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Amphicephali are the second alien species encountered by posthuman races in Nemo Ramjet's novel "All Tomorrows". They inhabit a different galaxy and come in many species, probably because of the same history of the Qu experimenting on them. It's said that they had heads on both ends of their bodies, but I've interpreted the second head as being reduced and used primarily as a third hand with a couple of extra spiracles. The one on the picture also has a headphone-like device attached to the sides of his body, where the internal ears of these creatures are most likely situated.
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primitive is relative, I guess neuroblood barriers and how the respiratory system would vary but still it wouldn't be so crazy to have something similar, but yeah I agree that is not the only setup, evne on earth it may vary but I would have to check aint sure, birds for example cant smoke bc of how their breathing works.