Now on to our plenary. I am really excited to introduce our plenary speaker for today, Dr. Daniel Kraft. Dr. Kraft is a Stanford and Harvard-trained physician scientist, inventor, and entrepreneur. With over 25 years of experience in clinical practice, biomedical research, and healthcare innovation, he has served as faculty chair for medicine at Singularity University since its inception in 2008. He is also founder and chair of NextMed Health, a program that explores convergent, rapidly developing technologies in their potential in biomedicine and healthcare. Dr. Kraft is the founder of Digital Health, co-founder and partner at Continuum Health Ventures, and is serving as chair of the XPRIZE Pandemic and Health Alliance Task Force, where he co-led the Rapid COVID Diagnostics XPRIZE. Following undergraduate degrees from Brown University and medical school at Stanford, he was board-certified in both internal medicine and pediatrics after completing a Harvard residency at the Massachusetts General Hospital and Boston Children's Hospital. He also completed fellowships in hematology, oncology, and bone marrow transplantation at Stanford, where he finished a postdoctoral in the laboratory of Irving L. Weissman. Dr. Kraft is a member of the inaugural class of the Aspen Institute Health Innovators Fellowship, and is a member of the Kauffman Fellows Society. He's often called upon to speak to the future of health, medicine, and technology, and has given four TED Talks and two TED Med Talks. He has multiple scientific publications and medical device immunology and stem cell related patents through NIH-funded faculty positions with Stanford University School of Medicine, and as clinical faculty for the Pediatric Bone Marrow Transplant Service at the University of California, San Francisco. Please join me in welcoming Dr. Kraft as he discusses the future of health and medicine, where technology can take us. Wow, thank you so much. What an honor and pleasure to be here. First time back in New Orleans for a while. It's great to see Dr. Mike Katsaka, who I hadn't seen since I was in Stanford Medical School, and to have the next 54 minutes to get a chance to take a bit of across the spectrum of where we are with health, medicine, technology, how it's going to impact the future of physiatry, PM&R, and beyond. And so, inspired by being here back in New Orleans, I thought I'd do a little bit of art this morning and look at the future of maybe rehab from interesting perspectives, add a little New Orleans framework to PM&R. Of course, I'm a terrible artist. I didn't do any of this, certainly not that. I had a little help, as we're all getting today, from Generative AI. This is the new DALI-3, which is much better than the last generation of DALI-2, and I'm sure many of you all have all been experimenting with GPT, now 4. It only launched November 30th, last year, first GPT-3, so that world is moving so incredibly fast, and it already can do better than me and probably most of us in passing the board exams. And what's exciting about this sort of technology is it's moving so quickly. It's being adopted faster than any other technology in the history of man. It's a bit of a Gutenberg moment, right? We all remember when the Internet turned on in the 90s. This is probably more transformative, and it's gonna have huge implications, of course, across health and biomedicine, and hopefully take health care to an era that's much more intelligent, much more data-driven, precise, personalized, and hopefully democratized and accessible around the planet. And, of course, it has the opportunity to shift us, as many tools and technologies will talk about, from where we kind of are now in this sort of sick care era, very much based on episodic data, physical location, cognition of an individual clinician, to a future that's much more proactive, personalized, continuous with our data, hybridized, leveraging the knowledge of the crowd, hopefully aligned with our reimbursement models and our workflows. And, of course, we're seeing examples just again in the last year of GPT exploding everywhere, from the Googles and now the Metas and even the Xs making platforms. And there's utility already today. You can cut the scut on Doximity and go on there and have it write wound care instructions in Spanish, for example, even if you don't speak Spanish. We're seeing clinicians use it to improve their bedside manner. We can always use a little help. Some folks are going a little maybe too far to use it to tell their patients bad news. We're even seeing parents now, where I trained at Boston Children's, use it interesting ways. Boston Children's is now hiring prompt engineers. Parents who are having challenges getting a diagnosis made after 17 specialty visits are finding it through ChatGPT. So it's a really interesting time. And I just made one this morning, like literally in five minutes, this new GPT maker I made for this iatry pal, a friendly expert, right? I asked it, how do I rehab my torn rotator cuff? And it gave me pretty good recommendations. Not perfect, but, you know, GPT is coming for all of us in some ways. So just a small example, which you could build again today in five, ten minutes and add your own knowledge set to. So this disruption, ChatGPT and generative AI as just one area, is moving quickly. It's faster than we can figure out the regulatory and reimbursement and ethics and policy and politics around it. There's still a lot of limitations. I was with the head of research at Microsoft Health. Peter Lee has a great book about this. You know, lots of benefits and limitations and some risks, but we're still kind of in the early days. It does have mistakes. It does hallucinate. But again, we're only a year or so into this new revolution. So don't underestimate the power of what's next. And of course, today we can already do some pretty incredible things with AI and other tools. I think if we jump forward a few years, we'll enter this world of what I like to call generative health. So imagine each of us has their own personalized chatbot or for those of our patients, and it talks to them in their language and culture and incentive models and personality type. It's sort of a one-size-fits-all UI that we have for most of our engagements today. So you can imagine that sort of whole world integrating across physiatry as well. We can really personalize our interactions using this new generative age. So let's back up and talk about health, medicine, technology. Of course, health is wealth, and health and medicine is being driven now by the advancement of many accelerating technologies. AI is just one of them. And it's really at the convergence point where things get interesting. I gave my second TED Talk way back in 2011. The theme was, you know, future medicine. There's an app for that. At the time, 2011, there's like 10,000 health related apps. Now there's over 300,000 apps. And it's not just about apps, but the ability now to converge technologies that are getting faster, cheaper, smaller, more available, appified, and gives us the opportunity to think differently about where we're moving, right? Exponentially. You know, what used to fit on your desktop in 2000 fits on your smartwatch, which is now FDA cleared that can track or predict falls or atrial fibrillation. And so it's at that interface that we have the opportunity, particularly as you're thinking about the future of physiatry, you know, what are these new tools we have? You know, when I was a medical student 20-something years ago, we didn't have computational biology and low-cost gene sequencing and digital health records, medical health records, which may be a good thing not to have had. AI means radiology, robotic surgery, digital therapeutics, CRISPR, VR, AR, really didn't exist as usable tools. Now they're in our tool set and give us this opportunity to reimagine health and medicine, not just for today, but what's coming next in this next moving decade and beyond. And so I think it gives us this opportunity not just to think about the sort of sick care model, but even leveraging our field physiatry and beyond to think about precision health and wellness and prevention and maybe even longevity. Or I like to frame it more as healthspan, right? I come from Silicon Valley. A lot of people want to live forever. That's a long time. I think we need to focus more on quality of a year. We want 120 to be the new 60. And there is this new emergent realm looking at even stopping and reversing aging, which is going to get super interesting as the technology and the science is becoming more and more real. And speaking of long healthy lives, this is my 104-year-old grandmother-in-law holding the hand of my then six-year-old, so there's a 98-year-old difference between their ages. And one of the reasons she's gotten to 104 quite healthy, still speaks four languages, still mobile, is I think her sort of social determinants of aging. So of course, while technology is great and we all use it in our clinical lives, it's often our social elements. Our zip code is more impactful than our genetic code in terms of our healthspan in many cases. So we need to pay attention to that in our patients and our communities. And of course, there's sort of base levels. We need to work on education and water and vaccinations. But in our new digital age, we have new digital determinants of health. I wish someone could just fix battery life for me. That's sort of a tough one. And so when you're thinking about your patients, do they have access to Wi-Fi and high-speed Internet or a mobile phone? And now, you know, 50% of the planet will soon have high-speed Internet through Starlink and other methods. So the world's opening up in this realm. Now, we are in 2023, which used to feel like the future. When I go back to the ward at Mass General Hospital where I trained White 9, still get a little PTSD. You know, it's not that different than 20-something years ago. The same alarms are beeping, some of the same nurses, some of the same patients, and they're still using a fax machine to communicate to the pharmacy down the street, right? Same at Stanford. Paper forms are still often the norm. I had a cardiac study done a year ago at Stanford. How did I get my results? On a DVD. I don't even own a DVD player anymore. I don't know about you. So we're still often basing our clinical practices on the old constructions, HIPAA included, right? And we're not doing a great job. We know in the U.S. we pay the most per capita, but life expectancy is actually going down. We like to think we're practicing precision medicine, but it's really still imprecision medicine for the top 10 grossing drugs sold in the U.S. last year. They're only effective for about 1 in 4 to 1 in 24 of the folks who take them. So we have a long way to go to get to this sort of future of health and medicine. But we can take some inspiration and examples from other fields that have reached that sort of fourth industrial age, how we digitize banking and how we can stream a thousand movies on demand at the click of a button. We've seen disruption come, of course, over the last four years, particularly in health care, from the terrible COVID pandemic, which was a bit of a forcing function, right? It made us realize that many fields had reached the fourth industrial age, but health and medicine is still stuck in the third or, in many cases, the second. And it was a bit of a chief transformation officer for many of us, right? It often took 10 years or 10 months, sometimes happened in 10 days, how we innovated in the ICU and beyond. So the optimist in me wants to think that, you know, just like Sputnik set off the space age, COVID has sparked a bit of a new health age. We need to take some of that energy, momentum and mindset across accelerating health, medicine, physiatry and beyond. And so that was a bit of a topic of a TED talk from last year, how COVID-19 transformed the future of medicine from, you know, mRNA vaccines and new forms of telehealth and crowdsourced clinical trials. But it gave me a chance to look back, where were we 10 years ago in that 2011 TED talk? Where were we now? And essentially, where could we be in the next decade? So I want to kind of use that as a frame set for much we're going to talk about in the next few minutes. Where are we? Where were we? Where are we? And where can we go next? Because I love this quote from Bill Gates, it kind of summarizes it. Most people tend to overestimate what they can do in one year, but underestimate what they can do in a decade. And believe me, while the last decade was pretty exciting, the next 10 years will make the last decade look slow. So how am I in this realm of talking about the future of medicine? Well, trained in MedPeds, CMON, bone marrow transplant. About 13, 14 years ago, I got pulled in to help chair medicine for something called Singularity University. It looks at the convergence of technologies, how we address grand challenges. I built a whole program looking at the future of health care through that called Exponential Medicine, now called Next Med Health, where the unique thing about that is to bring people from all sorts of fields, patients, investors, technologists, the whole spectrum from 40-plus countries. We meet in San Diego every year to kind of cross-fertilize, right? You want to get out of your silo, want to learn what other folks are doing, you know, learn from everybody from doing chatbots to psychedelics to drone technology. And we learn from that kind of community how to accelerate knowledge. And sometimes we need to bring the regulators in. Of course, some new platforms need new mindsets. We brought the head of digital health at the time from the FDA. That helped them catalyze developing software as a medical device and some other new regulatory pathways, which will help speed up new innovations to market. We also have the head of NHS innovation join us each year, and he shared this old quote, which I love, from John Maynard Keynes. The difficulty lies not in the new ideas, which many of us have new ideas, but in escaping from the old ones. So we are all new idea makers, but who's holding us back with their sort of old mindsets? That's often part of the challenge. And the technology can be incredible. I mean, some of the stuff you're gonna see in innovation lab next door that many of you are developing in your academic and industry lives are pretty incredible, but we know technology is not enough. We don't practice evidence-based medicine. We practice reimbursement-based medicine, and traditionally, we're on that right side of the curve, paying for sick care, for more procedures, more challenges when someone has the accident or needs the bypass or total hip replacement. And of course, we're seeing that shift a bit more to value-based care. I think that raises all boats, but it's a moving target, and you need to understand where the incentives lie. Some of those incentives, of course, are moving where care happens, from hospital to home to phone to on and even inside our bodies. It's coming to the corner of pharmacy, which is battling it out to become primary care-type centers. It's coming to our mobile apps, of course, in some regards. It's even coming to the big-box stores. Many people live far closer to Walmart than a hospital, and they're building in elements, maybe not rehab elements yet, but you can think about bringing health care to new locations. So part of that future medicine is new ways of doing things. It's also about, again, I give that the thematic of bringing technologies together. I wrote the opening article for NetGeo's episode or edition all on the future of medicine, and again, it's not really about any one innovation, but how you put them together. So let's look at a few fields and where they are, where they're heading now, 10 years ago, and what they might be in the next decade ahead, starting with something we're all a bit familiar with, genomics. You know, 10 years ago, you could all get on 23andMe, maybe meet a long-lost cousin like I did and get happy haplotype t-shirts. A decade ago, the full genome would cost about $10,000. Now it's about $100 to $200, and in a decade, it'll be $10 or cheaper than a CBC or a chest x-ray. Of course, we're not even using the information we have today. Pharmacogenetics comes with your 23andMe, or certainly for a full genome. How are you leveraging that, if at all, when prescribing a certain medication or maybe even understanding how someone's going to react to opiates or other rehab related elements? So that's going to hopefully plug into the system. We're going to understand almost every disease at the genomic level. Type 2 diabetes is not one disease, of course. There's at least three very distinct genomic subsets that we can understand the impact of diet, nutrition, intervention, etc. And we're going to start to connect those loops between the genome and the clinic, as Genomics England is sort of feedbacking that. So in your workflow, you're going to understand how we make sense of genome or other omics as we go forward. And as we're seeing now already at Stanford, we can do a genome in under six hours. In a decade from now, that might be common, and we'll be able to sequence, you know, on pocket-sized devices when relevant. So it's the beginning of that genomics age, but it's going to accelerate from here to the point where, today, you can already sequence your children pre-birth. And we'll hopefully understand each individual's genomics and other risk factors to help guide their health care journeys in much more integrated, personalized ways. Now, of course, we can read DNA. Now we're starting to write DNA. We're in this era of synthetic biology. And, of course, the gene editing world is starting to really open up with the ability to do cures for fields, my field, and, you know, hematology, oncology, and you cure sickle cell, thalassemia, maybe even HIV. We're seeing the ability now, published just last week, to do in vivo gene modifications in humans who have hypercholesterolemia genes. The genes go to their liver and switch off with base editing, and it looks like that might be effective to knocking out their risks for high cholesterol. So really even being proactive before the disease even raises its head. And genome is only one part. Now we have the proteome we're starting to measure at scale, the exposome, where your patients have lived, but they're in a high-pollution environment or radiation, etc. The metabolome is measurable. Of course, the microbiome, the bugs on our skin and our gut, which plays such a huge role in everything from obesity to inflammatory bowel disease to psychiatric diseases to risk for dementia. And so it's not about any one omics. Increasingly in the next decade, it'll be how we integrate them together, this idea of the digital twin, which I'm sure you've heard of in different regards. Folks have built digital twins for hearts, for example. Scan the heart and do a virtual angiogram and understand your patient's FFR, and do they need a stent, and would you even 3D print a personalized stent to match that individual, as one example. We're in the era of cancer digital twins. In my field, we're so much information for the oncologist now, you can't just use the old-fashioned protocols, blending immunotherapies and beyond. So what could be the digital twin for a PMNR patient? To integrate multiple omics and other data sets to really guide optimal prevention, diagnostics, therapy, and rehab. And of course, some of these digital twins are living on the dish. You can take a person's stem cells, make basically organoids on a chip, and speed up drug development in personalized, optimal ways. And so a little caveat, since I trained in BMT and regenerative medicine, I thought, and that's playing a role in a lot of musculoskeletal care and regenerative medicine, orthobiologics. A little taste of something I did, built out of Stanford, trying to address the pain point of how do we get more stem cells for BMT or regenerative or orthobiologic or other applications. And my pain point as a fellow was harvesting bone marrow. I was taking the Stanford bi-design class at the time, going, this is a pain point, I want to solve for it. The common way is, you know, hundreds of serial small-volume punctures get about five mils at a time, otherwise it's diluted. I thought, this is kind of crazy. The patient ends up with Swiss cheese, takes an hour, lots of general anesthesia, and came up with something now called the marrow miner. So instead of serial punctures, it's a bit of a little rotaroo that goes inside the hip. Here's the next generation device, here's sort of how it works. Just, so some of you I know might use marrow in orthobiologic and joint and other procedures, you might be interested in trying this. It can speed up the whole process to get marrow faster, better, cheaper, and much higher concentrations, both mesenchymal stem cells and others. So you can basically enter the marrow cavity just once instead of multiple times under local anesthesia and drive this little rotaroo device to this, this cartoon's too slow, and do that multiple paths in one go. So kind of get the idea here. It sort of looks like this in the clinic. And again, it's very tolerable by the patient. This is what it looks like in a real patient, just like the cartoon. And again, faster, better, cheaper way to start with marrow, which some of you might be interested, come track me down later. We published the results, get many more MSCs and a lot more cells compared to the old-fashioned needle. So that's a bit of a way we might end up with more personalized stem cell-based approaches. And of course, in orthobiologics, there's a lot of new interest and areas where that's improving. So let's look at the speed and pace of technology and where it's going. I know I'm talking fast. There's a lot to cover here. At the end, there'll be a little QR code. You can get that and download most of my slides. So apologies for going exponentially fast, because technology is moving fast. We're linear oftentimes in our mindsets, but technology's often doubling in its speed and price performance, right? The classic Moore's Law, the exponential we all live with in our smartphones. Now, this is actually an old iPhone 2, but 10, 15 years ago, it felt amazing. Now it's slow and clunky and low resolution compared to my new iPhone 15. That's the example of Moore's Law on steroids. It's changed our entire world. So what we can fit on a chip now is incredible, and soon quantum computing is gonna disrupt that field. But this exponential field has taken all these analog devices we grew up with and now Appify them. You don't buy a video camera anymore or a GPS unit. They've all become digitized, demonetized, and in some cases, democratized. You know, the bottom billion all have cell phones and soon smartphones that can leverage these technologies as well as we can. So our brains kind of have trouble getting exponentials. 30 linear steps, you kind of get, I'll be across to the door, but if I took 30 exponential steps, two, four, eight, 16, 32, 64, by the 15th step, you're at 32,000, but by the 30th step, boom, you're at a billion meters. That's 26 times around the planet. And that's sometimes the deceptive power of exponentials that are now changing the world more rapidly around us. And so many companies have leveraged these sorts of exponential technologies to disrupt the world, right? Uber didn't invent cell phones, GPS, online maps, online payments, taxis, or limos. They connected the dots to disrupt the taxi industry. And Uber and Lyft are now delivering patients on their platforms or nurses to deliver vaccines. In fact, everyone wants the Uber of everything to make things easy. My favorite example is human Uber, developed in Japan, provides a way to attend events remotely using another person's body. It's surprisingly natural. So next time, send your human Uber here to the meeting. But seriously, there are now Uberized doctor calls. I'm not sure there's Uber rehab, but you can certainly press a button and get a masseuse to come to your house or have your drugs delivered. There's now Uberized lab draws, like this one I tried out the other week, and you can track the phlebotomist coming to your house. And of course, in this new year, big tech, the folks who understand the consumer are all getting into healthcare in very interesting ways. Sometimes they're learning that healthcare is hard and having bubbles and bumbles, but a tremendous change there, particularly when Amazon comes into the pharmacy space, for example, and you can order your meds that way. And I used to joke about Amazon delivering your drugs by drone, but just last year, the first FDA-cleared drone delivery for drugs and devices and labs has been approved in the US. And in fact, sometimes these technologies start outside the US, like Zipline, delivering blood products in Africa, and now just got clearance to deliver your packages and your medications in the US, so watch that space. Or look up in the sky when you need a defibrillator. This is a published example in the UK where they delivered a defibrillator to save the patient's life by drone. So drones can be used for good and for bad. A decade ago, they were toys. Now they're really powerful in many interesting ways. So disruption's coming, right? To our friends in pharma, the big blockbuster drugs are gonna maybe shift as we get more hyper-personalized with genomics and beyond. We're hopefully gonna see the advent of cancer vaccines and vaccines for dementias and others. We'll hopefully advent the need for oncologists like myself. We'll hopefully see payers and the interactions with our insurance companies get more disrupted by better user interfaces as we go forward. And we can see that many fields have been entirely disrupted, and companies have gone bust. That used to be the top Fortune 50 companies. You know, when was the last time you went to a blockbuster? Or, you know, Airbnb has much more market cap than all of Hyatt, for example. And Kodak is the poor poster child for this, right? Kodak, you might recall, invented digital photography. But they didn't wanna cut into their film sales. Digital photography wasn't very good for a couple years, but they weren't paying attention to its exponential improvement. When it got really good in 2012, Kodak went basically bust, bankrupt. The same year, 12 kids in Palo Alto built and sold Instagram for a billion dollars. So bottom line, you wanna be the disruptor, not the disruptor, you wanna Uber yourself before you get Kodak. What would be the Uberization of PM&R and physiatry that you could be imagining with some of the tools and technologies that are here or coming next? So of course, one of the tools we all use that's been somewhat disruptive is a smartphone. Some of us are old enough to remember Michael Douglas talking on the beach in Wall Street in the 1980s. Wow, he's on a mobile phone. And of course, those phones are dissolving into our glasses and beyond. I'm waiting to get my Apple Vision, you know? And they start expensive and a bit kludgy, but wait a couple generations, right? I think in 10 years, we'll all have, or have the opportunity to have contact lenses that give us augmented and virtual reality and can bring our patients and our counselors around us. This era of avatars are already here. They're kind of getting more and more realistic. They've passed the uncanny divide and are gonna become more and more integrated into care, virtually or otherwise. And speaking of that, one field that's moving super quickly and impacts, I think, rehab and healthcare in general is augmented, virtual, and extended reality. You know, 10 years ago, we had that amazing, not so amazing, Google Glass. I still have mine, they don't work very well. But they weren't a great commercial hit, but clinicians, this surgeon, Rafael Grossman, came to my first Next Med Health program and was the first to bring it into the operating room and innovated on ways to think about augmented reality to give guidance to a surgeon through a procedure, for example. And now we're seeing much more advanced versions that can bring very complex information into the clinical space, whether you're in the OR or anywhere else. All this data can be synthesized in super interesting ways. Clinicians are now being guided step-by-step. You can see through your patient and do a guided spinal fusion, for example, with better outcomes and lower cost. Or in the neurosurgical space, it's being used to improve procedures and learning. So augmented virtual reality feels magical compared to where it was a decade ago. It can also be used to educate and engage our patients when they can see inside their own bodies through augmented reality and understand everything from an injury recovery or about their statin or their high cholesterol. It can give them more insights. You can now use an augmented reality teacher to teach your kids or patients about their basic physiology. It's a really engaging type platform for medical education. Here's my son Leo, and he's three, wearing his AR t-shirt. And hopefully he knows more about his physiology and health and keep him on the right path. He's so far so good. So imagine a decade from now, each of us has our sort of smart mirror with augmented reality. It gives us our health score. It gives us nudges for the day that are highly personalized. It doesn't just show you you of today, but it might show you you of tomorrow. You of tomorrow if you're working out, you're doing your P90X, you're doing your Peloton. You of tomorrow, or shows your patient how they're gonna do if they keep on with their physical therapy and rehab. It might also show them you of tomorrow if you keep having Dunkin' Donuts for breakfast. You of tomorrow, right? And so you can already use this today. Here I am now, here I'm 1,000 Dunkin' Donuts later. I'll only have one Dunkin' Donut, right? If you're trying to coach a patient to stop smoking, and you can show them what they're gonna look like now or five years later of two packs a day smoking, that can be leveraging behavior change. Or if they spend too much time on social media, which happens. Now these technologies of course start expensive in Kluge, but they are integrating in new ways into our lives. I like to take lessons from aviation. I've been a pilot since college. I served as a flight surgeon, an officer in the Air National Guard, flying and taking care of fighter pilots. And in the cockpit, we have augmented reality. We have something called the heads-up display. So we're not buried in our notes or our round dials. We can look up and look at who the bad guy is and where's your wingman. And the cockpit has augmented reality to actually talk to us and remind us if we're getting into trouble. That'll wake you up if you're about to hit a mountain. Imagine we leverage that for each of us and our patients with behavior change. They have their augmented reality contact lenses on, they see their breakfast in one way, now they see it in another way, and they get a little nudge. So part of our future of behavior change. Now back to aviation for a second. I learned to fly in the late 80s, Brown University Flying Club, 20 bucks an hour for a plane in a round dial cockpit, and essentially paper maps, very analog. I still can't imagine I flew that way. My new little plane, it's got a glass cockpit, touch screen GPS, you know where the traffic is, you know where the weather is, you can get real time information about everything. It's amazing what we call situational awareness. That needs to come to us as clinicians, just like the F-35 pilot has a headset now that can look through the plane, bring real time information, not something that's 10 year old or off of a chart or a paper, a double blind study from 10 or 20 years ago. That real time elements are coming to healthcare. And then of course there's virtual reality. It's really fun to put grandma on a roller coaster, right? And I hope you've all tried VR because it's getting pretty amazing. It's the new syringe, really. It's for all sorts of applications, for something that you often deal with, which is pain, right? You can put folks in a VR headset with burn injuries and beyond, I get chills thinking about it, and they lower their need for opiates dramatically. Or blending it with mental health, without psychedelics to change your brain and mental health outcomes. PM&R, perfect application. Gets folks really engaged, it gamifies, it gives them points. The physical therapist can come in remotely and scorify it, really impactful for folks to do their other elements. It can help folks who are stressed out go to the, before surgery or procedure, you know, go to the beach. In fact, early in COVID, while the gyms were closed, I spent 100 days straight doing this supernatural workout game in a VR environment. I lost like three pounds and my resting heart rate went down by like 10 points. So these things can be super engaging and powerful. And now video games are definitely coming for mental health, rehab and beyond. So watch that space, it's getting really amazing and you need to collaborate with the game makers to make that happen. I think the biggest application for VR in our field is of course education. It's been used in interesting ways. I was in the OR with my friend Dr. Shafi, I met a few years ago, did the first live stream surgery to I think 3,000 medical students around the world in real time, just using, you know, smartphones and Google Cardboard. So can dramatically shift, get people, you know, out of the OR to learn in new places. I can never remember my cardiac anatomy and tautology of Fallot. Now you can walk into their heart and look at the anatomy and leverage that with your clinician, with your medical team and with the patient themselves to understand their disease, cardiovascular or beyond. And of course, simulation has changed medical education. We can now simulate an analog and simulate anything. I mean, anything can be simulated these days. But as you all know, we all trained, you know, see one, do one, teach one. How often do you get to remove this kind of challenge, right? Video games for doctors are here to help up level skills. So I think, you know, instead of seeing patients and practicing on them in the future, we're increasingly going to try out procedures, especially in our surgical realm where you can try new devices, practice on the patient's exact anatomy that you're going to intervene on in some way. And not just individually, but come in as teams collaboratively. So that's already coming to the fold, shown to dramatically improve learning, retention and outcomes. So from see one, do one, teach one, to see one, sim one, sim one, sim one, until you get it right. And I think broadly the future of health education, any procedure or encounter will be guided by the knowledge of thousands and millions of encounters. It's happening in the OR, where you can start to film laparoscopic surgeries and learn what the challenges are and give that guidance real time. And of course, robotic surgery is blending in and we're going to end up in an era where many clinicians are being augmented from sort of like our modern cars, which can stay in their lane and are getting more and more capable from driver assist to clinician assist. And think about how that can enable you and often the shortage of clinicians out there in many parts of the world, because believe it or not, 50% of surgeons and physiatrists and oncologists are below average. We need to bring everybody up, right? Okay. So let's look at what's happening in the diagnostics space that relies on technology. It's getting super interesting. Of course, a decade ago, we had the first examples of a glucometer that could snap on your smartphone. The first examples of a prototype EKG on a smartphone case, which now a decade later, you see ads on CNN for the cardia and you can buy a 6-lead EKG for yourself or your patients to track AFib or other elements and even a credit card size version. The blood pressure cuff, which has been even made small enough to fit on a cuff, it still squeezes your wrist, now is gonna go away because there's a few technologies out, and just FDA cleared, that can do real-time blood pressure and soon maybe even blood sugar. So I think two more clicks of Moore's Law and the next generation Apple Watches and Fitbits of the world will do real-time blood pressure and blood sugar. What are you gonna do with that kind of information? You don't need to wear anything now to do vital signs. The camera on your laptop or a smartphone can pick up heart rate, blood pressure, oxygen saturation, and more. So that's gonna democratize our ability to collect vital signs pretty much anywhere, anytime, almost for free. Or to look at your patient's face and quantify their pain, for example. There are other examples of the medical selfie. For those of you dealing with complex wounds, you can now take a picture of the wound and analyze it with AI and help the wound care nurse and the patient and the clinician make sense of it. I'm on the board of this Israeli company called Healthy IO. They can bring the urinalysis to your smartphone. You don't bring the urine to the lab to check for UTIs or preeclampsia or proteinuria. Tip it at home, take a picture with a smartphone camera, and boom, easy peasy. You've got your urinalysis results, which can be really good for screening and lowering costs and lowering burden. Easy peasy. So AI on your phone. So the phone is really becoming a platform for healthcare. It's able to be modified to look in your kid's ear and diagnose an ear infection. The microphone is becoming a platform for voice as a biomarker. You can find early signs of neurologic disease or track progression of Parkinson's or find ALS early or mental health challenges. The sound of your cough is that croup, COVID, or a common cold can be diagnosed. My friends at Click Health just published last month that you can estimate blood sugar based on voice. So you can screen for type 2 diabetes with 10 seconds of voice. So really interesting new ways to pick up challenges just on your mobile device. And speaking of voice, for example, it's being super useful in many settings. Amazon Alexa's only been out for about eight or nine years, but Google Home, et cetera, can be a whole conduit. Whether you're nine or 99, you can use your voice to interact with technology or if you're paralyzed. So new ways voice is coming into play. But of course, all technologies sometimes have some downsides, some unintended consequences. So I'm gonna give you a little brain break here for a second. Watch this little video about the unintended consequences of voice technology. Have a listen. Play jazz. Playing jazz. Smoothie. Making smoothie. Calendar. No meetings today. Remember dentist at 9.30. Fire off. Fire off. Open door. Open door. Open. And we're gonna do one more. Fire off. Open door. Wrong voice command. Open door. Wrong voice command. Open. Open door. Repeat that. Open door. I didn't understand that. Hey, open door. Play on the floor. Play on the floor. Eat cake on the floor. Open the door. Open the door. Error. Error. With a rock? Open door. Open. So sometimes keeping things simple is important. I'm not saying technology is the answer. It has, sometimes we need to imagine some of the dark side or other implications. But the possibilities of these new diagnostic tools, of course, is they can start to measure our behaviors, especially our risky ones, that drive most of our costs in chronic disease and mortality and morbidity. So speaking of quantifying behaviors, 20 years ago I did a project out of Stanford with NASA. We built a black box for the body for astronauts. It was this huge clunky device. Six, seven years after that, we had the first Fitbits launch only 13, 14 years ago. I'm sure many of you are wearing some sort of wearables. Sometimes some of the bad actors are getting in there. The health insurance companies or life insurance will give you a lower premium if you walk 10,000 steps a day. Not that 10,000 steps is the answer. So some of you who are entrepreneurial might be looking for some new business opportunities. People pay me to put steps on their Fitbits. Of course, actually, that won't really work because your Fitbit or your Apple Watch can tell from your gait who it is. As I'm sure many of you are aware, can be a real lens into who's wearing it and their mobility issues. But bottom line, these wearables and otherables can now measure almost every element of physiology and behavior. I'm sure many of you are wearing some. I've got two different wings and sensors I've got a bunch on I won't show you. I'm just curious, how many of you have ever prescribed a wearable to a patient? Few, okay, 5% so far. Or Wi-Fi in the home to pick up bottles seamlessly without wearing anything, that's coming next. But what's interesting here is these sensors are evolving from what's on your wrist to a sensor in a pill to track adherence. And we know about the challenges with medical adherence. They're impatchables now, they're powered by body movement. It can be a wearable ultrasound device to track cardiovascular disease. Stockables for your diabetic patients with feet that might have issues they can't feel, pick up hotspots early. Shakeables, tremor can be measured and then medications can be optimized through a simple wearable device. Or now this world of electroceuticals. Stanford spin out called Kala Health, you've probably heard of. Now for essential tremor for example, it's not just a wearable, it doesn't just track tremor, but it measures it and applies electricity back to sort of like noise cancellation headsets, knock out the tremor. So a good example of a wearable device is now therapeutic. And that's just an early example of the field that really impacts I think PM&R which is electroceuticals, right? Everything from pacemakers for the gut to pain, to bowel disorders, to obesity, to vagal stimulation. So a really interesting space. Other wearables are coming to the ear, not just for hearing enhancement, but to give you vital signs measurements or guidance to someone who might have cognitive disabilities after a stroke or dementia. Sweatables, might be useful for you running a marathon, but also might be useful if you have a patient with, I don't know, renal disease or CHF. Tattooables are coming next, the next decade. It might be very personalized and give you real time information. That's kind of artistic blend. Underwearables, like these are so cheap that this company started as an internet of things for little sensors that would track your breath, your stress, and give you meditation. Now with the new incentives, with new CPT codes for remote patient monitoring, they're sending folks home and clinicians and teams are getting paid to track their patients and their respiratory status for COPD, COVID, and beyond. So a blend of health to medical. And of course, analog scales have become digitized for a while, but the next generation won't just track your weight. Whether you like it or not, they'll track your shape, what your muscle mass is, any swelling, any other changes. That might be very useful in many rehab settings to have that in the clinic or eventually the home. Other things you can start to quantify. Breath can be quantified. This sort of idea of a breathometer might be useful before you go into social engagement, but there are now nanonoses to pick up metabolic disease and screen for certain cancers, from lung, colon, and breast cancer through the breath. Ringables are, of course, a wearable. Some of you might have the Oura Ring. I've got a couple versions on. Think about all the exponential technology that fits on a ring today. And one of its best applications, frankly, is for sleep. If you guys do nothing else for you or your patients, they start to track an optimized sleep. There's some ways to do it fun if you're on call or at home, but that, we know, plays such a huge role in risk for disease and recovery, and there are ways now, obviously, to track that. In fact, the Oura Ring can not just track sleep, but can predict pregnancy, five days before a home pregnancy test. It can also predict your COVID booster response based on heart rate variability, temperature, and respiratory rate, and beyond. So really interesting public health measures will come from our wearable devices. And these devices are becoming more and more integrated. There's just now a couple patches out like this one that gives you an intensive care unit level of data streaming from a dollar-a-day disposable or rechargeable patch. Who's gonna manage that data? How do we make sense of it? It's still a challenge, but now you can send a patient home and have much more high levels of monitoring. And it's not just monitoring, but now the ability for these devices to do training, trainables, right? We all have issues now with our smartphones and laptops and Zoom and our posture. Many of your patients have low back pain and beyond. You may have seen this little device called Upright. It's been around for a while. But it's kind of like your digital mother. You put it on your back. And if your posture isn't great, it recognizes that you're hunched over for a little too long and gives you a little nudge. Hey, Daniel, stand up straight. In a week or so of wearing that, my posture's better. This is super useful for folks with lower back pain, an example of a feedback loop, right? So it can take just simple data, right? It doesn't take something fancy. You've sent a patient home, or you're working with an orthopedic team. And if a patient is kind of fragile, sent home after a total knee replacement, total hip, or other procedure, are they walking more each day? Or are they walking less? If they're walking more each day and doing well, that might be on path to recovery. If they're walking less, you can track that from a simple Fitbit. You might want to intervene early before they have the fall. Or maybe you can tell about their gait from now these censored belts that can censor risk for fall. So if you have patients with fall risk, you might try them out with another sort of prototype wearable. I call them protectables, right? So it might prevent hip fractures in folks who are certainly wearing an airbag. Not a great idea yet, but getting there. And then, of course, firmly in your world, the ability to upskill, up-enable someone who might be paralyzed, or worse, with exoskeletons. I think you have Rewalk over in the hall next door. Those are getting super interesting, smarter, better, cheaper. I got to try one on last summer in Europe. This one's 3D printed. It has AI. And about three minutes into training, I was being walked around by the robot. Really powerful demonstration that hopefully can, again, start to democratize access for many folks who have severe disabilities. In fact, these are coming for folks without full paraplegia, as you've seen. This is out of MIT. And even new devices, a consumer one, that'll help folks run faster, carry more weight. And it certainly can be applied to folks with strokes, and motor weaknesses, and all sorts of disabilities. I think it's going to be a really exciting area as these technologies converge and get cheaper and more available. My favorite wearable, of course, seeing as a pilot, is a jet suit, which actually has applications in health care. They're trying these out to help rescue folks in the mountains after they can't reach them with a helicopter or in bad weather. I got a chance to try flying this. I was tethered, so most of the time I did not look like James Bond. These were my better flights. Most of the time, I look more like that, yeah. But the ultimate wearable for health care. OK, what else is important in health, medicine, and rehab, of course, is our diets. Food, medicine, food, said Hippocrates a long time ago. Now we can use technology to measure our food, our calories. And the food itself can be detected from very smart AIs on your phone. It can detect input. Is it gluten or peanuts? So you can measure ins, and increasingly, you can measure your outs in all sorts of interesting consumer-based ways coming to a toilet near you. So ins and outs aren't just for the clinical space. And it sounds a bit funny, but we know that we can now also start to measure metabolome. Many of you have tried CGMs, even if you're not diabetic. And that gives us other levels of information. And we know there's all these fad diets and things that aren't proven out. But when we blend metabolomics, microbiome, genome, and real-time insights, we're going to really enter this age of precision nutrition, which I think can play a super key role, as you know, in preventing injuries, recovery from disease, surgery, and beyond. So watch that space. All right. So where are we going to be in a decade with all these new wearables and otherables? Our Digitome, our digital exhaust, will be collected 24-7. Who owns that data? How do we share it? How do we make sense of it? It's still a challenge. How do we personalize that to the individual and the clinical team? Another part that's moving quickly on diagnostics and therapeutics is imaging, right? Here's my brain. It comes color-coded with AI. Some of you have had your full body scans done for a couple thousand dollars. In the next decade, those will get cheaper and more driven by AI. You might go to your corner pharmacy and get your full body scan done in 10 minutes, read by the AI radiologist, and screened for cancers or other challenges. In fact, the machines, the MRIs are getting smaller and more mobile. This is not a 5 Tesla machine, but I, in my own brain, MRI-ed going down the Hudson River on a boat in five minutes, plugged in the wall power. That could be useful to, again, democratize how and where folks get brain imaging. And these devices are even becoming wearable. This is an open water, which can use a wearable head link to diagnose stroke, brain masses, and even apply therapeutics. And as you know, there's a lot happening in the neurologic space, very applicable to your field, to the brain-computer interface world, neurostimulation. All the way, my friend I went to Brown with, Lee Hochberg, driving the BrainGate work for folks with really severe challenges and exciting work you also published this summer at UCSF with BCI and AI giving paralysis, a paralyzed woman who's locked in her voice back. So really incredible convergence of technologies, which is going to unlock the world for many who have severe disabilities and upskill some of us who have minor disabilities or super-enable us in really interesting ways. So this kind of tool set can, again, take health care in new places. This is a picture of my digital doctor's bag, or it could be for a community health worker, or nurse practitioner, or anybody who wants to leverage these tools to help make a diagnosis, right? I'm never good at listening to heart sounds, but now I can pull out my, where is it? Somewhere in my pocket is my echostethoscope, right? It does an EKG and does heart sounds and can diagnose a heart murmur better than most cardiologists. Or soon we're throwing away our stethoscopes because low-cost, pocket-sized ultrasounds are here for $2,000 or less. Driven with AI can guide almost anyone to be an ultrasonographer, and that's going to open up and democratize diagnostics. And speaking of diagnostics, as was mentioned, I've been helping at XPRIZE as an advisor for many years, chaired this XPRIZE and Health Pandemic Alliance. We actually ran an XPRIZE back in 2020 when COVID testing wasn't fast, frequent, cheap, or easy. And we ended up with 700 teams from over 70 countries driving and developing really novel new ways to do COVID and other infectious and non-infectious diagnostics. And so when you leverage the power of a prize, sometimes you can get a lot of new insights and innovation. Just like Charles Lindbergh crossed the Atlantic to win an XPRIZE, that can catalyze change. And that's coming to our home diagnostics environment. In fact, I helped design an early cancer detection XPRIZE spurred by the cancer moonshot element. That prize isn't even needed today, because we can now go online and order your own blood-based biopsy-like gallery to find, in some cases, early cancer. So that world can be incented by prizes. We were just at an XPRIZE Visioneering last week. We had a couple prizes in the realm of potential physiatry and rehab proposing XPRIZE to stimulate new forms of non-invasive mobility devices. So think about how you, in small and big ways, can leverage prize models to achieve things faster and cheaper. Now, speaking of achieving things, it's hard to achieve things when you're overwhelmed by data. And AI is a tool to start to make sense of that. I like to call it not AI, but IA, Intelligence Augmentation, because it's really starting to augment our brains and our practices. And sometimes it can get a little overhyped. Remember, IBM Watson beat Jeopardy! Champions 2011 or so. There's all this hype that we're going to have IBM AI doctors in two or three years. That didn't quite pan out, kind of because of Amara's law. Sometimes we see something new, and we kind of overhype it, over-expect what's going to happen in two years. But it didn't underestimate what's going to happen in a decade. And now we have all these new AI FDA-cleared applications coming to the fore. Again, AI is getting faster and better with us, in many ways, faster than we predicted. The singularity is getting nearer and nearer. And so today, again, we can already use AI for simple ways to get rid of the scut work and the friction levels in health care. And it's already being used and powered, of course, in the radiologic space to find lesions that might have been missed. Google is coming out with a very easy-to-use interface. You can take a picture of your X-ray or MRI, and it can read it for you. And that's going to be very helpful for democratizing imaging around the world. That's about to launch soon. Of course, even for our friends in the GI world, AI can pick up a lesion that might have been missed during a colonoscopy. And then if that lesion's biopsied, AI pathology is here. That's getting really, really powerful across the pathological spectrum. So again, superconvergence happening in diagnostic procedures. And I think across the spectrum, it can start to sift all this sort of data. Whether you're in the ICU or the rehab facility, it'll help prevent medical errors. It'll help find problems early, who's at risk for a fall, or sepsis. And we can intervene early before things get super expensive. It's also coming to drug delivery, a whole other topic, and drug development. So the challenge for all of us, as this is moving so quickly, is how do we collaborate and not compete? It's not human versus machine. In fact, AI is blending increasingly with robotics. These are still kind of kludgy humanoid robotics. You see how quickly they accelerate. They can start to do maybe some health applications from future pharmacy to telepresence. But 10 years from now, these are going to be almost fully autonomous, be able to help with our care, with rehab, with all sorts of elements. So again, watch that space. It's coming quickly. So the tagline, of course, is that AI is not going to replace your physiatrist, nurse practitioner, PT. But those who are using AI are going to replace those who don't. So watch for that ability, as well as the ability for it to upskill all of us, in some cases where there's a shortage of clinicians and specialists of all sorts, to upskill the community health worker or the caregiver at home to do some things that used to require a medical license and many years of training. So a lot of these new tools, technologies, blend together something that's often called digital health. The ability to take these new forms of data and make sense of them, sometimes on an app, sometimes in other forms, to individualize that for the patient, or the clinician, or the health care system, or the public health service. And we're down in the era where we don't just prescribe a drug or a device. We might prescribe an app, an app to track exercises and rehab, or apps that might help folks quit smoking, or track their home physical therapy, or big challenges in mental health. A lot of new digital health mental health platforms often blend with human psychologists that can really help manage anxiety, oppression, PTSD, burnout, and beyond. Or video games, FDA cleared, that can treat kids with ADHD with better results than Ritalin. So it's a really interesting time to take these new forms of apps and data and shift us from where it's sort of siloed as an app on our phone, quantified self. We can track our steps, our sleep, it's on our device, to quantified health, where that data increasingly is going to flow from your patients to you and your health care team, so that we can use that data in impactful ways. In fact, a survey came out last month that 91% of Americans are somewhat interested in sharing their personal health data with their clinical teams. And we can then use that data, whether it's from the censored home, and aging in place, or someone who's in a rehab facility, to be much more proactive about prevention and wellness, diagnosing disease at stage 0, not stage 3, or therapy, using that feedback loop, whether it's how many steps they've done, how many reps on their rehab or their exercise, or changes in blood pressure, for example. And now, again, we can start to collect all that data at scale through our mobile devices. Verily, the Google spun out has done this baseline trial measuring thousands of Americans with their digital exhaust in the medical records. Or the NIH, you might have heard of the All of Us trial, kind of a Framingham trial on steroids to make sense of all this new data and make it useful. So we don't just base our clinical guidelines on Framingham, a population of mostly Caucasian nurses and folks that isn't representative of our heterogeneous population. So that's going to take us to this era of hopefully really optimized real-time predictolitics. Imagine each of us and each of our patients had a bit of a FICO score that integrates not just their labs and their vital signs, but their financial health, their sexual health, their social connection scores, which plays such a huge role in health. Imagine that each of us has a bit of our own personal check engine light, or your patients do that give you early warning before they're going to have that fall, stroke, or heart attack. And that's not science fiction. My colleagues at Stanford have already been building these check engine light systems that predicted obesity early, sorry, diabetes early, or Mike Snyder's diagnosed his own Lyme disease through this. In fact, his lab published during the pandemic that their Apple Watch could tell who has COVID sometimes two days before they're PCR positive. So huge public health implications from our wearable devices have shared at scale, or shared with our social graphs, because your Facebook often knows when you might be getting sick based on who you've been around. So the future, a bit dystopian might be, before you go into a meeting and shake hands with someone, you'll kind of get a little score. I think Dr. Flanagan's okay, but social interactions will be interesting as we get heads up knowledge. So 10 years from now or less, we'll almost be in this minority report year. We're gonna know when our patients are in trouble, or are gonna have a disease, or something that's gonna really bite them a bit earlier, certainly much earlier than we have today. Now, I've already thrown a lot at you. You're gonna see a lot of technology and solutions already out there. How do you make sense of what's here today and let alone what's coming next? 10 years ago, I could keep track of most of the wearables and digital stuff. Now it's a challenge. So to address that pain point, I just launched a new platform. It's a website called digital.health, easy domain to remember. If you go to digital.health, it's a bit of a digital health formulary to find solutions for clinicians to use in their patients. So for example, you're looking at digital monitoring and diagnostics. You might be interested in that in a live core device that does an EKG. You can look at its evidence base, the trials. You can put it in your own digital formulary, your favorites bag, or you can start to put it in a digital prescription bag and prescribe that along with a app for stress or other elements to your patients. So prescribing digital health. Or you have a patient with type two diabetes, you wanna help them reverse their disease, not with a drug, but with diet medication. There's platforms like Virta that can reverse diet with coaching and diet. Or there's a whole bunch of elements on the site. I just looked up in rehabilitation and physiatry. So if you have a solution, put it there. Please find it, use it. I would love to build physiatry.digital.health or some version. If someone's interested in helping build that data set and it's a free platform, please let me know. Now, again, more apps, more wearables, more data isn't always helpful. We're already overwhelmed with our current amount of data. The internet of medical things is only getting bigger and bigger. It's 5G today. In 10 years, it'll be 6 or 7G, 1,000 times faster. None of us want more data from our patients. We want the insights that we can use and have actionable information. And we don't want the data siloed between EMRs and medical records and wearable data and have to log into five or 10 different systems. The challenge is we have lots of data, the new oil, but that's not enough. We need to go from data to insights and knowledge. And not just something that's published here you might learn in this great meeting, but something that can be translated immediately to the bedside or increasing the website, narrowing that 17-year gap that we've often heard about and improving the dissemination of real-time knowledge, this new field of implementation science. I think it's really interesting. How do we go from new knowledge, again, to something that's used in real time? And that has to integrate, of course, into our workflow, which has been kind of kludgified over the years by EMR systems. Burnout is a real thing. And we talked about the quadruple aim of improving the clinician experience. And AI and other tools are here to help write our notes for us and sort of give us more human time with our patients and less computer time. Now, where this gets super interesting is when we start to crowdsource all this new knowledge. Imagine 15 years ago we still drove with Google Maps and Waze, remember that? That would be hard to imagine getting around New Orleans or San Francisco or New York without Google Maps. Imagine we built a Google Maps or Waze for patients with certain conditions and they shared that knowledge. And we could all not just be organ donors and blood donors, but also be data donors and build that kind of Google Maps for our patients and glean that scale knowledge. That engages our patients to be involved with their knowledge in clinical trials. The engaged patient is often the new drug and they do much better. And they can then now, of course, opt into virtual clinical trials, which accelerated through the pandemic in really interesting ways. At Stanford we had the My Heart Counts trial. I think it recruited the equivalent of the Framingham trial in its first week. So really interesting new ways to think about having a medical share button for all of us across societies, across organizations, across clinics. There's some tools you can try today like Quantified Citizen. You can build your own clinical trials. There's Stuff That Works, kind of a Waze-like platform to find what's working for individual patients and learning what's working for patients like mine. So pay attention to the crowdsourcing space. So let me close up with how this is gonna start to change our practice of medicine. Of course, telemedicine has been here for a while. It's shifting how we do care. The ability now to go from intermittent episodic data, collected only in the four walls of the clinic or ER, ICU, and leading to our reactive mindset where we tend to wait for the patient to show up with a heart attack or the stroke or a late stage cancer or a fall, is gonna shift into a new era where we've kind of touched on a more continuous data that's much more personalized, much more proactive, can start to bring care anytime, anywhere, arguably at lower costs with even better outcomes and more accessibility and health equity. And again, shift where healthcare's happening. Increasingly, it's gonna move from hospital to home hospital. A lot of rehab can move in that direction as well. And we're gonna need to think differently about how we interact. The chatbots are okay today, but our virtual visitors of the future won't just be talking to the chatbot. They're gonna know you, your genome, your medical record. If you have abdominal pain, it'll know if you had your appendix out, for example. Particularly for complex patients, it'll be that first layer of care. And some of you will show up as a personalized avatar. It's pretty easy to turn yourself into an avatar today and enter the Mediverse, the Mediverse, not the Metaverse, and interact with your patients in new ways. You can actually today be turned into an avatar pretty easily. Here's my little version that was done in like 20 seconds of computation, and you can be pushed into almost any situation. So it's gonna be a really interesting time to think about augmenting our abilities with AR, VR, and not just the old-school models. Here's just an example of how amazing these interactions are getting. This is on the new Oculus platform, where Zuckerberg's being interviewed by a podcaster. You were like right here. I don't know if people can see this, but this is incredible. The realism here is just incredible. Where am I? Where are you, Mark? Where are we? You're in Austin, right? No, I'm here in this place. So you get the idea. That's the art of the possible, and so that means how do we think about the clinicians of the day in the future? How do we train them in not good bedside manner, but good website manner? What is the future of medical education needing with all these new tools? I'll finish up with a very quick example in a matter of time about personalized precision, this idea now that 3D printing, you use it a lot in maybe making certain rehab elements from hearing aids to braces to medical implants. What if we could think about 3D printing and blending that with personalization of our medications, instead of taking a pile of meds and polypharmacy in the wrong doses, what if we could build personalized polypills, leveraging AI, machine learning, big data to print the right pill for you or your patient for proactive prevention or for managing chronic disease, starting with generics, sorting the right dose of Coumadin or statin or other neuroleptics that might need to change day to day, starting at your corner pharmacy, but eventually imagine printing that personalized polypill at home on a small printer that could adapt to you as you need it. So I think that might be this future of hyper-personalization data and feedback loops as we go forward. So to close, I think we're in for a really interesting next decade or beyond, we're really entering this new health age. I think in the world of physiatry, we have so many opportunities to leverage these conversion technologies, here's the theme from Norlin's, to really think differently about the art of the possible in the future. And it's not again about any one technology, it's not about AI or 3D printing or nanotech or blockchain or wearables or otherables or VR, it's about how you think about cludging them together to address the pain points you experience in your practice and those of your patients and community. So it's an exciting time, again, not to think about where we are in 2023, but be like Wayne Gretzky, the hockey player and skate to where the puck is gonna be in 2033. And if we have that exponential convergent mindset, we really can go from our now, intermittent reactive sick care to a future that's much more continuous, proactive, personalized, crowdsourced and available. So let's not take incremental steps in health medicine and PM&R, let's take exponential ones, the future is already here, it's just not evenly distributed, many of you are building that future. So it's our opportunity not to predict the future of medicine, but boldly create it together. So with that, thanks for your time and attention and keep building the future of psychiatry. Thank you.

technology

healthcare industry

genomics

augmented reality

virtual reality

artificial intelligence

proactive approach

personalized care

data analysis