It gets worse?

Sure, as think about facial recognition: useful as assistive technology for the blind, bad if used for racial profiling

Right, I see what you mean

Also with Brain Computer Interfaces and neurostimulation: what could it be used for?

You tell me!

Well, have you seen or read “Clockwork Orange” ?                            

The old Kubrick movie?

Yes, but it’s actually based on a book by Anthony Burgess.                  

Right, I remember the main character, Alex, being somehow conditioned, right? 😉

That’s right: aversion therapy to block bad behaviour. Like spraying your cat when it gets on the counter.

Ok, so like behavioursim? Pavlov’s dogs?

Exactly. The story criticizes the attempt to “re-train” someone to be good. What if we could do that directly in the brain?

Oh my goodness! That’s straight-up mind control! 😣

Yep, put your tinfoil hat on. 😄                                                                

So there actually could be a way to do that? 🤔

It is realistic enough that people are afraid about this possibility    

Really? 😯

Maybe not now and not with a decade, but think about how much computers have shrunk: from room size to pocket size    

True, I even have one on my wrist …

So what if everyone gets a Brain-Computer Interface in 50 years because it is useful and practical … and then it gets hacked? 

Now suddenly it doesn’t sound so unreasonable anymore …

There are various means and goals when measuring and stimulating the brain, it’s not easy to say stuff in general about this.

It’s not like you install a USB hub in the brain and then hook up your laptop

No, I get that, sure. And it seems to be ethically controversial too 😅

Absolutely! Even before staring human trials for a new device, we need to think things through.

What are some of the questions that come up?

For more general research: what could it be used for? And how could it be abused?

For specific devices: what happens if it does or doesn’t work? And how will people react to their implant?

Could you elaborate on that last one?

Sure. It is always a risk that people reject the implant, in the sense that it feels weird to them

Having a computer “control” what you do feels creepy, even if it allows you to walk or talk again.

I think I understand: the implanted device feels alien, and it’s not like a walking stick you can leave behind

Nope: it is part of you now, more like the hip replacement that you cannot take out.

So we need to educate and guide people in understanding the procedure and functionality

But still: if it helps you live a more normal life, why would there be a problem. 🤔

Well, Deep Brain Stimulation was developed as treatment for Parkinson’s at first

It reduces the tremors?

Yes, but it is also being used for mental health issues, like depression or OCD.

People feel that it interferes with their autonomy: who am I anymore?

I see, the risk is that it takes away agency and decision making form the patient.

Exactly, but it gets worse!                                                               

So the category of Implantable Medical Devices is quite large and diverse

The most common ones are probably lens implants for cataracts   

Oh, I hadn’t thought of those! My grandma had that!

Yep, very common, and knee replacements are more common than hip replacements

OK, sure, but stuff like this is … an old hat, right? We’ve been doing this for a long time?

Absolutely, knee replacements started in the 19th century already

Now what about the new and controversial devices? You mentioned working on a brain implant?

That’s right, a neurostimulator for chronic back pain after spinal injury

Cool! So what does that do exactly? 😁

After a spinal injury a lot of people develop chronic pain and our device basically intercepts the pain signals

So we can detect and block such specific signals?

There are various techniques to measure brain activity, like an EEG or fMRI

An EEG is an “electroencephalogram”: measuring electrical activity on the scalp that corresponds to activity in the brain.

fMRI is “Functional Magnetic Resonance Imaging”, measuring brain activity by measuring blood flow in the brain

OK, I did know about those. These are non-invasive, without surgery, right?

Right, but with surgery we can also put electrodes directly in the brain

Like Deep Brain Stimulation? 😵‍

Well, there is a difference between measuring and stimulating, but basically yes.

And then you can hook the electrodes up to a computer?

Not always, but, yes, that is a possibility                                                

That’s the kind of implantable device I was talking about: Brain-Computer Interfaces!