3D printing raises ethical issues in medicine › Analysis and Opinion (ABC Science)
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- Advantages of personalising medicine are most obvious in cases where the condition affects patients in very different ways and standardised treatments offer imperfect benefits.
- Until recently, the cost and time required to provide a series of customised prostheses of different sizes for a child who has lost a leg to cancer, for example, has been prohibitive for many patients.
- Researchers combining 3D printing with personalised stem cell therapies beyond the experimental stage will need to develop new models for testing their treatments for safety and effectiveness.
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Personalised medicine is most closely associated with research in genomics and stem cell therapies. Advantages of personalising medicine are most obvious in cases where the condition affects patients in very different ways and standardised treatments offer imperfect benefits. For example, conditions affecting the growing bones of children are among those where personalising treatments, if these can be adapted to the rapidly changing bodies of children, can make a very big difference in the child's comfort and capacity to participate in ordinary childhood activities and play. Until recently, the cost and time required to provide a series of customised prostheses of different sizes for a child who has lost a leg to cancer, for example, has been prohibitive for many patients. 3D printing will bring down the time and cost of customising and producing prosthetic legs. In cases like that of Ben Chandler, printers can also be used for implants, which might avoid the need to amputate the original limb, even where significant bone loss has occurred. The capacity to use 3D printing technology to substantially reduce the cost of prosthetics, or orthopaedic surgery to restore lost bone structures, means that this area of personalised medicine can avoid the criticism that personalised medicine inevitably increases the cost of health care and puts effective personalised treatments out of the reach of many patients. Will 3D printing treatments be safe? A second ethical concern about any new treatment, including the use of 3D printing, is how we can test that the treatment is safe and effective before it is offered as a clinical treatment. In the case of 3D printing to replace bone, the materials used — for example titanium — are those already used for orthopaedic surgery, and have been tested for safety over a long period and with many patients, so it is unlikely that there are new risks from the materials. In the future, 3D printing may be used in combination with stem cell derived cell lines. This could lead to the development of printed functioning organs that can replace a patient's damaged organ, but without the risk or rejection associated with donor organs, because it uses that patient's own cells. How can we know in advance that these treatments are safe? unlike the case of developing a new drug, a stem cell therapy can't be tested on a sizable number of healthy people prior to being tested on patients and then, finally, being made available as a standard treatment. The point of using a patient's own stem cells is to tailor the treatment quite specifically to that patient, and not to develop a treatment that can be tested on anybody else. Researchers combining 3D printing with personalised stem cell therapies beyond the experimental stage will need to develop new models for testing their treatments for safety and effectiveness. Regulatory bodies that give approval for new treatments, such as Australia's Therapeutic Goods Administration (TGA), will also need to establish new standards of testing for regulatory approval before these treatments can become readily available. This means that even if researchers were ready to print a functioning prosthetic organ, it will be quite some time before patients with kidney disease should expect to be offered a 3D printed prosthetic kidney that uses their stem cells as a routine treatment. Human enhancement The third issue is whether or not we should use 3D printing for human enhancement.
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