Prediction is very difficult, especially if it’s about the future (Niels Bohr)

I always find it fascinating how certain terms become part of the vernacular. The term “moonshot” refers quite self-evidently to a grand project on the scale of getting a man to the moon. It still is truly unbelievable that this was possible in the time before modern computers. At least, if it really does happen, sending humans to Mars, not just to visit but even to live there, will benefit from all of the technological miracles that surround us today.

For example, 3-D printing might solve the problem of how to get new equipment to a Mars-based community that has no large-scale manufacturing in place. So the basic rules for how such a Mars ecosystem will be set up are totally different. A moonshot project also usually demands the creation of technology that doesn’t even exist yet, that will take many years  [if not decades] to implement and which will understandably cost a bloody fortune.

The inherent problem with a moonshot scale project is that technology is advancing so quickly that the moonshot project might become ineffectual by the time it’s completed. And it’s important to appreciate this if you’re anyone other than the multi-billion-dollar companies like Google and Microsoft and Apple. If you are a startup, and your foundation is a technology that will take seven years (for example) to develop, there is a tremendous risk in this.

If you are developing something which is totally radical in its design, and in practical terms no one else is working on the same type of project, that’s a different story. If you’re presently working on a functioning quantum computer’s motherboard with its associated CPU, short-term and long-term memory, then it’s reasonable to take the long view. And a relatively small startup with a great idea might be able to bring in billions of dollars in investment because of the potential. One wouldn’t think that a company like SnapChat would be as successful as it is, versus another company that, perhaps, develops a subcutaneous chip for monitoring our health. But getting investment money for subcutaneous chips is hard and SnapChat is already a multibillion dollar company. So logic does not always play a part in investment decisions.

Let’s take an example. Driverless cars are definitely a moonshot project. It requires a tremendous amount of new technology, a fundamental change in the way our society works, possibly the simultaneous integration of clean energy to drive the cars, and a lot more. And when people talk about the future of driverless cars, they usually speak to 2030 to 2040 when such devices will be ubiquitous.

Let’s say I look at this and decide that if every car is driverless and constantly in communication, I could build a driverless ambulance that could safely navigate the roads at twice the speed that an average ambulance drives today. Imagine the patient who has a serious injury, being driven at the speed of 200 miles an hour to the closest hospital. And imagine that the risk of an accident, even at this speed, approaches zero because of this meshwork of communication between the driverless ambulance and driverless cars on the roads.

So I put together a team, find some top engineers, maybe even manage to get a couple of major car manufacturers on board, and the work begins. Years go by, endless simulations have been done, real world scenarios are tested and we are perhaps a couple years away from delivering pre-ordered driverless ambulances. The investors are happy, the company is happy, the birds are chirping outside, and the world is a perfect place.

The next day, you see a demonstration of a military grade flying transport system [a drone on mega steroids] that can carry up to 2 patients, 2 staff, and the necessary medical equipment to begin life-saving procedures before arriving at the hospital. Due to an amazing Gyro stabilization system, the work area within this mega-drone [not Megatron, but the similarity frightens me] is totally stable, and the staff can even begin surgery before the patient gets to the target hospital, which may be a couple of hours away even at top aerial speed.

Besides being mega-cool, such a flying ambulance/hospital would unquestionably save lives. There is in the medical literature a term “the golden hour”. In major trauma, where the patient has had a serious injury but is still alive after the initial trauma, like a car crash, the chances of saving that person’s life drop dramatically as you approach  the one hour period after the incident. Needless to say, a great amount of time can be lost just transmitting the location of the accident to the appropriate authorities, then dispatching the necessary teams, then having the patients transported to a hospital that can do the necessary work and so on.

With the aerial mega drone, the self driving cars will immediately and automatically send notification of an accident. The health care team could probably be on the drone within minutes, and at the site as quickly as a 300 mph flying machine can move. And here’s the kicker. Once investors do the math, they realize that you need a lot less of these drones than you would of the ambulances. The disruption to regular traffic would be almost nil with the flying drone. And quite simply, in one shining moment, the benefits of the superfast driverless ambulance moonshot project, are effectively lost.

You can easily replace the pieces of this puzzle with other scenarios and types of technology. I obviously have a tendency to look at the potential effects on health care. Imagine all the companies that are now working on various ways to measure blood sugar without needles [noninvasively]. The first company that really comes out with a simple, small, totally noninvasive system for measuring glucose in the blood will make billions. It may very well revolutionize the whole treatment of diabetes.

At this moment, in labs around the world, both academic and commercial [big company and startups], a whole range of solutions is being worked on to help manage diabetes. The term “artificial pancreas” has appeared multiple times in the daily newspapers over the last couple of years. In some cases, the research is being done on a bionic, electronic artificial pancreas. Other labs are working on growing a new pancreas from the cells of the patient, so that there is no concern over the body’s immune system rejecting the organ.

Quite frankly, it is very difficult to predict the order in which these various companies will succeed with their moonshot projects. And the order is critical because if we are growing human organs at a low cost in almost every hospital, within the next 10 to 15 years, there won’t be a lot of time for other technologies to fully mature and really make a difference. On the other hand, if a bionic pancreas is the best solution for a 30 year period, that is effectively forever in the world of technology.

This is one of the reasons why it takes astonishing vision to imagine a technology that will be successful, not just in the next 2 to 3 years but in the next 5 to 10 years. I don’t envy investors who need to make, effectively, an excellent, extremely accurate, totally unverifiable guess about what companies and what technologies to invest in. But as I have heard said many times, that’s the game, and you don’t throw in unless you have the resources and nerve to stay the course.

A lot of this will be unnecessary in any case when we finally develop a time machine (in a Delorean, of course). Then we can just go back and make predictions that cause changes that cause a time machine to never be built which causes my brain to implode. In the meantime though …

Thanks for listening.

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.