Interview with Dr. Alan Dang, co-Founder of PrinterPrezz (updated)

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Dr. Alan Dang is a board-certified, licensed orthopedic spine surgeon. He is an HS Clinical Associate Professor at UCSF. Along with his brother, Dr. Alexis Dang, he started the Orthopaedic Rapid Intelligent Fabrication (ORIF) program at UCSF/San Francisco VA and is a founding member of the UCSF Center for Applied 3D+ Technologies.  Dr. Dang is also a capstone mentor and member of the selection committee for the UCSF/UC Berkeley Masters in Translational Medicine program. He is also the co-founder of PrinterPrezz, a 3D printing medical company offering design, prototyping, mass production, and regulation assistance to orthopedic device companies. Alan will join us on the 3DHEALS|NAMIC Healthcare 3D Printing Forum this week.

3D Printing Ti6Al4V Orthopaedic Implants: As Easy as Counting 1-2-3 (3DHEALS2020 Video)

Jenny: When was your first encounter with 3D printing like? Who first got into 3D printing? Your brother (Dr. Alexis Dang) or you? =)

Alan: I was the first to get into 3D printing, but my brother, Dr. Alexis Dang gets all the credit for developing the processes required to ramp up to in-hospital production.  We started in early 2013 with a MakerBot Replicator 2X.  At the time, I thought the label “Experimental Printer” was just a bit of marketing, and I would only find out many years later that the Replicator 2X was a product where the public announcement was also the first time the engineering team had heard of it.  Since Alexis and I didn’t know that it wasn’t supposed to work, we worked hard to disassemble, tweak, and reassemble the printer.  We actually did get it working reliably, and in doing so, we built a body of knowledge that has helped UCSF and the San Francisco VA Health Center produce reliable precision anatomic models for surgical planning off today’s much more reliable enthusiast-level desktop printers.  At the San Francisco VA, whenever a CT scan is indicated clinically, we consider making a 3D printed model for surgical planning, resident education, or patient education.

In the beginning, we thought 3D Printing in plastic would help novices only, but we quickly saw how precision anatomic models could guide pre-operative plans by even the most skilled and experienced surgeons.  Everyone got a bump from the technology regardless of skill level, and we saw that the everyone was performing at their full potential.  3D Printing continues to be a focus of our research at the University and published on how mechanical performance of plastic surgical retractors are affected by print parameters and post-processing.

Jenny: What inspired you to start your journey from an orthopedic surgeon to eventually co-founding a company focusing on healthcare 3D Printing? 

Alan: At UCSF and the San Francisco VA, we are blessed to have resources needed to generate plastic precision anatomical models in-house on clinical timelines.  A patient can come to the clinic on Monday afternoon and we can have a print-ready for the operating room team on Tuesday morning.

However, moving from 3D printing in plastic to 3D printing in metals such as Ti6Al4V-ELI is a leap that isn’t feasible to do at the university hospital. 

Manufacturing orthopedic implants require advanced manufacturing skills to manufacture in titanium alloy or other advanced materials.  This expertise was not found in the university but was instead found in the semiconductor and advanced software application world.  The four co-founders of PrinterPrezz decided that our collective skills filled the gaps in individual knowledge.

What is most exciting to me about 3D Printing is that it is an enabling technology that not only makes a surgeon’s life better through improved ergonomics, but it also helps patients experience more gratifying lives too.  When surgery is easier or smoother for a surgeon, there are fewer complications and recovery can be quicker for patients.  3D printed structures like lattices can enhance bone on-growth and through-growth, enabling patients to heal better.

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For class 2 medical devices, which include hip and spine implants, the FDA approval path is known and defined. PrinterPrezz expects to become progressively more experienced and efficient at completing this path, as described in the article below.

Jenny: What were some of your early failures and successes? How did these shape your choices today? 

Alan: In residency, when things got tough, we used to say: “Pressure makes diamonds.”  Our early struggles with getting desktop level plastic 3D printing to reliability standards would shape 

PrinterPrezz’s focus on maximizing reliability of metal 3D printing and optimizing performance of Class II medical devices, such as spinal implants, that are manufactured in Ti6Al4V-ELI.

Jenny: Since you are also part of the VA system as a surgeon, what kind of experience do you have with the VA 3D Printing Innovation network? 

Alan: The opinions expressed in this answer are my own and do not reflect the view of the Veterans Administration, or the United States government.

My brother and I are founding members of the National VA 3D Printing Workgroup.  We received Federal Employee of the Year awards from the San Francisco Bay Area Federal Executive Board for our work to bring the benefits of 3D printing for surgical planning to our Veteran population.  Most people just think of the VA as providing healthcare for our nation’s Veterans.  While that is our primary mission, research and education are equally important.  

Recently, with the Covid-19 pandemic, the VA 3D Printing Innovation has helped our frontline hospital workers by validating print designs and manufacturing face shields.  The San Francisco VA Health Center has additionally used 3D printing to establish a secondary “emergency” supply of critical components that have extended back orders.  Thankfully, the Covid-19 situation in the San Francisco Bay Area has remained manageable for our hospital resources.

Jenny: How is everyone dealing with COVID19 situation at work? 

Alan: The opinions expressed in this answer are my own and do not reflect the view of the Veterans Administration, or the United States government.

For me, work includes both direct clinical care as a physician, as well as my role as the CMO of PrinterPrezz.  The VA has had a pandemic preparedness plan in place since the Bush Administration including telework/telehealth strategies.  This has allowed us to continue to provide on-going care to our Veterans.  UCSF has leveraged the University’s 3D printing resources to repurpose the currently closed library into a plastic 3D printing production facility for locally manufactured face shields.  Over 6,500 shields were manufactured across a fleet of almost twenty printers to bridge the gap between the clinical need and the availability of standard parts.

PrinterPrezz has been doing great. Even before the shelter-in-place orders were officially issued in the Bay Area, we were already taking steps early on to prepare for the possibility of Covid-19 getting worse.  This meant simple things like having structured hand washing time, reminding employees that they are supported with paid time off if they showed any signs or symptoms of any illness, and ensuring our digital infrastructure was resilient and secure enough to allow work-from-home.  When the shelter in place orders came, it was easy to transition to as much work-from-home as possible.  Several local hospitals came to us for support with Covid-19 countermeasures. As a medical-focused contract manufacturer and with our design expertise, PrinterPrezz operations were maintained as essential activities throughout the Shelter in Place period in California.  We’ve already delivered tens of thousands of PPE components all over the Bay Area and are continuing to supporting the Covid-19 response in the next phase of the pandemic.

We have strict adherence to workforce and visitor scheduling to maintain social distance and keep our employees, customers and partners safe as we resume non-Covid-19 operations, coordinate deliveries, and collaborate with customers.

Jenny: What advantages (and disadvantages) does your clinical background bring when it comes to entrepreneurship? 

Alan: Clinicians tend to be cautious and risk-averse, yet must also make quick decisions based upon best available data or evidence, even if the data is limited.  As an entrepreneur, being able to move quickly and make decisions on the fly while being grounded in facts is essential.  More importantly, clinicians trust in the concept of specialization, the need to call consults, and the concept of an entire healthcare team.  Most startups require a true team effort for success.

Jenny: I know you work closely with your brother Dr. Alexis Dang, who is also very passionate about healthcare 3D printing. What is the dynamic like between you when it comes to working together? 

Alan: We’re only two years apart, so we grew up as brothers and best friends.  We trained at a lot of the same institutions, are both orthopedic surgeons, and share a strong technical background across multiple disciplines from healthcare to computing to even hobbies like photography and hi-fi.  But our personalities are actually very different and that helps us approach problems with different perspectives which is complementary more often than contentious.

Jenny: Software, materials, or 3D printers. It has been a debate in the industry forever as to which is the most important player. What do you think is the most important player in healthcare 3D printing? 

Alan: With my conflict-of-interest declared, I would say that the role PrinterPrezz has in collaborating with clinicians is the most important element of healthcare 3D printing.  No one asks if the anesthesiologist, the nurse, or the surgeon is the most important person in the operating room.  Without the team working together, the patient isn’t going to have a successful outcome.  It goes beyond that.  There are teams of people dedicated to cleaning the operating room between cases, teams of people who sterilize and maintain instruments along with room equipment, teams of people who ensure that electricity, air conditioning for the operating room is reliable, teams of people to ensure that gloves, gowns, masks, needles, IV tubing, medications are stocked, teams of people to call the patients before the day of surgery to make sure they remember their preoperative instructions and teams of people to follow-up to make sure the recovery is smooth.  

While you can do things solo under austere conditions (like a battlefield), the best scenario is having an entire team focused on success and recognizing that the team goes far beyond your immediate contacts.

PrinterPrezz is the only ISO-13485 contract manufacturers to have an open platform with software from multiple vendors, materials from multiple vendors, and 3D printers from multiple vendors with an infrastructure to cross-pollinate between technologies.  We rely on teams of people, each focused on critical components of medical manufacturing including the FDA regulatory process involved at every step of the development and production.  Our customers want a successful outcome, and when we consistently select the best combination of technologies for a given project, and teams of people are focused on what they do best, everyone wins.  Our expertise with all aspects of the supply chain is one way we’ve been able to reverse engineer and delivered thousands of critical components to local hospitals.

Jenny: What advice would you give to a smart driven college student in the “real world”? What bad advices you think they should ignore? 

Alan: Everyone understands the idea of learning from one’s own mistakes.  However, that lesson often gets lost when thinking about how we interact with others.  Research shows that college freshmen are more politically polarized today than they have been in the previous 50 years.  College is actually the best time to meet people with different views and come to respect and understand them even if you completely disagree with their opinions.  Being able to calmly understand conflicting opinions based upon the same set of data is essential.  It doesn’t mean that you have to agree with someone else in politics — you just need to be able to understand how some facet of an opposing opinion may make sense to that person, and if you need to, you  can quantify their opinion internally as the equivalent of a “mistake.”  The us-vs.-them mentality is a damaging part of our world today and it shows up even in subtle ways.  How many times have you seen a reality singing or dancing show where a single judge offers a lackluster review with constructive criticism and gets booed by the audience instead of being considered as another data point?

The ability to weigh opposing opinions based upon identical facts translates into the real-world of entrepreneurship directly.  Imagine that you’re the CEO of a startup that needs to determine if path A or path B is the best path for the company’s resources.  As a real-world problem, more research won’t necessarily elucidate the answer.  As a real-world problem, there may not be a way to split the middle or to do both simultaneously.  

The first mistake would have been building a team where there was group think, and only Path A was presented or considered.  The second mistake would be trying to solve every problem with harmony or splitting the differences as it may not be possible.  Chances are that you will have a better time assessing tough decisions if you’re used to having a wide diversity of opinions.

With all that said, “bad advice” is probably defined as advice based upon faulty knowledge.  But instead of ignoring it, it may be better to consider, even for a moment, how the person giving that advice came to the wrong conclusion. At PrinterPrezz, we promote learning as a team and as a core value of our company.

Jenny: What was the best investment you made in 3D printing? 

Alan: Personally, it was in putting in the time to learn and troubleshoot that early Makerbot Replicator 2X.

Jenny: What do you enjoy in your spare time? What are you passionate about outside of your work/3d printing?

Alan: I have a two-year-old and an almost four-month-old, so there isn’t a lot of spare time anymore!  When I do get some free time, I enjoy photography and listening to music on a hi-fi system.  

Jenny: What is your favorite quote? Why?

Alan: I don’t have a single favorite quote – but at least in the context of entrepreneurship, one of my favorites is from Jen-Hsun Huang: “There is no technology that will not be commoditized faster than you can take your company public.”

Jenny: What does the word “3DHEALS” mean to you?  =)

Alan: Hope for a better tomorrow.

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