A recent piece on Wired.com brought me to the current issue of Neurosurgical Focus and Tadayoshi Kohno‘s interesting take on the potential necessity of, what he coins, “neurosecurity” – the protection of the confidentiality, integrity, and availability of neural devices from malicious parties with the goal of preserving the safety of a person’s neural mechanisms, neural computation, and free will. He suggests that as neural implantable devices become more complicated and develop wireless capabilities nefarious hackers may try and exploit these devices to alter, block, or eavesdrop on neural signals. Although Kohno admits this is a problem of the future, not the present, “the consequence of a breach in neurosecurity – where human health and free will are at stake – is very different from a breach in computer security, where the victim is a computer on a desk.” He stresses the importance of thinking about neurosecurity in advance of the development of the technology and draws upon the Internet, and its myriad of after-the-fact security issues, as an example of what could happen if neurosecurity is not a critical consideration in the design of future neural devices. So what if it isn’t? Will the shelves at home electronics stores be stocked with anti-virus software for the brain? On a somewhat tangential note, and perhaps because I had recently watched this YouTube video of a woman experiencing alien hand syndrome after suffering a stroke, I got to thinking about brain-computer interfaces and the difference between the experience of a device being hacked into (for example, a prosthetic limb being controlled by another) and the experience of being hijacked by one’s own brain. Further, what really is the difference between dialing into one’s own implanted device to elevate pain relief by increasing the activity of the brain’s reward centers and popping a couple Advil? It’s all manipulation of the brain, is it not?
According to Dr. Michael Krausz, the LEEF Leadership Chair in Addiction Research, chronic substance abuse and mental illness are of critical concern and pose significant challenges, especially when they are co-occurring. Dr. Krausz recently brought his international expertise in concurrent disorders – the dual diagnosis of mental illness and drug addiction – to the University of British Columbia to address the crisis in Vancouver’s Downtown Eastside where addiction, psychiatric illness and homelessness are rampant. Hailed as the poorest postal code in Canada, the Downtown Eastside is a microcosm of social problems where overdose and suicide are the leading causes of death.
At the “Neuroethics of Addiction” conference Dr. Krausz’s message was clear – treatment availability and access to those is need is seriously lacking in Vancouver. Dr. Krausz stated that he views the current situation as ethically problematic. For instance, he stressed that people with addiction and mental health issues have the highest unmet need for treatment but are often excluded from medical care, have increased rates of mortality and are amongst the most stigmatized and socially marginalized of groups. They suffer from many health-related burdens including HIV/AIDS, Hepatitis C, suicide, addiction-related cancers and homelessness. Nevertheless, a general lack of treatment and support is available. It it Dr. Krausz’s hope that the BC Centre for Excellence in HIV/AIDS will serve as a model for the creation of a similar Centre for Excellence, to provide focused resources and structures to facilitate state of the art addiction and mental health research in Canada.
Dr. Krausz described the current situation in Vancouver’s Downtown Eastside as being in “crisis mode” and lamented that emergency care is an insufficient reaction to the increasing needs of the community. He stated that part of the issue is the misconception that addiction is a moral issue – bad people making poor choices and until the public at large realizes that addiction is their problem too, no real change will take place.