Factors Mediating Public Perceptions of Therapeutic Closed-Loop Brain Implants for Epilepsy and Mood Disorders
Abraham Dada1, Bryan Chen1, Tobias Haeusermann1, Kristina Celeste Fong1, Roy Hamilton2, Jennifer E. James3, Daniel Dohan1, Winston Chiong1
1UCSF Memory and Aging Center, 2Department of Neurology, University of Pennsylvania, 3UCSF Institute for Health and Aging
Objective:
To examine perceptions of implanted neural devices among groups underserved by prevailing neuropsychiatric treatment approaches.
Background:
“Closed-loop” devices that both sense and modulate brain activity represent a new paradigm for neuropsychiatric treatment. However, neurotechnologists and even neuroethicists are not demographically representative of U.S. society, so the concerns of groups most in need of new paradigms may not be reflected in current neurotechnology development.
Design/Methods:
We fielded a nationally representative survey (n=1047) oversampling non-Hispanic Black (n=214), Hispanic (n=210), and rural Americans (n=219), eliciting treatment preferences in scenarios comparing (1) a therapeutic closed-loop brain implant versus surgical resection for refractory epilepsy, and (2) an investigational closed-loop brain implant versus medications for mood disorders. We asked respondents to rate the importance of differing considerations favoring either the implanted device or traditional treatment. We examined whether such considerations mediate demographic differences in treatment preferences using survey-weighted logistic regression models.
Results:
In both scenarios, non-Hispanic Black Americans were less likely to prefer the implanted neural device than non-Hispanic White Americans (epilepsy OR 0.28, p<0.001; mood OR 0.23, p=0.008); there was no main effect contrasting Hispanic with non-Hispanic White Americans, or contrasting rural with urban/suburban Americans. In the epilepsy scenario the difference between non-Hispanic Black and non-Hispanic White Americans’ treatment preferences was partially mediated by preference for established treatments, concerns about privacy, and concerns about hacking. In the mood scenario the difference between non-Hispanic Black and non-Hispanic White Americans’ treatment preferences was partially mediated by indifference to temporally specific action of a closed-loop device, concerns about changes to core traits, and preference for established treatments.
Conclusions:
Black Americans are less likely than White Americans to prefer closed-loop brain implants to traditional treatment, with specific concerns that may be informed by the history of unethical medical experimentation targeting Black people.