MAY 15, 2007


When patients take surgery into their
own hands

Extreme body modification divides
physicians along ethical lines

Amal Graafstra's RFID chip implant allows him to open his door and start his motorcycle just by moving his hand near them
Photo credit: Amal Graafstra,

At the intersection of medicine and mutilation sits, rather precariously, body modification. Body modification is, at its essence, surgery for non-medical reasons. But a strict definition is elusive: it includes surgeries ranging from the kinds of procedures that the public and the medical community have come to accept — like body piercing, facelifts and breast enlargements — to those that limn the borders of what's socially acceptable and even, in some cases, brazenly and proudly transgress such barriers, like having horns implanted in one's head, or metal objects placed beneath the skin of one's chest.

For the physicians who encounter these patients, several important questions must be answered. First, is the patient sane? Body modification can, in some cases, fit the diagnostic criteria for body dysmorphic disorder, in which a patient is obsessed with changing an aspect of his or her appearance.

Second, even if the patient is sane, do you feel comfortable doing the procedure? Many doctors already perform cosmetic surgeries, so it becomes a question of where you draw the line between what's acceptable and what's not.

Another consideration for some physicians may be whether patients will try to do it themselves if you refuse. "If they want them enough they're going to get them, so they might as well get them safely," says Wired Magazine journalist Quinn Norton, who's spent the last year studying body modification culture, responding to questions (fittingly enough for a tech journalist) via Instant Messenger chat. "There are a lot of mods I'd like to see doctors take over doing, or collaborating with the modding community to get them doing them safely."

Ms Norton types ominously: "Let me show you what I find to be one of the most interesting, scary and a-shadow-of-things-to-come documents on the internet." She sends the link for, which is, as she promises, a truly horrifying thing: a guide to Elective Home Surgery. "How do I know if a procedure is safe?" asks the guide. The answer: "Generally, you don't."

According to Ms Norton, some body modification enthusiasts have attempted surgical procedures using butter knives as scalpels and photographs they found on the internet as their surgery textbooks.

Many of the people who attempt body modification are likely in need of psychiatric evaluation: a survey of regular users of the body modification website was conducted by a team of three American psychologists and published in the journal Death Studies in 2006. They found a strong correlation between body modification and suicidal ideation: 66% of the 4,700 people surveyed had considered suicide; 27% had made at least one attempt.

Ms Norton, as part of her research, decided to get a mod herself. She chose a small magnet to be implanted into her fingertip. She visited body modification artist Steve Haworth in Phoenix in 2005 who numbed her finger in ice water and then used a scalpel to slice open a space to slide in the silicone-encased magnet. The magnet is said to grant a sort of "sixth sense" — the ability to detect electromagnetic fields, by stimulating somatosensory receptors in the fingertips.

But two months into the experiment, the silicone casing developed a hole and Ms Norton's finger turned black and became infected. She could no longer detect magnetic fields. She visited her family doctor to see if he could take it out. He was fascinated and baffled, she says, but wasn't able to remove the magnet. Four months later, the spot became even darker and she regained her sixth sense. But a recent knee injury has made an MRI necessary, so she's consulting with a hand surgeon — who was surprisingly unconcerned by her admittedly strange decision, she says — to have it taken out for good.

In Ms Norton's research — including discussions with physicians who perform body modification procedures, all of whom have asked to remain anonymous — she found a worrying ethical double-standard in the medical community. "I asked Steve Haworth [who did her mod] why plastic surgeons weren't the ones doing this," she says. "He told me the AMA [American Medical Association] said modification towards societal norms was OK, but away was considered unethical."

"I found that a disturbing basis for medical ethics — it shouldn't be so tied to fashion, I think," she says.

One cosmetic surgeon from Seattle was willing to speak openly to NRM about performing a minor body modification surgery. Dr Virginia Stevens had known Amal Graafstra, a computer technician, for some time. He bought an RFID (radio frequency identification) chip and asked her to implant it in his hand. "It was a minor insertion," she says. "Nothing surprises me, so I was up for doing it."

The procedure took about three minutes. "The webbed space between the thumb and the finger is good — there's lots of play and nothing important there," she says. "I sterilized the area, numbed it up with some lidocaine, then you plunge the needle in, already loaded with the RFID chip. Puncture the skin, then push the plunger that moves the chip out of the needle into the hand." Dr Stevens has since performed about 10 more RFID chip implants.

Mr Graafstra had the implant to allow him to automate certain tasks. "I wanted to be able to access my office door without getting my keys out of my pocket or any of that stuff. I was carrying heavy stuff, so it was a pain in the butt," he says. Mr Graafstra has not suffered any complications. "It's in biocompatible glass, so the only issue is migration," he says. So far that hasn't happened. He's since had his family doctor implant a second RFID chip in his other hand.

But Dr Stevens says she draws the line at procedures she considers "self-mutilatory," like some of the more extreme examples of body modification. "It's dysfunctional and dysmorphic," she says.

Toronto cosmetic surgeon Dr Lorne Tarshis is even more categoric: "Personally I wouldn't do it. It just sounds bizarre." He says he'll only perform cosmetic procedures to help people make their appearances fit the way they feel and body modification does not meet that criterion.

But won't some of those people still have the procedures done, but in a more dangerous environment, as Ms Norton has suggested? "I don't think you can save the world, you know what I mean?" says Dr Tarshis. "Each surgeon has to decide if it is something they feel comfortable doing for themselves — not because someone might have something done less safely elsewhere."



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