Authors Aakash A. Dave and Dr. Laura Cabrera, Assistant Professor in the Center for Ethics, have an article in the December issue of the Journal of Cognitive Enhancement. The article, “Osteopathic Medical Students’ Attitudes Towards Different Modalities of Neuroenhancement: a Pilot Study,” was available online first in January of this year.
Abstract: The advancement of society has coincided with the development and use of technologies intended to improve cognitive function, which are collectively known as neuroenhancers. While several studies have assessed public perception towards the moral acceptability of pharmacological and device-based cognitive enhancers, just a few have compared perceptions across different modalities of cognitive enhancers. In this pilot study, 154 osteopathic medical students were asked to read one of six possible vignettes describing a certain type of improvement—therapy or above the norm—brought about by using one of three modalities—neurodevice, pill, or herbal supplement. Subjects answered questions that were designed to reveal their attitudes towards the given scenario. Our participants suggested that improvement using neurodevices and herbal supplements is more acceptable than when pills are used. We also found that acceptable attitudes towards cognitive enhancement were subserved by reasons such as “positive outcome from use” and “it’s safe” and unacceptable attitudes by reasons such as “safety concerns” and “no need.” Furthermore, a majority of participants would prefer to consult with a physician regarding the use of cognitive enhancers prior to accessing them. These results provide novel insights into pressing neuroethical issues and warrant further studying.
The full text is available online via Springer Link (MSU Library or other institutional access may be required to view this article).
Center Assistant Professor Dr. Laura Cabrera and co-author Dov Greenbaum have written an editorial published in Frontiers in Genetics, titled “ELSI in Human Enhancement: What Distinguishes It From Therapy?”
The open access editorial, published June 23, is available in full from Frontiers in Genetics.
Center Assistant Professor Dr. Laura Cabrera and Dr. Karen Herrera-Ferrá (Asociación Mexicana de Neuroética) are co-authors of an article published in the March 2020 issue of the Journal of Cognitive Enhancement. Their article is titled “¿Neuroensanchamiento?: Concepts and Perspectives About Neuroenhancement in the Hispanic Literature.”
Abstract: While neuroenhancement has been widely debated in the bioethics and neuroethics literature, the Anglo-American perspective has dominated a majority of these discussions. Thus, little is known about the motives and attitudes towards neuroenhancement in other cultures. Cultural values and linguistic peculiarities likely shape distinct attitudes and perspectives about neuroenhancement. In this paper, we aim to identify universals and points of divergence between the Anglo-American and the Hispanic discussions about neuroenhancement. We carried out a literature review of articles published in the Spanish language discussing perspectives and ethical issues around neuroenhancement. We analyzed the content for (1) the terms used to convey the concept of “neuroenhancement” and (2) the ethical concerns raised. Our results show a wide range of Spanish terms used to refer to neuroenhancement, as well as important differences on the scope and concerns raised. These results invite further research regarding cross-cultural perspectives on neuroenhancement and neuroethical discussion.
The full text is available online via Springer (MSU Library or other institutional access may be required to view this article).
The search for a brain device capable of capturing recordings from thousands of neurons has been a primary goal of the government-sponsored BRAIN initiative. To succeed would require developing flexible materials for the electrodes, miniaturization of the electronics and fully wireless interaction. Yet this past summer, it was corporately funded Facebook and Elon Musk’s Neuralink that stepped forward with announcements regarding their respective technological investment to access and read our human brains.
Image description: A black and white graphic of a person’s head with an electric plug extending out of the brain and back of the head. Image source: Gordon Johnson from Pixabay
Elon Musk, the eccentric technology entrepreneur and CEO of Tesla and Space X, made a big announcement while at the California Academy of Sciences. This time it was not about commercial space travel or plans to revolutionize city driving. Instead Musk presented advances on a product under development at his company Neuralink. The product features a sophisticated neural implant which aims to record the activities of thousands of neurons in the brain, and write signals back into the brain to provide sensory feedback. Musk mentioned that this technology would be available to humans as early as next year.
Mark Zuckerberg’s Facebook is also funding brain research to develop a non-invasive wearable device that would allow people to type by simply imagining that they are talking. The company plans to demonstrate a prototype system by the end of the year.
These two corporate announcements raise important questions. Should we be concerned about the introduction of brain devices that have the capacity to read thousands of neurons and then send signals to our brains? The initial goal for both products is medical, to help paralyzed individuals use their thoughts to control a computer or smartphone, or in the case of Facebook to help those with disabling speech impairments. However, these products also are considered to be of interest to healthy individuals who might wish to “interact with today’s VR systems and tomorrow’s AR glasses.” Musk shared his vision to enable humans to “merge” with Artificial Intelligence (AI), enhancing them to reach superhuman intelligence levels.
Time will tell whether or not these grand visions, that currently veer into science fiction, will be matched by scientific progress. However, if they ultimately deliver on their promise, the products could change the lives of those affected by paralysis and other physical disabilities. Yet, if embraced by healthy individuals such technologies could radically transform what it means to be human. There are of course sound reasons to remain skeptical that they will be used. First off there are safety issues to be considered when implanting electrodes in the brain, including damage to the vasculature surrounding the implant as well as tissue response surrounding the device. And that is what is currently known about inserting brain-computer interfaces with only a couple of electrode channels. Consider what might happen with thousands of electrodes. There remain simply too many unknowns to endorse this intervention for human use in the next year or so. There also are salient issues regarding brain data collection, storage, and use, including concerns connected to privacy and ownership.
Image description: a black and grey illustration of a brain in two halves, one resembling a computer motherboard, the other containing abstract swirls and circles. Image source: Seanbatty from Pixabay
Beyond these concerns, we have to think about what happens when such developments are spearheaded by private companies. Privately funded development is at odds with the slow, careful approach to innovation that most medical developments rely upon, where human research subject regulations and safety measures are clear. It is the “move fast and break things” pace that energizes start-up companies and Silicon Valley entrepreneurs. The big swings at the heart of these entrepreneurial tech companies also bring considerable risks. When addressing sophisticated brain interfaces, the stakes are quite high. These products bring to mind scenarios from Black Mirror, a program that prompts a host of modern anxieties about technology. On one hand, the possibility of having a brain implant that allows hands-free device interaction seems exciting, but consider the level of information we then would be giving to these companies. It is one thing to track how individuals react to a social media post by clicking whether they “like” it or not, or by how many times it has been shared. It is another thing altogether to capture which parts of the brain are being activated without us having clicked anything. Can those companies be trusted with a direct window to our thoughts, especially when they have a questionable track record when it comes to transparency and accountability? Consider how long it took for Facebook to start addressing the use of customer’s personal information. It remains unclear just how much financial support Facebook is providing to its academic partners, or whether or not volunteers are aware of Facebook’s involvement in the funding-related research.
The U.S. Food and Drug Administration as well as academic partners to these enterprises may act as a moderating force on the tech industry, yet recent examples suggest that those kinds of checks and balances oftentimes fail. Thus, when we hear about developments by companies such as Facebook and Neuralink trying to access the thoughts in our brains, we need to hold on to a healthy skepticism and continue to pose important challenging questions.
Laura Cabrera, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Translational Neuroscience at Michigan State University.
Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, September 26, 2019. With your participation, we hope to create discussions rich with insights from diverse perspectives.
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On May 17, Center Assistant Professor Dr. Laura Cabrera presented on “‘Neuroenhancement’ en países de habla hispana” on the panel “Neuroethics in Mexico: Considerations for development.” The panel part of the Academia Nacional Mexicana de Bioética conference series in Mexico City in conjunction with the Mexican Neuroethics Association (Asociación Mexicana de Neuroética). Dr. Cabrera’s presentation was based on an ongoing collaboration with Mexican Neuroethics Association President Dr. Karen Herrera-Ferrá, looking at examining the similarities and points of divergence between the Euro-American and the Hispanic discussions about neuroenhancement.
Photo: Dr. Cabrera (right) presenting in Mexico City on May 17. Photo courtesy of Dr. Cabrera.
Center Assistant Professor Dr. Laura Cabrera recently spoke at the Michigan Academy of Nutrition and Dietetics annual conference, held April 26-27 in Bay City, MI. Dr. Cabrera spoke on “Dietetics and Ethics: What is your Professional Role?” Her talk aimed to provide guidance on understanding and identifying ethical issues that registered dietitian nutritionists (RDNs) and nutrition and dietetic technicians, registered (NDTRs) may face in their practices. Her session was well attended and interactive.
Dr. Cabrera also traveled to New Jersey to speak at the Ethics of Enhancement Workshop at Rutgers University-Camden, held April 27. There she spoke on “Neuroenhancement: Rethinking Human Values.” Her talk aimed to explore the way values affect and are affected by enhancing cognitive, affective and social abilities, and argued that a social responsibility framework could help us bridge the tensions underlying the interplay of values and neuroenhancement practices.
Should we be worried about the use of direct brain stimulation to improve memory? Well, it depends. If we think of people with treatment refractory memory conditions, or those situations where drugs are not helping the patient, such an approach might seem like the next sensible step. There is reason, however, to remain skeptical that this strategy should be used to improve the memories of people who function within a normal memory spectrum.
Image description: The illustration “Light Bulb” by Alvaro Tapia is a colorful abstract depiction of the human head/brain as a light bulb. Image source: Alvaro Tapia/Flickr Creative Commons
The quest to improve memory is hardly new. Throughout time people have engaged in ways to improve their memories, such as eating particular foods, employing mnemonic strategies, or taking certain drugs, but the quest does not end there. A recent New York Times article discussed findings from a direct brain stimulation study (Ezzyat et al., 2018) on the possibility of using brain stimulation to rescue functional networks and improve memory. In that study, 25 patients undergoing intracranial monitoring as part of clinical treatment for drug-resistant epilepsy were additionally recruited with the aim of assessing temporal cortex electrical stimulation on memory-related function.
The prospect of using brain stimulation to improve memory, initially introduced in the 1950s (Bickford et al., 1958) re-emerged in 2008 when a study using hypothalamic continuous deep brain stimulation (aka open-loop DBS) to treat a patient with morbid obesity revealed an increased recollection capacity in that same patient (Hamani et al., 2008). Subsequent studies have attempted to prove that direct brain stimulation is useful for memory improvement. However, the data on open-loop deep brain stimulation currently remains inconclusive.
The approach by Ezzyat and colleagues, wherein neural activity is monitored and decoded during a memory task, suggests an improvement over open-loop approaches. In this treatment modality stimulation is delivered in response to specific neural activity, detecting those times when the brain is unlikely to encode successfully and rescuing network activity to potentially improve overall performance.
In that study stimulation was triggered to respond exclusively to those patterns of neural activity associated with poor encoding, effectively rescuing episodes of poor memory and showing a 15% improvement in subsequent recall. Indeed, those results might sound promising, but this type of memory intervention raises a number of ethical issues.
In a very direct fashion memory is related to the core of who we are. It allows us to build an interpretation of ourselves and our environments, and in so doing gives us orientation in time as well as in our moral life. As surrealist Luis Bunuel put it, “Life without memory is no life at all … Our memory is our coherence, our reason, our feeling, even our action. Without it, we are nothing …” Equally, memory plays a crucial role in cognition, learning, and performance, and as such it is not a surprise that many people feel particularly drawn to memory improvement strategies. Yet there are salient, concerning issues when directly meddling with the human brain, including those risks associated with deep electrode insertion such as infection, hemorrhage, seizure and hardware complications. One might reasonably question whether a 15% memory improvement is worth such high stakes risks?
Another concern is the potential for undesirable – but as yet undetermined – side effects. Those uncertainties are why it seems unlikely that such an approach will be used in healthy individuals or for mild memory dysfunction cases. Still and yet, closed-loop deep brain stimulation has alternative utility. It can be used to improve understanding about the specific brain target most centrally related to certain memory functions, and then use that information to employ less invasive interventions, such as transcranial magnetic stimulation (TMS).
The sorts of studies engaged by Ezzyat’s team and others overlook the fact that memories are not just physically located within the cranial cavity. We have external technologies such as photographs, videos, and agendas to help us remember, and so one might reasonably ask if we really need invasive brain implants to achieve the same ends? The brain’s plasticity is equally overlooked, erroneously assuming that the same brain targets will bring equivalent outcomes for healthy individuals as well as for those with memory impairments. Moreover, the identified interventions improve memory encoding, but do not help with the many errors to which memory is perplexingly prone, such as misattribution, suggestibility, and bias. For healthy individuals, addressing those common memory errors could potentially be more helpful than improving encoding with brain stimulation.
In addition, certain types of memory enhancement could bring new perspectives on one’s life, and even affect the ability to understand the past and imagine the future. In fact if we truly were to remember everything we encounter in our lives we might well be overburdened with memories, unable to focus on current experiences and afflicted by persistent memories of those things that we deem unimportant.
Open-loop neural implants already bring a different configuration of human agency and moral responsibility. Closed-loop implants with their ability to both stimulate and continuously monitor neural patterns bring further issues for consideration, such as neurosecurity (e.g. brain hacking) and mental privacy. Improved connectivity of this type of implant further enables the potential for malicious interference by criminals. Concerns about mental privacy figure prominently in other neurotechnologies, which, similar to brain implants, have the ability to access neural data correlated with intentions, thoughts, and behaviors. This enhanced proximity encroaches on the core of who we are as individuals, providing access to mental life that in the past was accessible only to oneself.
Finally, the media hype in itself is problematic. The New York Times’ article mentioned that the 15% improvement observed in the Ezzayt study was a noticeable memory boost. This sort of inflated media coverage does a disservice to the good intentions and professional rigor of scientists and engineers, and misleads the reader to be either overly-optimistic or overly-worried about the reported developments.
With these many considerations in mind, it is clear that direct brain stimulation will replace neither pharmaceuticals nor less invasive memory improvement options anytime soon. Those who crave memory improvement through memory intervention technologies might best be mindful of the aforementioned ethical and social considerations.
Laura Cabrera, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Translational Science & Molecular Medicine at Michigan State University.
Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, May 10, 2018. With your participation, we hope to create discussions rich with insights from diverse perspectives.
You must provide your name and email address to leave a comment. Your email address will not be made public.
Visit The Conversation to read “It’s not my fault, my brain implant made me do it,” a collaborative article from Center Assistant Professor Dr. Laura Cabrera and College of Law Associate Professor Dr. Jennifer Carter-Johnson. They combine their neuroethics and legal expertise to address questions such as: “Where does responsibility lie if a person acts under the influence of their brain implant?” The article was also published in Scientific American.
In November 2017, Drs. Cabrera and Carter-Johnson participated in a Brews and Views event of the same name, “It’s not my fault: my brain implant made me do it.” Brews and Views events, moderated discussions addressing the most fascinating and provocative areas of bioscience and engineering, are a collaboration between the Institute for Quantitative Health Science and Engineering and the Center for Ethics and Humanities in the Life Sciences at Michigan State University.
On November 10-11, 2016, Center Assistant Professor Dr. Laura Cabrera attended the International Neuroethics Society (INS) Annual Meeting held in San Diego, California. This year the INS meeting celebrated the 10th anniversary of the society, and it was a day and half of intense and engaging discussions of relevant neuroethics topics.
Dr. Cabrera presented a flash talk and a poster on “Neuroensanchamiento?: Perspectives and terms in the Latin American and Spanish Literature regarding neuroenhancement” (Colon-Ortiz and Cabrera), and also had another poster showcasing results from her S3 grant entitled “Psychiatric Deep Brain Stimulation: Recurrent and Neglected Ethical Issues” (Cabrera, Bluhm and McKenzie).
Image description: Dr. Laura Cabrera with her poster “Psychiatric Deep Brain Stimulation: Recurrent and Neglected Ethical Issues.” Photo courtesy of Laura Cabrera.
The first day of the meeting started with the INS presidential address, which emphasized the fact that the society was celebrating its 10th anniversary. As part of this celebration a new logo for the society was presented. The keynote of the first day was given by Steven E. Hyman on “Emerging Genetics of Human Cognition and Behavior: New Challenges for Ethics and Policy.” After his engaging talk, there was the international ambassador session and breakouts with representatives from China, Japan, Europe and the US discussing the state of neuroethics in the brain initiatives within their respective countries. The first day closed with the public program on “Meet Tomorrow’s World: A Meeting on the Ethics of Emerging Technologies.” Panelists at this event covered topics ranging from the neurobiology of storytelling, social robots, privacy, virtual reality, moral enhancement, and brain stimulation.
The second day of the INS meeting started with a keynote plenary by Walter J. Koroshetz on “Neuroethics and the BRAIN Initiative.” Dr. Koroshetz highlighted the importance of the BRAIN Initiative in the context of other big American projects and its focus on exciting new discoveries and new technologies to better understand the brain. The following session was on “Mind-Brain and the Competing Identities of Neuroethics” with Paul Appelbaum, Tom Buller, Jennifer Chandler and Ilina Singh as panelists. This session explored three main questions: (1) is it important to discuss questions related to the status and identity/ies of neuroethics?, (2) are there avoidable pitfalls created by the multiple identities of neuroethics and can they be avoided?, and (3) what could INS do to help answer some of the issues discussed at the meeting?
Just before lunch there was the flash talk presentations, where nine selected top abstracts were given three minutes each to present. Dr. Cabrera presented, on behalf of her graduate student Celizbets Colon-Ortiz, the work they have been carrying out on cross-cultural neuroethics.
Center Assistant Professor Dr. Laura Cabrera was interviewed for episode #13 of the podcast “Algocracy and the Transhumanist Project,” created by John Danaher. Topics discussed include human enhancement, communication and values, and Dr. Cabrera’s book Rethinking Human Enhancement: Social Enhancement and Emergent Technologies.
Visit this blog post to learn more about the episode and to listen to the interview.
Center Assistant Professor 
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