3D Printing in Medicine

three D printing. You may have heard us talk about this in such episodes as all the other ones we've done, but literally every episode they've ever done on Forward Thinking, But we wanted to specifically look at three D printing in emerging fields of medicine, not and not in the way that you might think, because we have talked about three D printers being used to print things like joints, like a new knee joint or hip joint, and we've talked about three D printers to print even things like

prosthetic arms or even in the further off in the future, because this is not a mature technology yet, but living organs using three D printers to print actual organs for transplant patients. Maybe possibly if we work a whole lot of stuff out, But stuff that is working right now in the incredible future that is today is a bunch of stuff. Yeah, there's some more stuff that we wanted to talk about that that is outside of those uses.

So one of them is the concept of three D printed drugs, which I think we may have mentioned on a previous episode, But the reason we're bringing it back up now is that in August two thousand fifteen, the US Food and Drug Administration also known as the f d A, approved a three D printed drug for the first time ever called spritum or sprite um or it could be spit tom. It's also known as a the

Tierra se tam cool. Yeah, it's it's a pill specifically designed to help treat patients who are suffering from seizures like epilepsy or other types of seizures. And and it's really interesting. Yeah, they created it with a three D printer specifically because that technology lets them build a pill that's that's porous throughout that therefore can dissolve rapidly on contact and you know, get the medicine into the patient immediately. Yeah.

In fact, one of the things I was reading about because I was curious, I was like, well, so it dissolves better. Okay, so what but two things. One, for people who have seizures, it means they can get that medication in their system much more rapidly and prevent the onset of the seizures, stop it before it really starts.

And another is that we're talking like seriously dissolving rapidly, so that people who have trouble swallowing pills, whether it's due to a medical issue or maybe it's a child who doesn't normally swallow pills, it's much easier to get the pill down than four people, you know, than are than a standard pill that would take a while to dissolve within the stomach itself. Oh sure. And furthermore, if if someone doesn't like swallowing pills, they're unlikely to take

their medication as described, and this could help alleviate that. Yeah, it's called adherence, the concept of patients adhering to their medication, not sticking to it, but sticking with it. So in other words, they are more likely to continue taking their medication at the right time. Because it's not a completely unpleasant experience. Any of us who have had to take medications that are rough for one reason or another. Maybe it's the application itself, like it's an injection, or maybe

it's the way it makes us feel afterward. You know, it takes an effort of will to continuously do that through the course of a medication, and it can get really hard on you psychologically. So anything that reduces that psychological burden on a patient is yeah. Yeah, And the technology came out of m I T. Right, Yeah. M

I T developed the actual three D printing technology. The company that makes the drug is Appreciate A Pharmaceuticals, and they ended up calling the specific implementation of this technology originally developed by m I T zip dose, So zip dose is how they call it, and it's a neat process. It first involves laying down a layer of powdered medicine. Then it applies a drop of liquid that binds the particles together and creates that first porous layer. So that's

layer one of your medication. And if you've ever used a three D printer, you will see that it lays down a thin layer of plastic or some other material. The plastic is generally what the consumer ones use, and then it will lay another layer on top of that, and another one on top of that and build it layer by layer until you get a final product. Well, in this case, it's doing that but with the powdered medication and then a drop of liquid to buying stuff together.

The neat thing about this is using this process, you can actually determine you can you can tailor each pill to have a specific amount of the active pharmacological drug in that stuff, right, which again makes it easier on the patient because the patient doesn't have to like split a pill in half, or you know, maybe they've got a whole bunch of different stuff that they have to take together. And this could potentially let you print a

single pill to take something like that. Yeah, so it means that like you might say, well, we want to give a certain number of milligrams of this as a dose. Normally we would get these one type of pills and cut them in half, like Lauren was saying, which is not always an exact science. If they give it to you to take to home, usually the pharmacologist will do it, you know, like the pharmacist will do it rather um

they'll do it, do it for you. But but this way you print the pills specifically to the needs of the patient, meaning that down the road we could see personalized medicine where a very specific dosage is created for that person, and it may even be that that dosage needs to change over time, and that they could continuously print these pills so that they met the patient's needs throughout the course of the treatment. So it's a revolutionary step in that regard. Yeah, yeah, and it means you

have incredible amount of control, So pretty neat. Yeah yeah. Now some people are theorizing that it could be even neater than that. Yeah, Lee Cronin of the University of Glasgow said at a TED talk once he talked about the possibility of this being used to the extent that people could have the printers in their own homes. So a patient might be able to have a drug printer at home and instead of going out and pursue, you know, having to fill a prescription, having to go down to

the pharmacy or chemist or whatever you call it. Yeah, you instead of having to go down there, you would instead have a doctor's prescription for an algorithm, and the algorithm would be whatever your printer would need to do to create the chemically the drug. So I have a bunch of chemical inks to pull from, and the combining of those chemical inks and various temperatures, etcetera would allow for the creation of the drugs. Now, this is very much a future oriented idea. It's for many reasons. I

think future oriented is a polite way of putting Yeah. Yeah, we Lauren and I both think that this is probably if it does happen, it's going to have to overcome some significant hurdles, and not just technological hurdles, although there's certainly that right, well, certainly it's not like the three D printers that we have today. Even the most fabulous ones and the most fabulous labs are capable of molecularly

combining stuff. That's a different issue. Yeah, So even if you had you know, forty different quote unquote inks, chemical inks, you know, you would have to design a printer that would be able to use all those properly to to build whichever drug you're specifically trying to make. Plus, then you also have to worry about well, let's say let's say that I do that. Let's say that I've built

the printer. Okay, that's a really big step, because because right now what you're talking about is having like a tub of powdered drug that you give to a patient, which seems like a poor plan. Well, let's let's say that I've got let's say that we've worked this out. Yeah, I've got I've gotta I've gotta somehow, I've got like a cartridge that has all the different chemical components for various drugs, and that the printer can can access these

in the appropriate amounts to make a drug. But then, even then, even saying I've somehow solved that problem, which is a huge if you still have other issues like cleanliness, I mean, if anything contaminates that, then you've got a possible toxicity problem. I mean, imagine that you have to print like let's say it's for a family, and you're printing out drugs to treat one person who is elderly and needs a certain type of medication. But then your child falls sick and you need to be able to

treat your child too. Yeah, and so so all of a sudden, you've got you've got Nana's heart medicine and little Susie's tail and all all in the same printer. What if there's crossover contamination and not not good time, super scary. So so there's there's that basic technological hurdle which maybe is not insurmountable, but certainly is not something

that we can achieve right now. And the home Yeah, I'm just just the number of potential problems that I'm thinking of with this and and you know this this is nay saying, but but man, like you know, if they think of all the problems that you're normal like p L a plaster printer, yea, yeah, I think about the ones that we've had, like we've we've had some deformed chess pieces come out of our Yeah, but you know, right, like, but if if that kind of thing messes up you,

you've wasted a tiny bit of plastic, right as opposed to a human life and some of your time. Yeah, yeah, this this is it could be so dangerous and very expensive to make that kind of mistake. Right, So, even even if somehow we were to solve all that, we still have other issues. We've got ethical issues to consider. For example, what if someone gets hold of one of these and starts using it to make illicit drugs? Um Now, you could try and build protections in place to prevent

that from happening. But here's the deal. When there is something technological out there that means it's hackable, that means people will find ways to manipulate that to some extent or another. They may not be able to completely revolutionize it, completely change it, but they might be able to nudge it enough to make a real problem happen. Certainly, so ethical and legal issues are here besides the technological ones.

But either way, even even if this technology never sees that kind of application, uh, it's still it still has those those other upsides that we were talking about, you know, like certainly for doctors and pharmacies and uh and it could also potentially help with with with with development of drugs. Yes, it means that you could prototype us much more quickly.

If you were developing a drug and you want to test the efficacy, You want to find out what the actual pharmacological dosage is, the the what is the effective uh dose for treating whatever ailment it might be. You know,

that's a lot of trial and error. If you have a three D printing mechanism where you can say, all right, well let's print a pill that has you know, five milligrams of the effective drug in it, or one that has ten or fifteen, and then you can test each one to find out where those thresholds are both for the effectiveness of the drug and even the potential toxicity of the drug. Then that could make the medication uh much safer, much earlier than traditional methods and saving lab time.

Is is a terrific way to get you know, cheaper drugs. Yeah. Yeah, and that's definitely in the news right now. I'm not going to go into it because BOYD made me mad, indeed, but let's talk about something that that person involved in that news story lax, which is hard. Yeah, that's very well put, Lauren. I like how civil we are being

while we're both extremely angry about this. Um. Yes, if you wanted to ever give your heart to your sweetie, you could possibly do that by undergoing an m R I and then having that information mapped out and then printed in a three D model where you actually have a three D model of your heart. This would be the uh sort of the the Indiana Jones and the

Temple of Doom method of giving your sweetheart. Yeah, it's not it's not like a little actually, I could if if this, if this technology ever ever grows to a consumer market, like I I know twenty people off the top of my head who would do it. Like, we know the same twenty people because lots of names. I mean a certain puppeteer we both know. Uh yeah, there's tons of many of them are artists. Yeah weird. But but but more more critically and to the point to

this episode, this could be terrific for heart surgeons. Yeah, so this is actually not the The idea of making a model of a heart for a surgeon to get a look at before performing surgery on a specific patient is not entirely new. Uh, that's something that's been done for a while. But the three D printing and the development of a new algorithm are making this a faster process that could save a lot of time. And for some patients, time is the difference between a lifesaving operation

and sadly passing away. So so this could have a

real difference. And uh, this all comes down to a partnership between M I T and Boston Children's Hospital and they started looking at a way to create three D printed hearts using a computer algorithm to build out as much of the heart as possible into a kind of a three D model so that could then be printed um and taking out the element as much as you could of having a human have to go by like frame by frame and check and make sure that everything matches up to probable reality based on these m r

I scans. Yes, so m r I s when they when they do an m r I scan, you get a bunch of cross sections of a three dimensional object, and m r I s have light sections and dark sections that tell you about different tissues and different uh anatomical features. And generally speaking, the boundaries between the two tend to show a actual edge of an anatomical structure like an ajorda for example, but they don't always. Sometimes that border is deceptive, it's not actually an anatomical feature.

So usually what would happen is experts would pour over these images and kind of manually tweak what they believed to be the actual boundaries of any anatomical feature of the heart so they could tell the three D printer what to do. Yeah, so this would take ten hours on average for experts to go over all the information.

That's before you even sent it to be built. Right, So the m i T and Boston Children's Hospital partnership is all about creating this algorithm that can take a little bit of information from an expert and then extrapolate based on that information what the rest of the m

r I actually means. And what they did was they divided the heart up into nine sections, and they had uh the expert give a little bit of information about each section, and then the algorithm took over from the From there, so while the algorithm knew a little bit about nine different sections of the heart, it had to extrapolate the rest and they found that it agreed uh at at nine of the experts belief of what was actually represented in the m r I, right, right, and

and yeah, so it cut down this this eight to ten hour process, this full extra day that you're atting to the prep for surgery, down to to nothing that humans really had to do. Yeah, it's it's down to like an hour total just to build out the model and then another couple of hours to physically build the

heart with the three D printer. So something that took ten hours just for the analysis now took three three to four hours total to have a finished model heart that the surgeon could then use to plan out uh surgical procedures right because you know, usually if someone is having heart surgery, it means that there's something irregular about the structure of their heart. So it's extra it's really really cool to to be able to have the surgeon

who's going to be working with it. You know that the imaging alone is terrific, but being able to actually hold that image uh and hold that model and and poke into it with stuff, it has to be just incredible. Yeah. And in fact, one of the quotes that we saw around this was from Paulina Galand of m I T, a computer scientist with m I T, who said that the phrase I heard is that surgeons see with their hands.

So a surgeon getting his or her hands on a model heart has a much better feel for what they need to do when the surgery is is when it's time to actually perform the surgery. So this is not something that's just being rushed into practice. In fact, it's being put into a very controlled test system. Yes, seven cardiac surgeons at Boston Children's Hospital are going to be working with this new technology right exactly, so no patients

lives will be at risk. What they're doing is they're actually going to use ten cases that have already gone through treatment. So these are people who have already had surgical procedures done on them, and they're just using the data from those ten cases. So the patients are gone there,

they've left the hospital, but their information remains. And so these seven cardiac surgeons are going to get these ten cases, which includes all the mri I data that was gathered about the different patients and will include either a physical model or a three D model that will be randomly determined on each case basis for each surgeon, and the source of the information for that physical model or three D model will either be from the traditional ten hours

of expert analysis or through this computer algorithm. All of that's going to be randomly determined. I imagine they're going to do this in a double blind approach, so that none of the cardiac surgeons will be aware if the model they have came from the traditional method or through

the algorithm. Then all the cardiac surgeons will describe what their process would be, what their plan would be for surgery for that particular case out of all the ten cases, and then what will happen is at the very end of it, they will start to compare what was actually done in the in the in cases, yeah, that the plan that the actual surgeons made with the traditional stuff. Yeah, and also what the outcome was, like did the model

accurately represent what was really in that patient? And then after all of that, they're going to see if the algorithm three D approach is uh, is something that would be of value to the surgeons, right, something that that

hypothetically would have created a better plan. Uh. It could also help reduce problems after surgery because sometimes prosthetic patches need to be be applied to the heart and of course, having you know, the wrong shape or the wrong size of patch, even even slightly off, can wind up causing damage like lesions and stuff like that from the line. And so this technology could let surgeons tailor three D

printed patches to the patients a lot more easily. Yeah, it's pretty pretty cool stuff and uh so we really pleased when we saw this one. Also, if you get a chance to look at the stories, you can see the actual three D models have been printed and they're pretty funky looking. They're they're a little bit gruesome. I

like them a lot. Yeah, I want Yeah, you wonder if you can actually request what color plastic they're going to print yours in probably clear all around, but but yeah, yeah they had a bluish tinge but I couldn't tell if that was just the background there, and and and the three D printed models are just made of conventional plastics. Yeah, yeah, they're not made out of anything particularly bizarre or icky.

But something that is made of particular stuff is our third and final story in our three D Printed Medicine kind of uh episode, which is this idea of creating three D printed scaffolding specifically to encourage nerve regeneration in the wake of injury or illness. Yeah, because when your nerves are damaged, that that sucks. Yeah. You could be in severe pain or even suffer paralysis as a result

of it. Yeah, and it and it can be very difficult to get nerves to regrow, especially through damaged tissue, which tends to be the case when you have had nerve damage. Yeah, so it's a a very tough problem. And so we can we've seen some ways where people have have tried to address nerve damage. We've seen some surgical attempts that involve grafting healthy nerves in the area where there was nerve damage, and that that's exactly what

sounds like. A surgeon will take healthy nerves from one part of your body and then graph them onto the nerves in your damaged or ill part of your body, whichever parts suffered the nerve damage in the first place. Right. But there can be a lot of problems with with that. You know, the graft can be rejected by by your body sometimes, right, or also you could have lasting pain and the sight of where they harvested the nerves in the first place. So, in other words, you've just traded

where the nerve damage has because you're you're losing. Yeah. So so it's it's not ideal. Yeah. And and the plus you have to have two surgeries in that you have to have one on the site where they're harvesting and one on the site where they need to implant it. Yeah. And of course limiting that kind of invasion is one of the major points of modern medicine. Yeah, because, as we know, anytime you have any kind of surgical incision,

you are opening up the opportunity for infection. And obviously, the fewer surgeries that are required to address any one problem the better, right, as long as they're effective. Obviously, you don't want to undergo ineffective medical procedures for well, we thought we would put a horse in this one. We dipped her in a pond. Uh didn't seem to help,

but it was at least entertaining. So there's there's an alternate area of research besides nerve grafting, which involves building channels for nerves to grow through the idea being that you can create these pathways for the nerves, plus incorporate proteins within those channels that encourage nerve growth so that you can kind of egg this regeneration process along going. And you can do that without the use of three

D imaging and printing. However, if you use three D imaging and printing, you can you can fit the channels specifically to a patient's body, again, therefore making the whole thing much more effective, especially if you're trying to correct a larger complex area of damage, right, because nerve pathways can be geometrically complex, and in fact, that's what the experts who were the researchers who are trying to build out these three D printed nerve pathways are doing. They

specifically want to look at, uh complex geometrical patterns. Yeah, because it's it's not like in illustrations in your elementary school health books where all the nerves just go in a single straight line right down all your limbs, little linear nerve and then everything else works just fine. You know. It gets a little more complex than that. It's not like the streets of New York. It's not a it's

not a basic grid. No. No, it's more like Atlanta where you make a wrong turn and you end up in Alabama because you couldn't figure out how they get back to where you were, and then on another street named peach Tree, all Peachtree. Uh so yeah, this this approach is really interesting. They end up scanning a nerve, which involves a little invasiveness. The way they did it with mice was that they made an incision and then used a light scanner to get a three dimensional model

of a nerve's pathway. Um, so obviously they had to expose the nerve first to get this image. Then they were able to create this three D printed channel out of silicone was the main material, but then they also included proteins that would be used to encourage the growth of nerves and also to quote unquote explain to the nerve, hey, you need to split here. We need run channel going this way and one going this way. So that was

pretty interesting. Uh, you know, it's it's it seems to be working as a proof of con except we are still years away from this potentially potentially at least years away from this being used for humans. Oh yeah, yeah, we're not even in human testing yet. Now, we're in petri dish and my mouse territory right now. But it does seem like this could potentially help people regenerate nerves further down the line, which would be fantastic for people

who suffer from these these kind of debilitating injuries. Really. Yeah, so that to me is a really cool story too. We've seen a lot of really interesting ones pop up recently. All three of these actually are are recent stories that popped up in our news feed, and we just thought it was interesting that that three different applications of three D printing that are so different but but have so

much hope for for really improving doctors and in patients lives. Yeah, yeah, we we just thinking that we needed to have a conversation about this. It was it was the right time to do it. Also, it's really nice to occasionally talk about happy stuff. Yeah, not not about how you know something is as an existential threat. That is nice. Yeah, I can't wait to hear now now in the interest of full disclosure, Uh, the week following the one that we're recording this episode on, I will be on vacation.

So I can't wait to find out what kind of world destroying bugs you guys will be talking about when I come back. Yeah, because every time I come back, it's either about the world coming to an end or bugs. Look, bugs are the future, they're also the past. They're also everywhere. Yeah, that I've been having a house fly problem at I'm sorry. That's that's that is that. I hope that's not the future for you. Every time I every time I get rid of one, I find two more, and it's starting

to really get to me. I would say, bug me. But you know I'm above such things, all right, So yeah, well I still made the joke. I just got to pretend like it was above it. But yeah, this concludes our discussion. If you guys have any thoughts about three D printing something that maybe we haven't covered yet, that you think. Hey, you know, I can't believe you guys have done twenty episodes of three D printing and not talked about this. Let us know because we love talking

about it. Also, if you have any other topics, anything else that you want to know about how is this going to work in the future, send us your suggestion. We love hearing from you, guys. Our email address is fw Thinking at how Stuff Works dot com, or you can drop us a line on Twitter, Google Plus or Facebook. At Twitter and Google Plus, we are f W Thinking. Just search f W Thinking and Facebook, our profile will

pop right up. You can leave us a message there and we will talk to you again really soon for more on this topic and the future of technology. This is forward Thinking dot Com, brought to you by Toyota. Let's go places,