Editorial

www.thelancet.com Vol 381 April 13, 2013 1247

Mapping the mind—smart thinking for brain health?On April 2, US President Barack Obama launched his most ambitious scientifi c research plan to date—the BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative. The programme aims to accelerate the development of new tools to map comprehensively, for the fi rst time, the activity of the human brain. The White House claims that the project will not only revolutionise our understanding of the human mind but also uncover new ways to treat, prevent, and cure brain disorders like Alzheimer’s disease, schizophrenia, autism, epilepsy, and traumatic brain injury. Obama has requested US$100 million in federal funding for the initiative, which will be channelled through the National Institutes of Health (NIH), the Defense Advanced Research Projects Agency, and the National Science Foundation. He has also called for companies, universities, foundations, and philanthropists to join the project, which he hopes will generate thousands of jobs and provide a boost to America’s economy.

Will the reality match the ambition? Reaction has been mixed. In its favour, the project’s leaders recognise that the tools to map the complex neural circuits of the brain, and accurately and non-invasively record the activity of almost 100 billion neurons in real-time, do not yet exist. With its technological focus, the Initiative could therefore produce real advances in methods, such as brain imaging. The BRAIN Initiative also seems a sounder endeavour than its European counterpart, the Human Brain Project, which promises to build a supercomputer simulation that integrates everything known about the human brain, including the structures of ion channels in neural cell membranes. But detractors say that the data for such a reconstruction of the brain are inadequate.

The BRAIN Initiative certainly has high-level political and academic support and a coherent approach to tackle the task. The NIH will establish a high-level working group to shape and develop a plan for the project, including timetables, milestones, and cost estimates. But there are problems. Questions have been raised about how useful mapping the brain will be. Given that our brains change, learn, think, remember, and are shaped by our experiences, interactions with other people, and society, mapping the electrical spikes in the brain seems an overly restrictive biomedical

approach to understanding the most complex organ in the human body. It is also doubtful that this approach will yield cures for conditions such as Parkinson’s disease and Alzheimer’s disease as purported, at least not for several decades to come. Furthermore, this high-level initiative might divert funds from other areas of brain research—eg, brain chemistry, physiology, and pharmacology—that are more likely to have clinical impact sooner.

There are also non-biomedical aspects of brain disorders that require urgent attention. For example, access to psychological treatments for depression worldwide is woefully inadequate and the costs and availability of social care for people with Alzheimer’s disease is a growing concern in many countries.

Parallels have been made between the BRAIN Initiative and the Decade of the Brain (1990–1999), which was announced with a similar fanfare by then President George H W Bush. Yet, experts note that during the Decade there was neither a substantial increase in the rate of recovery from mental illness, nor a detectable decrease in suicide or homelessness—both of which are associated with a failure to recover from mental illness.

Additionally, concerns exist about the creation of a divide in brain science if equity and global health implications are not considered up front. Such divides arose with the development of digital and genomic technologies. Peter Singer, chief executive offi cer of Grand Challenges Canada, an organisation that funds innovative global health projects, told The Lancet that one of the most important ways to promote equity would be to focus on early child development. As many as 200 million children fail to reach their full potential as a result of exposure to risk factors—malnutrition, infection, poor management of pregnancy, birth complications, and lack of stimulation and nurturing—in the fi rst 1000 days of life. Protecting young brains from these threats in developing nations should be part of the BRAIN Initiative to ensure that the project has global impact, he says.

Ultimately, the BRAIN Initiative is a valiant attempt to unlock the mysteries of the human mind. But whether it is a wise move for better brain health globally is debatable. The Lancet

For more on the BRAIN Initiative see http://www.whitehouse.gov/infographics/brain-initiative

For more on equity in child health see http://www.thelancet.com/series/child-equity

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