My 3D Printing Adventure

by Bernard Golden on June 29, 2015

makerbot 3D Printer

You may have seen a demonstration of 3D printing — a head sweeping back and forth dribbling out liquified plastic and depositing it to build up an object, layer by layer. I have and found it fascinating. As a result, I’m extremely interested in 3D printing. It’s part of the burgeoning maker movement, which is allowing people to pursue creative passions; many do it for fun (e.g., a Lego drink-pouring setup), but for many others, the maker movement represents the foundation of entrepreneurial opportunity.

Autodesk makes a number of free 3D design tools under the family moniker of 123D — e.g., 123D Design, 123D Catch, etc. However, one of the most important Autodesk tools has a different name: Meshmixer. Meshmixer allows you to take your 3D object and prepare it for 3D printing.

I downloaded the tools and experimented with them, but frankly, I found the experience quite frustrating. They reminded me of when I tried to use Photoshop: I was very impressed with the tool and what I had heard could be done with it, but upon confronting it, found that while I believed it could accomplish everything, I couldn’t figure out how to do anything.

Autodesk provides video tutorials on YouTube for some of the tools; to be honest, they’re a bit helpful but nowhere near what you need to really learn the products. Moreover, some of the videos reflect previous versions of the products and are out of date. Frankly, I found the situation really frustrating: I knew enough about 3D printing to be inspired, but couldn’t really figure out how to get going.

However, I resolved to keep trying and found another set of videos put out by the 3D printing service Shapeways. In these 7 videos, a Shapeways evangelist walks through an introduction to 123D Design and provides an example of how to design something real — a hook.

No fool I, I decided to do the exact same project and follow her steps slavishly. Which I did. At the end of the process I had a real-deal, 3D hook design, of which I was immensely proud (one of the benefits of being a novice is simple accomplishments seem like great achievements).

I saved the file in one of the two most common object formats, .stl (the other is .obj) and then imported it into Meshmixer to prepare it for printing. Meshmixer is really powerful and a quasi-design tool in its own right. You can use it to do mashups of two (or more) 3D objects, slice parts of an object off, smooth object surfaces, and much more. It also helps you position the object for efficient printing, which is what I was interested in. When I hit the optimize button, it moved the hook from an upright orientation with tail down to on its side; it also moved it from the original position, in which it sat above the printing surface, to lying flat on the printing surface.

Meshmixer has a “print” option, in which you can select a 3D printing service (like Shapeways), the material and color you want, and then execute a print transaction. Or so the theory goes. In my experience, you are able to select the service and object options, but then Meshmixer hangs. So I downloaded the object and then uploaded it to Shapeways and Sculpteo, where I priced out printing the object. Surprisingly, there was a significant difference in price, with Sculpteo around twice as much. Of course, each service offers different printing materials and colors, so the price comparison was not perfect. But I figured this is an experiment, so I wasn’t as bothered about which material it arrived in. I was more interested in the process.

Shapeways gave me a date range that was about three or four weeks out. So I sat back and waited to see how my little experiment would play out. Then it got more interesting.

I got an email inviting me to a TechShop Redwood City tour and I decided to go along and check it out. I went to an open house in Menlo Park perhaps three years ago and found it very frustrating — disorganized and not very informative. This tour was completely different. The four people in my group were guided around by a TechShop employee, a very interesting guy in his own right — a former Stanford mechanical engineering student who started using TechShop when the Stanford facilities were booked round the clock. He liked it and, I guess, never left.

TechShop is really impressive, with industrial-grade equipment available for use by anyone who is a member (and gets trained on the equipment to avoid lost fingers and the like). As the guide took us around we stepped into a room. There were a couple of guys sitting there and I, trying to be friendly, said hi and asked what they did. They told me they run a 3D printing service as part of an offering called Fictiv — “Uber for 3D printing,” one of them said. When I inquired what that meant, he said that Fictiv allowed you to upload your design and then choose where to have it printed, but that rather than printing the object itself, Fictiv would farm it out to one of a number of 3D printing services in the locale. The benefit, according to him, is that the objects are available much more quickly, and at a lower price than the better-established services like Shapeways.

Naturally, I decided to check it out. I uploaded my awesome hook design and selected a color and material. Fictiv doesn’t display which service will actually do the printing; it is, in effect, an aggregator of individual printing job shops and encapsulates their information. In part, this may be to prevent direct ordering, but I think it’s more likely that most of the printers are very small entities not really set up for retail and online operations.

Once I made my selection, Fictiv provided a cost and estimated delivery date (a range of a few days). The cost was perhaps half of the Shapeways cost, and the delivery was scheduled for less than a week away — a significant advantage over Shapeways, which was on the order of three weeks. True to its word, my print arrived within four or five days.

A week or so later, the Shapeways print arrived, in line with its original estimate.

So how did the two stack up? Here are two pictures of my printed hooks, front and back, captioned to identify which came from which service.

3D Hooks 3D Hooks — Front Hook 2 3D Hooks — Back


The differences between the two hooks — besides color — may not be apparent from the photo. However, here is what I noticed:

  • The Shapeways hook is much heavier — on the order of twice or more
  • The Shapeways hook is “richer” feeling, with a graininess to it that provides a pleasant tactile experience; the Fictiv hook feels slippery and like a cheaper plastic
  • The Shapeways hook is much more “polished” — if you look on the lower photo you can see the lines where the Fictiv object sat on the printer bed; it may be that Shapeways personnel did some finishing hand work on the hook, whereas the Fictiv printer just pulled the object off the printer plate and sent it off to me.

Now, some of this may be due to the differences in the materials the hooks were printed in by the two services. I’m not very familiar with the ins and outs of printing materials (and frankly, the services don’t do a great job explaining the differences, they just list them with technical descriptions but no information about the object will look like after printing; fair enough, that might be something the customer should be expected to research and understand), so the differences may be down to pilot error, so to speak. If this object were something intended for actual use, I would say the Shapeways would be far more preferable. However, I have the impression that Fictiv is attempting to address the maker movement with quick-and-dirty solutions that help customers prototype and iterate quickly; for them, the quality of the print may not be important, whereas time to availability is.

This also speaks to the challenges of learning 3D printing. You have to be pretty motivated to learn how to do it. The jumbled collection of video tutorials is useful (thank God for YouTube!), but requires a lot of searches and clicking back and forth among videos whose quality ranges from excellent to execrable. I ordered a book on Autodesk’s tools written by one of its evangelists, but it’s currently 18 months late and not scheduled to arrive until later this year; I’ll believe that when I have it in my hands. The founders of HoneyPoint 3D, a local retail and education firm, did a Kickstarter campaign to fund a Meshmixer tutorial video series; I contributed as did enough others to completely fund the effort, so it should be along in a few months. I expect it will be quite helpful.

All in all, I feel like I’ve made significant progress in 3D printing, although I am just barely scratching the surface. It’s clear an ecosystem is springing up to help people be successful more quickly with 3D printing. Obviously, 3D printing is a tremendous enabler for innovation and I expect it will grow dramatically over the next few years. The 3D printing services make it really convenient to get started, since you don’t need to own a printer yourself in order to receive objects. The biggest barrier, I think, is the difficulty of learning the 3D design tools, and I’m not sure how that can be fixed. Slowly but surely, though, 3D skills are being built and will diffuse into the general workforce over time. Then things will get really interesting.



The Future of Medicine: My Visit to Theranos

by Bernard Golden on June 9, 2015

Blood vials larger attribution

I first heard about Theranos a year or so ago (alas, I cannot find the original piece I read; I think it may have been in Forbes). My reaction to the Theranos service was simple: it struck me as brilliant. Theranos figured out how to run blood-based medical tests with much smaller amounts of blood — instead of the three sizable vials typically drawn for a standard array of tests, Theranos could run the same tests with a droplet that could be drawn with a fingerprick. (For a lengthier description of the service and its celebrated CEO, see this New Yorker piece). Even more striking was the news that Theranos had struck a deal with Walgreens to put its testing stations into the pharmacy, allowing walk-in testing. It wasn’t clear from what I had read whether the partnership had come to fruition or if the Theranos service was actually available today.

So it was with some excitement that, on a visit last week to a physician, he wanted me to get a set of tests and told me about a new service he was looking at called Theranos. I was to be his guinea pig.

This is the story of my visit, and what I think it says about the future of medicine.

First, and obviously, the service has now launched. The only place Theranos is available is Walgreens — a number of them in Arizona, and a single California location conveniently close for me in Palo Alto, which is where I went. It’s drop-in and available from 7 am to 8 pm and 9 am to 5 pm weekdays and weekends, respectively.

Here is a picture of the Theranos kiosk:

Theranos checkin

The actual Theranos facility is two rooms around the corner — a small waiting room and a blood draw room. Both have a TV showing a dreamy underwater video accompanied by lilting new age music (they wouldn’t let me take a picture of the facility due to privacy rules, so you’ll just have to imagine it). The phlebotomist who drew my blood said that the facility had been open for around 18 months. Who knew?

As it turned out, I didn’t get to use the fingerprick method as I was having so many tests done that more blood was required. She ended up taking three vials, although it seemed to me that the vials were smaller than those I’ve seen used (and filled!) in conventional blood draws in the past. I was out within about 10 minutes, and even received a nice gift from Theranos whilst there:

Theranos bottle


Now why do I say Theranos represents the future of medicine?

Well, it’s extremely convenient, although drop-in blood tests aren’t unusual. However, the results were available overnight, and Theranos has a mobile app that shows the results to you; this is quite unusual in my experience, because most testing sends the results to the physician, who then can forward them to the patient. This is less convenient, and requires the physician to act as middleman. As a side note, should anyone from Theranos read this post, the mobile app needs a lot of work; it’s attractive, but when I entered my email address incorrectly for my signup there was no way to correct it and I had to create an entirely new identity. This bespeaks a lack of design thinking on whoever created the app/user identity process.

With respect to the service itself, the founder of Theranos has implied that its services will be available for anyone to use, rather than only to those with a medical order. A potential ability for end users to directly control their tests is revolutionary, moving patients from dumb consumers to informed participants. It’s not clear to me whether I could have ordered this battery of tests on my own or if I required a doctor’s signature to get the blood drawn. Of course, a sticking point in this is prices and reimbursement. The world of medical costs and insurance makes Kafka look reasonable and transparent. I have had medical procedures that one provider priced at $2000, while another less than three miles away charged $600. On top of this pricing variability, there is the craziness of medical list prices vs. insurance prices. I have seen insurance prices that are a 90% discount to list price. Naturally, if you are ordering this on your own, the medical list would be a strong deterrent to self-prescribing.

Here is a picture of my blood draw order, with the specific tests ordered blurred out for privacy reasons:

Theranos Order Blur


In case you can’t read this very conveniently, here is a section of the order form:

Theranos prices


A Magnesium test for $4.61! Homocysteine for $11.61! When I checked in, the phlebotomist told me that it was possible that my insurance might cover part of the cost, but if it didn’t my total bill would be no more than $181, which was the cost of all the tests ordered (remember, this is a set of tests that required several vials of blood because it the order was unusually comprehensive). $181!

Of course, one might question the quality of the tests. As a patient, convenience and low price at the cost of accuracy in such a personal and important area would be irrelevant. Conveniently enough, I had recently gotten a base set of tests done, which I compared to the Theranos results. The two were very consistent, which made me feel the Theranos process was probably quite accurate.

The Future of Medicine

To my mind, what Theranos delivers illustrates the future of medicine. It disrupts the existing market for blood tests by combining several elements, each of which on its own is interesting but as a single offering would be unable to disrupt the existing value chain. It has created:

  • New science offering blood tests that require much smaller amounts of blood. The new machinery Theranos uses operates more efficiently and much faster, making the blood test itself more capable of acting as a disrupting enabler.
  • A business model that serves new markets. The walk-up kiosks provide Theranos with large-scale distribution while offering Walgreens  an opportunity to get into the lucrative medical test market.
  • Closer engagement with patients, who heretofore have been treated as blood donors rather than customers. The information sharing with patients, along with the potential for self-testing, positions Theranos for the new breed of more active patients and the burgeoning quantified self movement.
  • A pricing structure that reflects a streamlined value chain. Not only does the pricing cut against the insanity of the existing medical system, the lower prices enable more consumer use of the service, which will drive additional growth.

If Theranos attempted to bring just one of these elements to market, it would likely falter. The new science, on its own, would need to be taken up by the existing testing providers like Quest Diagnostics. Not only would this confront the inertia of a field set in its ways, but a provider base that makes more money the more complicated the value chain. Partnering with Walgreens to offer drop-in service without the other elements would struggle to drive demand, given that it would pretty much be a me-too service. The closer engagement with patients, while valuable, wouldn’t be enough to convince other participants in the value chain to change their way of doing business. And, of course, without a significant price advantage, it would be hard to differentiate the service enough to motivate patients and doctors to direct testing toward the Theranos offering.

In a way, Theranos reminds me of Amazon Web Services. When Amazon developed its offering, it deliberately did not go down the path of existing technology companies, which were married to their high margins and extensive customer engagement. Had Amazon gone that route, it’s likely that its pricing would have had to be roughly consistent with incumbents and its offering far less distinctive, which would have, in turn, made it less attractive to a set of users who were dissatisfied with the status quo and eager for an alternative (in fact, I maintain that, absent Amazon, what we now call cloud computing wouldn’t exist, as no mainstream technology vendor would ever have seen an AWS service as an attractive business model). As Clayton Christensen has written, it’s difficult to innovate in an existing market, since incumbents can easily co-opt the innovation, while innovating in a way that allows serving an entirely new market provides tremendous new opportunities, since incumbents will disdain or misunderstand the offering. I wrote about this in a recent CIO blog post, outlining how technology incumbents still fail to grasp the reasons for AWS adoption and therefore continue to compete along the wrong dimension, which gives AWS even more runway to disrupt the industry.

I believe our society and economy is on the threshold of enormous change, and medicine will be transformed from a symptom-reactive industry to a health-enabling industry. I was really excited to get to use the Theranos service and found the experience fascinating. The company really does provide a glimpse into the future of medicine.


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AWS Kinesis Introduction Tutorial

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AWS vs. CSPs: Software Infrastructure

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In my last post I discussed Amazon Web Services’ approach to its hardware infrastructure, noting that Amazon appears to view its hardware infrastructure quite differently from other CSPs. In that post, I said: Amazon, however, appears to hold the view that it is not operating an extension to a well-established industry, in which effort is […]

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