Brain candy
Crossing biomedicine's final frontier
What did you do this summer? I spent several of the warmer months of this year researching and writing a new long read for The Economist on neuroscience. I’ve been intrigued by the flurry of interest and optimism in this area. It has traditionally been the “difficult” bit of biomedicine, with a long history of failures in drug development—although notably in Alzheimer’s and Parkison’s. The drugs we have to hand for mental health disorders are failing too many people, in too many ways.
Yet behind this narrative is one of growing optimism. I call it a renaissance in neuroscience in my new Technology Quarterly for The Economist. That is certainly what it looks like, although this sort of shift is really best judged from the rear-view mirror. We will see in three to five years whether I’ve truly nailed it.
What is clear right now is that there are some big steps forward are taking place. Taking a step back, though, it is worth remembering that our ability to deliver drugs for brain dysfunction is far behind our abilities in the heart, or in cancers. Yet there is a great deal to be optimistic about. One reason is that the failures of the past are driving the exploration of more fundamental ideas about what could be going on in the brain, whether it is in the way that energy is produced in mitochondria, or in its failure to clear up and throw out its neurological garbage over time. Inflammation, too, is another factor in brain health that is coming under growing scrutiny. These investigations will deliver drugs that are bound to be useful in many ways.
Another idea that is being pursued is a rethink of how diseases of the brain are split up. This means less focus on the symptoms that are described for a disorder, whether depression or autism and more on the biology that might underpin it. Along with these ideas come new tools such as optogenetics, which uses light to reveal the inner workings of the brain, and organoids—where mini brains are grown in a dish. Then there are biomarkers, which are finding increasing success in tracking the progress of diseases, such as migraine and amyotrophic lateral sclerosis, and drugs to treat them. The drug firm Denali is trying to find better ways of getting drugs past the blood-brain barrier, something that has proven a particular challenge in the development of drugs for the brain.
On top of all this come promising developments in the field of psychedelic medicines, genetic medicines, and brain-computer interfaces and related technologies. It is an exciting time.