Neurotechnology: Science Fiction or Applied Science?

"Any sufficiently advanced technology is indistinguishable from magic."
--Arthur C. Clarke

In fact, advances in neurotechnology are capitalizing on the brain's remarkable sleight of hand.

Neurotechnology refers to the applied science of understanding the brain, consciousness, thought, and higher-order activities of the mind. Neurotech's brainchildren are today's mental magic. Such fantastical items include electrode-laden "thinking caps" or Transcranial Direct Current Stimulation (TDCS) to enhance human concentration; neuroimages of our dream lives, and perhaps even our waking thoughts; remote artillery weapons that soldiers can fire at a combatant by mind control; and video games operated by the player's thoughts. These aren't a sci-fi creation; now they're real.

Advancing from science fiction to applied science is a fast-growing, $8-billion business, with investments from commercial, military, and academic interests. This might seem to be good news for countless sufferers from neurological (e.g., Alzheimer's and other dementias, Parkinson's disease, Multiple Sclerosis, stroke, etc.) and mental disorders (e.g., depression, PTSD, OCD, mania, etc.). But for every scientific step forward, there is the chill of possible diabolical applications -- where there's neural firing, there's apt to be the smoke (and mirrors?) of self-serving and questionable ethics.

This is the first of a two-part series examining emerging neurotechnologies and their potential value. In the second post to follow, we will consider their ethical and practical conundrums.

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The diagnosis and treatment of behavioral health conditions has yet to fulfill the promises of the 1990s, the so-called "Decade of the Brain." Since then, technological wizardry has transformed our markets, if not our lives. The next iProduct comes with lines of consumers snaking around the block. But for the people who just want to feel well, diagnostic and treatment advances in psychiatry and neurology still lack a magic bullet.

Here's the good news: With neuroimaging advances, the brain is a veritable neural Google Map. Functional MRI (fMRI) neuroimaging, as well as PET and CT scans, now allow medical scientists to observe a highly detailed landscape of the brain that reveals locations where mental diseases emerge, where behavioral therapies might do their job, and how a drug can find entry into the brain. It can even pinpoint the brain's "funny bone" -- or which neurons light up when we laugh at a joke.

An fMRI scan uses an electromagnetic field to navigate the brain, much in the same way a compass has guided travelers for millennia. One notable neuroimaging explorer is Dr. Helen Mayberg, a neurologist who identified a tract of brain tissue deep within the frontal cortex known as "Area 25," a region that is likely a "nerve center" for depression. When a depressed person responds to treatment with antidepressants and cognitive behavioral therapy (CBT), neuroimaging reflects a corresponding response in Area 25.

Beyond imaging to pinpoint neural landmarks and monitor responses to therapeutics is repetitive Transcranial Magnetic Stimulation (rTMS), an example of using applied science to treat depressed (and anxious) people. Resembling a large wand, rTMS is an FDA-approved treatment for depression in which a low-frequency electromagnetic pulse is applied to specific areas of the brain through the scalp, never directly touching the brain; it is performed safely in your doctor's outpatient office. Research demonstrates that rTMS improves mood -- and without the side effects of medication or using electroconvulsive therapy (ECT). Moreover, rTMS may help lessen the intrusive thoughts of obsessive-compulsive disorder, improve the painful apathy associated with certain psychotic disorders, and diminish chronic pain due to migraine headaches and phantom limb syndrome.

Broaching the realm of science fiction, rTMS may even have an effect on our thoughts and morality. When the wand is waved over the brain's right temporoparietal junction, it seems to exert a neuronal "superego" force! In one study, research subjects responded to a morality play where they were asked whether Cain should slay Abel. Chillingly, rTMS was able to dampen study participants' ability to judge right from wrong. Remember the brainwashing of Laurence Harvey in The Manchurian Candidate?

rTMS is not alone. Modern electro- and magneto-encephalography can now detect tumors, find stroke sites, and localize areas prone to epilepsy. Deep Brain Stimulation (DBS) utilizes a surgically implanted probe -- a brain "pacemaker" -- that stimulates brain regions instrumental to Parkinson's disease and depression. Brain-computer interfaces (BCI) are poised to enable a person's thoughts to operate a computer that could drive a wheelchair, operate a pain pump, or communicate for people who can think but not talk.

Advanced drug delivery systems are being developed to zero in on diseased brain sites or turn on genes that could promote cell growth -- and do so with little damage. Smart drugs or "nootropics" that selectively boost the neural circuits of memory and cognition are another budding frontier. And why not have an amnesic pill to erase bad memories or disabling trauma? Perhaps most incredible is the field of optogenetics, where specially engineered, light-activated (or inactivated) neurons are implanted in the brain to control anxiety. This work is underway with mice, a few cortical steps away from man. Beam me up, Scotty.

As science makes a reality of what has been science fiction, we will face questions of how to best apply neurotechnologies. Should these advances be limited to helping those who have illnesses? Or should they bolster the performance of a wartime soldier, enable a C student to get straight As, or supercharge corporate CEOs? Should an MRI or an EEG be used for lie detection or "brain fingerprinting"? If a magnetic wand can influence human morality and tip right to wrong (or vice versa), then what mischief lies ahead in using neurotechnologies to perform Jedi mind tricks on unwitting victims?

In part two of this article, we will look at how the value of neurotechnologies may go astray in the hands of mere humans.

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The opinions expressed here are solely those of Drs. Erlich and Sederer, as physicians and public health advocates. Neither receives support from any pharmaceutical or medical device company.

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