Collaborative development of open source

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BMJ Innovations Publish Ahead of Print, published on April 3, 2015 as doi:10.1136/bmjinnov-2014-000034
COMMENTARY
Collaborative development of open
source-appropriate technologies:
a way to reduce the global
access gap?
Roberto Aufieri, Simonetta Picone, Piermichele Paolillo
Division of Neonatology and
Neonatal Intensive Care, Casilino
General Hospital, Roma, Italy
Correspondence to
Roberto Aufieri, Policlinico
Casilino, Via Casilina,
1049, Roma 00169, Italy;
r.aufieri@gmail.com
Accepted 13 March 2015
To cite: Aufieri R, Picone S,
Paolillo P. BMJ Innov
Published Online First: [ please
include Day Month Year]
doi:10.1136/bmjinnov-2014000034
Healthcare systems in low- and middleincome countries (LMIC), due to scarcity
of economic resources, often lack appropriate health technologies necessary for
the prevention, diagnosis and treatment
of many curable diseases.1 WHO
acknowledges that most of the current
global health targets and goals would be
impossible to achieve without an increase
in access to essential medical devices,2
hence promotes the development and
local production of appropriate devices.3
Nonetheless, despite the increasing interest and efforts, prices of devices, as well
as prices of patents for local producers,
continue to not be appropriate for many
LMIC. Research, development and production of biomedical devices are mostly
performed by companies in high-income
countries for high-income markets, and it
has been estimated that only 13% of
manufacturers are located in LMIC.2
Consequences are that high prices, along
with inefficient local production and distribution, among other factors, contribute to set back commercialisation and
availability of final products in lowresource settings. This problem has been
recently highlighted and defined as the
last mile translation.4
In the past few years, information technology achievements have had a profound impact on most people’s everyday
lives. These have been obtained not only
through research and development of
novel technologies, but also thanks to the
adoption of so-called open source
licenses. Open source licenses are conceived to allow everyone to use, copy,
modify and freely redistribute, under
defined terms and conditions, a piece of
software and its source code.5
The most notable example of free and
open source software is represented by
the Linux operating system. When, in
1991, its creator, Linus Torvalds, released
the source codes of this new operating
system to the public, asking for the collaboration of other developers, he unwittingly launched what has probably
become the biggest collaborative software
project ever. Nowadays, Linux is a fast,
stable and secure operating system,
widely used on web servers, personal
computers, smartphones and tablets. The
same philosophy, adopted for software
licenses, later also found application in
the hardware field, resulting in the development of low-cost, versatile products
(eg, Arduino, an open source microcontroller) that inspire different uses and
applications, and that are, together with
the diffusion of three-dimensional (3D)
printing, contributing to foster the
“maker movement”, a growing community of novel inventors.
3D printing, also known as additive
manufacturing, allows printing of solid
objects of any shape from its digital
model, layer by layer, out of plastic or
other material. This novel technology has
been shown to be highly cost-efficient and
project files can be easily shared, allowing
collaborative prototyping. A successful
example of a 3D printing based collaborative project is the e-NABLE Project (http://
www.enablingthefuture.org), where a
community of more than 1500 contributors collaborate to prototype open source
3D printed prosthetic hands that can be
downloaded and printed by anyone for
less than $50 in materials.
Furthermore, the possibility of reducing research costs with the creation of
Aufieri R, et al. BMJ Innov 2015;0:1–2. doi:10.1136/bmjinnov-2014-000034
Copyright 2015 by All India Institute of Medical Sciences.
1
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COMMENTARY
open source scientific hardware by combining 3D
printing with open-source microcontrollers running
on open source software has been emphasised.6
However, only a limited number of pieces of scientific
equipment and devices, including a certified diagnostic electrocardiograph, optics components and syringe
pumps for laboratory research, have been conceived
and released under an open source license.7–9
The OS4BME (Open Source for Biomedical
Engineering) project, in 2013, during the Innovator
Summer School (an initiative of the United Nations
Economic Commission for Africa), held an intensive
course of open source design and rapid prototyping
for biomedical engineering at the Kenyatta University
(Kenya). Throughout the 1 week course, students
designed and assembled an open source neonatal
monitor.10
It is our opinion that, in a field where conventional
approaches have not yet obtained the desired
outcome, future strategies to reduce the medical technology access gap in LMIC should consider the promotion of collaborative development of appropriate
open source technology for global health purposes.
The use of 3D printing combined with low-cost
microcontrollers or single-board computers, could
help to reduce costs of prototyping, and open source
projects, once available, could be freely used and
modified by global biomedical companies.
Trying to stimulate the debate and to provide a platform for online collaboration, we have ultimately
started up the WikiBioMed project (http://www.
wikibiomed.org). This is a collaborative non-profit
project, aimed at creating a multidisciplinary collaborative coworking community that would conceive and
prototype open source biomedical devices, shared on a
wiki site. However, any initiative aimed at the development of open source appropriate technology for LMIC
would be beneficial and therefore is to be encouraged.
It is hoped that, in the future, the adoption of open
source licensing along with application of new technologies, as mentioned earlier, will contribute towards
increasing access to essential, appropriate and potentially life-saving technology in low-resource settings.
2
Contributors RA conceived the work, performed the literature
research, wrote the first draft of the manuscript and revised
subsequent and final drafts. SP, PP conceived the work and
revised subsequent and final drafts.
RA, SP, PP: read and approved the final manuscript. RA, SP, PP
are accountable for all aspects of the work in ensuring that
questions related to the accuracy or integrity of any part of the
work are appropriately investigated and resolved.
Competing interests None.
Provenance and peer review Not commissioned; internally peer
reviewed.
REFERENCES
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2 WHO. Local production and technology transfer to increase
access to medical devices. Addressing the barriers and challenges
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1240EHT_final.pdf (accessed 24 Nov 2014).
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Aufieri R, et al. BMJ Innov 2015;0:1–2. doi:10.1136/bmjinnov-2014-000034
Downloaded from http://innovations.bmj.com/ on July 6, 2015 - Published by group.bmj.com
Collaborative development of open
source-appropriate technologies: a way to
reduce the global access gap?
Roberto Aufieri, Simonetta Picone and Piermichele Paolillo
BMJ Innov published online April 3, 2015
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