We live in a medication nation.
我们住在药物治疗的过渡。
Four point five billion drug prescriptions will be prescribed by doctors like me this year,in the United States alone.
今年，光是在美国，像我这样的医生就开出了45亿张药物处方。
That's 15 for every man, woman and child.
男性、女性、小孩都算进来，平均一人15张。
And for most of us,our experience with this medication is often confusing number of pills,instructions, side effects, one-size-fits-all dosing, which all too often we aren't taking as prescribed.
对我们大部分人来说，我们对于药物的经验通常是搞不懂要吃几颗药、用药指示、副作用、适用所有人的统一剂量，我们经常会不依照处方来吃药。
And this comes at tremendous expense, costing us our time, our money and our health.
这样造成的代价非常大，成本是我们的时间、我们的金钱、及我们的健康。
And in our now exponential, connected, data-driven age,
在这个指数成长、相互连接、资料驱动的时代，
I think we can and we must do better.
我认为我们可以且必须要做得更好。
So let's take a dive at some of the challenges we have and some potential solutions.
所以，我们来探讨一下我们面临的困难以及一些可能的解决方案。
Let's start with the face that many drugs don't work for those who are prescribed to them.
我们先来谈一项事实：许多药物对于拿到处方的人并不见得有用。
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.
今年，美国总量排名前十名的药物，只对1/4到1//23的用药者有效。
That's great if you're number one, but what about everybody else?
如果刚好对你有效，那很好，但其他人怎么办？
And what's worse, drugs, when they sometimes don't work, can still cause side effects.
更糟糕的是，药物即使没有效用，有时仍然会引发副作用。
Take aspirin -- about one in four of us who take aspirin to reduce our risk of cardiovascular disease, are unknowingly aspirin-resistant.
比如，阿司匹林——服用阿司匹林来减少心血管疾病的人当中有1/4并不知道自己有阿司匹林抗性。
And still have the same risks of gastrointestinal bleeds that kill thousands every year.
他们仍然有同样的风险会发生消化道出血，每年有数千人因消化道出血而死。
It's adverse drug reactions like these that are, by some estimates, the number four leading cause of death in the United States.
像这样的药物不良反应，估计是美国排名第四的死因。
My own grandfather passen away after a single dose of antibiotic caused his kidneys to fail.
我自己的祖父过世了，原因是一剂抗生素让他的肾脏衰竭。
Now, adverse drug reactions and side effects are often tied to challenges in dosing.
药物不良反应和副作用通常都和剂量选择的困难有关。
I trained in pediatrics -- little people, internal medicine -- big people, so one night I
might have been on call in the NICU, carefully dosing to the fraction of a milligram, a
medication for a NICU baby. The next night -- on call in the emergency room, treating a
400-pound lineman or a frail nursing-home patient, who, by most accounts, usually
would get the same dose of medications from the formulary. Which would mean, most
of the time I would be underdosing the lineman, and overdosing the nursing-home
patient. And beyond age and weight, we tend to ignore differences in sex and race in
dosing.
我受的训练是儿童的小儿科 和大人的内科，所以我可能会在一晚 被找去新生儿重症
监护室，小心地给了一毫克的药， 给新生儿重症监护室的宝宝。隔天晚上——则被找去
急诊室，治疗四百磅重的架线工人 或是虚弱的护理之家病人，大部分的说法都认为他们
应该接受同样剂量的处方药物。那就表示，大部分的时候， 我给架线工的剂量是不足的
，给护理之家病人的剂量是过多的。除了年龄和体重，我们在决定剂量时 也倾向会忽略
性别和种族。
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.
除此之外，我知道 我们有个很大的困难，就是不顺从性和低依顺性。许多需要服药
的人不愿服药， 或以不正确的方式服药。在美国，有 40% 65 岁以上的人通常服用 5 种
以上的药物。 有时甚至到 15 种以上。只要依顺性能有小小的改善，就能省下很多钱、
拯救很多性命。
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?
所以，在我们遥想未来时，你认为我们现今的状况，我们通常会听到智慧型、 个人
化的标靶药物，物联网、基因治疗法、人工智慧，好像我们已经到了 精准用药的时代。
在现实中，我们仍然处在靠经验主义和试误法的 不精准用药时代。我认为我们能做得更
好。如果我们能重新想像其他方式，让服药变得更容易，会如何？依你的状况，选择正
确的剂量和组合？如果我们能够超越现今先进的切药器和传真机，进入一个新时代，有
更好的结果、更低的成本、拯救人命、
Well, I think part of the solution is all the emerging ways that we can measure and
connect our health care information. Today, we pretty much live in a reactive, sick-care
world, siloed information that doesn’t flow. We have the potential to move into more
continuous, real-time proactive world of true health care. And part of that starts with the
emerging world of quantified self, we can measure so much of our physiology and
behaviors today, and often it’s siloed on our phones and scales, but it’s starting to
connect to our clinicians, our caregivers, so they can better optimize prevention,
diagnostics and therapy. And when we can do that, we can do some interesting things.
节省药柜中的空间，会如何？我认为，解决方案有一部分在于我们可以用来测量和
连结 健康照护资讯的新兴方式。现今，我们算得上是住在 一个反应式、病人照护的世界
，资讯被储存起来，不会流动。我们有潜力可以做到更连续、即时、主动式、真正健康
照护的世界。其中一部分开端是 量化自我的新兴世界，现今我们可以测量我们 许多生理
状况和行为，这些资讯通常都储存在 我们的手机和测量计当中，但这些资讯已经开始连
结到 我们的临床医生、照护者，让他们可以把预防、 诊断、治疗做到最好。
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.
当我们能做到这些时， 我们就能实行一些有趣的做法。以高血压为例。在全世界
，它是早死 和发病的第一名风险因子。大约一半的成年美国人有高血压，不到一半的人
有做好控制。通常是因为他们需要服用 两、三种不同类的药物，很难做到依顺和调整 你
的血压药物。在美国，每天就有 500 件 因为高血压未控制好而致死的案例是可以避免的
。但我们现在所处的时代 已经发明出了脉压带——食品及药物管理局（FDA）核准了 一
种能和手表结合的脉压带，现在还有无带式 雷达血压装置的原型，可以持续提供你的血
压资讯。所以，在未来，我可以不用到诊所去检测我的血压，我的医生仍然可以知道 我
的即时数据和趋势，并依需要来做调整，只要有血压剂量 演算法的协助就能办到，或是
使用物联网也可以。
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.
现今的技术能做的还不只如此。我现在的智慧手表就 已有内建的心电图，可以用人
工智慧来解读。我戴着一块小型的 OK 绷尺寸贴片，它现在就在即时传输 我的生命特征
资讯。咱们来看看。现在的这些数字 其实有点让人忧心。
Now, it’s not just my real-time vitals that can be seen by my medical team or myself, it
could be my retrospective data, and again, that’d be used to modify dosing and
medication going forward. Even my weight can be super-quantified. My weight, now my
shape, how much body mass, fat, muscle mass I might have, and use that to optimize my
prevention or therapy. And it’s not just for the tech-savvy. Now, MIT engineers have
modified wi-fi so we can seamlessly connect and collect our vital signs, from our
connected rings and smart mattresses, we can start to share this digital exhaust, our
digitome, and even potentially crowdsource it, sharing our health information, just like
we share with our Google Maps and driving, to improve our -- not our driving, but our
health experience globally.
我的医疗团队或我自己能看到的并不只有我的即时生命特征资讯，还能看到我的回
溯资料，可以参考这些资料来调整 后续的剂量和用药选择。连我的体重也可以被超级量
化。我的体重、体型、身体质量、脂肪、肌肉质量，用这些资讯来将我的 预防或治疗做
到最好。并不只有精通技术的人能用。麻省理工学院的工程师 已经修改了无线上网，让
我们可以做到无缝连结， 从连线的戒指和智慧床垫，收集我们的生命特征资讯，我们能
开始分享这些数位产出， 个人专属的数位资料集，甚至有可能将它做群众外包， 分享我
们的健康资讯，就如同我们分享 Google 地图和驾驶，来改善我们的——不是我们的驾驶
， 而是我们全球的健康体验。
So, that’s great. We can potentially now collect this information. What if your labs can
go from the central lab to your home, to your phone, to even inside our bodies to
measure drug levels or other varieties? And of course, we’re in the age of genomics. I’ve
been sequenced, it’s just less than 1,000 dollars today. And I can start to understand my
pharmacogenomics -- how my genes impact whether I need high dose, low dose, or
maybe a different medication altogether. Let’s imagine if your physician or your
pharmacist, had this information integrated into their workflow, augmented with
artificial intelligence, AI, or as I like to refer to it, IA -- intelligence augmentation, to
leverage that information, to understand of the 18,000 or more approved drugs, which
would be the right dose and combination for you.
那很棒。我们现在可能可以收集这些资讯。若你的实验室能从中央实验室转到你的
家中、你的手机上， 甚至你的体内，来测量药物浓度 或其他变数，会如何？当然，现在
是基因组学的时代。我们已经能做定序， 现今的价格不到一千美元。我能开始了解我的
药物基因体学，我的基因会如何影响 我需要的剂量高低，或是根本要换一种药物。咱们
来想像一下， 如果你的医生或药师能把这些资讯整合到 他们的工作流程中，用人工智慧
（AI）来增强，我喜欢把它称为 IA，即：智慧式增强，以发挥那些资讯，来了解在一万
八千种以上的 被核准药物中，你需要的药物组合和剂量是什么。
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?
很好，现在也许我们能帮你 把药物和剂量最佳化，但现今的问题是， 我们仍然在用
这项了不起的技术持续追踪我们的药物。当然，这些技术会演进，有连线的智慧药盒、
提醒专用的应用程式、智慧药瓶盖，如果你还没有吃药，就会传简讯或推特讯息 给你或
你母亲。PillPack 才刚被亚马逊并购，很快我们就会有药品当日 递送服务，由无人机送达
。所有这些在现今都是可能的，但我们却仍然在吃多种药物。如果我们能把它简化呢？
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.
我认为其中一个解决方案 就是善用复方制剂。复方制剂是把多种药物 整合到单一药
锭中。现今我们在一般的无处方 伤风感冒药物中就有用复方制剂。已经有人做过了 预防
药复方制剂的研究，结合了施德丁、血压、阿斯匹灵，在随机研究中已经发现这些组合
相对于安慰剂，能大大减少风险。但这些复方制剂并没有被个人化， 没有针对个人做最
佳化。若我们为你制作最好的 个人化复方制剂，如何？它会是为你打造的， 以你为基础
，它适合你，且可以每天取得。在这 3D 列印的时代，你能列印出个人化的支架、 助听
器、骨科用装置，我甚至接受扫瞄之后 取得了客制化的牛仔裤。
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.
这让我去思考，如果我们能把个人化的复方制剂 列印出来，会如何？比如，就不用
一次吃六种药物，我可以把它们整合成一种。这样吃药就更容易了， 依顺性也能改善
，还有可能把补给品也整合进来，比如维生素 D 或辅酶 Q10。靠着一些协助——我称它
们为 「智慧药物（IntelliMeds）」——靠着我的智慧药物工程团队协助，我们打造了第一
台 智慧药物原型列印机。
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.
它的运作方式是：用微型药物， 而非完整的药锭，每个只有一或二毫克，会根据个
人所需要的剂量和药物组合来挑选。当然，这些是你本来就能一起服用的剂量和组合，
FDA 核准的药物。我们能改变药物代谢动力学，做法是针对个别的微型药物， 将不同元
素以专业方式层叠上去。当我们按下列印键，你就能印出你在任何一天可能需要的药物
组合。同样的，我们也是从治疗 最常见问题的非专利药物做起。现今有 90% 的处方药
都是低成本的非专利药物。一旦我们把药锭列印出来， 我们就能再做些有趣的额外功能
。我们能列印出病人的名字、日期、星期几、一个 QR 码。我们能为在做类固醇减药 或
止痛药减药的病人列印出不同的药物供减药用。
So, this is actually a look at our prototype IntelliMedicine printer. See, unveil it here. It
has about 16 different silos, each containing individual micromeds. And I can now adjust
on the software individual dosings. And when I do that, the robotic arm will adjust the
height of these spansules and the micromeds will release. I can now -- The automated
process would rotate and cycle through, to make sure the micromeds are loaded. And
when I hit print, these will all fall through the device, I now pull out my personalized
printed polypill, with the doses and medications meant for me. And we can take a look,
if you look back to the slides, 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.
让各位看看我们的 原型智慧药物列印机。在此揭幕。它有 16 个不同的筒仓，每个当
中都装有个别的微型药物。我可以透过软体 来调整个别的剂量。当我操作软体时， 机械
手臂就会调整这些长效胶囊的长度， 微型药物就会被释出。我现在可以——它会自动旋
转和轮转， 确保微型药物有被装载上去。当我按下列印键，这些都会透过装置落下，现
在我可以取出我的 个人化列印复方制剂，它的剂量和内含药物 都是针对我做的。我们可
以回头看一下投影片，你们可以看到整个过程， 我们能看到药物筒仓被选取，药锭从不
同的筒仓落下，被收集放入个别的胶囊。
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.
这很棒，我可以依我个人需求 来列印我的药物，不用吃六种药物。我现在可以察看
我的个别剂量，我的智慧手表在看我的血压，我需要调整我的血压药物，我的华法林浓
度，我的血液太稀，所以我降低了我的华法林 微型药物剂量，它会稀释血液。可以智慧
地做调整， 配合每天的状况，由我的内科医生 或心脏科医生来制订计画。你们可以想像
像这样的 列印机，但更大、更快，摆放在你家附近街角的药房里、你的医生的办公室里
、 乡村的诊所里。最终，它可以被合并和缩小， 成为小型个人家用列印机，有像这样的
整合药筒， 由无人机来递送。放在你的厨房或是浴室储存柜中，每天列印出你的个人化
复方制剂。我认为，这有可能会演进，成为一种很棒的方式， 来改善全球的依顺性。
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.
我希望我们能够以新的方式 来重新想像药物的未来，从多重用药、所有人通用的剂
量、低顺从性、复杂混乱，转变为个人化、精确、 依需要来供应的药物，将我们自己的
健康给个人化，也将世界各地的健康 和药物给个人化。
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?
主持人：丹尼尔，那真的很棒。非常酷。但，有问题想请教。还要多久才能让， 比
如，你提到的护理之家病人，能够在他们自己的家中 列印他们的药锭？
Daniel Kraft: Well, again, this is just a prototype. We think that the regulatory route be
automated compounding, and especially in nursing homes, folks are taking multiple
medications, and they’re often mixed up, so it would be a perfect place to start with these
technologies. These aren’t going to evolve and start with printers on your bathroom
counter. We need to be intelligent and smart about how we roll these things out, but
realizing there’s so many challenges with dosing, adherence and precision, and now that
we have all these amazing new technologies that can integrate and be leveraged, I think
we need approaches like this to really catalyze and foster I think we need approaches
like this to really catalyze and foster a true future of health and medicine.
丹尼尔克拉夫特： 再次强调，它只是样本机。我们认为还有待改善的部分 是使其能
够自动合成，特别是在护理之家， 那里的人会服用多种药物，他们常常会搞混，护理之
家是这些技术 最完美的起始点。这些技术不可能从你浴室 柜台上的列印机开始和演进。
我们必须要以很聪明的方式 来推出这些东西，但要知道，在剂量、依顺性， 和精准度上
都还有许多困难挑战，现在我们有这么多了不起的 新技术，可以被用来整合，我认为我
们需要这样的新方法， 来真正催化和促进健康和药物的真正未来。
转载——TED英语演讲。