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We live in a medication nation.
我们住在药物治疗的国度。
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,
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、
instructions, side effects, one-size-fits-all dosing, which all too often we aren't taking as prescribed.
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、数据驱动的时代，
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，我们来探讨一些我们面临的困难以及一些可能的解决方案。
Let's start with the fact that many drugs don't work for those who are prescribed to them.
咱们先来谈一项事实：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，据估计，是美国排名第四的死因。
My own grandfather passed away after a single dose of antibiotic caused his kidneys to fail.
我的祖父过世了，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,
我受的训练是儿童的小儿科和大人的内科，
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.
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。
The next night -- on call in the emergency room, treating a 400-pound lineman or a frail nursing-home patient,
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，
who, by most accounts, usually would get the same dose of medications from the formulary.
大部分的说法都认为他们应该接受同样剂量的处方药物。
Which would mean, most of the time I would be underdosing the lineman, and overdosing the nursing-home patient.
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。
And beyond age and weight, we tend to ignore differences in sex and race in dosing.
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.
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。
Many of us who need to take our medications aren't taking them or are taking them incorrectly.
许多需要服药的人不愿服药，或以不正确的方式服药。
You know, 40 percent of adults in the US over 65 are on five or more prescription medications.
在美国，有40%的65岁以上的人通常会服用5种以上的药物。
Sometimes 15 or more. And even small improvements in adherence can dramatically save dollars and lives.
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,
所以，在我们遥想未来时，你认为我们现今的状况，
as we often hear about smart, personalized, targeted drugs, Internet of Things, gene therapy, AI,
我们通常会听到智能型、个人化的标靶药物，物联网、基因治疗法、人工智能，
that we'd already arrived in this era of precision medicine.
好像我们已经到了精准用药的时代。
In reality, we still live in an age of empiric, trial-and-error imprecision medicine.
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。
I think we can do better. What if we could reimagine ways to help make your medicine-taking easier?
我认为我们能做得更好。如果我们能重新想象其他方式，让服药变得更容易，会如何？
To get the right doses and combinations to match you?
依你的状况，选择正确的剂量和组合？
What if we could move beyond today's literal cutting edge of pill cutters and fax machines,
如果我们能够超越现今先进的切药器和传真机，
to an era where we could have better outcomes, lower costs, saving lives and space in your medicine cabinet?
进入一个新时代，有更好的结果、更低的成本、拯救人命、节省药柜中的空间，会如何？
Well, I think part of the solution is all the emerging ways that we can measure and connect our health care information.
我认为，解决方案有一部分在于我们可以用来测量和连接健康照护信息的新兴方式。
Today, we pretty much live in a reactive, sick-care world, siloed information that doesn't flow.
现今，我们算得上是住在一个反应式、病人照护的世界，信息被储存起来，不会流动。
We have the potential to move into more continuous, real-time proactive world of true health care.
我们有潜力可以做到更连续、实时、主动式、真正健康照护的世界。
And part of that starts with the emerging world of quantified self,
其中一部分开端是量化自我的新兴世界，
we can measure so much of our physiology and behaviors today, and often it's siloed on our phones and scales,
现今我们可以测量我们许多生理状况和行为，这些信息通常都储存在我们的手机和测量计当中，
but it's starting to connect to our clinicians, our caregivers, so they can better optimize prevention, diagnostics and therapy.
但这些信息已经开始连接到我们的临床医生、照护者，让他们可以把预防、诊断、治疗做到最好。现在的这些数字 其实有点让人忧心。
And when we can do that, we can do some interesting things.
当我们能做到这些时，我们就能实行一些有趣的做法。
Take, for example, hypertension. It's the number one risk factor for early death and morbidity worldwide.
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。
Half of adult Americans, on approximation, have hypertension, less than half have it well-controlled.
大约一半的成年美国人有高血压，只有不到一半的人控制的很好。
It's often because it takes two or three different classes of medications,
通常是因为他们需要服用两、三种不同类的药物，
it's tough to do adherence and adjust your blood pressure medications.
很难做到依顺和调整你的血压药物。
We have 500 preventable deaths from noncontrolled hypertension in the US, every day.
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。
But now we're in the era of connected blood pressure cuffs
但我们现在所处的时代已经发明出了脉压带，
the FDA just approved a blood pressure cuff that can go into your watch.
食品及药物管理局（FDA）核准了一种能和手表结合的脉压带。
There are now prototypes of cuffless radar-based blood pressure devices that can continuously stream your blood pressure.
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信息。
So, in the future, I could -- instead of spot-checking my blood pressure in the clinic,
所以在未来，我可以不用到诊所去检测我的血压，
my doctor could see my real-time numbers and my trends, and adjust them as necessary,
我的医生仍然可以知道我的实时数据和趋势，并依需要来做调整，
with the help of a blood pressure dosing algorithm, or using the Internet of Things.
只要有血压剂量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.
现今的技术能做的还不只如此。
My smartwatch, already today, has an EKG built in, that can be read by artificial intelligence.
我现在的智能手表就已有内建的心电图，可以用人工智能来解读。
I'm wearing a small, Band-Aid-sized patch, that is live-streaming my vital signs right now.
我戴着一块小型的创口贴尺寸贴片，它现在就在实时传输我的生命特征信息。
Let's take a look. They're actually a little concerning at the moment.
咱们来看看。此刻有一点点让人不安。
Now, it's not just my real-time vitals that can be seen by my medical team or myself,
我的医疗团队或我自己能看到的并不只有我的实时生命特征信息，
it could be my retrospective data, and again, that'd be used to modify dosing and medication going forward.
还能看到我的回溯数据，可以参考这些数据来调整后续的剂量和用药选择。
Even my weight can be super-quantified.
连我的体重也可以被超级量化。
My weight, now my shape, how much body mass, fat, muscle mass I might have, and use that to optimize my prevention or therapy.
我的体重、体型、身体质量、脂肪、肌肉质量，用这些信息来将我的预防或治疗做到最好。
And it's not just for the tech-savvy.
并不只有精通技术的人能用。
Now, MIT engineers have modified wi-fi so we can seamlessly connect and collect our vital signs,
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，
from our connected rings and smart mattresses, we can start to share this digital exhaust, our digitome,
从联机的戒指和智能床垫，收集我们的生命特征信息，我们能开始分享这些数字产出，个人专属的数字数据集，
and even potentially crowdsource it, sharing our health information,
甚至有可能将它做群众外包，分享我们的健康信息，
just like we share with our Google Maps and driving, to improve our -- not our driving, but our health experience globally.
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.
那很棒。我们现在可能可以收集这些信息。
What if your labs can go from the central lab to your home,
若你的实验室能从中央实验室转到你的家中、
to your phone, to even inside our bodies to measure drug levels or other varieties?
你的手机上，甚至你的体内，来测量药物浓度或其他变量，会如何？
And of course, we're in the age of genomics.
当然，现在是基因组学的时代。
I've been sequenced, it's just less than 1,000 dollars today.
我们已经能做定序，现今的价格不到一千美元。
And I can start to understand my pharmacogenomics
我能开始了解我的药物基因体学，
how my genes impact whether I need high dose, low dose, or maybe a different medication altogether.
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。
Let's imagine if your physician or your pharmacist, had this information integrated into their workflow,
咱们来想象一下，如果你的医生或药师能把这些信息整合到他们的工作流程中，
augmented with artificial intelligence, AI, or as I like to refer to it, IA
用人工智能（AI）来增强，我喜欢把它称为IA，
intelligence augmentation, to leverage that information, to understand of the 18,000 or more approved drugs,
即：智能式增强，以发挥那些信息，来了解在一万八千种以上的被核准药物中，
which would be the right dose and combination for you.
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,
很好，现在也许我们能帮你把药物和剂量优化，但现今的问题是，
we're still using this amazing technology to keep track of our drugs.
我们仍然在用这项了不起的技术持续追踪我们的药物。
And of course, these technologies evolve, there's connected dispensers, reminder apps,
当然，这些技术会演进，有联机的智能药盒、提醒专用的应用程序、
smart pill bottle caps that can text or tweet you or your mother if you haven't taken your medications.
智能药瓶盖，如果你还没有吃药，就会传简讯或推特信息给你或你母亲。
PillPack was just acquired by Amazon, so soon we may have same-day delivery of our drugs, delivered by drone.
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。
So, all these things are possible today, but we're still taking multiple pills. What if we can make it simpler?
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.
我认为其中一个解决方案就是善用复方制剂。
A polypill is the integration of multiple medications into a single pill.
复方制剂是把多种药物整合到单一药丸中。
And we have these today in common, over-the-counter cold and flu remedies.
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。
And there have been prevention polypill studies done, giving combinations of statins, blood pressure, aspirin,
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、阿司匹林，
which in randomized studies have been shown to dramatically reduce risk, compared to placebo.
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。
But these polypills weren't personalized, they weren't optimized to the individual.
但这些复方制剂并没有被个人化，没有针对个人做优化。
What if we could optimize your personalized polypill?
如果我们为你制作最好的个人化复方制剂，如何？
So it would be built for you, based on you, it could adapt to you, even every single day.
它会是为你打造的，以你为基础，它适合你，并且可以每天取得。
Well, we're now in the era of 3D printing, you can print personalized braces, hearing aids, orthopedic devices,
在这3D打印的时代，你能打印出个人化的支架、助听器、骨科用装置，
even I've been scanned and had my jeans tailored to fit to me.
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?
这让我去思考，如果我们能把个人化的复方制剂打印出来，会如何？
So instead of taking six medications, for example, I could integrate them into one.
比如，就不用一次吃六种药物，我可以把它们整合成一种。
So it would be easier to take, improve adherence and potentially,
这样吃药就更容易了，依顺性也能改善，
it could even integrate in supplements, like vitamin D or CoQ10.
还有可能把补给品也整合进来，比如维生素D或辅酶Q10。
So with some help -- I call these "IntelliMeds"
靠着一些协助--我称它们为“智能药物”，
and with the help of my IntelliMedicine engineering team, we built the first IntelliMedicine prototype printer.
靠着我的智能药物工程团队协助，我们打造了第一台智能药物原型打印机。
And here's how it works: instead of full tablets, we have small micromeds, one or two milligrams each,
它的运作方式是：用微型药物，而非完整的药丸，每个只有一或二毫克，
which are sorted and selected based on the dose and combination needed for an individual.
会根据个人所需要的剂量和药物组合来挑选。
And of course, these would be doses and combinations you could already take together, FDA-approved drugs.
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。
We could change the pharmacokinetics by professionally layering on different elements to the individual micromeds.
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迭上去。
And when we hit print, you print your combination of medications that might be needed by you on any individual day.
当我们按下打印键，你就能印出你在任何一天可能需要的药物组合。
And we'd start with, again, generic drugs for the most common problems.
同样的，我们也是从治疗最常见问题的非专利药物做起。
About 90 percent of prescribed drugs today are low-cost generics.
现今有90%的处方药都是低成本的非专利药物。
And once we've printed the pill, we can do some fun bells and whistles.
一旦我们把药丸打印出来，我们就能再做些有趣的额外功能。
We could print the name of the patient, the date, the day of the week, a QR code.
我们能打印出病人的名字、日期、星期几、一个QR码。
We could print different meds for tapering for a patient on a steroid taper, or tapering from pain medications.
我们能为在做类固醇减药或止痛药减药的病人打印出不同的药物供减药用。
So, this is actually a look at our prototype IntelliMedicine printer.
让各位看看我们的原型智能药物打印机。
See, unveil it here. It has about 16 different silos, each containing individual micromeds.
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。
And I can now adjust on the software individual dosings.
我可以透过软件来调整个别的剂量。
And when I do that, the robotic arm will adjust the height of these spansules and the micromeds will release.
当我操作软件时，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。
I can now -- The automated process would rotate and cycle through, to make sure the micromeds are loaded.
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。
And when I hit print, these will all fall through the device,
当我按下打印键，这些都会透过装置落下，
I now pull out my personalized printed polypill, with the doses and medications meant for me.
现在我可以取出我的个人化打印复方制剂，它的剂量和内含药物都是针对我做的。
And we can take a look, if you look back to the slides,
我们可以回头看一下投影片，
you can see the whole process, we can see the drug silos being selected,
你们可以看到整个过程，我们能看到药物筒仓被选取，
the pills doing down the different silos, and being collected in the individual capsule.
药丸从不同的筒仓落下，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.
这很棒，我可以依我个人需求来打印我的药物，不用吃六种药物。
I can now be looking at my individual dosing, my smartwatch is looking at my blood pressure,
我现在可以察看我的个别剂量，我的智能手表在看我的血压，
I needed an adjustment in my blood pressure medicines, my coumadin level, my blood is too thin,
我需要调整我的血压药物，我的华法林浓度，我的血液太稀，
so I lower my micromed dose of coumadin, a blood thinner.
所以我降低了我的华法林微型药物剂量，它会稀释血液。
So, this could be smartly adapted, day to day, programmed by my physician or cardiologist.
可以智能地做调整，配合每天的状况，由我的内科医生或心脏科医生来制订计划。
And you can imagine that larger printers, fast printers like this,
你们可以想象像这样的打印机，但更大、更快，
could be in your corner pharmacy, in your doctor's office, in a rural clinic.
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。
But it could eventually merge and shrink to small ones, that could be in your home,
最终，它可以被合并和缩小，成为小型个人家用打印机，
with integrated cartridges like this, that are delivered by drone.
有像这样的整合药筒，由无人机来递送。
Could print your personalized polypill, each morning on your kitchen or your bathroom cabinet.
放在你的厨房或是浴室储存柜中，每天打印出你的个人化复方制剂。
And this could evolve, I think, into an incredible way to improve adherence in medications across the globe.
我认为，这有可能会进化，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
我希望我们能够以新的方式来重新想象药物的未来，从多重用药、所有人通用的剂量、低顺从性、复杂混乱，
to an era of personalized, precise, on-demand medications,
转变为个人化、精确、依需要来供应的药物，
that can take us and individualize our own health and health and medicine around the planet. Thank you very much.
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。非常感谢。
Daniel, that's kind of awesome. Really cool. Question for you, though.
丹尼尔，那真的很棒。非常酷。但有问题想请教。
How long is it until, say, that nursing-home patient that you mentioned is able to print their pills in their home?
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打印他们的药丸？
Well, again, this is just a prototype.
再次强调，它只是样本机。
We think that the regulatory route be automated compounding,
我们认为还有待改善的部分是使其能够自动合成，
and especially in nursing homes, folks are taking multiple medications, and they're often mixed up,
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，
so it would be a perfect place to start with these technologies.
护理之家是这些技术最完美的起始点。
These aren't going to evolve and start with printers on your bathroom counter.
这些技术不可能从你浴室柜台上的打印机开始和进化。
We need to be intelligent and smart about how we roll these things out,
我们必须要以很聪明的方式来推出这些东西，
but realizing there's so many challenges with dosing, adherence and precision,
但要知道，在剂量、依顺性和精准度上都还有许多困难挑战，
and now that we have all these amazing new technologies that can integrate and be leveraged,
现在我们有这么多了不起的新技术，可以被用来整合，
I think we need approaches like this to really catalyze and foster a true future of health and medicine.
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。
Great, thank you. Thanks.
好极了，谢谢你。谢谢。
