October 2, 2015 • 27 mins
Lauren and Jonathan explore three ways 3D printers could change medicine. From printing drugs to regenerating nerves, we explore what happens when doctors work with additive manufacturing.
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Episode Transcript
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Speaker 1 (00:00):
Brought to you by Toyota. Let's go places. Welcome to
Forward Thinking. Hey there, and welcome to Forward Thinking, the
podcast that looks at the future and says, I'm not
a real doctor, but I am a real worm. I'm
(00:20):
Jonathan Strickland, and I'm Lauren Volke Bam and our other
co host, Joe McCormick is out today, but he will
be back very soon. And in the meanwhile, we're gonna
talk three D printing because it's been like three days, yeah,
or two and a half minutes, so you know, so
three D printing. You may have heard us talk about
(00:40):
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
(01:02):
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
(01:23):
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
(01:46):
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
(02:06):
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.
(02:30):
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
(02:53):
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,
(03:15):
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
(03:38):
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
(04:00):
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.
(04:21):
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
(04:42):
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
(05:03):
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
(05:24):
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
(05:46):
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
(06:07):
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
(06:29):
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
(06:52):
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
(07:16):
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
(07:39):
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
(08:01):
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
(08:21):
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,
(08:44):
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
(09:05):
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
(09:28):
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
(09:49):
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,
(10:10):
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
(10:31):
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
(10:53):
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,
(11:15):
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
(11:35):
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,
(11:56):
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
(12:17):
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
(12:39):
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
(13:00):
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
(13:23):
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
(13:45):
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
(14:05):
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
(14:29):
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
(14:51):
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
(15:12):
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
(15:32):
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
(15:54):
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
(16:14):
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
(16:36):
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,
(17:01):
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
(17:22):
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
(17:44):
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
(18:08):
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
(18:30):
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,
(18:51):
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
(19:13):
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,
(19:34):
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
(19:56):
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,
(20:16):
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
(20:37):
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
(20:59):
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
(21:21):
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
(21:42):
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.
(22:04):
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,
(22:26):
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
(22:49):
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
(23:10):
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
(23:30):
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
(23:51):
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,
(24:12):
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
(24:32):
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
(24:52):
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
(25:14):
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
(25:36):
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
(25:57):
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
(26:17):
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
(26:39):
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
(26:59):
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
(27:20):
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and we will talk to you again really soon for
(27:41):
more on this topic and the future of technology. This
is forward Thinking dot Com, brought to you by Toyota.
Let's go places,
Brought to you by Toyota. Let's go places. Welcome to
Forward Thinking. Hey there, and welcome to Forward Thinking, the
podcast that looks at the future and says, I'm not
a real doctor, but I am a real worm. I'm
(00:20):
Jonathan Strickland, and I'm Lauren Volke Bam and our other
co host, Joe McCormick is out today, but he will
be back very soon. And in the meanwhile, we're gonna
talk three D printing because it's been like three days, yeah,
or two and a half minutes, so you know, so
three D printing. You may have heard us talk about
(00:40):
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
(01:02):
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
(01:23):
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
(01:46):
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
(02:06):
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.
(02:30):
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
(02:53):
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,
(03:15):
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
(03:38):
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
(04:00):
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.
(04:21):
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
(04:42):
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
(05:03):
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
(05:24):
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
(05:46):
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
(06:07):
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
(06:29):
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
(06:52):
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
(07:16):
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
(07:39):
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
(08:01):
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
(08:21):
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,
(08:44):
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
(09:05):
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
(09:28):
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
(09:49):
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,
(10:10):
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
(10:31):
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
(10:53):
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,
(11:15):
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
(11:35):
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,
(11:56):
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
(12:17):
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
(12:39):
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
(13:00):
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
(13:23):
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
(13:45):
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
(14:05):
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
(14:29):
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
(14:51):
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
(15:12):
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
(15:32):
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
(15:54):
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
(16:14):
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
(16:36):
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,
(17:01):
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
(17:22):
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
(17:44):
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
(18:08):
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
(18:30):
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,
(18:51):
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
(19:13):
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,
(19:34):
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
(19:56):
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,
(20:16):
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
(20:37):
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
(20:59):
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
(21:21):
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
(21:42):
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.
(22:04):
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,
(22:26):
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
(22:49):
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
(23:10):
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
(23:30):
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
(23:51):
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,
(24:12):
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
(24:32):
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
(24:52):
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
(25:14):
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
(25:36):
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
(25:57):
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
(26:17):
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
(26:39):
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
(26:59):
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
(27:20):
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
(27:41):
more on this topic and the future of technology. This
is forward Thinking dot Com, brought to you by Toyota.
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Hosts And Creators
Jonathan Strickland
Joe McCormick
Lauren Vogelbaum
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