Juan Leon Garcia
“One of the most influential scientific minds in the world” for Thomson Reuters; “Best scientist” and “Leader in neuroscience” for Research.com. These qualifiers are directed at the figure of the Dr. Álvaro Pascual-Leoneprofessor of neurology at Harvard Medical School and medical director of the Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife in Boston (USA). Who, on the occasion of the second Technology, Health and Society Forum, organized by the Spanish Federation of Health Technology Companies (Fenin) and the Ortega-Marañón Foundation, went to Madrid to reflect on the state of neurosciences that, in the future, will not very far away, they could read our minds (this time, for real).
What does it mean for you to participate in a forum like this? From your point of view, what symbiosis exists between technology, health and society today?
It’s a privilege. And it is because it seems to me that it is a very important topic. I believe that medicine, healthcare, needs to connect, adapt, use cutting-edge technologies and, at the same time, maintain the essence of humanity that the art of medicine represents.
“What we have to do is prevent neurological disease, and that requires a focus on brain health”
How to do both is something that the Dr. Gregorio Marañón. It’s something we’ve sort of forgotten for all sorts of reasons. Among other things, because people have become so hyper-specialized that we have broken the patient into little pieces. And we have to put it back together into a unit; focus on the person. We now have the technologies to approach that person systematically and really get into understanding fundamental principles of the organization of the organism. In my case, from the brain.
Learning new things based on a kind of reverse engineering that begins in the clinic and treating one case at a time. Help the patient and understand fundamental principles, in that order. That is almost the reverse of the usual translation: it is not doing science and seeing how it translates to the clinic; It is doing clinical work and seeing how you deconstruct it in research. But to do this we have to change society: from the clinic, to the way people understand these technologies.
Seeing a forum that raises exactly this, health, technology, society, promotes and requires an interaction between various specialties that I believe is necessary to make it real.
How do you assess the state of Spanish Neurology?
I think that, in general, Neurology in all parts of the world is very good. We know many things about the brain that we didn’t know; We know more than before about diseases that affect the brain.
But we also know that, in a sense, we have missed the boat. Because we continue to focus on treating disabilities, and with that what we achieve is to keep disabled people. We cannot remove the disability. Really, for that, what we have to do is prevent neurological disease, and that means a focus on brain health.
“I hope it will fundamentally change Neurology and become more integrated with Psychiatry or other aspects of brain diseases”
And, among other things, we do not wait for the patient to go to the specialist but we have to empower family doctors to do brain health checks, promote brain health, understand what the challenges are… We have to do in Neurology what We have diabetes, cancer. Keep specialists in the specialty, but know what, how and with what tools to make a lifelong brain health program.
And Neurology, neither here nor anywhere in the world, has finished learning to do that. However, we are trying. We know what is needed.
In the coming years, I hope to fundamentally change Neurology. That it be more integrated with Psychiatry or other aspects of brain diseases and that we really manage to prevent or minimize the type or risk of disability due to diseases of the nervous system. Which by the way, today is the number one cause of disability. More than cancer and cardiovascular diseases combined.
The topic of his presentation revolves around neurotechnology and brain health. How are the two connected?
In order to do what I just said, to prevent and identify individual risk, or to promote brain health, we need technologies. Using neurotechnologies to read the brain, see what’s under the hood of the car. Not only to see clearly how it is working, but to be able to modify that brain and make it work better and prevent possible negative consequences.
“Today, disability due to diseases of the nervous system is the number one cause of disability, above cancer and cardiovascular diseases combined”
In fact, I believe that this approach can only be done with neurotechnologies. And, at the same time, these neurotechnologies have the potential risk of doing things that we have to consider whether it is ethically appropriate to do or not. Because if we can promote health or minimize the risk of disease, perhaps we can also increase abilities, make people smarter, or read things from your brain that you wouldn’t want us to reveal. All this is not fiction.
And, therefore, we must anticipate the reality of this type of potential interventions and propose a serious discourse on ethics and, in turn, adequate regulation of this type of technologies.
Health technology has marked a before and after in the diagnosis, treatment and approach of various diseases. In the case of the brain, what transformations has it entailed and what innovations has its application generated in the study of the brain and pathologies of neurological origin?
The number of advances is enormous. Normally, the criticism in the US of Neurology is that it consists of “diagnose and goodbye”. That is, you diagnose and you can’t do anything else. Well, that is no longer the case. We have gone from neurotechnology that is excellent at identifying the problem to having tools that make this identification infinitely easier and that, in fact, empower doctors and other specialists. Even patients have the possibility of detecting problems without having to see a specialist. But, above all, to have tools that can treat and minimize risks.
“We must propose a serious discourse on ethics in medicine and adequate regulation regarding neurotechnologies”
And that ranges from new technologies for more precise, more targeted and specific medicines, to brain stimulation technologies, invasive or non-invasive brain neuromodulation; brain activity detection; closed loop to modify it; ultrasounds; light… There is a real range of technologies that make it real that we can treat the sick, reduce their suffering and improve their prognosis.
That is a reason for hope. I think we are at the tip of the iceberg of that development. In other words, I think it will quickly get worse. But I still say that, however, we have to focus on preventing problems and promoting health before we have to tackle reducing disabilities.
Why is it so relevant to talk about non-invasive brain stimulation? How does it work and how does it improve current treatments?
What we know today is that the functional unit of the brain is ensembles of neurons. It is not an area of the brain that does one thing. It is a network of neurons, of areas, active in a certain pattern of activity. We can measure that. We can detect it. We can identify the substrate of the problem. We can demonstrate the alteration in those circuits or assemblies. And we know that those assemblies are in a certain area and use electricity, among other things, to determine the pattern of activity.
This gives us an intervention target where we can ‘force’ the normalization or modification of that activity pattern. It can be done with different techniques. What I have dedicated myself to is developing non-invasive electromagnetic technologies to be able to do that. It’s not the only way, but it’s the only one I know anything about.
“There is a real range of technologies that make it real that we can treat patients, reduce their suffering and improve their prognosis”
This allows the activity to be modified in such a way that it induces a change and results in an improvement in the symptoms and also drastically alters the pathological process. That is, it improves function and, at the same time, reduces the risk of the disease continuing to worsen.
The way I really think about it, and we are at the beginning of everything that can be achieved, is as follows: imagine that I want to drink a glass of water and fill this glass with water. What we traditionally do in medicine is open the roof, make it rain here, the glass fills, we all get wet (what we call side effects), but I have filled the glass and I can drink. It is not precise, it is effective, it has problems.
What the neuromodulation approach helps is to put a dropper in that glass, selectively fill it with water, stop it at an appropriate time and not touch anything else. And for that we need a precision approach that, today, with pharmacology, biochemistry, etc., we cannot do. But with brain stimulation we can. Pretty accurate. Not at the cellular level, but at the level of neuron assemblies.