16 years ago, a medical researcher in New York demonstrated the unthinkable: an interface between the nervous system and the immune system. The discovery flew in the face of “settled science”.
The vagus nerve and its branches conduct nerve impulses — called action potentials — to every major organ. But communication between nerves and the immune system was considered impossible, according to the scientific consensus in 1998. Textbooks from the era taught, he said, “that the immune system was just cells floating around. Nerves don’t float anywhere. Nerves are fixed in tissues.” It would have been “inconceivable,” he added, to propose that nerves were directly interacting with immune cells.
Ah, but the “scientific consensus” of the day was wrong. He went on to show that by transmitting tiny electrical impulses into the vagus nerve some four times per day, patients suffering from the incurable rheumatoid arthritis (RA) exhibited symptom relief, including reduced joint inflammation, very quickly. One patient, so crippled that she could barely pick up a pencil, now regularly rides her bike 20 miles:
Before getting the SetPoint implant in April 2013, she could barely grasp a pencil; now she’s riding her bicycle to the Dutch coast, a near-20-mile round trip from her home. Mustacevic told me: “After the implant, I started to do things I hadn’t done in years — like taking long walks or just putting clothes on in the morning without help. I was ecstatic. When they told me about the surgery, I was a bit worried, because what if something went wrong? I had to think about whether it was worth it. But it was worth it. I got my life back.”
Bioelectronics is now a field of study, and is on track to supplant many of the drugs currently in use. With increased miniaturization and the use of WiFi both to recharge implants’ batteries an transmit and receive data, they’re now targeting specific peripheral nerve systems to localize and fine-tune communication with specific organs – rather than flooding the body with drugs or some combination thereof, information itself is becoming the treatment.
And it makes sense to target peripheral systems because there’s less noise to sort through; just as it’s easier to tap a telephone line by tagging in close to the line of interest rather than the local switching station, so it’s easier to eavesdrop on nervous transmissions and manipulate them with precision. This approach affords opportunities to target other currently intractable issues:
In addition to rheumatoid arthritis, Famm believes, bioelectronic medicine might someday treat hypertension, asthma, diabetes, epilepsy, infertility, obesity and cancer. “This is not a one-trick pony.”
Indeed not; 95% of the hardware can be applied toward any implant, unlike the case for drugs, which are in general comprised of unique molecular combinations. Moreover, as noted above, bioelectronics free doctors from the problems associated with current drug therapies, which employ a “flood and hope” strategy. Hope that a combination doesn’t result in unwelcome interference; hope that side effects aren’t unbearable for the patient.
Of course, there’s a downside: on the one hand, the ability to fine-tune the implants and recharge them without the necessity of running wires into the body is a great benefit in terms of patient mobility, reduced risk of infection, and other issues. On the other hand, the hardware interchangeability and reliance upon WiFi opens another door – to hackers.
While this may seem a ridiculous non-issue (and likely so for most people), consider the candidate out on the campaign trail who suffers an acute asthma attack triggered by an opposition operative who used an iPhone to tweak the settings on her implant. While means of hardening the systems exist, there are no incentives for companies to add such features. That’s likely because to date, no such attacks have occurred. But then, there aren’t many patients (yet) who have such implants.
At the current rate of progress in the field, that seems likely to change in the coming decade. Hence, the FDA has considered the possibilities:
In August, the F.D.A. offered guidelines to medical-device manufacturers, recommending “wireless protection” to reduce “risks to patients from a security breach.”
But the guidelines aren’t mandatory, so don’t look for that to happen any time soon.