Nathan Copeland had always loved science fiction, but an accident in 2004 would eventually bring him about as close to science fiction as one can get.

At age 18, Copeland lost the use of his arms and legs in a severe car accident that left him with quadriplegia. His injuries forced him to drop out of school and, for several years, he was unable to find a job. As his health declined, he signed up for a research registry allowing doctors working on medical research to contact him.

Contact him they did—with a rare opportunity to have his brain implanted with electrodes. These electrodes would enable him to connect directly to a computer that would enable him to operate a robotic arm and potentially restore his sense of touch.

Six years later, Copeland is not only able to operate that robotic arm, but he’s also used his implants to play computer games and draw on a computerized tablet. And Copeland, experts say, is just the beginning. Brain-computer interface technology, like the implants Copeland uses, may very well bring about a world where technology has eliminated disability, mental illness, and many age-related diseases.

Multiple researchers and companies, including the University of Utah and Utah-based Blackrock Neurotech, are working to break down the remaining barriers between the present and that final frontier. Technical and philosophical questions remain—particularly about how society will ensure equitable access to potentially life-changing implants that could be perceived as granting super-human capabilities—even though experts say that likely won’t be the case.

Part man?

When Copeland wants to use his computer tablet or the robotic arm he works with in the lab, all he has to do today is, essentially, think about what he wants to happen. Neurologists in Pittsburgh implanted tiny, two-way electrodes in Copeland’s brain capable of receiving and sending electrical signals. In the beginning, Copeland initially watched a computer operate the robotic arm while imagining the arm was his own, and he was the one making the motions he saw. The electrodes recorded the activity this process created in his brain. Once the device was programmed to fit his neural circuitry, Copeland only had to think what he wanted to happen and the robotic arm would respond.

“It’s actually effortless, intuitive,” for the operator, Copeland says.

High-tech as this may sound, the basic concept is already used to treat a number of conditions. At the University of Utah, neurosurgeon John Rolston implants epilepsy patients with electrodes approved by the FDA over a decade ago to control their seizures. Similar technology is also in use to control tremors created by Parkinson’s disease. But unlike Copeland’s implants, Dr. Rolston says, these devices only work in one direction—that is, the electrodes can’t respond to the patient’s natural brainwaves. The electrical stimulation they provide is determined before implantation.

Creating responsive implants, Dr. Rolston says, is the next phase of research. It’s not always clear what’s causing a person to have seizures, so if an implanted electrode had the capacity to listen to and essentially talk back to the brain, it might be able to forecast and prevent seizures. This would give the patient even more control over their condition and may even cure them.

So far, trials of these two-way electrodes haven’t had a significantly greater effect than their more static predecessors, Dr. Rolston says. This could be because the implants in use today can only listen to a few dozen cells at a time. If the electrodes could listen to hundreds or even thousands of cells, the devices could be more sensitive—and this is where Utah entered the brain implant scene.

Richard Normann, now an emeritus professor of bioengineering at the University of Utah, realized this need for more complex brain implants while working on his Ph.D. He used individual electrodes to study how individual neurons interact with the physiology of the human eye to create sight. When he accepted a position at the University of Utah, he wanted to take this work further, connecting the electrodes to cameras to restore sight to blind individuals. But he needed more than an individual electrode could accomplish to make it happen.

“The problem is, the way the brain works, nothing is associated with the firing of a single neuron,” Normann says. “Everything that happens in the brain—motor functions, sensory functions—requires activation of dozens to hundreds or thousands of neurons.”

So Normann developed a more complex implant, now called the Utah electrode array, that consists of 100 tiny microelectrodes. According to company CEO Marcus Gerhardt, the fact that the technology was developed in Utah was instrumental in attracting Blackrock to the state.

Rather than pick a single application and develop a technology to suit like other medical device companies, Gerhardt says, he wanted to try a different approach—taking a promising technology and making it available for the whole swath of users who could benefit.

“What if we could identify a neural interface platform, what we call a living pharmacy?” Gerhardt says. “An implant that much more accurately deploys pharmaceuticals or stimulates the brain? These are not that out there conceptually. The question is making them a reality.”

Part machine?

Making science a reality can be a slow, iterative process, says Robert Gaunt, an associate professor of physical medicine and rehabilitation at the University of Pittsburgh.

Gaunt’s colleagues first demonstrated that neural implants could be used to restore a paralyzed person’s sense of touch in 2016. Earlier this year, they accomplished the next step: the implant allowed patients to “feel” objects they picked up with a robotic arm, which greatly improved the patients’ ability to complete simple tasks with the robotic arm, like moving objects around.

Incremental as the progress may be, each step demonstrates a new possibility. Normann continues to work on studies to use his implants to restore sight, and the results of his latest study should be out soon, he says. Animal studies have suggested the implants could prove superior to existing cochlear implants to restore hearing. Other areas of investigation are perhaps less intuitive—Normann and his colleagues have also investigated the possibility of using similar technologies to treat incontinence, while a whole coalition of researchers affiliated with the National Institute of Mental Health (NIMH) is investigating their use in treating a host of mental health concerns, primarily depression.

Much of the focus in the mental health world is on the ability to record what is happening in the brain, according to Dr. David McMullen, who heads the neuromodulation and neurostimulation program at NIMH. It’s believed that faulty networks cause conditions like depression within the brain, but it’s still unclear exactly what goes wrong in the brain under these circumstances. One patient might respond to treatment, while another does not—suggesting that what we currently call depression could have more than one root cause.

Computer-brain interfaces, McMullen says, may one day allow doctors to simply scan a patient’s brain and pinpoint what has gone wrong and how it can be corrected. “Based on the brain scan, the doctor might say, you should get a drug, you should get some therapy,  or you should get brain stimulation,” he says. “We’re not there yet, but that’s really the goal.”

Where we’re at currently, Gaunt says, is on the cusp of releasing technology that would allow people with disabilities to control a computer with their mind, moving a cursor or inputting data into a spreadsheet. This could be available as early as 2022, Gerhardt says. After that, Gaunt says, the kind of technology exemplified by the research Copeland participates in will gradually become available, allowing people with disabilities to control robotic limbs. Only after that—likely long after that—will brain implants capable of restoring an individual’s limb function or senses become available outside research labs.

So if you’re looking to get a brain implant that will give you night vision, grant you super-human speed or genius, or just hook you up to the internet—well, some of those things are already technically feasible. They’re just not as useful as you might think.

Although shows like The Terminator and Star Trek were part of what inspired him to pursue work in computer-brain interfaces, Gaunt, like most experts in the field, dismisses the idea that neural implants will one day connect humans to the internet. It’s not that it’s strictly impossible, he says. It’s just that it isn’t going to work out like it does in the movies.

“I could do something really silly like take the value of some particular stock, and I could turn that into a signal that stimulates your brain using technology that is available today,” Gaunt says. “But that would still feel like a buzzing in your hand. You have to ask, is this useful?”

Even with existing senses like eyesight, the likelihood that implants will surpass the human brain’s capabilities any time soon is essentially zero, Normann says. Human eyes have 150-200 million photoreceptors and a million optic nerve fibers that convey those signals to the brain, he explains. The auditory nerve consists of 30,000 fibers. The Utah array, with all its impressive study results, contains 100 electrodes.

“I just don’t see how you can do a better job than is being done by our brains already,” Normann says. “I just can’t imagine how we can begin to make supermen out of this technology because the existing pathways are so well designed to convey information to the brain that I don’t believe you’re ever going to be able to come close to what exists naturally.”

It’s important to realize that the sight or touch restored by these implants is artificial, Gaunt says. Electrodes connected to a camera can give a blind person the ability to see, essentially, dots of color. Or, as Copeland explains from his first-hand experience, he can feel things when he picks them up with the robotic arm, but that doesn’t mean he feels them like he did before his accident.

“The sensations change, but they’ve been limited to a tingle or pressure, warmth or tapping, that kind of thing,” Copeland says. 

The same goes for his ability to control a computer with his implants, Copeland continues. While he can paint and play some simple computer games, his control over the computer is actually less accurate with his implants than with the function he still has in his pinky and arms.

So while there are ethicists like Judy Illes, a professor of neurology at the University of British Columbia, who study the question of what we should do with these implant technologies, the questions they focus on aren’t what you might expect. There’s less, “Should we connect the human race to the internet?” and more, “Why are we even talking about that when the focus should be on people who can actually benefit from implant-assisted mobility or even communication?”

“Where we need to focus our attention around implantable devices is the medical domain,” Illes says. “Augmenting humans with implantable devices is important in thinking about the future, but I feel the ethical imperative is to use these powerful technologies to alleviate the burden of neurological and mental health disorders and bring dignity to people who are losing it because of their conditions.”

Who gets access?

Given the historical disenfranchisement of individuals with disabilities, Gaunt says, he would be naive to not “have this question rolling around in the back of my head, which is, ‘Are we just creating technologies that make the divides that exist in this world even bigger?’” 

Although he did not have to pay for his implants, Copeland still experienced this dynamic in his own life. Having his brain implanted so he could participate in research may have interested him from the very beginning. Still, his mother was opposed to the idea—and that posed some challenges beyond those generally associated with having parents who disapprove of your life choices.

“At the time, [my mother] was my primary caregiver,” Copeland says, “but I had people like my sister and my grandma, and they took me to my appointments.”

Copeland says he can’t call his mother’s initial objections irrational. Surgery comes with risks, the study requires that he travel to the laboratory multiple days a week, and regardless of the outcome, someone would have to facilitate his ongoing treatment. 

“A big majority of people in situations like this end up in the same boat as me, where the people taking care of them are their immediate family. If my immediate family all said, we don’t stand by your decision, we don’t think this is safe for you…that’s something people don’t consider,” Copeland says. “Someone might be willing [to get a brain implant], but not have the support needed.”

There’s also the reality, Copeland says, that he’s not allowed to retain any personal benefit from the study. He does not have a robotic arm to assist him at home, and he doesn’t technically own the implants in his own brain. When the study he’s participating in wraps up, the implants will be removed, though currently, the plan is to leave them in as long as possible so researchers can learn more about the longevity of the electrodes.

Still, the relationship between commercial interests and brain-computer interfaces remains a complicated one, Dr. Rolston says. It might open up the potential for inequities. Funding from private companies also helps to accelerate research efforts significantly.

Copeland is holding out for such a development on the hope that when the time comes to remove his current implants, he might be able to purchase new ones—perhaps an upgrade with more advanced electrodes inserted on both sides of his brain. This would give him even greater functionality so he can pursue his dreams of making more art and streaming video games online.

In science fiction movies and books, it’s a lot easier to imagine the bad things that could happen—like using implants to send advertisements to people’s brains, Copeland says. But there’s also potential good to come of it, and which way it goes will depend on who ultimately controls the technology.