October 16, 2024 • 30 mins
Our growing series exploring today’s disruptive technologies through the lens of ethics and faith continues! In this episode, Rev. Jo Owens, Pastor for Digital Ministry, and Dr. Sonia Coman, Director of Digital Engagement, sit down with innovator Sam Glassenberg, Founder & CEO of Level Ex, to discuss the transformative potential of video games and AI for medical training and life-saving advances in the medical field.
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(00:02):
What do we find
at the intersection of faithand the world?
Our new podcast,Crossroads, explores this question
and thought provoking conversationsfeaturing guests from around the world
who are seeking to livefaithfully in the public square.
This is a safe spaceto discuss politics, technology,
and our responsibilities as citizens.
(00:23):
Pull up a chair and meet usas we search for a better way forward.
Welcome to Crossroads, where we discussthe intersection of sacred and civic.
I'm your host, Jo Nygard Owens.
On today's episode, we're delighted towelcome Sam Glassenberg, founder
and CEO of Level Ex, the world's leadingmedical video game studio.
(00:44):
Welcome, Sam.Where are you joining us from?
Great to be here.
I'm calling in from Chicago,the center of the universe.
Fantastic.
And we also welcome back DoctorSonia Coman,
the Cathedral'sdirector of digital engagement.
Sonia's work at the Cathedral includesforging the trail of what it means
to have a digital Cathedraland make it a lived reality.
(01:07):
For those of you who join us from afar.
Welcome, Sonia.
And where you joining us from?
Hi, Jo.
Hi, Sam. I'm
joining from Washington, D.C., actuallyfrom my office here at the Cathedral.
Fantastic.
And I am in my home office in Cleveland,Ohio.
So, Sam,your career began in the video game
(01:28):
industry working for companieslike Lucas Arts, Microsoft and others.
And tell us about your movefrom the entertainment side of gaming
to the instructive sidewhen you founded Level Ex?
Look, I would love to say thatLevel Ex was some grand idea that I had,
but actually levelX was founded by accident.
(01:48):
Oh. So yeah,I've had this. I'm very lucky.
I've had this impactful careerin video games, which essentially made me
the disgrace of my family because I comefrom a long line of doctors.
From my grandfather on down.
To give you a senseof how bad this got, in 2006,
(02:08):
I accepted a technical Emmyon behalf of my team
at Microsoft for pushingthe cutting edge of video game graphics.
It's not a one they show on TV.
It's the technical Emmys,but it's the same stature.
It's a big. Deal.
You do, you know, I, I, I that's what I thought.
So I called my parentsto be like a big deal.
Like I'mmy dad is an anesthesiologist just here
at northwestern without skipping a beat.
(02:30):
He goes, Sam, that's very nice.
But in this family,we only recognize Nobel Prizes.
He goes, you're not yet 30 years old.
You can still go to medical school.
So this is the universethat I come from. Wow.
So I think it was about six years later.
So around 2012, he gives up.
He says, Sam,you're too old to go to medical school.
(02:51):
Put all this gaming nonsense to good use.
Make me a game to train my colleaguesto do a fiber optic intubation.
Tricky procedure.
We only do it on difficult patients.
Even experienced anesthesiologists
will struggle with itif they haven't done enough cases.
He goes.
Can you just make me a gamethey can play on their phones?
Now I'm busy running like the biggestindependent video game studio
(03:11):
in Hollywood.
We're making games for HungerGames and Mission Impossible.
Sure, dad, out of guilt,I sit down for three weekends.
I throw together this crappy little game,and I upload it to the App store.
I don't think about it again.
Two years later, he calls me.
Hey, Sam, how many people downloaded it?
(03:32):
I go, dad, I don't knowhow many of your friends downloaded
your fiber optic laryngoscope game,but I'll check for you.
And I lookedand we had rallied an audience of 100,000
doctors, nurses and airway specialistswho've been playing this thing.
Well, I had no idea.
So I Google itto try to figure out how this happened.
And I discover, unbeknownst to me,they've been doing
(03:54):
efficacy studies at medical schoolsall over the world.
That shows this like little gameI made for
my dad is drastically improvingphysician performance.
Oh my gosh.
You can't make this up.
So I have to say that, like Level Exwith some grand idea.
Nope.
It was all an accident.
A little bit of parental guilt.
And so that was the thing.
(04:14):
Like, what if it wasn't just me?
What if we took the top video gamedesigners, artists, engineers
who've worked on everything from,
I don't know, mortal combatto words With Friends, team
Em up with hundreds of physician advisorsand contributors across every major
therapeutic area in medicineto use video game technology and video
game design to accelerate the adoptioncurve in health care.
(04:38):
So did you get respect for the game?
So, Idon't know that my dad would admit it,
but he does love coming to the officeand driving all the game designers,
artists, engineers crazywith all of his ideas for games
to capturethe various challenges of anesthesiology.
I can picture that for sure.
(05:00):
So I only recently learnedthat the gaming industry eclipses
both the film and the music industries,like making three times
as much as the music industry,and almost four times as much as film.
And part of the beauty of the gamingindustry is its diversity,
both in how the game is playedand what its topics can be.
(05:21):
So how does the neuroscienceof play contribute to the industry,
and how can we utilize this mediumin ways that enhance our society
and not simply entertainnot that entertainment is bad.
I'm not knocking that look.
And of course, you know, during Covidthe games industry did a great job at like
keeping people entertained, connectedwith their friends at a safe distance.
(05:45):
Exactly. So where does neuroscience playinto all of this?
So like you said, the video gamesindustry is huge.
Now it's $200 billion in revenue a year.
We keep growing year over year.
New audiences, people play more and more.
There's like 3 billion people playinggames.
Everybody's playing. How do we do this?
Over the last 30 years,we have distilled the neurochemical recipe
(06:08):
for changing behavior and drivinglearning, basically among any audience.
Game designers have figured outhow do you hit the perfect balance
of reward and frustration of challengeand skill to maximize the release
of neurochemicals in the brainto maximize behavior change and learning?
When we think about behavior change.
(06:28):
So, you know, the Obama administrationspent eight years,
I think it was close to 2 to $3 billionto try to stem the obesity epidemic.
At what point
I think Michelle Obama took it onas her person
like as one of her personal missionsduring her second term.
It's like,
how do we get overweight Americans tojust get off the couch and go for a walk?
And then we saw within 48 hours,
(06:50):
all of these meritorious effortswere eclipsed by a single video game
that got tens of millions of Americans upand walking for miles.
Pokemon Go oh, right.
I don't know what the situation wasin downtown D.C.
downtown Chicago was a zombie apocalypsefor a month, and we don't have the
no kids in downtown, right?
The average players in their late 20s,everybody's playing this.
(07:14):
Now, you look at thatas this weird phenomenon,
but actually all videogames are doing that.
They're changing behavior.
The difference is what they're doing isinstead of
most video games aren't getting youto walk around strange neighborhoods,
but they're getting you to come backevery day, invite your friends, engage
with sponsored content, spend moneylike they're driving behavior
(07:37):
through complex,you know, systems of reward and whatnot.
And they're driving that behavior change.
And so you can utilize this same toolbox
to train doctors to educate, to drive
whatever sorts of societal improvementsthat we want to do at scale.
I mean, we're using this at Level Exto train doctors to do everything from
(08:00):
how to manage a ventilator, the puzzleof how to diagnose rare disease.
We do a lot of work using videogames, skin,
rendering technology to train doctorshow to recognize
skin disease on skin of color, patientsthat might not represent
the majority of patientsthat they see every day.
So there's just endless examplesabout how you can use this
(08:22):
toolbox to drive behavior change and drivelearning.
That's amazing.
Sam, what you're sharing with us is,first of all, extraordinary.
And I can think of two areasin which video games seem to be pushed
outside of what we considertheir traditional boundaries.
One is this integrationof the virtual environment
(08:45):
with the actual reality around us,and the other is more
generally this notion of gamificationin many fields.
You know, gamification has along the beenthus enriching method, right?
To facilitate better learning experiences.
For example, online training programs,you know, in health care,
but also across many other fields,including cybersecurity
(09:09):
and employee engagement,more often than not will gamify
the learning processto keep course seekers engaged,
to help them remember takeawaysfrom what they're learning.
And I read somewhereabout this notion of serious games,
you know, including in studieson technology for the medical field,
basically referring to games that are,as you were saying,
(09:30):
Jo, not for entertainment,but games that have a clear utility
in terms of sustainingattention, increasing capacity for memory.
And I think it's also being usedin healthcare for screening patients.
Right.
Sam, you're
mentioning a little bit about thisin terms of monitoring vitals or behaviors
while a patient is engaged in such a,you know, quote unquote serious game.
(09:53):
So, Sonya, I am curious.
Just this past Sunday on our worshipYouTube chat,
I was askedabout video tours of the Cathedral.
So we have a wonderful playlist on YouTubethat I shared, and folks
were very excited about that.
But as you're working on our digitalCathedral, it's more than a YouTube
playlist.
(10:14):
What are the plansfor our digital Cathedral?
And how can folkswho might never step foot in our building
be able to interact with it?
Oh, I'm so glad you asked that, Jo.
Well, we have
some very,very exciting plans in the works.
I think it touches onsomething that we've been discussing here
a little bit,which is this notion of having enriching,
(10:38):
truly immersive experiencesin a virtual reality.
And very soon,you know, stay tuned or listeners,
we will have a fully walkable
virtual tour, a 3D model of the Cathedral,
and we will soon publish a walkabletour of the nave of the crypt
(11:00):
of our new Virginia Center,and we hope that it can also serve
as a foundationfor VR experiences in this virtual space.
And similar to what Sam was describing,
it's just a way of empowering peopleto experience
something that maybe otherwisethey can't physically,
(11:21):
and also to learn while having funand being engaged.
These wonderful 3D modelsare made possible by our friends
at costar, who's leadership and very,very talented staff
have made this dream of the Cathedralcome true.
Well, I cannot wait,and I know that many of our folks
(11:43):
who lovethe Cathedral are so excited about this.
So one area where I is making leapsand bounds
for good is in the waysit's able to help those with disabilities.
So in your experiences, Sam and Sonya,what are some of the ways
we're already seeingthis assistive technology at work,
and what types of thingscan we expect to see in the near future?
(12:08):
I think from an AI perspective,we've been seeing actually
for a number of years, cochlear implants
and other tools that actually, includingsome of the newer vision implants
they literally like, they simulate humanneural networks using artificial ones.
I mean, these are some of the same neuralnetwork architectures behind ChatGPT
(12:28):
and others, right?
The way they create these justmassive arrays of artificial neurons,
and we use those to,
again, for, you know,to help the deaf hear and the blind see.
And so that's justsort of one of the more obvious examples.
But over time, you know, we're goingto continue to see ways that AI is going
to help people read and understand thingsand help people with vision issues
(12:50):
and motor issuesand in addition to, you know,
helping doctors in the operating roomtreat patients that have conditions
that can be addressed through surgicalor medical intervention.
Wonderful. Sonia, what have you seen?
Well, using AI and video games to help us
(13:10):
as a societyimprove medical care and truly support
the breakthroughs that can save livesand improve quality of life.
That is just incredible.
Jo, I'm thinking that on this podcast,especially in our previous episodes on AI
and ethics, some of our guests have notedthat I hold such tremendous potential.
(13:32):
You know,it can be used effectively for good, while
it also poses some serious concernsand even threats to our understanding
of ourselves, our jobs,you know, our privacy and so on.
And I think that whatSam mentioned, terms of his work
at Level Ex and this array of options,so that AI,
(13:54):
especially when combinedwith virtual reality,
when combined with video games, the waysthat this new technology can help people
with disabilities, peoplewho have serious medical concerns,
that's also inspiring,because it represents
a kind of an unequivocal exampleof using AI for good.
And I think that can be extendedalso to the realm of video games,
(14:17):
because this one, too, historicallyhas been seen in a very complex way.
Right.
It's a positive, as we said,extremely successful industry, but
it also comes with complex ethical issuesand all kinds of ramifications.
And it helps us see the upside.
It has a clearly beneficial purpose.
(14:38):
I'd love to return actually to thinking
about the social aspect of video games
and the social aspectof this kind of medical gamification.
You know,
I think that very often
when we think of people playingvideo games,
we have a little bitin the back of our mind
this picture of someone who's somehowdivorced from reality, right?
(14:59):
Someone who who's immersed
in that virtual context,perhaps alienated from their friends
in real lives and say,what are some of your experiences?
Some of your projects?
I'm curious in terms of gamificationand virtual reality.
So specifically with regardto connecting people.
(15:21):
One of the things that we've been doing,again, we're constantly
bringing over the latest technologiesfrom games and finding ways
that they can solve problemsin health care.
And so, for example,we've actually built cloud gaming systems.
One of the things
that gaming is exceedingly goodat is allowing people to play together.
During Covid,that's was one of the primary ways
that people can actually find activitiesto do together
(15:43):
without being in the same room. Yeah.
And so we've been utilizingthose technologies to create environments
where doctors can collaborateand play medical video games.
So a doctor in London can train remotely,
a trauma surgeon in Kiev by doing surgery
(16:03):
together on a virtual patientsimulated in the cloud or, you know,
solving a complexdiagnostic puzzle collaboratively.
And so we're utilizing the combinationof game technologies and neuroscience
based game mechanics to help accelerate
this adoption and enable doctorsfrom around the world to be able to train
(16:25):
without having to be in the same location,but train in virtual patients.
That's amazing.
That's amazing. That's extraordinary.
We're having a lot of fun.
I've heard of waysthat whether it's a headset
or something that reads the eyes,there are ways for folks who's bodies
may not work as well to still be ableto take on jobs and to write
(16:50):
and to do all sorts of thingsthat might not have been possible before.
One of the miracles ofAI is their ability now
to literally allow peoplewith locked in syndrome to communicate.
So essentially what you're able to dois, you know, one of the things
that AI is very good at is interpretingthe output of neural networks.
(17:12):
So they're able to, you know, essentiallyput probes in people's brains
and then interpret that using AI systemsin order to allow people who otherwise
can't really move muscles effectivelyto outwardly communicate and interact.
And I mean, play games as one example,but communicate interact with the
with a broader world.
So I think that, you know,
AI is really just sort ofhas this incredibly malleable ability,
(17:35):
especially when combined with,you know, robotics and other tools
to fill a lot of the,you know, when humans have,
you know, the inabilityto do certain things or their senses
or their ability to move or communicate,our limited AI and these tech
combined with these other technologiescan come in and fulfill great human needs.
I'm thinking of the history
(17:57):
of this, a recent history,thinking of that moment in 2021
when Facebook announcedthat it would change its name to meta.
I think thatin the news and for the general public,
it was this, sign that the tech communityis embracing the metaverse.
(18:18):
But then that shift, that was really quitea dramatic win.
Towards the end of 2023, all we could hearabout was that the metaverse.
But I once ChatGPT came into focus.
I think the important thingwith any technology,
and we were startedtalking about this earlier.
When you talk about games or AI,any of these things can be, you know,
(18:41):
they're just technologies.
They can be used for good,they can be used for evil,
they can be used to benefitsociety or not.
Okay. What can we do?How do we guide that?
And I think the most importantfactor is who's using it.
And that's the important thing.
So when people who was theyindex high on the fulfillment scale.
(19:02):
Right.
The folks who you knowcould otherwise be doing anything
but instead are working in health careor are working in entertainment,
working in something where they wantto have a fulfilling purpose in life.
You want those to be the peoplethat are jumping on these technologies,
because the bad actors automatically are.
And what worries me is
when the good actors look at technologieslike AI and they go, oh no, here's the,
(19:23):
you know, dystopian future,and there's a utopian future.
And they go, oh, here's the possibledystopian future I shouldn't touch.
It means it's going to arcin the wrong direction, right?
You need the good people.
You need the altruistic people
to be the onesthat are jumping on this technology.
And I think that's actually where thegames industry provides an excellent model
for how to embrace tools like generativeAI in the video games industry.
(19:47):
Every five years,we need to deliver an order of magnitude
more content at an order of magnitudegreater detail as the game
platforms get better and better,but the games price stays the same.
It's still $60.
So you're not going to be able to hire
10,000 people to recreatethe City of New York for your next game.
So every five years, the video gamesindustry reinvents how it makes things.
(20:11):
New generations of tools are constantlycoming out to make every artist
in the industry an order of magnitudemore productive every five years.
And so games look at generativeAI as the sort of welcome toolbox growing.
Now, I don't have to dothe thing I was doing before.
I can move up the stack, and I think it's
that healthy approachthat every industry should be taking.
(20:33):
When they look at generative AI.
Not like,oh, what does it mean for my job?
But how can I use this
so my job can be more fulfillingand I can have more impact.
Right?
I was at a churchand AI conference recently,
and one of the most interesting questionsraised was,
you know, when social media hit, big time,
(20:54):
churches were the ones who were like,oh no, no, no, we can't be doing this.
And we lost a voice.
And so how do we get ahead?
Just like what you were saying?
And as the folks on the positive sideand get our voices out there
and utilize the technology in waysthat can build up rather than break down.
(21:14):
A friend of mine compared the
advent of AI to the Industrial revolution.
You know,
I think that we very often hearAI compared to the advent of the internet.
And for sure there is a paradigm shiftwith the advent of the internet.
But I think that probably the comparisonto the Industrial revolution
(21:35):
is even more apt,because, as both of you were saying,
it has such a wide ranging implicationsfor people's understanding
of who they are, for their jobs,for how they function in society.
And it doesn't have to bean existential threat to right.
It can be a tool boxthat will actually enhance
what people do and make dreams possible,
(21:58):
like the ones that we were discussingin the medical field.
Sam, we have loved hearing about the workthat you've been doing.
Can you tell us what future projectsyou have coming up?
Sure.
We have all sorts of interestingprojects underway.
We just launcheda video game on the SpaceX
Polaris Dawn mission to train astronauts.
(22:19):
How to, do proceduresunder ultrasound in zero gravity.
So we are busy in every therapeutic areain medicine.
Capturing the challenges
of medical practice using video gametech and video game design.
When I think about evenjust things like ultrasound
and I think aboutwhy NASA funded that work.
(22:41):
So we were funded by the Mars missionbecause if you are nine
months into the Mars mission, it can be
40 minutes for the speed of lightto make a round trip.
You're in a resourceconstrained environment
where you don't havethere's no CT scanner or there's no X-ray.
The only tool you have to see insidethe body is ultrasound.
(23:04):
And the nearest professional is,you know, billions of miles away.
This is very similar to resourceconstrained environments here on Earth.
My wife was recently on the PolishUkrainian
border taking care of refugeesstreaming across.
And she's a primary care pediatrician.
She was having pregnantpatients come across the border.
She remembered enough ultrasound to beable to, you know, get a fetal heartbeat.
(23:28):
But she was like, look,if I had better ultrasound training,
you know, just in time,I could deliver better care.
And so throughout the world,we see just as one example
of one technology, ultrasound,which is very difficult to interpret.
But if you can train the human brain
to recognize it, an expert stenographer,you know, looks at ultrasound.
You and I look at it, we just see noise.
(23:48):
She looks at it and she goes, oh, yeah,I see that.
That's fluid, that's air, that's bone.
If you can help a novice become an expertin interpreting ultrasound,
then with $1,000 devicethat plugs into your phone,
anyone in sub-Saharan Africa,a nurse, a midwife in in India
can now see inside the body,diagnose and treat
all sorts of conditionsbecause again, it's resource constrained.
(24:10):
And so I look at these technologies,even technologies
that are literally buildingfor the space program have the ability
to improve quality of carefor a billion people here on Earth. Wow.
Even within the United States,in the southeast,
Alabama, Mississippi,there's a dearth of ObGyn.
And women are not gettingthe care that they need, and they're dying
(24:32):
in greater numbers
in the US than any other developed nationbecause they don't have this care.
In rural environments.
They're you're far from an academicmedical center.
People have limited training.
There's limited resources.
How do you empower and train those people?
In order to be able to providethe best quality of care and video
games can do that. Amazing.
(24:52):
We got SpaceX, we got Ukraine,
we got resource constrained environmentsin sub-Saharan Africa.
I think we touched on almost every singletype of use of video games, and I.
Know those.
And that even close.
Oh my goodness. Well, it's.
It's very inspiring. It's really. Amazing.
(25:12):
It is in this intersection of artificialintelligence, medicine and gaming.
What gives you hopeboth for the near future,
but then also what dreamsmight be realized with greater time?
I think we're at an incrediblythrilling intersection
where a huge set of society's
(25:33):
long standingproblems are going to be solved.
And I think if you look in the shortterm, let's just talk about games
and medicine.
For decades, we've had this challenge
where new devices, new techniques,new treatments
are invented or become available.
But it can be years.
(25:53):
It can be decades until those technologiesand those treatments
become the standard of care, right, thatthe average patient has access to them.
And the reason for that is notbecause doctors are Luddites.
It's not because they're backwards.
It's because historically,the tools and technologies available
to them to learnhave basically been read a document,
(26:17):
maybe watch a video and then practiceon live human beings for a surgeon.
You know, when you get a new device,the first hundred patients
you do that procedure on,the outcomes aren't going to be as good.
You don't want to haveto make that sacrifice.
And so now we have technologythat can be applied to the problem.
And so doctorscan train on virtual patients,
(26:39):
and they can sit down for an hourand train on eight years of rare,
unforeseen, rare complicationsto prepare themselves and help themselves
develop a mental model
for really how to think about this deviceguideline or technique.
I think what that doesbroadly is accelerate the adoption
curve in health care,
which is exciting for everyone,especially those with limited access.
(27:03):
And thinking
of patient empowermentthrough tools like AI.
We are very often thinking of technologyas leaving some people behind,
especially thosewho are not as digitally literate.
But I think that applied correctly,these tools can actually empower
all of us.
I've seen this in hospitals,in clinics, various
(27:25):
AI tools that will provide summariesfor patients.
Some of them are clickable summaries.
They can not only remember
what their doctor recommended,but they can also have a reliable source
to understand the vocabularyof what was presented to them.
And that's such a simple toolthat is really very, very simple
(27:45):
when it comes towhat they can do these days.
And yet it can really playsuch an important role.
You know, in terms of making surethat people understand
that what they should do,what their condition is,
and empowering their familiesand their friends, right,
who are often around them as chaperonsand trying to make sense
of what's happening in sometimes momentsthat are very emotionally intense.
(28:10):
And to what Sam was describingbefore, in terms of simulations,
of course, the benefits are incredible.
I am thinking of my own researchin generative AI,
and this notion of hyper realitywith AI and with video games,
especially. Sam, you were saying that
the newest generationsare always constantly improving.
(28:34):
You know, the realitythat is presented in this virtual realms
is sometimes even more accurate, more highdefinition, more filled with details
then the realitythat we observe around us.
And that has also really interesting
ethical and estheticand cognitive implications.
(28:55):
But applied to medical training,for example,
that sense of an enhancedunderstanding of reality
can help doctors become betterat what they do without that element
of potential sacrifice, without thatelement of initial loss of quality.
All of these are incredible advancements,and it truly gives me hope
(29:17):
to think of visionarieswho can take this very complex,
the realm of AI and gamificationand give it a simple purpose,
one that is clearly orientedtowards the benefit of those around us.
Thank you both for those visions of whatthe future might look like.
I can't waitand I know that it will change our world.
(29:39):
Thank you both so much for your timetoday, Sam.
It was such a pleasure to have you on
and to learn about the amazing workthat you're doing with Level Ex.
Great to be here.
And Sonia, as always, it's wonderfulto have you on the podcast
and sharing all the work that you doat the Cathedral and beyond.
Thank you both.
Thank you, Sam, for joining us.
(30:02):
You won't want to miss our next episodewhen I'll be sitting down with former U.S.
Treasurer Rosie Rios, along withgetting to know this extraordinary woman.
We'll talk about her workas chair of America 250,
the United States Congressional Commissionplanning the 250th
anniversary of the signingof the Declaration of Independence.
(30:24):
Thanks for listening to Crossroads.
And until next time.
Peace be with you.
If the digital offerings of the Cathedralenrich your daily life,
please consider becoming a supporter todayby making a gift
at Cathedral.org/inspire
What do we find
at the intersection of faithand the world?
Our new podcast,Crossroads, explores this question
and thought provoking conversationsfeaturing guests from around the world
who are seeking to livefaithfully in the public square.
This is a safe spaceto discuss politics, technology,
and our responsibilities as citizens.
(00:23):
Pull up a chair and meet usas we search for a better way forward.
Welcome to Crossroads, where we discussthe intersection of sacred and civic.
I'm your host, Jo Nygard Owens.
On today's episode, we're delighted towelcome Sam Glassenberg, founder
and CEO of Level Ex, the world's leadingmedical video game studio.
(00:44):
Welcome, Sam.Where are you joining us from?
Great to be here.
I'm calling in from Chicago,the center of the universe.
Fantastic.
And we also welcome back DoctorSonia Coman,
the Cathedral'sdirector of digital engagement.
Sonia's work at the Cathedral includesforging the trail of what it means
to have a digital Cathedraland make it a lived reality.
(01:07):
For those of you who join us from afar.
Welcome, Sonia.
And where you joining us from?
Hi, Jo.
Hi, Sam. I'm
joining from Washington, D.C., actuallyfrom my office here at the Cathedral.
Fantastic.
And I am in my home office in Cleveland,Ohio.
So, Sam,your career began in the video game
(01:28):
industry working for companieslike Lucas Arts, Microsoft and others.
And tell us about your movefrom the entertainment side of gaming
to the instructive sidewhen you founded Level Ex?
Look, I would love to say thatLevel Ex was some grand idea that I had,
but actually levelX was founded by accident.
(01:48):
Oh. So yeah,I've had this. I'm very lucky.
I've had this impactful careerin video games, which essentially made me
the disgrace of my family because I comefrom a long line of doctors.
From my grandfather on down.
To give you a senseof how bad this got, in 2006,
(02:08):
I accepted a technical Emmyon behalf of my team
at Microsoft for pushingthe cutting edge of video game graphics.
It's not a one they show on TV.
It's the technical Emmys,but it's the same stature.
It's a big. Deal.
You do, you know, I, I, I that's what I thought.
So I called my parentsto be like a big deal.
Like I'mmy dad is an anesthesiologist just here
at northwestern without skipping a beat.
(02:30):
He goes, Sam, that's very nice.
But in this family,we only recognize Nobel Prizes.
He goes, you're not yet 30 years old.
You can still go to medical school.
So this is the universethat I come from. Wow.
So I think it was about six years later.
So around 2012, he gives up.
He says, Sam,you're too old to go to medical school.
(02:51):
Put all this gaming nonsense to good use.
Make me a game to train my colleaguesto do a fiber optic intubation.
Tricky procedure.
We only do it on difficult patients.
Even experienced anesthesiologists
will struggle with itif they haven't done enough cases.
He goes.
Can you just make me a gamethey can play on their phones?
Now I'm busy running like the biggestindependent video game studio
(03:11):
in Hollywood.
We're making games for HungerGames and Mission Impossible.
Sure, dad, out of guilt,I sit down for three weekends.
I throw together this crappy little game,and I upload it to the App store.
I don't think about it again.
Two years later, he calls me.
Hey, Sam, how many people downloaded it?
(03:32):
I go, dad, I don't knowhow many of your friends downloaded
your fiber optic laryngoscope game,but I'll check for you.
And I lookedand we had rallied an audience of 100,000
doctors, nurses and airway specialistswho've been playing this thing.
Well, I had no idea.
So I Google itto try to figure out how this happened.
And I discover, unbeknownst to me,they've been doing
(03:54):
efficacy studies at medical schoolsall over the world.
That shows this like little gameI made for
my dad is drastically improvingphysician performance.
Oh my gosh.
You can't make this up.
So I have to say that, like Level Exwith some grand idea.
Nope.
It was all an accident.
A little bit of parental guilt.
And so that was the thing.
(04:14):
Like, what if it wasn't just me?
What if we took the top video gamedesigners, artists, engineers
who've worked on everything from,
I don't know, mortal combatto words With Friends, team
Em up with hundreds of physician advisorsand contributors across every major
therapeutic area in medicineto use video game technology and video
game design to accelerate the adoptioncurve in health care.
(04:38):
So did you get respect for the game?
So, Idon't know that my dad would admit it,
but he does love coming to the officeand driving all the game designers,
artists, engineers crazywith all of his ideas for games
to capturethe various challenges of anesthesiology.
I can picture that for sure.
(05:00):
So I only recently learnedthat the gaming industry eclipses
both the film and the music industries,like making three times
as much as the music industry,and almost four times as much as film.
And part of the beauty of the gamingindustry is its diversity,
both in how the game is playedand what its topics can be.
(05:21):
So how does the neuroscienceof play contribute to the industry,
and how can we utilize this mediumin ways that enhance our society
and not simply entertainnot that entertainment is bad.
I'm not knocking that look.
And of course, you know, during Covidthe games industry did a great job at like
keeping people entertained, connectedwith their friends at a safe distance.
(05:45):
Exactly. So where does neuroscience playinto all of this?
So like you said, the video gamesindustry is huge.
Now it's $200 billion in revenue a year.
We keep growing year over year.
New audiences, people play more and more.
There's like 3 billion people playinggames.
Everybody's playing. How do we do this?
Over the last 30 years,we have distilled the neurochemical recipe
(06:08):
for changing behavior and drivinglearning, basically among any audience.
Game designers have figured outhow do you hit the perfect balance
of reward and frustration of challengeand skill to maximize the release
of neurochemicals in the brainto maximize behavior change and learning?
When we think about behavior change.
(06:28):
So, you know, the Obama administrationspent eight years,
I think it was close to 2 to $3 billionto try to stem the obesity epidemic.
At what point
I think Michelle Obama took it onas her person
like as one of her personal missionsduring her second term.
It's like,
how do we get overweight Americans tojust get off the couch and go for a walk?
And then we saw within 48 hours,
(06:50):
all of these meritorious effortswere eclipsed by a single video game
that got tens of millions of Americans upand walking for miles.
Pokemon Go oh, right.
I don't know what the situation wasin downtown D.C.
downtown Chicago was a zombie apocalypsefor a month, and we don't have the
no kids in downtown, right?
The average players in their late 20s,everybody's playing this.
(07:14):
Now, you look at thatas this weird phenomenon,
but actually all videogames are doing that.
They're changing behavior.
The difference is what they're doing isinstead of
most video games aren't getting youto walk around strange neighborhoods,
but they're getting you to come backevery day, invite your friends, engage
with sponsored content, spend moneylike they're driving behavior
(07:37):
through complex,you know, systems of reward and whatnot.
And they're driving that behavior change.
And so you can utilize this same toolbox
to train doctors to educate, to drive
whatever sorts of societal improvementsthat we want to do at scale.
I mean, we're using this at Level Exto train doctors to do everything from
(08:00):
how to manage a ventilator, the puzzleof how to diagnose rare disease.
We do a lot of work using videogames, skin,
rendering technology to train doctorshow to recognize
skin disease on skin of color, patientsthat might not represent
the majority of patientsthat they see every day.
So there's just endless examplesabout how you can use this
(08:22):
toolbox to drive behavior change and drivelearning.
That's amazing.
Sam, what you're sharing with us is,first of all, extraordinary.
And I can think of two areasin which video games seem to be pushed
outside of what we considertheir traditional boundaries.
One is this integrationof the virtual environment
(08:45):
with the actual reality around us,and the other is more
generally this notion of gamificationin many fields.
You know, gamification has along the beenthus enriching method, right?
To facilitate better learning experiences.
For example, online training programs,you know, in health care,
but also across many other fields,including cybersecurity
(09:09):
and employee engagement,more often than not will gamify
the learning processto keep course seekers engaged,
to help them remember takeawaysfrom what they're learning.
And I read somewhereabout this notion of serious games,
you know, including in studieson technology for the medical field,
basically referring to games that are,as you were saying,
(09:30):
Jo, not for entertainment,but games that have a clear utility
in terms of sustainingattention, increasing capacity for memory.
And I think it's also being usedin healthcare for screening patients.
Right.
Sam, you're
mentioning a little bit about thisin terms of monitoring vitals or behaviors
while a patient is engaged in such a,you know, quote unquote serious game.
(09:53):
So, Sonya, I am curious.
Just this past Sunday on our worshipYouTube chat,
I was askedabout video tours of the Cathedral.
So we have a wonderful playlist on YouTubethat I shared, and folks
were very excited about that.
But as you're working on our digitalCathedral, it's more than a YouTube
playlist.
(10:14):
What are the plansfor our digital Cathedral?
And how can folkswho might never step foot in our building
be able to interact with it?
Oh, I'm so glad you asked that, Jo.
Well, we have
some very,very exciting plans in the works.
I think it touches onsomething that we've been discussing here
a little bit,which is this notion of having enriching,
(10:38):
truly immersive experiencesin a virtual reality.
And very soon,you know, stay tuned or listeners,
we will have a fully walkable
virtual tour, a 3D model of the Cathedral,
and we will soon publish a walkabletour of the nave of the crypt
(11:00):
of our new Virginia Center,and we hope that it can also serve
as a foundationfor VR experiences in this virtual space.
And similar to what Sam was describing,
it's just a way of empowering peopleto experience
something that maybe otherwisethey can't physically,
(11:21):
and also to learn while having funand being engaged.
These wonderful 3D modelsare made possible by our friends
at costar, who's leadership and very,very talented staff
have made this dream of the Cathedralcome true.
Well, I cannot wait,and I know that many of our folks
(11:43):
who lovethe Cathedral are so excited about this.
So one area where I is making leapsand bounds
for good is in the waysit's able to help those with disabilities.
So in your experiences, Sam and Sonya,what are some of the ways
we're already seeingthis assistive technology at work,
and what types of thingscan we expect to see in the near future?
(12:08):
I think from an AI perspective,we've been seeing actually
for a number of years, cochlear implants
and other tools that actually, includingsome of the newer vision implants
they literally like, they simulate humanneural networks using artificial ones.
I mean, these are some of the same neuralnetwork architectures behind ChatGPT
(12:28):
and others, right?
The way they create these justmassive arrays of artificial neurons,
and we use those to,
again, for, you know,to help the deaf hear and the blind see.
And so that's justsort of one of the more obvious examples.
But over time, you know, we're goingto continue to see ways that AI is going
to help people read and understand thingsand help people with vision issues
(12:50):
and motor issuesand in addition to, you know,
helping doctors in the operating roomtreat patients that have conditions
that can be addressed through surgicalor medical intervention.
Wonderful. Sonia, what have you seen?
Well, using AI and video games to help us
(13:10):
as a societyimprove medical care and truly support
the breakthroughs that can save livesand improve quality of life.
That is just incredible.
Jo, I'm thinking that on this podcast,especially in our previous episodes on AI
and ethics, some of our guests have notedthat I hold such tremendous potential.
(13:32):
You know,it can be used effectively for good, while
it also poses some serious concernsand even threats to our understanding
of ourselves, our jobs,you know, our privacy and so on.
And I think that whatSam mentioned, terms of his work
at Level Ex and this array of options,so that AI,
(13:54):
especially when combinedwith virtual reality,
when combined with video games, the waysthat this new technology can help people
with disabilities, peoplewho have serious medical concerns,
that's also inspiring,because it represents
a kind of an unequivocal exampleof using AI for good.
And I think that can be extendedalso to the realm of video games,
(14:17):
because this one, too, historicallyhas been seen in a very complex way.
Right.
It's a positive, as we said,extremely successful industry, but
it also comes with complex ethical issuesand all kinds of ramifications.
And it helps us see the upside.
It has a clearly beneficial purpose.
(14:38):
I'd love to return actually to thinking
about the social aspect of video games
and the social aspectof this kind of medical gamification.
You know,
I think that very often
when we think of people playingvideo games,
we have a little bitin the back of our mind
this picture of someone who's somehowdivorced from reality, right?
(14:59):
Someone who who's immersed
in that virtual context,perhaps alienated from their friends
in real lives and say,what are some of your experiences?
Some of your projects?
I'm curious in terms of gamificationand virtual reality.
So specifically with regardto connecting people.
(15:21):
One of the things that we've been doing,again, we're constantly
bringing over the latest technologiesfrom games and finding ways
that they can solve problemsin health care.
And so, for example,we've actually built cloud gaming systems.
One of the things
that gaming is exceedingly goodat is allowing people to play together.
During Covid,that's was one of the primary ways
that people can actually find activitiesto do together
(15:43):
without being in the same room. Yeah.
And so we've been utilizingthose technologies to create environments
where doctors can collaborateand play medical video games.
So a doctor in London can train remotely,
a trauma surgeon in Kiev by doing surgery
(16:03):
together on a virtual patientsimulated in the cloud or, you know,
solving a complexdiagnostic puzzle collaboratively.
And so we're utilizing the combinationof game technologies and neuroscience
based game mechanics to help accelerate
this adoption and enable doctorsfrom around the world to be able to train
(16:25):
without having to be in the same location,but train in virtual patients.
That's amazing.
That's amazing. That's extraordinary.
We're having a lot of fun.
I've heard of waysthat whether it's a headset
or something that reads the eyes,there are ways for folks who's bodies
may not work as well to still be ableto take on jobs and to write
(16:50):
and to do all sorts of thingsthat might not have been possible before.
One of the miracles ofAI is their ability now
to literally allow peoplewith locked in syndrome to communicate.
So essentially what you're able to dois, you know, one of the things
that AI is very good at is interpretingthe output of neural networks.
(17:12):
So they're able to, you know, essentiallyput probes in people's brains
and then interpret that using AI systemsin order to allow people who otherwise
can't really move muscles effectivelyto outwardly communicate and interact.
And I mean, play games as one example,but communicate interact with the
with a broader world.
So I think that, you know,
AI is really just sort ofhas this incredibly malleable ability,
(17:35):
especially when combined with,you know, robotics and other tools
to fill a lot of the,you know, when humans have,
you know, the inabilityto do certain things or their senses
or their ability to move or communicate,our limited AI and these tech
combined with these other technologiescan come in and fulfill great human needs.
I'm thinking of the history
(17:57):
of this, a recent history,thinking of that moment in 2021
when Facebook announcedthat it would change its name to meta.
I think thatin the news and for the general public,
it was this, sign that the tech communityis embracing the metaverse.
(18:18):
But then that shift, that was really quitea dramatic win.
Towards the end of 2023, all we could hearabout was that the metaverse.
But I once ChatGPT came into focus.
I think the important thingwith any technology,
and we were startedtalking about this earlier.
When you talk about games or AI,any of these things can be, you know,
(18:41):
they're just technologies.
They can be used for good,they can be used for evil,
they can be used to benefitsociety or not.
Okay. What can we do?How do we guide that?
And I think the most importantfactor is who's using it.
And that's the important thing.
So when people who was theyindex high on the fulfillment scale.
(19:02):
Right.
The folks who you knowcould otherwise be doing anything
but instead are working in health careor are working in entertainment,
working in something where they wantto have a fulfilling purpose in life.
You want those to be the peoplethat are jumping on these technologies,
because the bad actors automatically are.
And what worries me is
when the good actors look at technologieslike AI and they go, oh no, here's the,
(19:23):
you know, dystopian future,and there's a utopian future.
And they go, oh, here's the possibledystopian future I shouldn't touch.
It means it's going to arcin the wrong direction, right?
You need the good people.
You need the altruistic people
to be the onesthat are jumping on this technology.
And I think that's actually where thegames industry provides an excellent model
for how to embrace tools like generativeAI in the video games industry.
(19:47):
Every five years,we need to deliver an order of magnitude
more content at an order of magnitudegreater detail as the game
platforms get better and better,but the games price stays the same.
It's still $60.
So you're not going to be able to hire
10,000 people to recreatethe City of New York for your next game.
So every five years, the video gamesindustry reinvents how it makes things.
(20:11):
New generations of tools are constantlycoming out to make every artist
in the industry an order of magnitudemore productive every five years.
And so games look at generativeAI as the sort of welcome toolbox growing.
Now, I don't have to dothe thing I was doing before.
I can move up the stack, and I think it's
that healthy approachthat every industry should be taking.
(20:33):
When they look at generative AI.
Not like,oh, what does it mean for my job?
But how can I use this
so my job can be more fulfillingand I can have more impact.
Right?
I was at a churchand AI conference recently,
and one of the most interesting questionsraised was,
you know, when social media hit, big time,
(20:54):
churches were the ones who were like,oh no, no, no, we can't be doing this.
And we lost a voice.
And so how do we get ahead?
Just like what you were saying?
And as the folks on the positive sideand get our voices out there
and utilize the technology in waysthat can build up rather than break down.
(21:14):
A friend of mine compared the
advent of AI to the Industrial revolution.
You know,
I think that we very often hearAI compared to the advent of the internet.
And for sure there is a paradigm shiftwith the advent of the internet.
But I think that probably the comparisonto the Industrial revolution
(21:35):
is even more apt,because, as both of you were saying,
it has such a wide ranging implicationsfor people's understanding
of who they are, for their jobs,for how they function in society.
And it doesn't have to bean existential threat to right.
It can be a tool boxthat will actually enhance
what people do and make dreams possible,
(21:58):
like the ones that we were discussingin the medical field.
Sam, we have loved hearing about the workthat you've been doing.
Can you tell us what future projectsyou have coming up?
Sure.
We have all sorts of interestingprojects underway.
We just launcheda video game on the SpaceX
Polaris Dawn mission to train astronauts.
(22:19):
How to, do proceduresunder ultrasound in zero gravity.
So we are busy in every therapeutic areain medicine.
Capturing the challenges
of medical practice using video gametech and video game design.
When I think about evenjust things like ultrasound
and I think aboutwhy NASA funded that work.
(22:41):
So we were funded by the Mars missionbecause if you are nine
months into the Mars mission, it can be
40 minutes for the speed of lightto make a round trip.
You're in a resourceconstrained environment
where you don't havethere's no CT scanner or there's no X-ray.
The only tool you have to see insidethe body is ultrasound.
(23:04):
And the nearest professional is,you know, billions of miles away.
This is very similar to resourceconstrained environments here on Earth.
My wife was recently on the PolishUkrainian
border taking care of refugeesstreaming across.
And she's a primary care pediatrician.
She was having pregnantpatients come across the border.
She remembered enough ultrasound to beable to, you know, get a fetal heartbeat.
(23:28):
But she was like, look,if I had better ultrasound training,
you know, just in time,I could deliver better care.
And so throughout the world,we see just as one example
of one technology, ultrasound,which is very difficult to interpret.
But if you can train the human brain
to recognize it, an expert stenographer,you know, looks at ultrasound.
You and I look at it, we just see noise.
(23:48):
She looks at it and she goes, oh, yeah,I see that.
That's fluid, that's air, that's bone.
If you can help a novice become an expertin interpreting ultrasound,
then with $1,000 devicethat plugs into your phone,
anyone in sub-Saharan Africa,a nurse, a midwife in in India
can now see inside the body,diagnose and treat
all sorts of conditionsbecause again, it's resource constrained.
(24:10):
And so I look at these technologies,even technologies
that are literally buildingfor the space program have the ability
to improve quality of carefor a billion people here on Earth. Wow.
Even within the United States,in the southeast,
Alabama, Mississippi,there's a dearth of ObGyn.
And women are not gettingthe care that they need, and they're dying
(24:32):
in greater numbers
in the US than any other developed nationbecause they don't have this care.
In rural environments.
They're you're far from an academicmedical center.
People have limited training.
There's limited resources.
How do you empower and train those people?
In order to be able to providethe best quality of care and video
games can do that. Amazing.
(24:52):
We got SpaceX, we got Ukraine,
we got resource constrained environmentsin sub-Saharan Africa.
I think we touched on almost every singletype of use of video games, and I.
Know those.
And that even close.
Oh my goodness. Well, it's.
It's very inspiring. It's really. Amazing.
(25:12):
It is in this intersection of artificialintelligence, medicine and gaming.
What gives you hopeboth for the near future,
but then also what dreamsmight be realized with greater time?
I think we're at an incrediblythrilling intersection
where a huge set of society's
(25:33):
long standingproblems are going to be solved.
And I think if you look in the shortterm, let's just talk about games
and medicine.
For decades, we've had this challenge
where new devices, new techniques,new treatments
are invented or become available.
But it can be years.
(25:53):
It can be decades until those technologiesand those treatments
become the standard of care, right, thatthe average patient has access to them.
And the reason for that is notbecause doctors are Luddites.
It's not because they're backwards.
It's because historically,the tools and technologies available
to them to learnhave basically been read a document,
(26:17):
maybe watch a video and then practiceon live human beings for a surgeon.
You know, when you get a new device,the first hundred patients
you do that procedure on,the outcomes aren't going to be as good.
You don't want to haveto make that sacrifice.
And so now we have technologythat can be applied to the problem.
And so doctorscan train on virtual patients,
(26:39):
and they can sit down for an hourand train on eight years of rare,
unforeseen, rare complicationsto prepare themselves and help themselves
develop a mental model
for really how to think about this deviceguideline or technique.
I think what that doesbroadly is accelerate the adoption
curve in health care,
which is exciting for everyone,especially those with limited access.
(27:03):
And thinking
of patient empowermentthrough tools like AI.
We are very often thinking of technologyas leaving some people behind,
especially thosewho are not as digitally literate.
But I think that applied correctly,these tools can actually empower
all of us.
I've seen this in hospitals,in clinics, various
(27:25):
AI tools that will provide summariesfor patients.
Some of them are clickable summaries.
They can not only remember
what their doctor recommended,but they can also have a reliable source
to understand the vocabularyof what was presented to them.
And that's such a simple toolthat is really very, very simple
(27:45):
when it comes towhat they can do these days.
And yet it can really playsuch an important role.
You know, in terms of making surethat people understand
that what they should do,what their condition is,
and empowering their familiesand their friends, right,
who are often around them as chaperonsand trying to make sense
of what's happening in sometimes momentsthat are very emotionally intense.
(28:10):
And to what Sam was describingbefore, in terms of simulations,
of course, the benefits are incredible.
I am thinking of my own researchin generative AI,
and this notion of hyper realitywith AI and with video games,
especially. Sam, you were saying that
the newest generationsare always constantly improving.
(28:34):
You know, the realitythat is presented in this virtual realms
is sometimes even more accurate, more highdefinition, more filled with details
then the realitythat we observe around us.
And that has also really interesting
ethical and estheticand cognitive implications.
(28:55):
But applied to medical training,for example,
that sense of an enhancedunderstanding of reality
can help doctors become betterat what they do without that element
of potential sacrifice, without thatelement of initial loss of quality.
All of these are incredible advancements,and it truly gives me hope
(29:17):
to think of visionarieswho can take this very complex,
the realm of AI and gamificationand give it a simple purpose,
one that is clearly orientedtowards the benefit of those around us.
Thank you both for those visions of whatthe future might look like.
I can't waitand I know that it will change our world.
(29:39):
Thank you both so much for your timetoday, Sam.
It was such a pleasure to have you on
and to learn about the amazing workthat you're doing with Level Ex.
Great to be here.
And Sonia, as always, it's wonderfulto have you on the podcast
and sharing all the work that you doat the Cathedral and beyond.
Thank you both.
Thank you, Sam, for joining us.
(30:02):
You won't want to miss our next episodewhen I'll be sitting down with former U.S.
Treasurer Rosie Rios, along withgetting to know this extraordinary woman.
We'll talk about her workas chair of America 250,
the United States Congressional Commissionplanning the 250th
anniversary of the signingof the Declaration of Independence.
(30:24):
Thanks for listening to Crossroads.
And until next time.
Peace be with you.
If the digital offerings of the Cathedralenrich your daily life,
please consider becoming a supporter todayby making a gift
at Cathedral.org/inspire
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