|
iPlant
|
Welcome Deep brain stimulation of the reward system is increasingly being used to help patients who suffer from depression (Bewernick et al., 2010; Malone et al 2009; Schlaepfer et al., 2008), obsessive-compulsive disorder (Haq et al., 2011; Goodman et al., 2010; Huff et al., 2010; Greenberg et al., 2008) and other psychiatric conditions (Ackermans et al., 2008; Kuhn et al., 2007). The Reclaim implant developed by Medtronic Inc for example targets the nucleus accumbens and has recieved regulatory approval to treat obsessive compulsive disorder in the European Union and in the United States. This trend is expected to continue and has generated discussion about the possibility of using these deep brain stimulation implants to induce powerful feelings of motivation and reward (rewarding brain stimulation) in human patients (Synofzik et al., 2012; Oshima and Katayama, 2010). Rewarding brain stimulation has previously been used as a reinforcer to motivate rats to perform specific behaviours such as physical exercise (Burgess et al., 1991, Garner et al., 1991) and problem solving (Hermez-Vasquez et al., 2005). iPlant.eu is a science communication project that was created to provide a public forum for exploring whether and how rewarding brain stimulation might similarly be used to help people perform challenging behaviours. Specifically the aim is to provide concrete and accessible information and examples of how this might be accomplished and to use social media to promote public engagement with these ideas. The project is organized around the concept of an "iPlant" - a hypothetical deep brain stimulation system for delivering rewarding brain stimulation whenever certain challenging but beneficial behaviours such as physical exercise, learning or research are performed. Use of this concept provided structure and focus for communication and allowed discussions about iPlants taking place elsewhere on the net to be found and analysed. A range of opinions about the possibility of developing iPlants have been classified and used to develop the project further. The outcome of the project was presented at the 9th World Conference of the International Neuromodulation Society (Harris and Kilarski, 2009). Since then iPlant.eu has been more or less inactive, awaiting further developments in the field. Why is a project like this necessary? Deep brain stimulation The reward system Rewarding brain stimulation Rewarding brain stimulation in the human brain iPlants - Artificial motivation? Safety and ethics Fiction Site author Comments For up-to date information about rewarding deep brain stimulation and related issues follow @iPlant on Twitter or subscribe to the iPlant page on Facebook. There is also an iPlant channel on YouTube. The iPlant.eu website is written and maintained by Christopher Harris and is licensed under a Creative Commons License. Please reference the project "Harris, C.A. and Kilarski, L.L. (2009) A Novel, Web-Based Approach To Public Participation in Neuromodulation Research. 9th World Conference of the International Neuromodulation Society." 
Why is a project like this necessary? Rapid advances in science and medicine have led to calls for increased public participation in deciding the direction of research (Eurobarometer survery, 2005; Bucchi & Nerresini, 2004). But while scientists generally value public understanding of science few endorse fully the need for public participation in the scientific decision-making process (Royal Society report, 2006) particularly when such participation requires complex scientific issues be simplified or dramatized (Maeseele, 2007). Many scientists also avoid speculating on future research findings, their possible applications and societal impacts (Colingridge, 1980). Public participation in science when it does occur is often narrowly focused on risk and does not constitute a genuine discussion among scientists and non-scientists about the values, vision and direction of scientific progress (Maeseele, 2007). One symptom of this is that many research institutions fail to take advantage of the opportunities for public engagement in science offered by the internet and instead use the net merely as a tool for showcasing ongoing research (Massoli, 2007). This is particularly troubling at a time when news organizations are drastically reducing their science coverage and citizens are moving to the net as their primary source of information. These problems are clearly present also in deep brain stimulation research. Experts tend mainly to insist on proceeding with care (Fins et al., 2010; Kringelbach & Aziz, 2008) and in the words of one neurosurgeon speaking on Swedish radio in 2008 "hope we never get too good at this". In contrast the iPlant.eu project describes in detail a hypothetical advance in our use of deep brain stimulation technology and invites every reader and viewer to discuss, criticise and help develop the project further. Information about deep brain stimulation and the reward system is provided and several social media technologies including YouTube, Facebook, Twitter, blogs, web-crawlers, polls and forums have been used for communication.
Video from the International Neuromodulation Society
conference in 2009 (audio from the actual conference presentation is available
here)
Deep brain stimulation Deep brain stimulation is a surgical procedure in which small wires are inserted into the brain. The tip of each wire contains several electrodes that are used to modulate abnormal activity in specific brain regions. The operation currently takes 8-12 hours and costs ca €30.000 not counting the additional cost of regular follow-ups and battery replacement. Complications include bleeding, infection, electrode misalignment and damage to brain tissue during surgery. Deep brain stimulation is most frequently used to treat refractory Parkinson's disease, tremor and dystonia. In 2009 the Activa implant developed by Medtronic Inc had been used to treat more than 40.000 patients, making it the most widely used deepr brain stimulation implant. St Jude Medical is another prominent manufacturer of deep brain stimulation technology. 
Deep brain stimulation implant. Image by Medtronic Inc. The reward system The reward system is a network of neurons that attribute value to events. It is fundamental to attention, motivation, learning and volontary movement. Central to the reward system are dopamine-producing neurons located near the middle of the brain in the ventral tegmental area and substantia nigra. Destroying these neurons or blocking their activity severely impairs goal-seeking behaviour and learning. Dopamine increases signal-to-noise in neural activity and promotes synapic plasticity. Dopaminergic neurons extend axons via the medial forebrain bundle and into the frontal cortex, striatum, hippocampus and amygdala. The nuscleus accumbens in the ventral striatum receives particularly dense dopaminergic projections and is a central node in the reward system network. The dopaminergic neurons themselves recieve input from many parts of the brain including their forebrain targets. These inputs modulates the activity of the dopaminergic neurons and determine the what an animal finds rewarding. Rewards like food and sex are associated with sharply increased realease of dopamine (Schultz 2007) whereas low concentrations are associated with distractability and a lack of motivation (Cools & Robbins, 2004). Stimulants such as Adderall and Ritalin enhance attention by increasing dopamine concentrations and are used to treat attention deficit disorder. Other transmitters such as serotonin (Bari et al., 2010; Dayan & Huys, 2009, Jans et al., 2007) and adranaline (Sara, 2009) also have important roles to play in reward and motivation.
What is dopamine?,
Dopamine and the frontal lobes, Spontaneous and
dopamine-driven brain activity
Visit the dopamine fan page on Facebook
Dopaminergic projections in the brain. Image modified from CNSforum.com. Rewarding brain stimulation Strong activation of the reward system by current incjection is refered to as rewarding brain stimulation or brain stimulation reward. Targets for stimulation include the cell bodies of dopamine-producing neurons, their axons as they project to the forebrain along the medial forebrain bundle and their target regions in the ventral striatum and prefrontal cortex. One wireless implant developed for rats uses four electrodes to stimulate dopaminergic cell bodies and the medial forebrain bundles on both sides of the brain (Xu et al., 2004). It is also possible to make dopaminergic neurons light-sensitive activate them with implanted optical fibers (Bass et al., 2010; Tsai et al., 2009). Electrical stimulation of the reward system raises dopamine concentrations in the brain sharply, particularly in the striatum and frontal cortex (Garris et al., 1997; Fiorino et al., 1993; Bean and Roth, 1991), and animals work very hard to receive it. Rats for example forgoe all natural rewards including food and sex if given unlimited opportunity to stimulate their own reward systems by pressing a lever (see image) (Olds, 1958). Rewarding brain stimulation can therefore be used to motivate animals to perform difficult behaviours. Rats will run on treadmills, lift wheights and solve problems to recieve rewarding brain stimulation, and perform better than rats recieving natural rewards (Burgess et al., 1991, Garner et al., 1991, Hermer-Vasquez et al., 2005).
What is rewarding brain stimulation?,
Rat motivated to exercise through conditional rewarding brain stimulation,
Precise control of rat locomotion through rewarding brain stimulation,
Rat self-stimulation of lateral hypothalamus
 Rewarding brain stimulation. Image from Johansen (2005). Rewarding brain stimulation in the human brain Early attempts to use rewarding brain stimulation as a medical treatment (Heath, 1963; Moan and Heath, 1972) were discontinued but established that rewarding brain stimulation can be induced in the human brain. When given the opportunity to self-stimulate one patient "stimulated himself to a point that, both behaviourally and introspectively, he was experiencing an almost overwhelming euphoria and elation and had to be disconnected, despite his vigorous protests" (Moan and Heath, 1972). Today deep brain s). Today deep brain stimulation applied to the reward system (specifically to the nucleus accumbens) is increasingly being used to treat depression (Bewernick et al., 2010, Malone et al 2009; Schlaepfer et al., 2008), obsessive-compulsive disorder (Haq et al., 2011; Goodman et al., 2010; Huff et al., 2010; Greenberg et al., 2008) and other psychiatric conditions (Ackermans et al., 2008; Kuhn et al., 2007). However, the current that is applied is constant and is deliberately set at an intensity that induces only moderate feelings of happiness (Synofzik et al, 2012). Obviously a consta). Obviously a constant state of euphoria (mania) can be maladaptive and dangerous but, as the experiments with rats showed, occasional pulses of strongly rewarding brain stimulation can be used to motivate specific behaviours. iPlants - Artificial motivation? The term "iPlant" is used here as a shorthand for a hypotehtical deep brain stimulation system. This system would deliver rewarding brain stimulation whenever a specific behaviour is performed, thus reinforcing a person's desire to continue the behaviour. An iPlant could be used as a "motivation prosthesis" for beneficial behaviours such as physical exercise, learning or even research. To motivate execise rewarding brain stimulation could be delivered when for example a user pulls a stroke on a rowing machine or when pressure-sensitive sensors in his or her running shoes hit the ground. The health benefts of artificially motivated exercise might for a range of people outweigh the risks associated with deep brain stimulation surgery, for example in the treatment of obesity. Note that that deep brain stimulation to the hypothalamus has already been attempted to reduce feelings of hunger in human patients (Hamani et al., 2008). Rewarding brain stimulation could similarly be delivered when a user provides correct answers to questions posed by a computer programme designed to provide taining in foreign languages, mathematics etc. Such an application could be particularly useful for people suffering from learning difficulties. Indeed, rodent models of attention deficit hyperactivity disorder show increased sensitivity to rewarding brain stimulation (Johansen & Sagvolden 2005). More speculatively, iPlants might be used to motivate the simpler and more repetitive aspects of laboratory research. Participants with iPlants could volunteer a few hours every week to take part in iPlant-driven reserch. (A hundred volunteers working four hours per week could save an institution more than a quarter million euro every year and would free scientists up to pursue more challenging tasks.)
iPlant 101,
iPlant seminar
 Safety and ethics iPlants raise a number of practical and ethical concerns. The figure below shows the range of opinions expressed by people in comments around the web regarding the development of iPlants. Three concerns feature prominently and all hinge on the fact that iPlants depend fundamentally on rewarding brain stimulation being delivered if and only if the user performs a pre-specified beneficial behaviour. Some fear that users would find ways to circumvent such restrictions and self-stimulate unconditionally and endlessly or that malicious individuals might find ways to circumvent restrictions and take control of the behaviour of another person. Use of iPlants would clearly require that users have limited access to the settings of their implants, that such limitations are subject to robust encryption and enforcement, and that an accountable implant manufacturer, hospital or doctor is able to maintain access control without abusing the trust of the user. This leads to a second class of concerns, namely that governments or cultures might misuse iPlants by motivating citizens to engage in demeaning or dangerous behaviour, by forcing individuals to conform to for instance unreasonable standards of productivity, or conversely by being excessively cautious and restrictive in regulating the technology. These concerns indicate that development of iPlants should only proceed in the context of transparency, public participation and democratic debate, and under the oversight of appropriate civil rights groups and the UN's International Bioethics Committee. A third class of concerns higlight the negative impact artificial motivation could have on users' natural self-discipline. For instance, a person who exercises one hour per week before being fitted with an iPlant might able to exercise much more frequently with the aid of the implant but would also be tempted always to use the implant for motivation when exercising. Removing that one weekly hour of iPlant-free exercise might be psychologically damaging since regular exertion of effort is necessary for the maintenance and growth of self-discipline. This indicates that "iPlant-driven behaviour" should only be engaged in when the user would normally be idle or engaged in destructive behaviour. Again the need for a manufacturer, hospital or doctor able to ensure beneficial use of the technology without abusing the trust of the user appears crucial. 
Classification of the content of 145 comments regarding the development of iPlants. Fiction A few chapters on a novel were writen to explore the idea of iPlants further. In the novel, conditional rewarding brain stimulation is first introduced as a last-resort procedure to help morbidly obese patients exercise. The move is motivated by a worsening epidemic of cardiovascular and neurodegenerative disease, stemming from obesity and an aging population. Following success in a number of hospitals, the procedure is rapidly applied to a variety of patient groups to motivate a range of behaviours. As the efficacy and safety of the implants improve a growing number of clinically healthy individuals choose to obtain implants. Private clinics specializing in the procedure become increasingly lucrative. Ike, Meg, Lucy and the narrator Chris are reserchers in such a clinic. Their work is necessarily self-experimental. The novel begins with the public launch of the first "iPlant" - an advanced deep brain stimulation implant for inducing conditional rewarding brain stimulation, aimed at a general market. Unlike previous conditional rewarding brain stimulation implants the iPlant targets dopamine and serotonin nuclei directly. Four chapters are currently available. Foreword Chapter 1 - Program yourself Chapter 2 - iPlant-driven research Chapter 3 - New job Chapter 4 - Make your needs known
Chapter 1,
Chapter 2, Chapter 3 Site author iPlant.eu is written and maintained by Christopher Harris. Christopher is a doctoral student in neuroscience working at the University of Sussex. His work involves the use of multielectrode arrays to study how dopamine and reward shape neural networks (Harris et al., 2010; Spontaneous and dopamine-driven brain activity). You can download his CV here.  Email: christopher@iplant.eu Twitter: @chrisharris Comments Comments on the iPlant project were received on an almost daily basis prior to 2010. This was while new material was being produced and publicised on the site, on various blogs, on YouTube and Twitter etc. Most commenting and discussion took place on the iPlant YouTube channel, on the iPlant Google Group, on Christopher Harris' personal blog or on FutureBlogger. People also wrote direct emails and posted about iPlants on their own blogs, including these on Enogamez, Something Awesome, Technovelgy, Futurismic, Emerging Ideas, psique and Brain Implant. Since 2010 no new material has been produced and discussion about iPlants around the web has been largely absent although the videos on YouTube and the dopamine fan page on Facebook continue to attract interest. |