The Brain RevolutionMichael Sughrue, MD

The Most Complex Device Imaginable

1 Billion Neurons10,000 connections per neuronFunction changes several times a sec

1850’s model of the brain

In 2019…

In our clinic this year alone

Doctors still don’t have access to satisfying brain imaging tools. This results in nearly all patients with brain diseases to be treated without having a clear understanding how their brain is functioning or how it is connected.

Outdated technologies, diagnosis based on discussion alone, drug treatment without a clear plan lead to suboptimal patient care and outcomes.

John was told after having surgery that his brain tumor couldn’t be removed, extinguishing any hope of survival.

Emilia visited 14 doctors, each unable to give her answer as to why she was in severe pain.

Cathy was told that the brain damage she incurred would result in her never being able to walk again.

Functional Resonance Imaging (fMRI) Over 500,000 published studies.

Diffusion Tensor Imaging (DTI)Over 17,000 published studies

Connectomic Brain Mapping

Transcranial Magnetic Stimulation (TMS)Over 16,000 clinical trials and case studies.

A gap exists between what research is bringing and what doctor can use

Taking a knife to a GunTank fight

• Epic Problems• Mental illness• Brain cancer• Dementia• Traumatic brain injury• Chronic pain• Coma• Stroke

• 40% of humanity

• Few options

• Extreme complexity

• Preposterous tools• Verbal history

• Visual observation

• Images which show the brain’s shape

• A few lab tests

• Doctors use ~10 data points in a 5 million dimensional problem

It isn’t Brain surgery to realize this is madness

An ongoing catastrophe

Disorder % population Patient in the US*

Brain Cancer 0.02% 78,980

Depression 8.7% 28,500,000

Chronic Pain 5.8% 19,000,000

Strokes 0.24% 795,000

Trauma 0.86% 2,800,000

Epilepsy 1.04% 3,400,000

Fibromyalgia 3.06% 10,000,000

Alzheimer’s 1.53% 5,000,000

Autism 1.7% 5,500,000

OCD 2.5% 8,200,000

ADHD 1.87% 6,100,000

Total 27.32% 89,373,980

*Statistics are consistent across countries

Right now

John is being told his tumor could not be removed last surgery

Emilia is being told by doctor #14 that they don’t know what’s wrong with her

Cathy is being told that she will never walk again

Millions of lives are spiraling out of control from mental illness

It’s time to stop wasting time making a better Facebook...and do something that matters..

What if….?

Neurotechnology could make that all false…tommorrow

How did this happen?

• A case study about• Failure to translate

• A Misallocation of resources (and values)

• How good tech teams fail to make med tech meaningful products

Tech revolution

BlockchainAI

IOT Machine Learning

Actually in Daily Medical practice

BlockchainAI

IOT Machine Learning

An article of faith..

• “AI and Machine learning will change medicine”

Less clear

• What exactly will change what?

• What is the goal?

• What problem does it solve?

Lasers which cut butter

“Hi, do you have any interesting projects for my AI group”

A fancy solution to something we are good at

Don’t speak the same language

Might be the wrong person-Famous ≠ creative

A litany of Butter cutting lasers

• AI which makes diagnoses

• AI which reads images

Successful Innovation in medicine

• Historically• Has been driven by doctors

• Aimed at a specific problem- not big concepts

• Makes something possible• Medicine is very good at refinement

• What doesn’t ever… ever…. ever work• Industry driven concepts

• Years of refinement in the lab

• Adding steps

Ideas squandered..?

• University Tech transfer• 70% (or more) inventor share

• University bureaucracy

• Advisors with no personal stake

• Industry• R&D is dwarfed by sales force

• MD’s in business • Large number haven’t really practiced

Why the tech revolution missed the brain

Production process in Isolation

Inconsistent Outcomes

Wrong problemsWrong applicationsWrong outputWrong deliveryWrong MD consultants

Software World

Clinical world

Pretty software that doesn’t solve problems

Ideal Outcomes

Clinical Decision Process

Information gap

Why I learned to code

• Brain tumor surgeon• One of the largest practices in the US

• Published 250 papers thus far

• Just wanted to know where to not cut brain

Our Maps

SLF/Arcuate

State of Neurotechnology

Vast Majority of hospitals cannot get thisBeen in the lab for 30 years500,000 papersResearch subjects get better images than patients

Depression is 4 diseases

Misguided priorities

• More important priorities for AI/ML• Making banks wealthier

• Sorting social media posts

• Ad targeting

• Less important priorities• Helping doctors make better decisions

• Solving mental illness

The Connectome revolution…

What we get now • What we actually need

Shape of the brainThe wiring diagram, how it functions, and what this might mean

The data we are not getting

• HCP: 1200 scans

• Oasis Database: 1098 scans

• ADNI: 1000 scans

• Schizconnect: 1362 scans

Number of scans in current datasets

• 4 hospitals: 240 scans/day

Daily brain scans at our Chinese Pilot hospitals

Data models are DIY

The future of connectomics is obvious

Data models are professionally done

User-friendly Products….

Maps the brain to the Human connectome project scheme using data not an atlas. Can map deformed brains.

If the brain has reorganized and functional areas have moved, this will find them

Automated Brain Mapping

Functional Tract Selection

• 3 Breakthroughs

We can display brain networks and their connections from a pull down menu

AI Displacement Prediction

Not only do they find the problem, but can be used to solve it .

Built by experts… delivered anywhere

We made the largest atlas in the world about the brain’s connections. All of it is in our software

• Anatomic Detail

Unprecedented Detail

370 unique areas studied in our software. We know what most of them are doing

Cutting edge classification

If it is published somewhere and is useful, we are doing it

Levering progress

Pioneering field of medicine

Connectomics is new. We know it as well as anyone

Changing neuroscience now

• 10 year timeline is unacceptable• 6 month conception to launch

• Making the right thing financially sound

• Redirecting ML/AI to something that matters

• Time to stop wasting time making a new Facebook