Matthew MacDougall

Since forever. As far back as I can remember, I've been interested in the human brain. I mean, I was a thoughtful kid and a bit of an outsider. And you sit there thinking about what the most important things in the world are. in your little tiny adolescent brain.

Since forever. As far back as I can remember, I've been interested in the human brain. I mean, I was a thoughtful kid and a bit of an outsider. And you sit there thinking about what the most important things in the world are. in your little tiny adolescent brain.

And the answer that I came to that I converged on was that all of the things you can possibly conceive of as things that are important for human beings to care about are literally contained in the skull, both the perception of them and their relative values. the solutions to all our problems and all of our problems are all contained in the skull. And if we knew more about how that worked,

And the answer that I came to that I converged on was that all of the things you can possibly conceive of as things that are important for human beings to care about are literally contained in the skull, both the perception of them and their relative values. the solutions to all our problems and all of our problems are all contained in the skull. And if we knew more about how that worked,

how the brain encodes information and generates desires and generates agony and suffering, we could do more about it. You think about all the really great triumphs in human history. You think about all the really horrific tragedies. You think about the Holocaust. You think about any prison full of human stories. And all of those problems boil down to neurochemistry.

how the brain encodes information and generates desires and generates agony and suffering, we could do more about it. You think about all the really great triumphs in human history. You think about all the really horrific tragedies. You think about the Holocaust. You think about any prison full of human stories. And all of those problems boil down to neurochemistry.

So if you get a little bit of control over that, you provide people the option to do better. In the way I read history, the way people have dealt with having better tools is that they most often in the end do better with huge asterisks. But I think it's an interesting, worthy, and noble pursuit to give people more options, more tools.

So if you get a little bit of control over that, you provide people the option to do better. In the way I read history, the way people have dealt with having better tools is that they most often in the end do better with huge asterisks. But I think it's an interesting, worthy, and noble pursuit to give people more options, more tools.

Yeah. I mean, a lot of that has to do with how well people like that can organize those around them.

Yeah. I mean, a lot of that has to do with how well people like that can organize those around them.

Yeah. And so I always find it interesting to look to primatology, look to our closest non-human relatives for clues as to how humans are going to behave and what particular humans are able to achieve. And so you look at... chimpanzees and bonobos. They're similar, but different in their social structures, particularly.

Yeah. And so I always find it interesting to look to primatology, look to our closest non-human relatives for clues as to how humans are going to behave and what particular humans are able to achieve. And so you look at... chimpanzees and bonobos. They're similar, but different in their social structures, particularly.

I went to Emory in Atlanta and studied under Franz De Waal, the great Franz De Waal, who was kind of the leading primatologist. who recently died. And his work at looking at chimps through the lens of how you would watch an episode of Friends and understand the motivations of the characters interacting with each other, he would look at a chimp colony and basically apply that lens.

I went to Emory in Atlanta and studied under Franz De Waal, the great Franz De Waal, who was kind of the leading primatologist. who recently died. And his work at looking at chimps through the lens of how you would watch an episode of Friends and understand the motivations of the characters interacting with each other, he would look at a chimp colony and basically apply that lens.

I'm massively oversimplifying it. If you do that, instead of just saying, you know, subject 473, you know, through his feces at subject 471, you talk about them in terms of their human struggles, accord them the dignity of themselves as actors with understandable goals and drives, what they want out of life.

I'm massively oversimplifying it. If you do that, instead of just saying, you know, subject 473, you know, through his feces at subject 471, you talk about them in terms of their human struggles, accord them the dignity of themselves as actors with understandable goals and drives, what they want out of life.

And primarily it's, you know, the things we want out of life, food, sex, companionship, power. you can understand chimp and bonobo behavior in the same lights much more easily.

And primarily it's, you know, the things we want out of life, food, sex, companionship, power. you can understand chimp and bonobo behavior in the same lights much more easily.

And I think doing so gives you the tools you need to reduce human behavior from the kind of false complexity that we layer onto it with language and look at it in terms of, oh, well, these humans are looking for companionship, sex, food, power, And I think that's a pretty powerful tool to have in understanding human behavior.

And I think doing so gives you the tools you need to reduce human behavior from the kind of false complexity that we layer onto it with language and look at it in terms of, oh, well, these humans are looking for companionship, sex, food, power, And I think that's a pretty powerful tool to have in understanding human behavior.

Right. Breeding rights often go with... Alpha status. And so if you can get a piece of that, then you're going to do okay.

Right. Breeding rights often go with... Alpha status. And so if you can get a piece of that, then you're going to do okay.

Yeah, I think that's true.

Yeah, I think that's true.

Basically, the moment I got to college, I started looking around for labs that I could do neuroscience work in. I originally approached that from the angle of looking at interactions between the brain and the immune system, which isn't the most obvious place to start. But I had this idea at the time that

Basically, the moment I got to college, I started looking around for labs that I could do neuroscience work in. I originally approached that from the angle of looking at interactions between the brain and the immune system, which isn't the most obvious place to start. But I had this idea at the time that

the contents of your thoughts would have an impact, a direct impact, maybe a powerful one, on non-conscious systems in your body, the systems we think of as homeostatic, automatic mechanisms like fighting off a virus, like repairing a wound. And sure enough, there are big crossovers between the two. I mean... it gets to kind of a key point that I think goes under-recognized.

the contents of your thoughts would have an impact, a direct impact, maybe a powerful one, on non-conscious systems in your body, the systems we think of as homeostatic, automatic mechanisms like fighting off a virus, like repairing a wound. And sure enough, there are big crossovers between the two. I mean... it gets to kind of a key point that I think goes under-recognized.

One of the things people don't recognize or appreciate about the human brain enough, and that is that it basically controls or has a huge role in almost everything that your body does. Like you try to name an example of something in your body that isn't directly controlled or massively influenced by the brain. And it's pretty hard.

One of the things people don't recognize or appreciate about the human brain enough, and that is that it basically controls or has a huge role in almost everything that your body does. Like you try to name an example of something in your body that isn't directly controlled or massively influenced by the brain. And it's pretty hard.

I mean, you might say like bone healing or something, but even those systems, the hypothalamus and pituitary end up playing a role. in coordinating the endocrine system that does have a direct influence on, say, the calcium level in your blood that goes to bone healing. So non-obvious connections between those things implicate the brain as really a potent prime mover in all of health.

I mean, you might say like bone healing or something, but even those systems, the hypothalamus and pituitary end up playing a role. in coordinating the endocrine system that does have a direct influence on, say, the calcium level in your blood that goes to bone healing. So non-obvious connections between those things implicate the brain as really a potent prime mover in all of health.

Yeah, you could understand how that would be driven by evolution too, just in some simple examples. If you get sick, if you get a communicable disease, you get the flu, it's pretty advantageous for your immune system to tell your brain, hey, now be antisocial for a few days. Don't go be the life of the party tonight.

Yeah, you could understand how that would be driven by evolution too, just in some simple examples. If you get sick, if you get a communicable disease, you get the flu, it's pretty advantageous for your immune system to tell your brain, hey, now be antisocial for a few days. Don't go be the life of the party tonight.

In fact, maybe just cuddle up somewhere warm under a blanket and just stay there for a day or two. And sure enough, that tends to be the behavior that you see both in animals and in humans. If you get sick, elevated levels of interleukins in your blood and TNF-alpha in your blood ask the brain to cut back on social activity and even moving around.

In fact, maybe just cuddle up somewhere warm under a blanket and just stay there for a day or two. And sure enough, that tends to be the behavior that you see both in animals and in humans. If you get sick, elevated levels of interleukins in your blood and TNF-alpha in your blood ask the brain to cut back on social activity and even moving around.

You have lower locomotor activity in animals that are infected with viruses.

You have lower locomotor activity in animals that are infected with viruses.

You know, it was sort of an evolution of thought. I wanted to study the brain. I started studying the brain in undergrad in this neuroimmunology lab. From there... realized at some point that I didn't want to just generate knowledge. I wanted to effect real changes in the actual world, in actual people's lives.

You know, it was sort of an evolution of thought. I wanted to study the brain. I started studying the brain in undergrad in this neuroimmunology lab. From there... realized at some point that I didn't want to just generate knowledge. I wanted to effect real changes in the actual world, in actual people's lives.

And so after having not really thought about going into medical school, I was on a track to go into a PhD program. I said, I'd like that option. I'd like to actually potentially help tangible people in front of me. And doing a little digging found that there exists these MD-PhD programs where you can choose not to choose between them and do both.

And so after having not really thought about going into medical school, I was on a track to go into a PhD program. I said, I'd like that option. I'd like to actually potentially help tangible people in front of me. And doing a little digging found that there exists these MD-PhD programs where you can choose not to choose between them and do both.

And so I went to USC for medical school and had a joint PhD program with Caltech, where I actually chose that program particularly because of a researcher at Caltech named Richard Anderson, who's one of the godfathers of primate neuroscience.

And so I went to USC for medical school and had a joint PhD program with Caltech, where I actually chose that program particularly because of a researcher at Caltech named Richard Anderson, who's one of the godfathers of primate neuroscience.

It has a macaque lab where Utah rays and other electrodes were being inserted into the brains of monkeys to try to understand how intentions were being encoded in the brain. So I ended up there with the idea that maybe I would be a neurologist and study the brain on the side and then discovered that neurology, again, I'm going to

It has a macaque lab where Utah rays and other electrodes were being inserted into the brains of monkeys to try to understand how intentions were being encoded in the brain. So I ended up there with the idea that maybe I would be a neurologist and study the brain on the side and then discovered that neurology, again, I'm going to

make enemies by saying this, but neurology predominantly and distressingly to me is the practice of diagnosing a thing and then saying, good luck with that when there's not much we can do.

make enemies by saying this, but neurology predominantly and distressingly to me is the practice of diagnosing a thing and then saying, good luck with that when there's not much we can do.

And neurosurgery, very differently, it's a powerful lever on taking people that are headed in a bad direction and changing their course in the sense of brain tumors that are potentially treatable or curable with surgery. You know, even aneurysms in the brain, blood vessels that are going to rupture, you can save lives really is at the end of the day what mattered to me. And so...

And neurosurgery, very differently, it's a powerful lever on taking people that are headed in a bad direction and changing their course in the sense of brain tumors that are potentially treatable or curable with surgery. You know, even aneurysms in the brain, blood vessels that are going to rupture, you can save lives really is at the end of the day what mattered to me. And so...

I was at USC, as I mentioned. That happens to be one of the great neurosurgery programs. And so I met these truly epic neurosurgeons, Alex Kalesi and Micah Puzo and Steve Gianotta and Marty Weiss, these sort of epic people that were just human beings in front of me. And so it kind of changed my thinking from neurosurgeons are

I was at USC, as I mentioned. That happens to be one of the great neurosurgery programs. And so I met these truly epic neurosurgeons, Alex Kalesi and Micah Puzo and Steve Gianotta and Marty Weiss, these sort of epic people that were just human beings in front of me. And so it kind of changed my thinking from neurosurgeons are

distant gods that live on another planet and occasionally come and visit us. These are humans that have problems and are people, and there's nothing fundamentally preventing me from being one of them. And so, At the last minute in medical school, I changed gears from going into a different specialty and switched into neurosurgery, which cost me a year.

distant gods that live on another planet and occasionally come and visit us. These are humans that have problems and are people, and there's nothing fundamentally preventing me from being one of them. And so, At the last minute in medical school, I changed gears from going into a different specialty and switched into neurosurgery, which cost me a year.

I had to do another year of research because I was so far along in the process to switch into neurosurgery. The deadlines had already passed. So it was a decision that cost time, but absolutely worth it.

I had to do another year of research because I was so far along in the process to switch into neurosurgery. The deadlines had already passed. So it was a decision that cost time, but absolutely worth it.

Yeah. Two things, I think. Residency in neurosurgery is sort of a competition of pain, of how much pain can you eat and smile. Yeah. And so there's... work hour restrictions that are not really, they're viewed at, I think, internally among the residents as weakness. And so most neurosurgery residents try to work as hard as they can.

Yeah. Two things, I think. Residency in neurosurgery is sort of a competition of pain, of how much pain can you eat and smile. Yeah. And so there's... work hour restrictions that are not really, they're viewed at, I think, internally among the residents as weakness. And so most neurosurgery residents try to work as hard as they can.

And that, I think, necessarily means working long hours and sometimes over the work hour limits. And, you know, we care about being compliant with whatever regulations are in front of us. But I think more important than that, people want to

And that, I think, necessarily means working long hours and sometimes over the work hour limits. And, you know, we care about being compliant with whatever regulations are in front of us. But I think more important than that, people want to

give all give their all in becoming a better neurosurgeon because the the stakes are so high and so it's a real fight to get residents uh to say go home at the end of their shift and not stay and do more surgery are you seriously saying like one of the hardest things is literally like getting forcing them to get sleep and rest and all this kind of stuff historically that was the case.

give all give their all in becoming a better neurosurgeon because the the stakes are so high and so it's a real fight to get residents uh to say go home at the end of their shift and not stay and do more surgery are you seriously saying like one of the hardest things is literally like getting forcing them to get sleep and rest and all this kind of stuff historically that was the case.

I think, I think the next generation, I think the next generation is more, uh, compliant and more self-care.

I think, I think the next generation, I think the next generation is more, uh, compliant and more self-care.

That's what you mean. All right. I'm just, I'm just kidding.

That's what you mean. All right. I'm just, I'm just kidding.

The personalities, uh, and maybe the two are connected, but. So is it, was it pretty competitive? It's competitive and it's also, um, you know, as we touched on earlier, primates like power and I think, um, neurosurgery has long had this aura of mystique and excellence and whatever about it. And so it's an invitation, I think, for people that are cloaked in that authority.

The personalities, uh, and maybe the two are connected, but. So is it, was it pretty competitive? It's competitive and it's also, um, you know, as we touched on earlier, primates like power and I think, um, neurosurgery has long had this aura of mystique and excellence and whatever about it. And so it's an invitation, I think, for people that are cloaked in that authority.

A board-certified neurosurgeon is basically a walking, fallacious appeal to authority, right? You have license to walk into any room and act like you're an expert on whatever. And fighting that tendency is not something that most neurosurgeons do well. Humility isn't the forte.

A board-certified neurosurgeon is basically a walking, fallacious appeal to authority, right? You have license to walk into any room and act like you're an expert on whatever. And fighting that tendency is not something that most neurosurgeons do well. Humility isn't the forte.

sort of heroic aspect to neurosurgery and i think it gets to people's head a little bit yeah well that i think that uh you know that allows me to play well at an elon company because elon uh one of his strengths i think is to just instantly see through fallacy from authority so nobody walks into a room that he's in and says well god damn it you have to trust me

sort of heroic aspect to neurosurgery and i think it gets to people's head a little bit yeah well that i think that uh you know that allows me to play well at an elon company because elon uh one of his strengths i think is to just instantly see through fallacy from authority so nobody walks into a room that he's in and says well god damn it you have to trust me

i'm the guy that built the last you know 10 rockets or something and he says well you did it wrong and we can do it better or i'm the guy that you know kept ford alive for the last 50 years you listen to me on how to build cars and he says No. And so you don't walk into a room that he's in and say, well, I'm a neurosurgeon. Let me tell you how to do it.

i'm the guy that built the last you know 10 rockets or something and he says well you did it wrong and we can do it better or i'm the guy that you know kept ford alive for the last 50 years you listen to me on how to build cars and he says No. And so you don't walk into a room that he's in and say, well, I'm a neurosurgeon. Let me tell you how to do it.

He's going to say, well, I'm a human being that has a brain. I can think from first principles myself. Thank you very much. And here's how I think it ought to be done. Let's go try it and see who's right. And that's proven, I think, over and over in his case to be a very powerful approach.

He's going to say, well, I'm a human being that has a brain. I can think from first principles myself. Thank you very much. And here's how I think it ought to be done. Let's go try it and see who's right. And that's proven, I think, over and over in his case to be a very powerful approach.

Yeah, there's a sweet spot where people disagree and forcefully speak their mind and passionately defend their position. and yet are still able to accept information from others and change their ideas when they're wrong. I like the analogy of how you polish rocks. You put hard things in a hard container and spin it. People bash against each other and out comes a more refined product.

Yeah, there's a sweet spot where people disagree and forcefully speak their mind and passionately defend their position. and yet are still able to accept information from others and change their ideas when they're wrong. I like the analogy of how you polish rocks. You put hard things in a hard container and spin it. People bash against each other and out comes a more refined product.

To make a good team at Neuralink, we've tried to find people that are not afraid to defend their ideas passionately and occasionally strongly disagree with people that they're working with and have the best idea come out on top. It's not an easy balance, again, to refer back to the primate brain. It's not something that is inherently built into the primate brain to say,

To make a good team at Neuralink, we've tried to find people that are not afraid to defend their ideas passionately and occasionally strongly disagree with people that they're working with and have the best idea come out on top. It's not an easy balance, again, to refer back to the primate brain. It's not something that is inherently built into the primate brain to say,

I passionately put all my chips on this position and now I'm just going to walk away from it and admit you were right. You know, part of our brains tell us that that is a power loss. That is a loss of face, a loss of standing in the community. And now you're a Zeta chump because your idea got trounced. Yeah.

I passionately put all my chips on this position and now I'm just going to walk away from it and admit you were right. You know, part of our brains tell us that that is a power loss. That is a loss of face, a loss of standing in the community. And now you're a Zeta chump because your idea got trounced. Yeah.

And you just have to recognize that that little voice in the back of your head is maladaptive and it's not helping the team win.

And you just have to recognize that that little voice in the back of your head is maladaptive and it's not helping the team win.

Yeah, I think working your ass off, working hard while functioning as a member of a team, getting a job done, that is incredibly difficult. Working incredibly long hours, being up all night, taking care of someone that you think probably won't survive no matter what you do. working hard to make people that you passionately dislike look good the next morning.

Yeah, I think working your ass off, working hard while functioning as a member of a team, getting a job done, that is incredibly difficult. Working incredibly long hours, being up all night, taking care of someone that you think probably won't survive no matter what you do. working hard to make people that you passionately dislike look good the next morning.

These folks were relentless in their pursuit of excellent neurosurgical technique, decade over decade. And I think we're well-recognized for that excellence, especially Marty Weiss, Steve Gianotta, Micah Puzo, they made huge contributions, not only to surgical technique, but they built training programs that trained dozens or hundreds of amazing neurosurgeons.

These folks were relentless in their pursuit of excellent neurosurgical technique, decade over decade. And I think we're well-recognized for that excellence, especially Marty Weiss, Steve Gianotta, Micah Puzo, they made huge contributions, not only to surgical technique, but they built training programs that trained dozens or hundreds of amazing neurosurgeons.

I was just lucky to kind of be in their wake.

I was just lucky to kind of be in their wake.

Yeah. It's especially challenging when you with all respect to our elders, it doesn't hit so much when you're taking care of an 80 year old and something was going to get them pretty soon anyway. And so you lose a patient like that. And it was part of the natural course of what is expected of them in the coming years, regardless. Taking care of

Yeah. It's especially challenging when you with all respect to our elders, it doesn't hit so much when you're taking care of an 80 year old and something was going to get them pretty soon anyway. And so you lose a patient like that. And it was part of the natural course of what is expected of them in the coming years, regardless. Taking care of

you know, a father of two or three, four young kids, someone in their 30s that didn't have it coming, and they show up in your ER having their first seizure of their life, and lo and behold, they've got a huge malignant, inoperable, or incurable brain tumor. You can only do that, I think, a handful of times before it really starts eating away at your at your armor.

you know, a father of two or three, four young kids, someone in their 30s that didn't have it coming, and they show up in your ER having their first seizure of their life, and lo and behold, they've got a huge malignant, inoperable, or incurable brain tumor. You can only do that, I think, a handful of times before it really starts eating away at your at your armor.

Or a young mother that shows up that has a giant hemorrhage in her brain that she's not going to survive from, and they bring her four-year-old daughter in to say goodbye one last time before they turn the ventilator off. The great Henry Marsh is an English neurosurgeon who said it best. I think he says, every neurosurgeon carries with them a private graveyard.

Or a young mother that shows up that has a giant hemorrhage in her brain that she's not going to survive from, and they bring her four-year-old daughter in to say goodbye one last time before they turn the ventilator off. The great Henry Marsh is an English neurosurgeon who said it best. I think he says, every neurosurgeon carries with them a private graveyard.

And I definitely feel that, especially with young parents. That kills me. They had a lot more to give. The loss of those people specifically has a knock-on effect that's going to make the world worse for people for a long time. And it's just hard to feel powerless in the face of that.

And I definitely feel that, especially with young parents. That kills me. They had a lot more to give. The loss of those people specifically has a knock-on effect that's going to make the world worse for people for a long time. And it's just hard to feel powerless in the face of that.

You know, and that's where I think you have to be borderline evil to fight against a company like Neuralink or to constantly be taking potshots at us because what we're doing is to try to fix that stuff. We're trying to give people options to reduce suffering. We're trying to We're trying to take the pain out of life that broken brains brings in.

You know, and that's where I think you have to be borderline evil to fight against a company like Neuralink or to constantly be taking potshots at us because what we're doing is to try to fix that stuff. We're trying to give people options to reduce suffering. We're trying to We're trying to take the pain out of life that broken brains brings in.

And yeah, this is just our little way that we're fighting back against entropy, I guess.

And yeah, this is just our little way that we're fighting back against entropy, I guess.

Yeah, we're just starting. We're going to do so much more.

Yeah, we're just starting. We're going to do so much more.

Yeah, it's a really simple, really simple, straightforward procedure. The human part of the surgery that I do is... Dead simple. It's one of the most basic neurosurgery procedures imaginable. And I think there's evidence that some version of it has been done for thousands of years. There are examples, I think, from ancient Egypt of healed or partially healed trephinations and from...

Yeah, it's a really simple, really simple, straightforward procedure. The human part of the surgery that I do is... Dead simple. It's one of the most basic neurosurgery procedures imaginable. And I think there's evidence that some version of it has been done for thousands of years. There are examples, I think, from ancient Egypt of healed or partially healed trephinations and from...

Peru or, you know, ancient times in South America, where these proto-surgeons would drill holes in people's skulls, you know, presumably to let out the evil spirits, but maybe to drain blood clots. And there's evidence of bone healing around the edge, meaning the people at least survived some months after a procedure. Yeah. And so what we're doing is that.

Peru or, you know, ancient times in South America, where these proto-surgeons would drill holes in people's skulls, you know, presumably to let out the evil spirits, but maybe to drain blood clots. And there's evidence of bone healing around the edge, meaning the people at least survived some months after a procedure. Yeah. And so what we're doing is that.

We are making a cut in the skin on the top of the head over the area of the brain that is the most potent representation of hand intentions. And so if you are an expert concert pianist, this part of your brain is lighting up the entire time you're playing. We call it the hand knob. The hand knob.

We are making a cut in the skin on the top of the head over the area of the brain that is the most potent representation of hand intentions. And so if you are an expert concert pianist, this part of your brain is lighting up the entire time you're playing. We call it the hand knob. The hand knob.

there's a little squiggle in the cortex right there. One of the folds in the brain is kind of doubly folded right on that spot. And so you can look at it on an MRI and say, that's the hand knob. And then you, you do a functional test and a special kind of MRI called a functional MRI, fMRI.

there's a little squiggle in the cortex right there. One of the folds in the brain is kind of doubly folded right on that spot. And so you can look at it on an MRI and say, that's the hand knob. And then you, you do a functional test and a special kind of MRI called a functional MRI, fMRI.

And this part of the brain lights up when people, even quadriplegic people whose brains aren't connected to their finger movements anymore, they think, imagine finger movements and this part of the brain still lights up. So we can ID that part of the brain in anyone who's preparing to enter our trial and say, okay, that part of the brain we confirm is your hand intention area.

And this part of the brain lights up when people, even quadriplegic people whose brains aren't connected to their finger movements anymore, they think, imagine finger movements and this part of the brain still lights up. So we can ID that part of the brain in anyone who's preparing to enter our trial and say, okay, that part of the brain we confirm is your hand intention area.

And so I'll make a little cut in the skin. We'll flap the skin open, just like kind of opening the hood of a car, only a lot smaller. Make a perfectly round uh one inch diameter hole in the skull remove that bit of skull uh open the lining of the brain the covering of the brain it's like a like a little bag of water that the brain floats in and then show that part of the brain to our robot

And so I'll make a little cut in the skin. We'll flap the skin open, just like kind of opening the hood of a car, only a lot smaller. Make a perfectly round uh one inch diameter hole in the skull remove that bit of skull uh open the lining of the brain the covering of the brain it's like a like a little bag of water that the brain floats in and then show that part of the brain to our robot

And then this is where the robot shines. It can come in and take these tiny, much smaller than human hair electrodes and precisely insert them into the cortex, into the surface of the brain to a very precise depth in a very precise spot that avoids all the blood vessels that are coating the surface of the brain.

And then this is where the robot shines. It can come in and take these tiny, much smaller than human hair electrodes and precisely insert them into the cortex, into the surface of the brain to a very precise depth in a very precise spot that avoids all the blood vessels that are coating the surface of the brain.

And after the robot's done with its part, then the human comes back in and puts the implant into that hole in the skull and covers it up, screwing it down to the skull and sewing the skin back together. So the whole thing is a few hours long.

And after the robot's done with its part, then the human comes back in and puts the implant into that hole in the skull and covers it up, screwing it down to the skull and sewing the skin back together. So the whole thing is a few hours long.

It's extremely low risk compared to the average neurosurgery involving the brain that might, say, open up a deep part of the brain or manipulate blood vessels in the brain. This opening on the surface of the brain is... with only cortical microinsertions carries significantly less risk than a lot of the tumor or aneurysm surgeries that are routinely done.

It's extremely low risk compared to the average neurosurgery involving the brain that might, say, open up a deep part of the brain or manipulate blood vessels in the brain. This opening on the surface of the brain is... with only cortical microinsertions carries significantly less risk than a lot of the tumor or aneurysm surgeries that are routinely done.

Yeah, that's a good question. Humans are general-purpose machines. We're able to adapt to unusual situations. We're able to change the plan on the fly. I remember well a surgery that I was doing many years ago down in San Diego where the plan was to...

Yeah, that's a good question. Humans are general-purpose machines. We're able to adapt to unusual situations. We're able to change the plan on the fly. I remember well a surgery that I was doing many years ago down in San Diego where the plan was to...

open a small hole behind the ear and go reposition a blood vessel that had come to lay on the facial nerve, the trigeminal nerve, the nerve that goes to the face. When that blood vessel lays on the nerve, it can cause just intolerable, horrific shooting pain that people describe like being zapped with a cattle prod.

open a small hole behind the ear and go reposition a blood vessel that had come to lay on the facial nerve, the trigeminal nerve, the nerve that goes to the face. When that blood vessel lays on the nerve, it can cause just intolerable, horrific shooting pain that people describe like being zapped with a cattle prod.

And so the beautiful, elegant surgery is to go move this blood vessel off the nerve. The surgery team, we went in there and started moving this blood vessel and then found that there was a giant aneurysm on that blood vessel that was not easily visible on the pre-op scans. And so the plan had to dynamically change and that the...

And so the beautiful, elegant surgery is to go move this blood vessel off the nerve. The surgery team, we went in there and started moving this blood vessel and then found that there was a giant aneurysm on that blood vessel that was not easily visible on the pre-op scans. And so the plan had to dynamically change and that the...

Human surgeons had no problem with that, were trained for all those things. Robots wouldn't do so well in that situation, at least in their current incarnation. Fully robotic surgery, like the electrode insertion portion of the Neuralink surgery, it goes according to a set plan. The humans can interrupt the flow and change the plan, but the robot can't really change the plan midway through.

Human surgeons had no problem with that, were trained for all those things. Robots wouldn't do so well in that situation, at least in their current incarnation. Fully robotic surgery, like the electrode insertion portion of the Neuralink surgery, it goes according to a set plan. The humans can interrupt the flow and change the plan, but the robot can't really change the plan midway through.

It operates according to how it was programmed and how it was asked to run. It does its job very precisely, but not with a wide degree of latitude in how to react to changing conditions.

It operates according to how it was programmed and how it was asked to run. It does its job very precisely, but not with a wide degree of latitude in how to react to changing conditions.

Currently. I think we are at the dawn of a new era with AI of the parameters for robot responsiveness to be dramatically broadened, right? I mean, you can't look at a self-driving car and say that it's operating under very narrow parameters

Currently. I think we are at the dawn of a new era with AI of the parameters for robot responsiveness to be dramatically broadened, right? I mean, you can't look at a self-driving car and say that it's operating under very narrow parameters

You know, if a chicken runs across the road, it wasn't necessarily programmed to deal with that specifically, but a Waymo or a self-driving Tesla would have no problem reacting to that appropriately. And so surgical robots aren't there yet, but give it time.

You know, if a chicken runs across the road, it wasn't necessarily programmed to deal with that specifically, but a Waymo or a self-driving Tesla would have no problem reacting to that appropriately. And so surgical robots aren't there yet, but give it time.

I'm not worried about my job in the course of my professional life. I think I would tell my kids not necessarily to go in this line of work, depending on how things look in 20 years.

I'm not worried about my job in the course of my professional life. I think I would tell my kids not necessarily to go in this line of work, depending on how things look in 20 years.

Yeah, yeah. I do the parts it can't do, and it does the parts I can't do. And we are friends.

Yeah, yeah. I do the parts it can't do, and it does the parts I can't do. And we are friends.

It's pretty intense. So there's no analog to this in human surgery. Human surgery is sort of this artisanal craft that's handed down directly from master to pupil over the generations. I mean, literally the way you learn to be a surgeon on humans is by doing surgery on humans. I mean, first you watch...

It's pretty intense. So there's no analog to this in human surgery. Human surgery is sort of this artisanal craft that's handed down directly from master to pupil over the generations. I mean, literally the way you learn to be a surgeon on humans is by doing surgery on humans. I mean, first you watch...

your professors do a bunch of surgery and then finally they put, you know, the trivial parts of the surgery into your hands and then the more complex parts. And as your understanding of the point and the purposes of the surgery increases, you get more responsibility in the perfect condition. It doesn't always go well. In Neuralink's case, the approach is a bit different. Um,

your professors do a bunch of surgery and then finally they put, you know, the trivial parts of the surgery into your hands and then the more complex parts. And as your understanding of the point and the purposes of the surgery increases, you get more responsibility in the perfect condition. It doesn't always go well. In Neuralink's case, the approach is a bit different. Um,

And we, of course, practiced as far as we could on animals. We did hundreds of animal surgeries. And when it came time to do the first human, we had just an amazing team of engineers build incredibly lifelike models.

And we, of course, practiced as far as we could on animals. We did hundreds of animal surgeries. And when it came time to do the first human, we had just an amazing team of engineers build incredibly lifelike models.

One of the engineers, Fran Romano in particular, built a pulsating brain in a custom 3D printed skull that matches exactly the patient's anatomy, including their face and scalp characteristics. And so

One of the engineers, Fran Romano in particular, built a pulsating brain in a custom 3D printed skull that matches exactly the patient's anatomy, including their face and scalp characteristics. And so

And when I was able to practice that, I mean, it's as close as it really reasonably should get to being the real thing in all the details, including having a mannequin body attached to this custom head. And so when we were doing the practice surgeries, we'd...

And when I was able to practice that, I mean, it's as close as it really reasonably should get to being the real thing in all the details, including having a mannequin body attached to this custom head. And so when we were doing the practice surgeries, we'd...

wheel that body into the CT scanner and take a mock CT scan and wheel it back in and conduct all the normal safety checks verbally, you know, stop this patient. We're confirming his identification is mannequin number, blah, blah, blah.

wheel that body into the CT scanner and take a mock CT scan and wheel it back in and conduct all the normal safety checks verbally, you know, stop this patient. We're confirming his identification is mannequin number, blah, blah, blah.

And then opening the brain in exactly the right spot using standard operative neuronavigation equipment, standard surgical drills in the same OR that we do all of our practice surgeries in at Neuralink, and having the skull open and have the brain pulse, which adds a degree of difficulty for the robot, you know, perfectly, precisely plan and insert those electrodes to the right depth and location.

And then opening the brain in exactly the right spot using standard operative neuronavigation equipment, standard surgical drills in the same OR that we do all of our practice surgeries in at Neuralink, and having the skull open and have the brain pulse, which adds a degree of difficulty for the robot, you know, perfectly, precisely plan and insert those electrodes to the right depth and location.

And so... Yeah, we kind of broke new ground on how extensively we practiced for this surgery.

And so... Yeah, we kind of broke new ground on how extensively we practiced for this surgery.

Well, we were lucky to have just incredible partners at the Barrow Neurologic Institute. They are I think the premier neurosurgical hospital in the world. They made everything as easy as possible for the trial to get going and helped us immensely with their expertise on how to arrange the details. It was a much more high-pressure surgery in some ways. I mean, even though the

Well, we were lucky to have just incredible partners at the Barrow Neurologic Institute. They are I think the premier neurosurgical hospital in the world. They made everything as easy as possible for the trial to get going and helped us immensely with their expertise on how to arrange the details. It was a much more high-pressure surgery in some ways. I mean, even though the

You know, the outcome wasn't particularly in question in terms of our participants' safety. The number of observers, you know, the number of people—there's conference rooms full of people watching live streams in the hospital— rooting for this to go perfectly.

You know, the outcome wasn't particularly in question in terms of our participants' safety. The number of observers, you know, the number of people—there's conference rooms full of people watching live streams in the hospital— rooting for this to go perfectly.

And that just adds pressure that is not typical for even the most intense production neurosurgery, say removing a tumor or placing deep brain stimulation electrodes. And it had never been done on a human before. There were unknown unknowns. And so...

And that just adds pressure that is not typical for even the most intense production neurosurgery, say removing a tumor or placing deep brain stimulation electrodes. And it had never been done on a human before. There were unknown unknowns. And so...

Definitely a moderate pucker factor there for the whole team, not knowing if we were going to encounter, say, a degree of brain movement that was unanticipated, or a degree of brain sag that took the brain far away from the skull and made it difficult to insert, or some other unknown unknown problem.

Definitely a moderate pucker factor there for the whole team, not knowing if we were going to encounter, say, a degree of brain movement that was unanticipated, or a degree of brain sag that took the brain far away from the skull and made it difficult to insert, or some other unknown unknown problem.

Fortunately, everything went well, and that surgery was one of the smoothest outcomes we could have imagined. Were you nervous? I mean, you're a bit of a quarterback in the Super Bowl kind of situation. Extremely nervous. Extremely. I was very pleased when it went well and when it was over. Yeah. Looking forward to number two.

Fortunately, everything went well, and that surgery was one of the smoothest outcomes we could have imagined. Were you nervous? I mean, you're a bit of a quarterback in the Super Bowl kind of situation. Extremely nervous. Extremely. I was very pleased when it went well and when it was over. Yeah. Looking forward to number two.

Well, I think wealth is easy to hate or envy or whatever. And I think there's a whole industry around driving clicks and And bad news is great for clicks. And so any way to take an event and turn it into bad news is going to be really good for clicks.

Well, I think wealth is easy to hate or envy or whatever. And I think there's a whole industry around driving clicks and And bad news is great for clicks. And so any way to take an event and turn it into bad news is going to be really good for clicks.

Now that there is a human with literal skin in the game, there's a participant whose well-being rides on this doing well. You have to be a pretty bad person to be rooting for that to go wrong. And so hopefully people look in the mirror and realize that at some point.

Now that there is a human with literal skin in the game, there's a participant whose well-being rides on this doing well. You have to be a pretty bad person to be rooting for that to go wrong. And so hopefully people look in the mirror and realize that at some point.

Yeah. I mean, I, you know, because, uh, um, an MD needs to be in charge of all of the medical decision-making throughout the process. Um, I unscrubbed from the surgery after exposing the brain and presenting it to the robot and, um, place the targets on the robot software interface that tells the robot where it's going to insert each thread.

Yeah. I mean, I, you know, because, uh, um, an MD needs to be in charge of all of the medical decision-making throughout the process. Um, I unscrubbed from the surgery after exposing the brain and presenting it to the robot and, um, place the targets on the robot software interface that tells the robot where it's going to insert each thread.

That was done with my hand on the mouse for whatever that's worth.

That was done with my hand on the mouse for whatever that's worth.

Yeah.

Yeah.

Right. The software engineers are amazing on this team. They actually provided an interface where you can essentially use a lasso tool and select a prime area of brain real estate, and it will automatically avoid the blood vessels in that region and automatically place a bunch of targets. That allows

Right. The software engineers are amazing on this team. They actually provided an interface where you can essentially use a lasso tool and select a prime area of brain real estate, and it will automatically avoid the blood vessels in that region and automatically place a bunch of targets. That allows

the human robot operator to select really good areas of brain and make dense applications of targets in those regions, the regions we think are gonna have the most high fidelity representations of finger movements and arm movement intentions.

the human robot operator to select really good areas of brain and make dense applications of targets in those regions, the regions we think are gonna have the most high fidelity representations of finger movements and arm movement intentions.

Yeah, love that subreddit.

Yeah, love that subreddit.

As a person who has a visceral reaction to the brain bleeding, I can tell you it's extremely satisfying watching the electrodes themselves go into the brain and not cause bleeding.

As a person who has a visceral reaction to the brain bleeding, I can tell you it's extremely satisfying watching the electrodes themselves go into the brain and not cause bleeding.

Yeah, so talking broadly about neurosurgery, we can get anywhere. It's routine for me to put deep brain stimulating electrodes near the very bottom of the brain, entering from the top and passing about a two millimeter wire all the way into the bottom of the brain. And that's not revolutionary. A lot of people do that. And we can do that with very high precision.

Yeah, so talking broadly about neurosurgery, we can get anywhere. It's routine for me to put deep brain stimulating electrodes near the very bottom of the brain, entering from the top and passing about a two millimeter wire all the way into the bottom of the brain. And that's not revolutionary. A lot of people do that. And we can do that with very high precision.

I use a robot from Globus to do that surgery. several times a month. It's pretty routine.

I use a robot from Globus to do that surgery. several times a month. It's pretty routine.

Yeah, so it's a cool process on the software side. You take a preoperative MRI that's extremely high resolution data of the entire brain and You put the patient to sleep, put their head in a frame that holds the skull very rigidly, and then you take a CT scan of their head while they're asleep with that frame on, and then merge the MRI and the CT in software.

Yeah, so it's a cool process on the software side. You take a preoperative MRI that's extremely high resolution data of the entire brain and You put the patient to sleep, put their head in a frame that holds the skull very rigidly, and then you take a CT scan of their head while they're asleep with that frame on, and then merge the MRI and the CT in software.

you have a plan based on the MRI where you can see these nuclei deep in the brain. You can't see them on CT, but if you trust the merging of the two images, then you indirectly know on the CT where that is and therefore indirectly know where in reference to the titanium frame screwed to their head those targets are.

you have a plan based on the MRI where you can see these nuclei deep in the brain. You can't see them on CT, but if you trust the merging of the two images, then you indirectly know on the CT where that is and therefore indirectly know where in reference to the titanium frame screwed to their head those targets are.

And so this is 60s technology to manually compute trajectories given the entry point and target and dial in some goofy-looking titanium actuators with little tick marks on them. the modern version of that is to use a robot, just like a little KUKA arm you might see building cars at the Tesla factory.

And so this is 60s technology to manually compute trajectories given the entry point and target and dial in some goofy-looking titanium actuators with little tick marks on them. the modern version of that is to use a robot, just like a little KUKA arm you might see building cars at the Tesla factory.

This small robot arm can show you the trajectory that you intended from the pre-op MRI and establish a very rigid holder through which you can drill a small hole in the skull and pass a small rigid wire deep into that area of the brain that's hollow and and put your electrode through that hollow wire and then remove all of that except the electrode.

This small robot arm can show you the trajectory that you intended from the pre-op MRI and establish a very rigid holder through which you can drill a small hole in the skull and pass a small rigid wire deep into that area of the brain that's hollow and and put your electrode through that hollow wire and then remove all of that except the electrode.

So you end up with the electrode very, very precisely placed far from the skull surface. Now that's standard technology that's already been out in the world for a while. Neuralink right now is focused entirely on cortical targets, surface targets, because there's no trivial way to get say hundreds of wires deep inside the brain without doing a lot of damage. So your question, what do you see?

So you end up with the electrode very, very precisely placed far from the skull surface. Now that's standard technology that's already been out in the world for a while. Neuralink right now is focused entirely on cortical targets, surface targets, because there's no trivial way to get say hundreds of wires deep inside the brain without doing a lot of damage. So your question, what do you see?

Well, I see an MRI on a screen. I can't see everything that that DBS electrode is passing through on its way to that deep target. And so it's accepted with this approach that there's going to be about one in a hundred patients who have a bleed somewhere in the brain as a result of passing that wire blindly into the deep part of the brain. that's not an acceptable safety profile for Neuralink.

Well, I see an MRI on a screen. I can't see everything that that DBS electrode is passing through on its way to that deep target. And so it's accepted with this approach that there's going to be about one in a hundred patients who have a bleed somewhere in the brain as a result of passing that wire blindly into the deep part of the brain. that's not an acceptable safety profile for Neuralink.

We start from the position that we want this to be dramatically, maybe two or three orders of magnitude safer than that. Safe enough really that you or I without a profound medical problem might on our lunch break someday say, yeah, sure, I'll get that. I've been meaning to upgrade to the latest version. And so the safety constraints given that are high.

We start from the position that we want this to be dramatically, maybe two or three orders of magnitude safer than that. Safe enough really that you or I without a profound medical problem might on our lunch break someday say, yeah, sure, I'll get that. I've been meaning to upgrade to the latest version. And so the safety constraints given that are high.

And so we haven't settled on a final solution for arbitrarily approaching deep targets in the brain.

And so we haven't settled on a final solution for arbitrarily approaching deep targets in the brain.

Exactly. So we've got vision on the surface. We actually have made a huge amount of progress sewing electrodes into the spinal cord as a potential workaround for a spinal cord injury that would allow a brain-mounted implant to translate motor intentions to a spine-mounted implant that can affect muscle contractions in previously paralyzed arms and legs.

Exactly. So we've got vision on the surface. We actually have made a huge amount of progress sewing electrodes into the spinal cord as a potential workaround for a spinal cord injury that would allow a brain-mounted implant to translate motor intentions to a spine-mounted implant that can affect muscle contractions in previously paralyzed arms and legs.

Yeah. So we have anesthetized animals doing grasp and moving their legs in a sort of walking pattern. Again, early days, but the future is bright for this kind of thing. And people with paralysis should look forward to that bright future. They're going to have options.

Yeah. So we have anesthetized animals doing grasp and moving their legs in a sort of walking pattern. Again, early days, but the future is bright for this kind of thing. And people with paralysis should look forward to that bright future. They're going to have options.

Exoskeletons are getting better too. Exoskeletons.

Exoskeletons are getting better too. Exoskeletons.

Yeah. Our first participant is, he's incredible.

Yeah. Our first participant is, he's incredible.

Practice. Repetitions. Same with anything else. There's a million ways of people saying the same thing and selling books saying it, but do you call it 10,000 hours? Do you call it spend some chunk of your life, some percentage of your life focusing on this, obsessing about getting better at it? Repetitions...

Practice. Repetitions. Same with anything else. There's a million ways of people saying the same thing and selling books saying it, but do you call it 10,000 hours? Do you call it spend some chunk of your life, some percentage of your life focusing on this, obsessing about getting better at it? Repetitions...

humility, recognizing that you aren't perfect at any stage along the way, recognizing you've got improvements to make in your technique, being open to feedback and coaching from people with a different perspective on how to do it, and then just the constant will to do better. that fortunately, if you're not a sociopath, I think your patients bring that with them to the office visits every day.

humility, recognizing that you aren't perfect at any stage along the way, recognizing you've got improvements to make in your technique, being open to feedback and coaching from people with a different perspective on how to do it, and then just the constant will to do better. that fortunately, if you're not a sociopath, I think your patients bring that with them to the office visits every day.

They force you to wanna do better all the time.

They force you to wanna do better all the time.

Yeah.

Yeah.

Yeah, a fair bit. I mean, a good example for us is the angle of the skull relative to the normal plane of the body axis. of the skull over hand knob is pretty wide variation. I mean, some people have really flat skulls and some people have really steeply angled skulls over that area.

Yeah, a fair bit. I mean, a good example for us is the angle of the skull relative to the normal plane of the body axis. of the skull over hand knob is pretty wide variation. I mean, some people have really flat skulls and some people have really steeply angled skulls over that area.

And that has consequences for how their head can be fixed in sort of the frame that we use and how the robot has to approach the skull. Yeah, people's bodies are built as differently as the people you see walking down the street, as much variability in body shape and size as you see there. We see in brain anatomy and skull anatomy.

And that has consequences for how their head can be fixed in sort of the frame that we use and how the robot has to approach the skull. Yeah, people's bodies are built as differently as the people you see walking down the street, as much variability in body shape and size as you see there. We see in brain anatomy and skull anatomy.

There are some people who we've had to kind of exclude from our trial for having skulls that are too thick or too thin or scalp that's too thick or too thin. I think we have the middle 97% or so of people, but you can't account for all human anatomy variability.

There are some people who we've had to kind of exclude from our trial for having skulls that are too thick or too thin or scalp that's too thick or too thin. I think we have the middle 97% or so of people, but you can't account for all human anatomy variability.

Not too bad. Once you really get used to this, that's where experience and skill and education really come into play. If you stare at a thousand brains... It becomes easier to mentally peel back the, say, for instance, blood vessels that are obscuring the sulci and gyri, the wrinkle pattern of the surface of the brain.

Not too bad. Once you really get used to this, that's where experience and skill and education really come into play. If you stare at a thousand brains... It becomes easier to mentally peel back the, say, for instance, blood vessels that are obscuring the sulci and gyri, the wrinkle pattern of the surface of the brain.

Occasionally, when you're first starting to do this and you open the skull, it doesn't match what you thought you were going to see based on the MRI. And with more experience, you learn to kind of peel back that layer of blood vessels and see the underlying pattern of wrinkles in the brain and use that as a landmark for where you are. The wrinkles are a landmark? Yeah.

Occasionally, when you're first starting to do this and you open the skull, it doesn't match what you thought you were going to see based on the MRI. And with more experience, you learn to kind of peel back that layer of blood vessels and see the underlying pattern of wrinkles in the brain and use that as a landmark for where you are. The wrinkles are a landmark? Yeah.

So I was describing hand knob earlier. That's a pattern of the wrinkles in the brain. It's sort of this sort of Greek letter omega shaped area of the brain.

So I was describing hand knob earlier. That's a pattern of the wrinkles in the brain. It's sort of this sort of Greek letter omega shaped area of the brain.

Yeah. Where is it? So you have this strip of brain running down the top called the primary motor area. And I'm sure you've seen this picture of the homunculus laid over the surface of the brain, the weird little guy with huge lips and giant hands. That guy sort of...

Yeah. Where is it? So you have this strip of brain running down the top called the primary motor area. And I'm sure you've seen this picture of the homunculus laid over the surface of the brain, the weird little guy with huge lips and giant hands. That guy sort of...

lays with his legs up at the top of the brain and face arm areas farther down, and then some kind of mouth, lip, tongue areas farther down. And so the hand is right in there, and then the areas that control speech, at least on the left side of the brain in most people, are just below that. And so any muscle that you voluntarily move in your body

lays with his legs up at the top of the brain and face arm areas farther down, and then some kind of mouth, lip, tongue areas farther down. And so the hand is right in there, and then the areas that control speech, at least on the left side of the brain in most people, are just below that. And so any muscle that you voluntarily move in your body

The vast majority of that references that strip or those intentions come from that strip of brain and the wrinkle for hand knob is right in the middle of that.

The vast majority of that references that strip or those intentions come from that strip of brain and the wrinkle for hand knob is right in the middle of that.

Yep.

Yep.

Vision's a little deeper. And so this gets to your question about how deep can you get. To do vision, we can't just do the surface of the brain. We have to be able to go in, not as deep as we'd have to go for DBS, but maybe a centimeter deeper than we're used to for hand insertions. And so that's work in progress. That's a new set of challenges to overcome.

Vision's a little deeper. And so this gets to your question about how deep can you get. To do vision, we can't just do the surface of the brain. We have to be able to go in, not as deep as we'd have to go for DBS, but maybe a centimeter deeper than we're used to for hand insertions. And so that's work in progress. That's a new set of challenges to overcome.

Yeah, I mean, the goal there comes from experience. I mean, we stand on the shoulders of people that... made Utah rays and used Utah rays for decades before we ever even came along.

Yeah, I mean, the goal there comes from experience. I mean, we stand on the shoulders of people that... made Utah rays and used Utah rays for decades before we ever even came along.

Neuralink arose partly, this approach to technology arose out of a need recognized after Utah rays would fail routinely because the rigid electrodes, those spikes that are literally hammered using an air hammer into the brain those spikes generate a bad immune response that encapsulates the electrode spikes in scar tissue, essentially.

Neuralink arose partly, this approach to technology arose out of a need recognized after Utah rays would fail routinely because the rigid electrodes, those spikes that are literally hammered using an air hammer into the brain those spikes generate a bad immune response that encapsulates the electrode spikes in scar tissue, essentially.

And so one of the projects that was being worked on in the Anderson lab at Caltech when I got there was to see if you could use chemo therapy to prevent the formation of scars. Things are pretty bad when you're jamming a bed of nails into the brain and then treating that with chemotherapy to try to prevent scar tissue, it's like, maybe we've gotten off track here, guys.

And so one of the projects that was being worked on in the Anderson lab at Caltech when I got there was to see if you could use chemo therapy to prevent the formation of scars. Things are pretty bad when you're jamming a bed of nails into the brain and then treating that with chemotherapy to try to prevent scar tissue, it's like, maybe we've gotten off track here, guys.

Maybe there's a fundamental redesign necessary. And so Neuralink's approach of using highly flexible, tiny electrodes avoids a lot of the bleeding, avoids a lot of the immune response that ends up happening when rigid electrodes are pounded into the brain.

Maybe there's a fundamental redesign necessary. And so Neuralink's approach of using highly flexible, tiny electrodes avoids a lot of the bleeding, avoids a lot of the immune response that ends up happening when rigid electrodes are pounded into the brain.

And so what we see is our electrode longevity and functionality and the health of the brain tissue immediately surrounding the electrode is excellent. I mean, it goes on for years now in our animal models.

And so what we see is our electrode longevity and functionality and the health of the brain tissue immediately surrounding the electrode is excellent. I mean, it goes on for years now in our animal models.

I think the most interesting, maybe underappreciated fact is that it really does control almost everything. I don't know. For an out-of-the-blue example, imagine you want a lever on fertility. You want to be able to turn fertility on and off. I mean, there are legitimate targets in the brain itself to modulate fertility, say blood pressure. You want to modulate blood pressure.

I think the most interesting, maybe underappreciated fact is that it really does control almost everything. I don't know. For an out-of-the-blue example, imagine you want a lever on fertility. You want to be able to turn fertility on and off. I mean, there are legitimate targets in the brain itself to modulate fertility, say blood pressure. You want to modulate blood pressure.

There are legitimate targets in the brain for doing that. Things that aren't immediately obvious as brain problems are potentially solvable in the brain. And so I think it's an underexplored area for primary treatments of all the things that bother people.

There are legitimate targets in the brain for doing that. Things that aren't immediately obvious as brain problems are potentially solvable in the brain. And so I think it's an underexplored area for primary treatments of all the things that bother people.

Yeah, not always. Kidney disease is real, but there are levers you can pull in the brain that affect all of these systems.

Yeah, not always. Kidney disease is real, but there are levers you can pull in the brain that affect all of these systems.

Yeah.

Yeah.

I think the use case right now is use a mouse, right? I can already do that, and so there's no value proposition. On safety grounds alone, sure, I'll do it tomorrow.

I think the use case right now is use a mouse, right? I can already do that, and so there's no value proposition. On safety grounds alone, sure, I'll do it tomorrow.

Yeah.

Yeah.

Yeah. I think recording speech intentions from the brain might change things as well. The value proposition for the average person. A keyboard is a pretty clunky human interface, requires a lot of training. It's highly variable in the maximum performance that the average person can achieve. I think taking that out of the equation and just having a natural

Yeah. I think recording speech intentions from the brain might change things as well. The value proposition for the average person. A keyboard is a pretty clunky human interface, requires a lot of training. It's highly variable in the maximum performance that the average person can achieve. I think taking that out of the equation and just having a natural

you know, word-to-computer interface might change things for a lot of people.

you know, word-to-computer interface might change things for a lot of people.

Yeah. I mean, with a bone conducting case that can be an invisible headphone, say, and the ability to think words into software and have it respond to you. That starts to sound sort of like embedded superintelligence. If you can silently ask for the Wikipedia article on any subject and have it read to you without any observable change happening in the outside world.

Yeah. I mean, with a bone conducting case that can be an invisible headphone, say, and the ability to think words into software and have it respond to you. That starts to sound sort of like embedded superintelligence. If you can silently ask for the Wikipedia article on any subject and have it read to you without any observable change happening in the outside world.

For one thing, standardized testing is obsolete.

For one thing, standardized testing is obsolete.

Yeah, and the technology on the academic side is progressing at light speed here. I think there was a really amazing paper out of UC Davis, Sergei Stavisky's lab, that basically made an initial solve of speech decode. It was something like 125,000 words that they were getting with, you know, very high accuracy, which is.

Yeah, and the technology on the academic side is progressing at light speed here. I think there was a really amazing paper out of UC Davis, Sergei Stavisky's lab, that basically made an initial solve of speech decode. It was something like 125,000 words that they were getting with, you know, very high accuracy, which is.

Yeah.

Yeah.

Right.

Right.

I can't wait to see what people do with it. I feel like we're cavemen right now. We're like banging rocks with a stick and thinking that we're making music. At some point, when these are more widespread, there's going to be the equivalent of a piano that someone can make art with their brain in a way that we didn't even anticipate. I'm looking forward to it.

I can't wait to see what people do with it. I feel like we're cavemen right now. We're like banging rocks with a stick and thinking that we're making music. At some point, when these are more widespread, there's going to be the equivalent of a piano that someone can make art with their brain in a way that we didn't even anticipate. I'm looking forward to it.

I'm not the first one. There's this whole community of weirdo biohackers that have done this stuff. And I think one of the early use cases was storing private crypto wallet keys and whatever. I dabbled in that a bit and had some fun with it.

I'm not the first one. There's this whole community of weirdo biohackers that have done this stuff. And I think one of the early use cases was storing private crypto wallet keys and whatever. I dabbled in that a bit and had some fun with it.

Actually, yeah. It was the modern-day equivalent of finding change in the sofa cushions. I put some orphan crypto on there that I thought was worthless and forgot about it for a few years. Went back and found that some community of people loved it and had propped up the value of it, and so it had gone up 50-fold. So there was a lot of change in those cushions. That's hilarious.

Actually, yeah. It was the modern-day equivalent of finding change in the sofa cushions. I put some orphan crypto on there that I thought was worthless and forgot about it for a few years. Went back and found that some community of people loved it and had propped up the value of it, and so it had gone up 50-fold. So there was a lot of change in those cushions. That's hilarious.

But the primary use case is mostly as a tech demonstrator. It has my business card on it. You can scan that in by touching it to your phone. It opens the front door to my house, whatever simple stuff.

But the primary use case is mostly as a tech demonstrator. It has my business card on it. You can scan that in by touching it to your phone. It opens the front door to my house, whatever simple stuff.

Yeah, we have a kind of a mysticism around the barrier of our skin. We're completely fine with knee replacements, hip replacements, dental implants. But there's a mysticism still around the inviolable barrier that the skull represents. And I think that needs to be treated like any other pragmatic barrier. The question isn't how incredible is it to open the skull?

Yeah, we have a kind of a mysticism around the barrier of our skin. We're completely fine with knee replacements, hip replacements, dental implants. But there's a mysticism still around the inviolable barrier that the skull represents. And I think that needs to be treated like any other pragmatic barrier. The question isn't how incredible is it to open the skull?

The question is, what benefit can we provide?

The question is, what benefit can we provide?

The answer that is sad for me and other people of my demographic is that plasticity decreases with age. Healing decreases with age. I have too much gray hair to... To be optimistic about that. There are theoretical ways to increase plasticity using electrical stimulation, nothing that is totally proven out as a robust enough mechanism to offer widely to people.

The answer that is sad for me and other people of my demographic is that plasticity decreases with age. Healing decreases with age. I have too much gray hair to... To be optimistic about that. There are theoretical ways to increase plasticity using electrical stimulation, nothing that is totally proven out as a robust enough mechanism to offer widely to people.

Yeah, I think there's cause for optimism that we might find something useful in terms of, say, an implanted electrode that improves learning. Certainly, there's been some really amazing work recently from Nicholas Schiff, Jonathan Baker, and others who have a cohort of patients with moderate traumatic brain injury

Yeah, I think there's cause for optimism that we might find something useful in terms of, say, an implanted electrode that improves learning. Certainly, there's been some really amazing work recently from Nicholas Schiff, Jonathan Baker, and others who have a cohort of patients with moderate traumatic brain injury

who have had electrodes placed in the deep nucleus in the brain called the central median nucleus or just near central median nucleus. And when they apply small amounts of electricity to that part of the brain, it's almost like electronic caffeine. They're able to improve people's attention and focus. They're able to improve how well people can perform a task.

who have had electrodes placed in the deep nucleus in the brain called the central median nucleus or just near central median nucleus. And when they apply small amounts of electricity to that part of the brain, it's almost like electronic caffeine. They're able to improve people's attention and focus. They're able to improve how well people can perform a task.

I think in one case, someone who was unable to work after the device was turned on, they were able to get a job. And that's sort of, you know, one of the holy grails for me with Neuralink and other technologies like this is from a purely utilitarian standpoint, can we... can we make people able to take care of themselves and their families economically again?

I think in one case, someone who was unable to work after the device was turned on, they were able to get a job. And that's sort of, you know, one of the holy grails for me with Neuralink and other technologies like this is from a purely utilitarian standpoint, can we... can we make people able to take care of themselves and their families economically again?

Can we make it so someone who's fully dependent and even maybe requires a lot of caregiver resources, can we put them in a position to be fully independent, taking care of themselves, giving back to their communities? I think that's a very compelling proposition and what motivates a lot of what I do and what a lot of the people at Neuralink are working for.

Can we make it so someone who's fully dependent and even maybe requires a lot of caregiver resources, can we put them in a position to be fully independent, taking care of themselves, giving back to their communities? I think that's a very compelling proposition and what motivates a lot of what I do and what a lot of the people at Neuralink are working for.

Yeah, it's like eliminating a species from an ecology. You don't know what the delicate interconnections and dependencies are. The brain is certainly a delicate, complex beast, and we don't know every potential downstream consequence of a single change that we make.

Yeah, it's like eliminating a species from an ecology. You don't know what the delicate interconnections and dependencies are. The brain is certainly a delicate, complex beast, and we don't know every potential downstream consequence of a single change that we make.

I think it's a certain kind of brittleness or a failure on the company's side if we need me to do all the surgeries. And I think something that I would very much like to work towards is a process that is so simple and so robust on the surgery side that literally anyone could do it. We want to get away from requiring intense expertise or intense experience.

I think it's a certain kind of brittleness or a failure on the company's side if we need me to do all the surgeries. And I think something that I would very much like to work towards is a process that is so simple and so robust on the surgery side that literally anyone could do it. We want to get away from requiring intense expertise or intense experience.

to have this successfully done and make it as simple and translatable as possible. I mean, I would love it if every neurosurgeon on the planet had no problem doing this. I think we're probably far from a regulatory environment that would allow people that aren't neurosurgeons to do this, but not impossible.

to have this successfully done and make it as simple and translatable as possible. I mean, I would love it if every neurosurgeon on the planet had no problem doing this. I think we're probably far from a regulatory environment that would allow people that aren't neurosurgeons to do this, but not impossible.

To a certain degree, it's, yeah, it's a complex relationship. Yeah. All the good relationships are. It's funny when in the middle of the surgery, there's a part of it where I stand basically shoulder to shoulder with the robot. And so, you know, if you're in the room reading the body language, you know, it's my brother in arms there. We're working together on the same problem.

To a certain degree, it's, yeah, it's a complex relationship. Yeah. All the good relationships are. It's funny when in the middle of the surgery, there's a part of it where I stand basically shoulder to shoulder with the robot. And so, you know, if you're in the room reading the body language, you know, it's my brother in arms there. We're working together on the same problem.

Yeah, I'm not threatened by it.

Yeah, I'm not threatened by it.

Yeah. You know, it gives you a very visceral sense, and this may sound trite, but it gives you a very visceral sense that death is inevitable. You know, on one hand... You know, you are, as a neurosurgeon, you're deeply involved in these, like, just hard-to-fathom tragedies. You know, young parents dying, leaving, you know, a four-year-old behind, let's say.

Yeah. You know, it gives you a very visceral sense, and this may sound trite, but it gives you a very visceral sense that death is inevitable. You know, on one hand... You know, you are, as a neurosurgeon, you're deeply involved in these, like, just hard-to-fathom tragedies. You know, young parents dying, leaving, you know, a four-year-old behind, let's say.

And on the other hand, you know, it takes the sting out of it a bit because... You see how mind-numbingly universal death is. There's zero chance that I'm going to avoid it. I know You know, techno-optimists right now and longevity buffs right now would disagree on that 0.000% estimate, but I don't see any chance that our generation is going to avoid it.

And on the other hand, you know, it takes the sting out of it a bit because... You see how mind-numbingly universal death is. There's zero chance that I'm going to avoid it. I know You know, techno-optimists right now and longevity buffs right now would disagree on that 0.000% estimate, but I don't see any chance that our generation is going to avoid it.

Entropy is a powerful force, and we are very ornate, delicate, brittle DNA machines that aren't up to the cosmic ray bombardment that we're subjected to. So, on the one hand, every human that has ever lived died or will die. On the other hand, it's just one of the hardest things to imagine happening. inflicting on anyone that you love is having them gone.

Entropy is a powerful force, and we are very ornate, delicate, brittle DNA machines that aren't up to the cosmic ray bombardment that we're subjected to. So, on the one hand, every human that has ever lived died or will die. On the other hand, it's just one of the hardest things to imagine happening. inflicting on anyone that you love is having them gone.

I mean, I'm sure you've had friends that aren't living anymore, and it's hard to even think about them. And so I wish I had arrived at the point of nirvana where death doesn't have a sting, I'm not worried about it, but I can at least say that I'm comfortable with the certainty of it. If not,

I mean, I'm sure you've had friends that aren't living anymore, and it's hard to even think about them. And so I wish I had arrived at the point of nirvana where death doesn't have a sting, I'm not worried about it, but I can at least say that I'm comfortable with the certainty of it. If not,

having found out how to take the tragedy out of it when I think about my kids either not having me or me not having them or my wife.

having found out how to take the tragedy out of it when I think about my kids either not having me or me not having them or my wife.

Yeah, it definitely makes you ask the question of how many of these can you see and not say, I can't do this anymore. But you said it well. I think it gives you an opportunity to just appreciate that you're alive today and I've got three kids and an amazing wife and I'm really happy. Things are good. I get to help on a project that I think matters. I think it moves us forward.

Yeah, it definitely makes you ask the question of how many of these can you see and not say, I can't do this anymore. But you said it well. I think it gives you an opportunity to just appreciate that you're alive today and I've got three kids and an amazing wife and I'm really happy. Things are good. I get to help on a project that I think matters. I think it moves us forward.

I'm a very lucky person.

I'm a very lucky person.

Yeah. I think ultimately we want to give people more levers that they can pull, right? Like you want to give people options. If you can give someone a dial that they can turn on how happy they are. I think that makes people really uncomfortable.

Yeah. I think ultimately we want to give people more levers that they can pull, right? Like you want to give people options. If you can give someone a dial that they can turn on how happy they are. I think that makes people really uncomfortable.

But now talk about major depressive disorder, talk about people that are committing suicide at an alarming rate in this country, and try to justify that queasiness in that light. You can give people a knob to take away suicidal ideation, suicidal intention. I would give them that knob. I don't know how you justify not doing that.

But now talk about major depressive disorder, talk about people that are committing suicide at an alarming rate in this country, and try to justify that queasiness in that light. You can give people a knob to take away suicidal ideation, suicidal intention. I would give them that knob. I don't know how you justify not doing that.

Well, and on a grander scale, the fabric of society. People have a lot of complaints about how our social fabric is working or not working, how our politics is working or not working. Yeah. Those things are made of neurochemistry, too, in aggregate. Our politics is composed of individuals with human brains, and the way it works or doesn't work is potentially tunable.

Well, and on a grander scale, the fabric of society. People have a lot of complaints about how our social fabric is working or not working, how our politics is working or not working. Yeah. Those things are made of neurochemistry, too, in aggregate. Our politics is composed of individuals with human brains, and the way it works or doesn't work is potentially tunable.

in the sense that, I don't know, say, remove our addictive behaviors or tune our addictive behaviors for social media or our addiction to outrage, our addiction to sharing the most angry political tweet we can find. I don't think that leads to a functional society. And if you had... options for people to moderate that.

in the sense that, I don't know, say, remove our addictive behaviors or tune our addictive behaviors for social media or our addiction to outrage, our addiction to sharing the most angry political tweet we can find. I don't think that leads to a functional society. And if you had... options for people to moderate that.

maladaptive behavior there could be huge benefits to society maybe we could all work together a little more harmoniously toward useful ends there's a sweet spot like you mentioned you don't want to completely remove all the dark sides of human nature because those kind of uh are somehow necessary to make the whole thing work but there's a sweet spot yeah i agree we gotta you gotta suffer a little just not so much that you lose hope

maladaptive behavior there could be huge benefits to society maybe we could all work together a little more harmoniously toward useful ends there's a sweet spot like you mentioned you don't want to completely remove all the dark sides of human nature because those kind of uh are somehow necessary to make the whole thing work but there's a sweet spot yeah i agree we gotta you gotta suffer a little just not so much that you lose hope

You know, I have this sense that I never found it, never removed it, you know, like a Dementor in Harry Potter. I have this sense that consciousness is a lot less magical than our instincts want to claim it is. It seems to me like a useful analog for thinking about what consciousness is in the brain.

You know, I have this sense that I never found it, never removed it, you know, like a Dementor in Harry Potter. I have this sense that consciousness is a lot less magical than our instincts want to claim it is. It seems to me like a useful analog for thinking about what consciousness is in the brain.

We have a really good intuitive understanding of what it means to, say, touch your skin and know what's being touched, I think consciousness is just that level of sensory mapping applied to the thought processes in the brain itself. So what I'm saying is consciousness is the sensation of some part of your brain being active. So you feel it working.

We have a really good intuitive understanding of what it means to, say, touch your skin and know what's being touched, I think consciousness is just that level of sensory mapping applied to the thought processes in the brain itself. So what I'm saying is consciousness is the sensation of some part of your brain being active. So you feel it working.

You feel the part of your brain that thinks of red things or winged creatures or the taste of coffee. you feel those parts of your brain being active the way that I'm feeling my palm being touched, right? And that sensory system that feels the brain working is consciousness.

You feel the part of your brain that thinks of red things or winged creatures or the taste of coffee. you feel those parts of your brain being active the way that I'm feeling my palm being touched, right? And that sensory system that feels the brain working is consciousness.

Which isn't like a warping of space-time or some quantum field effect, right? It's nothing magical. People always want to ascribe to consciousness. something truly different. And there's this awesome long history of people looking at whatever the latest discovery in physics is to explain consciousness because it's the most magical, the most out there thing that you can think of.

Which isn't like a warping of space-time or some quantum field effect, right? It's nothing magical. People always want to ascribe to consciousness. something truly different. And there's this awesome long history of people looking at whatever the latest discovery in physics is to explain consciousness because it's the most magical, the most out there thing that you can think of.

And people always, you know, want to do that with consciousness. I don't think that's necessary. It's just a, you know, a very useful and gratifying way of feeling your brain work.

And people always, you know, want to do that with consciousness. I don't think that's necessary. It's just a, you know, a very useful and gratifying way of feeling your brain work.

Yeah.

Yeah.

It's been a joy.

It's been a joy.

Exactly.

Exactly.

Yeah.

Yeah.

Yeah, it was good. Well done. Yeah, yeah.

Yeah, it was good. Well done. Yeah, yeah.

To show that you're still there, that you love her.

To show that you're still there, that you love her.

You've gotten super famous.

You've gotten super famous.

Is there a score that you get? Like, can you do better on a bubble game?

Is there a score that you get? Like, can you do better on a bubble game?

Writing down suggestions from Nolan. Make it more fun, gamified.

Writing down suggestions from Nolan. Make it more fun, gamified.

The interviews with athletes are always like that exact, it's like that template.

The interviews with athletes are always like that exact, it's like that template.

So WebGrid is a grid itself.

So WebGrid is a grid itself.

Yeah.

Yeah.

Since forever. As far back as I can remember, I've been interested in the human brain. I mean, I was a thoughtful kid and a bit of an outsider. And you sit there thinking about what the most important things in the world are. in your little tiny adolescent brain.

And the answer that I came to that I converged on was that all of the things you can possibly conceive of as things that are important for human beings to care about are literally contained in the skull, both the perception of them and their relative values. the solutions to all our problems and all of our problems are all contained in the skull. And if we knew more about how that worked,

how the brain encodes information and generates desires and generates agony and suffering, we could do more about it. You think about all the really great triumphs in human history. You think about all the really horrific tragedies. You think about the Holocaust. You think about any prison full of human stories. And all of those problems boil down to neurochemistry.

So if you get a little bit of control over that, you provide people the option to do better. In the way I read history, the way people have dealt with having better tools is that they most often in the end do better with huge asterisks. But I think it's an interesting, worthy, and noble pursuit to give people more options, more tools.

Yeah. I mean, a lot of that has to do with how well people like that can organize those around them.

Yeah. And so I always find it interesting to look to primatology, look to our closest non-human relatives for clues as to how humans are going to behave and what particular humans are able to achieve. And so you look at... chimpanzees and bonobos. They're similar, but different in their social structures, particularly.

I went to Emory in Atlanta and studied under Franz De Waal, the great Franz De Waal, who was kind of the leading primatologist. who recently died. And his work at looking at chimps through the lens of how you would watch an episode of Friends and understand the motivations of the characters interacting with each other, he would look at a chimp colony and basically apply that lens.

I'm massively oversimplifying it. If you do that, instead of just saying, you know, subject 473, you know, through his feces at subject 471, you talk about them in terms of their human struggles, accord them the dignity of themselves as actors with understandable goals and drives, what they want out of life.

And primarily it's, you know, the things we want out of life, food, sex, companionship, power. you can understand chimp and bonobo behavior in the same lights much more easily.

And I think doing so gives you the tools you need to reduce human behavior from the kind of false complexity that we layer onto it with language and look at it in terms of, oh, well, these humans are looking for companionship, sex, food, power, And I think that's a pretty powerful tool to have in understanding human behavior.

Right. Breeding rights often go with... Alpha status. And so if you can get a piece of that, then you're going to do okay.

Yeah, I think that's true.

Basically, the moment I got to college, I started looking around for labs that I could do neuroscience work in. I originally approached that from the angle of looking at interactions between the brain and the immune system, which isn't the most obvious place to start. But I had this idea at the time that

the contents of your thoughts would have an impact, a direct impact, maybe a powerful one, on non-conscious systems in your body, the systems we think of as homeostatic, automatic mechanisms like fighting off a virus, like repairing a wound. And sure enough, there are big crossovers between the two. I mean... it gets to kind of a key point that I think goes under-recognized.

One of the things people don't recognize or appreciate about the human brain enough, and that is that it basically controls or has a huge role in almost everything that your body does. Like you try to name an example of something in your body that isn't directly controlled or massively influenced by the brain. And it's pretty hard.

I mean, you might say like bone healing or something, but even those systems, the hypothalamus and pituitary end up playing a role. in coordinating the endocrine system that does have a direct influence on, say, the calcium level in your blood that goes to bone healing. So non-obvious connections between those things implicate the brain as really a potent prime mover in all of health.

Yeah, you could understand how that would be driven by evolution too, just in some simple examples. If you get sick, if you get a communicable disease, you get the flu, it's pretty advantageous for your immune system to tell your brain, hey, now be antisocial for a few days. Don't go be the life of the party tonight.

In fact, maybe just cuddle up somewhere warm under a blanket and just stay there for a day or two. And sure enough, that tends to be the behavior that you see both in animals and in humans. If you get sick, elevated levels of interleukins in your blood and TNF-alpha in your blood ask the brain to cut back on social activity and even moving around.

You have lower locomotor activity in animals that are infected with viruses.

You know, it was sort of an evolution of thought. I wanted to study the brain. I started studying the brain in undergrad in this neuroimmunology lab. From there... realized at some point that I didn't want to just generate knowledge. I wanted to effect real changes in the actual world, in actual people's lives.

And so after having not really thought about going into medical school, I was on a track to go into a PhD program. I said, I'd like that option. I'd like to actually potentially help tangible people in front of me. And doing a little digging found that there exists these MD-PhD programs where you can choose not to choose between them and do both.

And so I went to USC for medical school and had a joint PhD program with Caltech, where I actually chose that program particularly because of a researcher at Caltech named Richard Anderson, who's one of the godfathers of primate neuroscience.

It has a macaque lab where Utah rays and other electrodes were being inserted into the brains of monkeys to try to understand how intentions were being encoded in the brain. So I ended up there with the idea that maybe I would be a neurologist and study the brain on the side and then discovered that neurology, again, I'm going to

make enemies by saying this, but neurology predominantly and distressingly to me is the practice of diagnosing a thing and then saying, good luck with that when there's not much we can do.

And neurosurgery, very differently, it's a powerful lever on taking people that are headed in a bad direction and changing their course in the sense of brain tumors that are potentially treatable or curable with surgery. You know, even aneurysms in the brain, blood vessels that are going to rupture, you can save lives really is at the end of the day what mattered to me. And so...

I was at USC, as I mentioned. That happens to be one of the great neurosurgery programs. And so I met these truly epic neurosurgeons, Alex Kalesi and Micah Puzo and Steve Gianotta and Marty Weiss, these sort of epic people that were just human beings in front of me. And so it kind of changed my thinking from neurosurgeons are

distant gods that live on another planet and occasionally come and visit us. These are humans that have problems and are people, and there's nothing fundamentally preventing me from being one of them. And so, At the last minute in medical school, I changed gears from going into a different specialty and switched into neurosurgery, which cost me a year.

I had to do another year of research because I was so far along in the process to switch into neurosurgery. The deadlines had already passed. So it was a decision that cost time, but absolutely worth it.

Yeah. Two things, I think. Residency in neurosurgery is sort of a competition of pain, of how much pain can you eat and smile. Yeah. And so there's... work hour restrictions that are not really, they're viewed at, I think, internally among the residents as weakness. And so most neurosurgery residents try to work as hard as they can.

And that, I think, necessarily means working long hours and sometimes over the work hour limits. And, you know, we care about being compliant with whatever regulations are in front of us. But I think more important than that, people want to

give all give their all in becoming a better neurosurgeon because the the stakes are so high and so it's a real fight to get residents uh to say go home at the end of their shift and not stay and do more surgery are you seriously saying like one of the hardest things is literally like getting forcing them to get sleep and rest and all this kind of stuff historically that was the case.

I think, I think the next generation, I think the next generation is more, uh, compliant and more self-care.

That's what you mean. All right. I'm just, I'm just kidding.

The personalities, uh, and maybe the two are connected, but. So is it, was it pretty competitive? It's competitive and it's also, um, you know, as we touched on earlier, primates like power and I think, um, neurosurgery has long had this aura of mystique and excellence and whatever about it. And so it's an invitation, I think, for people that are cloaked in that authority.

A board-certified neurosurgeon is basically a walking, fallacious appeal to authority, right? You have license to walk into any room and act like you're an expert on whatever. And fighting that tendency is not something that most neurosurgeons do well. Humility isn't the forte.

sort of heroic aspect to neurosurgery and i think it gets to people's head a little bit yeah well that i think that uh you know that allows me to play well at an elon company because elon uh one of his strengths i think is to just instantly see through fallacy from authority so nobody walks into a room that he's in and says well god damn it you have to trust me

i'm the guy that built the last you know 10 rockets or something and he says well you did it wrong and we can do it better or i'm the guy that you know kept ford alive for the last 50 years you listen to me on how to build cars and he says No. And so you don't walk into a room that he's in and say, well, I'm a neurosurgeon. Let me tell you how to do it.

He's going to say, well, I'm a human being that has a brain. I can think from first principles myself. Thank you very much. And here's how I think it ought to be done. Let's go try it and see who's right. And that's proven, I think, over and over in his case to be a very powerful approach.

Yeah, there's a sweet spot where people disagree and forcefully speak their mind and passionately defend their position. and yet are still able to accept information from others and change their ideas when they're wrong. I like the analogy of how you polish rocks. You put hard things in a hard container and spin it. People bash against each other and out comes a more refined product.

To make a good team at Neuralink, we've tried to find people that are not afraid to defend their ideas passionately and occasionally strongly disagree with people that they're working with and have the best idea come out on top. It's not an easy balance, again, to refer back to the primate brain. It's not something that is inherently built into the primate brain to say,

I passionately put all my chips on this position and now I'm just going to walk away from it and admit you were right. You know, part of our brains tell us that that is a power loss. That is a loss of face, a loss of standing in the community. And now you're a Zeta chump because your idea got trounced. Yeah.

And you just have to recognize that that little voice in the back of your head is maladaptive and it's not helping the team win.

Yeah, I think working your ass off, working hard while functioning as a member of a team, getting a job done, that is incredibly difficult. Working incredibly long hours, being up all night, taking care of someone that you think probably won't survive no matter what you do. working hard to make people that you passionately dislike look good the next morning.

These folks were relentless in their pursuit of excellent neurosurgical technique, decade over decade. And I think we're well-recognized for that excellence, especially Marty Weiss, Steve Gianotta, Micah Puzo, they made huge contributions, not only to surgical technique, but they built training programs that trained dozens or hundreds of amazing neurosurgeons.

I was just lucky to kind of be in their wake.

Yeah. It's especially challenging when you with all respect to our elders, it doesn't hit so much when you're taking care of an 80 year old and something was going to get them pretty soon anyway. And so you lose a patient like that. And it was part of the natural course of what is expected of them in the coming years, regardless. Taking care of

you know, a father of two or three, four young kids, someone in their 30s that didn't have it coming, and they show up in your ER having their first seizure of their life, and lo and behold, they've got a huge malignant, inoperable, or incurable brain tumor. You can only do that, I think, a handful of times before it really starts eating away at your at your armor.

Or a young mother that shows up that has a giant hemorrhage in her brain that she's not going to survive from, and they bring her four-year-old daughter in to say goodbye one last time before they turn the ventilator off. The great Henry Marsh is an English neurosurgeon who said it best. I think he says, every neurosurgeon carries with them a private graveyard.

And I definitely feel that, especially with young parents. That kills me. They had a lot more to give. The loss of those people specifically has a knock-on effect that's going to make the world worse for people for a long time. And it's just hard to feel powerless in the face of that.

You know, and that's where I think you have to be borderline evil to fight against a company like Neuralink or to constantly be taking potshots at us because what we're doing is to try to fix that stuff. We're trying to give people options to reduce suffering. We're trying to We're trying to take the pain out of life that broken brains brings in.

And yeah, this is just our little way that we're fighting back against entropy, I guess.

Yeah, we're just starting. We're going to do so much more.

Yeah, it's a really simple, really simple, straightforward procedure. The human part of the surgery that I do is... Dead simple. It's one of the most basic neurosurgery procedures imaginable. And I think there's evidence that some version of it has been done for thousands of years. There are examples, I think, from ancient Egypt of healed or partially healed trephinations and from...

Peru or, you know, ancient times in South America, where these proto-surgeons would drill holes in people's skulls, you know, presumably to let out the evil spirits, but maybe to drain blood clots. And there's evidence of bone healing around the edge, meaning the people at least survived some months after a procedure. Yeah. And so what we're doing is that.

We are making a cut in the skin on the top of the head over the area of the brain that is the most potent representation of hand intentions. And so if you are an expert concert pianist, this part of your brain is lighting up the entire time you're playing. We call it the hand knob. The hand knob.

there's a little squiggle in the cortex right there. One of the folds in the brain is kind of doubly folded right on that spot. And so you can look at it on an MRI and say, that's the hand knob. And then you, you do a functional test and a special kind of MRI called a functional MRI, fMRI.

And this part of the brain lights up when people, even quadriplegic people whose brains aren't connected to their finger movements anymore, they think, imagine finger movements and this part of the brain still lights up. So we can ID that part of the brain in anyone who's preparing to enter our trial and say, okay, that part of the brain we confirm is your hand intention area.

And so I'll make a little cut in the skin. We'll flap the skin open, just like kind of opening the hood of a car, only a lot smaller. Make a perfectly round uh one inch diameter hole in the skull remove that bit of skull uh open the lining of the brain the covering of the brain it's like a like a little bag of water that the brain floats in and then show that part of the brain to our robot

And then this is where the robot shines. It can come in and take these tiny, much smaller than human hair electrodes and precisely insert them into the cortex, into the surface of the brain to a very precise depth in a very precise spot that avoids all the blood vessels that are coating the surface of the brain.

And after the robot's done with its part, then the human comes back in and puts the implant into that hole in the skull and covers it up, screwing it down to the skull and sewing the skin back together. So the whole thing is a few hours long.

It's extremely low risk compared to the average neurosurgery involving the brain that might, say, open up a deep part of the brain or manipulate blood vessels in the brain. This opening on the surface of the brain is... with only cortical microinsertions carries significantly less risk than a lot of the tumor or aneurysm surgeries that are routinely done.

Yeah, that's a good question. Humans are general-purpose machines. We're able to adapt to unusual situations. We're able to change the plan on the fly. I remember well a surgery that I was doing many years ago down in San Diego where the plan was to...

open a small hole behind the ear and go reposition a blood vessel that had come to lay on the facial nerve, the trigeminal nerve, the nerve that goes to the face. When that blood vessel lays on the nerve, it can cause just intolerable, horrific shooting pain that people describe like being zapped with a cattle prod.

And so the beautiful, elegant surgery is to go move this blood vessel off the nerve. The surgery team, we went in there and started moving this blood vessel and then found that there was a giant aneurysm on that blood vessel that was not easily visible on the pre-op scans. And so the plan had to dynamically change and that the...

Human surgeons had no problem with that, were trained for all those things. Robots wouldn't do so well in that situation, at least in their current incarnation. Fully robotic surgery, like the electrode insertion portion of the Neuralink surgery, it goes according to a set plan. The humans can interrupt the flow and change the plan, but the robot can't really change the plan midway through.

It operates according to how it was programmed and how it was asked to run. It does its job very precisely, but not with a wide degree of latitude in how to react to changing conditions.

Currently. I think we are at the dawn of a new era with AI of the parameters for robot responsiveness to be dramatically broadened, right? I mean, you can't look at a self-driving car and say that it's operating under very narrow parameters

You know, if a chicken runs across the road, it wasn't necessarily programmed to deal with that specifically, but a Waymo or a self-driving Tesla would have no problem reacting to that appropriately. And so surgical robots aren't there yet, but give it time.

I'm not worried about my job in the course of my professional life. I think I would tell my kids not necessarily to go in this line of work, depending on how things look in 20 years.

Yeah, yeah. I do the parts it can't do, and it does the parts I can't do. And we are friends.

It's pretty intense. So there's no analog to this in human surgery. Human surgery is sort of this artisanal craft that's handed down directly from master to pupil over the generations. I mean, literally the way you learn to be a surgeon on humans is by doing surgery on humans. I mean, first you watch...

your professors do a bunch of surgery and then finally they put, you know, the trivial parts of the surgery into your hands and then the more complex parts. And as your understanding of the point and the purposes of the surgery increases, you get more responsibility in the perfect condition. It doesn't always go well. In Neuralink's case, the approach is a bit different. Um,

And we, of course, practiced as far as we could on animals. We did hundreds of animal surgeries. And when it came time to do the first human, we had just an amazing team of engineers build incredibly lifelike models.

One of the engineers, Fran Romano in particular, built a pulsating brain in a custom 3D printed skull that matches exactly the patient's anatomy, including their face and scalp characteristics. And so

And when I was able to practice that, I mean, it's as close as it really reasonably should get to being the real thing in all the details, including having a mannequin body attached to this custom head. And so when we were doing the practice surgeries, we'd...

wheel that body into the CT scanner and take a mock CT scan and wheel it back in and conduct all the normal safety checks verbally, you know, stop this patient. We're confirming his identification is mannequin number, blah, blah, blah.

And then opening the brain in exactly the right spot using standard operative neuronavigation equipment, standard surgical drills in the same OR that we do all of our practice surgeries in at Neuralink, and having the skull open and have the brain pulse, which adds a degree of difficulty for the robot, you know, perfectly, precisely plan and insert those electrodes to the right depth and location.

And so... Yeah, we kind of broke new ground on how extensively we practiced for this surgery.

Well, we were lucky to have just incredible partners at the Barrow Neurologic Institute. They are I think the premier neurosurgical hospital in the world. They made everything as easy as possible for the trial to get going and helped us immensely with their expertise on how to arrange the details. It was a much more high-pressure surgery in some ways. I mean, even though the

You know, the outcome wasn't particularly in question in terms of our participants' safety. The number of observers, you know, the number of people—there's conference rooms full of people watching live streams in the hospital— rooting for this to go perfectly.

And that just adds pressure that is not typical for even the most intense production neurosurgery, say removing a tumor or placing deep brain stimulation electrodes. And it had never been done on a human before. There were unknown unknowns. And so...

Definitely a moderate pucker factor there for the whole team, not knowing if we were going to encounter, say, a degree of brain movement that was unanticipated, or a degree of brain sag that took the brain far away from the skull and made it difficult to insert, or some other unknown unknown problem.

Fortunately, everything went well, and that surgery was one of the smoothest outcomes we could have imagined. Were you nervous? I mean, you're a bit of a quarterback in the Super Bowl kind of situation. Extremely nervous. Extremely. I was very pleased when it went well and when it was over. Yeah. Looking forward to number two.

Well, I think wealth is easy to hate or envy or whatever. And I think there's a whole industry around driving clicks and And bad news is great for clicks. And so any way to take an event and turn it into bad news is going to be really good for clicks.

Now that there is a human with literal skin in the game, there's a participant whose well-being rides on this doing well. You have to be a pretty bad person to be rooting for that to go wrong. And so hopefully people look in the mirror and realize that at some point.

Yeah. I mean, I, you know, because, uh, um, an MD needs to be in charge of all of the medical decision-making throughout the process. Um, I unscrubbed from the surgery after exposing the brain and presenting it to the robot and, um, place the targets on the robot software interface that tells the robot where it's going to insert each thread.

That was done with my hand on the mouse for whatever that's worth.

Yeah.

Right. The software engineers are amazing on this team. They actually provided an interface where you can essentially use a lasso tool and select a prime area of brain real estate, and it will automatically avoid the blood vessels in that region and automatically place a bunch of targets. That allows

the human robot operator to select really good areas of brain and make dense applications of targets in those regions, the regions we think are gonna have the most high fidelity representations of finger movements and arm movement intentions.

Yeah, love that subreddit.

As a person who has a visceral reaction to the brain bleeding, I can tell you it's extremely satisfying watching the electrodes themselves go into the brain and not cause bleeding.

Yeah, so talking broadly about neurosurgery, we can get anywhere. It's routine for me to put deep brain stimulating electrodes near the very bottom of the brain, entering from the top and passing about a two millimeter wire all the way into the bottom of the brain. And that's not revolutionary. A lot of people do that. And we can do that with very high precision.

I use a robot from Globus to do that surgery. several times a month. It's pretty routine.

Yeah, so it's a cool process on the software side. You take a preoperative MRI that's extremely high resolution data of the entire brain and You put the patient to sleep, put their head in a frame that holds the skull very rigidly, and then you take a CT scan of their head while they're asleep with that frame on, and then merge the MRI and the CT in software.

you have a plan based on the MRI where you can see these nuclei deep in the brain. You can't see them on CT, but if you trust the merging of the two images, then you indirectly know on the CT where that is and therefore indirectly know where in reference to the titanium frame screwed to their head those targets are.

And so this is 60s technology to manually compute trajectories given the entry point and target and dial in some goofy-looking titanium actuators with little tick marks on them. the modern version of that is to use a robot, just like a little KUKA arm you might see building cars at the Tesla factory.

This small robot arm can show you the trajectory that you intended from the pre-op MRI and establish a very rigid holder through which you can drill a small hole in the skull and pass a small rigid wire deep into that area of the brain that's hollow and and put your electrode through that hollow wire and then remove all of that except the electrode.

So you end up with the electrode very, very precisely placed far from the skull surface. Now that's standard technology that's already been out in the world for a while. Neuralink right now is focused entirely on cortical targets, surface targets, because there's no trivial way to get say hundreds of wires deep inside the brain without doing a lot of damage. So your question, what do you see?

Well, I see an MRI on a screen. I can't see everything that that DBS electrode is passing through on its way to that deep target. And so it's accepted with this approach that there's going to be about one in a hundred patients who have a bleed somewhere in the brain as a result of passing that wire blindly into the deep part of the brain. that's not an acceptable safety profile for Neuralink.

We start from the position that we want this to be dramatically, maybe two or three orders of magnitude safer than that. Safe enough really that you or I without a profound medical problem might on our lunch break someday say, yeah, sure, I'll get that. I've been meaning to upgrade to the latest version. And so the safety constraints given that are high.

And so we haven't settled on a final solution for arbitrarily approaching deep targets in the brain.

Exactly. So we've got vision on the surface. We actually have made a huge amount of progress sewing electrodes into the spinal cord as a potential workaround for a spinal cord injury that would allow a brain-mounted implant to translate motor intentions to a spine-mounted implant that can affect muscle contractions in previously paralyzed arms and legs.

Yeah. So we have anesthetized animals doing grasp and moving their legs in a sort of walking pattern. Again, early days, but the future is bright for this kind of thing. And people with paralysis should look forward to that bright future. They're going to have options.

Exoskeletons are getting better too. Exoskeletons.

Yeah. Our first participant is, he's incredible.

Practice. Repetitions. Same with anything else. There's a million ways of people saying the same thing and selling books saying it, but do you call it 10,000 hours? Do you call it spend some chunk of your life, some percentage of your life focusing on this, obsessing about getting better at it? Repetitions...

humility, recognizing that you aren't perfect at any stage along the way, recognizing you've got improvements to make in your technique, being open to feedback and coaching from people with a different perspective on how to do it, and then just the constant will to do better. that fortunately, if you're not a sociopath, I think your patients bring that with them to the office visits every day.

They force you to wanna do better all the time.

Yeah.

Yeah, a fair bit. I mean, a good example for us is the angle of the skull relative to the normal plane of the body axis. of the skull over hand knob is pretty wide variation. I mean, some people have really flat skulls and some people have really steeply angled skulls over that area.

And that has consequences for how their head can be fixed in sort of the frame that we use and how the robot has to approach the skull. Yeah, people's bodies are built as differently as the people you see walking down the street, as much variability in body shape and size as you see there. We see in brain anatomy and skull anatomy.

There are some people who we've had to kind of exclude from our trial for having skulls that are too thick or too thin or scalp that's too thick or too thin. I think we have the middle 97% or so of people, but you can't account for all human anatomy variability.

Not too bad. Once you really get used to this, that's where experience and skill and education really come into play. If you stare at a thousand brains... It becomes easier to mentally peel back the, say, for instance, blood vessels that are obscuring the sulci and gyri, the wrinkle pattern of the surface of the brain.

Occasionally, when you're first starting to do this and you open the skull, it doesn't match what you thought you were going to see based on the MRI. And with more experience, you learn to kind of peel back that layer of blood vessels and see the underlying pattern of wrinkles in the brain and use that as a landmark for where you are. The wrinkles are a landmark? Yeah.

So I was describing hand knob earlier. That's a pattern of the wrinkles in the brain. It's sort of this sort of Greek letter omega shaped area of the brain.

Yeah. Where is it? So you have this strip of brain running down the top called the primary motor area. And I'm sure you've seen this picture of the homunculus laid over the surface of the brain, the weird little guy with huge lips and giant hands. That guy sort of...

lays with his legs up at the top of the brain and face arm areas farther down, and then some kind of mouth, lip, tongue areas farther down. And so the hand is right in there, and then the areas that control speech, at least on the left side of the brain in most people, are just below that. And so any muscle that you voluntarily move in your body

The vast majority of that references that strip or those intentions come from that strip of brain and the wrinkle for hand knob is right in the middle of that.

Yep.

Vision's a little deeper. And so this gets to your question about how deep can you get. To do vision, we can't just do the surface of the brain. We have to be able to go in, not as deep as we'd have to go for DBS, but maybe a centimeter deeper than we're used to for hand insertions. And so that's work in progress. That's a new set of challenges to overcome.

Yeah, I mean, the goal there comes from experience. I mean, we stand on the shoulders of people that... made Utah rays and used Utah rays for decades before we ever even came along.

Neuralink arose partly, this approach to technology arose out of a need recognized after Utah rays would fail routinely because the rigid electrodes, those spikes that are literally hammered using an air hammer into the brain those spikes generate a bad immune response that encapsulates the electrode spikes in scar tissue, essentially.

And so one of the projects that was being worked on in the Anderson lab at Caltech when I got there was to see if you could use chemo therapy to prevent the formation of scars. Things are pretty bad when you're jamming a bed of nails into the brain and then treating that with chemotherapy to try to prevent scar tissue, it's like, maybe we've gotten off track here, guys.

Maybe there's a fundamental redesign necessary. And so Neuralink's approach of using highly flexible, tiny electrodes avoids a lot of the bleeding, avoids a lot of the immune response that ends up happening when rigid electrodes are pounded into the brain.

And so what we see is our electrode longevity and functionality and the health of the brain tissue immediately surrounding the electrode is excellent. I mean, it goes on for years now in our animal models.

I think the most interesting, maybe underappreciated fact is that it really does control almost everything. I don't know. For an out-of-the-blue example, imagine you want a lever on fertility. You want to be able to turn fertility on and off. I mean, there are legitimate targets in the brain itself to modulate fertility, say blood pressure. You want to modulate blood pressure.

There are legitimate targets in the brain for doing that. Things that aren't immediately obvious as brain problems are potentially solvable in the brain. And so I think it's an underexplored area for primary treatments of all the things that bother people.

Yeah, not always. Kidney disease is real, but there are levers you can pull in the brain that affect all of these systems.

Yeah.

I think the use case right now is use a mouse, right? I can already do that, and so there's no value proposition. On safety grounds alone, sure, I'll do it tomorrow.

Yeah.

Yeah. I think recording speech intentions from the brain might change things as well. The value proposition for the average person. A keyboard is a pretty clunky human interface, requires a lot of training. It's highly variable in the maximum performance that the average person can achieve. I think taking that out of the equation and just having a natural

you know, word-to-computer interface might change things for a lot of people.

Yeah. I mean, with a bone conducting case that can be an invisible headphone, say, and the ability to think words into software and have it respond to you. That starts to sound sort of like embedded superintelligence. If you can silently ask for the Wikipedia article on any subject and have it read to you without any observable change happening in the outside world.

For one thing, standardized testing is obsolete.

Yeah, and the technology on the academic side is progressing at light speed here. I think there was a really amazing paper out of UC Davis, Sergei Stavisky's lab, that basically made an initial solve of speech decode. It was something like 125,000 words that they were getting with, you know, very high accuracy, which is.

Yeah.

Right.

I can't wait to see what people do with it. I feel like we're cavemen right now. We're like banging rocks with a stick and thinking that we're making music. At some point, when these are more widespread, there's going to be the equivalent of a piano that someone can make art with their brain in a way that we didn't even anticipate. I'm looking forward to it.

I'm not the first one. There's this whole community of weirdo biohackers that have done this stuff. And I think one of the early use cases was storing private crypto wallet keys and whatever. I dabbled in that a bit and had some fun with it.

Actually, yeah. It was the modern-day equivalent of finding change in the sofa cushions. I put some orphan crypto on there that I thought was worthless and forgot about it for a few years. Went back and found that some community of people loved it and had propped up the value of it, and so it had gone up 50-fold. So there was a lot of change in those cushions. That's hilarious.

But the primary use case is mostly as a tech demonstrator. It has my business card on it. You can scan that in by touching it to your phone. It opens the front door to my house, whatever simple stuff.

Yeah, we have a kind of a mysticism around the barrier of our skin. We're completely fine with knee replacements, hip replacements, dental implants. But there's a mysticism still around the inviolable barrier that the skull represents. And I think that needs to be treated like any other pragmatic barrier. The question isn't how incredible is it to open the skull?

The question is, what benefit can we provide?

The answer that is sad for me and other people of my demographic is that plasticity decreases with age. Healing decreases with age. I have too much gray hair to... To be optimistic about that. There are theoretical ways to increase plasticity using electrical stimulation, nothing that is totally proven out as a robust enough mechanism to offer widely to people.

Yeah, I think there's cause for optimism that we might find something useful in terms of, say, an implanted electrode that improves learning. Certainly, there's been some really amazing work recently from Nicholas Schiff, Jonathan Baker, and others who have a cohort of patients with moderate traumatic brain injury

who have had electrodes placed in the deep nucleus in the brain called the central median nucleus or just near central median nucleus. And when they apply small amounts of electricity to that part of the brain, it's almost like electronic caffeine. They're able to improve people's attention and focus. They're able to improve how well people can perform a task.

I think in one case, someone who was unable to work after the device was turned on, they were able to get a job. And that's sort of, you know, one of the holy grails for me with Neuralink and other technologies like this is from a purely utilitarian standpoint, can we... can we make people able to take care of themselves and their families economically again?

Can we make it so someone who's fully dependent and even maybe requires a lot of caregiver resources, can we put them in a position to be fully independent, taking care of themselves, giving back to their communities? I think that's a very compelling proposition and what motivates a lot of what I do and what a lot of the people at Neuralink are working for.

Yeah, it's like eliminating a species from an ecology. You don't know what the delicate interconnections and dependencies are. The brain is certainly a delicate, complex beast, and we don't know every potential downstream consequence of a single change that we make.

I think it's a certain kind of brittleness or a failure on the company's side if we need me to do all the surgeries. And I think something that I would very much like to work towards is a process that is so simple and so robust on the surgery side that literally anyone could do it. We want to get away from requiring intense expertise or intense experience.

to have this successfully done and make it as simple and translatable as possible. I mean, I would love it if every neurosurgeon on the planet had no problem doing this. I think we're probably far from a regulatory environment that would allow people that aren't neurosurgeons to do this, but not impossible.

To a certain degree, it's, yeah, it's a complex relationship. Yeah. All the good relationships are. It's funny when in the middle of the surgery, there's a part of it where I stand basically shoulder to shoulder with the robot. And so, you know, if you're in the room reading the body language, you know, it's my brother in arms there. We're working together on the same problem.

Yeah, I'm not threatened by it.

Yeah. You know, it gives you a very visceral sense, and this may sound trite, but it gives you a very visceral sense that death is inevitable. You know, on one hand... You know, you are, as a neurosurgeon, you're deeply involved in these, like, just hard-to-fathom tragedies. You know, young parents dying, leaving, you know, a four-year-old behind, let's say.

And on the other hand, you know, it takes the sting out of it a bit because... You see how mind-numbingly universal death is. There's zero chance that I'm going to avoid it. I know You know, techno-optimists right now and longevity buffs right now would disagree on that 0.000% estimate, but I don't see any chance that our generation is going to avoid it.

Entropy is a powerful force, and we are very ornate, delicate, brittle DNA machines that aren't up to the cosmic ray bombardment that we're subjected to. So, on the one hand, every human that has ever lived died or will die. On the other hand, it's just one of the hardest things to imagine happening. inflicting on anyone that you love is having them gone.

I mean, I'm sure you've had friends that aren't living anymore, and it's hard to even think about them. And so I wish I had arrived at the point of nirvana where death doesn't have a sting, I'm not worried about it, but I can at least say that I'm comfortable with the certainty of it. If not,

having found out how to take the tragedy out of it when I think about my kids either not having me or me not having them or my wife.

Yeah, it definitely makes you ask the question of how many of these can you see and not say, I can't do this anymore. But you said it well. I think it gives you an opportunity to just appreciate that you're alive today and I've got three kids and an amazing wife and I'm really happy. Things are good. I get to help on a project that I think matters. I think it moves us forward.

I'm a very lucky person.

Yeah. I think ultimately we want to give people more levers that they can pull, right? Like you want to give people options. If you can give someone a dial that they can turn on how happy they are. I think that makes people really uncomfortable.

But now talk about major depressive disorder, talk about people that are committing suicide at an alarming rate in this country, and try to justify that queasiness in that light. You can give people a knob to take away suicidal ideation, suicidal intention. I would give them that knob. I don't know how you justify not doing that.

Well, and on a grander scale, the fabric of society. People have a lot of complaints about how our social fabric is working or not working, how our politics is working or not working. Yeah. Those things are made of neurochemistry, too, in aggregate. Our politics is composed of individuals with human brains, and the way it works or doesn't work is potentially tunable.

in the sense that, I don't know, say, remove our addictive behaviors or tune our addictive behaviors for social media or our addiction to outrage, our addiction to sharing the most angry political tweet we can find. I don't think that leads to a functional society. And if you had... options for people to moderate that.

maladaptive behavior there could be huge benefits to society maybe we could all work together a little more harmoniously toward useful ends there's a sweet spot like you mentioned you don't want to completely remove all the dark sides of human nature because those kind of uh are somehow necessary to make the whole thing work but there's a sweet spot yeah i agree we gotta you gotta suffer a little just not so much that you lose hope

You know, I have this sense that I never found it, never removed it, you know, like a Dementor in Harry Potter. I have this sense that consciousness is a lot less magical than our instincts want to claim it is. It seems to me like a useful analog for thinking about what consciousness is in the brain.

We have a really good intuitive understanding of what it means to, say, touch your skin and know what's being touched, I think consciousness is just that level of sensory mapping applied to the thought processes in the brain itself. So what I'm saying is consciousness is the sensation of some part of your brain being active. So you feel it working.

You feel the part of your brain that thinks of red things or winged creatures or the taste of coffee. you feel those parts of your brain being active the way that I'm feeling my palm being touched, right? And that sensory system that feels the brain working is consciousness.

Which isn't like a warping of space-time or some quantum field effect, right? It's nothing magical. People always want to ascribe to consciousness. something truly different. And there's this awesome long history of people looking at whatever the latest discovery in physics is to explain consciousness because it's the most magical, the most out there thing that you can think of.

And people always, you know, want to do that with consciousness. I don't think that's necessary. It's just a, you know, a very useful and gratifying way of feeling your brain work.

Yeah.

It's been a joy.

Exactly.

Yeah.

Yeah, it was good. Well done. Yeah, yeah.

To show that you're still there, that you love her.

You've gotten super famous.

Is there a score that you get? Like, can you do better on a bubble game?

Writing down suggestions from Nolan. Make it more fun, gamified.

The interviews with athletes are always like that exact, it's like that template.

So WebGrid is a grid itself.

Yeah.