Shock And Awe

Today we travel to a future where super-bandages can heal wounds really fast. Sound like science fiction? Well it might be closer than you think!  

Guests:

• Dr. Daniel Cohen — Assistant Professor, Mechanical and Aerospace Engineering at Princeton University
• Dr. Keisha Ray — Assistant Professor, McGovern Medical School at UTHealth in Houston
• Sylvan* — street medic in Portland (*pseudonym)

Voice Actors:

• Emma Bracy: Website
• Shara Kirby: Twitter
• Tamara Krinsky: Website

Further Reading:

• Galvanotactic control of collective cell migration in epithelial monolayers
• Researchers use electric fields to herd cells like flocks of sheep
• Bioelectricity and Regeneration: Large Currents Leave the Stumps of Regenerating Newt Limbs
• Measurement of electrical currents emerging during the regeneration of amputated finger tips in children
• SCHEEPDOG: Programming Electric Cues to Dynamically Herd Large-Scale Cell Migration
• Tiny Sheep: UC Berkeley Researchers Use Electricity to Herd Cells and, Potentially, Speed Up Healing
• The Experiment That Shocked The World
• Giovanni Aldini: from animal electricity to human brain stimulation
• An Account of the Late Improvements in Galvanism With a Series of Curious and Interesting Experiments Performed Before the Commissioners of the French National Institute and Rep
• The Body Electric
• A strand of vermicelli: Dr Darwin’s part in the creation of Frankenstein’s monster
• Zap Yourself Healthy With The Electric Corset, 1883
• Strange Antique Medical Devices That Promised to Cure Everything With Electricity
• Abraham Flexner
• Mr. Frankenstein Is Not Invited
• At High Risk From Coronavirus, Undocumented Seniors Fear Seeking Medical Care
• Towards an Integration of PrEP into a Safe Sex Ethics Framework for Men Who Have Sex with Men
• Change in Sexual Behavior With Provision of No-Cost Contraception
• PrEP doesn’t lead to increases in risky sex among gay men
• Vulnerable population and methods for their safeguard
• Police Targeting ‘Street Medics’ at US Protests
• Meet the ‘Grandmother of Street Medics’
• 50 days of protest in Portland. A violent police response. This is how we got here.
• ‘It was like being preyed upon’: Portland protesters say federal officers in unmarked vans are detaining them
• The black men from Pittsburgh who made up America’s original paramedic corps wanted to make history and save lives—starting with their own.
• Tear Gas Is Way More Dangerous Than Police Let On — Especially During the Coronavirus Pandemic
• The Black Cross Collective
• Pepper Spray Trials

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Flash Forward is hosted by Rose Eveleth and produced by Julia Llinas Goodman. The intro music is by Asura and the outtro music is by Hussalonia. The episode art is by Matt Lubchansky. The voices from the future this episode were provided by 

If you want to suggest a future we should take on, send us a note on Twitter, Facebook or by email at info@flashforwardpod.com. We love hearing your ideas! And if you think you’ve spotted one of the little references I’ve hidden in the episode, email us there too. If you’re right, I’ll send you something cool. 

And if you want to support the show, there are a few ways you can do that too! Head to www.flashforwardpod.com/support for more about how to give. But if that’s not in the cards for you, you can head to iTunes and leave us a nice review or just tell your friends about us. Those things really do help. 

That’s all for this future, come back next time and we’ll travel to a new one. 

FULL TRANSCRIPT BELOW

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FLASH FORWARD

S6E11- “Shock and Awe”

[Flash Forward intro music- “Whispering Through” by Asura, an electronic, rhythm-heavy piece]

ROSE EVELETH:
Hello, and welcome to Flash Forward. I’m Rose, and I am your host! Flash Forward is a show about the future. Every episode we take on a specific possible- or not so possible-  future scenario. We always start with a little field trip to the future, to check out what’s going on, and then we teleport back to today to talk to experts about how that world we just heard might actually go down. Got it? Great!

A quick note that on this episode we are going to talk a little bit about domestic violence and abuse, and that’s about the 27 minute mark, so, just so you know.

This episode we are starting in the year 2034.

FICTION SKETCH BEGINS

[The sounds of a crying child sniffling]

PARENT 1:
Okay, shhh, okay, you’re okay. We’ll just get you cleaned up and you’ll be alright.

[As she comforts the kid, she start rustling through a medicine cabinet]

PARENT 1:
What is all this stuff; there must be bandages somewhere.

[As they continue to look, PARENT 2 walks past the bathroom, stops, looks in– they’re caught red handed]

PARENT 2 (slightly annoyed):
What’s going on here, exactly? 

PARENT 1:
Nothing- We had a bit of a mishap on the trampoline, but it’s totally fine.

PARENT 2:
That trampoline is a hundred years old. Tell me you did not try to jump on it.

PARENT 1:
Trampolines don’t expire! (laughing) It’s totally fine, we were just playing around. It was fun. Now, where does your mom keep the bandages?

PARENT 2:
I don’t know. Can you please try not to kill our only child?

PARENT 1 (laughing):
If I wanted to kill him I certainly wouldn’t have picked the trampoline as a weapon. (more rummaging) Seriously, where are the bandages? Does she not have any?

PARENT 2 (calling):
Ma? Where do you keep the bandages? 

GRANDMOTHER (calling back):
In the hall closet!

PARENT 1:
Hall closet? Why?

[She opens the hall closet and pulls a box down with a clatter]

PARENT 1 (CONT’D):
Oh, Jesus these are ancient. 

[She continues to search]

PARENT 1 (CONT’D):
Does she only have these? She doesn’t have any, uh, of the electrical ones? 

PARENT 2:
She must have some somewhere.

[More searching]

PARENT 1:
I don’t see any electricals.

[Just in time, Grandma’s made her way into the room to help]

GRANDMOTHER:
Ah, you found them, good.

PARENT 2:
Do you have any.. newer ones? These are as old as I am.

GRANDMOTHER (stern):
Bandaids don’t expire. 

PARENT 2:
Sure, but these don’t work nearly as well as the electrical ones.

GRANDMOTHER:
No way, I’m not putting any zapping zapper on my skin. 

PARENT 1:
They don’t zap you. They heal you. 

PARENT 2 (let’s nip this in the bud):
I might have some in the car. 

[We hear her leave to go find them]

[But grandma doesn’t want to let this go:]

GRANDMOTHER:
Not every invention is for good, you know.

PARENT 1 (annoyed):
I’m pretty sure bandages that heal you 400% faster than normal are good.

GRANDMOTHER:
But at what cost? Who even knows what that stuff does to you?!

PARENT 1:
It heals you, that’s what it does. That’s what it’s for.

GRANDMOTHER (gearing up):
So you just trust whatever these drug companies say. “Put this electrical current on your skin! No side effects!” How can that be? When I was growing up we were always told not to put our fingers in the socket. That was dangerous! Electric fences? We use those to keep people out! But now, suddenly when there’s money to be made, you just slap that electrical current right on your body?

PARENT 1 (sighing to keep her cool):
It’s a very small current; you can’t feel it.

GRANDMOTHER:
Ah, so you admit that too much would be bad! And yet, you use them over and over. How can that not add up? The neurons in our brains rely on electricity. 

[As she’s triumphantly resting her case, Parent 2 returns]

PARENT 2:
I couldn’t find any in the car. We’ll just have to use these old ones. 

GRANDMOTHER (immediately):
Good, can’t risk my grandson’s health.

PARENT 1 (rolling eyes):
Well, if that’s what you’re worried about you should get some electrical ones, they’re proven to reduce risk of infection since the wound closes up so much faster. These old bandages can turn into playgrounds for bacteria. 

PARENT 2 (to kid):
Come here, let me see. 

GRANDMOTHER:
Well I certainly did fine without the- zippy zaps.

PARENT 2:
Mom, you had to have your left foot amputated from an infection. That wouldn’t have happened if you had the kind of wound care we do today. 

GRANDMOTHER:
You don’t know that.

PARENT 2: Yes I do, mom, I’m a doctor, remember? This is my job?

GRANDMOTHER:
Yes, and I’m very proud of you, but don’t you come near me with any kind of wired up bandaid you hear me? I don’t want to rise from my grave like some kind of weird Frankenstein. 

PARENT 1 (small laugh):
It’s actually, uh, Frankenstein’s monster.

PARENT 2 (oh no):
Don’t.

PARENT 1:
The doctor was named Frankenstein; the creature you’re referring to was Frankenstein’s monster.

GRANDMOTHER:
Ah, who cares?

PARENT 1:
I do! Everybody gets it wrong!

[Scene fades out]

FICTION SKETCH ENDS

ROSE:
Okay, so today’s episode is about the future of medicine. 

You know how in a lot of science fiction there is some kind of amazing healing technology? Whether it’s force healing in the most recent Star Wars- which I have a LOT of opinions about that we will not go into right now, or a Doctor Who episode with tons of nanobots that heal you, or Oryx & Crake by Margaret Atwood where the Crakers purr over a wound to heal it, or the Stargate sarcophagus– I could go on and on and I’m sure you have your favorite, or perhaps least favorite example.

Super fast wound healing is convenient in science fiction, because in a lot of cases our heroes are out doing a bunch of dangerous stuff and getting hurt, and it is kind of boring to watch someone heal for a couple months in between adventures. In reality, while there have been a lot of amazing medical advances that can accelerate the healing process, we’re still kind of at the mercy of our cells and how fast they want to grow and move and close up our cuts and scrapes. 

Or are we!?

DR DANIEL COHEN:
When you get an injury, the process of healing requires massive, choreographed, beautifully coordinated motion into the wound site to heal it. And we heal at a certain rate, not necessarily because it’s optimum, but because it was good enough to survive from an evolutionary perspective. So one could ask the question, could you accelerate simple wound healing, could you make it go faster than it would normally go? 

ROSE:
This is Dr. Daniel Cohen, a researcher at Princeton University.

DANIEL:
I’m a professor of mechanical and aerospace engineering at Princeton, but I moonlight as a tissue engineer and cell herder.

ROSE:
And one of the ways that Daniel is experimenting with herding cells is by using electricity.

Okay, time for a little bit of a refresher on some high school biology! All cells are constantly exchanging ions— atoms or molecules that have an electric charge. This is how your muscles actually move and your neurons actually fire— the cells create an action potential, using these ions. And in fact, all cells have some kind of charge, all cells produce and respond to these ionic currents. And these are currents strong enough that we can actually measure them.

DANIEL:
Wound healing in skin was one of the first areas where they were measured. So this was back in the 1800s, and- you can measure at a skin wound an electric current in the injury site. It forms almost immediately after being injured and persists for some time. And-

ROSE:
So let’s say you cut your arm, and there is now a gap in your skin. Your body is like, oh no, that’s bad, we gotta close that up! But have you ever wondered how your skin knows to grow in the right direction? How does your body know for the two sides of the cut to grow towards one another? Well, one of the ways that it does that, is through electrical fields.

DANIEL:
The hypothesis is that these endogenous fields act as navigational cues that help cells move around. 

ROSE:
Otherwise known as Galvano or electrotaxis.

DANIEL:
Which- maybe I’ll pause and say that that word just means electricity, and then taxis is motion. So chemotaxis is motion in a chemical gradient or chemical signal; electrotaxis is motion in an electrical signal. 

ROSE:
Some cells tend to want to move towards positive charges, and other cells- most cells, in fact- tend to want to move towards negative charges. So you can think of a battery, where you have a positive side and a negative side. Some cells are going to want to head up to the nubby top of the battery, and others are going to want to make their way down to the bottom flat end.

In the 1970’s, researchers did some experiments measuring the currents on newts who had a limb cut off, and they found that the stumps in question had steady electrical currents for 5-10 days after the amputation. But what about humans? Well, in one study from 1980, researchers looked at children who had accidentally cut the tips of their finger off. Turns out, this is not that uncommon of an injury- the hospital in question saw about 30 kids every year who had done this. And they measured the current at the tips of those sliced-off fingers, and found that these stumps had a consistent electrical current.

DANIEL:
Injuries happen to be negative in the center and positive around the periphery.

ROSE:
So the theory is that the skin cells are drawn to the center of the injury, which is negative, and that’s how they close up the wound.

Researchers have known about the electrical charges that happen around wounds for a long time. But it wasn’t until relatively recently that they’ve actually been able to do much of anything with this information. And that is exactly what Daniel works on: actually manipulating these electrical currents to steer or shepherd the cells where they want them to go. 

DANIEL:
It’s an active response. It’s not simply that you’re pulling on the surface of the cell with some powerful force or pulling on the center of mass and the cells being dragged along. It’s really more like you’re actively hacking the compass that the cell uses to figure out which direction is forwards, backwards, et cetera. And you’re kind of rerouting that and rotating it around to align with the field. And then the cells follow it.

ROSE:
In June of this year, Daniel published a paper outlining a method of doing this. They call the technique SCHEEPDOG: Spatiotemporal Cellular HErding with Electrochemical Potentials to Dynamically Orient Galvanotaxis. SCHEEPDOG.

ROSE (on call):
How long did it take you to figure out the acronym for SCHEEPDOG?

DANIEL:
The original acronym was BELCH, which was BioELectric Cellular Herding, and then SCHEEPDOG, uh, progressed over a couple of days. So I think it should eventually- or, it began with a SCHEEP and then the DOG was added. When we were like oh, we might as well just commit to it. 

[Rose laughs]

DANIEL:
The dog was added at the last moment. And it works, too!

ROSE:
That is a very long acronym.

DANIEL:
Yeah, but come on. We’re herding cells!

[Rose laughs again]

ROSE:
No, it’s good; it’s good. I was, I- It’s like- you know when someone tells a dad joke, and you, like, groan, but it’s a good kind of groaning? It’s like that. (another slight giggle)

DANIEL:
Oh, yeah. That’s what we were going for. This is, this is not supposed to be a particularly serious, easy, roll-off-the-tongue acronym. 

ROSE (Mono):
Before SCHEEPDOG, scientists were able to use electrical currents to move cells back and forth, in kind of a linear way. But Daniel says that that work saw electrotaxis as more of a quirk than anything else— like hey, isn’t it cool and weird that this happens? What SCHEEPDOG is trying to do is turn that on its head and see electrotaxis as a tool to harness. 

One of the cool things about SCHEEPDOG, is that it can be a lot more flexible, and move cells in all sorts of directions. There are some amazing videos on Daniel’s lab website that show the cells moving, honestly, like sheep in a flock. The whole group of them shifting one way, and then the other, following this invisible electrical current. And the ability to do this is crucial if you are going to use this kind of technology, to, say, convince cells to move closer to one another faster, to heal a wound. 

DANIEL:
Wounds aren’t simple, pretty structures that have perfect geometry. And so there’s a lot of reason why you would want to be able to program in a motion pattern. So you might want cells to converge at the center of a wound that’s maybe shaped like a circle. Or maybe you have a wound that’s shaped like a completely random mess, and you need to watch how it’s growing over time. And maybe you have a smart Band-Aid that’s constantly sampling the wound, detecting its shape and adjusting, you know, a field in two dimensions to help things grow in a way that reduces scarring or increases the speed of healing. 

ROSE:
This work is so cool and so interesting. It’s also pretty new, and there is a lot to figure out still. But I did find one thing sort of weird when I was talking to Daniel. Earlier he mentioned that scientists have known about the electrical signals that wounds give off since the 1800s. But until recently, there hasn’t really been very much research into using that fact to do- exactly what we’ve been talking about, right? To try and steer cells in the precise direction you want them to go. Which is kind of weird, right? 

Well it turns out: there is a reason that many scientists have not touched this topic. 

So. Indulge me, if you will, in a trip to the 1780s. We are in a lovely backyard garden in Italy with a man named Luigi Galvani, and he is waiting for a storm. You see, Galvani had an experiment all set up, all ready to go. But in order for this experiment to work, he needed lightning. All of the rest of it was totally laid out— a lightning rod, connected by a wire to a dead frog laying on a table in the middle of the garden. 

And eventually, the storm did come, and Galvani was overjoyed, because every time lightning flashed nearby, the little leg of his poor, dead frog, twitched. 

DANIEL:
You have the frog leg experiment where the frog legs twitch. And it’s something that wasn’t really fully explainable at that time.

ROSE:
Remember, this is before scientists really understood how electricity worked or even what it was. It’s just a few decades after Benjamin Franklin’s famous kite experiment. And we definitely didn’t know very much at all about how the body worked and how muscles fired.

DANIEL:
So that’s why Galvani was really taken by these things and thought that he was releasing some sort of vital energy, when he shorted the sciatic nerve of a frog back into a muscle somewhere and the leg twitches. 

ROSE:
This led Galvani to a theory called “animal electricity,” and it was a very big deal in the scientific circles of the day. And it was a big advance for science, this weird frog laying on a table in a garden in Italy with a twitching leg, because eventually it led to our modern understanding of the way that the body creates motion using electrical potential. Earlier I mentioned that electrotaxis is also called galvanotaxis, and that actually comes from Galvani’s name.

Eventually, a physicist named Allessandro Volta took up the idea, and spent a lot of his time trying to refine and rebut Galvani, which eventually led to something called the Voltaic pile, which is basically the first ever battery. If Volta’s name sounds familiar, it’s probably because he’s the guy that the Volt, as in the standard unit of electrical potential, is named after. 

Okay, so why would any of this keep researchers from studying the medical potential here? Well, there is an additional wrinkle to the scientific sparring that is happening here, and that is.. the public. 

DANIEL:
It’s an exciting idea. It’s action at a distance. It’s spooky. People get excited in general and then twitching. And then you get the, the turn of the century leading to a bunch of incidences of science becoming a form of theater and popular entertainment and people going to watch lectures and demonstrations at fairs and at theaters 

ROSE:
Eventually, Galvani’s nephew, Giovanni Aldini, decides to try this frog twitching thing on humans.  

DANIEL:
So he’s done a bunch of work testing various cow body parts and things attached to large Voltaic piles to make them twitch. And he’s ready to get started and make the big bucks and make a splash. 

ROSE:
But to do this, you need a body. And not just any body. You need a fresh one. This will not work if rigor mortis has set in. So Aldini goes to the courthouse. ˛

DANIEL:
George Forster is accused of murdering his wife, found guilty, and declared that he needs to be hung until dead, at which point is waiting right there to grab the body and take it to a surgical amphitheater with a big battery.

ROSE:
And at this surgical amphitheater, Aldini performs his famous Corpse Galvinism experiments.

DANIEL:
that culminate with him causing this corpse to sit up on the table, Based on where he’s placed the electrodes and how they cause muscles to contract.

ROSE (slight laugh):
And, perhaps unsurprisingly, this did indeed make a splash. And one person who heard about these experiments and who was deeply impacted by them was none other than… Mary Shelley.

So in case you don’t know the story behind Frankenstein, it goes like this: Mary Shelley was eighteen years old. She had recently lost a child, and she and her husband decided to take a vacation and spend the summer on Lake Geneva with Lord Byron and John Polidori. And Byron was like “I know what will make this lovely summer getaway even better! A horror story writing contest!” 

Shelley liked this idea, but when it came time to write, she was stuck— she couldn’t think of anything that would impress and excite her fellow writers. 

DANIEL:
And she says that one night she overheard a drunken conversation between Percy Shelley and Lord Byron trying to describe some of the published works of Erasmus Darwin, who was an ancestor of Charles Darwin. Erasmus was famous for the concept of spontaneous generation, that- that the fruit flies that come out of the banana peel that you forgot about come out of it as a result of decay. So his idea was that garbage and decay produces life.

ROSE:
In his book The Temple of Nature, Erasmus Darwin recounted a bunch of these experiments that tried to prove spontaneous generation. Scientists would leave vegetables, meat, and even just flour and water out, waiting for life to arise out of it as if by magic. In one experiment Darwin writes about, they boiled veal broth and sealed it up in a vial to see if anything would grow in it. But in their drunken memories, Percy and Byron didn’t get… any of these details correct.

DANIEL:
The story that Percy and Lord Byron recounted to each other is more of an example of what two people who know nothing about something get to when they talk about it, and they arrived at a statement where they were convinced that Erasmus had, through some arcane means, coaxed vermicelli to life and caused it to move. And Mary Shelley thinks this is patently ridiculous- and vermicelli has really only ever meant pasta. In Italian, it means little worm, but it was always applied to pasta.

And what they were probably trying to describe was an experiment desiccating the organism Vorticella, which is a small organism that if you dry it out and rehydrate it has some retention of function.

ROSE:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               I’m just going to pause here and say that I find this (slight laugh) absolutely hilarious. Two cocky drunk men recounting science incorrectly, and confusing a tiny creature with a type of pasta and being like (slight laugh) “Ah yes, we are great men of knowledge!” I mean, who among us has not been around those men? Very relatable. Anyway, Mary Shelley knew that these two guys had no idea what they were talking about, but she did find inspiration in their conversation nonetheless. 

DANIEL:
She was thinking about life and death and how to bring things back potentially. She said she had a dream where she kind of saw some key elements of the story come together. And then it was off to the races.

ROSE:
Frankenstein was published shortly after, and it was a sensation. Now, it’s worth noting that Shelley never explicitly says what animates Frankenstein’s monster. 

DANIEL:
She actually says that the secret is too dangerous to put into writing, which kind of makes it a timeless book in its own right. Whatever your bogey man technology is of a given age could be what she used. So maybe CRISPR today.

ROSE:
Even without an explicit term for it everybody assumed she was talking about Galvanism, about the corpses, about this bioelectrical stuff that had been in the news. 

DANIEL:
And shortly after Frankenstein, you get this big rise of quack medicine. So you get, uh, factories making electric corsets that bind metallic plates designed to improve posture and bust size. You get virility belts, same deal like early male enhancement, e-mail, spam, essentially. You get chairs that you sit in them and they’d statically charge your hair, and that’s supposed to be some sort of electrostatic therapy to cure cancer, libido, and gallstone issues. 

And none of these things work, which doesn’t help the reputation of bioelectricity either. So you’ve gone from sort of- corpses sitting up to some vague science fiction thing about body parts being put together and bioelectricity and corpses again to quack medicine. 

And it gets worse over time and by the early 1900s it’s so bad that there are thousands of fake bioelectric medicine practitioners just on the eastern seaboard of the US. 

ROSE:
At the same time, in the United States there was a big push to reform medicine and medical schools. A guy named Abraham Flexner was hired by the Carnegie Foundation to do an evaluation of 155 medical schools in the US and Canada.  

DANIEL:
And he writes a report called the Flexner Report, which is a document that essentially bans the teaching of what he calls non-allopathic medicine and medical school, which is things like homoeopathy and bioelectricity would be grouped in there.

ROSE:
And after that, the exploration of the uses of bioelectricity fell off of most people’s radar. 

DANIEL:
there’s a large number of just biologists today who haven’t heard of the effect, and that when you’re speaking to scientists about it, sometimes you get looks of incredulity and surprise that such a thing is possible, and they think you might be pulling their leg.

ROSE:
Even in modern papers about the topic, you will sometimes find these interesting caveats and apologies in the introduction, noting the association people might have between this work and Frankenstein. 

DANIEl:
There’s this sense of, kind of, guilt in the field that things kind of got out of hand and that science communication didn’t keep up with sort of public perception. 

ROSE:
And yet, the work that Daniel is doing seems really promising. The ability to herd cells to and fro, to move them where you want or away from things that you don’t want them to be near, has tons of applications. We’ve talked about wound healing already, and Daniel thinks that the scene that you heard at the beginning isn’t that far fetched at all.

DANIEL:
We are gonna probably have bioelectric bandaids in the not too distant future and those bandaids are going to be really useful just for everything from basic injuries to, uh, diabetic ulcers and things that don’t normally heal on their own.

ROSE:
But it doesn’t end there. If you can move cells around however you want, there’s a ton of potential.

DANIEL:
Surgical incisions, fractures are already known to have an electroactive response potential. If we’re really going out there, for various forms of tumor therapies, because cancer cells are in some cases known to move in the opposite direction of healthy cells. They may be able to guide blood vessel growth for all sorts of either organ growth in the lab-type settings or improving healing processes in the body where you need to bring in more blood vessels. And then just a whole slew of new kinds of interactive medical implants that use electrical cues to affect different things internally.

ROSE:
This is all incredibly cool. Obviously, getting to these applications will take work and time, but it seems really promising and worth exploring. I mean, even if we just figure out a way to heal wounds way faster, that’s great, right? There is no downside, right? We don’t even have to talk about ethics, right!?

Wrong! 

(laughing slightly) We always have to talk about ethics! And when we come back, we are going to do just that. But first, a quick word from our sponsors! 

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ROSE:
This episode of Flash Forward is supported by the new season of Invisible Forces, a podcast about the surprising unseen influences that are rapidly transforming our way of life and global economy.

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I got a sneak preview of the Invisible Forces upcoming season, and I learned that in the 1930s, jigsaw puzzles were so popular that there were actually pop songs written about them! Did you know that? I had no idea- also, jigsaw puzzles are named after the jigsaw, like, the actual saw that is used to make them, or was at one point used to make them. Again- no idea!

Search for Invisible Forces anywhere you listen to podcasts; I will also include a link in the show notes so you can find it. Many thanks to Invisible Forces for their support.

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ROSE:
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ROSE:
Okay, so let’s say we have these electrical bandaids that heal us way faster than today’s medical technology. That seems like a good thing! But even with good things, we still have to talk about ethics. 

DR KEISHA RAY:
I’m always thinking about how technology is going to bridge or further widen the gap between the haves and the haves not- have nots, or how technology is going to affect the bridge between the healthy and unhealthy, or the healthy and the unhealthy who are made unhealthy by social and external factors.

ROSE:
This is Dr. Keisha Ray, a bioethicist at the University of Texas Health Science Center in Houston.

KEISHA:
So I’m always thinking about bridging this gap and then I’m always thinking about, relatedly, access. If this technology comes out, who is going to have access to it? Is it going to be widely available? Is it going to cost too much? 

ROSE:
In many places, the United States especially, access to medical care is incredibly striated and unequal. So the first question we would want to ask ourselves is how to make this technology more affordable and more accessible to everybody. 

And Keisha points out that making medicine more accessible isn’t just about the direct one-time interaction. It’s not just about making sure that one person can get that super-bandaid when they get hurt. It’s also about the bigger relationships between marginalized groups and medicine more generally.

KEISHA:
So I’m always looking for ways for medicine to sort of reconcile, eight, to think about reparations, right. Reparations don’t always mean money. It can mean changing attitudes and mending relationships. So I think technology can be one of those tools to mend relationships with these marginalized pop- populations.

ROSE:
Many groups in the US have a fraught relationship with medicine— Black people, immigrants, Latinx people— they’ve been alternatively taken advantage of and ignored throughout medical history. And one of the things I think is really interesting about these super-bandaids is that they could actually help those folks avoid harmful interactions with doctors. If people can just heal their cuts at home instead of having to go into a doctor’s office, that could be really good.

KEISHA:
I think for many populations it will be an excellent thing. So the first population I think of are undocumented immigrants, who are fearful of going to the doctor because they’re fearful that they’re going to be deported. So they often forego medical treatment that is sometimes a matter of life and death. We’re seeing that right now with COVID, with immigrants who have all the symptoms and are likely spreading it to the other members that live in their home, but they’re not going to the doctor because they’re afraid of deportation. But imagine if they got injured and needed stitches. Now, they’re not going to go to the doctor, but if they had this technology, they could do it themselves.

ROSE:
Other people might avoid going to the doctor because they’re not insured, and they have no idea how much those stitches might wind up costing. And, really, the less you have to go to the doctor, the better, right?

KEISHA:
It’s kind of hard to think about a population that wouldn’t help because it would even help health care, because that’s one less thing that they can worry about. They can now focus on things like pandemics and (slight laugh) all of the other things that require much more attention and resources and clear up some space for people who need more care and more attention. So I can’t think of a population who could not benefit from this. I can think of populations who may take advantage of it and use it for reasons that we may not, um, may not think are appropriate. But I can’t think of who would not benefit. 

ROSE (on call):
What are some of those advantages that you’re thinking of?

KEISHA:
So.. I don’t know if this is dark, but I’m thinking of people who intend to harm other people and intend to continue the harm. So first, I think about domestic violence. So I can imagine a battered person being injured and oftentimes in hospitals, when it gets reported- not a lot, but sometimes it gets reported and that sort of spurs change to happen. But if they don’t have to go to the hospital for care for the results of domestic violence, then.. they’re having less interaction with authorities that could help.

ROSE (Mono):
Abusers could also use this technology to further entrap their victims.

KEISHA:
Now I’m not only your abuser, but I’m now- I’m your savior as well. And then that creates a complex. Even with, um, children and child abuse, right. It can be used the same way. I’m the parent, so I can hurt you, but then I can also fix you, and now I hold even more power over your well-being.

ROSE:
Now, before you throw up your hands and yell at me for always finding the darkest possible version of every future, every time, I want to explain why I am talking about this. The point of raising all these concerns, the point of thinking through all of this stuff, is not to be a downer for no reason. It’s not to constantly be poo-pooing on technological advances. I know some listeners (and iTunes reviewers, hello there) think that I am too dark, too skeptical. But the point of asking these questions is not necessarily to say that we should or shouldn’t develop this technology. It’s to help understand and prepare for these advances, and start doing the work now to try and avoid whatever possible downsides might exist. 

KEISHA:
And this is why medical ethicists, even philosophers, right- my background’s in philosophy- really advocate for collaboration. Because a lot of times, if you’re so focused on the technology, you can be blinded to the ethical considerations that you should be giving this technology. If you have someone where that’s their sole job, 24/7 that’s all they think about- I wake up thinking about ethics, right? If you consult people who do that, they can sort of help you say, “Huh, I didn’t think about that”. So you’re getting all these different aspects that are looking at this one technology and saying, “okay, how can this create harm?”

ROSE:
I’m not raising any of these concerns to say that we shouldn’t have magic bandaids. We totally should! They sound awesome! But I also do think it’s important to consider every element so we can do a good job of deploying this awesome technology. And part of that means thinking through the ripple effects. For example: How would having amazing wound healing technology change the way we think about risky behaviors? 

KEISHA:
There’s always an issue in medicine of patients- and all different kinds- being blamed for their injuries. So I- when you say, you know, I mean, I’m in the hospital and I’m bleeding, I automatically think of someone that got injured doing something risky but took the risk on themselves, like, uh, rock climbing or bungee jumping gone wrong, right. Or something that we all would look at and say, that’s very dangerous and you took that risk, and now you want medical help, right. You decided to jump that cliff on your motorcycle and now (laughing slightly) you have wounds that need to be sealed up. 

ROSE:
If we had this tech, and you could zip up scrapes and bruises a lot more easily, would we all, like, take up parkour, or rock climbing or mountain biking? 

[A rolling-clanking sound. Someone yells “PARKOUR!” and then we immediately hear a thump as they fall to the ground. Someone else, concerned, calls out: “Michael!” But the fallen person, presumably Michael, ignores them in favor of continuing to say, “Parkour! Parkour!”]

[Another brief moment of the clanking, and then someone says “Extreme!” Michael immediately follows it with another “Parkour!”]

KEISHA:
Wouldn’t that change the perception of these kinds of extreme sports and the people that get injured from participating in them? I, I think it would.

ROSE:
This question of risk is super interesting to me, because there are cases in the past where doctors have really worried about this. In 2012, the FDA approved something called pre-exposure prophylaxis, or PrEP, a medication that decreases the risk of contracting HIV. 

For years before, and even since that approval, there were lots of conversations about whether or not this would accidentally encourage people— and in these conversations they are pretty much always talking about gay men— to behave in riskier ways than they would have otherwise. The argument here being that if gay men are taking PrEP they might be more likely to not use condoms or not get tested as often because they feel protected from HIV. 

You hear the same argument with birth control— that we should not let people have it because they will go out and have a ton of risky sex. But there is some evidence that neither of those things are true; neither of those things happened. Birth control and PrEP did not cause people to make riskier sexual choices.

And, even if better treatment will encourage people to act in quote unquote “less safe ways,” not everybody agrees that this concern should drive health policies.

KEISHA:
I don’t think that we should go into medicine and technology that can help people have better health with the apprehension of, well, if we create this technology, maybe they’ll use it in ways that we don’t intend. I think the ultimate goal and ultimate concern should be how do we help people live better lives, live healthier lives? 

ROSE:
I’m super interested in the questions around how super amazing healing technology might change our relationships, not just to risk, but to medicine more generally. If we no longer have to go to the doctor for the more routine scrapes and bruises, how does that impact the idea of what medicine is? What it’s for? What doctors do?

KEISHA:
We might see medicine very differently because the sub-professions that would be left, the ones-  would be the ones that are needed for extreme injuries, like cancer, viruses, or surgery or broken bones or, you know, things like that. Will the face of medicine change if we have this balloon technology? Will our relationship with medicine change? 

Now, again, that’s not always a bad thing. Medicine is not perfect and it’s not always- It’s kind of glorifying it to say, you know, will our relationship with medicine change? Sometimes it needs to. (slight laugh) Sometimes our relationship with medicine needs a big change. It’s not necessarily a bad thing to say, “Maybe we should view medicine and its practitioners differently.” 

ROSE:
But I also (sigh) do wonder if we’re kind of giving doctors the short shrift here. Doctors are not robots, simply stitching up wounds and slicing out tumors and looking in your ears with that weird little flashlight thingie. Wounds are also about more than just tissue healing. And in thinking about this episode, I started thinking a lot about what we even mean when we talk about “healing.” Sure, there is the physical cut that has to close up. But there’s also more to it than that.

And, when we come back, we are going to talk about wounds— physical and mental— and about what it’s like to be on the front lines. But first, a quick break.

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ROSE:
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ROSE:
Okay, so we have this cool tech, it’s really promising, we want to use it to help heal people faster. And at some point, that means they will have to test this. So, who does it get tested on? And how? Those are important ethical questions because historically, medical technology has often been tested on people who didn’t or couldn’t consent to it.

KEISHA:
In medical ethics, one of the just mainstays, just something that no matter what the bioethicists or medical ethicists study, they have a knowledge of what we call vulnerable populations, right. And vulnerable populations, particularly in biomedical research, are those groups that, because of maybe historical abuses, current abuses, or just the inability to say no, they give special protections in research.

ROSE:
It’s possible that one of the first groups that a technology like this would get tested on, is soldiers, or people in the military. It’s not hard to see why militaries all over the world would be interested in this kind of technology- the faster they can heal their people, the more quickly they can send them back out on duty. But here’s a thing I actually did not know about ethics and soldiers: Soldiers are actually considered by ethicists, in this context, a vulnerable population.

KEISHA:
Soldiers are one of those groups because they don’t have the ability to say no. If their superior says “do this or you’re not in the army,” you’re going to do it. I, I think a medical ethicist would look at this and say, if the military has access to wound repair technology, does it make soldiers more vulnerable?

ROSE:
But in the context of combat, people being on the front lines, there’s also an additional thing to think about.

KEISHA:
With wound technology, it would be an extra concern of how they can be taken advantage of and particularly how their health could be worsened by the continuous repair without it being supervising by a physician or without it being seen by a physician. 

ROSE:
So let’s say you have a soldier, they get injured, you have this fancy magic bandaid, you heal them up, you can send them right back out. Great. But that kind of ignores the other ways in which getting hurt can manifest itself. It’s not just about the injury to the skin, right? Many members of the military return from combat not just with literal battle scars, but with mental ones, too. 

KEISHA:
If you heal the wounds, do you eliminate the chance for post-traumatic stress disorder? Does- Is it still- Are the chances still there? Or are you saying no blood, no mental disorder, right. Or is that something that still will be there despite the wound being closed very rapidly? And I think that’s something that we have to think about with soldiers, and beyond, that, just a, a natural question to have with wound technology is, does it heal the mental aspects of the wound?

ROSE:
Thinking about this got me thinking about other places where people might be “on the front lines” so to speak. And it made me wonder how this technology might be used, for example, at a protest.

“SYLVAN”:
The role of protests is to signal discomfort of people to that government and try and push it to improve how it serves people. And the best and most sustainable protest movements are the ones that have good logistical operations. That’s like medics and food and supplies. 

ROSE:
This is Sylvan, but that is not her real name.

SYLVAN:
Um, I- (slight laugh) I’ve used the name Sylvan in the past for circumstances where I didn’t want to be identified. Street medic and organizer from the Pacific Northwest. 

ROSE:
I’m using a pseudonym for Sylvan here because street medics like her have recently become targets. In case you’ve never encountered them, street medics are informal assistants to a protest, people with training in first aid who help support protestors.

SYLVAN:
And that often looks like a lot of patching up minor wounds and dealing with a great deal of chemical weapons exposure.

ROSE:
A couple of weeks ago when we spoke, Sylvan’s city, Portland, was in the midst of continuous protests against police brutality. 

SYLVAN:
We have continuous protests, marches, and gatherings every single day for that entire 60 day period. 

ROSE:
And one of the pretty regular features of these protests was a continued escalation of violence, spurred almost entirely by the police forces that were present.

SYLVAN:
There has been nightly clashes with first the Portland police and then now the federal- uh, a random group of a bunch of different federal agencies that have been placed together to come to Portland to just beat the hell out of us because?

ROSE:
You probably heard about this on the news, right? Portland’s local police was bolstered by federal agents, who arrived in the city ostensibly to help. But journalists on the ground continuously documented the ways in which these forces made things worse. 

SYLVAN:
And they just filled the entirety of this, like, three block radius with tear gas and rubber bullets and pepper balls. They’re using clubs and pulling people off the street into unmarked vans. They’re all dressed in camo and they don’t wear any- or they, they have- um they’ve started since a lot of criticism was levied at them. But for a while there, they had no names and no insignia to tell you which government branch they were.

ROSE:
At the end of July, the federal government agreed to withdraw those federal troops from the city. And Sylvan’s job, in all of this, as a street medic, is to help the protesters who continue to show up, every night, to speak out against police brutality. To help patch them up if they get hurt, to treat people who’ve been tear gassed, and to generally try and support anybody with an injury. 

SYLVAN:
So if the job of the police is to make the cost of participation higher, the job of medics is to kind of- is to make up for that, is to, to make it so that even though people will experience some level of threat and physical harm and danger, you go out into the streets knowing that there is a crew of people, be it medics, be it legal observers, and, and to some extent, journalists, who have your back.

ROSE:
Quick aside here: the history of street medics is really interesting, and they have their roots in the civil rights movement of the 1960s. Some doctors and nurses at the time realized that one way they could support these movements was by helping provide emergency first aid. This was before emergency medical services were really a thing- the first paramedics wouldn’t exist until the late 1960s. 

And that spirit continued even to testing even methods and techniques. When police started using tear gas on protestors,. street medics realized they needed to figure out the best way to respond.

SYLVAN:
In the 90s, The Black Cross, which was a street medic organization, they actually did clinical trials because they had a bunch of like, you know, science nerds and nurses and stuff in their group. And they did clinical trials showing that, uh, that LAW, which is liquid antacid mixed 50/50 with water, seemed to be effective in helping treat chemical weapons exposure, at least to the eyes. So we, we continue to use that. 

ROSE:
Oh and one tip, for your future protesting needs:

SYLVAN:
Don’t put milk in people’s eyes. Don’t put toothpaste in people’s eyes. Don’t put baking soda in people’s eyes. Someone told me about crushing up Tums in wa- in water, and then putting that in people’s eyes. Don’t do that.

Anyway, thinking about this wound healing technology, these super bandaids, made me wonder how this might fit into a street medic’s toolkit- which is really a fannypack most of the time. And Sylvan says that she thinks it might mean that more people show up to these protests.

SYLVAN:
Fear is the cop’s greatest weapon and it’s the thing that they are trying to instill in you when they hurt you, right. Because punching you, beating you with a baton, shooting you with a beanbag round, that doesn’t- that’s not going to stop you from wanting the cops to stop killing Black people, right. Like, that doesn’t change my political opinions. All it does is it gives me a physical memory. It gives me a memory. It gives me a physical experience of suffering that every time I think about going back out into the streets, I, I, my body remembers. RIght, he body keeps score. My body remembers that- those times that I’ve been hurt by the police, and the less that I have to fear those lasting injuries, the, the more fearless I can be, the more I can put myself out there.

ROSE:
If you no longer feared the physical pain or hurt that you might face at a protest, would you be more likely to go? Sylvan thinks maybe you would! 

And yet, I still had this question about what a wound actually is. Even if you can zip up somebody’s external cut and they can race right back to the front lines, should they?

SYLVAN:
Yeah, that, that conversation comes up a lot. So- like, I remember treating somebody who who was complaining of some respiratory distress and a lot of pain in their, in their chest after getting, uh, jabbed- you know, kind of stabbed with a police baton in the rib cage. And I suspected that they had a broken rib. But, you know, we always say we don’t have X-ray vision, so I don’t know that that’s what’s happening. All I can do is look at the symptoms. 

And I’m not a nurse. I’m not your doctor. I’m, I’m a street medic. And I only have the tools and the knowledge that I have. And based on the tools and knowledge that I have, I think that you might you probably should go home and probably go to the hospital and get an X-ray and talk to somebody. And this person was, you know, absolutely just like, “No, absolutely not. I’m going right back out there.” So there’s, there’s an interplay there where, like, your role as street medics is to help people stay in the streets. 

ROSE:
Ultimately, Sylvan said that it’s not her job to force anyone to leave a protest if they don’t want to. That’s up for each person to decide. And she hopes that more people will decide to show up.

SYLVAN:
I’m a participant in this culture and I see it as my duty to go out there and put my body on the line to try and make things better. And so I recognize and I think all st- we, we all recognize that our patients are out there for, for that reason, so if we can patch them up and they want to be there, we want to support that. And if they are clearly struggling with the, you know, with the fear, with the trauma or the injury that they’ve experienced and the counterbalance of their desire to be on the front line, to be there, we might either encourage them to go home or at least take them somewhere safe. 

ROSE:
In so many cases, what we consider an “injury” is defined by the physical. By something that we can see. We focus on healing the cut or the broken bone, and once the physical manifestation is gone, we tend to think that the job is done. But so many people live with chronic physical pain or mental illness that is largely invisible to the outside world.

KEISHA:
You get IN an accident. There’s lots of blood, maybe lots of injuries. You get healed using this wound technology, but you still have the memories of it. You still remember how it felt. You still remember the, then sight of seeing your body torn open and, and blood. It’s not supposed be on the outside, supposed to be on the inside, right. That trauma doesn’t go away. 

So I think it’s a real concern to think about the mental aspects of injury. And I think that’s a very philosophical question, is just what is pain? What is injury? And are there different dimensions of pain and injury? And the answer is yes, there is.

ROSE:
Often, people who have lasting trauma hear things like “oh you’re still not recovered from that?” or “oh that’s still a problem for you?” It takes time to recover — not just physically but also emotionally. We might be able to speed up wound healing, but it’s unclear that we can speed up some of these other less visible parts of the recovery process. So as we march towards really cool healing technology, let’s remember that amazing fancy bandaids and SCHEEPDOGS are just one piece of the puzzle. Healing means lots of different things — and it can take more than one technology to get there.

[A snapping, synthy music comes in- the Flash Forward closing theme]

ROSE:
Flash Forward is hosted by me, Rose Eveleth, and produced by Julia Llinas Goodman. 

The intro music is by Asura and the outro music is by Hussalonia. The episode art is by Matt Lubchansky. 

The scene at the beginning of this episode was performed by Shara Kirby, Emma Bracy and Tamara Krinsky. Check out the show notes for more about the work that they do. They are all awesome!

Flash Forward is a completely independent podcast— the only way this show exists is because people choose to support it! So if you liked this episode, or any other episode, (slight laugh) you can become a supporter for as little as two dollars a month. Head to Flashforwardpod.com/support and you can find out about all the ways that you can chip in. 

So there’s a Patreon page, to support Flash Forward, this podcast, specifically, and there’s also a brand new- airhorn noises- membership program to support the broader network Flash Forward Presents, which includes this podcast as well as my other work and some really cool new surprises on the horizon. Again, that’s flash forwardpod.com/support for more about all of that stuff.

If you can’t give dollars but you still want to help the show, please head to Apple Podcasts and leave a nice review! I know that seems like a little thing, but it really does help people find the show. And if you have already done that, another great way to help is to simply tell people that this show exists and that you like it. Share this episode on Facebook or Twitter or Instagram or WeChat or TikTok. Tell your quarantine buddies! Text your mom! Whatever it is.

If you want to suggest a future that we should take on, you can send a note on Twitter, Facebook or the best way is by email at info@flashforwardpod.com. I do love hearing your ideas! We’re about halfway through this season, and so now is a great time to suggest some episodes because we’re trying to figure out what the next half of the season is going to look like.

And if you think that you have spotted one of the little references that I’ve hidden in the episode, you can email me there too, info@flashforwardpod.com. If you are right, I will send you something cool. If you want to discuss this episode, or some other episode, or Elon Musk’s Neuralink a- announcement, or just the future in general, you can join the Facebook group to do all of those things. Just search Flash Forward Podcast and ask to join; there is one question that you have to answer, and all you have to do is answer it and then I will let you in, to make sure that you are not a bot or a troll or someone who actually hates the show, or something like that; I don’t know. 

That’s all for this future. Come back next time, and we’ll travel to a new one. 

[Music fades out]