The pharmacy of the future Personalized pills 3D printed at home Daniel Kraft
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,
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.
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)
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.
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 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.
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.
(Laughter)
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.
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.
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, 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.
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.
(Applause)
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?
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.
Host: Great, thank you.
DK: Thanks.
(Applause)