The ethical implications of Elon Musk’s unorthodox approach to medical science

Medical milestones broadcast via tweet. Scientific progress revealed via live YouTube demo. Teasers for updates followed by a livestream from a patient’s home. These aren’t the latest social media influencer tactics, but the way Neuralink, Elon Musk’s neurotechnology company, has disseminated information about its medical research.

Neuralink’s unconventional approaches to research have challenged many norms of medical science. Instead of attending scientific conferences and sharing interim progress, Neuralink has communicated information via social media, oscillating between extreme secrecy and openness. This strategy has left the scientific community playing catch-up, scrambling to glean insights from tweets and YouTube videos.

Rather than transparently sharing information about its ongoing clinical trial, Neuralink has kept details about it tightly guarded. The company’s unusual decision to publish its sole peer-reviewed article in a journal unrelated to neural engineering — and list the authors as Elon Musk and Neuralink — deviates from the norms of scientific publishing. And rather than projecting a sober commitment to patient benefit, Musk has stated that his ultimate goal with Neuralink is to advance humanity’s capability to achieve symbiosis with artificial intelligence.

Neuralink’s unorthodox approach has unsettled many in the scientific community, who are deeply rooted in an ethos that values the collective pursuit of knowledge, openness, and collaborative progress. These norms are so deeply ingrained that deviation prompts instinctive backlash. You aren’t a real scientist or doing real science if you aren’t abiding by traditional standards of data sharing, interacting with peers at academic conferences where scientific knowledge is exchanged, or appropriately contextualizing your progress in the context of prior scientific achievements.

But as Neuralink showed in March (via livestream on X, of course), it did accomplish real science. A team from the company successfully implanted a device into the brain of Noland Arbaugh, a quadriplegic who was paralyzed in a diving accident, that let him control a computer cursor using just his thoughts. While achieving such control was not by itself groundbreaking, its significance lay in the context: prior individuals achieved similar control in laboratory settings, though typically with bulky equipment visibly protruding from their skulls. In stark contrast, Arbaugh was in a home environment, as evidenced by the presence of his two dogs, with no external hardware in sight.

The nine-minute livestream of Arbaugh was nothing short of a triumph for Musk and Neuralink. They engineered a working brain-computer interface and safely implanted it in a human. In the video and in a subsequent interview, Arbaugh shared that the implant has already changed his life: he can now interact at length with a computer without the need for assistance.

Even more remarkable is that Musk and the Neuralink team achieved this feat by eschewing nearly every norm of medical science. In doing so, they challenged the notion that adherence to these norms is the only path to legitimate discoveries. They demonstrated that valid science is possible in a way that is foreign, unrecognizable, and entirely uncomfortable to most scientists.

There are benefits to showcasing alternative approaches to medical science. Namely, it forces the scientific community to step back and question if the way science is done now — often mired in bureaucratic inefficiencies, slow funding mechanisms, and carefully orchestrated publicity efforts — is the way it must always be done. Neuralink’s accomplishment presents an occasion to reflect on why the bureaucratic structures of science and its norms developed in the first place. Indeed, the established playbook of medical science — a constellation of cultural norms, ethical standards, and legal rules — did not arise in a vacuum. Rather, it emerged in response to historical abuses in medical research.

This history underscores the importance of disentangling cultural norms — sets of shared expectations about behavior — from ethical standards in medical science, which protect those who participate in scientific research. While Neuralink’s deviation from convention might be unsettling for the scientific community, deviating from a norm is not inherently unethical. The critical task, then, is to differentiate between practices that merely challenge norms from those that may pose genuine risks.

First, a cornerstone of ethical medical research is ensuring that participants are adequately informed about a study. Musk’s hyped promises about what Neuralink might accomplish and the guaranteed instant-celebrity status of the first Neuralink patients threaten to compromise the standard of informed consent, as prospective participants may overrate the benefits of participation. This is further complicated by the company’s selective approach to sharing information: While Neuralink publicized its recent success, will it give equal attention to its failures? A rocket exploding minutes after launch is hard to hide; technical problems in implanted brain-computer interfaces may be more easily obscured. Selective representation of results could influence future individuals’ decisions about participating in Neuralink’s research, raising concerns about informed consent and the ethical recruitment of research participants.

Second, the principles of ethical medical research mandate fair selection of research participants. One has to wonder whether Arbaugh — a charismatic and attractive 29-year-old described by a recent Bloomberg article as a “Musk fan” — was selected for Neuralink’s trial purely based on the stated inclusion criteria (at least 22 years old, diagnosed with quadriplegia or ALS, and having a reliable caregiver) or whether publicity considerations came into play, given that Neuralink was almost certain to shine an international spotlight on its first patient.

Third, participation in medical research must be voluntary, and participants should be able to withdraw from research at any time without facing negative consequences. But if Arbaugh wishes to withdraw or worse — if the technology fails or his relationship with Neuralink sours — he may risk backlash from one of the world’s most powerful individuals.

Fourth, those carrying out medical research have a duty to not harm their patients. Yet recent articles have drawn attention to companies that have prematurely halted experimental neural implant trials or have gone bankrupt, leaving participants with obsolete and unsupported technology permanently in their brains. While those applying for government funding from the National Institutes of Health for neural device research must submit a long-term support plan for participants (although there is no system in place to ensure these plans are followed), those operating entirely on private funds have no analogous requirements, raising questions about their long-term commitment to patients.

In Arbaugh’s case, if the Neuralink implant fails to gain regulatory approval, what happens next? Will he continue to have access to and support for this life-altering technology 10, 20, or even 40 years down the line?

What Neuralink has already given Arbaugh — increased independence after a devastating spinal cord injury — is extraordinary. Both Musk and the Neuralink team deserve to be recognized for this scientific achievement. But as the company moves forward and continues challenging longstanding scientific norms, it must remain cognizant of bedrock ethical standards. It is the involvement of human participants in Neuralink’s research that amplifies the ethical stakes and requires heightened moral responsibility from those doing this pioneering research.

Anna Wexler is a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania and an assistant professor in the Department of Medical Ethics and Health Policy at Penn’s Perelman School of Medicine.