He’s mad that trusts in the tameness of a wolf

I am an obstetrician, and not a neuropsychiatrist, but I feel a definite uneasiness with the idea of messing with brains –especially from the inside. Talking at it, sure –maybe even tweaking it with medications- but it seems to me there is something… sacrosanct about its boundaries. Something akin to black-boxhood -or pregnant-wombhood, if you will– where we have a knowledge of its inputs and outputs, but the internal mechanisms still too complex and interdependent to be other than interrogated from without.

I suppose I have a fear of the unintended consequences that seem to dog science like afternoon shadows -a glut of caution born of reading about well-meaning enthusiasms in my own field. And yet, although I do not even pretend to such arcane knowledge as might tempt me to meddle with the innards of a clock let alone the complexities of a head, I do watch from afar, albeit through a glass darkly. And I am troubled.

My concern bubbled to the surface with a November 2017 article from Nature that I stumbled upon: https://www.nature.com/news/ai-controlled-brain-implants-for-mood-disorders-tested-in-people-1.23031 I recognize that the report is dated, and merely scratches the surface, but it hinted at things to come. The involvement of DARPA (the Defense Advanced Research Projects Agency of the U.S. military) did little to calm my fears, either –they had apparently ‘begun preliminary trials of ‘closed-loop’ brain implants that use algorithms to detect patterns associated with mood disorders. These devices can shock the brain back to a healthy state without input from a physician.’

‘The general approach —using a brain implant to deliver electric pulses that alter neural activity— is known as deep-brain stimulation. It is used to treat movement disorders such as Parkinson’s disease, but has been less successful when tested against mood disorders… The scientists behind the DARPA-funded projects say that their work might succeed where earlier attempts failed, because they have designed their brain implants specifically to treat mental illness — and to switch on only when needed.’

And how could the device know when to switch on and off? How could it even recognize the complex neural activity in mental illnesses? Well, apparently, an ‘electrical engineer Omid Sani of the University of Southern California in Los Angeles — who is working with Chang’s team [a neuroscientist at UCSF] — showed the first map of how mood is encoded in the brain over time. He and his colleagues worked with six people with epilepsy who had implanted electrodes, tracking their brain activity and moods in detail over the course of one to three weeks. By comparing the two types of information, the researchers could create an algorithm to ‘decode’ that person’s changing moods from their brain activity. Some broad patterns emerged, particularly in brain areas that have previously been associated with mood.’

Perhaps this might be the time to wonder if ‘broad patterns’ can adequately capture the complexities of any mood, let alone a dysphoric one. Another group, this time in Boston, is taking a slightly different approach: ‘Rather than detecting a particular mood or mental illness, they want to map the brain activity associated with behaviours that are present in multiple disorders — such as difficulties with concentration and empathy.’ If anything, that sounds even broader -more unlikely to specifically hit the neural bullseye. But, I know, I know –it’s early yet. The work is just beginning… And yet, if there ever was a methodology more susceptible to causing collateral damage, and unintended, unforeseeable consequences, or one that might fall more afoul of a hospital’s ethics committee, I can’t think of it.

For example, ‘One challenge with stimulating areas of the brain associated with mood … is the possibility of overcorrecting emotions to create extreme happiness that overwhelms all other feelings. Other ethical considerations arise from the fact that the algorithms used in closed-loop stimulation can tell the researchers about the person’s mood, beyond what may be visible from behaviour or facial expressions. While researchers won’t be able to read people’s minds, “we will have access to activity that encodes their feelings,” says  Alik Widge, a neuroengineer and psychiatrist at Harvard University in Cambridge, Massachusetts, and engineering director of the MGH [Massachusetts General Hospital] team.’ Great! I assume they’ve read Orwell, for some tips.

It’s one of the great conundrums of Science, though, isn’t it? When one stretches societal orthodoxy, and approaches the edge of the reigning ethical paradigm, how should one proceed? I don’t believe merely assuming that someone else, somewhere else, and sometime else will undoubtedly forge ahead with the same knowledge, is a sufficient reason to proceed. It seems to me that in the current climate of public scientific skepticism, it would be best to tread carefully. Science succeeds best when it is funded, fêted, and understood, not obscured by clouds of suspicion or plagued by doubt -not to mention mistrust. Just look at how genetically modified foods are regarded in many countries. Or vaccinations. Or climate change…

Of course, the rewards of successful and innovative procedures are great, but so is the damage if they fail. A promise broken is more noteworthy, more disconcerting, than a promise never made.

Time for a thought experiment. Suppose I’ve advertised myself as an expert in computer hardware and you come to me with particularly vexing problem that nobody else seemed to be able to fix. You tell me there is a semi-autobiographical novel about your life that you’d been writing in your spare time for years, stored somewhere inside your laptop that you can no longer access. Nothing was backed up elsewhere –you never thought it would be necessary- and now, of course, it’s too late for that. The computer won’t even work, and you’re desperate.

I have a cursory look at the model and the year, and assure you that I know enough about the mechanisms in the computer to get it working again.

So you come back in a couple of weeks to pick it up. “Were you able to fix it?” is the first thing you say when you come in the door.

I smile and nod my head slowly. Sagely. “It was tougher than I thought,” I say. “But I was finally able to get it running again.”

“Yes, but does it work? What about the contents? What about my novel…?”

I try to keep my expression neutral as befits an expert talking to someone who knows nothing about how complex the circuitry in a computer can be. “Well,” I explain, “It was really damaged, you know. I don’t know what you did to it… but a lot of it was beyond repair.”

“But…”

“But I managed to salvage quite a bit of the function. The word processor works now –you can continue writing your novel.”

You look at me with a puzzled expression. “I thought you said you could fix it -the area where my novel is…”

I smile and hand you back the computer. “I did fix it. You can write again -just like before.”

“All that information… all those stories… They’re gone?”

I nod pleasantly, the smile on my face broadening. “But without my work you wouldn’t have had them either, remember. I’ve given you the opportunity to write some more.”

“But… But was stored in there,” you say, pointing at the laptop in front of you on the counter. “How do I know who I am now?”

“You’re the person who has been given the chance to start again.”

Sometimes that’s enough, I suppose…

 

 

 

 

 

 

 

 

 

Recycling the Old

For everything there is a season, and a time for every matter under heaven

Really? It made sense when I was young, I suppose -when all of Time was ahead. When I needed to think there was some order to things. That past and future meant old and new. But as the years slip past, I find myself wondering about disparate things. Opposites. Like what, really, is the difference between new and old? Is it merely a temporal distinction? A nudge along a spectrum? Or a more fundamental change -a conceptual shift? I suspect it can be any of these, of course, but it still begs the question: does any change, any difference qualify? What if there is no change in form at all, but rather a change in function? In Purpose? Would that be new, or merely a rose with another name?

The concept of recycling has been with us from the dawn of time. When materials were scarce or unavailable things were used again, either in their original roles, or repurposed for something else their makers had not anticipated -a new situation, a new need. And so the old rises from its ashes like a Phoenix, but this time in a different play as another, unfamiliar actor.

The tradition of respecting the wisdom of elders and retelling their stories is also an honoured tradition. But as stories do, they alter over time and are often interpreted in new and unexpected ways. The knowledge is not lost, it’s just explained in different words. Understood in a new context. Reconstituted. Society has learned that there is often a benefit that accrues to re-examining the old and looking at it from an altered perspective. So has Science: http://www.bbc.com/news/health-33635575 Bisphosphonates have been around for a while as treatments for osteoporosis, a condition in which there is decreased bone mass. They help to prevent bone loss and so strengthen the bones themselves. It is most frequently used in the post menopausal woman when she no longer produces bone-protective hormones from her ovaries.

Bone is a common site for breast cancer cells to travel to (metastasize) however, and they can lie dormant there for years after the primary tumour has been removed from the breast. And yet, interestingly, those women who were already being treated with the bisphosphonates in the menopause and later developed breast cancer, showed a 28% reduction in cancers developing in their bones. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60908-4/fulltext And because the patents on bisphosphonates have expired in many jurisdictions, the cost of these bisphosphonates is minimal when compared to other ‘new’ treatments on the market.

But there’s more. A medication originally designed for diabetes –glitazone- has been found to decrease the likelihood of developing Parkinson’s disease. http://www.bbc.com/news/health-33608725 Of course this is just a comet in an otherwise cloud-filled night because glitazone is not without its own serious side effects –bladder and heart problems, to name just two- but it is a promise whispered emphatically, albeit quietly, to anyone working in the field. A starting point for future research…

So I suppose we should keep poking about in the ashes. Stirring embers to see if there is a Phoenix hiding somewhere in the cinders, fast asleep and dreaming of another job. We affix labels to things –categorize, then name them for all time. It’s a way of keeping track. Knowing what to expect. The problem, of course, is that things change. Evolve. Mutate. And as Jiddu Krishnamurti, a philosopher, once said of the disadvantage of naming god, it constrains the concept. Limits it. Doesn’t allow for growth and development. I think it is sort of like naming and classifying something when it is only a seed and we are still unaware of its potential. Maybe old is something like that. Where there is life there is always a seed and its age is beside the point. Meaningless.

I’m beginning to see age as a definitional issue, and not in the currently favoured framework of chronological versus biological –or even psychological- age so condescendingly mouthed by those too young to have experienced the ill-disguised discrimination it entails. There is useful wisdom that accretes with years and experience of course. But age is an oven that cooks whatever has been put inside –changes it into something else. Sometimes something entirely new.

I opened with a quote from Ecclesiastes, so let me close with one from the Talmud: ‘For the unlearned, old age is winter; for the learned, it is the season of the harvest.