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

翻译人员: Tianji (Homer) Li 校对人员: jacks peng

We live in a medication nation.

我们生活在一个药物王国。

4.5 billion drug prescriptions will be prescribed by doctors like me

仅仅在美国， 今年就有45亿份的处方

this year, in the United States alone.

被像我这样的医生开出来。

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

平均起来就是每个人15份。

And for most of us,

对于大多数人来说，

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

我们对药物的体验往往是 搞混药物剂量、

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

说明、副作用、 以及一刀切的剂量，

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

我们也经常不按处方服药。

And this comes at tremendous expense,

这也带来了非常昂贵的代价，

costing us our time, our money and our health.

浪费了我们的时间、金钱和健康。

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

在我们这个指数、互联、 数据驱动的时代，

I think we can and we must do better.

我想我们可以并且必须做得更好。

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

让我们来深入的探讨 一下我们面临的挑战

and some potential solutions.

以及潜在的解决方案。

Let's start with the fact

让我们先从一个事实开始，

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

那就是很多药物 对服用它们的人无效。

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

美国今年最畅销的10种药物

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

也只对1/4到1/23的服用者有效。

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

如果你是当中的那个1, 那当然很好，但其余的人呢？

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

更糟糕的是，当药物没疗效时，

can still cause side effects.

它还能产生副作用。

Take aspirin -- about one in four of us

以服用阿司匹林为例 ——大概每4个服用

who take aspirin to reduce our risk of cardiovascular disease

阿司匹林来降低心血管疾病风险 的人就有一个

are unknowingly aspirin-resistant

会对阿司匹林产生未知的抗药性。

and still have the same risks of gastrointestinal bleeds

而且还有胃肠出血的风险，

that kill thousands every year.

而这每年也会导致数千人死亡。

It's adverse drug reactions like these

这些药物的不良反应，

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

据估算，是美国境内的

第4大死因。

in the United States.

我自己的爷爷就是在使用了

My own grandfather passed away

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

单一抗生素后导致的肾衰竭 而逝世的。

Now, adverse drug reactions and side effects

现在，药物不良反应和副作用

are often tied to challenges in dosing.

经常跟剂量相关。

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

我受的训练是：儿科——小人儿， 内科——大人儿，

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

可能前一天晚上我还 在新生儿重症监护室

carefully dosing to the fraction of a milligram

小心地调配着几分之一毫克的剂量

a medication for a NICU baby.

供新生儿重症监护室里的 某个婴儿使用的药物，

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

第二天晚上——我又在 急诊室治疗一个400磅

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

的线路工或一个疗养院里的虚弱的病人，

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

在大多数情况下，两者 都会得到处方一览表上

from the formulary.

所规定的同样剂量的药物。

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

也就是说，多数情况下， 我可能给线路工

and overdosing the nursing-home patient.

的剂量不足，而又会给 疗养院的病人用药过量。

And beyond age and weight,

除了年龄和体重，

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

我们在配药时还会忽略性别和种族。

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

除此之外，我们还面临着病人

with noncompliance or low adherence.

不按时服药和较低的 持续治疗率的挑战。

Many of us who need to take our medications

我们许多需要用药的人

aren't taking them or are taking them incorrectly.

不去用药或者不正确的用药。

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

要知道，在美国有40% 的65岁以上老人

are on five or more prescription medications.

需要要服用5种或以上的处方药。

Sometimes 15 or more.

有时甚至是15种或者更多。

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

所以即便仅治疗依从性上提升一点， 能省下大量金钱并拯救很多的生命。

So, as we think into the future,

因此，当我们想象未来时，

you think that where we are today,

想想我们现在，

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

我们经常听到智能、 个性化、有针对性的药物、

Internet of Things, gene therapy, AI,

物联网、基因疗法、人工智能，

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

似乎我们已经进入了 精准医疗的时代。

In reality, we still live in an age

可事实上，我们仍然 生活在一个经验主义、

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

试错法、不精准治疗 大行其道的时代。

I think we can do better.

我想我们可以做得更好。

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

如果我们能重新想出 让你用药更方便的方法，

To get the right doses and combinations to match you?

配出适合你的剂量和 药物组合那将会怎样？

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

如果我们能够超越今天所谓的

of pill cutters and fax machines,

尖端药丸切割机和传真机，

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

进入一个可以更好的 控制结果、节约成本、

saving lives and space in your medicine cabinet?

拯救生命以及节省药柜空间 的时代会怎样？

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

我想部分的解决方案 就是所有这些

that we can measure and connect our health care information.

能让我们测量并连接 我们的健康信息的方法。

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

今天，我们几乎 生活在一个被动的

siloed information that doesn't flow.

疾病照料的世界， 封闭的信息不能流通。

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

我们有潜力进入一个 更持续的，实时的，

proactive world of true health care.

前瞻性的真实医疗保健的世界。

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

这其中部分始于量化自身的新兴世界，

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

今天我们能很好的测量 我们的生理机能和行为，

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

通常这些信息储存在 我们的手机和仪器中，

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

但现在已经开始跟 医生的监护工连接，

so they can better optimize prevention, diagnostics and therapy.

使他们能更好的优化 预防措施、诊断和治疗。

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

而当我们能做到这一点时， 我们就能做一些有趣的事。

Take, for example, hypertension.

举个例子，比如说高血压。

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

它是全球头号致人早逝的 危险因素，发病率也第一。

Half of adult Americans, on approximation, have hypertension.

约一半的美国成年人有高血压，

Less than half have it well-controlled.

而其中只有不到一半的人 能很好的控制病情。

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

通常是因为它要使用 两到三种不同的药物，

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

很难持续治疗并调整你的高血压药物。

We have 500 preventable deaths from noncontrolled hypertension

在美国，每天有500个 本来可以预防的病人

in the US every day.

因为不加控制的高血压而死亡。

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

但是我们正处在一个 联网血压袖带时代——

the FDA just approved a blood pressure cuff

美国食品药品管理局刚批准了一个

that can go into your watch.

能够连接智能手表的血压袖带。

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

现在还有很多无袖带的、 使用雷达的血压测试设备的模型，

that can continuously stream your blood pressure.

它们能持续监测你的血压。

So, in the future, I could --

所以，未来，我就可以——

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

不用去诊所现场测量血压，

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

我的医生能观测我的实时血压和动态，

and adjust them as necessary,

并且如果有必要就在

with the help of a blood pressure dosing algorithm

一个血压剂量算法的帮助下

or using the Internet of Things.

或者运用物联网进行调整。

Now, technology today can do even more.

今天，科技能做到的甚至更多。

My smartwatch, already today, has an EKG built in

今天我的智能手表上， 已经植入了心电图，

that can be read by artificial intelligence.

它能被人工智能读取。

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

我身上有一个小小的、 创可贴大小的贴片，

that is live-streaming my vital signs right now.

它现在正现场直播着我的生命特征。

Let's take a look.

让我们来看一看。

They're actually a little concerning at the moment.

它们现在看起来的确有点令人担心。

(Laughter)

（笑声）

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

不仅能被我的医疗团队

that can be seen by my medical team or myself,

和自己看到的我的实时生命特征，

it could be my retrospective data,

它还是我的回顾性数据，

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

而且它还能被用于 进一步修正剂量和药物。

Even my weight can be super-quantified;

甚至我的体重还能超级量化。

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

我的体重、身形， 我的身体质量、脂肪，

muscle mass I might have,

肌肉质量可能是多少，

and use that to optimize my prevention or therapy.

这些都能用来优化我的预防和治疗。

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

这不仅仅是为那些 懂科技的人准备的。

Now, MIT engineers have modified wifi

现在，麻省理工学院的 工程师们改进了无线网

so we can seamlessly connect and collect our vital signs

使我们能从已经连上的 戒指和智能订垫上，

from our connected rings and smart mattresses.

无缝地连接和获取我们的生命特征，

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

我们可以开始分享这个数字排放器， 我们的数字转换器，

and even potentially crowdsource it, sharing our health information

甚至是潜在的众包它， 分享我们的健康信息，

just like we share with our Google Maps and driving,

就像我们在分享我们的 谷歌地图和驾驶信息一样，

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

不是为了提高我们的驾驶技术， 而是为了提高我们的全球健康经验。

So, that's great.

所以，这太好了。

We can potentially now collect this information.

我们现在可以收集这些信息。

What if your labs can go from the central lab

如果你的实验室可以从中心区域

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

到你家，甚至在你的手机上， 甚至在我们的身体里

to measure drug levels or other varieties?

来测量药品指数或者其它的变量呢？

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

当然, 我们处在基因组学的时代。

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

我已经做了测序， 价格还不到1000美元。

我开始明白了我的药物基因组学,

And I can start to understand my pharmacogenomics --

我的基因影响我是否需要高剂量， 还是低剂量，

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

or maybe a different medication altogether.

或者换一种药物。

Let's imagine if your physician or your pharmacist

假设你的医生，或者你的药剂师,

had this information integrated into their workflow,

将这个信息融入他们的工作流程，

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

加上人工智能，AI，或者 我喜欢这样称呼它，IA—

intelligence augmentation,

人类智能（与人工智能相对）

to leverage that information;

来处理这些信息，

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

来利用这18000吨或 更多获批准的

which would be the right dose and combination for you.

符合你计量和方法的药剂。

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

太棒了，也许我们可以 优化你的药物和剂量，

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

但今天的问题是，我们仍然 在使用这项神奇的技术

to keep track of our drugs.

来跟踪我们的药物。

And of course, these technologies evolve,

当然，这些技术在不断发展，

there's connected dispensers, reminder apps,

联网的配药器以及提醒应用，

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

智能药片瓶盖，这些应用可以发短信 或者发推特给你或者你妈妈，

if you haven't taken your medications.

假如你没有按时服药。

PillPack was just acquired by Amazon,

PillPack刚刚被亚马逊收购，

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

所以可能很快就会有无人机 当日送达我们的药物。

So, all these things are possible today,

因此，所有这些在今天都是可能的，

but we're still taking multiple pills.

但我们仍在服用多种药物。

What if we can make it simpler?

那如果我们把它简化呢?

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

我认为其中一个解决方案 是更好地利用复方药。

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

复方药是多种药物组合成一粒药丸。

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

今天我们有这些常见的， 非处方的感冒和流感药物。

And there have been prevention polypill studies done,

也有一些关于预防复方药的研究。

giving combinations of statins, blood pressure, aspirin,

将抑制素，血压药，阿司匹林组合在一起，

which in randomized studies have been shown

随机抽样调查结果显示

to dramatically reduce risk, compared to placebo.

相比于安慰剂很大程度上减少了风险。

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

但是这些药丸不是个性化的， 它们没有针对个人进行优化。

如果我们可以优化你的 个性化的复方药呢？

What if we could optimize your personalized polypill?

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

将它们为适应你， 基于你的需求而生产，

even every single day.

甚至是每一天。

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

我们现在处在3D打印的时代， 你可以打印个性化的物品集合，

hearing aids, orthopedic devices,

助听器、骨科器械、

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

我甚至曾经也通过被 扫描来量身定做牛仔裤。

So this got me thinking,

因此这使我思考，

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

如果我们可以3D打印 属于你的复方药片呢？

So instead of taking six medications, for example,

比如说：将六种药物合成一种药物，

I could integrate them into one.

而不是分别服用六种药物。

So it would be easier to take, improve adherence

这样一来，服药者 便会很容易坚持服药，

and potentially, it could even integrate in supplements,

集成药物甚至可能带来补药的作用。

like vitamin D or CoQ10.

例如维生素D或者双酶。

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

在一些帮助下， 我称之为“综合药物”--

and with the help of my IntelliMedicine engineering team,

并且在我“综合药物” 工程组的帮助下，

we built the first IntelliMedicine prototype printer.

我们建造了第一个 “综合药物”打印机的原型。

And here's how it works:

它的具体工作是：

instead of full tablets, we have small micromeds,

相比于整个药物，我们 选用了其中的一小部分，

one or two milligrams each,

每个1或2毫克，

which are sorted and selected based on the dose and combination

它们基于病人所需的

needed for an individual.

剂量和组合被选择及整理。

And of course, these would be doses and combinations

当然，这些根据剂量和 组合选择出来的药物

you could already take together, FDA-approved drugs.

都是美国FDA通过的 你已经可以服用的药物。

We could change the pharmacokinetics

我们可以通过对不同元素分类到

by professionally layering on different elements to the individual micromeds.

单个微小的药物来改变 药物（代谢）动力学。

And when we hit print,

当我们按下打印键时，

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

你可以在任何时间根据自己的需要，

on any individual day.

打印药物组合。

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

之后，针对最常见的问题， 我们以仿制药为起始点。

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

现在大约90%的处方药 是低成本的仿制药。

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

一旦我们打印出药片， 我们可以做一些有趣的事情。

We could print the name of the patient,

我们可以打印出病人的名字，

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

日期，星期以及二维码。

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

对于一个使用类固醇锥体的病人， 我们可以打印出不同的药物

or tapering from pain medications.

或者逐渐减少止痛药的使用。

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

这实际上是我们的 综合药物打印机的原型。

See, I'll unveil it here.

看，在这里揭开真相。

It has about 16 different silos,

它有16个不同的筒仓，

each containing individual micromeds.

每个都包含单独的微型药物。

And I can now adjust on the software individual dosings.

现在我可以调整软件上 的个人剂量。

And when I do that, the robotic arm will adjust

当我这样做的时候， 机器人手臂会调整

the height of these spansules and the micromeds will release.

这些扳手的高度， 然后微型药物就会释放。

I can now --

我现在可以--

The automated process would rotate and cycle through,

自动化过程需要旋转和循环，

to make sure the micromeds are loaded.

以保证微型药物被装载。

And when I hit print,

当我按下打印时，

these will all fall through the device,

这些都将通过设备，

I now pull out my personalized printed polypill

现在，我生成了我个性化 印出的复合药片，

with the doses and medications meant for me.

其剂量和药物正好适合我。

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

如果你回头看幻灯片，我们看一下，

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

你可以看到整个过程， 我们可以看到药物筒仓被选中，

the pills doing down the different silos,

药丸被装在不同的筒仓里，

and being collected in the individual capsule.

再被单独的每个胶囊收集。

Now, this is great,

一切顺利，

I can potentially print my meds based on me,

可能的话，我可以打印出 任何我想要的药片。

instead of taking six pills.

而不是服用六个药片。

I can now be looking at my individual dosing.

我现在可以看到我个人的剂量，

My smartwatch is looking at my blood pressure:

我的智能手表正在检测我的血压，

I needed an adjustment in my blood pressure medicines,

我的血压药需要进行调整，

my coumadin level. My blood is too thin,

我的香豆素水平出了问题， 我的血液含量过于稀薄，

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

因此，我减少服用香豆素， 一种血液稀释剂。

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

智能适应每一天，

programmed by my physician or cardiologist.

具体程序有我的医生 或者心脏病医生编写。

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

你可以想象一个更大的打印机， 跟这个打印机一样快的打印机。

could be in your corner pharmacy,

可以在你街角的药房，

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

在你医生的办公室， 在一个乡村诊所里。

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

它最终会出现并缩小到 可以被你的家所容纳，

with integrated cartridges like this that are delivered by drone.

像这样由无人机运送的集成墨盒，

Could print your personalized polypill,

将有可能打印出为你 量身定制的复合药片，

each morning on your kitchen or your bathroom cabinet.

每天早上在你的厨房 或者你的浴室橱柜。

And this could evolve, I think,

并且我认为这可能会进化成

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

一种不可思议的方法来 改进全球药物依从性。

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

所以，我希望我们能切换视角， 重新想象医学的未来，

moving from polypharmacy,

从多药疗法，

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

以一敌百的，依从性低的，并发症

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

进入到个人的，精确的， 随需应变的药物的时代。

that can take us and individualize our own health

这可以让我们个性化我们自己的健康

and health and medicine around the planet.

和地球上的健康和医学。

Thank you very much.

非常感谢。

(Applause)

（掌声）

Host: Daniel, that's kind of awesome.

主持人：丹尼尔，真是太棒了。

Really cool.

太酷了。

Question for you, though.

不过我有个问题要问你。

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

比如说，你提到的那位 疗养院病人还要多久

is able to print their pills in their home?

才能够在家中打印药物？

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

丹尼尔·克拉夫特: 嗯， 再次声明，这只是一个原型。

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

我们认为监管途径是自动复方，

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

尤其是在养老院，人们正在服用多种药物，

and they're often mixed up,

而且那些药物经常会混在一起，

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

所以这是开始这些技术的最好地方。

它们一开始不会从 浴室柜台上开始进化。

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

我们需要在如何推广这些东西方面 变得聪明，

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

但要意识到，在剂量、坚持治疗 和精确度方面存在如此多的挑战，

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

现在我们有了这些惊人的新技术

and now that we have all these amazing new technologies

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

可以被整合和利用。 我认为我们需要这样的方法

to really catalyze and foster

来进行真正的催化和培养

a true future of health and medicine.

健康和医学的真正未来。

主持人:好的，谢谢。 丹尼尔·卡夫特: 谢谢。

Host: Great, thank you. DK: Thanks.

（掌声）

(Applause)