Experiments on yourself
Biohacking: Is there medicine for healthy people?
Cardiologist Yaroslav Ashikhmin on why it is dangerous to try to control the biochemistry of your body manually.
Over the past decades, ideas about health and illness have changed a lot. From the Middle Ages to the middle of the twentieth century, doctors divided patients into healthy and sick. Now the WHO definition says that health is not just the absence of illness, but a state of complete mental and physical well–being. Thus, there are very few completely healthy people. And there is a transitional phase between the states of illness and somatic health: we say that people in it belong to a group of high risk of developing diseases. Such people have certain changes, for example, atherosclerotic plaques in the vessels or mutations that can lead to the development of cancer. But at the same time they feel absolutely healthy.
We began to better understand how diseases occur, but the profile of risk factors for death has changed a lot, and we were not ready for this evolutionarily. Chronic mental stress, air pollution, smoking, food that contains carcinogenic components – all this leads to the development of diseases. And the goal of any doctor is to treat people from these diseases and get rid of the suffering associated with them. And people want not just to be cured, but also to stay healthy for a long time and get more than their body can give. This is how esoteric currents such as anti-aging or well-being appear, because traditional medicine is not yet ready to respond to the requests of healthy people. From the doctor's point of view, the more professional you are, the more you want to deal with serious patients, and usually amateurs go into the field of maintaining health. Therefore, doctors are angry at biohackers: they believe that they are invading the holy of holies – the management of human health.
About the traps of biohacking
I would characterize biohacking as changing a healthy body with the help of modern technologies and medicines aimed at improving its functioning. For example, all doping is biohacking, as well as excitatory stimulants and hallucinogens like LSD or methamphetamine. It is important to understand that I am talking about biohacking, applicable only to a healthy body, although many modern technologies have come to medicine as biohacking. One of the first biohackers was the doctor Werner Forsman. In 1929, he developed a method of catheterization of the heart and tested it on himself by passing a probe through the ulnar vein into the right atrium. His colleagues believed that when a foreign object penetrates into the heart, a shock will occur and it will stop, but Forsman decided to experiment. He cut a vein at the elbow and inserted a narrow tube into it. For the first time, the tube did not reach the heart, because the assistant refused to continue the dangerous experiment. For the second time Forsman acted independently. He inserted a catheter 65 centimeters and reached the right atrium, then turned on the X-ray machine and received confirmation of his success. For the technique he developed, he, together with other American doctors, received the Nobel Prize in 1956.
Today, every idea of treating a disease can be implemented through a standard schedule of clinical trials. It is wonderful that we have learned how to produce biocompatible devices. But sometimes engineers decide that they dare to offer something to doctors or patients without consulting clinicians, and believe that their ideas can be translated into clinical practice. This often leads to disasters of various scales. There is also a simple deception. A striking example is the Theranos project, which attracted huge investments in the development of a non–existent blood test technology based on a minimal sample of material. The same thing is happening now with all devices that take an ECG from the surface of the body.
Evaluating patients who come to me as a doctor with a request to improve the quality of life and increase productivity, I see that in the vast majority of cases they have a psychosomatic disorder or psychological problems of varying severity. And the danger of biohacking is that such people are very greedy for any magic. They really want to get a device or technology that will remove their problem at the click of their fingers. But in fact, they first need to explain that everything is fine in the body, they just have to go on vacation for two weeks, turn off the phone, relax, become more aware (practice the mindfulness approach). If this doesn't help, they need to go to a therapist, not engage in biohacking. A person who is tired and wants to improve something in his body is very easy to catch an expensive solution that "instantly solves his problem," but in fact it is usually simple charlatanism in various wrappers.
About biohacking and traditional medicine
Biohacking can be used when a healthy person with an optimized profile of risk factors wants to improve their fitness. First you need to go through a checkup with a doctor and make sure that there is no clinically pronounced disease or hidden diseases in the body. And a lot of what biohackers are talking about is already in the standard clinical guidelines: it says that you need to run 30 minutes a day, that high-intensity workouts are shown even to patients with serious illnesses, that functional nutrition is useful. Today, medicine is gradually spreading to healthy people. It does this more slowly than biohacking: before we recommend something, we must first conduct a clinical study.
I don't do biohacking, but I do health maintenance. Businessmen come to me who want to feel good, conduct multi-day negotiations, work at night. And in the vast majority of cases, I manage to cope using evidence-based medicine: to conduct ergospirometry and choose a training schedule, prescribe vitamin D or recommend a CPAP device that gives additional pressure on inspiration and allows a person to feel fresh. You can normalize sleep, testosterone levels and blood pressure, and this will help a person feel better. This is not biohacking, but standard medicine.
And now we come to the most interesting category of people. They are doing well, they are healthy, they have passed the checkup, the doctor told them that all risk factors have been adjusted. Such a person wants to work more, be more sexually active, achieve more in science or sports. The standard approach in this case used to imply some spiritual practices, but now this niche can be occupied by biohacking management of your body with the help of new technologies and medicines.
Any biohacker can call himself a biohacker in a good sense of the word only after reading the main document on medical research – the Helsinki Declaration, which regulates medical ethical issues
This approach is non-medical. Throughout the history of Western medicine, we have studied the human body from the perspective of prevention, diagnosis and treatment of diseases. We know the targets inside unhealthy cells and different methods of treatment. These methods do not work for healthy people for the reason that they did not think about it. And biohackers are trying to use drugs that have no targets in a healthy body. Therefore, doctors have a negative attitude to biohacking. If you really want to do something for healthy people, you need new approaches and clinical research. Who will go to search for targets in healthy people? Large scientific teams still treat this as heresy, considering it unethical to give "strong" medicines to completely healthy people. Perhaps we can find a small group of people – drivers of long–term flights, astronauts, pilots - for whom biohacking and correct research will be justified.
One of the areas for the use of biohacking is the prevention of aging. But the only positive results of maintaining health in this direction are due to the use of well-known drugs for the prevention of complications of diseases. For example, 35% of all people develop hypertension. It is possible to prescribe pressure-lowering drugs to healthy people, they will live longer, but not due to the ephemeral "prevention of aging", but due to the prevention of heart attacks and strokes, the risk of death from which is extremely high in the general population. You can prescribe statins to people with the smallest atherosclerotic plaques in the vessels, and then the plaques will burst less often, and people will survive more often. But there can be no question of preventing aging.
When I see patients who want to radically improve something in their body through special technologies, I always ask them one question: to what extent will the advantages they will receive from biohacking outweigh the disadvantages? This is a very dangerous choice, but if we, doctors, do not talk about it, this niche will be occupied by laymen. People will take dangerous drugs bought on the black market like LSD, methamphetamine, modafenil or ecstasy in unknown dosages. But there are permitted and more gentle technologies that do not cause dangerous dependence. Therefore, I advocate the inclusion of the medical community in the discussion of how to properly help healthy people who want to improve the capabilities of their body, and especially those who want drastic changes. I believe that the dialogue should be built according to the principles of traditional medicine, which clearly sets goals and raises the question of the correctness of the concept at each stage of the discussion. If we properly conduct a dialogue with biohackers, a lot of things will quickly disappear, but at the same time the logical core of the use of these technologies in the future will emerge.
About biohacking technologies
Some biohacking technologies have a right to exist and do not contradict key medical principles. The first is the neural interfaces that read the EEG. In the future, it will also be possible to use fMRI technologies to build a human–machine interface. The second is the modification of human embryos. We have CRISPR/Cas technology that could potentially be used to modify embryonic cells to grow a superhuman. In this regard, a huge number of ethical prohibitions will soon be formulated.
The third is telemetric implantable devices. Despite the fact that they still give some figures, this is not enough for a comprehensive assessment of the state of the human body. In addition, the harm from this kind of biohacking in healthy people will be greater than the benefit: the risks may be due to the implantation of devices. Therefore, the future belongs to non-invasive methods, which are still imperfect. A good example is sensors for non–invasive glucose monitoring. Technically, this is a monstrously difficult task, which has not yet been solved by any company in the world, although glucose in human blood is present in a high concentration – 5 millimoles per liter. Therefore, it is too early to talk about the definition of any hormones or substances that are contained in significantly lower concentrations.
The fourth is psychiatric biohacking. Neurophysiology is moving forward, and potentially we know promising targets in a healthy brain that can speed up brain function and improve, for example, memory. Such technologies have a huge number of limitations. They are associated with the development of addiction and with the fact that with long-term activation of neurons, negative consequences are possible. With prolonged excitation, neurons are overloaded with calcium, and the effect of excitotoxicity occurs. So you can "burn" nerve cells.
An ultra-low-carb diet can also be considered biohacking, but should be used with caution, because it is a matter of switching a person's metabolism to using ketone bodies. This is not recommended by traditional medicine, because it has not been fully investigated. Such a diet gives a certain effect of reducing body weight, but at the same time raises two questions. Firstly, this is a safety issue for patients who may have silent atherosclerotic plaques: high fat intake does not hurt if you are healthy, but if you have a plaque, there may be a different situation. And secondly, it is a question of long-term preservation of the effect, that is, the preservation of body weight.
About hormonal biohacking and biochemical parameters
The use of hormones – thyroxine, somatotropin and adrenal hormones – is a well-known example of biohacking. In France and Belgium, there are doctors who actually transfer the endocrine system of patients to manual control mode. In this case, huge dosages of various hormones are prescribed, and healthy people really begin to feel much better. But there are very serious concerns about the long-term outcome. Even the simplest medications can lead to serious side effects – what to say about hormones? In large doses, they can do more harm than good. We see similar cases in athletes who use various hormones to achieve high results, and then at the age of 40-50 they develop dilation of the heart cavities. The risks of heart failure and reproductive disorders are very high ten years after the use of hormonal drugs.
I consider it absurd to try to "manage your biochemistry" manually, relying on blood tests. Even a qualified doctor with great difficulty can interpret changes in biochemical analyses in a healthy person. The reference values are very ambiguous, and you need to navigate very well inside them. The average indicator is not always a normal indicator. A good example is the huge work done by the people who did the Fibromax test. They have developed an algorithm that compares morphological changes in the liver with the indicator of blood biochemistry and can predict the probability of liver fibrosis based on the figures of blood biochemistry. This required huge resources.
The problem here is that, even if the doctor is a very experienced hepatologist, it is not enough just to see the figures of biochemistry, a formula is needed. The interweaving of biochemical analyses is critically complex, and it is impossible to interpret it unambiguously. Many negative and positive changes in metabolism are not translated into changes in the biochemistry of peripheral blood at all. Some indicators stand rigidly at one point for a very long time, even when the pressure of the risk factor is high, for example, the level of potassium and albumin. Some indicators are constantly changing during the day, for example, the levels of interleukins and hypothalamic hormones, and generally do not talk about anything. And you also need to take into account that a person is often actually ill or is under pressure from additional risk factors, and then the tests need to be read in a completely different way. Reading biochemical analyses requires a very deep level of knowledge. Perhaps we will achieve it if we construct a neural network that will be able to compare and take into account a huge number of parameters at the same time.
I have not yet seen a biohacker who understands blood tests at the level of a doctor. I can't imagine that a person could independently navigate these indicators and change something in his body by following them. In addition, many analyses have low sensitivity. For example, liver damage caused by medications can develop with normal liver enzymes. A person thinks that he is doing well, but in fact he has hepatitis. Or a person thinks that his C-reactive protein is in the normal range (up to 5 mg / l), and believes that everything is fine, but in fact indicators above 1.5 mg / l in some cases can be very significant.
In the coming years, doctors will have to increasingly respond to the requests of healthy people who want to live even better. If medicine cannot meet their needs, people may reach out to biohackers, who may well become shamans of the XXI century.
About the author:
Yaroslav Ashikhmin – Candidate of Medical Sciences, researcher at the I. M. Sechenov First Moscow State Medical University.
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