Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue No. 18 - Evidence - March 8, 2017
OTTAWA, Wednesday, March 8, 2017
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 4:15 p.m. to study the role of robotics, 3-D printing and artificial intelligence in the healthcare system.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[English]
The Chair: Colleagues, we have a lot of interesting things to deal with today. We want to get under way and get moving.
[Translation]
Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
I'm Kelvin Ogilvie, a senator from Nova Scotia and chair of the committee. I'm going to start by asking each senator to identify themselves, and I'm going to start on the left.
Senator Meredith: Senator Meredith from Ontario.
[Translation]
Senator Mégie: Marie-Françoise Mégie from Quebec.
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Senator Hartling: Nancy Hartling from New Brunswick.
[Translation]
Senator Petitclerc: Senator Chantal Petitclerc from Quebec.
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Senator Stewart Olsen: Carolyn Stewart Olsen from New Brunswick.
Senator Seidman: Judith Seidman from Montreal, Quebec.
The Chair: I'll remind us all that we are continuing our study on the role of robotics, 3-D printing and artificial intelligence in the health care system.
I want to make sure everyone is aware that the formal part of the meeting will last 90 minutes. I will adjourn the meeting at that point, because we have a demonstration that will occur at the end, as well as a number of samples of 3- D printed materials to give you all a good chance to look at this kind of thing. I think we're all looking forward to that.
We have two witnesses appearing as individuals, and a third who will be identified specifically as well. I'm going to invite those appearing as individuals to present first, starting with Dr. Matt Ratto, Associate Professor, Faculty of Information, University of Toronto.
Matt Ratto, Associate Professor, Faculty of Information, University of Toronto, as an individual: Thank you very much for inviting me to speak with you today. I'm an Associate Professor in the Faculty of Information at U of T. I'm also the Chief Science Officer of Nia Technologies, which is a non-profit social enterprise created out of research that I did at the University of Toronto.
I provided some research notes to the committee late yesterday. Hopefully those notes will be useful for you. I'll speak generally to those notes, specifically highlighting the two examples that I provide in those notes that come from my own research and some of the implications and potential recommendations that I think the committee might make use of.
I'm going to specifically talk about additive manufacturing — a more descriptive term for 3-D printing — and health care. I will focus explicitly on the printing of custom medical devices using low-cost 3-D printing technologies. I'll provide two examples of that.
My main point here is simply to say that these 3-D printing innovations are well posed to provide enhanced treatment options for both direct and indirect personalized health care currently as it stands right now, but they are currently limited by the difficulty of integrating them into mainstream medical practice. I'll talk about that at the end of my comments.
I want to give just a quick set of reasons why additive manufacturing can be utilized in health care, or good reasons for it to be utilized. These follow three different points. I'm going to describe those three and then I'm going to talk about the last one.
The three are that 3-D printing can be utilized to produce objects with complex geometries or materials that can't be manufactured using other techniques. I think my colleague Konrad will speak about that use of 3-D printing. The other reason why 3-D printing is often used is to produce objects on demand due to limited storage space or other procurement issues. I think Dr. Wong will speak about her own work in that space. Finally, 3-D printing can be utilized to produce custom, patient-specific devices or objects. Those are the examples primarily that I will give.
Again, I have some examples in the notes that I won't talk about right now except to highlight the last one, which is the use of 3-D printing to create custom, patient-specific objects. There is in fact a use of 3-D printing right now that some people have described as the largest use of 3-D printing that people don't know about, which is the 3-D printing of custom hearing aids. In fact, hearing aids produced through 3-D printing is a real growth industry. Over 10 million hearing aids have been printed so far to date. Yet, we don't think very much about that as part of the landscape.
What I want to talk about briefly here are two projects that emerged from my own research and moved out into the world in interesting ways. Those are the Advanced Perioperative Imaging Laboratory, APIL, at Toronto General Hospital and Nia Technologies. I'll take those in order.
APIL is a facility at Toronto General Hospital started by two cardiac anesthesiologists, Dr. Meineri and Dr. Mashari, who are both at the University of Toronto, Faculty of Medicine. That group carries out both research and educational activities associated with the production of custom and patient-specific models for surgical training and planning.
I actually did bring one of their models here, a cardiac model taken explicitly from a specific patient's CT scan and echo sound data. I'll hand it around if you want to take a look. It actually pulls apart in various pieces and was utilized in a surgical training exercise to teach cardiac surgeons and medical students various specific anatomy of the heart.
Other projects at APIL include the production of printed airways, used to train surgeons and other practitioners on how to properly scope an airway; the production of 3-D printed heart phantoms that are echogenic, meaning they actually look the same way as a real heart does under ultrasound. Those are utilized to train cardiac anesthesiologists in transesophageal echocardiogram, a specific cardiac ultrasound technique. They have also created patient-specific lumbar and thoracic spine phantoms to train anesthesiologists and others in the proper procedures for ultrasound- guided epidural procedures so that when that medical student or surgeon is sticking a needle into somebody's back for the first time, they have actually practised on this kind of phantom. Interestingly enough, the phantoms that have been produced in this training mechanism come from specific patient data. They are not standardized models; they are models based on specific patient anatomy.
The main purpose of the research of the APIL and their educational work is to resolve issues associated with preventable medical error which is, according to some authors, the third leading cause of fatalities, at least in the United States, by providing new opportunities for hands-on and skill-based training. APIL emerged from some of the research in my lab in partnership with others at Toronto General and the Faculty of Medicine.
Another example of custom 3-D printing is Nia Technologies, which again emerged out of a research project in partnership with others. It is a non-profit start-up that provides software and hardware tool chains for the production of prosthetics and orthotics in low- to middle-income countries. In this context, 3-D printing basically accelerates the process by which trained practitioners can produce devices.
Some of those devices are here. I will give you a sense of what they look like. They include transtibial prosthetic sockets. These are custom sockets based on 3-D scanning a patient, moving it into software that we have written, converting that into a model and then printing it on a low-cost 3-D printer. The key aspect of this work is that using the traditional methods for this production, a socket takes about one week to make. Using the 3-D printed tool chain, it takes less than one day. We are currently 3-D printing sockets and ankle foot orthoses — and I'm happy to hand them around if you want to take a look at them — in three different countries, at four different clinics, as part of the largest-ever clinical trial of 3-D printed prosthetics in the world.
The results of this are quite positive. The results of that trial will come out in about another month. It appears that 3-D printing provides a five times acceleration of the speed of prosthetic development and produces objects that are equivalent in strength and quality to traditionally produced objects. I have a whole list of people who I would thank in relationship to that, but I don't think I quite have enough time.
I want to add two more things. First, I have a set of implications here that basically say these forms of 3-D printing are ready to dramatically change patient-specific care in the health care environment. I have some recommendations around the use of lower-cost printers because of the ways in which they operate more successfully in both the low- resource clinical settings. Even the high-resource clinical settings such as Toronto General, you can have 10 printers for the price of one and operate a simultaneous printing operation which is, at least at APIL, much more successful than having one more expensive printer.
The main thing I want to highlight is the integration of these technologies — not their technical development but their integration — suffers because of the ways in which we tend to compartmentalize the types of knowledge that is necessary for really moving these into clinical and medical infrastructure. Between the medical knowledge, the technical knowledge and the social knowledge, which is really required to figure out how to fit these technologies into organizational and economic contexts, we suffer because we have a lack of integration across that. My recommendation is that we focus more on some multidisciplinary skill sets to really take these technologies and deploy them more widely.
The Chair: Thank you. I will now turn to Dr. Konrad Walus, Associate Professor, Electrical and Computer Engineering, University of British Columbia. Please proceed.
Konrad Walus, Associate Professor, Electrical and Computer Engineering, University of British Columbia, as an individual: Thank you, honourable senators and members of the committee. I feel deeply privileged to have this opportunity to share with you my perspective on 3-D printing in health care.
As you mentioned, I'm an associate professor at the University of British Columbia in the Department of Electrical and Computer Engineering. I'm also Chief Technology Officer at Aspect Biosystems, a company that started in part from the research we are doing in our lab at UBC. Over the last 15 years, I have been involved in research in a number of important areas, including computational nanotechnology, microsystems, 3-D printing and 3-D bioprinting. All of these are coming together in the work that we're doing.
As already has been mentioned, 3-D printing is a technology that is capable of recreating 3-D objects layer by layer. You can use a number of different materials: plastics, ceramics, metals and now even living cells. 3-D printing was invented in 1980 by Charles Hall and presently is a multibillion dollar market. You can find 3-D printers in grade school classrooms now and in individual homes. You may even hear stories of 3-D printers actually printing homes these days, so it's proliferating very quickly.
I began a research on 3-D printing technology at UBC 10 years ago. With the support of the Natural Science and Research Council, we invented and developed a new kind of 3-D bio-printer system that offers greater capabilities to recreate 3-D printed tissue. We call that "lab-on-a-printer technology.''
In 2013, I co-founded Aspect Biosystems with two of my graduate students who developed the printing technology, Tamer Mohamed and Simon Beyer, and our collaborator at UBC Centre for Heart-Lung Innovation, Dr. Sam Wadsworth. The company is a great example of an interdisciplinary team. We have cell biologists working mechanical, software and electrical engineers to realize our ambitious goal. We're developing the bioprinting systems and tissue technology needed to address challenges in drug development and regenerative medicine. Our company has received international attention for our work and was just recently mentioned in The Economist as one of the leaders in the space.
I see two distinct areas where 3-D printing can impact health care. You have heard about that now. First, pretty much anyone with a desktop 3-D printer is able to print plastic or other kinds of material prosthetics, even at home, so they don't even have to buy that anymore.
In a different example, doctors are using 3-D models of organs prior to surgery to plan and review medical procedures with patients, and I think in this way, the impact of 3-D printing is already being felt today. In fact, developments in these areas are coming out so quickly it's really hard to keep up.
Second, a different and very powerful approach to 3-D printing is that of 3-D bioprinting. The inks that are patterned by the 3-D printer contain biomaterials and living cells, again deposited layer by layer to reconstruct the basic structure of a tissue. This is not the final step, as these 3-D printed constructs must be incubated and provided with the appropriate chemical and physical stimulus to develop into their final structure and function. Rather than simply modelling the structure of a tissue in plastic, for example, these printers are able to generate living tissue, and these tissues have very important applications in research and medicine.
One major application is actually improving a drug development process. It is a process that presently takes more than 10 years, in some cases, 15 years, and well over a billion dollars per drug. Using 3-D bioprinting, we can print and culture human tissue in a way that expresses a particular disease and then dose those tissues with candidate compounds and monitor their response. 3-D bioprinted models enable a more natural human response to the drug to be monitored and investigated earlier in the development process and hopefully reduce the present critical need that we have for animal studies. This application has enormous need, as presently 90 per cent of investigational new drugs do not make it to the pharmacy due to failures in safety and efficacy. In some cases, that's after they have been found to have been both efficacious and safe in the animal model.
Using 3-D bioprinting technology, our team at Aspect has developed a model containing 3-D printed smooth muscle cells that make up the human airway for testing and studying drug candidates against diseases such as asthma. We are able to manufacture those tissues rapidly and at sufficient scale to do parallel testing. Our company is presently working with pharmaceutical companies to advance the model and test drug candidate compounds.
Another important application of 3-D bioprinting is in medicine, directly through 3-D bioprinting of replacement human tissue, so this would be an application of 3-D printing and regenerative medicine. It's actually the dream of the community to one day have the means to create entire human organs using patient's own cells. Clearly this outcome would have a profound impact on medicine by reducing or eliminating the need for organ donors and the many challenges with organ rejection.
However, realizing this bold vision demands contributions from across Canada and globally. I think our company and our lab are taking a very collaborative approach to this problem. In this regard, our start-up company is working with global medical leaders, DePuy Synthes and Johnson & Johnson, to develop 3-D bioprinting technology to address the medical need for replacement knee meniscus. We are establishing collaborations with universities across Canada to tackle this challenge.
In closing, I believe that Canadian researchers and companies are presently positioned to have a leading and major role in this area. I do suggest we take continued and increased effort to build on Canadian successes by supporting research and industry clusters, working in those areas and further supporting and developing highly qualified engineering and science talent in Canada.
I would like to acknowledge that Canada is already doing a lot, and part of my message is to evidence the positive role these programs and organizations are having. At Aspect, we have benefitted from the Industrial Research Assistance Program, or IRAP, through direct funding of R&D activities in support of the IRAP industrial technology advisers, who have been absolutely outstanding. Our company is collaborating with university researchers, and those partnerships are benefitting from the NSERC programs, specifically their partnership grants.
I also want to acknowledge essential research support provided by CMC Microsystems, an organization that is helping numerous Canadian researchers get access to design and prototyping capacity, a necessary capability for taking our ideas from the lab and into Canadian start-ups.
With that, I thank you for this opportunity, and I look forward to your questions.
The Chair: Thank you. I will now turn Dr. Julielynn Wong, Founder, Chairman and Chief Executive Officer, 3D4MD.
[Translation]
Dr. Julielynn Wong, Founder, Chairman and Chief Executive Officer, 3D4MD: Good afternoon, Mr. Chair and distinguished senators.
[English]
I'm a Queen's University- and Harvard-educated public health and aerospace medicine physician who founded 3D4MD, an organization that makes low-cost 3-D printing and drone technology solutions to save lives, time and money.
3D4MD has demonstrated 3-D printing technologies in two analogue space missions and one International Space Station mission. We have published our outcomes in peer-reviewed medical journals, filed 14 pending patents and partnered with over 30 organizations. We have received a number of awards and grants, including the Canadian Medical Association's inaugural Joule Innovation grant.
3-D printing is an affordable, portable, patient-centred, cost-saving, labour-saving and environmentally friendly technology for health care. Our work has identified the following useful health care applications of 3-D printing: unforeseen objects needed to prevent or treat a medical condition in a remote setting; custom-made expensive or difficult-to-obtain specialized medical items; medical models for education; and pre-surgical planning for uncommon, complex high-stakes operations.
In December 2014, I used solar energy to power my 3-D printer to make the first medical supplies, including custom mallet finger splints, on site at the remote Mars Desert Research Station. In January 2015, I brought my 3-D printer in a carry-on suitcase and printed the first custom mallet splint on site for a patient at Sunnybrook Health Sciences Centre in Toronto.
3-D printing custom mallet splints lowers costs and offers greater convenience for patients. The material cost of 3-D printing this mallet splint is less than half the material cost for a handmade splint. If a clinic has two 3-D printers, they can be operated simultaneously to print two identical custom splints if the patient desires an alternate splint for hygienic reasons. In the rare event that a splint breaks, a 3-D printer can manufacture an identical replacement. We also 3-D printed that same splint out of material containing 25 per cent recycled plastic drink bottles.
Statistics show that nearly 4 million Canadians have a disability. Many people with disabilities can't get assistive devices that allow them to participate fully in everyday life. We make award-winning 3-D printable assistive devices that can be made on community-based 3-D printers in out-patient clinics, libraries, schools, maker spaces, print shops and people's homes. And this saves time and money for people with disabilities.
Last summer, we signed a contract to set up the nation's first 3-D printing service in an assisted living facility to make lower-cost and personalized assistive devices on demand for 1,000 seniors living at Mon Sheong Court in Markham. This is an award-winning design created by a Canadian-Chinese female high school student of a 3-D printable writing aid that fits any pen or pencil and is five times cheaper than a pen with proprietary refill cartridges that is sold to patients with limited grasp.
To cite another example, almost 2.4 million Canadians have diabetes. We designed a $1, 3-D printable handle that attaches to an insulin syringe. This device could allow diabetic patients with limited use of their hands to continue self- injections and avoid having a home care nurse visit their home twice a day.
We also helped a veterinarian who wanted 3-D printed bone models to teach residents and to plan a complex surgery to repair the legs of a rescue dog.
We've learned that it's possible to upload an imaging scan to a privacy-compliant website and have 3-D printed surgical models or guides shipped to you in less than one week by an ISO-certified company.
A recent report authored by Stanford radiologists concluded that outsourcing the 3-D printing of medical models saves money because in-house 3-D printing adds overhead and staffing costs to hospitals.
We recommend the Canadian government prioritize resources for 3-D printing based on a simple four-step framework.
Step one: How many people does the solution impact? The more the better.
Step two: Can the solution be crowdsourced and can the solution be created using free software? Crowdsourcing and freeware can substantially reduce research and development time and costs.
Step three: What is the evidence to show that the solution saves more lives, time or money compared to existing alternatives?
Step four: Can the 3-D printing of the solution be outsourced outside of hospitals to community facilities? Outsourcing will save time and money for our health care system, widen accessibility to maximize benefit to Canadians, support the local economy and promote community engagement with public institutions.
We are working to get Health Canada approval of the 50 devices in our rapidly expanding digital catalogue. We need government support to provide expedited regulatory review so Canadians today can benefit from access to lower cost, time-saving and personalized 3-D printable medical supplies. Our goal is to ensure the safe, ethical and appropriate use of 3-D printing in health care.
We request your funding support to build and grow our 3D4ME Exchange. This is 3D4MD's privacy-protected global platform, where patients, caregivers and health care providers can post requests for 3-D printed medical designs, connect to obtain proper clinical supervision and report long-term clinical outcomes, adverse events and cost benefit data for research publications and policy planning.
With 3-D printing, anybody can be an innovator, because if you have an idea you can draw it digitally using free software and make it physically real by clicking "print.'' Last fall I founded Medical Makers, a growing global network of medical innovators with chapters across 10 Canadian cities. One of our Medical Makers is a high school student, and she used free software to make a 3-D printable sensory evaluation tool that's shaped like a ninja star and is over 10 times cheaper than the gold standard device. Plus the case is 3-D printed and we can personalize it with your name.
With our digital library, we are building a legacy to benefit humanity. This year, we are launching Medical Make-A- Thons worldwide, to add 150 new 3-D printable designs to our digital catalogue to celebrate Canada's a one hundred and fiftieth birthday. We ask you to sponsor Medical Make-A-Thons at home and abroad to promote universal and accessible health care globally, to advance our federal government's disability agenda worldwide and to use grassroots innovation projects to teach Canadian students cutting-edge STEM skills — that is, skills in science, technology, engineering and math — for future jobs in this digital age.
Innovation happens at the interface of different disciplines, so 3-D printing belongs to all of us: students, patients, caregivers and health care providers. Together we can make solutions to save lives, time and money.
Thank you.
The Chair: Thank you. We will now turn to questions from senators.
Senator Stewart Olsen: Thank you for being here. This is fascinating.
My first question is about how you are integrating the developments with medical schools and teaching facilities. The technology is expanding so rapidly, and I would prefer, if I had to have a knee replacement, an orthopod who has knowledge in these areas. How is that happening throughout the country?
Mr. Ratto: That's one of the reasons for APIL, this research and education group at Toronto General. I have provided some basic research for it, but it is being operated by cardiac anesthesiologists and medical staff who actually teach students. As part of their goal, they are interfacing directly with medical schools, particularly the University of Toronto Medical School but others as well, to provide curriculum that teaches people appropriate ways to engage with these technologies.
That is the biggest issue, which is how do we get it out of the labs and the engineering contexts, and to some degree I would say also out of the homes and the libraries, and into the context where the professionals are actually acting. That seems to me to be a key point for this work to be addressed. We need the orthopod using it and not just the high school student.
Senator Stewart Olsen: Thank you. Mr. Walus, on the production of living cells, are you finding that other companies, not just health care but industry, are using the living cells that are more like humans than animals to replace their animal testing?
Mr. Walus: Currently, industry uses human cells as part of their drug development process, as part of pre-clinical drug development, but they use those in a 2-D format. They will do the culture in a multi-well plate, a plate that contains many different wells in which you can culture cells, and they put their drug in there and look at what happens.
What we found is that those models do not necessarily accurately represent the human response because cells cultured in 3-D will express different proteins and genes and reform their native phenotype more accurately. 3-D tissue models also use human cells, but those human cells are behaving as they would in human tissue, not this maybe more artificial response that you get in a 2-D environment. What we are doing with our technology is creating novel tissues that can be used to test drugs that you couldn't otherwise test on these 2-D models.
You also asked about the animal studies. Animal studies right now are absolutely critical in the drug development process because they provide a system-level response. I can make you a 3-D tissue of your airway and you can see how the airway responds to that particular drug or that model, but it doesn't give you an entire-system-level response. That particular test will be hard to do away with. But we can do more of the tests on these human-relevant 3-D models and do fewer tests ultimately just to validate safety, for example, in animal studies. I do hope that in the future we'll see a reduction. We're not quite there yet.
Senator Stewart Olsen: Thank you very much.
Senator Seidman: If we ever thought about using the often overused word "awesome,'' we might use that word right now because that was truly an awesome presentation on all your parts and it takes some doing to get our heads around it.
If I might, Mr. Ratto, I'd like to ask you more about some language that you used, which is rather intriguing. You talked a lot about deeper attention to the social context of production, and you talked about emerging technologies and social change and the multi-disciplinary aspect of this work. Your work has been described as crossing both the boundaries between the digital and physical world and the divide between the humanities and the engineering disciplines. Could you help us understand the challenges that might be associated with this kind of work, and also what ethical considerations there might be and how you would manage to deal with that?
Mr. Ratto: The ethics of this work is something extreme, particularly when you get into the world of human analogues and those kinds of things.
I will try to answer your question about the intersection and the need for social knowledge by telling a short story. When we first started working on the 3-D-printed prosthetics project, it was specifically focused on a clinic in Uganda called CoRSU at the south side of Kampala. Our initial model was to basically send 3-D scanners and printers to CoRSU, have the staff there scan patients' legs, send the model back to us here in Canada, have prosthetists and orthotists work with us in the lab to take the scans of these patients' residual limbs, convert them into sockets and send the model back to Uganda for printing.
As soon as we started thinking more about that from a more humanistic perspective, we realized that was an incredibly bad idea. From a technical point of view, it was an instrumentally rational way to proceed; it was the easiest way to carry out and deliver services. But it actually drained expertise out of that context. If I can be even a little bit bold here, another way of talking about that project in that way would have been to say that we would have had the Black people do the manual labour and the White people carry out the intellectual labour. That's the way we were configuring, potentially, a socio-technical system for developing 3-D printing.
We said we don't want to do that. We want to create a system that enhances and builds the capacity of the practitioners out in those contexts, even if, technically, it's a harder process to engage in. That idea of starting from a value- and human-based perspective and using it to inform our technological development is one way to know about the ethical issues that emerge when we go in and try to transform these contexts of expertise in medical treatment.
Senator Seidman: Dr. Wong and Mr. Walus, you might respond to that same question.
Dr. Wong: Could you repeat the question?
Senator Seidman: Let's specifically focus on the ethical issues from your context, because they must be rather great since you're crossing many divides here. How do you deal with that? Are there protocols, for example, and how do you protect around the ethics and the ethical considerations?
Dr. Wong: Having a 3-D printer is like having a 3-D photocopier. There have been ethical concerns raised about the 3-D printer taking over the job of a highly skilled health care worker like a hand therapist. If it can make a 3-D-printed custom mallet finger splint, it is essentially a robotic hand therapist. We are automating somebody's job.
My answer to that is that it's not the case. With hand therapists, there are a very small number of them, both nationally and globally. There will always be a shortage of that type of highly skilled workforce. 3-D printing is actually not replacing them by any means, because we'll never be able to train enough of them to meet the demand. It is, in fact, augmenting their work.
For example, you could have a Canadian patient living in a remote community who injures themselves and requires a custom-fitted splint for a mallet finger injury, because we know through research that's the best way to treat such injuries. As it stands right now, if that patient cannot find a local hand therapist, and they are not equally geographically distributed, nationally and worldwide, then that patient will have to research, take time and find somebody who can make these splints — not all of them do. Then they have to set up an appointment, wait for that appointment, travel to see that person, pay out-of-pocket for those expenses and then have to pay that skilled worker for their labour and material costs.
With 3-D printing, we've actually made it a lot more convenient and lower-cost to the patient. If there is no hand therapist in a remote setting, why not go to a local clinic, have your local health care staff there take a couple pictures of your hand and use free software to make a custom-fitted splint for you. It can be made there on site, but you will need the clinical supervision of a hand therapist. We have a wonderful telemedicine network here, so you could actually be evaluated and monitored remotely.
3-D printing is not, through automation, going to take away jobs. It's going to extend the reach of a highly skilled workforce, of which there is a global shortage.
The Chair: Mr. Walus, do you have a quick comment?
Mr. Walus: Yes. From our perspective, while the 3-D bioprinting technology is new, the ethical considerations and ethical protocols for dealing with human cells and using those in drug tests and whatnot are already well established, so I don't think we're actually breaking any new ground in that regard. But we are certainly breaking new technical ground.
[Translation]
Senator Mégie: My question is for Professor Walus. You spoke about the development of medication using the 3-D process. I'm having trouble understanding how all of that works. I understand how it could be done for the actual pill casing, but how can you do studies on the effectiveness and safety of the medication?
To my mind, the 3-D process could be used to make the casing or the powder that goes into it, but how do you evaluate the effect on the organism of the person who takes it? Can you assess that with 3-D?
[English]
Mr. Walus: I didn't hear the beginning, but I think I got the entire question. I think you're referring to the idea of using a 3-D printer to actually make a pill. Interestingly enough, that's something that people are investigating, and there are companies trying to make 3-D printers for pills.
Our 3-D printers do not make the drug and do not structure the drug. What we are doing is taking human cells and suspending them in a biomaterial. These living human cells and this biomaterial make the ink of the printer. That ink is patterned in three dimensions in a similar way that you see with these objects here, except we're working right now in much smaller scale. Those cells make up this 3-D-printed structure, ultimately.
At the end of the process, we have a living 3-D-printed object. It literally contains human cells. We then take that object and put it into an incubator. That provides the appropriate environmental conditions for those cells to start reforming a tissue. Originally, they are just there on their own, but they don't like to be just there on their own; they will connect up with their neighbours and then reconstitute the structure of a human tissue.
Then we take the compound, the drug of interest that you're looking to test, and we dose that tissue with that drug. Then we put it back in the incubator, and we can watch what happens to that tissue under the effect of that drug. Ideally, we want to see the disease be pulled back or the disease response to be reduced.
So we're using our tissues as living models on which to do drug testing. We're not actually making the drugs with our printers.
[Translation]
Senator Mégie: I still don't understand. To my mind, these are high-wire acrobatics, because a living tissue is a tissue; I cut a tissue, I do a test, but the disease as such involves everything. When you test medication, it goes into one's system, it goes into the heart, the lungs, the kidneys, everything; do you have to get a sample from each organ to test the product? You do tests on the product to see if it will harm the tissue, or manage the disease. I'm having trouble understanding, but I may get there. In a few years, we will surely be able to do that. Thank you for your answer.
[English]
Mr. Walus: I actually think that you had it almost right on in the last statement you said.
Senator Meredith: Thank you all for your phenomenal presentations. As my colleague Senator Seidman said, this is awesome stuff. I was making a joke about passing a foot; usually you lend a hand, you pass a foot. It's just great to see the innovation that is in Canada and the fact that government has supported this through our research council and with the IRAP.
One of the concerns I have is around security. I sit on the security committee. Dr. Wong, you talked about carrying a 3-D printer in your suitcase. Do you have any concerns about the security of 3-D printing? Could all three of you comment on that for me with respect to this technology being taken in the wrong direction? I don't want to elaborate, but have you given consideration to that?
Dr. Wong: Having a 3-D printer, as I said before, is like having a 3-D photocopier. There is incredible flexibility with this technology. I believe that 3-D printing, like most technologies, is neither good nor bad. It all depends on the user. You can take my 3-D printer and you can use it to make a lower-cost life-saving medical device, or you can take that same printer and use it to make a gun.
But it is within us, and so I think with 3-D printing, you have to recognize it's kind of like the Internet. It is there, it exists and it's available and accessible to all of us. I think the focus should be not necessarily on what the potential negative applications are, but, in fact, what we can do as a society to encourage people to make moral choices when it comes to using technology, how we can foster that and how we can provide the environment such that people can make positive ethical choices not just for 3-D printing technology, but also for other technologies that are accessible to us as well, like drones.
The Chair: Dr. Ratto and Dr. Walus, do you have anything to add?
Mr. Ratto: A number of years ago, I 3-D printed a gun in my lab and appeared on a television program with Cody Wilson, who is the Texas law student at the time who produced that model of the Liberator handgun. We debated the question of 3-D printing and guns. As part of that work, one of the key aspects of it was yes, you could 3-D print a gun, but there were easier ways to get your hands on a gun, including, in fact, going to Home Depot, buying some springs and pieces of pipe — or going across the border.
I think Dr. Wong's statements are true: We have to learn how to make good ethical choices. The other point of it is that regulating 3-D printers in order to reduce the possibility of these negative outcomes doesn't in fact reduce those outcomes because of all the simpler venues that exist.
Senator Meredith: Thank you. We'll also look at the embracing of this technology. Is there anything that you can tell this committee with respect to what Canada, the government and Health Canada need to do with respect to truly embracing this?
We talked about the effectiveness, and doctor, I'm glad you talk about Uganda and our development program with respect to us assisting other countries from a medical standpoint. We have spent billions of dollars doing so.
What should our government be doing from that perspective in embracing and encouraging this technology as we look at it from an exportable sort of opportunity? I need your comments on that, please.
Mr. Ratto: I have to say that our work has been deeply funded by Grand Challenges Canada, and in some ways, one of the reasons why the work proceeded to look primarily at low- to middle-income countries as the site for its deployment was both because the problems of a lack of access to prosthetics is much greater in those contexts, but also because to some degree there is a greater appetite for innovative technologies.
That's not to say anything negative about developed world contexts or Canada specifically, but we have a lot of systems in place that have to be addressed when you're trying to innovate in these contexts. One thing we could do was really work to facilitate better ways to navigate the complexity of those systems.
I'll say for prosthetics that every province has a different way of funding and regulating them; Quebec does it differently than Ontario. For a company to operate, and again, we're a non-profit, but if we were trying to operate on a for-profit basis in deploying solutions across Canada, we would find it very difficult. In fact, it might be easier to try to deploy those solutions in the United States, where the market is both larger but also more condensed in a funny way.
I think there is a great appetite for innovation in Canada. There is a great appetite for innovation that follows from social and value-laden principles. I think we just have to build upon those capacities and extend not just in the direction of innovation, but also towards creating a Canada type of innovation, which I think is social as well as technical.
Mr. Walus: I'm not an expert in the regulatory part, but one thing I do notice is in the United States, the FDA is taking an active role in supporting the development of novel 3-D in vitro models for drug testing, and they are providing quite significant grant programs to do that. I think that will pay off quite a lot.
I also see that they are funding and supporting workshops to develop new policy on how to embrace this kind of technology as part of the drug development process. I haven't seen that yet in Canada, so I think there is room for us to get more engaged, because I think this will positively affect the lives of Canadians.
Senator Gold: Thank you, and welcome.
I remember first being exposed to 3-D printing in the 1990s as an investor in a company that was making medical devices, and in that case, dental ones. Subsequently, my son, bless his little heart, got involved with Blender, which is a freeware modelling program and 3-D printed some of his artistic directions. I'm delighted to see the continuing expansion in the medical area.
As a constitutional lawyer, I really empathize with your jurisdictional problems, province to province. C'est la vie.
I want to go back to your point about silos and the need to integrate the training of researchers, doctors, IT people and the like to best take advantage of this technology. We are focusing on the printing, which is kind of the end product, but behind it, of course, is the design, the modelling and the analysis of the needs, and so on and so forth.
I know there is a program at MIT — the name escapes me — that brings together multimedia and IT people and philosophers and puts together teams, and they do some really creative, multi-disciplinary work, for want of a better term.
If they exist, where are the centres in Canada — either university or research centres — that are really environments within which groups of diversely trained, competent people can come together and work on these kinds of matters, and therefore contribute, whether in the medical schools, the engineering schools and the social services demands? Are we well-equipped as a country to produce the next generation of multidisciplinary, multi-competent researchers?
Dr. Wong: My answer is that that is happening today. That's why I created Medical Makers. We are a growing global network of innovators, health care providers and patients working together to build solutions to save lives, time and money.
At Medical Makers, we believe that anybody can be an innovator. We have Medical Makers who are high school students. You saw examples of their work that we passed around here. We have Medical Makers who are retirees, working professionals and university students, and what actually brings us together is our creativity and compassion and wanting to solve problems with social impact.
By the way, we do interface with universities. We're actually launching a medical make-a-thon at the University of Guelph this month. I have had a number of Guelph students come through and do amazing 3-D printing work.
So my answer to you is I want you to consider looking outside the traditional network of centres of excellence and outside of academia and understand, that with the accessibility of 3-D printing, that in fact, you can have this happening at a very grassroots level.
Medical Makers came about because people heard about the work I was doing. They said, "This is amazing. How do I get involved?'' I was getting pinged by people who had patients or health care providers who faced certain challenges. I was just bringing them all together. Now it's taken on a life of its own. We have so many projects going on. We're in 10 different countries.
We are happy to collaborate and partner with both industry and academia, but it's happening in people's homes. It's a virtual network. It doesn't have to be a physical one.
Mr. Ratto: I'll speak from a more formal side. Not to deny any of what Dr. Wong was saying, but from a more formal side, Canada has a number of really interesting programs that do cross between these divides. It has tons; I know a few.
There is a really interesting program at UBC called Engineers in Scrubs, which brings engineering and medicine together. There are equivalent programs in other universities. There is a bioengineering and biomaterials programs at the University of Toronto. The one thing about all those programs is they don't actually incorporate the humanistic and social science context that, in fact, is my home base. I'm a humanity scholar who somehow ended up in the world of technology. I study the social implications of technology and somehow I'm making it at the same time.
If I can say things about my own faculty in this context, which is the information faculty of U of T, we have faculty members from medicine, computer science, the humanities and the social sciences. We try to train our master's students in that regard.
The thing that all of these programs suffer from, to some degree, is the way in which Canada divides up its funding bodies, where you have CIHR, NSERC and SSHRC. Specifically, I have had issues with grants returned to me because CIHR thinks it's an engineering project, and SSHRC thinks it is something else. There are ways that those programs, like Engineers in Scrubs and others, can be better supported.
One thing I think is great is the NCE program, and I think you're having a great representative speaking with you tomorrow, Dr. Alex Mihailidis, talking about the AGE-WELL Network. AGE-WELL is a great example of the bringing together of all those disciplines.
I think the more we can create those opportunities, the better. More to that point, the more we can create educational programs as well, not just the granting and the research programs, but the pedagogy that moves between those types of work, the better off we will be.
The Chair: In addition, I wanted to mention we'll be having witnesses on March 29 who are likely to be able to cover some of these issues as well.
Senator Griffin: I'm sitting in for Senator Tony Dean. Senator Meredith asked my main question, but I do have a smaller one. We'll deal with him.
Are the existing regulations for medical devices appropriate for the assessment of your 3-D printed medical products? If not, what changes would you propose?
Dr. Wong: We're going through that process right now. Whether you manufacture on a 3-D printer or through another alternative manufacturing process, you want to have quality control. In some ways with 3-D printing, it's a lot easier because you have automated stuff. When I click "print,'' I would expect to have the same device manufactured in an identical way every time. My answer to you is we are discovering that right now as we go through applying to get regulatory clearance of the over 50 devices in our digital catalogue. I'm more than happy to follow up with you with a written brief and communications if I do identify the issues that you have requested.
Mr. Ratto: The only comment I have is that I was very glad to discover when we first started this work that these devices are not regulated. Custom prosthetics and orthotics are not regulated. The practitioner that produces them is regulated. As long as they are made by somebody who is licensed as a practitioner, they are basically covered off, except in Quebec, where it's another situation.
The interesting thing has more to do with how they are paid for than necessarily how they are regulated. In Ontario, ADP pays for these devices. One of the interesting things about ADP is that it will not pay for a centrally fabricated device. If you wanted to design this and send this to a service bureau to print, in other words not print in your office but somewhere else, ADP potentially wouldn't cover it. So regulation and payment are complex and, as you say, jurisdictionally different.
Senator Petitclerc: Thank you very much for this very exciting presentation. It's fascinating. My question will be for you, Mr. Ratto, because I'm fascinated by the prosthetics. I have a 30 year background of a Paralympic athlete, so I have seen the evolution of prosthetics. I have been part of international aid trips as well, and I have seen the challenges internationally with people needing prosthetics.
You have all touched on this a little bit, but I want to have a better idea on how democratic this is now and in the future, in Canada and abroad. When I see that, I'm thinking you're going to save the world, because it looks like everything is advantageous, from what I hear. It's cheaper, quicker and more precise. And we know this changes lives. I have memories of friends that had to go through one year of waiting and then if it's the wrong measurement by one millimetre, they have to go back on the list.
To me, this seems really good. Is it reaching the population right now? When do you expect it? Do you see it like as an international democratization of helping persons with disability?
Mr. Ratto: Our work at Nia is specifically focused on exactly that. It's serving and scaling this opportunity out to a broader context. It is democratic in the sense that it increases availability by increasing the ability of practitioners to produce devices. It's not democratic in making it possible for anyone to produce a good device.
You mentioned that this is more accurate. Not really. In fact, from my research, a prosthetic is good not because of how it was made, 3-D printed or a traditional plaster-based process, but based on the skill of the prosthetist. A good prosthetist makes a good prosthetic.
It's democratic in the sense that we can speed up, increase the capacity and in some cases deliver to remote context. It's not democratic in the sense that it takes away the need for the clinical practitioner. That is of great benefit to us, but it's also a point where we struggle because, of course, we have to retrain and re-skill, and we have to validate these technologies for a class of clinical practitioner who is used to working in a different way.
Much of our work is focused on providing the legitimate clinical evidence that, in a sense, proves the quality of these activities. We go to prosthetic conferences, and we're going to the International Society for Prosthetics and Orthotics' World Congress in Cape Town in May to present this. All we're presenting is, "They are as good as.'' That's as far as we are willing to go at this point.
But yes, I do think that in the end, prosthetics and orthotics is going in this direction. Getting it there will take not just the technical work, as I said before, but a lot of social, organizational, economic and legal activities as well.
Dr. Wong: Since 2015, 3D4MD has been working with Canadian high school and university students to make lower- cost prosthetic devices like this prosthetic hand. This one here, actually, which you're welcome to look at, it's based on an open-source design. It costs less than $25 to make. It is about 40 times cheaper than an off-the-shelf prosthetic of comparable functionality. And in fact, with 3-D printing, you can pick different colours. This patient's family wanted a colour prosthetic that matched her skin tone, which is what we did for her. And so, yes, so it's democratizing, as Matt pointed out, access to prosthetics on an unprecedented global scale.
However, I also want you to be aware that it is democratizing innovation in the prosthetics sector. One of our medical make-a-thon themes is making 3-D printable adaptive sports equipment for disabled athletes so they can participate fully in athletic competitions like their able-bodied counterparts. We see that as a huge, unaddressed need, particularly because this year, it would be timed with the Invictus Games. There is lots of democratization in terms of access and innovation in prosthetics.
Mr. Walus: Our technology is different because we're using living cells. In our case, it tends to be quite a bit more expensive to do, orders of magnitude more. It's not something that I foresee people doing in their own homes. But we are democratizing innovation, because these 3-D bioprinting systems, which are now appearing in university labs across the world, are able to reproduce a biological experiment that maybe we designed and sent the digital files over to that lab.
I see 3-D printing in general democratizing innovation. In the cases that were just described, I see that happening even at a user level. In our case, it's definitely happening at the research lab level.
Senator Raine: This is super interesting. Are you using this in orthotics? Because it seems to me there is a more efficient way, so for footbeds, so that's more of a cast, isn't it? What about for joint and cartilage replacement? Where are we at in those two fields?
Mr. Ratto: That's an orthotic. That's an ankle foot orthosis. What you're talking about is orthotic, which comes from a different class of medical practitioner, a pedorthist, which is a custom footbed that is produced. These are made for people suffering from not a disability, necessarily, but an inability to walk or some other problems. These are more clinical devices. Orthotics are generally more accessible devices. There are companies that are 3-D printing them, though none of them in Canada as of yet. But that is happening.
There are a number of companies that are 3-D imprinting orthopaedic implants. I mentioned one in my research notes, a lumbar cage, which is used for spinal fusion. In most cases, these are not necessarily patient-specific 3-D printed, but they are printed with certain types of surfaces on them that you couldn't fabricate in any other way. Those surfaces encourage the ingrowth of bone and fixation into the biology of the patient.
There are a number of products on the market right now that use additive manufacturing for orthopaedic implants — hips, knees, a lot of different stuff. They tend to be the more expensive ones.
Dr. Wong: There is a company based in San Francisco called UNYQ. They make 3-D printed scoliosis braces. Because a typical scoliosis patient is a female teenager, getting her to wear her brace 24 hours a day for months at a time can be very difficult. We know if these patients aren't compliant with their brace, they will probably require surgery, which is something we try to avoid.
They are able to take a scan of a scoliosis patient's torso, and if you look online, they make these beautiful scoliosis braces. The design of scoliosis braces really hasn't changed in decades. I hope they will obtain the data to show that with 3-D printing, you can do complex things. You can make things specific to a patient, but as well to their personal aesthetic tastes. They make these beautiful reticulated lacework-like scoliosis braces. You have never seen these before. They are phenomenal.
The hope is that by making something patient-centred that speaks to their personal aesthetic, that the patients will be more compliant and thereby avoid surgery. I am waiting for that data to come out, but it makes sense. Keep an eye out for that.
Mr. Walus: In our case, we can make the cartilage itself. Right now, we are working with Johnson & Johnson on a knee meniscus project. That's very exciting. There is a big need for that.
In the future, I can see tissue implants for plastic surgery — not plastic anymore; it's an actual tissue — and these are technically lower-hanging fruit than trying to print a functional organ like a kidney or a liver. I see those areas as being viable in the relatively short term.
The Chair: You mentioned the facility of all this and how easy and accessible it is, and you have implied "inexpensive'' relative to some traditional routes. Dr. Wong, you mentioned the cost of one particular printout, the hand that you just passed around.
In terms of the printer, we have got the individual at home who is going to need a relatively simple device like we're talking about being readily printed out. What is the cost of the printer and roughly what is the overall cost to the individual of a single item? I recognize we're at the beginning of this. Costs are going to go down rapidly. We have already seen dramatic changes in that regard. Give us a ballpark figure.
Dr. Wong: Desktop 3-D printers typically range from $300 to $3,000. Those printers print either a rigid or flexible plastic. That printer feedstock is typically pennies a gram. But the truth is that people don't need to purchase 3-D printers for their homes; if they choose to do so, that's fine. The reason is because they are in public libraries. If you want to use one, go to your public library.
The Chair: The scanning capability to do your own physical measurement so that it's integrated into the computer program?
Dr. Wong: Your smartphone is a 3-D scanner. You can download a free app that turns your smartphone into a 3-D scanner.
The Chair: We saw the one where you can look at your veins so you don't get all punched up by the person taking blood samples.
Mr. Ratto: In addition to regular phones being 3-D scanners, they are now making phones that contain 3-D scanners. This is one made by Lenovo, and if you look at this back cover, it contains a 3-D scanner. You can use this to capture depth information of the room around you or of components. We are trialing it now as a way to capture the topology of patients' residual limbs.
The Chair: Dr. Walus, you gave a very good description of your printing of cells to create cell colonies and for testing. In one of our previous presentations, we had an individual describing the state of the art with regard to whole organs. The difficulty in there is nutrient and communication flow among the cells embedded in the scaffold. Therefore, right at the moment, there is a relatively short lifetime for that. It's clearly work in progress.
You obviously don't have that problem in terms of your specific examples that you have given. Would you have comments on where you think this is going with regard to moving up from the cell colony into perhaps the capability of communication among cells in printed organs?
Mr. Walus: There are definitely major challenges left to make a whole organ; for example, a kidney. Right now, we are essentially making micro tissues or parts of organs. You correctly pointed out that providing nutrients for thick tissues is very challenging. In fact, if it's a thick cellular mass, there is no way that tissue will survive. The cells and the inner part of the tissue will just die.
One of the things the entire community is working on is vascularization. The research community is making major progress in that. People have shown examples of vascularized models, but it's still early on. Vascularization is a major challenge to making a whole organ model.
The Chair: In a recent issue of New Scientist, there was a description of a two-section unit of backbone that had been printed. Essentially, the backbone replacement acts as a scaffold for it. They had succeeded in printing a modified cellular structure on the surface that would allow a compatible juncture with a human interface, but it was an actual flexible backbone so it provided both the strength of backboned tissue and the flexibility of a normal backbone. I thought it was a remarkable combination of the two types of techniques you're talking about here.
Regarding your comments, Dr. Ratto, about jurisdictional blockages, it is well known that it is easier to do business around the world than it is across this country. We have free trade agreements that we brag about, yet we're not capable of trading with ourselves. There is something fundamentally wrong with this model, in many people's opinion.
You gave an example of the challenges of funding. When we hit radical changes in the direction of research capabilities, this occurs. However, the evidence seems to suggest that there are some outside of the traditional granting agencies' access to funding that provide that bridging. If history is an example, things like biotechnology arose with exactly the same kinds of issues; that is, the cross-disciplinary issues and dimension. Once there is the established knowledge, which there already is in Canada, we hope the granting agencies will break down their silo capabilities and move into the theory.
The issue of funding those who do research that has an impact in the health area has always been a problem in funding across the jurisdictions. A chemist develops something that has a medical application, yet they don't qualify in those various areas. We will have to deal with those things rapidly if we are going to remain competitive in this area. You've brought forward a number of important issues.
Senator Seidman: I would like to ask you a couple of questions about evidence. I think some of you used or talked about the concept of evidence. Dr. Ratto, I want to ask you about APIL. You said the main purpose is to resolve issues associated with preventable medical error. Of course, as you said, it is a huge issue, the third leading cause of fatalities in the U.S. Is there work done to demonstrate that APIL, for example, has indeed helped reduce medical error?
Mr. Ratto: The efficacy of 3-D printing as an adjacent tool for training is being shown in a range of publications and academic contexts. Some of those papers that came out of the work of APIL are listed in the notes that I sent you, but that's not just the work of APIL. There are a range of folks working on these issues.
In some ways, the 3-D printing part does not matter as much as the use of things like surgical phantoms, which is a longer tradition, and the ways in which the standard model of medical training, which is see one, do one, teach one, is disrupted by increased access to phantoms. By "phantoms,'' I mean human analogues that can be used for carrying out analogue surgical procedures. Increasing the amount of time that medical students are able to spend on these analogues increases their skill and reduces error. There are obvious examples of that.
I think the research on whether or not getting the actual brain of the patient you're going to do neurosurgery on, doing that work and how that will benefit the procedure that you then carry out, is primarily anecdotal at this point. I don't know how many really durable studies have been done directly on that point. There are a number, but I think people are still working through that part.
Anecdotally, surgeons seem to love it. The corollary to that is patients love it because those same models that help the surgeon understand the surgery often help the surgeon translate that to the patient, so patient knowledge is increased as well.
Dr. Wong: One of the challenges for getting the evidence for the benefits of 3-D printed surgical models is that they are probably of greatest advantage for complex, high-stakes, uncommon cases, so it's very difficult to get a control for comparison and then to be able to say the operative times were shorter because we had a 3-D printed model. The Mayo Clinic started 3-D printing a number of years ago because they had a set of conjoined twins that they were going to separate. Those are not common cases, so it's hard to get a large enough powerful sample size to be able to definitively say this is a benefit.
The other thing is that even though 3-D printing a medical model may decrease operative times, there is still the time of that surgeon who had to prepare and use that model. These types of measurements, qualitative and quantitative, are very difficult to demonstrate a true time and cost savings of 3-D printed models.
[Translation]
Senator Mégie: I don't want to put a damper on things, don't worry; I know how important evolving technology is in the development of medicine. However, I would like to know — as the area you work in is very exciting — if on your team you have an expert on health economics to advise you on costs. Everyone knows, as reports show, that health care costs are rising exponentially. Here we are talking about a technology that is evolving and that will be costly, even if there will be advantages for patients in terms of individual costs. Do you have a health economics expert who can provide economic benchmarks and guidance as to how far you can go?
[English]
Dr. Wong: I'm going to refer back to the framework that I spoke about earlier that I suggest be adopted by our government. I want to reemphasize that when you use crowdsourcing and outsourcing for 3-D printing, the costs are very low. As we said before, if you choose to buy a 3-D printer — and you don't have to because they are in public libraries as well as schools and people's homes — it's not that expensive; it's under $3,000. We make a point of gathering the evidence to convince ourselves that our 3-D printed solution saves lives or time or money — more so compared to alternative solutions.
For example, later today, I'm going to show you a 3-D printed custom figure of eight splint that we made for a Toronto woman with cerebral palsy. Normally, she needs to wear these splints on her right hand for the rest of her life. They do break and they have to be replaced. From a time cost to the patient, she has to research, book an appointment, wait for an appointment, travel, take time off work and pay that hand therapist for their labour, time and material costs. There is time and cost for that patient; whereas we made her 3-D printed splints, and she can go to the public library, pick the colour she wants, print another splint for less than $2 and not have to miss work.
We are writing up these reports as case reports, because we understand these research publications will demonstrate the value of this technology to our patients, health care providers and the health care system.
Mr. Ratto: Based on the work at APIL, APIL has as part of their training resources a cardiac ultrasound phantom called the Blue Phantom, I believe, which costs around $40,000. They created their own version of the Blue Phantom using inexpensive 3-D printing technology, and that cost about $60. Obviously, these are not entirely comparable models, but there's an article here that looks at the resolution and quality of training provided by the Blue Phantom versus the one they produced themselves. The evidence demonstrates that they're fairly comparable, and there is a huge price difference.
Senator Meredith: You stole my question with respect to costs, Dr. Wong, but I'm delighted to see in your presentation that 3-D printing is an affordable, patient-centred, cost-saving, labour-saving, environmentally friendly technology for health care. In terms of engagement of young people around this technology, I'm delighted to see that with your Medical Makers, but my number one question is around funding and research, and the chair alluded to it. That's with respect to out-of-the-box thinking here around funding that's necessary to move you forward. Can you elaborate what that will take with respect to potential individuals, organizations or businesses lining up to support you and ensure this innovative technology goes out en masse?
Dr. Wong: That's a great question. I'm happy to follow up with a written submission that would explain these details more.
The Chair: That's a very wise idea, because that's a complex issue. If we can get a written statement, that would be extremely helpful.
The on-camera part of this meeting has been tremendously useful and helpful to us. Your explanations were excellent, and this was focused on 3-D printing. We can clearly see the stages that are examples of existing technology, and the imagination is unlimited in terms of where this potentially can go. In this kind of technology, we've already seen examples of youth who are taking products such as the vein identification from a $5,000 commercial product into a free app on your cell phone. The direction that much of this will move in is obviously almost unlimited. It's exciting to be here at a stage where things are really happening; it's not just pie-in-the-sky. The examples already are tremendously important to those who benefit from them, and the potential is enormous.
With that, I thank you on behalf of the committee. I'm going to adjourn the meeting, and we're immediately going to go to a private demonstration of 3-D printing.
(The committee adjourned.)