In this episode, we'll be talking about building organizational design capabilities, how to design for nomadic welfare systems, and how far design can reach to achieve political goals. And here is the guest of this episode. I'm Stefan Holmeldt from Linköping University and this is the Service Design Show. Hi guys, my name is Marc Fontijn and welcome to the Service Design Show. This show is all about helping you to create more human-centered businesses and we all know that this is important but also can be a big struggle sometimes. When I started the show, I wanted to learn from the ideas of the people that are shaping the service design field, believing that by carefully listening to them, I'd be able to quicker overcome the hurdles we meet every day and thus create a bigger impact with the work we do. So on the show, we talk about topics ranging from design thinking and customer experience to organizational change and creative leadership. If these are the topics you're also interested in, know that we bring a fresh new episode of the show every two weeks on Thursday. If you enjoyed this episode and would like to show your support, please click that like button or leave a short comment. It lets me know that the things we're doing here are appreciated by people like you. My guest in this episode is Stefan Holmeldt. Stefan has quite an impressive track record and here's a short summary. He started out as a GUI designer in the 80s. He co-founded as a global service design network in mid 2000 and currently is leading the design research area at the Link Chipping University. In the next 30 minutes or so, Stefan will be talking about building organizational design capabilities, designing for nomadic welfare systems and how far design can reach to achieve political goals. If you want to fast forward to one of these topics, check out the episode guide down below in the description or just stick around and enjoy the whole episode. And in case you prefer to listen to a podcast version of this episode, head over to soundcloud.com slash service design show where you'll find this episode and all the previous ones. For now, let's jump right in. Welcome to the show Stefan. You've been in service design for so long do you even remember the very first time that you came in touch with the term? No, actually not. Can you guess? Yeah, I mean, when I was a PhD student in the 90s, I probably stumbled across it because I read a lot of management and service management literature. I was working with banks and interaction design at that time. But it kind of landed on me when I was working at Ericsson in the early 2000s. Ericsson was setting up a service business globally and we were, as designers and the design researchers at Ericsson, we saw an opportunity to find better places and better possibilities to do really good user research. And that's when the term service and the term design kind of landed on me as something that could be really, really interesting. And then in 2003 somewhere, I met Birgit and we invited her to Sweden and had a bit of a strategic discussions with the ministries and so forth. So from then on. That was quite early, 2003 or 2000. And that's quite interesting because I had more guests from Sweden actually on the show. And it sort of, it seems that it started really early there somehow. Yeah, I guess, I mean, it all depends on how you look at it, of course. So if you look at the old service marketing people, I mean, they started all their 70s talking about these things, trying to figure out how to make these customer experiences into something that was part of the relationship between service providers or service providers and customers and so forth. So, I mean, in one sense, they've been working on it for a long time there. But from the design point of view, of course, there was also the participatory design, collaborative cooperative design kind of arena here, also starting in the 70s. We had a lot of things kind of coming together and suddenly there were things clicking and just working. You had the right breeding ground, I guess. Exactly. Let's move on, because you gave me a few interesting topics and you're coming from an academic background and people will notice this definitely in the topics that you provided. But I'll try to, yeah. I'm from the books, right? From the books. But I'll try to make them as concrete as possible. So, and you've got a bunch of question starters that you'll use to co-create the actual questions, right? Let's start. Topic one. And this has been on the show quite a few times so I'm interested in your take on this. And this one is called Building Organizational Capabilities. Which question starter goes along with this one? It's a why. So, why are we talking about building organizational capabilities? And which ones are we talking about to be specific? Yeah, that's a really good question, of course. In one sense, I mean, it's organizational capabilities has to do with how we, as organizations, make use of different kinds of knowledge areas or professions or practices or whatever. So, in relationship to design then, it's of course how do we make sure that design is not only something that is sitting in a person's head or just sitting in a method that we're saying that we're using or a tool maybe. So, understanding how these organizational capabilities can be built and developed so that we can, in a more confident way or in a more systematic way, make use of the very specific things that design and designers bring. Have you found something that is specifically challenging for design to become an organizational capability? Yeah, one of the difficulties, I think, for design is that designers want to do things, right? And designers want to make sure that people experience that fantastic feeling of being with the users, getting all that empathic kind of boost that you get when you see what they're doing and the IDs that users can have and your prototype and all these things. You want other people, but maybe not all designers, to experience that. And then you hope that they will take that further on in the organization and promote that or whatever. And that's actually a problem. Because most people then that we invite into these experience-based kind of learning processes, they don't necessarily have the possibility when they get back into their own organization without the designer as a help to do this. They experience something fantastic and when they maybe try to apply it, they don't have the support within their organization to be able to do the same things. They might know everything. They might be really good at exactly getting the empathic knowledge out of patients and sketching out whatever, but they don't have the support in the organization. It's that kind of support that is needed to make sure that we build these organizational possibilities for them. And is this something that is... Do you think this is part of service design? Also being able to think about and build these organizational capabilities? Yeah, I do.  But if you think that you're going to contribute with something beyond just the project you're involved in, then you need to figure out what is it actually that is the kind of leverage that this brings into the organization. There are all these labs around, right? And when I was working in Ericsson, we also built a usability lab. And the reason for that was not necessarily to do all these usability studies, but to make sure that after the lab, more people would be doing usability studies in their own projects. So the lab is more interesting from the after-the-lab perspective, which then also feeds back into, if you look at yourself as a designer, what comes after me in this organization that I have been working with. Yeah, and that's from a perspective where service designers are working with an external agency. Of course, the whole tendency now is to start building internal teams, right? Yeah, yeah. In-housing is, I mean, that's been expanding just the last five years really, really much. But the saying goes there, of course, that if you direct all the work onto yourself or into that specific team, that also creates a certain kind of structure and a certain way of working things. But what happens in the next step when someone is saying, we're going to distribute this, you know, centralization and decentralization, that happens all the time in organizations. You need to figure out how to work that, both as a centralized kind of function and decentralized, maybe in markets or whatever. And you've got some experience also with public services. Do you see any difference between building these capabilities in a publicly run organization and a privately run organization or is it both the same? I think it's hard to tell. But I mean, a lot of the work we've been doing on these capabilities building has been in the public sector. And one challenge there is that a lot of the professions that are involved in public sector organizations, they are experts in the same sense that the designer is an expert. And many of them, especially in healthcare, are actually experts in being empathic. So a nurse spends all day being empathic, right? So it's both an opening, of course, because then there is someone else coming in also saying that, oh, I have this empathy kind of ideas that I can work with. So that might be a bonding thing, but it's also, it might be a threat, of course. So trying to figure out how this, how it works from the contextual perspective is, of course, really important. Maybe before you go in or being open when you go in and say, okay, so I'm if you're new to it, I mean, I'm new to this and I'm open to understanding what this actually means. So adopting the beginner's mind also from a service designer perspective, especially from a service designer perspective. One final question around this topic, and this is, I'm sure you also have a lot of questions yourself around this topic. So what is the biggest question you have regarding building organizational capabilities that we don't have to answer right now? So that's my, this is my profession, right, asking questions that we want to know things about. No, but we are working with a specific idea about, or a set of specific theories and ideas about these capabilities, and they are both on the individual level, how these capabilities can be built from the individual level, but also from the institutional level. So I have two things that I'm kind of interested in right now. And it's, so one of the models is about the learning processes that happens in an organization when they try to take in new knowledge. And so there are three sets of learning processes. One is the explorative learning process, the transformative learning process, and the exploitative learning process. And given that designers and other professions, especially in healthcare, build their identity and their practices on aesthetic knowledge, the kind of knowledge that we get from feeling things and seeing things and yeah, whatever. So how can we capture that in the transformative phase? It's easy in the explorative phase, right? Because we can just experience it and do it and try to figure it out. But how can we capture that into the transformative process where we both adapt the way we are doing those things and the way that the organization is working to accommodate for that kind of knowledge? So that's a really tricky question right now at least. Interesting. Let's leave it at that for this moment and move on to the second topic because I'm expecting that we'll need some time also for this one. And this one is even already curious on paper and it's called Nomadic Welfare Systems. And which question starter goes along with this topic? Yeah, I did a little bit of hacking so it's a what is Nomadic Welfare Systems? Yeah, that's a really good question Stefan. So what is or what are Nomadic Welfare Systems? Yeah, that's what we're going to find out, right? No, but it started out as kind of an idea coming from Etsu Masini actually. He was here a couple of years ago giving a talk at our big literature fair. And I mean we have a lot of people moving around in the world between 50 and 100 million that's the kind of estimate that we have for the future that will be constantly moving around in the world. And for different reasons. Some will be refugees, some will be moving because they want an education, some will be moving inside Europe just to get work, whatever. And that's somewhat just curious, right? So, but our Welfare Systems, they are kind of built around and the Welfare kind of services also. They are built around an idea either that you pay up up front, maybe with subsidiaries, but also that you have kind of a base. It might be city-based. A physical location. Exactly, and when we start to move around that doesn't work anymore, right? So, how do we make sure that we can... We don't have to go as far as looking at this 50 to 100 million people moving around. We can just look at, in Sweden for example, we have Gotland, which is an island on the east coast of Sweden. And they are probably the most visited place in Sweden during summers. So, they grow 100 fold during summer. And it's a small island. So, in the winter when there is just the fixed inhabitants or whatever that is in English, they don't have all the welfare that all those millions that comes during the summer expects from their home cities, like Stockholm or whatever. So, it's kind of a... We can even look at the micro kind of level and see that there is already these things happening. And how do we rig and how do we set up systems and services that works under these conditions where we have variations in volume, maybe variations in scope that are huge? So, for me to understand, this is really related to the fact that everybody who lives in a country who is a resident in a country has a backpack with, I don't know, with insurance, with healthcare, with people that fix the roads. But as soon as you move across the border, even the border can be a country border, by your city border, you leave some of that welfare behind. And the question is, how do we design systems for people that are constantly moving, right? Yeah, exactly. And where does service design come into play in this story? Well, I mean, it comes into play, I think, where if we start to look at the individual perspective, for example, and trying to figure out how do people, what do people expect? How can we make that backpack into something that you know maybe that you're leaving behind or can carry with you? If we scale it, scale escalates to the policy or politics level, how can we find ways of structuring systems? And that might be just the way that two cities pay each other for giving healthcare, for example, based on taxes or whatever. So what can we do then? And what kinds of policies do we need to design based on the idea that people are moving around like this? What do you find the most interesting or inspiring example that has this nomadic welfare system already developed or embedded? I haven't found any yet.  So we have like Gotland or... And in the United States, you have Arizona, which is a state that is... A lot of people go to and play golf, right? But they pay their taxes somewhere else in the United States. So probably it might be even, as usual, it might even be easier to find these things in systems that are not to the Western systems, that have other ways of thinking about how we structure things and why we do things. I mean, we've been building these kind of welfare systems from the bottom up for a long time. So there is a lot of installed base stuff that it might be really difficult to throw overboard, right? And I'm really curious, how did this topic even came on your radar? You have to ask my PhD students. I don't know, no, but seriously, my mind works in mysterious ways. Nobody in my mind... Usually I kind of... I go running, right? So and when I'm running, things pop up in my head. And then I write them down. And then four days later, I go running again. And then the opposite thing turns up. And that turns out to be the interesting thing. So this was part of that, actually. It started out as collaborative welfare systems. But that's not so interesting, right? Sounds kind of boring. So I was running around the creek here. And then the idea, yes, it's not collaborative, it's nomadic. That's the thing. And then when that clicked, suddenly, oh, is it the... And it was just a word. It was nothing, no content, basically. But then suddenly, you start thinking, oh, so what does it mean? What is a nomadic welfare system? Does the system move? Or is it the person who moves? Is it for people in the north of Sweden, the Somic people? All these different things start to grow. So if people are interested in this idea, would like to know more or would like to explore this topic or help you out in these ideas, what should they do? Where should they look? I'm kind of thinking, look around you. I mean, probably there are examples of this happening already, but just that we haven't thought about them in that way, like Gotland. I mean, I didn't think about that as that kind of thing before. And then there's probably a lot of things happening around in tourist areas, for example. Might be bad examples, of course, but that's another question. And then I mean, we're in our new master programme that we're starting. This will be one of the topics that the students will be working on next spring. So I'm really grateful for all the kind of feedback and input we can get, of course. And the students will work on that next spring, which is spring 2018. Maybe the third topic also hints up on that. So let's see and let's explore that one. And maybe this one is even as cryptical or even more cryptical than the previous one. And this topic is called mediators and political goals. Yeah. And it's cryptic because you had to write it in three words, right? Yeah, actually four in this case, but yeah. We don't count and. Right, so my question here is, how far can designers work with social causes? Or how far can designers go in their in their own kind of work? And this builds on a. Yeah, yeah, how do. Okay, so social goal, social causes, political goals, mediators. How do these link up in this scenario? Yeah, it links up in the way, in the sense that. Well, I just do it really based on example. Okay, sure. So we're working in this project with, it's called Night Football. It's not a new idea. It's it was around in the US as midnight basketball in the 80s. And the idea here in Sweden is that. Football is a way to help migrants to. Find ways of understanding how things are working. Find friends, find people that they can look up to, find things to do, whatever, you know, all these things that kind of drives people to be part of society. And feel that they are part of society. And so as desires, of course, it's difficult to drive these things. We might want to. We might want to do these social innovations, but these things are difficult in the sense that they are the goals, you know, getting to a society which is integrated. And it's that's important, actually, that it's society. It's it's society that is integrated. It's not people who are integrated. So getting to those goals is a difficult thing because it has to do with politics, which might it doesn't change from day to day, but it's it's still a negotiation kind of business. And it's also a business where where argumentation is part of the democratic structure. So you will have people saying one thing in debates in that end. And other people saying things in this end in the debates. Not only as a part of a debate, but as a part of showing in our democratic structures that there is this whole space to work with. And it's the job of the of the more of the government and the political structure to find a position here that will work. And that's when policies made and those policy makers might want to have might have the same goals as these social innovators that wants to do good. And which means that there will be political pressure or policy pressure also on these people that are working, for example, with night football. So working as a designer in that space is is not as simple as just helping these innovators to design a better thing. But you actually have to understand how the system interacts, how the different ways of working within that kind of system is can be matched and can be integrated or synchronized, or maybe they should there should even be friction. Everything doesn't have to be smooth, right? But isn't you say it's not as easy to work in these kind of environments? And is it is the challenge that if you want to create really big impact, you need to take all these factors into account. So you of course, you can sort of design or innovate on a small scale. But if you really want to make an impact, you need to integrate all these elements. Is that why it's so challenging? Yeah. And also because it's it's partly this policy thing, which also makes it I mean, policy is one thing, of course, but it's the politics policy kind of relationship that makes it also difficult. So how does this play out in the example of the night soccer? We call it soccer in the Netherlands instead of football. Okay. That's all right. No. So it plays out in the sense that the if you look at the entrepreneur, the football entrepreneur, they have one idea of how this, how they work this network of stakeholders to make their goals come true. And they might have their own ideas of what is important. And then you have the funders, which might be, you know, nonprofit organizations or whatever that have their own ideas on and their own idea about how the network should be should be worked. And then you have the policy level and the politics that might have another idea of how the stakeholders and actors work together and what the goals actually are. So starting to work with those three different ways of looking at how this structure is working is part of that, that thing that makes it difficult. And you need to understand, not only there is no, there might be no idea in trying to make them match or make them be the same, right? They will always be different than that's good. So there will be no way of doing a seamless kind of design. But I guess that's the, that is the part where designers are really good at having design challenges where there is a real challenge, right? Yes. And also to sort of wrap up this topic, which question do you find most interesting surrounding this topic? What is it the thing you think about when you're out running? Well, then it's the meeting between the policy way of, or the politics and policy way of making things happen and the experiential way of making things happen. So it's the meeting between the policy drive and the experiential drive actually. Stefan, I want to thank you and just now let's wrap up this episode. What did you find the most interesting thing we discussed in this episode? Let us know down below in the comments. And remember, more people like you are watching the show. So your comment might just be the thing that gives them the next meaningful breakthrough. If this is your first time here and you'd like to see more interviews, check out some of the past episodes and be sure to click that subscribe button. I'll see you in two weeks time with a new episode. For now, thanks for watching and I'll see you then.


Live from San Diego, California, it's theCUBE. Covering KubeCon and CloudNativeCon, brought to you by Red Hat, the CloudNative Computing Foundation and its ecosystem partners. Welcome back, this is theCUBE's live coverage, three days wall-to-wall coverage of KubeCon, CloudNativeCon in San Diego, I'm Stu Miniman. My co-host for these three days is John Troyer and welcome to the program. First of all, from the keynote stage, Heather Kirksey, who is the vice president of Community and Ecosystem Development with the Linux Foundation, of course, CNCF, part of the Linux Foundation, and from some of the technology behind the scenes, joining her, Sandeep Panasar, the SVP of Strategic Engagement at Ternium. Thank you so much for joining us. Thank you. Thank you for having us. All right, so Heather, this was a really cool demo with a lot of things going beyond the scene. People actually go watch an interview we did yesterday with the people at Red Hat, talk about, it's a good thing it was CloudNative because there was a brown-out, power was lost, had to rebuild the entire thing, and everybody up on stage the next day didn't know anything the wiser. So, really cool, pod on stage, talking about 5G, global engagement, China Mobile, other banks like, I'm sorry, other mobile providers like from Canada and from Europe involved in this. Give us a little bit of the foundation view as to how something like this comes together and how you get participation from the technology providers, the telco providers, it takes a village.  But, I mean, that's really kind of the premise of open source, right? Is that people come together and they build things together. And so, we've done some demos in the past where we looked at sort of the modernization of the central office.  And so, it just ended up that basically 15 organizations said yes, that sounds like something that we would like to prove out and 80 volunteers across those organizations ended up working on it. So. Yeah, and I understand what it was about four months to put all the pieces together. Bring us through kind of, you know, how the stack gets built and the projects involves.  So, you know, we started with sort of the complexities of getting equipment, you know, and getting 5G radio. You know, we had a partner in China who had a 5G handset that then wanted us to indemnify, you know, all these things to the extent that like we as an on profit didn't feel comfortable signing the agreement. So, you know, it started actually just, I mean, this was so cutting edge with in terms of the 5G aspect that getting equipment was challenging, you know, and that's before you even get to sort of the challenges of building the stack. So, you know, it started kind of figuring out what pieces started building things, you know, found some, you know, gaps in Kubernetes around supporting the sophistication of networking that we have to do. So we figured out how to work around it for the demo, but what we want to do is start upstreaming some changes into some of the projects there. All right, so Sandeep, your company is one of the providers inside here. So tell us what drew you into it and how it is living on that bleeding edge with something like 5G? Well, it's absolutely thrilling living on that bleeding edge. It's exciting, you know, lots of risk, but the payoff yesterday was fantastic to be able to complete that call on stage. You know, from our perspective, we were invited in fairly early on into the project and we were thrilled to be part of it. And as once we understood the scope and what everyone was trying to do, we realized like we're providing the SD-WAN for this project, connecting the public cloud, the private cloud and we're deploying and using containers Kubernetes and we are able to bring the entire thing together by creating one virtual network so that it's seamless and all the underlying infrastructure, the layer two, layer one, the underlay is just completely invisible to be able to transport that call, to do the signaling, to do everything that needs to be done. So for us to become part of this project was really powerful for one, for us to just work with some of the companies that were there, like the Linux Foundation, Intel, Lenovo, all the other big name players that were out there and so that was an amazing experience but then the community itself that came together, like the people that we met, we met them all at the show, it's all phone calls, we met them all at the show and it really is a community filled with love and a real drive and desire to build something new and different, right? Sprinkle with a bit of crazy. Yeah. Well, so I mean, this is a great example of how the Linux Foundation can be a catalyst here. I mean, one of the Linux Foundation is so broad, the CNCF is so broad and you're operating in many domains and this being, you know, bringing the telecom world together being one of them but I don't know, can you maybe just talk a little bit about the ecosystem and the unique challenges of, I mean, there are sometimes open source approaches that are a little more like strongly opinionated, like this is going to be our, this is what we're working on, this is going to be our stack, this is the projects in our stack. CNCF has obviously a well documented and open process around bringing projects in and projects graduating but how does that make your life, you know, harder in terms of the breadth? So I mostly focus on our networking projects and working with the telecom industry and yeah, I mean, telecom definitely likes to be opinionated, you know? I mean, that's kind of in our soul and so, but it also is useful because really at the end of the day, interoperability for the type of scale that telecom operators has is very important, right? It, yeah, some of the cloud providers, right? It's up to the people who want to run on them to like work with their APIs but the telecom operators, they're using all these applications to provide services to their customers so they have a business need to make sure everything really works into end and so there's actually an initiative right now between the LF networking projects and the GSMA where we're really trying to not too prescriptively because we do also understand that that doesn't know, you're not going to get the exact same pieces of software that work for every single operator's network or business but with a lot more sort of opinion around, what should the cloud platforms, whether they are VM based or container based, what do they look like and how can we start doing things like compliance and verification programs around commercial implementations, whether it is the underlying platform or whether it's the applications on top and so that's the thing that we're working on right now because at the end of the day, we're really needing to help them accelerate their deployments and get that agility that's the promise of cloud. So Heather, I want to go back to something you mentioned earlier that there were some gaps in Kubernetes, speak to how fast the community rallied around to allow this solution to go forward.  For the demo itself, we weren't going to fork or make our own sort of changes to Kubernetes so we did some things to tie things together probably. You're using the SD-WAN. You're using the SD-WAN piece, but absolutely. Yeah, SD-WAN part, but one of the big issues is just being able to expose multiple interfaces which in a service provider network, you have multiple interfaces, right? V6 support is another big issue and so being able to expose those natively in Kubernetes or natively just using CloudNative, it's something that we're still working on. There are a couple of projects that are looking at that multis, network service mesh, maybe there's some different CNIs who are beginning to think through that problem. None of them were quite there, so we didn't want to start forking and writing pseudo Kubernetes code. So we kind of just use some of the tools and the players in place to work around that but what we would love is to upstream that code into mainline. Sandy, would love to hear a little bit more about how SD-WAN fits in the entire 5G multi-cloud discussion. So we were, we had a pop here in San Diego, there's a lab in Montreal, and then there is a lab in France and we used public accommodation of the Alibaba Cloud in North America and in Europe and what we had to do is we had to create a way for the phones to reach each other. So we had to do this initial signaling where you do the request and you have to get to all the different pods to make the request. So what we did is we put our containers in all the cloud providers and also in the labs and we were able to create that private network and that's what allowed for the call signaling to happen and for the actual call to actually be completed from one handset to the other.  I suppose that you usually hear more on an enterprise side of the show, right?  This is a little bit different, right? As you, I don't know if you've had a chance to wander either in the sessions or on the floor. Kind of curious, there is a little bit of networking out there, a little bit of networking security and a couple of other, certainly some service mesh stuff. I don't know, what are your thoughts about how this is growing up in this open source world? It's growing, listen, it's growing up very fast, right? That's 100% sure. I mean, the show is growing like leaps and bounds every year, it's insane. And that performance yesterday was in front of, I don't know how many thousands of people, but I mean, that was huge and it was amazing.  And if you take all of these tools and put them together, you can actually build something wonderful, right? And that's what we did in this project here. We were able to deliver a 5G call and run it everywhere. So I think what's important in the community, even though this is really primarily a developer event and developer show, you are seeing some edge people here. You are seeing some networking people here. And people are the awareness of, oh wait, we need edge and we need networking to actually build commercializable platforms or products. It's that awareness that's, I think this year at least, is really starting to come out. And I think next year, it's going to be even more prevalent and you're going to, the show may evolve. That's where I kind of see it going. Yeah, I mean, I think application developers in general tend to think networking is amazing. It just happens to be there, sort of like plumbing and power, but to actually deliver it is a fairly complicated challenge. And the other reason we wanted to do the demo yesterday was actually to kind of show some of the challenges and to kind of show what it takes to set up a mobile network so that if we're going to use Kubernetes to do that, the developers here would have a little bit more understanding so that when we're like, we need multiple interfaces or we need to be able to address things in a certain way, they have a better understanding of why so they can help us from the talk-on industry design and build it out. Yeah, I guess Heather, the last thing is we've had theCUBE at the open source summit, we've been at the open networking summit. When you got off at stage, you put, there's so many different open source projects that span, just give us a view as to how things span across all of these communities to make sure that we don't end up with a lot of fragmented things. How does everything kind of pull together in the networking? I can't hear you with the first person side. All right, so many projects across so many sources. How does Linux Foundation make sure that we don't just end up with siloed places? Well, to be honest, it's a little bit of a challenge because sometimes the reason that we end up with multiple projects serving what looks like similar needs is because they're different technical approaches and so maybe one will work better than the other. I mean, that's kind of the idea of open source is that people can try different things. We just try to help people have less of a not invented here sort of mindset that if there's a good reason to try a different approach, go for it and let's see what takes fruit and what flowers. But also, other people are doing things just because you're not aware of them. So there's a lot of stuff around education and sharing of information that we try to do. That helps with that, but I mean, yeah. Absolutely. Heather, Sandy, thank you so much for joining us. Thank you very much. Congratulations on the demo. Know a lot of hard work by a lot of people. Thank you. I just have to tell you, I feel a thousand pound weight has been lifted off my shoulders now, but it was extraordinarily fun to do. Yeah, it was fun. Thank you. For John Troyer, I'm Stu Miniman. Getting towards the end of our three days wall-to-wall coverage. They're running for the t-shirts that are left, but we've got a couple more interviews. Thank you for watching theCUBE.


Welcome, viewers, to Channel 17, Center for Media and Democracy here in Burlington, Vermont. This is the ongoing series, Nuclear Free Future Conversation. I'm your host, Margaret Harrington, and welcome everybody to this discussion today with Dr. John Ruer. Welcome back, Dr. Ruer, to our program. You've been here before and talking about the nuclear arms race, and now we have the topic set before us today. The new nuclear arms race, national security or insecurity? So, taking from the top, Dr, what about the bulletin of atomic scientists who set the doomsday clock forward to two minutes to midnight? What does this mean? Thank you for having me, Margaret. This is a topic that's very dear to my heart because I think it impacts our future more immediately than almost any other issue that we face today. So the bulletin of the atomic scientists was a publication and a group of people that started with the very scientists who created the atomic bomb through the Manhattan Project for use in World War II. And it didn't take them long to realize they had let a genie out of the bottle that really terrified them and realized the implications for our future if we continued to make these weapons. Many of them had regrets. Not all, but many had regrets that they had done it in the first place. So in 1947, they began to publish this bulletin and they developed this doomsday clock. The idea was to give their professional scientific opinion, as the real experts in these weapons, how much danger they posed to our survival at any given point in time. So that clock has been yearly changed, how many minutes toward midnight, and has waxed and waned according to their professional assessment of the danger that we face from nuclear weapons. Last year, they moved it up to the most it had been in over 20 years. And this year again, because of the threats they see, they moved it up to two minutes to midnight. It's only been that close one other time in history the very year, 1953, when the United States and the Soviet Union both up to the anti from the small atomic weapons of the Hiroshima and Nagasaki disasters to the thermonuclear weapons that are hundreds to thousands of times stronger. And why is it this year? What are the reasons why they're pushing the clock forward? Well, they're really worried about the attitude, the cultural attitude, both the United States and the other nuclear powers that seems to be moving away from eliminating these weapons that everybody has agreed to all long needs to happen. And to starting a new arms race by building new weapons, modernizing the ones we have, and worst of all, making them more usable. And therefore likely to be used in any of the conflicts that are going on. Meanwhile, those conflicts are getting worse. With India and Pakistan, two nuclear arm powers now threaten each other and having regular border skirmishes. And North Korea, of course, in 2017 testing nuclear missiles and its first thermonuclear weapon, the first hydrogen bomb that puts it in the league with the big boys in the nuclear club and can threaten the United States. And mostly what we hear are the verbal threats between North Korea and President Trump. And so to know what the background is that is, but this isn't a background, this is up front, right? That there is a buildup of nuclear weapons on all sides. That's right, North Korea is the latest addition, the ninth member of the nuclear club, and has its weapons because after agreeing with all the other non-nuclear weapons, not to build them in return for the promise that the nuclear weapons states would eliminate their nuclear weapons in due time. At the time everybody signed the Nuclear Nonproliferation Treaty. When realizing that the nuclear powers weren't very fast about disarming, decided to withdraw from that treaty and build nuclear weapons, which has succeeded in doing. Which treaty is that, and which countries withdrew from the treaty? The Nuclear Nonproliferation Treaty, which went into effect in 1970, was the promise between the five nuclear powers at the time and the rest of the world that no one would develop new nuclear weapons if the nuclear states worked on getting rid of theirs. Since then, four other nations have acquired nuclear weapons and several had them and eliminated them. The latest is North Korea, which has decided to withdraw from the treaty and build its own nuclear weapons, thinking it needs them for its self-defense. So of course the United States is still going, abiding by the treaty. Depends on how you interpret it. Article 6 of the treaty says that the states will work in very efficient fashion to eliminate nuclear weapons, allotting the 1.2 or 5 trillion dollars that we just allotted to modernize them. To me, doesn't sound like much of an effort to get rid of them. So on paper, the United States is still ascribing to this treaty. But in action, it's another story, and it's a frightening story. It is a frightening story. And there's a document that's produced every so many years by the United States government called the Nuclear Poster Review, which is an assessment of how many weapons we have, how many we need, what their purpose is. And that document has always contained an element of, yes, we're still working on getting rid of these. And while the latest one published by the Trump administration still has a sentence in there about, yes, we want to get rid of them, there's nothing else in that document that suggests that we're headed in that direction at all. In fact, it's quite the opposite. In addition to modernizing all the weapons in the delivery systems that we've had up until now, they want to introduce new weapons. For example, small tactical nuclear weapons for the use of submarines. See, before submarines, which one of the three delivery systems, right? We have submarines and intercontinental ballistic missiles from silos in the ground and strategic air bombers. The subs have always had strategic weapons. That is, weapons large enough to take out whole cities that were never intended to be used, but intended as deterrents.  But now they want to put weapons small enough that could be used in a battlefield situation, and that makes them more usable. The word they use in the posture review is flexibility, which is very frightening to those of us who know in intimate detail what those weapons will do. And so, meanwhile, we have the nuclear submarines in strategically placed all around the world. Well, the Navy won't tell you where they are at any one time, but there's a couple of big bases. The largest is, I think, in Washington State and Norfolk. The two largest, but then the Soviets, the Chinese, the French, the British all have nuclear-equipped submarines. Is it important to know that the Soviets and the Chinese may have been developing more nuclear weapons before the United States got on board this policy? Is that true, or is it important to know that they were the ones who did instigate this? Instigate the latest buildup? Yes, the latest. Oh, I think you'll hear accusations on both sides. The point is, all those countries have a signed treaty, that Article VI of the Non-Polarization Treaty, it says they'll get rid of them, and no one is at this point. The possible exception of Great Britain may not be modernizing as fast. At least they're having public discussions about whether they should or not in the public square or something we're not having here. There's no discussion about whether this trillion and a quarter dollars is worth it, given all the other security needs, how these weapons can't protect us from 21st century threats. And continue? So you'd think there'd be more public discussion about this? Yeah. Well, Doctor, why do you think that there is such apathy about this? Most of us, we see this and we say, okay, it's just proceeding as usual, and there's nothing to worry about because there hasn't been another bomb dropped in 70 years or more. Yes, well, I think for young people, they have no awareness of what these weapons are. I talked, I was lobbying recently about this in Washington, D.C., and a young front office staff of a U.S. Congressperson, I asked them how many nuclear weapons they thought there were in the world, and they said 500,000. I've asked other people that age, and they say five or 10. So the ignorance about this is enormous, and that's simply a reflection that it hasn't been covered by the media. It's just a fact. And I'm sure the people that are making these hundreds of billions of dollars building these weapons really probably don't want it discussed a whole lot. But it's not been a news item for young people. So the misinformation is enormous. Now for the older folks who know about these weapons and the UNI who got under our desks in grade school, and I can remember measuring the walls of my house to see how long I can survive fallout radiation, have that jolt so that when we see these pictures, that brings back a memory. It doesn't for young people. So it's our job to bring them up to snuff, I think, on talking about what it means if these weapons are used in a small or a big way. Now when you talk about people constantly going back to the argument, and I've seen this as the top level of the State Department to people in the street. Oh, of course they're safe. They've proven themselves safe over 70 years. Look, we used them intentionally against Japan. They saved us an invasion maybe. And look how safe they are since. But, and this is where education comes in, if you look at the mistakes that near misses, there have been 32 broken arrows where the United States Pentagon agrees they lost or accidentally fired a nuclear missile that wasn't intended 37 times. That's the ones they admit to. It says nothing about what the Soviets did. And there have been seven near Armageddon's where a launch on one side or the other by Russia, the United States, would have started an all out nuclear exchange, which would have ended civilization and caused misery like we've never seen before. I hope that people will begin to learn about these and we do have an opportunity to do that as we'll talk about later in the show with this upcoming series of films about nuclear weapons. But here's the way I look at people who say we'll look they're safe.  Things that I saw the results of poor behavior in the emergency department, the lung disease and the terrible smash faces and the deaths and so forth from the car accidents. But the longer people do those behaviors, the thing I was guilty of was not riding on my bicycle with a helmet. I was 35 before one of my colleagues said, John, that's really dumb. So now I ride with one. But because you don't get hurt during those things or you don't get the cancer or you don't get the COPD, the longer you go, oh, this must be benign, right? It's normal human, that's the way the brain thinks. Well, it reminds me of us as if we were turkeys. An egg hatches, a turkey is born. Its human caretakers give it food and incubator and they nurture it. And every week that goes by, that turkey has to feel better about life. It's growing, it's healthy, it's being fed and watered.  Who knows if turkeys are having discussions about whether their human caretakers has the best interest in mind. But even if they did, they would probably win the argument that life is good. And so their confidence level with time goes up and up and up until Thanksgiving day. It's gone. And this is what really gets me is if nuclear weapons are launched tomorrow and most of our cities are destroyed, nobody looking at the history of what you'll see in these movies will look back and say, well, that was a shock. It'll say, of course, how could they not see that coming? And that's the point I want to get. Why be turkeys? Well, John, you mentioned the movies and tell us about the week long movies, the showings on nuclear issues. Yes. Right here in Burlington. Right, so at the urging of me as a member of Physicians for Social Responsibility who wants to educate people about this, the Peace and Justice Center here has arranged for the showing of five different movies and six different locales next week, starting Tuesday through Saturday evenings and one Sunday afternoon in different venues, each with a different topic. So there'll be the movie Threads, for example, shown at the University of Vermont on Tuesday, which is a tough to watch movie, but it's the most realistic picture of what a nuclear exchange would mean for a given place. It's a story of Britain being attacked in the 1980s and it's very sobering, tough to watch, but everybody should see it just so you can make a decision. Do you want these weapons in the world existing that can do this? And they can do it in an hour's time on any given day. And then there are uplifting movies, like on Wednesday, the Women's International League for Peace and Freedom is sponsoring a movie about how the peace movement has dealt with this in the past and particularly the wonderful things we did by changing Ronald Reagan's mind from coming into office, he signed an order about explicitly how we would beat the Soviet Union in a nuclear war and three years later in a state of union speech after much education, he said we can't win one, it'll never be fought and became the greatest disarmament advocate of all time. We need to do that again. These movies are powerful for that. Then there's some documentaries about accidents and terrorism and then there's one very uplifting almost fantasy but not as unrealistic as you might think about how some sports players actually made a difference in reducing nuclear weapons called Amazing Grace and Chuck, a really fun movie to watch. And please, if you watch Threads, make sure you watch that one too so you won't feel so bad and have hope. So hope, how can we have hope in the face of this nuclear escalation of this machine that is just going forward into... This threatened... There's just so much money in this. It's so many jobs for so many people and people don't know the fact that money in military industries like this creates so many fewer jobs than doing anything else, including not taxing people in the first place. You'd have a lot more jobs without those military expenditures but the money is there. People don't wanna lose their jobs. They don't understand the realities of these weapons. So the hope comes from people changing their minds and we did it before. Like I said, in the 1980s, we were as close as ever to an all-out nuclear exchange and we reversed the whole thing. When people say, oh, you'll never get rid of them. Now that they're there, how could you ever get rid of them? How could you trust that the other guys are getting rid of them? Almost nobody knows that we went from 70,000 nuclear warheads in the world to less than 15,000 now. Does anybody listening feel less safe because we have fewer ones? Just continue that trend. For having to say it's 122 nations in the world last summer. I was at the UN, signed a treaty, agreed on a treaty to just eliminate these, to make them illegal as a major step toward getting rid of them. We can join the rest of the world. The non-nuclear nations are tired of the nuclear bullies having the weapons all the time and they're demanding that they get rid of them. We can support that. We can call on our congresspeople. We have some of the most progressive minds in Congress with our congressional delegation who signed on to some bills limiting nuclear expenditures a little bit, limiting the power of the present to unilaterally start a nuclear war, trying to make it illegal to start even a conventional war against North Korea, preemptive strike without congressional approval. These are all in the books. Our leaders are more progressive far and away than most in the country. But we need them to, this is really existential threat stuff. This could happen like the scientists that the bulletin say anytime. There were two minutes to midnight. And if it goes off, nobody's gonna be surprised. That to me suggests that we ought to ask these guys to take more of a leadership role in opposing this modernization of the nuclear arsenal. And we have this great example because the military budget right now has two trillion dollar programs that we could debate more. One is the nuclear weapons built up in the modernization and the other is the F-35. So there's this fighter plane, the most expensive single weapon system ever built and it's gonna cost over a trillion dollars too. In fact, we've spent I think close to $400 billion to have a few hundred of these flying planes of questionable value. And if the country says yes, we absolutely need them, great, but if we don't. And here, after fighting that for eight years, losing every battle to try to eliminate those planes coming to the airport in Burlington, they've resurrected the movement again and now there's gonna be on March 6th a ballot where the city of Burlington voters, not the city council gets to vote whether they want that plane here with all its noise and medical consequences of which there are many. And remember that it's a nuclear capable aircraft. And while it's unlikely to have nuclear weapons at the airport in Burlington because its range is so limited it couldn't deliver them anywhere you can imagine it using, these will be, if used in action, maybe flown to Guam where they'll pick up the nuclear weapons and drop them on North Korea to start the whole mess or whatever. So it's all related, but we have hope because this tough little group of people in Burlington is gonna bring this issue despite everybody including their own congressional reps fighting in them at every step of the way. They're still saying we can make a difference as people. And with the nukes we've done it before it's time to do it again. So plenty of reason for hope. We're still here. Yes, and could you speak to that? Like why after 70 years of this turmoil and this reality, I mean it seems that to me like a question of what is reality? This is the reality what you're talking about. And a lot of us are living in a place that is unreal like in a, well for an old fashioned term it's like a fool's paradise that we are in. That it's not clicking with us that this is what's happening or that we do have any power to stop this progress. You know that's really Margaret what he gets down to. And we've all been educated to think that the powers that be are just too powerful to us and we don't have a say. But the fact is we do and history shows it. We can make a difference. And on an issue this important it's worth putting the time into. And the biggest motivator really is the education. You know when I gave these talks back in the 1980s there weren't too many people who would give me an hour or an hour and a half or watch these films and come away thinking exactly the way they had before. Not everybody, some people say well that's a risk but it's worth taking and they can respect that. But the overwhelming majority of people once they see the reality of this in great detail most of them will say yeah let's not go there. And as soon as the people say let's not go there it disappears. Are you saying that the power of truth is a true power and that things can change with that? Of course, of course. See the belief in deterrence that these weapons keep us safe is really based on well believing like turkeys that they're safe because they're well fed until that day when they're not. And I don't understand how folks can say they'll never be used when every weapon system that wasn't eliminated in history has been used. And even if you say well we have all these safeguards in place again you should watch these movies to see how close those safeguards have come to doing it all in. I said this on the other show, General Lee Butler who commanded all the ICBMs all the strategic bombers and all the submarines at one time in 1980s recently wrote a book on his deathbed practically saying it was all a mistake and it's only by luck and divine intervention that we haven't eliminated ourselves. That's the guy on the inside who knew everything about these weapons. I looking at it from the outside came to the same conclusion and was very affirmed when I heard that this year at the United Nations. It's almost magical thinking that somehow we can build something, threaten to use it and never actually use it. In gaming theory anything that's probability is not zero will happen if given enough time. That's just a mathematical fact. And there's nobody on the earth I've ever heard say that it's a zero chance these things will be used by accident. So you're approaching the issue with a logic, right? Well from every angle, mathematical logic, common sense, morality, and hopefully with the treaty to prohibit nuclear weapons it'll actually become illegal to have these things and that'll give a boost to the cultural resistance to what we inherently know as a dumb idea. And in closing for this short interview, doctor could you talk about that treaty to abolish nuclear weapons and the international campaign to abolish nuclear weapons and what impact that is having on the powers that be today? Right, so the international campaign to abolish nuclear weapons which works hand in hand with physicians for social responsibility and the international physicians for the prevention of nuclear war, some of their founding members. I remain on those mailing lists and every day I see something exciting going on in some country around the world, including Iran and places you would never dream of with ordinary people pushing their governments, pushing their parliamentarians and their congresspeople, educating people about these. There's a peace boat, large cruise ship that part of the year goes around educating people about nuclear war mostly through the efforts of the Hibakasha, the survivors who are getting very old now from Hiroshima and Japan. And they will be coming to Burlington in September. We'll have a big educational program where we get the benefit of these wise old folks who lived through what we're trying to prevent. So all of these things are pathways to hope. Yes. As we can see. And could you have some closing remarks now for our program today? Well, it's clear that governments under the influence of weapons manufacturers are not by themselves going to eliminate these silly weapons, the F-35 or really anything else without pressure from the people. And if we believe we have any semblance of democracy left, we have to know that we do have the power to change our government's mind. We've done it before and we can do it again. So I would just ask not to feel hopeless but to do the minimum, whatever your life allows you to do to push back against these things, do it. Educate people, invite speakers from ICANN or speakers from PSR, show these movies, get and watch these movies. Anytime you get a venue talking about it, most human beings that I know make the right decision once they know enough. And meanwhile, this movie festival starts. Next Tuesday. Okay, could you, next, okay, we have the, we have a flyer that shows the. That'll be up on the. Yeah, that'll be on the screen. So Tuesday, Wednesday, Thursday, Friday and Saturday evenings and Sunday afternoon. Okay, well thank you very much for talking with me today and lifting us into a greater reality about what's going on and please come back to talk to us again. Thank you, Margaret. Thank you so much. Thank you viewers.


As Russia's invasion drags on into its 17th month, Ukrainian forces say Moscow is ramping up its use of a dangerous low-cost assault drone capable of destroying equipment many times its value. The Lancet drone, an angular grey tube with two pairs of four wings, has been an increasing threat on Ukraine's front lines in recent months, according to Ukrainian solders. Ukrainian servicemen from four different artillery crews named Lancets as one of the main threats they faced on the battlefield in conversations with Reuters. Although the device was first unveiled in 2021, several soldiers said the frequency of their use had increased in recent months. It has increased by a lot. Earlier, in spring, they were not using Lancets as often as they are now, 35-year-old artillery gunner Bodan, who gave his call sign as Doc, told Reuters near Avdiivka on the Donetsk region front lines. Russia's defense ministry has been encouraging an increase of production of the Lancet as a cheap way to hit high-value Western equipment given to Ukraine for its counter-offensive, said Samuel Bandet, adjunct senior fellow at the Center for a New American Security. Assault drones can either send payloads to hit their target or be used as single-use loitering munitions where they are strapped with explosives and ram the target themselves. Lancets are going after high-priced targets such as artillery systems, rocket systems, as well as single systems like tanks and others. We're starting to see more Lancet 3 used by the Russian military, at least by the frequency of posts that are on social media.


That's what I don't f*** with, it's like when you get the money, bro, buy more s***, you know what I'm saying? Buying too s***, buy for promotion, buy for advertising, buy, like, buy your way into more music, you know what I'm saying? And probably stay away from staying the same and spending money on s*** that don't got nothing to do with music.  Stay away from s*** that don't got nothing to do with the music.


Growth and development in the United Arab Emirates is taking place at a fast pace. It's hard to imagine that less than half a century ago cities like Abu Dhabi and Dubai were sleepy backwaters on the Arabian Peninsula. Nowadays it's not just the buildings that are growing but also the population, construction, industry and, as a result, the need for more energy. At today's growth rate, the Emirates expects demand for electricity to double by 2020. To meet these demands, this oil-rich nation had to rethink its energy policy. Extensive studies concluded that nuclear power was the best way forward. We've looked at all the different technologies when deciding on what option the UAE will adapt as a baseload technology for the UAE. We looked at the security supply issues, we looked at the commercial issues, we looked at the environmental issues. Nuclear power came as, or emerged as an option that meets the commercial, the environmental factors but also as a reliable technology that's been proven in the past to be a good option to meet such a substantive portion of the electricity demand. Away from the skyscrapers of Abu Dhabi, the first nuclear power plant in the Arab world is under construction in the desert. The Baraka plant, which is being constructed by the South Korean Ketco Corporation, is expected to be operational by 2017. Since starting its nuclear power program in 2008, the UAE has been supported and guided by the International Atomic Energy Agency, the IAEA. The UAE is the first country in 27 years to start the construction of its first nuclear power plant. The cooperation between the UAE and the Korean partner is very comprehensive and intensive. The IAEA is also cooperating with the UAE. This is a huge project. The UAE was already three years into its nuclear power program when the accident at the Fukushima Daiichi Nuclear Power Plant in Japan occurred in March 2011. The Federal Authority for Nuclear Regulation, FANA, says the industry learned from the accident. FANA had already a robust safety framework for its nuclear power program and the Fukushima accident allowed us an opportunity to work with other countries of operating nuclear power programs to see what lessons have been learned and make sure that they are incorporated into our nuclear power program. The UAE is a country that prepares for the future today. This also applies to its energy program and the government knows that a nuclear program is a long-term commitment. Building power plants takes 10 years. Operating them takes 60 years. Managing them with their waste takes 150 years. So that commitment and that understanding has been explained to all the people and to the public of the UAE and also to our people and the government who understand the magnitude of this project and they understand the added value of this project and understand the economical value of it, the environmental value of nuclear industry. The UAE is planning for energy diversity by investing in renewable energy sources as well as in nuclear power. Research into solar and wind power is centered at Mazda City in Abu Dhabi with the goal of increasing the contribution of renewables to the country's energy supply to 7% by the end of the decade. As for nuclear, all going to plan, the Baraka plant should have four reactors by 2020. These would be capable of providing 20% of the electricity of this fast-growing nation.


ThinkTek Hawaii, civil engagement lives here. Aloha and good morning ladies and gentlemen. I'm Pauline Schachmacher and your host for We Like the 1%. We Like the 1% is about individuals and entrepreneurs and today we're going to concentrate on entrepreneurship and technology within the healthcare sector. Hawaii is proud to be home to one of the 69 NCI-designated cancer centers across America and my guest today is Dr. Randall Holcomb, director of the University of Hawaii's Cancer Center. Good morning Dr. Holcomb. Good morning, it's a pleasure to be here this morning. Wonderful, thank you, it's great you could make it today. So what we're going to discuss is slightly abstract, a little bit esoteric because we're looking into the future of healthcare and patient care and we're going to focus on oncology in the area of cancer. So before we get to all the technical things and these futuristic ideas, can you please just tell the viewers and listeners a little bit about yourself first? Certainly, I've been in Hawaii for about a year and a half now as director of the University of Hawaii Cancer Center. I came from Mount Sinai Medical Center in New York where I was for the past six years and I've been an oncologist and in academic centers really for the last 30 years. Okay and what drew you to the study of medicine? Why did you choose this subject yourself? Well I was very interested at the time in immunology and how the immune system affected different diseases and I found that the study of the immune system and cancer was very interesting. At the time that was a pretty hot topic, it then waned and wasn't such a hot topic and now is a very hot topic again so it goes in cycles but that's really why I went into oncology and went into research and the study of the science of oncology. I also really enjoyed taking care of cancer patients. I think that as a physician you can just do so much for patients who are going through a difficult journey with cancer and it was very rewarding to be able to care for patients. Yes that's good. You have that immunology interest as well. My guest yesterday was also a doctor and he's an immunologist by training so there's something in common there for this week and also you still see patients. Is that correct? You still actively see patients in Hawaii. I do. People can come to you Dr. Holcomb not just at the cancer center but also as a physician. That's absolutely true. We work at the cancer center through the Hawaii Cancer Consortium which involves Queen's Medical Center, the Hawaii Pacific Health Hospitals and Kua Kini Medical Center and I have started to see patients through the HPH system and shortly through the Queen's system as well. Okay and you're licensed to practice in Hawaii and New York? At the moment in Hawaii and New York. Okay brilliant. Two wonderful places extreme sides of the American country. So let's get to these futuristic ideas about cancer detection, prevention, awareness, eradication hopefully completely and one of the things that for example Mitio Kaku when he does these futuristic talks he brings up in the cancer arena liquid biopsies this idea about liquid biopsies being able to detect the cancer before you even have to go to the physician so if you go to the Lou there'll be this kind of technology that can tell you whether you have cancer or not and how does this work, this idea of a liquid biopsy? It might not be quite as simple as going to the Lou and getting your liquid biopsy done. We have always diagnosed cancer by finding some kind of tumor growth or mass and then biopsying it and looking at it under a microscope and that is still the standard way to do it at this time. What we have found is that we can detect minute amounts of cancer cells that are circulating in the blood so people who have cancer have some cancer cells that can be found in the blood but they're very few so we've needed to develop the technology to isolate those few cells among the millions of cells that are within the bloodstream to try to determine whether there's cancer in the body or not. That's really what a liquid biopsy is. At the moment it's used mostly for people who have been diagnosed with cancer to try to follow their cancer while they're undergoing treatment and then after they finish treatment to see if there might be a relapse or early signs of relapse. I think that in the future we might be able to use liquid biopsies as we refine the technology for cancer detection even in the general population. We're not quite there yet though. We mentioned liquid biopsies but is this the primary method in the future for the detection or are there other ways besides liquid biopsies that you can see? Liquid biopsies have the advantage of sampling the blood or potentially the urine but most likely the blood and finding some cancer cells that you can do some studies on, genetic studies for example. It's not the way we diagnose most cancers now. Certainly now we diagnose them by physical examination and also by radiographic tests such as a CAT scan or an MRI scan and then followed by some kind of biopsy. Okay great. Now we're going to slightly move away from the liquid biopsy and we're going to automation in the medical arena. So on a couple of other occasions when I've had guests we've been talking about this topic about robot revolution and how automation is going to take over 70 to 90% of jobs fulfilled by people at the moment probably in about 10, 20 years down the line. So I always tell people the study of medicine is always safe because you always still need a human person. Even if you have the robotic surgeon known as Da Vinci or even if you have these elaborate technologies there is a level of judgment, a level of care, a level of compassion that is associated with being a physician that a robot cannot completely replace, that an algorithm cannot completely replace. So is that a fair thing to say that if somebody is a little bit confused about what they want to study or what career they want to pursue because they're frightened that a robot or an algorithm might take their place in 10 years? Healthcare is one of the safer options would it be fair to say? I think that's fair to say. I think my job is pretty safe right now. We do use a lot of technology and technology is coming into healthcare. Every year there's something new. We do use robots for surgery but the robots don't function by themselves. They function with a physician who's guiding the robot. And the advantage of a robot is that they're very steady and can sometimes do surgery in very close quarters and areas where it's difficult for the surgeon to actually manipulate tissues. So the robots are exceptionally helpful in that circumstance. We use a lot of technology also for outreach to rural areas for instance. We certainly have lots of rural areas here in Hawaii and also other remote areas where there may not be healthcare providers or a physician of particular expertise present. And we do that. We can use robots to do physical examination. We can use them for telecommuting. I think that on the other end of that robot is always a person. And so I think there's going to be a need for physicians and other healthcare providers as we move forward because you really need that. You need the judgment that comes from a human as opposed to just the robot. We do use a lot of technology though for trying to review medical records. For example, there's new technology such as IBM Watson that reads physician notes and tries to discern patterns from that. This is an algorithm, is that right? This is an algorithm that's used. And this can be very beneficial, but in the end it always comes back to a person to try to make the final determination about what should be done for a person. This is a little bit similar to what's being done with the legal profession as well because in law they said the algorithm just detects the casework looking for keywords and patterns and it doesn't get tired like a lawyer does and it doesn't stop. It's 24 out of 7 whereas a lawyer has to take breaks. And it's much faster. Yes, that's right. And it doesn't enjoy a drink or two like a lot of lawyers like to enjoy. So it will be faster. And one of the other elements is the 5G technology that's due to come out around 2020. That's when they're predicting. So we're in 4G world at the moment with the smartphones. But it's moving to 5G world where there's greater demand for data and what's going to be relevant in the medical field is that you would be able, one surgeon who is a specialist in a very tricky area can remotely help another surgical team in another country with a patient. Is that my understanding? I think there'll be those opportunities. 5G certainly allows for a much greater bandwidth for data streaming and could be utilized for surgery, for instance, so that someone could be stationed remotely while someone else is in an operating room at a different location. Also, the transmission of radiographic images is still rather difficult with 4G because of the amount of data that's included in each of those images. And with 5G, I think that should be much improved. And one of the other things about the relevance of the health care professions in the future is not only because there'll be one of the few percentage-wise jobs that a human is needed at, Michio Kaku said it's the garbage man also. You need garbage man and people like the people in the health care professions because a robot can only see in squares and circles. It cannot discern trash, for example. So you still need a human to point out what is the trash in the room because the robot does not understand that concept, at least currently the way they're making the robots. So it's the extremes, not necessarily just the professions but things that are very helpful and useful in society like the dustbin man. So I'm not sure that I took those two things right next to each other. But they're both very important. They're both very important. And I think certainly in health care, what's important is that you do need a human connection. So when people are sick, they need that sort of human connection to understand and process. The holding of the hand, especially in trauma. You should really process the whole situation. And especially for individuals with cancer, it's very important. So I think that we're not going to be outsourced to robots any time soon. I think we'll be needed. But technology does help us quite a bit. Yes. And also on the point about manual dexterity, surgeons have to have very great amounts of manual dexterities, as do most doctors, but particularly an ER physician. They have to sort something out very quickly and very delicately. It's very delicate work. So the comment always made in romantic novels and films is that doctors have very beautiful hands. Like in the killing of the sacred deer, there's the same director as the person who made the lobster. So it's a slightly strange film. It's a bit quirky. But it is about doctors. So the problem with the robots as they currently stand as the testing is done is that even to it's the grasping mechanism that's tricky to get a hold of. Because I did go to one robotic summit where I think it takes 800,000 grasps to pick something up, and it only has an 82% success rate on average. So what is very simple for a human to do, to replicate it in a robot or a machine, is quite complex. So on that level as well, it's a slightly more simplistic level, but you still need the manual dexterity of a human hand. I think for robots, they're very good in being directed by visual cues. So if someone is looking at a screen and seeing what's there, you can move the robot to the particular location and do things. What we haven't really perfected yet is the tactile sensation through a robot. So to understand what things actually feel like. So when you pick something up, you feel it. And that makes it much easier to pick it up. If you didn't feel it, you wouldn't be able to pick it up. And transmitting that tactile sensation through a robot is much more difficult. But people are working on that. So I think that in the future, that will get better as well so that the operator may be able to put their hands into a glove and actually somewhat feel what the robot is feeling. But we're not there yet. Yeah, I don't want to get too science fiction-y on you, but I think one of the ways you can overcome that problem is eventually when you combine man with machine and you create human clones. Because then you can replicate physicians, couldn't you? Presumably so, but I think that's too much Blade Runner, isn't it? I think we're a ways away from that. That's 2049, like in Blade Runner. So it's a little bit too abstract as a concept. So we'll get into a little bit more about the genomic items right after we take this quick break. So we'll be right back. Climbing all week for the day of the big game. Watching at home just doesn't feel the same. But on the list is who's going to drive. It's nice to know you're going to get home alive. Planning for fun and responsibility. Captain of our team is the DD. For every game day, assign a designated driver. Well, I'm Dave Stevens, host of the Cyber Underground. This is where we discuss everything that relates to computers that's going to scare you out of your mind. So come join us every week here on thinktecawaii.com, 1 PM on Friday afternoons. And then you can go see all our episodes on YouTube. Just look up the Cyber Underground on YouTube. All our shows will show up. And please follow us. We're always giving you current, relevant information to protect you. Keepin' you safe. Aloha. Aloha, and welcome back, everybody. So we're speaking with Dr. Randall Holcomb at the University of Hawaii's Cancer Center. And we're going to move into the realm of personalized medicine and personalized prevention. So one of the things that fascinates me, even though we just had this discussion before the break that the health care professions are lesser likely to be taken over by robotic or automation, robotic functions or automation, is that one of the things that are envisaged is that the smart home will have many, many features. So it's almost as if you don't have to leave the house to do anything, including having your annual checkup at the physician. Because there is this idea about having a sort of AI within the walls of your living room. And a holograph or a hologramic doctor come out that may or may not look like you, for example, if it's your patients or just a general doctor in a lab coat. And the house will actually analyze the health of the inhabitants of the house. So what do you think of that idea? Is that strange to you? Or is it something practical? Or what do you feel about, how do you feel as a physician about that? It lacks the personal touch, but it's interesting, don't you think? I think it has no personal touch, but I think we may be able to do many things remotely like that. I think that radiographic imaging, such as X-rays, CAT scans, ultrasounds, we may be able to perfect these things so that they can be done from home as opposed to going to a particular location to do that. I think that analysis of blood could potentially be done as well. People certainly check their glucose at home if they have diabetes all the time. And they put a little drop of blood into an analyzer. There's no reason that analyzer could not connect into a more robust testing system that could test for lots of things and could avoid a trip to the physician, for instance. So I think the smart home may bring a lot of things to home, but it won't bring that personal touch. And I think that many times that's fine for screening for people that are healthy, but may not be so good for people that are actually ill and need to see a physician. Would it make them feel a little bit better if the hologram looked like you, for example? I'm sure it would, of course. If it was their own doctor and it looked as opposed to a generic image of a doctor with gray hair or something. There's no reason that they couldn't have their own doctor projected. Or they can design it how they wish they could look. So the possibilities are limitless with that sort of thing. So the other thing is wearables. So it reduces the need to go actually physically see a physician because there are gadgets that are being created and already in the market that check your heart rate, your blood pressure, things of that nature that people just have on them all the time or is attached electronically to their smartphone. So what do you think of those ideas? Are they pretty handy, especially if somebody does have a serious medical condition? I think they're good for some conditions, certainly for testing and monitoring blood pressure, heart rate, heart rhythm. These are great because you can get a recording of what's going on over time that is really much better than just going to the physician and getting a single determination at one point in time. So I think the wearables are great for some things in my field in oncology, probably not so great because we have to monitor many other things. But some of the things that we do monitor and have people come into the office for all the time are things like blood counts after chemotherapy. There's no reason that that couldn't be done at home that people couldn't test it just like they do their blood sugar at home and send those results into the physician. And that would really dramatically change how we practice oncology today. Okay, so what's very trendy that everybody's seeing the commercials for is Ancestry.com, 23andme.com. It's this personalized genetic testing. And from the commercials and the information, the appeal of it, the marketing seems to be so you know where your ancestors came from geographically wise. They don't focus on the medical elements so much. But it does cover that as well.  They don't seem to touch upon the medical detection or the ability to detect any diseases within that person's DNA. So is that something that could lead to eventually being cancer free if the cancer can be detected early on and eradicated? So most of these tests are looking for genetic abnormalities that are inherited that might predispose someone to develop cancer. It doesn't mean they have cancer. And it doesn't mean that they are necessarily going to get cancer, but it might indicate that they have an increased risk of developing cancer. 23andme is approved for testing, I think, for 10 different genetically inherited diseases. Most of them are not really related to cancer. Most of them are very rare blood disorders that occur in an inherited fashion. There are many tests that we can do for looking for cancer risk, inherited mutations that may increase somebody's cancer risk. Most of those are not available through either ancestry.com or 23andme, but could be done by seeing a physician or genetic counselor if the family history warrants such testing. I think that we can identify many things that may predispose to the development of cancer, but cancer's really complex. And it doesn't occur just because of genetic predispositions. It occurs in the context of genetics as well as environmental exposures. So you need to know what is happening to people and what they're being exposed to and what they've been exposed to over time to understand if those genetic abnormalities may actually lead to the development of cancer or not. So I'm not sure that the testing is going to identify and eliminate cancer, but I think it will identify individuals who may be more at risk for certain environmental exposures. For instance, work that we're doing at the University of Hawaii Cancer Center looks at different genetics that may predispose people to development of cancer when exposed to cigarette smoke. And so this may give an indication to people that they shouldn't be smoking because they have a particular genetic predisposition to developing lung cancer. That sort of information I think we can now reasonably determine by very complex testing. And that complex testing may become more commonplace in the future. And have you done one of these test kits yourself? I have not. Oh, OK. I was wondering. I wanted to ask anybody or particularly a physician, if you did both tests, if you took a kit from Ancestry.com and you took a kit from 23andMe, if you get the exact same result. I'm very curious about that. It is unlikely. Because they use different methodologies? People have looked at that. Well, not only, and they use different algorithms. So they really try to determine what your ancestry is based on a collection of information that they have by having tested people in different areas of the world and looking at what the genetic profiles are and then using that information and comparing it to your genetic profile and seeing where the likelihood is that you got most of your genes from. The different companies use different algorithms. They have a different database. So you're going to get slightly different results. Actually, if you use the same company and you send the testing in twice, you may get different results as well. So it isn't that precise. It gives an indication of where some of your genes may have come from. But the actual percentage is pretty much an estimation. I see. OK. But it might be fine-tuned in five, 10 years time. Oh, I think it's going to get better and better. As more people do the testing, I think it's going to get better and better. The databases will get larger and it will become more precise. But right now, I think that you get an indication of where your ancestors may have come from. But knowing that it's 13% or 18%, that's probably not precise enough to really make that determination. So hopefully within five to 10 years time, it'll be more accurate. And the medical assessments will be more accurate from each person's DNA. And you're going to have longer living people because you're going to have eradication or prevention at a higher level. So people will live longer lives, is that correct? We hope so. We hope so. Now, the problem with that is that it's the care of the elderly. So unless we overcome, which some companies are trying to overcome, the fact that even if you're aging, they still, even at 70, you can have the body of a 30-year-old. So they're working on technology related to that. But let's assume you just become more decrepit but you live longer. So there's going to be a high amount of high population of very elderly people. So elder care is going to be another branch within the general group of health care professionals that are going to be needed. And there are companies working on robots that can care for the elderly because they did. I did go to another event where they were talking about this issue. And when they asked elderly people, they took a sample survey. I don't know how many people it was. But they did say, because it's such an intimate thing, this kind of elder care, that they would actually feel more comfortable if a robot was doing it. It is impersonal, but in this case, perhaps, that is preferred. I think the robots can help. I think that as people live longer, there certainly is a greater need from a societal level for care of the elderly. And particularly if we don't make the same kind of progress related to elderly dementia and Alzheimer's disease, which, of course, is a terrible problem for people as they age, they're going to need help. They both physically and mentally things decline with age. And I think robots can really help quite a bit, especially because we have such a mobile society so that the family is not always where the elderly person is. And it used to be everybody was in a single unit, and there were people there to care for you as you got older. That was the purpose of having children in the first place. That was one of them, Brad. And looking after the farm. That's why I had to have 12 of them. But nowadays, people are scattered. So I think that technology will help.  So it would be nice to know that, but I think that's not always the case. So there's always a robot to look after you in the future. A robot to help. Yes, a robot to help. And the Japanese are very advanced on this because they already deploy robotic nurses. So they're particularly advanced in this area. So one last thing is because you've only been in Hawaii a year and a half, we expect you to be here a very long time. So what are your impressions of Hawaii? I'm just curious because you haven't been here for very long. It's fabulous. It is, isn't it? We love it here. My wife and I have really enjoyed the culture here. It's a great place to live. The people are so welcoming. It's been a wonderful time here. And the work at the Cancer Center has been extremely rewarding. There's a tremendous amount of great research that's going on there. And I think that the faculty that we have at the Cancer Center are really contributing tremendously to advancing the science of cancer care. Yeah, it really is top notch. So that's why you have that NCI designation. That's exactly right. Thank you so much, Dr. Holcomb, for being here. It has been great to be here and talk to you about some of these things that are gonna happen in the future. It's been a lot of fun to think about. It's exciting. So we'll see everybody next Thursday at 11 a.m. for We Like the 1%, aloha.