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

Translator: antía - Reviewer: Serv. de Norm. Lingüística U. de Santiago de Compostela

We live in a medication nation.

Vivimos nunha nación medicada.

4.5 billion drug prescriptions will be prescribed by doctors like me

Médicos coma min prescribirán 4.500 millóns de medicamentos

this year, in the United States alone.

este ano, só nos Estados Unidos.

That's 15 for every man, woman and child.

Iso son 15 para cada home, muller e neno.

And for most of us,

E, para a maioría de nós,

our experience with this medication is often a confusing number of pills,

a experiencia coa medicación é a miúdo un confuso número de pílulas,

instructions, side effects, one-size-fits-all dosing,

instrucións, efectos secundarios e doses únicas,

which all too often we aren't taking as prescribed.

que moitas veces non tomamos como nos prescribiron.

And this comes at tremendous expense,

Isto supón un gasto tremendo

costing us our time, our money and our health.

de tempo, cartos e saúde.

And in our now exponential, connected, data-driven age,

E nesta era exponencial, conectada e orientada aos datos,

I think we can and we must do better.

coido que podemos e debemos facelo mellor.

So let's take a dive at some of the challenges we have

Mergullémonos nalgúns dos retos que temos

and some potential solutions.

e as súas posibles solucións.

Let's start with the fact

Comecemos co feito

that many drugs don't work for those who are prescribed them.

de que moitos remedios non funcionan a quen se lles receitan.

The top 10 grossing drugs in the United States this year,

Os 10 medicamentos máis vendidos este ano nos Estados Unidos

they only benefit one in four to one in 23 of who take them.

só benefician a entre un de cada catro e un de cada 23 dos que os toman.

That's great if you're number one, but what about everybody else?

É estupendo se es o número un, pero... que pasa cos demais?

And what's worse, drugs, when they sometimes don't work,

E o que é peor, os medicamentos, aínda cando non funcionan,

can still cause side effects.

poden ter efectos secundarios.

Take aspirin -- about one in four of us

Por exemplo, a aspirina; un de cada catro

who take aspirin to reduce our risk of cardiovascular disease

dos que a toman para reducir o risco de doenza cardiovascular

are unknowingly aspirin-resistant

é, sen sabelo, resistente a ela

and still have the same risks of gastrointestinal bleeds

e aínda así ten o mesmo risco de sufrir o sangrado intestinal

that kill thousands every year.

que mata milleiros cada ano.

It's adverse drug reactions like these

Reaccións adversas coma esta son,

that are, by some estimates, the number four leading cause of death

segundo algunhas estimacións, a cuarta causa de morte nos EEUU.

in the United States.

O meu avó faleceu tras unha soa dose de antibiótico

My own grandfather passed away

after a single dose of antibiotic caused his kidneys to fail.

que lle provocou un fallo renal.

Now, adverse drug reactions and side effects

As reaccións adversas e os efectos secundarios

are often tied to challenges in dosing.

están moitas veces relacionados coa dosificación

I trained in pediatrics (little people) and internal medicine (big people).

Formeime en pediatría (xente pequena) e medicina interna (xente grande)

So one night I might have been on call in the NICU,

Unha noite podía ter que estar na UCI pediátrica,

carefully dosing to the fraction of a milligram

medindo á fracción do miligramo

a medication for a NICU baby.

a medicación para un bebé;

The next night -- on call in the emergency room,

Á noite seguinte, na sala de urxencias,

treating a 400-pound lineman or a frail nursing-home patient

tratando un defensa de 180 quilos ou un fráxil paciente dunha residencia

who, by most accounts, usually would get the same dose of medications

que, normalmente, recibirían a mesma dose de medicamento segundo o manual.

from the formulary.

Which would mean, most of the time I would be underdosing the lineman

Isto implica que, moitas das veces, estaría inframedicando o defensa

and overdosing the nursing-home patient.

e sobremedicando o paciente da residencia.

And beyond age and weight,

E ademais da idade ou o peso

we tend to ignore differences in sex and race in dosing.

tendemos a ignorar o sexo e a raza na dosificación.

Now, beyond this, we know we have a massive challenge

Alén disto, temos un reto enorme

with noncompliance or low adherence.

cos incumprimentos e a baixa adherencia.

Many of us who need to take our medications

Moitos dos que precisamos medicación

aren't taking them or are taking them incorrectly.

non a estamos tomando ou estámolo a facer mal.

You know, 40 percent of adults in the US over 65

Nos EE.UU., o 40% dos adultos maiores de 65 anos

are on five or more prescription medications.

teñen prescritos 5 medicamentos ou máis.

Sometimes 15 or more.

Ás veces máis de 15.

And even small improvements in adherence can dramatically save dollars and lives.

E incluso pequenas melloras na adherencia poden salvar moitos cartos e vidas.

So, as we think into the future,

Así que, cando pensamos no futuro,

you think that where we are today,

cremos que aí é onde estamos hoxe,

as we often hear about smart, personalized, targeted drugs,

pois a miúdo oímos falar de fármacos intelixentes, personalizados, dirixidos,

Internet of Things, gene therapy, AI,

do Internet das Cousas, a terapia xénica, a IA,

that we'd already arrived in this era of precision medicine.

que chegamos á era da medicina de precisión.

In reality, we still live in an age

En realidade, aínda vivimos

of empiric, trial-and-error, imprecision medicine.

nunha era de empirismo, de ensaio-erro, de medicina imprecisa.

I think we can do better.

Podemos facelo mellor.

What if we could reimagine ways to help make your medicine-taking easier?

E se reimaxinásemos o xeito de que tomar as menciñas fose moito máis doado?

To get the right doses and combinations to match you?

De tomar as doses e combinacións que mellor funcionan para ti?

What if we could move beyond today's literal cutting edge

E se puidésemos deixar atrás a realidade

of pill cutters and fax machines,

dos cortadores de pastillas e as máquinas de fax

to an era where we could have better outcomes, lower costs,

e comezar a obter mellores resultados con custos máis baixos

saving lives and space in your medicine cabinet?

e salvar vidas e aforrar espazo na túa caixa de urxencias?

Well, I think part of the solution is all the emerging ways

Coido que parte da solución está nas novas formas

that we can measure and connect our health care information.

nas que podemos medir e compartir a información sobre a nosa saúde.

Today, we pretty much live in a reactive, sick-care world,

Vivimos nun mundo reactivo, de coidado dos enfermos,

siloed information that doesn't flow.

onde a información fica almacenada.

We have the potential to move into a more continuous, real-time

Temos o potencial de mudalo a un mundo dinámico,

proactive world of true health care.

proactivo, de verdadeiro coidado da saúde.

And part of that starts with the emerging world of quantified self.

Parte diso comeza co mundo emerxente do eu cuantificado.

We can measure so much of our physiology and behaviors today,

Podemos medir moito da nosa fisioloxía e dos nosos costumes,

and often it's siloed on our phones and scales,

que moitas veces fica nos nosos móbiles,

but it's starting to connect to our clinicians, our caregivers,

pero estamos comezando a conectar cos médicos e os coidadores

so they can better optimize prevention, diagnostics and therapy.

para que poidan optimizar a prevención, o diagnóstico e a terapia.

And when we can do that, we can do some interesting things.

E cando o consigamos, poderemos facer outras cousas interesantes.

Take, for example, hypertension.

Tomemos, por exemplo, a hipertensión.

It's the number one risk factor for early death and morbidity worldwide.

É o primeiro factor de risco de morte prematura e morbilidade no mundo.

Half of adult Americans, on approximation, have hypertension.

Arredor da metade dos norteamericanos adultos teñen hipertensión.

Less than half have it well-controlled.

Menos da metade téñena ben controlada.

It's often because it takes two or three different classes of medications.

Isto ocorre porque ás veces fan falta dous ou tres tipos de medicamentos.

It's tough to do adherence and adjust your blood pressure medications.

E é difícil axustar as doses e seguir os tratamentos.

We have 500 preventable deaths from noncontrolled hypertension

Cada día, hai 500 mortes evitables nos Estados Unidos

in the US every day.

debido á hipertensión non controlada.

But now we're in the era of connected blood pressure cuffs --

Pero agora estamos na era do medidor de tensión conectado.

the FDA just approved a blood pressure cuff

A FDA vén de aprobar un medidor de tensión que pode colocarse no teu reloxo.

that can go into your watch.

There are now prototypes of cuffless radar-based blood pressure devices

Existen prototipos de medidores baseados na tecnoloxía do radar

that can continuously stream your blood pressure.

que poden compartir en directo a túa presión sanguínea

So, in the future, I could --

Así que, no futuro, podería,

instead of spot-checking my blood pressure in the clinic,

no canto de medir a miña tensión nun centro de saúde,

my doctor could see my real-time numbers and my trends,

o meu doutor podería ver os meus datos en tempo real

and adjust them as necessary,

e axustalos segundo fose necesario,

with the help of a blood pressure dosing algorithm

coa axuda dun algoritmo dosificador para a presión

or using the Internet of Things.

ou usando o Internet das Cousas.

Now, technology today can do even more.

Pero hoxe a tecnoloxía pode facer incluso máis.

My smartwatch, already today, has an EKG built in

O meu reloxo intelixente ten unha función ECG

that can be read by artificial intelligence.

que pode ser interpretada pola intelixencia artificial.

I'm wearing a small, Band-Aid-sized patch,

Levo un pequeno adhesivo, do tamaño dun parche,

that is live-streaming my vital signs right now.

que está a emitir os meus signos vitais en directo.

Let's take a look.

Botémoslle un ollo.

They're actually a little concerning at the moment.

A verdade é que son un pouco preocupantes.

(Laughter)

(Risos)

Now, it's not just my real-time vitals

Ben, non son só os meus signos vitais actuais

that can be seen by my medical team or myself,

os que o meu equipo médico ou eu podemos ver,

it could be my retrospective data,

podería ser todo o meu historial,

and again, that'd be used to modify dosing and medication going forward.

e, de novo, podería usarse para modificar a medicación e a dose no futuro.

Even my weight can be super-quantified;

Incluso o meu peso pode ser cuantificable;

my weight, now my shape, how much body mass, fat,

o meu peso, a miña figura,

canta masa, graxa, músculo debería ter,

muscle mass I might have,

and use that to optimize my prevention or therapy.

e usar esta información para optimizar a prevención ou a terapia.

And it's not just for the tech-savvy.

E non é só para os máis tecnolóxicos.

Now, MIT engineers have modified wifi

Os enxeñeiros do MIT veñen de modificar a wifi

so we can seamlessly connect and collect our vital signs

para que poidamos recoller e conectar os nosos signos vitais

from our connected rings and smart mattresses.

dende aneis conectados e colchóns intelixentes.

We can start to share this digital exhaust, our digitome,

Podemos comezar a compartir esta información, o digitome,

and even potentially crowdsource it, sharing our health information

e compartir a nosa información sanitaria mediante crowdsourcing

just like we share with our Google Maps and driving,

igual que compartimos a condución con Google Maps,

to improve our -- not our driving, but our health experience globally.

para mellorar a nosa experiencia global de saúde.

So, that's great.

Así que, xenial,

We can potentially now collect this information.

podemos recoller esta información.

What if your labs can go from the central lab

E se os laboratorios puidesen ir dende as súas centrais

to your home, to your phone, to even inside our bodies

ao teu fogar, ao teu móbil, mesmo ao interior do corpo

to measure drug levels or other varieties?

para medir os niveis de fármacos ou outros parámetros?

And of course, we're in the age of genomics.

E, por suposto, estamos na era da xenómica.

I've been sequenced, it's just less than $1,000 today.

Eu secuenciei o meu xenoma, hoxe custa menos de 1.000 dólares.

And I can start to understand my pharmacogenomics --

E podo comezar a entender a miña farmacoxenética,

how my genes impact whether I need high dose, low dose,

como os meus xenes determinan se preciso máis ou menos dose

or maybe a different medication altogether.

ou un tratamento completamente diferente.

Let's imagine if your physician or your pharmacist

Imaxina que o teu médico ou o teu farmacéutico

had this information integrated into their workflow,

teñen esta información integrada no fluxo de traballo,

augmented with artificial intelligence, AI, or as I like to refer to it, IA --

aumentada coa intelixencia artificial, IA, ou como eu lle chamo, AI

intelligence augmentation,

aumento da intelixencia,

to leverage that information;

para poder aproveitala,

to understand, of the 18,000 or more approved drugs,

para entender, dos máis de 18.000 fármacos aprobados,

which would be the right dose and combination for you.

cal sería a dose e a combinación correctas para ti.

So great, now maybe we can optimize your drugs and your doses,

Ben, quizais agora poidamos optimizar a medicación e a dose,

but the problem today is, we're still using this amazing technology

pero o problema hoxe é que aínda usamos esta tecnoloxía para facer

to keep track of our drugs.

o seguimento dos nosos medicamentos.

And of course, these technologies evolve,

Por suposto, esta tecnoloxía evoluciona,

there's connected dispensers, reminder apps,

hai dispensadores conectados, aplicacións de recordatorio,

smart pill bottle caps that can text or tweet you or your mother

tapas intelixentes que poden mandarche un chío, a ti ou á túa nai

if you haven't taken your medications.

se non tomaches a túa menciña.

PillPack was just acquired by Amazon,

Amazon vén de adquirir PillPack,

so soon we may have same-day delivery of our drugs, delivered by drone.

así que pronto teremos envío nun día de medicamentos, repartidos por dron.

So, all these things are possible today,

Todas estas cousas son hoxe posibles,

but we're still taking multiple pills.

pero aínda tomamos unha chea de pílulas.

What if we can make it simpler?

E se puidésemos facelo máis doado?

I think one of the solutions is to make better use of the polypill.

Coido que unha das solucións é usar mellor a polipílula.

A polypill is the integration of multiple medications into a single pill.

Unha polipílula é a integración de varios fármacos nunha soa pílula.

And we have these today in common over-the-counter cold and flu remedies.

Xa as usamos hoxe nas menciñas contra a gripe e os catarros.

And there have been prevention polypill studies done,

E existen estudos de prevención con polipílulas,

giving combinations of statins, blood pressure, aspirin,

nos que a combinación de estatinas, tensión, aspirina

which in randomized studies have been shown

demostrou en estudos aleatorizados

to dramatically reduce risk, compared to placebo.

reducir moito o risco, comparado co placebo.

But these polypills weren't personalized, they weren't optimized to the individual.

Pero estas polipílulas non eran personalizadas, optimizadas ao individuo.

What if we could optimize your personalized polypill?

E se puidésemos personalizar a túa polipílula?

So it would be built for you, based on you, it could adapt to you,

Estaría feita para ti, baseada en ti, podería adaptarse a ti,

even every single day.

todos e cada un dos días.

Well, we're now in the era of 3D printing. You can print personalized braces,

Agora estamos na era da impresión 3D. Podes imprimir próteses personalizadas,

hearing aids, orthopedic devices,

audiófonos, aparatos ortopédicos,

even I've been scanned and had my jeans tailored to fit to me.

a min incluso me escanearon para facerme uns vaqueiros a medida.

So this got me thinking,

Isto fíxome pensar...

what if we could 3D-print your personalized polypill?

e se puidésemos imprimir a túa polipílula personalizada en 3D?

So instead of taking six medications, for example,

Así, no canto de tomar seis menciñas, por exemplo,

I could integrate them into one.

poderías combinalas nunha soa.

So it would be easier to take, improve adherence

Sería máis doada de tomar, melloraría a adherencia

and potentially, it could even integrate in supplements,

e sería posible incluso integrar suplementos,

like vitamin D or CoQ10.

como a vitamina D ou o CoQ10.

So with some help -- I call these "IntelliMeds" --

Así que, con algunha axuda,

eu chámolles "IntelliMeds",

and with the help of my IntelliMedicine engineering team,

e a axuda do meu equipo de enxeñeiros de IntelliMedicine

we built the first IntelliMedicine prototype printer.

construímos o primeiro prototipo de impresora IntelliMedicine.

And here's how it works:

E así é como funciona:

instead of full tablets, we have small micromeds,

no canto de blísters, hai pequenas micromenciñas,

one or two milligrams each,

dun ou dous miligramos,

which are sorted and selected based on the dose and combination

que se ordenan e seleccionan en base á dose e combinación

needed for an individual.

necesaria para un individuo.

And of course, these would be doses and combinations

Por suposto, habería doses e combinacións

you could already take together, FDA-approved drugs.

que xa estarían dispoñibles, as aprobadas pola FDA.

We could change the pharmacokinetics

Podemos cambiar a farmacocinética,

by professionally layering on different elements to the individual micromeds.

superpoñendo profesionalmente diferentes elementos nas micromenciñas individuais.

And when we hit print,

E, cando prememos imprimir,

you print your combination of medications that might be needed by you

imprimes a combinación de medicamentos que poderías precisar un día calquera.

on any individual day.

And we'd start with, again, generic drugs for the most common problems.

Comezariamos con fármacos xenéricos para os problemas máis comúns.

About 90 percent of prescribed drugs today are low-cost generics.

Case o 90% dos medicamentos que se prescriben son xenéricos de baixo custo.

And once we've printed the pill, we can do some fun bells and whistles.

E unha vez que temos a pílula impresa, podemos facer cousas divertidas.

We could print the name of the patient,

Podemos imprimir o nome do paciente,

the date, the day of the week, a QR code.

a data, o día da semana, un código QR.

We could print different meds for tapering for a patient on a steroid taper,

Podemos imprimir menciñas diferentes para reducir a dose de esteroides dun paciente,

or tapering from pain medications.

ou para reducir as medicacións para a dor.

So, this is actually a look at our prototype IntelliMedicine printer.

Esta é unha ollada ao noso prototipo de impresora IntelliMedicine.

See, I'll unveil it here.

Vouna desvelar.

It has about 16 different silos,

Ten uns 16 silos diferentes,

each containing individual micromeds.

cada un con micromenciñas individuais.

And I can now adjust on the software individual dosings.

Agora podo axustar co software as doses individuais.

And when I do that, the robotic arm will adjust

E cando o fago, o brazo robótico axusta

the height of these spansules and the micromeds will release.

a abertura destas cápsulas para que liberen as micromenciñas.

I can now --

Agora podo --

The automated process would rotate and cycle through,

O proceso automatizado vai rotar

to make sure the micromeds are loaded.

para asegurar que se cargan as menciñas.

And when I hit print,

E, cando premo imprimir,

these will all fall through the device,

caerá a través da máquina,

I now pull out my personalized printed polypill

e agora recollo a miña polipílula personalizada

with the doses and medications meant for me.

coa medicación e a dose específicas para min.

And we can take a look, if you look back to the slides,

E podemos botar unha ollada, se mirades a presentación,

you can see the whole process, we can see the drug silos being selected,

podedes ver o proceso enteiro, como se seleccionan os silos das menciñas,

the pills doing down the different silos,

as pastillas caendo dos diferentes silos,

and being collected in the individual capsule.

e xuntándose na cápsula individual.

Now, this is great,

Isto é xenial,

I can potentially print my meds based on me,

podo imprimir as menciñas feitas para min

instead of taking six pills.

en vez de tomar seis pílulas.

I can now be looking at my individual dosing.

Agora podo controlar a miña dosificación.

My smartwatch is looking at my blood pressure:

O meu reloxo está medindo a miña tensión:

I needed an adjustment in my blood pressure medicines,

preciso axustar a miña menciña para controlala, o meu nivel de Coumadin.

my coumadin level. My blood is too thin,

O meu sangue está diluído,

so I lower my micromed dose of coumadin, a blood thinner.

así que baixo na miña micromenciña a dose de Coumadin, un anticoagulante.

So, this could be smartly adapted, day to day,

E podería adaptarse así todos os días,

programmed by my physician or cardiologist.

de maneira controlada polo meu médico ou cardiólogo.

And you can imagine that larger printers, fast printers like this,

Podedes imaxinar impresoras máis grandes, rápidas coma esta,

could be in your corner pharmacy,

na farmacia da esquina,

in your doctor's office, in a rural clinic.

na consulta do médico, nun centro de saúde rural.

But it could eventually merge and shrink to small ones that could be in your home

Pero co tempo poderán facerse máis pequenas e colocarse no teu fogar,

with integrated cartridges like this that are delivered by drone.

con cartuchos integrados coma este, que serían repartidos por dron.

Could print your personalized polypill,

Poderías imprimir a túa propia polipílula,

each morning on your kitchen or your bathroom cabinet.

cada mañá na túa cociña ou no armario do teu baño.

And this could evolve, I think,

E podería evolucionar, penso,

into an incredible way to improve adherence in medications across the globe.

nun xeito incrible de mellorar a adherencia das menciñas en todo o mundo.

So, I hope we can reimagine the future of medicine in new ways,

Agardo que poidamos reimaxinar o futuro da medicina de novas maneiras

moving from polypharmacy,

pasando da polifarmacia,

one-size-fits-all, low adherence, complications

as doses únicas, a baixa adherencia e as complicacións

to an era of personalized, precise, on-demand medications

a unha era de medicacións personalizadas, precisas e baixo demanda,

that can take us and individualize our own health

que poidan levarnos a individualizar a nosa propia saúde

and health and medicine around the planet.

e a saúde e a medicina en todo o planeta.

Thank you very much.

Moitas grazas.

(Applause)

(Aplausos)

Host: Daniel, that's kind of awesome.

Presentadora: Daniel, iso é incrible.

Really cool.

Realmente xenial.

Question for you, though.

Pero teño unha pregunta.

How long is it until, say, that nursing-home patient that you mentioned

Canto pasará ata que o paciente da residencia que mencionaches

is able to print their pills in their home?

sexa capaz de imprimir as súas propias pílulas?

Daniel Kraft: Well, again, this is just a prototype.

Daniel Kraft: Ben, isto é só un prototipo.

We think that the regulatory route [may] be automated compounding,

Pensamos que o camiño para regulalo será o proceso automatizado,

and especially in nursing homes, folks are taking multiple medications,

sobre todo, nas residencias, onde a xente toma moitas menciñas

and they're often mixed up,

que ás veces se mesturan,

so it would be a perfect place to start with these technologies.

así que sería un lugar perfecto para comezar con esta tecnoloxía.

These aren't going to evolve and start with printers on your bathroom counter.

Non van evolucionar e comezar con impresoras no armario do teu baño.

Precisamos ser intelixentes e listos ao manexar estas cousas,

We need to be intelligent and smart about how we roll these things out,

pero decatándonos dos retos coa dosificación, a adherencia e a precisión,

but realizing there's so many challenges with dosing, adherence and precision,

e agora que temos estas novas tecnoloxías que podemos aproveitar e integrar,

and now that we have all these amazing new technologies

that can integrate and be leveraged, I think we need approaches like this

coido que precisamos novos enfoques como este para activar e fomentar

to really catalyze and foster

un verdadeiro futuro da saúde e da medicina.

a true future of health and medicine.

Presentadora: Moi ben, grazas. Daniel Kraft: Grazas.

Host: Great, thank you. DK: Thanks.

(Applause)

(Aplausos)