Walter Greenleaf: Virtual Reality and AI in Healthcare

0:00:12 I’m Guy Kawasaki and this is Remarkable People.
0:00:19 We’re in a mission to make you remarkable and today we have with us the remarkable Walter
0:00:20 Greenleaf.
0:00:24 Walter is a neuroscientist and medical technology developer.
0:00:27 He works at Stanford University.
0:00:33 He’s a leading authority in digital medicine and medical virtual reality technology.
0:00:38 He has designed and developed clinical systems including products for surgical simulation,
0:00:47 3D medical visualization, clinical informatics and simulation assisted rehabilitation techniques.
0:00:52 He is the co-founder and board chair for the International Virtual Reality Health Association.
0:00:57 He has served as the principal investigator for research projects funded by the National
0:01:00 Institutes of Health and NASA.
0:01:02 I’m Guy Kawasaki.
0:01:10 This is Remarkable People and now here is the remarkable Walter Greenleaf.
0:01:16 Do you know about the Meta Ray-Ban partnership where they have sunglasses with a camera and
0:01:17 AI built in?
0:01:22 Yes, I do and I’ve run across a few friends who are wearing them.
0:01:23 Okay.
0:01:25 It reminds me of the Kogo glass of course.
0:01:27 Is it reality right now?
0:01:29 Because with that you could just say what am I looking at?
0:01:31 What’s the history of this city?
0:01:32 What’s the history of this building?
0:01:33 What am I seeing?
0:01:39 So it’s a combination of this visual representation plus AI.
0:01:41 So is that reality now?
0:01:47 It’s getting there and I think the other layer that’s on top of that is not only what
0:01:53 we have, visual representations of extra information overlaid upon what we’re seeing.
0:01:58 I think we will also, and this is an interesting issue, there’s a lot of work going on with
0:02:05 capturing eye gaze, facial expressions, body language, voice tone, to come up with scores
0:02:13 related to our mood, our emotional state, and how alert we are, how grumpy we are.
0:02:16 And that’ll be overlaid too and filtered.
0:02:22 So I could be filtering my interactions with you right now, both visually and auditorily.
0:02:27 I could say I want to look a little more friendly or I want to look a little bit more savvy
0:02:29 and that’s what you would be seeing.
0:02:34 So as we interact with the built environment and with each other, there’s going to be a
0:02:38 layer of technology between it and us and each other and that’s going to be an interesting
0:02:39 change.
0:02:45 I saw that you reshared an article about tracking eye movements to use in diagnosis.
0:02:50 So you’re telling me that someday in the future, we could have this kind of virtual
0:02:54 conference and at the end you say, “Guy, by the way, I think you have Parkinson’s?”
0:02:55 I think we’re there.
0:02:57 I think there’s ways to do that right now.
0:03:00 The quote by William Gibson, of course, the future is already here.
0:03:03 It’s just unevenly distributed.
0:03:10 And I think using eye gaze and voice tone as a way of diagnosing neurodegenerate disease
0:03:11 like Parkinson’s, we can do that.
0:03:16 But it’s mostly the research zone hasn’t been translated out.
0:03:20 And I’m sure people are listening to this and their heads are exploding and they’re
0:03:25 saying, “Maybe Mark Zuckerberg knows my moods because he’s watching my eye movements
0:03:26 and he knows if I have Parkinson’s.”
0:03:30 And that’s a little scary, no?
0:03:32 Oh, I think it’s both exciting and scary.
0:03:38 It’s exciting because, hey, with an aging population as the boomers get up into their
0:03:44 80s and 90s and longer, and we’re all going to live a lot longer, there’s some challenges
0:03:45 that we will have.
0:03:47 We want to keep our brains healthy.
0:03:48 We want to keep our bodies healthy.
0:03:50 We want to age in place.
0:03:53 We want to expand our health span instead of having a long, slow decline.
0:03:57 We want to be fantastic until we’re not.
0:04:02 But the technologies we have right now will help us with that, but again, there haven’t
0:04:04 been a position to scale.
0:04:08 So it’s exciting to have these new breakthroughs that will help us with not just better diagnosis,
0:04:14 understanding if you have Parkinson’s, but new therapeutics and ways to do it more precisely
0:04:16 for you because we’re all different.
0:04:20 There should be different prescriptions for interventions.
0:04:26 The scary part is exactly what we were looking at earlier, that this is very personal, very
0:04:28 private information.
0:04:33 It’s right now available publicly when you’re on an online game and playing with other players
0:04:40 and speaking, your impulsiveness could be scored, your abilities as a leader or a follower,
0:04:46 your voice tone can indicate your mood, and so there’s a lot that can already be extracted
0:04:53 publicly and even more so privately that we just have to find ways to lock down and protect.
0:05:00 And so yeah, people should be worried about as the tech titans move into this zone and
0:05:02 especially as they move into health care, it’s exciting.
0:05:03 We need it.
0:05:05 We need better technology.
0:05:06 We have an aging population.
0:05:12 It’s going to be extremely expensive to address worldwide, how to support people living so
0:05:18 much longer could be more expensive than dealing with climate change, but there’s also very
0:05:21 sensitive issues we have to address.
0:05:30 I think we should just hook this up to JD Vance right now and get insights into his
0:05:33 head, but that’s a different subject.
0:05:35 You open the door here for me.
0:05:42 So can you just describe the state of the art of the neurology of getting old, brain
0:05:46 health as you get old, what’s the latest, greatest insights into that?
0:05:52 I think the first thing we should remind everyone is that what’s good for the body is what’s
0:05:53 good for the brain.
0:05:58 So if people say, what can I do now to help my brain be healthier when I’m in my 70s,
0:06:06 80s, or 90s, it’s sleep, exercise, diet, stress, or do stress.
0:06:10 All the things that keep our body healthy, we know keep our brain healthy.
0:06:14 So that’s one thing you can do to mitigate the risk.
0:06:19 That said, those things may or may not make a big difference if genetically you’re on
0:06:27 the pathway to develop Alzheimer’s or Parkinson’s or some of the other neurodegenerative diseases.
0:06:32 Invest in research would be one thing I would say is that there’s some great potential therapeutics,
0:06:39 both as molecules and pharmaceutical interventions, but other technologies that can help us intervene.
0:06:42 And we need to move forward with them as best we can.
0:06:47 Because again, three out of every seven of us will, when we get up into the age zone,
0:06:53 that’s the way things are, develop Alzheimer’s or Parkinson’s or Lewy body disease or some
0:06:55 other things that we don’t want to have happened.
0:07:00 So yeah, keep your brain healthy now by doing what keeps your body healthy, but we need to
0:07:02 move forward with an aging population.
0:07:07 We’ve gotten maybe 10 years before that tidal wave hits, but we do need to move forward.
0:07:11 So is the corollary also true that good for the body, good for the brain?
0:07:14 Does that mean bad for the body, bad for the brain?
0:07:15 Yes.
0:07:20 I’m guilty of not getting as much sleep as I should or exercising as much as I should.
0:07:25 And I’m very conscious that this is a trade off versus keeping my brain healthy.
0:07:28 Yeah, that’s our current thinking.
0:07:33 Okay, good for the body, good for the brain, but are there things that are good for the
0:07:34 brain?
0:07:40 Is it like playing Sudoku or is it playing chess or are those things just a fad from
0:07:44 these influencers and thought leaders want to sell stuff?
0:07:47 Or do these kind of mental things really help?
0:07:52 We’re getting into a zone where there’s controversy and I’ll tell you what my opinion and my beliefs
0:07:57 are and I’m sure I’m going to get some pushback from my esteemed colleagues who disagree.
0:07:58 But here goes.
0:08:02 We do know that it used to be viewed that many of the things that were being brought
0:08:08 out there by some of the companies that had games for brain health, for example, the claims
0:08:13 were exaggerated that groups would say this will prevent the possibility of having Alzheimer’s
0:08:18 or this will address our cure attention deficit disorder.
0:08:22 And a lot of the research did not really back the claims that were being made.
0:08:24 That was the past.
0:08:30 Now we know that there are some things that we can do that are impactful and make a big
0:08:32 difference and can help.
0:08:37 There’s recently been products that, for example, games you can play that you can get a prescription
0:08:38 from for a doctor.
0:08:42 You can get a prescription for something that helps with attention deficit disorder.
0:08:48 We know that there’s some interventions that can be used that will help you with what we
0:08:55 call executive functions, some of the decision making and navigation skills, etc.
0:09:02 Very interesting work by Adam Ghazali’s group at UCSF, looking at how we can play a game.
0:09:08 They have one called NeuroRacer that NOAA-Felstein helped design that improves the scores that
0:09:14 people in their 60s have that normally are very low compared to people in their 20s and
0:09:16 certain executive functions.
0:09:21 But if you play this game, not only can you raise your scores up to what you would have
0:09:27 had in your 20s, they’ve gone back years later to see if it persists and it does.
0:09:32 And now the evidence, in my opinion, is that yes, there are things that we can do in terms
0:09:38 of exercising our brain that make a difference in terms of cognitive decline.
0:09:41 I am really interested in this topic in two regards.
0:09:45 First of all, I’m 70, so I would like to know exactly what to do.
0:09:47 Not just conceptually, but just tell me.
0:09:52 If you and I were best friends and I asked you, “Come on, Walter, just tell me what do
0:09:53 I do?
0:09:57 Will you just tell me the game or what do I eat or what should I do, Walter?”
0:10:01 You might come back to me in a week and I’ll have a more refined answer to that because
0:10:03 there’s a lot of different options.
0:10:06 And also, I would want to know a little bit more about you.
0:10:11 I think one of the challenges we have in healthcare is that we have sort of a one-size-fits-all.
0:10:14 This is what everyone should do.
0:10:17 And I would need to know a little bit more about you, and I would also want to know your
0:10:18 goals.
0:10:22 Is your goal to live as long as possible, or is your goal to have the highest quality
0:10:25 in the next 30 or 40 years?
0:10:30 Is your goal to continue to work, or is your goal to continue to enjoy leisure?
0:10:33 So there’s more I would need to know before I could give you a good answer.
0:10:38 But I’ll think about it, and maybe if we talk further, I can understand what I could recommend.
0:10:40 I’m not a clinician.
0:10:46 I’m an activating enzyme, helping the clinicians and the healthcare providers and the scientists
0:10:50 and the healthcare networks understand what’s new and what they should look at, and I’m
0:10:52 not the person who writes the prescription.
0:10:57 I actually have great respect for that answer because it shows it’s not a flippant answer
0:11:01 that you’re just talking shit, basically.
0:11:03 A slightly related thing now.
0:11:10 You mentioned that there are games that can help kids with executive function.
0:11:12 What’s the game for that?
0:11:13 I want to hear that.
0:11:15 I’m taking notes.
0:11:20 There’s a company that I have great respect for, Akili, that developed two games.
0:11:25 One that is available over the counter, meaning you can download it from an app store, and
0:11:32 that’s endeavor, E-N-D-E-V-O-U-R, and then there’s endeavor, R-X.
0:11:43 Endeavor is for adults with ADHD, and endeavor, R-X, is positioned for children who have ADHD.
0:11:49 Endeavor, R-X, requires a prescription to get, but the other form of endeavor for adults
0:11:53 can be downloaded from an app store, and it is validated in interventions.
0:11:56 Wait, I’m trying to wrap my head around this.
0:12:00 If a parent is listening to this and they’re part of Kaiser, they call up Kaiser, they
0:12:05 call up the Palo Alto Medical Foundation, and they speak to their pediatrician, and
0:12:08 they say, “Give me a prescription for endeavor, R-X.”
0:12:13 I’m actually not sure if you need to go see a specialist.
0:12:19 You probably need to go to see who’s here with this intervention, but yes, the basic
0:12:27 concept is that these are validated interventions prescribed video game for treatment for children
0:12:37 with ADHD, and I just went to their website, E-N-D-E-A-V-O-R-X.com, there’s a tab for getting
0:12:38 a prescription.
0:12:39 Wow.
0:12:40 That’s a shirt for people to follow up with.
0:12:41 Wow.
0:12:42 Oh my God.
0:12:45 So, are you saying that this thing went through FDA trials?
0:12:47 Yeah, you are partially responsible for this.
0:12:53 What you did back in the ’80s and ’90s to help move forward digital technology has helped
0:12:55 put us in a position to be able to have things like this.
0:12:57 Thank you for that.
0:12:58 Okay.
0:13:01 Here’s to reaping what you sow.
0:13:08 So now, getting out of this particular topic here, I want to move back up to virtual reality
0:13:09 and medicine.
0:13:15 So what is the current cutting edge of virtual reality in medicine?
0:13:23 We’re using VR right now for better training of clinicians, surgical skills or understanding
0:13:26 neuroanatomy in three dimensions.
0:13:32 We’re using it for better assessments, a better way of doing a differential diagnosis for
0:13:39 anxiety, depression, attention deficit disorder, different aspects of stroke or traumatic brain
0:13:46 injury, and we’re using it for better therapeutics, ways to promote better recovery from an injury,
0:13:53 or ways to address addictions or ways to help people who are on the autism spectrum learn
0:13:57 how to recognize body language and facial expressions and others.
0:14:03 So really, the full stack of healthcare has been impacted by the technology.
0:14:07 The Veterans Health Administration has done an amazing job of rolling it out, and there
0:14:12 are largest healthcare network, they’ve trained more than 3,000 clinicians, I think they’re
0:14:17 using it for more than 30 different clinical indications throughout their network.
0:14:23 And again, still at an early stage in many ways, it’s been held back because new technology
0:14:27 in medicine very appropriately takes a while to get established, and especially because
0:14:32 of our business model of needing to establish a code for reimbursement.
0:14:37 And that’s why the VA has been able to move forward faster than other groups, because
0:14:43 they don’t rely on reimbursement codes, they’ll roll something out and use it if it’s impactful.
0:14:48 So it’s happening, I’d say though we’re at that transition point from early adopters
0:14:54 and the people that are willing to try new things and for better results, it’s now starting
0:15:01 to move over into just how we do things and get beyond that early adopter threshold, especially
0:15:07 for pain, there’s some fantastic ways to both address acute pain and chronic pain using
0:15:12 virtual reality and augmented reality technology that’s been well validated and it’s starting
0:15:15 to be used throughout the healthcare system.
0:15:21 Wait, so how can doing something online with virtual reality relieve pain?
0:15:23 Isn’t pain at a chemical level?
0:15:30 It doesn’t have to be done online, it could be, but two ways for an acute aspect of pain,
0:15:35 they can distract you if you’re getting a lumbar puncture for example or they’re degrading
0:15:41 your skin which is very painful for a burn injury or if you have back pain.
0:15:49 For chronic pain we teach skills, we use virtual reality as a medium to people to learn mindfulness,
0:15:56 relaxation skills, to learn how to mitigate their pain, to reframe the way our brain reacts
0:15:59 to a pain signal and it works, it’s been validated.
0:16:01 Where does AI come into this?
0:16:08 Is it people in India who have MDs or is it AI scanning x-rays and looking at results
0:16:10 and giving you recommendations?
0:16:13 Well, AI is really empowering everything.
0:16:18 All these new digital health applications we’ve been talking about, not just the VR and AR,
0:16:25 require very sophisticated analytics and we now can extract more from the signals that
0:16:32 we have to do more and also because of generative AI we can take the analytics and we can use
0:16:38 it in the case of virtual reality or augmented reality for example, dynamically change the
0:16:41 user’s experience based on those signals.
0:16:49 So AI is empowering us both to do better diagnostics, to identify a lesion that might be seen on
0:16:55 an x-ray that might not be able to be captured easily by the clinician to support the clinicians
0:17:01 to do that or to help us look through some data and find the key features both on a research
0:17:05 level and on an individual level that we need to have.
0:17:09 So remember I mentioned earlier that in order to answer your question about what helps you,
0:17:11 I would need to know you a little bit better.
0:17:17 AI is helping us look at the data from an individual, understand them a little bit better compared
0:17:23 to the larger population and make recommendations as to what would be a precision way to help
0:17:26 you with your healthcare problems.
0:17:32 And these treatments, they’re being tested scientifically double-blind, placebo effect,
0:17:34 all of that kind of stuff.
0:17:37 It’s not just Donald Trump saying drink Clorox.
0:17:40 This is FDA, everything, the whole shooting match.
0:17:48 We’ve had more than 30 years worth of research on specifically for VR technology for healthcare
0:17:52 decades of research and that’s just in that zone, the other zones we’re talking about
0:17:53 even longer.
0:17:57 But the technology hasn’t been affordable until recently.
0:17:58 So we’re now in the process.
0:18:04 That’s why it’s the process of moving it out of the research labs into clinical care doing
0:18:05 the validation studies.
0:18:11 But yes, we’ve done double-blind, placebo-controlled studies on the impact of these digital health
0:18:14 interventions and the FDA reviews them.
0:18:19 I was part of a team at a company named Paratherapeutics, which was the first company to establish
0:18:22 software as a medical device.
0:18:29 So that the FDA will review and regulate these interventions and make sure they’re healthy
0:18:36 and safe and effective, just like they do any other pharmaceutical pill or any sort of
0:18:37 other device.
0:18:43 And here’s the cool thing, guys, we’re also now starting to see combination therapy where
0:18:51 it might not just be a pill to manage depression or anxiety or pain, but a pill that is using
0:18:57 combination with the digital health app that can help you, again, adjust it for you individually,
0:19:01 see what’s working, what’s not working by measuring the impact of the therapy, and then
0:19:07 maybe doing something in combination and for anxiety, maybe not just taking a medication,
0:19:12 but also learning relaxation skills, mindfulness skills, et cetera.
0:19:16 So it’s not just either/or, it can be together, combination.
0:19:21 And that means we can leverage the established distribution channels that the pharmaceutical
0:19:26 companies and the medical device companies have to bring out these very powerful digital
0:19:28 health applications.
0:19:33 Can you just give us an idea of a specific treatment?
0:19:40 I read that, and I think you mentioned that there’s software as a medical device to help
0:19:42 people with PTSD.
0:19:46 So let’s say you are undergoing this treatment, exactly what happens?
0:19:53 For post-traumatic stress, and also for addictions and anxiety disorders in general, we use an
0:19:58 approach called exposure therapy, where what’s happened with post-traumatic stress, and I’m
0:20:04 being very simplistic here for the sake of not spending 20 hours going over it with you,
0:20:09 what happens with a learned fear reaction like post-traumatic stress, where you’ve had
0:20:15 some trauma and your brain has very appropriately learned to fear what almost killed you or
0:20:18 what was uncomfortable for you.
0:20:23 But that’s useful when we were evolving, but now in today’s world, some things that
0:20:29 can be traumatic might be something that happened to you in combat or something that happened
0:20:36 to you one time, but you’re having an overreaction, you’re being triggered and you’re having challenges.
0:20:42 So we use exposure therapy to address that, same thing with addictions.
0:20:47 You may get beyond the metabolic aspect of an addiction, but you still are triggered
0:20:52 by cravings when you go into a bar and you’re friends are drinking a beer or you go by some
0:20:55 place where your dealer used to sell you a meth.
0:21:02 So in both situations, what we use is to gradually teach people to understand what is triggering
0:21:07 their reaction and to gradually habituate that reaction, to take what’s a learned fear
0:21:14 reaction or perhaps a learned craving and turn it into something that your forebrain is reacting
0:21:19 to and saying, “Oh, there’s a pile of trash on the side of the road, but I’m driving on
0:21:27 Interstate 280 in California, I’m not over in Iraq,” that pile of trash is not necessarily
0:21:28 a threat.
0:21:33 So I don’t need to get really upset when I see a pile of trash on the side of the road.
0:21:39 And we use virtual reality, for example, to gradually expose you to what is triggering
0:21:44 those reactions and under the supervision of a clinician and teach you how to manage
0:21:48 your learned fear reaction and to habituate the response.
0:21:49 And it works.
0:21:50 We get great results.
0:21:55 Now, when you say you’re using virtual reality, are the people wearing headsets, is it like
0:21:57 an Apple Vision Pro?
0:21:59 Is it that level?
0:22:01 They really think they are in this.
0:22:06 For exposure therapy, you don’t have to wear a head-mounted display.
0:22:11 For a long time, people have taken people with fear of flying to an airport and having them
0:22:12 go up.
0:22:15 But if you’re doing it in vivo, in real time, it’s expensive.
0:22:21 So the advantage of using a VR system is we can do it in a clinic.
0:22:24 And in some cases, we can do it online, like teaching people who have a fear of public
0:22:26 speaking, for example.
0:22:31 You can rehearse online with a virtual audience in practice.
0:22:40 But for a learned fear reaction, post-traumatic stress from an IED explosion in Iraq, we really
0:22:44 do want to use a VR system, because then we can block out the outside world.
0:22:46 The brain doesn’t want to go there.
0:22:51 If it’s something you’re traumatized by and you’re scared of, and I start talking to you
0:22:55 about it and say, “Guy, remember that horrible thing that happened to you?
0:22:57 You’re going to be triggered.”
0:23:01 But I can gradually take you there if I have a way of blocking out the rest of the world
0:23:06 and say, “Let’s start by walking up to the ticket counter at the airport.”
0:23:10 So it’s not just post-traumatic stress, it’s also phobias that we can treat using exposure
0:23:11 therapy.
0:23:18 And then I can gradually evoke the learned fear response and without re-traumatizing
0:23:26 you, because I have control of how the level of reality, the level of exposure you have,
0:23:29 and teach you the skills and habitually you learn fear response.
0:23:30 Wow.
0:23:34 Walter, I’ve got to say, if anybody else was telling me this, I would be saying, “This
0:23:36 guy is full of shit.”
0:23:39 I’m telling you about what other people have done research on.
0:23:44 There’s been decades of people working behind the scenes, developing this new wave of technology
0:23:47 that’s finally coming out, which is great, because we need it.
0:23:51 My head is exploding here until I prepare for this interview.
0:24:08 I never heard of this concept of software as a medical device.
0:24:10 So what’s the career path?
0:24:13 Let’s say somebody’s listening to this and saying, “Man, this is the coolest stuff.
0:24:15 I want to do this.
0:24:20 I don’t necessarily want to be a general practitioner or pathologist, but I just love
0:24:22 this application of software.”
0:24:24 So what’s this person’s career path today?
0:24:26 Do you go to medical school?
0:24:28 What’s the whole thing you do?
0:24:34 I think if you’d asked me this five years ago, I would have said find an academic research
0:24:40 center that is studying how to use digital health and virtual reality technology and
0:24:42 other technologies for pediatric care, for example.
0:24:47 I say find a group that has an indication that you’re interested in, maybe you’re interested
0:24:53 in helping children who have had stress from the pandemic learn to help with their mental
0:24:56 health issues and work at that academic center.
0:24:58 That would have been a while ago.
0:25:01 Now I think I could say that’s one option and that would be great.
0:25:07 We could use your help on the academic research side, but now we’re starting to see the technology
0:25:13 move and there are companies, public companies, Penumbra, for example, is one.
0:25:21 They’re selling virtual reality products to treat traumatic brain injury, to treat post-traumatic
0:25:26 stress, to treat mental health issues, to help with neuro rehabilitation, that’s one
0:25:27 of their fortes.
0:25:33 It would be more go to a center, continue with your career as a clinician, but make sure
0:25:38 you’re aware of what’s possible and get your hospital, get your clinic to up their game
0:25:41 by bringing these new technologies in.
0:25:42 So that would be one way.
0:25:47 Another way is to get involved, not necessarily as the clinical or research side, but also
0:25:48 on the tech side.
0:25:53 We need to put additional layers of technology on top of what we’re doing so that we can
0:25:54 do more.
0:25:59 We can leverage machine learning to look at the data a little bit better and come up with,
0:26:04 again, a precision approach to fine-tuning the intervention to match what the individual
0:26:05 needs.
0:26:11 So do you think this is going to take longer or in five years are going to just be amazed
0:26:16 at what has happened because Bill Gates has this theory that things happen faster than
0:26:21 you think they are, but not as fast as these visionaries say?
0:26:23 I guess it depends.
0:26:27 I think we have the technologies that can make a big difference.
0:26:35 The tech titans are moving into healthcare, Apple, Google, Samsung, Amazon, and Meta
0:26:40 are all starting with consumer health and wellness, which is fantastic, but some are
0:26:43 moving into the clinical zone too.
0:26:49 I think as that happens, the speed will pick up because the tech titans know how to design
0:26:55 for scale and they know how to design good user interfaces, which frankly the medical
0:27:00 device in the pharma companies have not had that skill set before and their business model
0:27:04 has been more slow and careful, which is appropriate for medicine.
0:27:07 But I think now that there’s new players coming into the game.
0:27:13 Also, the other things that gives me a reason to say things will happen faster than otherwise,
0:27:15 so we have some acute needs.
0:27:18 We’re dealing with three major problems right now.
0:27:24 One is an aging population, which will cripple our economy worldwide if we don’t do something
0:27:25 about it.
0:27:30 If three out of every seven of us has Alzheimer’s in our 70s, 80s, or 90s, there’s smaller families
0:27:34 and there’s a wave front of people getting older, especially in Asia.
0:27:38 That’s going to be more expensive unless we get on top of it, extremely expensive unless
0:27:40 we get on top of it.
0:27:46 At the other end, we have a whole strata of youngsters who went through the pandemic with
0:27:52 seeing their parents completely fearful, not able to go to kindergarten and learn social
0:27:57 emotional learning skills, learning a lot of fear and stress.
0:28:02 If you talk to our colleagues in pediatric care at the Children’s Hospitals, they’re
0:28:07 saying an avalanche of new problems in mental health.
0:28:12 Also, our society in general, I think, is challenging our mental health issues for so
0:28:13 many reasons.
0:28:18 Then, meanwhile, the overburdened healthcare system with so many burnt-out clinicians who
0:28:20 have been really working so hard.
0:28:26 Those three issues can’t be solved by anything other than technology right now.
0:28:31 We can’t grow family members fast enough to support the aging population better.
0:28:35 It has to be technology and the tech titans are moving in.
0:28:40 I have reasons to be optimistic that things will happen faster than not.
0:28:42 I’ve been wrong so many times before.
0:28:46 I always think five years from now, we’ll start using this technology.
0:28:47 It is happening.
0:28:52 I look at what the VA health system, for example, is doing and feel like it’s starting to happen.
0:28:55 But, hey, your listeners can help it happen, too.
0:29:00 Let’s ask for these technologies, let’s invest in these technologies, let’s make it happen.
0:29:06 I have to say when I watched your video of you talking to the VA health system.
0:29:11 I think, like many other people, I have this impression in my brain that the VA health system
0:29:16 is broken and you read these articles about people waiting 18 months to get an appointment.
0:29:20 This is like government bureaucracy, it’s just the worst thing.
0:29:24 And then I watch your video and you’re telling me they’re the early adopter and they’re the
0:29:25 pioneer.
0:29:26 I love that.
0:29:31 Sure, governments have a tendency to be aggravatingly slow and frustrating.
0:29:37 But within the VA, there are some amazing people and they have really pivoted to innovation,
0:29:39 to encouraging innovation.
0:29:45 When at that conference where you saw the video from, one of the opening remarks by Ann Bailey
0:29:51 was a quote from Margaret Meade, that never doubt the power of a small group of individuals
0:29:56 to change the world is the only method that has.
0:30:01 And I think there are some great individuals within the VA that are changing things.
0:30:07 So yes, there’s been a legacy of slowness and government bureaucracy, Congress is their
0:30:08 board of directors.
0:30:13 And sometimes managing your board of directors is a problem in general, but if it’s Congress,
0:30:15 then more please don’t get mad at me, Congress.
0:30:17 But they’re making it happen.
0:30:23 And I also think the boomers grew up loving gadgets and technology.
0:30:28 And I think that as we age, we’re going to be asking for the latest and greatest and
0:30:33 purchasing it on our own if it’s affordable, if we can’t get it from our docs.
0:30:37 I think there is a pathway to be optimistic about this.
0:30:43 My last question for you, Walter, and I need you to put all semblance of modesty aside
0:30:49 and my podcast is called remarkable people and we’re on a mission to help people become
0:30:51 remarkable and make a difference.
0:30:56 And obviously we consider you remarkable because we have you on this episode.
0:31:02 So again, putting modesty aside, if you can look back on your life and say like, what has
0:31:06 enabled me to do such remarkable work?
0:31:12 I would say that what has enabled me to do such remarkable work has been.
0:31:16 I had a very wonderful childhood and that’s helped me feel self confident.
0:31:22 I’ve also enjoyed meeting other remarkable people along the way.
0:31:28 And so the confluence of where I went to college, which was an experimental college
0:31:32 called Hampshire College, it was just getting started at the time, no grades, no required
0:31:37 courses and I met some amazing people as colleagues then.
0:31:44 And then just as I’ve been fortunate enough to run across some incredible people as friends,
0:31:49 Jaren Lanier was my best friend during grad school at Stanford, Eric Horvitz who set up
0:31:52 Microsoft Research Labs also.
0:31:58 So I’ve been fortunate by running across amazing people that helped me go down my pathway.
0:32:02 And like all of us, I think it’s a combination of seeing some doors open and going through
0:32:07 it, but we need the good fortune of those doors to be around and we, if we’re able to
0:32:10 grab the hook as it goes by, then we’re fortunate.
0:32:13 But if the timing doesn’t work out or we don’t have that fortune, that doesn’t mean we’re
0:32:14 not remarkable.
0:32:18 It just means that we didn’t have that opportunity in front of us.
0:32:24 I just thought of one last question, which is, Walter, what do you want to be remembered
0:32:25 for?
0:32:32 Oh, I honestly, I will put aside all modesty here again, because you asked guy, I honestly
0:32:36 don’t really think about being remembered.
0:32:38 I want to have an impact in my lifetime.
0:32:40 That makes me happy.
0:32:46 But I don’t feel it has to do about me at all to the extent that I can see things that
0:32:52 I think are helpful and important to happen, especially involving what can happen with
0:32:55 science and research and tech coming together, then I’m happy.
0:32:56 It doesn’t have to be me.
0:33:02 But what I hope is remembered is that this was a time where our generation took the challenges
0:33:06 in front of us and found pathways to solve them.
0:33:10 And there’s many things to worry about to, of course, climate change, conflict, but also
0:33:16 those three big health care challenges I mentioned, I think we can solve them and I hope we do.
0:33:17 And I think we can.
0:33:22 I will remember this time with a smile if we rise to the occasion and address some of
0:33:27 these challenges instead of just missing that opportunity.
0:33:32 I hope that you’ve enjoyed this little window into the future.
0:33:36 Although as Walter has pointed out, maybe it’s not, quote, the future.
0:33:42 Maybe it’s here already, and we just have to more evenly distribute it.
0:33:44 I’m Guy Kawasaki.
0:33:46 This is Remarkable People.
0:33:49 I want to thank the rest of the Remarkable People team.
0:33:53 That of course includes Tessa Nizmer, our ACE researcher.
0:33:59 Madison Nizmer, she’s the producer of this podcast, co-author of Think Remarkable With
0:34:04 Me, and finally, she’s the co-author of the Substack Newsletter that we have.
0:34:09 I don’t think I’ve ever mentioned the Substack Newsletter on this podcast.
0:34:10 What a bozo.
0:34:17 Check out our Substack Newsletter where every week we put out an issue about how to be remarkable.
0:34:18 Where was I?
0:34:20 Oh, the rest of the Remarkable People team.
0:34:26 That would be the sound designers extraordinaire, Jeff See and Shannon Hernandez.
0:34:31 And finally, there’s Louise Magana, Fallon Yates, and Alexis Nishimura.
0:34:34 Finally, I want to thank Jean Sealy.
0:34:42 Jean Sealy and I worked together in the McIntosh division a long time ago, and poor Jean.
0:34:46 She was kind of tasked with keeping me in line.
0:34:48 That was a very big challenge.
0:34:49 I hope you hear this, Jean.
0:34:52 Thank you for introducing me to Walter Greenleaf.
0:34:53 Alrighty, that’s it.
0:34:55 I’m Guy Kawasaki.
0:34:57 This is the Remarkable People team.
0:35:07 We’re on the mission to make you remarkable, and until next time, mahalo and aloha.
0:35:09 This is Remarkable People.