Electronic medical implants are at least 50 years old, but new devices are raising unforeseen ethical and social concerns. Dr. Mae-Wan Ho calls for thorough public debate and consultation before these devices are let loose on society
Hollywood comedian Jerry Lewis, now 78, has suffered from chronic back pain for years until April 2001, when he received an implant. The pain pacemaker delivers low-voltage stimulation to his spinal cord to block the pain messages from reaching his brain, so he no longer feels pain.
Before that, he tried everything to quell his "37 years of constant pain"; analgesics, steroids and cortisone, and was addicted for 13 years to the painkiller Percodan. He was about to shoot himself when his young daughter Danielle walked in and inadvertently brought him back to his senses.
That very day, he received a trial model of a neuro-stimulation device with a hand-held control that sends electronic pulses to the affected nerves, blocking the pain message to the brain. Within days, he underwent surgery to implant electrode leads in his spine and a battery pack just under the skin near his left hip. And he has been singing the praises of the device ever since.
Jerry Lewis is living in a kind of virtual reality. His back problem still exists, but he is made to think it doesnt.
The implant costs about $10 000 plus doctor and hospital fees, and is covered by most HMOs and other insurance plans. It is said to come with a small risk of infection, and patients with implants cannot have MRI screenings because the heat on the electrodes metal tips could cause serious nerve damage.
Could a non-implanted, more easily controlled version do just as well? After all, the trial (pre-implant) model appeared to have been good enough to convince Jerry Lewis to accept the implant.
In fact, implanted devices are known to have a range of electronic, mechanical and other problems that has resulted in massive product recalls by the FDA (see "Electronic medical implants promises & perils", this series).
Yet newer implants that interface with computers have been approved, which are raising additional unforeseen ethical and social concerns.
Brain-computer interfaces are developing rapidly to help paralysed people regain control of their lives and the ability to communicate.
A quadriplegic 25 year-old man had a chip implanted into his brain in June 2004; and by October, he was able to control a computer to check his e-mail and play computer games simply by thinking. He can also turn light on and off and control a television while talking and moving his head. All of which is pretty impressive.
The chip, BrainGate, is developed by Massachusetts company Cyberknetics, based on research at Brown University, Rhode Island. Up to five more patients will be recruited for further research into the safety and potential utility of the device.
John Donoghue, professor of neuroscience at Brown University and co-founder of Cyberkinetics in 2001, said BrainGate could help paralysed people control wheelchairs and communicate using e-mail and internet-based phone systems. "Our ultimate goal is to develop the BrainGate System so that it can be linked to many useful devices," he said.
Donoghue received an innovation award from Discover magazine for his work.
Donoghues initial research, published in the journal Nature in 2002, involved an implant to a monkeys brain that enabled it to play a simple pinball computer game remotely. The four-millimeter square chip, placed on the surface of the motor-cortex in the monkeys brain contained 100 electrodes each thinner than a hair, and inserted into individual brain cells to detect its electrical activity. The implanted chip is connected to a computer via a small wire attached to a pedestal mounted on the skull.
This invasive brain implant carries risks of infection and of neurons dying. And if it goes wrong, it cannot be easily removed.
Another research team has raised hopes that brain implants may not be necessary at all for brain computer interface.
Four people put on an electrode-studded "thinking cap" and were able to control a computer with their thoughts. No surgery or implant was required. The US researchers reported their experiment in the Proceedings of the National Academy of Sciences in December 2004.
"The results show that people can learn to use scalp-recorded electroencephalogram rhythms [brain waves] to control rapid and accurate movement of a cursor in two dimensions," wrote Jonathan Wolpaw and Dennis McFarland of the New York State Department of Health and State University of New York, Albany.
The thinking caps were tested on four people, two partly paralysed men who used wheelchairs, a healthy man and a healthy woman. In the experiments, the four volunteers faced a video screen wearing the cap with 64 electrodes against the scalp to record the brain waves.
The key was a special adaptive algorithm - a computer programme - that successively optimised the translation of filtered brain signals into what the users wanted the computer to do. It took practice, but all four learned to move a cursor on the screen in two dimensions, vertically and horizontally. The two disabled men were better at the task, possibly because they were more strongly motivated, or because they have a brain forced to be more adaptable to cope with the injuries that left them paralysed.
"The impressive non-invasive multidimensional control achieved in the present study suggests that a non-invasive brain control interface could support clinically useful operation of a robotic arm, a motorised wheelchair, or a neuroprosthesis," the researchers wrote. In movement time, precision, and accuracy, the results are comparable to those with invasive implants.
So, is a non-implanted thinking cap an unadulterated good? For the individuals concerned, no doubt. It is non-invasive and does not require surgery to remove. It can be put on and taken off at will. With practice, and with robotic machines under their control, the users could be more able-bodied than almost anyone else.
But brain-computer interface raises new concerns. Could employers or government agents or the police make people wear thinking caps while being interviewed so their very thoughts could be revealed? Could a disloyal thought about ones boss cost a job?
And further down the line, could a death wish be literally used to kill people you dont like?
Could an evil warlord set off an atomic missile attack just by thinking?
Or enslave the entire world via the internet, when people could be tagged and implanted with nano-devices without their knowledge?
New electronic tags are indeed here, that enable all ones records to be instantly recalled, and reciprocally, potentially allows a computer to know exactly where one is 24 hours a day.
In October 2004, a US company, Applied Digital Solutions in Delray Beach, Florida, got the green light to implant a chip in a persons arms that can give instant access to the individuals medical records.
The VeriChip, the size of a grain of rice, is implanted by injecting under the skin. The company received approval from the Food and Drug Administration to market the chip in the United States.
VeriChip is a radio-frequency identification (RFID) tag containing a chip encoded with a unique identification number and a tiny antenna. To read the tag, a scanner that emits radio waves is passed over it. The antenna detects the radio waves emitted by the scanner and generates a tiny electrical current in the chip to beam back a radio signal that reveals the ID number.
The company says that the tiny implant could be used to extract a patients personal and medical records from a secure database, and could prove useful when, for example, someone is unconscious or has numerous records at different clinics that must be pulled together in an emergency.
But critics point out that tagged bracelets or cards carrying medical information are just as effective as an implanted chip. They warn that the chips might be used to compulsorily tag and track prisoners, or even foreigners visiting a country in the name of fighting terrorism. (Some of us have had our fingerprints and iris patterns recorded at immigration visiting the United States recently.)
"Theyve crossed a line by placing it under peoples skin," says Marc Rotenberg of the Electronic Privacy Information Center, a civil liberties group in Washington DC.
RFID tags have been around for over 50 years, although many of them are larger, battery-powered and actively transmit data carried on their chips.
Smaller, cheaper passive chips that only release information when scanned have been developed over the past decade, and are now poised to invade many aspects of our lives. As wireless technology increasingly intrudes into workplaces and homes, a tagged person will not even be aware that he or she is being scanned.
"The technology is very much coming to the forefront," says Dan Mullen, president of Association for Automatic Identification and Mobility, a trade group based in Warrendale, Pennsylvania.
Most people are already using RFID tags unawares; as in security badges that allow access to buildings, or in keys that communicate with a car to allow only the driver in. Many companies are also starting to use the chips to track goods shipped from manufacturers to their destination, and avoid them being mislaid or misplaced.
RFID tags are also routinely implanted in pets, so they can be identified if lost. But VeriChip is the first implant designed for use in people, and some people have already been tagged. The Attorney General of Mexico and some of his staff had chips implanted to limit access to a secure room.
Dr. Michael Antoniou of Guys Hospital, Kings College London, says, "This is really frightening; if this gets over here then its totally the end of our rights and freedoms!"
In 2002, ISIS launched a discussion paper, Towards a Convention on Knowledge, jointly with SGR (Scientists for Global Responsibility), INES (International Network of Engineers and Scientists), TWN (Third World Network) and Tebtebba (an indigenous peoples network based in the Philippines), to ensure that all forms of knowledge, including western science, should be used responsibly for the good of all.
In that paper, we have explicitly warned against implantable (nano)devices and prostheses that cannot be easily removed if the individuals so chose. We also stated that people should not be coerced into accepting those implants.
There is an urgent need for thorough public debate and consultation before these devices are let loose on society.
Article first published 14/12/04
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