Summary

The development of technologies to modify natural human physical and cognitive performance is one of increasing interest and concern, especially among military services that may be called on to defeat foreign powers with enhanced warfighter capabilities. Human performance modification (HPM) is a general term that can encompass actions ranging from the use of “natural” materials, such as caffeine or khat as a stimulant, to the application of nanotechnology as a drug delivery mechanism or in an invasive brain implant. Although the literature on HPM typically addresses methods that enhance performance, another possible focus is methods that degrade performance or negatively affect a military force’s ability to fight.

Advances in medicine, biology, electronics, and computation have enabled an increasingly sophisticated ability to modify the human body, and such innovations will undoubtedly be adopted by military forces, with potential consequences for both sides of the battle lines. Although some innovations may be developed for purely military applications, they are increasingly unlikely to remain exclusively in that sphere because of the globalization and internationalization of the commercial research base.1

Based on its review of the literature, the presentations it received, and on its own expertise, the Committee on Assessing Foreign Technology Development in Human Performance Modification chose to focus on three general areas of HPM:

• Human cognitive modification as a computational problem (Chapter 2),

• Human performance modification as a biological problem (Chapter 3), and

• Human performance modification as a function of the brain-computer interface (Chapter 4).

HUMAN COGNITIVE MODIFICATION AS A COMPUTATIONAL PROBLEM

Human perception and performance can be augmented by the use of technological systems that complement and enhance human cognitive abilities: the combined system of the human(s) and the computational tool(s) becomes smarter or more capable than the human alone (Norman, 1993). All functional cognitive systems must have technologies to sense and measure, to process and analyze, and to control or achieve a desired outcome (Norman, 1980). As an example, a system that assists a battle-vehicle operator in maneuvering through rough terrain might record

1Academic papers reviewed by the committee frequently reflected cooperation between researchers from multiple countries and movement of ideas between university laboratories. Large companies increasingly sponsor global research and development, with laboratories, ideas, and development unrestricted by national borders. Technological development is sped by the global information infrastructure, most notably the Internet, and the rapid worldwide spread of knowledge is normal to the point of being unremarkable.



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Summary The development of technologies to modify natural human physical and cognitive performance is one of increasing interest and concern, especially among military services that may be called on to defeat foreign powers with enhanced warfighter capabilities. Human performance modification (HPM) is a general term that can encompass actions ranging from the use of “natural” materials, such as caffeine or khat as a stimulant, to the application of nanotechnology as a drug delivery mechanism or in an invasive brain implant. Although the literature on HPM typically addresses methods that enhance performance, another possible focus is methods that degrade performance or negatively affect a military force’s ability to fight. Advances in medicine, biology, electronics, and computation have enabled an increasingly sophisticated ability to modify the human body, and such innovations will undoubtedly be adopted by military forces, with potential consequences for both sides of the battle lines. Although some innovations may be developed for purely military applications, they are increasingly unlikely to remain exclusively in that sphere because of the globalization and internationalization of the commercial research base.1 Based on its review of the literature, the presentations it received, and on its own expertise, the Committee on Assessing Foreign Technology Development in Human Performance Modification chose to focus on three general areas of HPM:  Human cognitive modification as a computational problem (Chapter 2),  Human performance modification as a biological problem (Chapter 3), and  Human performance modification as a function of the brain-computer interface (Chapter 4). HUMAN COGNITIVE MODIFICATION AS A COMPUTATIONAL PROBLEM Human perception and performance can be augmented by the use of technological systems that complement and enhance human cognitive abilities: the combined system of the human(s) and the computational tool(s) becomes smarter or more capable than the human alone (Norman, 1993). All functional cognitive systems must have technologies to sense and measure, to process and analyze, and to control or achieve a desired outcome (Norman, 1980). As an example, a system that assists a battle-vehicle operator in maneuvering through rough terrain might record 1 Academic papers reviewed by the committee frequently reflected cooperation between researchers from multiple countries and movement of ideas between university laboratories. Large companies increasingly sponsor global research and development, with laboratories, ideas, and development unrestricted by national borders. Technological development is sped by the global information infrastructure, most notably the Internet, and the rapid worldwide spread of knowledge is normal to the point of being unremarkable. 1

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2 HUMAN PERFORMANCE MODIFICATION: REVIEW OF WORLDWIDE RESEARCH images with a camera, process the information (for example, categorizing and locating objects in scenes), and alert the operator. Computation and Human Cognition The reality of human perception can be modified (augmented) through the use of cognitive artifacts of varied sophistication. Cognitive artifacts are technological systems that complement and enhance human cognitive abilities. A cognitive artifact does not make a person smarter; instead, it is the combined system of the human and the artifact that is smarter or more capable (Norman, 1993). For example, advanced cognitive artifacts can be worn on the body or implanted in various parts of the body and potentially offer enhancement of biological system performance, memory, sensory abilities, and communication. Augmented reality (AR) has great potential to improve command choices and decisionmaking, with external experts providing relevant information and interpretation from remote and geographically dispersed locations. Another application is enhanced training; through enhanced communication and visualization methods, it is possible to enhance the performance of distributed work teams dramatically. By extension, the integration of nonhuman autonomous components with humans in team-like arrangements could enhance the cognitive performance of groups of humans. Computational Limitations The enhancement of cognition by computational means is limited by power demands and architecture design that do not currently support complex cognitive processing. Although information technology (IT) has continued to provide better performance with decreasing power consumption every year, current capabilities are being outpaced by spiraling data and information-processing demands (Izydorczyk, 2010). For example, the IBM Watson is an advanced computing system that “understands” questions in natural language, finds information in relevant sources, determines the confidence level of different options, and responds with factual answers (Ferrucci, 2012). However, Watson’s impressive capability for artificial intelligence and cognitive information processing is still far less than the capability of the human brain, which is by comparison orders of magnitude smaller and more efficient. Although advances in data storage and hardware design will improve this situation, computers may need to become more brain-like to meet the requirements of augmented reality. Reconfigurable computing2 offers one approach to much more energy efficient, brain-like computers capable of self-learning and adjusting to tasks and requirements without having to be programmed. Such tools for enhancing cognition will require research and development on neuromorphic devices and circuits in which computing elements and memory are “fused” together or finely interleaved (Indiveri et al., 2011). To become brain-like, computers will require dense interconnections between neuron-like computing units. In addition, challenges posed by space constraints for the logical units and by mapping of the neurosynaptic functions of the brain to configuration requirements will have to be overcome. Such developments could fundamentally change the nature of computing, although it might be 15 years or more before real-world applications could be ready. 2 Reconfigurable computing allows the building of intelligent circuits that can be adjusted on the basis of experience and learning.

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SUMMARY 3 Worldwide Research According to the committee’s research, the United States currently has a competitive advantage in augmented cognition technology because it leads in the development of human- centered software, although strong research in cognitive computing is performed worldwide. Strong research efforts using reconfigurable computing for neural networks exist in Australia, Ireland, Turkey, and Switzerland. In addition, large international programs, such as the European FACETS (Fast Analog Computing with Emergent Transient States) consortium with participants from seven countries (Austria, France, Germany, Hungary, Sweden, Switzerland, and the United Kingdom), drive research and development for novel neuromorphic computing architectures. The Importance of Good Design Machines excel at precise, repetitive operations—tasks for which humans are poorly designed. In contrast, humans excel at tasks requiring flexibility and creativity, and at responding to novel, unexpected situations—tasks in which machines perform poorly. Unfortunately, many computational designs currently do not take advantage of human capabilities and instead force humans to operate by machine rules and logic. With better attention to the well-established principles of human-centered design and human-systems integration, including modeling and simulation of human cognitive performance, there could be a significant enhancement in human cognitive capability with no need for new research or new applications. Technologies for Degrading Human Cognitive Performance Although most HPM computational advances are intended to enhance performance, the committee’s research identified a class of technology designed to degrade performance. An example has been described by Japanese researchers who have developed a device, using commercial off-the-shelf components, to interfere with and prevent speech production (Kurihara and Tsukada, 2012). In combat or peacekeeping environments, use of such a device could lead to serious consequences by preventing spoken commands, instructions, or assurances intended for friendly or enemy troops, or civilians.3 Although no additional examples of purposeful degradation of human cognitive capability were uncovered, the potential for such technologies should not be dismissed. HUMAN PERFORMANCE MODIFICATION AS A BIOLOGICAL PROBLEM Two primary areas of research and development in HPM as a biological problem were assessed by the committee as having the most likely impact in the next 10-15 years: tissue engineering and mechanisms for addressing fatigue (including sleep patterns). Tissue Engineering Tissue engineering can be defined as the use of cells, engineered materials, and suitable biochemical and physiochemical factors to improve or replace biological functions. Success has been achieved in tissues that are thin membranes, that are avascular, or that have high regeneration potential. For example, tissue-engineered skin, cartilage, bone, and corneas have been used clinically (Khademhosseini et al., 2009). Three approaches to tissue engineering include the conductive approach, which uses a material to provide the structural framework for cell infiltration; the inductive approach, which 3 By contrast, accidental or unintended degradation of human performance can occur with the inappropriate use of devices meant to enhance performance, such as, for example, the use of a cell phone while driving.

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4 HUMAN PERFORMANCE MODIFICATION: REVIEW OF WORLDWIDE RESEARCH uses soluble materials to promote cell infiltration; and the cell-replacement approach, which provides either an allograft (from a donor) or an autologous graft (from the patient) to repair a tissue. Tissue engineering can be used to speed recovery and to improve the quality of the generated tissue. The primary potential application for military purposes is to increase and improve healing processes, thereby returning soldiers to their job duties more quickly. Currently, tissue engineering methods are unable to enhance the normal functioning of healthy tissue. This situation is unlikely to change in the near future because of the substantial challenges involved in organizing large numbers of viable cells. Worldwide Research Tissue engineering is a subject of active inquiry throughout the world. The research is being conducted in sports-medicine laboratories, genetic-engineering laboratories, and rehabilitative- surgery centers. The committee found it to be one of the most difficult topics to investigate because it is so vast, varied, and complex. In addition, because the topic involves direct interference in the human body, there are widely differing views worldwide as to what kinds of research are morally acceptable. Combating the Effects of Fatigue The negative effects of work-related fatigue on basic psychomotor and cognitive performance are well understood. Physical fatigue manifests itself in deteriorated dexterity, reduced eye-hand coordination, tremors, discomfort, and loss of strength and endurance. The primary contributors to work-related fatigue are long duty hours, inadequate sleep, and disruptions to daily (circadian) rhythms that affect alertness and cognitive performance. Physical and mental workload are also important determinants of reduced performance due to fatigue (Chaffin et al., 2006). Shift work is especially detrimental, because humans are not wired biologically to work at night. In the pre-dawn hours, the metabolic rate begins to drop toward its circadian low point, and complex biological mechanisms in the brain that generate sleep are at their most powerful. Fatigue has been studied extensively, and models have been incorporated into formalized fatigue risk-management plans. The accrued knowledge has been used to optimize operational plans and to inform the choice of shift and movement scheduling. New technologies that have been developed to detect and manage fatigue range from timed use of pharmacologic agents, such as modafinil, to highly precise light treatment devices. The integration of the technologies into management of human resources may affect the functional effectiveness of units that operate in extreme situations, such as long shifts, rotating shifts, and quick deployments across many time zones. There is research funding for some knowledge gaps, including those related to the effects of fatigue on team cognitive performance and the elucidation of phenotype and genotype for sleep and fatigue traits. Some knowledge gaps without research funding are related to nontherapeutic effects of transcranial stimulation on sleep and psychomotor performance, interactive effects of automation and fatigue on human operators’ cognitive skills, and the effects of fatigue on higher- level cognitive constructs, such as naturalistic decision making, risk taking, and situation awareness. In the next 5 to 10 years, top-down fatigue-risk management systems will become commonplace in 24/7 operations, as will the practice of removing sleep debt before critical operations. In the next 10 to 15 years, pre-travel adjustment of the circadian rhythm will be routine, and on-duty napping during 24/7 and nighttime operations will become an accepted practice.

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SUMMARY 5 The committee also found that genetic analysis of individuals with unique sleep patterns has important potential for military operations. This category includes short sleepers, those susceptible to sleep deprivation or restriction, and people who experience unique circadian rhythm effects. Large-scale screenings are underway to identify genes that regulate sleep, and sleep circuitries and functions are being investigated at a molecular level. If a military force could remain fully functional with less sleep than its enemy, the implications for military effectiveness could be significant. Worldwide Research The results obtained by the committee indicate that the European Union is the leader in the field of fatigue research, with the United States, Australia, and Japan providing extensive contributions as well. Shift work in railroad operations, similar to military operations whose 24- hour demands encourage irregular schedules based on the clock, has been studied extensively in Europe and Japan. Only recently has the United States begun to fund similar research to better understand the physical, cognitive, and other effects of irregularly scheduled work. Additional countries conducting notable research include Brazil, Canada, Iceland, New Zealand, Norway, Singapore, and South Korea. HUMAN PERFORMANCE MODIFICATION AS A FUNCTION OF THE BRAIN-COMPUTER INTERFACE Brain-Computer Interfaces Brain-computer interfaces (BCIs) involve direct communication of neural signals with an external device. A large body of research is concerned with the ability to detect and translate neural activity and to direct it to control a machine and thereby enhance human performance (Brunner et al., 2011). The most common application is in the realm of rehabilitative medicine. For example, neural implants that enable a disabled person to control a wheelchair, prosthesis, or voice simulator have been developed (Rebsamen et al., 2010; Bell et al., 2008; Brumberg and Guenther, 2010). Conversely, electronic signals may be used to stimulate portions of the brain to induce a particular motor response, although this effect has been demonstrated only in animals (Arfin et al., 2009; Nuyujukian et al., 2011). Although potential applications for performance enhancement may develop in the future, current BCIs are slower and less accurate than the normal human function they are meant to replace. Critical to the successful use/operation of brain-computer interfaces is the identification of brain regions activated during particular processes. Recently, electroencephalogram (EEG) spectra obtained using neural probes implanted into a subject’s brain have been successfully reconstructed as sounds heard by the subject. Future research will seek to extend this capability to analyze EEG spectra of thoughts and convert them to speech. This is an exciting advance that could lead to individuals regaining their lost ability to speak. Role of Nanotechnology The implementation of BCIs and many other HPM technologies is enabled by nanotechnology, which can be instantiated in a wide variety of technologies and fields relevant to HPM, including electronics, microelectromechanical systems, energy harvesting and storage devices/systems, and biomedicine. Especially intriguing for HPM is the use of nanotechnology for biointerfaces—materials, smaller than cells, that could possibly interact directly with the body on a biological level. For example, subdermal nanoparticles inserted into the body could enhance sensory perception (Cash and Clark, 2010).

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6 HUMAN PERFORMANCE MODIFICATION: REVIEW OF WORLDWIDE RESEARCH A more invasive use of nanotechnology for HPM is in the development of neural implants. These devices are placed directly into the brain to detect electric signaling (Navarro et al., 2005). To increase the signal-to-noise ratio and the resolution, the probes have to be on the same scale as the neurons that they monitor, that is, with a size of a few micrometers. Furthermore, they must be made of materials that are biocompatible and that produce as little damage and scarring in the surrounding tissue as possible. Sophisticated nanomaterials are being developed to achieve these characteristics (Zhang and Webster, 2009). Worldwide Research The committee’s literature search suggested that non-U.S. entities are more active in such research on cognitive function, with international players including Israel, Germany, Japan, and the Netherlands. Taiwan and South Korea have research infrastructure and expertise in this area as well, and China has also shown interest. Despite a great deal of progress, however, how the human brain functions is still largely unknown, and it seems unlikely that human performance can be significantly enhanced via BCIs in the near term. CONCLUDING THOUGHTS It is clear that human performance modification—both for enhancement and degradation of capabilities—is a subject of active research in all the technologically developed countries and regions of the world. The span of research is enormous, ranging from sports-related research to worker-enhancement research, to military applications. And the potential for crossover applications in each category is high. For example, research in injury recovery and physical performance enhancement, now mostly in the sports-research sector, clearly has applicability to military force development and maintenance. The committee noted that the sheer breadth of the scope of inquiry is staggering, from nanotechnology to genetic engineering to manipulating normal human processes (such as healing or fatigue). Predicting where each will go is difficult; predicting or even imagining the interactions, cross-applications, and unintended consequences borders on the impossible. One need only look at today’s human performance modifications that were not even dreamed about 20 years ago: wireless pacemakers that are monitored over the Internet, massively multiplayer on- line games that are used for tactics and training, and global groupware that enables geographically distributed teamwork. These examples show how one development—the commodification of the Internet backbone—enabled huge changes. Although some technologies are exotic and require specialized infrastructure and knowledge, such as nanotechnology and genetic engineering, others (perhaps most) do not require such infrastructure and can be pursued with fairly minimal investments. This situation makes it problematic to monitor the state of HPM technology development. The complexity of the field requires monitoring of the entire technology ecosystem (see Appendix D) associated with any element of an application. Finally, because of its very nature, HPM technology development will be influenced by differing legal norms, cultural values, and social mores in different parts of the world. It is a form of bias to assume that the methods and approaches used in one’s own geographic area are the same as those used in other areas. And even within a given country, there may be differences with regard to social mores, philosophies, and legal constraints. Two examples that illustrate the point are agriculture research involving genetically modified organisms and stem-cell research. In some parts of the world the former is fully acceptable and the latter less so, and vice versa in other parts. Any analysis of potential developments in HPM must be attuned to these cultural influences.