Through my work as a neuroscientist who designs neural implants to monitor the injured brain after severe traumatic brain injuries, stroke, and brain cancers, it has become very clear to me that my field needs to communicate more directly and more often with general audiences. Neurotechnology research is becoming an increasingly important and mainstream part of the neuroscience field, and with that, disseminating information and implementing regulations is essential. Not doing so risks public distrust
and the proliferation of misinformation at a time where we are seeing a boom in the development and translation of devices that interface with the brain and central nervous system.
The Toll of Neurological Disorders
In my role, I see how a closer relationship between man and machine could have transformative benefits for the treatment of various neurological disorders, which lead to an estimated 9 million deaths globally each year. This loss of life is bad enough on its own, but is further compounded by the number of people who have long-term disability because of brain injuries, disorders, and neurodegeneration. Neurological disorders are the leading cause of disability adjusted life years (DALYs) lost, which have increased a whopping 18% since 1990. In the aftermath of a neurological diagnosis or incident, people may lose their ability to provide or care for themselves, and walk or even talk, and the impact is felt personally by the patient, as well as in families and communities.
We often simplify disease to a false dichotomy of survival and death, underplaying the impact of what happens to patients post-occurrence. This was highlighted most recently by the COVID-19 pandemic and ensuing reports of long COVID; initially, the voices of "long-haulers" were disregarded and many felt neglected. We now understand there's a connection between long COVID and neurological sequelae. We need new tools to combat the prevalence of these conditions, both as they relate to COVID and more broadly.
This is where devices that interface with the brain, such as brain computer interfaces (BCIs), can excel.
The Potential of Neurotechnology
Deployed in the correct manner, future BCIs have the potential to enable their users to control computers with their thoughts after loss of function. This could be life-changing for millions of patients with conditions such as locked-in syndrome, amyotrophic lateral sclerosis (ALS), or tetraplegia. Clinical research and testing of devices for various conditions is ongoing, and several companies have made significant strides to bring these devices toward commercialization and reaching patients.
In academic research, we have seen the demonstration of a brain-spine interface to restore a person's ability to walk after a serious car accident, the decoding of neural signals to facilitate speech, and the use of brain implants to control neuroprostheses. By implanting electrodes that can record the electrical signals that emanate from neurons and decoding the resulting information, users can passively or actively control computer systems to create desired outputs.
That being said, these devices and interventions are not without risks.
The Need to Regulate and Communicate
We have an incredible new frontier in which to innovate, but one that we should regulate immediately. As we begin to address the neurological disease burden, what are the boundaries? What risks are acceptable? What are the ethical concerns?
The for-profit startup Neuralink, one of the more well-known players in the development of BCIs, has the mission to "Create a generalized brain interface to restore autonomy to those with unmet medical needs today and unlock human potential tomorrow." While this may sound promising at face value, experts and policymakers have raised safety concerns related to the company's interventions and trials. For-profit companies can do great things, but I worry that if profit is the priority, morals and ethics may quickly fade.
When it comes to neurotechnology of any kind, there is a major risk of harm that needs to be more widely discussed now, before such devices become mainstream.
Our current trajectory and history -- quickly embracing social media, AI, and smart devices -- suggest that we won't be able to resist the temptation to augment ourselves with neurotechnology, due to an insatiable desire to "progress." But look at other examples: the dangers of smartphones are nearly as numerous as their virtues. We are already playing catch up with the mental health consequences of our increased connectedness to social networks through smartphones, not to mention their impact on our sleep, brain development, and self-esteem. Tech advancement comes with positives and negatives. The importance, therefore, of checks and balances for any emerging technology should be part of the process of its development and maturation.
And, at least when it comes to smartphones, people interacting with them can unplug, turn them off, or otherwise moderate their interaction level. How can patients do that when the technology is located within their bodies?
There's an infinite number of other questions: What are the limits on determining who will benefit from neurotechnology? Can we protect such systems from weaponization? What about consent? Will we create more inequality from devices that were originally intended to facilitate equity? Hacking, privacy, altered perception -- you name it. BCIs employed in the wrong way could very easily be abused. The placement and long-term implantation of such devices also risks injury, infection, and lasting damage. The general public needs to be aware of the risks.
A Path Forward
I believe that limiting the use of BCIs to restoring function for those with injuries and disorders, and supporting individuals with disability, is not a concession but a bold way forward. Physically connecting our brains to BCIs purely to augment ourselves as human beings seems like an area of serious ethical concern. Other fields, such as robotics and AI, have begun to consider and set their boundaries, the same should be done with BCIs.
BCIs have the power to transform the lives of those with neurological disorders and long-term disability. We have an opportunity to be proactive by addressing the ethical and brain-altering challenges inherent in BCIs now. The scientific community needs to get ahead of this potentially disruptive technology, inform the general public and patients, and create safeguards. Let's not make today's solutions tomorrow's problems.
De-Shaine Murray, PhD, MSCI, MRes, is a Wu Tsai Institute postdoctoral fellow at Yale University, Black in Neuro co-founder, and development director and a Public Voices Fellow of the OpEd Project.
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