AI in Brain Surgery: Medtronic Fireside | Thomas Anglero

Thank you for participating in this educational event. This program, sponsored by Medtronic, is intended to educate and train customers regarding the approved or cleared uses of Medtronic products. As such, unapproved products or indications may not be presented or discussed during the program.

Please welcome to the stage the president of Medtronic Cranial and Spinal Technologies, Skip Keele.

It is an absolute pleasure to be here with you this evening. I see everyone kind of making their way in, finding their seats, and Welcome to Las Vegas. Welcome to, uh, kind of what we're doing with Luminate. This is a, uh, a first event for us, uh, here at Medtronic. We're switching it up, changing the idea of education, uh, on a number of different levels, and, uh, looking forward to the partnership and collaboration. And this is less about Medtronic and much more about you and the time you spend here, and you'll get out of it, uh, what you put into it. Uh, we've got an exciting program planned. For the rest of the evening and then obviously tomorrow. So look forward to spending some time with you. So let's get started. You know, when you think about the Wright brothers, the question was always the right question. And they really acknowledged the challenges that were at that time. And they talked about, you know, could they create sustained and durable flight? It's kind of what's going on in the industry today. How do we drive ourselves to a better outcome, in cranial and spinal technologies. Uh, and we're all in the business of solving the problem with asking the right question. And they achieved something that was seemed impossible at the time they did this. 120 years ago, 120 years ago, they flew 120 feet over 12 seconds. And how they did that was they decided on a direction. They created momentum, and they took advantage of the right conditions. Similarly, what's going on in our industry today. All of us, all of you, we're in the business of turning science fiction into science fact. We're actually doing this in a quite similar way. We are transforming the standard of care in our industry, creating more outcomes than that are more predictable and that are going to create an environment that they're more replicatable. Now, two other pioneers asked a very similar question. What if and why not they could correct scoliosis in a different or a better way? And if you look to the left, Dr. Courtel, and to the right, Professor Dubosset, Gretel in 1983 made a decision to evolve the industry in a very different way. They created the first approach to correct the spine in all 3 planes, the coronal, the sagittal, and the axial. In fact, the CD in our CD Horizon product that's been around for over 40 years is actually named for Dr. Gretel. And Dr. Duboiset. These two pioneers, much like the Wright brothers, set the tone, set the change in motion. If you think about what we're doing here at Medtronic, we're in the business of creating a legacy, and we have this history and heritage of disrupting the industry. You're going to learn a lot about ABLE over the next few days. You're going to hear about what it is, what it's going to become, and where we're going. We've gone from plastics and metals to procedural workflow and ultimately to the digitization of healthcare and the influence of AI, machine learning, and smart implants. And what if robots could really create this inference of information, data, and analytics? We are partnering with some of the best and the brightest from a teaching perspective, on really leveraging all of this technology and really giving ourselves an opportunity to really move this organization and move this industry in a different direction. Think about this quote here, "Machine intelligence is the last invention that humanity will ever need to make," by Nick Bostrom. Nick is an Oxford University professor, theoretical physicist, computational neuroscientist, logic and artificial intelligence. The one thing I would say is this pandemic that we've exited has really driven us in a different direction. They've allowed us to take on the adoption of technology that typically would've taken 7, 8 years to happen. We've done that in over a year. It's allowed us to do anything from DoorDash, everything, to have Amazon deliver whatever you want, self-autonomous driving cars. I had an opportunity to get into an autonomous driving car a few months ago, and it was a very unnerving experience. I was sitting in the passenger seat. There was no one in the driver's seat. And when I was able to do that, I really had to like just process my brain because there was no brake, there was no steering wheel. I was at the influence of this machine and it was really amazing because for about the first 15 or 20 seconds I couldn't breathe. I was holding my breath because I wasn't sure exactly what was going to happen. But as I was cruising around the streets of San Francisco, I kind of liked it. It was pretty interesting because I got to take in what was going on around me and it created a different paradigm I was at JP Morgan, uh, a few weeks ago, and, um, the former UK Prime Minister Tony Blair was speaking, um, and he shared this fascinating insight around the influence of artificial intelligence and the effect that it's gonna have not only on healthcare, but in all industries. And he made a statement that was pretty profound from my perspective. Artificial intelligence will have a more profound effect on society and where we're going and what we're doing than the Industrial Revolution had on the 19th century. Just think about that for a moment. Think about the Industrial Revolution, light, railroads, a lot of different topics happened over that 100-year period. Pretty amazing. You think about where we're going with robotics and harnessing the power of machine learning, data analytics becoming a more predictable and safer environment for all of us in what we do on each and every day. You know, GPS is a relatively novel concept now, but do you remember the days when we were running around with plastic-coated maps and Thomas Guides where you're having to flip open, look at A12 and figure out exactly where you're going and flip to page 437? It was about this thick, looked like a giant notebook and former phone book. But that really is allowing us the opportunity to create GPS. You think about Maps, we think about Google and Waze. It, it's really a pretty amazing environment. You don't even think twice about it now. You just get in your car, you pop in where you're going to GPS, or you just speak into your phone, it takes you where you want to go. So we're, we're not quite there with surgery and what we're doing on the cranial and spinal side of the business, but very similar into where we're going and what we're doing. You've seen or heard a little bit about ABLE. This is really the next frontier from surgical innovation, and it's really being built on the opportunity for connecting everything in the ablement of our environment. We're focused on predictive planning, performing with ultimate precision in what we do, and really allowing us to, with the partnership of surgeons, trailblaze in advancing your craft. This is with you and with us, Changing the paradigm of surgery. You know, and ABLE's really a customized solution that integrates into the connected care environment, predictive technology, and advancing surgery. So with that, I'd like you to learn a little bit more about ABLE, and we'll take it on to the next speaker.

Please welcome to the stage Dr. Michael Lawton, Dr. Russell Launser, and Dr. Tiffany Hodges.

Well, can you hear me? Yes, sounds like the mic is on. Well, I wanted to start things off just by thanking all of you for taking time out of your schedules to be with us tonight and tomorrow. This is a very exciting program, and we've been working over the last 2 months to try and put together some good agenda, good program for you, and I think we've done it. So again, thank you for the time, and we hope you like this. Just, you know, Skip gave a nice introduction, and I think, you know, we— I just want to give a couple remarks to get the night going. We really are, as he mentioned, in the middle of another revolution, a digital revolution, and it's just a really remarkable time. I think about some of the work that I've done over my career where trying to get a grading system or some way of making surgical decisions has always been a matter of taking a lot of information and then simplifying it down to a point here and adding up a number, making something really complex into something very different. And now we're really on the edge of being able to go the other direction, where we can put more information into that black box and come up with more complicated ways of making those decisions and managing patients. And so it's a— it's an entire paradigm shift or a change of the way we think. So I'm excited about what is happening, and we're going to really delve into some of those issues over the next 24 hours. The other theme that's kind of come up in Skip's talk and also in talking to our exciting speaker who you're going to meet in just a minute is this concept of disruption. And I think with all of the AI, machine learning, deep learning that we're going to be talking about, We are poised for an incredible amount of disruption that will happen very shortly. And we're going to talk about all those things. But this idea that engineering and computational science is here and it's transforming what we do, I mean, it really is now. And so this is what this is about. We're going to spend all this time over the next day talking about what that looks like, how you can get involved, what we think it might look like. And it's a great topic. So that's what we're set out to do. And any other remarks, Russ and Tiffany?

I'll just echo what, you know, Mike, what you said. I think this is— we spent a couple months planning this with Medtronic. And I think it's going to be a great event. I think what we're seeing here— and Skip alluded to this, and we talked a little about this earlier this afternoon— is I think what will happen in the next 10 years would have, you know, is will mirror what's happened over in medicine. The last 100 years, the pace at which things are occurring is absolutely remarkable. All the information, you know, from when I trained, you know, finished up training over 20 years ago to now, the amount of information, the amount of tools in our armamentarium is mind-boggling today. We could never imagine even 20 years ago that what it would be like, and I think what you're going to see, you know, today and tomorrow is a platform now that allows everything from the preoperative, the intraoperative, and postoperative and exploits AI along that platform to really improve care, make more consistency among surgery, the individual surgeon and across surgeons. So it's really probably, I think, the most exciting time to be a neurosurgeon and to be in medicine.

So—

Yes, just to echo what Mike and Russ said, we are at an age where technology and the future of AI is coming to a head. And so this meeting is extremely important. We've really enjoyed being able to put something together for you guys to enjoy for the next 24 hours. One thing I want to encourage you all is to stay curious. I'm really looking forward to the expo today, as well as the small group discussions. But feel free to ask questions and challenge each other this evening. Thank you.

Thanks.

OK, well. The highlight of the night is gonna be our guest speaker, and Tom, where are you? Do we have an intro?

Joining our chairman, Dr. Lawton and Dr. Launser, please welcome to the stage guest speaker Thomas Anglero. Good evening. Good evening.

Well, Tom, thank you for joining us. You've come a long way from Norway, and just so everybody knows, we— it's a long way to travel, and we really appreciate you taking the time to do that. So you're a world authority on so many different things, so I'm gonna just let you introduce yourself and some of those things that you're the authority on.

Okay, so I've learned through many years of experience to introduce myself in a different way. I am a proud husband. My wife always says, "Make sure you say that first thing or I'll divorce you." So I'm a proud husband. I'm a father of 3. And on the technology side, I've been a nerd for 20 years. I've worked in some of the biggest companies in the world. IBM, Ericsson. I now work with Cognizant. I've just launched my fourth startup, and my fifth one, I'm registering that one now. And here's an inappropriate but great story. You guys could turn red as I tell the story. So another thing about my wife, I always talk about her. It's a risk, but it's the truth. So in my world, being married to me, Typically, when you nudge your wife at 4 o'clock in the morning when you're in bed, that usually means something else. Everybody's got that in their mind. With me, my wife, she goes, "Oh no!" But for different reasons. Every time I nudge her at 4 o'clock in the morning, it means I'm quitting my job. Because there's an idea within me that I have to give birth to. I have to give birth to this idea. I have to— I would leave everything I know that is secure and bring to life this idea, this, and I'd start up another company. And that's who I am. And it's a high risk, but it's a lot of fun. And that's my intro.

So, well, one of the things that came out when we were getting to know you backstage was that You had an interest in medicine and being a doctor, and you put that dream aside to become this entrepreneur and give birth to all these ideas. And I just want to tell you that Russ and I are probably the exact opposite. We were committed to being doctors and going to med school and following that path. And I don't know about Russ, but like, as I've gotten older in my career, I've learned that like the entrepreneurial side is really exciting, giving birth to ideas, building a program for this or that or the next great idea. And that has become a passion late in a career, but only after the medicine. And I just wonder if you can talk us through how you went through your life with that early interest in medicine and your entrepreneurship and bringing those together.

Well, what a great question. Did somebody pay you?

That was awesome.

So back to the wife thing. I can't help it. I'm trying to get brownie points. So I was a full-time engineer and doing my pre-med in the evenings and weekends. I got a full scholarship. And my wife, who's Norwegian, she moved back to Norway. When she moved back to Norway, this is— I'm gonna date myself, I'm old as hell. So what year was this? This was 1992, and that was dial-up internet. And it cost $15 a minute to call Norway back then. That's a lot to keep a long-distance relationship. So one of my claim to fames is I'm the 10th person in the world to ever use the internet as a phone call. So this startup company in Israel, they launched a company to make internet telephony, And within 10 minutes of them launching, I was on the call with the CEO in Israel saying, "Give me access to the software. I gotta save my relationship." So love drove me the tech and made me more innovative. And then I left my life, 'cause she gave me the ultimatum like women do. Is that, it's the truth. And she said, "Either you go become a doctor or you move to Norway and be with me. You have, make a choice." And I chose love. And when I landed in Norway, I said, what am I going to do? I was— I had learned so much about technology and internet and telephony, and that just led me down this career. So following my heart, following the woman I want to spend the rest of my life with, and we're still together, has led me into this life. Take risks, go for it. You know, going for love actually gave me a whole new career. I would have been a boring engineer in New York City. Instead, I'm now 28 years in Norway, and I still suck at skiing. You know, but, you know, it creates an interesting personality. And I think one thing I can say to all you amazing doctors, and that is that— and you two especially, because I hear you two are like really famous and really good, and that you possibly be turning red and saying thank you very much. No, as good as you are, and I meet a lot of great people along the way, you should always say to yourself, "I can be better." You know, as much as I get a lot of publicity and I'm flown around the world, and whenever I get off the stage, I always go, "Damn, that was horrible. I can be better." The best people in the world, the best billionaires, and the reason why they stay billionaires, I can be better. I can be more. You know, you take your wife out to dinner, blah, blah, blah. I could do that better. Every attitude in, in your life should be, I can be better. Never accept who you are and what you did. That's your old reference standard. Where can I go now? And, and with AI, I think that's why AI is exploding is because all the nerds in the world are going, we can do this better.

Yep.

And AI is moving at a rate that is nothing I've ever seen in tech move this fast.

So Thomas, you had a chance to look around some of the things at a high level that's happening in neurosurgery here.

Very cool.

Yeah. Yeah. What, you know, and we'll come back to that in a bit, but what do you think when, from your context of where AI machine learning is going and seeing what some of the things that are happening right now in neurosurgery, what do you think are going to be the most impactful areas that are going to impact us as surgeons and medicine in general? From your perspective with what's happening with data management, disruptive data, that type of stuff?

Well, that's a lot to answer there. So I'll put the good stuff, then I'll put the bad stuff at the end. The good stuff is you're going to become immortal. I get you to laugh. That's good.

That's cool.

Okay. So what do I mean by immortal? See your— so what we can do today is in my head when I was preparing for this conference, I was thinking, what story can I tell? And so this is a story for both of you. You're both in an operation. Wouldn't it be amazing during this operation to have with you, let's say you have on the Apple, I forget what the name, their new product of the virtual reality headset, what it was called. In that virtual reality headset, during the operation, you will have through artificial intelligence, you will have the other world-famous surgeons with you. The gentleman or woman from Italy, the other one from Japan and China, they will be with you, watching what you're doing, talking to you. You could be talking to them, interacting with them, and this is all through software. Now they actually aren't with you, they're asleep or whatever in different time zone, but wouldn't that be amazing to have all those people with you? And then vice versa, You can duplicate yourself all over the world to other surgeons all at the same time. This massive sharing of knowledge and learning all the time. You're right there about to do something and one of the surgeons, one of the, your colleagues from around the world can say, "Can I show you a video quickly of what I did in this situation?" And you take a 5-second break, watch it, very interesting. This is all possible today. So I'm extremely excited, like I want to jump up and down excited for all of you. And also when I talk to young doctors, I'll give you a story. I was at a presentation for— at a hospital, and this is going to the negative story. And I walk into the room and it's a long table. And of course, at the end of the table is a senior doctor. You know, I've worked 40 years. I'm the head of this department. And as you went down the table, the younger and younger doctors, anybody familiar with this situation, whatever. So, uh, at the end of the meeting I presented, uh, AI and I presented what we could do. And at the end of the meeting, the senior guy goes, no. One hour presentation. All he said was no. I walked down the corridor after the meeting, walked nice and slow cuz I knew exactly what would happen. 2 of the youngest doctors came running after me and they go, Thomas, what can we do to implement this stuff now? These, the young doctors, your kids, you know, they're called, every child now is an iPad kid 'cause every parent gives their kid an iPad. What we're doing is we're training them. Those kids are brought up, they only know AI. AI is in every culture, every country I travel around the world, every child has got a damn iPad or iPhone. They only know AI. You cannot stop what is already here. It is not coming. It is here. Embrace this. I know it's uncomfortable, but it's okay. Some of the moments in life that we progress the most are the most uncomfortable. It's okay.

So if you don't mind, I'd like to drill down a little bit because I love the vision and I agree with you. I think The future for a surgeon is to bring in all of this additional information that we now operate without. Yeah. And the question I have for you is, can you just take us another layer deeper? And you mentioned a little video snippet, but like, how is it that you see that coming to bear? You're at a critical moment in a case and an aneurysm, a blood vessel starts to bleed. Like, what is it at that moment that AI will do for us?

Wow.

So there's— I, I see two answers to that. So one, repeating myself again, AI will be able to provide you with your colleagues from around the world giving the best advice in that moment of what you should do, what they have done historically. So one of the things, thing when people think about AI, AI is trained on what people have done before, right? So what people don't know and what we don't want to admit is the scary part of AI. Is that the AI of today, ChatGPT, it's making its own decisions and we don't know why. We did not train it to do that. We trained it to say, learn from everything that's done before. So the answer to your question is, in that moment, the AI will say, have you thought about this? Even though this is never done before. Before we talked about this, we talked about— what was that?

We were talking about Move 37 with the Watson Project.

There we go.

I was just going to ask you—

There you go.

So do you think that this AI technology can provide the surgeons moves that have never been done before?

Yes, it will. And in that moment, you have to make a judgment call. The AI software will only advise you. It's up to you. And you'll see, you'll have many move 37. So people know what we're talking about. So two nerds talking to each other. So IBM, do you guys remember IBM compete against Garry Kasparov something in chess and it beat him? Yeah, AI. And then was, was it Go?

Go.

Go, the Chinese game. And IBM beat the champion and move number 37. 37 was a move never done, it's ever seen before. Now, what was interesting about move 37, remember, AI learns from every other person, whatever they done. Move 37 was never done in the history of the game Go. It was never programmed. And when it did move 37, everybody watching, and they said, the two commenters said, "That was an alien move." The IBM developers spent years looking at the code going, "Where the hell did that come from?" And what happens now with the AI, especially today, and that was like 5 years ago, 7 years ago, especially if you look at ChatGPT, because it's using, utilizing neural networks like our brain is, but nowhere near like our brain. Trust me, we are at infantile stage compared to what's up here. We don't know why it's learning when we're telling it don't learn. It actually is learning on its own and connecting dots. Remember, it doesn't forget. So every medical book, everything you ever learned about anatomy, which you probably know, you're good at that, so I won't challenge you on that. Every conversation you ever had, every smell you've ever smelled, everything you ever touched in your entire life. Do you remember when you were in 4th grade? What was the teacher when she yelled at you that Tuesday? What color socks did you wear? It remembers that. Now imagine all that knowledge, all that information available to you at all time. Who are you now? One joke I like to make is, When you guys were in college, did you drink beer?

Oh yeah.

Oh yeah. You didn't say anything.

Okay.

Are you a wine man or something?

No.

Okay. And do you remember that Friday night when she knocked on the door and said, do you want to go out party? And you went out partying?

Yes.

Yes.

The AI is that version of you that actually stood there working. Imagine that version of you that was diligent. And I know you guys were diligent. I'm just making fun of you guys. But that ultimate version of you with you at all time, that's where we are today. And one last thing, and I could talk too much, but, uh, Google, you know, you have ChatGPT done by OpenAI and then the competitors Google and they launched Gemini 2 weeks ago and is 1.0. Last night when I landed, they announced version 1.5. They said 2 weeks ago version 1.5 will take 6 months to 2 years to get— no, 6 months to a year to ready with version 1.5. They did it in 2 weeks because 1.5 learned itself and matured. We're moving at 1 year per 2 weeks. It's going faster and faster and faster.

It's like Moore's Law for AI.

And Moore's Law doesn't even make sense with this algorithmic turn up. So you should be so excited about all of the resources, all of the information, how much better you can be, how much better care you can give, how much more free time you could possibly have so you could play some more golf? Yes, no? You guys don't laugh much. No.

Well, so we're a bunch of surgeons, and we're actually probably a little nervous when you start talking like that, because what we're thinking is, if this is going so well, what about the robots who are going to come in and take our jobs away from us? Can you talk about that?

I'm laughing because I'm nervous. Okay, so here's a fact. The robots are going to be here on August 1st. Put it in your calendar. I got you smiling again. This is good. This is good. So here's the fact. Um, what are they called? Yeah, so the startup is called Figure.ai. That's their website. They make a humanoid robot. They have an order now from the top Fortune 100 companies in the United States. They all have— are under contract to— and they've all ordered thousands of these robots. But the order wasn't just for the robots. To make the order, they had to provide Figure.AI with all of their training data because these top Fortune 100 companies want this robot to be trained in, let's say, factory work or something like that. The top Fortune 100 companies in the United States have all given all their training data for launching these robots August 1st. This is done. The robots are here. And it starts August 1st. And it's being backed by tens of billions of dollars and data from these companies, and the number one repository of data, it's the coolest thing, Anybody know where's the biggest repository of data of how-to? Anybody? Yell it out because I can't see you. Where's the biggest how-to place in the world? YouTube. Oh, somebody here nailed it. Every time you guys put on your iPhone, said, this is how I change a tire, you were training the robots. Every time you do so and then they're cooking food, you're training the robots. So all these robot companies have these robots watching YouTube and they're mastering us.

So you touched on a little bit just now and a little bit before, there's a lot of fear about AI.

Yeah.

So what things should we be afraid of?

I'm sorry?

What things should we be afraid of? And where do you see the biggest vulnerabilities? Not just in surgery, but across everything.

Do you really want to go there?

Sure.

Okay, biggest thing we should be afraid of, um, the fact that we don't know why it does what it does. We have no idea, and it's doing more and more things independently, and we don't know why. We're writing the code with restrictions, and it's still doing what it wants to do, and it's getting better at doing that. But because it does that, it finds solutions to problems that human beings cannot think about. So I was watching a video and this guy said it pretty interesting. He says, soon— you guys are gonna be so depressed by the time I'm done with this talk. So if you're not already. So he said, today is two human beings talking. Within 5 years, it will be like us talking to a dolphin. Because it's connecting dots that we can't connect. But what problems will it solve, right? So, so that's the stuff that disturbs me very, very much. The other thing that bothers me is regulations and regulatory privacy. We need to have that in place. We need to protect people's privacy and everything. There is no question about that. But there are parts of the world, like in Asia, There is none. So very simple. When I talk about AI, AI is like a child. Do you have kids? Yeah.

You got 4.

You must be tired. How old are they?

I got 27, 2 25s, and a 15.

Took a break.

Okay, cool.

So, how many kids do you have?

3.

3, and?

23, 19, and 16.

Okay, so as good papas, what did you give your kids for breakfast? And when they were, you know, little ones, did you give them cereal, or did you give them carrots or apples? What kind of papa were you?

I think I was at work by the time they woke up.

Okay, you were one of those papas. They sleep in. What kind of papa were you?

I raised my children in California, So we were— they ate well.

There it is.

So when you think about AI, AI is just like a child. If you give a child for breakfast good food, it's like giving AI good data. And that's the way we have to look at it. When people talk about AI, it's too general. You have to look at the quality of data. You look at a child. If a child grows up eating apples and oranges and all these wonderful things, it's going to probably be a very good child. If a child, well, I can't pick on you 'cause you weren't home, but I gotta pick on my own kids. You know me, I got in trouble one day 'cause I always, I didn't know in Norway when you give your kids food to take to school, you're not supposed to put in Oreo cookies. And they sent home a note saying, stop giving kids junk food. And they were talking about me. I had no idea it's against the culture. But AI is only as good a data you give it. And in Asia, Because they have no privacy laws, China has a deal with India and they have a deal with Pakistan. So China's 1.5 billion people, India's 1.4 billion people, Pakistan's approaching a billion people, and they're sharing tons and tons of data. In Europe we have GDPR, in the United States, how many privacy laws you have here? You can't share anything, right? Even in a hospital, one department can't share data with another department. How good is the AI going to be when that child can only eat peas? When that kid's 20 years old, it's not going to be a very healthy kid. And so from a technology point of view, there is a war going on. And Western Europe, the Western European countries and the North American countries, we are so far behind. The Asian countries, their AI is incredible because there are no restrictions. It can eat whatever it wants as much So there's just so much behind just AI. When we really want to get into it, it's all about the data. And to all you doctors, I love saying this to doctors, you think you have good data? You don't have good data. Every project we start at a hospital, we start the project, we say, are you sure your data is good? And you doctors go, yes, yes, yes, yes. My data is fantastic in this hospital. You should see the guidelines that I have. We put the data in, 5 seconds later, the whole thing stops. Because the data is not good enough. So data, quality of data is incredibly important.

The data, well, we've tried to spin out a company based on healthcare data, and I'm in a system that has tremendous data. The EMR and the quality of data that's in our electronic medical records in this country is pretty high quality. It's a question of compliance and privacy matters and getting to the data and having people be comfortable releasing that. Do you have any thoughts about how we break that logjam or we get that good data out so that it can actually be used?

Get rid of lawyers. I can't stand lawyers. This is the IT. The lawyers are killing the world. So how to get the data out? The short answer is anonymized data. That's what everybody says. It does work from a technical point of view, but there's so many restrictions. It's a very difficult question because every hospital, every county, every state in the US, it's the lawyers. It's so many— it's gonna take decades. We have to do something about this whole thing about the power we gave lawyers. From a technology point of view, it drives us out of our mind. And the AI that's being, being birthed in the United States is an inferior AI, and the AI being born in other parts of the world is limitless. So it's a huge, huge problem. You as a doctor working in the United States, you want to have access to the best AI? Your AI only eats peas and is only allowed to eat a pea maybe once a day. Do you understand from it? You didn't say my talk about— so it's really these regulations are holding back the innovation globally except for that part of the world. And I'm not saying that better because, you know, well, let me give you a story about the robotics. So in China, everybody knows that as people walking down the street, if you jaywalk, they do something on your credit score and then you get fined. And that's because you jaywalk, because they have everything integrated. But what people don't understand is that the Chinese, their AI is watching you walk. Every human being has a certain gait as you walk. So China's not so much doing it to find people, they're doing it because they're training their robots how to walk. So they have 1.4 billion people walking and their AI is watching you walk. So their AI's ability to walk, its AI ability to run, When you fall down in the street and you pick up your groceries, it understands this is how you pick up groceries. There was a recent startup, they taught an AI how to make a coffee with the little coffee pellet. What is that? Capsule?

Yeah.

And so the guy, the human being, he put the capsule machine and he told the AI, do it. The AI put the capsule in wrong. The robot, sorry, not the AI, I apologize. The humanoid robot put the capsule in wrong. It stepped back, it then took the capsule, put it in correct, it fixed it. And the entire— all the people in the room were like, okay. The developers came running out of the back going, that's impossible. We didn't train it to fix. It should have just repeated what you did. The code self-taught. And then they go, we only wrote the code in 5 minutes. In 5 minutes of coding, somewhere in that 5 minutes of code, it learned self-learning. Where did the self-learning come from? It's exciting where we're at, where the software is self-learning in real time, just like a human being, just like a baby. This is where we're at. It's extremely exciting. And it starts August 1st to make everybody more nervous.

So it's clear that, you know, more and more AI is going to be integrated into our practice in a very short period of time.

What do you—

What will be the biggest barriers, do you think?

I'm sorry?

The biggest barriers to adoption, or will we not have a choice?

Human beings.

Yeah.

People. Every AI project I know of has failed or slowed down or had a problem because of the humans. Egos, a lot of male egos. Older men, we seem to have a lot of problem. We human beings, we have so many issues. We stop things when we're afraid or we're uncertain. Some of you listening to me talk now are going, I don't know if I like AI. He's making me feel uncomfortable. On these projects, they think a lot of these people who, I've been working this for 40 years, I'm finally the boss. I'm not— this thing take my job. It's a threat to my job. Stop the project. Stop the project. So many times it's human beings that are stopping the project. These are our own internal insecurities on a personal level. We bring that into work and it stops innovation. It stops the company from growing. And it's human beings. We're the biggest thing. So I always tell people, reflect, do some spirituality, soul searching, take care of your issues, and embrace innovation.

So I'm going to change gears a little bit. We're with Medtronic. Medtronic is one of the biggest producers of brain-computer interface.

Yes.

And I'd really like to hear your thoughts on brain-computer interface in general and where you think that field is moving.

You're asking nothing but good questions. They're all like landmines.

I'm setting you up here.

I'm setting you up. I gotta buy you a beer or something like that. So I've done a lot of presentations on Elon Musk's Neuralink, and one of the scenarios I see, because Neuralink just opened on their website where if you fill out the information, then you'll be put on a list to to be the next one for surgery. Okay, so they're that far. So here's the story that, here's the example that scares the crap out of me, to answer you one of the things I'm scared of. And that is that as parents, you guys are parents, when your kid is no, when there's another kid in the class who's been chipped and they're getting straight A's and your kid is no longer the smartest kid and all the scholarships all the awards and everything is going to all the other kids 'cause everybody's being chipped. How much peer pressure it is on parents to chip your kid?

It's huge.

It's going to be huge. My kid is not stu— are your kids stupid? You guys look at me like I'm crazy, right? But it is an issue for the young parents today. They will have that pressure of the neighbor's kid is chipped, that kid over there who we all know is an idiot is now getting perfect grades, Do we chip our kid? This is a serious question that's now coming up. And this is going back to humanity, our culture, what are we as human beings, how do we live life? When we talk about chipping the brain, boy, we enter a slippery slope of questions that we haven't had before. And as a parent, what do I do? I don't want to chip my kid, but my kid's not an idiot. But everybody's making fun of my kid. My kid's not being— the teacher's not talking because she's the only one that's not chipped. She's holding the class back. This is an issue that's going to be a serious discussion on tables in the next, what, 1 year, 2?

Yeah.

So that's a— well, Neuralink, for example, you brought up Neuralink. Their focus, at least, out of the gates is in spinal cord injury and getting paralyzed people to use a limb or to be able to control a computer, which is kind of takes all that chip in kids to learn better off the table. I'm curious, getting back to brain-computer interface and its marriage with AI, you know, it seems like just getting that data. I mean, there's an example of what you said, eating peas or getting good data. We're going to be able to get so much good data on how the brain is actually signaling its networks electrically. And AI is going to be really important in unscrambling that language. And so I'm just curious, like, where do you see that going? Do you see, from your vantage point, companies moving in that direction or not?

Absolutely. They have to.

They—

this is the last bastion of what we don't understand, right? Gathering just— I always tell every company, even companies that just got their first computer, and there are a lot of companies that don't have— they haven't modernized, record everything. Don't delete anything. The human brain with the limited amount— we were talking about before that We're able to tap into a certain part of the brain so we can collect the data from that part of the brain, save it all. Today we don't have the algorithms and the understanding to understand it, but we will, right? One of the things, if you want to really mess— get really nerdy, is, you know, and if you— NVIDIA is now making all the chips for all the AI, blah blah blah blah blah blah. What nobody wants to talk about is is quantum computing. Do you guys know how quantum computing works? It's so cool. So here's an example from an IBM guy, one of the people in IBM who works in IBM quantum computing. I asked him, talk to me like an idiot, how does quantum computing work? He goes, Thomas, it's really simple. You know, in a quantum computer, he says, we move it down to almost zero Kelvin. It's almost impossible to get to zero Kelvin. He goes, do you know what happens when you move it to zero Kelvin? Time stops. So what happens if I'm running a calculation and time stops? I can run that calculation for 1 million years, warm up the computer, the clock starts again, and I have 1 million years of analysis. My point to my story, I know your eyes are going, what the hell's he talking about? Quantum computing is, it doesn't obey, abide by the law of physics. So it actually makes sense if you believe that once we leave the world of law of physics and time, then we enter a different realm of dimension in which time is a controlled variable. And I'm getting too nerdy, but to your point, gather all the data because what we don't understand today, we will begin to understand tomorrow. And the software, because it's able to connect dots that we can't connect, like ChatGPT does today, it may understand it literally tomorrow, much faster than we thought it could. So that whole thing, why is it doing what it's doing? It may solve, it may look, what's tomorrow, Friday? Friday, it may connect, look at your data and say, you know what, the brain works in this and such and such way, which may be such an epiphany for you and change the way we all live. And that's super exciting. So yes, record everything. Don't delete any data. Never delete data, ever. And if I could add one more— I'm talking a lot, but I apologize. Your own personal data. We haven't gotten to the part— each one of you have the right to your own personal data. Today, Google knows everything about you, correct?

Yes?

Are you guys on Facebook? How many people on Facebook? Put your hand up. Oh, that's really scary. Okay, so do you want something cool? So Mark Zuckerberg, about 4 years ago, he made an announcement and then he used all his power to delete the announcement, but I saw it. So Mark Zuckerberg said, we at Facebook, we have so much data that we know with 95% accuracy what you're going to be doing 24 hours from now, where will you be standing, and with who. And then he deleted it from the internet like it was never said. So the big IT companies have all your data. This is a problem today. So try to— we need to have people have their own data. We need to have a global bank of people, a bank that stores all your data. Or you should have your own data, and everything you do should be your own. But we're not there yet. Because we don't— nobody even thinks that way. But nobody has the right to your data, so it's a bigger conversation. But I'm excited, but at the same time, there's a lot of flaws in what we're doing.

So as an entrepreneur and as someone who's— I think you said you've taken 4 companies to, to exit. What, what's next for you? Like, what's your next startup or your next big idea that you're Jason?

Oh man, that's so cool. I have an idea of what I want to do, and I know it's wrong. It's fantastic.

You know it's wrong?

Absolutely.

Okay.

The reason why is every startup I've done, the business plan I wrote from day one was wrong. Because as I launched the company, as I talked to clients and partners, terrible. I'm embarrassed by Business Model 1.0. And you mature and you learn and you tear it apart and you learn. You have a meeting with a partner, there's someone smarter than you, and you go, oh really? Wow, okay. Oh man, damn, how much time did I waste on that? And that's the beauty of it, is that I've learned that I have to take my ego, throw that crap away, and go, there are people smarter than me. I'm going to listen to you and I'm going to learn from you and I'm going to take that and make my startup better, better, better, better, better, better, better, better, better. It's, it's the human being that makes the startup better. Technology is nothing but a tool. It's like a hammer. It's just a tool. We are the most innovative thing. Um, I was talking to somebody here today about ChatGPT and all that. That is a virtual advisor. That's like a $15,000 an hour consultant. You don't have to use that. Just use these AIs. ChatGPT. If you have a question, a life question, um, it's Valentine's Day. How many of you guys forgot to buy somebody, uh, your wife, flowers?

Raise your hand.

Not one guy's gonna lift his hands, and about 10 of these guys did. So you should go into ChatGPT tonight. I forgot to buy her flowers. What should I do? It will tell you. You should start using AI in that way. Um, and I use it for for almost everything because I'm going, this is the way it should be done. I have the access to the world's best minds. I'm gonna take my startup, I'm gonna use the best world's best minds, I'm gonna use human beings and geniuses, and I'm gonna rewrite my business plan, I'm gonna rewrite the startup every single day. I don't know where I'm going, super excited.

Are you doing that right now?

I'm sorry?

Are you doing that right now?

Hell yeah. With pride. Yeah. Every meeting I look forward to talking to someone and going, wow, I made a mistake. But I have it in a— I've learned to take it playfully versus going, you know, I'm an idiot. Oh my God, Jesus Christ, what did I do? I go, no, this is great. I just disrupted myself. What an awesome day. That's a much more healthier way of living life than getting depressed every other meeting. You know, I did too many years of that.

I was impressed doing my research on you that you have time for a podcast, and I went to your podcast and—

Oh, you listened to my podcast?

Oh my gosh.

I did.

I listened to an episode on the plane coming out here. Talk to us about that. It seems much more kind of motivational and somewhat spiritual.

Wow.

It's a side of you that Wow. For an AI geek, I wasn't really expecting.

Wow.

You really did.

Okay.

So I love you for that.

Thank you very much.

So my podcast means a lot to me. So the name of my podcast is called The Soul of Innovation. And my podcast, because I'm a geek or nerd, whatever you want to call it, people don't expect me to talk from my heart, to talk about love. To take my insecurities that I have as a person and share with the world. That's my podcast. Because I figure I'm not the only one that wakes up at 6 o'clock, 5:30 in the morning. Almost all my podcasts are done at 5:30 AM. Because I wake up and I go, I feel like, excuse my language, I feel shit about myself. I could have handled that situation so much better. So what I do, I grab a microphone, I turn on my PC, and I record my podcast, and I record my reflection. Let me— and I always go, let me tell you a story. And I tell the story, and then I share what I've done, what I could have done better, because I'm not the only person in the world that thinks this. So my podcast is my version of love to everyone. And if I could share a story, it means a lot to me. I get a lot of amazing emails from people all over the world, but one video I got on Instagram— I hope I don't cry— but this single mom sent me a message and she goes, Thomas, my son is 12 years old and he's not— he's grown up without a father. I'm sending you this video of how he goes to bed every night. So I'm like, where's this coming from? So I click on the video. Her son is in his pajamas, he's laying in bed, and she writes, and he's listening to something, and it's my podcast, and she goes, he can only go to bed every night listening to your podcast and your voice. She was in the Ukraine. This is before the war. And I was like, oh, I've had people on the subway in Norway come up to me and say, are you Thomas Anglero? And I go, yes. And this one guy said, I heard your podcast. I quit my job the next day. It's 6 months later. I'm now making $100,000 a month in my own company. "Can I give you a hug?" And we both started crying and hugging each other on the train.

Love.

I'm not embarrassed. I've been doing— I'm a human being on this planet, ups and downs, and we're all driven by— just share your love. There is no ego. There is— how many cars, how many houses you gonna buy? What the hell does it matter? Everybody should remember How they felt when they met you. How you made them feel. Who you are, what you were, who gives a shit? Love, love, love. That's the only thing that matters in life.

That's a good way to— good message to end on. We've hit the end of our time, so I think at this point I would welcome anyone from the audience who would like to come to the microphone and ask Tom some questions. We've got a few minutes for some Q&A.

Where's the mic?

We've got one there, one there, or you can shout.

So Andrew, I think you're up first.

All right, there's a mic over there.

Yeah, yeah, I know you can't see me over here, but so I was curious about this idea of—

Can you talk a little louder? I'm sorry.

Hello.

All right, can you hear me?

Yeah, perfect.

So my name is Andy Graham from Minnesota. So I'm curious about this idea of AI learning even though it hasn't been programmed to learn. And you gave a couple examples of someone who's walking down the street and then falls and picks up the groceries. So the AI is learning how to pick up groceries. And then you gave another example of the coffee, how they put the coffee maker in, it was the wrong way, and the AI learned to fix it. So I'm just wondering, are we thinking about the problem from our perspective, from our lens of humans where we see the groceries as one incident, coffee as another incident? I know that these aren't related per se, but does the AI see this as coffee, as groceries, or does the AI see someone walking down the street and falls And that person who fell now has to solve a problem. They have to actually pick something up. The coffee is something different where the coffee goes in the wrong way. I mean, does AI almost see the coffee as the falling and picking up the groceries? And rather than actually learning, um, has the AI actually received the information before by studying other scenarios and it's actually just basing the other scenarios to solve the problem?

The, the answer to your question is we train the AI on past experiences. So we train the AI so that it sees the person picking up the groceries as picking up the groceries. Pick up the groceries, put it back in the bag, stand up, keep on going. Uh, the capsule is a capsule. It must fit in this round hole. Hole put in the round hole. What we are understanding is that it sees a correlation between the orange rolling down the street and the capsule in the coffee machine that's located 3,000 miles away, and we don't know why. The human brain— the reason why you're asking that question is because you're saying indirectly you don't see a correlation, but because it has infinite capabilities of tying together very infinite number of variables, It sees a correlation. I think that is super exciting because the problems we have with microplastics in the water everywhere, the problems we have with systemic pollution, the problems we have in healthcare, we're gonna have some amazing solutions. We're also gonna have some really crazy problems coming up as well. So yes, it sees a correlation, but we don't, we never programmed it to do that. The same way if you're a father, you tell your kid, "Don't do that," the damn kid does it anyway. You didn't program it, but it did it anyway. Sort of the same, but at a scale that is infinite where we're limited, it has no limitations. But great question, thank you.

Jeez.

I really enjoyed hearing you speak. Your passion is obvious.

Yes.

Talk a little louder, please.

Sorry. I really enjoyed hearing you speak, and your passion is obvious and infectious.

Thank you.

My biggest worry about AI—

I have a lot.

My biggest worry about AI is disinformation and misinformation. If you look at the history of humanity, large masses of people have acted on incorrect principles for thousands of years, and many people have died because of it. I think in recent political events, we're being reminded of that yet again with a lot of questions about how the last election was manipulated by misinformation. Yep. I think from a medical perspective, if we keep it medical, Jerry Grant may remember a year ago at the ASPN, Brandon Roach was doing a presentation on the medical topic arachnoid cysts, and he presented a PowerPoint that he had ChatGPT make for him. He didn't do anything. All he did was say, ChatGPT, make me a presentation on arachnoid cysts geared to medical students. The PowerPoint looked legit. It looked like it was out of a textbook. Two-thirds of it was accurate, 1/3 of it was wildly inaccurate. And perhaps the most fascinating thing to me was it had a reference of bibliography that looked like a properly formatted bibliography, completely made up. Not a single article that was referenced in that bibliography was actually an article. And in that moment, it actually scared the living bejesus out of me because it made me think everyone was watching, students would see a PowerPoint that looks legit, feels legit, and is wildly inaccurate.

Yep.

And I, I just really wonder, how do we tackle that? And I could see that creeping its way into everything, including medicine. Who's the truth police? And how do you optimize something that is a tool being created by flawed organisms, which are humans? Using data that, as you suggested, is not always high-quality data. Sorry to be too pedantic.

No, that was fantastic. Don't say sorry at all. So I have two answers to your statement, your question statement. Answer number one is using the reference I had to Google Gemini from last night and two weeks ago. One of the improvements from version 1 to 1.5, that is 20 times more accurate than version 1. So accuracy is something they're working on as a top priority for the conclusions that it makes is more accurate. So they're aware of it and it's getting better. Where we are in the generative AI world, ChatGPT is part of the generative AI applications. If it's a baby that was born, the baby's only 16 months old. So in your example, that professor, like, or doctor, asked the 16-month-old baby to create a PowerPoint. Give that baby some time and the PowerPoint will be better. So that's my first answer. And then my second answer to you is not a, is not a very good answer you like. Bad people Bad things with AI. Really, really bad things. And good people will do really, really good things. And it's we humans who are ultimately responsible. But don't blame the AI. It's us humans that look at it and go, ooh, how can I do this? How can I rob a bank? How can I— we humans, again, I think it's your question, as human beings, we're so such a flaw, but our flaws are so beautiful, right? Here's this to all of you. Do all of you remember the first time you told somebody I love you? Has everybody here said I love you to everybody, yes? You've all had that moment? Okay, do you remember the moment before you told that person I love you what your stomach felt like? Were your stomach grumbling? Your finger's all numb and everything. We have no idea how to code that. Human beings, our spontaneity, our feelings, our emotions, our flaws are unprogrammable, but they're beautiful. But bad people will do bad things, and it's just part being human when we have access to these tools. Thank you for the question, though.

I think it's also important to go back to your idea of the Ps.

The Ps.

Because when they generate that slide deck for arachnoid cyst, the Ps that they've ingested are just what's available on the open internet typically. And for us to get higher precision, higher accuracy, then you've got to break down the subscription barriers that can ingest other articles and more detailed information that would enhance the accuracy. And that gets to the human. Side because human greed and profiteering and all things prevent that. And I think, you know, that's one solution for us to work on, which is making better, more specific AI databases that can drive that.

Yes.

Yeah.

Put it on the other side of the subscription wall for the journals that we have. You get a wildly different, accurate answer.

Yeah.

So I think you're—

Thank you very much.

This is a very inspiring and scary. I'm Mohammed Khaled from Hartford, Connecticut.

Pleasure.

I recently read a book called Scary Smart by Mo Gawdat. He used to be the chief business officer of Google X, and he was talking about much of what you were talking about. And one of the topics that was raised that you raised as well is the ethical and moral decision-making process of AI. So maybe we can technically do something better, but is it ethical?

What's ethical in your house is different than what's ethical in his house. What's ethical in your house— slippery slope question. Too different for all. What you believe is ethical can be different in mine. Technology can't answer that question. That's a very individualistic question.

So how can we trust AI to individualize that for us?

What we're doing with ethics is we are taking a journal, we take a, I know one project where they took a book of ethics and they just had the developers code the book of ethics. That's not a solution. You're asking, I can't answer that question because you're asking me why can't AI make the right ethical choice for humanity? I don't want it to. Ethics is a very difficult question. So do you really want it to? I know, I don't want, this is my own personal, I don't want AI making ethical decisions for the planet Earth.

Nein.

Hell no. I want human beings to make that final decision, and if we make it flawed, we fix it, as we've always done since we've walked this planet.

But AI will be more powerful than us.

Why will it be more powerful than us? You already drank the Kool-Aid. Okay, I scared the hell out of you. Good luck on August 1st when all the robots are walking down the street. Isn't that a beautiful thing to have something that is smarter than you that works with you? Don't frame it as it's more powerful than us. It is smarter than us and it is my friend. How will my life be tomorrow or 5 minutes from now? Same, more powerful. You're going into Twilight Zone and sci-fi and all that stuff. The realistic thing is that ChatGPT today make— can make your problems you have in life better 2 minutes from now. And that's the way you should look at it. Don't look at it so doom and gloom is more powerful, is gonna kill us. That's for Terminator and Hollywood. Look at it more realistic. It can make my— this moment better. That's the way you should see it.

Okay, thank you.

You're welcome. Thank you.

Great. Thank you so much for the discussion tonight. My question is digging a little bit more into the access to higher-level data, not just the amount. And so as we were talking before, access to subscriptions, there was recently the New York Times that were trying to sue ChatGPT because of, you know, they spend all this time and effort and money journalism creating the data, and they put it out there, and now these AI companies just get to reap the benefits of that. And so kind of how do you foresee that kind of moving forward with providing high-end quality data that typically takes a lot of resources to get but will end up giving the AI more power, but then the AI company is trying to get, you know, access to that, not just whatever is on the internet?

Okay, the cat's already out of the bag. Most of those learning language models, the algorithms have already learned from what's out there. We can't pull it out of it. So it's too late in that regard. And they're getting better. What is really interesting is the new music, especially the new music that's being made, and a lot of the famous artists are going, these AIs are making music that that we've never heard before and is inspiring me to do different things. So, there's not just such a— corporations want to sue and make more money, back to lawyers, you know, me and my thing with lawyers, right? That's the dark side. Positive side, it is making— oh, sorry, it's providing an environment of innovation for the planet Earth. I think that's a beautiful thing. I'm always gonna default to the beauty of humanity. I refuse to move from that, right? There's always bad people, but if all of us are thinking in a beautiful way, the bad people could go to hell. We got them beat. Excuse my language, I'm sorry.

It's okay.

This is the New York City coming out. Yes, sir.

Hi, Joel McDonald.

Hi, Joel.

Country neurosurgeon. I'm from Utah. I'm interested in your premise that the robots are going to take over, and I'm not sure I quite believe that yet.

Augmented source, baby.

Well, I feel like, you know, we're all surgeons, and the problems that we face I think have a different level of sophistication than a lot of the problems that AI is currently solving. You're probably familiar with Plato's allegory of the cave. Which is this theory that if you took a child and chained them to a rock from birth in a way that they could only see shadows cast on the cave wall by objects passed in front of a candle, then they would grow up believing that the shadows were actually reality and not the objects which generated those shadows. And I sort of feel like a lot of the problems AI has addressed and, and solved so far are kind of two-dimensional in that way. For example, I don't think you could train a surgeon to be a good surgeon simply by asking them to watch thousands of videos of how surgery is done. And the reason is you're missing like several dimensions of data that have to do with how humans are wired with sensory apparatus. You know, we hear and we feel and we can experience those emotions that you were describing.

100%.

We can't teach a car to drive autonomously without running over people. I don't know anybody that would get in an airplane that's flown by, you know, an AI-driven algorithm yet. And I really don't think that because of the depth of the problem, we can't model the physics of weather and air the way that we can for aviation simulation yet for the operating room. We just simply can't do it. It's much more complex. So I feel like there's this barrier there that simply learning from the past is not going to conquer. And I wonder— we've had a robot, for example, in surgery for 20 years. But it's not really a robot. It's a device that assists surgeons. The da Vinci is the one I'm talking about. It's basically a way to stabilize hand movements for, for humans. It doesn't— it's not an effector in the same way that a trained surgeon is. And then there's the other part which has to do with wisdom. You know, like, you can teach lots of people to go through the motions, but you can't necessarily teach wisdom. And I can see how, like, having your virtual reality goggles and being in connection with other experts and even with AI-generated knowledge base can be very beneficial for decision-making. But in terms of actually implementing that on the spot and deciding what move is going to be the safest and how to avoid the risk and how to optimize the outcome, that's a different order of magnitude problem. And I'm not aware really of these commonly available systems that are learning from the haptics of the problem. What do you think about that?

So two answers to your question again. So surgeons will not be replaced. Everybody could calm down. Your job is fine. That's not the goal that we're going at at all. So in all the companies I've worked with, never have we said we want to replace surgeons at all. The technology is not there. The humanoid robots have the dexterity, but we don't want to do that, which means that there is time for experts like these two and all of you in the next years, decade to train the software to be more of what you think a proper surgeon should be. Remember, we're only— remember, the generative AI is only 16 months old. It's not— it doesn't belong in surgery. It's a 16-month-old baby. So my answer to you is that there is time for especially the young surgeons of the world that are coming through medical school today They're going straight to AI. They're gonna spend all their time training the AI, and eventually it will learn more and more and more. But human beings cannot be replaced. You're 100% right. In that one moment, the aura of the patient and your aura, there's a feeling, there's a communication going on between you two. You could feel how that person's doing. We cannot code that. We have no idea what the hell that is. We don't know what sensor to build to pick up on that. When you're in love with someone and you have that feeling, I have to be with them, we have no idea what the hell that is. We know we cannot reproduce that, so that's fine. That's not our goal. That is not the goal. Our goal is to work with all of you to create an atmosphere of learning that you want to have pre, during, post. That is beneficial for you and the patient. That's our goal. That is yet, that is being written as we sit here. So that's my one answer to you. And then the second answer to you is that 90% of all airplanes today fly and land using AI for the last decade. I was flying into, I'll never forget this, I was freaking out, flying into Orlando, Stockholm, foggy like you can't believe. I'm in the first row looking out the window going, We're going to die. I could not see anything out the window. The stewardess is sitting right in front of me, seeing me sweat, and she goes, calm down. This airplane is only— has AI, and the pilots don't even have their hands on the—

I don't know if you call it the wheel or whatever, the yoke, says.

And we landed so smoothly. And when they opened the gate and we're leaving, and the pilot, one pilot was there, and I go, how the hell did you do that? He goes, wasn't me. AI has been landing airplanes for at least 10 to 15 years. That's easy. So you could trust AI. It lands every airplane around the world forever. That's it.

Yeah. Well, I think that sort of brings us to Abel, which is that from my perspective, I don't worry that I'm going to be anytime soon. I've never seen a robot do a bypass, and the level of complexity of the things that we do, just, it's not there yet. But it's an incredible tool. It opens up ways of looking at our data, ideas for treating patients that we never entertained before, and that's what I think the next day is about, is to see how we can use Able as a tool and enhance what we do to not replace us, but just— Exactly. —you know, get to a point where we're actually making better decisions, we're planning our surgical procedures better, we're executing in the operating room more smoothly, and the outcomes show it. And that's really, I hope, what, you know, to set the tone for the next day, you know, this whole meeting is about, is to find ways where we can look at this technology, not be threatened by it, but find ways to integrate it into routine and make us all better as doctors and surgeons. So our time has run out, so I think at this point I'm going to close the session. Thomas, it's been a pleasure. My honor. Thank you for sharing yourself with us. Thank you.

Thank you.

At this time, we'd like to welcome all of the faculty to the stage.

It's good. I like it.

So I guess if everybody could introduce themselves, start down there.

Hi everyone. Good evening. It's a great honor for me to be here. I'm Vanessa Milanese, a functional neurosurgeon from Brazil, and I'm doing mostly deep brain stimulation, spinal cord stimulation. I'm really excited about what we are going to have with artificial intelligence helping us with this, in this kind of procedures, and really getting the information that we may have Depending on which symptom, like a Parkinson's disease, might have, we can imagine and get exactly the area in the STN or in the GPI that we can improve the symptom. Thank you.

I am Verena Desai.

I'm a pediatric neurosurgeon at University of Oklahoma.

Glad to be here.

I'm Big proponent of the Stealth Autoguide. So—

Yeah. Hi, I'm Jay Hautman. I'm in Seattle, Washington. I'm pediatric. I'm in a row of pediatric neurosurgeons here. I'm in very good company. And I'm passionate about stereotaxy, functional neurosurgery in children, epilepsy surgery, robotics, and intraoperative imaging. Thank you.

Hi, Jerry Grant, Duke University, a pediatric and adult neurosurgeon. Tom, wherever you are, that was tremendous. Thank you for doing that. And I'm still in mourning after the 49ers lost this week. It's hard to be here and realize what just happened in this city. But this is exciting. This brings us back to— just such a transformational time, and I appreciate Medtronic bringing us all together. I hope to learn from all of you and our colleagues here on the stage. I mean, something I was thinking about was, you know, the public, the layperson thinks the operating room is perfect. They think what happens there is perfection, and we all know that's not the case. There is so much happening, and we We get away with it, but imagine what we can do if it's data-driven and transformational, what we're talking about tonight. Our outcomes could even get better and better. So I'm really excited about this forum.

So thank you.

Okay. Well, hi everyone. I'm a little bit of an anomaly here because unfortunately I'm not a neurosurgeon. I guess the only neurologist in the room, and I guess you guys needed us too. And by the way, we know that what happens in the OR is not perfect because we see the effect. But anyhow, no, it's really a pleasure to be here with all these smart gentlemen and ladies and Vanessa, my dear friend. And it's really interesting that we've been talking about AI Also because what we've been doing for a while now in functional neurology, or functional neurosurgery if you want, is recording brain data. We record local field potentials of patients. I don't follow movement disorders patients anymore alone, I mean, I follow also epilepsy patients and people with a variety of neurological disorders, and we collect local field potentials over and over, and we're collecting a lot of data, and there's always the question of big data doesn't equal better data. And I guess with AI, at some point we'll make sense of what we're sensing. And so looking forward to the rest of the program. Thank you for having me as a humble neurologist. Thank you.

I'm Jason Gerard. I'm a functional and epilepsy neurosurgeon as well, director of functional neurosurgery at Sims Murphy University University of Tennessee. And I'm going to be talking about using intraoperative imaging to help us. And I think that the, the thing that I really enjoyed is how it was wrapped up where, you know, I think there's a lot of different approaches to AI and what machine learning can do for us and how we can handle our big data. But what really excites me is this idea of using it to give us new perspectives, to really sort of tell us about solutions that might work that we just would never have thought of. And therefore, that lets us take the different data sets that we're collecting in functional human neuroscience. We're constantly collecting, you know, more and more data and really be able to figure out hopefully solutions to questions that may have taken us a decade to answer in a year.

Thank you. I'm Andy Grand from University of Minnesota. So I'm a vascular neurosurgeon. I'd like to reiterate what Dr. Grant had mentioned. Thomas, that was phenomenal. You know, as I was listening to you talk, I was getting very excited about the opportunities in neurosurgery. One of the things I'm most excited about for this event is Medtronic's interest in the care continuum, in owning the data, and using that data for prediction, to help us make our decisions on what to do for cerebrovascular neurosurgery. So I can envision in the future what aneurysms should we treat, which ones should we not treat, and to be driven by AI with regards to that. I think then beyond that, the care of our patients and using that data to enable us to make better decisions over time. And I think that that's going to be a game changer for us. Yeah. Thank you. Russ Lanzert.

I had a chance to talk to you earlier. I'm at Ohio State University, a neurosurgical oncologist, and, you know, just to echo what Andy said, it's super— it's really a super exciting time. Medtronic is unique in a platform that goes from preoperative through postoperative, and we're really living in an exciting time, as Thomas beautifully expressed just now.

Well, I'm Michael Lawton, and I'm at the Barrow Neurological Institute. I'm the chairman there. Jerry, I sympathize with you with those 49ers and the big loss. It still hurts. I'm going to talk about the things, the tools that we have in the operating room, like Stealth and tractography. That's really important to me because it's really all about trying to elevate our game and be better as surgeons. But I'll share with you a little story. I was an engineer in college, a bioengineer, and what excited me about that was that I thought that we could use our work to really understand the organ that we work on. I actually wanted to be a heart surgeon, and it always impressed me that the heart surgeons could actually build an artificial heart. They knew it so well, backwards and forwards, that you could make the Jarvik 7 and put that in somebody and have them live. As a vascular neurosurgeon, I realized late in my career that we're not doing the same thing for the brain. We're working around the brain. We're trying to avoid getting into it, and we're not really understanding its magic and how it actually works. And so I'm actually kind of like a closet functional neurosurgeon fan. I love the fact that all of you at Medtronic are trying to gather electrical signals from in the brain and figure out how that brain is working. And so that's like a real passion for me. So as a vascular neurosurgeon, I don't get to do any of that, but with you all, I get to think about all of these things with AI and LFPs and reading brains and closing the feedback loops. And this is really, I think, where the field is gonna explode in the future. So that's what excites me about this. And AI is going to bring us there. And so hopefully we'll have some good conversation about that.

Hey, everybody. My name is Shabir Adhanesh. I'm a neurosurgeon at Jersey Shore in New Jersey. Here I'm going to focus talking a little bit about laser interstitial thermal therapy. But I'm really most excited about all these tools that have come together over the last decade or so by Medtronic. And I'm most excited about how Medtronic's going I'm going to put these tools together and figure out how AI is going to see patients for me in the clinic, going to figure out who needs surgery, and then AI is going to do those operations, but I still want the paycheck.

Stefan Wolfsberger from Europe, from Graz in Austria. Well, I've been trained 26 years in Vienna in this country. Honestly, I was a bit disappointed when I started because I'm coming from a very technologically orientated family, and I realized neurosurgeons are not very technological guys, honestly. Most of them cannot even write with 10 fingers. Nobody can really code. So I thought there must be something wrong. So we have to get a bit more technology in our brains. And from that time on, I thought my credo should be one innovation per day should make neurosurgery better. And I think with the innovation and with the help of the Medtronic company building Autoguide for not doing any manual biopsies anymore, as I was, as I saw it when I was young, and with tractography where we now know at least at least what's happening in the white matter during our surgeries, and we didn't do that before, I think we could actually make some innovations that really, really help neurosurgery to go forward. And I hope that AI is now a possibility that neurosurgeons really exponentially increase their interest in technology. Thank you very much.

Great, hi, my name is Michael Ivan. I'm from the University of Miami, a skull base and brain tumor surgeon. And I just wanna thank Medtronic for bringing us together. I think we're all like beginners in this idea of AI and connection and especially Able. And so we're all kind of white belts. And you know, what Medtronic has done here is had this vision to bring us together into almost like a dojo so that we could all kind of learn learn together and turn from Ralph Macchio into Mr. Miyagi altogether by learning about what this actually means and how we could put it together. And I look forward to kind of talking to you and watching you wax on, wax off over in the other room and really try to pick your brain about what are the data points and the data collections that we think we need to kind of build all these instruments together to kind of get the most out of them.

Good afternoon, everyone. I am not a neurosurgeon. My name is Beth Balkin, and I'm actually the associate vice president of neurosciences with Atrium Health Wake Forest Baptist in North Carolina. And so we're going to be taking a little different approach, and I think it's going to be really exciting to be able to have some conversations and figure out how we can strategize with our physicians position partners and champions for all of this really cool technology and ways that we can actually help you from either the hospital perspective or the administrative perspective. We can partner together to actually help you be able to continue to provide excellent care to your patients. So, I think it's going to be really cool conversations here.

Meredith Wells, I guess they did alphabetical, so this is, I end up at the end, but Meredith Wells, and I'm gonna actually go with Thomas, so I'm a wife, mother of two, and actually a nurse by background. That's how I started, neonatal intensive care nurse, and how I went from a baby nurse, literally a baby nurse, to a service line leader, I'm now VP for Neuroscience and Trauma for Ascension Texas, which is partnered with Dell Medical School, UT Austin. But how I went from baby nurse to my position now is I, I would hear people say, well, I want this, so this is the right thing to do. Well, it's really hard to go from that to implementation. There's a lot of work and a lot of conversations and a lot of relationships that have to be leveraged, and that's what I'm passionate about. That's what I love doing. I love creating programs with great people, and part of what excites me about these conversations that we're gonna have is technology will help us advance all of those conversations, hopefully quicker, and also enhance the programs that we have.

So, wanna thank all the faculty, and we'll turn it over to Tiffany Hodges, who you met earlier. She's gonna walk us through that.

Dojo over there. I hope you all have had a great evening tonight, but the evening is still young. I'm Dr. Tiffany Hodges at Case Western University in Cleveland, Ohio, and the night is not over. You can join us over here at the exhibition hall for dessert, drinks, and also a tech immersion experience with our esteemed faculty. See you shortly.

This concludes our program. Please join us next door for our technology expo.