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Targeted Neuroplasticity Training: An Operational Neuroethical Risk Assessment,
Mitigation Paradigm, and Further Speculation
Aneesh Rahangdale
Dr. James Giordano
Abstract:
The program Targeted Neuroplasticity Training, TNT, is part of the BRAIN
Initiative, a White House program started in 2013 to bring advances in neuroscience and
technology. Development for TNT started in the Fall of 2016 under the BRAIN Initiative.
TNT augments cognitive function past the boundaries of current known limits to man. As
such, this Operational Neuroethical Risk Assessment and Mitigation Protocol
(ONRAMP) aims to determine what TNT should and should not be used for, what TNT
could be used/misused for, what could come about from TNT, and what should be done
to mitigate potential problems and concerns resulting from TNT. This assessment deals
with neuroethico-legal and social issues arising from TNT and suggests strategies for
dealing with the issues, ranging from continuity of clinical care to establishing programs
allowing for expanded access to the technology.
________________________________________________________________________
With neuroscience and technology progressing to an intellectual frontier, a
thorough examination of ethics must accompany the human race as we move into
uncharted territory. This comes in the form of optimizing various processes that involve
modifying humans. To detail modifications made to humans, one may differentiate
between types of enhancements which advance capabilities beyond normal levels. While
an enablement adjusts changeable physiology within the given situation of socially
common and constant activities, an augmentation aims to create a special and/or unique
modification (Shook & Giordano). To elucidate, an enablement hopes to bring about
inclusion and fully integrate individuals into society, while an augmentation allows for
specialized performance and can affect self, self-worth, and self-identity of persons,
requiring heightened ethical scrutiny. Pushing the envelope of the limits to mankind,
neuroscience and technology can alter neural functions to optimize aspects of cognitive
and behavioral performance.
Recent developments in neuroscience and technology recover memory, restore
cognitive function, and allow for improved prosthetics, and alleviate mental illnesses
such as schizophrenia and depression (National Research Council (US) Committee on
Military and Intelligence Methodology for Emergent Neurophysiological and
Cognitive/Neural Research in the Next Two Decades; Morrison). Additionally, the White
House commenced the BRAIN Initiative (Brain Research through Advancing Innovative
Neurotechnologies) in 2013 in order to further our understanding of the brain and
advance developments in neuroscience and technology (National Institutes of Health). By
researching how the brain functions, operates, and learns, the BRAIN Initiative hopes to
not only enable individuals to bring various skills up to par in their respective
communities but also augment individuals to perform at a previously unreached higher
level.
The Defense Advanced Research Projects Agency, DARPA, has a number of
programs under the BRAIN Initiative. For example, the Electrical Prescriptions (ElectRx)
program aims to help the human body heal itself “through neuromodulation of organ
functions using ultraminiaturized devices, approximately the size of individual nerve
fibers, which could be delivered through minimally invasive injection” (Defense
Advanced Research Projects Agency). In addition to this, DARPA is also developing the
Hand Proprioception and Touch Interfaces (HAPTIX) program, which seeks to create
neural-interface microsystems in order to allow amputees to feel naturalistic sensations
(Defense Advanced Research Projects Agency). Another project, the Neural Engineering
System Design (NESD) program, hopes to provide “unprecedented signal resolution and
data-transfer bandwidth between the brain and digital world” (Defense Advanced
Research Projects Agency). In conjunction with this, the Neuro Function, Activity,
Structure, and Technology (Neuro-FAST) program, seeks to learn more about how the
brain operates by visualizing and decoding brain activity in order to assess and address
threats to the human brain (Defense Advanced Research Projects Agency). Further,
DARPA hopes to create a wireless, implantable device that will recover and recall
memories and learned skills through the Restoring Active Memory (RAM) Replay
program (Defense Advanced Research Projects Agency). Additionally, the
Revolutionizing Prosthetics program seeks to improve functionality of upper limb
prosthetics (Defense Advanced Research Projects Agency). Moreover, the Systems-
Based Neurotechnology for Emerging Therapies (SUBNETS) program aims to treat
neuropsychological illnesses (Defense Advanced Research Projects Agency). While all of
these programs will likely work in conjunction with one another in order to effectively
and successively accomplish their goals, one program under the BRAIN Initiative in
particular stretches the bounds of the mind.
In the fall of 2016, DARPA began developing the Targeted Neuroplasticity Training
(TNT) program, with the aims of combining conventional training practices with
peripheral nerve stimulation in order to “boost the release of brain chemicals, such as
acetylcholine, dopamine, serotonin, and norepinephrine, which play a role in regulating
synaptic plasticity, the process by which connections between neurons change to improve
brain function during learning, in order to speed up the learning processes in the brain”
(Weber). TNT hopes to address the current problem of expensive and time-consuming
training of individuals in the Defense Department, especially because individuals must
learn a lot of information for the sake of the specific missions. Presently, those in the
Defense Department often take months at a time to learn new skills and information, such
as languages, foreign cultures, and symbols. With this new approach, Targeted
Neuroplasticity Training intends to speed up the learning process of cognitive activities
with the precise activation of peripheral nerves that can in turn promote and strengthen
neuronal connections in the brain. If successful, the immediate impact would be to
significantly save time and money in education and training of operatives by reducing the
amount of time and resources needed for the training of military personnel. The speed at
which individuals can learn and the retention of learned information will measure the
success of the TNT program. As of now, the organization of TNT includes 8 research
programs at 7 universities across the United States, which can be seen below in Table 1
(DARPA Public Affairs).
Table 1. Eight research programs at seven different universities across the United
States are investigating the capacities and capabilities of Targeted Neuroplasticity
Training (TNT). This research aims to optimize application of the TNT program with
respect to nerve stimulation, plasticity, invasiveness, and types of cognitive skills
affected.
Location of Research Goal of Research
Arizona State University Targeting stimulation of the trigeminal
nerve to promote synaptic plasticity in the
sensorimotor and visual systems of the
brain -- one group studying intelligence,
surveillance, reconnaissance, and another
group practicing marksmanship and
decision-making
Johns Hopkins University Focusing on regions of the brain involved
in speech and hearing to understand the
effects of plasticity on language learning
University of Florida (2) Identifying which neural pathways in the
brain Vagal Nerve Stimulation, VNS,
activates and the impact of VNS on
perception, executive function, decision-
making, and spatial navigation &
Optimizing VNS parameters around this
circuitry to accelerate learning
University of Maryland Studying the impact of VNS on foreign
language learning, particularly looking at
electroencephalography (EEG) to examine
the effects of VNS on neural function
during speech perception, vocabulary, and
grammar training
University of Texas at Dallas Identifying optimal stimulation parameters
to maximize plasticity, comparing the
effects of invasive versus non-invasive
stimulation, and investigating the longevity
of stimulation effects to determine if
follow-up training is needed for long-term
retention of learned skills
University of Wisconsin Measuring the influence of vagal and
trigeminal nerve stimulation on boosting
activity of neuromodulatory neurons in the
brain
Wright State University Identifying epigenetic markers of
neuroplasticity and indicators of an
individual’s response to VNS
As a program, DARPA is developing Targeted Neuroplasticity Training for
government officials and operatives of the US Defense Department, but this does not
limit the potential for this program to be mimicked or expanded for commercial use or
foreign military use. TNT presents a case of reverse dual use, which is when a program
initially developed for military purposes becomes corporatized for civilian use. As the
idea of TNT is rather attractive because of its potential to increase human productivity
and functioning, the chance of reverse dual use is rather high.
When developing any new neuroscience and technology, there are a number of
neuroethico-legal and social issues (NELSI) created by “imperatives for innovation,
novelty of approaches, limitations of knowledge, and resultant uncertainties of benefits,
burdens, and harms” (Giordano). By developing how and why Targeted Neuroplasticity
Training gives rise to such concerns, a preparatory paradigm for assessing, addressing,
and mitigating resulting NELSI can be developed. These issues can be a result of the
nature of TNT itself or a result of the use, misuse, or distribution of TNT in a social
context. In reality, these issues all are “interactive and reciprocal in effect,” thereby
requiring a multilateral, intersectional assessment (Giordano).
Issues from the inherent nature of TNT are the uncertainties in the effectiveness
of TNT, the safety of TNT, and how TNT will push the frontier of developments.
Additionally, these uncertainties are difficult to resolve until after TNT has been tested,
but this puts constraints upon informed consent, as nobody can study long-term
consequences of TNT until someone tries TNT. The extent to which TNT will improve
cognitive function is unknown at the time, and whether TNT will cause an unexpected
health risk – either in the short term or long term – is impossible to know without first
testing the program. Furthermore, derivative social issues highlight changing norms,
altered autonomy, personality, and/or sense of self, distributive justice, and legal
concerns. For example, varying psychological effects may be common amongst all
participants or dependent upon the particular individual treated, so determining whether
TNT affects autonomy may be trickier than assessing the first batch of treated
individuals. Additionally, establishing a way of making TNT accessible for many people
– as the product will probably be of high demand and thus elicit reverse dual use – will be
an important issue to tackle (Marchant and Gulley). Also, the concerns arising from the
nature of TNT can overlap with social issues; e.g. constraints upon informed consent can
present legal concerns. Nonetheless, by not only carefully monitoring development of the
program and actively informing participants in the Targeted Neuroplasticity Training
program of the capacities, consequences, character, and contexts of the research but also
continuously providing clinical care and developing cutting-edge research, we can
attempt to mitigate these NELSI.
Some technical and practical considerations, constraints, and concerns with the
program are more easily addressable than others. Easily addressable concerns include
whether there are enough trials and participants consenting to participate in the research
and how the program will identify an improvement in cognition due solely to the TNT
device (i.e. how confounding will be avoided in research trials). By performing double-
blind experiments with a sufficient number of trials, these concerns can be made moot.
However, the potential for TNT to improve in the future presents an issue for the
individuals who do not receive the newest edition of the Targeted Neuroplasticity
Training. Further, the prospect of unforeseen, long-term medical consequences because
of the treatment is a tricky concern, as these consequences are difficult to determine
without first performing the treatment on individuals. At this time, the best way to
address this issue is to support both the provision of TNT as well as the continuity of
research and care necessary for sound translation of the treatment.
In performing an Operational Neuroethical Risk Assessment and creating a
Mitigation Paradigm (ONRAMP) for the Targeted Neuroplasticity Training program, all
research and advances pertaining to TNT ought to abide by the ethical principles of self-
creativity (“the right of persons to recreate themselves to enrich their lives”),
nonobsolescence (“the duty to avoid the creation of obsolete people”), empowerment (the
duty to increase the capabilities of people to live autonomous and fulfilling lives”), and
citizenship (“the duty to promote free, equal, law-abiding, and participatory citizenship”)
(Giordano; Shook and Giordano). By respecting these principles, we may respect the
body, the self, and the person of the treated participants and ensure that the program
progresses in an ethically sound fashion by committing to preserving beneficence,
nonmaleficence, justice, and autonomy.
When considering neuroethico-legal and social issues, questions, and concerns,
the most useful protocol is in developing a dialectic approach. As TNT may affect the
self, self-worth, self-identity of persons, consciousness, agency, and the affected
individuals’ personality, the program will require heightened ethical scrutiny, as this
would stem from the very nature of the TNT program. Whether TNT would create a new
identity for those participating is a matter that is highly subjective to the particular
individual. Increased cognitive function and the ability to learn faster may create a more
enlightened and thereby entirely different individual if the program can augment certain
personality traits in addition to cognitive functions. To argue for TNT, if the treatment
can augment beneficial personality traits, people with the treatment may feel more
confident in themselves and more capable and non-obsolete. While people’s personalities
may change, the change may be positive, such as being more confident, understanding, or
resourceful. On the other hand, the argument against TNT can highlight that people with
the treatment may feel their self-worth attached and dependent upon the TNT program.
As a result, TNT would also be negatively affecting individuals’ sense of agency by
disempowering them affecting their sense of self-creativity. Also, there is the potential of
people’s personalities becoming different in a negative way with increased cognitive
function; an increased since of nonobsolescence and agency with the program could lead
treated individuals to become arrogant, dismissive, vindictive, or manipulative.
Determining the effects of TNT on personality a priori is difficult to do before treatment,
as there may not be a significant effect on an individual’s personality and how the
treatment affects certain people may likely be on a case-by-case basis.
While TNT can affect many aspects of the self and potentially expand the
possibilities of the human brain past known bounds, there inevitably will be limits of
TNT’s effects. As TNT will increase cognitive function with electrical stimulation to the
peripheral nervous system, whether the effects will continue or fade away after
implementation is to be determined. If the effects fade, this program could lead to
individuals feeling the need to have the device to learn anything else after using the
device. Further, there most likely will be a point at which TNT will not be able to boost
cognitive function any further without new research and development. These issues
describe post-enablement syndrome, which is when affected individuals will feel disabled
without TNT or discouraged when a peak where performance cannot get any better is
reached (Shook and Giordano). At this point, treated individuals will need to be
accommodated or included back into regular society, which may yield a series of various
effects.
One potential solution is reversibility in contexts of discontinuation of effect for
cause, as to allow treated individuals to assimilate back into society without any potential
judgment from being cognitively advanced. Nonetheless, this solution may be more
problematic, as affected individuals may feel disabled without TNT, leading to various
aspects of post-enablement syndrome. In addition to this, affected individuals may have
trouble assimilating back into society after being treated with TNT, or worse, treated
individuals may refuse to go back to not having augmented abilities. If this becomes the
case, the presence of a few augmented individuals could cause a domino effect of people
clamoring for TNT and/or an elite military-industrial class of geniuses, unless this
program is corporatized and brought to the market. Furthermore, treated individuals who
have an older version of the treatment may not feel accommodated or included with
individuals who have a newer version of TNT. Additionally, TNT-affected individuals
may be unable to cooperate or function on a normal, person-to-person basis with other
people who were not treated with TNT. At the highest level, even a widespread use of
TNT can lead to an eventual normalization of TNT that would negate the comparative
advantages of its application in the first place. While this would increase the baseline of
cognitive function, the norms and expectations of productivity also would increase.
While much speculation can and should be done for the potential consequences of
the research and its translation with regards to reverse dual-use, the direct consequences
resulting from the military application of Targeted Neuroplasticity Training should first
be considered. There will be a reduced timeframe for acquiring necessary skills for
operatives in the US Defense Department, which may translate to decreased costs. As
such, the direct argument for TNT is that the program is economically and strategically
advantageous to the United States. On the other hand, when speculating consequences of
TNT further down the line, many of the above concerns become apparent. The argument
against TNT, even in just considering the consequences of the military employing the
technology, can highlight its potential short-term risk in leading to overspecialized
operatives and exploitation of employees by the state department and its potential long-
term risk in changing many aspects of civil-military relations.
By framing the conditions and goals under which the TNT program ought to
function, an Operational Risk Assessment and Mitigation Paradigm can be prescribed in
order to address, assess, and mitigate technically and socially derived ethico-legal issues
with regards to relative benefits, burdens, risks, and harms. As TNT can improve the
process and speed at which individuals learn various cognitive functions, the premise for
the technology is established. However, the capacities of TNT and the extent to which
this program can improve cognitive learning is not yet known and is currently being
assessed in research trials (Pellerin). When considering the neuroethical argument for
TNT, this void of knowledge is fascinating as much of the capacities and capabilities for
TNT and its application are yet to be explored. Nevertheless, the argument against TNT
could frame this lack of knowledge as problematic and dangerous in that we do not know
the extent to which the treatment will increase cognitive abilities and affect treated
individuals. Yet, the project is much like a catch-22 because we cannot know the full
capacities and constraints of TNT before pursuing the program, but as a result, we cannot
fully inform those participating in the research of the full extent and capacities of TNT.
As such, considering the character of the research and how its products may affect
individuals and communities is extremely relevant.
At the moment, Targeted Neuroplasticity Training is being developed exclusively
for military personnel through the Defense Advanced Research Projects Agency to
optimize functional goals. One may argue that augmentation of beneficence that may
result from TNT augmenting good morals in individuals and allowing individuals to have
more freedom in choosing what actions to take may yield empowerment, as the program
allows operatives to have more time available to accomplish more good things with their
time. Further, this can allow treated individuals to feel more nonobsolescent and creative
because of these augmented skills and morals. Another may argue that TNT could create
an elite military class of geniuses that may threaten the regular citizenry of our country
and even democracy. To mitigate this concern, the Department of Defense can restrict
access to TNT and establish strict legal parameters and limitations for the use of TNT
devices. Establishing context in which Targeted Neuroplasticity Training may be used
within various situations, institutions, and socio-cultural contingencies can mitigate many
of the ethical conundrums.
While this research is initially being developed exclusively for certain operatives,
there is the potential of the commercialization of this technology. In fact, the likelihood
of commercialization of this technology is very high, considering the appeal of
potentially becoming smarter, more productive, and better as a human. Looking at the
past, in the military/medical silos there is considerable non-intentional permeability and
directly intentional permeability that enables “leakage” into other domains of possible
public use, such as with Cooperative Research and Development Agreements (CRADAs)
in which colleagues from government, business, and academia join together to pursue
common research and/or to develop and leverage research and development efforts, and
with the internet (Office of Technology Transfer, Office of Intramural Research, National
Institutes of Health; Leiner, Cerf, and Clark). With regards to TNT, this history suggests
that commercialization is ever more likely to occur. While keeping TNT extremely
restricted to the military is the easiest solution to deal with the slew of resulting
neuroethico-social and legal issues, addressing how to deal with the commercialization of
TNT is prudent, as this is highly probable.
This expansion and dispersal of TNT may further improve the condition of our
human race. Augmentation of cognitive abilities can augment autonomy,
nonobsolescence, self-creativity, and empowerment, as increased knowledge as a result
of this program can allow persons to recreate themselves in never-before-realized ways to
enrich their lives. On the other hand, commercialization as a means of distribution of
TNT could widen the socioeconomic divide between classes in the United States, and, at
a larger scale, between developed and developing countries, as the rich and privileged
would have easy access to the technology while others may not have that same access to
TNT. In addition to this, there are many types of potential public health scenarios
requiring attention with the application of TNT. With TNT, the capabilities of humans
will expand past once thought boundaries, but there may be unforeseen medical
consequences down the road from using TNT – perhaps epileptic seizures, as repeated
electrical stimulation of neurons in an unnatural way may wear on the internal intricacies
and homeostasis of the brain. Another plausible situation is for a lack of TNT treatment
to cause depression, as individuals may perceive themselves as inadequate and feel
obsolete. In the socioeconomic sector, TNT may worsen already wide income gaps (Cobb
and Stevens). Within a developed country like the United States of America, the
socioeconomic divide can deepen between the rich, who can afford this treatment and
thus accomplish things unimaginable to those without the treatment, and everyone else
who does not have access to the treatment.
One way to mitigate these potential issues that is not restricting access to TNT
and banning its commercialization is to establish strict legal parameters and limitations
for the use of TNT devices. Perhaps, the commercialized version can be a limited version
of the full-fledged technology in the military. Further, the US could establish government
welfare programs for distribution of TNT devices to underprivileged communities by
surveying socioeconomic status domestically and distributing TNT through health
insurance, welfare, or other public facilities, and this may even provide more jobs.
Nonetheless, orchestrating such a massive government program will require a political
and bureaucratic reorganization of available government assets and funds.
Internationally, the US can assist other countries in developing their own forms of TNT
to allow wider reaching access by sharing the infrastructure for the technology with those
other countries. Ultimately, making TNT more accessible can address the potential of
gigantic divides.
Continuity of clinical care and research to address and manage effects of TNT
will be paramount. If arguing for TNT, this expansion and continuous improving of TNT
is necessary to further improve the condition of our human race by becoming more
intelligent and efficient. Additionally, augmentation of cognitive abilities can augment
autonomy in individuals by allowing them more freedom in choosing what actions to take
and empower treated individuals, allowing participants to feel more nonobsolescent and
creative because of these augmented skills and morals. To avoid making others obsolete,
those employing TNT should strive for as much distribution of access as possible to
allow for justice. If arguing against TNT, one may highlight the large monetary costs of a
continual revamping of the program. TNT can render both non-participants and initial
participants in the program obsolete, as the initial participants could become obsolete if
not cared for and treated with upgrades given to later participants and non-participants
could become obsolete for not partaking in the program and thereby not becoming as
useful or efficient. In the same vein of thought, if this costly continual treatment of those
affected is necessary and the number of people treated with TNT increases, the cost will
continually increase, as well. Whether the benefits of the program, such as increases in
productivity and decreases in the time to learn information and skills, would outweigh the
costs of the program is difficult to determine a priori. Establishing strict legal parameters,
limitations for the use of TNT devices, and government welfare programs can allow for a
marketization of TNT. Further, assisting other countries in developing their own forms of
TNT and including consistent checkups to assure continuity of clinical care will be key in
the implementation of the program. Nonetheless, the most important aspect of the
application of TNT, whether the program is strictly limited or expanded, will be consent.
Consent will be paramount in integrating TNT in both clinical trials and military
personnel application. By ensuring continuity of clinical care and access throughout the
entire TNT program and allowing participants to opt out at any time upon receiving
updates and upgrades, the Targeted Neuroplasticity Training program can ensure proper
and legitimate consent.
As much is still unknown about the capacities and constraints of TNT, at this
time, the best way to promise fully informed consent would be to restrict access to TNT
to specified individuals with military clearance. As the program develops and more
information about the technology is elucidated, establishing legal parameters and
limitations for the use of TNT devices can protect treated individuals. As such, extant
ethical principles might not completely capture the specificity and diversity of aspects
necessary to guide use-in-practice, particularly when considering both community and
more cosmopolitan applications.
TNT has the potential to change the way the world functions in scientific
research, military application, and corporate efficiency. Still, caution and strict limitations
ought to be enforced if TNT is commercialized. Furthermore, constant therapy and
continuous medical evaluations should be conducted on test participants to ensure no
major negative changes are happening to the core parts of the human, e.g. personality,
consciousness, agency, and self-worth. While an effort to make TNT accessible should be
made if TNT is expanded, distributing TNT domestically will require large bureaucratic
changes to government programs, and establishing TNT internationally will be even more
strenuous, particularly with the divide between developing and developed countries.
Above all, continuity of clinical research and care for affected individuals will be of the
utmost importance. As technology improves and expands, the use of Targeted
Neuroplasticity Training and other biotechnological programs seems inevitable, but
employment of such programs must be sufficiently careful and cautious.
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