Films from the Future

by Andrew Maynard

  Elysium is driven by the social inequities that are sustained and magnified by these technological disparities. But it’s the medical pods that lie at the heart of this tale of the 1 percent versus the 99 percent. These pods can seemingly detect any illness or injury in a patient and treat it in seconds, even down to reconstructing human tissue and bone. It’s a dream technology that, in the movie, has conquered sickness and disease, and made permanent injuries a thing of the past. But it’s also a technology that’s only available to citizens of Elysium, the orbiting space habitat that gives the movie its title. Everyone else left on Earth is destined to grapple with outdated technologies and with disease, injury, and death, living hard, stressful lives while constantly being reminded of how little they have compared to the people they serve.

  The medical technology in Elysium is very much used as a metaphor for how technological capabilities in the hands of a few people can amplify the power they have over others. I’m not sure the medical pods are meant to be a realistic portrayal of a future technology, and to be clear, they are not scientifically plausible. Rather, I suspect that they represent an extreme that drives home the message that powerful technologies come with great social responsibility. And yet as we’ll see, scientifically implausible as they are, these pods echo some quite amazing developments in 3-D tissue and organ construction in the real world that are beginning to radically challenge how we think about some forms of medical treatment.

  As Elysium opens, we’re introduced to Max (played by Maxwell Perry Cotton as a child), a young orphan living in the future slums of Los Angeles, looking up into the sky toward a massive toroidal space habitat. This is Elysium, a technologically advanced space-orbital where the uber-rich live in opulent luxury, surrounded by technologies that keeps them disease-free, secure, and deeply pampered. In contrast, the “99 percent” who are left on Earth live in dirt, poverty, and misery, working long, hard hours under the watchful eye of zero-tolerance autonomous-robot law enforcement. Max’s dream, one he shares with his childhood sweetheart Frey (Valentina Giron), is to make enough money to move to Elysium. But like so many dreams, it fades into the harsh reality of a life trapped in poverty as he grows up.

  Here, we fast-forward to a grown-up Max (played by Matt Damon). Max is still living in the slums of LA. Since we saw him as a child, he’s dabbled in some less-than-legal activities, but is now legitimately employed and is working long hard hours for little pay for the company Armadyne. This is the company that supplies much of Elysium’s technological needs, together with the AI-based security robots that keep order on Earth. Max is going straight when we catch up with him, but an offhand comment to a security robot leads to him being mercilessly beaten and ending up in hospital with a broken wrist. There, he’s reunited with a grown-up Frey (Alice Braga). Frey is now working as a doctor, and, as we later discover, has problems of her own. Max wants to renew their relationship, but Frey brushes him off, and discourages him from getting involved in her own complicated life.

  Once his wrist has been seen to, Max is required to visit his parole officer—another humorless autonomous robot—and once again his flippant attitude gets him into trouble. Having finally got through his parole meeting, he arrives late to work, and is threatened with dismissal for being tardy. Fortunately for him, Max gets off with a warning, and goes back to making robots designed to suppress the poor and pamper the rich. But when a glitch in the manufacturing process threatens production, he is forced to take a dangerous shortcut to fix it, and receives a lethal dose of radiation in the process.

  Following the incident, an Armadyne robot patches Max up, gives him a bottle of pills to counter the radiation’s effects, and calmly tells him that, in five days’ time, he’ll die. Meanwhile, Armadyne’s CEO John Carlyle (William Fichtner) is horrified by the thought of having a sick and incapacitated worker on the premises, and responds with a less-than-caring “Does his skin fall off or something? I don’t want to replace the bedding. Just get him out.”

  Carlyle is a “citizen” of Elysium, and the person who originally designed the station’s operating system, although, because of his position with Armadyne, he spends a lot of time commuting between Earth and the orbital. As Max’s really bad day plays out, we discover that Elysium’s Defense Secretary Delacourt (Jodie Foster) is conspiring with Carlyle to oust the orbital’s current President and install herself into this position of ultimate power. Carlyle, it transpires, wrote the operating system for all of Elysium, and is still able to hack it. This is a system that defines and oversees all of the orbital’s operational and social functions, including who is a citizen (and therefore has access to Elysium’s facilities) and who is not. It also determines who has the authority to govern the orbital, and who occupies the highest positions of power, including that of President. Because of this jaw-dropping level of vulnerability in the technology, Carlyle is able to write a patch that reconfigures the system, replacing the current President with Delacourt.

  Carlyle configures the patch while on Earth, and securely saves it in his brain using a neural interface (this is, it has to be said, a technology of convenience that supports the movie’s narrative, but otherwise makes little sense). And because the patch is so valuable, he adds a lethal security lock which will end up killing anyone who tries to steal and run it.

  Meanwhile, Max is dying, and he’s angry. His only hope of surviving is to get to one of the medical pods on Elysium, and so he makes a deal with an old partner-in-crime, Spider (Wagner Moura), to smuggle him up to the orbital on one of Spider’s “illegal immigrant” runs.

  Spider agrees to help Max, but at a price. First, he must agree to steal something from an Elysium citizen that will enable Spider to more successfully circumvent the orbital’s defenses. Max agrees, but on one condition: He’ll only participate in the theft if the mark is Carlyle. Fortunately, an opportunity to jump Carlyle arises almost immediately. In the ensuing hijacking, Carlyle is killed, and Max ends up with his Elysium-reboot patch in his brain; little realizing at the time how dangerous it is. Spider, however, understands all too well what he has stolen, and that this is a piece of code that, if executed correctly, could make Elysium and everything it represents accessible to anyone on Earth. In his mind, it’s the key to wiping out the social inequity that Elysium, and its medical technology in particular represents, and one that could level the social and technological playing field between the orbital and the Earth. But there’s a problem: If Spider runs the patch, Max dies.

  Incensed that Max has interfered with her plans, Delacourt dispatches Kruger (Sharlto Copley), a psychopathic mercenary, to track him down and reclaim the patch. Max evades Kruger, but sustains serious injuries in the process, and this leads him back to Frey. As Max persuades Frey to treat him, he learns her daughter is dying of leukemia, and, just like Max, her only hope is to get to Elysium.

  Unfortunately, Kruger discovers Frey’s connection with Max, and he kidnaps her and her daughter in an attempt to bring him in. Kruger is well aware of what’s in Max’s head, and is formulating his own plans for how he could use the patch himself. But for this, he needs Max alive. Having little choice, Max gives himself up, and persuades Kruger and his crew to shuttle him, Frey, and her daughter to Elysium by threatening to destroy the patch if they don’t. And, as they are transported up to the orbital, Spider tracks them, and follows behind with his own crew.

  This being a sci-fi action film, lots of fighting, blood, and grisly deaths follow. Eventually, though, Frey gets her daughter to one of Elysium’s medical units, only to hit a seemingly insurmountable problem. Because Frey’s daughter isn’t a registered citizen of Elysium, the machine refuses to treat her. The only solution is for Max to use the patch to reconfigure Elysium’s systems so they recognize her as a citizen, but the only way he can do this is to be killed in the process.

  Max insists that Spider make the necessary modifications to the patch, and sacrifices himself so that Frey’s daughter can live. But it’s not just Fre
y’s daughter who benefits. Spider has reconfigured the patch to reclassify everyone on Earth as a citizen of Elysium. And so, as Max dies, the “99 percent” finally have access to all the privileges of the “1 percent ” that Elysium represents. As the change in citizenship registers, the orbital’s autonomous systems realize there’s a whole planet full of citizens who are sick and suffering below it, and they commit Elysium’s extensive resources—which (inexplicably) include hundreds of medical relief vessels—to assisting them. Through Max’s sacrifice, the technologies previously used to benefit the rich at the expense of the poor are made available to everyone, and social equity is restored.

  It has to be said that Elysium is, in many ways, a rather naïve movie. In real life, the roots of social inequity are deeply complex, as are the ways of tackling them, and they are certainty not amenable to simple, quick fixes. And, throughout the movie, the plausibility of the technologies we see plays second fiddle to the story the film’s creators want to tell. Yet despite this, the movie highlights social challenges that are deeply relevant to technological innovation in today’s world. And, despite its naïvety, it gets closer than might be imagined to some of the more disruptive technologies that are now beginning to emerge around us, including (re)constructing biological tissues with 3-D printers.

  Bioprinting Our Future Bodies

  In 2016, a quite remarkable series of images started to permeate the internet. The images showed what looked like the perfectly formed outer parts of a human ear. But, unlike a real ear, this one was emerging, as if grown, from an iridescent pink liquid held in a laboratory petri dish.

  The ear was the product of a technique that scientists around the world had been working on for some years: the ability to, quite literally, print replacement body parts. Inspired by developments in 3-D printing, researchers were intrigued to see if they could achieve the same effects using human cells. The idea was relatively simple: If a matrix of living cells and a permeable but shape-holding material could be formed using a modified 3-D printer, it should be possible to build up three-dimensional human tissue samples, and even complete organs. Of course, the devil was in the details, as even the simplest tissue samples have a highly complex architecture of capillaries, nerves, connecting tissues, and many different cell types. But early enthusiasm for “bioprinting” 3-D tissue samples using sophisticated cell-containing inks, or “bio-inks,” paid off, and research in this area is now leading to quite revolutionary technological breakthroughs. And while Elysium-like medical pods that reconstruct damaged bodies in seconds will always be beyond our grasp, 3-D printed replacement body parts may not be as far off as we think.

  The year 2016 might have been a landmark year for bioprinting, but it was far from the first successful attempt to 3-D print biological structures. Some of the earliest attempts to use 3-D printing technology with biological materials date back to the early 2000s, and by the mid-2000s, an increasing number of papers were beginning to appear in the scientific literature on bioprinting. But these early approaches led to materials that were very basic compared to naturally formed tissues and organs. Unlike even the simplest natural tissues—the cartilage that forms the structure of ears, for instance—they lacked the fine structure that is inherent in the stuff we’re made of. Scientists had begun to make amazing breakthroughs in printing 3-D structures that looked like viable body parts, but they lacked the essential ingredients necessary to grow and function as effectively as their biological counterparts.

  This was only a temporary setback, though, and the 2016 ear was proof that the technology was progressing by leaps and bounds. The ear, created by Anthony Atala and his colleagues at Wake Forest School of Medicine, was printed from a bio-ink mix of rabbit ear chondrocytes—cells that form cartilaginous tissue—and a hydrogel that enabled a persistent three-dimensional structure to be formed while keeping the cells viable. The shape of the ear was based on a 3-D scan of a real ear, and when printed, it looked uncannily like a flesh-and-blood human outer ear. What made it unusual, though, was the inclusion of microscopically fine channels threaded through its structure, allowing nutrients to diffuse to the cells and enabling them to stay alive and multiply.67

  Atala’s team effectively demonstrated that it’s possible to print simple body parts that remain alive and healthy long after the printing process is finished, and that are potentially useable as transplantable replacements. But despite this, bioprinting continued to be dogged by the extensive challenges of reproducing naturally-occurring biological materials, and doing this fast enough to prevent them beginning to die before being completed. It’s one thing to be able to print something that looks like a functioning replacement body part, but it’s something completely different to bioprint tissue that will behave as well as, if not better than, the biological material it replaces.

  Part of the challenge here is the sheer complexity of human tissues. Most organs are made up of a finely intertwined matrix of different types of cells, materials, and components, which work together to ensure they grow, repair themselves, and function as they’re supposed to. Embedded within this matrix are vital networks of nerves and capillaries that relay information to and from clusters of cells, provide them with the fuel and nutrients they need to function, and remove waste products from them. Without comparable networks, bioprinted parts would remain crude facsimiles of the tissues they were designed to replace. But building such complexity in to 3-D printed tissues would require a resolution far beyond that of Atala’s ear, and an ability to work with multiple tissue types simultaneously. It would also require printing processes so fast that cells don’t have time to start dying before the process is complete.

  These are tough challenges, but at least some of them began to be directly addressed in 2018 by the company Prellis Biologics. Prellis is working on a hologram-based 3-D bioprinting technology that, rather than building up organs layer by layer, near-instantaneously creates three-dimensional structures of cells and support material in a specially prepared liquid suspension. By creating a light hologram within the liquid, the technique forms brighter “hot spots” where the light-sensitive liquid is cured and set, creating a semi-solid matrix of cells and support material. If the “hot spots” are a three-dimensional representation of an ear, or a kidney, the living architecture for the 3-D-printed organ can be produced in seconds. But here’s the clever bit. Above the resolution of the system, which is a few micrometers, complexity is essentially free, meaning that it can be used to produce extremely complex three-dimensional tissue structures with ease; including embedding capillaries within the organ that’s being printed.

  In other words, we’re getting close to a technology that can reproduce the structural complexity of something like a kidney, capillaries and all, in a matter of hours. Reflecting this, Prellis’ ultimate goal is being able to print the “entire vasculature of a human kidney in twelve hours or less.”

  Whether this technology continues to develop at the current breakneck speed remains to be seen. I’m a little skeptical about how soon we’ll be able to print replacement body parts on demand, as biology is constantly blindsiding us with just how deeply complex it is. But, despite my skepticism, there’s no doubt that we are getting closer to being able to print replacement tissues, body parts, and even vital organs. And while we’re still a world away from the fantastical technology in Elysium, it’s shocking how fast we’re beginning to catch up. With advances in high-speed, high-resolution and multi-tissue bioprinting, it’s conceivable that, in a few years, it will be possible to 3-D-print a replacement kidney or liver, or jaw bone, or skin grafts, using a patient’s own cells as a starting point. And even if we can only get part of the way toward this, it would revolutionize how we’re able to treat diseased bodies and extend someone’s quality of life. With kidney disease alone, it’s estimated that over 2 million people worldwide depend on dialysis or kidney transplants to stay alive, and the number of people needing a new kidney could be as high as 20 million. The ability
to print replacement organs for these people could transform their lives. But why stop there? New livers, new bones, new hearts, new limbs; once we crack being able to print replacement body parts on demand that are fully biocompatible, fully viable, and act and feel just like their naturally grown counterparts, our world will change.

  This is quite amazing stuff. In a world where there remains a desperate need for new technologies to counter the ravages of disease and injury, it’s a technology that promises to make millions of lives better. And yet, as Elysium reminds us, just because we can cure the sick, that doesn’t mean that everyone will benefit. As bioprinting-based medical treatments become available, who will benefit from them, and what are the chances of this leading to a two-tiered society where the rich get to live longer, healthier lives and the poor get to sit on the sidelines and watch? This is a scenario that already plays out daily with less sophisticated medical technologies. But if bioprinting turns out to be as revolutionary as it promises, it could drive a much bigger social wedge between people who are rich enough and powerful enough to constantly be upgrading their bodies with 3-D-printed parts and those who are destined to be left struggling in their wake.

  This is the scenario that plays out in Elysium, as the inhabitants of the orbital enjoy access to medical facilities that those left on Earth can only dream of. But it’s only one of a number of ways in which powerful technologies lead to social disparity in the movie. Another, and one that is near and dear to my professional heart, as it’s an area I focused on for many years, is just how risky workplaces can become when their owners put profits before people, regardless of how sophisticated the technology they are producing is.