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Last week you had a chance to ask Dr. Tarek Loubani about his 3D-printable, 30-cent stethoscope project, and other open source, ultra-low cost medical equipment. Below you'll find his answers to your questions. What about patents?
by ciaran2014

Most activities that can be performed commercially but which can also be performed non-commercially are either exempt from patents or never get prosecuted. Fixing other people's bicycles, writing a book, and performing music come to mind. (Software development is a grey area.) But 3D printing is taking an activity where efficient production on any reasonable scale was pretty much the exclusive domain of businesses, and making it accessible to DIY-ers and people who would do it while doing their job or performing some task at home, without any direct commercial aspect. Any idea what stage the debate is at regarding patent restrictions on printing or distributing designs for things more complicated or more modern than stethoscopes?

Tarek: This project does not aim to innovate as such. We aim to drop the bottom out of the costs on devices whose patents have long since expired. We might be trolled, harassed and sued into oblivion, but not because we are in violation of any patents. Indeed, the patents that cover the stethoscope we made are long expired US3168160, filed in 1962; US3108652, filed in 1960; US3515239, filed in 1968. The patents that cover a few small innovations in the Littmann Cardiology III expire in just a couple of years US5945640, but fundamentally the tech is ancient.

It's the same for pulse oximetry. Same for electrocardiograms.

Regarding your overarching question, brilliant minds like Geist, Doctorow, Stallman, etc. might be better positioned to answer. My hope, of course, is that the copyright bargain turns in favour of users and citizens sooner rather than later.



Was your stethoscope 3D printed in Gaza?
by mrops

It seems there are a lot of restrictions on what can be imported into gaza as there is a risk technologies might fall into terrorist hands and used for nefarious purpose. Under this, is it really possible to import a 3D printer into gaza for such tasks?

Tarek: There are already 3D printers in Gaza. Those who have made Prusa i3 printers know that it's trivial to make one from salvaged parts taken from old inkjet and laser printers. These printers will be used in the production of prosthetics and medical devices.

Those who support the blockade or oppose the rights of patients in Gaza to access health care might contend that 3D printers could be used to make weaponry. This is a ridiculous claim: Gaza has hundreds of CNC routers, and most of the weaponry currently in the hands of the Palestinian resistance was either captured from Fatah forces during an “attempted coup” (David Wurmser's words) in 2007 or smuggled, mostly via tunnels under the Egyptian border. The armed resistance groups in Gaza are not waiting for us to bring in 3D printers. If they wanted them, they'd have brought them in with the last batch of rockets.



Are medical devices restricted?
by Anonymous Coward

I see lots of stuff blamed on the import restrictions, but are medical devices actually blockaded, or are they stopped because they're used as a cover to smuggle in other things?

Tarek: According to Gisha, an Israeli NGO, the blockade is “not in order to protect against security threats ... but rather as part of a policy to apply 'pressure' or 'sanctions' on the Hamas regime.” Your question assumes that the blockade is security instead of sanction, which is not the case. Even so, there has never been smuggling of illicit items into Gaza under the cover of medical supplies.

Israel does not declare the list of banned items, but claims that medicines are not banned (see this partial list of banned items, but MSF and others report chronic severe shortages of medical supplies. The World Health Organization reported in 2011 that “shortages of the 190 medical disposable items include some basic and very critical items such as: syringes, Central Venous Pressure devices, ECG and CTG paper, X-Ray film, gauze, disposables used in laparoscopies, and filtration cartridges used in haemodialysis for patients with kidney failure.”

Frankly, I have never cared about why. In Gaza, it's blockade. In Democratic Republic of Congo it's war. In Rwanda, it's poverty. The end result is the same: The denial of health care to the world's most vulnerable people. Everyone deserves health care. This project is about ensuring that doctors and patients in Gaza and elsewhere can alleviate their own suffering without waiting for international law and public goodwill to catch up with illegal occupations, collective punishments and colonial legacies.



3D Printing, catalyst for Intermediate Technology?
by Anonymous Coward

Your 30-cent stethoscope seems to be an excellent example of "Intermediate Technology" (or “Appropriate Technology“) as popularized by Dr Hans Schumacher in his influential book, Small is Beautiful. Do you think that 3D printing will become increasingly important in the third world with regards to improving basic medicine, agriculture etc?

Tarek: I see my 3D printer as a portable factory. It can't do all the same things at the same scales, but it is possible for people in very poor places to create high precision plastic parts that were previously impossible. Because these parts are created from digital models, it also allows collaboration via open source models, as we see on various model repositories. Open source models and repositories are where I think exponential achievements are happening today.

3D printing then becomes one of the ingredients in the empowering of disenfranchised people to take control and come up with indigenous solutions to problems.



Local making of tools
by fortunatus

While reviewing the online repository for the stethoscope design, I saw that mainly it's the sound gathering part that is 3D printed. The rest is - reasonably - made out of regular stuff. So then, with some regular stuff, can't local people figure out how to make stethoscopes? They really can't figure out that one sound gathering piece? It takes a doctor/hacker to come from some land far away bearing the URL to a 3D printable part to solve the problem?

Tarek: You're right - there is nothing special here, and I embrace my mediocrity as a doctor and geek. Somebody just had to do a bit of work and spend a bit of money. I don't consider myself to be from some “land far away”: I am Palestinian and lived as a stateless refugee the first 13 years of my life in Kuwait where I was born, and then in Canada. However, I now have the luxury of a Canadian passport, a first-world academic post at the Division of Emergency Medicine in London, Canada, and the ability to connect two disparate worlds.

When I saw the problem while trying to treat wounded patients in the 2012 war in Gaza, I didn't ask myself “why not somebody else?” I asked: “why not me?”



non alergenic materials for printing
by McLae

With all the allergies to various materials, such as nickel and latex, what materials can be 3d-printed that are medically inert? Surgical instruments are stainless steel, implants are titanium, how do you print these? It seems another whole line of questions to find proper materials that can be printed.

Tarek: A few plastics come to mind. ABS is FDA approved, as is Nylon 680 and some PETT. For now, underserviced populations will not be able to receive 3D printed metals – it's too costly and out of scope. However, there can be some creativity. 3D4MD, a group in Toronto, Canada has successfully developed and published on 3D printed surgical instruments made from ABS. Because their models are not published online and I believe are not open source, we have started our own surgical tools project, which will have tremendous impact when completed.

Your answer, then, has two parts. The first is that we should aim at the low-hanging fruit of medicine. Off-patent, ubiquitous devices like stethoscopes, pulse oximeters, electrocardiograms, and hemodialysis are good examples.

The second part is that we in the global south accept that some people will die because of the lack of proper supplies. Given latex gloves or no gloves at all, the choice is obvious. This is not academic: physicians and policymakers have been forced to make this decision in Gaza at the Shifa hospital's emergency department, where most of our gloves are latex.

We're talking about basics like gloves and gauze. Nobody here is talking about custom-printed titanium implants.



Challenges
by Anonymous Coward

What do you see as the main challenges in getting your devices to the regions that need them?

Tarek: I guess the main challenge by far is buy-in. Once a ministry of health or hospital buys into the idea, then the technical parts are trivial and inexpensive.



What else is out there?
by ciaran2014

I've read there are other 3D-printed stethoscopes. Is yours (the Gila 3D stethoscope) attracting attention because it's better, or cheaper, or because it's actually getting used? Or is the Gila 3D stethoscope getting attention not for what it is but for it being an example from a domain where 3D seems set to bring radical change?

Tarek: I know of a few other stethoscopes. In that sense, what we're doing is not unique technically. Our innovation is taking the technology and mixing it with the politics of Free hardware and enfranchisement and the science of verification and validation. Then, as you noted, we put it to use in the real world.

Our stethoscope is as good or better than a Littmann Cardiology III. I can prove it. You can build it today, all of the models are available to modify, and soon it will be Health Canada approved as a Class I device. A peer-reviewed publication is hopefully forthcoming.

The attention is indeed because of the idea and the promise, not the stethoscope. However, the stethoscope has created a model and a high standard that we and other groups must meet when working on future projects of this kind.

eldavojohn writes "Doctors Without Borders is reporting that four patents for tenofovir disoproxil fumarate, a key AIDS/HIV drug, have been revoked on grounds of prior art. This is potentially good news for India & Brazil who need this drug to be cheap; if the US action leads to the patent being rejected in these countries, competition could drastically lower prices. But the ruling bad news for Gilead Sciences. The company has vowed to appeal. We discussed this drug before."