In our world today, technology has become the center of progression, the eye of universities, and the aid of industry. Technology guides the future of tomorrow; it is societies’ way of becoming stronger and healthier.  One such important technological field is the field of three-dimensional printing or 3D printing for short. Teetering on the edge of science fiction, what else is better to represent the future than a technology that can create anything with the tap of a button. Three-dimensional printing revolves around the same concept as a typical inkjet printer, but instead of ink, successive layers of plastics, polymers, resin, metal, and even cells are used. Products are no longer limited to what we can imagine in plastic as marketed for the typical hobbyist, but far beyond. Livers, ears, cars, guns, dresses, shoes, engines, etc. are not possibilities of tomorrow but are achievable today. With the capability to print products of such complexity the possibilities for the future are limitless. In medicine’s best interest it is important that medical professionals and research teams strive to develop the field and converge all fields that are applicable. Convergence is especially required for three-dimensional printing, as without it limitations of engineering can inhibit advancements in biology and vice-versa. Convergence in 3D printing requires convergence between all fields; medicine, engineering, digital design, and politics must all come together to solve the problems of the future to improve the human condition. 

The question to answer is how much will we utilize this tool to improve the scope of treatment. Even today lithographs for skin therapy where the skin is printed to better fit the contour of the patient along with numerous other operations is already being done and developed. Yet limitations such as vascular tissue for organs and neurons for kidneys still hinder organ development being done by research teams such as Wake Forest Institute of Regenerative Medicine. Fields such as 3D printing are vital to the future field of medicine and need to be pursued to their utmost potential. As a student on a pre-med track who has an interest and past encounters with three-dimensional printing, I am intrigued by three-dimensional printing and wish to see its future applications. For 3D printing to have the greatest impact in the future convergence must occur through numerous fields allowing medical advancements to arise. Convergence with 3D printing and medicine will allow the greatest breakthroughs to occur and advance healthcare into a new age 

3D printing can be summed up as a manufacturing process done by depositing or fusing materials layer by layer into a schematic to produce a 3D product (Ventola). Like an inkjet printer a 3D printer works in the same fashion to lay material in a pre-determined pattern coordinated by a digital file. The image to the right illustrates the earliest 3D printer, a stereolithographic apparatus (SLA) which was first invented by Charles Hull in 1980 and patented by his company 3D Systems in 1992 (Banham). With this type of printer, a laser source solidifies material that the beam is directed over.  Doing so deposits a solid material at the place of contact of the laser’s rays. When in contact with a UV laser, the photopolymer would solidify to produce a hard plastic like material. Next an elevator would lower the solidified material layer by layer so more material could be deposited onto the previous laser. Layer by layer material built up in a designated pattern to produce the desired 3D object.

 As SLA printers advanced more polymer types were created that allowed for clear resin and harder ABS plastics to be printed to produce more and more variety of products. As time went on the industry progressed to Direct Metal Laser Sintering (DMLS) and Selective Laser Sintering (SLS) printers progressed the industry further with the capability to make products from glass, nylon, plastic, and metals such as gold, silver, and titanium along with countless other materials. In the manufacturing industry 3D printers allowed for complex prototypes and needed intricate parts to be produced overnight in the most durable of materials. For medicine this meant medical parts and products could be modified before procedure and printed for the respective operation or patient. In today’s medicine SLA and SLS printers are already used to produce prostheses, medical models, and titanium bone replacements and are expected to do more in the coming future. 

In the modern world, it would be negligent not to acknowledge the media’s presence in forming the opinion of the public. The most overbearing perception of 3D printing is current trend of plastic nozzle extruding systems that are being marketed to schools and home lobbyists. Companies such as Makerbot and Ultimaker offer systems for the home environment that can produce any plastic component that one could design or download offline. The trend about 3D printed products is so large that companies like Shapeways capitalize from it by offering endless products for consumers to buy such as phone cases. What these printers are grabbing the attention for are their integration into secondary school systems and home systems. The application of 3D printers and education converges very well by working problem solving skills and prototyping processes used in real world businesses. It is indeed great that these products are catching the attention of the public. The companies bring positive publicity to the field and most importantly excite interest in younger generations. By bringing publicity to the field of 3D printing future developments will have more support and backing benefiting developments subsequent fields dealing with 3D printing such as medicine. 

The most recent buzz in mainstream media towards 3D printing in medicine has been from HBO’s show Westworld. While farfetched and not plausible in our lifetime, the show brings attention to the field (Kheyfets). In an interview by Circa with Dr. Atala remarking on the idea of “Westworld” he states “You know one thing is certain. In science, you never say never” (Kheyfets). Although cliché and not always true the saying “There is no such thing as bad publicity” carries validity for 3D printing. Publicity of any kind for companies and people not generally in the public often will benefit the target. The recent publicity of “Westworld” has allowed attention to be brought back to Wake Forest Institute of Regenerative Medicine and research being done by Dr. Atala. Attention that was once held from his TED talk in 2011. The Wake Forest Institute out of Winston Salem, North Carolina is a pinnacle of development of 3D printing. At the institute a machine esteemed ‘ITOP’ (Integrated Tissue and Organ Printing System) is currently working on 30 total tissues and organs for application in medical procedures (Kheyfets). Atala in his TED talk makes the point that in modern medicine we are now living longer and a health crisis has arisen from a shortage of organs. The waitlist for a replacement organ is so long that many of those waiting on a replacement will never receive their desired replacement. In the current state the organ waitlist will become so long that it will be next to impossible to depend upon it as a viable option (Atala). This introduces the idea of using 3D printing in the field of regenerative medicine to solve this problem. Since the operation uses the patient’s own tissue to produce the organ, risk of rejection would become a problem of the past. In the lecture Atala showcases the newest advancement towards that goal with biomaterial. Biomaterial uses biodegradable material that acts as a scaffolding for regenerative healing. A procedure done numerous times by Dr. Atala is a bladder implant where bladder tissue from the patient is grafted onto a biomaterial scaffolding and grown to produce a functional bladder. In the TED talk a success story from a bladder implant is told about Luke Masella. With this technique, it is possible to use one’s own cells to repair parts of the human body.

In Groopman’s article “Print Thyself- How 3-D Printing is Revolutionizing Medicine” a sense of how the public perceives the industry of 3D printing is attained and built upon with successful medical procedures. Groopman introduces numerous studies and operations that have taken place due to a 3D printer. The hook of his article revolves around a three-month-old boy who was taken off a ventilator and regained the ability to breath. Suffering from a partially collapsing trachea (tracheobronchomalacia) a splint made from biomaterial was grafted to fit his airway that would dissolve after three years allowing the boys own cells to strengthen the airway (Groopman). Acknowledging people only knowing 3D printing for the figurines and products available on Amazon he uses that as a hook to introduce a bigger picture. The truth is that 3D printing is so much more. Advancements by 3D printing are already in application and being used today. The uses of 3D printers are vast and could be talked about for countless pages. Invisalign used by orthodontics as a replacement for braces was contributed to by 3D Systems in Rock Hill, South Carolina (Groopman). Braces for scoliosis victims that are bearable to wear are now making their way to children. Models of patients conditions that allow doctors to see and work with complex operations beforehand are being implemented now in hospitals. Bionics that fit patients missing limbs and allow them to regain mobility is being led by companies such as Bridgeway Bionics. 3D printed titanium bones that are replicas of the previous and not simply replacements are now being used in bone replacements. 

For the medical industries, major manufacturing advancements of 3D printing gave way to new abilities in the healthcare industry. Highly customizable prostheses are now available for patients produced in days to weeks versus the months required before. Current uses and applications of 3D printing are grouped as; “tissue and organ fabrication, creation of customized prosthetics, implants, and anatomical models; and pharmaceutical research regarding drug dosage forms delivery, and discovery” by C. Lee Ventola (Ventola). 3D printing benefits the medical industry in numerous ways. With medical products, such as prostheses, customization allows each patient to receive a product that best suits them. Imagine having to use crutches every day for the entirety of your life. It would be quite disappointing if all that was available was the one size fits all model. The beauty of 3D printing is that a crutch or prosthetic is created specifically to your own taste and body. Comfort and patient satisfaction are greatly improved by how personal 3D products potentially can be. Other benefits include the cost and time for manufacturing. 3D printers drastically cut the time of production of before highly intricate objects. Cost is reduced as well as all material needed is present at production and little waste results from the process. A 3D printer can better handle small production runs down to individual items as no molds or templates are necessary. A custom object now is as expensive to produce as a base model. The collaboration capability of 3D printing is limitless as seen with websites like “Thingiverse” where designs are open source and available. For example, if another case arose like the boy with a collapsed trachea the design could immediately be sent from the University of Michigan and modified to treat the case. 

The most important subject to the field of 3D printing is the idea of convergence. The idea concludes that for science to advance at its fastest rate and have major breakthroughs “fusion of life sciences, physical sciences, and engineering” is required (Desimone). DeSimone discovered and asserts just how much convergence applies to the field of technology and more importantly 3D printing. EIPI Systems, DeSimone’s 3D printer company, has seen great success at its launch due to the convergence it has already accomplished. His printers use different physics to operate and as a result operate at speeds hundreds to thousands times faster than previous printers. He asserts that his printer could compete even with speeds of injection molding. DeSimone argues that just as computation has essentially become free over the last decade due to the advancement of computers, 3D printing will now do the same plummeting the costs of complex manufacturing (DeSimone). 

The convergence of 3D printing and medicine involves numerous fields coming together. For instance, with bionics; robotics, engineering, and biology (nerve endings) must all come together to produce flawless mobility options for the disabled. While we can print the best looking bionic prosthetic we still lack in the ability to convey specific nerve signals for phantom limbs into computer code to elicit the correct response. In engineering current mobility mechanisms lack in the versatility of a real muscle to do actions such as fast twitch movements (Libson and Kurman).

Another way to look at convergence is to look at the current limitations and see where effort needs to be applied to aid development and progress. With tissue production, liver, nerve, and pancreatic cells are still unable to be grown and therefore are not able to be printed until breakthroughs have been made. Printing vast networks of capillaries for organs and neurons are still not yet plausible now. Liability concerns must be dealt with once patients start receiving organs. Patents and copyright issues will also become a concern for such an open source platform, and most importantly regulation for new procedures by the FDA will have to be conceived (Ventola). Atala’s research has already been affected by this with his cartilage implants still awaiting FDA approval before patients may be treated (Kheyfets). As of now December of 2016 the FDA now claims “The FDA's Center for Devices and Radiological Health (CDRH) regulates firms who manufacture, repackage, relabel, and/or import medical devices sold in the United States”, while this is a great first step for 3D printed medical products it still is elusive on 3D printer specific operations such as Atala’s (FDA). 

Like cloning a problem will not arise against 3D printing in medicine until something is done to hurt, offend, or go against someone’s faith. Susan Dobbs knows this and addresses the potential ethical issues that may arise with 3D printing in the years to come. Her first point is once procedures become more viable and clinically used will they only be reserved for those who can afford them or made available to the public. She makes an example about prosthetics and children. While non-3D printed prosthetics are available for children, 3D printing offers more comfort and less pain through the ability to better fit patients contour. The problem esteems from will insurance companies or the government cover 3D printed prostheses or will it be for only those who can afford to. The second point is the safeness of these studies. To test such advancements as printed organs, due to the complexity of human tissue, human trails would eventually be involved. Lastly but furthest away for the future is if 3D printing should be used for human enhancement and whether this goes too far and is deemed unethical like human cloning is. By acknowledging these problems now government and regulatory agencies have the chance to converge with research being done now and in the future to prevent such problems from arising.  While government intervention may indeed hinder the speed of progress and advancement it is necessary to insure ethical practices and an appeased public therefore governmental guidance by organizations like the FDA must occur. If not opposition will arise just like opposition has risen towards the first head transplant being done in Russia where the government has chosen to not intervene. 

Overall 3D printing has already arisen to be a vital tool in the field of medicine alongside other fields like the automotive industry. As the tool of 3D printing continues to improve researchers will also improve in developing new application. What 3D printers have done already in fields like medicine is astonishing. With time, research, and convergence the future holds some unimaginable outcomes. One day problems could be solved by a 3D printer alone. Such a problem that could benefit is the organ shortage prevalent in the U.S. Every 10 minutes a new name makes its way onto an organ waiting list. Every year an astonishing 4,600 people die just from waiting for a kidney (Siegel). If humans continue to live organ shortage and problems alike will continue to arise in healthcare. Healthcare industries and governments alike will continue to be pressured in finding a solution to these problems. 3D printing offers a solution to these problems and will be the future of tomorrow.  
