. Like the man from Atlantis. Lucy, apart

from human civilisation ending in 100 years, do you feel optimistic? No, I don't. I don't feel optimistic about anything, to be honest with you. We've got 12 years till most places flood, haven't they? And then we're going to see

mass destruction like we've never seen before. And some people don't people out there are just not going to cut most people all they're doing is um just oh i've got paper straws now and then they think that's all right i've got friends you know they don't recycle they eat meat three four times a day but they've got paper straws so but when we're talking like i just don't understand how how the body can be so complex and the things you learn take you know 60 70 years to let and then like but it can take people like five times to pass the driving lesson how can the body be so complex and the brain be so dim.

It doesn't make sense, does it? Brian's got an idea to fuse himself with a terrapin. That's how he's going to survive. That's why I'm so interested in this. Do you think things are going to be okay? That's what I tell my patients.

Well, we've covered a lot of ground in that last five minutes, so we're... It's got little to do with the... So we asked the audience, what part of your body would you most like to make bionic and why? And we added that we go out at 4.30. So, uh... Eyes. So I could see where my boyfriend has hidden his secret hoard of

chocolate. That's from Helen. Sheila says bionic liver so I can drink more Prosecco. Carl says my throat so I can successfully swallow Brexit. My chin. It's otherwise dull but could be usefully employed as a torch if I could illuminate it at will.

All these are... Mainly, these are about alcohol. The renal system to fulfil my dream of becoming the world's greatest whisky taster. Brian Cox's brain. Then all his talk would make sense. Well, that fitted in well up to your last bit. Brain, then all his talk would make sense. Well, that fitted in well up to your last bit.

Bladder, to relive my bygone nights of undisturbed slumber. Oh, this is one for your legs. I'd finally have enough pockets for all my useless scraps of paper. Oh, yeah. I like this one from Andrea. It's stomach. She wants her stomach converted so that excess calories get converted to electricity to recharge her phone instead of expanding her hips. Nice.

Thank you very much to our panel, Lucy Beaumont, Kevin Fong and Noel Fitzpatrick. Next week, we're talking about how to measure the universe. 5, 2, 3, point, 1, 2, 1. What has that got to do with the universe? Dewey Decimal System, brief history of time. Check it, that is correct. Thank you very much. Bye-bye.

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