“We become what we behold. We shape our tools, and thereafter our tools shape us.”― Marshall McLuhan
In October 2008, one month after the American housing crisis sent a shock through the global financial system, a paper was published titled Bitcoin: A Peer-to-Peer Electronic Cash System. These nine fairly easy to read pages posted anonymously on an open forum birthed a global marketplace now valued at $1.5 trillion dollars backed by nothing other than some mathematical proofs and computer code existing entirely in distributed digital ledgers known as blockchains. The author, Satoshi Nakamoto, is a pseudonym. To this day no one knows who wrote it.
The paper uses a solution to a problem in game theory known as the Byzantine general’s problem or the double-spending problem to give step by step instructions on how to use that proof to build a secure decentralized open ledger. Together that enabled the creation of databases and networks that could be self governing and keep track of just about anything with near perfect security. The primary use case so far has been the creation of digital money and decentralized finance (DeFi), but it has the potential to be applied to many other aspects of civil life. (For more background dive into the history of money with The Bullish Case for Bitcoin.)
I first dipped my toe into this world over four years ago and wrote this on the potential I saw. But the space was still too young for people without much programming experience to really engage with for anything other than speculating which coins would moon.
Earlier this year I peaked back in to see how it had grown and was quickly struck by what I saw. Though still in its infancy, it is now much more accessible, with a wide variety of different communities and all sorts of applications and use cases springing up.
For those wondering just what a blockchain is, the video above does the best job I have seen of describing it, but I’ll try to cover what I think people should know.
To most, crypto is still just a scheme to make money. And they are not entirely wrong, most cryptocurrencies can not continue to exist if they do not appreciate in value. Each blockchain has a coin that acts as the token needed to complete transactions on that network. Ideally the more utility a blockchain has the more people will use it and the higher in value the associated coin will be. But there are many exceptions, the biggest being Bitcoin itself. It basically acts as just a store of value, but because it was first and there is a limited supply, a single bitcoin is now worth around $50,000. Likewise, it is not uncommon for newer coins to appreciate in value 1000% in a year propelled by nothing other than hype from influencers or the power of a good meme. That said, there is a good case to be made that cryptocurrency offers a more permanent store of value than the fiat currencies we have. Click here for more on that.
But Satoshi’s vision of a decentralized world and all it could mean has also proven to be a powerful pull. A movement is growing of people who took the time to understand some of the complexity of the blockchain world and are doing what they can to help it grow. It’s an experiment in mass organizational structure, and the number of people finding themselves drawn to that vision has been rising steadily.
The question is, will this trend level off at some point or will it continue to rise? How many people will be actively trading and working in this space 5, 10, 20 years from now? At the moment there is too steep of a knowledge barrier to entry for those numbers to really start to rapidly rise. But the competition within the space is forcing enough innovation that it is not inconceivable that that could soon change.
There are now almost 5000 different crypto currencies in circulation with nearly 200 different exchanges running on dozens of different blockchains. Each is its own experiment that constantly fluctuates in value and utility based largely on the price of its coin and the number of people that make transactions on its network. Most coins today will not be here in 10 years, but some will still be thriving in what by then may be a much, much larger pool. So, how to figure out which (if any) will survive long term?
Well, it’s probably impossible at this early stage to know for sure. There are too many variables and too many unknown unknowns. Ultimately it likely won’t be the code or the coin that decides which blockchains last, but the character of the communities each attracts. Blockchains get their resilience from the individuals on the network as they are reliant on their community to create most of the applications, utilities and markets that ultimately give it value and staying power.
For now we can look to two trend lines, two different tugs of war happening simultaneously. The push and pull between blockchains over users already comfortable in this space, and the pull on people in the legacy systems into the blockchain world.
Now, before jumping in to look a little more closely at a few of the blockchains that are out there, it might help to know that there are different categories of cryptocurrency. There are exchange coins issued by some of the popular crypto exchanges, stablecoins that don’t really fluctuate in value and are often pegged to a national currency, and utility coins that have some functional quality to them such as those tied to decentralized applications (DApps). There are some very interesting coins in each of these categories doing some truly novel things, but they are reliant on someone else’s blockchain to function.
Then there is the classic blockchain coin that is the token of exchange in a blockchain network. These blockchains create the underlying infrastructure that the rest of the coins and all the users in all the various networks on that blockchain rely on. They function almost like digital sovereign nation-states with their own institutions and forms of governance. These coins tend to have the largest market cap and the companies behind them usually have the most programmers on staff.
One other important side note that many who just see crypto as a scheme miss is that owning coins in most of these systems actually gives you the equivalent of citizenship in the network and often a vote in its governance. Governance is a complex topic that I won’t go into but here is a brilliant overview of all the factors that go into them.
It’s The Blockchain, Stupid
Which brings me to the different blockchains themselves. I am less concerned with which coins will have the largest returns on investment and more with which will be here in the long run and attract the most robust communities. Here are the two that I think are the most likely to still be here in 10 years.
Ethereum – Launched in 2014, Ethereum is widely acknowledged to be blockchain 2.0. It has the second largest market cap after bitcoin and by far the most diverse ecosystem of applications being built on it. The breakthrough Ethereum made that allowed it to gain prominence was applying smart contracts. Smart contracts enable secure transactions of programming code on the blockchain. As the name implies, this code can act almost exactly like contracts in the real world, allowing people to safely and securely exchange services or goods for tokens. For more here is a good guide from IBM on smart contracts. And here is an illuminating interview with the founder of Ethereum,
Cardano – Started in 2017 by one of the co-founders of Ethereum who had a messy falling out and decided to start his own blockchain. (For more on the drama filled backstory of the founding of these companies read this.) The protocol that runs the Cardano network promises to be capable of realizing the vision Satoshi laid out in the original Bitcoin paper of a fully decentralized self-governing blockchain. There are also other technical achievements layered into it that allow it to process many more transactions per second while vastly reducing the energy demands of the system. For more watch the founder explain the Cardan white paper, or see this presentation at MIT.
There are a few other blockchain networks that I think show a lot of promise, namely Polkadot, Algorand and Avalanche. Where is Bitcoin you might be asking? It was the first and is probably the safest bet to be here in the long run, there just isn’t much you can do with it except buy stuff.
Accelerating Medical Science and Improving Healthcare
So, what does any of this have to do with neurodegenerative research? I see four primary use cases that this technology enables that could improve all of medical research and healthcare, though I am sure there are more that I am not seeing or some that I am at least partially wrong on. Regardless, my reason for writing all of this is to hopefully inspire some curious minds to start looking into how this technology might be used to help accelerate the pace of medical science and start doing what needs to be done to make that happen. Knowing whatever it is will likely take years to develop, but the sooner more people start working on them the sooner they will exist.
Here are the four I see. Each probably deserves its own book that expands on how to build and implement them, but I am just going to give a very brief overview of each.
A global database of patient information – Instead of patients handing over their data to any one company or organization, all patient data could and should be put on public blockchains. This could include medical records, genomic data, ancestry, and anything else they choose to put on. The great thing is blockchains could enable patients to have complete control over who gets to access their data and how that data is used, while allowing them to be paid for their data. It would also open up all sorts of possibilities for making better use of patient reported outcomes and N of 1 cases, while giving companies and labs big and small around the world the opportunity to access it.
Better clinical trial database/recruitment – Simply put, a vastly superior version of clinicaltrials.gov could be built on a blockchain. Click here for more. Come to think of it, this might be able to be layered onto the first one….I’ll let someone else figure that out.
Decentralized science journals- I see this as the natural evolution of the open science movement. An open distributed database of papers that is open, free and perfectly traceable. We could determine exactly what each author contributed to each paper, and directly reward them for citations. It would also allow papers to become dynamic living documents instead of static numb files for archives. And most appealing of all, it would make the need for large publishing houses largely obsolete. Click here or here for more.
New funding models – Within each blockchain there are various mechanisms and incentive structures that allow users to pool resources together and accrue more coins. For example, in the Cardano ecosystem these are called staking pools that act as their own node on the network. They contribute to the blockchain by helping produce new blocks and in return get rewarded with more of the network’s coins.
As I was learning about staking pools I started seeing the potential to create a fund for neurodegenerative research. So, I reached out to the Cardano community seeing if I could find any help getting set up. I was blown away by some of the responses I got, one in particular from a developer in Bristol, England was Martin Hunt who offered to devote the pool that he had already started to this cause. Here we are just over a week later and Neuro Pool is up and running with 1.3 million ADA (Cardano’s currency, as of writing 1ADA = 1.11USD) staked, a landing page (neuropool.io), some freshly minted Neuro Coin, and most importantly, a knowledgeable partner who I trust to run this with.
We have a lot of plans for where we want to go with this pool and what it could become. Eventually I would like to decentralize the governance of this pool, using tools that IOHK(parent company of Cardano) is developing, so that anyone who contributes to it will have a say in how the funds are spent. For more on the pool click here for a letter we wrote to the Cardano community.
For anyone that would like to get involved or even contribute to the pool I would encourage you to first do your own research and learn a bit about blockchains, Cardano and stake pools. This is a complex space and there are risks involved. I want to stress again that this is still a nascent industry and that Cardano is early in its development. If it becomes what I think it could it has a great deal of potential to do a lot of good, but for now it is still an experiment and there is no guarantee any of that will happen. Still, it has me very excited for the future and dreaming of all that this technology could do to help accelerate better therapies and care for people with neurodegenerative diseases. As anybody who has followed my writing or watched any of the talks I’ve given will know, I think there are a lot of things about the current system that slows down the pace of medical science. I see blockchains as a way to potentially address some of those things. I could be wrong of course, but either way I plan on finding out.
Phew, that was a long one. If you made it this far, thank you. Feel free to reach out if you have any questions and please consider subscribing at neuropool.io to follow us along on this new path.
Finally here are a couple other resources I found useful in learning about this space.
The final lecture of the open MIT course titled: Blockchain and Money
Blockchain beyond the hype: What is the strategic business value?
IBM’s Blockchain in Healthcare page
Fit-for-purpose?’ – challenges and opportunities for applications of blockchain technology in the future of healthcare
A systematic literature review of blockchain-based applications: Current status, classification and open issues
Like any complex system, it has its own vocabulary used to classify all the various elements. This can act as a barrier to entry for those who want to enter this space. These include words like protocols, yield farming, cryptographic hash functions, permissioned vs. permissionless chains, layer 2 solutions, proof of stake vs. proof of work, sharding, hard forks, oracles, and much more. I don’t think you need to understand them all in detail to be able to understand this space, I certainly don’t, but it will help you get a little more comfortable in it if you start familiarizing yourself with the terms used. I recommend for anyone wanting to get started to just start reading what you can and every time you see a word you don’t recognize, write it down and look it up.
Fantastic stuff Ben. You are visionary. I will be taking a long look into this. Well done.