As I was driving to work the other day a story caught my attention on WBUR, my local NPR station. Apparently the Defense Advanced Research Projects Agency, or DARPA, is launching a $70 million program to help military personnel with certain key psychiatric disorders using electronic devices implanted in their brains. These devices will first sense abnormal brain activity and then deliver electrical impulses to certain parts of the brain that would suppress the abnormal signals. My first thought was “ouch”. My second reaction was “It’s 1984 all over again”.
As a physician with a long-standing interest in neuroscience, this wasn’t my first exposure to implanting devices in the brain, but it was my first exposure to DARPA. Apparently the Defense Advanced Research Projects Agency (DARPA) was established in 1958 “to prevent strategic surprise from negatively impacting U.S. national security and create strategic surprise for U.S. adversaries by maintaining the technological superiority of the U.S. military”. Wow—that’s some pretty heavy stuff. How come I didn’t know about it? I decided to do a little investigative work.
Apparently DARPA created the Systems-Based Neurotechnology for Emerging Therapies (SUBNETS) program to pursue advances in neuroscience and neurotechnology that could lead to new clinical understanding of how neuropsychological illnesses manifest in the brain and to advance therapies to reduce the burden and severity of illness in afflicted troops and veterans. DARPA is known for taking on big technological challenges, from missile defense to creating a business plan for interstellar travel. In 2013, the agency announced it would play a big role in President Obama’s initiative to explore the human brain.
This new program will fund development of high-tech implanted devices able to both monitor and electrically stimulate specific brain circuits. The effort will be led by scientists at the University of California, San Francisco and Massachusetts General Hospital. I guess this is supposed to be our “moon shot” in neuroscience.
When we talk about moon shots, I think it’s important that we think about the nature of this type of endeavor. It’s clear that man has been thinking about going to the moon long before we had the means to do so. An 1865 novel by Jules Vern titled De la terre à la lune (from the earth to the moon) first envisioned the task of sending humans to the moon. In retrospect his speculations were remarkably accurate. After all, sending someone to the moon might have been inspired by a rock thrower a hundred thousand of years ago. It’s merely a matter of throwing a larger object a little bit farther—the basic principles are the same.
I can certainly empathize with an effort to help our soldiers deal with our current epidemic of PSTD, depression, anxiety disorders, traumatic brain injury (TBI) and drug abuse problems. If implanting something in their brain fixes these problems, count me on board. But in this situation we clearly aren’t dealing with throwing the rock a little bit farther–basically a physics problem. Instead we are dealing with biology and the brain. It’s important to remember that biology is complex in a way that is even hard to explain. We have all these physical laws that apply neatly to the world of inanimate objects, yet in the world of biology they quickly fall apart. We don’t even know how to define life, let alone how to apply these laws to living beings. Life is certainly complex and the brain is at the top of the heap when it comes to complexity and life.
Apparently these implanted devices will be capable of measuring the electrical activity of individual neurons. That seems pretty impression until you realize that you could measure the electrical activity of all the billions of neurons in the brain and it wouldn’t bring you any closer to understanding how the brain actually works. To understand why, let’s look at where we are today when it comes to diagnosis and treatment of brain disorders. We do understand that the brain’s electrical activity is important. Electroencephalography (EEG) was discovered by German Psychiatrist Hans Berger in 1929. This is the test where they attach multiple electrodes to your head and measure brain wave activity. This type of test can tell you whether or not you have seizures and whether or not you are brain dead and that’s about it. The test is still a cornerstone of Neurology today.
DARPA is also planning on using electrical impulses to “fix” damaged brains. It sounds like a good idea because we already use electricity to treat various types of brain problems. Electroconvulsive therapy (ECT) is already widely used to manage treatment resistant depression. In this therapy they apply enough electricity to your head to cause a seizure and when this happens depression seems to get better in some people. We don’t have a clue why this works. These patients often end up with side effects like memory problems. Can anyone say: “Shooting a mouse with a shotgun”? Smaller doses of electricity have been helpful for treating depression and other disorders using a technique called cranial electrical stimulation (CES). It seems to be helpful, but again we don’t know why it works.
Deep brain stimulation (DBS) involves planting a stimulator and battery pack in the brain. This combination is called a brain pacemaker. This device has been used to treat Parkinson’s disease, chronic pain, major depression, Tourette syndrome and other difficult to treat conditions. Although these treatments can dramatically improve the quality of life of some patients, we don’t have a clue why it works when it is effective and it can have serious neuropsychiatric side effects.
If you’re not so much into frying your brain with electricity, you might give transcranial magnetic stimulation (TMS) a shot. In this technique they use powerful magnets applied to the head to alter brain activity, hopefully in a positive way for people with depression and other common brain disorders. Again we are clueless about why this may or may not work. All of these treatments work in some patients, yet to date we don’t know why. DARPA is telling us that first they are going to answer the “why” question and then they will provide the “how to fix it” answer. Good luck with that!
When you take an objective look at where we are today, to me it looks like we haven’t moved very far beyond that ancient art of trepanning where circular holes were cut in people’s skulls presumably to treat mental disorders over 40,000 years ago. It was done with a sharp rock and no anesthesia. How many ways can you say “ouch”?
This effort to improve treatments for these disorders was inspired by the abysmal results of drug therapy. As a clinician I am a slave for results, so if DARPA has a better approach, let’s take careful look at the benefits and risks. I am also a slave to common sense and this approach doesn’t come close to passing the common sense test. Lets back up for a moment. When confronted with complex challenges it sometimes makes sense to look for simplicity. Let’s look at the soldiers who are suffering from these disorders that were rare a generation ago and epidemic today. It seems like wherever you go today where there is war we find a high incidence of TBI, PTSD, depression, anxiety disorder, substance abuse disorder and similar conditions. On the surface this makes perfect sense, especially to those of us who have never been to war. Putting people in harms way in a very stressful environment is bound to lead to problems—that is until it doesn’t. Humans have been brutally killing each other since the dawn of mankind without a high incidence of these disorders until recently. We need to know why.
One thing we do know is that the incidence of PTSD, TBI, depression and substance abuse appears to be rapidly increasing in he members of the armed forces who have participated in recent wars. This epidemic is now overwhelming the VA medical system, likely leading to the recent VA scandal involved long wait times for Veterans. It’s little wonder that DARPA has been assigned the challenging task of turning around this mess. After all, DARPA played a key role in developing the Internet, GPS and the Star Wars anti-missile technologies, so why not fix brains?
I hate to put a damper on DARPA, but the simple answer is because we don’t have a clue about how the brain actually works. Thus it will next to impossible to fix things with our existing knowledge and technology regardless of how much effort and money we throw at the problem. So is it time to give up? Of course not–if DARPA really wants turn this ship around, I have a safe, simple and cheap answer–Let’s change the diet of all the folks serving our country. In my humble opinion we should be looking at this type of “Grandma knows best” option before implanting electronic devices in people’s heads. We don’t need some secretive government agency to tell us that our modern diet of highly process food (HPF) is toxic to our metabolic and brain health. This diet is clearly driving our current epidemic of insulin resistance, obesity and type II diabetes. Recent research has also shown us that many common brain disorders are co-morbid with these metabolic disorders.
It makes perfect sense that if your metabolism goes south for a long enough period of time, your brain will eventually take a hit. In recent years we have come to understand that the brain takes a hit very early in this process. In other words, when you eat that Twinkie or Pizza or guzzle that Coke or Pepsi, you are frying your brain today, not tomorrow. Although this concept is a bit radical, it is supported by a mounting tsunami of medical studies. We now even have a word for it. When you consume highly refined foods for a long enough period of time to change your brain, you have a disease called Carbohydrate Associated Reversible Brain syndrome or CARB syndrome. People with CARB syndrome can develop up to 22 brain dysfunction symptoms that overlap with traditional disorders like depression, ADHD, PTSD, bipolar disorder and similar conditions, creating a great deal of diagnostic confusion.
Now lets walk back through our present situation when it comes to soldiers and conflict. We send our brave men and woman into harm’s way and to make them feel “at home” we also send along McDonald’s, Coke, Kellogg’s, Pepsi, Pizza Hut, Red Bull and other American classics. Do you see a problem here? When you combine CARB syndrome with physical brain trauma, you end up with a brain that won’t heal. The same is true for traumatic experiences. This is a simple formula:
Emotional/physical trauma + Processed food = Brain dysfunction (CARB syndrome)
I hate to say it but we are wasting huge amounts of time and money thinking that implantable brain devices will solve these problems in the foreseeable future. Perhaps in 2084 this sort of thing will work out, but today the solution is at hand and it’s simple, safe and cheap–eat whole foods and stay away from processed food. We don’t need a moon shot to solve this problem—we just need a little old fashioned common sense and elbow grease. To me the headlines should read “DARPA Gets Duped.” You folks did OK with the Internet and GPS but your Star Wars missile defense wasn’t so swift. Do us a favor and stay out of the world of biology until the technology catches up. It’s just not your forte.
Instead of throwing all this money at DARPA to fix our brains, I suggest donating to NuSi, the non-profit started by Gary Taubes and Peter Attia to fund nutritional research untainted by money from the food industry. If you really want to make a dent in these common disorders in those bravely serving our country, I suggest putting service men and women on a mandatory Paleo style diet. This diet eliminates all toxic processed food yet provides all the nutrients our brain needs to function as intended. We control just about everything else in the lives of our soldiers, so controlling their diet wouldn’t be so much of a stretch. I guarantee you that over a relatively short period of time these common brain disorders would begin to improve and disappear in most soldiers. Those who continue to have significant problems could volunteer for DARPA’s brain implant program if they so desired. I suspect that this latter group would be very small.
It’s also important to remember that like the rest of our country, people serving in our armed services are plagued with an epidemic of obesity and associated metabolic disorders. Implanting devices in their brain will have absolutely no impact on these metabolic disorders, but following a Paleo style diet will almost certainly eliminate or curtail these common metabolic problems. Now that’s something to get excited about—killing two huge birds with one stone! If you don’t like full Paleo, give the Mediterranean diet a try. I’m not big fan of vegan diets but if you go vegan based on plants without processed food, your brain will likely do much better. Any diet that eliminates or curtails highly processed food will likely be beneficial in this regard.
My message to DARPA is: “Expensive, complex and risky” is OK in some venues, but in others “cheap, simple and safe” works much better. You folks don’t seem to deal in the latter. Perhaps it’s time to give it a look.