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「Daniel Kraft:未來藥局?自行在家 3D 列印出特製藥丸」- The Pharmacy of the Future? Personalized Pills, 3D Printed at Home


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We live in a medication nation. Four point five 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 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, 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 to 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. 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.

I trained in pediatrics—little people, 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.

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.

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?

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 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. 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.

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.

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 wi-fi 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.

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 dollars 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.

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?

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.

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. 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.

So, this is actually a look at our prototype IntelliMedicine printer. See, 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 for a minute, sort of 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.

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. 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. Thank you very much.

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?

Well, again, this is just a prototype. We think that the regulatory route 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 I think we need approaches like this to really catalyze and foster a true future of health and medicine.

Great, thank you.

Thanks.

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