That’s why I was so excited to read about Smileyscope, a VR device for kids that recently received FDA clearance. It helps lessen the pain of a blood draw or IV insertion by sending the user on an underwater adventure that begins with a welcome from an animated character called Poggles the Penguin. Inside this watery deep-sea reality, the cool swipe of an alcohol wipe becomes cool waves washing over the arm. The pinch of the needle becomes a gentle fish nibble.
Studies suggest the device works. In two clinical trials that included more than 200 children aged 4 to 11, the Smileyscope reduced self-reported pain levels by up to 60% and anxiety levelsby up to 40%.
But how Smileyscope works is not entirely clear. It’s more complex than just distraction. Back in the 1960s, Ronald Melzack and Patrick Wall posited that pain signals travel through a series of “gates” in the spinal cord that allow some to reach the brain and keep others out. When the brain is occupied by other stimuli, the gates close and fewer pain signals can get through. “And that’s the mechanism of action for virtual reality,” says Paul Leong, chief medical officer and co-founder of Smileyscope.
Not all stimuli are equally effective. “[In] traditional virtual reality you put on the headset and you go somewhere like a beach,” Leong says. But that kind of immersive experience has nothing to do with what’s happening in the real world. Smileyscope aims to reframe the stimuli in a positive light. Mood and anxiety can also affect how we process pain. Poggles the Penguin takes kids on a thorough walk-through of a procedure before it begins, which might reduce anxiety. And experiencing an underwater adventure with “surprise visitors” is undoubtedly more of a mood-booster than staring at clinic walls, waiting for a needle prick.
“There are a lot of ways to distract people,” says Beth Darnall, a psychologist and director of the Stanford Pain Relief Innovations Lab. But the way Smileyscope goes about it, she says, is “really powerful.”
Researchers have been working on similar technologies for years. Hunter Hoffman and David Patterson at the University of Washington developed a VR game called SnowWorld over two decades ago to help people with severe burns tolerate wound dressing changes and other painful procedures. “We created a world that was the antithesis of fire,” Hoffman told NPR in 2012, “a cool place, snowmen, pleasant images, just about everything to keep them from thinking about fire.” Other groups are exploring VR for postoperative pain, childbirth, pain associated with dental procedures, and more.
Companies are also working on virtual reality devices that will address a much tougher problem: chronic pain. In 2021 RelieVRx became the first VR therapy authorized by the FDA for pain. (The FDA keeps a list of all authorized VR/AR devices.) The tool aims to teach people how to manage chronic pain, which is entirely different from the temporary sting of a needle stick. “It’s vastly more complex on every level,” says Darnall, who helped develop RelieVRx and now serves as chief science advisor for AppliedVR, which markets the device.
Chronic pain is long term, and often life altering. “You have now literal changes in your nervous system as a consequence of experiencing pain long term,” Darnall says. “You have stored tension, you have maybe persistent anxiety, your activity levels have changed, you have sleep problems.” The alarm bell rings long after the danger has passed, for months, years, or even decades.
These robots know when to ask for help
A new training model, dubbed “KnowNo,” aims to address this problem by teaching robots to ask for our help when orders are unclear. At the same time, it ensures they seek clarification only when necessary, minimizing needless back-and-forth. The result is a smart assistant that tries to make sure it understands what you want without bothering you too much.
Andy Zeng, a research scientist at Google DeepMind who helped develop the new technique, says that while robots can be powerful in many specific scenarios, they are often bad at generalized tasks that require common sense.
For example, when asked to bring you a Coke, the robot needs to first understand that it needs to go into the kitchen, look for the refrigerator, and open the fridge door. Conventionally, these smaller substeps had to be manually programmed, because otherwise the robot would not know that people usually keep their drinks in the kitchen.
That’s something large language models (LLMs) could help to fix, because they have a lot of common-sense knowledge baked in, says Zeng.
Now when the robot is asked to bring a Coke, an LLM, which has a generalized understanding of the world, can generate a step-by-step guide for the robot to follow.
The problem with LLMs, though, is that there’s no way to guarantee that their instructions are possible for the robot to execute. Maybe the person doesn’t have a refrigerator in the kitchen, or the fridge door handle is broken. In these situations, robots need to ask humans for help.
KnowNo makes that possible by combining large language models with statistical tools that quantify confidence levels.
When given an ambiguous instruction like “Put the bowl in the microwave,” KnowNo first generates multiple possible next actions using the language model. Then it creates a confidence score predicting the likelihood that each potential choice is the best one.
The Download: inside the first CRISPR treatment, and smarter robots
The news: A new robot training model, dubbed “KnowNo,” aims to teach robots to ask for our help when orders are unclear. At the same time, it ensures they seek clarification only when necessary, minimizing needless back-and-forth. The result is a smart assistant that tries to make sure it understands what you want without bothering you too much.
Why it matters: While robots can be powerful in many specific scenarios, they are often bad at generalized tasks that require common sense. That’s something large language models could help to fix, because they have a lot of common-sense knowledge baked in. Read the full story.
Medical microrobots that travel inside the body are (still) on their way
The human body is a labyrinth of vessels and tubing, full of barriers that are difficult to break through. That poses a serious hurdle for doctors. Illness is often caused by problems that are hard to visualize and difficult to access. But imagine if we could deploy armies of tiny robots into the body to do the job for us. They could break up hard-to-reach clots, deliver drugs to even the most inaccessible tumors, and even help guide embryos toward implantation.
We’ve been hearing about the use of tiny robots in medicine for years, maybe even decades. And they’re still not here. But experts are adamant that medical microbots are finally coming, and that they could be a game changer for a number of serious diseases. Read the full story.
5 things we didn’t put on our 2024 list of 10 Breakthrough Technologies
We haven’t always been right (RIP, Baxter), but we’ve often been early to spot important areas of progress (we put natural-language processing on our very first list in 2001; today this technology underpins large language models and generative AI tools like ChatGPT).
Every year, our reporters and editors nominate technologies that they think deserve a spot, and we spend weeks debating which ones should make the cut. Here are some of the technologies we didn’t pick this time—and why we’ve left them off, for now.
New drugs for Alzheimer’s disease
Alzmeiher’s patients have long lacked treatment options. Several new drugs have now been proved to slow cognitive decline, albeit modestly, by clearing out harmful plaques in the brain. In July, the FDA approved Leqembi by Eisai and Biogen, and Eli Lilly’s donanemab could soon be next. But the drugs come with serious side effects, including brain swelling and bleeding, which can be fatal in some cases. Plus, they’re hard to administer—patients receive doses via an IV and must receive regular MRIs to check for brain swelling. These drawbacks gave us pause.
Sustainable aviation fuel
Alternative jet fuels made from cooking oil, leftover animal fats, or agricultural waste could reduce emissions from flying. They have been in development for years, and scientists are making steady progress, with several recent demonstration flights. But production and use will need to ramp up significantly for these fuels to make a meaningful climate impact. While they do look promising, there wasn’t a key moment or “breakthrough” that merited a spot for sustainable aviation fuels on this year’s list.
One way to counteract global warming could be to release particles into the stratosphere that reflect the sun’s energy and cool the planet. That idea is highly controversial within the scientific community, but a few researchers and companies have begun exploring whether it’s possible by launching a series of small-scale high-flying tests. One such launch prompted Mexico to ban solar geoengineering experiments earlier this year. It’s not really clear where geoengineering will go from here or whether these early efforts will stall out. Amid that uncertainty, we decided to hold off for now.