Commercializing Cognitive Neurotechnology—The Ethical Terrain

COMMENTARY Commercializing cognitive neurotechnology—the ethical terrain Margaret L Eaton & Judy Illes Lack of recognition of the ethical, social and policy issues associated with the commercialization of neurotechnology could compromise new ventures in the area. ental illness is one of the leading causes of Mdisability worldwide, afflicting one in five 1 http://www.nature.com/naturebiotechnology Americans and over one in four Europeans . Cognitive neurotechnologies—technologies that enable the monitoring and/or modula- tion of the function of the brain—promise to improve the treatment of neurodegenerative and psychiatric disorders and may ultimately be applied to enhance emotional stability, cognitive clarity and sensory experiences. At the same time, they challenge existing notions of free will, identity, privacy and mental health and well-being, and pose additional social Nature Publishing Group Group Nature Publishing 7 and ethical concerns when commercialized as products for both medical and nonmedical 200 2,3 © applications . If ignored, these concerns could compromise successful application of neurotechnology products in the marketplace and increase the potential for harm. Companies must therefore anticipate and appreciate social and ethical issues so that corporate decisions ©Pete Saloutos/CORBIS can maximally promote health benefit and Companies cannot afford to ignore the ethical and social implications of implementing neurotechnology in both medical and nonmedical applications. neurocognitive well-being, and preserve the value of the technology. enable enhancements of mental performance technology, positron emission tomography What is possible? and cognitive capacity, and open up new oppor- (PET)/single-photon emission-computed Like any new technology, neurotechnology tunities for commerce4. Although the health- tomography (SPECT) and functional magnetic promises much but also poses several ethical, care market is neurotechnology’s major focus, resonance imaging (fMRI), to identify, control social and policy problems. On the upside, it nonmedical uses of neurotechnology assess- and predict diseases of aging, childhood disor- may offer new treatments for mental illness, ment tools are also proliferating. Such uses ders, addiction and anxiety disorders represents concern a range of professionals—neuroscien- a large portion of the cognitive neurotechnol- tists, bioethicists, scholars from the humanities, ogy market5,6. The techniques variously rely on Margaret L. Eaton is at the Graduate School of law and policy2—and include applications by electrical signals recorded at the scalp (EEG/ Business, Stanford University, 518 Memorial judicial, government or military authorities as ERP), on changes in brain metabolic activity Way, Stanford, California 94305-5615, USA, and well as in business and sports. (PET/SPECT) and on stimulus-related changes Judy Illes is at the Stanford Center for Biomedical in regional levels of blood oxygenation (fMRI). Ethics, Department of Pediatrics (Medical Diagnosis and management of disease. The With or without brain scans, clinical workups Genetics), 701 Welch Road, Building A, Suite application of brain-scanning techniques, such for cognitive impairments can involve complex 1105, Palo Alto, California 94304-5748, USA. as electrophysiology (electroencephalogram, protocols, can take many days and, because they e-mail: [email protected] EEG) and evoked response potential (ERP) require the services of highly trained neurology NATURE BIOTECHNOLOGY VOLUME 25 NUMBER 4 APRIL 2007 393 COMMENTARY or psychology professionals, can cost thousands purposes. Studies include those on personal- Education. Many researchers are currently of dollars. The results are often variable due ity assessment, cognitive perceptions of eth- using fMRI and EEG-based tools to investigate to patient and test administration differences nicity and race12–14 and researchers may in the neural networks underlying learning. Studies and are subject to differences of interpreta- future investigate musical, verbal or athletic have shown, for example, that intensive reme- tion. Physicians, parents, patients, teachers and prowess. dial training can promote brain plasticity in medical insurers have long lamented the lack of children with dyslexia and generate normal certainty in diagnosis because relatively small Government, law enforcement, security responses with a concomitant improvement interpretive changes can significantly alter the and military uses. Nonmedical government, in reading skill23. These studies ensure that diagnosis for a given patient. judicial and military applications of neurocognitive assessment will become widely used Neuroimaging research aims to eliminate technology include training of personnel to to screen for learning skills and disabilities, the problems of interpretation and poten- subvert interrogation and cope with stress- validate interventions and assess outcomes. tially, with streamlined technology, lower cost. ful combat situations, and for the purpose Current technology allows simultaneous neuro- of detecting socially problematic behaviors, Consumer product marketing. Among the imaging and real-time cognitive assessment. cognitive overload, stress and waning atten- most controversial of the nonmedical uses of Developers expect that automated screening tion and arousal. Several startup companies new neurotechnologies is their application to and assessment will soon be performed in less working in this domain began with an initial advertising. Newly emerging ‘neuromarketing’ than one day (possibly in an hour or less) and, business plan to develop medical products firms use fMRI in consumer research to assess depending on the equipment used, cost orders and services but then redirected R&D when people’s unconscious, unfiltered reactions of magnitude less. Some of the new technology given funding from sources, such as the US to advertisements for consumer products24. will also require much less active participation Department of Homeland Security or the US These companies were formed in the wake of by the clinician and the patient because detec- Defense Advanced Research Projects Agency studies reporting brain function correlates to tion, transmission and assessments of brain (DARPA)15. brand preference25. activity will be done using wireless and other http://www.nature.com/naturebiotechnology automated sensing equipment. These improve- Cognitive enhancement. Good cognitive Issues related to neurotechnology ments will produce more detailed brain func- assessment tools will create opportunities for Although neurotechnologies clearly promise tion images and thus improved quantification enhancing mental function16,17, and some significant benefits in diverse applications, their and precision of brain function characteriza- such systems have already been given approval increasing adoption is likely to prompt further tion. In addition, because some of these tech- by the US Food and Drug Administration reexamination of existing concepts of mental nologies capture brain function without relying (FDA). Electrical Geodesics (Eugene, OR, health and illness as well as pose questions con- on responses that are consciously or actively USA), for example, has used its EEG technol- cerning infringement of an individual’s right to controlled by the person being tested, artifacts ogy on Tibetan monks to study the brain activ- privacy, autonomy and identity. due to limited cooperation may be eliminated. ity and benefits of meditation. Harnessing the As neurotechnologies are increasingly Reminiscent of older biofeedback methods, inherent powers of the mind can potentially applied in diagnosing and treating disease, dis- emerging neurofeedback technologies based enhance behavior, memory, sexual experience, agreements may arise concerning definitions Nature Publishing Group Group Nature Publishing 7 on cues about changing levels of blood oxygen- sleep, attention and confidence without the of brain health, and acceptable thresholds and ation, for example, may afford relief to patients side effects of drugs that can achieve similar ranges of human motor and cognitive behavior. 200 7 © suffering from debilitating pain . results. For example, imaging that can detect increasingly small differences in cognitive processing Assessment of cognitive state. Cognitive Lie detection. Functional MRI studies have can lead to disputes about whether these varia- assessment tests are currently being marketed demonstrated differences between levels of tions are within the normal human range or to physicians and athletic trainers to measure oxygenation in the brains of people who are are hallmarks of mental disease. Also, questions the effects of head injury, such as concussion8. performing truthfully or lying18–20. This still will probably arise whether or not use invites With greater diagnostic precision, the tests emerging capability has led to commercial coercion and invasion of privacy. can insure that return to pre-trauma activ- development of lie detection systems, with For affective and forensic applications, accep- ity is safe. Similar tests are also being tried to potential uses in crime investigations, parole and tance of the tempting conclusion that cogni- assess the cognitive impact of physiological child-custody hearings, immigration screening, tive assessment tools can provide an objective states, such as hypoglycemia9 and fatigue10,11. insurance or government security interviews, description of a person’s brain

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