Context

As reflected in both the primary literature and neuroethical commentaries on neurotechnological innovation, early neuromodulatory interventions have principally focused on the remediation of well-defined disease states and severe, treatment-resistant mental health conditions with established diagnostic criteria.^{Reference Neren, Johnson, Legon, Bachour, Ling and Divani1,Reference Illes, Lipsman and McDonald2} Scholarly writing on the future of neuromodulation, however, reveals ambitions to expand its uses into more enhancement-oriented (i.e., non-pathological) and less physician-mediated domains.^{Reference Tyler, Schmorrow and Fidopiastis3} Another notable tendency in the academic and entrepreneurial outlook on future neuromodulation is to forecast its intertwining with brain–computer interface (BCI) technologies.^{Reference De Ridder, Maciaczyk and Vanneste4} While BCI and neuromodulation are conceptually distinguishable categories, their complementarity is evident from both the level of excited interest and attendant scrutiny generated by promises to integrate them.^{Reference Dadia and Greenbaum5} Throughout this discussion of commercial neurotechnology, neuromodulation-capable BCI will be the principal focus.

Visions of a high-neurotechnology future are to some extent imaginary. They should not be treated as reliable factual predictions or inevitabilities. Imagination, however, is not inert: shared ways of thinking about the future provide a nucleus around which research agendas and entrepreneurial funding can cohere. Shared imagination can also influence popular expectations, leading to the motivating promise of profit for delivering on those expectations. Additionally, innovators and users alike will naturally seek to push neuromodulation towards improved safety, reduced invasiveness, and greater accessibility.

It is not guaranteed that technology will develop as imagined. However, given the prevailing market-oriented channels along which societies direct innovation efforts, some broad contours of its developmental trajectory are reasonably foreseeable. To advise planning around a by-default likelihood of increasingly commercialized advanced neurotechnology is not the same as doing neuroethics by speculative fiction. Speculation about the development of science and technology has well-documented pitfalls as a method.^{Reference Racine, Rubio, Chandler, Forlini and Lucke6} At the same time, if one encounters an acorn in the right conditions, it is not improperly speculative to view the eventual growth of an oak in that spot as a default outcome – not a certainty, but the presumptive result, absent other intervening factors.

Method

The above context helps situate a brief comparison to present-day internet technology companies. The comparison takes the form of an informal case study, one meant to better ground the overall argument. This case study furnishes only a loose analogy; it is intended to identify broad structural similarities between the contemporary internet and the foreseeable landscape for consumer neurotechnology. Specifically, the aim is to highlight how dominant technology firms influence society in consequential ways through product design decisions.

Media scholars have observed that discussions of so-called “big tech censorship” often envision an unregulated social internet, devoid of content moderation to curb bigotry, abuse, or disinformation.^{Reference Kor-Sins7} This case study and neuroethical analysis may appear sympathetic to such a vision, due to a shared emphasis on the value of decentralized power. The similarity is purely superficial. For clarity, I affirmatively oppose the wish for internet deregulation and reject the ideological project it stems from, which embraces discredited laissez-faire approaches to the marketplace of ideas.^{Reference Brietzke8} Rather, the values motivating this work are egalitarian and democratic ones.

Analysis

Proprietors of key internet platforms – such as Alphabet (encompassing Google and YouTube), Meta (Facebook and WhatsApp), and Twitter – have come to wield considerable influence as “custodians of the internet.”^{Reference Gillespie9} These entities actively set the terms, dynamics, and limits of much public discourse and at present are only weakly constrained by popular sentiment or legal authority in how they do so. Some of this term-setting is familiarly overt, for example, via creating and enforcing content moderation policies. Less obvious but equally notable is the ambient influence these companies exert on the public consciousness by overseeing the organization, dissemination, and accessibility of information. Sometimes their power functions through case-by-case human judgment or via deliberately crafted terms of use, but there is increasing reliance on automation as well. Automation can embed value-laden presumptions or harmful social attitudes, with examples ranging from image cropping algorithms recreating the male gaze to autocomplete suggestions perpetuating racial stereotypes.^{Reference Birhane, Prabhu and Whaley10,Reference Baker and Potts11}

The sheer size and dominant market position of the web’s foremost social hubs and media platforms exacerbate the stakes of proprietor design decisions. These services have become central to many spheres of civic life, and they tend not to be interoperable with competitor platforms. As a result, users of the internet have little meaningful choice among providers of its key communicative and information-organizing services; as legal scholars concerned about privacy have noted, pronounced consolidation in this space magnifies the impact of individual proprietor decisions on societally valued rights and norms.^{Reference Pasquale12,Reference Crawford13} This leads to a predicament where privately offered services take on key functions of a public commons, yet in many respects remain governed by private fiat.

Importantly, the enormous size of these platforms also leaves their proprietors with no effective way to opt out from their position of subtle authority. Choosing not to establish rules or automated systems governing content, after all, is still a choice; indeed, social network proprietors have come under especially intense scrutiny for their failures to take sufficient action against dangerous content.^{Reference Fink14,Reference Lavi15} Some scholars have applied the lens of behavioral psychology to make the case that levels of prosocial or antisocial behavior observed on the social internet are attributable in significant part to proprietor design decisions, rather than being solely a reflection of the user base.^{Reference Lavi16} For all of these reasons, it is fair to characterize these companies as making unusually high-consequence decisions from a position of low accountability.

This case study on internet technology has focused on widely adopted tools facilitating social and expressive activity, with special attention to how power can be exercised via design choices. In providing the context for the case study, I argued that there is a foreseeable path for neurotechnologies, especially neuromodulatory BCIs, to likewise become widely adopted tools facilitating social and expressive activity. The case study also noted the power-magnifying effect of market consolidation among internet technology firms. While clairvoyance is not possible, other medical device markets have consolidated, and commentators have characterized further consolidation in the neuromodulation industry as likely, with Medtronic and Boston Scientific as early dominant players.^{Reference Piuzzi, Ng and Song17,Reference Cavuoto, Krames, Peckham and Rezai18} Having drawn these analogies between the social importance of present-day internet technology firms and neurotechnology firms of the foreseeable future, I turn to the remaining question: Why view any of this as cause for concern?

Challenging Scenarios

Consider the following hypothetical examples and associated questions. These are posed not as exercises in ethics by speculative fiction, but rather to bring an underlying principle into sharper relief.

Opportunities for Action

What is undesirable about the powerful position of contemporary technology titans is not that they engage in consequential decision-making. Realistically, there is no avoiding this. The problem is that their titanic scale inhibits meaningful accountability and insulates them from demands for the same. It remains to be seen whether there is any realistic policy option that would restore accountability within the internet technology sector. Prudent early movers in the neurotechnology space, on the other hand, can take the example of behemoth technology firms as an opportunity for action and advocacy.

The example of big tech teaches that advocates for responsible neurotechnology innovation would be wise to cultivate vigilance against what has been called “the curse of bigness.”^{Reference Wu20} There is a recognized need to integrate stakeholder values and the public good into neurotechnology development. Yet, as seen in the social media context, when technology developers grow too big for accountability it becomes significantly more challenging to achieve such integration. The best antitrust scholarship teaches that consolidation has more harmful effects than simply driving up consumer prices; indeed, by keeping firms small enough to remain answerable to the public, antitrust reaches beyond narrow consumer-welfare goals and serves to protect democratic values.^{Reference Wu20,Reference Brietzke21} There is a corresponding neuroethical need to foster a decentralized ecosystem of neurotechnology firms. Doing so will make it less challenging to correct the course of any one firm should its decisions begin to disserve the public interest.