‘Doctrine of the Mean’: how the US lost a 2-decade race to China in brain implants

A man demonstrates a robotic hand with a brain-computer interface, which identifies the patient’s motor signals and controls the exoskeleton to move the limbs of the patient.

Photo: AFP For decades, the United States led the charge in the pursuit of brain-computer interface technology, betting big on bold, high-risk breakthroughs that promised to revolutionise medicine and human-machine integration.

In the end, it is China crossing the finish line first.

Using a semi-invasive approach that may lend credence to the Confucian “doctrine of the mean” – or the philosophy of seeking a middle path between extremes – a team in China has now come up with a commercially approved product ahead of all other players, including challengers in the US.

Earlier this month, Shanghai-based Neuracle Medical Technology received a commercial-use approval for an implantable brain-computer interface (BCI) from China’s National Medical Products Administration.

After decades of this technology being stuck in clinical trials globally, this feat makes their Neural Electronic Opportunity (Neo) implant the first invasive device in the world to be available outside trials.

The development of BCI has been defined by a difficult trade-off: a non-invasive approach that sacrifices precision or an invasive approach that sacrifices safety.

But in the global race to deploy commercial, high-performance BCIs, developers have faced challenges in balancing the superior performance of invasive approaches with long-term safety concerns.

The Neo implant, designed to restore hand motor function in patients with spinal cord injuries, was developed in collaboration between Hong Bo’s team at Tsinghua University and Neuracle, which was founded by Tsinghua graduate Xu Honglai in 2011.

BCIs are devices that record brain activity or electrical signals from neurons to guide outside devices, such as prosthetic limbs, wheelchairs or computer cursors.

These systems aim to provide improved motor function for patients with impairments such as paralysis.

In the early days of BCIs, there were two main developmental approaches.

The first was non-invasive devices, where sensors are placed outside the scalp.

These devices are safer but less accurate due to the physical barrier of the skull.

The second is the invasive approach, used by Elon Musk’s Neuralink in their brain implant, which involves implanting sensors directly into the brain’s cerebral cortex.

This method is more precise, but can have long-te

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