Update on the Technology and Future of

Medicine Course: Space, Regenerative Medicine,

Large Touch Screens, and Leonard Cohen

Kim Solez, MD

No Conflict of Interest

1. I do not have any conflict of interest and do not discuss any off-label use of drugs or devices.

Objectives For This Lecture1. To show how the LABMP 590 course - Technology

and the Future of Medicine - is morphing and changing to remain relevant, including the new areas of space, regenerative medicine, and large interactive touch screens.

2. To show, counterintuitively, how resistance to new ideas and nostalgia for the past can be beneficial in the consideration of changes brought about by regenerative medicine and stem cell biology.

3. To update progress since my last Grand Rounds presentation on the course Dec. 13, 2012:https://www.youtube.com/watch?v=BjOIzbR_X3Y http://www.cybernephrology.ualberta.ca/misc/solez/lmp/

Who Am I?

Who Am I?

Twenty-three years ago presided over a unique Meeting in Banff Canada. The course is an outgrowth of our consensus generating activities.

Banff Classification of Kidney Transplant Pathology

Histologic criteria for the diagnosis of rejection and other conditions in the transplanted kidney, began 1991, updated and expanded every two years in consensus meeting.

1991 First Conference 1993 First Kidney International publication 1995 Integration with CADI 1997 Integration with CCTT classification 1999 Second KI paper. Clinical practice guidelines. Implantation biopsies. 2001 Classification of antibody-mediated rejection: Regulatory agencies

participating

2003 Genomics focus, ptc cell accumulation scoring 2005 Gene chip analysis. Elimination of CAN, identification of chronic

antibody-mediated rejection. 2007 First meeting far from a town called “Banff” – La Coruna, Spain. 2009 Working groups. Meeting in Banff, Alberta, Canada 2013 Establishment of Banff Foundation for Allograft Pathology

BANFF Classification - Milestones

Significance of ‘Banff papers’

• 4244 citations of the 9 Banff meeting reports• 790 Banff / Transplantation papers in PubMed• Banff 2003 meeting report (ABMR criteria) = most cited AJT paper• 3 Banff meeting reports are among the top 4 cited AJT articles

Organizational structure of the Banff Foundation For Allograft Pathology

Board of Trustees: K. Solez (Chair), L. Racusen, D. Glotz, J. Demetris, M. Mengel, M. Mihatsch, D. Seron, N.

Schmidt

2015 Local Conference chair: Michael Mengel

Organ Steering committee Chairs: Composite tissues: Linda CendalesHeart : Rene RodriguezKidney: Mark HaasLiver: Jake DemetrisLung: William Wallace and Carol FarverPancreas: Cinthia Drachenberg

Banff Working Group (BWG) Leads: Molecular transplantation pathology: Michael Mengel, Banu SisIsolated v-lesions: Banu Sis, Ed KrausQuality assurance in transplantation diagnostics: Michael Mengel and Parmjeet RandhawaC4d-negative ABMR: Mark Haas, Banu Sis, Alexandre LoupyFibrosis scoring: Robert Colvin, Brad Farris, Michael MengelDigital Pathology in Transplantation: Jake Demetris

2015 Scientific program committee: Alex Loupy (Chair)Mark Haas, Banu Sis, Kathryn Tinkham, Candice Rofousse, Chris Bellamy, Lynn Cornell, Carmen LeFaucheurComposite tissues: Linda CendalesHeart : Rene RodriguezLiver: Jake DemetrisLung: William Wallace and Carol FarverPancreas/Islets: Cinthia Drachenberg and John Papadimitriou

Secretary/Treasurer: Michael Mengel

funding

collaboration

reports to

reports to

collaboration

collaboration

reports to

collaborationprogress reports to Budged

proposal and accountability for meeting costs

support

BANFF Conferences On Allograft Pathology 1991-Forever?

The Banff ProcessConsensus communication in renal transplantation

a

The Banff lesions

g, i, t, v - score

The Banff communityPathologistsNephrologistsTx-SurgeonsLab-Medicine

The Banff communityPathologistsNephrologistsTx-SurgeonsLab-Medicine

established by

consensus in 1991

The Banff classificationCurrent consensus for diagnostics

The Banff classificationCurrent consensus for diagnostics

moderated

Banff meetingsthesis-antithesis-synthesis

tentative

thresholds

participate

refinementBanff Working Groups

Feedback concerning weaknesses and strengths by results from independent research

New membersBiostaticiansMolecular Biologists“Omics”-specialists

New membersBiostaticiansMolecular Biologists“Omics”-specialists

Off-springsLiverPancreasLung, HeartCTA

Off-springsLiverPancreasLung, HeartCTA

Cutting Edge Technology Necessary for Banff Consensus Generation Led to NKF cyberNephrology and then to the LABMP 590 course.

The Technological SingularityThe technological singularity occurs as artificial intelligences surpass human beings as the smartest and most capable life forms on the Earth. Technological development is taken over by the machines, who can think, act and communicate so quickly that normal humans cannot even comprehend what is going on. The machines enter into a "runaway reaction" of self-improvement cycles, with each new generation of A.I.s appearing faster and faster. From this point onwards, technological advancement is explosive, under the control of the machines, and thus cannot be accurately predicted (hence the term "Singularity"). – Ray Kurzweil

Major Singularity Developments in February 2011

Focus Groups in May 2011

Course conceptualized in March 2011, tested with

focus groups in May for its suitability as a

course for both undergraduate and graduate students.

Over Time Our Course’s Sessions Have Developed a Pedagogical

Rhythm, Leading To A Self-organized Structure

Ten minute introduction Fifty minute lecture Twenty minute discussion In the course we talk about

machines replacing many of the functions of human beings. This picture was taken by a machine without human intervention, as were many of the best still images from the course. The video camera is constantly comparing the scene to algorithms and takes still pictures when the requirements of the interesting picture algorithm are satisfied.

Video and Audio Quality Superb Now!

First teaching session 2011 Recent teaching session 2014

Hot-linked tables of contents in YouTube video descriptions allow one to jump right to content of interest.

Some Student Presentation Videos Have Had Amazing Positive Effects!

Website: www.singularitycourse.comJonathan White’s first lecture originally began with a song “The Future Soon” by Jonathan Coulton.

We endeavor to shoot broadcast quality video of each lecture and discussion.

Previous lectures on YouTube.com at /user/KimSolez and /user/avoca99 . Students are asked to critique one past lecture, and suggest improvements in presentation and hot-linked table of contents (20% of grade).

Students write one 3,000 word paper (40%) and give 20 min. presentation on same subject (30%). Also graded on class participation (10%).

No required reading. Suggested reading list in course outline, readings suggested by Email.

Course Specifics

The technological Singularity. Existential risks, AI, genomics, and nanotech.

Ways to optimize a positive outcome for humanity in the co-evolution of humans and machines . The influence of these considerations on medicine of the future.

Prominent people internationally. Most lectures not very “medical”. Easily understood.

Balanced view provided by incorporating both tech skeptics and tech advocates.

Course Content

Nova program on PBS Television (7 million viewers) Doctor Who (BBC, 12 million viewers) Big Bang Theory (the TV show; 20 million viewers) Singularity Summit (9,000 views per video) Kim Solez – Technology and Future of Medicine Course

LABMP 590 (2,600 views per video)

The Technological Singularity – Dissemination of Ideas

Two Years Ago Structure Became Much Simpler. The Course Is One

Of Very Few Independent Singularity Entities.

Medical student elective participation in course. International peer review of YouTube videos, modifications made.

Two Quantum Biology lectures. Collaboration with Social Media in Medicine course in Budapest,

Hungary, the only other course somewhat like this one. Stem cell, regenerative medicine aspects. Space exploration aspects. Large touch screen pathology aspects. Leonard Cohen the cohesion binding elements together, he

commented on AI&Sony Aibo Robotic dog during 2005 visit . Edmonton Leonard Cohen Event planned for 2016, larger

than 2008 event. AP Midsummer Fest will benefit. Attended

2014 LC event in Dublin, visited Fimmic touch screen offices.

Innovations New in 2014

The Technological Singularity

The spectacular dynamics influencing the pace of stem generation of organs replacing transplantation in the future.

There were YouTube videos (now removed) suggesting that stem cell generation of complex organs in humans would be routine by 2020. Problems of clotting, endothelial loss, and cell type selection errors not mentioned.

The dramatic slowdown of new drug approvals (Eroom’s Law) by the FDA suggests that the FDA is ripe for disruptive innovation. Has started to happen.

However stem cell therapies may be the last area the FDA will relax regulation in, as unproven bogus stem cell therapies are causing widespread suffering and protection of the general public is needed.

Many problems with stem cell generate organs not being discussed. Do not exclude yourself from the action in this area!

Many problems with stem cell generate organs not being discussed. Need to make those conversations to happen.

The recellularized organ clots like crazy, impossible to regenerate more than 80% of endothelial surface. Artificial heparized surface not fenestrated. Cell traffic abnormal.

Hard to get right types of cells to right places. Podocytes seems to be terminally differentiated cells,

when attempt to culture them they turn into different type of cell.

Kidney progenitor stem cell difficult to identify, kidney work has lagged behind.

Easy to make stem cell generated kidneys that lack loop of Henle. Could produce lethal polyuria. What is “function”?

Many old fashioned questions of physiology about how the stem cell generated organ works, not just true for kidney, true for every organ. Do nephrons lacking loops of Henle contribute to final urine? Nostalgia for “old questions”!

Banff Foundation for Allograft Pathology and Banff Meetings Must Adapt to Future Changes in Field of Transplantation

Transplant pathologists will also become tissue engineering pathologists, pathologists who analyze organs grown from stem cells. This is not something beyond us, we can adapt to a work life that includes stem cells. Someone needs to cross the disciplines, why not us?

It is OK to Allow the Natural Resistance to Change and Nostalgia for the Past to Motivate You!

Many of the questions that need to be posed about stem cell generated organs are old fashioned questions, intact nephron hypothesis, cell regeneration, stunned myocardium, contraction band necrosis etc. Use your nostalgia! Stimulate conversations between stem cell researchers and transplant physicians.

Playing dead is not a useful physician skill! Learned helplessness. We can

learn about stem cells, influence what happens, help create the future!

Space Orientation in Course in 2014 Dr. Julielynn Wong - 3D Printing of

Surgical Instruments in Space

Me at International Space Development Conference in LA

Ross Lockwood lectures on “Real Life on Fake Mars”

Did Physics Demonstrations for You at AP Midsummer Fest

in 2013

Amazing Growth of Pathology Careers Facebook Group!

Visit to Fimmic Oy in Helsinki Finland

Visit to Fimmic Oy in Helsinki Finland

You can read about AI in books, and you can experience it first hand which is more vivid.

It is amazing how much of a "relationship“you can strike up with the Sony Aibo robotic dog despite the fact production ended in 2005. Imagine what their capabilities would be today if Sony had continued developing them over the past 9 years!

Aibo Back by Popular Demand!

Aibo ERS 7 M3 Features

There was much less interest in the Aibo in Canada than in the US

 The only way I could get one in 2003 and 2004 was to fly to the US stay in a hotel just long enough for the product to be delivered and then fly back home, they were impossible to get in Canada after 2002 through regular Sony channels here as there was not a market among Canadian consumers.

They are “adult” toys. The ears and tail come off very easily

A child quickly deconstructs them to a point where they look quite ugly and incomplete.  The main market in the US and Japan was affluent young women.

The Aibo dog has no sense of right and wrong but is not large enough to do

harm. Leonard Cohen in 2005 predicted he would find a way to get big.

Foxconn Announcement That It Was Replacing One Million

Workers with One Million Robots Made Singularity Appear Much

Nearer

The Microscope and the Megamacroscope-The very small picture and the very big

picture.We need to envision Medicine of the Future.

We need the mainstream public to regard the coming Technological Singularity as fact, not fiction.

We need to promote organized thinking about the future in Universities and beyond.

We need to think of all the ways to increase our reach from this one course to the world at large.

There are components of this lecture in which you can become directly involved!

Suggestions on how to capture the imagination of the public to start everyone thinking about

these matters are most welcome.