Monika Redzisz: Elon Musk has announced recently, that scientists from his start-up, Neuralink, have created an implant prototype which, when implanted in the brain, will connect to external device in broadband speed. Is this actually possible?

Professor Marek Harat: I find it hard to imagine. Every thought, command, incentive in the brain is an electrical impulse. A spike lasting for fraction of a second, difficult to register. And only a portion of these reactions happen in the cerebral cortex. Apart from this, there are many brain areas where impulse recording is impossible. Science still doesn’t know what particular areas of the brain are responsible for, where certain connections that decide on a particular course of action are.

We still know little about the brain, so I don’t believe that this kind of solution is around the corner. But we need visionaries. We need to be courageous by challenging ourselves.

You have been inserting implants in your patients for 20 years. How do they work?

We call them stimulators. Thanks to them we can stimulate the brain to work better. Unfortunately, at this point we can only block the areas of the brain overly stimulated by a disease. The cell membrane is charged positively to the outside, negatively from the inside. The implant leads the electrons to the external cell space, so it hampers neuron conduction and takes out the activity in this area. For example, in Parkinson’s disease we have impaired movement, shaking, increased muscle tension. During an operation these symptoms subside right before my eyes. It is fascinating. From one second to the next, a human who was shaking so much that it was difficult to keep him on an operating table, lies peacefully, crying tears of joy.

Is the patient conscious during the operating?

Yes, I need to communicate with him, only the top of the head is anesthetized. There are no nerve endings in the brain, so I can insert an electrode with ease. We talk. I ask how he feels.

How does it feel – to touch the brain of a live, conscious human being?

When I did it for the first time, as a medical student assisting my professor in operations, I had a feeling I was taking part in something extraordinary. The realization that the brain is what makes humans unique. I even had a feeling I was transgressing the taboo, something sacred, a secret inaccessible to most.

This doesn’t surprise me. When we realize how complex the human brain is, how many billions of neurons it consists of, it’s difficult not to classify it as a miracle…

Yes, but it gets routine with time. Now, during an operation, I focus on the task at hand.

What can be seen with the naked eye?

The brain is surrounded by meninges – membranes that protect it. After opening the first layer, we can see its outline, through the second membrane, the so-called arachnoid meninges layer. Only after cutting through the layer, can we clearly see the brain. We see its whole architecture: furrows, twists, scars, arteries, vein arteries and the capillary network. It is beige. One can see it’s alive, it moves along with the pulse and breathing. It is somewhat rubbery upon touch.

Professor Marek Harat at the Neurosurgery Department, 10th Military Research Hospital and Polyclinic in Bydgoszcz.

I’ve got to ask this question: can you point to a place, where our self-awareness, our consciousness, is born?

I won’t be so bold. Consciousness comprises billions of connections in our brain, it probably isn’t associated with one area.

Is it possible to observe significant individual differences?

No. There are no visible traits which could tell us that someone is evil, good, smart, or stupid. Emotions, pain, stimulation, they can’t be seen.

Is the location of functions in the brain constant?

It is changeable at times – the so-called plasticity of the brain, really important in the rehabilitation process. But when I perform the procedure, I must know where the cortex responsible for movement, speech and sight are located. More or less, because I get to know the exact boundaries during the procedure.

In what way?

I momentarily send an electrical charge to a given point – and observe, for example, if a patient stops speaking. This means I am not supposed to touch this area. I put the electrode a millimetre to the side and I see a facial muscle spasm. This tells me that damaging this area will cause a facial muscle weakness. I know that the move I am about to make will determine if this person is going to be healthy, or disabled. Image research is helpful, of course – functional resonance or positron emission tomography. But, ultimately, I uncover this extraordinarily complex system with my actions.

Neuropatic pain is the kind of pain which can dominate everything and life becomes unbearable. The implant blocks pain pathways and restores equilibrium.

For example in the case of treating the neuropathic pain. Usually the pain informs us that something is happening, for example that we are holding our hand in the fire; we have to be aware of it to save ourselves. Neuropathic pain is something abnormal. It arises from the damage of the pathways which conduct the impulses from the damaged area of the nervous system to the sensory cortex. As a result it hurts all the time. This pain can dominate everything and life becomes unbearable. The implant blocks pain pathways and restores equilibrium. But, what’s interesting, is that it blocks the worst pain by placing the electrodes on the motor cortex, and not the sensory cortex. Science can’t conclusively explain why it is so.

Does a stimulator once implanted stay in our brain for good?

If we can control the symptoms of a disease, then yes. The stimulator is recharged through the skin. We had to remove the implants only in cases of failure, when patient did not feel any improvement or when inflammation complications occurred.

Does the stimulator work non-stop?

Usually, yes, but we can program it to work only during the day. Certain states, such as epileptic seizures, are preceded by an aura, a set of symptoms preceding the seizure. When the aura appears, a patient can turn on the stimulator on his own and prevent an attack. And if side effects manifest, such as numbing, he can momentarily alter the current intensity.

The patient himself? How?

Just like that – with a remote.

Don’t you have the feeling that the modern medicine is getting closer to creating a human-machine hybrid?

No. But it’s true we can interfere in the human organism more and more.

As an expert with practical experience, what do you expect from engineers working on implants?

To increase treatment effectiveness, miniaturization is necessary. At the moment, the electrode cross-section is 1.4 millimetres, the whole implant is the size of a matchbox. It is a large foreign body which is conducive to inflammatory states, and they are the main reason behind unsuccessful treatment. Nanotechnology will make my treatment more effective, maybe even using several implants simultaneously in several areas. I am confident that the work is in progress. The biggest implant-producing consortiums are searching for such solutions.

Don’t you have the feeling that the modern medicine is getting closer to creating a human-machine hybrid?

No. But it’s true we can interfere in the human organism more and more.

For patients, remote control of stimulation parameters would be really helpful. We could talk on the phone, and I would change implant settings remotely. Patients would not have to visit me every time, sometimes traveling hundreds of kilometres. For many people suffering from these conditions, it is a major problem.

As a first doctor in Poland, you performed a psychosurgical operation and inserted an implant in an individual with obsessive-compulsive disorder. It raised ethical questions how far we can infringe on human personality.

Yes. The operation was being streamed on live television. It did not make my job easier, but since the matter was a controversial one, everything had to be done with absolute transparency. Thankfully, it was successful. The patient responded well to treatment. After 20 years, he could finally discontinue medications and start living normally. This opened the door for me to perform other operations.

World Health Organization estimates that in 2035, depression will be the most common condition affecting humanity. According to careful estimates, over 20 percent of patients are resistant to pharmacology and psychotherapy. An improperly treated depression is a lethal disease. These people can be helped…

Apart from patients with severe depression, I operated on obese people as well. And again: the obesity was not caused by disregarding the diet, but by the damage to the brain. Satiety centre wasn’t working. These people were insatiably hungry, regardless of how much they had eaten. So hungry, they stole food. They lived on the fringes of society. Today, after having been implanted, they live normally: studying, working. They control themselves.

You are interfering in human psychology, surgically influencing the world of human emotions. Where does the boundary lie?

It would be unethical to create a perfect human, forcing him to adjust to societal expectations. I do not do that. I treat only those who need my help. I long thought this boundary for me is treating aggression. Until I met a patient who was brought to me by her parents: she had her hands tied; a mask on her face. When they removed the mask, I realized this is a seriously ill person. She was experiencing aggression all the time, against others, but most of all – against herself. She was always trying to injure herself, gouging her eye out, biting off a piece of her body. I had no doubt her treatment was ethical; leaving her like this would be unethical.

There are increasingly complex computer programs being created that we call artificial intelligence. It’s an aim, an idea to which we aspire: to mimic natural intelligence. Do you believe this project has real prospects to be implemented?

It is difficult for me to speak on the topic, but in my opinion, the answer is no. I hold the brain in high regard, too high to believe the most complex organ in an entire universe can be replicated.

Professor Marek Harat is the head of the Neurosurgery and Head Surgery Clinic at the 10th Military Research Hospital and Polyclinic in Bydgoszcz. For over twenty years, he has been specialising in, among others, surgical treatment of Parkinson’s disease sufferers, implanting them with stimulators (he was the first Polish doctor who performed an operation of inserting such an implant in the patient’s brain). In recognition of his achievements in neurosurgery, the ‘’Poland Now’’ Foundation’s board of directors awarded him the title: ‘’Promoter of Poland’’ in 2018.

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