The neurotech industry is in a very interesting position as of now. There are many hopes, wishes, and ideas of what the industry will become. There are countless startups and companies working tirelessly to produce cutting edge devices and technologies. Most of all, there is an incredibly strong need for this industry to flourish from those that suffer from neurological diseases. In fact, nearly 1.5 billion people worldwide and over 100 million Americans suffer from a brain or nervous system illness. The annual economic burden has reached over $1 trillion dollars worldwide with $300 billion a year for these individuals alone (commercializing neurofutures). Despite all of this, there are very few devices that are actually being put to routine use. This appears to be due to two main factors: 1) that the formation of most companies in the neurotech, at this point, doesn’t actually rely on the sale of assets and devices, but rest instead on intangible promissory assets that are hard to exchange or value and depend entirely on the expectations of their future worth and 2) the idea of neuroethics seems to be in a major gray area and still needs a lot of flushing-out before any neurotech device can fully be implemented into society.
As far as the first prong goes in terms of promissory organizations and intangible assets that must be guessed upon for their final value, this kind of hurdle can be explained by some important neurotech companies that are present now. Examples of these are NIO (Neurotechnology Industry Organization) and NNI (National Nanotechnology Initiative). NIO has been incredibly successful in its venture to enroll a broad membership, lobby Congress, build a wide network, rally investors, analysts and patient groups, and make the neuro-industry viable as a field for investment. They have set the standard for making huge pushes for visibility and selling the promissory value. NNI has done the same, but has also been able to get funding from the government. Both the NIO and the NNI have therefore acted to promote the emergence of new technologies, but the NIO is unusual in not having state sanction. As a result, it is much more focused on mobilizing private actors and explicitly creating economic value through the capitalisation of hope (commercializing neurofutures). There are also several different consultancy firms that claim that companies have a very high output of tangible products that are either out now or that are coming out soon. In fact, the consultancy firm called NeuroInsights provided a detailed analysis of a range of neurotechnologies, such as neural stimulators, neuroprostheses and the brain/computer interfaces that could generate significant venture capital interest. It is with these kinds of companies that this precarious position becomes all the more realized. They have people backing them, they have a huge expectation for technology that will greatly assist a huge amount of people, and now there is the difficulty of actually finishing up these projects and meeting the standard set. There are other considerations, however, like the ethical aspect of a lot of these projects. As for the current state of neuroethics, which is the second factor discussed here, there is a lot of controversy and discussion surrounding the topic. At the fundamental level, there of course has to be some kind of ethical requirement present when looking at neurotech and its future. Neurotech itself has created the possibility of accessing, collecting, sharing, and manipulating information from the brain a real possibility. These kinds of things, however, can be as dangerous as they are useful. For a long time, people have thought that the ultimate privacy one could have is to their own thoughts, but this could finally be coming to an end. The availability to know what someone is thinking has profound implications on human rights such as privacy, freedom of thought, the right to mental integrity, the freedom from discrimination, the right to a fair trial, and the principle against self-incrimination. This means that technologies such as lie detector tests based on brain waves that are accurate or devices that can tell if the decision making area of someone’s brain is underdeveloped, leading to a higher probability of crime that are a real possibility of being developed at some point in the near future need to be watched closely. This overlap between neuroethics and law is aptly named “neurolaw,” and while it may be helpful in certain cases (like helping someone who has undergone a lot of trauma recover) it may also be detrimental to the human rights of every person.
Beyond the conceptual idea of looking at what neurotech might become in the near future and discussing what limits it should have, there are some that have taken a presumptive strike and attempted to put regulations on it now. A prominent example comes from the National Congress of Chile that has amended article 19 of the Magna Carta to “protect the integrity and mental indemnity of the brain from the advances and capacities developed by neurotechnologies.” This, at the moment, is still incredibly vague and leaves a lot of specific ideas and technologies to be considered as to whether they infringe upon this. For example, there are technologies that already exist that can read brain waves to determine how someone is feeling or thinking, so would this kind of technology already be prohibited under the “mental indemnity of the brain”? Beyond this, Chile is looking to push a bill that mandates all neurotech devices to have the same regulations as medical devices. Additionally, they want neural data to be considered equivalent to a human organ which would prevent the sale of that data. There are some that think that preemptive strike in order to maintain neurorights is a good one, but there are others that feel this may put a strain on the developing technologies and limit the ways that we would be able to help individuals who suffer greatly from neurological disorders.
Beyond these considerations, there are many different companies that are producing a lot of interesting and useful technology that will make huge impacts once they are done with development. The top three funded projects in neurotech are MindMaze, Neurolink, and Neuronetics. MindMaze has received around 340.7 million in funding and focuses primarily on therapeutics to treat rehab patients, Neurolink has around 363 million in funding and hopes to eventually provide an interface that would assist people who suffer from paralysis, and Neuronetics has received around 313.4 million in funding and focuses on non-invasive, magnetic therapies for things like depression (from industry chart). Outside of these, most of the other neurotech companies deal with Alzheimer's and mild cognitive impairment (MCI). Beyond these big companies, there have been several interesting research ventures using neurotechnology that have been very exciting and promising. One specific case that has been published recently (January, 2022) is the use of robotics in brainstem biopsies. In general, stereotactic biopsies are considered the gold standard for intracranial biopsies due to the high diagnostic yield, yet there has been a lot of controversy surrounding it. The idea behind the controversy is that there is a high amount of eloquent tissue (areas of the cortex that, if removed, will result in loss of memory or sensory processing) in the area where they usually penetrate the cranium for the biopsy. Most cases show that if something does go wrong during the biopsy, around 30% of the time the individual will die within 30 days. Additionally, there is the idea that the actual therapies that can be applied after they find the lesions are limited, so taking this extra risk for biopsy may not be in the patient’s best interest. In an attempt to circumvent the risk of brainstem biopsies, they attempted to utilize two different robot assisted procedures. In the small study that they did, they found no surgery-related mortality and only two of the cases had complications. One of the cases involved the patient having a hematoma which regressed spontaneously after the surgery and in the other case, the patient had a minor intratumoral hemorrhage at the biopsy site but completely recovered in 3 days. Thus, this method was shown to be much more effective than traditional biopsies.