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The Medical Experimen- than employing the digital computer as merely a tal Computer (SUMEX) was established in number calculator, scientists in this field utilize January, 1974, to provide the first shared na- the computer to reach decisions and solve prob- tional computing facility for medical research. lems through symbolic analysis and reasoning. Directed by Dr. Joshua Lederberg, professor and Initial applications of this approach to medicine chairman of the Department of Genetics, are being actively pursued in medical diagnosis, SUMEX is an innovative effort to help biomedi- interpretation of data from advanced chemical cal scientists meet today's research requirements studies, and development of a computer model and to explore computer applications in many for studying human behavioral processes. health fields, ranging from basic research to The following is a partial description of bedside care. The project is funded by a five- SUMEX-AIM projects. It illustrates some of the year $2.75 million grant from the Division of problems researchers around the country are Research Resources of the National Institutes of tackling with the help of this unique resource. Health (Biotechnology Resources Branch). MYCIN At present SUMEX consists of a powerful A Computer Program for Advising Physicians PDP-10 computer available to approved users Regarding Selection ofAntimicrobial Therapy throughout the States over computer United a For many years physicians have struggled network on a time-shared basis. communication with the problem choosing the appropriate The goals over the next years are: of project's five antibiotic for treating applications of artificial a patient with a bacterial 1) to encourage intelli- infection. It also be difficult gence in medicine (AIM) and the managerial, may to decide 2) whether antimicrobial therapy is administrative, and technical demonstration of a even war- ranted. The MYCIN System is a novel nationally shared technological resource for computer program designed to advise physicians health research. regarding the treatment of such patients. Since the advice There are not only significant economic is designed to be similar to that which would be advantages when scientists share expensive tech- offered by the expert himself, MYCIN is partic- nical equipment, but also there is greater oppor- ularly useful at times of day when the specialist tunity for them share ideas about their to re- is unavailable or in locations where no experts search. This is especially in true computer sci- are easily accessible. Patients with infectious field and complex ence, a so new that it has diseases often require treatment before complete tended encourage development of to relatively information about the bacterium becomes avail- isolated research groups, each pursuing its line of able. Experts in infectious disease therapy there- investigation with limited use of working pro- fore have identified clinical and historical grams available from others. The crite- SUMEX-AIM ria that serve as decision rules for the project seeks lower early to these barriers in the field selection of antibiotic therapy. Such rules have of applied to health re- been coded and stored in the computer so that search. the MYCIN program can use them to guide its Artificial intelligence interactive consultation session with the non- Artificial intelligence is a part of computer expert physician. science concerned with the symbol-manipulation The physicians and computer scientists who processes that produce intelligent action. Rather developed this system have equipped it with

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SS SSSSSSS SSSSSSS SS SSSSSSS SSSSSSS features that will increase its acceptance by the statements about people's motivations and doctors who use it. They also hope that the actions. The SUMEX-AIM environment provides MYCIN experience, including the novel applica- an excellent medium for collaboration between tions of artificial intelligence techniques upon Dr. Schmidt's group and other researchers which it is based, will have potential impact around the country in the development and upon the broad range of medical decision- testing of this computer-based theory. making problems which rest on informal judg- The Rutgers project includes, in addition, sev- mental knowledge. eral fundamental studies in artificial intelligence Dr. Stanley Cohen, associate professor and and system design. These provide much of the head of the Division of Clinical Pharmacology, support needed for the development of complex directs the research in association with Dr. system such as the glaucoma consultation and Stanton Axline. He hopes, as soon as MYCIN'S the "Believer" programs. effectiveness as a clinical tool is fully demon- strated, to introduce it on the hospital wards for DENDRAL general use. In 1964 Nobel Laureate Joshua Lederberg Computers in Biomedicine devised a computational procedure for classi- The Rutgers Project fying chemical structures in accordance with graph-theoretical principles. Because it generates Prof. Saul Amarel, a Rutgers University com- names of chemical structures in a treelike (den- puter scientist, is directing several research dritic) algorithm, the procedure to efforts designed to introduce advanced methods came be known as the algorith. in —particularly in artificial in- Lederberg dentritic DENDRAL group telligence and interactive data base systems—into is the name of a of Stanford- related specific areas of biomedical research. projects involving Drs. Lederberg, Edward Feigenbaum For example, a group of computer scientists (computer science), and led by Prof. Casimir Kulikowski is developing Carl Djerassi (chemistry). They are applying arti- ficial computer-based consultation systems for di- intelligence techniques to the study of seases of the eye in collaboration with Dr. Aran unknown organic compounds. The computer Safir, an ophthalmologist from the Mount Sinai analyzes data from instruments such as mass School of Medicine. An important development spectrometers in an attempt to determine mole- in this area is the establishment of a national cular structure. gas chromatographs network of collaborators for diagnosis and treat- In the research, separate complex ment of glaucoma by computer. The computer chemical mixtures into constituents for analysis. separated system, which includes an elaborate patho- The constituents are fed into mass spectrometers, which break down physiological model of the disease, is about to the chemical compounds electrically be tested through the SUMEX-AIM network at into charged The three eye centers: Mount Sinai Hospital and fragments. fragments are sorted according to their Medical Center, New York; Washington Univer- differences in charges and masses. The charge fragments sity, St. Louis; and The Hopkins Univer- are electronically detected and Johns counted, and the computer sity in Baltimore. Glaucoma, in one form or gives an instant read-out and interpretation. The scientists plan another, affects two percent of all people over to study the chemical constituents of human 40 years of age. It is a disease in which increased body fluids which may change depending pressure within the eye may lead to on the irreparable disease. Dr. Djerassi, the damage of the optic nerve and blindness. The principal developer of the contraceptive "pill," is noted for his work in computer-based program has great potential for the chemistry of natural products— steroids, anti- assisting clinicians and researchers in under- biotics, alkaloids, and in medicinal standing the disease, in diagnosing it more accu- chemistry (antihistamines and anti-inflammatory agents). rately, and in improving its treatment. Dr. Feigenbaum is an authority computer In another project, Prof. Charles Schmidt, a on science, particularly the application of artificial social psychologist, is developing on the com- intelligence to study puter a theory of how people arrive at interpre- the of learning and human memory. tation of the social actions of others. The theory will be tested in situations such as the psychia- Computing Applied to tric interview and the legal trial. The computer Protein Crystallography system which currently represents the theory is Members of the artificial intelligence project called "Believer." It includes a large body of at Stanford are also collaborating with Prof. Joseph Kraut and Dr. Stephan Freer, protein tance of a local advisory committee, as a princi- crystallographers at the University of California pal investigator for the SUMEX grant. National in San Diego. They seek to develop a computer users may gain access to the facility resources system that can infer protein structure from through an advisory panel for a national pro- data obtained by X-ray detraction from crystal- gram in artificial intelligence in medicine (AIM). lized samples. Crystallography is concerned with The AIM advisory group consists of members- the study of the regular atomic or molecular at-large of the Al and medical communities, arrangements within a crystal, the bonding of facility users, and the principal investigator of atoms or molecules, and the physical and chemi- SUMEX as an ex officio member. A representa- cal properties that result from certain arrange- tive of the National Institutes of Health-Biotech- ments. X-ray crystallography is a tool for nology Resources Branch (NIH-BRB) serves as examining these arrangements by scattering of executive secretary. an X-ray beam from the atoms in a crystal. The The SUMEX-AIM computing resource is ini- scientists seek to apply problem-solving tech- tially allocated to qualified users without fee. niques, which have emerged from artificial intel- This, of course, entails a careful review of the ligence research, to bridge the gap between ex- merits and priorities of proposed applications. perimental data and the molecular structure. At the direction of the advisory group, expenses The computational system under development related to communications and transportation to differs from conventional techniques by its use allow specific users to visit the facility may be of experts' judgmental knowledge in conjuction covered as well. with formal analysis. Modeling ofHigher Mental Functions User Qualifications In general terms, potential users of the Dr. Kenneth Colby, a as well as SUMEX-AIM facilities are judged on the basis computer scientist at UCLA School of Medicine, of: has programmed computers to conduct prelimi- 1. The scientific interest and merit of the nary interviews with psychiatric patients, and in proposed research. others to simulate a patient's mental processes 2. The relevance of the work to the artificial for other to diagnose. He has also intelligence approach of SUMEX-AIM had some success in getting autistic children to as opposed to other computing alternatives. talk with a computer when they could not speak 3. The prospective contributions with anyone else. Dr. Colby is using SUMEX- and role of a user in the community, AIM to improve simulation of human belief e.g., developing and sharing new systems or applications programs, systems and pathological thought processes, sharing use of special hardware, etc. attempting to program computers to take over 4. The user's capability and intentions of the psychotherapist's job at least in the early operating in a community-effective style for stages of treatment. The idea would aid the mutual advantage. Besides the programming psychiatrist, not replace him. "If the computer in- participants can be used in to help thousands novations that some may be able to expected of patients in understaffed hospitals," Dr. Colby contribute, all are to furnish expert says, "we could use it." knowledge and advise about the existing art in their fields of interest. SUMEX-AIM Management Facility Information A significant part of the SUMEX-AIM experi- The computing facility, consisting of a DEC ment is the development of a management struc- model KI-10 CPU operating under TENEX, has ture to maximize the utility of the computer 256K words (36 bit) of high-speed memory, capability for a national community. 1.5M words of swapping storage, 70M words of Users of the SUMEX facility are divided for disk storage, two 9-track, 800 bpi industry-com- administrative purposes into two groups: 1) patible tape units, a dual DEC-tape unit, a line those at Stanford University School of Medicine printer, and communications-network interfaces and 2) those elsewhere in the United States. The providing user terminal access. The initial com- facility resources (computing capacity and con- munications network is TYMNET. However, sulting support) are allocated in equal portions SUMEX will be available as a remote host over to the two groups. Dr. Lederberg will review the ARPANET in the near future. Stanford medical school projects with the assis- Program (software) support will evolve from \ system by the basic as dictated the research guages include INTERLISP, SNOBOL, SAIL ) goals and needs of the user. Initially, available FORTRAN-10, BLISS-10, BASIC, and Macro programs include a variety of TENEX user, util- 10. ity, and text editor programs. Major user lan-

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New Project Contact For further information about new projects, write: Prof. Joshua Lederberg, SUMEX-AIM Computer Project Stanford University Medical Center Stanford, CA 94305

Formal applications for access should be addressed to: Biotechnology Resources Branch Division of Research Resources National Institutes of Health Bldg. 31, Room 581 9 Bethesda, MD 20014