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When Humans Become Cyborgs | DAVOS 2020

Ronaldo Lemos
Director at Institute for Technology & Society
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World Economic Forum 2020
January 24, 2020, Davos, Switzerland
World Economic Forum 2020
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About speakers

Ronaldo Lemos
Director at Institute for Technology & Society
Hiromi Marissa Ozaki
Associate Professor at Tokyo University of the Arts
Victor Dzau
President at National Academy of Medicine
Ilina Singh
Professor of Neuroscience and Society at University of Oxford

LLM, Harvard. Visiting Scholar, MIT Media Lab, Oxford and Princeton University. Twenty years of work experience in technology and policy in the private and public sectors. Visiting Professor, Columbia University's School of International Public Affairs (SIPA). Member of the Board, Mozilla Foundation. Founder, Institute for Technology & Society of Rio. Partner with PNM Law, a leading law firm specialized in tech in Brazil. Co-created Brazil’s Internet Bill of Rights Law (2014). Co-created Brazil’s National IoT Plan (2018). Writes weekly for Brazil’s main newspaper (Folha de S. Paulo) and hosts a weekly show on national TV about technology. Winner of Prix Ars Electronica's Golden Nica (2007). Winner of the Sichuan TV Festival Gold Panda (2019) for the documentary "Expresso Futuro" covering technology and innovation in China.

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Japanese/British artist based in Tokyo. Known for film and multi-media installation works which explore the social and ethical implications of emerging technologies. Has recently presented works in exhibitions such as the Cooper Hewitt Design Triennial (2019, NY), Milan International Design Triennial (2019, Milan) and Setouchi Art Trienniale (creating a permanent art pavilion at the Benesse Art Site on Teshima). Currently an Associate Professor at the Tokyo University of Arts. From 2013 to 2017, Assistant Professor at the MIT Media Lab, founding and directing the Design Fiction group. To date, has had pieces included in the permanent collections of museums such as the V&A and the 21st Century Museum of Contemporary Art, Kanazawa.

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BSc and MD, McGill University. Formerly: Professor of Medicine, Duke University and Chancellor for Health Affairs, President and Chief Executive Officer, Duke University Health System; Professor of Medicine, Stanford University; Professor of Theory and Practice of Medicine, Harvard University; Founder, Corgentech; Founder, Clerigen; former Chairman, CV Therapeutics. Currently: President, US National Academy of Medicine. Author of academic papers, books and patents. Recipient of numerous honours and awards.

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Professor of Neuroscience and Society at the University of Oxford and Co-Director of the Wellcome Trust Centre for Ethics and Humanities at Oxford. A core research interest is the ethical implications of novel neurotechnologies and psychiatric innovations, especially for children and adolescents. Team also builds innovative tools that give young people a voice in mental health policy, practice and research. Has served on advisory committees e.g. US NIH, UK NHS, JnJ/Janssen, Shire, NICE, EU Research Councils. Member of Lancet Commission on Global Mental Health (2018) and academic lead for the Lancet Global Young Leaders for Mental Health. Holds a Wellcome Trust grant for: Becoming Good: Early Intervention and Moral Development in Child Psychiatry (www.begoodeie.com). Also leads a collaborative research programme on the ethics of genomic research in global psychiatry across six sites in Africa (www.neurogene.org). Past research has focused on the ethics of Ritalin-type drugs for children (www.adhdvoices.com) and neuroenhancement. The ethics of big data, digital interventions, and collective emergent intelligence (bio-engineered insect swarms) are major areas of research development. BA and MA in English Literature, University of Pennsylvania; PhD in Human Development and Psychology, Harvard University.

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About the talk

Recent advances in brain-computer interfaces are blurring the lines between mind and machine. What steps do leaders need to take now to ensure the ethical and responsible application of human enhancement?

Join an in-depth discussion that explores the principles and priorities for governing disruptive technologies.

Speakers: Ronaldo Lemos, Hiromi "Sputniko!" Ozaki, Victor Dzau, Ilina Singh

The World Economic Forum is the International Organization for Public-Private Cooperation. The Forum engages the foremost political, business, cultural and other leaders of society to shape global, regional and industry agendas. We believe that progress happens by bringing together people from all walks of life who have the drive and the influence to make positive change.

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We're going to stop humans become cyborg session. You know, I always want to be a cyborg. I'm waiting for the day. We like to really talk about the recent developments of brain computer interface and how that 3D blurring the line between man and machine and that's opening up many many questions about social cultural and ethical implications of these Technologies. And today we have to talk about that first day. I like to introduce myself. I'm your Romeo Zakia Manassas are so young Global leader from

Japan than I make at work based on tax and future Tech of technology and And Ronaldo is a specialist in law and technology in Brazil and Professor X the society in University office. And next to me is Victor cell president of National Academy of Medicine Goldberg. Thank you for being of the discussion in and out. You have something you like to show us about the recent progress state of play on the field stuff. If you could come in very quick visuals to start because I don't

know if everyone knows what these Technologies look like. This isn't of course in exhausting set of visuals. I'd like to start session is on, you know, sophisticated brain machine interface spy saying we have been trying to enhance functioning in the human brain for quite some time and the probably the first controversy that came up was with the use of smart drugs. So these were ADHD drugs roof for a clinical condition ADHD that we've been used by students and to try to enhance their attention and focus and there's very poor evidence that it actually does

that you can tell you or college student at the college students, you know, it seems to just keep you awake for a long time. Another technology vets at colleagues of mine up in using in an Oxford is deep brain stimulation not give us an example of how that's being used to. This is the neural implant that can planted deep into the brain in areas that people think are implicated in whatever the problem is that trying to solve. It's been very successful for example and treating parkinsonian Tremor and but if you also being used more experimental Lee in anorexia

nervosa, for example, and then and then also have been the seems to be quite successful than epilepsy device that is just under the skin and it sends an electric current to the implant and in that way regulates the area of the brain And that electric current is set by your doctor. At this is actually going to wear their brain-computer interfaces at our today. One reason. I like to show this picture is to give a sense of actually where the technology is at the moment, which is that it's a lot of wiring and so although we would like to think of ourselves as being able

to sit is increasingly adopt a lifestyle where we are continually hooked up to a computer or a machine that helps enhance our capabilities particularly our intellectual capabilities and we think about being wired into the internet getting our brains to upload information. But this represents actually the technology problem, which is we have to solve the wiring problem. And so there are people like Elon Musk you're trying to work on closed-loop system where the the the read of the brain and the name for into the brain all happens within the

brain in an implant that then it is actually very small and play. Amvets put just underneath the skull. I'm so doesn't require huge surgery. So that's the other thing of course about brain implants is that they require major surgery. So that's that's really where most of the work on the technology in hunting work is happening at the moment. And then I just wanted to talk because I won't be able to say much about this today. But this is a project that I'm really excited about. It's a partnership that we're developing with Airbus and to think about Collective swarm intelligence

and this is about flying brain. So trying to bioengineer the brain capabilities, for example of insects. Do you know why don't they smack into each other when they fly how do they know which direction to take and then just a icicle don't I'm a narcissist I should say long ago change and in Neuroscience, but one of the interesting things about these this technology is that it's an emergent intelligence. It's arguably is enough to fully on Thomas intelligence system. So if you think about this technology one day being a million tiny insect type

drones that we released for surveillance, you know, whether its military surveillance are called surveillance. What have you do it? So this is really where I think some of the most interesting areas of of this technology million braids Beyond just doing their own thing potentially so that I don't know at this point to talk about I need more about any of these examples of whether I should continue to highlight that there are in a mini many ethical issues that arise in these Technologies and the ones that we focus on the issues of rain for the sea. Do you have a right to privacy of your

Is data surveillance, you know, some of these Technologies can be used for surveillance ever what happens if things go wrong what happens when you send the wrong electrical current into the brain and of course accountability for something like this or any of our autonomous functioning brains in the world that we create who's who the Council Grove and something goes wrong. But if I really wanted to give you to concrete examples of the way in which ethics is implicated in some of these Technologies did the first is from the Play

some T-Pain stimulation with anorexia to just very briefly. Anorexia. Nervosa is a condition in Psychiatry that has severe implications at the end of the road. If you if you have untreatable anorexia, and that person will have both starve and die and one of the features of the anorexic identity and in some of these particular when we see younger people is that they don't see the anorexia as independent of their identity. They they don't want to separate the illness from themselves. So when we do when my colleague Rebecca park

at Oxford, he's been working on this so they're experimental implanting. Different areas of the brain so we're not sure which areas of the brain or to be implanted. But all of them are involved somehow and trying to get that person to eat again. If you have a sense of yourself as a friend sickly and anorexic and you don't want to eat that's not your desire. Then what are the implications of bypassing your own volitional control over your eating by doing it through an implant? So we've been talkin to people coming into the country

about that problem. Are we violating? You are a sense of personal identity. And then the second gem Study Bible studies in this area, but one another one that I liked feature is one of the major investors in this area is the military service afternoon in the UK in the US can probably elsewhere because these are technologies that will enhance her you never thought to enhance human capacities and it will also protect soldiers but enable us to do much more than then we can already and so we've been talking to

Military Officers around the world where been the third wave of data collection. So we don't have any concrete finding to share at the moment, but we've been talking to them about their neural implants, you know, if they were to have for example of a retinal implant and Hans their site capabilities or a Cochlear inside that allowed them to hear, you know, cross great distances. Really interesting is bodily Integrity. So they want to know things like, you know, do I own my inside does my inside become part of me? What

happens when I leave the military who pays for my Amazon. Does it get removed? Does it get do I get to keep it for life? Does it get upgraded who pays for that? And so it reminds us in our preliminary thinking about this of issues of of ownership over what you have in your body and the way than which I bodies through the this technology will extend to Machinery certainly but also extend potentially to machines that exist outside the confines of our bodies. So that's just

thank you so much. And then that's really interesting point that something by commencing the brain and brain is so close to your identity that it does read. Have the ethical issues like you said in the anorexia? And I think the borderline between touring something and enhancing something is very I think it's a very difficult for the line right there. Like maybe DC like during an anorexia is that is that tearing? But any few have students enhancing the brains to do well in the exams? What is that in the realm of

medicine? Do you have any wisdom from medicine for interview? Thank you for asking. But I also been involved with these areas for a while through four examples is global Futures Council on healthy longevity, which I chair and of cuz these issues Get into what do you do with the elderly? How do you use this technology academy? And that's a good vacations of science and technology. So first of all, I think that I think it's pretty safe ground when you sees technology for the purpose of you know, is he's feeding disease at least addressing impairment.

I do think you start quoting lawn when you see Martin & hensman augmentation will come back to that. But you know, you thought we were you living in the age of 5 lug because like it or not actually 1980s Coke to him friend wasn't I won my second remember when I was translate Duke Frank Wilson and he's able to see the new interface that being able to pick up for example sound signal and then being able to have it into face so they can interpret the signal for those. Who have hearing loss and now 400,000 people are using cocaine fine, but

that's clearly an area that you would agree. That's helpful. And if you begin to look down the road, I think you're already talked about rain and fans don't even know about deep brain stimulation that is being used to treat people with Parkinson's tremors and depression depression of resistant to drop so it's inside electrical stimulation is a way to go. So that's also a medical indication which is helpful. It's not brought. But in fact that is useful. Now as we speak about the technology is moving into the space off looking at reading

disease or helping you wouldn't had I think about people's choked. So as you know, if you have a stroke and you have say impairment off as you're paralyzed impairment of your motor system, we do physical therapy and Rehabilitation of this repetitive movement how to stimulate the nerve and actually get no stimulation and muscular stimulation to begin to recover some of your muscular and motor skills. In fact, no stimulation, which allows you to for those who are unable to walk to

begin to stimulate the nerve to get muscle activation to stop working. And I keep thinking about my grandmother who wentto said young child. She had a stroke is 50 and she left for another 20 years totally impaired bedridden. Now, this is back in Hong Kong and what causes some years ago, but I do think that these technology helpful to people a good friend of mine had a major bike accident and ski at 7 court. So he's he's paralyzed as a paraplegic as you as your hood now. It's possible to your brain machine interface

sent to drive with your brain signal newest PlayStation. So if you would be able to move limbs And the exoskeleton where you can actually drive and movement of exoskeletons we can walk again. Now, it's been pointed out Technologies two more recently. Concave you well, you have been fine electrodes, but there are Sunday now technology, whereby you can actually measure EG transcranial you can put a cap on and a screwdriver signal. So one of my factors member Miguel nicolelis actually spoke a lot

of this meeting previously Sunday been able to show that if you take a sick no pressure monitor at finding you can move a robot in China. And in fact, she was able to be in to do the Sandman and the 2014 World Cup project called walk again and which actually a paraplegic was able to open the game by kicking the ball. So you still very early, but I think these are really important technology. Imagine people who have so so much impairment being able to do so many

things again the new technology. This is why we stopped thinking about what's in the future has been pointed out if you know and your sensors which control appetite control memory San Jose Austin studies that show them you stimulate the phonics which areas for memory formation that appears to improve memory so quickly stop thinking about how can you use this in a manner of the ticket for the older population and you begin to have problems with memory? So I think that these Technologies hold a lot

of promise And I do think that it might have a strong opinion. They ought to be developed from and plans to transcranial technology of measuring EEG and that signal being able to drive responds to help someone who is impaired right? You mentioned in fact about anorexia. So you can imagine in the future and already does experimental evidence that you can help control appetite. So as a cardiologist think about obesity and all those things. Is that something you want to use and when do you draw the

line by saying when you get into that area autism kids with a better social interaction, so I do think they will come. when we use it how to use it and what all should we use it I think You think about how we use it? How government should be placing regulations for another I do wish I could easily imagine some of these Technologies being used in the way to possibly control someone's Identity or they moved and that are there any regulation area about the I'm afraid lawyer in the room. So I teach

technology University my task is to think about the problems in the issues that can come up after all these devices. So basically I made a few notes that I like to share with you the pointiest when you enhance the brain when you make the the human body answers answers at capable of collecting data. Exciting technologist Miguel nicolelis has been doing amazing work about reading the brain signals basically allowing people to control mechanical arms through them understanding how the brain thinks. So this is all data collection. It's all excited all new technologies, but the

infrastructure. That is used to collect the data to share the data is nothing new Under the Sun and we know the problems that actually can emerge out of that are connected. For instance. What are you possibly thinking? What are you basically what areas of your brain that are being stimulated at a certain point there is even like devices that can collect what year is measuring your feelings either through facial recognition devices micro muscle movements and so on

these data is going to be Sports. So you might be in the cloud service. What will be disclosed service? Where is the servers being located? Is it in Brazil? Is it in China? Is it in United States? So depending on the jurisdiction you have a different approach riggity how that day? That will be treated. So this is number one number two is that we become there for sensors. So when you meet a new person and you shake hands will we have to sign like a privacy notice to talk to that person like the person you say so

this is my terms of use. So you have to click this button before we start sake because everything that will be talkin to be recorded and so on. This is my privacy notice and resulted bye-bye cannot talk to you. So that's the type of things that we have to think about because when the human brain and like I like how my body becomes full of census data is being cold. And there's legislation that actually requires the consent of all the people in order to collect data about them. So this is like sounds like a crazy but actually that is already required. So

this is not like something that is going to happen regarding drones. I think this is also very interesting because all drone regulation around the world today Arby's regarding the weight of the machine. So dismal machines, I like a 250 grams kilograms and then you have like a big drones the ones that can fly and make a lot of noise Behavior the Drone heavier de-regulation. But what worries me is not about the big drums is actually about the real small ones because if your drawing is the size of an insect and you can come through the sewage system are basically in jail.

Poison in the first inning commit and then disappear into the sewage system again. What are you going to do about that? So my question is you should not only think about regulating draw about their weight. But actually you should think about the regulation about these smaller the Drone maybe you have actually to think about specific regulation for that. So these are just like a a few examples that I think I would share with you because the problem with this technology is there nudity exciting but right now the

data collection problems in the privacy issues in the legislation already made us know and we already know that there's so many problems that can emerge out of that and I still don't have any answers to this question, but I think like I will have to be thinking very carefully about the regulation. Windsor when you say they suck collection cuz I would imagine cuz to me without my smartphone I feel really tired right now. I can't even though it doesn't have any electrodes in my brain feels like it is how I feel today

knows how I think today. So it's that resolution to come I can easily imagine big tech companies having a lot of control over that day that sees that you said that yeah and sofritas transcranial readings like a did the capability of understanding how the human brain enlightens depending only stipulation that has a huge application for advertising for instance. If there's actually being a lot of stuff about how to do that and the problem with our tools when we cry Made it to we use that to to control the

world, but actually we end up being controlled by our tools as well. If you view the hammer your hand we will assume a certain posture in order to use that hammer and that is true for everything that we create. So the problem with these tools and understanding the brain like that is that actually that can be used 3/4 Lee in terms of like human human brain in order to achieve certain States or certain proclivities and so on and I like very much the position of Yuval Harari. He

spoke your deformed couple of times this year and he fears and I agree with him that we might Crack the Code of the human brain at some point. Maybe not now maybe in 30 years and so on but if we are going to be much more Warner Bros targets for advertising in why not? Fake news Museum formation contains manipulation of political Fosters and so on. So that's the type of problems that we should think because we would you like I think everybody's worried about this question is what we

doing about this medical feel pain. I think many of these technologies have to advance because it helps people it's not that technology is what we do with it and and how we oversee it and I've been lots of sessions about discussion ethics regulation. But in fact, there's not much of a framework called are not from my point of view. If you really looking at the use of these Technologies to address issues, which I clearly one of helping impaired individuals. I think that really ought to be used because

imagine Douglas we don't have today the kind of medical treatment and others right but I think for us to the line can be gone fairly easily just like a genome editing but you do know that certain ethical issues that you don't cross. I think that is where the Takis challenge for the medical profession is better than I do have an impairment of my vision and I don't have it right but if I were to make myself, you know that Manute Bol and being able to run faster than anybody else because I'm able to either and hens it

through, you know, you know, you know jeans my muscle or other neuroactive. I think that that's where we draw the line right, but I think that if you look at the human's body which degenerates of the time and the fact that you can prevent degeneration Does that cross the line? So I think for the medical profession as you started asking very early, I just think that Do no harm is I'll Hippocratic oath and of course everything we can do to relieve human suffering the issues that you race are critically important and they are

but I do think it's time now to create some framework we encounter this pic filed with Juno matching. It was out meeting in Hong Kong with the scientist as well. I just did it. I created twins by overeating frantically trying to move around saying what are the framework record for frame with when you do this when we have an international commission that we looking at this right now sswhl but to be proactive is why we need to be yes, I agree in ethics of

how do you say he's the designing of the finger guns? Council of bioethics framework on Noble near Technologies and I think one of the fundamental principles of that framework, which was that you have to balance the precautionary principle with the good of innovation in a terrible situation off. The World War II it is designed to stop people doing bad things and actually to stifle a lot of ways to stifle Innovation to prevent people from stepping over the edge and actually, you know, our ethics needs to change a alongside these Technologies because our ethics, you

know, actually just be a barrier to two moving ahead. But the other thing I want to say that hasn't come up today is there's a way that I work in in my team is that we don't create normative Frameworks without thinking about the public about public trust and public acceptability. So we use the tools of social science. Understand the phenomenon on the ground and we've done in across European surveys on the acceptability of genome editing and and I do think Victor is you were saying that what comes up time and time again in those surveys is that this distinction between

treatment and enhancement is T So European Publix are fine. If you're going to use genome-editing to solve a medical problem, but if you're going to use it to enhance the intelligence of your child, that's not okay, but they've the final thing I want to say is that of course we've done those surveys in the Westin. I think you are both probably be well positioned to talk about what we need to do in on an international scale because we know talking to colleagues in the human brain project in Korea and China and Japan that the values that we bring to human brain

enhancement are not Universal values that are there are cultural elements to these values. I'm so that the Korean my Korean Collies have said That intelligence enhancement would be something they were under a picture. I think Asia or Europe. I don't think we should stop this technology can actually I think the role of Regulation is twofold establish. The Baseline of what's acceptable in terms of Law Society ethics and wasps. These guidelines are basically to promote Innovation. So good regulation will always look into these two things create the

ethical framework that accept low for that political community and then allow people to innovate on top of that the measure for a good regulation that I think might be important like to think about this issue. Is that right now, we don't have clear rules as we we've been discussed. And in order to decide those rules, you need processes that involve multiple stakeholders. So not only the scientific Community but also you have to get involved the private sector

governments non-profit non-government organizations in still want the more stakeholders you bringing to the table the more likely you will come up with good regulation in the last point is the world's when you think about the developed world in the developing world. We have also always think that in our society there are places that are at the margins of the regulation and there will always be do-it-yourself movements that will completely ignore whatever regulations we come up with

when will example of that is the genomic process of crispr has nine. So basically it's a possibility of editing did Turn on mix of a human being a living being and of course this is being done in the community said actually I doing experiments in their garages in their kitchens are there so many YouTube videos of people injecting themselves is crispr to what makes muscles grow and basically doing that in there that kitchens so to deal with that have the answers to rain hacker. I

want to make a new friend at Mendon Soul Festival in meditating. I think you mentioned that it's permissible, you know, it is as long as it's not too intense for them, which is not true because if you look at Joe, Embryo editing altering the genetic makeup of an issue. It's a lot more complex. I think they were regulation is probably way too overarching and strong. I think it's really a government issue. And if you look at the governor's would you really saying is it should

be motivated covenants? It's not just a gunman coming into regulated but there's a lot of self-governance and I think that way we'd I see the problem is that spending our country we have free market. So when people have great Innovation and then there's a market they quick to move into the market and not spend enough time sync about what these new Innovations. What are the implications so scientists have a responsibility in terms of Governor's through scientific publication oversight of ethics of several

industry have also hosted of Governors issue eventually of cause she was included in the government as a quote regulation, but I think these issues have to be addressed much earlier than call regulation is a fundamental issue of you know, your social norms and your ethics Exedra and what does right practice levels are? Headed City Christian Church in five years or ten years time what kind of brain computer interface product application? Can I be using Reynaldo? You've been making documentaries about technology. Do you have any ideas about what I could be?

Like, I'm the lawyer. Who's that guy? I could be using in the next 5-10 years. I think you already using the most sophisticated brain computer interface that we have available that we underestimate and it's the thing you held up before that is that is unbelievably powerful machine that he is, you know, it's not actually wired into your brain, but there's definitely connectivity happening there and it's change. Do with enhanced you already and you think that could be something in my brain in the next 10 years,

maybe a chip Define me like a creep, Health devices the ones that we used to track our house like a wristband to that sort of stuff much much better. Look how they're going to evolve very quickly so they will track emotions because if you use like a facial recognition to track our facial muscles of these devices, they're evolving like really really fast heart beats the tracker blood pressure sugar level is going to get deeper and deeper into what we are. So this whole thing about the Quantified Self, that's the name of for

these things. They're going to move like really really fast. Thank you. So many one is equity. I think that's a bit concerned. What causes these technology is going to create tremendous disparities in equities. It's not only the cost is access to it as well. And of course when you think about the global use as you know, we've been pushing their hot in addressing you show mental health and this particular forum. And these Technologies can be very helpful eventually adjust mental health issues. But the question is

that you know, what does be accessible to most people in low and middle-income countries official intelligence and all these technology every place. I don't think they understand this and I do think that that's what distinguish human beings from machines that is really important to maintain That understanding about equality needs to be maintained with this kind of technology and any questions from the audience about brain computer interface. I can bring hiking.

Hi, I'm I might my name is Tyree diamond from the Japan times. It's very very interesting discussion. But also very very scary as hell and you mentioned about the military industry is investing a lot in this area. I'm wondering about you know, what kind of discussions are in a being made now to sort of like putting in terms of regulatory framework for a military purpose, you know like usage. I mean like there are ethicist you've been working with military people who

are trying to develop these Technologies for for many years. So I think I'm in my view. The military has been quite actively engaged and thinking about the ethics them and if you go to the doctor website, it is quite transparent about these new technologies that it's working on. I think of course the Frameworks that their country complete transparency by nature of the military contacts. So one question is how much the the Frameworks that we create for people outside. The military to civilian context would would apply in the in the military contacts itself.

Any any other questions from Union? When do you think we can have been when it when it when will it become common for people to have some sort of an implant for memory of a mood swing? I mean, whatever. When would it become a normal practice? You can visualize even if it's legally allowed or not allowed? I don't think so legality in-laws going to stop this from happening and these things just continue. But when you think will it happen like Daniel Tiger's?

When is easy to use I think you can imagine that depression which is very significant issue can be treated. I do think that we are well on the way to be able to try some of those issues. So it's videos issue of whether you can me and their tries it and use it effectively. I won't put it past that you can see this within 10 years, even though the depend on how broadly would you use this for versus the ability to show in the experimental settings that this is effective that 300 million people with depression.

Just a follow-up on that Indian formal Market. If you go on eBay and other sites, there's a lot of people selling electric devices that actually put electrical currents into your brain mood swings and depression with probably no scientific basis whatsoever, but actually people but you know, how you use your cellphone your voice your tongue and how you use your computer is that reflect your mood swings and that they have realistic nose of has buffets. In fact, when you begin to see it at the men's Exchange in the way with your usual from your usual problem, so that's already exists.

Lourdes skills up too much high-level to be used as a way of monitoring and just so you can have are the intervention. I guess this question is for a professor professor job. If you take the example of people who are doing neurostimulation, and even those who maybe buy something from eBay the sad thing is that patient population really does have a real need and is really trying to get better the information. They collect from doing essentially itself experiment is a course lost because it's not part of a structure given that a lot of these

types of Innovations are going to happen outside the formality the clinical trial what type of systems level changes would you like to see such that we can study things as they go but don't necessarily involve the cost structure of a of a randomized control trial. Father this is a complex question because what in fact is good ethical approaches to this and do you collect good data of the day's information useful standardized but that being said I guess most of us are looking

at real world evidence right connecting real world data. So as you move away from randomized control trial, there's suddenly a lot of movement was pragmatic trial design using Registries using information and of cause using data that will collect together with enough sufficient body of data that can allow you to begin analyze whether certain things which are used in the population do have evidence that will make a difference. But you know when you have all this informal uses, I'm not sure how you collect that information. Maybe my colleagues can tell

you how that can be done. This is a really important question because I think this real real date is really something we will to be collecting. So I know now that you might be the kind of work we're doing around casting mean and the devil listen to Janet drugs which are coming back into Psychiatry now, but in a knot in a clinical trial way very often. So we've created the framework around texting me and it does suggest you use the registry, but you can capture the range of

what's going on experiments Ali supposed to be in a single case design experiments but more at Hawk experiments and you can because we need dates on all of that because people aren't going to stop using these Technologies drugs Technologies to just because you know, we we save they should and still actually having an understanding of how people are using it in the real world is just as important as an understanding. How people are using it clinically in order to collect data for research purposes.

There's even people that are claiming that you are going to have not only clinical trials, but you have like a data-driven research and all these devices that I mention like a Fitbit in this stuff that collects Health Data might end up being used for the development of new treatments drugs and sowon weeks ago with 23andMe, which is a company that this genomic research you spit on a small tube and you send it to them and they send you back your DNA DNA profile, but there was

quite a few controversy in 2 weeks ago because they were using that data from so many individuals that have taken that test drive to develop a new drug and people were debating. What was the privacy? Locations of that but definitely we are moving into a data-driven research model. Thank you. So we're at the end coming to the end of the session but I think today we really thought we talked about the issues in a Call of Duty or some of the borderline between touring and enhancing also the military implications and the application and I think

at the very very very pleased if each of you could give baby is 15 seconds to show up on The Next Step full. You think we should take because I see so many things we need to discuss it and we need regulations. What's the next step I make maybe from ecology make it happen. But stablish the Baseline where ethics and political values are acceptable. One of the major concerns is that we need to prevent these Technologies from exacerbating social stratification and inequities.

I agree with my colleague. He said this is a multi-sectoral multi-domain issue and not just in medicine or social science or engineering. It's cuz across economic government regulation investment. Right and Industry Private Business Academy. We have just created a committee that will bring together people from all segments and using case study approach to look at what would be the right way. When a new technology being thought of as being introduced what are the steps of them must think about

hopefully, you know that when people begin to think about the new technology they at least know what the steps should be in the dressing some of these issues and perhaps one day. It could be more formalized that everybody understands what to expect when you want to introduce a technology for human use My next step is I'm going to go on eBay and rainbows machine. Thank you so much for the thank you so much everyone. Thank you.

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