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,
Živimo u naciji lekova. 4,5 milijardi recepata za lekove biće prepisano od strane lekara poput mene ove godine, samo u SAD-u. To je 15 po svakom muškarcu, ženi i detetu. A za većinu nas, iskustvo sa ovim lekovima je često zbunjujući broj pilula, uputstava, nuspojava, univerzalnih doziranja, koje prečesto ne uzimamo kako je prepisano. A to nosi ogromnu cenu, koštajući nas vremena, novca i zdravlja. A u našem sada brzom, povezanom, vremenu kojim caruju podaci,
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.
mislim da možemo i moramo raditi bolje. Zato uronimo u neke od izazova koje imamo i u neka potencijalna rešenja. Počnimo činjenicom da mnogi lekovi ne deluju kod onih kojima su prepisani. Deset lekova koji donose najveći profit u Sjedinjenim Državama ove godine, donose korist samo jednoj od četiri do jednoj od 23 osobe koje ih koriste. To je sjajno ako ste broj jedan, ali šta je sa svima ostalima? A što je još gore, lekovi, kad nekad ne deluju, ipak mogu izazvati nuspojave.
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.
Evo aspirin - oko jedno od nas četvoro koji ga uzimamo da umanjimo rizik od kardiovaskularne bolesti smo ne znajući rezistentni na apirin, a i dalje imamo iste rizike od gastrointestinalnog krvarenja koji ubiju na hiljade ljudi svake godine. Neželjene reakcije poput ovih su, po nekim procenama, četvrti najčešći uzrok smrti u Sjedinjenim Državama. Moj deda je umro nakon jedne doze antibiotika zbog koje su mu otkazali bubrezi. Neželjene reakcije i nuspojave često su povezane sa izazovima doziranja.
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.
Obučavao sam se u pedijatriji (mali ljudi) i internoj medicini (veliki ljudi). Jedne noći sam bio na odeljenju za neonatalnu intenzivnu negu, pažljivo dozirajući u delić miligrama lek za bebu na odeljenju. Sledeće noći - na dužnosti u urgentnom centru, tretirajući fudbalera od 180kg ili krhkog pacijenta iz staračkog doma koji bi, po svemu sudeći, obično dobili istu dozu lekova sa liste. Što bi značilo, većinu vremena davao bih nižu dozu fudbaleru, a višu dozu pacijentu iz staračkog doma. A sem godina i telesne mase, imamo običaj da ignorišemo polne i rasne razlike pri doziranju.
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.
Sad, sem ovoga, znamo da imamo ogroman izazov sa neposlušnošću ili slabim pridržavanjem. Mnogi od nas koji treba da uzimamo lekove ne uzimamo ih ili ih uzimamo pogrešno. Znate, 40 procenata odraslih u SAD-u starijih od 65 su na pet ili više prepisanih lekova. Nekad 15 ili više. A čak mala poboljšanja u pridržavanju mogu drastično da uštede dolare i spasu živote.
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?
Tako da, kako gledamo u budućnost, pomislili biste da ovo gde smo danas, pošto često slušamo o pametnim, personalizovanim, ciljanim lekovima, internetu stvari, genskoj terapiji, VI, da smo već stigli u ovu eru precizne medicine. U stvarnosti, i dalje živimo u dobu empirijske, neprecizne medicine nagađanja. Mislim da možemo bolje. Šta kad bismo mogli da iznova smislimo načine da učinimo uzimanje lekova lakšim? Da učinimo da prave doze i kombinacije odgovaraju vama? Šta kad bismo mogli da napredujemo od današnjeg vrhunca sekača za tablete i faks mašina, do doba u kom bismo mogli da imamo bolje ishode, niže cene, spasavajući živote i štedeći prostor u ormariću za lekove?
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.
Pa, mislim da je deo rešenja svi načini koji se pojavljuju pomoću kojih možemo da izmerimo i povežemo naše zdravstvene podatke. Danas uglavnom živimo u reaktivnom svetu brige o bolesnima, sa izolovanim informacijama bez protoka. Imamo mogućnost da pređemo u neprekidan, u realnom vremenu proaktivan svet prave zdravstvene zaštite. A deo toga počinje sa trendom vođenja evidencije o ličnim navikama. Možemo izmeriti toliko parametara naše fiziologije i ponašanja danas, a često nam je to izolovano na telefonima i vagama, ali počinje da se povezuje sa našim lekarima, starateljima, tako da mogu bolje optimizovati prevenciju, dijagnostiku i terapiju. A kada postignemo sve to, moći ćemo neke zanimljive stvari.
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.
Uzmite, na primer, hipertenziju. To je faktor broj jedan za preranu smrt i morbiditet širom sveta. Polovina odraslih Amerikanaca, približno, pate od hipertenzije. Manje od polovine je drže pod kontrolom. To je često zato što su potrebne dve ili tri različite vrste lekova. Teško je pridržavati se i prilagođavati krvni pritisak lekovima. Imamo 500 bespotrebnih smrti od nekontrolisane hipertenzije u SAD-u svaki dan. Ali sada smo u dobu narukvica za merenje krvnog pritiska - Agencija za hranu i lekove je odobrila jednu koja može da se ubaci u ručni sat. Postoje modeli uređaja za merenje pritiska na bazi radara bez narukvica koji neprekidno očitavaju vaš krvni pritisak. Pa, u budućnosti, mogao bih - umesto nasumične kontrole pritiska na klinici, lekar bi video moje brojke u realnom vremenu i navike, i prilagodio ih po potrebi, pomoću algoritma za doziranje za pritisak ili koristeći internet stvari.
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.
Sad, tehnologija danas može još više. Moj pametni sat, već danas, ima ugrađen EKG koga može da očita veštačka inteligencija. Nosim mali povez veličine flastera, koji upravo očitava moje vitalne funkcije. Pogledajmo. Zapravo su trenutno malo zabrinjavajuće.
(Laughter)
(Smeh)
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.
Sad, nisu samo vitalne funkcije u realnom vremenu ono što može videti moj medicinski tim ili ja, to mogu biti retrospektivni podaci, i opet, bili bi korišćeni za modifikaciju doziranja kako napredujemo. Čak moja težina može biti precizno merena; moja težina, moja trenutna kondicija, koliko telesne mase, masti, mišićne mase možda imam, i koristim to da optimizujem svoju prevenciju ili terapiju. I to nije samo za tehnički potkovane. Inženjeri sa MIT-a su modifikovali vaj-faj tako da možemo glatko da se povezujemo i prikupljamo vitalne znake sa svog povezanog prstenja i pametnih dušeka. Možemo da delimo ovaj digitalni izbljuvak, naš digitom i čak ga možemo da kraudsorsujemo, deleći naše zdravstvene podatke isto kao što delimo sa Gugl mapama dok vozimo, da bismo poboljšali - ne vožnju, već svoje zdravstveno iskustvo globalno.
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 $1,000 today. And I can start to understand my pharmacogenomics -- how my genes impact whether I need high dose, low dose, or maybe a different medication altogether. Let's imagine if your physician or your pharmacist had this information integrated into their workflow, augmented with artificial intelligence, AI, or as I like to refer to it, IA -- intelligence augmentation, to leverage that information; to understand, of the 18,000 or more approved drugs, which would be the right dose and combination for you.
Tako da, to je super. Možemo možda sada da prikupljamo ove podatke. Šta ako vaše laboratorije mogu da idu od centralne laboratorije do vašeg doma, vašeg telefona, čak unutar vaših tela kako bi izmerili nivoe leka ili druge stvari? I naravno, u dobu smo genomike. Sekvenciran sam, košta nešto manje od 1000$ danas. I mogu početi da razumem svoju farmakogenomiku - kako moji geni utiču na to treba li mi jača, slabija doza ili možda drugačiji lek. Zamislimo da vaš lekar ili vaš apotekar imaju ove informacije integrisane u njihovom procesu rada, ojačane veštačkom inteligencijom, VI, ili kako ja volim da je zovem, IV - intelektualnom veličinom, koja podupire te informacije; koja razume, od 18 000 ili više odobrenih lekova, koja bi bila prava doza i kombinacija za vas.
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?
Pa super, sada možda možemo da optimizujemo vaše lekove i doze, ali sad je problem što još koristimo ovu izvanrednu tehnologiju da vodimo evidenciju o lekovima. A naravno, ove tehnologije evoluiraju, postoje povezani dispenzeri, aplikacije podsetnici, pametni poklopci za bočice koji šalju poruke vama ili vašoj majci ako niste popili svoje lekove. Amazon je upravo nabavio PillPack, tako da uskoro možemo imati dostavu lekova istog dana, dostavljenu dronom. Dakle, sve ove stvari su moguće danas, ali mi i dalje pijemo nekoliko pilula. Šta ako to uprostimo?
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.
Mislim da je jedno od rešenja bolja upotreba polipilule. Polipilula je integracija više lekova u jednu jedinu pilulu. A to danas imamo u običnim lekovima za prehladu i grip. Imamo i studije o preventivnoj polipiluli, sa kombinacijom statina, lekova za pritisak, aspirina, koje su u nasumičnim studijama pokazale da drastično smanjuju rizik, u poređenju sa placebom. Ali ove pilule nisu bile personalizovane, nisu bile optimizovane za pojedinca. Šta ako bismo optimizovali personalizovanu polipilulu? Da bude izrađena za vas, zasnovana na vama, može da se prilagodi vama, čak svakog dana. Sada smo u dobu 3D štampe. Možete štampati personalizovane proteze, slušne aparate, ortopedska pomagala, čak sam bio skeniran i skrojene su mi farmerke.
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.
Ovo me je navelo da pomislim, šta ako bismo mogli da štampamo vašu personalizovanu polipilulu u 3D? Pa umesto da pijemo šest lekova, na primer, mogao bih da ih integrišem u jedan. Bilo bi lakše lekove uzimati, dozirati, a možda bi mogli da ih integrišemo u suplemente, poput vitamina D ili koenzima Q10. Tako da uz malo pomoći - zovem ih ″intelilekovima″ - i uz pomoć mog inženjerskog tima Intelilek, izradili smo prvi prototip štampača Intelilek.
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.
I evo kako funkcioniše: umesto celih tableta, imamo male mikrolekove, gde svaki ima jedan ili dva mg, koji su sortirani i odabrani prema dozi i kombinaciji neophodnoj za pojedinca. I naravno, ovo bi bile doze i kombinacije koje biste već mogli da uzimate zajedno, odobrene od Agencije. Promenili bismo farmakokinetiku, profesionalno dodajući slojeve različitih elemenata na individualne mikrolekove. A kada pritisnemo štampaj, odštampate vašu kombinaciju lekova koja vam može biti potrebna bilo kog pojedinačnog dana. A počeli bismo, opet, generičkim lekovima za najobičnije probleme. Oko 90 procenata lekova koji se prepisuju danas su jeftini generički. I kad odštampamo pilulu, možemo da se zabavimo sitnicama. Mogli bismo odštampati ime pacijenta, datum, dan u nedelji, ili QR kod. Mogli bismo štampati razne lekove za pomoć pacijentu tokom ukidanja steroida ili tokom ukidanja lekova protiv bolova.
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.
Dakle, ovo je zapravo pogled na prototip našeg štampača intelilek. Vidite, otkriću ga ovde. Ima oko 16 različitih rezervoara, od kojih svaki sadrži svoje mikrolekove. I sad mogu da prilagodim na softveru pojedinačne doze. A kad to uradim, robotska ruka će prilagoditi visinu ovih kapsula i mikrolekovi će se osloboditi. Mogu sada - Automatizovani proces bi rotirao i kružio, da osigura da su mikrolekovi napunjeni. I kad pritisnem štampaj, svi će pasti kroz uređaj, sad vadim svoju personalizovanu odštampanu polipilulu sa dozama i lekovima namenjenim meni. I možemo pogledati, ako pogledate nazad na slajdove, možete videti ceo proces, možemo videti kako se biraju rezervoari lekova, kako pilule idu niz različite rezrvoare, i sakupljaju se u pojedinačne kapsule.
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.
Sad, ovo je super, mogu možda da štampam lekove prema sebi, umesto da pijem šest pilula. Možda upravo gledam u svoju individualnu dozu. Moj pametni sat gleda u moj krvni pritisak: bilo mi je potrebno podešavanje lekova za pritisak, nivo kumadina. Krv mi je previše retka, tako da u svom mikroleku snižavam dozu kumadina, koji razređuje krv. Dakle, ovo bi moglo pametno da prilagođavaju svakodnevno, moj lekar opšte prakse ili kardiolog. A možete da zamislite da bi veći štampači, brzi štampači poput ovog, mogli biti u vašoj apoteci na ćošku, u ordinaciji vašeg lekara, u ruralnoj klinici. Ali vremenom bi mogao da se smanji tako da bi mogao biti u vašem domu sa integrisanim kertridžima poput ovog, koji se dostavljaju dronom. Štampalo bi personalizovanu polipilulu, svakog jutra na kuhinjskom ili ormariću u kupatilu. A ovo bi moglo da se razvije, mislim, u neverovatan način da poboljša pridržavanje terapije širom sveta.
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.
Pa, nadam se da možemo da stvorimo budućnost medicine na nove načine, napredujući od polifarmacije, univerzalnosti, lošeg pridržavanja, komplikacija do doba personalizovanih, preciznih, lekova po potrebi prilagođenih nama i inidividualizovanih prema našem zdravlju, i zdravlju i medicini širom planete.
Thank you very much.
Hvala vam puno.
(Applause)
(Aplauz)
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?
Voditeljka: Danijele, to je nekako sjajno. Stvarno super. Nego, pitanje za tebe. Koliko dugo treba dok, recimo, pacijent iz staračkog doma kog si pomenuo bude u mogućnosti da štampa pilule u domu?
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.
Danijel Kraft: Pa, opet, ovo je samo prototip. Mislimo da regulatorni put može biti automatizovani kompleks, a posebno u staračkim domovima, ljudi piju više lekova, i često se pomešaju, pa bi to bilo savršeno mesto da se počne sa ovim tehnologijama. One neće evoluirati i početi sa štampačima na ormariću u vašem kupatilu. Moramo biti inteligentni i pametni oko toga kako započinjemo ovo, ali shvatajući da ima izazova oko doziranja, pridržavanja i preciznosti, a sada kad imamo sve ove divne nove tehnologije koje se mogu koristiti, potrebni su nam slični pristupi kako bismo zaista katalizovali i podstakli pravu budućnost zdravstva i medicine.
Host: Great, thank you. DK: Thanks.
Voditeljka: Sjajno, hvala ti. DK: Hvala.
(Applause)
(Aplauz)