We live in a medication nation. 4.5 billion drug prescriptions will be prescribed by doctors like me this year, in the United States alone. That's 15 for every man, woman and child. And for most of us, our experience with this medication is often a confusing number of pills, instructions, side effects, one-size-fits-all dosing, which all too often we aren't taking as prescribed. And this comes at tremendous expense, costing us our time, our money and our health. And in our now exponential, connected, data-driven age,
Vivimos nunha nación medicada. Médicos coma min prescribirán 4.500 millóns de medicamentos este ano, só nos Estados Unidos. Iso son 15 para cada home, muller e neno. E, para a maioría de nós, a experiencia coa medicación é a miúdo un confuso número de pílulas, instrucións, efectos secundarios e doses únicas, que moitas veces non tomamos como nos prescribiron. Isto supón un gasto tremendo de tempo, cartos e saúde. E nesta era exponencial, conectada e orientada aos datos,
I think we can and we must do better. So let's take a dive at some of the challenges we have and some potential solutions. Let's start with the fact that many drugs don't work for those who are prescribed them. The top 10 grossing drugs in the United States this year, they only benefit one in four to one in 23 of who take them. That's great if you're number one, but what about everybody else? And what's worse, drugs, when they sometimes don't work, can still cause side effects.
coido que podemos e debemos facelo mellor. Mergullémonos nalgúns dos retos que temos e as súas posibles solucións. Comecemos co feito de que moitos remedios non funcionan a quen se lles receitan. Os 10 medicamentos máis vendidos este ano nos Estados Unidos só benefician a entre un de cada catro e un de cada 23 dos que os toman. É estupendo se es o número un, pero... que pasa cos demais? E o que é peor, os medicamentos, aínda cando non funcionan, poden ter efectos secundarios.
Take aspirin -- about one in four of us who take aspirin to reduce our risk of cardiovascular disease are unknowingly aspirin-resistant and still have the same risks of gastrointestinal bleeds that kill thousands every year. It's adverse drug reactions like these that are, by some estimates, the number four leading cause of death in the United States. My own grandfather passed away after a single dose of antibiotic caused his kidneys to fail. Now, adverse drug reactions and side effects are often tied to challenges in dosing.
Por exemplo, a aspirina; un de cada catro dos que a toman para reducir o risco de doenza cardiovascular é, sen sabelo, resistente a ela e aínda así ten o mesmo risco de sufrir o sangrado intestinal que mata milleiros cada ano. Reaccións adversas coma esta son, segundo algunhas estimacións, a cuarta causa de morte nos EEUU. O meu avó faleceu tras unha soa dose de antibiótico que lle provocou un fallo renal. As reaccións adversas e os efectos secundarios están moitas veces relacionados coa dosificación
I trained in pediatrics (little people) and internal medicine (big people). So one night I might have been on call in the NICU, carefully dosing to the fraction of a milligram a medication for a NICU baby. The next night -- on call in the emergency room, treating a 400-pound lineman or a frail nursing-home patient who, by most accounts, usually would get the same dose of medications from the formulary. Which would mean, most of the time I would be underdosing the lineman and overdosing the nursing-home patient. And beyond age and weight, we tend to ignore differences in sex and race in dosing.
Formeime en pediatría (xente pequena) e medicina interna (xente grande) Unha noite podía ter que estar na UCI pediátrica, medindo á fracción do miligramo a medicación para un bebé; Á noite seguinte, na sala de urxencias, tratando un defensa de 180 quilos ou un fráxil paciente dunha residencia que, normalmente, recibirían a mesma dose de medicamento segundo o manual. Isto implica que, moitas das veces, estaría inframedicando o defensa e sobremedicando o paciente da residencia. E ademais da idade ou o peso tendemos a ignorar o sexo e a raza na dosificación.
Now, beyond this, we know we have a massive challenge with noncompliance or low adherence. Many of us who need to take our medications aren't taking them or are taking them incorrectly. You know, 40 percent of adults in the US over 65 are on five or more prescription medications. Sometimes 15 or more. And even small improvements in adherence can dramatically save dollars and lives.
Alén disto, temos un reto enorme cos incumprimentos e a baixa adherencia. Moitos dos que precisamos medicación non a estamos tomando ou estámolo a facer mal. Nos EE.UU., o 40% dos adultos maiores de 65 anos teñen prescritos 5 medicamentos ou máis. Ás veces máis de 15. E incluso pequenas melloras na adherencia poden salvar moitos cartos e vidas.
So, as we think into the future, you think that where we are today, as we often hear about smart, personalized, targeted drugs, Internet of Things, gene therapy, AI, that we'd already arrived in this era of precision medicine. In reality, we still live in an age of empiric, trial-and-error, imprecision medicine. I think we can do better. What if we could reimagine ways to help make your medicine-taking easier? To get the right doses and combinations to match you? What if we could move beyond today's literal cutting edge of pill cutters and fax machines, to an era where we could have better outcomes, lower costs, saving lives and space in your medicine cabinet?
Así que, cando pensamos no futuro, cremos que aí é onde estamos hoxe, pois a miúdo oímos falar de fármacos intelixentes, personalizados, dirixidos, do Internet das Cousas, a terapia xénica, a IA, que chegamos á era da medicina de precisión. En realidade, aínda vivimos nunha era de empirismo, de ensaio-erro, de medicina imprecisa. Podemos facelo mellor. E se reimaxinásemos o xeito de que tomar as menciñas fose moito máis doado? De tomar as doses e combinacións que mellor funcionan para ti? E se puidésemos deixar atrás a realidade dos cortadores de pastillas e as máquinas de fax e comezar a obter mellores resultados con custos máis baixos e salvar vidas e aforrar espazo na túa caixa de urxencias?
Well, I think part of the solution is all the emerging ways that we can measure and connect our health care information. Today, we pretty much live in a reactive, sick-care world, siloed information that doesn't flow. We have the potential to move into a more continuous, real-time proactive world of true health care. And part of that starts with the emerging world of quantified self. We can measure so much of our physiology and behaviors today, and often it's siloed on our phones and scales, but it's starting to connect to our clinicians, our caregivers, so they can better optimize prevention, diagnostics and therapy. And when we can do that, we can do some interesting things.
Coido que parte da solución está nas novas formas nas que podemos medir e compartir a información sobre a nosa saúde. Vivimos nun mundo reactivo, de coidado dos enfermos, onde a información fica almacenada. Temos o potencial de mudalo a un mundo dinámico, proactivo, de verdadeiro coidado da saúde. Parte diso comeza co mundo emerxente do eu cuantificado. Podemos medir moito da nosa fisioloxía e dos nosos costumes, que moitas veces fica nos nosos móbiles, pero estamos comezando a conectar cos médicos e os coidadores para que poidan optimizar a prevención, o diagnóstico e a terapia. E cando o consigamos, poderemos facer outras cousas interesantes.
Take, for example, hypertension. It's the number one risk factor for early death and morbidity worldwide. Half of adult Americans, on approximation, have hypertension. Less than half have it well-controlled. It's often because it takes two or three different classes of medications. It's tough to do adherence and adjust your blood pressure medications. We have 500 preventable deaths from noncontrolled hypertension in the US every day. But now we're in the era of connected blood pressure cuffs -- the FDA just approved a blood pressure cuff that can go into your watch. There are now prototypes of cuffless radar-based blood pressure devices that can continuously stream your blood pressure. So, in the future, I could -- instead of spot-checking my blood pressure in the clinic, my doctor could see my real-time numbers and my trends, and adjust them as necessary, with the help of a blood pressure dosing algorithm or using the Internet of Things.
Tomemos, por exemplo, a hipertensión. É o primeiro factor de risco de morte prematura e morbilidade no mundo. Arredor da metade dos norteamericanos adultos teñen hipertensión. Menos da metade téñena ben controlada. Isto ocorre porque ás veces fan falta dous ou tres tipos de medicamentos. E é difícil axustar as doses e seguir os tratamentos. Cada día, hai 500 mortes evitables nos Estados Unidos debido á hipertensión non controlada. Pero agora estamos na era do medidor de tensión conectado. A FDA vén de aprobar un medidor de tensión que pode colocarse no teu reloxo. Existen prototipos de medidores baseados na tecnoloxía do radar que poden compartir en directo a túa presión sanguínea Así que, no futuro, podería, no canto de medir a miña tensión nun centro de saúde, o meu doutor podería ver os meus datos en tempo real e axustalos segundo fose necesario, coa axuda dun algoritmo dosificador para a presión ou usando o Internet das Cousas.
Now, technology today can do even more. My smartwatch, already today, has an EKG built in that can be read by artificial intelligence. I'm wearing a small, Band-Aid-sized patch, that is live-streaming my vital signs right now. Let's take a look. They're actually a little concerning at the moment.
Pero hoxe a tecnoloxía pode facer incluso máis. O meu reloxo intelixente ten unha función ECG que pode ser interpretada pola intelixencia artificial. Levo un pequeno adhesivo, do tamaño dun parche, que está a emitir os meus signos vitais en directo. Botémoslle un ollo. A verdade é que son un pouco preocupantes.
(Laughter)
(Risos)
Now, it's not just my real-time vitals that can be seen by my medical team or myself, it could be my retrospective data, and again, that'd be used to modify dosing and medication going forward. Even my weight can be super-quantified; my weight, now my shape, how much body mass, fat, muscle mass I might have, and use that to optimize my prevention or therapy. And it's not just for the tech-savvy. Now, MIT engineers have modified wifi so we can seamlessly connect and collect our vital signs from our connected rings and smart mattresses. We can start to share this digital exhaust, our digitome, and even potentially crowdsource it, sharing our health information just like we share with our Google Maps and driving, to improve our -- not our driving, but our health experience globally.
Ben, non son só os meus signos vitais actuais os que o meu equipo médico ou eu podemos ver, podería ser todo o meu historial, e, de novo, podería usarse para modificar a medicación e a dose no futuro. Incluso o meu peso pode ser cuantificable; o meu peso, a miña figura, canta masa, graxa, músculo debería ter, e usar esta información para optimizar a prevención ou a terapia. E non é só para os máis tecnolóxicos. Os enxeñeiros do MIT veñen de modificar a wifi para que poidamos recoller e conectar os nosos signos vitais dende aneis conectados e colchóns intelixentes. Podemos comezar a compartir esta información, o digitome, e compartir a nosa información sanitaria mediante <i>crowdsourcing</i> igual que compartimos a condución con Google Maps, para mellorar a nosa experiencia global de saúde.
So, that's great. We can potentially now collect this information. What if your labs can go from the central lab to your home, to your phone, to even inside our bodies to measure drug levels or other varieties? And of course, we're in the age of genomics. I've been sequenced, it's just less than $1,000 today. And I can start to understand my pharmacogenomics -- how my genes impact whether I need high dose, low dose, or maybe a different medication altogether. Let's imagine if your physician or your pharmacist had this information integrated into their workflow, augmented with artificial intelligence, AI, or as I like to refer to it, IA -- intelligence augmentation, to leverage that information; to understand, of the 18,000 or more approved drugs, which would be the right dose and combination for you.
Así que, xenial, podemos recoller esta información. E se os laboratorios puidesen ir dende as súas centrais ao teu fogar, ao teu móbil, mesmo ao interior do corpo para medir os niveis de fármacos ou outros parámetros? E, por suposto, estamos na era da xenómica. Eu secuenciei o meu xenoma, hoxe custa menos de 1.000 dólares. E podo comezar a entender a miña farmacoxenética, como os meus xenes determinan se preciso máis ou menos dose ou un tratamento completamente diferente. Imaxina que o teu médico ou o teu farmacéutico teñen esta información integrada no fluxo de traballo, aumentada coa intelixencia artificial, IA, ou como eu lle chamo, AI aumento da intelixencia, para poder aproveitala, para entender, dos máis de 18.000 fármacos aprobados, cal sería a dose e a combinación correctas para ti.
So great, now maybe we can optimize your drugs and your doses, but the problem today is, we're still using this amazing technology to keep track of our drugs. And of course, these technologies evolve, there's connected dispensers, reminder apps, smart pill bottle caps that can text or tweet you or your mother if you haven't taken your medications. PillPack was just acquired by Amazon, so soon we may have same-day delivery of our drugs, delivered by drone. So, all these things are possible today, but we're still taking multiple pills. What if we can make it simpler?
Ben, quizais agora poidamos optimizar a medicación e a dose, pero o problema hoxe é que aínda usamos esta tecnoloxía para facer o seguimento dos nosos medicamentos. Por suposto, esta tecnoloxía evoluciona, hai dispensadores conectados, aplicacións de recordatorio, tapas intelixentes que poden mandarche un chío, a ti ou á túa nai se non tomaches a túa menciña. Amazon vén de adquirir PillPack, así que pronto teremos envío nun día de medicamentos, repartidos por dron. Todas estas cousas son hoxe posibles, pero aínda tomamos unha chea de pílulas. E se puidésemos facelo máis doado?
I think one of the solutions is to make better use of the polypill. A polypill is the integration of multiple medications into a single pill. And we have these today in common over-the-counter cold and flu remedies. And there have been prevention polypill studies done, giving combinations of statins, blood pressure, aspirin, which in randomized studies have been shown to dramatically reduce risk, compared to placebo. But these polypills weren't personalized, they weren't optimized to the individual. What if we could optimize your personalized polypill? So it would be built for you, based on you, it could adapt to you, even every single day. Well, we're now in the era of 3D printing. You can print personalized braces, hearing aids, orthopedic devices, even I've been scanned and had my jeans tailored to fit to me.
Coido que unha das solucións é usar mellor a polipílula. Unha polipílula é a integración de varios fármacos nunha soa pílula. Xa as usamos hoxe nas menciñas contra a gripe e os catarros. E existen estudos de prevención con polipílulas, nos que a combinación de estatinas, tensión, aspirina demostrou en estudos aleatorizados reducir moito o risco, comparado co placebo. Pero estas polipílulas non eran personalizadas, optimizadas ao individuo. E se puidésemos personalizar a túa polipílula? Estaría feita para ti, baseada en ti, podería adaptarse a ti, todos e cada un dos días. Agora estamos na era da impresión 3D. Podes imprimir próteses personalizadas, audiófonos, aparatos ortopédicos, a min incluso me escanearon para facerme uns vaqueiros a medida.
So this got me thinking, what if we could 3D-print your personalized polypill? So instead of taking six medications, for example, I could integrate them into one. So it would be easier to take, improve adherence and potentially, it could even integrate in supplements, like vitamin D or CoQ10. So with some help -- I call these "IntelliMeds" -- and with the help of my IntelliMedicine engineering team, we built the first IntelliMedicine prototype printer.
Isto fíxome pensar... e se puidésemos imprimir a túa polipílula personalizada en 3D? Así, no canto de tomar seis menciñas, por exemplo, poderías combinalas nunha soa. Sería máis doada de tomar, melloraría a adherencia e sería posible incluso integrar suplementos, como a vitamina D ou o CoQ10. Así que, con algunha axuda, eu chámolles "IntelliMeds", e a axuda do meu equipo de enxeñeiros de IntelliMedicine construímos o primeiro prototipo de impresora IntelliMedicine.
And here's how it works: instead of full tablets, we have small micromeds, one or two milligrams each, which are sorted and selected based on the dose and combination needed for an individual. And of course, these would be doses and combinations you could already take together, FDA-approved drugs. We could change the pharmacokinetics by professionally layering on different elements to the individual micromeds. And when we hit print, you print your combination of medications that might be needed by you on any individual day. And we'd start with, again, generic drugs for the most common problems. About 90 percent of prescribed drugs today are low-cost generics. And once we've printed the pill, we can do some fun bells and whistles. We could print the name of the patient, the date, the day of the week, a QR code. We could print different meds for tapering for a patient on a steroid taper, or tapering from pain medications.
E así é como funciona: no canto de blísters, hai pequenas micromenciñas, dun ou dous miligramos, que se ordenan e seleccionan en base á dose e combinación necesaria para un individuo. Por suposto, habería doses e combinacións que xa estarían dispoñibles, as aprobadas pola FDA. Podemos cambiar a farmacocinética, superpoñendo profesionalmente diferentes elementos nas micromenciñas individuais. E, cando prememos imprimir, imprimes a combinación de medicamentos que poderías precisar un día calquera. Comezariamos con fármacos xenéricos para os problemas máis comúns. Case o 90% dos medicamentos que se prescriben son xenéricos de baixo custo. E unha vez que temos a pílula impresa, podemos facer cousas divertidas. Podemos imprimir o nome do paciente, a data, o día da semana, un código QR. Podemos imprimir menciñas diferentes para reducir a dose de esteroides dun paciente, ou para reducir as medicacións para a dor.
So, this is actually a look at our prototype IntelliMedicine printer. See, I'll unveil it here. It has about 16 different silos, each containing individual micromeds. And I can now adjust on the software individual dosings. And when I do that, the robotic arm will adjust the height of these spansules and the micromeds will release. I can now -- The automated process would rotate and cycle through, to make sure the micromeds are loaded. And when I hit print, these will all fall through the device, I now pull out my personalized printed polypill with the doses and medications meant for me. And we can take a look, if you look back to the slides, you can see the whole process, we can see the drug silos being selected, the pills doing down the different silos, and being collected in the individual capsule.
Esta é unha ollada ao noso prototipo de impresora IntelliMedicine. Vouna desvelar. Ten uns 16 silos diferentes, cada un con micromenciñas individuais. Agora podo axustar co software as doses individuais. E cando o fago, o brazo robótico axusta a abertura destas cápsulas para que liberen as micromenciñas. Agora podo -- O proceso automatizado vai rotar para asegurar que se cargan as menciñas. E, cando premo imprimir, caerá a través da máquina, e agora recollo a miña polipílula personalizada coa medicación e a dose específicas para min. E podemos botar unha ollada, se mirades a presentación, podedes ver o proceso enteiro, como se seleccionan os silos das menciñas, as pastillas caendo dos diferentes silos, e xuntándose na cápsula individual.
Now, this is great, I can potentially print my meds based on me, instead of taking six pills. I can now be looking at my individual dosing. My smartwatch is looking at my blood pressure: I needed an adjustment in my blood pressure medicines, my coumadin level. My blood is too thin, so I lower my micromed dose of coumadin, a blood thinner. So, this could be smartly adapted, day to day, programmed by my physician or cardiologist. And you can imagine that larger printers, fast printers like this, could be in your corner pharmacy, in your doctor's office, in a rural clinic. But it could eventually merge and shrink to small ones that could be in your home with integrated cartridges like this that are delivered by drone. Could print your personalized polypill, each morning on your kitchen or your bathroom cabinet. And this could evolve, I think, into an incredible way to improve adherence in medications across the globe.
Isto é xenial, podo imprimir as menciñas feitas para min en vez de tomar seis pílulas. Agora podo controlar a miña dosificación. O meu reloxo está medindo a miña tensión: preciso axustar a miña menciña para controlala, o meu nivel de Coumadin. O meu sangue está diluído, así que baixo na miña micromenciña a dose de Coumadin, un anticoagulante. E podería adaptarse así todos os días, de maneira controlada polo meu médico ou cardiólogo. Podedes imaxinar impresoras máis grandes, rápidas coma esta, na farmacia da esquina, na consulta do médico, nun centro de saúde rural. Pero co tempo poderán facerse máis pequenas e colocarse no teu fogar, con cartuchos integrados coma este, que serían repartidos por dron. Poderías imprimir a túa propia polipílula, cada mañá na túa cociña ou no armario do teu baño. E podería evolucionar, penso, 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, moving from polypharmacy, one-size-fits-all, low adherence, complications to an era of personalized, precise, on-demand medications that can take us and individualize our own health and health and medicine around the planet.
Agardo que poidamos reimaxinar o futuro da medicina de novas maneiras pasando da polifarmacia, as doses únicas, a baixa adherencia e as complicacións a unha era de medicacións personalizadas, precisas e baixo demanda, que poidan levarnos a individualizar a nosa propia saúde 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. Really cool. Question for you, though. How long is it until, say, that nursing-home patient that you mentioned is able to print their pills in their home?
Presentadora: Daniel, iso é incrible. Realmente xenial. Pero teño unha pregunta. Canto pasará ata que o paciente da residencia que mencionaches sexa capaz de imprimir as súas propias pílulas?
Daniel Kraft: Well, again, this is just a prototype. We think that the regulatory route [may] be automated compounding, and especially in nursing homes, folks are taking multiple medications, and they're often mixed up, so it would be a perfect place to start with these technologies. These aren't going to evolve and start with printers on your bathroom counter. We need to be intelligent and smart about how we roll these things out, but realizing there's so many challenges with dosing, adherence and precision, and now that we have all these amazing new technologies that can integrate and be leveraged, I think we need approaches like this to really catalyze and foster a true future of health and medicine.
Daniel Kraft: Ben, isto é só un prototipo. Pensamos que o camiño para regulalo será o proceso automatizado, sobre todo, nas residencias, onde a xente toma moitas menciñas que ás veces se mesturan, así que sería un lugar perfecto para comezar con esta tecnoloxía. Non van evolucionar e comezar con impresoras no armario do teu baño. Precisamos ser intelixentes e listos ao manexar estas cousas, pero decatándonos dos retos coa dosificación, a adherencia e a precisión, e agora que temos estas novas tecnoloxías que podemos aproveitar e integrar, coido que precisamos novos enfoques como este para activar e fomentar un verdadeiro futuro da saúde e da medicina. Presentadora: Moi ben, grazas. Daniel Kraft: Grazas.
Host: Great, thank you. DK: Thanks.
(Aplausos)
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