{"id":72,"date":"2020-08-14T16:16:51","date_gmt":"2020-08-14T16:16:51","guid":{"rendered":"http:\/\/newsletters.aans.org\/assfn\/?page_id=72"},"modified":"2020-08-14T16:28:33","modified_gmt":"2020-08-14T16:28:33","slug":"presidential-address","status":"publish","type":"page","link":"https:\/\/newsletters.aans.org\/assfn\/summer-2020\/presidential-address\/","title":{"rendered":"Presidential Address"},"content":{"rendered":"

Originally presented at the ASSFN Virtual Scientific Update on June 28, 2020.<\/em><\/p>\n

Thoughts on Technology, Times and The Future or our Species: Good, Bad or Other?<\/h1>\n

Thank you for the introduction, Emad.<\/p>\n

And thank you Emad and Sameer and the organizing committee for this first \u2013 and hopefully NOT biennial Virtual ASSFN meeting.<\/p>\n

For the last year or more, I had planned to be speaking today about the process of innovation and disruptive technology. In the last four months, however, we\u2019ve seen striking disruption of another kind affecting the CONTEXT of this address, not to mention the setting, and I didn\u2019t feel like that could be ignored. I will indeed speak on the topic of innovation and disruption, but it will be in the BROADER context of disruption, not just in technology, but in our lives. <\/p>\n

\u201cIt was the best of times, it was the worst of times.\u201d That\u2019s how Dickens famously opens \u201cA Tale of Two Cities\u201d. Is that a paradox? These do seem like OUR worst of times: Worldwide pandemic, high unemployment, recession, lives disrupted, educational plans on ice, meetings cancelled – and even some good ones! <\/p>\n

Add to that the inequity of the burden on vulnerable segments of the population – in particular Black Americans and others of color, and of people in poverty. Add again the acutely escalating evidence of systemic racial inequality in our local and national institutions and worldwide. More lives lost and disrupted. <\/p>\n

Maybe the worst of times\u2026. But in what way could these possibly be the best of times? Dickens, remember, is writing of the past: it WAS the best of times, and it WAS the worst of time. And it is with perspective that we should take OUR measures of the present circumstances, and place our judgments upon the recent events. <\/strong>What is the \u2018best\u2019 that will come out of all this disruption? Are we even in a position to judge best and worst, good from bad, without historical perspective? Perhaps this will seem an odd and maybe even insensitive question, but: IS there really a good and a bad when it comes to current events?<\/p>\n

The answer, of course, comes from Star Trek. Yes, we are nerds. As some of my students, residents and fellows know, I think most of life can be reduced to an analogy from the original Star Trek series. In the award-winning episode \u201cThe City on the Edge of Forever\u201d – McCoy is delirious on some medication, and jumps through a time portal to inadvertently end up in NYC in 1930. And this of course somehow changes the entire course of history. The Enterprise and the Federation no longer exist. So Kirk and Spock jump through the portal to enter a week earlier to figure out what happened and change it back. Spoiler alert: it turns out that because of McCoy\u2019s presence, Sister Edith Keeler – a compassionate young social worker played by Joan Collins – lives to become a pacifist who eventually delays the United States entry into WW2. Nazi Germany gets the bomb first, wins the war and changes history. Spock, with only vacuum tubes to play with, amazingly figures out that she must die<\/u> for the Allies to win the war, save the world and the galaxy! Tough stuff! Ultimately Kirk, despite of course having fallen in love with her, has to restrain McCoy to prevent him from saving her from being hit by a truck. Of course, the Enterprise reappears and the galaxy returns to normal, but who could watch and say her death is anything but horrible? Kirk is conflicted and distraught. Spock is, well, Spock. And McCoy is incredulous because he doesn\u2019t have the perspective of history. And THAT\u2019s the point. It is only with this perspective, from the passage of decades, that this tragic event can be understood to be, in fact, a \u2018good\u2019 thing. The lesson here is that to judge is human hubris. We can\u2019t judge until we know the \u2018end game\u2019 which we never<\/span><\/strong> know. <\/p>\n

Can we, and should we, apply the same reasoning to \u201cdisruptive\u201d technology? We definitely value disruptive technology as \u201cGood.\u201d The iPhone and Android and cell communications, GPS, Waze, – I even take it to work 4 miles away, social media. They keep us connected and even oriented in this increasingly centrifugal and disorienting world of mobility. We can stay in touch with parents and children moment to moment, keep long distance friendships warm. Capture crimes in real time. Turns out the revolution IS being televised, and that is the key! This is indubitably \u201cGood.\u201d On the other hand, kids \u2013 and grown-ups too – sit in rooms all alone, seeing everyone else\u2019s movie-lives, feeling increasingly isolated. And people are willing to say almost anything to anyone on social media, never confronted by the person sitting across from them, and the resultant empathic activation of their own anterior cingulate cortex. This fuels polarization and the echo chamber. This is indubitably NOT \u201cGood.\u201d \u201cDisruptive technology\u201d \u2013 both good AND bad. Yin AND Yang. BOTH\u2026or \u2013 lesson 1 \u2013 neither.<\/p>\n

Spock had to twiddle with vacuum tubes in 1930. But in 1947 Bell Labs gave us the transistor, one of the most disruptive of technologies in the history of mankind. Today\u2019s electronic connectivity is the direct outgrowth of the Bell Labs environment – fostering direct and unregulated collisions between scientists and engineers, yielding the transistor and unleashing Moore\u2019s law, cell communication, and the laser \u2013 something near and dear to me. <\/strong>I have tried to emulate in some small way this concept in the Emory Neuromodulation Technology Innovation Center which I had one of the great honors of my career to found with the towering figures of Mahlon DeLong and Helen Mayberg. Here they are, and there in the lower left corner with my predecessor at Emory – the late, great Roy Bakay. (Emory always gives out these OR hats when we are being filmed). Anyone who doesn\u2019t know who Roy Bakay was please look him up. Roy\u2019s departure from Emory in 2000 gave me the opportunity of a lifetime. <\/p>\n

Our mission at ENTICe is to innovate new technology for the treatment of neurological and psychiatric disorders and our modus operandi<\/em> is the collision of clinicians, scientists, and engineers, like the environment at Bell Labs that yielded the transistor. And we presume that such innovation is good \u2013 who wouldn\u2019t? \u2026All but the most entrenched Luddite would judge the transistor to be \u201cGood.\u201d But do we yet have the appropriate perspective of time, do we know the endgame? The transistor is certainly the basis for the incredible and literally mind-expanding advances in our own field of functional neurosurgery. It is the basis for deep brain stimulation \u2013 both the \u2018dumb\u2019 kind and its open loop stimulation, and \u2018smart devices\u2019 that can analyze an endless stream of data coming from both inside you and from outside, too. The transistor is the enabler of AI, which can diagnose you with depression or coronavirus, and which can figure out if your beta oscillations are too high or too low. All of this is, ostensibly, \u201cGood.\u201d But what happens when, not<\/span><\/u> if, we lose control of this, as asked by Yuval Noah Harari, the Israeli historian and author of \u201cSapiens.\u201d His 2nd<\/span><\/sup> book, \u201cHomo Deus: A Brief History of Tomorrow\u201d is one of the most expansive and mind-expansive books I have ever read \u2013 actually 3 times. Another spoiler alert: It\u2019s all about the data: data is lord, he convincingly argues, always has been and always will be. Homo Sapiens\u2019 superior command of the data was responsible for our species\u2019 ascension. It was the underpinning of the triumph of agriculture. And more rapid data transmission within the marketplace was why, he argues, communism capitulated to capitalism. But, he posits, as Homo Sapiens, for the first time, loses<\/span><\/u> the battle of intelligence to the artificial kind, left only with consciousness in our corner, we will have to join em because we can\u2019t beat em. And thereby become Homo Deus, or Man God, when we all have devices implanted in or on our heads, and assimilate with them and the data. We are already altering humans with onboard computers \u2013 that\u2019s the holy grail of functional neurosurgeons! And yes, we believe we are doing \u201cGood.\u201d Helen does\u2026I know I do. But when will it cross the line? When will WE cross the line? Is the advent of cognitive augmentation even in doubt? And given that it would be self-paid, will it lead to empowerment of the haves over the have nots? And, Harari wonders, are there cultural, socioeconomic and\/or racial factors – call them classifiers – that will decide who has them and who doesn\u2019t? Smart devices are \u201cGood.\u201d But, this is perhaps NOT so \u201cGood.\u201d Disruptive technology \u2013 both good AND bad. Both Yin AND Yang.<\/p>\n

I was honestly depressed for months after reading Homo Deus \u2013 thought I\u2019d need one of these stimulators. Are functional neurosurgeons unknowingly – in our unbridled enthusiasm for shiny new toys – being complicit in the demise of our species? <\/strong>I even invited Professor Harari to our meeting in 2022 to discuss this, but his AI said he was busy\u2026next year. But then my friend and 1st<\/span><\/sup> MD\/PhD student, John Rolston, now functional neurosurgeon at University of Utah \u2013 the site of my own 1st<\/span><\/sup> job \u2013 put me onto Steven Pinker, the Harvard cognitive psychologist, psycholinguist, stylist, and somewhat controversial popular writer, and in this situation my life-raft. In Enlightenment Now – his most recent book – Pinker in some detail catalogues how \u201cDoomsday Scenarios\u201d \u2013 such as Harari\u2019s – have always been with us, and he even cogently counters the Harari thesis. The trajectory of humanity has steadfastly, if not steadily, been upward. The apocalyptic fear of nuclear holocaust has not manifested – at least not yet. Global famine from explosive population growth \u2013 the apocalyptic Malthusian theory re-popularized by Paul Ehrlich in 1968 – never manifested because both curves were incorrect \u2013 population growth is actually going down and food production up – although that didn\u2019t stop Dan Brown from coming up with his own twisted pandemical solution to our Inferno. Whether it is poverty, violent deaths, life expectancy, and myriad other metrics, the arc is improvement – ups and downs, but always improvement. Perhaps we are<\/span><\/u> now in a downcycle, a correction. But alas, we always come out of it, and it is always<\/span><\/u> in fact technology that comes to the rescue. And when we are despondently looking into the future, we never know the technology around the corner that will be our savior. Maybe it won\u2019t come this time, but it always has in the past. Perhaps Zoom meetings, such as this one, are part of the good technology to come out of this pandemic, and will help mitigate global warming. For certain, Telehealth is; we\u2019d been working on this at Emory for 10 years to no avail, and it literally took 1 week to implement, and our patients love it. Neurosurgical house calls save gas, time, money, and aggravation, and maybe our planet. As reasonable as Professor Harari\u2019s arguments are, I am more inclined towards Pinker\u2019s more so-called \u2018possibilist\u2019 if not \u2018optimist\u2019 views. Technology will come to the rescue\u2026.<\/p>\n

But will disparities in the adoption of new technology, such as AI and smart devices, inevitably lead to Harari\u2019s mythical Homo Deus. I argue that it won\u2019t, not because we, Homo Sapiens, and functional neurosurgeons in particular, have the will to stop it \u2013 I don\u2019t<\/u> think we do. It\u2019s because, as he says, \u2018data is lord.\u2019 Data has to be transmitted, and that happens through connectivity; connectivity between neurons\u2026 and people\u2026 and communities. And connectivity between people and communities is ever increasing – again due to the transistor. Increasing connectivity links components in ever enlarging systems or networks. And systems have principles governing their behavior. <\/p>\n

How do these systems behave? Systems theory applied to business was developed into The Deming Philosophy, which was arguably the major driver of The Toyota Production System. This may seem trite and obvious, but it\u2019s not: as he said: \u201cIt would be better if everyone worked together as a system with the aim for everybody to win.\u201d The individual must appreciate their role in the system and their interactions with others. Many of us are experiencing the Lean system in healthcare these days. These principles include, amongst many others, the following: <\/p>\n