Technology Medicine and Richard M Satava MD FACS

Technology Medicine and Richard M. Satava, MD FACS Professor of Surgery University of Washington and Senior Science Advisor US Army Medical Research and Materiel Command 4 to Simposium Internacional Ingenieria Biomedical Engineering Students Society Monterrey, Mexico March 7, 2008

Presenter Disclosure Slide* Richard M. Satava, MD FACS METI, Inc Preimera BC/BS In. Touch Technologies, Inc Karl Storz Stryker Simu. Lab US Surgical * There will be no discussion of any products from these companies

… From To …

Greetings from Monterey California

Disruptive Visions “The Future is not what it used to be” …. Yogi Berra

Current Visions “The Future is here … . . . it’s the Information Age”

Fundamental Concept New technologies that are emerging from Information Age discoveries are driving our basic approach in all areas of healthcare education EXAMPLES . . .

The Fundamental Change Information basis for Medicine Borrow from Industry – eg, CAD/CAM Medical education has only begun to realize the potential

Why Robots? Movie: Alien The Touch Lab, MIT

Information Representation of a Patient Medical equivalent of CAD/CAM Holomer Total body-scan for total knowledge Virtual Soldier Program Multi-modal total body scan on every trauma patient in 15 seconds Satava March, 2004

Virtual Autopsy. . . is a SIMULATED Autopsy Wound Tract Less than 2% of hospital deaths have autopsy Statistics from autopsy drive national policies

Why modeling & simulation, imaging and robotics • Healthcare is the only industry without a computer representation of its “product” • A robot is not a machine. . . it is an information system with arms. . . • A CT scanner is not an imaging system it is an information system with eyes. . . thus • An operating room is an information system with. . . * “The Information Age is about changing from objects and atoms to bits & bytes” Nicholas Negroponte “Being Digital” - 1995

Total Integration of Surgical Care Minimally Invasive & Open Surgery Remote Surgery Pre-operative planning Surgical Rehearsal Simulation & Training Pre-operative Warmup Intra-operative navigation Courtesy of Joel Jensen, SRI International, Menlo Park, CA

Information and computers Cornerstone of Systems Integration Single instrument which - performs both diagnosis & therapy - in real time - can be autonomous

Surgical MEMS - Smart Surgical Tools MEMS Sharps Instrumented Scalpel XACTIX CONVENTIONAL Courtesy: E. C. Benzel, L. A. Ferrara, A. J. Fleischman, S. Roy

The Fundamental Change From tissue and instruments to Information and energy* * “The Information Age is about changing from objects and atoms to bits & bytes” Nicholas Negroponte “Being Digital” - 1995

“Tri. Corder” Point-of-care noninvasive therapy Mechanics to energy HIFU High Intensity Focused Ultrasound for Non-invasive Acoustic hemostasis Courtesy Larry Crum, Univ Washington Applied Physics Lab

Courtesy Larry Crum, Univ Washington Applied Physics Lab 2003

Bring the hospital to the casualty, not the casualty to the hosp “. . . with a fully functional ICU ” The LSTAT Life Support for Trauma and Transport Courtesy of Integrated Medical Systems, Signal Hill, CA Total Patient Awareness • Defibrillator • Ventilator • Suction • Monitoring • Blood Chemistry Analysis • 3 -Channel Fluid/Drug Infusion • Data Storage and Transmission • On-board Battery • On-board Oxygen • Accepts Off-Board Power and Oxygen

LSTAT Deployment to Kosovo - March 2000 212 th MASH Deployed with LSTAT - Combat Support Hospital Courtesy of Integrated Medical Systems, Signal Hill, CA

Aeromedical evacuation Nightingale UAV Goal Ø Identify “optimum” VTOL UAV design Ø Create a new VTOL UAV tailored to the operational need LSTAT

Why now? VTOL UAV technology is maturing rapidly enough to minimize risk.

Disruptive Technology in Surgery N. O. T. E. S. Natural Orifice Transluminal Endoscopic Surgery Trans-Gastric Surgery New surgery for great new opportunities New “tools” for the new procedures New simulators for education and training We need:

Trans Oral Intra-peritoneal Surgery - Future Courtesy of N Reddy, Hyperbad India 20005

Early Luminal Malignancies - Robotic Endoscopic Mucosal Resection - EMR Courtesy of N Reddy, Hyperbad India 20005

Trans-gastric appendectomy Courtesy of N Reddy, Hyperbad India 20005

What next?

It’s all about the man-machine interface Courtesy Lee Swanstrom, MD Portland OR 2007

Future Endoscopic. Workstation? Conventional colonoscopy Tele-endoscopy. Controlling micro-robot (which has been inserted into the rectum) from endoscope workstation [ Courtesy R Satava, GI Clinics North America, 1983] Endo-vascular work station – by Hansen Medical, Inc URL http: //hansenmedical. com Feb, 2007

Classic Education and Examination What is the REVOLUTION in surgical education?

Two components of revolution Objective Training of Technical Skills Simulators Curriculum Assessment of Cognitive and Technical Skills Criterion-based tools Objective metrics

Military role in medical simulation 1992 – 2002 1992 - present TATRC

The Dream of Simulation - Aviation The Dream Edwin Link - 1939 The Realization Current commercial simulator

The Dream of Simulation – Medicine Virtual Reality & Head Mounted Displays The Dream NASA original HMD The Realization Wearing HMD for prolonged time

The Dream of Simulation – Medicine Virtual Reality & ‘Immersive Environment’ The Dream The Realization First immersive VR Surgical Simulator Immersive VR today ? Courtesy. Satava - 1987 Courtesy A Van. Dam, Brown U, 2005

Mannequin-based Simulator - Realistic physiologic response Individual and Team Training The Realization The Dream First Mannequin VR Simulator – David Gaba 1984 Human Patient Simulator 2005 Courtesy Med. Sim, Inc - 1991 Courtesy METI, Inc Sarasota, FL 2006

Manikin Simulators Limitations and Challenges • Change the anatomy (incl patient specific) • Realistic tissues for surgery (one time use) • Only simple invasive procedures (trach, etc) • Integrate into surgical systems (rehearsal) • Automatic objective assessment

Disruptive Simulation Virtual Reality Simulators Provides all levels of simulation Integrates into current procedural systems Surgical Rehearsal in clinical practice

Simulation Incorporates Training and Objective Assessment Surgical Simulators Laparoscopic hysterectomy Courtesy Michael van. Lent, ICT, Los Angeles, CA Lap. Sim simulator tasks - abstract & texture mapped Courtesy Andres Hytland, Sugical Science, Gothenburg, Sweden, 2000 Laparoscopic Simulator with tactile feedback Courtesy Murielle Launay, Xitact, Lausanne Switzerland

Dermatology Simulators Pre-operative planning • Strong collaborative environment • UW Dermatology – Daniel Berg • Human Interface Technology Laboratory (HIT lab) – Suzanne Weghorst – Peter Oppenheimer Virtual Reality Suturing Simulator Computer-based wound planning

Endovascular Simulators (Surgical rehearsal) Patient specific image Graphic overlay

Virtual Hospital Combat Trauma Training Chain of Survival Civilian Hospital Training Chain of Safety Medical Simulation Training Center (MSTC) Riverside Hospital Simulation Center Madigan Army Hospital, Ft. Lewis, WA Columbus Ohio Pre-Hospital Point of Injury Hospital Ward Combat Support Hospital OPERATIONAL TEST & ASSESSMENT Air Ambulance Ground Ambulance Casualty Collection Point MISSION REHEARSAL Forward Surgical Team Ground Ambulance Critical Care OPERATIONAL TEST & ASSESSMENT Air Ambulance MISSION REHEARSAL Battalion Aid Station Operating Room Emergency Department Courtesy of METI, Inc , Sarasota, FL - 2004

Pacific Northwest Simulation Consortium WWAMI: Washington, Wyoming, Alaska, Montana, Idaho University of British Columbia, Vancouver, BC Anchorage Oregon University of Health Sciences, Portland, OR Harborview VA ISIS University of Washington Vancouver Spokane Seattle Billings Children’s Portland Madigan AMC Boise WWAMI Represents 27% of entire land mass of USA Cheyenne

2015

Objective Assessment of Cognitive and Technical Skills • Cognitive: Use Standard Testing Methods Multiple Choice, Case Based, etc Objective Structured Clinical Exam (OCSE) • Technical: Opportunity for new methods Standard simulated objects, animal parts Computer-enhanced systems (manikin, dragon) Virtual Reality Systems

Objective Assessment of Technical Skills Objective Structured Assessment of Technical Skills – OSATS Richard Reznick, Univ of Toronto

Simulation and Objective Assessment Lap. Sim simulator tasks - abstract & texture mapped Courtesy Andres Hytland, Sugical Science, Gothenburg, Sweden, 2000 Laparoscopic hysterectomy Courtesy M van. Lent, ICT, Los Angeles, CA Laparoscopic Simulator Surgical. SIM Courtesy METI, Sarasota, FL

Cognition from Psychomotor

“Red Dragon” “Blue Dragon” passive recording device Courtesy Blake Hannaford, Ph. D University of Washington, Seattle

Novice Objective Assessment Intermediate Expert MEMS based tracking, RFID, etc Hand motion tracking patterns Ara Darzi, MD. Imperial College, London, 2000

Inferring Judgment Can we understand what you are thinking? Ara Darzi, Imperial College, London, 2005

Paradigm Change for All Surgical Education & Training • Adhere to the 6 competencies (ACGME & ABMS) • Curriculum, not the simulation • Validation of the curriculum (and simulator) • Objective assessment • Criterion-based (proficiency level) training

The 6 Competencies 2001 Consensus by the AGCME & ABMS • Knowledge • Patient Care • Interpersonal and communication skills • Professionalism • Practice-based learning and improvement • Systems-based practice

Standardized Curriculum Suggested template • Goals of the Simulation • Anatomy • Steps of the Procedures • Errors TEST • Skills Training • Outcomes

The American College of Surgeons • Embraced simulation and assessment for skills Collaborated with the Residency Review Committee to require simulation for all residency training programs • Committee on Simulation Curricula Begun development of standardized curricula (with American Board of Surgery) • Committee on Certification of Simulation Centers Certify and endorse applicant centers Level 1: Comprehensive Center Level 2: Basic Training Laboratory

Future Directions of Simulation • Pre-operative planning • Pre-operative warm-up • Surgical rehearsal • Intra-operative assistance (incl navigation) • Automatic assessment and outcomes analysis. . . all occurring at the surgical workstation

Total Integration of Surgical Care Minimally Invasive & Open Surgery Remote Surgery Pre-operative planning Surgical Rehearsal Simulation & Training Pre-operative Warmup Intra-operative navigation Courtesy of Joel Jensen, SRI International, Menlo Park, CA

New Concepts for OR of the Future “The OR Without Lights” Eric La. Porta, Barcelona, Spain 2005

ROBOT SURGICAL TECHNOLOGIES, INC “Penelope” – robotic scrub nurse Currently in Clinical Trials Michael Treat MD, Columbia Univ, NYC. 2003

Integrating Surgical Systems for Autonomy The Operating Room (personnel) of the Future 100, 000 Surgeon Assistant Scrub Nurse Circulating nurse Borrowing from the standard practices of other industries

Demonstration of Phase 1 Operating Room with no People SRI International, Menlo Park, CA January, 2007

Demonstration of Phase 1 Operating Room with no People SRI International, Menlo Park, CA January, 2007

Fighter Pilots – until 2002 Predator 2003 Fighter Pilots – Beyond 2003 SATAVA 7 July, 1999 DARPA

“Remote Pilots” A last bastion of guts-and-glory aviation is falling, as the U. S. Air Force prepares to unveil a new breed of unmanned aircraft pilots. Known as “remote pilots”, they’ll wear wings. They’ll fly aircraft. But chances are many will never climb into a cockpit. . Senior leaders have yet to approve the new Undergraduate Remote Pilot Training (URT), but Air Force officers familiar with the project expect approval by the end of the year. Instead of sticking reluctant manned aviators behind a console, the Air Force will groom remote pilots from the start to fly what the service now calls unmanned aerial systems 28 Training & Simulation Journal August/September 2006

Robotic Medical Assistant Nursing shortage crisis Applicable at all levels Hospitals Clinics Nursing Home Assisted living Courtesy Yulun Wang, In. Touch Technologies, Inc, Goleta, CA SATAVA 7 July, 1999 DARPA

Disruptive Visions “The Future is not what it used to be !” - Yogi Berra http: //depts. washington. edu/biointel

The Information Age is NOT the Future The Information Age is the Present . . . There is something else out there . . SATAVA 7 July, 1999 DARPA

Scientific Method. . . is DEAD? HISTORY Observation, Phenomenon Experiment Scientific method, …? Not all science is explainable using scientific method Intuition Creativity Quantum mechanics What comes BEFORE the hypothesis? Observation, phenomenon, experiment, scientific method, …? A new “science” may need to be invented THE STRUCTURE OF SCIENTIFIC REVOLUTIONS THOMAS S. KUHN

SCIENTIFIC METHOD Controlled, randomized, double-blind trial Control Group No Parachute Still looking for volunteers for the control group Test Group Parachute

Scientific Method A Paradigm Change? Hypothesis Study Design Experiment Results Report Modeling & Simulation Hypothesis Study Design Modeling & Simulation Experiment Results R

Clayton M Christensen

BIO-INTELLIGENCE AGE TECHNOLOGY DEVELOPMENT AGRICULTURAL AGE INDUSTRIAL AGE CONSUMER ACCEPTANCE INFORMATION AGE BIOINTELLIGENCE AGE 2000 BC 0 1500 TIME (year) 1800 1900 2000 AD Satava 29 July 99

BIO-INTELLIGENCE AGE BIOLOGIC Biosensors Biomaterials Biomimetic PHYSICAL FUTURE Genomics Bioinformatics Biocomputation Robotics HPCC/WWW MEMS/Nano INFORMATION Satava 2 Feb 1999

¿And just what are these incredible new technologies?

University of Wisconson, 1999

Biomimetic Micro-robot Courtesy Sandia National Labs Courtesy Danny Scott Texas Southwestern Dallas, TX Capsule camera for gastrointestinal endoscopy Courtesy Paul Swain, London, England Courtesy D. Oleynkov, Univ Nebraska

Femtosecond Laser (1 x 10 – 15 sec) Los Alamos National Labs, Los Alamos NM Time of Flight Spectroscopy Cold Spring Harbor Laboratory, Long Island, NY Cellular opto-poration

Surgical console for cellular surgery Courtesy Prof Jaydev Desai, Drexel Univ, Philadelphia, PA 2005

Surgical console for cellular surgery Motion Commands Courtesy Prof Jaydev Desai, Drexel Univ, Philadelphia, PA 2005

Molecular Imaging Bio. Surgery Courtesy: Rahul G. Thakar, Ph. D. 2007

Simulataneous multifunctional – 6 different fluorophores in a cell Monitoring Roger Tsien, UC-San Diego, La Jolla, CA 2006

Monitoring Whole body visualization Fluorescent antibodies (GFP and anti-tumor) – rat model

New Surgical Tools Atomic Force Microscope Manipulato Femtosecond Lasers Fig. 2. Top: Fluorescent micrograph of the actin cytoskeleton of an engineered striated muscle cell. Bottom: AFM-acquired topographical map. Wrinkles and lines along the diagonals of the 30 micron square actin stress fibers under the lipid membrane surface. Fig. 3. Schematic illustrating the technique for functionalizing AFM tips to identify specific molecules on the cell surface during raster scanning. Fig. 4. Nanoincision by electroporation. (A) The AFM cantilever is positioned above a region of interest in the cell. (B) Electrical current is injected through the cantilever tip, causing the formation of a nanometer scale pore in the membrane, thru which the AFM tip can be dropped, or other instrumentation attached to the tip, prior to the membrane resealing. Courtesy Prof Kit Parker, MD, Harvard Univ, Boston, MA 2005

Surgical Cockpit

“Brain. Gate” John Donohue, Brown University, 2001 Richard Andersen, Cal. Tech, 2003 Greg Kovacs. Stanford University, 1990

Brain Machine Interface – Controlling motion with thoughts Recorded activity for intended movement to a briefly flashed target. TARGET PLAN MOVEMENT Time Courtesy Richard Andersen, Cal Tech, Pasadena, CA Direct brain implant control of robot arm Miguel Nicholai, Duke University, 2002

Sterilization without supplies Leishmanaisis Determine efficacy of inactivation of parasites Insure safety of other cells and tissues Live/dead before and after treatment

Replacing human body parts Intelligent Prostheses Tissue Engineering Artificial Ear a) Rheo Bionic knee Ossur, Reyknavik, Iceland b) C-leg Otto Bock, Minneapolis, MN Liver Scaffolding Artificial Blood Vessel J. Vacanti, MD MGH March, 2000

Organs

Commercial Products Neo-bladder – a commercial synthetic bladder A surgeon takes a small, full-thickness biopsy from the patient’s bladder. urothelial and smooth muscle cells that are capable of regeneration are isolated. The isolated cells are cultured separately until there a sufficient quantity. The cultured cells are properly seeded onto a biodegradable scaffold shaped like a bladder. The biodegradable scaffold dissolves and is eliminated from the body, leaving a functioning bladder made only of the patient’s own newly regenerated tissue. The body uses the neo-bladder construct to regenerate and integrate new tissue, restoring the bladder’s functionality. The neo-bladder construct is implanted by the surgeon using standard surgical techniques. Quality assurance that the cells attach and grow properly throughout the scaffold. After about 8 weeks, the neo-bladder construct is returned to the surgeon for implantation. Tegion, Courtesy of Tengion East Norrington, PA 2007.

Genetically re-engineering the body Orb spider - web Spinnerette of spider Spider silk protein as biomaterial -Bio. Steel Cross section of synthetic fiber Nexia Biotechnologies, Montreal Canada

e ativ rn Auto-anesthesia - FRAMR Suspended Animation ( Alte ) Institute of Arctic Biology’s Toolik Field Station, Alaska's North Slope active hibernating heart rate 300 3 (beats/min) resp. rate 150 <1 (breaths/min) body temp. 37 o. C -2 o. C gene ongoing transcription function and translation suppressed metabolic rate 0. 5 0. 01 (2%) (ml. O 2/g/h) Brian M. Barnes, Institute of Arctic Biology , University of Alaska Fairbanks 11/02

Co de fi n al ti n

Be careful of unintended consequences Experience is the name everyone gives to their mistakes - Oscar Wilde If you are not making mistakes you are not working hard enough … … and that’s a big mistake! Anonymous

Technologies will change the Future • The rate of new discovery is accelerating exponentially • The changes raise profound fundamental issues • Moral and ethical solutions will take decades to resolve Sector Rate of Change Technology Business Society Healthcare TIME Differing responses to scientific discovery by various sectors

The Moral Dilemma Technology is Neutral - it is neither good or evil It is up to us to breathe moral and ethical life into these technologies And then apply them with empathy and compassion for each and every patient

Human embryos cloned Chinese Cloning Control Required Tuesday 16 April, 2002, 10: 41 GMT 11: 41 UK Strict ethical guidelines are needed in China to calm public fears about new cell technologies such as cloning, the country's leading scientist said. Professor Ching-Li Hu, the former deputy director of the World Health Organization, was speaking at the Seventh Human Genome Meeting in Shanghai. His call follows recent reports that Chinese scientists are making fast progress in these research fields. One group in the Central South University in Changsa is said to be producing human embryo clones, while another team from the Sun Yat-sen University of Medical Sciences in Guangzhou is reported to have fused human and rabbit cells to make tissues February 12, 2004 South Korean team demonstrates cloning efficiency for humans similar to pigs, cattle | Thersa Tamkins After outlandish claims, a few media circuses, and some near misses by legitimate researchers, a team of South Korean researchers reports the production of cloned human embryos. The findings, were released Wednesday (Science, DOI: 10. 1126 /science. 1094515, February 12, 2004). Wook Suk Hwang and Shin Yong Moon of Seoul National University used somatic cell nuclear transfer to produce 30 human blastocysts and a single embryonic stem cell line; SCNT-h. ES 1. Using 242 oocytes and cumulus cells from 16 unpaid donors, the group achieved a cloning efficiency of 19 to 29%, on par with that seen in cattle (25%) and pigs (26%).

Jeffery Steinberg, MD Fertility Institutes of Los Angeles Genetically “designed” child 1997 Five "designer babies" created for stem cell harvest Five healthy babies have been born to provide stem cells for siblings with serious non-heritable conditions. Preimplantation Genetic Screening General Science: May 13, 2006 A British woman has become the first in the country to conceive a "designer baby" selected specifically to avoid an inherited cancer, This is the first time "savoir siblings" have been created to treat children whose condition is not genetic, says the medical team. The five babies were born after a technique called preimplantation genetic diagnosis (PGD) was used to test embryos for a tissue type match to the ailing siblings, reports the team, led by Anver Kuliev at the Reproductive Genetics Institute in Chicago, US. The aim in these cases was to provide stem cells for transplantation to children who are suffering from leukaemia 'Unlawful and unethical' However, the use of this technology to provide a "designer baby" to treat an ill sibling is Science Vol 315: 1723 -25, Mar 2007 highly controversial. A UK couple involved in this Gregory Stock The woman, who was not identified, used controversial genetic screening technology to ensure she does not pass on to her child the condition retinoblastoma, an hereditary form of eye cancer from which she suffers. Emergence of Novel Color Vision in Mice Engineered Doctors tested embryos created by the woman and her partner using in-vitro fertilisation (IVF) methods to Express Human Cone Photo-pigment for the cancer gene. Only unaffected embryos were implanted in her womb, the newspaper said. Changes in the genes encoding sensory recptor proteins are an essential step in It suggested the woman's pregnancy would the evolution of new sensory capacities “new sensory capacities". In primates, triincrease controversy over the procedure -- prechromatic color vision evolved aftre changes in x chromosome linked photopigment genes. implantation genetic diagnosis (PGD) -- because Heterogous mouse females whose retinas contained both mouse pigment and critics say it involves destroying otherwise healthy human L pigments showed enhanced long-wavelength sensitivity and chromatic human L pigments embryos whose conditions are treatable. discrimination. An inherent plasticity in the mammalian visual system thus permits emergence 1. Verlinsky Y, Rechitsky S, Sharapova T, Morris R, Taranissi M and Kuliev A. Preimplantation HLA Testing. JAMA (2004) 29: 2079

Can conception, the most intimate of human experiences, be automated? 26 July 2007 Womb-on-a-chip may boost IVF successes Linda Geddes Teruo Fujii of the University of Tokyo in Japan and his colleagues are building a microfluidic chip to nurture the first stages of pregnancy. They hope, eventually, to create a fully automated artificial uterus in which egg and sperm are fed in at one end an early embryo comes out the other, ready for implanting in a real mother. They say using such a device could improve the success rate of IVF. "While there have been many advances in the production of in vitro embryos, these embryos are still sub-optimal [compared] to their in vivo counterparts, " says Matt Wheeler of the University of Illinois in Urbana-Champaign who is also working on automated IVF systems. One reason for this is that during IVF, eggs or embryos are often moved or washed with culture fluid, causing changes in temperature and p. H, he says. To tackle these problems, Fujii's team has created a "lab on a chip" that is 2 millimetres across and 0. 5 millimetres high, in which up to 20 eggs can be fertilised and then grown until they are ready for implantation. Endometrial cells, which line real wombs, are also grown in the device, so that the chemicals they produce can reach the embryos From the movie MATRIX RELOADED New Line Cinema help them grow. "We are providing embryos (cont. p 28) Embryo-on-a-chip

Extending Longevity Life extension A strain of mice that have lived . . . more than three normal lifespans Should humans live 200 years? April 14, 2004 Life extension consists of attempts to extend human life beyond the natural lifespan. So far none has been proven successful in humans. Several aging mechanisms are known, and antiaging therapies aim to correct one or more of these: Dr. Leonard Hayflick discovered that mammalian cells divide only a fixed number of times. This "Hayflick limit" was later proven to be caused by telomeres on the ends of chromosomes that shorten with each cell-division. When the telomeres are gone, the DNA can no longer be copied, and cell division ceases. In 2001, experimenters at Geron Corp. lengthened the telomeres of senescent mammalian cells by introducing telomerase to them. They then became youthful cells. Sex and some stem cells regenerate the telomeres by two mechanisms: Telomerase, and ALT (alternative lengthening of telomeres). At least one form of progeria (atypical accelerated aging) is caused by premature telomeric shortening. In 2001, research showed that naturally occurring stem cells must sometimes extend their telomeres, because some stem cells in middle-aged humans had anomalously long telomeres.

CAN I REPLACE MY BODY ? Artificial organs Smart Prostheses Genetic engineering Regeneration If I replace 95% of my body . . . Am I still “human”? Should there be replacement “parts” for astronauts?

Humans vs Machine Humans 4. 0 X 10 19 cps Red Storm 3. 5 X 10 15 cps Moore’ s Law “computer power doubles every 18 months” Do the Math !! Who is smarter now? ? WHEN COMPUTERS EXCEED HUMAN INTELLIGENCE The Age of Spiritual Machines Ray Kurzweil ROBOT Hans Moravec Will Machines become “smarter than humans? Should astronauts be provided with super-intelligent systems* * HAL of “ 2001: A Space Odeyssey

The new face of “Hal” – emotional and affective robotics Courtesy David Hanson, Hanson Robotics, Austin, TX

Moral and Ethical Issues Raised by Technological Success will take DECADES of debate Summary of Examples Should we do research in areas we may not be able to control? (eg, genetics, cloning, nanobots, intelligent machines? ) Will prolonging life with technology result in more disease in the overall population Can we change medicine from treatment to prevention of disease In defeating diseases, will technology change a human into a combination of man and machine - what does it mean to be “human” 6 How will we decide who gets the technology, especially in 3 rd World SATAVA 7 July, 1999 DARPA

The Ultimate Ethical Question? For the first time in history, there walks upon this planet, a species so powerful, that it can control its own evolution, at its own time of choosing … … homo sapiens. Who will be the next “created” species?

http: //depts. washington. edu/biointel Do Robots Dream ?

Monitoring Whole body visualization Fluorescent antibodies (GFP and anti-tumor) – rat model

Simulataneous multifunctional – 6 different fluorophores in a cell Monitoring Roger Tsien, UC-San Diego, La Jolla, CA 2006

Disruptive Visions “The Future is not what it used to be !” - Yogi Berra http: //depts. washington. edu/biointel

Tissue Engineering . . . is the creation of a functional biological substitute using living cells and a matrix to maintain, improve or restore damage to tissues and organs Atala, A. Engineering tissues, organs and cells. 2007 J Tissue Eng Regen Med 1: 83 -96