Interviews With Scientists

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Foreword
On September 21-22, 2023, the Tianqiao and Chrissy Chen Institute (TCCI), in collaboration with the Shanghai Academy of Social Sciences and the Shanghai Mental Health Center, hosted a special symposium titled “Brain-Machine Interfaces and Philosophy: Interdisciplinary Dialogues.”
The event brought together over 60 experts and scholars from fields including clinical medicine, natural sciences, philosophy and ethics, the science and technology governance, and industrial planning. The discussions focused on core topics such as the role of brain-machine interfaces in national governance, ethical considerations in technology, human cognition, human-computer interaction, and legal challenges.
As one of the symposium’s conveners, Professor Ji Haiqing, a research fellow at the Shanghai Academy of Social Sciences and Director of the Science and Technology Philosophy Research Office, was invited for an exclusive interview with us. From the perspective of technological ethics, Professor Ji offered a deep analysis of the social integration process of brain-machine interfaces and their potential impacts. He shared insights into the motivations behind organizing the symposium and provided unique perspectives on the ethical distinctions between brain-machine interfaces and traditional medical devices, the implications of these technologies for privacy, the expansion of human boundaries, and human enhancement.
The following is the interview with Ji Haiqing. We have condensed the text to make it easier to read.
Question: Could you introduce yourself to our audience?
Ji Haiqing: I am Ji Haiqing from the Institute of Philosophy at the Shanghai Academy of Social Sciences. During my undergraduate studies, I majored in a science and engineering discipline—computer science. However, over time, I developed a deep interest in topics related to the humanities, society, and history.
In my twenties, I realized that the answers to the questions I had been pondering could not be found in the computer science books I was reading—such as those on data structures or programming languages. As a result, I made what seemed like an unusual decision: I transitioned from studying computer science to pursuing philosophy, hoping to freely explore the issues that intrigued me.
Since then, I have been engaged in philosophical research, particularly in the field of philosophy of technology. I am deeply satisfied with this career because it allows me to observe and reflect on societal and technological developments through thinking, writing, and discussions with colleagues. It’s an intellectually stimulating and fulfilling endeavor.
Question: Thank you for organizing this symposium on brain-machine interfaces and philosophy. What inspired you to host this event?
Ji Haiqing: The motivation for organizing this symposium stemmed from my interest in brain-machine interface (BMI) technology. BMI integrates cutting-edge advancements across various disciplines, including biology, neuroengineering, neuroscience, electronics, and artificial intelligence. It brings together the achievements of these advanced fields and combines them with the human brain—a complex and critical organ.
BMI represents the forefront of the current technological wave and serves as a crucial component worthy of deep investigation. My personal interest in BMI is closely tied to one of my research areas: the ethics of technology.
The ethics of technology explores how science and technology integrate into society. This integration is not merely a straightforward application of technology; it is a complex process involving a delicate balance of competing forces. I often use the analogy of a diver to illustrate this point: a skilled diver enters the water from a great height with barely a splash, but if a new technology is ethically immature, even a dive from a lower height can create significant backlash. The process of integrating technology into society is much the same.
The goal of philosophical and ethical research is to explore how technological products can &#8220;enter the water&#8221;—that is, integrate into society—at the optimal angle, minimizing their negative impacts, aligning them with human values, and facilitating their acceptance by society. My particular focus on BMI arises from its status as a frontier technology. I am eager to understand how it integrates into society.
Will society embrace BMI technology? Will it be fully accepted, or will it encounter resistance—perhaps due to conceptual biases or other factors? These are fascinating questions that led me to combine brain-machine interfaces with philosophy as a research theme. This symposium was an opportunity to bring together experts from various fields to explore these questions collaboratively.
Question: Compared to other medical devices, brain-computer interfaces (BCIs) raise more ethical controversies. In your opinion, what are the fundamental differences between BCIs and traditional medical devices?
Ji Haiqing: The uniqueness of BCIs lies in their direct interaction with the human brain, which is an extraordinarily mysterious, critical, and irreplaceable organ. Throughout the history of philosophy, there have been extensive discussions about the mind, the spirit, and thought. Although the term &#8220;heart&#8221; was historically used to describe these concepts, in reality, all advanced cognitive functions, emotions, and bodily regulation are carried out by the brain, not the heart.
Traditional medical devices may replace certain parts of the human body, such as prosthetic limbs or even artificial hearts, but the brain remains irreplaceable. The distinctive feature of BCIs is their direct engagement with this irreplaceable organ. To use a computing analogy, components like hard drives or memory can be replaced in a computer, but if the central processing unit (CPU) is damaged, the entire system becomes nonfunctional. Similarly, the brain plays an essential role in the human body, making the uniqueness of BCI technology particularly significant.
While BCIs hold immense potential for treating neurological and psychiatric disorders, their direct interaction with the human brain necessitates a dedicated focus on their ethical implications. In summary, BCIs are fundamentally different from traditional medical devices because they can access and interact directly with brain data, making their ethical considerations distinct and profound.
Question: In your view, how might BCI technology impact mental privacy?
Ji Haiqing: On the topic of privacy, I’d like to offer a broader perspective from the philosophy and history of technology. Scholars in the philosophy of technology often argue that our value judgments about certain concepts, such as privacy, may appear to be independent, but they are actually closely tied to the tools we use.
These tools not only help us achieve goals but also subtly shape our perceptions. For example, the invention of clocks changed our understanding of time. Before clocks, people perceived time through natural phenomena, such as the rising and setting of the sun or the shadow of a sundial. However, with the advent of clocks, time became segmented into measurable units like hours and minutes.
Similarly, the concept of privacy is deeply intertwined with the tools we use. For instance, the presence of a camera evokes a sense of privacy awareness. If I am willing to be seen by others, I face the camera willingly; if I am not, I avoid it. Privacy is not a concept that exists in a vacuum but is shaped by our attitudes toward and use of technological tools.
Thus, privacy does not imply complete concealment; rather, it depends on whom we wish to share information with and to what extent. This reflects the mutual interaction and co-construction of technology and our perceptions. The crux lies in how we view these technological tools and our attitudes toward privacy.
Question: How will brain-computer interface (BCI) technology affect the boundaries of what it means to be “human”?
Ji Haiqing: This question requires clarifying several concepts. In Chinese, the term &#8220;人&#8221; corresponds to two distinct terms in Western languages: human being and person. Human being refers to humanity in a biological sense, while person denotes an individual human. When discussing person, you and I are distinct individuals, but from the perspective of human beings, we belong to the same species without differentiation.
When it comes to BCIs and their impact on individual personality, there are many intriguing topics to explore. One of the key concepts we often discuss is personal identity. Generally, external changes, such as changing clothes, do not affect our personal identity—who we are. However, when we implant devices like deep brain stimulation (DBS) to regulate physiological states due to illness or other reasons, do we remain the same person? How society perceives the impact of these technologies on personality and identity becomes a critical question.
Interestingly, we have already seen some exceptional cases. For example, the Spanish artist Neil Harbisson was born colorblind. To compensate for this, he implanted a device that converts the color spectrum into sound waves, enabling him to &#8220;hear&#8221; colors. While he successfully gained this ability, it also introduced new challenges. A microphone-like antenna is now attached to his skull, and when crossing border checkpoints, officials noticed his passport photo did not include this device. He was eventually required to take a new photo, incorporating the device as part of his body.
This case illustrates how, as society gradually accepts individuals who merge with technology—sometimes referred to as &#8220;cyborgs&#8221;—the traditional biological boundaries of what constitutes a &#8220;human being&#8221; are shifting. This transformation not only expands the boundaries of humanity but also raises numerous ethical, political, anthropological, and philosophical questions.
Question: Do you think the “technologization of the body” will inevitably become a future trend for humanity?
Ji Haiqing: The answer to this question is both &#8220;yes&#8221; and &#8220;no.&#8221; If we say &#8220;no,&#8221; it’s because the question assumes this will become a new trend in the future. From my perspective, this is not a new trend but rather one that has existed throughout human history. Humanity has always sought to extend its capabilities and activities through the integration of technology. The only difference now is that we are facing a new technological product—BCIs.
From the perspective of the philosophy of technology, technology can be broadly defined as any man-made artifact, an extension of human capabilities. Based on this definition, the integration of humans and technology has always been an ongoing trend. Books such as *Sapiens: A Brief History of Humankind* and works in technological anthropology discuss similar themes.
For example, Polynesians in the South Pacific built canoes from island trees to travel between islands, while farmers in temperate northern regions felled large trees to construct ships for long-distance navigation. Despite differences in tools and techniques, both examples illustrate humanity’s use of natural resources in combination with technology to achieve their goals.
Therefore, I believe the fusion of humans and technology is a continuously evolving trend, not merely a phenomenon of the future.
Question: In the discussions surrounding brain-computer interfaces (BCIs) and philosophy, are there any significant studies that have been undervalued?
Ji Haiqing: This question touches on many aspects. As BCI devices become more widely applied, numerous issues will gradually emerge. The expansion of their usage will reveal problems over time rather than exposing them all at once.
I believe there are many important topics worthy of attention. If you’re interested, I recommend exploring the work of internationally renowned posthumanist scholars. These academics, while conducting serious research, possess imaginations that rival those of science fiction writers. For instance, American posthumanist scholar Katherine Hayles and others in the field of posthumanism often use imaginative depictions of humanity&#8217;s future existence to explore the relationship between humans and technology. Such works can serve as a source of intellectual inspiration.
Question: What is the topic you are most focused on at the moment?
Ji Haiqing: In recent years, I have been particularly interested in the topic of human enhancement. Human enhancement refers to using technology not only to meet conventional needs, such as treating diseases, but also to further augment individual capabilities. This enhancement goes beyond external devices and integrates with our bodies to improve physiological functions.
Broadly speaking, ever since humanity invented airplanes, we can say that humans have learned to fly, though this differs significantly from how birds fly. Birds rely on their physiological structures to fly, while humans achieve flight through technological tools. The trend of human enhancement likely involves technological tools directly altering human physiological structures, granting us unprecedented abilities. This trend has become especially prominent with advancements in electronics, nanotechnology, and other fields in the 21st century.
I believe this trend of human enhancement prompts an essential question: How will it shape our self-perception and influence our future development?
Question: How can we address the potential social issues arising from human enhancement to ensure technology benefits all populations?
Ji Haiqing: From my perspective, this is not an especially grave issue. Human societies have always adapted to the introduction of new technologies, which often create disparities among groups to some extent.
Looking back at history, some early societies improved farming efficiency with iron tools or agricultural equipment, leading to better harvests, while others domesticated animals to aid in labor. Meanwhile, some regions lacked these conditions. Such inequality has been a historical norm. Over time, societies have employed various methods to mitigate the inequalities brought about by technological advancements.
In our field of research, this phenomenon is known as the issue of technological accessibility. There are, in fact, numerous ways to address the social problems caused by unequal access to technology. If such inequality disrupts social stability or exacerbates class divisions, governments can intervene through public financial measures. For example, governments could procure and provide certain technologies for free or offer subsidies to help those who cannot afford new technologies.
Thus, I don’t see this as an insurmountable problem. We already have well-established economic theories and policy tools to tackle these challenges and ensure that technology can more widely benefit all populations.
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[:en]<div style="line-height: 1.5;">
Foreword

On September 21-22, 2023, the Tianqiao and Chrissy Chen Institute (TCCI), in collaboration with the Shanghai Academy of Social Sciences and the Shanghai Mental Health Center, hosted a special symposium titled “Brain-Machine Interfaces and Philosophy: Interdisciplinary Dialogues.”

The event brought together over 60 experts and scholars from fields including clinical medicine, natural sciences, philosophy and ethics, the science and technology governance, and industrial planning. The discussions focused on core topics such as the role of brain-machine interfaces in national governance, ethical considerations in technology, human cognition, human-computer interaction, and legal challenges.

As one of the symposium’s conveners, Professor Ji Haiqing, a research fellow at the Shanghai Academy of Social Sciences and Director of the Science and Technology Philosophy Research Office, was invited for an exclusive interview with us. From the perspective of technological ethics, Professor Ji offered a deep analysis of the social integration process of brain-machine interfaces and their potential impacts. He shared insights into the motivations behind organizing the symposium and provided unique perspectives on the ethical distinctions between brain-machine interfaces and traditional medical devices, the implications of these technologies for privacy, the expansion of human boundaries, and human enhancement.

The following is the interview with Ji Haiqing. We have condensed the text to make it easier to read.

Question: Could you introduce yourself to our audience?

Ji Haiqing: I am Ji Haiqing from the Institute of Philosophy at the Shanghai Academy of Social Sciences. During my undergraduate studies, I majored in a science and engineering discipline—computer science. However, over time, I developed a deep interest in topics related to the humanities, society, and history.

In my twenties, I realized that the answers to the questions I had been pondering could not be found in the computer science books I was reading—such as those on data structures or programming languages. As a result, I made what seemed like an unusual decision: I transitioned from studying computer science to pursuing philosophy, hoping to freely explore the issues that intrigued me.

Since then, I have been engaged in philosophical research, particularly in the field of philosophy of technology. I am deeply satisfied with this career because it allows me to observe and reflect on societal and technological developments through thinking, writing, and discussions with colleagues. It’s an intellectually stimulating and fulfilling endeavor.

Question: Thank you for organizing this symposium on brain-machine interfaces and philosophy. What inspired you to host this event?

Ji Haiqing: The motivation for organizing this symposium stemmed from my interest in brain-machine interface (BMI) technology. BMI integrates cutting-edge advancements across various disciplines, including biology, neuroengineering, neuroscience, electronics, and artificial intelligence. It brings together the achievements of these advanced fields and combines them with the human brain—a complex and critical organ.

BMI represents the forefront of the current technological wave and serves as a crucial component worthy of deep investigation. My personal interest in BMI is closely tied to one of my research areas: the ethics of technology.

The ethics of technology explores how science and technology integrate into society. This integration is not merely a straightforward application of technology; it is a complex process involving a delicate balance of competing forces. I often use the analogy of a diver to illustrate this point: a skilled diver enters the water from a great height with barely a splash, but if a new technology is ethically immature, even a dive from a lower height can create significant backlash. The process of integrating technology into society is much the same.

The goal of philosophical and ethical research is to explore how technological products can "enter the water"—that is, integrate into society—at the optimal angle, minimizing their negative impacts, aligning them with human values, and facilitating their acceptance by society. My particular focus on BMI arises from its status as a frontier technology. I am eager to understand how it integrates into society.

Will society embrace BMI technology? Will it be fully accepted, or will it encounter resistance—perhaps due to conceptual biases or other factors? These are fascinating questions that led me to combine brain-machine interfaces with philosophy as a research theme. This symposium was an opportunity to bring together experts from various fields to explore these questions collaboratively.

Question: Compared to other medical devices, brain-computer interfaces (BCIs) raise more ethical controversies. In your opinion, what are the fundamental differences between BCIs and traditional medical devices?

Ji Haiqing: The uniqueness of BCIs lies in their direct interaction with the human brain, which is an extraordinarily mysterious, critical, and irreplaceable organ. Throughout the history of philosophy, there have been extensive discussions about the mind, the spirit, and thought. Although the term "heart" was historically used to describe these concepts, in reality, all advanced cognitive functions, emotions, and bodily regulation are carried out by the brain, not the heart.

Traditional medical devices may replace certain parts of the human body, such as prosthetic limbs or even artificial hearts, but the brain remains irreplaceable. The distinctive feature of BCIs is their direct engagement with this irreplaceable organ. To use a computing analogy, components like hard drives or memory can be replaced in a computer, but if the central processing unit (CPU) is damaged, the entire system becomes nonfunctional. Similarly, the brain plays an essential role in the human body, making the uniqueness of BCI technology particularly significant.

While BCIs hold immense potential for treating neurological and psychiatric disorders, their direct interaction with the human brain necessitates a dedicated focus on their ethical implications. In summary, BCIs are fundamentally different from traditional medical devices because they can access and interact directly with brain data, making their ethical considerations distinct and profound.

Question: In your view, how might BCI technology impact mental privacy?

Ji Haiqing: On the topic of privacy, I’d like to offer a broader perspective from the philosophy and history of technology. Scholars in the philosophy of technology often argue that our value judgments about certain concepts, such as privacy, may appear to be independent, but they are actually closely tied to the tools we use.

These tools not only help us achieve goals but also subtly shape our perceptions. For example, the invention of clocks changed our understanding of time. Before clocks, people perceived time through natural phenomena, such as the rising and setting of the sun or the shadow of a sundial. However, with the advent of clocks, time became segmented into measurable units like hours and minutes.

Similarly, the concept of privacy is deeply intertwined with the tools we use. For instance, the presence of a camera evokes a sense of privacy awareness. If I am willing to be seen by others, I face the camera willingly; if I am not, I avoid it. Privacy is not a concept that exists in a vacuum but is shaped by our attitudes toward and use of technological tools.

Thus, privacy does not imply complete concealment; rather, it depends on whom we wish to share information with and to what extent. This reflects the mutual interaction and co-construction of technology and our perceptions. The crux lies in how we view these technological tools and our attitudes toward privacy.

Question: How will brain-computer interface (BCI) technology affect the boundaries of what it means to be “human”?

Ji Haiqing: This question requires clarifying several concepts. In Chinese, the term "人" corresponds to two distinct terms in Western languages: human being and person. Human being refers to humanity in a biological sense, while person denotes an individual human. When discussing person, you and I are distinct individuals, but from the perspective of human beings, we belong to the same species without differentiation.

When it comes to BCIs and their impact on individual personality, there are many intriguing topics to explore. One of the key concepts we often discuss is personal identity. Generally, external changes, such as changing clothes, do not affect our personal identity—who we are. However, when we implant devices like deep brain stimulation (DBS) to regulate physiological states due to illness or other reasons, do we remain the same person? How society perceives the impact of these technologies on personality and identity becomes a critical question.

Interestingly, we have already seen some exceptional cases. For example, the Spanish artist Neil Harbisson was born colorblind. To compensate for this, he implanted a device that converts the color spectrum into sound waves, enabling him to "hear" colors. While he successfully gained this ability, it also introduced new challenges. A microphone-like antenna is now attached to his skull, and when crossing border checkpoints, officials noticed his passport photo did not include this device. He was eventually required to take a new photo, incorporating the device as part of his body.

This case illustrates how, as society gradually accepts individuals who merge with technology—sometimes referred to as "cyborgs"—the traditional biological boundaries of what constitutes a "human being" are shifting. This transformation not only expands the boundaries of humanity but also raises numerous ethical, political, anthropological, and philosophical questions.

Question: Do you think the “technologization of the body” will inevitably become a future trend for humanity?

Ji Haiqing: The answer to this question is both "yes" and "no." If we say "no," it’s because the question assumes this will become a new trend in the future. From my perspective, this is not a new trend but rather one that has existed throughout human history. Humanity has always sought to extend its capabilities and activities through the integration of technology. The only difference now is that we are facing a new technological product—BCIs.

From the perspective of the philosophy of technology, technology can be broadly defined as any man-made artifact, an extension of human capabilities. Based on this definition, the integration of humans and technology has always been an ongoing trend. Books such as *Sapiens: A Brief History of Humankind* and works in technological anthropology discuss similar themes.

For example, Polynesians in the South Pacific built canoes from island trees to travel between islands, while farmers in temperate northern regions felled large trees to construct ships for long-distance navigation. Despite differences in tools and techniques, both examples illustrate humanity’s use of natural resources in combination with technology to achieve their goals.

Therefore, I believe the fusion of humans and technology is a continuously evolving trend, not merely a phenomenon of the future.

Question: In the discussions surrounding brain-computer interfaces (BCIs) and philosophy, are there any significant studies that have been undervalued?

Ji Haiqing: This question touches on many aspects. As BCI devices become more widely applied, numerous issues will gradually emerge. The expansion of their usage will reveal problems over time rather than exposing them all at once.

I believe there are many important topics worthy of attention. If you’re interested, I recommend exploring the work of internationally renowned posthumanist scholars. These academics, while conducting serious research, possess imaginations that rival those of science fiction writers. For instance, American posthumanist scholar Katherine Hayles and others in the field of posthumanism often use imaginative depictions of humanity's future existence to explore the relationship between humans and technology. Such works can serve as a source of intellectual inspiration.

Question: What is the topic you are most focused on at the moment?

Ji Haiqing: In recent years, I have been particularly interested in the topic of human enhancement. Human enhancement refers to using technology not only to meet conventional needs, such as treating diseases, but also to further augment individual capabilities. This enhancement goes beyond external devices and integrates with our bodies to improve physiological functions.

Broadly speaking, ever since humanity invented airplanes, we can say that humans have learned to fly, though this differs significantly from how birds fly. Birds rely on their physiological structures to fly, while humans achieve flight through technological tools. The trend of human enhancement likely involves technological tools directly altering human physiological structures, granting us unprecedented abilities. This trend has become especially prominent with advancements in electronics, nanotechnology, and other fields in the 21st century.

I believe this trend of human enhancement prompts an essential question: How will it shape our self-perception and influence our future development?

Question: How can we address the potential social issues arising from human enhancement to ensure technology benefits all populations?

Ji Haiqing: From my perspective, this is not an especially grave issue. Human societies have always adapted to the introduction of new technologies, which often create disparities among groups to some extent.

Looking back at history, some early societies improved farming efficiency with iron tools or agricultural equipment, leading to better harvests, while others domesticated animals to aid in labor. Meanwhile, some regions lacked these conditions. Such inequality has been a historical norm. Over time, societies have employed various methods to mitigate the inequalities brought about by technological advancements.

In our field of research, this phenomenon is known as the issue of technological accessibility. There are, in fact, numerous ways to address the social problems caused by unequal access to technology. If such inequality disrupts social stability or exacerbates class divisions, governments can intervene through public financial measures. For example, governments could procure and provide certain technologies for free or offer subsidies to help those who cannot afford new technologies.

Thus, I don’t see this as an insurmountable problem. We already have well-established economic theories and policy tools to tackle these challenges and ensure that technology can more widely benefit all populations.
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Interview with Ji Haiqing: How Do We Define “Human” in the Context of Brain-Machine Interfaces?

[:en]Interview with Ji Haiqing: How Do We Define “Human” in the Context of Brain-Machine Interfaces?[:]

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Foreword
With the rapid advancement of technology, Brain-Computer Interfaces (BCIs), serving as a vital bridge between the human brain and external devices, have progressively emerged as a research hotspot in neuroscience and artificial intelligence. Researchers worldwide are actively exploring innovations in this cutting-edge field, striving to overcome technical bottlenecks and enable smarter, more efficient human-machine interactions.
In this exclusive interview, we are honored to have Professor Wang Shouyan, Director of the Center for Neural Modulation and Brain-Computer Interface Research at Fudan University. Professor Wang provides an in-depth analysis of the current state, development advantages, and future trends of BCI research in China. He also shares forward-looking insights and invaluable experiences from his work in the field.
The following is the interview with Professor Wang Shouyan. We have condensed the text to make it easier to read.
Question: What is the current state of Brain-Computer Interface (BCI) development in China?
Wang Shouyan: I am from the Institute of Brain-Inspired Intelligence Science and Technology at Fudan University and am responsible for establishing the Center for Neural Modulation and Brain-Computer Interface Research. First, I’d like to thank you for organizing this interview, which provides an opportunity to help the public better understand the true meaning, development status, and key contributors of BCI, rather than focusing solely on Musk’s promotional activities.
In fact, BCI research extends far beyond Musk’s endeavors. Recently, I proposed a four-stage developmental roadmap for BCIs*: (1) Brain Reading, (2) Brain Writing, (3) Brain-Computer Interaction, and (4) Brain-Intelligence Integration. This roadmap encompasses processes from basic signal decoding to advanced human-machine interaction. Currently, research is largely focused on decoding brain signals, a field in which both Musk and Tsinghua University in China are actively engaged.
*Professor Wang emphasizes that the scientific development of BCI will follow four phases: from Brain Reading (decoding motor, speech, memory, and consciousness) to the currently thriving field of Brain Writing (neural function modulation and reconstruction) and Brain-Computer Interaction (brain interfacing), eventually reaching Brain-Intelligence Integration (brain-inspired intelligence and digital life).
From the perspective of decoding brain signals, could using MRI scans also count as “Brain Reading”? International studies have already employed MRI and magnetoencephalography to analyze brain functions, which represents one direction of BCI research. Simultaneously, techniques such as electromagnetic stimulation are being explored to regulate brain activity.
The essence of BCI lies in achieving two-way information exchange between the human brain and external machines. We aim to enable this interaction through more intelligent means, such as using virtual reality to modulate brain activity. Therefore, I proposed BCI 3.0 (Brain-Computer Interaction), which emphasizes deep interaction and integration between the human brain and machines. The more advanced BCI 4.0 (Brain-Intelligence Integration) focuses on the coexistence and collaboration between human brains, intelligent agents, artificial intelligence, and future intelligent societies.
In these research directions, many Chinese neuroscientists, engineers, and physicians are actively exploring. For example, Huashan Hospital and Tiantan Hospital have achieved significant progress in this field.
In addition, we must strengthen science communication. The public needs to recognize the importance of BCI and the national commitment to its development. Relying solely on Musk’s research cannot represent the strategic development of a country. True strategic development involves core foundational technologies, which have profound implications for the health and well-being of society and its people.
Overall, BCI is advancing by integrating multiple factors, driving societal progress, forming the prototype of future industries, and becoming a vital part of national strategic planning.
Question: What are the advantages of China’s BCI development?
Wang Shouyan: First, we have a significant international advantage in terms of talent and disciplinary foundation. China’s BCI research began in the 1980s, and after decades of accumulated experience, we now possess a wealth of experience in BCI research, constituting a major strength.
Second, China has a solid foundation in medical and neurological disease research, which provides essential support for BCI development. We can leverage this foundation to make advances in the medical applications of BCI technologies.
Third, we have a long-standing foundation in technological development, particularly in scientific research and engineering technologies related to BCI, laying a solid groundwork for future progress.
However, we also face challenges, particularly in the integration of interdisciplinary research. We need to enhance collaboration among experts from various fields to jointly address major scientific, technological, and industrial challenges. Both the central government and the Shanghai government are actively planning and addressing these issues to further drive the development of BCIs.
Question: What breakthrough discoveries do you foresee in the field of Brain-Computer Interfaces (BCIs) over the next 5 to 10 years?
Wang Shouyan: The future breakthroughs in BCIs are likely to focus on several key areas. First, significant advancements have been made by researchers at ETH Zurich in spinal cord rehabilitation*, particularly in technologies that enable paraplegic patients to walk again. This represents a cutting-edge direction where artificial intelligence intersects with BCIs. Additionally, the integration of brain-reading and brain-writing technologies, especially innovations in deep brain stimulation for Parkinson’s disease and pain management, is currently a major focus of international research in both basic science and clinical medicine.
*In China, the team led by Jia Fumin at Fudan University&#8217;s Institute of Brain-Inspired Intelligence Science and Technology has developed a new generation of implantable brain-spinal interface devices for patients with spinal cord injuries. This innovation won the 2024 National Disruptive Technology Innovation Competition and is expected to undergo its first clinical trial by the end of the year, offering hope for spinal cord injury patients to stand and walk again.
These breakthroughs are not accidental; they are driven by profound underlying forces. By analyzing these driving forces, we can anticipate future trends. China’s early brain initiatives strategically invested in critical technologies such as neural modulation and BCIs, laying a strong foundation for future technological breakthroughs.
One clear trend from these initiatives is the move toward intelligent implantable deep brain stimulation technologies. The national strategic goal is to achieve a leading position in global competition, leveraging China&#8217;s strengths in medical industries and technology to achieve leapfrog development.
Another potential breakthrough lies in the decoding of neural activity. China has extensive resources in clinical research and data accumulation. With the launch of upcoming major national projects, progress in brain information decoding is expected to accelerate, paving the way for new advancements in BCI technology.
Question: If we gather enough brain data, is it possible to build a general brain model similar to ChatGPT?
Wang Shouyan: Large language models (LLMs) like ChatGPT have indeed provided us with significant inspiration. However, this question should be approached from two perspectives: the problem and the methodology. While LLMs offer a promising approach for understanding and decoding brain information, they are not the sole solution to the problem.
Although large data-driven models are disruptive and innovative, helping us better interpret and analyze brain data, relying solely on one approach in brain science research often leads to bottlenecks. Therefore, we advocate for a research paradigm that combines mechanisms and methodologies. For instance, optogenetics can help us better understand specific neural phenomena.
Currently, we are conducting research on integrating LLMs with large-scale EEG data modeling. The critical question is whether these models can genuinely help us address fundamental scientific questions. The future direction is likely to involve the convergence of data, mechanisms, and modeling. The ultimate value and significance of this technical approach depend on its ability to solve major scientific challenges.
Question: What research question are you most focused on?
Wang Shouyan: My primary focus is on how to effectively model under limited data conditions. In hospital-based research, we often cannot collect sufficient large-scale datasets, particularly when studying specific diseases. For example, in implantable device research, studies involving dozens of patients are already considered substantial, while those with over a hundred patients are extremely rare.
Does this mean that patients in such circumstances should not be studied? Or that they do not deserve treatment? These questions are not only scientific but also philosophical in nature. We must explore how to conduct effective research with limited data. Specifically, we are currently focused on leveraging large language models (LLMs) for precise modeling with small datasets. This approach aims to develop more personalized and intelligent strategies for neural modulation and brain-computer interaction.
Question: Are there valuable research cases in the application of small data?
Wang Shouyan: I can share some examples from our research on deep brain stimulation (DBS) for Parkinson’s disease. In China, over 100 hospitals are now offering this treatment, and tens of thousands of patients undergo this surgery every year. However, there are still hundreds of thousands of patients who need treatment, but only a small fraction have access to it. Our current focus is on how to use more precise neural modulation technologies to help a broader range of patients, especially those with significantly varied symptoms, benefit from treatment.
Additionally, we are collaborating with Huashan Hospital and Tiantan Hospital to study chronic pain patients. This includes those who have no effective pharmaceutical treatments or even patients in a vegetative state. Our goal is to use disruptive technologies to help these patients reconnect and communicate with their families. The core of these studies is leveraging small datasets to develop more precise and effective treatments.
Question: What challenges and difficulties do you see in the development of the Brain-Computer Interface (BCI) field?
Wang Shouyan: One of the biggest challenges in the broader scientific research landscape is interdisciplinary collaboration. Currently, China’s research evaluation system, with its emphasis on publishing papers and securing funding, often creates conflicts of interest. Consequently, institutional and systemic issues, particularly barriers to interdisciplinary collaboration, pose significant difficulties.
The root of these barriers lies in a value assessment system historically driven by metrics such as the number of publications and performance indicators. Researchers tend to focus on their specialized fields and are often reluctant to engage deeply with experts from other disciplines. Additionally, issues related to data sharing, especially disputes over authorship, frequently complicate collaborations. These evaluation criteria not only affect the publication of scientific results but also directly impact researchers&#8217; year-end bonuses and personal assessments.
We are currently advocating for institutional innovation in the BCI field to break down these barriers. Chinese researchers are highly intelligent and hardworking, but overcoming these remaining challenges requires addressing systemic issues and establishing efficient collaborative teams. Adequate funding support and the creation of interdisciplinary platforms are essential. Other technical challenges can be resolved gradually in accordance with the natural progression of scientific development. Interdisciplinary collaboration is not an insurmountable scientific problem; instead, institutional obstacles represent the real bottleneck.
Question: What advice would you give to young scientists?
Wang Shouyan: BCI is a highly interdisciplinary field, making a broad knowledge base and the establishment of collaborative networks especially important. For young scientists, I have a few straightforward suggestions. First, read extensively and learn continuously. The old saying “read ten thousand books and travel ten thousand miles” remains relevant. Young scholars should visit and learn from different laboratories to broaden their horizons. Second, make friends and actively participate in academic conferences. Don’t hesitate to ask questions and engage in discussions during these events.
For students and postdoctoral researchers in the BCI field, stepping out of their narrow research focus is particularly critical. Understanding the scientific questions that other researchers are exploring will help them gain a broader perspective and achieve greater heights, ultimately making their work more forward-looking and practically meaningful. I hope everyone can gain something valuable from this process. Thank you.
<div style/>

[:en]<div style="line-height: 1.5;">
Foreword

With the rapid advancement of technology, Brain-Computer Interfaces (BCIs), serving as a vital bridge between the human brain and external devices, have progressively emerged as a research hotspot in neuroscience and artificial intelligence. Researchers worldwide are actively exploring innovations in this cutting-edge field, striving to overcome technical bottlenecks and enable smarter, more efficient human-machine interactions.

In this exclusive interview, we are honored to have Professor Wang Shouyan, Director of the Center for Neural Modulation and Brain-Computer Interface Research at Fudan University. Professor Wang provides an in-depth analysis of the current state, development advantages, and future trends of BCI research in China. He also shares forward-looking insights and invaluable experiences from his work in the field.

The following is the interview with Professor Wang Shouyan. We have condensed the text to make it easier to read.

Question: What is the current state of Brain-Computer Interface (BCI) development in China?

Wang Shouyan: I am from the Institute of Brain-Inspired Intelligence Science and Technology at Fudan University and am responsible for establishing the Center for Neural Modulation and Brain-Computer Interface Research. First, I’d like to thank you for organizing this interview, which provides an opportunity to help the public better understand the true meaning, development status, and key contributors of BCI, rather than focusing solely on Musk’s promotional activities.

In fact, BCI research extends far beyond Musk’s endeavors. Recently, I proposed a four-stage developmental roadmap for BCIs*: (1) Brain Reading, (2) Brain Writing, (3) Brain-Computer Interaction, and (4) Brain-Intelligence Integration. This roadmap encompasses processes from basic signal decoding to advanced human-machine interaction. Currently, research is largely focused on decoding brain signals, a field in which both Musk and Tsinghua University in China are actively engaged.

*Professor Wang emphasizes that the scientific development of BCI will follow four phases: from Brain Reading (decoding motor, speech, memory, and consciousness) to the currently thriving field of Brain Writing (neural function modulation and reconstruction) and Brain-Computer Interaction (brain interfacing), eventually reaching Brain-Intelligence Integration (brain-inspired intelligence and digital life).

From the perspective of decoding brain signals, could using MRI scans also count as “Brain Reading”? International studies have already employed MRI and magnetoencephalography to analyze brain functions, which represents one direction of BCI research. Simultaneously, techniques such as electromagnetic stimulation are being explored to regulate brain activity.

The essence of BCI lies in achieving two-way information exchange between the human brain and external machines. We aim to enable this interaction through more intelligent means, such as using virtual reality to modulate brain activity. Therefore, I proposed BCI 3.0 (Brain-Computer Interaction), which emphasizes deep interaction and integration between the human brain and machines. The more advanced BCI 4.0 (Brain-Intelligence Integration) focuses on the coexistence and collaboration between human brains, intelligent agents, artificial intelligence, and future intelligent societies.

In these research directions, many Chinese neuroscientists, engineers, and physicians are actively exploring. For example, Huashan Hospital and Tiantan Hospital have achieved significant progress in this field.

In addition, we must strengthen science communication. The public needs to recognize the importance of BCI and the national commitment to its development. Relying solely on Musk’s research cannot represent the strategic development of a country. True strategic development involves core foundational technologies, which have profound implications for the health and well-being of society and its people.

Overall, BCI is advancing by integrating multiple factors, driving societal progress, forming the prototype of future industries, and becoming a vital part of national strategic planning.

Question: What are the advantages of China’s BCI development?

Wang Shouyan: First, we have a significant international advantage in terms of talent and disciplinary foundation. China’s BCI research began in the 1980s, and after decades of accumulated experience, we now possess a wealth of experience in BCI research, constituting a major strength.

Second, China has a solid foundation in medical and neurological disease research, which provides essential support for BCI development. We can leverage this foundation to make advances in the medical applications of BCI technologies.

Third, we have a long-standing foundation in technological development, particularly in scientific research and engineering technologies related to BCI, laying a solid groundwork for future progress.

However, we also face challenges, particularly in the integration of interdisciplinary research. We need to enhance collaboration among experts from various fields to jointly address major scientific, technological, and industrial challenges. Both the central government and the Shanghai government are actively planning and addressing these issues to further drive the development of BCIs.

Question: What breakthrough discoveries do you foresee in the field of Brain-Computer Interfaces (BCIs) over the next 5 to 10 years?

Wang Shouyan: The future breakthroughs in BCIs are likely to focus on several key areas. First, significant advancements have been made by researchers at ETH Zurich in spinal cord rehabilitation*, particularly in technologies that enable paraplegic patients to walk again. This represents a cutting-edge direction where artificial intelligence intersects with BCIs. Additionally, the integration of brain-reading and brain-writing technologies, especially innovations in deep brain stimulation for Parkinson’s disease and pain management, is currently a major focus of international research in both basic science and clinical medicine.

*In China, the team led by Jia Fumin at Fudan University's Institute of Brain-Inspired Intelligence Science and Technology has developed a new generation of implantable brain-spinal interface devices for patients with spinal cord injuries. This innovation won the 2024 National Disruptive Technology Innovation Competition and is expected to undergo its first clinical trial by the end of the year, offering hope for spinal cord injury patients to stand and walk again.

These breakthroughs are not accidental; they are driven by profound underlying forces. By analyzing these driving forces, we can anticipate future trends. China’s early brain initiatives strategically invested in critical technologies such as neural modulation and BCIs, laying a strong foundation for future technological breakthroughs.

One clear trend from these initiatives is the move toward intelligent implantable deep brain stimulation technologies. The national strategic goal is to achieve a leading position in global competition, leveraging China's strengths in medical industries and technology to achieve leapfrog development.

Another potential breakthrough lies in the decoding of neural activity. China has extensive resources in clinical research and data accumulation. With the launch of upcoming major national projects, progress in brain information decoding is expected to accelerate, paving the way for new advancements in BCI technology.

Question: If we gather enough brain data, is it possible to build a general brain model similar to ChatGPT?

Wang Shouyan: Large language models (LLMs) like ChatGPT have indeed provided us with significant inspiration. However, this question should be approached from two perspectives: the problem and the methodology. While LLMs offer a promising approach for understanding and decoding brain information, they are not the sole solution to the problem.

Although large data-driven models are disruptive and innovative, helping us better interpret and analyze brain data, relying solely on one approach in brain science research often leads to bottlenecks. Therefore, we advocate for a research paradigm that combines mechanisms and methodologies. For instance, optogenetics can help us better understand specific neural phenomena.

Currently, we are conducting research on integrating LLMs with large-scale EEG data modeling. The critical question is whether these models can genuinely help us address fundamental scientific questions. The future direction is likely to involve the convergence of data, mechanisms, and modeling. The ultimate value and significance of this technical approach depend on its ability to solve major scientific challenges.

Question: What research question are you most focused on?

Wang Shouyan: My primary focus is on how to effectively model under limited data conditions. In hospital-based research, we often cannot collect sufficient large-scale datasets, particularly when studying specific diseases. For example, in implantable device research, studies involving dozens of patients are already considered substantial, while those with over a hundred patients are extremely rare.

Does this mean that patients in such circumstances should not be studied? Or that they do not deserve treatment? These questions are not only scientific but also philosophical in nature. We must explore how to conduct effective research with limited data. Specifically, we are currently focused on leveraging large language models (LLMs) for precise modeling with small datasets. This approach aims to develop more personalized and intelligent strategies for neural modulation and brain-computer interaction.


Question: Are there valuable research cases in the application of small data?

Wang Shouyan: I can share some examples from our research on deep brain stimulation (DBS) for Parkinson’s disease. In China, over 100 hospitals are now offering this treatment, and tens of thousands of patients undergo this surgery every year. However, there are still hundreds of thousands of patients who need treatment, but only a small fraction have access to it. Our current focus is on how to use more precise neural modulation technologies to help a broader range of patients, especially those with significantly varied symptoms, benefit from treatment.

Additionally, we are collaborating with Huashan Hospital and Tiantan Hospital to study chronic pain patients. This includes those who have no effective pharmaceutical treatments or even patients in a vegetative state. Our goal is to use disruptive technologies to help these patients reconnect and communicate with their families. The core of these studies is leveraging small datasets to develop more precise and effective treatments.

Question: What challenges and difficulties do you see in the development of the Brain-Computer Interface (BCI) field?

Wang Shouyan: One of the biggest challenges in the broader scientific research landscape is interdisciplinary collaboration. Currently, China’s research evaluation system, with its emphasis on publishing papers and securing funding, often creates conflicts of interest. Consequently, institutional and systemic issues, particularly barriers to interdisciplinary collaboration, pose significant difficulties.

The root of these barriers lies in a value assessment system historically driven by metrics such as the number of publications and performance indicators. Researchers tend to focus on their specialized fields and are often reluctant to engage deeply with experts from other disciplines. Additionally, issues related to data sharing, especially disputes over authorship, frequently complicate collaborations. These evaluation criteria not only affect the publication of scientific results but also directly impact researchers' year-end bonuses and personal assessments.

We are currently advocating for institutional innovation in the BCI field to break down these barriers. Chinese researchers are highly intelligent and hardworking, but overcoming these remaining challenges requires addressing systemic issues and establishing efficient collaborative teams. Adequate funding support and the creation of interdisciplinary platforms are essential. Other technical challenges can be resolved gradually in accordance with the natural progression of scientific development. Interdisciplinary collaboration is not an insurmountable scientific problem; instead, institutional obstacles represent the real bottleneck.

Question: What advice would you give to young scientists?

Wang Shouyan: BCI is a highly interdisciplinary field, making a broad knowledge base and the establishment of collaborative networks especially important. For young scientists, I have a few straightforward suggestions. First, read extensively and learn continuously. The old saying “read ten thousand books and travel ten thousand miles” remains relevant. Young scholars should visit and learn from different laboratories to broaden their horizons. Second, make friends and actively participate in academic conferences. Don’t hesitate to ask questions and engage in discussions during these events.

For students and postdoctoral researchers in the BCI field, stepping out of their narrow research focus is particularly critical. Understanding the scientific questions that other researchers are exploring will help them gain a broader perspective and achieve greater heights, ultimately making their work more forward-looking and practically meaningful. I hope everyone can gain something valuable from this process. Thank you.
<div style/>[:]

Interview with Prof. Wang Shouyan: Do We Need Large Models or Small Models for Brain-Computer Interfaces?

[:en]Interview with Prof. Wang Shouyan: Do We Need Large Models or Small Models for Brain-Computer Interfaces?[:]

Observations

[:en]<div style="line-height: 1.5;">
On an ordinary evening, as you wrap up a day of work and sit down to start a game, the loading bar finishes, and a virtual world appears on the screen.

Immersed in the game, you suddenly notice an ant crawling slowly on your monitor. In that instant, an image from the novel The Three-Body Problem comes to mind. The ant feels like a subtle reminder of something profound, sending a chill down your spine. A startling thought strikes you like lightning—what if each of our lives, or even this vast world, is nothing more than a simulation crafted by an advanced civilization?

At first, the idea may seem absurd. But consider this: the foundation of our existence, much like many major discoveries in human history, has been overturned repeatedly. Five hundred years ago, geocentrism was an unshakable belief. Two hundred years ago, proposing that humans evolved from apes could have branded someone a heretic. Humanity's understanding of nature is a journey of realizing that we are not as exceptional as we once believed. This concept is embodied in the Copernican Principle, which asserts that no observer should regard themselves as uniquely special.

<img src="https://admin.next-question.com/wp-content/uploads/2025/01/simulation-1.png" alt="" width="433" height="399" class="aligncenter size-full wp-image-2697" />
▷ The diagram “M” (Latin for Mundus) from Johannes Kepler’s Epitome of Copernican Astronomy illustrates this point: Earth is just one of countless stars, a stark reminder that humans, whether on Earth or within the solar system, are not privileged observers of the universe.

1. Ancestor Simulation

If you are familiar with the history of video games, you might recall how gaming has evolved dramatically over just a few decades—from the simple, pixelated graphics of ping-pong games to the lifelike environments of modern massively multiplayer online games. Looking to the future, with the rapid advancement of virtual reality, the scenarios depicted in the sci-fi series Black Mirror—such as uploading and downloading consciousness—seem almost within reach.

In this context, the notion that "we are virtual beings living in a simulation" begins to feel less far-fetched. After all, on a cosmic timescale, a few decades are barely a blink of an eye. And as the Copernican Principle reminds us, it is statistically improbable that humanity represents the pinnacle of civilization in the universe.

So, how likely is it that we are living in a simulation? Once you begin to think seriously about this question, you'll realize you are not alone. Many physicists and philosophers have explored this possibility, sharing their thoughts through publications and public debates. In 2016, the American Museum of Natural History in New York hosted a panel where four physicists and a philosopher spent two hours discussing whether reality as we know it could be a simulation. Their estimates of the probability ranged widely, from as low as 1% to as high as 42%. That same year, Elon Musk famously declared in an interview that "we are most likely living in a simulation."

However, following the crowd has never been your style. Determined to explore this question independently, you start gathering evidence. Could we, in fact, be living in a simulation? And if so, is there a way to break free from it?

The type of "simulation" discussed here is not a simple game like The Sims. Instead, it is a comprehensive model of the observable universe—what scholars refer to as an Ancestor Simulation. [1] This hypothesis proposes that a civilization with sufficiently advanced technology might create a simulation on an immense scale. While we cannot predict the exact capabilities of such future technologies, we can attempt to estimate their upper limits based on the physical laws of our observable universe.

If running a simulation of this magnitude would require energy and computational power beyond the constraints of physics, we could argue that such a civilization could not exist. In that case, the Ancestor Simulation hypothesis would be disproven—or, at the very least, humanity’s existence within such a simulation would become highly improbable.

<img src="https://admin.next-question.com/wp-content/uploads/2025/01/simulation-cover-1024x768.jpg" alt="" width="1024" height="768" class="aligncenter size-large wp-image-2698" />
▷ Source: Claire Merchlinsky

2. The Energy Required for Simulation

High-fidelity simulations necessitate immense information processing, which, with current technological capabilities, translates into extraordinarily high computational demands. In such scenarios, the state of every fundamental particle would need to be recorded and updated in real time, requiring computational resources on an astronomical scale. Furthermore, the energy needed to power these highly complex simulations would entail staggering demands. According to thermodynamic principles, extracting energy from cosmic background radiation to sustain computations of this magnitude would not only require overcoming theoretical physical limitations but also addressing significant practical challenges in technology.

These arguments suggest that, within our current technological and theoretical framework, energy constraints make it improbable that we are living in a simulated universe. However, such constraints may not represent an insurmountable barrier. For instance, a super-advanced civilization might bypass energy limitations by creating less precise simulations. Quantum mechanics, with its uncertainty principle—which prevents precise knowledge of an electron’s exact position—and the non-local effects of quantum entanglement, could serve as efficient methods to conserve computational resources during simulation construction.

If we are indeed part of a simulation, and its creators used resource-saving measures, we might uncover evidence of this illusion. One potential approach is to continuously increase the resolution of our observations to detect whether we encounter discrete, pixelated structures. This is similar to video games, where increasing the resolution can expose hidden inconsistencies or graphical artifacts. Interestingly, quantum mechanics already reveals that the world appears discontinuous at extremely small scales, lending some plausibility to the simulation hypothesis.

Moreover, in video games, wandering to the edges of the map often leads to graphical glitches or invisible "walls" that limit further exploration. By analogy, searching for similar anomalies could help determine whether we exist within a simplified ancestor simulation. However, in reality, humanity's farthest-reaching probe, Voyager 1, has traversed the edge of the solar system without encountering any discontinuities or anomalies. Likewise, the Hubble Space Telescope has captured images of galaxies over 10 billion light-years away without uncovering any apparent anomalies. While these observations cannot definitively rule out the possibility that we are living in a simulation, they do significantly reduce its likelihood.

<img src="https://admin.next-question.com/wp-content/uploads/2025/01/simulation-3.png" alt="" width="838" height="599" class="aligncenter size-full wp-image-2696" />
▷ Source: Staudinger + Franke

3. A Simulated Universe Does Not Require Full Brain Simulation

Beyond the vastness of the starry sky, the human mind is equally complex. The number of neural connections in the human brain is estimated to rival the number of stars in the observable universe. A 2024 study published in Science [2] conducted a nanoscale simulation of just 1 cubic millimeter of brain tissue, encompassing 57,000 cells and 150 million synapses. The resulting mapping data totaled 1.4 petabytes (Pb). When extrapolated to the full volume of the human brain, creating a static map of the entire brain would require 1.76 zettabytes (1 Pb = 1,024 terabytes [Tb], 1 Zb = 1,024 Pb). This vastly exceeds the parameter count of current open-source models, such as Llama 3.1, which had 405 gigabytes (GB) of parameters as of October 2024.

To create an ancestor simulation, it would be necessary to simulate not only every star in the sky but also the mental activities of every human who has ever lived. Attempting to replicate all neural activity from ancient times to the present on a supercomputer would demand energy that exceeds the physical limits of our universe, challenging the notion that we are living in a simulation [3].

However, one might argue that simulating mental activities does not always require extensive computation. A super-advanced civilization might only simulate minimal portions of the brain for most people, reserving significant computational resources for individuals engaged in deep thought. This raises an intriguing testable hypothesis: if billions of people simultaneously engage in reflective thinking, requiring full brain simulations, the computational load might overwhelm the simulation, causing delays reminiscent of frame rate drops in video games. Such anomalies could provide evidence supporting the simulation hypothesis.

Additionally, there are two counterarguments to the assertion that simulating human minds consumes excessive energy:

(1) On-Demand Rendering: In constructing an ancestor simulation, a super-advanced civilization might only render areas being actively observed. This is analogous to the "fog of war" in video games, where unobserved areas remain hidden, significantly reducing computational demands.

(2) Selective Simulation: The creators might simulate only the neural activities of "you," ensuring your subjective experience feels authentic while generating others' responses through simplified models. Current large-scale AI models can already simulate human-like interactions; for a civilization capable of ancestor simulations, this task would be trivial, drastically reducing energy consumption.

<img src="https://admin.next-question.com/wp-content/uploads/2025/01/simulation-4-1024x576.png" alt="" width="1024" height="576" class="aligncenter size-large wp-image-2695" />
▷ Source: Mart Biemans

Beyond energy considerations, another way to evaluate the simulation hypothesis is to detect inevitable computational errors. If we live in a simulation, modeling inaccuracies would eventually accumulate, creating observable inconsistencies—similar to how The Matrix required regular reboots. In video games, prolonged gameplay often reveals modeling errors that necessitate developer patches to maintain consistency. By analogy, if we live in a simulation, changes in fundamental constants, such as the speed of light, could serve as evidence. However, the brevity of human history and our understanding of physics limits our ability to detect such long-term changes. It is possible that such patches exist but operate on timescales of tens of thousands or even millions of years. Therefore, even though we have not observed changes in physical constants, we cannot completely rule out the possibility that we are living in a simulation.

An additional counterargument is that a super-advanced civilization might prohibit ancestor simulations for ethical reasons. While less robust, this argument reduces the likelihood of such simulations existing. Similar to how the Drake Equation explores the probability of extraterrestrial civilizations' existence—calculated by multiplying the number of stars in the universe by the probability of life arising on them and the probability that intelligent life is willing to communicate—thereby estimating the number of extraterrestrial civilizations capable of establishing communication.

<img src="https://admin.next-question.com/wp-content/uploads/2025/01/simulation-5-1024x511.png" alt="" width="1024" height="511" class="aligncenter size-large wp-image-2694" />
▷ Source: University of Rochester
The Drake Equation, originally used to estimate the number of extraterrestrial civilizations, now includes:
N: The number of civilizations capable of creating simulations. R*: The rate of star formation in the Milky Way. fp: The fraction of stars with planetary systems. ne: The average number of habitable planets per system. fe: The fraction of habitable planets where life arises. fi: The fraction of life-bearing planets where intelligent life evolves. fc: The fraction of intelligent life willing to communicate or simulate. L: The time such civilizations remain active.

By adding two new factors to the Drake Equation—first, the probability that intelligent life advances to the point of being able to simulate a world; second, the probability that a super-advanced civilization would prohibit ancestor simulations for ethical reasons—we can use the modified equation, based on current technological and cultural development, to estimate the probabilities of these new factors. This allows us to assess the number of planets that might be willing to simulate worlds and, consequently, infer the probability that we are living in a simulation.

4. Three Possibilities for a Simulated World

In his 2003 paper Are You Living in a Computer Simulation?, philosopher Nick Bostrom redefined the debate by proposing three possibilities that cover all potential scenarios:

First, humanity or other intelligent beings go extinct before achieving simulation technology.
Second, super-advanced civilizations capable of creating ancestor simulations either lack the will or face prohibitions against using such technology.
Third, We are currently living in an ancestor simulation.

To evaluate which of the first two possibilities is more likely, two critical questions arise.The first question examines the probability of life successfully reaching the singularity. For example, before humanity develops general artificial intelligence, could it face extinction due to catastrophic events like runaway climate change or nuclear war? On this issue, the scientific community provides some predictions, though the outcomes remain uncertain.

The second question delves into the societal structures and moral frameworks of super-advanced civilizations—a nearly impossible task. Just as a gorilla cannot grasp the utility humans derive from advanced technology, we cannot envision the motivations or priorities of beings capable of ancestor simulations. Perhaps such civilizations lack the drive to undertake the creation of simulations that, once initiated, require no further involvement. Alternatively, ethical considerations or cultural values might prohibit such endeavors altogether. However, our complete lack of insight into their reasoning makes assessing this possibility extremely challenging.

At its core, if we ourselves do not believe we are living in a simulation, there is little reason to assume that future post-human civilizations would conduct large-scale ancestor simulations. Conversely, if we think humanity could one day simulate an entire world, why not accept the likelihood that we are already part of such a simulation?

One way to approach this paradox is through Occam’s Razor, which suggests that the simplest explanation is often more likely than a complex one. Believing we live in a simulation assumes the existence of a super-advanced civilization, thereby adding unnecessary complexity to the model. The maxim “entities should not be multiplied without necessity” thus provides a compelling framework for addressing the simulation hypothesis. However, Occam’s Razor is not absolute; in some cases, scientific consistency, predictive power, or internal logic may require adopting a more complex model.

<img src="https://admin.next-question.com/wp-content/uploads/2025/01/simulation-6-1024x510.png" alt="" width="1024" height="510" class="aligncenter size-large wp-image-2693" />
▷ Source: Claudio Araos Marincovic

5. Why Is Speculative Thinking Meaningful?

Readers who have reached this point might wonder: “Like Zhuangzi dreaming of a butterfly or the butterfly dreaming of Zhuangzi, why should we concern ourselves with such abstract questions when life is already fraught with its own challenges?” This line of inquiry may seem akin to the philosophical stance of agnosticism—ultimately irresolvable. However, our concerns and curiosities drive exploration and foster awe for the universe’s diversity and mysteries. Throughout the history of science, many revolutionary discoveries have emerged from profound questions about the essence of existence.

When we explore the possibility of a simulated universe, we are not only questioning the nature of reality but also sparking deeper discussions about technology, ethics, and existence itself. For example, this inquiry intersects with advancing technologies such as virtual reality (VR) and mixed reality (MR), raising questions about how we treat virtual beings powered by AI-driven models. As we approach the advent of general artificial intelligence (AGI), such discussions also highlight concerns about losing control over intelligent agents and whether these agents might attempt to escape the simulated environments we create for them. Speculating on whether we are living in a simulation inspires research into AI alignment while also deepening our understanding of existence.

In the future, as technology advances and humanity’s understanding of the universe grows, we may approach these questions with entirely new perspectives. More detailed observations, refined data analyses, and novel technological methods could help us test these hypotheses. Yet, in the pursuit of truth, maintaining curiosity and humility toward the unknown remains among the most enduring values in scientific inquiry.
<div/>[:]

How Can We Determine If the Universe Is Not a Simulation?

[:en]How Can We Determine If the Universe Is Not a Simulation?[:]

<div style="line-height: 1.5;">
Introduction: Using advanced neuroimaging technologies such as fMRI and EEG, scientists have identified subtle signs of consciousness in patients previously diagnosed with a &#8220;vegetative state&#8221; (VS). This breakthrough not only challenges the traditional understanding of the vegetative state but also highlights the concept of &#8220;covert consciousness&#8221; or &#8220;cognitive-motor dissociation.&#8221;
In Edward Yang’s film Yi Yi, an elderly woman falls into a coma following an accidental fall. Her caregiver advises the family to talk to her daily to aid recovery. But does speaking to a comatose individual truly make a difference? Can such patients actually hear, or even retain any degree of consciousness?
1. Conscious Responses in the “Vegetative State”
The question of whether comatose individuals retain consciousness has sparked debate since the 1990s.
Modern medicine traditionally defines the vegetative state as a condition characterized by a lack of conscious awareness and unresponsiveness. Yet, research indicates that 13–19% of patients diagnosed with VS or coma exhibit conscious responses to external stimuli.
<img loading="lazy" decoding="async" src="https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-1.png" alt="" width="970" height="274" class="aligncenter size-full wp-image-2688" srcset="https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-1.png 970w, https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-1-300x85.png 300w, https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-1-768x217.png 768w" sizes="auto, (max-width: 970px) 100vw, 970px" /> 
▷ Owen, Adrian M., et al. &#8220;Detecting awareness in the vegetative state.&#8221; science 313.5792 (2006): 1402-1402.
A groundbreaking 2006 study published in Science (Owen et al., 2006) reported a compelling case [1]: a 23-year-old female patient in a vegetative state following a traffic accident demonstrated neural activity indistinguishable from that of healthy individuals when exposed to linguistic stimuli. Strikingly, when presented with sentences containing ambiguity, her left ventrolateral prefrontal cortex displayed neural responses typical of language comprehension.
Even more remarkably, the patient exhibited evidence of &#8220;imaginative behavior.&#8221; When instructed to imagine specific actions such as playing tennis or walking (motor imagery), her neural activity was indistinguishable from that of healthy controls.
<img loading="lazy" decoding="async" src="https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-2-1024x763.png" alt="" width="1024" height="763" class="aligncenter size-large wp-image-2687" srcset="https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-2-1024x763.png 1024w, https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-2-300x223.png 300w, https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-2-768x572.png 768w, https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-2.png 1046w" sizes="auto, (max-width: 1024px) 100vw, 1024px" /> 
▷ The study monitored the activity of the supplementary motor area (SMA) in both the patient and a control group of 12 healthy volunteers during the process of imagining playing tennis. When imagining moving around her home, the researchers detected neural activity in the parahippocampal gyrus (PPA), posterior parietal cortex (PPC), and premotor cortex (PMC).
Despite meeting the clinical criteria for a vegetative state, her ability to comprehend and follow instructions suggested a preserved awareness of herself and her environment. This study underscored that neural activity in response to stimuli can serve as a marker of consciousness, while its absence does not necessarily confirm unconsciousness.
Previously, it was widely believed that comatose patients either progressed to brain death or transitioned into a vegetative state—both thought to lack consciousness entirely. However, Adrian Owen’s findings introduced the possibility of intermediary states, such as the &#8220;minimally conscious state&#8221; (MCS) or &#8220;covert consciousness.&#8221;
This raises a profound question: how can we accurately determine whether a person, especially one unable to communicate verbally or behaviorally, retains consciousness?
2. Determining the Presence of Consciousness
To assess the presence of consciousness in individuals with severe neurological conditions, it is crucial to first understand the classifications of death. Death is generally divided into two main categories: legal death (the cessation of legal personhood) and natural death, which itself encompasses three progressive stages: clinical death, brain death, and biological death [2].
<img loading="lazy" decoding="async" src="https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-3.png" alt="" width="709" height="415" class="aligncenter size-full wp-image-2686" srcset="https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-3.png 709w, https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-3-300x176.png 300w" sizes="auto, (max-width: 709px) 100vw, 709px" /> 
The vegetative state (VS) is a condition that resembles these stages but retains certain physiological functions. According to the Merck Manual of Diagnosis and Therapy [3]:
The vegetative state is a chronic condition in which patients can sustain blood pressure, respiration, and cardiac functions but lack higher cognitive abilities. While the hypothalamus and medullary brainstem functions remain intact to support cardiopulmonary and autonomic systems, the cortex suffers severe damage, eliminating cognitive function. Despite this, the reticular activating system (RAS) remains functional, allowing wakefulness. Midbrain or pontine reflexes may or may not be present. Typically, such patients lack self-awareness and interact with their environment only via reflexive responses.
However, findings from Owen’s team demonstrate that patients diagnosed as being in a vegetative state may indeed possess self-awareness and can even interact with their environment autonomously through neural activity. For example, patients have been shown to imagine actions, such as playing tennis, in response to instructions from clinicians. This neural activity, which can be detected using fMRI or EEG, indicates the presence of consciousness despite the absence of observable physical behavior. This phenomenon is referred to as &#8220;covert consciousness.&#8221;
3. Cognitive-Motor Dissociation: A New Understanding of Consciousness
Building on Adrian Owen&#8217;s groundbreaking research, subsequent studies have confirmed the phenomenon of &#8220;covert consciousness&#8221; in patients previously classified as being in a vegetative state. These findings, often based on motor imagery techniques, have identified a condition termed Cognitive-Motor Dissociation (CMD).
CMD describes a state in which patients demonstrate measurable neural responses to external stimuli, including motor imagery comparable to that of healthy individuals. However, due to motor system impairments, they are unable to execute corresponding physical actions.
<img loading="lazy" decoding="async" src="https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-4.png" alt="" width="856" height="310" class="aligncenter size-full wp-image-2685" srcset="https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-4.png 856w, https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-4-300x109.png 300w, https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-4-768x278.png 768w" sizes="auto, (max-width: 856px) 100vw, 856px" /> 
▷ Schiff, Nicholas D. &#8220;Cognitive motor dissociation following severe brain injuries.&#8221; JAMA neurology 72.12 (2015): 1413-1415.
In 2015, Nicholas D. Schiff’s team used advanced imaging techniques such as Dynamic Causal Modeling (DCM) and Diffusion Tensor Imaging (DTI) to assess the functional integrity of brain networks supporting motor imagery in these patients. Their research aimed to uncover the neural mechanisms underlying Cognitive-Motor Dissociation [4].
The study revealed that in healthy individuals, excitatory coupling between the thalamus and motor cortex is critical for executing motor behaviors. However, in patients with covert consciousness, analyses using DCM and DTI demonstrated a selective disruption of this coupling. This disruption explains the dissociation between preserved motor imagery and absent skeletal movement. It is akin to operating the mechanical arm of an excavator when the circuit between the control panel and the arm is severed—you can still issue commands, but the arm cannot carry out the movements.
*DCM: A neuroimaging technique that examines causal relationships and connectivity between brain regions, providing insights into their functional interactions. 
DTI: An MRI-based method for mapping the direction and integrity of white matter tracts, offering a detailed view of brain structural connectivity and its changes.
4. Research on the Prevalence of Cognitive-Motor Dissociation
Patients with Cognitive-Motor Dissociation (CMD) are often misdiagnosed as being in a vegetative state. However, there is currently no standardized method for accurately identifying CMD. The mechanism identified by Schiff&#8217;s team, discussed earlier, may not apply universally to all CMD cases. Moreover, previous studies on CMD have generally been small-scale, fragmented, and lacking consistency, with limited sample sizes. Under these conditions, developing a globally applicable standard for patient assessment is challenging, let alone designing targeted treatment approaches for CMD.
To address this issue, the paper titled &#8220;Cognitive Motor Dissociation in Disorders of Consciousness&#8221;, [5] supported by the Tianqiao Chen Institute-MGH Research Scholar Award, offers a potential solution. This study, published in The New England Journal of Medicine in August 2024, features Chen Scholar Brian L. Edlow as a key participant.
<img loading="lazy" decoding="async" src="https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-5.png" alt="" width="744" height="352" class="aligncenter size-full wp-image-2684" srcset="https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-5.png 744w, https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-5-300x142.png 300w" sizes="auto, (max-width: 744px) 100vw, 744px" /> 
▷ Bodien, Yelena G., et al. &#8220;Cognitive motor dissociation in disorders of consciousness.&#8221; New England Journal of Medicine 391.7 (2024): 598-608.
This study recruited patients from diverse settings, including intensive care units, rehabilitation centers, nursing homes, and community populations. A unified inclusion criterion was applied: participants had no prior history of neurological or psychiatric disorders and were physiologically capable of undergoing brain imaging techniques, including MRI and EEG.
The research analyzed 353 adult patients diagnosed with disorders of consciousness using motor imagery tasks assessed via fMRI and EEG. Among these, 241 patients were classified as being in a coma, a vegetative state, or a minimally conscious state (MCS) based on the internationally recognized Coma Recovery Scale-Revised (CRS-R). Notably, 25% (60 patients) of this group exhibited CMD, characterized by task-based neural responses despite the absence of behavioral responses. Additionally, 112 patients were diagnosed as being in an MCS+ state or as having recovered from MCS. Among this subgroup, 43 patients (38%) exhibited observable task-based responses to commands detected via fMRI, EEG, or both.
*Minimally conscious states are further categorized as MCS− and MCS+, based on language processing abilities: MCS+ patients demonstrate simple command-following, intelligible verbal expression, or conscious but non-functional communication. MCS− patients exhibit more limited behaviors, such as visual pursuit, localization to noxious stimuli, or basic spontaneous activities like grasping bedsheets.
This study reported a higher prevalence of CMD (25%) than previous research, which estimated that 10–20% of patients with disorders of consciousness exhibit CMD symptoms. While traditional behavioral metrics like CRS-R offer valuable insights into assessing patient consciousness and responsiveness, task-based neuroimaging technologies significantly enhance diagnostic accuracy. Notably, the combined use of EEG and fMRI further improves measurement precision. These findings suggest that the prevalence of CMD may have been underestimated in prior studies.
5. The Significance of Measuring Consciousness in the Vegetative State
Imagine being aware of everything around you—the hum of medical equipment by your bedside, the whispers of family and friends—yet being unable to speak, move, or respond in any way. This state of isolation and helplessness could lead one to abandon even the faintest will to live. Although the phenomenon of &#8220;living dead&#8221; occurs in only a minority of vegetative state patients, every individual, no matter how rare their condition, represents a unique and precious life.
Whether driven by technological advancement or humanistic ethics, we need a measurement method that is more accessible, precise, and cost-effective to determine the consciousness state of comatose patients. The research conducted by Y.G. Bodien and colleagues stands out by integrating patient data from multiple locations and unifying measurement methodologies through brain imaging techniques. This unprecedented approach has maximized the accuracy of identifying Cognitive-Motor Dissociation (CMD) patients and pointed the way forward for future medical technologies and treatments. Most importantly, it offers a renewed sense of hope to those trapped in a silent world.
<div/>

[:en]<div style="line-height: 1.5;">
Introduction: Using advanced neuroimaging technologies such as fMRI and EEG, scientists have identified subtle signs of consciousness in patients previously diagnosed with a "vegetative state" (VS). This breakthrough not only challenges the traditional understanding of the vegetative state but also highlights the concept of "covert consciousness" or "cognitive-motor dissociation."

In Edward Yang’s film Yi Yi, an elderly woman falls into a coma following an accidental fall. Her caregiver advises the family to talk to her daily to aid recovery. But does speaking to a comatose individual truly make a difference? Can such patients actually hear, or even retain any degree of consciousness?

1. Conscious Responses in the “Vegetative State”

The question of whether comatose individuals retain consciousness has sparked debate since the 1990s.

Modern medicine traditionally defines the vegetative state as a condition characterized by a lack of conscious awareness and unresponsiveness. Yet, research indicates that 13–19% of patients diagnosed with VS or coma exhibit conscious responses to external stimuli.

<img src="https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-1.png" alt="" width="970" height="274" class="aligncenter size-full wp-image-2688" />
▷ Owen, Adrian M., et al. "Detecting awareness in the vegetative state." science 313.5792 (2006): 1402-1402.

A groundbreaking 2006 study published in Science (Owen et al., 2006) reported a compelling case [1]: a 23-year-old female patient in a vegetative state following a traffic accident demonstrated neural activity indistinguishable from that of healthy individuals when exposed to linguistic stimuli. Strikingly, when presented with sentences containing ambiguity, her left ventrolateral prefrontal cortex displayed neural responses typical of language comprehension.

Even more remarkably, the patient exhibited evidence of "imaginative behavior." When instructed to imagine specific actions such as playing tennis or walking (motor imagery), her neural activity was indistinguishable from that of healthy controls.

<img src="https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-2-1024x763.png" alt="" width="1024" height="763" class="aligncenter size-large wp-image-2687" />
▷ The study monitored the activity of the supplementary motor area (SMA) in both the patient and a control group of 12 healthy volunteers during the process of imagining playing tennis. When imagining moving around her home, the researchers detected neural activity in the parahippocampal gyrus (PPA), posterior parietal cortex (PPC), and premotor cortex (PMC).

Despite meeting the clinical criteria for a vegetative state, her ability to comprehend and follow instructions suggested a preserved awareness of herself and her environment. This study underscored that neural activity in response to stimuli can serve as a marker of consciousness, while its absence does not necessarily confirm unconsciousness.

Previously, it was widely believed that comatose patients either progressed to brain death or transitioned into a vegetative state—both thought to lack consciousness entirely. However, Adrian Owen’s findings introduced the possibility of intermediary states, such as the "minimally conscious state" (MCS) or "covert consciousness."

This raises a profound question: how can we accurately determine whether a person, especially one unable to communicate verbally or behaviorally, retains consciousness?

2. Determining the Presence of Consciousness

To assess the presence of consciousness in individuals with severe neurological conditions, it is crucial to first understand the classifications of death. Death is generally divided into two main categories: legal death (the cessation of legal personhood) and natural death, which itself encompasses three progressive stages: clinical death, brain death, and biological death [2].

<img src="https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-3.png" alt="" width="709" height="415" class="aligncenter size-full wp-image-2686" />
The vegetative state (VS) is a condition that resembles these stages but retains certain physiological functions. According to the Merck Manual of Diagnosis and Therapy [3]:

The vegetative state is a chronic condition in which patients can sustain blood pressure, respiration, and cardiac functions but lack higher cognitive abilities. While the hypothalamus and medullary brainstem functions remain intact to support cardiopulmonary and autonomic systems, the cortex suffers severe damage, eliminating cognitive function. Despite this, the reticular activating system (RAS) remains functional, allowing wakefulness. Midbrain or pontine reflexes may or may not be present. Typically, such patients lack self-awareness and interact with their environment only via reflexive responses.

However, findings from Owen’s team demonstrate that patients diagnosed as being in a vegetative state may indeed possess self-awareness and can even interact with their environment autonomously through neural activity. For example, patients have been shown to imagine actions, such as playing tennis, in response to instructions from clinicians. This neural activity, which can be detected using fMRI or EEG, indicates the presence of consciousness despite the absence of observable physical behavior. This phenomenon is referred to as "covert consciousness."

3. Cognitive-Motor Dissociation: A New Understanding of Consciousness

Building on Adrian Owen's groundbreaking research, subsequent studies have confirmed the phenomenon of "covert consciousness" in patients previously classified as being in a vegetative state. These findings, often based on motor imagery techniques, have identified a condition termed Cognitive-Motor Dissociation (CMD).

CMD describes a state in which patients demonstrate measurable neural responses to external stimuli, including motor imagery comparable to that of healthy individuals. However, due to motor system impairments, they are unable to execute corresponding physical actions.

<img src="https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-4.png" alt="" width="856" height="310" class="aligncenter size-full wp-image-2685" />
▷ Schiff, Nicholas D. "Cognitive motor dissociation following severe brain injuries." JAMA neurology 72.12 (2015): 1413-1415.

In 2015, Nicholas D. Schiff’s team used advanced imaging techniques such as Dynamic Causal Modeling (DCM) and Diffusion Tensor Imaging (DTI) to assess the functional integrity of brain networks supporting motor imagery in these patients. Their research aimed to uncover the neural mechanisms underlying Cognitive-Motor Dissociation [4].

The study revealed that in healthy individuals, excitatory coupling between the thalamus and motor cortex is critical for executing motor behaviors. However, in patients with covert consciousness, analyses using DCM and DTI demonstrated a selective disruption of this coupling. This disruption explains the dissociation between preserved motor imagery and absent skeletal movement. It is akin to operating the mechanical arm of an excavator when the circuit between the control panel and the arm is severed—you can still issue commands, but the arm cannot carry out the movements.

*DCM: A neuroimaging technique that examines causal relationships and connectivity between brain regions, providing insights into their functional interactions.
DTI: An MRI-based method for mapping the direction and integrity of white matter tracts, offering a detailed view of brain structural connectivity and its changes.

4. Research on the Prevalence of Cognitive-Motor Dissociation

Patients with Cognitive-Motor Dissociation (CMD) are often misdiagnosed as being in a vegetative state. However, there is currently no standardized method for accurately identifying CMD. The mechanism identified by Schiff's team, discussed earlier, may not apply universally to all CMD cases. Moreover, previous studies on CMD have generally been small-scale, fragmented, and lacking consistency, with limited sample sizes. Under these conditions, developing a globally applicable standard for patient assessment is challenging, let alone designing targeted treatment approaches for CMD.

To address this issue, the paper titled "Cognitive Motor Dissociation in Disorders of Consciousness", [5] supported by the Tianqiao Chen Institute-MGH Research Scholar Award, offers a potential solution. This study, published in The New England Journal of Medicine in August 2024, features Chen Scholar Brian L. Edlow as a key participant.

<img src="https://admin.next-question.com/wp-content/uploads/2025/01/vegetativee-5.png" alt="" width="744" height="352" class="aligncenter size-full wp-image-2684" />
▷ Bodien, Yelena G., et al. "Cognitive motor dissociation in disorders of consciousness." New England Journal of Medicine 391.7 (2024): 598-608.

This study recruited patients from diverse settings, including intensive care units, rehabilitation centers, nursing homes, and community populations. A unified inclusion criterion was applied: participants had no prior history of neurological or psychiatric disorders and were physiologically capable of undergoing brain imaging techniques, including MRI and EEG.

The research analyzed 353 adult patients diagnosed with disorders of consciousness using motor imagery tasks assessed via fMRI and EEG. Among these, 241 patients were classified as being in a coma, a vegetative state, or a minimally conscious state (MCS) based on the internationally recognized Coma Recovery Scale-Revised (CRS-R). Notably, 25% (60 patients) of this group exhibited CMD, characterized by task-based neural responses despite the absence of behavioral responses. Additionally, 112 patients were diagnosed as being in an MCS+ state or as having recovered from MCS. Among this subgroup, 43 patients (38%) exhibited observable task-based responses to commands detected via fMRI, EEG, or both.

*Minimally conscious states are further categorized as MCS− and MCS+, based on language processing abilities: MCS+ patients demonstrate simple command-following, intelligible verbal expression, or conscious but non-functional communication. MCS− patients exhibit more limited behaviors, such as visual pursuit, localization to noxious stimuli, or basic spontaneous activities like grasping bedsheets.

This study reported a higher prevalence of CMD (25%) than previous research, which estimated that 10–20% of patients with disorders of consciousness exhibit CMD symptoms. While traditional behavioral metrics like CRS-R offer valuable insights into assessing patient consciousness and responsiveness, task-based neuroimaging technologies significantly enhance diagnostic accuracy. Notably, the combined use of EEG and fMRI further improves measurement precision. These findings suggest that the prevalence of CMD may have been underestimated in prior studies.

5. The Significance of Measuring Consciousness in the Vegetative State

Imagine being aware of everything around you—the hum of medical equipment by your bedside, the whispers of family and friends—yet being unable to speak, move, or respond in any way. This state of isolation and helplessness could lead one to abandon even the faintest will to live. Although the phenomenon of "living dead" occurs in only a minority of vegetative state patients, every individual, no matter how rare their condition, represents a unique and precious life.

Whether driven by technological advancement or humanistic ethics, we need a measurement method that is more accessible, precise, and cost-effective to determine the consciousness state of comatose patients. The research conducted by Y.G. Bodien and colleagues stands out by integrating patient data from multiple locations and unifying measurement methodologies through brain imaging techniques. This unprecedented approach has maximized the accuracy of identifying Cognitive-Motor Dissociation (CMD) patients and pointed the way forward for future medical technologies and treatments. Most importantly, it offers a renewed sense of hope to those trapped in a silent world.
<div/>
[:]

Hearing the Silent Soul: Consciousness in Vegetative State Patients

[:en]Hearing the Silent Soul: Consciousness in Vegetative State Patients[:]

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<a href="https://www.nature.com/articles/s41593-023-01468-4">Read the paper on Nature Neuroscience</a>

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