Manufacturing a New Solution for an Old Problem

The past 20 years have been a time of exciting progress in the field of regenerative medicine. Yet examples of tissue engineering strategies that are currently used in the clinic are few.

A new era in tissue regeneration has started with the advent of 3D bioprinters. As Proto highlighted (“Printing a New You,” Fall 2014), the 3D printing of living organs will be revolutionary. Nevertheless, a great gap exists between what we have learned from single layers of cells cultured on petri dishes, and what we must learn about fabricating solid 3D organs.

While 3D printers may make it easier to mimic the 3D structure of living tissues, a far greater challenge is to understand and control the biological requirements that allow a group of cells to become functional organs. Bioprinters are certainly powerful tools, but the answers that will determine the future of bioprinted tissues are more likely to be uncovered in the longstanding foundations of biology and medicine than in engineering textbooks. Still, one will not progress without the other.

We may be a long way from 3D bioprinting entire organs, but when that happens, the future of health care will change. And that is an achievement well worth waiting for.

Luiz E. Bertassoni  // Assistant Professor, School of Dentistry, University of Sydney

Technology for the Now

Almost a half century after Keneth Bird found a way to examine patients via two-way television in Logan Airport’s Medical Clinic, telehealth has finally reached its tipping point. Yes, there continue to be challenges with reimbursement and licensing, but these are now forces fighting the momentum of a boulder rolling downhill. These countervailing forces should not be discounted, as they have held relatively strong for decades. But the mass of the boulder has grown larger and is now growing exponentially.

Telehealth is the right technology for the now.  Americans are demanding empowerment and convenience of their health care providers—in addition to high-quality, personalized care. With the widespread adoption of electronic health records and patient portals, providers and patients alike have progressively shown increased comfort and trust in the use of information technology for health. And the growth of accountable care organizations (ACOs), as well as high-deductible health insurance, support cost-efficient interventions—in spirit, if not in deed. 

Proto’s article “(Out of) Office Visit” (Fall 2014) details important and diverse telehealth case studies from which we all can learn. The authors also point to important areas in which we need to grow. First, we need more data-driven evidence, of the sort High Point Regional Health and Lee Memorial Health System have shared, to guide our practice for the safe and effective use of telehealth. Specifically, we need more trials comparing telehealth to traditional in-person care for both inpatient and ambulatory care in diverse patient populations—not just rural or disenfranchised populations. Second, technology companies and health care providers alike need to continue to improve reliability and usability, and to optimize our telehealth workflows and patient interactions. Robots versus carts—coming soon to a hospital or clinic near you.

Seth Bokser  // Associate Professor of Pediatrics and Clinical Informatics, University of California, San Francisco