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An academic paper just changed my life. Don’t you love when that happens?
So, imagine you’re about to launch a Substack focused on two really specific things: Analyzing commercial markets for new brain technology, and exploring storytelling’s potential for better advocacy and guidance in this space.
“Too niche? Too nerdy? Too much? Too little? Too soon? Too late?”
Enter NAM
The National Academy of Medicine, that is.
“Neurotechnology and Noninvasive Neuromodulation: Case Study for Understanding and Anticipating Emerging Science and Technology” sprawls even more than its title. Its 30 pages (sans footnotes) are crammed with patient vignettes, a governance case study with a segment-by-segment analysis of transcranial direct current stimulation (tDCS), followed by guiding questions about ethics and societal implications.
Halfway through, a section titled “VISIONING” jumped out at me (emphasis mine)
“In an effort to probe the kinds of worries the authors have about the trajectories of emerging technologies, to expand the range of lessons learned from each case, and ultimately to “pressure test” the governance framework, the authors have developed a brief “visioning” narrative that pushes the technology presented in the core case 10–15 years into the future, playing out one plausible (but imagined) trajectory. The narrative was developed iteratively in collaboration with a case-specific working group, with additional feedback from members of CESTI. All reviewers are acknowledged in the back matter of this paper. Each narrative is told from a particular perspective and is designed to highlight a small set of social shifts that shape and are shaped by the evolving technology.”
(Specific authors listed in the working group roster)
tldr; The National Academy of Medicine commissioned a short story about neurotech to guide commercialization efforts.
My pre-launch jitters settled into a quiet hum as I turned the page.
A Story about Neurotech Futures
Excerpted summary, emphasis mine:
It is 2030, and BCIs (are) small, powerful devices that are now readily available to patients and consumers. These devices allow for the acquisition, interpretation, and translation of brain signals into commands that can be transmitted to another individual or used to control an external device (e.g., computers, prosthetics, and other devices).
Today, BCIs build on the early experience in the military, where prototypes were financed by DARPA and facilitated previously unfathomable image and data processing capabilities and focus among military personnel. This led to a rapid dissemination in the health care sector…applications, including stroke rehabilitation, cerebral palsy, and treatment of depression, Alzheimer’s disease, and ADHD.
The applications outside of clinical care are as unimaginable today as the iPhone was in 1990: BCIs offer the promise of better health, better memory, better concentration, and a more collaborative world. They have been broadly adopted in Silicon Valley, especially among companies in the SaaS sector.
The small size, modest cost, and user-friendliness of these devices, combined with provision of end-user control, led to widespread, though not uniform, acceptance. For example, devices could be turned on or off easily, and consumers were able to modulate and personalize the output (i.e., what types of brain signals can be transmitted). The fact that the military was an early adopter went a long way to alleviating fears about downstream risks for many employees.
One company chose to offer BCIs to its workforce (full-time employees and contract workers), and within the first 18 months, 90 percent opted to use it.
If you’re thinking, is this the setup for Severance Season 2, you have to remember that this was written by an elite cabal of experts in neuroscience, digital health, medicine, commercial research, and policy….not TV screenwriters.
Plot Summary: Unintended Consequences
Here is a quick summary of the case study:
What I liked about it
It exists! Kudos to the authors for trying to stretch their imagination and produce something thought-provoking.
Thoroughly (but not completely) imagined, with particular attention to use case, positive impacts, unintended and unforeseen negative impacts, off label use, social/interpersonal dynamics, societal fallout and ripple effects, equity and access are clearly articulated.
The lessons learned were copious and complete, offering a rigorous assessment of the case study/visioning exercise.
Where it fell short
My overarching critique is that this paper was too lengthy and complex to be effective as a piece of speculative analysis. By mixing in too many ingredients (most of them before the case study section), the authors overwhelm the palate. More specific nitpicking below.
Muddy Product: By mashing together the origins, descriptions, applications, and other details of the actual technology, the case study lost some clarity. There’s a whole multi-page section on tCDS, but then we switch to a nebulous, futuristic and all-powerful BCI that does…everything. A concise, self-contained product description is missing. What does it look like? What is it named? What do people call it? What is the name of the employer-sponsored program? How much does it cost? Where else is it available in society?
Out of Touch: In the lead-up to the case study, the authors cite “Mindstrong Health” as an example of where technology development is going. Whoops: Mindstrong went out of business eight months before this paper came out. Maybe this is a small, unimportant oversight. To me, a paper about technology commercialization should do a better job selecting real world examples.
Missing Leadership: Even in a fictional setting, a story that mentions no company names, no industry representatives, no investors or board members, and only nominal leadership from the employer in question, just feels…made-up. Cramming all of this into the lessons learned section avoids the responsibility of grappling with real-world consequences in the story itself. The most important part of the case study is supposed to be the consequences, the “so what.” The only people in this story are the victims, and that’s just weak writing.
Zero Accountability: This is a story in which people are harmed by neurotechnology and the government does nothing. The paper punts saying anything about the specific role of the FDA or FTC or DOJ in a scenario like this, in favor of a coy closing paragraph and some lessons learned bullets about how the government is behind the curve. Duh. To me, this was a major missed opportunity. The authors, who are some of the nation’s leading experts on regulation by the way, are implicitly asserting that federal agency leadership are unwilling or unable to play a role in this fictional scenario. Is that really the world they are imagining for us? Why not imagine a government that shows interest and takes action?🤔
No Heart - I HATE when a story leaves its characters hanging. By choosing to create harm to (fictional) end-users, but not addressing those harms, the authors demonstrate a critical lack of empathy and imaginative problem-solving. How were access gaps addressed, and by whom? How were adverse health impacts mitigated or reversed? How was off-label use eventually mitigated? A simple paragraph about how the employer, schools, company leadership, or clinical organizations mopped up the mess afterwards could leave the story - and the reader - in a much more solutions-oriented frame.
The authors, for all their pedigrees, are not fiction writers. My real issues with this come down to craft choices.
As writers, we make craft choices all the time. We choose what to include, and what to leave out. The choices we make that we are not aware we are making comprise our bias, our blind spots, and our limitations as storytellers.
Unintentional or not, the paper’s craft choices create a docile, hapless consumer class that are the unintended victims of not-yet-fully-understood tech rather than people, rather than a workplace culture, rather than an industry, rather than a society.
If a fictional scenario is afraid, unwilling, or otherwise unable to implicate a real world audience, it loses key functionality as a lens on the real world.
We’ll be exploring more speculative scenarios for neurotechnology in the coming months. My goal in writing these is not (just) to get on a soapbox; it’s to compile best practices and lessons learned. So please, send me your scenarios, thoughts, and questions.