3D printing might save your life one day. It's transforming medicine and health care.
What can 3D printing do for medicine? The "sky is the limit," says Northwell Health researcher Dr. Todd Goldstein.
- Medical professionals are currently using 3D printers to create prosthetics and patient-specific organ models that doctors can use to prepare for surgery.
- Eventually, scientists hope to print patient-specific organs that can be transplanted safely into the human body.
- Northwell Health, New York State's largest health care provider, is pioneering 3D printing in medicine in three key ways.
Imagine that a health emergency strikes and you need an organ transplant – say, a heart. You get your name on a transplant list, but you find out there's a waiting period of six months. Tens of thousands of people find themselves in this dire situation every year. But 3D printing has the potential to change that forever.
The technology could usher in a future where transplantable organs can be printed not only cheaply, but also to the exact anatomical specifications of each individual patient.
What other innovations could 3D printing bring to medicine and health care? The sky is the limit, according to Dr. Todd Goldstein, a researcher with the corporate venturing arm of Northwell Health, New York State's largest health care provider and an industry leader in 3D-printing research and development.
"It comes down to what people can think up and dream up what they want to use 3D printing for," Goldstein says. "Ideally, you would hope that 50 years from now you'd have on-demand, 3D printing of organs."
While that's still on the horizon for researchers, 3D printing is already improving lives by revolutionizing medicine in three key areas.
Printing realistic, customized organ models
3D printers can take images from MRI, PET, sonography or other technologies and convert them into life-size, three-dimensional models of patients' organs. These models serve as hands-on visualization tools that help surgeons plan the best approaches for complex procedures.
They also allow doctors to customize patient-specific models prior to surgery. For example, Northwell employs 3D printing in several clinical applications:
- Tumor resection models clearly highlight the tumor and surrounding tissue
- Orthopedic models are useful for pre-surgery measuring and medical device adjustments
- Vascular models identify malformations in organs, tumors, sliced chambers, blood flow, valves, muscle tissue, and calcifications
- Dentistry oral implants and appliances can be created in just one day, significantly reducing wait periods for Northwell dentists and their patients
Using realistic models not only delivers better health results but also shortens operating times. That gives patients less time under anesthesia, and hospitals potential savings of millions of dollars over just a few years.
Being able to visualize procedures before they occur also helps to comfort patients and their families. Take, for instance, the case of Barnaby Goberdhan, a man who discovered that his young son, Isaiah, had an aggressive tumor in his palate. Goberdhan met with Neha A. Patel, MD, a pediatric otolaryngologist at Cohen Children's Medical Center, a Northwell Health hospital, to discuss the procedure and learn about it with help from a 3D-printed model.
"Having a 3D printed depiction of my son was really helpful when talking with the doctor about his surgery," said Mr. Goberdhan. "The doctor was able to do more than talk me through what they were going to do – Dr. Patel showed me. There is almost nothing more frightening and stressful than having your child go through surgery. There were several options Dr. Patel walked us through for the best way to preserve Isaiah's teeth and prevent additional cuts within his mouth. I wanted all of my questions answered so I could be less fearful and more prepared to talk my son through what he was about to face. I wanted Isaiah to feel prepared. With the 3D model, we both felt more at ease."
For years, 3D printing surgical models was prohibitively expensive. Now, more affordable systems such as Formlabs' Form Cell give more hospitals across the country access to the technology in order to produce realistic, patient-specific models, usually within one day.
Credit: Northwell Health
While 3D-printed organs are a long way in the future, today's technology is well suited for manufacturing prosthetics. 3D-printed prosthetics are often remarkably more affordable and personalized than their traditional counterparts. That's a big deal for many families, especially those with children who outgrow prosthetics and are forced to buy new ones.
One recent breakthrough in 3D-printed prosthetics came when Dan Lasko, a former Marine who lost the lower part of his left leg in Afghanistan, wanted the ability to swim with his prosthetic leg. Wearing prosthetics in water has been possible for years, but they typically slow swimmers down. No device had been able to go seamlessly from land to water or to help propel its wearer through the water.
To fix that, Northwell Health recently funded a project that developed The Fin – the world's first truly amphibious prosthetic. With The Fin, Lasko and his family can go straight into the pool from the locker room – or the diving board.
"I got back in the pool with my two young sons and for the first time was able to dive into the pool with them," Lasko said.
3D-printed prosthetics will help improve the daily lives of the nearly 2 million Americans who've lost a limb. That's promising because the increasing prevalence of Type 2 diabetes is expected to greatly increase the number of amputees in the U.S., according to a study published in the Archives of Physical Medicine and Rehabilitation.
For years, 3D printers have manufactured various products: phone cases, toys, and even operational guns. To produce these objects, the machines heat a raw material, typically plastic, and build the object layer-by-layer according to a particular design.
3D bioprinting, a young field developed by researchers with Northwell Health, may someday perform the same process but instead with living cells in a raw material called bioink.
Daniel A. Grande, director at the Orthopedic Research Laboratory in the Feinstein Institute for Medical Research, an arm of Northwell Health, said he and his team first pursued 3D bioprinting by modifying 3D printers so they'd accept living cells.
"My initial concept of 3D printing was early studies that looked at modifying ink-jet printers, where we incorporate a bioink that includes cells within a delivery vehicle," Grande says. "That hydrogel can then be polymerized, or hardened, upon heat or UV-light stimulation, so that we can actually make a complex structure, three-dimensionally, that incorporates living cells. The hardened hydro-gel is then able to keep the cells alive and viable. It's also biocompatible, so it can be safely implanted in humans."
It's a promising enterprise, and it can radically change how we experience medical care.
"3D bioprinting's potential is almost limitless and has the potential to replace many different parts of the human body," says Michael Dowling, president and CEO at Northwell Health, and author of Health Care Reboot. "Researchers envision a future with 3D printers in every emergency room, where doctors are able to print emergency implants of organs and bones on demand and revolutionize the way medicine is practiced."
Dr. Todd Goldstein explains more about 3D bioprinting below:
The experience of life flashing before one's eyes has been reported for well over a century, but where's the science behind it?
At the age of 16, when Tony Kofi was an apprentice builder living in Nottingham, he fell from the third story of a building. Time seemed to slow down massively, and he saw a complex series of images flash before his eyes.
As he described it, “In my mind's eye I saw many, many things: children that I hadn't even had yet, friends that I had never seen but are now my friends. The thing that really stuck in my mind was playing an instrument". Then Tony landed on his head and lost consciousness.
When he came to at the hospital, he felt like a different person and didn't want to return to his previous life. Over the following weeks, the images kept flashing back into his mind. He felt that he was “being shown something" and that the images represented his future.
Later, Tony saw a picture of a saxophone and recognized it as the instrument he'd seen himself playing. He used his compensation money from the accident to buy one. Now, Tony Kofi is one of the UK's most successful jazz musicians, having won the BBC Jazz awards twice, in 2005 and 2008.
Though Tony's belief that he saw into his future is uncommon, it's by no means uncommon for people to report witnessing multiple scenes from their past during split-second emergency situations. After all, this is where the phrase “my life flashed before my eyes" comes from.
But what explains this phenomenon? Psychologists have proposed a number of explanations, but I'd argue the key to understanding Tony's experience lies in a different interpretation of time itself.
When life flashes before our eyes
The experience of life flashing before one's eyes has been reported for well over a century. In 1892, a Swiss geologist named Albert Heim fell from a precipice while mountain climbing. In his account of the fall, he wrote is was “as if on a distant stage, my whole past life [was] playing itself out in numerous scenes".
More recently, in July 2005, a young woman called Gill Hicks was sitting near one of the bombs that exploded on the London Underground. In the minutes after the accident, she hovered on the brink of death where, as she describes it: “my life was flashing before my eyes, flickering through every scene, every happy and sad moment, everything I have ever done, said, experienced".
In some cases, people don't see a review of their whole lives, but a series of past experiences and events that have special significance to them.
Explaining life reviews
Perhaps surprisingly, given how common it is, the “life review experience" has been studied very little. A handful of theories have been put forward, but they're understandably tentative and rather vague.
For example, a group of Israeli researchers suggested in 2017 that our life events may exist as a continuum in our minds, and may come to the forefront in extreme conditions of psychological and physiological stress.
Another theory is that, when we're close to death, our memories suddenly “unload" themselves, like the contents of a skip being dumped. This could be related to “cortical disinhibition" – a breaking down of the normal regulatory processes of the brain – in highly stressful or dangerous situations, causing a “cascade" of mental impressions.
But the life review is usually reported as a serene and ordered experience, completely unlike the kind of chaotic cascade of experiences associated with cortical disinhibition. And none of these theories explain how it's possible for such a vast amount of information – in many cases, all the events of a person's life – to manifest themselves in a period of a few seconds, and often far less.
Thinking in 'spatial' time
An alternative explanation is to think of time in a “spatial" sense. Our commonsense view of time is as an arrow that moves from the past through the present towards the future, in which we only have direct access to the present. But modern physics has cast doubt on this simple linear view of time.
Indeed, since Einstein's theory of relativity, some physicists have adopted a “spatial" view of time. They argue we live in a static “block universe" in which time is spread out in a kind of panorama where the past, the present and the future co-exist simultaneously.
The modern physicist Carlo Rovelli – author of the best-selling The Order of Time – also holds the view that linear time doesn't exist as a universal fact. This idea reflects the view of the philosopher Immanuel Kant, who argued that time is not an objectively real phenomenon, but a construct of the human mind.
This could explain why some people are able to review the events of their whole lives in an instant. A good deal of previous research – including my own – has suggested that our normal perception of time is simply a product of our normal state of consciousness.
In many altered states of consciousness, time slows down so dramatically that seconds seem to stretch out into minutes. This is a common feature of emergency situations, as well as states of deep meditation, experiences on psychedelic drugs and when athletes are “in the zone".
The limits of understanding
But what about Tony Kofi's apparent visions of his future? Did he really glimpse scenes from his future life? Did he see himself playing the saxophone because somehow his future as a musician was already established?
There are obviously some mundane interpretations of Tony's experience. Perhaps, for instance, he became a saxophone player simply because he saw himself playing it in his vision. But I don't think it's impossible that Tony did glimpse future events.
If time really does exist in a spatial sense – and if it's true that time is a construct of the human mind – then perhaps in some way future events may already be present, just as past events are still present.
Admittedly, this is very difficult to make sense of. But why should everything make sense to us? As I have suggested in a recent book, there must be some aspects of reality that are beyond our comprehension. After all, we're just animals, with a limited awareness of reality. And perhaps more than any other phenomenon, this is especially true of time.
Might as well face it, you're addicted to love.
- Many writers have commented on the addictive qualities of love. Science agrees.
- The reward system of the brain reacts similarly to both love and drugs
- Someday, it might be possible to treat "love addiction."
Since people started writing, they've written about love. The oldest love poem known dates back to the 21st century BCE. For most of that time, writers also apparently have been of two (or more) minds about it, announcing that love can be painful, impossible to quit, or even addictive — while also mentioning how nice it is.
The idea of love as an addiction is one that is both familiar and unsettling. Surely it can't be the case that our mutual love with our partner — a thing that can produce euphoria, consumes a great deal of our time, and which we fear losing — can be compared to a drug habit? But indeed, many scientists have turned their attention to the idea of "love addiction" and how your brain on drugs might resemble your brain in love.
Love and other drugs
In a 2017 article published in the journal Philosophy, Psychiatry, & Psychology, a team of neuroethicists considered the idea that love is addicting and held the idea up to science for scrutiny.
They point out that the leading model of addiction rests on the notion of a drug causing the brain to release an unnatural level of reward chemicals, such as dopamine, effectively hijacking the brain's reward system. This phenomenon isn't strictly limited to drugs, though they are more effective at this process than other things. Rats can get a similar rush from sugar as from cocaine, and they can have terrible withdrawal symptoms when the sugar crash kicks in.
On the structural level, there is a fair amount of overlap between the parts of the brain that handle love and pair-bonding and the parts that deal with addiction and reward processing. When inside an MRI machine and asked to think about the person they love romantically, the reward centers of people's brains light up like Broadway.
Love as an addiction
These facts lead the authors to consider two ideas, dubbed the "narrow" and "broad" views of love as an addiction.
The narrow view holds that addiction is the result of abnormal brain processes that simply don't exist in non-addicts. Under this paradigm, "food-seeking or love-seeking behaviors are not truly the result of addiction, no matter how addiction-like they may outwardly appear." It could be that abnormal processes cause the brain's reward system to misfire when exposed to love and to react to it excessively.
If this model is accurate, love addiction would be a rare thing — one study puts it around five to ten percent of the population — but could be considered a disorder similar to others and caused by faulty wiring in the brain. As with other addictions, this malfunction of the reward system could lead to an inability to fully live a typical life, difficulty having healthy relationships, and a number of other negative consequences.
The broad view looks at addiction differently, perhaps even radically.
It begins with the idea that addiction exists on a spectrum of motivations. All of our appetites, including those for food and water, exist on this spectrum and activate similar parts of the brain when satisfied. We can have appetites for anything that taps into our reward system, including food, gambling, sex, drugs, and love. For most people most of the time, our appetites are fairly temperate, if recurring. I might be slightly "addicted" to food — I do need some a few times per day — but that "addiction" doesn't have any negative effects on my health.
An appetite for cocaine, however, is rarely temperate and usually dangerous. Likewise, a person's appetite for love could reach addiction levels, and a person could be considered "hooked" on relationships (or on a particular person). This would put love addiction at the extreme end of the spectrum.
None of this is to say that the authors think that love is bad for you just because it can resemble an addiction. Love addiction is not the same as cocaine addiction at the neurological level: important differences, like how long it takes for the desire for another "hit" to occur, do exist. Rather, the authors see this as an opportunity to reconsider our approach to addiction in general and to think about how we can help the heartsick when they just can't seem to get over their last relationship.
Is "love addiction" a treatable disorder?
Hypothetically, a neurological basis for an addiction to love could point toward interventions that "correct" for it. If the narrow view of addiction is accurate, perhaps some people will be able to seek treatment for love addiction in the same way that others seek help to quit smoking. If the broad view of addiction is correct, the treatment of love addiction would be unlikely as it may be difficult to properly identify where the cutoff of acceptability on a spectrum should be.
Either way, since love is generally held in high regard by all cultures and doesn't quite seem to be in the same category as a bad cocaine habit in terms of social undesirability, the authors doubt we'll be treating anyone for "love addiction" anytime soon.
A brief passage from a recent UN report describes what could be the first-known case of an autonomous weapon, powered by artificial intelligence, killing in the battlefield.
- Autonomous weapons have been used in war for decades, but artificial intelligence is ushering in a new category of autonomous weapons.
- These weapons are not only capable of moving autonomously but also identifying and attacking targets on their own without oversight from a human.
- There's currently no clear international restrictions on the use of new autonomous weapons, but some nations are calling for preemptive bans.
Nothing transforms warfare more violently than new weapons technology. In prehistoric times, it was the club, the spear, the bow and arrow, the sword. The 16th century brought rifles. The World Wars of the 20th century introduced machine guns, planes, and atomic bombs.
Now we might be seeing the first stages of the next battlefield revolution: autonomous weapons powered by artificial intelligence.
In March, the United Nations Security Council published an extensive report on the Second Libyan War that describes what could be the first-known case of an AI-powered autonomous weapon killing people in the battlefield.
The incident took place in March 2020, when soldiers with the Government of National Accord (GNA) were battling troops supporting the Libyan National Army of Khalifa Haftar (called Haftar Affiliated Forces, or HAF, in the report). One passage describes how GNA troops may have used an autonomous drone to kill retreating HAF soldiers:
"Logistics convoys and retreating HAF were subsequently hunted down and remotely engaged by the unmanned combat aerial vehicles or the lethal autonomous weapons systems such as the STM Kargu-2... and other loitering munitions. The lethal autonomous weapons systems were programmed to attack targets without requiring data connectivity between the operator and the munition: in effect, a true 'fire, forget and find' capability."
Still, because the GNA forces were also firing surface-to-air missiles at the HAF troops, it's currently difficult to know how many, if any, troops were killed by autonomous drones. It's also unclear whether this incident represents anything new. After all, autonomous weapons have been used in war for decades.
Lethal autonomous weapons
Lethal autonomous weapon systems (LAWS) are weapon systems that can search for and fire upon targets on their own. It's a broad category whose definition is debatable. For example, you could argue that land mines and naval mines, used in battle for centuries, are LAWS, albeit relatively passive and "dumb." Since the 1970s, navies have used active protection systems that identify, track, and shoot down enemy projectiles fired toward ships, if the human controller chooses to pull the trigger.
Then there are drones, an umbrella term that commonly refers to unmanned weapons systems. Introduced in 1991 with unmanned (yet human-controlled) aerial vehicles, drones now represent a broad suite of weapons systems, including unmanned combat aerial vehicles (UCAVs), loitering munitions (commonly called "kamikaze drones"), and unmanned ground vehicles (UGVs), to name a few.
Some unmanned weapons are largely autonomous. The key question to understanding the potential significance of the March 2020 incident is: what exactly was the weapon's level of autonomy? In other words, who made the ultimate decision to kill: human or robot?
The Kargu-2 system
One of the weapons described in the UN report was the Kargu-2 system, which is a type of loitering munitions weapon. This type of unmanned aerial vehicle loiters above potential targets (usually anti-air weapons) and, when it detects radar signals from enemy systems, swoops down and explodes in a kamikaze-style attack.
Kargu-2 is produced by the Turkish defense contractor STM, which says the system can be operated both manually and autonomously using "real-time image processing capabilities and machine learning algorithms" to identify and attack targets on the battlefield.
STM | KARGU - Rotary Wing Attack Drone Loitering Munition System youtu.be
In other words, STM says its robot can detect targets and autonomously attack them without a human "pulling the trigger." If that's what happened in Libya in March 2020, it'd be the first-known attack of its kind. But the UN report isn't conclusive.
It states that HAF troops suffered "continual harassment from the unmanned combat aerial vehicles and lethal autonomous weapons systems," which were "programmed to attack targets without requiring data connectivity between the operator and the munition: in effect, a true 'fire, forget and find' capability."
What does that last bit mean? Basically, that a human operator might have programmed the drone to conduct the attack and then sent it a few miles away, where it didn't have connectivity to the operator. Without connectivity to the human operator, the robot would have had the final call on whether to attack.
Key line 2: The loitering munitions/LAWS (depending upon how you frame it) were enabled to attack without data conn… https://t.co/5u89cDDA60— Jack McDonald (@Jack McDonald)1622114029.0
To be sure, it's unclear if anyone died from such an autonomous attack in Libya. In any case, LAWS technology has evolved to the point where such attacks are possible. What's more, STM is developing swarms of drones that could work together to execute autonomous attacks.
Noah Smith, an economics writer, described what these attacks might look like on his Substack:
"Combined with A.I., tiny cheap little battery-powered drones could be a huge game-changer. Imagine releasing a networked swarm of autonomous quadcopters into an urban area held by enemy infantry, each armed with little rocket-propelled fragmentation grenades and equipped with computer vision technology that allowed it to recognize friend from foe."
But could drones accurately discern friend from foe? After all, computer-vision systems like facial recognition don't identify objects and people with perfect accuracy; one study found that very slightly tweaking an image can lead an AI to miscategorize it. Can LAWS be trusted to differentiate between a soldier with a rifle slung over his back and, say, a kid wearing a backpack?
Opposition to LAWS
Unsurprisingly, many humanitarian groups are concerned about introducing a new generation of autonomous weapons to the battlefield. One such group is the Campaign to Stop Killer Robots, whose 2018 survey of roughly 19,000 people across 26 countries found that 61 percent of respondents said they oppose the use of LAWS.
In 2018, the United Nations Convention on Certain Conventional Weapons issued a rather vague set of guidelines aiming to restrict the use of LAWS. One guideline states that "human responsibility must be retained when it comes to decisions on the use of weapons systems." Meanwhile, at least a couple dozen nations have called for preemptive bans on LAWS.
The U.S. and Russia oppose such bans, while China's position is a bit ambiguous. It's impossible to predict how the international community will regulate AI-powered autonomous weapons in the future, but among the world's superpowers, one assumption seems safe: If these weapons provide a clear tactical advantage, they will be used on the battlefield.
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