Ryan Mills snaps black surgical gloves on his hands and plucks a syringe off a paper-shrouded tray. Its 10-gauge needle gleams under the fluorescent lights. Hidden inside the tip is a half-inch long electronic implant.
Mills prepares for the procedure with professional quickness and ease that come with experience. He's done more than 50 implants in 2015, here at the Skin Art Gallery tattoo parlor in Addison. Mills' ears, stretched to accommodate platters, today are adorned with brass rings that dangle just past his jaw line. The empty, elongated lobes sway a little as he preps the table.
Anthony E., the implant's 37-year-old recipient, eyes the syringe. His skin has been inked with tattoos, flayed and branded for aesthetic scarring and punctured with fishhooks. His tongue's been split in two and his arms are lumped with ridges and shapes, silicon implants that he says were installed in protracted, bloody procedures. "I'm a big fan of sensation," Anthony says. (He's a social worker who asked we not include his last name.) "It's not really about how extreme the sensation is. I just want to know what these things feel like."
For someone with his advanced experience with body modification, the impending, quick jab of a needle should be simple. But this time there's a difference — his implant will be no mere ornament. He's receiving a radio frequency identification implant.
He hopes to use this implanted device to guard his Android. When he brings the phone close to his hand, it will induce a current in the chip, which will transmit the code that unlocks the phone. The implant itself, encased in a capsule of biosafe glass, requires no power.
Part of Anthony's impetus today — beyond body-modding curiosity — is to guard his phone against the depredations of his friends, not hackers or thieves. "I lost my phone at the State Fair," he says. "When my friends found it and gave it back, there were all these photos of people's balls on it."
His wife, Janal, who has suffered the same experience, chimes in as she watches him prep for his implant. "You can always tell whose balls are whose based on the way they've been modified," she says. "Who's got a piercing, who's got a tattoo, who's got a scar."
The couple are "hookers" who enjoy dangling from metal impaled into their bodies. Janal is in her late 20s, athletic but almost pixieish. Anthony is not much taller, pale-skinned and stoutly built. They laugh easily and are eager to describe the history — and extol the virtues — of the tightly knit suspension, body modification and scarification community in Dallas.
They are not reckless. The couple is deep into exercise, and they value experts who can help them push the edges of experience with the minimum risk. "We demand a lot of our bodies, and so we need to treat them well," Janal says. "You can't do these things to your body if you don't respect it."
Still, Mills knows they are open to trying nearly anything. He's the one who carved those cosmetic patterns in Anthony's chest and traced triangular shapes onto his back with a small soldering iron-type torch typically used by surgeons to cauterize small wounds. When Mills entered the implant business last year, he knew the couple would be interested.
They started with magnets. And here's why they trust Mills — he refused to get involved when he read reports of the magnet implants disintegrating inside clients' bodies. He only recommended the procedure when a vendor, Dangerous Things, adopted titanium casings.
A small incision in their right index fingers, a pea-sized magnet implant and a suture is all they needed to gain a new sense. Janal and Anthony say they could feel nearby motors activate by the tingling sensation caused by the magnets stirring in their digits. "It makes you more aware of things turning on around you," Anthony says. "I kept thinking, if machines took over like in The Terminator, I could tell them apart from humans just by shaking hands."
Living with a magnetic finger turned out to be harder than the procedure. Anthony's finger ached when he lifted metal weights. Janal, who has a job constructing hearing aids, found the magnets would turn the devices on and off as she worked. With a quick nick from a scalpel, Mills removed their magnets.
Now Mills is offering his clients a new experience: implantable electronics. At Skin Art Gallery, none of this seems rash, or even odd. The Texas Department of State Health Services says it has no history of penalties taken against the parlor. "We [are] heavily scrutinized so [we] have to be careful," Mills says.
It's time for Anthony to receive his implant. Seated on the cushioned table, on top of white sterile paper, he hardly seems nervous. Janal quickly positions herself to get a good view.
A swab of disinfectant and a quick pinch at the fleshy base of his thumb, on top of his hand, readies Anthony for the needle. Mills slides it in smoothly. "How does it feel?" Janal asks, a little breathlessly.
"Like I'm being stabbed," Anthony responds evenly.
Mills then depresses the plunger and inserts the implant. He withdraws the needle quickly, leaving a small hole that soon trickles blood. Anthony holds up his hand, shaking it a little to inspire more flow. Mills takes the limb back, applies gauze and snaps a black surgical glove on Anthony's hand to keep the wound under pressure.
"You're a good boy," Janal says, smiling at her husband. "You want a lollipop?"
"Yeah," he says, looking away from his hand to meet her eyes. "I want a lollipop."
Dallas is at the center of two movements that are each trying to bring implants to the mainstream. Tattoo artists and technophiles head one, and well-heeled university neurologists and medical device engineers form the vanguard of the other.
The fringe commercial types, who design and inject mail-order devices into their bodies, call themselves "grinders." The high-end researchers, with advanced degrees and government contracts, call themselves "bioengineers." They have radically different approaches, but they're actually pulling humanity in the same direction — toward a fusion of hardware and wetware by incorporating technology into the body.
The prime driver of both of these movements is the shrinking size of wireless electronics. Implanted electronic devices are not new; surgeons in Sweden installed the first heart pacemakers in 1958 and researchers first implanted cochlear implants to mitigate hearing loss in the 1970s. But this is the iPhone generation, and electronics have grown small and powerful enough to appear in some unlikely places.
Like inside your pets' bodies. Veterinarians and shelters offer microchips for dogs and cats that contain information about the animals' owners. (The SPCA of Texas chips all its adoptable animals.) When a lost animal arrives at the pound or clinic, staff scan the animal for a microchip and retrieve information they compare with an online registry, which contains the owner's contact data. The wayward critter gets to go home.
The hardware and registry are operated by private companies, but the ASPCA supports microchip identification of pets. The only debate over microchipping animals is focused on the failure of the United States to adopt internationally accepted standards.
There's a large leap from accepting Fido's microchip and getting one yourself, but we're getting there. Western society has become accustomed to having electronics at our disposal at all times — to receive news, communicate with friends and provide satellite-guided directions. Now imagine the pervasive capabilities if all these electronics are inside your body, ready whenever you need or want them.
The state of Texas oversees implants under the same rules for licensing, record-keeping and reporting infections applied to piercing. Anyone can buy the syringe and implants on Dangerous Things' website, but the company suggests going to a doctor or licensed body piercer. The company, based near Seattle, doesn't bother to claim its implants are proven to be safe. Its website bluntly states: "This device has not been tested or certified by any regulatory agency for implantation or use inside the human body. Use of this device is strictly at your own risk."
Amal Graafstra, the founder of Dangerous Things, has provided a global community of body hackers the ability to buy and inject implanted electronics. Graafstra, who has an implant in each hand, says business is booming. "We've sold thousands, and the pace is increasing," he says. "And I think we'll have some very interesting things to show off in 2016."
So how can his company sell these devices, with naught but a warning sign on the website? Part of the formula is that people have a hard time winning lawsuits if they choose to use a dangerous item that is clearly labeled as such unless it malfunctions.
The other loophole depends on regulatory gymnastics. "Our products don't fall under Food and Drug Administration regulation as medical devices, based on their criteria," he says. "However, we actually had the option, but this would have put our professional body piercer partners into a tough legal situation. They are not medically licensed to handle or install medical devices, so we opted to keep our products out of that arena."
Others are jumping into that space, but they're not fringe technophiles who are adopting implants. Doctors, universities and even the Pentagon are getting involved and changing the relationship between man and machine in ways that are more revolutionary than anything the most ambitious grinder could imagine.
Ten miles away from the Skin Art Gallery, on the campus of the University of Texas-Dallas, Rob Rennaker holds a half-inch aluminum-ceramic cylinder in his palm. The ceramic is black, but the cylinder is capped on each end with bright titanium.
Inside this casing is a circuit board the size of the sliver of white at the base of his pinkie nail. He's designed this device to be implanted in a patient's neck, where it can help heal brains ravaged by a stroke or other damage. He anticipates doing this in late 2016. "We hope that in 12 to 18 months this will be ready for clinical trials." Rennaker says. "This changes neurology; this changes rehab; this changes everything."
Understanding what is happening in this lab requires a crash course in brain science 101. The brain is a massive bundle of cells called neurons, 100 billion of them, more or less. They
communicate with each other with electric signals that prompt the release of chemicals. These signals are passed, one neuron to the next, via skinny arms called dendrites and their skinnier cousins, axons. The more these signals pass through these arms, the stronger the connection and the quicker the transmission.
This is what learning is: Neurons growing stronger bonds through electrochemical repetition. It's the difference between reading a speech once and memorizing it after reading it 20 times. Or practicing the swing of a baseball bat until you can hit a fastball. Or ... well, everything.
So the brain is not static; it's always changing. (Researchers call this "plasticity.") There are unfathomable neural pathways, formed by links of interconnected synapses which are created whenever we learn or experience anything. Mapping each one is impossible.
Instead, neural engineers wait for the signal and amplify it at the exact moment the pathways are open. Timing is everything: If they can stimulate the brain with a mild electric pulse at the right moment, the brain will release chemicals that reinforce those active connections. "You can think of it as an old-fashioned switchboard," Rennaker says. "You plug in the right connections and go from my house to the White House. That's the connection we want to strengthen. The key is when we press the button."
Planting electrodes into the brain is incredibly invasive, dangerous and expensive. Instead, the bioengineers at UTD are using a backdoor into the brain, through the vagus nerve in the side of the neck. It travels from the brain stem through the neck and into the abdomen, one of the central highways of a mammal's nervous system.
By attaching an implant on this nerve, neural engineers can hack people's brains without opening their skulls. "The vagus nerve is God's gift to neuroscience," says Dr. Michael Kilgard, a professor of neuroscience at UTD.
Many thousands of people already have vagus nerve stimulation (VNS) implants; the FDA approved it for treating seizures in 1997 and depression in 2005. But Kilgard and Rennaker are among a new crop of researchers making inroads into new therapies.
In December the pair co-published a study that seems to demonstrate VNS is a possible treatment for those trying to recover from strokes, the first time researchers studied this possibility in actual humans. The patients in the study, published in the journal Stroke, who received vagus nerve stimulation regained more arm motion faster than those who didn't. The test group and lead researcher hails from Scotland, but UTD and UT Southwestern Medical Center are now conducting a round of human trials in Dallas.
UTD also has an active program to prove that VNS can help brain-damaged patients regain the ability to speak. By integrating sensors on the tongue, the therapist could tell when the patient is moving her tongue in the position to form a word correctly.
The second that happens, the vagus nerve implant fires a jolt of electricity to stimulate the brain. So the next time the patient pronounces the sound correctly — the next time neural pathways are open to do so — her brain will respond more quickly. "If I can put this little device in and enhance your stroke therapy twofold or fourfold, it reduces that therapy from a year to three months," Rennaker says.
Rennaker is a forceful and persuasive advocate for using implants to improve treatments of brain injuries. The former Marine turned neural engineer is the executive director of the Texas Biomedical Device Center at UTD. Like many researchers, he has a passionate belief that these things can transform the way modern medicine treats patients, and his descriptions of the possible future of implants can outpace current reality. But his confidence comes from the university's very real effort to make cheaper implants that can enable more clinical trials, essentially pressing the accelerator on future studies.
The current state of the art for a VNS implant takes more than a syringe. A surgeon cuts into the patient's chest and implants a pulse generator under the skin. A second incision in the lower neck enables the surgeon to wind a wire, which carries the current from the generator, around the vagus nerve.
These implants are 2 inches long and thin as a wallet, pretty slim but actually large when it's installed in someone's chest. They're also expensive, at $20,000. Rennaker's team is removing the battery and microprocessor from the implant and placing these things in a piece of jewelry to make the devices wireless and dramatically shrink their size.
The UTD staff sees the scope of its use growing, since smaller implants mean cheaper implants. The device Rennaker hopes to approve for human implants in 2016 cuts the price from $20,000 to $1,000. The distant future, they say, could bring implants — tiny circuit boards lathered in soft silicon — as cheap as $50.
"Right now it's almost cost-prohibitive to do the clinical trials that we do," he says. "Our goal is to build a manufacturing facility here at UTD to build these devices, so we can provide them to our patients for research."
The Biomedical Device Lab founders are hoping that the studies that prove to the FDA that VNS implants can treat various ailments will seed an industry. "My vision of what's going to happen when these devices are ready is that Dallas is going to become a hub for neural innovation," Rennaker says. "Everyone who wants to build an app for a therapy, all they have to do is build an app that can talk to this. You can imagine all these spinoff companies in Dallas that are focused on neural rehabilitation."
Others are not sold on the idea. Surgeon Dr. Charles Burton has been involved with medical implants for decades. He designed electronic devices for people with spinal injuries that speed recovery and neutralize pain. He performed the first such surgery in 1975. At the time, he had a tough time persuading nurses to work in the operating room "because it was against God to put any devices into the body," he recalls. Now he advocates against unnecessary surgery and is the head of the Association for Medical Ethics.
"This is very, very primitive," he says of vagus nerve stimulation. "Everyone knows about the VNS but, by the same token, our knowledge of the brain is fairly limited. So the efficacy of the treatment is highly controversial. Many effects are not measurable and are often subjective."
If there's an easier way to treat people, he tends to favor it. He cites a company in New Jersey called ElectroCore that sells a device that looks a lot like a vibrator, meant to treat headaches by pressing against the skin of your neck to stimulate the vagus nerve. The FDA has not approved the device, so it's not for sale in the United States.
Burton isn't claiming it's any better or worse than an implant, but sees the risk-versus-reward tradeoff as being more favorable. "An external device is clearly the most optimal way to achieve neural stimulation," Burton says. "I'm particularly sensitive to unnecessary surgical procedures."
And that brings us to the development of an emerging technology that could doom future implants — wearable electronics. The goal of so-called "e-textiles" is to integrate the sensors so seamlessly that they are indistinguishable from fabric. "We are in contact with textiles for more than 90 percent of our lives, and they are starting to become intelligent," says one report from the market forecast firm IDTechX. "From clothing to bandages, bed linen to industrial fabrics, new products integrating e-textiles are being created." Why get an implant when your clothes can do the work without breaking the skin?
Despite skepticism and headwinds, the UTD researchers have every reason to have high hopes. The Texas Biomedical Devices Lab has serious financial backing. Texas Instruments donated $3 million to the university, an anonymous donor threw in another $5 million and the board of regents went in for $5 million. This February the university is opening up a new facility called the Bioengineering and Sciences Building. The entire third floor of the building will be dedicated to the device lab.
Dallas' work on implants has also attracted the attention of the Pentagon. Last month the Texas Biomedical Device Center landed a $6.5 million research contract with the Defense Advanced Research Project Agency (DARPA) to study treatments of post traumatic stress disorder. The DARPA grant will provide support for research at nine labs at UTD and a team of about 30 researchers, including professors, postdoctoral researchers, graduate students and engineers.
The goal is to prove in preclinical trials — rat studies — that VNS can mitigate fear responses in the brain. Rodents naturally avoid bright, open spaces, so if they can do tasks in that environment, researchers can claim the fear response has been tamped down.
The DARPA grant is part of the large Brain Research through Advancing Innovative Neurotechnologies program that the National Institutes of Health launched in 2013. So yes, the Obama administration is directly funding research into implants that are designed to alter people's brains. Conspiracy theorists, take note.
Mitch Cerroni is, by definition, an enhanced human. It just takes the 27-year-old a while to admit that the radio frequency identification (RFID) chip in his hand has given him abilities the rest of us don't have. "I am enhanced in that I have one more security measure in my body," he finally says. "There are fingerprints and iris scans, and these are unique things to identify people. I have three unique things, not just those two."
He snorts, and adds, "I won't become an X-Man or anything."
In September, Cerroni and four other members of MakerSpace Dallas met for a class on biohacking. Cerroni, who teaches classes and serves as co-chair of 3-D printing at the nonprofit workshop and laboratory, has been intrigued by the opportunity to bring his tech inside his body. He doesn't normally rush into things and getting an implant was no exception. Months of research, plotting, evaluation and investigation preceded his choice. Cerroni spent more than six months wearing an RFID bracelet that he could program to interact with the tech around him.
"It's weird, but it's almost more sanitary to have RFID in your body than on a band," he says. "I didn't like how it got sweaty or water got under it. And if you take it off, there's a chance you lose it or forget it somewhere."
Ryan Mills, of Skin Art Gallery, taught the class that September day, and he came ready to puncture. The MakerSpacers already bought gear from Dangerous Things. "He came to the space [to] talk to us about it, and then he did the operations here in the classroom," Cerroni says. "This is the first body modification I've ever done. No tattoos, piercings or anything. I feel like a tattoo is almost too permanent."
Each implant has its own preprogrammed unique identification code. The five self-described "cyborgs" met with the building administrator to tweak the server that manages security. Each key card is matched with an approved user, so it was simply a matter of matching the key card ID with the unique ID in their implants. With a few keystrokes, the door readers were able to scan the implants and allow entrance with a wave of the hand. Likewise, Cerroni now taps his phone on his right hand to unlock it.
This is the textbook definition of enhancement. Therapy fixes something that's broken — like a stroke victim's brain — but enhancement gives a person a new ability.
So what Mills offers clients is certainly optional enhancement, but there's nothing stopping the treatments being done at UTD from becoming something else as well. "The medical establishment is always focused on therapy," says Adam Kolber, a professor at the Brooklyn Law School who taught the first law school course devoted to law and neuroscience. "But it's quite possible that the same sort of technology will be used for enhancement."
Any vagus nerve implant can be programmed to send that extra voltage for a variety of tasks and treatments, just by tweaking the timing. That means the implant can be a one-size fits all. Using that concept, vagus nerve implants made to repair damaged brains could enhance healthy ones. Welcome to the world of implant-assisted learning.
This seems far-fetched, but it's been demonstrated in lab animals. A 2006 study published in the journal Neurotrauma demonstrated that "VNS stimulated animals had accelerated learning" after brain injuries. (The researchers gave a bunch of mice head trauma and compared the recovery between VNS-stimulated rodents and those without.)
The researchers at UTD talk plainly about the possible future use of VNS to accelerate learning in humans "Because math is boring to some kids, I'm going to intervene and make it [neurologically] exciting," Rennaker says. "To those children, it will still be the same boring math, but they are going to get it faster, we think."
This would happen without the child feeling any different, outwardly. There's no burst of euphoria or change in mood. But inside the kid's brain, the communication between brain cells is being optimized to learn more quickly. "It doesn't hurt, it doesn't bother you, it doesn't get you excited or aroused, or any of those things," Kilgard says. "It just does its job."
UTD neural engineers are sold on the idea that brain stimulation can accelerate learning, but they draw the line at the direct download of skills, a technique that neural engineers call an absurdity that belongs in sci-fi movies. "You have to be doing something," Kilgard says. "You have to be awake. In the Matrix, you're asleep. With this, the learning is just accelerated."
Kolber sees the seeds of legal difficulty being planted if this works. "That raises a series of questions. One of them is, will augmentation lead to inequalities?" he says. "An enhancement can become the thing you need to have just to keep up."
If everyone has a neural implant at work and can produce faster than you can, is there a suit to be filed claiming discrimination? Kolber says it's a legal gray area. "It's hard to find good analogs because not many things have been proven to be actual enhancements," he says. "The closest real world example we have is Oscar Pistorius. His special prosthetics enabled him to race, which was therapeutic. But some were saying they were enhancements that weren't fair since others couldn't use them."
The bioengineers at UTD see checks and balances on the development of their brain-hacking apps, since the FDA would have to approve them and the university would have a license on the devices. "We won't be making super human beings, but we could make you become super proficient at something as you can be," Rennaker says. "We think there's a limit."
But Mills and his body modder clients don't like to admit limitations; they want to find the edge and push past it. "I'm down for a Blade Runner future," Mills says. "The day cybernetic implants are available, I'm first in line."
In August, biohackers took the stage at the DefCon hacker's convention in Las Vegas. The event is well established, but 2015 was the first year the biohackers had their own breakout sessions. Alex Smith of the implant-vending firm Cyberise.me offered this provocative setup to his session: "Ever cloned an office access card but been afraid you'd be caught and searched? In this talk I'll show you how to clone RFID cards to subdermal implants to avoid detection."
This does not surprise Mills, who watched body modification experimentation emerge from the underground and into his parlor. "Whatever you are seeing out in the open is only one part of what's ever going on," he says. "There's always someone working on something new, somewhere in private."
Of all the headwinds facing implants, privacy concerns are among the most often cited, but your car key fob or garage door opener is at more risk than an implant. The reason is proximity: The closer the signals need to be to control the device, the less of a chance a hacker can intercept it.
The RFID and near-field communication devices that Mills implants in his tattoo parlor have ranges of just a few inches. That makes the idea of a hacker triggering the device from across the room pretty remote — not impossible, but less likely. Just be careful when you shake hands; the person you're touching could be interrogating your implant.
The big impediment to implanted electronics has been safety. The cautionary tale here is Florida-based company VeriChip, which in 2001 introduced an implantable FDA-approved chip that could store a person's medical records. But when The Associated Press ran an article citing a study that showed high rates of cancerous tumors in lab rats, investors ran for the hills.
The study was not conclusive — in fact, the rats used in the study had been bred to form tumors more quickly — but the company's stock dropped 40 percent. It stopped selling VeriChip devices in 2010, changed its name to Positive ID and are now trying to sell tiny biological and chemical weapon detectors to the Department of Homeland Security.
The debate over implants still echoes from the rise and fall of VeriChip. The debate is most clearly articulated these days by pet owners, who worry about the health effects of identity chips in their dogs and cats. This directly informs the grinder community, since the biosafe transponder glass used by Dangerous Things is the same as the stuff used on pets.
The American Veterinary Medical Foundation sums up the mainstream, medically accepted position neatly: "There have been reports that mice and rats developed cancer associated with implanted microchips. However, the majority of these mice and rats were being used for cancer studies when the tumors were found, and the rat and mice strains used in the studies are known to be more likely to develop cancer. Tumors associated with microchips in two dogs were reported, but in at least one of these dogs the tumor could not be directly linked to the microchip itself."
Burton, of the Association for Medical Ethics, points out that much more medical literature connects health risks to tattoos than implants. "The toxicity of the materials used in implants has progressively decreased since the 1970s," Burton says. "The risk of allergic reaction and carcinogenicity is so low that it's now insignificant."
Burton is fairly laissez faire about the grinders and their non-FDA certified implants. "The issue there is quality control," he says. "But do you want the government approving everything you do? I don't know, but you do have to give the individual the leeway to use their judgment."
Grinders and bioengineers live in separate worlds, yet work to build the same future in different ways. The UTD Biomedical Device Lab scientists are not fans of commercial implants at tattoo parlors. They say they never knew about the grinder community, in Dallas or beyond, until the Observer brought it to their attention. But they didn't like what they heard.
When asked if it was a good idea to receive an implant at a tattoo parlor in Addison, both Rennaker and Kilgard contorted their faces with disgusted skepticism. "Um, no!" Rennaker blurts. "I would recommend not." They both politely declined to come to the tattoo parlor to watch Mills implant a customer.
Dangerous Things' Amal Graafstra, emailed the details about the bioengineers' work with VNS, liked what he saw. "Great stuff," he responded. "It's a practical way to enhance psychological treatment with physical brain stimulation that will likely improve outcomes over similar treatments based on prescriptive medicine."
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The UTD researchers also don't see the risk in grinders adopting their implants for more freewheeling body modification and enhancement. The device itself is not that complicated, but the location of the implant should give people pause. "The vagus nerve is very close to a major blood vessel, the jugular vein, so nobody will be goofing around with this," Rennaker says. "This device will require a surgeon — or someone crazy — to put in. We're not going to stop crazy but that should stop the mildly crazy, I guess."
As for the grinders of Dallas, the quest to enhance their bodies continues despite skepticism from friends and family. "I showed it to my mom after I got it and she was really upset. I have friends who are like, 'That's cool I guess,'" Cerroni says. "A lot of people just don't get it."
But he sees slow acceptance building. Late this month, MakerSpace Dallas plans to hold another biohacking class. "The first was so popular we decided to have a second," Cerroni says.
When the time comes, Mills will arrive with his black surgical gloves and the ranks of grinder cyborgs in North Texas will swell just a little, like a bump of scar tissue on the back of your hand.