Treating Soldiers with Tech
Exploring the Department of Defense's bio-additive manufacturing gambit to address mounting soldier care shortcomings
What price would you pay to heal your brother of third-degree burns?
What price would you pay to gift your sister back a leg lost to amputation?
What price would you pay to provide a loved one with an organ needed to replace a failing one?
These are questions that I considered as I transferred off active duty after six years of service in the United States Army. Spending a moment myself at the Warrior Transition Unit out of Schofield Barracks, Hawaii, I was privileged to witness the bravery of fellow soldiers as they pushed through grievous injuries to return to their families and lives. I have wondered if there was not more we could be doing for them.
The Department of Defense (DoD) has posited that we can, in fact, do more. In 2016, the DoD organized $284 million in funding to establish the Advanced Tissue Biofabrication (ATB) Manufacturing USA Institute in Manchester, New Hampshire. One of the primary purposes of this investment is to develop 3D ‘bio-printing’ technology to improve patient outcomes at military hospitals. [1]
The DoD is no stranger to Additive Manufacturing (AM). In recent years, the Army and Navy have used 3D printing to reduce inventory costs, optimize supply chain operations, and speed combat preparedness by creating functioning weapons systems in contested regions and spare parts for ships at sea. [2] However, its recent founding of the ATB signals the DoD’s belief in the potential for Additive Bio-Manufacturing (Bio-AM) to advance processes currently used to treat critically-wounded soldiers.
The need for process improvement in treating soldiers with debilitating injuries, and therefore the importance of Bio-AM in facilitating that improvement, is clear: since its inception in 2007, the Warrior Care and Transition Program (WCTP) has supported over 72,000 seriously-injured soldiers and is currently rehabilitating approximately 2,100 soldiers across 14 Warrior Transition Units. Of these soldiers, only 43% were able to return to the force. [3] For those soldiers who incurred injuries serious enough to prompt an early termination of service, a staggering 52% rated both their continuing medical care as inadequate. [4]
In an effort to treat the growing number of soldiers in these categories, the DoD is allocating more resources towards the expansion of the WCTP program in the short-term, and pursuing promising technological advancements that can address gaps in soldier care plans in the mid-term. The founding of the ATB is emblematic of the mid-term strategy. By awarding this new public-private Manufacturing USA Institute to the Advanced Regenerative Manufacturing Institute, the DoD has carefully curated a conglomerate of 47 industrial and 26 academic partners, and provided them the resources, and the vehicle to employ those resources, towards innovating medical solutions within the Bio-AM space. [5]
Because the DoD’s Bio-AM initiative is still young, we have yet to see a true integration of 3D bio-printing technology into government treatment facilities. That is not to say that Bio-AM field at large is not producing substantial innovations. Promising companies such as Organovo and 3D Bioprinting Solutions have been able to “use extruder needles or inkjet-like printer heads to lay down successive rows of living cells” to fabricate liver, kidney, and thyroid gland tissue for use in drug discovery and laboratory testing. [6] [7] [8] Other companies, such as Rokit, are developing in-situ 3D Bioprinters to produce human skin for patients afflicted with dermatological diseases and severe burns, while others still, like Cyfuse Biomedical, are using fine needle arrays to print cellular structures that can be arranged to form biological components such as tubular tissues, cartilage, digestive and urinary organs, and blood vessels. [9] [10] [11]
To amplify the progress and results of its organic Bio-AM consortium, I would recommend expanding industry partnerships. While the ATB is formed of some of the largest companies (Abbott, Becton Dickinson, United Therapeutics) and most prestigious academic institutions (Harvard, MIT, Cedars-Sinai Medical Center), much of the recent cutting-edge research is coming from the more agile players in the Bio-AM space, as previously illustrated. For the DoD to bring meaningful and timely process improvement to the care of soldiers with injuries addressable by 3D Bioprinting technology, it must be ever vigilante for brilliant new innovators and do whatever it can to foster their research and bring them into the fold of the ATB.
The first question I have for you is reminiscent of those I would ask myself during my time at the WTU in Hawaii: what price would you, and by extension should the DoD, pay to provide care to those who have served our country? The second question I have has implications for the DoD and beyond: given that this technology could foreseeably produce entire living organs and perhaps more in the future, should the DoD, or anyone else, pay any price to acquire it?
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[1] “DOD Announces Award of New Advanced Tissue Biofabrication Manufacturing Innovation Hub in Manchester, New Hampshire.” States News Service, December 21, 2016. Accessed November 13, 2018. http://www.highbeam.com/doc/1G1-474742417.html?refid=easy_hf.
[2] “3D Printing in the Defense Industry.” Accessed November 13, 2018. http://www.javelin-tech.com/3d-printer/industry/defense/.
[3] “WTB Fact Sheet – Wct.army.mil.” Accessed November 13, 2018. http://www.wct.army.mil/documents/factsheets/WTU_Fact_Sheet.pdf.
[4] Morin, Rich. “For Many Injured Veterans, A Lifetime of Consequences.” Pew Research Center’s Social & Demographic Trends Project. April 11, 2014. Accessed November 13, 2018. http://www.pewsocialtrends.org/2011/11/08/for-many-injured-veterans-a-lifetime-of-consequences/.
[5] As [1].
[6] Faulkner-Jones, Alan, Catherine Fyfe, Dirk-Jan Cornelissen, John Gardner, Jason King, Aidan Courtney, and Wenmiao Shu. “Bioprinting of Human Pluripotent Stem Cells and Their Directed Differentiation into Hepatocyte-like Cells for the Generation of Mini-livers in 3D.” Biofabrication7, no. 4 (2015): 044102. doi:10.1088/1758-5090/7/4/044102.
[7] Kolesky, David B., Ryan L. Truby, A. Sydney Gladman, Travis A. Busbee, Kimberly A. Homan, and Jennifer A. Lewis. “Bioprinting: 3D Bioprinting of Vascularized, Heterogeneous Cell-Laden Tissue Constructs (Adv. Mater. 19/2014).” Advanced Materials26, no. 19 (2014): 2966. doi:10.1002/adma.201470124.
[8] “11 Companies Leading the 3D Bioprinting Space.” 3DPrint.com | The Voice of 3D Printing / Additive Manufacturing. August 13, 2015. Accessed November 13, 2018. https://3dprint.com/88792/3d-bioprinting-companies/.
[9] As [8].
[10] Levato, Riccardo, Jetze Visser, Josep A. Planell, Elisabeth Engel, Jos Malda, and Miguel A. Mateos-Timoneda. “Biofabrication of Tissue Constructs by 3D Bioprinting of Cell-laden Microcarriers.” Biofabrication6, no. 3 (2014): 035020. doi:10.1088/1758-5082/6/3/035020.
[11] Murphy, Sean V., and Anthony Atala. “3D Bioprinting of Tissues and Organs.” Nature Biotechnology32, no. 8 (2014): 773-85. doi:10.1038/nbt.2958.
Great piece but I’m not sure if DOD acquisition is always a positive goal. First off, very few companies are “acquired” by the DOD, but rather it is their technologies that are purchased or sold to the DOD. Second, even if the DOD could create this capability internally, do you think it is best to do so? Having a dual purpose company for the civilian and military sectors maintains the agility of private markets while still addressing mission critical DOD needs.
Really interesting article. I would look at this from the perspective of the DoD underwriting the advances in technology on behalf of society. This is, I think, a fairly well established path towards innovation. From rocketry, to processed foods to the internet the broader economy has benefited from substantial defense spending. It seems to me that the taxpayer should be happy to underwrite the technologies discussed here for both the ethical reasons you discussed and the attendant economic benefits.
This is a tangible example of additive manufacturing affecting others’ lives in a very personal way by creating new limbs, organs, etc. I am curious as to how long it will take to produce functioning organs via 3D printing, as it still seems a long way off. In my opinion, the DoD should definitely provide care for those who have been injured serving our country because the U.S. as we know it would not exist without them. The answer to how much the DoD, and therefore taxpayers, should invest in this technology lies in its proven effectiveness and the speed of innovation. If there isn’t meaningful progress in this field after substantial amounts have been invested, the DoD should direct taxpayer dollars to other forms of care for wounded soldiers.
I think this is an amazing investment by the DoD not only to take care of the wounded members but also to help drive the medical technology forward. By being able to 3D print organs many service members lives will be saved not only in garrison, but hopefully, in the far future, in remote field hospitals where access to a larger hospital is not possible. My only hesitation with the new technology would be the willingness of the service member to adopt the new technology and be willing to accept a 3D printed organ. History has proved, time and time again, that the DoD tests multiple drugs with service members placing them in many times in harms way, thus many service members might be hesitant to accept this new technology as they might see it as another gimmick by the DoD to test new technology that might back fire on them in the near future.
I’ll take Desmond Wolfe’s point a step further. The DOD has historically played a big role in investing in emerging technologies in a way that other organizations have not been able to with the result being incredible learning externalities for the rest of the world. One could argue that the DOD has an obligation to invest in these technologies that have a direct military benefit primarily to unlock those externalities for the broader economy. Alex is right that the mechanism of this investment matters – grants/ loans/ investment/ tenders generally makes more sense than acquisition for this type of development in my mind.