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

Prevodilac: Teodora Bisenic Lektor: Milenka Okuka

Živimo u naciji lekova.

4,5 milijardi recepata za lekove biće prepisano od strane lekara poput mene

We live in a medication nation.

ove godine, samo u SAD-u.

To je 15 po svakom muškarcu, ženi i detetu.

4.5 billion drug prescriptions will be prescribed by doctors like me

A za većinu nas,

iskustvo sa ovim lekovima je često zbunjujući broj pilula,

this year, in the United States alone.

uputstava, nuspojava, univerzalnih doziranja,

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

And for most of us,

koje prečesto ne uzimamo kako je prepisano.

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

A to nosi ogromnu cenu,

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

koštajući nas vremena, novca i zdravlja.

A u našem sada brzom, povezanom, vremenu kojim caruju podaci,

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

And this comes at tremendous expense,

mislim da možemo i moramo raditi bolje.

costing us our time, our money and our health.

Zato uronimo u neke od izazova koje imamo

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

i u neka potencijalna rešenja.

I think we can and we must do better.

Počnimo činjenicom

da mnogi lekovi ne deluju kod onih kojima su prepisani.

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

Deset lekova koji donose najveći profit u Sjedinjenim Državama ove godine,

and some potential solutions.

Let's start with the fact

donose korist samo jednoj od četiri do jednoj od 23 osobe koje ih koriste.

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

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

To je sjajno ako ste broj jedan, ali šta je sa svima ostalima?

A što je još gore, lekovi, kad nekad ne deluju,

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

ipak mogu izazvati nuspojave.

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

Evo aspirin - oko jedno od nas četvoro

koji ga uzimamo da umanjimo rizik od kardiovaskularne bolesti

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

smo ne znajući rezistentni na apirin,

a i dalje imamo iste rizike od gastrointestinalnog krvarenja

can still cause side effects.

Take aspirin -- about one in four of us

koji ubiju na hiljade ljudi svake godine.

who take aspirin to reduce our risk of cardiovascular disease

Neželjene reakcije poput ovih

are unknowingly aspirin-resistant

and still have the same risks of gastrointestinal bleeds

su, po nekim procenama, četvrti najčešći uzrok smrti

that kill thousands every year.

u Sjedinjenim Državama.

Moj deda je umro

It's adverse drug reactions like these

nakon jedne doze antibiotika zbog koje su mu otkazali bubrezi.

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

Neželjene reakcije i nuspojave

in the United States.

često su povezane sa izazovima doziranja.

My own grandfather passed away

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

Obučavao sam se u pedijatriji (mali ljudi) i internoj medicini (veliki ljudi).

Now, adverse drug reactions and side effects

Jedne noći sam bio na odeljenju za neonatalnu intenzivnu negu,

are often tied to challenges in dosing.

pažljivo dozirajući u delić miligrama

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

lek za bebu na odeljenju.

Sledeće noći - na dužnosti u urgentnom centru,

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

tretirajući fudbalera od 180kg ili krhkog pacijenta iz staračkog doma

carefully dosing to the fraction of a milligram

koji bi, po svemu sudeći, obično dobili istu dozu lekova

a medication for a NICU baby.

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

sa liste.

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

Što bi značilo, većinu vremena davao bih nižu dozu fudbaleru,

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

a višu dozu pacijentu iz staračkog doma.

A sem godina i telesne mase,

from the formulary.

imamo običaj da ignorišemo polne i rasne razlike pri doziranju.

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

and overdosing the nursing-home patient.

Sad, sem ovoga, znamo da imamo ogroman izazov

And beyond age and weight,

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

sa neposlušnošću ili slabim pridržavanjem.

Mnogi od nas koji treba da uzimamo lekove

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

ne uzimamo ih ili ih uzimamo pogrešno.

Znate, 40 procenata odraslih u SAD-u starijih od 65

with noncompliance or low adherence.

su na pet ili više prepisanih lekova.

Many of us who need to take our medications

Nekad 15 ili više.

aren't taking them or are taking them incorrectly.

A čak mala poboljšanja u pridržavanju mogu drastično da uštede dolare i spasu živote.

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

are on five or more prescription medications.

Tako da, kako gledamo u budućnost,

Sometimes 15 or more.

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

pomislili biste da ovo gde smo danas,

pošto često slušamo o pametnim, personalizovanim, ciljanim lekovima,

So, as we think into the future,

internetu stvari, genskoj terapiji, VI,

da smo već stigli u ovu eru precizne medicine.

you think that where we are today,

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

U stvarnosti, i dalje živimo u dobu

empirijske, neprecizne medicine nagađanja.

Internet of Things, gene therapy, AI,

Mislim da možemo bolje.

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

Šta kad bismo mogli da iznova smislimo načine da učinimo uzimanje lekova lakšim?

In reality, we still live in an age

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

Da učinimo da prave doze i kombinacije odgovaraju vama?

I think we can do better.

Šta kad bismo mogli da napredujemo od današnjeg vrhunca

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

sekača za tablete i faks mašina,

To get the right doses and combinations to match you?

do doba u kom bismo mogli da imamo bolje ishode, niže cene,

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

spasavajući živote i štedeći prostor u ormariću za lekove?

of pill cutters and fax machines,

Pa, mislim da je deo rešenja svi načini koji se pojavljuju

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

pomoću kojih možemo da izmerimo i povežemo naše zdravstvene podatke.

saving lives and space in your medicine cabinet?

Danas uglavnom živimo u reaktivnom svetu brige o bolesnima,

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

sa izolovanim informacijama bez protoka.

that we can measure and connect our health care information.

Imamo mogućnost da pređemo u neprekidan, u realnom vremenu

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

proaktivan svet prave zdravstvene zaštite.

A deo toga počinje sa trendom vođenja evidencije o ličnim navikama.

siloed information that doesn't flow.

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

Možemo izmeriti toliko parametara naše fiziologije i ponašanja danas,

proactive world of true health care.

a često nam je to izolovano na telefonima i vagama,

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

ali počinje da se povezuje sa našim lekarima, starateljima,

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

tako da mogu bolje optimizovati prevenciju, dijagnostiku i terapiju.

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

A kada postignemo sve to, moći ćemo neke zanimljive stvari.

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

Uzmite, na primer, hipertenziju.

so they can better optimize prevention, diagnostics and therapy.

To je faktor broj jedan za preranu smrt i morbiditet širom sveta.

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

Polovina odraslih Amerikanaca, približno, pate od hipertenzije.

Take, for example, hypertension.

Manje od polovine je drže pod kontrolom.

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

To je često zato što su potrebne dve ili tri različite vrste lekova.

Half of adult Americans, on approximation, have hypertension.

Teško je pridržavati se i prilagođavati krvni pritisak lekovima.

Less than half have it well-controlled.

Imamo 500 bespotrebnih smrti od nekontrolisane hipertenzije

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

u SAD-u svaki dan.

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

Ali sada smo u dobu narukvica za merenje krvnog pritiska -

We have 500 preventable deaths from noncontrolled hypertension

Agencija za hranu i lekove je odobrila jednu

koja može da se ubaci u ručni sat.

in the US every day.

Postoje modeli uređaja za merenje pritiska na bazi radara bez narukvica

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

koji neprekidno očitavaju vaš krvni pritisak.

the FDA just approved a blood pressure cuff

that can go into your watch.

Pa, u budućnosti, mogao bih -

umesto nasumične kontrole pritiska na klinici,

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

lekar bi video moje brojke u realnom vremenu i navike,

that can continuously stream your blood pressure.

i prilagodio ih po potrebi,

So, in the future, I could --

pomoću algoritma za doziranje za pritisak

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

ili koristeći internet stvari.

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

Sad, tehnologija danas može još više.

and adjust them as necessary,

with the help of a blood pressure dosing algorithm

Moj pametni sat, već danas, ima ugrađen EKG

koga može da očita veštačka inteligencija.

or using the Internet of Things.

Now, technology today can do even more.

Nosim mali povez veličine flastera,

My smartwatch, already today, has an EKG built in

koji upravo očitava moje vitalne funkcije.

that can be read by artificial intelligence.

Pogledajmo.

Zapravo su trenutno malo zabrinjavajuće.

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

(Smeh)

that is live-streaming my vital signs right now.

Sad, nisu samo vitalne funkcije u realnom vremenu

Let's take a look.

ono što može videti moj medicinski tim ili ja,

They're actually a little concerning at the moment.

to mogu biti retrospektivni podaci,

(Laughter)

i opet, bili bi korišćeni za modifikaciju doziranja kako napredujemo.

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

Čak moja težina može biti precizno merena;

that can be seen by my medical team or myself,

it could be my retrospective data,

moja težina, moja trenutna kondicija, koliko telesne mase, masti,

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

mišićne mase možda imam,

Even my weight can be super-quantified;

i koristim to da optimizujem svoju prevenciju ili terapiju.

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

I to nije samo za tehnički potkovane.

Inženjeri sa MIT-a su modifikovali vaj-faj

muscle mass I might have,

and use that to optimize my prevention or therapy.

tako da možemo glatko da se povezujemo i prikupljamo vitalne znake

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

sa svog povezanog prstenja i pametnih dušeka.

Now, MIT engineers have modified wifi

Možemo da delimo ovaj digitalni izbljuvak, naš digitom

so we can seamlessly connect and collect our vital signs

i čak ga možemo da kraudsorsujemo, deleći naše zdravstvene podatke

from our connected rings and smart mattresses.

isto kao što delimo sa Gugl mapama dok vozimo,

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

da bismo poboljšali - ne vožnju, već svoje zdravstveno iskustvo globalno.

and even potentially crowdsource it, sharing our health information

Tako da, to je super.

just like we share with our Google Maps and driving,

Možemo možda sada da prikupljamo ove podatke.

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

Šta ako vaše laboratorije mogu da idu od centralne laboratorije

do vašeg doma, vašeg telefona, čak unutar vaših tela

So, that's great.

We can potentially now collect this information.

kako bi izmerili nivoe leka ili druge stvari?

What if your labs can go from the central lab

I naravno, u dobu smo genomike.

Sekvenciran sam, košta nešto manje od 1000$ danas.

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

I mogu početi da razumem svoju farmakogenomiku -

to measure drug levels or other varieties?

kako moji geni utiču na to treba li mi jača, slabija doza

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

ili možda drugačiji lek.

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

Zamislimo da vaš lekar ili vaš apotekar

And I can start to understand my pharmacogenomics --

imaju ove informacije integrisane u njihovom procesu rada,

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

ojačane veštačkom inteligencijom, VI, ili kako ja volim da je zovem, IV -

or maybe a different medication altogether.

Let's imagine if your physician or your pharmacist

intelektualnom veličinom,

koja podupire te informacije;

had this information integrated into their workflow,

koja razume, od 18 000 ili više odobrenih lekova,

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

koja bi bila prava doza i kombinacija za vas.

intelligence augmentation,

Pa super, sada možda možemo da optimizujemo vaše lekove i doze,

to leverage that information;

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

ali sad je problem što još koristimo ovu izvanrednu tehnologiju

which would be the right dose and combination for you.

da vodimo evidenciju o lekovima.

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

A naravno, ove tehnologije evoluiraju,

postoje povezani dispenzeri, aplikacije podsetnici,

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

pametni poklopci za bočice koji šalju poruke vama ili vašoj majci

to keep track of our drugs.

And of course, these technologies evolve,

ako niste popili svoje lekove.

Amazon je upravo nabavio PillPack,

there's connected dispensers, reminder apps,

tako da uskoro možemo imati dostavu lekova istog dana, dostavljenu dronom.

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

if you haven't taken your medications.

Dakle, sve ove stvari su moguće danas,

PillPack was just acquired by Amazon,

ali mi i dalje pijemo nekoliko pilula.

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

Šta ako to uprostimo?

Mislim da je jedno od rešenja bolja upotreba polipilule.

So, all these things are possible today,

Polipilula je integracija više lekova u jednu jedinu pilulu.

but we're still taking multiple pills.

What if we can make it simpler?

A to danas imamo u običnim lekovima za prehladu i grip.

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

Imamo i studije o preventivnoj polipiluli,

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

sa kombinacijom statina, lekova za pritisak, aspirina,

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

koje su u nasumičnim studijama pokazale

da drastično smanjuju rizik, u poređenju sa placebom.

And there have been prevention polypill studies done,

Ali ove pilule nisu bile personalizovane, nisu bile optimizovane za pojedinca.

giving combinations of statins, blood pressure, aspirin,

which in randomized studies have been shown

Šta ako bismo optimizovali personalizovanu polipilulu?

to dramatically reduce risk, compared to placebo.

Da bude izrađena za vas, zasnovana na vama, može da se prilagodi vama,

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

čak svakog dana.

Sada smo u dobu 3D štampe. Možete štampati personalizovane proteze,

What if we could optimize your personalized polypill?

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

slušne aparate, ortopedska pomagala,

čak sam bio skeniran i skrojene su mi farmerke.

even every single day.

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

Ovo me je navelo da pomislim,

šta ako bismo mogli da štampamo vašu personalizovanu polipilulu u 3D?

hearing aids, orthopedic devices,

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

Pa umesto da pijemo šest lekova, na primer,

mogao bih da ih integrišem u jedan.

So this got me thinking,

Bilo bi lakše lekove uzimati, dozirati,

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

a možda bi mogli da ih integrišemo u suplemente,

So instead of taking six medications, for example,

poput vitamina D ili koenzima Q10.

I could integrate them into one.

So it would be easier to take, improve adherence

Tako da uz malo pomoći - zovem ih ″intelilekovima″ -

and potentially, it could even integrate in supplements,

i uz pomoć mog inženjerskog tima Intelilek,

like vitamin D or CoQ10.

izradili smo prvi prototip štampača Intelilek.

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

I evo kako funkcioniše:

umesto celih tableta, imamo male mikrolekove,

and with the help of my IntelliMedicine engineering team,

gde svaki ima jedan ili dva mg,

we built the first IntelliMedicine prototype printer.

koji su sortirani i odabrani prema dozi i kombinaciji

And here's how it works:

neophodnoj za pojedinca.

instead of full tablets, we have small micromeds,

I naravno, ovo bi bile doze i kombinacije koje biste

one or two milligrams each,

već mogli da uzimate zajedno, odobrene od Agencije.

which are sorted and selected based on the dose and combination

Promenili bismo farmakokinetiku,

needed for an individual.

profesionalno dodajući slojeve različitih elemenata na individualne mikrolekove.

And of course, these would be doses and combinations

you could already take together, FDA-approved drugs.

A kada pritisnemo štampaj,

We could change the pharmacokinetics

odštampate vašu kombinaciju lekova koja vam može biti potrebna

by professionally layering on different elements to the individual micromeds.

bilo kog pojedinačnog dana.

A počeli bismo, opet, generičkim lekovima za najobičnije probleme.

And when we hit print,

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

Oko 90 procenata lekova koji se prepisuju danas su jeftini generički.

on any individual day.

I kad odštampamo pilulu, možemo da se zabavimo sitnicama.

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

Mogli bismo odštampati ime pacijenta,

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

datum, dan u nedelji, ili QR kod.

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

Mogli bismo štampati razne lekove za pomoć pacijentu tokom ukidanja steroida

We could print the name of the patient,

ili tokom ukidanja lekova protiv bolova.

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

Dakle, ovo je zapravo pogled na prototip našeg štampača intelilek.

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

Vidite, otkriću ga ovde.

or tapering from pain medications.

Ima oko 16 različitih rezervoara,

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

od kojih svaki sadrži svoje mikrolekove.

See, I'll unveil it here.

I sad mogu da prilagodim na softveru pojedinačne doze.

It has about 16 different silos,

each containing individual micromeds.

A kad to uradim, robotska ruka će prilagoditi

visinu ovih kapsula i mikrolekovi će se osloboditi.

And I can now adjust on the software individual dosings.

Mogu sada -

And when I do that, the robotic arm will adjust

Automatizovani proces bi rotirao i kružio,

da osigura da su mikrolekovi napunjeni.

the height of these spansules and the micromeds will release.

I kad pritisnem štampaj,

svi će pasti kroz uređaj,

I can now --

The automated process would rotate and cycle through,

sad vadim svoju personalizovanu odštampanu polipilulu

to make sure the micromeds are loaded.

sa dozama i lekovima namenjenim meni.

And when I hit print,

these will all fall through the device,

I možemo pogledati, ako pogledate nazad na slajdove,

I now pull out my personalized printed polypill

možete videti ceo proces, možemo videti kako se biraju rezervoari lekova,

with the doses and medications meant for me.

kako pilule idu niz različite rezrvoare,

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

i sakupljaju se u pojedinačne kapsule.

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

Sad, ovo je super,

mogu možda da štampam lekove prema sebi,

the pills doing down the different silos,

umesto da pijem šest pilula.

Možda upravo gledam u svoju individualnu dozu.

and being collected in the individual capsule.

Now, this is great,

Moj pametni sat gleda u moj krvni pritisak:

I can potentially print my meds based on me,

bilo mi je potrebno podešavanje lekova za pritisak,

instead of taking six pills.

nivo kumadina. Krv mi je previše retka,

I can now be looking at my individual dosing.

tako da u svom mikroleku snižavam dozu kumadina, koji razređuje krv.

My smartwatch is looking at my blood pressure:

I needed an adjustment in my blood pressure medicines,

Dakle, ovo bi moglo pametno da prilagođavaju

my coumadin level. My blood is too thin,

svakodnevno, moj lekar opšte prakse ili kardiolog.

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

A možete da zamislite da bi veći štampači, brzi štampači poput ovog,

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

mogli biti u vašoj apoteci na ćošku,

programmed by my physician or cardiologist.

u ordinaciji vašeg lekara, u ruralnoj klinici.

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

Ali vremenom bi mogao da se smanji tako da bi mogao biti u vašem domu

could be in your corner pharmacy,

sa integrisanim kertridžima poput ovog, koji se dostavljaju dronom.

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

Štampalo bi personalizovanu polipilulu,

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

svakog jutra na kuhinjskom ili ormariću u kupatilu.

with integrated cartridges like this that are delivered by drone.

A ovo bi moglo da se razvije, mislim,

u neverovatan način da poboljša pridržavanje terapije širom sveta.

Could print your personalized polypill,

each morning on your kitchen or your bathroom cabinet.

Pa, nadam se da možemo da stvorimo budućnost medicine na nove načine,

And this could evolve, I think,

napredujući od polifarmacije,

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

univerzalnosti, lošeg pridržavanja, komplikacija

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

do doba personalizovanih, preciznih, lekova po potrebi

moving from polypharmacy,

prilagođenih nama i inidividualizovanih prema našem zdravlju,

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

i zdravlju i medicini širom planete.

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

Hvala vam puno.

(Aplauz)

that can take us and individualize our own health

and health and medicine around the planet.

Thank you very much.

Voditeljka: Danijele, to je nekako sjajno.

(Applause)

Stvarno super.

Nego, pitanje za tebe.

Koliko dugo treba dok, recimo, pacijent iz staračkog doma kog si pomenuo

Host: Daniel, that's kind of awesome.

bude u mogućnosti da štampa pilule u domu?

Really cool.

Danijel Kraft: Pa, opet, ovo je samo prototip.

Question for you, though.

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

Mislimo da regulatorni put može biti automatizovani kompleks,

is able to print their pills in their home?

a posebno u staračkim domovima, ljudi piju više lekova,

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

i često se pomešaju,

pa bi to bilo savršeno mesto da se počne sa ovim tehnologijama.

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

One neće evoluirati i početi sa štampačima na ormariću u vašem kupatilu.

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

and they're often mixed up,

Moramo biti inteligentni i pametni oko toga kako započinjemo ovo,

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

ali shvatajući da ima izazova oko doziranja, pridržavanja i preciznosti,

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

a sada kad imamo sve ove divne nove tehnologije

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

koje se mogu koristiti, potrebni su nam slični pristupi

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

kako bismo zaista katalizovali i podstakli

pravu budućnost zdravstva i medicine.

and now that we have all these amazing new technologies

Voditeljka: Sjajno, hvala ti. DK: Hvala.

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

(Aplauz)

to really catalyze and foster

a true future of health and medicine.

Host: Great, thank you. DK: Thanks.

(Applause)