0:00:01.579,0:00:04.500
We live in a medication nation.

0:00:04.524,0:00:09.476
Four point five billion drug prescriptions[br]will be prescribed by doctors like me

0:00:09.500,0:00:11.347
this year, in the United States alone.

0:00:11.371,0:00:13.839
That's 15 for every man, woman and child.

0:00:13.863,0:00:15.022
And for most of us,

0:00:15.046,0:00:18.585
our experience with this medication[br]is often confusing number of pills,

0:00:18.609,0:00:22.204
instructions, side effects,[br]one-size-fits-all dosing,

0:00:22.228,0:00:24.704
which all too often[br]we aren't taking as prescribed.

0:00:24.728,0:00:26.751
And this comes at tremendous expense,

0:00:26.775,0:00:29.387
costing us our time,[br]our money and our health.

0:00:29.696,0:00:32.577
And in our now exponential,[br]connected, data-driven age,

0:00:32.601,0:00:35.068
I think we can and we must do better.

0:00:35.919,0:00:38.996
So let's take a dive at some[br]of the challenges we have,

0:00:39.020,0:00:41.783
and some potential solutions.

0:00:42.133,0:00:43.371
Let's start with the fact

0:00:43.395,0:00:46.672
that many drugs don't work[br]for those who are prescribed to them.

0:00:46.696,0:00:51.296
The top 10 grossing drugs[br]in the United States this year,

0:00:51.320,0:00:55.001
they only benefit one in four[br]to one in 23 of who take them.

0:00:55.025,0:00:58.518
That's great if you're number one,[br]but what about everybody else?

0:00:58.997,0:01:02.164
And what's worse, drugs,[br]when they sometimes don't work,

0:01:02.188,0:01:03.625
can still cause side effects.

0:01:03.649,0:01:05.525
Take aspirin -- about one in four of us

0:01:05.550,0:01:08.463
who take aspirin to reduce[br]our risk of cardiovascular disease,

0:01:08.487,0:01:10.400
are unknowingly aspirin-resistant.

0:01:10.424,0:01:13.433
And still have the same risks[br]of gastrointestinal bleeds

0:01:13.457,0:01:15.524
that kill thousands every year.

0:01:16.069,0:01:19.029
It's adverse drug reactions like these,

0:01:19.053,0:01:22.203
that are, by some estimates,[br]the number four leading cause of death

0:01:22.227,0:01:23.387
in the United States.

0:01:23.411,0:01:24.847
My own grandfather passed away

0:01:24.871,0:01:27.966
after a single dose of antibiotic[br]caused his kidneys to fail.

0:01:27.990,0:01:31.014
Now, adverse drug reactions[br]and side effects

0:01:31.038,0:01:33.998
are often tied to challenges in dosing.

0:01:34.022,0:01:37.760
I trained in pediatrics -- little people,[br]internal medicine -- big people,

0:01:37.784,0:01:40.220
so one night I might have been[br]on call in the NICU,

0:01:40.244,0:01:42.506
carefully dosing[br]to the fraction of a milligram,

0:01:42.530,0:01:43.847
a medication for NICU baby.

0:01:43.871,0:01:46.132
The next night -- on call[br]in the emergency room,

0:01:46.156,0:01:49.776
treating a 400-pound lineman[br]or a frail nursing-home patient,

0:01:49.800,0:01:53.744
who, by most accounts, usually[br]would get the same dose of medications

0:01:53.768,0:01:55.014
from the formulary.

0:01:55.038,0:01:58.371
Which would mean, most of the time[br]I would be under-dosing the lineman,

0:01:58.395,0:02:01.062
and overdosing the nursing-home patient.

0:02:01.498,0:02:02.832
And beyond age and weight,

0:02:02.856,0:02:06.149
we tend to ignore differences[br]in sex and race, in dosing.

0:02:06.704,0:02:10.854
Now, beyond this, we know[br]we have a massive challenge

0:02:10.878,0:02:13.077
with noncompliance or low adherence.

0:02:13.101,0:02:15.156
Many of us who need[br]to take our medications,

0:02:15.180,0:02:18.069
aren't taking them[br]or are taking them incorrectly.

0:02:18.093,0:02:20.791
You know, 40 percent[br]of adults in the US over 65

0:02:20.815,0:02:23.268
are on five or more[br]prescription medications.

0:02:23.292,0:02:24.617
Sometimes 15 or more.

0:02:24.641,0:02:30.130
And even small improvements in adherence[br]can dramatically save dollars and lives.

0:02:31.452,0:02:34.500
So, as we think into the future,

0:02:34.524,0:02:36.283
you think that where we are today,

0:02:36.307,0:02:40.292
as we often hear about smart,[br]personalized, targeted drugs,

0:02:40.316,0:02:42.196
internet of things, gene therapy, AI,

0:02:42.220,0:02:45.053
that we'd already arrived[br]in this era of precision medicine.

0:02:45.077,0:02:46.760
In reality, we still live in an age

0:02:46.784,0:02:49.783
of empiric trial and error[br]imprecision medicine.

0:02:49.807,0:02:51.102
I think we can do better.

0:02:51.126,0:02:55.503
What if we could reimagine ways[br]to help make your medicine-taking easier?

0:02:55.527,0:02:58.743
To get the right doses[br]and combinations to match you?

0:02:59.161,0:03:01.829
What if we could move beyond[br]today's literal cutting edge

0:03:01.853,0:03:04.640
of pill cutters and fax machines,

0:03:04.664,0:03:07.458
to an era where we could have[br]better outcomes, lower costs,

0:03:07.482,0:03:10.629
saving lives and space[br]in your medicine cabinet?

0:03:11.466,0:03:14.244
Well, I think part of the solution[br]is all the emerging ways

0:03:14.268,0:03:17.413
that we can measure and connect[br]our health care information.

0:03:17.815,0:03:20.825
Today, we pretty much live[br]in a reactive, sick-care world,

0:03:20.849,0:03:23.141
siloed information that doesn't flow.

0:03:23.165,0:03:26.142
We have the potential to move[br]into more continuous, real-time

0:03:26.166,0:03:28.420
proactive world of true health care.

0:03:28.444,0:03:31.609
And part of that starts with[br]the emerging world of quantified self,

0:03:31.633,0:03:34.958
we can measure so much of our[br]physiology and behaviors today,

0:03:34.982,0:03:37.133
and often is siloed[br]on our phones and scales,

0:03:37.157,0:03:40.145
but it's starting to connect[br]to our clinicians, our caregivers,

0:03:40.169,0:03:43.534
so they can better optimize prevention,[br]diagnostics and therapy.

0:03:44.851,0:03:47.755
And when we can do that,[br]we can do some interesting things.

0:03:47.779,0:03:49.847
Take, for example, hypertension.

0:03:49.871,0:03:53.656
It's the number one risk factor[br]for early death and morbidity worldwide.

0:03:53.680,0:03:56.974
Half of adult Americans,[br]on approximation, have hypertension,

0:03:56.998,0:03:58.950
less than half have it well-controlled.

0:03:58.974,0:04:02.491
It's often because it takes two[br]or three different classes of medications,

0:04:02.515,0:04:05.819
it's tough to do adherence and adjust[br]your blood pressure medications.

0:04:05.843,0:04:08.845
We have 500 preventable deaths[br]from non-controlled hypertension

0:04:08.869,0:04:10.626
in the US, every day.

0:04:10.929,0:04:13.794
But now we're in the era[br]of connected blood pressure cuffs --

0:04:13.818,0:04:15.827
the FDA just approved[br]a blood pressure cuff

0:04:15.851,0:04:17.545
that can go into your watch.

0:04:17.569,0:04:21.060
There are now prototypes of cuffs,[br]radar-based blood pressure devices

0:04:21.084,0:04:23.371
that can continuously stream[br]your blood pressure.

0:04:23.774,0:04:25.198
So, in the future, I could

0:04:25.222,0:04:27.895
instead of spot-checking[br]my blood pressure in the clinic,

0:04:27.919,0:04:30.506
my doctor could see my real-time[br]numbers and my trends,

0:04:30.530,0:04:32.699
and adjust them as necessary,

0:04:32.723,0:04:35.173
with the help of a blood pressure[br]dosing algorithm,

0:04:35.197,0:04:37.499
or using the internet of things.

0:04:37.523,0:04:40.189
Now, technology today can do even more.

0:04:40.904,0:04:43.291
My smart watch, already today,[br]has an EKG built in,

0:04:43.315,0:04:46.656
that can be read[br]by artificial intelligence,

0:04:46.680,0:04:49.601
I'm wearing a small, band-aid sized patch,

0:04:49.625,0:04:51.871
that is live-streaming[br]my vital signs right now,

0:04:51.895,0:04:53.085
let's take a look.

0:04:53.109,0:04:55.514
They're actually a little[br]concerning at the moment.

0:04:55.538,0:04:57.887
(Laughter)

0:04:57.911,0:05:00.349
Now, it's not just my real-time vitals

0:05:00.373,0:05:02.569
that can be seen[br]by my medical team or myself,

0:05:02.593,0:05:04.268
it could be my retrospective data,

0:05:04.292,0:05:07.878
and again, that'd be used to modify[br]dosing and medication going forward.

0:05:08.298,0:05:10.704
Even my weight can be super quantified.

0:05:10.728,0:05:15.604
My weight, now my shape,[br]how much body mass, fat,

0:05:15.628,0:05:16.886
muscle mass I might have,

0:05:16.910,0:05:19.830
and use that to optimize[br]my prevention or therapy.

0:05:20.823,0:05:22.633
And it's not just for the tech savvy.

0:05:22.657,0:05:25.832
Now, MIT engineers have modified wi-fi

0:05:25.856,0:05:29.260
so we can seamlessly[br]connect and collect our vital signs,

0:05:29.284,0:05:31.529
from our connected rings[br]and smart mattresses,

0:05:31.553,0:05:34.268
we can start to share[br]this digital exhaust, our digitome,

0:05:34.292,0:05:37.498
and even potentially crowdsource it,[br]sharing our health information,

0:05:37.522,0:05:39.982
just like we share[br]with our Google maps and driving,

0:05:40.006,0:05:43.773
to improve our -- not our driving,[br]but our health experience globally.

0:05:44.911,0:05:46.308
So, that's great.

0:05:46.332,0:05:48.604
We can potentially now[br]collect this information.

0:05:48.628,0:05:52.434
What if your labs can go[br]from the central lab

0:05:52.458,0:05:54.990
to your home, to your phone,[br]to even inside our bodies

0:05:55.014,0:05:57.616
to measure drug levels or other varieties?

0:05:58.085,0:06:00.149
And of course, we're in[br]the age of genomics,

0:06:00.173,0:06:03.046
I've been sequenced,[br]it's just less than 1,000 dollars today.

0:06:03.070,0:06:05.569
And I can start to understand[br]my pharmacogenomics --

0:06:05.593,0:06:08.252
how my genes impact,[br]whether I need high dose, low dose,

0:06:08.276,0:06:10.355
or maybe a different[br]medication altogether.

0:06:10.379,0:06:13.054
Let's imagine if your physician[br]or your pharmacist,

0:06:13.078,0:06:15.738
had this information integrated[br]into their workflow,

0:06:15.762,0:06:19.610
augmented with artificial intelligence,[br]AI, or as I like to refer to it, IA --

0:06:19.634,0:06:21.229
intelligence augmentation,

0:06:21.253,0:06:22.660
to leverage that information,

0:06:22.684,0:06:25.256
to understand of the[br]18,000 or more approved drugs,

0:06:25.280,0:06:28.601
which would be the right dose[br]and combination for you.

0:06:28.625,0:06:31.649
So great, now maybe we can[br]optimize your drugs and your doses,

0:06:31.673,0:06:34.823
but the problem today is,[br]we're still using this amazing technology

0:06:34.847,0:06:36.744
to keep track of our drugs.

0:06:36.768,0:06:39.335
And of course, these technologies evolve,

0:06:39.359,0:06:42.513
there's connected dispensers,[br]reminder apps,

0:06:42.537,0:06:45.553
smart pill bottle caps that can text[br]or tweet you or your mother

0:06:45.577,0:06:47.410
if you haven't taken your medications.

0:06:47.434,0:06:49.252
PillPack was just acquired by Amazon,

0:06:49.276,0:06:53.208
so assuming we may have same-day delivery[br]of our drugs, delivered by drone.

0:06:53.807,0:06:55.958
So, all these things are possible today,

0:06:55.982,0:06:57.895
but we're still taking multiple pills.

0:06:57.919,0:06:59.411
What if we can make it simpler?

0:06:59.435,0:07:02.641
I think one of the solutions[br]is to make better use of the polypill.

0:07:02.665,0:07:06.196
A polypill is the integration of multiple[br]medications into a single pill.

0:07:06.220,0:07:09.736
And we have these today in common,[br]over the counter cold and flu remedies.

0:07:09.760,0:07:12.331
And there have been prevention[br]polypill studies done,

0:07:12.355,0:07:15.045
giving combinations of statins,[br]blood pressure, aspirin,

0:07:15.069,0:07:17.110
which in randomized studies[br]have been shown

0:07:17.134,0:07:19.450
to dramatically reduce risk,[br]compared to placebo.

0:07:19.474,0:07:23.506
But these polypills weren't personalized,[br]they weren't optimized to the individual.

0:07:23.530,0:07:26.117
What if we could optimize[br]your personalized polypill?

0:07:26.141,0:07:29.263
So it would be built for you,[br]based on you, it could adapt to you,

0:07:29.287,0:07:30.906
even every single day.

0:07:30.930,0:07:34.850
Well, we're now in the era of 3D printing,[br]you can print personalized braces,

0:07:34.874,0:07:36.509
hearing aids, orthopedic devices,

0:07:36.533,0:07:39.975
even I've been scanned[br]and had my genes tailored to fit to me.

0:07:39.999,0:07:41.254
So, this got me thinking,

0:07:41.278,0:07:44.800
what if we could 3D print[br]your personalized polypill?

0:07:44.824,0:07:47.213
So instead of taking six[br]medications, for example,

0:07:47.237,0:07:48.935
I could integrate them into one.

0:07:48.959,0:07:51.251
So it would be easier to take,[br]improve adherence,

0:07:51.275,0:07:53.926
and potentially, it could even[br]integrate in supplements,

0:07:53.950,0:07:56.823
like vitamin D or CoQ10.

0:07:57.173,0:08:00.117
So with some help --[br]I call these intelli-meds --

0:08:00.141,0:08:02.887
and with the help of my[br]IntelliMedicine engineering team,

0:08:02.911,0:08:05.879
we built the first IntelliMedicine[br]prototype printer.

0:08:05.903,0:08:07.069
And here's how it works:

0:08:07.093,0:08:09.553
instead of full tablets,[br]we have small micromeds,

0:08:09.577,0:08:10.998
one or two milligrams each,

0:08:11.022,0:08:14.061
which are sorted and selected[br]based on the dose and combination

0:08:14.085,0:08:15.696
needed for an individual.

0:08:15.720,0:08:18.180
And of course, these would be[br]doses and combinations

0:08:18.204,0:08:20.656
you could already take together,[br]FDA-approved drugs.

0:08:20.680,0:08:22.545
We could change the pharmacokinetics,

0:08:22.569,0:08:26.699
by professionally layering on different[br]elements to the individual micromeds.

0:08:27.569,0:08:29.196
And when we hit print,

0:08:29.220,0:08:32.482
you print your combination of medications[br]that might be needed by you

0:08:32.506,0:08:34.244
on any individual day.

0:08:34.268,0:08:38.188
And we'd start with, again, generic drugs[br]for the most common problems.

0:08:38.212,0:08:41.863
About 90 percent of prescribed drugs today[br]are low-cost generics.

0:08:41.886,0:08:45.225
And once we've printed the pill,[br]we can do some fun bells and whistles.

0:08:45.249,0:08:47.276
We could print the name of the patient,

0:08:47.300,0:08:50.069
the date, the day of the week, a QR code.

0:08:50.093,0:08:54.086
We could print different meds for tapering[br]for patient on a steroid taper,

0:08:54.110,0:08:56.377
or tapering from pain medications.

0:08:56.958,0:09:01.926
So, this is actually a look at our[br]prototype in telemedicine printer.

0:09:01.950,0:09:03.284
See, unveil it here.

0:09:03.974,0:09:06.895
It has about 16 different silos,

0:09:06.919,0:09:09.643
each containing individual micromeds.

0:09:10.704,0:09:14.450
And I can now adjust on the software,[br]individual dosings.

0:09:14.926,0:09:18.363
And when I do that,[br]the robotic arm will adjust

0:09:18.387,0:09:21.498
the height of these [unclear][br]and the micromeds will release.

0:09:21.522,0:09:22.672
I can now --

0:09:23.093,0:09:25.514
Automated process would rotate[br]and cycle through,

0:09:25.538,0:09:27.442
to make sure the micromeds are loaded.

0:09:27.466,0:09:29.268
And when I hit print,

0:09:29.292,0:09:31.704
these will all fall through the device,

0:09:31.728,0:09:35.328
I now pull out my[br]personalized printed polypill,

0:09:35.352,0:09:38.873
with the doses and[br]medications meant for me.

0:09:39.379,0:09:42.315
And we can take a look,[br]if you look back to the slides,

0:09:42.339,0:09:45.958
sort of the whole process,[br]we can see the drug silos being selected,

0:09:45.982,0:09:47.990
the pills doing down the different silos,

0:09:48.014,0:09:50.796
and being collected[br]in the individual capsule.

0:09:50.820,0:09:52.547
Now, this is great,

0:09:52.571,0:09:54.635
I can potentially print[br]my meds based on me,

0:09:54.659,0:09:56.000
instead of taking six pills.

0:09:56.024,0:09:59.192
I can now be looking[br]at my individual dosing,

0:09:59.216,0:10:01.410
my smart watch is looking[br]at my blood pressure,

0:10:01.434,0:10:03.982
I needed an adjustment[br]in my blood pressure medicines,

0:10:04.006,0:10:06.339
my coumadin level, my blood is too thin,

0:10:06.363,0:10:10.291
so I lower my micromed[br]dose of coumadin, a blood thinner.

0:10:10.315,0:10:12.482
So, this could be[br]smartly adapted, day to day,

0:10:12.506,0:10:15.188
programmed by my physician[br]or cardiologist.

0:10:15.212,0:10:18.764
And you can imagine that larger printers,[br]fast printers like this,

0:10:18.788,0:10:21.553
could be in your corner pharmacy,

0:10:21.577,0:10:23.756
in your doctor's office,[br]in a rural clinic.

0:10:23.780,0:10:27.740
But it could eventually merge and shrink[br]to small ones, that could be in your home,

0:10:27.764,0:10:30.859
with integrated cartridges like this,[br]that are delivered by drone.

0:10:31.176,0:10:33.205
Could print your personalized polypill,

0:10:33.229,0:10:36.545
each morning on your kitchen[br]or your bathroom cabinet.

0:10:36.569,0:10:38.379
And this could evolve, I think

0:10:38.403,0:10:42.212
into an incredible way to improve[br]adherence in medications across the globe.

0:10:42.236,0:10:46.275
So, I hope we can reimagine[br]the future of medicine in new ways,

0:10:46.299,0:10:47.828
moving from poly pharmacy,

0:10:47.852,0:10:51.307
one-size-fits-all,[br]low adherence complications,

0:10:51.331,0:10:55.358
to an era of personalized, precise,[br]on-demand medications,

0:10:55.382,0:10:58.759
that can take us and individualize[br]our own health,

0:10:58.783,0:11:00.969
and health and medicine around the planet.

0:11:01.525,0:11:02.859
Thank you very much.

0:11:02.883,0:11:08.318
(Applause)

0:11:09.882,0:11:11.953
Host: Daniel, that's kind of awesome.

0:11:11.977,0:11:13.143
Really cool.

0:11:13.167,0:11:14.561
Question for you, though.

0:11:14.585,0:11:18.141
How long is it until, say that[br]nursing-home patient that you mentioned

0:11:18.165,0:11:20.442
is able to print[br]their pills in their home?

0:11:20.752,0:11:23.553
Daniel Kraft: Well, again,[br]this is just a prototype.

0:11:23.577,0:11:26.704
We think that the regular [unclear][br]be automated compounding,

0:11:26.728,0:11:30.069
and especially in nursing homes,[br]folks are taking multiple medications,

0:11:30.093,0:11:31.395
and they're often mixed up,

0:11:31.419,0:11:34.451
so it would be a perfect place[br]to start with these technologies.

0:11:34.475,0:11:38.150
These aren't going to evolve and start[br]with printers on your bathroom counter.

0:11:38.174,0:11:41.532
We need to be intelligent and smart[br]about how we roll these things out,

0:11:41.556,0:11:45.287
but realizing there's so many challenges[br]with dosing, adherence and precision,

0:11:45.311,0:11:47.915
and now that we have all these[br]amazing new technologies

0:11:47.939,0:11:49.686
that can integrate and be leveraged,

0:11:49.710,0:11:52.838
I think we need approaches like this[br]to really catalyze and foster

0:11:52.862,0:11:54.643
a true future of health and medicine.

0:11:54.667,0:11:56.326
Host: Great, thank you.[br]DK: Thanks.

0:11:56.350,0:11:58.636
(Applause)