Wisconsin Public Television Universtiy Place  Where Will Neurotechnologies Take Us?  Clark Miller  9/20/2013 UP920  cc >> This is the seventh year of the Neuroscience and Public Policy Seminar. In that time, I have introduced nearly 50 speakers. Some of these people have been the most distinguished individuals in the country, but this particular introduction means more to me than any of the previous ones because today it's my privilege to introduce Clark Miller. And we wouldn't have a Neuroscience and Public Policy program at the University of Wisconsin without Clark. So, I met Clark around 2004, I think it was, and I looked him up because I saw that there was somebody in the La Follette School of Public Affairs that had just been awarded a huge NSF grant. And I said to myself, my goodness gracious, this must be an unusual person. And so I met with Clark and we hit it off as if we were brothers. And it was a true collaboration. Each of us was putting something into it. We designed the program, and we got it approved. 

And then Clark went to Arizona State. [LAUGHTER] But in any case, Clark is the kind of person who has taken a very defined course in academics because typically what one sees is a breadth of interest as a graduate student which narrows as a postdoc which narrows as a faculty member and then tends to keep narrowing as one proceeds. Clark, on the other hand, got a PhD degree in electrical engineering to study a tiny niche of the atmosphere. He wasn't very happy about this as a career prospect, and so then he taught himself, got himself going in public policy. He spent time at the Kennedy School at Harvard. And his reach has been expanding as he goes through his academic career. So he is one of the broadest and biggest thinkers that I know. He's all over the place, from nanotechnology, climate change. He just did a book on nanotechnology and the brain. It's just remarkable. 

So Clark is really a very different kind of academic. He's very prolific. He has something like 56 papers in the last couple of years. He's associated with more than $30 million in grant funds in one way or the other. He's a phenomenal academic, but I think what really distinguishes him from most academics is that his horizons have broadened as he's continued, and I think that's great. So today he's going to talk about where are we going to take ourselves with neurotechnologies. And this is a very important issue because the foundation which is sponsoring these lectures, the Kavli Foundation, and we are very grateful to the Kavli Foundation. They are going to sponsor this series for the next two years and perhaps thereafter. They are putting together a combination between nanoscience and neuroscience. They want to see these two fields come together. 

And we'll see. Clark can probably comment much better than me about whether this is feasible and has any promise. But today, this is what we're going to hear about from Clark, and it's going to be based on a book that appeared in 2013, this year, that brings together technology and the brain and how this is going to impact our future. It's with tremendous pride that I present Clark Miller to you. [APPLAUSE]  >> Thank you, Ron. I appreciate that. I think we are living in a remarkable moment in human history, and I will say a little bit more about that in the future. But it is a moment for which the Neuroscience and Public Policy program here at Wisconsin is ideally defined, and I think that program remains an extremely important innovation, and it is one of the great regrets that I have over the last six years that I have not been here to witness the success of that program and to be able to participate in it. I'm delighted to be able to be here and to come back to be able to talk about why I think neuroscience and public policy is a space in which we have to innovate and we have to think seriously in the coming decades. And the talk that I want to give is going to have three parts. 

The first is going to be a short series of observations about what I call neurotechnologies. [COUGHING] Excuse me. And, really, the choice that neurotechnologies pose for us as we go forward in the field of neuroscience and in its related collaborations with other disciplines. And that choice really is the one that is on the title slide. Where will we take ourselves with these new technologies? I want to be clear upfront, it is a choice. Science is not leading us on a path that we do not control. But it is a choice that we are going to have to confront and make explicit in our thinking. And that's partly why I think this program is so important. The second part of the talk I want to share with you a few of the concepts and tools that we have been working with at the Consortium for Science, Policy and Outcomes at Arizona State University for confronting choices like this one. And neurotechnologies are not the only space in which we are confronting big choices about where to take ourselves with science and technology. 

And then, finally, I want to talk a little bit about some of the ideas that are in the book that try to put these new tools and new frameworks into practice. So this is Peter Paul Rubens' famous painting of Daedalus and his son Icarus as they try to escape from Crete in Greek mythology. It is a myth that has long symbolized humanity's quest for technological mastery and the potential dangers inherent in that quest. And my first observation about neurotechnologies is that from the very beginning of that quest, as represented in this myth, humans have dreamt of integrating biology and the machine. And in a very real way. Although, there are lots of ways in which you can talk about biology and machines having been integrated for a long time in human history. There is a very real shift happening today, and neurotechnologies are at the cutting edge of that shift, that really bring that integration at a cellular, even a molecular level, onto the table fundamentally in a huge way at the outset of the 21st century. But I want to just point out that it's not merely the culmination of that quest that is at hand. It is that the work that we do today is situated inside this historical enterprise that goes back several thousand years. It is a quest that continues to captivate us, however, today in, really, some quite remarkable ways. 

It is central to where we imagine that we are going whether we like it or not. And anyone who's interested in nanotechnology and neuroscience and how they interact together, I highly recommend reading this book. It's a lot of fun, and it raises some really, I think, quite challenging questions about what it will mean to be able to manipulate molecular objects in a way that's directly connected to our understanding of the human brain. So my second observation here at the beginning about neurotechnologies is precisely this: that over the next century we will use neurotechnology to change what it means to be human. I don't see any way that we can sort of think about it absent a collapse of modern civilization in which this statement is not true. We are already on the cusp. This, of course, is the bionic woman, with the version that I was familiar with from when I was growing up on the right, and apparently there's a new bionic woman. And this, of course, is, at least as the New York Times puts it from last February, the bionic eye. So this is Barbara Campbell. She's one of a handful of people who have been participating in the clinical trials for an artificial retina implant that allows her to see. 

We are already engaging in these kinds of technological spaces in a massive way. The students from the program and I watched at lunchtime a new documentary that will be released later this month called Fixed: The Science and Fiction on Human Enhancement in which prominently on display are, among others, a professor at MIT who is a double amputee who has designed legs for himself that allow him to climb mountains much more effectively than he could do so when he had full functioning human limbs. We're in this space. It's happening. But I want to make a point about how we think about this. We often think about people like Barbara Campbell and their stories as stories that are essentially about medicine, about repairing that which is broken or which has gone wrong or which didn't work to begin with. But note this quote from the New York Times article about Barbara. "Barbara Campbell, 59, relishes how the new bionic eye helps her navigate Manhattan streets, locate her bus stop, and spot her apartment building's foyer light while riding in taxi. Most exciting, though, is how it enhances her experience of museums, theater, and concerts." This isn't just about restoring sight. This is about participating in the human experience. 

A point that Oliver Sacks makes at depth in his book Seeing Voices about the death, excuse me, about the deaf. I'll let you read this quote and just tell you a little bit about it. Deaf children, if you do not teach them to communicate, do not communicate, they do not learn language. To not learn language is essentially to not be human. Deaf children, it turns out, are more effective at communicating visually. Indeed, all children are more effective at communicating visually in their first 18 to 24 months of life than they are at communicating orally. My kid, he's a kindergartener now, learned to communicate various hand signals before he learned to talk. But for much of human history, we did not teach language to deaf children. And thus, the phrase, of course, deaf and dumb. These kids were not dumb. 

They were not idiots. They were not impaired in their thinking in any way, shape, or form. They were, in many respects, some of the smartest kids out there, but we never taught them language because, of course, we've evolved as an oral linguistic species. So the brain is much more than a machine to be fixed. It is the locus of our personality, our identity, our memory, our choice, our behavior, our ideology, our values, or sociality, our community, our politics. All of those things are located between our ears. Everything that makes us who we are and who we hope to be is in the brain. And so when we intervene in the brain, we are intervening in all of those things at the same time. We are not just fixing a machine or repairing a tissue or an organ that has gone awry. So my third point or observation about neurotechnologies to start us off is that the US government and the US corporate sector are very interested in neurotechnologies. 

Whether it's Jonathan Moreno's book Mind Wars or Joel Garreau's book which is up here, Radical Evolution, we know from research that's been done that DARPA is deeply interested in technologies of the human brain. And so is the National Science Foundation. And this, to me, is one of the most remarkable claims made by a federal agency that I have ever read. In the early decades of the 21st century, concentrated efforts can unify science based on the unity of nature, thereby advancing the combination of nanotechnology, biotechnology, information technology, and new technologies based in cognitive science. With proper attention to ethical issues and societal needs, converging technologies could achieve a tremendous improvement in human abilities, societal outcomes, the nation's productivity, and the quality of life. Neurotechnologies are coming, financed by our federal government among others.  But the successful integration of mind and machine will be a far more profound accomplishment than simply curing a few diseases. All right, so the question is, in the face of these challenges, how should we proceed? Where 'we' means neuroscientists, neuroengineers, businesses, regulators, citizens, and others. And I think the answer has to be at least in part in finding new strategies for bridging the human and the technological. So without question, there's a lot of people thinking in this space already. 

On the one hand, you have folks from neuroscientists, like Michael Gazzaniga, and neurologists, like Oliver Sacks, to philosophers and humanists of all stripes thinking about what it means to have a brain and a mind, about identity and meaning, about ethics and norms, about well being and welfare as a human, about religion and spirituality. On the right, we have tremendous amounts of work going on in research agencies, in laboratories, in start-up companies, in pharma, among user groups of all kinds. We have social activism. We have emerging political economies around new innovations. But there isn't a lot of connectivity between, on the one hand, the sort of deep thinking that's happening about what these kinds of transformations might mean for humanity and, on the other hand, the work that's going on in the innovation system around neurotechnologies. And that's really an issue we've been beginning to try to experiment with some new ideas and some new concepts for action, if you will, in this space. So one of those is the idea of real-time technology assessment. These reports are all from an agency that operated in the federal government from the early 1970s until 1994 called the Office of Technology Assessment. We have really gone backwards in many respects in this country by no longer having an Office of Technology Assessment. But, at the same time, technology assessment as practiced at OTA and more generally around the world has always been, retrospective is probably too strong a word, but it's always been a practice that's focused on technologies that were very real. 

Right? That already existed, that were out in the marketplace and were beginning to have real consequences, and we were trying to figure out what to do with them. And my colleagues, Dave Guston and Dan Sarewitz, wrote an article about a decade ago in which they argued that that was no longer good enough. That the nature of the innovation system in this country had changed enough that what we needed was to begin to think about how we could do technology assessment what they called in real-time. So, in parallel with cutting edge research. So what does that mean? Well, they talked about a number of different kinds of strategies that we might undertake. The first is simply mapping the research and innovation enterprise. So, it turns out if I asked you what's going on in the field of neuroscience today in America, and I actually wanted some detail about that, there is no place I could go to get that answer. We don't know. One could download a list of research grants that have been funded by the NIH and the National Science Foundation, but that doesn't tell you what work is being done. One could compile, with a fair bit of work, a database of neuroscience research articles that have been published, but that actually takes a fair bit of work and no one has done it. 

So if you want a systematic picture, it doesn't exist. So part of what we would like to see is the emergence of strategies for actually doing this mapping for being able to find out what kind of research and innovation activities are going on and tracking those over time. Likewise, there is a similar gap in our charting of social, economic, and political value around these innovations. And more than just value emerging as these technologies emerge, emerging reconfigurations of social relationships and identities, economic markets, political dynamics. Because we know that society changes in and around new technologies as we introduce them. But how that's happening in a real-time sort of way is not something that we track. So similarly, we're interested in constructing, then, as a third step in this, scenarios and pathways that are either emerging or may emerge down the road. So actually trying to begin to get out ahead of the technological development that's happening in the lab, not in a predictive way but in an informative way. The people who are doing work in labs have lots of ideas about where that work might be going in the future. Generating conversations among them might give us useful insights about where those technologies might be going. 

Bringing in business innovators to that conversation might tell us something about the kinds of products that businesses might imagine that they could take into the marketplace. Bringing in social activists or religious leaders might tell us something about how people might react to those different kinds of technologies. What meanings they might make of them. How they might apply them in their lives. And then, of course, we want to have conversations, we call them deliberations, not only among those folks but among citizens about these kinds of opportunities, and, ultimately, we want to do some kind of evaluation and assessment of the trajectories that we're seeing, the kinds of societal responses that are emerging, and these scenarios and deliberations that follow. Can we do technology assessment in a way that is at least keeping up with the cutting edge of scientific research? And if not getting a little bit ahead of it. So the second idea that we've been working with is the idea of responsible innovation. So let me start with the corporate sector. The corporate sector in the United States in the last 20 years, despite what it might seem like sometimes, has become heavily invested in the idea of corporate social responsibility, of being good corporate citizens of the world that they live in. But despite that, if you look into the innovation spaces in the corporate sector and you look at corporate innovation, particularly corporate technological innovation, you will see that the corporate social responsibility division is over here and the innovation division is over here, and, actually, there's remarkably little interaction between the two. 

We're working with Intel at the moment because they have a pilot what they called shared value program in which they're trying to create both business value and social value out of the same product development cycle. It's actually really, really hard to do, but we're interested in this question of can you do it. Can you bring corporate social responsibility into the heart of the business enterprise, the innovation enterprise? The same is true of laboratories. How many of you who are graduate students have had a course or some kind of introduction to responsible conduct of research? So, a number of you. So that is the sort of common training that we give folks. But that turns out to mostly be focused on the sort of day to day ethical practice of collaborations, of authorship, and it's not really fully engaged with these larger questions, societal questions if you will, about what kinds of technologies are we developing and what are the sort of ethics and politics of those technologies. So responsible innovation is a concept which hopefully will begin to turn into a set of tools and practices for beginning to bring these ideas of social responsibility, and, just like in business, the scientific community has also articulated the idea that it needs to be socially responsible to bring that social responsibility into the work of laboratories, engineering design centers, and other parts of the innovation process. The final concept that we're working with is the idea of anticipatory governance.  The idea of anticipatory governance is to begin to try to engage the question of how to create, via science and technology, the kinds of worlds, communities, societies, whatever, that we actually want to live in going forward. That's sort of the big 30,000 feet kind of idea. 

What we know is that we're, in fact, creating that world right now all over the place. In laboratories and in companies, in the United States, in China, in India, in Europe. We also know that we are governing that process, often in a highly ad hoc way, certainly not in any kind of coordinated fashion. We are deeply concerned about, probably rightly so, the idea of centralized control or management of the innovation process. But the question is, can we take these practices of governance that we have and can we try to modify them and modulate them in ways that will lead us toward the development of futures that are, and this is a really loose concept so take it with a full grain of salt, but that are better than the ones we would get simply by letting things happen the way they're likely to happen. And it's an obviously highly speculative idea at the moment, but we're working with it around three ideas. So one is the idea of foresight. The idea of trying to articulate, and this goes back to some of the real-time technology assessment pieces, goes back to the idea of trying to think about the future and trying to think not necessarily about predicting the future but trying to create plausible notions of what kinds of futures we are already building so that we at least have a starting place to work from. The second idea that is important here is the idea of integration. And what we mean by that is the integration of the social and natural sciences and engineering. 

So to develop practices in which social scientists, for example, and humanists get embedded into scientific laboratories. So, I can't see Kris out there because of the lights, but Kris Saha told me he was coming and he told me this morning when we were chatting that he actually has some students and faculty members from the sociology department working in his lab at the moment. And this is something that we're doing a lot of at ASU in terms of embedding humanists and social scientists inside some of our major research centers. The third idea that is really at the heart of anticipatory governance is the idea of engagement, which is, again, connected back to these real-time technology assessment ideas. The idea of engaging the public in early and frequent deliberation about these larger kinds of questions to which science is an incredibly important part but it's only a part. These are ethical, social, political questions as much as they are business and technological questions. And so, for example, we've been working with science museums around the country as part of the Nano Informal Science Education Network to engage their adult audiences. Most science museums, their primary audience are fifth graders through eighth graders. But all of those fifth graders through eighth graders come to the museum with adults, whether they're parents or teachers, and science museums have typically not done very much at all to engage their adult audiences. And so we're working with them, there's a lot of interest at the moment in finding ways to create conversation around nanotechnology with adult audiences as part of the science museum content. 

Science museums have 45 million visitors a year in this country alone. So if you think about a space in which people are engaging in science and technology at a large scale already, that's the space that science museums offer. So that's an exciting, for us, opportunity to try to find ways that we can bring those folks who are visiting science museums into a productive dialog about cutting edge science and technology. So in terms of putting these ideas into practice, I want to give you some of the insights from this book that we published earlier this year. I have a bunch of copies of it. I would like to save six of them or so for the students in the Neuroscience and Public Policy program, but I brought a bunch more than that. So if anyone would like one afterward, you are welcome to come up and get one. The book is the result of a project that we have been doing as part of the Center for Nanotechnology in Society that was launched because of a lot of statements that we got in interviews with folks like Ron that were exactly like Ron's. What does nanotechnology have to do with neuroscience? Indeed this is a great quote, I think, from Professor the Lord Winston who's a big shot in Britain. He's, in fact, the science advisor now for the British government. 

He holds this endowed chair position in science and society at one of the big British universities, and he says in response to this question, do we have to worry about nanotechnology and how it's going to converge with neuroscience in the coming future? He says, no, I don't think so. "I don't think we should necessarily trouble ourselves with nanotechnology in this regard. Its possible impact is probably not yet relevant to mainstream neuroscience and therefore difficult to judge." And we thought, well, hey. We actually went to the trouble, or I should say our colleagues at Georgia Tech did as part of the center's research, to build a database of all nanotechnology research publications published in Web of Science between 1990 and 2008. And we said we can search that database for neuroscience related research 10,000 articles at the intersection between nanotechnology and neuroscience. The neuroscience community, at least big parts of it, didn't even know it was happening. I'll go back to that statement earlier. We do not track in any serious way what's going on in the nation's research laboratories. And, of course, an increasing trend. And that last, you might think it was leveling off, but the 2008 data was only a partial year data because you Web of Science updates 2008 articles for several years after 2008. 

This is what the map of that looks like by discipline. And I don't even know if I can read it so I can't really expect you to read it, but the yellow  is biomedical sciences, the red is clinical medicine, the blue is chemistry, the black is material science, the purple is physics, the light pink is computer science. You get the picture. This stuff is being done all over the place in a disciplinary sense. Well, not quite all over the place. There really isn't much being done in social studies or in business or, somewhat surprisingly, there's relatively little being done in psychology.  So we went and we classified these articles by application. And you can see that there's a wide range of applications from drug delivery and prosthetics and implants and transplants that you would expect to gene therapy, chemotherapy, radiation therapy, and other kinds of fields. So there's a lot of work being done, and if you sort of take larger, grosser categories, you can say that nano/neuro applications fall into three domains: brain analysis, which is to say trying to understand how the brain works; brain repair, so medical therapies to try to address known neural diseases; and brain enhancements, so efforts to improve brain and cognitive performance. And I want to, just as the final sort of point of this talk, although there's still a fair bit of it to go, talk about some of the implications of each of those areas for how we think about public policy. 

So, brain analysis. So, nanotechnology will provide a new window on the human brain. Tools and chemical agents for visualizing biological structures and processes. Biosensors to track brain functioning. This is all work that's already being done. I'm not making this up. These are the articles that we pulled out of the database. Imaging devices for observing nerve growth and regeneration. Instruments for measuring neural signals. Why is this important for public policy? Remember back what I said earlier. 

Public policy ultimately is human behavior. Human behavior is ultimately what's going on between our ears. No, I'm fine. Thanks. When you begin to look, and this took me by complete surprise when Ron approached me and said have you ever thought about neuroscience and public policy? And I said no. I have never thought about neuroscience and public policy. But I will. And I started to think about the domains of public policy that we were working on at La Follette. And I said, you know what? If we knew more about how the human brain functioned, that would have implications for every single domain of public policy that I can think about. So just some illustrative examples. 

Criminal law. Under what condition is a defendant mentally capable to stand trial? This question has vexed the legal system for centuries. Thanks to neuroscience it will continue to vex them, at least for the next few decades. I'll say more about that in a minute. When is a person's judgment impaired? I read a fascinating article about environmental stimulants, environmental chemicals, that were being applied to people's lawns that were being breathed in, for example, by the mailman who was delivering mail, short-circuited certain brain processes that impaired impulses that prevented impulse behavior, short-circuited those pathways, and people were literally committing murder without having any clue why because of these chemical transformations that were going on. Retirement. This is a huge one right now. We're having a big debate about 401(k) plans and how do you structure choices about 401(k) plans so as to encourage people to save adequately for retirement because what? Because we've gotten rid of all of the pensions. So you actually have to save your own money for retirement. All of you are young, pay attention. 

There will not be a pension in your life. Save money. I can talk like this, right, but public policy folks are trying to figure out how do you create policy, structures, that will make it much more likely for you to actually save for retirement. And knowing what's going on in your brain will help a lot. Education. How does a human brain learn at different stages of development? How should we organize curricula to match this development? In Canada they've had a very interesting program to actually revamp K-12 curricula based on new findings from neuroscience about patterns of brain development. We're having a different set of debates in the United States. I could go on and on about these kinds of questions. Let me give you two examples. So, you have a growing consensus in most of the world, thanks to neuroscience findings over the last quarter century that show that brain development is not complete until roughly the age of 25 and that the last things that happen in brain development, pay attention again those of you under the age of 25, is your impulse control. 

So it's not that kids are just naturally, well it is that kids are just naturally impulsive, but in particular the parts of the brain that adults, I evaluate my kindergartener as if he had a fully developed brain with full impulse control. But he doesn't. So there we have an evolving legal consensus as a result that we shouldn't execute kids in the judicial system because of that change in how we think about the development of the human brain. Just an example. Here's another one. Cass Sunstein and Richard Thaler have written a very influential book called Nudge which is being widely applied in public policy circles around the globe in which what they argue is that we should structure public policies so that the default choice structures associated with those public policies match the biases inherent in our mental pathways so that what we will do by default is what the policymakers want us to do. So here's a good example. This is a recent policy proposed by David Cameron, the prime minister of the United Kingdom, based on some research of a colleague of mine in the psychology department at ASU. And it's about energy efficiency. And what my colleague discovered is that if you compare, if you give people information that compares their energy consumption to the average of their neighbor's energy consumption, they will change their energy behavior to match that average. 

So, in other words, if, like in this particular case, the person is way, way outside of the bounds, this person in all likelihood will reduce their energy. Once their bills start showing them that they're way out of bounds, they will, as a social norming process, come right into line. Now, the problem is if it was the opposite, if the person was the green, they will also come into line. So that's not so good. So what do you do? This is actually the wrong smiley, but you put a smiley face on it. Bingo, you got them. The research shows, very clear, this research is being applied by utilities all across the United States at the moment to get you to change your energy behavior through this idea of nudge. But, of course, nudge is a relatively controversial idea as well. Not because they're taking away your choice but because they're creating choice architectures that are not being deliberated, that are not being democratically decided. So you have, essentially, bureaucrats in Washington who are engaged in an exercise of creating policy outcomes based on the biases inside your heads and what they know about those biases. 

So the better our knowledge of the brain, the better our ability to exercise, as policymakers, control over the choices that society makes without, or so Sunstein and Thaler argue, infringing on their freedom because they could always not take the default choice even though the evidence is very clear. I don't have the slide, I wish I did, but I saw one very recently that was brilliant. So in Europe, organ donation, you all know you can sign up for organ donation on your driver's license. So the slide had eight countries, all of which are culturally identical, not identical but very similar in central Europe. You start by looking at four of them which have 10% adoption rates or opt-in rates for organ donation. 10% of the people in those have signed up for adoption, for organ donation. You then open up the other half of the slide, the other four countries have 90% sign-up rates. And the only difference is whether you had to check the box to opt-in or opt-out. Turns out we really hate checking boxes and that's it. And if you know that ahead of time you can control whether you get 10% enrollment or 90% enrollment in a public policy program. 

Now, it's not that simple, David. I know. But this is the kind of work that people are beginning to do to try to think about how do we change significant policy behaviors. So let me go on to brain repair.  The idea of brain repair is, I think, for most of us relatively straightforward. It's the idea of curing diseases associated with either infection or trauma or breakdown or genetic flaws associated with the human brain. And there's a lot of work that's going on in this space from drug delivery to brain implants and so forth. Deep brain simulation and other areas. I want to talk about two kinds of policy challenges that arise in relation to this, however. So one is what I call the challenge of the colorblind squirrel monkeys. 

So squirrel monkeys naturally do not see red/green color differences. Not important for their evolutionary survival as a species. But in 2009 there was a report of a group of scientists who did gene therapy on squirrel monkeys to enable them to see red/green color differences. They cured these monkeys, who were never sick in the first place, of red/green colorblindness. That's how the article was presented. So this medical overlay was being presented on the idea that we were going to genetically engineer a whole species to cure them of their naturally evolved inability to see these color differences. So why is this important for people? Well, it's important for people and for public policy because we operate in a market-based healthcare system in which the more drugs you can sell, the more money you will make as a pharmaceutical industry. And so there's an awful lot of redefinition that goes on around medical diseases. So I take, on a daily basis, medicine for asthma, cholesterol, and allergies that 25 years ago I would not have taken. My physiological state would have been considered normal and not medically intervenable. 

But the drug companies have seen me and people like me as a market for their drugs. And so we see in other cases, like social anxiety disorder, like ADHD, significant programs to deliberate, strategic communication exercises both with the public and with doctors to expand the range of disease categories so that we can market more broadly these kinds of drugs. There's a second piece which comes out in this movie that we watched earlier, which is this idea once we also begin to entertain the idea of human enhancement. So, for example, and I'll say more about the drug Modafinil in a minute, Modafinil is a cognitive enhancer in that it allows you to stay sharp in your focus and your concentration for long periods of time. The military loves it because you can send people on 72-hour missions and they don't lose cognitive focus during those missions. It turns out middle management in highly competitive businesses love it, too, for all of those all-nighters that you have to pull in trying to stay ahead of your competitors. So the question is, as we begin to adopt these kinds of technologies, will we put ourselves into a position where the species typical functionality of the human is no longer adequate? In which we begin to sell based on a lack of competitiveness of the standard human model, so to speak. So another example of this comes in when we talk about deaf people and cochlear implants. The real question, I think, is, are deaf people disabled or do they just speak a different language, as Oliver Sacks pointed out to us. Because we don't make the French get implants so that they can speak English. 

Right? But we do have policies and there have been some bad instances that fortunately have not ultimately ended in children being implanted with cochlear implants against the will of their families. But there have been moments at which the state has sought to intervene to force families to implant deaf children with cochlear implants. Families with deaf parents because a lot of deafness is genetic. So these are important questions that I think we need to grapple with even in the case of what seem like relatively straightforward medical questions of brain repair. So, the final piece is brain enhancement. Cognitive enhancement is on the agenda today partly because of what may come in the future but partly because of what's already here. Ritalin has transformed our school systems. For many kids, it's done really remarkable things about enabling them to stay focused on school. For many of them, it's also enriched them greatly because they sell this stuff off-label after they get their prescription filled. There have been surveys that suggest at major universities that anywhere between 25% and 50% of law students are routinely taking Ritalin off-label as a cognitive enhancement drug to study for exams. 

So I have a PhD student who is doing research right now on universities and the way in which they are regulating cognitive enhancement on campuses through policies to regulate the use of Ritalin. Modafinil, as I said, is also a concentration enhancer. It works in different kinds of ways. And obviously cognitive enhancement also raises important public policy kinds of questions that, among others, have to do with the distribution of benefits and risks and costs associated with these kinds of technologies. Who will have access to them and who will not? Should we place some areas of cognitive enhancement off limits? And then more subtle things. So, for example, back in the day when we wrote our Constitution, we had just rested our country away from an autocratic British government which ran on the basis of a hereditary aristocracy, and we thought we have to find a different way to allocate resources and to structure our society that's not based on an aristocracy. And we came up with the idea of a meritocracy, and for all kinds of things, college admissions being an obvious example, we operate on this principle of meritocracy and we've had a whole long-running debate in our court system about affirmative action precisely on the basis of people saying you let a person into law school who scored worse on the LSAT than I did, how is that fair? Because these ideas of meritocracy have become enshrined in our notions of democracy. So that's all fine and dandy if you can argue that that meritocracy is based on natural talents. But once you enter enhancement, bought technological enhancement into the conversation, it becomes a lot more confusing picture, and it really undermines a particular strategy that we have used for handling competitive policy distribution in democratic societies. So hard questions that go from straightforward public policy questions about distribution of resources to fundamental political questions about the structure of our democracy. 

So, what do Americans think? And this is my last set of slides, and they're pretty quick because we did a survey. 72% of Americans either don't know or believe that the benefits of cognitive enhancement will fail to outweigh the risks. So there's a steep uphill climb at this point in this general space. You are on the hook. The public trusts scientists about these issues and very few others, quite frankly, to protect them from the risks of neurotechnologies.  The public is broadly supportive of cognitive enhancement technologies that have medical benefits but not for others. So we asked a question about different kinds of applications of neurotechnologies. We even asked this one in two different forms, the artificial eyesight question. We asked it in a form that was purely medical: would you support this if it could be used to restore a blind person's vision? And then we asked it in a second form which was: would you support this if it could be used to restore a blind person's vision and it could also be used to enhance the performance of soldiers on the battlefield? The numbers were identical. This is why DARPA has been on a campaign of late, quite controversially, in which they have been saying in places like Science magazine, if this technology we're investing in, DARPA is the Defense Advanced Research Projects Agency, it's part of the Department of Defense. 

Its goal is to create technologies for warfare. Simple. But it has been saying, if the technology we're investing in has a medical benefit, then we don't have to tell you what the military purpose of our research investment is. This is why. Because they know that the public will support technology investments that have medical benefits associated with them even if they know that DARPA is also interested in that particular technology. This is a question that we asked to get at this issue of competition. So, the public generally opposes the idea of enhancing their children, we asked the question: would you enhance your child if it would enhance their ability to, A, get a job, B, play sports, C, take college entrance exams, or D, run for public office? So, generally the public opposes enhancing children, but if the outcome is economic competition, so it's about getting a job or getting into college, then they're more likely to support it than they are for sports, which is not surprising, I think, given the level of debate going on around the use of performance enhancement drugs in sports, or running for public office. So they really don't want political leaders who are using cognitive enhancement technologies to do better at winning campaigns, for example.  And, finally, the public is fairly convinced that enhancement technologies will reinforce existing socioeconomic divides. That these will not be leveling technologies. 

Rather, they will be technologies that will allow the wealthy to get further ahead. So I want to come back to this slide I had earlier because I think this is sort of the central point of the talk. The successful integration of mind and machine will be a profound accomplishment in the sense that it will, yes, undoubtedly, if we can make it work, cure lots of diseases, but in curing lots of diseases we will give ourselves capabilities and we will intervene in systems that have far greater meaning and import to human societies than just disease alone. So, with that, thank you very much. I appreciate the opportunity to be here. [APPLAUSE]