So, our next speaker is a biohacker, a blogger, body mod artist, and a nurse. He's
collaborated on projects ranging from insufferable peptides that extend REM sleep all the way to
non-Newtonian armor implants. He actually hosts the annual event Grind Fest in Tecachapi,
California. I probably butchered that. I apologize. I chew. I'm sorry. A little fun fact
about him, he actually placed third in the biohack village oxytocin poker tournament and he
performed an implant on transhumanist presidential candidate Zoltan Isvan. Now, here to present
his talk on biohackers die, ladies and gentlemen, Jeffrey Tibbetts.
All right. I'm the first one to try out this mic, so.
It's good? Awesome. Okay. So, how's it going? I'm a biohacker and I have done a few high
profile grinds. Okay. So, a number of people in this room and I were on an MTV show snorting a
peptide called VIP that rat models have shown can radically alter circadian rhythms. It didn't
do much to our sleep cycles, but we did find that it seriously boosted visual memory function
on two methods of testing. We're still crunching the numbers on that study, but I think I had a lot
more fun last DEFCON where we all snorted the oxytocin. That's the so-called trust or bonding
hormone. And we did this up in a hotel room and then competed in a poker tournament. I've also
done some pretty cool work with nerve growth factors. And we found that introducing NGF at
the point of incision when implanting a magnet actually increases sensitivity and provides a
better result in terms of ability to perceive fields. So, essentially, where groups like
Grindhouse Wetware or CyberEyes or Dangerous Things are,
are focusing really on creating technology to place in the body, my focus tends to be on ways to
alter a person's physiology or anatomy, which is basically the antithesis of my day job. As a
registered nurse in an ER, my objective is bringing people back into normal limits. I'm fortunate
that I still get to be involved in it with all the cool new devices being developed because you
always need someone willing to cut you open and shove things inside. So, let's see if this is
actually going to work. Hey, okay. So, I've done hundreds of procedures at this point, ranging in
complexity from the quick poke of an ARFID injector, like you see Zoltan getting here,
to bilateral armor implants running the length of the recipient's chins. As far as I can tell,
everything I do is legal and falls under laws pertaining to body modification. I mean, I think
it's legal. Of course, saying something's legal doesn't necessarily mean it's safe, which is the
focus of what I'm going to talk about today. I've been active in the grinding community pretty much
since its exception, and it's only lately that I've really been willing to admit, even to myself,
that someone's going to die, okay, and something's going to go wrong and somebody will die.
Cool. Okay. So, grinders are commuted to radically altering the body. And so, sometimes it's
treatments like transcranial magnetic or direct current stimulation, or it could be through the
use of previously untested chemicals like VIP. Often, it takes the form of implanted devices.
All these approaches come with risks. What I'm going to focus on today is why, despite all the
risks being taken, a grinder hasn't died yet.
All right. If you didn't know about Tim Cannon and Circadia prior to this DEFCON, I'm sure you know
now. People have had a lot to say about his project, and not all of it was positive. I'm going to read
three comments that I found about Tim. So, I guess, if you want flesh-eating bacteria, sepsis, and
such, get one stuck in your body at a chop shop. This comment, the assumption underlying this type
of comment is that we're all incompetent, and with a total disregard for sterile technique and
safety. Trust me, this isn't the case. I don't know why, but media folk love to record our
arguments and family drama, but they always stop recording during the hours spent cleaning and auto-claving.
You idiots need to look more into potential side effects prior to doing these things. So, on top of being
incompetent, we're also totally ignorant. Despite the months, and in some cases, even years that we spend on
projects, people assume we know nothing at all. And once again, this is not the case. That's my favorite.
Yeah, when it comes to something like cutting somebody's body open, skin open, and putting some foreign
object under the skin, then it should be done by professional people, not just people at home.
I like this one because it acknowledges that, yes, somewhere out there has the skill to do this stuff, but it's not us, right?
I think the best way to address these concerns is by showing exactly how much knowledge and skill goes into even the most
basic of procedures. So, first off, yes, there are grinders that are performing procedures in their garages, okay?
Let's take a look at one. It's kind of cut off, but still, as you can see on the slide, all of the walls are non-porous.
They're wipeable. There's a HEPA-filtered air supply. There's overhead surgical lighting and air
ventilation. There's also a non-porous, wipeable procedure chair. Off to the left, where you can't see, there's a scrub sink.
There's a patient monitor. There's an electrosurgical unit over stuck in the corner, an IV pump. There's a biohazard disposal bin, a sharps
disposal bin. I'm still working on putting in oxygen and an air supply. Yes, this garage is not on par with an OR found in a hospital,
but it's better than most procedure rooms that you find in clinics, to be honest, okay? And the most important aspect of this entire room,
though, is that it's designed to be easily cleaned.
Okay, and cleanliness is usually a critic's first point of contention. Clean is not good enough, right?
Contrary to popular belief, operating rooms are not sterile. The best you can hope for is disinfected. People mix up all the time.
Sterilization and disinfection and antisepsis. So, antiseptics are cleansers that reduce the number of pathogens on the skin.
Grinders use either a mixture of 70% alcohol with a 4% chlorhexidine gluconate or a podone iodine 12% to disinfect the incision site.
Either works. I prefer chlorhexidine because it has a residual action.
Okay, in terms of disinfectants, they are chemicals which kill the majority of infectious agents on a surface.
We use a 1 to 10 dilution of bleach for surfaces and quaternary ammonia for more delicate items like equipment and tubes and cords and things, right?
In terms of sterilization, this is, sterilization is the elimination of all life.
You've got to sterilize anything that touches the incision site, like tools and gauze.
This is my Ritter M9022. Works by bringing tools to 121 celsius at a pressure of 15 psi for 30 minutes.
So, of course, just having these tools and supplies doesn't mean you're using them right.
And someone could totally still claim that we're incompetent based off of this.
But if I took the time to really explain how to scrub in and disinfect the environment and, you know, the use of the ultrasonic baths and enzymes and protectants prior to autoclaving, we'd never actually make it to my point.
So, we are using them correctly.
So, really, I mean, are we competent?
I know we're competent as the guys working in the hospital OR because I know those guys and I was trained by those guys.
And are we ignorant?
Well, I guess the question I have is why aren't operating rooms sterile?
There was a grinder project a few years back where some people made a chamber and the recipient would place his hand in the box and the whole procedure was performed by an artist reaching through this, like, gloved aperture, right?
They would fill the entire chamber with a vaporized disinfectant, like, immediately before doing the procedure, right?
I couldn't find a picture of this.
But what I did find a picture of, though, if it works, come on.
Yeah, okay.
Oh, too far.
There we go.
This is a hydrogen peroxide vapor system being made by a company called BioQoil and it's being trialed at John Hopkins.
I'd say no, we're not ignorant.
On the contrary, we're right at the forefront if not beyond what the medical field is already doing.
I mean, this is being trialed at John Hopkins.
We had a few years back someone already trying the same type of idea.
Okay, anyways, our next consideration is analgesia.
I can't use some of the methods because of where I live.
But plenty of grinders can and do.
The gold standard is infiltration of lidocaine because a lot of procedures we do are in distal areas with poor circulation.
We use 2% lidocaine without epinephrine.
Epinephrine is great in other areas because it constricts blood flow.
And this keeps the lidocaine in the area longer and it actually decreases bleeding.
So like in fingers and ears, though, it can restrict blood flow enough to cause necrosis.
So we're doing a technique.
Generally, most grinders are using techniques.
Yeah, there we go.
Called a flexor tendon sheath nerve block.
That's where you take a 25-gauge needle and you insert it at about 45 degrees just distal to the palmar crease.
Okay, this blocks pain throughout the entire finger for as long as an hour and a half.
In places where we can't use infiltration, people usually opt for a topical lidocaine gel.
5% gel applied for an hour and a half can provide a degree of analgesia as well.
I feel personally that this method takes too long and people still complain of pain.
This is an issue in medicine as well.
A few people like getting stuck with an IUD.
There is a product called Emlacreme, which can be applied beforehand and nub the site.
The problem, though, is it takes so long to be effective, physicians seldom even bother with it.
Some kids sometimes get it, but that's about it.
So we've been trialing a method of administration called ionophoresis.
Ionophoresis uses 120 milliamps to actively push lidocaine through the skin.
Using ionophoresis, we've gotten far better control of pain in as little as 30 minutes.
And this is something I've never heard of actually being used in the medical field.
So once again, are we competent?
Yeah, we're using the same methods, the same safe methods that you'd find in a hospital setting.
And are we knowledgeable?
Yeah, we're actually pushing beyond.
We're innovating at this point.
In terms of controlling bleeding, we control bleeding with tourniquets.
Did you know first aid kits don't even come with tourniquets anymore?
The improper use of a tourniquet can lead to some really serious problems.
These problems are usually because of either too much pressure or leaving them on for too long.
For a procedure like a magnet, though, we don't have to worry about pressure if we use a product intended for fingers.
Devices like T-rings, this is a T-ring, they apply less force than a traditional tourniquet,
and they let us work without blood to obstruct our view.
In terms of time, you don't even get a change in your lab values indicating muscle damage has occurred until about the 30-minute mark.
And two hours is considered the point at which lasting damage starts to occur.
Most procedures, we do take maybe 10 minutes.
And for more invasive procedures, we do use surgical tourniquets.
This approach requires a lot more specialized knowledge.
We have to pay attention to details like the proper limb occlusion pressure,
and we have to be really careful about recording time.
I'm going to skip over those details pretty much in the name of brevity,
but I don't want you to confuse this omission as being due to incompetence or ignorance.
So where are we? We have a disinfected procedure area and sterile tools.
We have a clean procedure site and clean hands.
We're pain-free. Bleeding is controlled, so we must start cutting.
Where do we cut?
The priority, of course, is avoiding blood vessels and nerves.
Then we worry about trying to minimize scarring.
In terms of, let's see, skin has a grain, kind of like how wood does.
The collagen fibers are naturally oriented in one direction called Langer's lines.
You can get these really cool topological maps showing the direction of collagen.
You also have to take into consideration the direction of maximum skin tension.
This is a different set of anatomical skin lines called Krasel's lines.
Plastic surgeons usually place incisions that are parallel to each other.
They're parallel to relaxed skin tension lines.
Those are known as Borge's lines.
Unless there's a nearby natural wrinkle that would hide your incision instead.
Basically, choosing an incision site to maximize aesthetics is more difficult than you would think.
For example, I switched out a North Star implant for my friend, Bird.
She's in the back right here.
When we switched out the North Star, oh, by the way, she really digs scars anyways,
and she explicitly gave me the okay to try a different approach.
Anyway.
I incised parallel to Langer's lines, hoping to minimize the scarring on her hand.
I didn't really account for the tension on the skin.
When it was healing, whenever she'd move her hand around, it was pulling on the incision site.
Basically, because I didn't account for the tension on the skin, it was constantly pulling.
I was really disappointed because the incision ended up scarring worse.
If you can see right here, this is actually, along this line, this is the original incision point.
Right here.
Right here is the incision that I made when I was switching them out.
The original one is about a year of healing further along than this one,
but still, I think that it's going to end up being a bigger scar overall.
It's one of these things where we're still playing with it and trying to figure out the best approaches,
but it's not something that I would say we're ignorant about.
Once again, are we ignorant or incompetent in this area?
I'd say it's a wash.
I've seen beautiful work done by both plastic surgeons and body modification artists.
At the Body Hacks Conference, I got to hang out with Russ Fox.
He's like a god in the body mod community.
His work's beautiful, and I'll be the first to admit I'm not at his level of competency.
I've also gotten to sit through a number of procedures performed by one of the top plastic surgeons in the LA area.
There's no way I can do what either of them do.
That said, people don't come to me and make them pretty.
What people expect is the safe placement of a safe device, which is something that grinders are competent to provide.
In terms of incisions, how we make the incision depends on what we're doing.
Objects in glass capsules like tritium fireflies or ARFIDs can be placed using an injector.
For other implants, we use a 15 or 11A scalpel blade or a number 3 handle.
A scalpel is held with a pencil grip in the dominant hand.
While the non-dominant hand provides tension on the skin, we make the incision slightly larger than the object to be implanted.
When you get below the dermis, the connective tissue tears easily.
The artist chooses between blunt or sharp dissection.
You can separate connections.
I use connective tissue with a probe, but I found blunt dissection causes more trauma and increases healing time,
so I usually opt for sharp dissection with a scalpel.
Sharp dissection comes with the risk of cutting through an important structure,
so if I'm working in an area I'm less familiar with, I like to go with blunt.
The point of separating the tissue is to create a pocket for the implant to sit in.
It's best to create a pocket that's somewhat larger than the device you want because you want skin laxity.
You want enough give in that area so that you can approximate the incision without it being under tension.
Let's see if this one shows up.
Hey!
It's a bagel head.
Are you guys familiar with what this is?
It was basically a year or two back, there was a physician who started posting on the biohack forums,
and he suggested we try a technique that's called fluid dissection.
It's like the bagel head thing right here.
What you're doing, the idea is you put fluid under the area, under pressure, and it creates the pocket for you.
So in this case, that's just normal saline that was done with an IV needle,
and you fill up the area and you push with your thumb in the middle.
You know, pretty much the saline reabsorbs within, I don't know, six to eight hours.
Anyways, so his idea was that we could do,
like, how you do a TB test.
You know, and I've done this hundreds of times as a nurse.
You know, you have, when you're doing a TB test, you're actually doing an intradermal injection.
You're going to go into the skin, do a little injection, it makes a bubble.
His idea was essentially that we could make this big saline fluid pocket that way,
and then just cut right into it, slip the magnet in, like, no problem, you know?
I was somewhat critical of it.
Oh, sorry.
I recorded a video where I tried out the fluid dissection method three different times in three different areas,
and it didn't work at all.
The weird thing, though, was when I posted what I found,
so I went up and I posted what I found,
the guy just, like, flipped his shit.
Despite giving him credit and only posting the video as a direct response to the threat he started,
he accused me of plagiarizing his work.
He swore to never help us again and quit the forums.
So why would I plagiarize a technique that doesn't work?
Seriously wonder if it had worked out, if he would have still been upset.
You know, I think the real ease of...
the issue may have been an ego bruise by someone with, like, one-fifth of his credentials demonstrating that he's wrong.
Okay?
So, closing the incision.
We use a non-absorbable suture like polypropylene with a 3-eighths curvature reverse cutting needle.
I taught a class during Grimefest a few years back on suturing,
and the three techniques we practiced were simple interrupted, running sutures, and horizontal mattresses
performed with an instrument tie.
So these types can be used for probably 90% of the procedures we're doing,
and we're just not doing anything complicated enough to require a larger repertoire.
The technique's then removed.
We let a small amount of blood out, flushing out the wound.
Then we apply pressure for a minute, and the bleeding stops.
The wound's then dressed using Steristrips.
Initial healing takes around three weeks,
during which the focus is on controlling inflammation using ice and ibuprofen.
Okay, sutures are pulled sometime between day three and seven,
after which Steristrips are kept on to prevent the site from reopening.
Collagen fibers reinforce the wound after a month,
and although wound maturation and remodeling can take more than a year.
Again, for the sake of brevity, I'm omitting a lot of information that I would consider essential.
Here. Let's go.
As much focus as I put into talking about the safe implantation,
the insertion of a device is actually the simple part.
It'd be easy to stand here for another hour speaking exclusively about biocompatibility.
The community is constantly brainstorming new types of coatings and ways to apply them.
Medical devices like Pacemaker are usually coated in either a biocompatible alloy like titanium nitride,
or a polymer like perylene.
The simplest biohacks don't require even these.
When injectable ARFIDs were first being marketed, I was concerned because they're encapsulated in glass.
My concern, and the concern of probably a lot of people,
is that if the glass breaks in your body, it seems like it could cause harm.
So I was involved in the testing of this idea,
and what we found is it takes so much force to break these things,
that if it happens, the glass is the least of your worries.
I mean, sure, it'll break if you drive over your hand, right?
Another concern I've seen pop up over and over is research indicating that ARFIDs implants
can cause tumors.
There are journal articles about this.
Rats and mice, particularly the types used in labs, are particularly prone to tumors.
These studies have shown that as many as 10% of the rats developed a harmless tumor near the ARFID capsule.
They're called post-injection sarcomas.
What you don't realize is these sarcomas occur in murine models regardless of whether the ARFID is there or not.
It happens in cats, too.
It has something to do with the animal's ability to handle oxidative stress.
Cats just sometimes get tumors if you poke them with a needle.
It's like acetaminophen.
What's poison to a cat isn't necessarily poison to us.
Dogs, on the other hand, they seldom ever get post-injection sarcomas.
That's why I only found one case study ever about a dog they found this type of tumor in.
We put hundreds of thousands of ARFIDs in dogs.
These studies, they just can't be applied to human applications.
I've never heard or seen of an ARFID being rejected, breaking inside of someone, or causing a tumor to form.
Most projects, however, they don't fit in glass.
So early work like the circadia,
and early work like circadia use silicone.
It's a material that's been safely used by the body and mind community for years.
It has its disadvantages, though, and we've almost entirely replaced it with titanium nitride and perylene.
The same coatings as biomedical devices.
I subscribed to a journal that discusses biocodings,
and I came across an article talking about a method developed which could apply a layer of diamond.
When I contacted the guy responsible for the research,
he helped me produce a batch of neodymium iron boron magnets coated in diamond.
Out of the ten I've implanted, only two have had problems.
We haven't yet determined if these problems were related to a defect.
A defect in manufacturing, a problem with diamond coatings,
or simply because of events related to healing.
But this is another example of the biohacking community
not only matching the diligence required in medical devices,
but striving to exceed them.
There are many considerations that go into making an implant I'm not even qualified to address.
I know there's a lot of work regarding appropriate batteries.
It's obvious something equivalent to a Samsung bursting into flames under the skin could be lethal.
But there are more subtle issues, like outgassing.
Bottom line is we don't expect our implants to fail,
but we have to engineer them so that if they do,
they do so harmlessly.
And we had to perform tests to determine if we succeeded in making them safe.
For devices to be approved by the FDA,
you need ISO 109903 certification.
This requires cytotoxicity testing,
like direct contact tests or agar diffusion tests.
Sensitization assays are used to determine whether a material is going to cause hypersensitivity or an allergic reaction.
Let me keep skipping through some of this.
Can I just get to the point?
Basically, with these tests,
we have no obligation to do these tests.
We're not in any way obligated by the FDA or anyone to essentially perform these tests,
and yet we still are.
I mean, if you look at what Grindhouse has done,
they've done these cytotoxicity tests.
If you look at some of the stuff we've done with the different coatings and just different stuff,
I mean, we're doing the majority of tests with, I think, what?
We're missing pretty much nobody does multigenerational tests
to see if four generations down the road there's going to be problems.
But I mean, with the majority of materials we're working with,
it's already been done with the exact same materials.
And yet we're still repeating these tests,
just because in the community we put so much emphasis
on trying to create a safe product to do this the right way.
So despite how simple something like a magnet implant seems to be,
it requires a lot of work and a lot of research.
This is work grinders are doing and skills we're learning.
Are we competent? Absolutely.
There may be a safer and better way to do these things,
but if there is, I'm willing to bet grinders will be amongst the first to put them into practice.
Are we ignorant? No.
We study and practice our craft without being blinded by ego.
Should we wait for those who consider themselves to be professionals to give us their blessing?
No.
Look, no surgeon is going to be willing to do the things we're doing.
Medicine returns the body to the state we consider normal.
It's not the pursuit of becoming more than human.
And body modification community is similarly unsuitable.
Biohacking is rooted in cooperation and collaboration.
There are great guys like Hayworth and Russ Fox,
but body modification in general is poisoned by an unwillingness to collaborate.
This is fine when we're talking about nipple piercings,
but grinders are already working on designs for brain-computer interfacing.
I want the skills to place a multi-electrode array
and expand on the type of work Kevin Warwick did 15 years ago.
I don't know any physicians willing or body modification artists capable of doing this.
There are no masters.
There are no professionals.
If we're not skilled enough, the only option is to become better at what we do.
Okay, so why is it I'm convinced someone's going to die?
One minute.
Wow.
Good.
I'm almost there.
Okay.
In 2011, there was a BMG case report titled Body Piercing with Fatal Consequences.
A man in his 50s died from a mesenteric infarct.
What that is is basically he had a belly button piercing and it migrated inward, right?
Cut off blood flow.
I've seen about three of these in my career.
What happens is, you know, they have some kind of GI upset.
They open them up for exploratory and their entire gut is already just gray and dead.
There's nothing to do.
You sew them back up and you tell them to say goodbye to your family.
You know, within a day, they're vomiting feces and then they die.
It's terrible.
Okay.
And obviously, this is not an exception.
You know, there are case after case of people dying from, you know, all kinds of things with piercings.
But it's not just piercings.
That's not the only thing that scares me.
You know, I mean, uh...
I'll actually read that part.
I'm convinced someone is going to die because there are between two and four deaths a year on average in the U.S. from people shaking vending machines.
Okay?
People take every precaution and are meticulous about after...
I mean, it's still a risk, man.
People are...
Someday, it's a numbers game and somebody's going to die.
The problem with this, the problem with this is that there's going to be that backlash from the first inevitable death.
Right?
So far, the media has been kind to us.
Right?
Everything we do...
I mean, like, people have been doing piercings for...
into antiquity.
And yet, we put a stupid magnet in and it's like, they're cyborgs, man.
They're, you know, they're, like, innovating.
No, no, no.
We're not really doing that amazing stuff.
But, you know, the way they're pitching us is being, you know, we're doing this amazing or we're doing something different than everyone else.
The problem with that is when somebody dies, that's just going to blow up in our face.
I mean, the way it's going to work is that same sensationalism that blew it up as a hundredfold of us doing these things.
It's also going to be, you know, oh, my God, these dangerous people doing these dangerous things.
And we know what they're going to say about it.
What it's going to be is they're going to say we're ignorant and we should have looked into the risks of what we're doing.
They're going to say we'll all get sepsis and flesh-eating bacteria, you know.
They're going to assume we're incompetent.
And they'll say procedures like this should be left to someone else.
Someone who has the knowledge and competency to do it right.
Right?
Okay.
So...
Less than a minute.
Damn.
I mean, come on, guys.
It goes like this.
I'm done, right?
Yeah.
Okay.
Eh, whatever.
Okay.
Real quick.
We drive cars around, right?
And we think it's okay, even though look at the number of deaths that occur from cars.
No one's saying we're going to stop driving because it's too dangerous, right?
Beyond that, even beyond necessity, there's, you know, people smoke.
You smoke cigarettes, you know, it's killing this many people and yet it's acceptable in society.
You know, we smoke cigarettes.
But what we're doing, it's also risky.
But you know what?
It's a risk we're taking because we believe in it.
We're trying to create a future, you know?
We're doing something that's meaningful.
And so I don't have anything to say about really the backlash when the first grinder dies.
We're screwed.
But I'll tell you what I do know.
I do know that that person that first dies, they died doing something they believe in.
They died doing something that they researched and knew the risks and they did it anyways.
And they died in a way that they thought was meaningful.
Yeah, that's right.
Yeah.
So that's all I got to say.
Thank you.