3D Printing and Global Health: An Ethical Perspective

GLOBAL HEALTH WRITES

3D printed prosthetic arms as part of Project Daniel in Sudan. Image: Not Impossible, LLC

Citizen Journalist: Muthukumaran Thangaramanujam (‘Muthu’)

Three-dimensional printing (3D printing) is currently sweeping across the globe as an accessible manufacturing technique for the masses. Though the concept of 3D printing itself pre-dates the Internet, it has only recently become accessible due to the expiration of related patents.

What is 3D printing?

Also known as Additive Manufacturing or Rapid-Prototyping, 3D printing is a manufacturing technique in which an object is built layer by layer. A digital 3D design is converted into several layers and each layer is ‘printed’ using printer specific materials including metals, plastics, and even paper.

3D printing in Medicine

3D printing has a wide range of applications in medicine; from patient-specific models used in surgery to limb prostheses.

Bioprinting is a 3D Printing technique, which uses biological materials to fabricate 3D printed organs. A study by Meticulous Research predicted that the global medical 3D printing market will reach $983.2 million by the year 2020. It is likely that 3D Printing will play a major role in the medical technology industry, especially in the personalized medicine sphere.

3D Printing has been recently making rapid strides in patient-centred assistive technology design, enabling patients to design their own bespoke assistive aids.

3D Printing in Global Health

In disaster zones after an earthquake or a tsunami, humanitarian supply chains are often long and complex. In such instances, rather than sending a generic load of non-specific assistive aid equipment, like prosthetic limbs, it would be more cost-effective to send 3D printers and materials to build patient-specific assistive devices.

Field Ready is one organisation that works to minimize the supply chain pathway by fabricating aid-equipment such as umbilical cord clamps and prosthetic limbs in disaster zones. While Project Daniel leading the way in fabrication of prosthetic limbs at the Nuba Mountains of Sudan. The use of 3D printing in disaster relief is not just confined to medical devices and aids. Oxfam is currently trialling 3D printing in Lebanon, printing parts of taps and faucets, as well as replacements for missing parts of imported sanitation kits.

Recently the US Food and Drug Administration (FDA) approved the first 3D printed drug. In the near future, several drugs can be mass printed at a specified dosage and combination. Such innovation could pave the way for targeted personalised medicine during epidemic outbreaks in the future.

Ethical concerns and considerations

Will 3D Printing be billed as the third Industrial revolution, without its Achilles heel?

Apart from the ethics of bio-printing organs, there is yet to be an active discussion focusing on the ethical aspects of 3D printing in a global health context.

There has been a lot of excitement in the media about 3D printing in medicine as a rapid, accessible, and sometimes economical manufacturing method. The focus of the media needs to be shifted from the fad of 3D printing to the final clinical solutions which patients and end-users will benefit from.

The primary duty of the clinician is to act in the best interests of the patient. Safety and sustainability of 3D printing should be thoroughly considered prior to implementation of them in disaster zones.

A 3D printer can be a double-edged sword. A 3D printer, which can fabricate medical assistive aids, can also fabricate weapons like guns and knives. Recently, there was been legislation introduced in New York, U.S.A, to ban undetectable 3D printed weapons. A well-planned execution of 3D printing services should happen in disaster zones to circumvent any inappropriate use of this technology, with rigorous vetting measures and sustainable, needs-based use of the printer in such settings.

At the moment there is a lot of palpable enthusiasm in implementing 3D printers in developing nations, however we may have to look into this with closer scrutiny. In some cases 3D printing may evolve into a branding exercise for sponsoring companies or worse, a testing exercise for nations in compromised situations, which may not only lack a regulatory environment, but also lack a safe and sustainable way of supporting humanitarian need.

With the spread of 3D printing technology, ensuring safe and sustainable pathways for its implementation should become vital. However, this will require adequate research and long-term planning prior to disaster zone implementation. The deployment of 3D printing should occur in a phased manner and maximize sustainable development in the long run.

The potential is great for 3D printing projects in Global Health, but the phrase, “With great power comes great responsibility” often comes to my mind.

Muthu is a Chartered Physiotherapist pursuing a Ph.D in Medical 3D Printing, at University College Dublin. His clinical experience spans more than thirteen years in various clinical settings such as the prestigious All India Institute of Medical Sciences Hospital, New Delhi, India and the Irish Health Service (HSE). His interests include Rehabilitation Robotics, Neuro-prosthetics, Health Informatics, and Global Health.

Email: [email protected]

Twitter: @muthu3D

Country of Residence: Ireland