"If brain activity is suboptimal, the device provides a small zap, undetectable to the patient, to strengthen the signal and increase the chance of memory formation."
I always wonder if things like this are worded like so for the layperson to understand? Because to me it sounds like an incredibly crude and hackish way to do anything. "Yeah, just shock the brain and it forms better memories! We're not entirely sure how or why, or what the implications are, but it seems to work for some reason!"
You’d be surprised but that’s how a lot of medicine works. Your common paracetamol (Panadol) has a mechanism of action that is “not completely understood”. We’ve come a long way in the past 100 years but certain areas are still pretty much trial and error.
So much of medicine is like this. My in-laws are doctors and so many of their diagnoses eventually end up as "we have no idea what's happening, but these steroids should help. Why, we have no clue."
And yet doctors reject all manner of so-called "alternative" therapies on the grounds that they have no plausible mechanism of action.
A family member of mine had a somewhat-debilitating chronic condition in high school, which only got better with a combination of what today are garden-variety alternative therapies (acupuncture, elimination diet, et al). Today, as a doctor, pooh-poohs a lot of that stuff. It's confusing and disappointing to see.
There’s a difference between “we’ve observed in clinical settings that [random herb X] treats the problem, although we have no understanding of how it does so—there’s a bunch of chemicals in [random herb X] that could be the cause, and nobody’s sat down and pinpointed the pharmacodynamics yet” and “this has never been observed in clinical settings to differentiate from placebo.”
- "this has never been studied in a clinical setting"
- "this has been tested in a clinical setting and no differentiation was seen from placebo, but there was an issue with the study that caused that result, but lacking omniscience and epistimic humility we and those who take our findings as gospel are not able to know this is the actual state of affairs, and therefore might mistakenly conclude there is no effect, even though that does not logically follow from these findings"
Those two things fall under my second clause. "This has never been proven to differentiate from placebo" isn't "this has been proven to be indistinguishable from placebo." It literally just means "there's no solid evidence that it works." There might or might not be non-solid evidence; it might or might not have ever even been tried. But "we don't have any reason yet to suspect that it might work" is usually the best knock-down argument a doctor can give against something being worth trying (anywhere other than in a research setting.)
Also, re: the second point, you're talking about studies, but I'm talking about a much weaker criterion: whether any doctors have ever personally seen the treatment make a difference. There are a lot of things that have bad or no studies, but doctors swear by due to a mountain of shared-by-grapevine clinical anecdata. (Most treatments invented before the advent of scientific positivism, for example!) When something doesn't even have that, it's immediately suspicious—doctors really like talking about things when they work!
The statement “this has never been observed in clinical settings to differentiate from placebo” is ambiguous whether it has or has not even been studied - my statement eliminates that ambiguity.
> It literally just means "there's no solid evidence that it works."
There is nothing to indicate whether there is or is not any evidence at all, let alone providing any indication as to the quality of the evidence.
On one hand one might say this is excessive pedantry, or just "semantics", but this ignores the massive amount of epistimically inaccurate memes that are taken as "generally true" "facts" across a wide variety of subjects. I would argue the prevalence of this problem is starting to cause major rifts within society, sometimes manifesting in violence, including death.
I have never met a single doctor that has given me any reason to suspect they happen to possess the extreme levels of pedantic logic required to support the authoritarian judgements they've laid upon me when asking specific questions I've asked after performing significant research on my own. I don't really see why they should be any different than a typical overconfident human being.
And it's not just doctors that are the problem. One can observe that a lack of (or, a lack of use of) logical skills and understanding of epistemology are significant factors in many of the disagreements that exist in the world. Very few people seem to appreciate how limited our understanding of things outside of fields like math and physics that follow very strict rules.
The ambiguity is intentional; the statement is intended to capture all of those cases, because the differences between them don’t matter in practice. No studies, only one good studies, one hundred bad studies: they’re all conditions where the right response is “don’t rely on this as evidence until you’ve done more studies.” And, critically, the case where there’s a bunch of evidence against efficacy cannot be practically distinguished from those cases; it could always turn out that the study methodology was wrong and your N null results will be later countermanded by 2N+1 non-null results. You can’t prove a negative; you have to treat a negative the same as an absence of evidence. (Which, in practice, means treating an absence-of-evidence as a negative.)
> doctors deploying authoritarian judgements despite not being masters of logic
That’s because doctors don’t use their own judgement. Doctors are embodiments of a system mapping a symptom-recognition model (mostly random, gets better with experience; this is the part humans are better at currently) to a fixed, explicit expert system of guidelines built by panels who study meta-analyses to reach recommendations.
In psychiatry, for example, this expert system is reified in the form of a book called the DSM. Doctors don’t need to know why the DSM recommends what it recommends to be right by making recommendations using it; just like a soldier doesn’t need to know what’s over the hill they’re lobbing grenades at in order to be aiding in winning a war. In both cases, the commander giving the orders has better “line of sight” on the problem than the person on the ground does. (And, in both cases, usually information-retaining expert consensus techniques are used to allow the commander+advisors system to actually have a greater-than-1.0xhuman level of rationality.)
> The ambiguity is intentional; the statement is intended to capture all of those cases, because the differences between them don’t matter in practice.
If an alternative remedy is effective, in fact, it matters to people who could benefit from the usage, but have been told, or led to believe (through dishonest, vague, weasel language that "covers" or "captures" more informative descriptions) by doctors or acquaintances who lack skills in logic or epistemology.
> No studies, only one good studies, one hundred bad studies: they’re all conditions where the right response is “don’t rely on this as evidence until you’ve done more studies.”
Tell that to doctors and half-educated iamverysmart people who confidently assert that an "alternative" treatment does not work, full stop, as opposed to "has not been found to work in clinical studies".
> You can’t prove a negative
Correct. And therefore, you shouldn't speak as if you have.
> you have to treat a negative the same as an absence of evidence.
Incorrect. You could simply state what is factually correct, for example: "Herb X has not been found to successfully treat ailment Y in clinical studies. This should not necessarily be treated as conclusive proof that it does not, but at this time scientific studies have not found any evidence of effectiveness. Be wary of anyone who states otherwise, whether for or against the treatment - anyone who claims to have conclusive evidence either way is mistaken."
> That’s because doctors don’t use their own judgement. Doctors are embodiments of a system mapping a symptom-recognition model (mostly random, gets better with experience; this is the part humans are better at currently) to a fixed, explicit expert system of guidelines built by panels who study meta-analyses to reach recommendations.
Doctors (and the general public) should be informed of the difference between guidelines resulting from our current, incomplete understanding, and absolute facts. Very few people, including doctors, seem to realize there even is such a difference.
> Doctors don’t need to know why the DSM recommends what it recommends to be right by making recommendations using it
A recommendation and a statement of "fact" (without actual evidence to support the fact) are two very different things.
> In both cases, the commander giving the orders has better “line of sight” on the problem than the person on the ground does.
You have no way of knowing whether an individual patient may happen to have a factually superior understanding of a particular ailment than their doctor. This is a fine example of a lack of understanding of epistemology.
> And, in both cases, usually information-retaining expert consensus techniques are used to allow the commander+advisors system to actually have a greater-than-1.0xhuman level of rationality.
This statement is better, in that it expresses uncertainty via usage of the word "usually".
Yeah, sometimes people don't understand the difference between "we don't fully understand how/why it works" and "works just the same as doing nothing".
The difference is the ability to privilege a medical establishment that is in control of the clinical setting. Doctors don't like competition. There's really nothing inherently better about randomized control trials as a way of knowing; that's why it is wrong so often.
In my experience body workers outside the medical establishment (like massage therapists for example) have a lot of ad-hoc knowledge about the body and its ailments from years of observation of their patients.
This kind of knowledge is actually a lot like most of the real knowledge employed by doctors - the knowledge of the hands and lived experience rather than some study in a journal.
Do a well designed study and it won’t be “so called ‘alternative’” anymore. We may not know why various real medical interventions work but we have better than “I’ve got a cousin” evidence that they do.
I can't speak to this from personal experience, but I constantly hear the accusation that any sort of solid study on say herbals is going to cost millions of dollars, and that no big-pharma company would even bother to sponsor such a study because they can't patent the result (because it's an herb).
They could patent a delivery mechanism, or isolate some compounds from the herb that work almost as well (that's not exactly an unusual result either). These arguments fall down because they don't make any sense.
There’s at least one pot based drug on the market. So I think there must be some way to profit from medicines that were known anecdotally to be medicinal in herb form.
And, to their credit, they don't really have time to become good statisticians. Once upon a time I had a classmate who was an experienced anesthesiologist, but when it came to probability and stats he was as much of a scrub is anyone else in the room. Why would it be any different? He's spent his life learning and applying his field of practice, not someone else's.
That said, baaic statistical analysis and statistical intuition is a severely underappreciated skill. It's hard to see it almost totally neglected in American public schools, even ones that purport to have a strong focus on STEM.
Yes, that is very true. I'm sorry I didn't include that sentiment in my own post. But it does mean that you should press your doctors for information, do your own research, argue with your doctor if you do have a good handle on stats.
And also, it is very common to read on HN that you should not google and research your own medical issues but instead listen to your doctor, because they are a trained professional.
So many neurological conditions are treated the same way. Like Bell's Palsy. We don't know what causes it, we don't know how to fix it, but steroids help a great deal
Same goes for our theory regarding depression for instance. We say the cause is a chemical imbalance, but this has never been measured; same goes for many mental conditions since it's next to impossible to measure the causal element given it's happening inside the brain.
In particular, this shows that it's not that it's not been measured. It's been measured and not found to be an incorrect explanation of what's happening.
A huge amount of medicine, and especially neuroscience, is like this. Nobody really knows why ECT works, for instances. Similarly, I don't think the mechanism behind TMS is well understood: https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulat...
That's because ECT and TMS don't work and have never been proven to be safe and effective by clinical trial. They were "grandfathered in" by the FDA but don't actually work and cause memory loss amongst other terrible side effects. See http://emord.com/blawg/wp-content/uploads/2016/08/1-ECT-Citi...
You shouldn't conflate those two, as they're very different things. TMS is currently undergoing lots of trials.
ECT does have significant negative side effects, but it does seem to help some people. You may be right that it wouldn't be approved as a new treatment today.
Just a word of caution, keep in mind that all those trials are designed around very crude observation or short term duration.
Also, lot of things are going into trial that shouldn't.
That being said I do have an uncle with Parkison who had a neurostimulator implanted (DBS) 15 years ago. It worked quite well for a while, more than any medication at the time. It doesn't anymore, and he has lost cognitive abilities also, which is most likely due to the progressive nature of the disease, rather than DBS. This technique has been in clinical trial for 20+ years...
Side note regarding DBS: There's some interesting research in grafting a nerve (I could be misremembering, but it's definitely a nerve graft) onto the substantia nigra (a part of the brain that we know produces dopamine), and then doing DBS on that region. Early stages, phase I trial, but a neat idea nonetheless.
Yep that's cuz we practice Evidence Based Medicine. If it works, it works, we don't care for the mechanism. Mechanism of action is only ever a hypothesis anyways.
But as a 2nd point, we don't always do things by evidence either. Obstetrics is an example of an entire field where there is not much evidence, and people practice what was passed down to them. The reason is because often you cannot do an RCT in an ethical way with Obs.
Additionally, often times when we prescribe a medication/treatment, there is a really significant chance it won't do anything for you. The number needed to treat before one person experiences a benefit could be quite high, like 10 or 15. We still do it if the benefit outweigh the risk.
TLDR: We don't care how it works just that it works. Some fields like obstetrics have little evidence for many things. And just cuz there is evidence, doesn't mean it'll help most of the ppl who get it.
This is not Evidence-based Medicine. EBM does not say to we shouldn't care about the mechanism of action. EBM will say that treatments without a randomized control trial can only be weakly recommended. In a perfect EBM world, everything would be strictly tested. You're describing why we have trouble practicing "pure" EBM.
" He was the first person the Finn had known who'd `gone silicon' -the phrase had an old-fashioned
ring for Case -and the microsofts he purchased were art history programs and tables of
gallery sales." - not quite the same thing but we are on the way there.
Someday a method/implant will be invented to trigger the orgasmic response in the brain. Will be interesting to see how humanity handles that drug.
Reminds me of Star Trek DS9, where the Cardassian tailor had the brain implant to make him resistant to torture. He had turned it on, and left it on for 20 years, then it failed.
Larry Niven writes about a similar idea in Ringworld[1] called a "tasp". In the book, users are referred to as "wireheads", and it's said to be extremely addictive.
This isn't really what the Ringworld books are about, but it comes up a few times, and I think it's a pretty interesting plot device.
spoilers in this paragraph One of the gadgets in the series is a "wireless" form of this technology that works without an implant in the victim. It comes up several plot points as a form of either overt coercion (since the victim would almost instantly become dependent on the device), or more subtly by applying it to a victim without their knowledge to make them associate the sensation with being in the presence of the wielder.
This following is completely unfounded, but I think that it would become a stigma to those who got it.
We are all driven by chemicals and everyone has their own preference on how to release dopamine and any other chemicals, be it exercise, drugs, alcohol, anything you can imagine. Getting a button to trigger such a strong response would mean a certain division in society, those who seek pleasure the new way or those who want to keep with the traditional way.
Overall I think that facilitating this would give people a huge (maybe too big) escape from reality and would certainly be abused.
Robin Cook had a plot about this (triggering orgasm-like responses on brains) many years ago in his book Brain:
>Getting a button to trigger such a strong response would mean a certain division in society, those who seek pleasure the new way or those who want to keep with the traditional way.
Isn't this already happening to a certain extent--and progressively getting worse? I think there's an ever-increasing chasm between people who occupy their leisure time with digital entertainment engineered to be an easy--and highly addictive--dopamine fix, and people who try to enjoy more mindful activities. The latter option is, of course, incomparably harder.
The reward circuitry in the brain is very much fundamental to how we operate and what motivates us in life. This is why drugs can be so life destroying. People tend to restructure their life so that they can keep getting that reward, at the expense of everything else.
It's something that's maybe hard to understand unless you've done drugs. I used to go out raving and do MDMA a lot. At the peak I was doing it almost every weekend. Until I found myself going out alone and looking for opportunities to go out, even if nobody I knew was going or the party wasn't good. I thought I really liked dancing, but I eventually realized, my brain was looking for an excuse to put me in that environment where I would typically do drugs, even if I actually knew going out that night would be a shitty experience. In other words, when you mess with your reward circuitry, your brain will begin to "lie" to you to guide you back to situations where you will get more of that reward. Your way of thinking will shift, and you might not even notice.
I personally don't think there is any way that brain implants can hook into our reward circuit and be used in a safe/responsible way. At least, not if the users themselves have direct control. The only way it could maybe be used sustainably is to reward certain behaviors in a way that the person themselves doesn't have control over, but that's a whole other dystopian can of worms. Personally, I think brain implants might fuck up society beyond recognition. Imagine if people could turn their sex drive on or off at will, or stop themselves from falling in love, get over someone instantly, make themselves love their miserable jobs. Sounds great right? Except we'll stop being human, we'll become machines.
I was kind of hoping for a chip that interfaces with the brain. Stores data digitally and responds to brain's request for information. But that's probably the wrong way of thinking about it on multiple levels.
As someone with no knowledge of how this stuff works, I like to imagine that when you try to remember something, your brain sends signals the same connections that were formed when you last saw that thing. It then activates your visual cortex, your auditory cortex and language centers. So you visualize it, see the word, and hear it in your brain, then suddenly you feel as if you know the answer to the thing you were trying to remember.
It's thought of as occurring just as you described, but it's very difficult to prove it even in rodent models.
Also, humans are wildly diverse. Some people have aphantasia, where they cannot 'image' things in their heads. Invariably when you bring this up on HN, you get a lot of people saying they cannot believe this and a lot of people saying that this is their normal reality. Similar to discussions on synestensia (hearing colors, tasting names, other 'mix ups') and if you stand or sit when you wipe in the bathroom.
>“I don’t think any of us are going to be signing up for voluntary brain surgery anytime soon,” Sanchez says. “Only when these technologies become less invasive, or noninvasive, will they become widespread.”
Are you kidding? 15-37% improvement in memory formation/recall? Where do I sign?
The surgery needed to install the chip is itself detrimental to your IQ. The brain was not made to be exposed to air. You don’t get your skull opened up unless there’s no other option — these are patients who were already forced into this circumstance.
Could you not e.g. operate in an artificial vacuum using oxygen masks? If open skull surgery is so detrimental to IQ, why is this not done? I understand there's a cost factor but given the scale of medical expenses, it seems within the realm of possibility?
Because brain and other body tissues normally have internal pressure of 1 atmosphere, so if you put it into vacuum, it will explode and blood and other liquids will boil.
Could use argon in a vat shaped system and continuously push in more to wash out any oxygen following the tools. Could probably be done with very little oxygen touching the brain if we really want to build the tools.
"Your zuppa-memory license has expired. Please kindly give us one million dollars to upgrade, or your memory cloud contract will be terminated in four days and downgraded to our Finding Dory's free account". Please note also that, unless human brain, a ten years old chip is obsolete technology and could fail anytime.
You can do similar things with tdcs devices bought off amazon. There’s a lot of evidence that electric stimulation can affect many different parts of your brain depending on the electrode placement: working memory, long-term memory, depression, etc.
tDCS devices work in a similar fashion to how Strength-Shoes work (strength-shoes.com): a person is very interested in improving X -- they see an ad from a company selling product 'Y' claiming they have mountains of evidence and testimonies that Y really does help to improve X -- the person buys Y, convinced that it will help, and uses it every day while practicing X harder than ever -- after a few months the person shows decent improvement at X -- the person thinks, "wow, Y really worked" and shares this testimonial with the world.
Yeah I'm aware. 100% garbage science IMO. I'm not going formulate a long-form takedown of the entirety of tDCS literature, here in the comment section of a hn post. And so just take this fwiw-
About a year ago I was quite surprised to find out that a colleague, dear friend, and brilliant neuroscientist took a job as research director of haloneuro.com
I was not surprised at all when he told me a few weeks ago that he had resigned, and that tDCS was total BS. The CEO of the company had him running dozens of clinical tests in parallel; they would publish the few that supported tdcs and would file drawer the rest.
But by all means, feel free to run an electric current through your brain if you think it will help X.
Unless you are an expert in the field, I'm not sure why I should believe you. Of course companies are going to publish only results that look good. But a lot of scientists are going the pre-registered route, and claiming that hundreds of studies are wrong seems like it would require extrordinary evidence.
I just talked to my wife about this, she was doing some research tdcs research as part of her PhD 3-4 years ago. She say's that extremely precise electrode placement is necessary for P < 0.05 effects, so that might support your position that retail tdcs devices are largely bullshit. But the research isn't about commercial devices (largely), it's on lab subjects who have properly placed electrodes.
Admittedly, I'm not an expert in tdcs. My experience is limited to what might be considered the typical, prevailing, suite of neuro-electrophysiology methods: stimulating electrodes + glass pipettes into acutely sliced rodent hippocampus/cortex; same for organotypic slice cultures; in vivo implantation of multiunit recording electrodes + fiberoptics into rat cortex. I think these methods provide enough background in ephys to formulate an educated opinion on tdcs. Also note that I'm just as cynical, if not more, when it comes to research reports using those established methods I mentioned above. Suffice to say, it's not the methods that concern me, it's reports of some marvelous thing that happened while using such methods.
You are right though, the claims about the utility of these commercial devices (and really any non-implanted device) that are by far the most dubious.
Also, the plastic surgery and body modification industries exist without having to be non-invasive. People will risk death to just have a different shape of bum.
A consumer can still decide for himself if he has enough and the right education and set of mind.
An electronic device connected to a brain could inject thoughts without the carrier even noticing it's not the thoughts who are supposed to be saved/generated in this chip.
Now they have relative control over the majority but it's still not absolute - in my opinion that is a huge difference.
Agreed. The term 'neural lace' was coined by Ian M. Banks (as far as I know) but the concept of an implanted brain-computer interface which can augment brain function is decades old.
They are hiring for several technical and non-technical positions, e.g. Software Eng both Full Stack and Robotics, Mech Eng, Electrical Eng, Accountant, Talent Aquisition, etc.
If I lived over there I'd definitely consider it. Such a cool area of work!
I always wonder if things like this are worded like so for the layperson to understand? Because to me it sounds like an incredibly crude and hackish way to do anything. "Yeah, just shock the brain and it forms better memories! We're not entirely sure how or why, or what the implications are, but it seems to work for some reason!"