Friday, September 23, 2011

Topic Discussion: A Fresh Look at The Banff Classification

The Banff Classification and the Singularity in Transplant Pathology

Many of you know I spend a great deal of time talking and thinking about artificial intelligence, exponential technological change and the Singularity, that point in time when machines are more intelligent that we are and technologic change becomes so rapid that we humans have difficulty keeping up with the progress going on around us.  I am teaching a course on the Singularity and the Future of Medicine at the University of Alberta and writing a book on the subject to be completed later this year.

So in my role as the transplant pathologist who runs the Banff meetings along with Lorraine Racusen a logical question is: Where or what is the Singularity equivalent in transplant pathology?

In talking about the Singularity we speak about an event horizon we cannot see beyond in future prediction, and so by definition the Singularity is hard to predict.

Nevertheless I think it is clear what the Singularity equivalent in transplant pathology might involve.  On the one hand it could be that point in time where our diagnostic methods to tell us what is going on in the transplanted kidney entirely change, where we are using noninvasive and/or genomic methods entirely to make diagnoses in the transplanted kidney.  Half of you are now thinking "no, no that will never happen!".

But you have not heard my "on the other hand" statement.  On the other hand the Singularity could be the point at which we are no longer doing transplantation because medical science is so advanced that when we need a new organ we just grow one from stem cells, print one using the 3D printer.  And now the other half of you are saying  "no, no that will never happen".

But when you think about it more deeply you will realize that one or the other of these things will certainly happen and maybe both.  Just like with the general Singularity, the only question is when.  If indeed the general singularity is 2045 I predict that the Singularity in transplant pathology will be much earlier than that.

Have you noticed that the organs made by tissue engineering so far are a bit misshapen?  There will be some natural pathologies in organs grown from stem cells, and the transplant pathologists of today will be central to figuring that out.

So that is my other prediction, that the Banff meetings and the Banff consensus process will be where these dramatic technologic changes are first manifest, and where the means of coping with them will be worked out.  So the people who attend the Banff meetings and participate remotely and the new people who join us in future meetings will be central to the management and adaption to the rapid technologic changes we will see in the future.

It that sense what we do in the Banff meetings has broad general applicability to problems of the future.  The specific advances and changes we discuss and incorporate in the meeting will also help us in a general way to be prepared for even greater changes in the future.

Some of you may feel that we allow too much shifting sand, we should demand more stability, a slowing of the pace of change.  But as Kevin Kelly says in his recent book What Technology Wants technology change has its own relentless momentum.  We cannot slow it down, and to prepare ourselves for what is coming in the future we must be prepared at some level to question everything.  Remember that old pre WW II adage "Keep Calm and Carry On"?  It is now enjoying a rebirth and is once again popular with young people.   Well we must do that, maintain stability, while questioning everything, the old and the new.  It is a difficult path to follow but also an exciting one.  There is a tension there but it is a healthy tension.  In the end that combination of stability and constant inquiry is the only logical course forward.
So here is to the future of the Banff process in transplant pathology. onward and upward!

Post by Kim Solez, MD
Transplant Pathologist
Univ of Alberta, Canada

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