0:00:01.560,0:00:04.416
We live in a medication nation.

0:00:04.440,0:00:09.496
4.5 billion drug prescriptions[br]will be prescribed by doctors like me

0:00:09.520,0:00:11.336
this year, in the United States alone.

0:00:11.360,0:00:13.776
That's 15 for every man, woman and child.

0:00:13.800,0:00:15.016
And for most of us,

0:00:15.040,0:00:18.576
our experience with this medication[br]is often a confusing number of pills,

0:00:18.600,0:00:22.216
instructions, side effects,[br]one-size-fits-all dosing,

0:00:22.240,0:00:24.696
which all too often[br]we aren't taking as prescribed.

0:00:24.720,0:00:26.736
And this comes at tremendous expense,

0:00:26.760,0:00:29.656
costing us our time,[br]our money and our health.

0:00:29.680,0:00:32.576
And in our now exponential,[br]connected, data-driven age,

0:00:32.600,0:00:35.080
I think we can and we must do better.

0:00:35.880,0:00:39.016
So let's take a dive[br]at some of the challenges we have

0:00:39.040,0:00:42.096
and some potential solutions.

0:00:42.120,0:00:43.376
Let's start with the fact

0:00:43.400,0:00:46.656
that many drugs don't work[br]for those who are prescribed them.

0:00:46.680,0:00:51.296
The top 10 grossing drugs[br]in the United States this year,

0:00:51.320,0:00:54.936
they only benefit one in four[br]to one in 23 of who take them.

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

0:00:59.000,0:01:02.056
And what's worse, drugs,[br]when they sometimes don't work,

0:01:02.080,0:01:03.496
can still cause side effects.

0:01:03.520,0:01:05.416
Take aspirin -- about one in four of us

0:01:05.440,0:01:08.376
who take aspirin to reduce[br]our risk of cardiovascular disease

0:01:08.400,0:01:10.376
are unknowingly aspirin-resistant

0:01:10.400,0:01:13.376
and still have the same risks[br]of gastrointestinal bleeds

0:01:13.400,0:01:15.160
that kill thousands every year.

0:01:16.040,0:01:19.016
It's adverse drug reactions like these

0:01:19.040,0:01:22.216
that are, by some estimates,[br]the number four leading cause of death

0:01:22.240,0:01:23.456
in the United States.

0:01:23.480,0:01:24.936
My own grandfather passed away

0:01:24.960,0:01:27.976
after a single dose of antibiotic[br]caused his kidneys to fail.

0:01:28.000,0:01:30.976
Now, adverse drug reactions[br]and side effects

0:01:31.000,0:01:34.016
are often tied to challenges in dosing.

0:01:34.040,0:01:37.776
I trained in pediatrics (little people)[br]and internal medicine (big people).

0:01:37.800,0:01:40.216
So one night I might have been[br]on call in the NICU,

0:01:40.240,0:01:42.496
carefully dosing[br]to the fraction of a milligram

0:01:42.520,0:01:43.936
a medication for a NICU baby.

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The next night --[br]on call in the emergency room,

0:01:46.240,0:01:49.776
treating a 400-pound lineman[br]or a frail nursing-home patient

0:01:49.800,0:01:53.696
who, by most accounts, usually[br]would get the same dose of medications

0:01:53.720,0:01:55.016
from the formulary.

0:01:55.040,0:01:58.376
Which would mean, most of the time[br]I would be underdosing the lineman

0:01:58.400,0:02:01.416
and overdosing the nursing-home patient.

0:02:01.440,0:02:02.816
And beyond age and weight,

0:02:02.840,0:02:05.800
we tend to ignore differences[br]in sex and race in dosing.

0:02:06.680,0:02:10.856
Now, beyond this, we know[br]we have a massive challenge

0:02:10.880,0:02:13.096
with noncompliance or low adherence.

0:02:13.120,0:02:15.216
Many of us who need[br]to take our medications

0:02:15.240,0:02:18.056
aren't taking them[br]or are taking them incorrectly.

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

0:02:20.800,0:02:23.256
are on five or more[br]prescription medications.

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Sometimes 15 or more.

0:02:24.640,0:02:30.120
And even small improvements in adherence[br]can dramatically save dollars and lives.

0:02:31.440,0:02:34.496
So, as we think into the future,

0:02:34.520,0:02:36.296
you think that where we are today,

0:02:36.320,0:02:40.296
as we often hear about smart,[br]personalized, targeted drugs,

0:02:40.320,0:02:42.216
Internet of Things, gene therapy, AI,

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

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In reality, we still live in an age

0:02:46.800,0:02:49.776
of empiric, trial-and-error,[br]imprecision medicine.

0:02:49.800,0:02:51.096
I think we can do better.

0:02:51.120,0:02:55.496
What if we could reimagine ways[br]to help make your medicine-taking easier?

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To get the right doses[br]and combinations to match you?

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

0:03:01.880,0:03:04.656
of pill cutters and fax machines,

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

0:03:07.520,0:03:10.520
saving lives and space[br]in your medicine cabinet?

0:03:11.440,0:03:14.256
Well, I think part of the solution[br]is all the emerging ways

0:03:14.280,0:03:17.776
that we can measure and connect[br]our health care information.

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

0:03:20.880,0:03:23.136
siloed information that doesn't flow.

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

0:03:26.160,0:03:28.416
proactive world of true health care.

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

0:03:31.640,0:03:34.896
We can measure so much[br]of our physiology and behaviors today,

0:03:34.920,0:03:37.136
and often it's siloed[br]on our phones and scales,

0:03:37.160,0:03:40.136
but it's starting to connect[br]to our clinicians, our caregivers,

0:03:40.160,0:03:43.360
so they can better optimize prevention,[br]diagnostics and therapy.

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And when we can do that,[br]we can do some interesting things.

0:03:47.760,0:03:49.816
Take, for example, hypertension.

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

0:03:53.680,0:03:56.976
Half of adult Americans,[br]on approximation, have hypertension.

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Less than half have it well-controlled.

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

0:04:02.541,0:04:05.856
It's tough to do adherence and adjust[br]your blood pressure medications.

0:04:05.880,0:04:08.856
We have 500 preventable deaths[br]from noncontrolled hypertension

0:04:08.880,0:04:10.896
in the US every day.

0:04:10.920,0:04:13.778
But now we're in the era[br]of connected blood pressure cuffs --

0:04:13.802,0:04:15.856
the FDA just approved[br]a blood pressure cuff

0:04:15.880,0:04:17.536
that can go into your watch.

0:04:17.560,0:04:21.055
There are now prototypes of cuffless[br]radar-based blood pressure devices

0:04:21.079,0:04:23.736
that can continuously stream[br]your blood pressure.

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So, in the future, I could --

0:04:25.240,0:04:27.907
instead of spot-checking[br]my blood pressure in the clinic,

0:04:27.931,0:04:30.507
my doctor could see[br]my real-time numbers and my trends,

0:04:30.531,0:04:32.696
and adjust them as necessary,

0:04:32.720,0:04:35.136
with the help of a blood pressure[br]dosing algorithm

0:04:35.160,0:04:37.496
or using the Internet of Things.

0:04:37.520,0:04:40.896
Now, technology today can do even more.

0:04:40.920,0:04:43.296
My smartwatch, already today,[br]has an EKG built in

0:04:43.320,0:04:46.656
that can be read[br]by artificial intelligence.

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

0:04:49.640,0:04:51.896
that is live-streaming[br]my vital signs right now.

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Let's take a look.

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They're actually a little[br]concerning at the moment.

0:04:55.600,0:04:57.896
(Laughter)

0:04:57.920,0:05:00.336
Now, it's not just my real-time vitals

0:05:00.360,0:05:02.536
that can be seen[br]by my medical team or myself,

0:05:02.560,0:05:04.256
it could be my retrospective data,

0:05:04.280,0:05:08.256
and again, that'd be used to modify[br]dosing and medication going forward.

0:05:08.280,0:05:10.696
Even my weight can be super-quantified;

0:05:10.720,0:05:15.616
my weight, now my shape,[br]how much body mass, fat,

0:05:15.640,0:05:16.896
muscle mass I might have,

0:05:16.920,0:05:19.880
and use that to optimize[br]my prevention or therapy.

0:05:20.800,0:05:22.616
And it's not just for the tech-savvy.

0:05:22.640,0:05:25.776
Now, MIT engineers have modified wifi

0:05:25.800,0:05:29.256
so we can seamlessly[br]connect and collect our vital signs

0:05:29.280,0:05:31.536
from our connected rings[br]and smart mattresses.

0:05:31.560,0:05:34.256
We can start to share[br]this digital exhaust, our digitome,

0:05:34.280,0:05:37.496
and even potentially crowdsource it,[br]sharing our health information

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just like we share[br]with our Google Maps and driving,

0:05:40.000,0:05:43.720
to improve our -- not our driving,[br]but our health experience globally.

0:05:44.880,0:05:46.296
So, that's great.

0:05:46.320,0:05:48.616
We can potentially now[br]collect this information.

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What if your labs[br]can go from the central lab

0:05:52.440,0:05:54.976
to your home, to your phone,[br]to even inside our bodies

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to measure drug levels or other varieties?

0:05:58.040,0:06:00.136
And of course,[br]we're in the age of genomics.

0:06:00.160,0:06:03.056
I've been sequenced,[br]it's just less than $1,000 today.

0:06:03.080,0:06:05.536
And I can start to understand[br]my pharmacogenomics --

0:06:05.560,0:06:08.176
how my genes impact[br]whether I need high dose, low dose,

0:06:08.200,0:06:10.256
or maybe a different[br]medication altogether.

0:06:10.280,0:06:13.056
Let's imagine if your physician[br]or your pharmacist

0:06:13.080,0:06:15.736
had this information[br]integrated into their workflow,

0:06:15.760,0:06:19.616
augmented with artificial intelligence,[br]AI, or as I like to refer to it, IA --

0:06:19.640,0:06:21.216
intelligence augmentation,

0:06:21.240,0:06:22.656
to leverage that information;

0:06:22.680,0:06:25.256
to understand, of the 18,000[br]or more approved drugs,

0:06:25.280,0:06:28.616
which would be the right dose[br]and combination for you.

0:06:28.640,0:06:31.656
So great, now maybe we can[br]optimize your drugs and your doses,

0:06:31.680,0:06:34.823
but the problem today is,[br]we're still using this amazing technology

0:06:34.847,0:06:36.736
to keep track of our drugs.

0:06:36.760,0:06:39.336
And of course, these technologies evolve,

0:06:39.360,0:06:42.496
there's connected dispensers,[br]reminder apps,

0:06:42.520,0:06:45.536
smart pill bottle caps that can text[br]or tweet you or your mother

0:06:45.560,0:06:47.416
if you haven't taken your medications.

0:06:47.440,0:06:49.256
PillPack was just acquired by Amazon,

0:06:49.280,0:06:53.776
so soon we may have same-day delivery[br]of our drugs, delivered by drone.

0:06:53.800,0:06:55.976
So, all these things are possible today,

0:06:56.000,0:06:57.896
but we're still taking multiple pills.

0:06:57.920,0:06:59.416
What if we can make it simpler?

0:06:59.440,0:07:02.616
I think one of the solutions[br]is to make better use of the polypill.

0:07:02.640,0:07:06.096
A polypill is the integration of multiple[br]medications into a single pill.

0:07:06.120,0:07:09.616
And we have these today in common[br]over-the-counter cold and flu remedies.

0:07:09.640,0:07:12.136
And there have been[br]prevention polypill studies done,

0:07:12.160,0:07:14.816
giving combinations[br]of statins, blood pressure, aspirin,

0:07:14.840,0:07:16.896
which in randomized studies[br]have been shown

0:07:16.920,0:07:19.256
to dramatically reduce risk,[br]compared to placebo.

0:07:19.280,0:07:23.216
But these polypills weren't personalized,[br]they weren't optimized to the individual.

0:07:23.240,0:07:25.736
What if we could optimize[br]your personalized polypill?

0:07:25.760,0:07:29.096
So it would be built for you,[br]based on you, it could adapt to you,

0:07:29.120,0:07:30.896
even every single day.

0:07:30.920,0:07:34.856
Well, we're now in the era of 3D printing.[br]You can print personalized braces,

0:07:34.880,0:07:36.496
hearing aids, orthopedic devices,

0:07:36.520,0:07:39.976
even I've been scanned[br]and had my jeans tailored to fit to me.

0:07:40.000,0:07:41.296
So this got me thinking,

0:07:41.320,0:07:44.816
what if we could 3D-print[br]your personalized polypill?

0:07:44.840,0:07:47.216
So instead of taking[br]six medications, for example,

0:07:47.240,0:07:48.936
I could integrate them into one.

0:07:48.960,0:07:51.296
So it would be easier to take,[br]improve adherence

0:07:51.320,0:07:53.940
and potentially, it could even[br]integrate in supplements,

0:07:53.964,0:07:57.136
like vitamin D or CoQ10.

0:07:57.160,0:08:00.136
So with some help --[br]I call these "IntelliMeds" --

0:08:00.160,0:08:02.856
and with the help of my[br]IntelliMedicine engineering team,

0:08:02.880,0:08:05.896
we built the first[br]IntelliMedicine prototype printer.

0:08:05.920,0:08:07.136
And here's how it works:

0:08:07.160,0:08:09.536
instead of full tablets,[br]we have small micromeds,

0:08:09.560,0:08:11.016
one or two milligrams each,

0:08:11.040,0:08:14.056
which are sorted and selected[br]based on the dose and combination

0:08:14.080,0:08:15.696
needed for an individual.

0:08:15.720,0:08:18.176
And of course, these would be[br]doses and combinations

0:08:18.200,0:08:20.656
you could already take together,[br]FDA-approved drugs.

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We could change the pharmacokinetics

0:08:22.520,0:08:26.480
by professionally layering on different[br]elements to the individual micromeds.

0:08:27.560,0:08:29.216
And when we hit print,

0:08:29.240,0:08:32.496
you print your combination of medications[br]that might be needed by you

0:08:32.520,0:08:34.256
on any individual day.

0:08:34.280,0:08:38.176
And we'd start with, again, generic drugs[br]for the most common problems.

0:08:38.200,0:08:41.856
About 90 percent of prescribed drugs today[br]are low-cost generics.

0:08:41.880,0:08:45.216
And once we've printed the pill,[br]we can do some fun bells and whistles.

0:08:45.240,0:08:47.496
We could print the name of the patient,

0:08:47.520,0:08:50.056
the date, the day of the week, a QR code.

0:08:50.080,0:08:54.096
We could print different meds for tapering[br]for a patient on a steroid taper,

0:08:54.120,0:08:56.936
or tapering from pain medications.

0:08:56.960,0:09:01.936
So, this is actually a look at our[br]prototype IntelliMedicine printer.

0:09:01.960,0:09:03.936
See, I'll unveil it here.

0:09:03.960,0:09:06.896
It has about 16 different silos,

0:09:06.920,0:09:09.520
each containing individual micromeds.

0:09:10.680,0:09:14.896
And I can now adjust on the software[br]individual dosings.

0:09:14.920,0:09:18.376
And when I do that,[br]the robotic arm will adjust

0:09:18.400,0:09:21.496
the height of these spansules[br]and the micromeds will release.

0:09:21.520,0:09:23.056
I can now --

0:09:23.080,0:09:25.576
The automated process[br]would rotate and cycle through,

0:09:25.600,0:09:27.456
to make sure the micromeds are loaded.

0:09:27.480,0:09:29.256
And when I hit print,

0:09:29.280,0:09:31.696
these will all fall through the device,

0:09:31.720,0:09:35.336
I now pull out my[br]personalized printed polypill

0:09:35.360,0:09:39.336
with the doses[br]and medications meant for me.

0:09:39.360,0:09:41.976
And we can take a look,[br]if you look back to the slides,

0:09:42.000,0:09:45.976
you can see the whole process,[br]we can see the drug silos being selected,

0:09:46.000,0:09:47.976
the pills doing down the different silos,

0:09:48.000,0:09:50.816
and being collected[br]in the individual capsule.

0:09:50.840,0:09:52.536
Now, this is great,

0:09:52.560,0:09:54.616
I can potentially[br]print my meds based on me,

0:09:54.640,0:09:56.016
instead of taking six pills.

0:09:56.040,0:09:59.176
I can now be looking[br]at my individual dosing.

0:09:59.200,0:10:01.376
My smartwatch is looking[br]at my blood pressure:

0:10:01.400,0:10:03.976
I needed an adjustment[br]in my blood pressure medicines,

0:10:04.000,0:10:06.696
my coumadin level.[br]My blood is too thin,

0:10:06.720,0:10:10.296
so I lower my micromed[br]dose of coumadin, a blood thinner.

0:10:10.320,0:10:12.496
So, this could be[br]smartly adapted, day to day,

0:10:12.520,0:10:15.176
programmed by my physician[br]or cardiologist.

0:10:15.200,0:10:18.776
And you can imagine that larger printers,[br]fast printers like this,

0:10:18.800,0:10:21.536
could be in your corner pharmacy,

0:10:21.560,0:10:23.776
in your doctor's office,[br]in a rural clinic.

0:10:23.800,0:10:27.736
But it could eventually merge and shrink[br]to small ones that could be in your home

0:10:27.760,0:10:31.136
with integrated cartridges like this[br]that are delivered by drone.

0:10:31.160,0:10:33.216
Could print your personalized polypill,

0:10:33.240,0:10:36.536
each morning on your kitchen[br]or your bathroom cabinet.

0:10:36.560,0:10:38.376
And this could evolve, I think,

0:10:38.400,0:10:42.216
into an incredible way to improve[br]adherence in medications across the globe.

0:10:42.240,0:10:46.256
So, I hope we can reimagine[br]the future of medicine in new ways,

0:10:46.280,0:10:47.816
moving from polypharmacy,

0:10:47.840,0:10:51.296
one-size-fits-all,[br]low adherence, complications

0:10:51.320,0:10:55.376
to an era of personalized,[br]precise, on-demand medications

0:10:55.400,0:10:58.776
that can take us[br]and individualize our own health

0:10:58.800,0:11:01.496
and health and medicine around the planet.

0:11:01.520,0:11:02.776
Thank you very much.

0:11:02.800,0:11:08.320
(Applause)

0:11:09.880,0:11:11.936
Host: Daniel, that's kind of awesome.

0:11:11.960,0:11:13.176
Really cool.

0:11:13.200,0:11:14.576
Question for you, though.

0:11:14.600,0:11:18.136
How long is it until, say, that[br]nursing-home patient that you mentioned

0:11:18.160,0:11:20.736
is able to print[br]their pills in their home?

0:11:20.760,0:11:23.536
Daniel Kraft: Well, again,[br]this is just a prototype.

0:11:23.560,0:11:26.696
We think that the regulatory route[br][may] be automated compounding,

0:11:26.720,0:11:29.990
and especially in nursing homes,[br]folks are taking multiple medications,

0:11:29.990,0:11:31.370
and they're often mixed up,

0:11:31.370,0:11:34.370
so it would be a perfect place[br]to start with these technologies.

0:11:34.370,0:11:38.030
These aren't going to evolve and start[br]with printers on your bathroom counter.

0:11:38.030,0:11:41.380
We need to be intelligent and smart[br]about how we roll these things out,

0:11:41.380,0:11:45.040
but realizing there's so many challenges[br]with dosing, adherence and precision,

0:11:45.040,0:11:47.610
and now that we have[br]all these amazing new technologies

0:11:47.610,0:11:49.700
that can integrate and be leveraged,[br]I think we need approaches like this

0:11:49.700,0:11:52.180
to really catalyze and foster

0:11:52.180,0:11:54.020
a true future of health and medicine.

0:11:54.020,0:11:56.336
Host: Great, thank you.[br]DK: Thanks.

0:11:56.360,0:11:58.840
(Applause)