3D printing: The desktop drugstore

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(Copyright: Science Photo Library)
Printers that create artificial limbs, cheap drugs and replacement organs could radically change medicine in poorer countries. But can this technology deliver?

A small Indian village is perhaps the last place you would expect to see the future of manufacturing, but 70 kilometres (43.5 miles) away from Pune in the Maharashtra region there are plans to create one of the hottest pieces of technology around. Farming may be the main occupation in Pabal, but an educational centre at the heart of its community hopes that later this year it will have the ability to solve practical problems in a way never possible before.

“Learning while doing” is the philosophy behind the educational project in Pabal called the Vigyan Ashram – part of a worldwide project called FabLab, set up by physicist and computer engineer Neil Gershenfeld at Massachussetts Institute of Technology. Through this initiative, local villagers are taught to find ways of solving problems using kit given to them by MIT. With the ashram’s FabLab fully set up in 2004, the first project involved making a sensor to check milk quality. Later this year, Amitraj Deshmukh hopes to build something for the ashram that might prove to be a life-saving piece of kit in remote regions like this – a 3D printer.

Like your average desktop printer, these three-dimensional versions have a set of injectors that move back and forth, up and down. The inks are printed layer by layer and build up into a 3D form. Inks range from plastics to silicone to ice to cookie dough to human cells. The technology has been around for around two decades – engineers and designers have been using this to create prototypes – but it’s only recently that lowering production costs has brought its potential to the reach of the public.

Now, companies such as MakerBot are selling 3D printers for under $2,000, others are even trying to make replicas that could be yours for just over $1,000. A report earlier this year stated that the global market for 3D printing could reach $2.99 billion by 2018. And its potential has already grabbed the media’s attention, with reports on how we will be able to print just about anything, from toys to guns, to food like burritos.

You could see 3D printing as rampant consumerism gone crazy, or you could see it as a world in which consumers become creators – saving waste, packaging and air miles. In regions of the world where “stuff” is not the ubiquitous commodity it is in western societies, though, cheap 3D printing could have a profound impact on the lives of the have-nots, not just furnishing the haves with the coolest piece of gadgetry around.

In a farming culture like India, a 3D printer could allow small parts for broken tractors to be printed, or custom-made connectors for irrigation systems cobbled together from metre upon metre of different types of hose. And take a faculty as basic but as important as sight. Glasses frames are easy to change in the western world, but in developing countries, they are expensive or impossible to replace, according to Phil Reeves, managing director of Econolyst, a UK-based consultancy in rapid manufacturing. “Often lenses outlive the frames in developing countries,” he says. If a village, or nearby town, has a 3D printer and access to some basic polymer raw materials, a new set of frames – custom made to fit the lenses – could be knocked out in no time.

Vital organs

The opportunity to do so stems from a bright idea that engineers Hod Lipson and Evan Malone at Cornell University in Ithaca, New York came up with in 2006. Their Fab@Home project aimed to bring cheap 3D printers, and the open source software to run them, to the masses. With these tools in hand and the right inks, anyone, anywhere can print their own plastic toys, gadgets, food in their suburban garage, or in a school in a remote Indian village.

Lipson is convinced that by democratising manufacturing and invention, 3D printing will change the world. “It’s nothing short of an industrial revolution,” he says. And the Fab@home kit isn’t the only option. Other open-source projects include RepRap, a 3D printer that is designed to be able to print replicas of itself, invented by Adrian Bowyer at Bath University, UK.

The immediate fruits of this personal manufacturing revolution will come from simple problem solving, like replacement glasses. But the world of medicine offers far more intriguing opportunities, and for many in the developing world it will provide a vital lifeline in villages and towns where there currently is none.

For instance, it’s not in the realm of fantasy to imagine printing replacement organs by squirting living cells rather than drops of ink. Organs could be created for transplant patients without any fear of an immune reaction, or new heart valves for transplanting directly into a patient on the surgeon’s table. These technologies are being developed already, albeit with extremely sophisticated printers. Simpler organs like skin, windpipes or blood vessels, will be the easiest to create, more difficult will be hollow sac-like organs, like the bladder or stomach, and hardest of all will be solid organs like the kidneys, heart and liver.

But there have been some notable achievements. Anthony Atala from the Wake Forest Institute for Regenerative Medicine in North Carolina printed a kidney, though a non-functioning one, on stage at a TED conference last year. Biologist Jonathan Butcher, Lipson’s colleague at Cornell, has already 3D-printed a working heart valve out of biological polymers. 3D printing allows complicated structures to be built easily, says Butcher. A heart valve has areas that need to be stiff and strong, other areas that need to be flexible, and a host of interconnecting, moving parts. Building a system as intricate as that using a mould instead would be mind-numbingly difficult Butcher suggests. “Anytime a tissue is anatomically complex... 3D printing will make a major impact,” says Butcher.

So far, Butcher has printed aortic heart valves and put them in a bioreactor, where stem cells are added that integrate with the polymers and eventually take over so that the valve is made entirely from human cells. The next step is to try this in an animal model, and Butcher is aiming for 2013 for that. The developments needed now are in the materials used as the inks, says Lipson, who is working with Butcher on the project. “Once people figure out the process it doesn’t require hi-tech,” says Lipson. Butcher agrees: “we’ve got the printing thing worked out,” he says.

Butcher anticipates that 3D printing could slash the cost of organ transplant surgery and help bring it to the developing world. “Some of the major costs for organ replacement are the limited supply and the transportation and storage costs,” he says. “3D printing-based tissue engineering creates a new organ from scratch, fundamentally removing those costs.” And even though new materials are needed, they needn’t be prohibitively expensive either. “We currently use about $10 of polymer to print a human sized heart valve,” says Butcher.

Personal medicine

Lipson also thinks that 3D printing could help to train doctors and surgeons. Removing a tumour accurately, for example, he says, could easily be practiced if a scan of the tumour site is made and then a replica printed. “There are ethical and cost issues with cadavers and animals, but a 3D printer can recreate what you need,” Lipson says. Not only that, but the texture of live tissues can be recreated: rigor mortis makes cadavers stiff and unrealistic for someone who wants to learn what surgery on a live patient really feels like.

As well as body parts, 3D printers might be able to print drugs. Chemist Lee Cronin at the University of Glasgow has found a way of using a Fab@Home printer to create a chemistry lab, rather than just creating the parts. By adding chemical reagents to the list of possible inks, he showed in April this year that a 3D printer could be used to print a set of reaction flasks and linking tubes out of bathroom sealant, and in the walls of these flasks he printed catalysts and sensors. Another set of liquid inks, the reagents, were then squirted into the printed equipment to carry out simple chemical reactions.

Cronin wants to print drugs, and has already managed to print ibuprofen using his so-called reactionware. Why not combine printed drugs with printed body tissues? Lipson imagines printing tissues for testing drugs – printed drugs perhaps. Cronin thinks that this kind of system could all be printed at once, a raft of reactions to find the best drug would be printed first, then the set-up needed to test them against a swathe of different printed cell cultures or tissues could be printed alongside.

Cronin also has accessibility in mind. He says that by turning the instructions for the printer into a smartphone app, combined with a pre-packaged set of chemical inks, his system could bring drugs to remote communities that desperately need them. He’s hoping to be able to provide printing instructions for simple painkillers, anti-malarials, or in future maybe even drugs that pharmaceuticals companies know how to make but don’t market because there isn’t high demand for them.

An app store for chemical reactions remains an endeavour for the future, and is fraught with problems, not least regulation and approvals from the US FDA and other drug regulatory bodies to make sure that any such systems are safe from hacking or abuse. But the idea that 3D printing combined with mobile phone technology can allow remote communities to access a range of things that otherwise would be impossible, is an attractive one.

Another dimension

Unaware of the interest he was about to get from 3D printing enthusiasts, computing engineer Grant Schindler at Georgia Tech launched Trimensional in 2011, a phone app that turns lots of 2D images into a 3D version. Schindler made the app as a social tool, for fun. But he quickly discovered that he’d created a 3D scanner that would be just the thing for the developing world, and could be put to use there soon. Schindler is certain that Trimensional will be useful to medical professionals in the developing world. “I have had some discussions with folks in the prosthetics and orthotics community who are excited about the potential for using Trimensional on the iPad to cheaply scan body parts for custom fit prosthetics and orthotics,” he says.

Deshmukh at the Vigyan Ashram in Pabal agrees. “Prosthetics is really one place where it’s very important that you have 3D printers,” he says, not just in India but in developing countries elsewhere. “The availability of a 3D printer would make us equipped to provide quick solutions,” for a whole section of society that gets overlooked at the moment, he says.

There are limitations at the moment, not least that smart phones or tablets weren’t designed as 3D scanners, says Schindler, but he knows what’s required to fix this: “we need to intelligently combine the phone's sensors and screen with new algorithms to extract 3D information from images.” This limits the technology to printing knick-knacks – for now. “There is every reason to think this level of quality and accuracy should improve over time,” Schindler says. This will be thanks to better cameras, faster processors, and better software.

It is still a leap to say that everyone in the developing world will be able to access the technology, though. The problem comes with distribution – tablets, smart phones and even basic 3D printing kits are out of the financial reach of individuals in many countries. But Deshmukh thinks it would be possible to base a 3D printing set-up in village schools. In fact, he thinks this is the best way to see the technology put to best use and accepted by communities.

If 3D printers are introduced in the right way, there is no reason why they won’t make a big impact for rural Indian people, says Deshmukh. “I think schools are the way to take these things to villages,” he says. This is the best way to get local politicians and community leaders to take note in India he says. It will also teach people to think around problems to find solutions with the available technologies.

Outstanding tests

As always, the question of who pays for the technology is a thorny one. Deshmukh thinks some combination of country, state and NGOs is the answer. Lipson agrees that governments in developing countries should take some responsibility, rather than diverting funds from ongoing philanthropic projects. “I would hesitate to take money away from the field,” he adds.

On a smaller scale, a recently launched competition might help to pay for a few projects, and could raise awareness of the power of 3D printing in the developing world. The 3D4D challenge is run by UK-based charity Techfortrade, and supported in part by Econolyst. They’ve called for ideas that use 3D printers to solve developing-world problems, be that by printing solar panels, or by coming up with a way to make a 3D printer-blueprint of a design for a piece of tribal jewellery and have it printed on demand, at the point of sale. The shortlist of the best seven ideas in the competition will receive $1,000 to develop a business case, and the winner announced in October will receive $100,000 to make their idea reality.

William Hoyle, CEO of Techfortrade says the idea of the competition is to harness mobile and 3D-printing technologies to leapfrog the infrastructure problems in many developing countries. How can goods be distributed when there’s only a handful of tarmaced roads in a country, he asks? This is where 3D printing and mobile technology could have a big impact, but not for another year or so, he says, until 3G mobile networks are more widely available.

In the Vigyan Ashram, Deshmukh offers a cautionary word. “We don’t want to work on technologies for the sake of technology,” he says. Undoubtedly 3D printers offer huge opportunities, but Deshmukh hopes that their thoughtful introduction will encourage people to solve their own problems innovatively, rather than just providing easy answers.

Lipson predicts, with an air of optimism, that in a decade the 3D printing revolution will have taken hold globally. “It removes barriers, anyone can make anything,” he says. The limiting factor is the imagination of the inventor.

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