Brains & Machines

I went into Brain Computer Interface research with the intention of enabling spinal cord injury patients to move and locked-in patients  to communicate.  After working on this for 10 years it still hasn’t happened.  There has been enormous excitement around the possibilities, smart people are poring into the field, and government agencies are funding the research like never before. But still – it hasn’t happened yet – why?  

            Most would say that there is still a lot that needs to be done,  key technical hurdle to be overcome, issues of reliability,  there would be a lot of hand waving and declarative words like “milestones,” “stakeholders,” and other useless technical jargon used. Lets ask this question, if there was an infinite amount of money available and all the research and technology was created next week, would we be able to help people with devastating spinal cord injury.  Sadly the answer is still no.

            The reason lies in the story of a company called Cyberkinetics.  The company raised millions of dollars from venture capitalists, they got FDA approval, and even demonstrated that quadriplegics could use robotic arms.  The reason for the failure was over inflated hype around the market.  Namely, that once they went through all this, there were only a handful of patients who would actually require the technology.  By handful, I mean several thousand patients per year, which is small in market terms (not small in terms of human suffering).  There were also some technical and engineering shortcomings, but at the end of the day there were not enough customers that wanted the product and the company regressed into a corporate acquisition footnote.

            Before getting cynical on the idea that money is all that matters, lets look at the food truck guys outside the med school where I work.  They have these great touch screen billing devices that are portable and wireless.  They’re called iPads.   When you think about it, iPads were not created for food truck workers.  Nor were they created for any other niche business operator.  If they were, nobody would invest that much money to make such a slick and highly refined technology.  Instead they were created for the largest market possible, everyone. As a result there was a  collateral benefit for all these additional uses.

            Similarly for neuroprosthetics, we have to be smarter and think more strategically to get our technology to markets that favor the creation of this technology so that they can then collateralize to all the niche clinical needs.   This is in no way minimizing the needs of patients with severe motor disability, rather its finding better ways to get the technology to them.  That path is not linear.  Going back to the analogy of market forces being similar to gravity, rather than fruitlessly trying to push a boulder up a hill why not use a waterfall to drive a waterwheel that pulls it up. Use gravity to work for you, rather than against you.  In the same light, capturing market forces that favor BCI applications will necessarily help brain computer interface (BCI) applications towards small market applications.   This is in part why my BCI efforts turned towards solutions to stroke.   There are 700,000 strokes per year that leave patients with motor impairment (versus 10,000 per year with spinal cord injury).  That’s a market.

            The stroke market is a pretty decent stream to power the possibility of BCIs getting clinically applied. To really push this technology, however, to every clinical corner require we need something like the Three Gorges Dam that generates twenty three thousand megawatts (minus the ecological disaster). To big river app, the Yangtze of BCI, is a device, like the iPad, that serves everyone.  Similar to the Apple we need to create technologies that enhance everyday lives.  We need to figure out how to make neural augments and neural complements to our brains that add to the usual grind of our lives.  Use these technologies to make us smarter,  more creative, have better memories. Once we do this then all the people who really need this stuff actually benefit.