TED Salon Optum
Daniel Kraft: The pharmacy of the future? Personalized pills, 3D printed at home
丹尼爾克拉夫特: 未來的藥房會是怎樣？透過 3D 列印，在家印出個人化藥錠
Filmed:
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1,746,534 views
醫生丹尼爾克拉夫特述說我們需要改變開處方的方式。太常發生用錯藥物劑量的狀況會有害或是完全沒療效。在這場演說兼概念展示中，克拉夫特分享他的遠景：個人化藥物的未來。他還揭示一台原型 3D 列印機，可以根據個人需求來設計藥錠。
Daniel Kraft - Physician scientist
Daniel Kraft is a physician-scientist, inventor and entrepreneur. He is the founder and chair of Exponential Medicine and has served as faculty chair for Medicine at Singularity University since its inception, exploring the impact and potential of rapidly developing technologies as applied to health and medicine. Full bio
Daniel Kraft is a physician-scientist, inventor and entrepreneur. He is the founder and chair of Exponential Medicine and has served as faculty chair for Medicine at Singularity University since its inception, exploring the impact and potential of rapidly developing technologies as applied to health and medicine. Full bio
Double-click the English transcript below to play the video.
00:13
We live in a medication nation.
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我們住在藥物治療的國度。
00:16
Four point five billion drug prescriptions
will be prescribed by doctors like me
will be prescribed by doctors like me
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今年，光是在美國，
像我這樣的醫生
像我這樣的醫生
就開出了 45 億張藥物處方。
00:21
this year, in the United States alone.
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男性、女性、小孩都算進來，
平均一人 15 張。
平均一人 15 張。
00:23
That's 15 for every man, woman and child.
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00:25
And for most of us,
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對我們大部分人來說，
我們對於藥物的經驗通常是
我們對於藥物的經驗通常是
00:27
our experience with this medication
is often confusing number of pills,
is often confusing number of pills,
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搞不懂要吃幾顆藥、用藥指示、
00:30
instructions, side effects,
one-size-fits-all dosing,
one-size-fits-all dosing,
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副作用、適用所有人的統一劑量，
00:34
which all too often
we aren't taking as prescribed.
we aren't taking as prescribed.
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我們經常會不依照處方來吃藥。
00:36
And this comes at tremendous expense,
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這樣造成的代價非常大，
00:38
costing us our time,
our money and our health.
our money and our health.
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成本是我們的時間、
我們的金錢，及我們的健康。
我們的金錢，及我們的健康。
00:41
And in our now exponential,
connected, data-driven age,
connected, data-driven age,
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在這個指數成長、相互連結、
資料驅動的時代，
資料驅動的時代，
00:44
I think we can and we must do better.
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我認為我們可以且必須要做得更好。
00:47
So let's take a dive
at some of the challenges we have
at some of the challenges we have
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所以，我們來探討
一些我們面臨的困難
一些我們面臨的困難
00:51
and some potential solutions.
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以及一些可能的解決方案。
00:54
Let's start with the fact
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咱們先來談一項事實：
00:55
that many drugs don't work
for those who are prescribed to them.
for those who are prescribed to them.
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許多藥物對於拿到
處方的人並不見得有用。
處方的人並不見得有用。
00:58
The top 10 grossing drugs
in the United States this year,
in the United States this year,
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今年，美國總量排名前十名的藥物，
01:03
they only benefit one in four
to one in 23 of who take them.
to one in 23 of who take them.
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只對 1/4 到 1/23 的用藥者有效。
01:06
That's great if you're number one,
but what about everybody else?
but what about everybody else?
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如果剛好對你有效，那很好，
但其他人怎麼辦？
但其他人怎麼辦？
01:11
And what's worse, drugs,
when they sometimes don't work,
when they sometimes don't work,
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更糟糕的是，藥物即使沒有效用，
有時仍然會引發副作用。
有時仍然會引發副作用。
01:14
can still cause side effects.
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比如，阿斯匹靈——服用阿斯匹靈
01:15
Take aspirin -- about one in four of us
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來減少心血管疾病的人當中有 1/4
01:17
who take aspirin to reduce
our risk of cardiovascular disease,
our risk of cardiovascular disease,
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並不知道自己有阿斯匹靈抗性。
01:20
are unknowingly aspirin-resistant.
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01:22
And still have the same risks
of gastrointestinal bleeds
of gastrointestinal bleeds
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他們仍然有同樣的風險
會發生消化道出血，
會發生消化道出血，
01:25
that kill thousands every year.
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每年有數千人因消化道出血而死。
01:28
It's adverse drug reactions like these
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像這樣的藥物不良反應，
01:31
that are, by some estimates,
the number four leading cause of death
the number four leading cause of death
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估計是美國排名第四的死因。
01:34
in the United States.
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我自己的祖父過世了，
01:35
My own grandfather passed away
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原因是一劑抗生素讓他的腎臟衰竭。
01:36
after a single dose of antibiotic
caused his kidneys to fail.
caused his kidneys to fail.
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01:40
Now, adverse drug reactions
and side effects
and side effects
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藥物不良反應和副作用
01:43
are often tied to challenges in dosing.
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通常都和劑量選擇的困難有關。
01:46
I trained in pediatrics -- little people,
internal medicine -- big people,
internal medicine -- big people,
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我受的訓練是兒童的小兒科
和大人的內科，
和大人的內科，
01:49
so one night I might have been
on call in the NICU,
on call in the NICU,
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所以我可能會在一晚
被找去新生兒重症監護室，
被找去新生兒重症監護室，
01:52
carefully dosing
to the fraction of a milligram,
to the fraction of a milligram,
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小心地給了一毫克的藥，
給新生兒重症監護室的寶寶。
給新生兒重症監護室的寶寶。
01:54
a medication for a NICU baby.
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隔天晚上——則被找去急診室，
01:55
The next night --
on call in the emergency room,
on call in the emergency room,
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01:58
treating a 400-pound lineman
or a frail nursing-home patient,
or a frail nursing-home patient,
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治療四百磅重的架線工人
或是虛弱的護理之家病人，
或是虛弱的護理之家病人，
02:01
who, by most accounts, usually
would get the same dose of medications
would get the same dose of medications
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大部分的說法都認為他們應該接受
同樣劑量的處方藥物。
02:05
from the formulary.
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02:07
Which would mean, most of the time
I would be underdosing the lineman,
I would be underdosing the lineman,
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那就表示，大部分的時候，
我給架線工的劑量是不足的，
我給架線工的劑量是不足的，
02:10
and overdosing the nursing-home patient.
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給護理之家病人的劑量是過多的。
02:13
And beyond age and weight,
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除了年齡和體重，
02:14
we tend to ignore differences
in sex and race in dosing.
in sex and race in dosing.
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我們在決定劑量時
也傾向會忽略性別和種族。
也傾向會忽略性別和種族。
02:18
Now, beyond this, we know
we have a massive challenge
we have a massive challenge
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除此之外，我知道
我們有個很大的困難，
我們有個很大的困難，
02:22
with noncompliance or low adherence.
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就是不順從性和低依順性。
02:25
Many of us who need
to take our medications
to take our medications
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許多需要服藥的人不願服藥，
02:27
aren't taking them
or are taking them incorrectly.
or are taking them incorrectly.
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或以不正確的方式服藥。
02:30
You know, 40 percent
of adults in the US over 65
of adults in the US over 65
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在美國，有 40% 65 歲以上的人
02:32
are on five or more
prescription medications.
prescription medications.
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通常服用 5 種以上的藥物。
有時甚至到 15 種以上。
有時甚至到 15 種以上。
02:35
Sometimes 15 or more.
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02:36
And even small improvements in adherence
can dramatically save dollars and lives.
can dramatically save dollars and lives.
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只要依順性能有小小的改善，
就能省下很多錢、拯救很多性命。
02:43
So, as we think into the future,
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所以，在我們遙想未來時，
你認為我們現今的狀況，
02:46
you think that where we are today,
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02:48
as we often hear about smart,
personalized, targeted drugs,
personalized, targeted drugs,
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我們通常會聽到智慧型、
個人化的標靶藥物，
個人化的標靶藥物，
物聯網、基因治療法、人工智慧，
02:52
Internet of Things, gene therapy, AI,
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02:54
that we'd already arrived
in this era of precision medicine.
in this era of precision medicine.
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好像我們已經到了
精準用藥的時代。
精準用藥的時代。
02:57
In reality, we still live in an age
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在現實中，我們仍然處在
02:58
of empiric, trial-and-error
imprecision medicine.
imprecision medicine.
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靠經驗主義和試誤法的
不精準用藥時代。
不精準用藥時代。
03:01
I think we can do better.
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我認為我們能做得更好。
03:03
What if we could reimagine ways
to help make your medicine-taking easier?
to help make your medicine-taking easier?
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如果我們能重新想像其他方式，
讓服藥變得更容易，會如何？
03:07
To get the right doses
and combinations to match you?
and combinations to match you?
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依你的狀況，選擇正確的劑量和組合？
03:11
What if we could move beyond
today's literal cutting edge
today's literal cutting edge
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如果我們能夠超越現今先進的
03:13
of pill cutters and fax machines,
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切藥器和傳真機，
03:16
to an era where we could have
better outcomes, lower costs,
better outcomes, lower costs,
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進入一個新時代，有更好的結果、
更低的成本、拯救人命、
03:19
saving lives and space
in your medicine cabinet?
in your medicine cabinet?
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節省藥櫃中的空間，會如何？
03:23
Well, I think part of the solution
is all the emerging ways
is all the emerging ways
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我認為，解決方案有一部分在於
我們可以用來測量和連結
健康照護資訊的新興方式。
健康照護資訊的新興方式。
03:26
that we can measure and connect
our health care information.
our health care information.
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03:29
Today, we pretty much live
in a reactive, sick-care world,
in a reactive, sick-care world,
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現今，我們算得上是住在
一個反應式、病人照護的世界，
一個反應式、病人照護的世界，
03:32
siloed information that doesn't flow.
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資訊被儲存起來，不會流動。
03:35
We have the potential to move
into more continuous, real-time
into more continuous, real-time
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我們有潛力可以做到更連續、即時、
03:38
proactive world of true health care.
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主動式、真正健康照護的世界。
03:40
And part of that starts with
the emerging world of quantified self,
the emerging world of quantified self,
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其中一部分開端是
量化自我的新興世界，
量化自我的新興世界，
03:43
we can measure so much
of our physiology and behaviors today,
of our physiology and behaviors today,
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現今我們可以測量我們
許多生理狀況和行為，
許多生理狀況和行為，
03:46
and often it's siloed
on our phones and scales,
on our phones and scales,
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這些資訊通常都儲存在
我們的手機和測量計當中，
我們的手機和測量計當中，
03:49
but it's starting to connect
to our clinicians, our caregivers,
to our clinicians, our caregivers,
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但這些資訊已經開始連結到
我們的臨床醫生、照護者，
我們的臨床醫生、照護者，
讓他們可以把預防、
診斷、治療做到最好。
診斷、治療做到最好。
03:52
so they can better optimize prevention,
diagnostics and therapy.
diagnostics and therapy.
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03:56
And when we can do that,
we can do some interesting things.
we can do some interesting things.
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當我們能做到這些時，
我們就能實行一些有趣的做法。
我們就能實行一些有趣的做法。
03:59
Take, for example, hypertension.
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以高血壓為例。
04:01
It's the number one risk factor
for early death and morbidity worldwide.
for early death and morbidity worldwide.
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在全世界，它是早死
和發病的第一名風險因子。
和發病的第一名風險因子。
04:05
Half of adult Americans,
on approximation, have hypertension,
on approximation, have hypertension,
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大約一半的成年美國人有高血壓，
04:09
less than half have it well-controlled.
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不到一半的人有做好控制。
04:11
It's often because it takes two
or three different classes of medications,
or three different classes of medications,
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通常是因為他們需要服用
兩、三種不同類的藥物，
兩、三種不同類的藥物，
04:14
it's tough to do adherence and adjust
your blood pressure medications.
your blood pressure medications.
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很難做到依順和調整
你的血壓藥物。
你的血壓藥物。
在美國，每天就有 500 件
因為高血壓未控制好
因為高血壓未控制好
04:17
We have 500 preventable deaths
from noncontrolled hypertension
from noncontrolled hypertension
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04:20
in the US, every day.
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而致死的案例是可以避免的。
04:22
But now we're in the era
of connected blood pressure cuffs --
of connected blood pressure cuffs --
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但我們現在所處的時代
已經發明出了脈壓帶——
已經發明出了脈壓帶——
04:25
the FDA just approved
a blood pressure cuff
a blood pressure cuff
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食品及藥物管理局（FDA）核准了
一種能和手錶結合的脈壓帶，
一種能和手錶結合的脈壓帶，
04:27
that can go into your watch.
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04:29
There are now prototypes of cuffless
radar-based blood pressure devices
radar-based blood pressure devices
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現在還有無帶式
雷達血壓裝置的原型，
雷達血壓裝置的原型，
04:33
that can continuously stream
your blood pressure.
your blood pressure.
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可以持續提供你的血壓資訊。
04:35
So, in the future, I could --
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所以，在未來，我可以
04:37
instead of spot-checking
my blood pressure in the clinic,
my blood pressure in the clinic,
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不用到診所去檢測我的血壓，
我的醫生仍然可以知道
我的即時數據和趨勢，
我的即時數據和趨勢，
04:39
my doctor could see
my real-time numbers and my trends,
my real-time numbers and my trends,
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04:42
and adjust them as necessary,
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並依需要來做調整，
04:44
with the help of a blood pressure
dosing algorithm,
dosing algorithm,
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只要有血壓劑量
演算法的協助就能辦到，
演算法的協助就能辦到，
04:47
or using the Internet of Things.
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或是使用物聯網也可以。
04:49
Now, technology today can do even more.
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現今的技術能做的還不只如此。
04:52
My smartwatch, already today,
has an EKG built in,
has an EKG built in,
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我現在的智慧手錶就
已有內建的心電圖，
已有內建的心電圖，
04:55
that can be read
by artificial intelligence.
by artificial intelligence.
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可以用人工智慧來解讀。
04:58
I'm wearing a small, Band-Aid-sized patch,
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我戴著一塊小型的 OK 繃尺寸貼片，
05:01
that is live-streaming
my vital signs right now.
my vital signs right now.
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它現在就在即時傳輸
我的生命特徵資訊。
我的生命特徵資訊。
05:03
Let's take a look.
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咱們來看看。
05:05
They're actually a little
concerning at the moment.
concerning at the moment.
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現在的這些數字
其實有點讓人憂心。
其實有點讓人憂心。
05:07
(Laughter)
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（笑聲）
05:09
Now, it's not just my real-time vitals
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我的醫療團隊或我自己能看到的
並不只有我的即時生命特徵資訊，
05:12
that can be seen
by my medical team or myself,
by my medical team or myself,
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還能看到我的回溯資料，
05:14
it could be my retrospective data,
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05:16
and again, that'd be used to modify
dosing and medication going forward.
dosing and medication going forward.
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可以參考這些資料來調整
後續的劑量和用藥選擇。
後續的劑量和用藥選擇。
05:20
Even my weight can be super-quantified.
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連我的體重也可以被超級量化。
05:22
My weight, now my shape,
how much body mass, fat,
how much body mass, fat,
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我的體重、體型、
身體質量、脂肪、肌肉質量，
05:27
muscle mass I might have,
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用這些資訊來將我的
預防或治療做到最好。
預防或治療做到最好。
05:28
and use that to optimize
my prevention or therapy.
my prevention or therapy.
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05:32
And it's not just for the tech-savvy.
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並不只有精通技術的人能用。
05:34
Now, MIT engineers have modified wi-fi
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麻省理工學院的工程師
已經修改了無線上網，
已經修改了無線上網，
05:37
so we can seamlessly
connect and collect our vital signs,
connect and collect our vital signs,
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讓我們可以做到無縫連結，
從連線的戒指和智慧床墊，
從連線的戒指和智慧床墊，
05:41
from our connected rings
and smart mattresses,
and smart mattresses,
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收集我們的生命特徵資訊，
05:43
we can start to share
this digital exhaust, our digitome,
this digital exhaust, our digitome,
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我們能開始分享這些數位產出，
個人專屬的數位資料集，
個人專屬的數位資料集，
05:46
and even potentially crowdsource it,
sharing our health information,
sharing our health information,
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甚至有可能將它做群眾外包，
分享我們的健康資訊，
分享我們的健康資訊，
05:49
just like we share
with our Google Maps and driving,
with our Google Maps and driving,
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就如同我們分享 Google 地圖和駕駛，
05:52
to improve our -- not our driving,
but our health experience globally.
but our health experience globally.
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來改善我們的——不是我們的駕駛，
而是我們全球的健康體驗。
而是我們全球的健康體驗。
05:56
So, that's great.
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那很棒。
05:58
We can potentially now
collect this information.
collect this information.
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我們現在可能可以收集這些資訊。
06:00
What if your labs
can go from the central lab
can go from the central lab
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若你的實驗室能從中央實驗室轉到
06:04
to your home, to your phone,
to even inside our bodies
to even inside our bodies
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你的家中、你的手機上，
甚至你的體內，
甚至你的體內，
06:07
to measure drug levels or other varieties?
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來測量藥物濃度
或其他變數，會如何？
或其他變數，會如何？
06:10
And of course,
we're in the age of genomics.
we're in the age of genomics.
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當然，現在是基因組學的時代。
06:12
I've been sequenced,
it's just less than 1,000 dollars today.
it's just less than 1,000 dollars today.
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我們已經能做定序，
現今的價格不到一千美元。
現今的價格不到一千美元。
我能開始了解我的藥物基因體學，
06:15
And I can start to understand
my pharmacogenomics --
my pharmacogenomics --
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我的基因會如何影響
我需要的劑量高低，
我需要的劑量高低，
06:17
how my genes impact
whether I need high dose, low dose,
whether I need high dose, low dose,
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或是根本要換一種藥物。
06:20
or maybe a different
medication altogether.
medication altogether.
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咱們來想像一下，
如果你的醫生或藥師
如果你的醫生或藥師
06:22
Let's imagine if your physician
or your pharmacist,
or your pharmacist,
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06:25
had this information
integrated into their workflow,
integrated into their workflow,
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能把這些資訊整合到
他們的工作流程中，
他們的工作流程中，
06:27
augmented with artificial intelligence,
AI, or as I like to refer to it, IA --
AI, or as I like to refer to it, IA --
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用人工智慧（AI）來增強，
我喜歡把它稱為 IA，
06:31
intelligence augmentation,
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即：智慧式增強，
06:33
to leverage that information,
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以發揮那些資訊，
06:34
to understand of the 18,000
or more approved drugs,
or more approved drugs,
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來了解在一萬八千種以上的
被核准藥物中，
被核准藥物中，
06:37
which would be the right dose
and combination for you.
and combination for you.
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你需要的藥物組合和劑量是什麼。
06:40
So great, now maybe we can
optimize your drugs and your doses,
optimize your drugs and your doses,
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很好，現在也許我們能幫你
把藥物和劑量最佳化，
把藥物和劑量最佳化，
06:43
but the problem today is,
we're still using this amazing technology
we're still using this amazing technology
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但現今的問題是，
我們仍然在用這項了不起的技術
我們仍然在用這項了不起的技術
持續追蹤我們的藥物。
06:46
to keep track of our drugs.
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06:48
And of course, these technologies evolve,
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當然，這些技術會演進，
06:51
there's connected dispensers,
reminder apps,
reminder apps,
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有連線的智慧藥盒、
提醒專用的應用程式、
提醒專用的應用程式、
06:54
smart pill bottle caps that can text
or tweet you or your mother
or tweet you or your mother
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智慧藥瓶蓋，如果你還沒有吃藥，
就會傳簡訊或推特訊息
給你或你母親。
給你或你母親。
06:57
if you haven't taken your medications.
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06:59
PillPack was just acquired by Amazon,
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PillPack 才剛被亞馬遜併購，
07:01
so soon we may have same-day delivery
of our drugs, delivered by drone.
of our drugs, delivered by drone.
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很快我們就會有藥品當日
遞送服務，由無人機送達。
遞送服務，由無人機送達。
07:05
So, all these things are possible today,
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所有這些在現今都是可能的，
07:08
but we're still taking multiple pills.
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但我們卻仍然在吃多種藥物。
07:09
What if we can make it simpler?
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如果我們能把它簡化呢？
07:11
I think one of the solutions
is to make better use of the polypill.
is to make better use of the polypill.
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我認為其中一個解決方案
就是善用複方製劑。
就是善用複方製劑。
複方製劑是把多種藥物
整合到單一藥錠中。
整合到單一藥錠中。
07:14
A polypill is the integration of multiple
medications into a single pill.
medications into a single pill.
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07:18
And we have these today in common,
over-the-counter cold and flu remedies.
over-the-counter cold and flu remedies.
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現今我們在一般的無處方
傷風感冒藥物中就有用複方製劑。
傷風感冒藥物中就有用複方製劑。
07:21
And there have been
prevention polypill studies done,
prevention polypill studies done,
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已經有人做過了
預防藥複方製劑的研究，
預防藥複方製劑的研究，
結合了施德丁、血壓、阿斯匹靈，
07:24
giving combinations
of statins, blood pressure, aspirin,
of statins, blood pressure, aspirin,
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07:26
which in randomized studies
have been shown
have been shown
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在隨機研究中已經發現這些組合
相對於安慰劑，能大大減少風險。
07:28
to dramatically reduce risk,
compared to placebo.
compared to placebo.
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07:31
But these polypills weren't personalized,
they weren't optimized to the individual.
they weren't optimized to the individual.
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但這些複方製劑並沒有被個人化，
沒有針對個人做最佳化。
沒有針對個人做最佳化。
若我們為你製作最好的
個人化複方製劑，如何？
個人化複方製劑，如何？
07:35
What if we could optimize
your personalized polypill?
your personalized polypill?
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07:37
So it would be built for you,
based on you, it could adapt to you,
based on you, it could adapt to you,
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它會是為你打造的，
以你為基礎，它適合你，
以你為基礎，它適合你，
07:41
even every single day.
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且可以每天取得。
07:42
Well, we're now in the era of 3D printing,
you can print personalized braces,
you can print personalized braces,
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在這 3D 列印的時代，你能列印出
個人化的支架、
助聽器、骨科用裝置，
助聽器、骨科用裝置，
07:46
hearing aids, orthopedic devices,
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07:48
even I've been scanned
and had my jeans tailored to fit to me.
and had my jeans tailored to fit to me.
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我甚至接受掃瞄之後
取得了客製化的牛仔褲。
取得了客製化的牛仔褲。
07:52
So this got me thinking,
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這讓我去思考，
07:53
what if we could 3D print
your personalized polypill?
your personalized polypill?
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如果我們能把個人化的複方製劑
列印出來，會如何？
列印出來，會如何？
07:56
So instead of taking
six medications, for example,
six medications, for example,
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比如，就不用一次吃六種藥物，
07:59
I could integrate them into one.
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我可以把它們整合成一種。
08:00
So it would be easier to take,
improve adherence
improve adherence
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這樣吃藥就更容易了，
依順性也能改善，
依順性也能改善，
08:03
and potentially, it could even
integrate in supplements,
integrate in supplements,
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還有可能把補給品也整合進來，
08:05
like vitamin D or CoQ10.
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比如維生素 D 或輔酶 Q10。
08:09
So with some help --
I call these "IntelliMeds" --
I call these "IntelliMeds" --
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靠著一些協助——我稱它們為
「智慧藥物（IntelliMeds）」——
「智慧藥物（IntelliMeds）」——
08:12
and with the help of my
IntelliMedicine engineering team,
IntelliMedicine engineering team,
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靠著我的智慧藥物工程團隊協助，
我們打造了第一台
智慧藥物原型列印機。
智慧藥物原型列印機。
08:14
we built the first
IntelliMedicine prototype printer.
IntelliMedicine prototype printer.
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08:17
And here's how it works:
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它的運作方式是：用微型藥物，
而非完整的藥錠，
而非完整的藥錠，
08:19
instead of full tablets,
we have small micromeds,
we have small micromeds,
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08:21
one or two milligrams each,
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每個只有一或二毫克，
08:23
which are sorted and selected
based on the dose and combination
based on the dose and combination
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會根據個人所需要的
劑量和藥物組合來挑選。
08:26
needed for an individual.
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08:27
And of course, these would be
doses and combinations
doses and combinations
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當然，這些是你本來就能
一起服用的劑量和組合，
FDA 核准的藥物。
FDA 核准的藥物。
08:30
you could already take together,
FDA-approved drugs.
FDA-approved drugs.
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我們能改變藥物代謝動力學，
08:32
We could change the pharmacokinetics
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08:34
by professionally layering on different
elements to the individual micromeds.
elements to the individual micromeds.
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做法是針對個別的微型藥物，
將不同元素以專業方式層疊上去。
將不同元素以專業方式層疊上去。
08:39
And when we hit print,
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當我們按下列印鍵，
08:41
you print your combination of medications
that might be needed by you
that might be needed by you
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你就能印出你在任何一天
可能需要的藥物組合。
08:44
on any individual day.
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08:46
And we'd start with, again, generic drugs
for the most common problems.
for the most common problems.
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同樣的，我們也是從治療
最常見問題的非專利藥物做起。
最常見問題的非專利藥物做起。
08:50
About 90 percent of prescribed drugs today
are low-cost generics.
are low-cost generics.
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現今有 90% 的處方藥
都是低成本的非專利藥物。
都是低成本的非專利藥物。
08:53
And once we've printed the pill,
we can do some fun bells and whistles.
we can do some fun bells and whistles.
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一旦我們把藥錠列印出來，
我們就能再做些有趣的額外功能。
我們就能再做些有趣的額外功能。
08:57
We could print the name of the patient,
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我們能列印出病人的名字、
08:59
the date, the day of the week, a QR code.
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日期、星期幾、一個 QR 碼。
09:02
We could print different meds for tapering
for a patient on a steroid taper,
for a patient on a steroid taper,
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我們能為在做類固醇減藥
或止痛藥減藥的病人
或止痛藥減藥的病人
09:06
or tapering from pain medications.
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列印出不同的藥物供減藥用。
09:08
So, this is actually a look at our
prototype IntelliMedicine printer.
prototype IntelliMedicine printer.
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讓各位看看我們的
原型智慧藥物列印機。
原型智慧藥物列印機。
09:13
See, unveil it here.
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在此揭幕。
09:15
It has about 16 different silos,
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它有 16 個不同的筒倉，
09:18
each containing individual micromeds.
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每個當中都裝有個別的微型藥物。
09:22
And I can now adjust on the software
individual dosings.
individual dosings.
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我可以透過軟體
來調整個別的劑量。
來調整個別的劑量。
09:26
And when I do that,
the robotic arm will adjust
the robotic arm will adjust
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當我操作軟體時，
機械手臂就會調整
機械手臂就會調整
09:30
the height of these spansules
and the micromeds will release.
and the micromeds will release.
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這些長效膠囊的長度，
微型藥物就會被釋出。
微型藥物就會被釋出。
09:33
I can now --
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我現在可以——
09:35
The automated process
would rotate and cycle through,
would rotate and cycle through,
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它會自動旋轉和輪轉，
確保微型藥物有被裝載上去。
確保微型藥物有被裝載上去。
09:37
to make sure the micromeds are loaded.
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當我按下列印鍵，
09:39
And when I hit print,
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09:41
these will all fall through the device,
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這些都會透過裝置落下，
09:43
I now pull out my
personalized printed polypill,
personalized printed polypill,
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現在我可以取出我的
個人化列印複方製劑，
個人化列印複方製劑，
09:47
with the doses
and medications meant for me.
and medications meant for me.
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它的劑量和內含藥物
都是針對我做的。
都是針對我做的。
09:51
And we can take a look,
if you look back to the slides,
if you look back to the slides,
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我們可以回頭看一下投影片，
09:54
you can see the whole process,
we can see the drug silos being selected,
we can see the drug silos being selected,
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你們可以看到整個過程，
我們能看到藥物筒倉被選取，
我們能看到藥物筒倉被選取，
09:58
the pills doing down the different silos,
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藥錠從不同的筒倉落下，
10:00
and being collected
in the individual capsule.
in the individual capsule.
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被收集放入個別的膠囊。
10:02
Now, this is great,
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這很棒，
10:04
I can potentially
print my meds based on me,
print my meds based on me,
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我可以依我個人需求
來列印我的藥物，
來列印我的藥物，
10:06
instead of taking six pills.
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不用吃六種藥物。
10:08
I can now be looking
at my individual dosing,
at my individual dosing,
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我現在可以察看我的個別劑量，
10:11
my smartwatch is looking
at my blood pressure,
at my blood pressure,
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我的智慧手錶在看我的血壓，
10:13
I needed an adjustment
in my blood pressure medicines,
in my blood pressure medicines,
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我需要調整我的血壓藥物，
我的華法林濃度，我的血液太稀，
10:16
my coumadin level, my blood is too thin,
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10:18
so I lower my micromed
dose of coumadin, a blood thinner.
dose of coumadin, a blood thinner.
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所以我降低了我的華法林
微型藥物劑量，它會稀釋血液。
微型藥物劑量，它會稀釋血液。
10:22
So, this could be
smartly adapted, day to day,
smartly adapted, day to day,
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可以智慧地做調整，
配合每天的狀況，
配合每天的狀況，
10:24
programmed by my physician
or cardiologist.
or cardiologist.
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由我的內科醫生
或心臟科醫生來製訂計畫。
或心臟科醫生來製訂計畫。
10:27
And you can imagine that larger printers,
fast printers like this,
fast printers like this,
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你們可以想像像這樣的
列印機，但更大、更快，
列印機，但更大、更快，
10:30
could be in your corner pharmacy,
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擺放在你家附近街角的藥房裡、
10:33
in your doctor's office,
in a rural clinic.
in a rural clinic.
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你的醫生的辦公室裡、
鄉村的診所裡。
鄉村的診所裡。
10:35
But it could eventually merge and shrink
to small ones, that could be in your home,
to small ones, that could be in your home,
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最終，它可以被合併和縮小，
成為小型個人家用列印機，
成為小型個人家用列印機，
10:39
with integrated cartridges like this,
that are delivered by drone.
that are delivered by drone.
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有像這樣的整合藥筒，
由無人機來遞送。
由無人機來遞送。
10:43
Could print your personalized polypill,
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放在你的廚房或是浴室儲存櫃中，
10:45
each morning on your kitchen
or your bathroom cabinet.
or your bathroom cabinet.
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每天列印出你的個人化複方製劑。
10:48
And this could evolve, I think,
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我認為，這有可能會演進，
10:50
into an incredible way to improve
adherence in medications across the globe.
adherence in medications across the globe.
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成為一種很棒的方式，
來改善全球的依順性。
來改善全球的依順性。
10:54
So, I hope we can reimagine
the future of medicine in new ways,
the future of medicine in new ways,
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我希望我們能夠以新的方式
來重新想像藥物的未來，
來重新想像藥物的未來，
10:58
moving from polypharmacy,
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從多重用藥、所有人通用的劑量、
10:59
one-size-fits-all,
low adherence, complications
low adherence, complications
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低順從性、複雜混亂，
11:03
to an era of personalized,
precise, on-demand medications,
precise, on-demand medications,
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轉變為個人化、精確、
依需要來供應的藥物，
依需要來供應的藥物，
11:07
that can take us
and individualize our own health
and individualize our own health
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將我們自己的健康給個人化，
11:10
and health and medicine around the planet.
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也將世界各地的健康
和藥物給個人化。
和藥物給個人化。
11:13
Thank you very much.
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非常謝謝。
11:14
(Applause)
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（掌聲）
11:21
Host: Daniel, that's kind of awesome.
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主持人：丹尼爾，那真的很棒。
11:23
Really cool.
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非常酷。
11:25
Question for you, though.
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但，有問題想請教。
11:26
How long is it until, say, that
nursing-home patient that you mentioned
nursing-home patient that you mentioned
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還要多久才能讓，
比如，你提到的護理之家病人，
比如，你提到的護理之家病人，
11:30
is able to print
their pills in their home?
their pills in their home?
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能夠在他們自己的家中
列印他們的藥錠？
列印他們的藥錠？
11:32
Daniel Kraft: Well, again,
this is just a prototype.
this is just a prototype.
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丹尼爾克拉夫特：
再次強調，它只是樣本機。
再次強調，它只是樣本機。
11:35
We think that the regulatory route
be automated compounding,
be automated compounding,
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我們認為還有待改善的部分
是使其能夠自動合成，
是使其能夠自動合成，
11:38
and especially in nursing homes,
folks are taking multiple medications,
folks are taking multiple medications,
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特別是在護理之家，
那裡的人會服用多種藥物，
那裡的人會服用多種藥物，
他們常常會搞混，
11:41
and they're often mixed up,
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護理之家是這些技術
最完美的起始點。
最完美的起始點。
11:43
so it would be a perfect place
to start with these technologies.
to start with these technologies.
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這些技術不可能從你浴室
櫃台上的列印機開始和演進。
櫃台上的列印機開始和演進。
11:46
These aren't going to evolve and start
with printers on your bathroom counter.
with printers on your bathroom counter.
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我們必須要以很聰明的方式
來推出這些東西，
來推出這些東西，
11:50
We need to be intelligent and smart
about how we roll these things out,
about how we roll these things out,
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但要知道，在劑量、依順性，
和精準度上都還有許多困難挑戰，
和精準度上都還有許多困難挑戰，
11:53
but realizing there's so many challenges
with dosing, adherence and precision,
with dosing, adherence and precision,
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現在我們有這麼多了不起的
新技術，可以被用來整合，
新技術，可以被用來整合，
11:57
and now that we have
all these amazing new technologies
all these amazing new technologies
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11:59
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
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我認為我們需要這樣的新方法，
12:01
I think we need approaches like this
to really catalyze and foster
to really catalyze and foster
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來真正催化
和促進健康和藥物的真正未來。
12:04
a true future of health and medicine.
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主持人：好極了，謝謝你。
丹尼爾：謝謝。
丹尼爾：謝謝。
12:06
Host: Great, thank you.
DK: Thanks.
DK: Thanks.
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（掌聲）
12:08
(Applause)
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ABOUT THE SPEAKER
Daniel Kraft - Physician scientistDaniel Kraft is a physician-scientist, inventor and entrepreneur. He is the founder and chair of Exponential Medicine and has served as faculty chair for Medicine at Singularity University since its inception, exploring the impact and potential of rapidly developing technologies as applied to health and medicine.
Why you should listen
Dr. Daniel Kraft is a Stanford and Harvard trained physician-scientist with more than 25 years of experience in clinical practice, biomedical research and innovation. He is Faculty Chair for Medicine at Singularity University and is the founder and chair for Exponential Medicine, a program which explores convergent, rapidly developing technologies and their potential to reshape the future of health and biomedicine.
After medical school at Stanford, Kraft was board certified in both Internal Medicine and Pediatrics following residency at the Massachusetts General Hospital & Boston Children's Hospital, and he completed Stanford fellowships in hematology/oncology & bone marrow transplantation. He is a member of the inaugural class of Aspen Institute Health Innovators Fellows.
Kraft has extensive research in stem cell biology and regenerative medicine with multiple scientific publications, medical device, immunology and stem cell-related patents through faculty positions with Stanford University School of Medicine and as clinical faculty for the pediatric bone marrow transplantation service at University of California San Francisco.
Kraft recently founded IntelliMedicine, focused on connected, data-driven and integrated personalized medicine. He is the inventor of the MarrowMiner, an FDA-approved device for the minimally invasive harvest of bone marrow, and he founded RegenMed Systems, a company developing technologies to enable adult stem cell-based regenerative therapies. He is an advisor the XPRIZE (having conceived of the Medical Tricorder XPRIZE and is helping lead a new Cancer focused prize), and advises several digital health and technology companies.
Kraft is an avid pilot and served for 14 years as an officer and flight surgeon with F-15 and F-16 fighter squadrons in the Air National Guard. He has conducted research on aerospace medicine that was published with NASA, with whom he was a finalist for astronaut selection.
Daniel Kraft | Speaker | TED.com