After watching the hit sci-fi movie “The Terminator,” I thought the concept of cyborgs was forever relegated to the realm of ’80s Hollywood imagination. Arnold Schwarzenegger blurred the lines between flesh and metal as an evil cyborg sent from the year 2029 to assassinate a woman whose unborn child was destined to save humanity. Part of the movie’s appeal to my younger self was Schwarzenegger’s robotic endoskeleton that allowed him to cut through buildings, run at lightning speed and hack into computers with his mind.
Little did I know, however, that a real-life melange of technology and brain tissue had begun to brew as early as the 1970s. Starting in 1969, researcher Jacques Vidal began the inaugural test of brain-computer interface development on monkeys at the University of California, Los Angeles. Brain-computer interfaces refer to any signal acquisition and processing technology that result in the control of an external device. Robotic limbs and electroencephalogram readings of brain activity are successful examples of BCIs in the current clinical setting. Vidal’s investigation was the culmination of a century’s worth of research relating the electric nature of a neuron signal to cognitive abilities, emotion and thought.
Then, in 2016, billionaire and serial CEO Elon Musk decided to invest in BCIs potential, founding Neuralink alongside a suite of engineers, scientists and investors. Neuralink is a BCI technology company determined to make implantable brain chips that translate human thoughts into device operation. From SpaceX’s Mars colony missions to Tesla’s electric vehicle revolution, Musk’s companies have never shied away from lofty goals. Neuralink is no exception and currently has two distinct ambitions: full development of the brain chip itself and the surgical robot that does the implanting. Both the chip and robot have not only been cleared by the Food and Drug Administration for clinical trials, but was also successfully used on Noland Arbaugh, a 29-year-old quadriplegic patient. After the robot needle punches 1,024 electrodes across key areas of the brain, the coin-sized chip decodes a person’s neural activity into commands for a smartphone to follow.
Arbaugh, who is paralyzed from the shoulders down, received the chip in January and has since been able to play chess, learn Japanese and play video games all with his mind. In a nine-minute live stream on X, Arbaugh cited that despite being paralyzed, he felt a greater sense of autonomy and control over his life.
Beginning last September, the company officially announced participant recruitment for the PRIME study, or Precise Robotically Implanted Brain-Computer Interface study. The six-year-long trial, which is exclusively recruiting patients with quadriplegia from cervical spinal cord injuries, is committed to developing devices to restore autonomy to those with unmet medical needs.
Neuralink’s biggest competitor, Synchron, has already implanted devices into 10 patients and, as early as 2021, had people posting on X using their thoughts alone. The arms race for the best BCI has subsequently embroiled Neuralink in a host of scandals, including improper transportation of contaminated devices and primate abuse. Pressure from Musk himself caused Neuralink scientists to rush surgeries, which allegedly led to the preventable death of pigs and monkeys.
Musk isn’t just in a hurry because of competitors, but also because he has lavish goals for Neuralink BCIs. Unsurprisingly, his vision expands far beyond the disabled community he banks on as conduits for the company’s success. Musk has pivoted away from the original mission of BCI to say that Neuralink will serve as a point of symbiosis between humans and artificial intelligence in order to protect humanity from AI. Leading up to the founding of Neuralink, Musk has always maintained that AI has the potential to be the most disruptive force in history. He also suggested that he may reapportion Neuralink resources to create BCIs for surveillance and military applications. This use of their technology is conveniently left out of Neuralink’s current marketing strategy structured around quadriplegia-driven altruism, where AI and surveillance have no relevant place.
Additionally, the company has not positioned its BCIs to complement traditional and low-cost support systems or accommodations available to quadriplegic people, such as accessible public infrastructure or testing accommodations. Perhaps, BCIs could help activate handicapped buttons to open doors or replace the need for a Scantron during an exam.
Regardless, the PRIME study brochure notes that in order to be eligible for the study, participants must have a reliable caregiver due to the invasive nature of the robotic surgery and chip upkeep. This implies that BCIs will not be accessible to low-resourced quadriplegic people when it hits the market.
The Neuralink implantation procedure and chip are also not nearly compatible with the demands of Durable Medical Equipment insurance coverage. This is because Musk focuses the company on aggrandizing device features, rather than addressing the basic limitations of quadriplegia. More than $464 million of Medicaid spending went toward DMEs, representing 20% of all Medicaid spending. Researchers note that this percentage is much lower than it should be because of a lack of medical necessity properly conveyed in DME insurance claims.
As Musk continues to shift the technology’s image away from assistive medical devices and toward catalysts for grandiose superhuman abilities, his attitude about BCIs will only exacerbate the already tall tasks of attaining DME coverage for Neuralink technology. He has already left quite a paper trail by tweeting far-fetched claims that Neuralink BCIs could one day cure mental disorders, create quasi-vision for the blind and reinstate hand and leg movement in quadriplegics. This is especially unfortunate, considering that Neuralink BCIs were targeting more visible diseases like quadriplegia for a reason — they are well-understood, researched and easily pathologized.
Because all brains are different, a standardized brain chip threatens to erode the individuality of quadriplegic patients and their unique needs. Though Neuralink has guaranteed full autonomy to control affiliate devices, at what point does that intrude on the various cognitive profiles of disabled patient populations that cannot be coached to think in a way compatible with BCI recognition? For young quadriplegic people, which comprise a significant portion of all paralyzed people, exclusion criteria are already met. Amid BCI competition, litigious accusation and Musk’s AI dreams, it is clear that the quadriplegic community simply deserves better. The crux of BCIs centered the fundamental, medically driven need for disabled people to participate in technology use. Elon Musk cannot frame Neuralink as a panacea for addressing disability-related challenges while harboring visions that leave the disabled community out of the picture. The issue of exploiting inclusivity transpires in different technological feats, and Neuralink is a clear perpetrator.
Moses Nelapudi is an Opinion Columnist who writes about healthcare and medicine. She can be reached at nelapudi@umich.edu.