The Body Electric

A revolution, Napoleon said, can be neither started nor stopped. In medicine it happens over decades. The emergence of cardiac stents, for example, revolutionized the use of coronary bypass surgery and provided nonsurgical options for millions of patients; decades later their use continues to be debated and improved.

Bioelectronic medicine (BEM) is the most recent medical revolution -- not an innovation or an improvement or a step up but a radical reimagining of our understanding that it should be possible to treat human illnesses using electrical signals to replace some drugs. The implications may change the approach to developing future medicine; looking at who has already joined the efforts to further develop this field, the likelihood of a decades-long transition is high. Support from the National Institutes of Health, Defense Advanced Research Projects Agency (DARPA) and GlaxoSmithKline (GSK), one of the leading pharmaceutical companies, has already begun to write this chapter in mankind's struggle against disease.

I am very fortunate to be on the forefront of this field. My work is based on the relatively simple concept that nerves, which affect nearly every cell in your body, can be controlled with electrical signals. The pursuit of these research goals is guided by three principles that I believe can be broadly applied to achieving worthwhile objectives.

The first principle is to follow your imagination. At the time I began my work on bioelectronics, circa 1998, you could have searched through textbooks and found that nerves ended in lymph nodes, thymus, spleen and other sites where certain immune cells resided. And it was generally known that immunological diseases were the result of white blood cells floating through the blood vessels, jumping into action to produce inflammation and disease. It was dogmatic that the neuroendocrine system could regulate the immune system, and that neurotransmitters could alter immune cell functions, but it was unimaginable that discrete neural reflex circuits regulated these systemic inflammatory responses. The immune system was studied as an autonomous, self-regulating system, outside the intimate reach required for specific neural circuits to function.

When I first imagined challenging that assumption, based on my own observations as a neurosurgeon and immunology researcher, as well as on the work of scientists who preceded me, many of my colleagues were stunned. During one of the first experiments I conducted, several members of my own lab good-naturedly placed bets against this idea. The discoveries, however, and those of other pioneers in this field, were unequivocal: Electricity delivered to the vagus nerve regulates the immune system -- the nerve signals turn off inflammation, in a manner that can replace anti-inflammatory drugs.

Naturally, such a discovery -- since clinically tested on rheumatoid arthritis patients in Europe using a device that takes about 30 minutes to implant during a clinical trial run by a company I co-founded -- is likely to have far-reaching implications. One implication has to do with pharmaceuticals designed on the basis of their highly specific interactions with a particular target. Once in the body, however, these specific molecules travel throughout the bloodstream, where unforeseen side effects can arise in numerous organs. The promise of bioelectronic medicine is that by targeting a specific organ, at a specific time, in a specific amount, many side effects can be eliminated. Prescription refills can be accomplished through a wireless interface. There will be no more daily injections, and no interruption to daily life. The potential exists for developing treatments for ailments ranging from rheumatoid arthritis to Parkinson's to diabetes to cancer; the immune system contributes to all of these. Now, one can imagine a day when the products of a robust bioelectronic medicine industry replace many chemical and biological staples in the drug industry altogether.

This is where the second principle comes in: Collaborate, don't compete. To bring bioelectronics -- or any other visionary accomplishment -- to life, it's crucial to step outside your own ecosystem and find the right, and perhaps unexpected, people who share your imagination. Collaboration between the drug industry, with its expertise in clinical trials and regulatory approval of effective therapies for countless diseases, and the emerging bioelectronic medicine industry has accelerated the revolution. Pharmaceutical giant GSK has invested in a bioelectronic medicine company I co-founded and launched a more-than-$50-million effort to promote necessary technological and neurophysiological work in research laboratories across the globe. The success of these endeavors requires ongoing investment in the underlying science to answer the major new questions arising within this new field of bioelectronic medicine.

The early investments in bioelectronic medicine came from government sources. For more than 50 years the NIH, the major research funding body in the United States, and DARPA have been on the leading edge of U.S. science, ranging from sequencing the human genome to creating the Internet. Both of these bodies have supported bioelectronic medicine research at a time when the idea was nearly unimaginable, and their support was crucial. Now the success of bioelectronic medicine will only be fully realized when an alliance is forged between transdisciplinary experts in many fields of science and technology, each bringing her or his diverse perspective to the table.

The third principle is persistence. The work of science and innovation can be complex, and not all important scientific discoveries were preplanned. But all have required time and persistence to be fully utilized, embraced, and perfected. The accidental discovery of penicillin is widely known. Less discussed is the decades of work by hundreds of people, whose names are lost to history, required to perfect manufacturing and distribution, and to optimize its use. I hope that the launching of BEM will provide a better life for millions of people; that can be hard to imagine. It is sometimes more comprehensible to hone your vision through the eyes of a single patient, like Mirela Mustacevic, a rheumatoid arthritis patient highlighted in The New York Times Magazine this past weekend. Her story of success following treatment with an implanted vagus nerve stimulator brought tears of joy to many readers, including me. The article also prompted scores of emails from people suffering from a host of conditions, evidence of a pent-up demand within the patient community for what bioelectronic medicine may produce: a side-effect-free, straightforward, economical, and highly effective way to fight the diseases that gnaw away life.

With collaborators banded together underneath a very big tent of research, financial support, and development, I believe that it is only a matter of time before bioelectronic medicine fulfills its promise. It is likely that this will produce a bigger, broader impact than cardiac stents, which are used daily in every major hospital. When it does, physicians will have new tools in their armamentarium, clinical trials will be more patient-specific, and the number of therapies using electricity will rival the number using biological agents. But that's not the important part. What matters most to me is that by implanting one device for one disease, it should be possible to eliminate suffering and pain in individual patients. That's a real revolution that I am grateful to witness.