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

139,507 views ・ 2018-11-08

TED


Please double-click on the English subtitles below to play the video.

00:13
We live in a medication nation.
0
13560
2856
00:16
4.5 billion drug prescriptions will be prescribed by doctors like me
1
16440
5056
00:21
this year, in the United States alone.
2
21520
1816
00:23
That's 15 for every man, woman and child.
3
23360
2416
00:25
And for most of us,
4
25800
1216
00:27
our experience with this medication is often a confusing number of pills,
5
27040
3536
00:30
instructions, side effects, one-size-fits-all dosing,
6
30600
3616
00:34
which all too often we aren't taking as prescribed.
7
34240
2456
00:36
And this comes at tremendous expense,
8
36720
2016
00:38
costing us our time, our money and our health.
9
38760
2896
00:41
And in our now exponential, connected, data-driven age,
10
41680
2896
00:44
I think we can and we must do better.
11
44600
2480
00:47
So let's take a dive at some of the challenges we have
12
47880
3136
00:51
and some potential solutions.
13
51040
3056
00:54
Let's start with the fact
14
54120
1256
00:55
that many drugs don't work for those who are prescribed them.
15
55400
3256
00:58
The top 10 grossing drugs in the United States this year,
16
58680
4616
01:03
they only benefit one in four to one in 23 of who take them.
17
63320
3616
01:06
That's great if you're number one, but what about everybody else?
18
66960
4016
01:11
And what's worse, drugs, when they sometimes don't work,
19
71000
3056
01:14
can still cause side effects.
20
74080
1416
01:15
Take aspirin -- about one in four of us
21
75520
1896
01:17
who take aspirin to reduce our risk of cardiovascular disease
22
77440
2936
01:20
are unknowingly aspirin-resistant
23
80400
1976
01:22
and still have the same risks of gastrointestinal bleeds
24
82400
2976
01:25
that kill thousands every year.
25
85400
1760
01:28
It's adverse drug reactions like these
26
88040
2976
01:31
that are, by some estimates, the number four leading cause of death
27
91040
3176
01:34
in the United States.
28
94240
1216
01:35
My own grandfather passed away
29
95480
1456
01:36
after a single dose of antibiotic caused his kidneys to fail.
30
96960
3016
01:40
Now, adverse drug reactions and side effects
31
100000
2976
01:43
are often tied to challenges in dosing.
32
103000
3016
01:46
I trained in pediatrics (little people) and internal medicine (big people).
33
106040
3736
01:49
So one night I might have been on call in the NICU,
34
109800
2416
01:52
carefully dosing to the fraction of a milligram
35
112240
2256
01:54
a medication for a NICU baby.
36
114520
1416
01:55
The next night -- on call in the emergency room,
37
115960
2256
01:58
treating a 400-pound lineman or a frail nursing-home patient
38
118240
3536
02:01
who, by most accounts, usually would get the same dose of medications
39
121800
3896
02:05
from the formulary.
40
125720
1296
02:07
Which would mean, most of the time I would be underdosing the lineman
41
127040
3336
02:10
and overdosing the nursing-home patient.
42
130400
3016
02:13
And beyond age and weight,
43
133440
1376
02:14
we tend to ignore differences in sex and race in dosing.
44
134840
2960
02:18
Now, beyond this, we know we have a massive challenge
45
138680
4176
02:22
with noncompliance or low adherence.
46
142880
2216
02:25
Many of us who need to take our medications
47
145120
2096
02:27
aren't taking them or are taking them incorrectly.
48
147240
2816
02:30
You know, 40 percent of adults in the US over 65
49
150080
2696
02:32
are on five or more prescription medications.
50
152800
2456
02:35
Sometimes 15 or more.
51
155280
1336
02:36
And even small improvements in adherence can dramatically save dollars and lives.
52
156640
5480
02:43
So, as we think into the future,
53
163440
3056
02:46
you think that where we are today,
54
166520
1776
02:48
as we often hear about smart, personalized, targeted drugs,
55
168320
3976
02:52
Internet of Things, gene therapy, AI,
56
172320
1896
02:54
that we'd already arrived in this era of precision medicine.
57
174240
2816
02:57
In reality, we still live in an age
58
177080
1696
02:58
of empiric, trial-and-error, imprecision medicine.
59
178800
2976
03:01
I think we can do better.
60
181800
1296
03:03
What if we could reimagine ways to help make your medicine-taking easier?
61
183120
4376
03:07
To get the right doses and combinations to match you?
62
187520
3616
03:11
What if we could move beyond today's literal cutting edge
63
191160
2696
03:13
of pill cutters and fax machines,
64
193880
2776
03:16
to an era where we could have better outcomes, lower costs,
65
196680
2816
03:19
saving lives and space in your medicine cabinet?
66
199520
3000
03:23
Well, I think part of the solution is all the emerging ways
67
203440
2816
03:26
that we can measure and connect our health care information.
68
206280
3496
03:29
Today, we pretty much live in a reactive, sick-care world,
69
209800
3056
03:32
siloed information that doesn't flow.
70
212880
2256
03:35
We have the potential to move into a more continuous, real-time
71
215160
2976
03:38
proactive world of true health care.
72
218160
2256
03:40
And part of that starts with the emerging world of quantified self.
73
220440
3176
03:43
We can measure so much of our physiology and behaviors today,
74
223640
3256
03:46
and often it's siloed on our phones and scales,
75
226920
2216
03:49
but it's starting to connect to our clinicians, our caregivers,
76
229160
2976
03:52
so they can better optimize prevention, diagnostics and therapy.
77
232160
3200
03:56
And when we can do that, we can do some interesting things.
78
236840
2896
03:59
Take, for example, hypertension.
79
239760
2056
04:01
It's the number one risk factor for early death and morbidity worldwide.
80
241840
3816
04:05
Half of adult Americans, on approximation, have hypertension.
81
245680
3296
04:09
Less than half have it well-controlled.
82
249000
2016
04:11
It's often because it takes two or three different classes of medications.
83
251040
3477
04:14
It's tough to do adherence and adjust your blood pressure medications.
84
254541
3315
04:17
We have 500 preventable deaths from noncontrolled hypertension
85
257880
2976
04:20
in the US every day.
86
260880
2016
04:22
But now we're in the era of connected blood pressure cuffs --
87
262920
2858
04:25
the FDA just approved a blood pressure cuff
88
265802
2054
04:27
that can go into your watch.
89
267880
1656
04:29
There are now prototypes of cuffless radar-based blood pressure devices
90
269560
3495
04:33
that can continuously stream your blood pressure.
91
273079
2657
04:35
So, in the future, I could --
92
275760
1456
04:37
instead of spot-checking my blood pressure in the clinic,
93
277240
2667
04:39
my doctor could see my real-time numbers and my trends,
94
279931
2576
04:42
and adjust them as necessary,
95
282531
2165
04:44
with the help of a blood pressure dosing algorithm
96
284720
2416
04:47
or using the Internet of Things.
97
287160
2336
04:49
Now, technology today can do even more.
98
289520
3376
04:52
My smartwatch, already today, has an EKG built in
99
292920
2376
04:55
that can be read by artificial intelligence.
100
295320
3336
04:58
I'm wearing a small, Band-Aid-sized patch,
101
298680
2936
05:01
that is live-streaming my vital signs right now.
102
301640
2256
05:03
Let's take a look.
103
303920
1216
05:05
They're actually a little concerning at the moment.
104
305160
2416
05:07
(Laughter)
105
307600
2296
05:09
Now, it's not just my real-time vitals
106
309920
2416
05:12
that can be seen by my medical team or myself,
107
312360
2176
05:14
it could be my retrospective data,
108
314560
1696
05:16
and again, that'd be used to modify dosing and medication going forward.
109
316280
3976
05:20
Even my weight can be super-quantified;
110
320280
2416
05:22
my weight, now my shape, how much body mass, fat,
111
322720
4896
05:27
muscle mass I might have,
112
327640
1256
05:28
and use that to optimize my prevention or therapy.
113
328920
2960
05:32
And it's not just for the tech-savvy.
114
332800
1816
05:34
Now, MIT engineers have modified wifi
115
334640
3136
05:37
so we can seamlessly connect and collect our vital signs
116
337800
3456
05:41
from our connected rings and smart mattresses.
117
341280
2256
05:43
We can start to share this digital exhaust, our digitome,
118
343560
2696
05:46
and even potentially crowdsource it, sharing our health information
119
346280
3216
05:49
just like we share with our Google Maps and driving,
120
349520
2456
05:52
to improve our -- not our driving, but our health experience globally.
121
352000
3720
05:56
So, that's great.
122
356880
1416
05:58
We can potentially now collect this information.
123
358320
2296
06:00
What if your labs can go from the central lab
124
360640
3776
06:04
to your home, to your phone, to even inside our bodies
125
364440
2536
06:07
to measure drug levels or other varieties?
126
367000
3016
06:10
And of course, we're in the age of genomics.
127
370040
2096
06:12
I've been sequenced, it's just less than $1,000 today.
128
372160
2896
06:15
And I can start to understand my pharmacogenomics --
129
375080
2456
06:17
how my genes impact whether I need high dose, low dose,
130
377560
2616
06:20
or maybe a different medication altogether.
131
380200
2056
06:22
Let's imagine if your physician or your pharmacist
132
382280
2776
06:25
had this information integrated into their workflow,
133
385080
2656
06:27
augmented with artificial intelligence, AI, or as I like to refer to it, IA --
134
387760
3856
06:31
intelligence augmentation,
135
391640
1576
06:33
to leverage that information;
136
393240
1416
06:34
to understand, of the 18,000 or more approved drugs,
137
394680
2576
06:37
which would be the right dose and combination for you.
138
397280
3336
06:40
So great, now maybe we can optimize your drugs and your doses,
139
400640
3016
06:43
but the problem today is, we're still using this amazing technology
140
403680
3143
06:46
to keep track of our drugs.
141
406847
1889
06:48
And of course, these technologies evolve,
142
408760
2576
06:51
there's connected dispensers, reminder apps,
143
411360
3136
06:54
smart pill bottle caps that can text or tweet you or your mother
144
414520
3016
06:57
if you haven't taken your medications.
145
417560
1856
06:59
PillPack was just acquired by Amazon,
146
419440
1816
07:01
so soon we may have same-day delivery of our drugs, delivered by drone.
147
421280
4496
07:05
So, all these things are possible today,
148
425800
2176
07:08
but we're still taking multiple pills.
149
428000
1896
07:09
What if we can make it simpler?
150
429920
1496
07:11
I think one of the solutions is to make better use of the polypill.
151
431440
3176
07:14
A polypill is the integration of multiple medications into a single pill.
152
434640
3456
07:18
And we have these today in common over-the-counter cold and flu remedies.
153
438120
3496
07:21
And there have been prevention polypill studies done,
154
441640
2496
07:24
giving combinations of statins, blood pressure, aspirin,
155
444160
2656
07:26
which in randomized studies have been shown
156
446840
2056
07:28
to dramatically reduce risk, compared to placebo.
157
448920
2336
07:31
But these polypills weren't personalized, they weren't optimized to the individual.
158
451280
3936
07:35
What if we could optimize your personalized polypill?
159
455240
2496
07:37
So it would be built for you, based on you, it could adapt to you,
160
457760
3336
07:41
even every single day.
161
461120
1776
07:42
Well, we're now in the era of 3D printing. You can print personalized braces,
162
462920
3936
07:46
hearing aids, orthopedic devices,
163
466880
1616
07:48
even I've been scanned and had my jeans tailored to fit to me.
164
468520
3456
07:52
So this got me thinking,
165
472000
1296
07:53
what if we could 3D-print your personalized polypill?
166
473320
3496
07:56
So instead of taking six medications, for example,
167
476840
2376
07:59
I could integrate them into one.
168
479240
1696
08:00
So it would be easier to take, improve adherence
169
480960
2336
08:03
and potentially, it could even integrate in supplements,
170
483320
2620
08:05
like vitamin D or CoQ10.
171
485964
3172
08:09
So with some help -- I call these "IntelliMeds" --
172
489160
2976
08:12
and with the help of my IntelliMedicine engineering team,
173
492160
2696
08:14
we built the first IntelliMedicine prototype printer.
174
494880
3016
08:17
And here's how it works:
175
497920
1216
08:19
instead of full tablets, we have small micromeds,
176
499160
2376
08:21
one or two milligrams each,
177
501560
1456
08:23
which are sorted and selected based on the dose and combination
178
503040
3016
08:26
needed for an individual.
179
506080
1616
08:27
And of course, these would be doses and combinations
180
507720
2456
08:30
you could already take together, FDA-approved drugs.
181
510200
2456
08:32
We could change the pharmacokinetics
182
512680
1816
08:34
by professionally layering on different elements to the individual micromeds.
183
514520
3960
08:39
And when we hit print,
184
519560
1656
08:41
you print your combination of medications that might be needed by you
185
521240
3256
08:44
on any individual day.
186
524520
1736
08:46
And we'd start with, again, generic drugs for the most common problems.
187
526280
3896
08:50
About 90 percent of prescribed drugs today are low-cost generics.
188
530200
3656
08:53
And once we've printed the pill, we can do some fun bells and whistles.
189
533880
3336
08:57
We could print the name of the patient,
190
537240
2256
08:59
the date, the day of the week, a QR code.
191
539520
2536
09:02
We could print different meds for tapering for a patient on a steroid taper,
192
542080
4016
09:06
or tapering from pain medications.
193
546120
2816
09:08
So, this is actually a look at our prototype IntelliMedicine printer.
194
548960
4976
09:13
See, I'll unveil it here.
195
553960
1976
09:15
It has about 16 different silos,
196
555960
2936
09:18
each containing individual micromeds.
197
558920
2600
09:22
And I can now adjust on the software individual dosings.
198
562680
4216
09:26
And when I do that, the robotic arm will adjust
199
566920
3456
09:30
the height of these spansules and the micromeds will release.
200
570400
3096
09:33
I can now --
201
573520
1536
09:35
The automated process would rotate and cycle through,
202
575080
2496
09:37
to make sure the micromeds are loaded.
203
577600
1856
09:39
And when I hit print,
204
579480
1776
09:41
these will all fall through the device,
205
581280
2416
09:43
I now pull out my personalized printed polypill
206
583720
3616
09:47
with the doses and medications meant for me.
207
587360
3976
09:51
And we can take a look, if you look back to the slides,
208
591360
2616
09:54
you can see the whole process, we can see the drug silos being selected,
209
594000
3976
09:58
the pills doing down the different silos,
210
598000
1976
10:00
and being collected in the individual capsule.
211
600000
2816
10:02
Now, this is great,
212
602840
1696
10:04
I can potentially print my meds based on me,
213
604560
2056
10:06
instead of taking six pills.
214
606640
1376
10:08
I can now be looking at my individual dosing.
215
608040
3136
10:11
My smartwatch is looking at my blood pressure:
216
611200
2176
10:13
I needed an adjustment in my blood pressure medicines,
217
613400
2576
10:16
my coumadin level. My blood is too thin,
218
616000
2696
10:18
so I lower my micromed dose of coumadin, a blood thinner.
219
618720
3576
10:22
So, this could be smartly adapted, day to day,
220
622320
2176
10:24
programmed by my physician or cardiologist.
221
624520
2656
10:27
And you can imagine that larger printers, fast printers like this,
222
627200
3576
10:30
could be in your corner pharmacy,
223
630800
2736
10:33
in your doctor's office, in a rural clinic.
224
633560
2216
10:35
But it could eventually merge and shrink to small ones that could be in your home
225
635800
3936
10:39
with integrated cartridges like this that are delivered by drone.
226
639760
3376
10:43
Could print your personalized polypill,
227
643160
2056
10:45
each morning on your kitchen or your bathroom cabinet.
228
645240
3296
10:48
And this could evolve, I think,
229
648560
1816
10:50
into an incredible way to improve adherence in medications across the globe.
230
650400
3816
10:54
So, I hope we can reimagine the future of medicine in new ways,
231
654240
4016
10:58
moving from polypharmacy,
232
658280
1536
10:59
one-size-fits-all, low adherence, complications
233
659840
3456
11:03
to an era of personalized, precise, on-demand medications
234
663320
4056
11:07
that can take us and individualize our own health
235
667400
3376
11:10
and health and medicine around the planet.
236
670800
2696
11:13
Thank you very much.
237
673520
1256
11:14
(Applause)
238
674800
5520
11:21
Host: Daniel, that's kind of awesome.
239
681880
2056
11:23
Really cool.
240
683960
1216
11:25
Question for you, though.
241
685200
1376
11:26
How long is it until, say, that nursing-home patient that you mentioned
242
686600
3536
11:30
is able to print their pills in their home?
243
690160
2576
11:32
Daniel Kraft: Well, again, this is just a prototype.
244
692760
2776
11:35
We think that the regulatory route [may] be automated compounding,
245
695560
3136
11:38
and especially in nursing homes, folks are taking multiple medications,
246
698720
3270
11:41
and they're often mixed up,
247
701990
1380
11:43
so it would be a perfect place to start with these technologies.
248
703370
3000
11:46
These aren't going to evolve and start with printers on your bathroom counter.
249
706370
3660
11:50
We need to be intelligent and smart about how we roll these things out,
250
710030
3350
11:53
but realizing there's so many challenges with dosing, adherence and precision,
251
713380
3660
11:57
and now that we have all these amazing new technologies
252
717040
2570
11:59
that can integrate and be leveraged, I think we need approaches like this
253
719610
2090
12:01
to really catalyze and foster
254
721700
2480
12:04
a true future of health and medicine.
255
724180
1840
12:06
Host: Great, thank you. DK: Thanks.
256
726020
2316
12:08
(Applause)
257
728360
2480
About this website

This site will introduce you to YouTube videos that are useful for learning English. You will see English lessons taught by top-notch teachers from around the world. Double-click on the English subtitles displayed on each video page to play the video from there. The subtitles scroll in sync with the video playback. If you have any comments or requests, please contact us using this contact form.

https://forms.gle/WvT1wiN1qDtmnspy7