At the turn of the millennium, the sudden ubiquity of the internet supercharged the idea that we would someday transcend the limitations of our physical bodies and live in a world of pure information.
It was around this time that the technology known as a brain-computer interface, or BCI, began to take its modern shape. Though the hardware that converts the brain’s electrical activity into signals that a machine can understand has still only been implanted in a handful of study participants and volunteers, patients with BCIs have demonstrated the ability to move a computer cursor — or open and close a prosthetic hand — using only their thoughts.
Price Engineering Professor Florian Solzbacher is one of the leading figures in this field. He is also Co-founder and Chief Science Officer of Blackrock Neurotech, one of the main manufacturers of BCIs, a majority share of which was acquired by fintech company Tether last month for $200 Million.
Solzbacher’s work at Blackrock stems from the Utah Electrode Array, the pioneering BCI developed by Richard Normann at the University of Utah beginning in the late 1980s to mid 90s. Solzbacher, who joined the U in 2004, built upon this foundation to advance and refine the device, by increasing reliability, scalability, manufacturability and long-term stability, add electronic signal processing as part of the implant and to significantly advance the portfolio of technologies and solutions. He also pushed towards system level solutions, including a variety of electrodes, but also electronics, materials developments, software and surgical tool development. In the few years of research, his work led to dozens of invention disclosures and more than 16 patents filed.
In 2007, he and Marcus Gerhardt merged their work on the Utah Electrode Array with technologies acquired from companies in the field, forming Blackrock Neurotech in the process. The new startup then licensed the technology from the University of Utah, allowing it to grow and operate independently from Solzbacher’s academic research.
That work is currently giving patients like James Johnson a new way of interacting with the world. Johnson, who is almost completely paralyzed from the shoulders down, recently showed CNN Decoded how his Blackrock-developed BCI allowed him to drive a car using only his thoughts, making him “feel like a Jedi.”
With a foot in both academic and entrepreneurial worlds, Solzbacher is in a unique position to assess the evolution of the technology, the businesses surrounding it, and the degree the public trusts these potentially life-changing devices.
We spoke with Solzbacher about the history of the field; an apparent overnight success that had been developing for decades.
Q: How did Blackrock Neurotech become such a hot commodity?
When you’re looking for an inflection point for something like brain-computer interfaces, the first question you have to ask is “is the technology ready?” Today, there’s just been an increasing frequency and number of first-in-human demonstrations of the more complex capabilities we want for BCIs, like sensory feedback, and true multitasking, which you would need to control multiple prosthetics at the same time.
Some of that is about the side technologies advancing — miniaturization, advances in AI and machine learning, longitudinal data on the safety of implants — but that is all just a prerequisite for capital entering the market. For example, with the Human Genome Project, the government made a $2 or 3 billion investment into genetic technologies, but it wasn’t until the capital markets and big business took notice that you started to see the ten-and-hundred-fold leveraging of that investment. Ultimately, it was that investment that led to the RNA technologies that helped us during the COVID Pandemic.
Q: Who represents the Big Business in this space then?
This is something that Elon Musk deserves credit for; when he announced Neuralink eight years ago, the world started to take notice. While his timelines are often wrong, he has a record of ultimately pulling a rabbit out of his hat and delivering these transformative technologies, giving him massive credibility with investors.
After Musk launched NeuraLink, Blackrock was no longer alone — suddenly the field had dozens of companies pursuing BCI, with perhaps six or seven that like us that actually do brain surgery and implant devices. And that has attracted even more attention. Investors don’t want to miss out on this Next Big Thing.
Fifteen years ago, when we were just starting Blackrock Microsystems, which we later renamed Blackrock Neurotech, this market just didn’t exist. It wasn’t clear what the killer application was, and there was no clear direction on reimbursement, clinical endpoints, or the regulatory environment.
Q: Enabling people with paralysis to be more self-sufficient seems like a pretty clear killer app!
That sort of societal impact is what drove me into this space — and the potential is absolutely massive — but the market is still too small.
Developing the commercial models are important for making this technology sustainable. That’s what motivated Marcus and me to first take serious external capital on board; we were privately held until three years ago then because we realized that the technology was poised to take off and we’d be missing the boat by just reinvesting our own profits.
Q: So when you say “the commercial model,” you mean how do you actually make this profitable within our current healthcare system?
Exactly. Surgeons are excited to be part of these projects because they know how much value BCIs give to our test subjects. But if you ask those same surgeons “would you prescribe one?” they will say no. From a medical point of view and for insurance companies, controlling a computer with your brain is just not considered a medical need, even if you’re tetraplegic. If you were an ALS patient and you lost the ability to speak, then a BCI that can help you communicate is something that could be covered, but even that’s only reimbursed for around $20,000, which is not nearly enough. Less expensive approaches, like eye-trackers, are generally considered to be sufficient.
That’s why we want to show how our patients have documented rehabilitation benefits, such as improvements in depression and a lot of other comorbidities and a significantly increased quality of life. If you can work a job or drive a car because you have additional tools for interacting with computers and communicating, that’s a huge social and economic benefit, but it’s not defined as a medical one, yet
Q: In that case, why shouldn’t that computer system be considered a prosthesis, like a prosthetic hand or leg?
Prosthetics do get covered, but very few people need BCIs compared to people who need limb replacements, and even that number is not particularly big when you compare it to other health problems, like cancer, or even obesity now. You need a few hundred thousand, or ideally, millions of patients to justify the cost of the investment that goes into getting medical devices through the regulatory and reimbursement processes. If you end up selling a few thousand devices per year, the unfortunate reality is that the numbers just don’t add up. It slowly starts to become feasible at the low tens-of-thousands devices per year but really only makes sense when you reach far larger volumes.
Some of that pain is self-inflicted; everything is so expensive because we’ve become so risk averse. Just to be very, very clear, safety is paramount when you’re dealing with patients’ brains. But there are hurdles both here and in Europe when it comes to losing some of that pioneering courage.
Q: What do you think it would take to get that kind of courage back?
That’s another thing Elon has been really, really good at — creating a vision that is completely disconnected from those practical realities. There is no business model or compelling reason for SpaceX to go to Mars other than it inspires people. But what he’s actually built underneath is a launch vehicle business that transports satellites and a communication company with valuations that would tower over any other company of that type.
And to some extent that is not un-similar to what he may be trying to do with BCI now as well. You can imagine a future where it’s not just people with diseases that have BCIs, but it’s an integral part of society, increasing our productivity and performance, prolonging life and assisting with jobs. First responders, military, pilots; there are so many places where we’re using technology to give us a fraction-of-a-second faster reaction times. We already have data suggesting that BCIs can do that as well; people are going to use them for enhancement, not just treatment.
Q: That’s the kind of sci-fi vision that makes some people skeptical of this kind of technology. How do you see those sorts of fears playing out?
Companies like Neuralink want to have BCIs proliferate even if it that initially means taking a loss on each one] because, once you have ten thousand people living with implants, the reimbursement and regulatory barriers start to drop. These people exist, now you have to figure out how to move forward with the relevant laws and policies.
I would not be surprised if that’s what dislodges the log jam that we have on that front now. I’m also a little frightened by the prospect of non-medical uses for BCIs, to be perfectly honest, but that’s why we need to have these ethics discussions. We don’t want to make the same foundational mistakes that we did with social media. We were so excited by that vision of democratizing that information that we ended up creating this sort of a monster, where the inherent mechanisms and business models and algorithms are so that they create these echo chambers with horrible consequences.
Q: Does doing this kind of work in the context of academia, rather than industry, give you more latitude to do that sort of thinking?
Utah — both the state and the University — has always had a very entrepreneurial culture and society, which came probably out of the pioneer days of people having to stand on their own feet, having shoestring budgets for everything, and just making things work. I see that mentality perfusing the culture here. In the mid-nineties, during my graduate studies, I already observed that the students, the faculty, almost everybody had some level of business acumen and in addition to being a scientist or an engineer and a teacher. That attracts a type of person that is looking for an environment where they have the freedom to pursue their own vision without a lot of red tape.
In the university setting, there are a lot of schools that say that they love the publicity and the success that comes out of this entrepreneurship, but very often, it’s just lip-service. They say that they want their faculty and students to create companies, but then six months later, ask you whether you want to be a professor or an entrepreneur?
I like that I don’t have to choose here, because, to me, it’s not a choice — I have to be both professor and an entrepreneur. The industry side alone, of course, is focused on translation, but can’t do it alone. You need to keep figuring out why things work, why they don’t work, and to keep replenishing the well of knowledge the next generation of people will draw from. That’s the only way to make your technology scalable; you’re nothing without the team, without the people around you. But without the industry side, there would not be true reproducibility, translation, scaling and impact in the real world.
Being in a university setting to do that is really wonderful, but you need a place that allows you the freedom to be both. When I came to the U, I was a little bit of an oddball compared to some of the basic scientists, but I was enabled and encouraged all the way through to my tenure case, where my entrepreneurial activities were counted and understood how they contributed to my career here.
That means you don’t have to be somebody who constantly writes Science and Nature papers. If you’re somebody who’s great at translating things and making things work, that’s just as valuable. And I was lucky that the Engineering Initiative connected my work at the U to the state’s interest in developing technologies for growing our local economy. That gave me a lot of freedom when I was just getting started, which has now paid off in a big way.
I think we need to fight tooth-and-nail to keep that attitude; it’s a competitive advantage. We need to retain the courage to blaze our own trail.