Kim Solez Ishita Moghe Seizing the opportunity of technology and the future of medicine creating the possibility of a positive medical future for everyone Medical Grand Rounds Presentation Feb. 1, 2019.

1. Kim Solez, MD and Ishita Moghe, BSc

2. Humble Herbalist Invites Country Pathologist
to Present at Medical Grand Rounds
Robert H. Heptinstall - Kim Solez Mentor
Referred to himself at “Country Pathologist”
Will be 99 on July 22, 2019.

3. Heptinstall Was Born and Raised in Keswick in the
UK Lake District population 4,821. Solez grew up in
Avoca, New York, population 1,099. Even More
“Country” Than Heptinstall! Both towns have had
stable populations for 80+ years.

4. Keswick has a Pencil Museum. Avoca (near
Bath) has a Bombardier Repair Facility that
repairs Edmonton LRT cars (among others).

5. Ishita Moghe BSc, Graduate
Student in Renal
Pathology/Nephrology
Immersion. Training in
Kidney Pathology in the Year
before Medical School.
Her Dog is Toto from Wizard of Oz
Reincarnated! Same Kind of Dog.

6. On my YouTube Channel
https://www.youtube.com/user/kimsolez
subscription rate went up six fold when
Ishita Moghe began co-presenting with me!

7. Previously I Only Knew Students’ Thoughts About
Tech&Future of Medicine Course Through Feedback
Questionnaire, but in Dec. 2018 Spontaneous
Positive Outpouring. Ishita Moghe Lectures Seemed
Like Only New Element to Account for This .
Bertalan Mesko - The

8. Moore’s Law Predicts Singularity

9.  The challenge of friendly AI becomes just a small part of
a much larger challenge of creating a friendly world in
which humans still have lives of significance, human
history is retained and extended.
 We all need to be engaged in ensuring a positive
outcome for humanity. The future is ours
to shape. We need to get busy doing that!
 Part of the imagined future could be
one where all disease was eliminated
but life was intolerable. Another where the only diseases
are from bioterrorism.
We Could Eliminate All Disease and Still
Have A Terrible World!

10.  All natural disease may be eliminated, leaving
only man-made diseases. But that may leave
as much for physicians to do as there is today!
 Challenging responses to bioterrorism and
stem cell technologies.
 Focus of medicine no longer disease but
enhancement, which will extend beyond the
physical to the moral and spiritual.
 Social responsibility an important aspect of
medicine and one of the focuses of the course.
2045 is only 26 years from now. Many of you
will still be working then. What will medical
careers be like then?

11.  “It is the curse of humanity that it learns to tolerate even
the most horrible situations by habituation. Physicians
are the natural attorneys of the poor, and the social
problems should largely be solved by them.”
-Rudolf Virchow
Rudolf Virchow on the Social
Responsibility of Medicine

12.  At the age of 27 I was an intern in Pathology at Johns
Hopkins. I read in the Oberlin Alumni Magazine about
the Oberlin Winter Term program and decided to offer
an experience in January 1973 when I was on my
cytology rotation. This involvement with students
continued 46 years to the present day. Dr. Heptinstall
called the students “the children” but benignly tolerated
them.
Most Quotes by Rudolf Virchow were
made in 1848 when he was 27 years of
age. What was I doing at the age of 27?
First engagement of undergraduate
students in my research.

13. Kim Solez Career Timeline
• MD With Honour and With Distinction in Research,
University of Rochester, Borden Award for Best Medical
Research done by a member of the Graduating Class
(Medical School) 1972
• Francis F. Schwentker Award for Best Research done by
a Johns Hopkins Hospital House Officer, 1974
• Assistant/Associate Professor of Pathology and Medicine
JHU 1977-87
• Chair of Department of Pathology, University of Alberta,
1987-92.
• First Banff Conference on Transplant Pathology 1991 (still
continues with future conferences planned to 2025!)
• National Kidney Foundation (U.S.) support of
cyberNephrology Center 1997- 2007

14. Kim Solez Career Timeline
• International Society of Nephrology support of Informatics
Commission 1997-2007
• William Boyd Lectureship 2002, Canadian Association of
Pathologists.
• Researcher of the Year, Capital Health Authority, 2005.
• National Kidney Foundation (US) Distinguished
International Medal, 2009
• Technology and Future of Medicine course begins 2011
• Tier 1 Clinical Mentoring Award, University of Alberta
Faculty of Medicine and Dentistry, 2016
https://www.youtube.com/watch?v=j03j1JMlYg0
• Teaching technology and the future of medicine to entire
first year medical student class directly begins in 2016.
• Eight publications in 2017-18 year. Career high.
• Medical Grand Rounds February 1, 2019 Age 72

15. Students Key to 1974 Award!
Francis F. Schwentker Award for Best Research done by a
Johns Hopkins Hospital House Officer, 1974 In presenting the
award Chair of Medicine Victor McKusick read the full names of
all coauthors saying “Since Dr. Solez was a busy house officer I
am sure the other authors did considerable work.”
Solez, K., Kramer, E.C., and Heptinstall, R.H.: The pathology of
acute renal failure: Leukocyte accumulation in the vasa
recta. Am. J. Pathol. 74:31a, 1974
“Solezocytes”
in vasa recta
in acute tubular
injury

16. Students Key to 1974 Award cont.!
Solez, K., Kramer, E.C., Fox, J.A., and Heptinstall, R.H.:
Medullary plasma flow and intravascular leukocyte accumulation
in acute renal failure. Kidney Int. 6:24-37, 1974.
Solez, K., Miller, M., Quarles, P.A., Finer, P.M., and Heptinstall,
R.H.: Experimental papillary necrosis of the kidney. IV.
Medullary plasma flow. Am. J. Pathol. 76:521-528, 1974.
Solez, K., Fox, J.A., Miller, M., and Heptinstall, R.H.: Effects of
indomethacin on renal inner medullary plasma flow.
Prostaglandins 7:91-97, 1974.
“Solezocytes”
in vasa recta
in acute tubular
injury

17. Full Professorship a Great Honor!
In 1977 Chair of Medicine Victor McKusick was happy to give me
joint appointment in Medicine and predicted it would keep pace
with my primary appointment in Pathology at the Assistant and
Associate Professor level but said “Being a Professor of Medicine
at Johns Hopkins is a great honour. It is unlikely that a pathologist
could achieve that honour.”
Full Professorship in
Medicine probably
unattainable for a
pathologist Victor
McKusick said.

18. Full Professorship a Great Honor!
That statement stuck with me, and I was very proud of my joint
appointment in Medicine. When I became Chair of Pathology at
the University of Alberta in 1987 I asked Chair of Medicine
Garner King about the joint appointment in Medicine. He just
looked at me in amazement. He had worked quite hard to recruit
me but did not anticipate this! The joint appointment did not
happen. Ah well. What might have been!
Full Professorship in
Medicine probably
unattainable for a
pathologist Victor
McKusick said.

19. Students who worked with me
1973-74:
Dr. Jennifer (Fox) Nuovo

20. Dr. Pamela Quarles
Became a psychiatrist in Alexandria, Virginia. Was the
daughter of legendary black historian Benjamin Quarles
(center of 1992 image)
https://en.wikipedia.org/wiki/Benjamin_Arthur_Quarles .

21. Elizabeth (Beth) Kramer “Are
you still doing that old stuff?”
Became a nursing leader. Five years later she
came back to see me. I told her what I was up to,
and she said “Are you still doing that old stuff?”
This embarrassing remark motivated me to
become an innovator, to step out of the box, to do
unexpected things.

22. Elizabeth (Beth) Kramer “Are
you still doing that old stuff?”
This drive to innovate led me to found and
direct a course on Technology and the
Future of Medicine, which talks about a
future world in which:
1) machines become smarter than we are
and take over the future agenda of the
world (The Technological Singularity),
and
2) stem cell generated organs and organ
repair offers a cure for most diseases.

23. Think Different – Sharing
cyberNephrology 5B3.09 WCM
HSC with Students & Fellows
since May 15 2015
Annette Shaff / Shutterstock.com

24. Here are the current students
from 2019. In many ways they are
a direct lineage from those
Oberlin college Winter Term
students 46 years ago in 1973!

25. If cyberNephrology were my whole
life there would be something out of
balance. Tuesday night poetry at
the Nook brings balance back. Many
at risk youth there. I provide video,
lighting and infrastructure.

28. New aspects of the future taught
in the LABMP 590 course suggest
two new disciplines of pathology:
1) Tissue Engineering Pathology, study of the
abnormalities in stem cell generated organs, a
discipline which helps to perfect regenerative
medicine therapies (Good!)
2) Apocalyptic Pathology, study of the pathology of the
elimination of the human species by sentient
machines who found us a nuisance (Bad! Theoretical
only (we hope!), the human remains/artifacts left
behind for robots to study after we meet our demise!)

29. Technology Run Amuck Scenarios,
Unfriendly AI & Nanotechnology Gone Wrong
- Grey Goo – Not Appealing Lecture Subjects!

30. You Know Something About the Apocalypse
The End of the World Through One of Robert
Frost’s Best Known Poems.

31.  In an anecdote he recounted in 1960, prominent
astronomer Harlow Shapley claims to have inspired "Fire
and Ice”. Shapley describes an encounter he had with
Robert Frost in 1922 a year before the poem was
published in which Frost, noting that Shapley was the
astronomer of his day, asks him how the world will end.
Shapley responded that either the sun will explode and
incinerate the Earth, or the Earth will somehow escape
this fate only to end up slowly freezing in deep space.
Shapley was surprised at seeing "Fire and Ice" in print a
year later, and referred to it as an example of how
science can influence the creation of art, or clarify its
meaning. (From Wikipedia)
Science Influences Art: Robert Frost’s
“Fire and Ice” Inspired by a conversation
with prominent astronomer Harlow Shapley

32. Acceptance. Share power. The AIs will not all be under our
control. They will compete and cooperate with us just like
other people, except with greater diversity and
asymmetries
 We need to set up mechanisms (social, legal, political,
cultural) to ensure that this works out well
 Inevitably, conventional humans will be less important
 Step 1: Lose your sense of entitlement
Step 2: Include AIs in your circle of empathy
The Future and All That Jazz: Art Helps
Convey Important Messages of Science.

33. Kim Solez, MD and Ishita Moghe, BSc

34. In 2019 We Have Agency, But Proof Is Lacking
Who Influenced What. As Instances Accumulate
Evidence Becomes Convincing. Timeline 2 days
to 6 months. Much Faster than Before! Formal
Documentation Lacking. Like Internal Medicine
My father Dr. Chester Solez now 95 and well,
is an internist whose first paper was
nephrologic, but who then concentrated on
cardiology working in the VA hospital system
in the US and finally rising to Chief of
Medicine and Chief of Staff. He emphasized
to me repeatedly that unless you were
performing procedures most of your day to
day patient encounters you could not be sure
you were helping the individual patient. You
only knew that in aggregate. That is very like
modern life today in general. Internal
medicine is the model!

35. Do We Have Agency? Can We Make
Change? In Previous Eras It Took Years to
Decades to Effect Change Via Journal
Articles and Books.
In Banff Classification, we are still
struggling with borderline changes after
27 years. Discussed with Leonard
Cohen in 2005, became the song
“Treaty” 11 years later. Isolated v
lesions discussed as evidence for
rejection for 6 years. Interaction stylized
documented, and formal. Slow, but you
knew who influenced what.

36. In 2019 We Have Agency, But Proof Is Lacking
Who Influenced What. As Instances Accumulate
Evidence Becomes Convincing. Timeline 2 days
to 6 months. Much Faster than Before! Formal
Documentation Lacking. Three Examples. #1
Instance #1 Human Cell Atlas Project
(HCAP) at ASN Meeting.
Oct. 29, 2017 “Blind-sided by the future”
message posted to Facebook complaining
about exclusion of HCAP from mainstream
meetings. Oct. 31, 2017 HCAP scientist and
nephrologist Benjamin Humphries appointed
Chair of Program Committee for 2018 ASN
Meeting. March 31, 2018 YouTube video
describing Moghe-Solez paradox of exclusion
of such subjects from mainstream meetings,
https://www.youtube.com/watch?v=dAb6Epw
pEkM
August 2018 Aviv Regev plenary
presentation on HCAP at 2018 ASN meeting
announced, in Kidney News received in Sept.

37. What a moment it was to hear Aviv Regev’s
ASN Plenary talk Oct. 26 2018 after all the
anticipation and talk with her afterward!

38. In 2019 We Have Agency, But Proof Is Lacking
Who Influenced What. As Instances Accumulate
Evidence Becomes Convincing. Timeline 2 days
to 6 months. Much Faster than Before! Formal
Documentation Lacking. Three Examples. #2
Instance #2 Sept 15th, 2018 Yuval Noah Harari Claims
humans will be stuck, all plot lines wrecked when machines
do all crucial decision making.
https://www.theatlantic.com/magazine/archive/2018/10/yuval
-noah-harari-technology-
tyranny/568330/?fbclid=IwAR2WjyHq_srFD4Zg_Wop-
3emHbWLpQRvtrgr5qW04cqRm_X8f1GpEzzYFw0
Sept 21, 2018 Our multithreading video points out humans
will adapt, culture could be many-fold better than today with
multithreading.
https://www.youtube.com/watch?v=wL2rL8LPfQM
Oct. 4, 2018 In his Wired interview Harari now says human
reaction to machine decision making is work in progress, no
predictions can be made!
https://video.wired.com/watch/yuval-harari-tristan-harris-
humans-get-
hacked?fbclid=IwAR1soHWIpmVz8P9HITPzd5Bdl2mYOy-
nXOe272x-6Eh5ufKVet5XXp_RmQU

39. In 2019 We Have Agency, But Proof Is Lacking
Who Influenced What. As Instances Accumulate
Evidence Becomes Convincing. Timeline 2 days
to 6 months. Much Faster than Before! Formal
Documentation Lacking. Three Examples. #2
Multithreading - Kim Solez, M.D.
Multithreading
Is where we're heading.
Obviously
Can't you see?
That's what in the future we will use extra intellect
for
So that instead of one life we can have four or more!
All concurrent
In the moment.

40. In 2019 We Have Agency, But Proof Is Lacking
Who Influenced What. As Instances Accumulate
Evidence Becomes Convincing. Timeline 2 days
to 6 months. Much Faster than Before! Formal
Documentation Lacking. Three Examples. #2
So everything fun and interesting you want to do you can
Even if events are in different places in the same short time
span!
Multiboxing in video games is just a small instance
Of something that in real life will allow us to pounce
On every desirable opportunity
With characters that are still us you see
And at the end of the day all our diverse facets of personality
Can compare notes on the day’s accomplishments endlessly.
Boy/Girl won't my multiple instances of self have fun
Swapping yarns about all the things they've done.

41. In 2019 We Have Agency, But Proof Is Lacking
Who Influenced What. As Instances Accumulate
Evidence Becomes Convincing. Timeline 2 days
to 6 months. Much Faster than Before! Formal
Documentation Lacking. Three Examples. #2
And imagine how compatible they will be
Since in the end they are all really me!
Every day lived with glorious concurrent adventures
And every night with grand stories told by raconteurs,
Multiple instances of ourselves
And gleeful as Santa's elves!

42. In 2019 We Have Agency, But Proof Is Lacking
Who Influenced What. As Instances Accumulate
Evidence Becomes Convincing. Timeline 2 days
to 6 months. Much Faster than Before! Formal
Documentation Lacking. Three Examples. #2
In his wired video interview Harari advises that individuals can
accomplish very little by themselves. They should join groups,
causes, he says. That is the opposite of our experience doing
videos together where we seem to be accomplishing a lot
without joining groups. More recent interviews do not have this.

43. All Five Reasons in this May 24, 2018
Article are Unsupported & Incorrect:
Bertalan Mesko - The

44. All Five Reasons in this May 24, 2018
Article are Unsupported & Incorrect:
Bertalan Mesko – The Medical
Futurist incorrectly states that:
1. AI cannot be empathetic.
2. AI cannot do nonlinear thinking.
3. Machines cannot interpret data.
“No robot or algorithm could clearly interpret complex,
multi-layered challenges – involving the psyche. While
they will provide the data, interpretation will always
remain human territory.”
https://medicalfuturist.com/5-reasons-artificial-intelligence-wont-replace-physicians
4. There will always be tasks like the Heimlich maneuver
algorithms and robots can never complete.
5. Human machine cooperation is the ultimate solution. There is
nothing better.

45. Directly contradicts author’s own
book from October 2017 about
physicians being replaced:
Bertalan Mesko - The Medical Futurist
states it correctly:
“AI will not replace physicians, but
physicians using AI will replace
physicians not using AI.”

46. We Directly Contradicted the May 24
July 20th 2018 posts in series of
videos from Aug. 20 to Oct 11th.
Bertalan Mesko - The

47. October 22 Bertalan Mesko video that
agrees with us does not mention us!
https://www.youtube.com/watch?v=h
T0ly4pDSoY.

48. Taken together these three examples
suggest our videos are accomplishing
major things, have agency.
Bertalan Mesko - The

49. Short time frame, days to weeks, in
these effects suggests a new model
of science communication.
Bertalan Mesko - The

50. Pathology and AI Came Together in
April 2017 FDA Approval of Digital
Pathology for Primary Diagnosis
Cytology,
Frozen Sections,
and
Hematopathology
were excluded
from approval.

51. In 2018 the First Ever Digital Pathology
and AI Congress in New York City

52. I recruited Digital Pathology expert
Yukako Yagi to joint UAlberta/Univ.
Pittsburgh position in early 1990s!
Now at Memorial Sloan Kettering, she was one of keynote
speakers at 2018 Digital Pathology and AI Congress.

53. Almost Overnight Pathology Went
From Having the Worst Promotion
of Any Specialty to the Best. We
became the Hollywood of Medicine!

54. Gone Are The Blood And Guts. Now
Every Page is Visually Appealing
and Seductive!

55. Every Effort Is Made to be Reassuring
and Comforting.
“AI pathology is never going to
replace pathologists.”
“Nobody should feel threatened by
advances in computational pathology.”
“The integrative aspects of pathology,
the cognitive abilities of pathologists,
and the collective wisdom generated
over many years as a community
cannot be replaced by a machine.”

56. These statements are only true near term,
not forever:
“AI will really help enrich your ability to
practice pathology and improve your
ability to serve your patients.”
“AI is not here to remove pathologists
from the decision-making process.”
“(AI is) an exciting step forward in
the discipline of pathology – one that
puts pathologists at the very center
of clinical care and precision
therapeutics.”

57. I direct a course on Technology and
the Future of Medicine which
considers many of these issues
Ishita took the course in Fall 2017.
Five AI faculty also teach in the
course.
Bertalan Mezko , Daniel Kraft, and
Gerd Leonhard teach similar courses
but as a professional keynote
speakers, not a full time academics.
The government of Finland has
recently started a free AI course which
it encourages all its citizens to take. It
teaches some special government
fictions.
www.singularitycourse.com
http://www.elementsofai.com/

58. New Finnish Government AI course
www.elementsofai.com Says We Do Not
Need to Fear AI because Self
Improvement Requires Human Help.
“… even if a system could optimize its own workings, it would keep
facing more and more difficult problems that would slow down its
progress, quite like the progress of human scientists requires ever
greater efforts and resources by the whole research community and
indeed the whole society, which the … entity wouldn’t have access
to. … human society still has the power to decide what we use AI
technology for. (With progress in AI we become)…better at
controlling any potential risks due to it.”

59. New Finnish Government AI course
www.elementsofai.com President of
Finland spoke at graduation ceremony
for course on Thursday Sept. 6th 2018!

60. Machines Will Be Able to Create Their
Own Models of the World but Humans
Will Want to Get a Word in Edgewise!
https://www.theguardian.com/books/2018/jun/15/rise-of-the-machines-has-
technology-evolved-beyond-our-control-

61. Machines Will Be Able to Create Their
Own Models of the World but Humans
Will Want to Get a Word in Edgewise!
"Google Translate was known for its humorous errors, but in
2016, the system started using a neural network developed
by Google Brain, and its abilities improved exponentially.
Rather than simply cross-referencing heaps of texts, the
network builds its own model of the world, and the result is
not a set of two-dimensional connections between words, but
a map of the entire territory. In this new architecture, words
are encoded by their distance from one another in a mesh of
meaning – a mesh only a computer could comprehend."
https://www.theguardian.com/books/2018/jun/15/rise-of-the-machines-
has-technology-evolved-beyond-our-control-

62. Fictional Worlds Presented to Sentient
AI As Fact Threaten Humanity’s Survival
AI Will be Sensitive to Lies About Itself

63. Fictional Worlds As Models of the Real
World Exist Already in 2018 and Will
Increase in Number and Influence