Forecasting the future is a tricky task. It’s not brain surgery—just more difficult. Baroness Susan Greenfield, brain physiologist, writer, and broadcaster shared her four challenges for the future in the context of science and humanity at the RCGP-SAPC Annual Primary Care conference.

1) Nanotechnology. Describing how nanotechnology might change the world would be like trying to explain to someone in the middle ages how plastics would change our lives. She suggested   innovations in drug delivery systems, or smart sensors on our toothbrushes or in the loo that could screen for conditions or make a diagnosis. And, if you think it is all in the imagination, just remember that it is now possible to capture the electronic signal of thoughts prior to a movement and repeat it so a quadriplegic person can move a prosthetic limb. But, this also brings the frightening possibility of transhumanism—the  technological enhancement  human features.

2) Normal ageing. Not as we know it. Altered understanding of health, appearance, reproduction,  and work will lead to a merging of generations. With stem cell technology, in particular, there may be huge potential in health, but such technology could be also be used to modify or enhance our appearance. Cosmetic applications may include, for example, stem cell use in male pattern baldness. Harvesting genetic material may mean that anyone could have child. Work will continue as economic factors push retirement further into the future. Ultimately we could look the same, feel the same, have children and work—until we die.

3) Dementia. No answers. There is little on the horizon for dementia with no new drugs in last 10 years. Drugs, surgery, diet, and brain exercises show little promise. Her own research takes an anticipatory approach—looking for a marker for early stage disease by identifying what cells are vulnerable to neuro degeneration. Her work indicates that neuro degeneration is an aberrant form of development releasing chemicals in an attempt to compensate. Her dream is to find a biomarker of dementia so, ultimately, a blood test might identify the very early stages and medication arrest further neuronal death.

4) Digital technologies damage the brain. Just what you tell your children. What makes us unique among the species is that we can learn. But, with learning we do not increase the number of neurons but their connections. She described a remarkable study where three groups were set a task of learning to play the piano. Those who practised showed brain changes, while those who sat doing nothing, didn’t. But, a third group who did mental practice without touching the piano showed similar changes to those who played. For the brain, it is not the muscle contraction but the thoughts that control the activity that is important. But, what is really important is that the brain adds meaning to objects and events—the learning process increases neuron connections. A chain of events give a personal significance—a cognitive experience. The neuron has more branches—more connections. These connections enrich your life.

But, if we  live in a two dimensional world—the electronic world—we lose those meanings. In a cyber world we lose the clues to communication and lose abstract concepts.  The prefrontal cortex changes are similar to those with obesity, gambling, and with some shared features of schitzophrenia. Video games, cyber world, electronic media, and impaired communication.  The future may include mind change as much as climate change; in both cases, global and unprecedented.

Domhnall MacAuley is primary care editor, BMJ