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Cheap, 3D-Printed Stethoscope Challenges Top-of-the-Line Model
mask.of.sanity writes: Tarek Loubani, an emergency physician working in the Gaza strip, has 3D-printed a 30-cent stethoscope that beats the world's best $200 equivalent as part of a project to bottom-out the cost of medical devices. Loubani together with a team of medical and technology specialists designed the stethoscope and tested it against global standard benchmarks, finding it out performed the gold-standard Littmann Cardiology 3. They now intend to make a range of ultra-low cost medical devices for the developing world.
It cost about US$10,000 to develop, and has been released as an open source model for anyone to use. Loubani says the project is following the footsteps of the free software movement and aims to replace expensive proprietary solutions. He hopes that within 25 years the devices will be common-place in the Third World, and be the "Apache of the medical world."
It cost about US$10,000 to develop, and has been released as an open source model for anyone to use. Loubani says the project is following the footsteps of the free software movement and aims to replace expensive proprietary solutions. He hopes that within 25 years the devices will be common-place in the Third World, and be the "Apache of the medical world."
My doctor doesn't, he uses an electronic device. Not sure what it is called.
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Will the patients see any of this reduced cost?
Or will it go straight to higher profits?
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if you ignore the amortized cost of the 3-d printer, the wages to the 3-d printer operator, the electricity to run the 3-d printer, the lease for the building where the 3-d printer resides, and all sorts of other overhead.
Because it was 3D printed.
If it's such a good design, then get some factory in China to injection mould 10,000s of them for pennies.
If we assume that the part could be produced via injection molding (not always true for odd geometries), then we still have the issue of distribution --
How do you get those 10,000 parts to the people who need them? Do you mail them out individually to all of the doctors that need them? Do you ship cases of them to NGOs and then let them distribute them?
There's still going to need to be *some* distribution from the 3D printer to the doctor, but as the printers become more wide-spread, the odds of the doctor having access to one goes up. With the ability to print prosthetic parts, I would hope that hospitals would be some of the early adopters ... this just might help a new hospital that isn't already kitted out w/ stethoscopes to justify the purchase.
Build it, and they will come^Hplain.
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I'm not a doctor, I don't know any, at least any that would be interested in trying (there's no way any doctor in my area would verify on his or her own that this works), but I'm still willing to try out this project myself. You know, for grins.
That having been said, people seem to be developing projects left and right and bending over backwards to make 3D printing a thing.
I can't say whether or not it will be, but it's a lot of fun trying to figure it out.
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I suspect that $0.30 cost is just the materials used in making it. Add in design costs, buying the machine, hiring people to watch over the machines, HR, accounting, sales, and support, that stethoscope can easily cost a full $3.00.
The reason a littmann is made of thick heavy materials is because hearing the subject is a whole lot easier than keeping outside noise out. I'd imagine a plastic head would be subject to a lot of outside noise.
The photo in the article is wrong, the one in the picture is the litmann device, i have looked at the printed parts and the assembled product looks nothing like the one in the photo. It does not use a y tube at all, but has a printed y junction box. Straight lengths of tubing connect to that. The diaphram in the cheap printed one is a circle of plastic card cut from a file folder.
One advantage to 3D printing and modelling is that the device can be optimized. They can dynamically change things such as the shape and thickness of materials and inner chamber and then determine whether it made a difference or not. And, they can do it cheaply. I wonder, can they reuse the plastic from earlier models?
More power to them for doing this. As I haven't had time to read the article, are they publishing their design as open source?
My wife is a veterinarian (graduated UC Davis) and has found that expensive stethoscopes are not as helpful as having significant experience with your stethoscope. She has used an inexpensive device to pick up very faint heart murmurs and other issues that others were not able to detect with their expensive devices. I would suggest that consistency is the most important aspect of creating these stethoscopes, so that if a physician develops a significant amount of experience with one, they could switch to another device without much trouble.
Littmann is mostly about brand recognition and status ; nurses buy £3.50 cheap mass produced stethoscopes, doctors buy £50 Littmanns.
The Littmann units are arguably superior in quality. On the other hand, I had a £10 stethoscope (it costs a bit more now) built like a piece of Russian miltary surplus that all my professional colleagues wanted to borrow because they thought it sounded clearer and louder than their expensive Littmanns.
It also lasted longer - the plastic Littmann use for their tubes is prone to fatigue and cracking. The rubber tubes on this thing lasted for years.
There's nothing in the Littmann that's inherently expensive or difficult to manufacture, it's just brand recognition, patents, and the fact that it's a niche product with a limited market.
After I lost my first Littmann, I started using this one the Sprague Rappaport - I see them on medical dramas sometimes, I guess they look just as "doctory" to a props department without breaking the budget.
My colleagues liked to borrow it, it was objectively louder than the Littmann. It doesn't use the fancy free-floating diaphragm the Littmann has, it just has a thin piece of plastic. It also comes with a pouch with a bunch of different bells, earpieces, a spare diaphragm, and you can screw the fittings on and off. It was kind of the Russian Military Surplus stethoscope, being somewhat more bulky and heavy than a Littmann, but much cheaper.
Those nurses stethoscopes do cost about $5 though.
The cost of medical care really does threaten to burst the US economy and the solutions are complex rather than simple. Here we have a great example of a medical device being created really inexpensively. It is a precursor of what must follow. If we can make all of the medical equipment much more inexpensively we can have more hospitals and clinics without the need for enormous funding, loans, etc.. If we follow that path we may be able to create medical schools which are not expensive to attend such that a would be doctor does not have to sink into severe debt to get his training. That should shrink his fees quite a bit as well. Obviously both technology as well as strict government oversight will be needed to reduce the cost of pharmaceuticals. In other words we can not start at the end point of the expense path and get costs down without brutal actions. But if we lower the price of the entire medical pathway we can have top notch medical care at a tiny cost compared to what we pay these days.
I am surprised that the git appears to only offer molds for making silicone ear pieces. I am not going to deny that the silicone earpiece is likely superior both for comfort and for ambient noise elimination. It seems like having additions options available would be important.
If these are being printed in a resource poor area a set of ear tubes that have ball ends built directly onto them so added material resources of liquid silicone is not necessary would seem to be an essential! Of course several diameters would be required since not all ears are the same size. Yes, this will prove to be a duplication of parts, but the cost of having an alternate design available is minimal, especially if it means that the device is more readily useable.
Availability of the diaphragm plastic is happily not essential as a stethoscope without a diaphragm will still perform better than an ear pressed to the patient.
A noble project. Stethoscopes are used for listening to the heart and lungs, the abdomen for digestion/gas sounds, taking blood pressure, and likely more.
Phil
Laugh, it's good for you!
Decent quality disposable injection molded plastic stethoscopes are available for less than $1, packaged sterile, make part of the need here difficult to accept. I am sure the sound quality on a disposable stethoscope is not even similar to a Littmann cardio III.
Laugh, it's good for you!
Personally, I buy hand tools for their durability and not necessarily their technical details. I want stuff that will last for decades and give reasonable results because I don't want to waste my time running out to the store to replace a broken tool.
If the $200 stethoscope lasts forever under normal use and the $0.30 version is easily broken in your pocket, give me the $200 version. If there is a $50 version that is nearly the best but works for my application and won't break on me every few weeks, I'll take that.
Sometimes cheap is just cheap.... Sometimes cheap really means disposable.
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The medical device space is ripe for Uberization. A high-end hearing aid contains perhaps a hundred dollars worth of electronics, but in the US market sells for $4000 and more because it's a sacred "medical device" that manufacturers have special legal rights to force Americans to pay the highest prices in the world for. Introduce medical electronics priced relative to real cost in the BRIC countries, and the market will explode to such an extent that US healthcare will have no choice but to let them in even before Rand Paul's second term.
I'm betting some top-secret clauses in the Transatlantic Trade and Investment Partnership will make such noble endeavors outright criminal.
One property of a metal stethoscope that a printed plastic one may have trouble replicating: the specific heat of metal. It is unlikely that the experience of a properly chilled metal 'scope can be replicated using plastic.
Have gnu, will travel.
When hundreds of medical devices are available for 3D printing, then remote areas with a 3D printer will have access to what they need, when they need it.
If only a few parts are available, purchasing and maintaining a 3D printer is a waste. Until more things are available to print, mass produced parts will be cheaper and probably much better.
$10k to develop this thing. Give me a Littman stethoscope, a $10 Harbor Freight digital caliper, and some free CAD software (DesignSpark Mechanical) and I'll have a copy rolling off my printer in about an hour. OK, maybe 3 hours if I have to modify the design a little and print a few test pieces.
The $10K probably included the cost of buying a 3D printer, a Solidworks license, and paid training for both.
So many of these articles that proclaim how inexpensive it is to produce things with 3-D printing technology completely misrepresent the true cost.
That 30 cents figure is probably just for the materials. It doesn't consider the development cost (which in this case may be donated, but in many cases must be amortized across every piece produced), the cost of production equipment (also to be amortized), employment of production labor, distribution costs, marketing, overhead, and any number of other real business expenses above and beyond materials costs.
Realistically, I would expect this to have a market price in the low 10s of USD, not "30 cents." That puts in the range of pretty much every stethoscope available. The typical third-world MD isn't going to have a 3-D printer at her disposal.
Give me my freedom, and I'll take care of my own security, thank you.
My mother (a MD) is pretty happy with her EUR 20 Rappaport type stethoscope.
"It's such a fine line between stupid and clever" -- David St. Hubbins, Spinal Tap
Littmann is not "mostly about brand recognition and status", instead it is mostly about standardization to a high level of precision. Maybe there are cheaper options that sometimes are better if you are lucky to get a good one, but cheaper options normally are the ones with more "flexible" manufacturing standards, resulting in batches with vastly different acoustic characteristics.
For the record, nurses can use £3.50 cheap mass produced stethoscopes because they use it to auscultate very unsubtle things. And on that same line I imagine an MD on a rich country also could go for the cheap ones as they also don't rely on subtle auscultation as a major diagnosis tool, instead relying on heavy use of tech like ultrasound, electrocardiogram, or even atomic imaging. But if you are an MD on a poor country having to diagnose subtle heart conditions with nothing but what you can hear, then a good stethoscope can make all the difference.
This is one of the interesting differences I've noticed between my first-world and underserved colleagues. The former think a stethoscope is a quaint fashion accessory. The latter look at it as an indispensable diagnostic tool. After all, who cares about hearing a little murmur if you have an ultrasound in your pocket and can assess ejection function on the fly?
My colleagues in Gaza have sharper clinical skills for exactly this reason, and it's why they need these tools.
tarek : )
It doesn't look good? Would most people rather trust a doctor coming out with a jagged, almost-translucent, noticeably home-printed stethoscope or the one with a nice black, smooth tube with a lithographical L emblazoned?
Being a doctor (at least in the western world) is more about appearances than healing. The more machines they use and the nicer they look, the better the doctor is. You could prescribe most people a placebo and they'll get better (just look at the effectiveness of homeopathy). If you ache or have a cough, people seek a doctor that needs to run tests and appear busy. Most aches and coughs disappear on their own, it's only when they don't that you should become concerned.
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