 We have this ancient drive to forage for information and technology has sort of shifted the balance that we now just switch so rapidly that it fragments our attention. If you look at perceptual abilities, decision-making, memory, emotional regulation, all of these capacities are diminished when they're fragmented. Teachers don't even know if you ask them about their classrooms who has the best working memory, who has the best sustained attention, who has the best emotional regulation, who has the best compassion. They don't know the and sustainability questions, they know the reading and math performance and that is that is a tragedy in my mind. We can use this closed-loop experience to improve abilities of the mind to a level that we could not achieve with any molecule because we don't have the targeting or the personalization. This is our AI vision, as I always say, AI for HI, artificial intelligence for human intelligence, that's where I think these types of algorithms should go. How many of you have seen a talk featuring Adam Gazzelli? Have many of you have read the book The Distractive Mind? How many of you have seen some talks or read the book? Okay, cool, okay, half of you, great. So for those that don't know, Adam Gazzelli is a world-renowned neuroscientist, author, speaker, the man behind Neuroscape, behind Akili, behind Jazz Partners, behind Sensing so much, there's so many things that Adam's doing, but it's all in the field of neuroscience and technology and enhancing human intelligence and human well-being. So without further ado, let's jump into the conversation with Adam. Thank you, everyone. Thanks, Sal. Thank you. Thank you for joining us. I'm really excited, Adam. I'm impressed with so many people on a Friday night who come out to talk about this, so thanks for being here. I appreciate that. And how many of you have been to First Fridays, Adam's gatherings? Yeah, that's cool. Yeah, okay. So Adam also hosts these gatherings at his place on the first Friday of every month for 100, almost 100 of them now? Yeah, 10 years, 92. 92 of them, so 10 years of these gatherings, and it's just a melting pot of multidisciplinary minds, which is awesome because then that's how really strong connections and ideas and execution happens in many ways, and I love that. And it's a big inspiration for me that you do that. So Adam, how long now has it been that you've been studying the brain? Has it been over two decades? Yeah, so I started, I guess, in 1990. Yeah, you're approaching third one. Yeah, third one, yeah. Wow. That's a long time to be studying the brain. This is an incredible, I don't know how we process the stimuli and how we live and how we evolve to get to this point. It's a beautiful, beautiful thing that we've gotten here. Tell us about the evolution of the mind to start because, however, this beautiful thing manifested its way up through four billion years of evolution up as this pinnacle on Earth is just gorgeous. And now we're building civilization and artificial intelligence is so much more. Sure. Okay, let's start at the beginning. We have a whole night in front of us. Well, you know, what one of my interests when, you know, speaking about neuroscience and writing about it, which I do in this book a bit, is to take a step back and think about why we have brains at all. Because when you view it from an evolutionary perspective, I think you get some really fresh insights on why we have challenges in our daily lives, which we all do in our own ways, and especially related to technology. I think that's a really important and timely topic. So, you know, if you think about the brain before there was a brain, we had this need as single celled organisms, so all the way back in our evolutionary past to survive, right? And our survival was dictated essentially by two features, two elements of how we interacted with our environment, how we could sense our environment, and how we could respond to that sensation. So, we did that in order to get nutrients and in order to avoid threats. And when I say we are speaking about organisms that didn't even have a brain, just single cell, so that basically sensing chemicals that they need to survive or they need to avoid, and then they move in response to that. That cycle of sensing and moving really set up for the entire evolutionary future in front of it, which was eventually multi-cellular organisms and eventually the brain, our ability to sense our environment and respond to it. In many ways, that's pretty much what our brain does, almost completely, is that as we evolved, sensation, which is a very sort of rudimentary ability to detect the world around you, became more complicated and became what we call perception. Perception is an interpretation of how we sense the world, basically defines our entire reality. But we don't just sense the world, we then respond to it. We call that action, where our behaviors come in. This cycle, the perception action cycle is part of every creature's brain, including our own. It is even anatomically localized, where you perceive from the middle of your brain back, from your sensory area, your visual cortex, your auditory cortex, and then your motor cortex and forward is the motion, the output, the action. So this cycle of responding to your environment by sensing it and then moving is really the core of how our brains work and always has worked. It's a good perspective because we haven't abandoned those aspects of our brains. It's a matter of fact, it's still largely how we interact with our world is by sensing and responding to it, often very reflexively. Now, lower order animals, and if you look in our past, basically we received information and then without any ado, we responded to it. These reflexive cycles are what allowed us to survive. I would say the most important and unique part of the human brain and brain evolution is that we've created a pause between sensing and responding. And in that pause, which exists to more or less success, as we'll talk about, there's the ability to judge and to make decisions and then to have goals that you carry out. And you can even resist a very strong reflexive response and decide not to have that sort of innate reaction that you're programmed to have, but have a different response. And other animals do not do that very much at all. If you look across some of our closest relatives and dolphins and other animals, you see that behavior, but it's still much... I don't have the pause. They have minimal pause. Some animals, you do see inserting a little bit of that, but it's very minimal. Most of their behaviors are really dictated in very reflexive responses to their environment. And Adam, are we running simulations of the potentials? Well, a lot of what the human brain does is really live a little bit in the future. We have this predictive machinery that allows us to so fluidly interact in the world. A lot of that makes us even less flexible in how we react than we might think that we are doing. But in either case, this ability to pause, even if it's momentary, to reappraise the information that you're getting, to then interpret it and then respond with a goal is what makes us so amazing. It's what allowed us humans to build the cultures and societies that we've created to have language and art and music and all of the technology that surrounds us. All of this is potential because we've basically unshackled the chains that make most creature slaves to their environment and don't allow them to break free in the way that we have. So with that has come the glory of being human and all the things that we've created and our real deep sense of consciousness and identity. But there's also been a lot of burden with that very unique human burden with the stresses and the depression and many of the challenges that go with those thinking processes that live in that pause. So that's like sort of my perspective on evolution. And when you think about it from that way, and then you take a look at what's going on around us in many, many different respects, not the least of which is modern day technology. It really helps give shed a light on why we are so challenged by modern tech. This is why I love Adam because he can go through this elaborate way of explaining the truth of how all creatures sense. And then we have now evolved a deeper sort of perception enabling us to pause putting us up cooperate language technology now etc with civilizations evolving. I love the way that you can go through that span of evolution with us. Now you you've taught me through the book and through your talks about the idea of foraging. I love this idea of foraging it, you know, thousands of years ago, food foraging food forging even even more 10s of 1000 years ago. And now it's information foraging information foraging. But now it's a fire hose that's just everything is just how do you turn it off and etc. This is a lot of what we see as a problem today. This is what you write in your piece about the cognition crisis and kind of what's going on with it. So walk us through kind of the foraging now in the Okay, this is yet another complex discussion, but it works better with slides. It's there are some figures in in the book that I could refer for you to but I'll give just just a basic overview. Sort of when I when I wrote this book The Distracted Mind and the subtitles ancient brains in a high tech world, I became very intrigued with it. I just didn't want to write another self help book. I'm not like a self help guru at all. You know, I'm figuring out like everyone else. But I you know, I wanted to not just like list things that make sense, but didn't have any foundation or any backing. And you know, there's just not a lot of data on some of the approaches, the practical approaches that you can do to deal with a distracted mind. And so I wanted to have a framework in order to give that advice, not just for other people, but for even myself, trying to manage it all. And so one of the things that I was struck with when I was thinking about this, and I wrote a lot of this book in other countries when I was traveling, giving talks and something about being on the road and in, you know, foreign locations that could sort of free your mind from your regular thinking process. And one thing that I sort of had a game with with myself with thinking about what parts of our brain are most ancient, and that are still part of our lives, whether we recognize them or not. And then how does those aspects of our brains that are preserved, how are they uniquely challenged by the modern world? That was sort of my my thinking process that I never really read about. But I sort of went through as an exercise. So I'll talk about foraging for a moment, but one one aspect that just connects with what I just told you about evolution is this aspect of being stimulated by the environment and making decisions reflexively on that. In my field in cognitive science, we call that bottom up information. It's how the environment imposes itself upon you making decisions, right? If there was a flash of light, a loud sound, your name also will do it. You will pay attention independent of your goals. You'll be pulled to it bottom up reflexively. You know, we still, we still have these, right? Bottom up stimuli that drive a response without our goals, right? We're full of them. We couldn't walk without them. We were it's still embedded in us in many ways. Much so a safety mechanism. Of course, I mean, if it was what enabled us to survive, is that you smell a predator, and you flee, right? These are just reflexes that lead to survival. We're still we still have them. If we didn't, we'd be in a lot of trouble. But what we have in addition to bottom up is top down, which is this ability that I said to have goals. We're in a constant sort of struggle. I mean, a more positive way of thinking about is an integration between bottom up and top down. We do it constantly. We're constantly dealing with the environment sort of imposing itself upon us and demanding us to do certain things, and then us making decisions either for or against it. And so this is another ancient part of our brains that exists. This in the book I wrote about one one thing that just blew me away. Because I lived through it. Probably a lot of you are watching the news when we had the giant tsunami that killed like 300,000 people. Very few animals died in that tsunami. It's really fascinating. Whoa, most all of the animals ran into the hills. Well, most of the humans ran onto the beach. This is like a top down bottom up issue, right? Because when the ocean recedes like that, that's like a very clear sign, at least it was to every animal and bird and elephant in the in these in these countries that this is really bad and we should run away. But humans because of our top down curiosity, thought maybe we should explore and it was a bad idea, right? And it's an example of what the human brain has done. That I said is like sort of an asset and a burden. And so before, you know, so I'll tell you about the forging thing. But I do want to impress upon you to start paying attention to these two competing aspects of your attention, your goal directed attention and the environment driven attention and watch how many decisions you make that may not be based on your goals that may not even be in your best interests. The technology story is very much about this. As we know our tech technology companies and I'm not saying that there's any malice here, but they certainly have figured out ways to use bottom up stimuli very effectively, you know, the buzzes, the flashes of lights, the the the vibrations. These are really strong bottom up stimuli that you respond to. And part of what I think is going on is this thing more rapid sort of activation by bottom up information that maybe makes us even less top down and just makes us more responsive to stimuli. So that's one aspect of the ancient brain. But despite the fact that you may know this, right, even hearing this, we still do this. And we especially children, they seek out information in, you know, a hungry way. I feel it in myself, right? You could, if you're in a quiet moment, maybe that quiet moment is just like 10 seconds at a red light. You're like, you know, what's going on here, right? You're trying to seek out information. And so I was really fascinated with this phenomena that everyone knows about. And in my readings, I found data showing that other primates like monkeys when you do experiments, looking at the reward system that shows that primates in particular are driven for information rewards using in very much the same systems that drove other animals to seek food and juice rewards. Even though it's not like critical for survival, information alone triggers the same ancient reward mechanisms. And so from that perspective, you could think of us, you know, and then you add the variability to the rewards and it gets even more. And also those rewards could, you know, have very extrinsic factors that drive them. They can be very frequent. But we seek out information in much the same ways, from my perspective, that other animals seek out food. And so from that, if you think about it that way, and I think the data suggests that that is a reasonable hypothesis, then I became interested in if we can explain human behavior by looking at animal behavior when it comes to animals foraging food. Fortunately, there's a very sophisticated school of thought related to this mathematically worked out called optimal foraging theories. There are many of them, animals forage and interact with their food in very different ways. So there's very complex mathematical relations related to predators and prey. There's also some really beautiful theories, one called the marginal value theorem, which describes animals that forage for food in what's known as patchy environments. Many animals do this, take a squirrel, right? A squirrel in a tree, if you've ever heard my talk site, sometimes give this example. A squirrel in a tree is foraging for food. And at some point, that squirrel will make a decision, a subconscious decision, to leave that tree and go to another tree. And mathematically, you could describe, and this has been well described and shown to very accurately predict behavior of animals, both in laboratory and the wild. What are the factors that leads an animal to leave a patch and go to another patch? And it's really related to two sides of this axis. One are the benefits of remaining in that patch, which is how many nuts are in that tree. Now the benefits have a diminishing return. As they eat them, it's getting less and less and less. The other side of the curve is the cost of getting to the next tree. If that next tree is a mile away, that squirrel will finish those nuts in that tree. If that tree is closer, they'll make the decision to leave earlier. So it's sort of a cost-benefit ratio. The idea that I had is that... And our trees are all right next to each other. Exactly. Well, that's what's changed. So we forge for information, like other animals forge for food. So if you think about it, our information is in patches as well. That patch might be your phone or a website. There's a density of it with sparse areas in between. So we make decisions about when you leave that website, when you leave that conversation. Those are our information patches. And I'd say we have the same subconscious decisions of other animals. The benefits of remaining there versus the opportunity or the cost to get to the next information patch. So if you think about our behaviors of forging information in that way, we're driven by those same elements. The idea that I sort of propose in this book is that technology has really put pressure on both sides of that. One side is incredibly obvious. So the accessibility, as you were just saying, Alan, to the next patch has become so small. That next patch might be that link in an article that you just have to touch on. It might be that other tab in a browser that's already open. It might be that other screen that you have. There is just so much accessibility information. It is so easy to get to that other information patch. The other part, which is a little more complicated, is on the benefit side of remaining in a patch. So one of the ideas that the literature supports is that we humans have become a lot less rewarded by remaining in a certain place, in a certain information patch. And there are really two influences on this. One is anxiety. And the other is boredom. We have a very, very low tolerance to boredom. The data would show that it's getting lower and lower. So boredom accumulates, so that's sort of like the squirrel, the nuts are disappearing for us. We're also using up that information, but we also have accumulating boredom and we also have anxiety driven by the fear of missing out, FOMO of what's going on in the next patch, as well as performance anxiety, productivity anxiety, how many things could I be doing at the same time. So that's the basic idea in a nutshell, is that like squirrels, we are being driven to switch by the subconscious signals related to our benefits of remaining and the cost of getting to the next one. And what technology has done through both influencing, both the cost and the benefits, is to drive rapid switching. And if you watch especially children use technology, it's not subtle. The data suggests switching every 30 seconds or more, thousands of check-ins on texting and social media, sometimes even in a day. And so that's the idea in a nutshell, that we have this ancient drive to forage for information and technology has sort of shifted the balance that we now just switch so rapidly that it fragments our attention. In that time that we have that pause to see that, oh, I'm on a bus or I'm doing something with time to pause. If we don't grab our phone and go to information forage, that can lead to a lot of the beautiful default mode network to the creativity. To see the world in new and interesting ways, we can take deeper breaths. We can find new ways of the thing that we want to build into the world. Whatever that top down, again, I want to get to that, that top down goal that you've set to build something into the world, that pause can give you the time to think about that goal and think about it in new ways and go and help yourself creatively execute that into the world. It's so important. So I love how you illustrate the bottom up versus top down processing and how top down is just so crucial. I think we see this all the time with ourselves is that we set ourselves, we try and have high conscientiousness. We set a goal and we want to achieve it and we do the steps that are needed to get it done and then there's distractions and distractions along the way and our tendency to go for those distractions, those short-term rewards versus the long-term ones, we just gain so much more actualization from the long-term. And this is becoming more complex now with the attention economy. You started referencing a little bit. You said no malice but a lot of people think there is lots of malice because the eyeballs are the dollars. And let's talk a bit about the way that the goals are being able to be set from top down and the importance of that because that's like huge on execution and people living healthy is finding these goals with their mental health balance and then also how that relates especially to the attention economy and how we're able to take control of our use of tech. Yeah so there's a lot that I'll try to unpack a little bit of it. So this idea of the foraging model, driving our behaviors is sort of why we do it. Even when we know we don't want to do it, we still feel the pull to do it. That's like really a hypothesis what I described to you. There's actually some papers that are starting to come back. Some have been inspired by this idea in the book to put data to that but it was really just a framework to think about if these are the factors that are stressing us in this manner this gives us a clue of what we could start reversing in our lives and how we could be more strategic about our interaction with technology so that we're healthier. Right because I love technology. I think many of us do. I don't think we're putting that genie back in the bottle. For me it's about being in control of the technology. So to sort of answer your question, if that's the reason why we do it, what are the consequences of it? And the consequences are dramatic and they pretty much act on every aspect of both our cognition and our behaviors. So most of my research up until I guess around 10 years ago when I started doing the work that we'll talk about a little bit using technology in a positive way was studying distraction and multitasking in the laboratory. So we have dozens of papers of participants that were in MRI scanners or EEG. So I'm a cognitive neuroscientist or was now sort of considering myself more of a translational neuroscientist. My PhD was actually in molecular neuroscience. So I'm on my third stage of my neuroscience life. But as a cognitive neuroscience we would study what are the neural mechanisms that lead to the negative impact of being distracted or multitasking. That's what the majority of the work that I did when I started my professorship at UCSF 12 years ago. And what we find is that when you are exposed to relevant information that pulls you away because of its strong bottom up salience, or you engage in more than one task, the neural networks that we engage to accomplish something at a high level essentially are broken and need to be reengaged. So we are now really, you know, convinced by so many converging research studies that we do not parallel process multiple top-down goals at the same time. It's just not how our brains work. I think, you know, clearly we wish they would. And we sometimes believe that we could make them. But for the most part these attention-directing networks, the top-down networks engage and then they need to switch when you redirect your attention to something else. So when you start fragmenting your attention because you're switching those patches rapidly, what's happening there is that you are just losing fidelity of the information that was being retained. And what we always, you know, the term that we'll use in our papers is that you suffer a cost, a switch cost with each one of these. And that cost is often represented as a slow slowing down of your abilities or a loss of accuracy. So what we see when we do our research is that if you look at perceptual abilities, decision making, memory, emotional regulation, all of these capacities are diminished in terms of the level that they could reach when they're fragmented. And then that cascades to deleterious effects on all of our behaviors. That behavior might be your work performance. If you're a child, it might be your school or your study. It might be your safety on the road driving. It might be the quality of your relationships, the compassion and empathy that you're able to deliver and share. All of these things are really, you know, suspect to and have the consequences of a breakdown in cognition. So that's I just say is it safe to say this, that as we're firing in a direction of top down processing on a task, then we switch, we activate a different part of our neural architecture. And it takes, you know, you're taking the, the electrical processing that's going on in that portion of the brain and transitioning it over to another area of potentially of the brain. Yeah, it's part of the cost of switching as well as all the gold that you were trying to achieve. Yeah. So the brain really works as a network system. So areas of the brain don't really work as islands. They work as networks. Brain areas have different functions depending upon the context that other brain areas are. We see this with neuro imaging. So if you have a network in the brain that's activated to accomplish a goal, which is how the brain works, we literally see those networks switch. They, they break down and they have to be rebuilt. And it, there's a time cost to do that. That time might be 150 milliseconds, right? Just a little bit over a tenth of a second. I'm not, it's not a long time, but it's time. And that time could add up depending on how many switches there are. And when you're doing something that demands precision, that, that cost can become quite, you know, quite real. Yeah. Okay. Now, you said something else a little bit ago. I thought it was really interesting, but I want to, I want to move to how this relates to the attention economics. And today, and then I want to get to how you're, what you're doing a solutions for this. So tell us a bit about your thoughts on, it's basically a big land grab that's going on in the attention economy. Who can get the, the most eyeballs for the longest periods of time. And these are young kids want to be influencers. This is good, you know, this is now bigger than it's ever been with these computers in our pockets. Yeah. So this is not really my area of expertise or research, but there is obviously a conflict in many ways between how the economics of our tech world, especially in places like social media, but other areas of e-commerce work in terms of demanding your attention in order to make their money. And so your attention becomes part of the transaction that leads to advertising dollars that allows all these sources to feel like they're free, but they're not really free. You're paying through your attention. And so that's really the gist of the issue that, you know, many people are, you know, paying a lot of attention to on how we can rework our technology so that the demands on your attention are not what actually leads to their business success. So that's the conflict is that what they want is your attention. Our attention is already fragmented, and it's very limited as we've been talking about. So in some ways, it's one of your most valuable things that you own, more valuable than the money in your pockets. And so instead of asking for your money, which you might pay, you know, your $20 a month to have social network access, maybe it would be worth it for you to have your attention under your own control. So we have enough challenge controlling our attention, even when we want to, when very smart organizations are figuring out how to move your attention for their own economic returns, it gets a lot more complicated. So that's essentially, if you hear these terms about attention economy, that's really what's being discussed is that the model itself is designed in such a way that it inflames this problem that I think would be there anyway, just because of the accessibility of technology. But because decisions are being made to move your attention in certain places for other motives, it complicates it a lot. So some of us, you know, like, I think the people in this field, there's a lot of fields here and a lot of eyeballs on it, I would say, and we were talking, I was talking about someone, because the money is on it. Yeah, I would say we're allies in this. My, my view is that we're not, I don't want to burn this village down. I think technology has done an amazing amount of things. And I'm a big fan, but we've made a lot of mistakes. I, to me, it does, I don't want to belabor whether or not those mistakes were intentional or just unwise. I feel like we need to assess where we're at. We need a better, more informed understanding of how the brain works. When we create new technologies, we could do a lot to fix our current system, and we should be doing a lot better going forward. So that's generally my views. And this is what you are doing right now, going forward. So let's, let's talk, because actually you listed these, these myths, you list some of the mental health issues as well as you started exploring some of them, of when we get too much into the habit of the ding, ding, ding, ding, ding, all of a sudden we're driving and texting and we're dying. And then the little, the kids don't have time to, you know, there's so many things that are going on with the mental health suicide rates. There's a lot of things that are going on with the mental health issues. Maybe we could pause enough for one second before moving on to the solutions, just because you mentioned the name Cognition Crisis and we didn't really talk about it all. I don't want to spend a ton of time on it, but you did mention it was in the title. And it's not the title of this book. This book is already old to me because, you know, by the time you write a book and then it comes out, it's like old news to me. I'm happy by the ideas in here, but they're great ideas. I'm happy with what we did, but I like, I don't know if I'm writing any more books. I like writing things, getting them out there while they feel fresh. So I wrote a piece early this year called The Cognition Crisis that I published on medium. The exchanges were much more timely. It was a better general experience for me. If you read that piece, it's not that long, 18 minutes according to medium. It's it's it's my more recent thoughts on this topic and just the very quick, you know, two minute summary is it sort of extends this idea that we already just talked about to what's impossible to ignore, especially when you travel around the world as I have been is like the world sort of looks very homogeneous in some ways. Like the problems that parents face and the challenges that children have are really the same everywhere. You know, I give probably on average 70 talks a year around the world and that's because I'm invited to speak about the same topic in all of these countries which to me is heartening because it makes the world feel a lot more connected than it seems if you read the news. The world feels like we're the same people. We have the same struggles and the cognition crisis was my response to that of saying that we're not doing a great job our species in terms of evolving our minds that we, you know, all the things that we've just talked about the challenges that we face we are sitting, you know, with half a billion people suffering debilitating effects of depression and anxiety and attention deficits and memory problems and they are getting worse. We see suicide rates increasing in children especially here but we see these trends around the world and we have two systems not even talking about the tech world now. Talking about our education system and our medical system our mental health system these should be the institutions that were created to help us have healthier minds. They're not doing their jobs so I actually put a lot more negative attention to those industries rather than the tech industry. I feel that our education system has largely focused still from its foundations in the industrial revolution to transfer information content maybe now in some more evolved schools skill development but not really building the underlying information processing systems of the brain cognition, attention teachers don't even know if you ask them about their classrooms who has the best working memory who has the best sustained attention who has the best emotional regulation who has the best compassion they don't know the answers to any of these questions they know the reading and math performance and that is a tragedy in my mind. So we're not assessing it and developing it in children and then on the mental health side when you do decide that a child has an attention problem not because you assessed it just because you know the bug in the shit out of you they go to a doctor you're like oh you have an attention problem then you give them a molecule that has a very blunt effect on their brain often depresses aspects of their personality and you send them back in the classroom and so on both sides of it from the education side and the medical side we've been using the same exact tools for hundreds of years certainly on the medical side you know 60 years of depending on small molecules to fix complex phenomena related to emotional regulation and attention and memory and they have tons of side effects that poorly targeted that not personalized and we still rely on them almost completely so that's my little spiel there it's related to this topic but I do think that the onus is not just on the tech world we talk about a lot especially here great point but the education the medical system are old they're inflexible this idea that technology would somehow be positively disruptive to them has not happened putting a book on an iPad is not disruptive technology that's like obvious use of the evolution of media we could do more and I hope we will that's really important yeah, yeah, I love it I love it good clap I'm so happy that you highlighted education and healthcare as these parts of kind of a three you could say as a tripod of the importance to this matter at hand and as you were illustrating I was thinking like whoa, what if teachers actually knew like yeah, so Sarah has the best working memory Johnny has the best emotional regulation I was just thinking like who's best at looking at the other kids in the eyes and feeling what they're feeling in motion I'd be so cool if we were and this is what a lot of what is going on so you were listing anxiety, depression, PTSD, ADHD even Alzheimer's, Parkinson's so Adam has Neuroscape an amazing lab here at UCSF in San Francisco and you're building out amazing ways to tackle some of these challenges and that's also going to with Achilles yeah, teach us about this because it's amazing I way prefer talking about this topic than the one we just finished talking about I'm an optimist if any of you know me I love thinking about a positive future how we could use technology in a really healthy way it's what I spend 95% of my life doing I think it's important to put in the context of what we just discussed of why it's so needed right now on a global level but what's more fun for me to discuss and to talk about is how do we fix this where do we go forward from here and so I have a lot of entities that I'm involved in they all do the same thing whether it's a venture fund or companies or my center at UCSF it's all how do we invent create new technologies to help us better understand the human brain in a more real world manner and to improve its function across a whole host of domains that we've been talking about and so this was not where I started so back in 1990 when I was a grad student in Manhattan I was an MD PhD student so as a medical professional I'm a neurologist the patients I saw the most were people with Alzheimer's disease as a scientist I'm a neuroscientist and I always had been as many of us in my field studying how the brain works that's what most neuroscientists do 10 years ago I just I got frustrated with that it's not why I did an MD PhD in the first place I wanna actually help people and I don't wanna help people in some abstract way that's something I discover when I'm 20 is used when like I'm 80 I wanna do it like while I'm alive and healthy and can see those things and be a part of it the translation yeah the translation of neuroscience into real world benefits and the only way we've really done that as neuroscientists mostly there's small other exceptions is through molecules that is like the vast giant ocean liner that we've created to help fix the brain is to give molecules small molecules we call them pharmaceuticals we call them drugs chemicals all the same thing LSD we put them in that's the whole of the story we get back to we put them in our mouths they go to our brains in general they have very non-selective effects and in my world of attention as I described in memory and aging they don't work very well at all the drugs that we used to treat Alzheimer's disease don't help some people at all so other people they help modestly we know the challenges with attention deficits and children as well and so I was thinking do we have another approach and I became inspired by two things first a literature I'm backing up this 2008 10 years ago because it doesn't make sense if I just jump to what we're doing today I was inspired by two things first there was a literature coming out at the time that video games consumer video games like Call of Duty the most controversial of all video games first person shooter games if you study them in young people that play them what you find is that their cognitive control abilities their attention their distraction resistance their working memory their task switching is so off the charts compared to children kids in their school that don't play these games sometimes you can't even use the same tests it's really fascinating and I was like huh that's interesting right because there's something there and these games were not designed for this so I was like cool quickly because I used to play this shit out of those games and a lot of my friends you know the halos the call of duties etc there's so much nuance that we typically forget about there's an array let's say of a dozen maps and then you study every single square foot of these maps the locations the spawn locations you study the different weaponry that you can use and the different attachments and there's of course that when someone's trying to bother you from while you're playing with your teammates you're focused on the game because your team's relying on you you have to make call outs you're talking and interacting with the team it's some fascinating things resource management there's so many cool things some of the aspects of games that were that at least a lot of the early researchers and I didn't do this research we're really latched onto the rapid switching that occurs and the need for very focused attention but also keeping broad attention at the same time so there were elements that were hypothesized as active ingredients and why this occurred at all I was also interested I started getting interested you know where we live and all not just video games but meditation and really ancient practices that lots of data was being generated that help our brain function and so you know the idea behind this is like one of the most foundational neuroscience discoveries of our time is that the brain is plastic that it will respond and modify itself in response to experience so I think that you know meditation and therapy and even education as experiential treatments they change the brain because they engage it in a certain experience and then if that engagement is repetitive and rewarded the brain changes I might not change in a good way it doesn't have any morality any directionality it just changes in response to the experience that experience could be so bad that it could detrimentally impact the function of your brain for the rest of your life one experience we call that post-traumatic stress disorder one event not a chemical not shrapnel seeing something can impact your brain function forever because of this plasticity phenomena so we know it's powerful that's not in question no neuroscientist questions that the idea is how do we create experiences that maximally harness the brain in a positive direction to try to improve these abilities that are not being helped in my mind by our current education system or our medical system and so with those two pieces I came up with the idea of building a video game a video game that was an experience of course all video games are an experience it is an experiential treatment whether you want it to be or not but the video games have this really interesting advantage over things like traditional meditation or therapy or music training or classroom education in that they can be designed in a way that's reproducibly delivered so you go to a meditation class and depending on the context or your teacher in particular you may or may not have the right experience and that has led to a lot of problems for these amazing practices in terms of their accessibility to people that might not have that access to that teacher also it's very hard to perform randomized control trials when what you're delivering is not consistently delivered and those fields as impressive as they are have suffered for it suffered to the degree that you don't see meditation being prescribed like you see Adderall or even physical exercise and so to put this together the ability of our software to create a closed loop system this is like the most common word I use nowadays because everything that I do is related to closed loop so a closed loop means that you could create a piece of software that records your performance ideally your physiology would know you in a deeper way than anything possibly could looking at your emotional responses your facial expressions your heart rate, your brain activity use that data to create a perfectly tailored experience to challenge you appropriately in just the perfect way and to reward you in such a manner that you're deeply engaged that plasticity changes your brain and improves your performance that was the idea and so with that foundation which is still the foundation of everything I do we created a video game with friends of mine at LucasArts called NeuroRacer my friend Matt Omernick who is a Chief Creative Officer at Lucas and that game went on we did numerous research studies on it we published our results in the journal Nature in 2013 which is as good as it gets for a scientist who was on the cover of the journal and what we showed there is that we could take a group of healthy old adults have them play this closed loop video game that actually challenged their abilities to resolve interference across multiple domains and what we showed was that we can improve their sustained attention and their working memory on tasks outside of the game with multiple control groups and neural recordings during gameplay to show mechanistically what was changing in their brain that led to these benefits out of the game that's what we showed 2013 love it so that's really changed the lives for myself and a lot of other people I know there are people here from Akili which grew out of NeuroRacer shout out yeah Akili people too so now we're 2013 so that was 2008-2013 2013 with that publication it had more web impressions than anything like in UCSF's history at the time I think 60,000 web impressions just in the first day it's still one of the most cited papers in nature in the last decade I mean it was a big deal because it really hit a sweet spot it was video games it was positive data on older adults and multitasking it had a lot of key words in there and it's a feel good story which seems to be hard to come by these days so with that event my laboratory converted into a research center it just got so big over time that we're now Neuroscape so it was Ghazali Lab now we've become bigger than that we have a whole team of faculty we have a technology program that first patent was now followed up by eight more of other closed loop technologies and that patent which I invented UCSF owns we licensed to a company we created called Akili Interactive with my friend Matt Omernik from LucasArts and an adventure group in Boston called PureTech and so Akili licensed that technology and has now over the last eight years created a way better game higher levels of art music story reward cycles usability cloud support server analytical everything elevated turning that game into what we now call digital medicine so the idea is that we can use this closed loop experience to improve abilities of the mind to a level that we could not achieve with any molecule because we don't have the targeting or the personalization and so that's what's going on now Akili is taking that technology all the way into people's lives we could talk about that more and Neuroscape is essentially an incubator we build new technologies using these principles that we talked about we don't build products we build prototypes we're right here at Mission Bay and then we do deep dive research studies to see if we have a signal that something important is going on here if so, then we move it out into the world of industry to turn it into products let's start I love it, Adam thank you so there was something that you started hinting at there with having the closed loop where you're actually measuring the results translationally with working memory, sustained attention and I love hearing about this this move towards digital medicine I love it, you know and we'll get to this but literally we're talking about once FDA approves prescribing video games as solutions to instead of these you called it like a sledgehammer molecules yeah, yeah you started hinting at the word flow you're challenging people your algorithms challenge people to their peak of their cognitive abilities so when they're struggling with the task you take the challenge level down a bit when they're succeeding too much you up the challenge level and you get them to this deep state of flow with the objective that they're competing at and then that translates out to the real world yeah, so teach us about I love that word flow and I wanna know what you think about that connection and also now where it's being applied and okay yeah, so you know the video game world knows the term flow well it's something that's used a lot my colleagues that are game designers and developers and it's one that we don't use as much in cognitive neuroscience but it's a clear phenomena when you engage personally I've experienced it it is what we do try to achieve by creating challenges that are not so difficult that you're frustrated and abandoned and not so easy that you're bored you can create and also coupled with tightly integrated reward cycles it's not trivial on how to create this but we believe it's possible to do I mean athletes, dancers, professional surfers people that engage in high level activities and take it to an extreme live in this world of flow and it's its own form of a drug in a way, but we also believe it is the way that plasticity is maximally harnessed in this state and one of the things that we're pursuing is how do we create that state as deeply and as excessively as possible using closed loop algorithms my view, so most of our games including like Achilles is really responding to your performance metrics in real time where we're going with this is what we call multimodal biosensing which is one of our divisions at Neuroscape to see how many signals we can measure about a person in the moment and then integrate it using machine learning algorithms to then understand the state of an individual in a much, much deeper way than we ever have before if that data can then be used to create an environment and we've gotten more sophisticated on our environment so a lot of our recent development is using virtual reality and when I say that I don't just mean a head-mounted display I mean full sensory stimulation ideal factory visual auditory tactile stimulation where you have this very, very complex loop of all this data about you flowing into a software system that knows how to interpret that data not trivial and then feedback an environment that is constantly and dynamically adjusting to you to create this state that allows you to adjust all these complex aspects of your thinking this is our AI vision as I always say AI for HI artificial intelligence for human intelligence that's where I think this type of these types of algorithms should go so that's a future vision that I described to you that is what we're working towards but not what we do right now we're working on the pieces of it so that's where we're heading but most of our algorithms right now are really adjusting to heart rate or to performance we're starting to feed brain signals into the algorithm but once we achieve this level then we really will I believe have digital medicines that outperform almost anything that we've ever used before and then just quick just teach us about where because where is this mental health application so what Akili is doing so I described Neuroscape I think you got a pretty good view of what we do here at UCSF Akili is a health care company we're a medical device company that largely is focusing on that very first technology that NeuroRacer technology that now has been developed to a much higher level and then taking that through multiple clinical trials Akili is a very unique tech company in that we have no revenue because we will not have any products until we have FDA approval so we're working to create a new type of medicine that reaches the same level of approval and rigor that drugs do right now that's basically the bar that we're holding ourselves to we have over a dozen clinical trials of many many different conditions some of them are very early like the work we're doing in traumatic brain injury and PTSD some are further along like autism and depression and multiple sclerosis we also have early work in Alzheimer's and Parkinson's many many studies going on the study that's most advanced the research is our work on ADHD so pediatric ADHD was our first main target lots of reasons why that should be the case I'm happy to dive into that if you're interested in the Q&A but we completed a phase three trial that's the type of research study that you do that's multi-site double blind randomized control that you do right before you submit to the FDA to get approval for clearance of a drug or a device that study was performed it took multiple years over 300 children involved in that study I think over 15 sites that study was successful we were successfully able to improve attention in these children beyond a placebo control group that played a different game that study has now been submitted to the FDA to get approval to have this type of digital medicine prescribable by physicians as the first non-drug treatment for ADHD and we expect and really hope that that will happen in 2019 so we're very close to that so it'll be the first non-drug treatment for ADHD the first of a first prescribable video game and the first of a new category of medicine of digital medicine I always like to think of this that we have pharmaceutical medicines that deliver molecular treatments a digital medicine delivers an experiential treatment I love it the treatment is the experience the video game is essentially like our pill it's how we deliver the experience to you in a way that's tasty and engaging and sustainable but it's the experience that changes your brain because of its plasticity this also makes me want to talk about psychedelics with molecules that deliver experiences that are incredible Adam, all right, this has been great I want to just do a couple rapid fire things on the way just before Q&A rapid fire with jazz ventures, jazz partners you guys are investing in tons of neuroscience related to neuro tech that is augmenting society what are some of your favorite applications of neuro tech to society right now and what are you most looking forward to in that? Yeah, so along the way I realized and friends of mine that we I couldn't do everything with this company or with Neuroscape so I started a venture fund with friends called Jazz Venture Partners we're now on our second fund and we invest in technology for human performance improvement and quality improvement things as diverse as using virtual reality to help people with certain impairments improve their function brain stimulation devices to help accelerate learning that's something that we do at UCSF as well we invest in companies in the medical domain like Achilles, Jazz is a big investor in Achilles but also in accelerated learning even like validated wellness products so where I go with the technology that we created Neuroscape might not be completely healthcare we're also interested in moving things into the education domain we recently completed a study probably the biggest ever of 1200 this is Neuroscape, 128 to 12 year olds around the Bay Area using our assessment tools to understand their cognitive abilities remember I said we don't assess cognition in children unless we think they have a developmental challenge or some learning disability this is healthy children understand their cognition and then after school playing select games to see if we could push on those levers to optimize them, right? So it would be one thing if we just assess children's cognition and then you're like you're stuck over here this is your fate that's not how we view it at all we assess the cognition just not to isolate or marginalize or just classify but to use that as the building blocks to have actionable tools to help improve those abilities so some of our products and some of what Jazz invests in and what Neuroscape makes will go more educational so Achilles as a prescription treatment just one pathway and one company this is simulation so when to be a simulation fight and ask you okay are we in a simulation? from some perspectives we are but you know I think that without even reaching outside of the normal construct that we've come to experience it's already mystical and magical enough so I'm happy believing in reality for however we define that and I don't feel that we need to be in a computer game to feel challenged you're leveling up quite quickly Adam and what do you think is the most beautiful thing in the world? nature I love nature I grew up in New York City so nature to me was like concrete and brick which is pretty you know but I discovered it when I was in my late 20s and changed my entire life and just got back from three weeks in New Zealand just completely immersed in the natural world and you know I think that there's so much healing could go on there as well so yeah yeah yeah those he has videos of him bungee jumping and skydiving and all this kind of crazy awesome stuff alright this was super fun Adam thank you for joining us on simulation everyone thank you for attending we'll have Q&A happen now thank you so much thanks Alan great question thank you