Augmenting the mind

The human brain, comprising 86 billion neurons, affords us intellectual and creative abilities far beyond any other species. But it is also the organ about which we still have much to learn, particularly its illnesses. 

One in eight people suffer a mental disorder, yet there are few effective pharmaceuticals. There are also no cures for Alzheimer’s disease or Parkinson’s disease despite billions of dollars of research investment. People with brain disorders and injuries, such as stroke and paralysis, lack technologies to communicate and have agency in the world.

Thankfully, from severe conditions to more common challenges like anxiety, we are entering a golden age of neuro innovation starting in healthcare and set to broaden into consumer-grade mind augmentation.

The growth of neuro-engineering

Brain Computer Interfaces (BCI) are high-tech devices which are inserted into the brain to gather its signals and convert them into commands that relay messages to external devices to carry out actions, bypassing neuromuscular machinery. That might look like the science fiction frontier of neuroscience, but BCI are already helping people overcome disabilities.

New York-based start-up Synchron has developed an interface that accesses the brain via blood vessels. Dubbed a ‘Brain Bluetooth’, the device gives people with paralysis the ability to text, shop, email, and bank online. 

And that’s just one example. The global BCI market was valued at USD1.4bn in 2021 and is expected to reach USD3.1bn by 2023. The broader field of bioelectronic medicine – which harnesses the electronic signalling of the nervous system – is set to triple by 2029.¹ It already helps people with Parkinson’s, epilepsy and hearing loss, and could potentially shift into mental health, as well as neurodegenerative, cardiovascular, and auto-immune conditions.

San Francisco-based Nesos is exploring ways to train the brain to fight autoimmune conditions. Their experimental device, an earbud that uses electrical fields to hack the brain to reduce inflammation and pain, has been shown to be effective in rheumatoid arthritis. The company is also exploring its potential application to help treat depression and migraine.

BCIs and neural devices are, given the surgical intervention required, currently limited to those with the most severe disabilities. Taking BCIs to the mass market will require exploring questions of feasibility, ethics and cybersecurity. Although more investment in research and development is required, companies are already considering the potential for commercialisation in the mass market.

The psychedelic rebirth

BCIs and neutral devices are not the only area of radical scientific innovation in the brain. University researchers and biotechnology companies are also becoming increasingly interested in a new approach to curing or mitigating mental health conditions through psychedelic compounds. 

While there is a long history of research showing that psychedelics could help mental health dating back to the mid-twentieth century, there are key reasons why they are gaining traction today, as evidenced by the growing number of clinical trials and psychedelic science companies. The scientific evidence is better quality thanks in part to improved neuroimaging technology. Attitudes to psychedelics, as well as stigma and misinformation, appear to be softening. A growing number of countries and regions are legalising psychoactive products like cannabis and even psilocybin (found in “magic” mushrooms), most recently in Germany and Colorado, respectively. The poor efficacy of mental health pharmaceuticals and the scale of unmet need help motivate these shifts. 

An analysis by Business Insider identified 11 venture capital firms that have collectively invested roughly USD140 million in the psychedelics category.² “There are more clubs, groups, societies, gatherings, and conferences than ever before about psychedelics, because people are more networked, and it's being driven by patient power,” says Dr Ben Sessa, co-founder and head of psychedelic medicine at Awakn, a UK-based life sciences company specialising in addiction. 

Psychedelic therapy combines psychotherapy with psychopharmacology. The psychedelic is a biological primer that puts the brain into a state of openness and plasticity while psychotherapy helps patients to move past illness, Dr Sessa explains. “If you look at the main underpinning factor about chronic, unremitting, untreatable mental disorders, [it] is this sense of being stuck: this inability to move on from stuck rigid narratives such as ‘I am useless, I am a failure’. What psychedelics do, through the biological process of neuroplasticity, is offer a psychological level of flexibility that allows patients to tackle the stuck narratives”. There is debate as to whether the psychedelics would work as effectively without therapy. On their own they evoke strong emotions which can allow some to confront past traumas, but combined with therapy, they are can help to keep mental health disorders at bay over the long term.   

Yet the field faces challenges. First, psychedelic medicines have to pass through the same rigorous clinical trials as more conventional drugs in order to receive medical approval. To gain traction, they also need to secure the approval of governments and insurance companies who reimburse healthcare. A ketamine-based nasal spray for depression was, for instance, rejected three times for use in NHS England and Wales by the National Institute for Healthcare and Excellence (NICE), the UK body that advises the government on drug reimbursement, due to uncertainty over its long-term efficacy and its high cost. It has however been approved for use by the MHRA for depression that has not responded to two other antidepressant medicines and is approved for use in NHS Scotland.

We also need governance and standards to ensure psychotherapy sessions, involving mentally ill patients in vulnerable states, are professionally handled. 

The 'limitless' moment?

Yet, psychedelics are already entering public consumption through ‘micro dosing’, a term used to describe doses below the threshold of inducing a hallucinogenic state, and favoured by Silicon Valley tech workers looking for a psychological edge. That could be the tip of a wider sea change as people look to improve their cognition, focus and mental performance, regardless of whether they have a mental health problem or illness.

Psychedelics are not the only products presently used to boost cognition and mental performance. Nootropics are over-the-counter mind-supporting supplements that improve attention, focus, sleep and mental health. Almost everyone uses a nootropic, whether they know it or not. Dr Tara Swart, chief science officer at nootropic company Heights, describes nootropics as a continuum running from B vitamins and caffeine to drugs like Ritalin. The global nootropics market is set to grow from USD3.36 billion in 2021 to USD6.61 billion in 2026.³

Many nootropics harness the power of natural ingredients. Clear Focus, from Belgium-based start-up Mindscopic, uses Bacopa Monnieri, a herb that stimulates protein synthesis in the part of the brain responsible for long-term memory. Studies have shown this traditional ayurvedic herb significantly improves cognitive function and inhibits the activity of enzymes controlling harmful processes in the body, such as removing the free radicals that can destroy our DNA.

Mindscopic also champions choline, which helps with the contraction of muscles, activation of pain responses and brain functions like memory and thought. While occurring naturally in the body, the effectiveness from higher doses is best achieved with supplements, according to Koen Indesteege, Mindscopic’s CEO and founder. This nutrient is essential, but unfortunately endogenous amounts produced are significantly below what is required for processes like synthesis of neurotransmitters and influencing liver function. Recommendations are that it is best obtained through foods such as beef and eggs, and additional supplements.

Indesteege believes the nootropics sector will grow as consumers look to healthier alternatives to pharmaceuticals. Post-Covid, he also thinks the public is more concerned about promoting health and preventing disease, although there are still taboos to overcome. “The funny part is that coffee, the most consumed drink in the world, is nootropic, and people drink coffee almost every day to enhance their focus, motivation, and alertness, and it is socially accepted. But it is still a different perception when it is in a capsule and called ‘nootropic’.”

Insights for investors

• In Europe alone, some 180 million people live with a brain disorder. Brain disorders cost nearly EUR800 billion a year in Europe - or around EUR5,500 per inhabitant - based on conservative estimates.
• The global bioelectronic medicine market is forecast to reach USD60 billion by 2029, giving a compound annual growth rate of more than 10 per cent. That includes cardiac, cochlear and retinal implants, as well as those for the central and peripheral nervous systems.
• Acceptance of psychedelics is growing. From 2023, the therapeutic use of psilocybin has become legal in Oregon, while Canada's Alberta province has allowed the regulated use of several psychedelic drugs for therapy.