The pharmacy of the future? Personalized pills, 3D printed at home | Daniel Kraft

139,947 views ・ 2018-11-08

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We live in a medication nation.
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4.5 billion drug prescriptions will be prescribed by doctors like me
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this year, in the United States alone.
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That's 15 for every man, woman and child.
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And for most of us,
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our experience with this medication is often a confusing number of pills,
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instructions, side effects, one-size-fits-all dosing,
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which all too often we aren't taking as prescribed.
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And this comes at tremendous expense,
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costing us our time, our money and our health.
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And in our now exponential, connected, data-driven age,
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I think we can and we must do better.
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So let's take a dive at some of the challenges we have
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and some potential solutions.
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Let's start with the fact
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that many drugs don't work for those who are prescribed them.
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The top 10 grossing drugs in the United States this year,
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they only benefit one in four to one in 23 of who take them.
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That's great if you're number one, but what about everybody else?
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And what's worse, drugs, when they sometimes don't work,
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can still cause side effects.
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Take aspirin -- about one in four of us
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who take aspirin to reduce our risk of cardiovascular disease
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are unknowingly aspirin-resistant
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and still have the same risks of gastrointestinal bleeds
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that kill thousands every year.
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It's adverse drug reactions like these
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that are, by some estimates, the number four leading cause of death
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in the United States.
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My own grandfather passed away
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after a single dose of antibiotic caused his kidneys to fail.
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Now, adverse drug reactions and side effects
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are often tied to challenges in dosing.
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I trained in pediatrics (little people) and internal medicine (big people).
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So one night I might have been on call in the NICU,
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carefully dosing to the fraction of a milligram
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a medication for a NICU baby.
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The next night -- on call in the emergency room,
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treating a 400-pound lineman or a frail nursing-home patient
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who, by most accounts, usually would get the same dose of medications
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from the formulary.
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Which would mean, most of the time I would be underdosing the lineman
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and overdosing the nursing-home patient.
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And beyond age and weight,
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we tend to ignore differences in sex and race in dosing.
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Now, beyond this, we know we have a massive challenge
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with noncompliance or low adherence.
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Many of us who need to take our medications
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aren't taking them or are taking them incorrectly.
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You know, 40 percent of adults in the US over 65
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are on five or more prescription medications.
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Sometimes 15 or more.
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And even small improvements in adherence can dramatically save dollars and lives.
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So, as we think into the future,
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you think that where we are today,
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as we often hear about smart, personalized, targeted drugs,
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Internet of Things, gene therapy, AI,
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that we'd already arrived in this era of precision medicine.
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In reality, we still live in an age
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of empiric, trial-and-error, imprecision medicine.
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I think we can do better.
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What if we could reimagine ways to help make your medicine-taking easier?
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To get the right doses and combinations to match you?
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What if we could move beyond today's literal cutting edge
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of pill cutters and fax machines,
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to an era where we could have better outcomes, lower costs,
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saving lives and space in your medicine cabinet?
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Well, I think part of the solution is all the emerging ways
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that we can measure and connect our health care information.
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Today, we pretty much live in a reactive, sick-care world,
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siloed information that doesn't flow.
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We have the potential to move into a more continuous, real-time
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proactive world of true health care.
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And part of that starts with the emerging world of quantified self.
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We can measure so much of our physiology and behaviors today,
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and often it's siloed on our phones and scales,
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but it's starting to connect to our clinicians, our caregivers,
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so they can better optimize prevention, diagnostics and therapy.
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And when we can do that, we can do some interesting things.
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Take, for example, hypertension.
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It's the number one risk factor for early death and morbidity worldwide.
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Half of adult Americans, on approximation, have hypertension.
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Less than half have it well-controlled.
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It's often because it takes two or three different classes of medications.
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It's tough to do adherence and adjust your blood pressure medications.
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We have 500 preventable deaths from noncontrolled hypertension
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in the US every day.
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But now we're in the era of connected blood pressure cuffs --
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the FDA just approved a blood pressure cuff
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that can go into your watch.
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There are now prototypes of cuffless radar-based blood pressure devices
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that can continuously stream your blood pressure.
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So, in the future, I could --
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instead of spot-checking my blood pressure in the clinic,
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my doctor could see my real-time numbers and my trends,
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and adjust them as necessary,
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with the help of a blood pressure dosing algorithm
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or using the Internet of Things.
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Now, technology today can do even more.
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My smartwatch, already today, has an EKG built in
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that can be read by artificial intelligence.
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I'm wearing a small, Band-Aid-sized patch,
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that is live-streaming my vital signs right now.
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Let's take a look.
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They're actually a little concerning at the moment.
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(Laughter)
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Now, it's not just my real-time vitals
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that can be seen by my medical team or myself,
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it could be my retrospective data,
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and again, that'd be used to modify dosing and medication going forward.
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Even my weight can be super-quantified;
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my weight, now my shape, how much body mass, fat,
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muscle mass I might have,
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and use that to optimize my prevention or therapy.
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And it's not just for the tech-savvy.
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Now, MIT engineers have modified wifi
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so we can seamlessly connect and collect our vital signs
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from our connected rings and smart mattresses.
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We can start to share this digital exhaust, our digitome,
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and even potentially crowdsource it, sharing our health information
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just like we share with our Google Maps and driving,
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to improve our -- not our driving, but our health experience globally.
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So, that's great.
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We can potentially now collect this information.
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What if your labs can go from the central lab
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to your home, to your phone, to even inside our bodies
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to measure drug levels or other varieties?
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And of course, we're in the age of genomics.
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I've been sequenced, it's just less than $1,000 today.
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And I can start to understand my pharmacogenomics --
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how my genes impact whether I need high dose, low dose,
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or maybe a different medication altogether.
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Let's imagine if your physician or your pharmacist
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had this information integrated into their workflow,
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augmented with artificial intelligence, AI, or as I like to refer to it, IA --
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intelligence augmentation,
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to leverage that information;
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to understand, of the 18,000 or more approved drugs,
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which would be the right dose and combination for you.
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So great, now maybe we can optimize your drugs and your doses,
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but the problem today is, we're still using this amazing technology
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to keep track of our drugs.
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And of course, these technologies evolve,
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there's connected dispensers, reminder apps,
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smart pill bottle caps that can text or tweet you or your mother
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if you haven't taken your medications.
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PillPack was just acquired by Amazon,
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so soon we may have same-day delivery of our drugs, delivered by drone.
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So, all these things are possible today,
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but we're still taking multiple pills.
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What if we can make it simpler?
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I think one of the solutions is to make better use of the polypill.
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A polypill is the integration of multiple medications into a single pill.
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And we have these today in common over-the-counter cold and flu remedies.
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And there have been prevention polypill studies done,
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giving combinations of statins, blood pressure, aspirin,
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which in randomized studies have been shown
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to dramatically reduce risk, compared to placebo.
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But these polypills weren't personalized, they weren't optimized to the individual.
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What if we could optimize your personalized polypill?
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So it would be built for you, based on you, it could adapt to you,
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even every single day.
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Well, we're now in the era of 3D printing. You can print personalized braces,
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hearing aids, orthopedic devices,
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even I've been scanned and had my jeans tailored to fit to me.
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So this got me thinking,
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what if we could 3D-print your personalized polypill?
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So instead of taking six medications, for example,
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I could integrate them into one.
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So it would be easier to take, improve adherence
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and potentially, it could even integrate in supplements,
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like vitamin D or CoQ10.
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So with some help -- I call these "IntelliMeds" --
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and with the help of my IntelliMedicine engineering team,
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we built the first IntelliMedicine prototype printer.
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And here's how it works:
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instead of full tablets, we have small micromeds,
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one or two milligrams each,
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which are sorted and selected based on the dose and combination
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needed for an individual.
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And of course, these would be doses and combinations
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you could already take together, FDA-approved drugs.
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We could change the pharmacokinetics
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by professionally layering on different elements to the individual micromeds.
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And when we hit print,
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you print your combination of medications that might be needed by you
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on any individual day.
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And we'd start with, again, generic drugs for the most common problems.
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About 90 percent of prescribed drugs today are low-cost generics.
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And once we've printed the pill, we can do some fun bells and whistles.
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We could print the name of the patient,
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the date, the day of the week, a QR code.
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We could print different meds for tapering for a patient on a steroid taper,
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or tapering from pain medications.
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So, this is actually a look at our prototype IntelliMedicine printer.
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See, I'll unveil it here.
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It has about 16 different silos,
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each containing individual micromeds.
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And I can now adjust on the software individual dosings.
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And when I do that, the robotic arm will adjust
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the height of these spansules and the micromeds will release.
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I can now --
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The automated process would rotate and cycle through,
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to make sure the micromeds are loaded.
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And when I hit print,
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these will all fall through the device,
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I now pull out my personalized printed polypill
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with the doses and medications meant for me.
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And we can take a look, if you look back to the slides,
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you can see the whole process, we can see the drug silos being selected,
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the pills doing down the different silos,
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and being collected in the individual capsule.
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Now, this is great,
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I can potentially print my meds based on me,
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instead of taking six pills.
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I can now be looking at my individual dosing.
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My smartwatch is looking at my blood pressure:
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I needed an adjustment in my blood pressure medicines,
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my coumadin level. My blood is too thin,
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so I lower my micromed dose of coumadin, a blood thinner.
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So, this could be smartly adapted, day to day,
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programmed by my physician or cardiologist.
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And you can imagine that larger printers, fast printers like this,
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could be in your corner pharmacy,
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in your doctor's office, in a rural clinic.
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But it could eventually merge and shrink to small ones that could be in your home
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with integrated cartridges like this that are delivered by drone.
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Could print your personalized polypill,
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each morning on your kitchen or your bathroom cabinet.
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And this could evolve, I think,
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into an incredible way to improve adherence in medications across the globe.
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So, I hope we can reimagine the future of medicine in new ways,
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moving from polypharmacy,
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one-size-fits-all, low adherence, complications
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to an era of personalized, precise, on-demand medications
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that can take us and individualize our own health
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and health and medicine around the planet.
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Thank you very much.
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(Applause)
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Host: Daniel, that's kind of awesome.
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Really cool.
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Question for you, though.
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How long is it until, say, that nursing-home patient that you mentioned
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is able to print their pills in their home?
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Daniel Kraft: Well, again, this is just a prototype.
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We think that the regulatory route [may] be automated compounding,
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and especially in nursing homes, folks are taking multiple medications,
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and they're often mixed up,
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so it would be a perfect place to start with these technologies.
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These aren't going to evolve and start with printers on your bathroom counter.
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We need to be intelligent and smart about how we roll these things out,
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but realizing there's so many challenges with dosing, adherence and precision,
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and now that we have all these amazing new technologies
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that can integrate and be leveraged, I think we need approaches like this
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to really catalyze and foster
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a true future of health and medicine.
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Host: Great, thank you. DK: Thanks.
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(Applause)
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