I'm sure they would if it helped relieve severe chronic pain. A limited period of relief is still better than zero relief.

I've seen videos at BCI conferences of deep brain stimulation implants which provide the patient with a "happy button" to relieve chronic pain/anxiety/depression/etc. They seem to work very well in a clinical setting, but the patient reactions make it clear that there will be an enormous potential for recreational use (and abuse).

I doubt overuse of a “happy button” brain implant is going to kill you; and I doubt it is going to end up in a similar legal situation to recreational drugs. So, whatever the negative impacts of overuse of such a button might be, I expect they’ll be a lot less severe than the opioid crisis

Maybe also if you pay a premium subscribtion the happy button can be pressed more often!

That said, I’d gladly stick my head in a microwave if it’s make a bad day more bearable.

Plenty of people live normal lives while on Suboxone, where they might have been living on the streets and doing things no one wants to do in order to obtain illegal opioids. A lot, if not the majority, of those people used illegal drugs as coping mechanisms.

Criminalization, lack of supply, lack of purity of substances and lack of public health treatment are really what makes opioid addiction a life threatening/ruining problem. Things like Suboxone address all of those issues, and the successful lives of Suboxone patients say a lot.

https://www.drugs.com/suboxone.html

That's a weird claim considering no one said that.

There are currently two long-term maintenance opioids on the market: Suboxone and methadone.

Compared to committing crime in order to afford a $200+/day heroin or fentanyl habit, regularly overdosing and/or living on the street, yeah, these drugs can be life saving and let people live normal lives.

They of course have their downsides, they're still opioids and you're still addicted if you take them, but they're legal, pure and given under controlled conditions, which seems to eliminate 99% of the life threatening/ruining effects of illicit opioid addiction. People can live functional lives on them, which given the alternative, is pretty nice. It also shows that drug use, under safe conditions, doesn't necessarily result in a long-term crisis.

That said, the only people who should consider long-term maintenance opioids are people who are going to die or end up in prison if they continue taking heroin/fentanyl/etc. The idea that "everyone should take this magical substance" is a joke that no one has ever claimed.

Furthermore, some argue that even medical use is over-regulated, to the point that people with genuine needs for them are being denied them by doctors who have become overly hesitant to prescribe them out of fear of the regulators. (Of course, if these claims of excessive hesitancy are true, that hesitancy itself is not a cause of the "opioid crisis", maybe rather a consequence of it; instead, that hesitancy would be a contributor to the "pain crisis" which has been with us since the dawn of time.)

One thing I personally find shocking - in a number of Australian states (and I believe the same is true in some US states), terminally ill people in severe pain can legally request assisted suicide – and yet, they can't legally have diamorphine (heroin) as a pain treatment, despite evidence that in some cases it is actually a superior pain treatment to any other opioid available.

Claims made by government agencies in some countries (such as the US or Australia) that diamorphine has "no legitimate use in medical treatment" are simply falsehoods. In some cases, it is the best clinical option. Those cases may be relatively rare, but they aren't non-existent, and to continue with an absolute ban on its clinical use (despite the fact that other jurisdictions, such as the UK, use it clinically with no major issues) is totally unjustifiable

It’s one thing to die from doing something stupid—it’s something else entirely to inflict pain and hardship on others.

Would they do that if the government just gave them the drug they are addicted to for free? I don’t think so.

Is the real problem then the addiction, or the public policy context in which the addiction exists?

Of course, I wouldn’t want to be addicted to opioids, even if the government gave them to me for free, due to the potential negative long-term health consequences, and also potential negative impacts on cognitive functioning which may in turn limit one’s educational/career/life prospects. But I don’t know if being in such a scenario, even if millions were in such a scenario, would be a “crisis” in the same sense that opioids currently are

It is unsurprising that if a person is addicted to substance A, trying to substitute it with substance B, which has different properties (even if chemically related to A), doesn't always work. The real solution is to supply them, legally, in pharmaceutical quality, and for consumption under trained supervision (whenever safety demands that), the actual drug they are addicted to, not some substitute.

> High quality government heroin/pills and supervised usage would likely work but it’s clear the US would never consider that an option.

Okay, but if you aren't willing to seriously consider every possible solution to a crisis, that makes your stubbornness a major part of its cause. Government drug policy is a huge contributor to the crisis, and if the government isn't willing to make major changes to its drug policies, the crisis is likely to continue, and the government deserves every blame for that.

Now, if you provide a "safe injection/usage site", that attracts the "black market" dealers. Seemingly, that also attracts other "undesired". Take, for example, the problem of homelessness where I live. It is actually difficult to remain unhoused. But, the care demands "no alcohol", "no drugs", "no violence". And a lot of customers do not like those terms and rather live on the street.

Government to blame? Do we not live in a democracy?

An addiction needn't kill you to destroy your life.

The better outcome for this technology is a user-settable mood regulator, not a user-pressable happy button.

https://www.northpointwashington.com/blog/big-pharma-big-lie... is an interesting article about this in the context of Oxycontin. One detail I find particularly interesting is that Purdue pharma marketed it as a 12 hour pain killer when the data clearly only supported it being good for 8 hours... leading to increasingly stronger doses being prescribed rather that admit the 12hr guideline was wrong.

This is debatable. Here's a legal drug that kills 3 million people a year

https://www.alcoholrehabguide.org/resources/medical-conditio...

Here's another that kills 7 million people per year

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast...

Note that I'm mostly for legalized drugs. I just have heard this data and I don't have an answer to it. My impression is I just take it on faith that less criminalization will be a net positive but I don't know that's for sure.

Personally I like the idea that people can take their lives in their own hands. As long as it's clear that they're opting out of the guiderails put into place for those of us who are more cautious.

But I mean widespread neural enhancements are probably as far away as… maybe not post scarcity society, but at least “I can get by on basic income” society. So I’m not too worried.

My assumption from your position on cognitive enhancement is that you'd support a separate category where your allowed to dope as much as you'd like?

Do we have any duty as a society to dis-incentivise people from pushing that too far?

We might find that there are some tasks where having people take on risky enhancements really helps “team humanity.” But certainly wouldn’t want “takes on risky enhancements” to become a trait required to get by.

I’d look at it as like minimum wage or OSHA. You could provide yourself a competitive advantage by working for less than minimum wage, or by being willing to work in an unsafe environment. But as a society, we’ve decided that engaging in that race to the bottom is not something we want to do.

You may already have heard of it but there's a movie called "Gattaca"[0] that questions a world where genetic enhancements have become effectively mandatory.

[0] https://en.wikipedia.org/wiki/Gattaca

I never saw the theme the movies is purported to present. I think Gattaca is conflated with other genetic-modification memes because it came out around the time those were current.

If the director wanted the movie to be about a hero, they fumbled it.

But rhey are not putting ut in rheir own hand, they are putting their luge unto rhe habds of a capricious and cruel, and occasionally fraudulent executive. Wonder, where did we see this play out before?

"renew subscribtuon or we turn off the implant"?

This will be a story of human rights abuses, debt ytades and endentured servitude.

https://en.wikipedia.org/wiki/Repo_Men

Especially the sorts of people who think they'll dead by 30 so side effects that show up in your 40's are no big deal.

This seems sorta like not letting 80 year olds have email because they don't understand it and might get scammed.

But not a year has gone by but I wish I had a time machine, not just for myself but for a friend who had big dreams when we were 16-26 and never found their way. Of the dozen smartest kids in our high school, one became a doctor (but married to the slacker in the group), one a lawyer, one a salty cynical programmer. I found one managing a movie theater a year after dropping out. One I imprinted on in college, because I thought she was so world-wise and knew what she wanted to be, ended up becoming a stay at home mom, never really had the writing career she hoped for. Student loans were part of that dynamic, which is another decision we put on children (see also John Mullaney).

You’re here talking to a group largely composed of people who won the career lottery. Did all of your college friends fare so well? How about high school? Hell in middle school and high school I had people trying to talk me out of software as a career because we were on one of the three AI hype cycles I’ve personally lived through.

It’s the rare, inspirational person who says Fuck It, I’m Starting Over in their thirties or even later. Many of the losers just live lives of quiet desperation. Those are the people I was thinking about above.

I think people deserve to control their own fate, disastrous consequences be damned. That's part of life, and always has been. To pretend that we need to protect against that type of insecurity is absurd.

I feel the same way, but with the opposite conclusion. The older I get, the more larval and innocent teenagers and twenty-somethings seem.

I mistake 25 year-olds for 17 year olds. When I'm explaining something, sometimes I can't think of a historical or technological analogy that a 25 year old is likely to understand.

I see the mistakes in reasoning that they're blundering into with the best intentions (and utmost seriousness) that could have been avoided by reading a little more, thinking a little longer - then realize I hadn't read that stuff by my early twenties either, and could have easily made the same mistake. Then I remember some of the mistakes I did make, and wish they had been harder for me to have made.

We don’t do this with gun safety, because the lesson comes too late and at too high a cost. There may be nobody to teach afterward. So we demand that they act a certain way and come down like a ton of bricks on anyone who fucks around.

But a medical implant isn’t just a personal decision, it’s a transactions with several other commercial enterprises, with financial interests in selling more of them. This will be the next heroin epidemic, or the one after that. It’s predatory. And as someone who has survived predators, it’s people like the three of us who have a moral obligation to watch out for predators while the children play. That’s part of the deal of being a pack/tribal mammal. It’s civilization.

So you're ok with startups hiring homeless people as test subjects, because they are poor and will consent to basically anything?

People who get neruo-tech, get it from highly vetted companies with a plausible risk-benefit tradeoff.

Speaking as someone who lived with chronic, daily, horrific pain for years before a surgery miraculously solved most of my problems - if that surgery had not worked or wasn't available, I would have eventually signed up.

Thousands or more people live with debilitating pain that drives them to suicidal ideation, drug abuse, and worse.

We already live in the future you describe and people turn to far worse things than neural implants to cope.

The key thing is that we won't be able to get much benefit from neural implants as an enhancement technology without solving this problem; there's a ton of potential value which will be left on the table because people are reasonably afraid of these risks.

You could have signed up only if excessive regulatory burden wouldn't have killed or prevented the startup from existing.

I find the whole "medical startups should support their patients post bankruptcy" train of thought very disingenuous: as long as we as a society make no public concerted effort to cure these people and leave them to the mercy of the markets, then surely some relief from their problems, even if temporary, is better than none, especially if it provides valuable experience that other more successful companies can use in the future for many more patients.

In view of these future possible patients, it would be downright imoral to burden such startups, which already take enormous risks, with unreasonable costs such as ensuring their devices function into perpetuity.

Yes, they should be regulated to not make the problem worse after they inevitably fail - primum non nocere. But most of the other ideas proposed in the article have a toxic effect on the business viability of medical startups, possibly preventing them altogether.

You also diminish the present value of the startup because the ability to liquidate IP after comercial bankruptcy is a factor reducing risk - investors get at least something back. If you dictate confiscation of that IP, you also reduce the willingness to invest in what already is a very risky proposition. And that's how you get to a 3 trillion ponzi bubble in crypto that solves no problem, while similar investment into medical startups would create thousands of products, treatments and long term wealth.

Sorry, but no amount of downvotes will make me accept a clearly populist and virtue signaling approach that will actively harm patients and discourage investment in medical innovation.

Virtue signalling? I call this "not being like dr Mengele"… if you think that's virtue signalling you are just a bad person.

He wants the patients to actually get their devices that make their lives bearable rather than these devices continuing to remain theoretical.

I am having a hard time treating investments as oxygen masks on airplanes.

Yes he did say that, but it's a false dilemma fallacy. Startups with insufficient regulation don't get you “devices that would otherwise remained theoretical”, they give you FTX and Theranos.

If you want to build a health start-up but cannot uphold basics ethical principles (like: do not abandon your patients on their own if your business plan failed), you should just seek another market.

I'm extremely glad that the types of people involved in crypto are in no way incentivised to do the same thing to the medical industry. Theranos was bad enough.

I'm not sure why you'd ever want to see crypto's web of scams and lies replicated in the medical industry. At least with crypto the harm is mainly limited to finances. When the grifters are peddling drugs and medical devices the consequences are much more dire.

> Sorry, but no amount of downvotes will make me accept a clearly populist and virtue signaling approach that will actively harm patients and discourage investment in medical innovation.

Not allowing bad actors free reign over people's health isn't populist or virtue signalling. The majority of these regulations were written in blood.

Sure, medical regulation should exist - I specifically mentioned the "primum non nocere" principle as the basis for that protection. Things like access to source code and right to repair, some guarantee the device can be removed and won't become actively harmful etc.

But some of the specific kind of regulation this article argues for are unreasonable to the point of killing the prospect of a cure.

The point of the crypto example is not that regulation is harmful, but that people respond to incentives - exactly the same investors have a choice between some sort of a MMORPG poker that is crypto versus a medical start-up. And guess what, they choose the "investment" where money is moved around and they have the chance to earn something at the loss of others, as opposed to the medical startup that could cure people but is - due to dumb regulations - more likely to lose money in the average/EV case. It's not me who brings the crypto madnesses into the medical field, it's whomever bombastically claims some irrational behavior from investors, while expecting them to foot the bill for medical innovation - that was the premiss of the comment you replied to.

When you count on the collusion of gamblers and oligopolists to take socially positive gambles you're already stuck in a dead end.

If the company goes bankrupt all IP will be released to the people. At least then motivated people can learn how to fix things.

That's what private companies currently do, and by relinquishing them to the government, the public has some say in what happens to them.

There are plenty of NIH patents that are licensed, and while some of the companies they're licensed to make my skin crawl, they're at least being used productively, and not locked away to be used as a cudgel in a legal racket.

Very likely unless some distribution or maintenance mechanism gets funded.

https://www.frontiersin.org/articles/10.3389/fmedt.2021.6965...

Desperate people who are willing to try anything to improve their lives.

Unscrupulous actors have been taking advantage of such people for millennia. You can see it happen today with the proliferation of quack doctors and remedies.

If your quality of life is so low, or you're facing death, taking a chance with experimental treatment might make sense in the moment.

This seems reasonable to me, and can be revised once we have a very good grasp of what actually happens with the technology after a few decades at least.

There's a 99% all of us will have to live with the consequences of it if we don't die young.

If someone gets a pain-killing implant or eye camera that goes off support after 5 years, how are you materially impacted for the worse?

This provides at least the tech basis for minimal right to repair/remove to other physicians.

Yes, because that went so well in oil/coal/agriculture/chemistry/electric vehicles industries, creating world-endangering practices and authoritarian moguls. What could go wrong when the mogul can shut down your brain.

It is funny to say the least that even here, a forum of a venture capital company, people expect "the government", the people, to give free money to companies. Has any VC ever given 1 dollar without expecting not only ROI, but ownership? Why doesn't the government own 99.99% of ExxonMobil, Nestlé, John Deere, DuPont, Tesla—they have been pumping venture capital for years, over a hundred in some cases? Right, capitalism, or with other words, socialism for the rich and powerful: all gain, no pain; privatize profits, socialize losses.

This public-private model never worked, perhaps it was never intended to. It's origin is the East India Company, founded December 31, 1600, who, for all intents and purposes, owned the world for a brief moment. Brief mostly due to lack of digitalization and communication latency (London-Bengal around 80 days). The last 400 years have been a stretch of this model, pushing again and again the location of the sweatshops: from the dimly lit, fumes-filled street in the city, to the ghetto, to overseas, as Thomas Smythe [1], governor of East India Company, originally intended. It is particularly funny we cannot even truly imagine a dystopic future where a company gets to own the world, where ownage is the same as helding hostage, for the next 10,000 years since every company is inherently suicidal, another word for something which grows every quarter: cancer.

Here is another solution: have a $1 trillion fund, gather some governments or ask nicely the Norwegian oil fund, fund the research and possible product development for the next 10 to 20 years, and have 100% of the technology be open, owned by all, with 100% of the profits going back to the governments/people. Companies Need Not Apply. You say this has never happened, it is unnatural? Sure it did, you see it right here in action, in this very language that I am using: could you imagine how it would be to have a company license the word "the", to have to pay a subscription for using certain "bundles" of words. Programmatic brain input/output is even more fundamental than language.

[1] "In 1620, Smythe was formally charged with enriching himself at the expense of the company", a true pioneer https://en.wikipedia.org/wiki/Thomas_Smythe#:~:text=In%20162....

Of course there’d be a guarantee: 5 years of security updates for your neural implant until you need new hardware.

Golly, that almost sounds completely fucking crazy until you realize it’s already their current policy for smartphones-which arguably already serve a similar role. That’s up from thee years previously. I think it was even two at one point.

I should have been a neurosurgeon.