Over the past few months, I have been focusing my energy on The AI Collective, created alongside my wonderful friend, colleague, and partner-in-crime, Whitley Yi. Now, with the Think Digital Health blog, I was inspired by recent conversations with two friends, Tim Fitzpatrick and Maria Crisan, unbeknownst to them, to write about the not-so-new, but still ever-growing, field of Neurotechnology. I have always been fascinated by the brain, ever since my biology classes in secondary school; this very structure is highly sophisticated, associated with intelligence, yet much of its inner workings eludes the brightest of individuals — how ironic!
Let me tell a quick story. When I first started my undergraduate degree, I wanted to pursue neuroscience as my major, but I never got the chance to do so. Instead, I went into pharmacy school, and this interest in neurology fell by the wayside amidst other priorities. Upon graduating from pharmacy school, I went into an industry fellowship at Sanofi Genzyme, and was serendipitously placed into the neurology medical team. It took me a moment before I even put two and two together, realizing that it had all come full circle, and there I was, exploring neuroscience as part of my career. If I may digress a little further, it seems like neuroscience (or even, neurotechnology) is a central theme in various aspects of my life, those being, my role as a medical science liaison in neurology within the pharmaceuticals industry, my passion for digital health, which includes this blog, and finally, my artificial intelligence initiative, The AI Collective. With The AI Collective in particular, I have found that in exploring and continuing to learn about AI, I have developed that much more of an appreciation of the human brain and its very intricacies.
Disclaimer — The content in this blog post is solely a collection of my thoughts, observations, and research that I have done. It is not meant to be a reflection of the company, for which I currently work.
What I hope to share in this blog post, and subsequent ones for that matter, is my preliminary research into the Neurotech space. As the OECD Recommendation of Responsible Innovation in Neurotechnology puts it, “there is a convergence of neuroscience, engineering, digitization, and artificial intelligence” giving rise to some “groundbreaking developments in brain science and neurotechnology.” A Forbes article written in February 2020 stated that “over $19 billion [had] been invested in NeuroTech companies in the last 20 years,” an industry that is further divided into brain-computer interfaces, neuromonitoring/imaging, cognitive assessment and enhancement, neurofeedback, neuropharmacology, and neuromodulation, among several others.
Brain-machine interface (BMI) or brain-computer interface (BCI) refers to technology that allows human beings to interact with machines (or computers) solely through brain activity (ex. electroencephalography or fMRI). From a technical standpoint, a BCI system must include four sequential components, those being, signal acquisition, feature extraction, feature translation, and device output. The machine picks up on changes in certain energy or frequency patterns in the brain; these changes essentially act as the input data, which is processed and translated into a valuable output, action, or command. EEG signals would be one of the easier types of brain activities to capture, as the method of recording is non-invasive and inexpensive; however, the challenge is that in having to go through the dura, skull, and scalp, much of the signal could be lost amidst the noise. Implanting devices directly beneath the skull would, of course, improve the signal, but invasive BCI requires surgery and comes with a whole host of other challenges.
Despite how futuristic it might sound, this technology is actually not new at all! These are your cochlear implants, which, using a microphone, help to translate audio signals into electrical pulses that can then stimulate the auditory nerve. We might also leverage implants for neuromodulation applications. Deep brain stimulation, probably the most well known of them all, has been used in Parkinson’s disease, essential tremor, and epilepsy, among many other conditions. And not so far behind, we have spinal cord stimulation for treatment of chronic pain. Beyond these use cases, research is still flourishing in the medical field, including recovery of motor function following a stroke or spinal cord injury, training inhibitory control and working memory in ADHD, and BCI-driven wheelchairs. Traditionally studied in movement disorders, as you can see in the above examples, BCIs are now being explored in various other areas. Consumer-targeted neurofeedback devices such as the Muse headband, leverages EEG data to provide insights into sleep quality, attention and engagement during the day, and other related trends. In the future, these devices may even allow for us to jot down meeting minutes or control presentation slides with just our minds!
We live in a digital age in which we are glued to some form of technology during most of our waking hours, but having a technology rely only on our thought patterns and be able to generate an action as a result, may be something entirely new, or frankly, foreign and unsettling. I am purely speculating on how I would react to this, and who knows? Others may think differently, but it is interesting to note some of the sentiments of the BCI users themselves. I found several published articles from the BMC Medical Ethics journal, which review user insights with BCIs. There is, no doubt, a paucity of social research looking at users’ perspectives, so what we see with the existing publications is that they will group together perspectives drawn from different groups of individuals (ie. potential users, actual users, caregivers and relatives, healthcare professionals and related experts). Many of the studies were largely centred on usability and feasibility of the technology, which suggests that more research needs to be done to truly understand the social and human impact of BCIs from the users’ own perspectives. Having said that, I do want to share some of the more salient points I was able to glean from these articles. For example, between non-impaired participants and those with physical impairments, the latter expressed that they had “certain expectations of BCIs,” in that they hoped to achieve more independence, more involvement in social activities, and an increased quality of life. Users reported that BCIs brought about a sense of satisfaction and enjoyment, and some of the studies postulated that there may even be an opportunity for BCIs to positively contribute to certain users’ self-esteem and self expression. By and large, however, the studies concluded that BCIs can only have a place in therapy if they improve the overall situation of patients and if they do so without adding extra burden onto patients’ relatives or caregivers.
There remain considerable limitations in this field of research. We have yet to tease out user perspectives from patients with different types of movement disorders; this is significant because someone with a more aggressive disease type such as ALS may have a higher degree of interest in BCIs compared to patients with other conditions who present with less debilitating motor impairments. And finally, what of the more philosophical questions in the context of BCIs? Kögel et al. left the reader mulling over questions like “What is it like to act without using my body? What is it like to be hooked up to a machine or computer? Is it [still] me that is acting within this BCI system or is it some kind of human-machine hybrid?” As I alluded to earlier, while many of us may be digitally savvy when it comes to smartphones and laptops, we cannot say the same for BCIs, which involve an entirely different form of interaction between our bodies and the machine that we may not have experienced before. Thinking, then, about that experience and how it may impact autonomy, personal identity, emotions, and other paradigms, may be worthwhile as we continue to develop these technologies (or, in my case, puts me in a philosophical conundrum all together).
As with all existing technologies and those that are in development, there are ethical, legal, and social challenges. Concerns have been brought up, particularly surrounding privacy of personal brain data and neuromarketing. Neuromarketing is a whole other field, in and of itself, and it refers to the study of the human brain, specifically measuring neural activity, to predict or influence consumer behaviour and decision-making. Leaving that topic aside, what about liabilities? In an article published in the Neuroethics journal, the author, Thomas Stieglitz, also asks us to consider, for BCIs, who becomes “responsible and accountable in case of accidents or harms?” Would it be the manufacturer? Would it be the user, since it was his brain’s electrical activity that led to a certain output? Is it even possible to be jointly responsible and accountable with the machine? All that is to say, neurotechnologies have an added layer of complexity; because there is an intricate connection between neural activity and the ensuing task. It is not as simple as a wearable sitting on your wrist, which, while informative of your physiology, is somewhat only passively collecting those data without resulting in an action. Instead, what we see is the possibility of such electrical signals in the central nervous system to directly lead to an action being performed.
This was by no means comprehensive. The more I read into neurotechnology, the more I realize that it is already rich in history, with plenty more to come on the short- and long-term horizon. There are, undoubtedly, distinct challenges in this field, as with any other field involving technology, which must be overcome to facilitate more rapid progression. What is important is that in addressing these challenges, the conversation needs to go beyond the developers and researchers. They need to include regulators, bioethicists, consumers, clinicians, caregivers, and patients. There needs to be diversity of voice if we are to see benefit with neurotechnologies for the global population and the individual.
Thanks for reading, as always!