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Science, Ethics … and the Future ?

UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE. Science, Ethics … and the Future ?. Richard M. Satava, MD FACS Professor of Surgery University of Washington School of Medicine and Program Manager, Advanced Biomedical Technologies Defense Advanced Research Projects Agency (DARPA) and

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Science, Ethics … and the Future ?

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  1. UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE Science, Ethics … and the Future ? Richard M. Satava, MD FACS Professor of Surgery University of Washington School of Medicine and Program Manager, Advanced Biomedical Technologies Defense Advanced Research Projects Agency (DARPA) and Special Assistant, Advance Medical Technologies US Army Medical Research and Materiel Command idea Toronto, CANADA June 17, 2004 City 04

  2. “The way to predict the future . . . . . . is to invent it ” fund Alan Kay RMS

  3. Full Disclosure

  4. Confidential Air Force 1 - refit Unofficial Administration request

  5. Virtual Surgery for the Future?? Figure 4 Scott Fisher wearing one of the first head mounted displays at the NASA Ames Research Center virtual reality laboratory – ca 1985. (Courtesy of Dr. Scott Fisher, PhD, Telepresence Research, Inc., Palo Alto, CA)

  6. Not quite ready for Prime Time !!

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

  8. The new technologies are emerging from Information Age discoveries to FUNDAMENTALLY change our approach in all areas of medicine . . . EXAMPLES Critical Basic Concept This is a revolution

  9. Holomer Total body-scan for total diagnosis From visible human to Virtual Soldier Multi-modal total body scan on every trauma patient in 15 seconds Satava March, 2004

  10. “TriCorder” Point-of-care noninvasive therapy HIFU High Intensity Focused Ultrasound for Non-invasive Acoustic hemostasis Courtesy Larry Crum, Univ Washinton Applied Physics Lab

  11. 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 “ . . .is aware of everything (patient) . . .” The LSTAT Courtesy of Integreated Medical Systems, Signal Hill, CA

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

  13. Intuitive Surgical, Inc. system Fred Moll, Intuitive Surgical, Menlo Park, CA

  14. Remote telesurgery “Operation Lindberg” First remote and trans-Atlantic Telesurgery procedure ROUTINE telesurgery from Hamilton to North Bay 300 mile distant Prof. Jacques Marescaux, IRCAD Dr. Mehran Anvari, MD McMaster Univ, Toronto CANADA

  15. Why robotics, imaging and • modeling & simulation • 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 . . .

  16. “Penelope” – robotic scrub nurse Michael Treat MD, Columbia Univ, NYC. 2003

  17. The Operating Room of the Future

  18. Creative Thinking How can I think OUTSIDE of the box When I don’t know where the edges are? OR S Am I still inside?

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

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

  21. The Future of Science Information is critical but not sole-sufficient Science is moving toward interdisciplinary fields Science must encompass all dimensions (or domains) Must alsoinclude time and information ? BioIntelligence Age SATAVA 7 July, 1999 DARPA

  22. Clayton M Christensen

  23. 2000 BC 0 1500 1800 1900 2000 AD TIME (year) BIO INTELLIGENCE AGE AGRICULTURAL AGE INDUSTRIAL AGE CONSUMER ACCEPTANCE INFORMATION AGE TECHNOLOGY DEVELOPMENT BIOINTELLIGENCE AGE Satava 29 July 99

  24. The BioIntelligence Age Biosensors Biomaterials Biomimetic PHYSICAL BIOLOGIC FUTURE Genomics Bioinformatics Biocomputation Robotics HPCC/WWW MEMS/Nano INFORMATION Satava 2 Feb 1999

  25. Global Concepts ?? BioIntelligence Age (what are the implications) The entire world is becoming “smarter” - embedded intelligence RF-ID, “smart dust” Networking provides distributed intelligence (informatics, telecom) The next wave will be Bio…..X mimicking or incorporating biologic processes Understanding biologic processes is a cornerstone (4 1/2 Billion yrs) 7 SATAVA 7 July, 1999 DARPA

  26. Antenna IC circuit Connector Chip substrate RF-ID Radio-Frequency Identification Courtesy David Brock, Auto-ID and MIT, Boston, Mass

  27. University of Montana, 1999

  28. University of Wisconson, 1999

  29. Capsule camera for gastrointestinal endoscopy Courtesy Paul Swain, London, England

  30. “BrainGate” John Donohue, Brown University, 2001 Richard Andersen, CalTech, 2003 Greg Kovacs. Stanford University, 1990

  31. Recorded activity for intended movement to a briefly flashed target. TARGET PLAN MOVEMENT Time Brain Machine Interface – Controlling motion with thoughts Courtesy Richard Andersen, Cal Tech, Pasadena, CA

  32. Thoughts into Action Direct brain implant control of robot arm Miguel Nicholai, Duke University, 2002 Satava March, 2000

  33. Spinal Instrumentation Antenna Electronics Module Strain Gauge Pressure Sensor Smart prostheses Neurosurgical MEMS for Monitoring of Spinal Fusion Courtesy: E.C. Benzel, L.A. Ferrara, A.J. Fleischman, S.Roy

  34. Tissue Engineering Artificial Ear Liver Scaffolding Artificial Blood Vessel J. Vacanti, MD MGH March, 2000

  35. Courtesy of J. Vacanti, MD MGH March, 2000

  36. Orb spider - web Spinnerette of spider Spider silk protein as biomaterial -BioSteel Nexia Biotechnologies, Montreal Canada Cross section of synthetic fiber

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

  38. Courtesy Dr. Ralph Merkel, Center for Biologic Nanotechnology, Univ Michigan, Ann Arbor, MI

  39. 4 m Spatial/temporal control of structure, function, morphology over multiple length scales Eisenstadt DARPA Feb. 2000

  40. Bacteria with flagella – Biology’s nanomotor

  41. *Courtesy: Richard Smalley, Director, Center for Nanoscience Technology at RICE UNIVERSITY

  42. Research in hibernation suspended animation hypometabolic states resuscitation reperfusion Relative size of subjects Alaska Black Bear Artic Ground Squirrel

  43. Institute of Arctic Biology’s Toolik Field Station, Alaska's North Slope Suspended Animation Brian M. Barnes, Institute of Arctic Biology , University of Alaska Fairbanks 11/02

  44. active hibernating heart rate 300 3 (beats/min) resp. rate 150 <1 (breaths/min) body temp. 37oC -2oC gene ongoing transcription function and translation suppressed metabolic rate 0.5 0.01 (2%) (mlO2/g/h)

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