Medical Nanotechnology: The Ethical Concerns

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Medical Nanotechnology The Ethical Concerns

• David Orentlicher, MD, JD
• Indiana University Schools of Law and Medicine
• April 15, 2009

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Scientific background

• Nanomedicinecreation of drugs and devices by
  operating on a nanometer scale (1-100 nanometers)
  and exploiting the novel biological, chemical and
  physical properties present at that scale
• 1 nanometer one-billionth of a meter 50-80,000
  nanometers width of a single hair
• Greater ability to penetrate cell walls or cross
  the blood-brain barrier
• Nanoparticles are not just very small particles
• Lighter, stronger, more resilient materials
  (e.g., new bone) drugs that are more effective
  and better targeted

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Nanoparticles are not new

• Natural
• Gas to particle conversions (e.g., ammonia
  emissions from livestock manure)
• Forest fires
• Volcanoes
• Viruses

• Human-generated
• Internal combustion and jet engines
• Power plants
• Incinerators
• Metal fumes (smelting, welding)
• Polymer fumes
• Frying, broiling, grilling
• 113 Env. Health Persp. 823 (2005)

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Medical uses

• Nanochips and probes for collection of more
  comprehensive, more nuanced data (e.g., blood
  chemistry, genetic makeup, cancer cell detection)
• More focused delivery of drugsenhanced
  effectiveness at lower doses (nano.cancer.gov)
• Greater ability to remove infectious agents and
  toxins and repair or replace damaged cells (?
  forestall aging)
• Nanodevices to improve the precision of surgery
• ? Enhancement of normal human attributes (e.g.,
  radar-like vision, supra-normal hearing)

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Ethical concerns the overselling of technology

• New technologies often are over-hyped
• Diversion of funding from better uses
• Failure to account for potential risks
• Durability may result in persistence in the
  environment and very small size makes it more
  difficult to detect presence of nanomaterials.
• Smaller size may mean increase in respiratory
  disease, longer retention in body, ability to
  pass through intact skin
• Greater surface area may heighten inflammatory
  response
• Failure to sustain public support (as happened
  with genetically-modified foods)

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Ethical concernsthe risks to privacy

• Nanochips may provide comprehensive and nuanced
  medical data that can be transmitted to a
  physicians computer
• What are the risks of hacking?
• ? Neuro-implants to improve cognitive ability and
  allow brain-to-brain communication
• Will our thoughts be monitored by others?

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Ethical concerns theover-identification of
illness

• Nanodiagnostics and detection of subtle changes
  in DNA or blood chemistry. How many cancer cells
  make for a cancer diagnosis?
• Will nanodiagnosis provoke unwarranted anxiety in
  patients and over-treatment of risk factors?

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Ethical concerns enhancement vs. treatment

• Some writers predict remarkable possibilities for
  nanomedicine
• Enhanced memory (total recall)
• Infra-red night vision
• Long-range vision
• Wide-spectrum hearing
• But a number of scholars draw a distinction
  between permissible treatment of disease and
  impermissible enhancement of the human condition

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Ambivalence abouthuman improvement

• On one hand, we commend self-improvement

• Consider also the praise for people who practice
  to become accomplished musicians or study to
  become innovative scholars.

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Ambivalence abouthuman improvement

• But just as we often applaud effort at
  self-improvement, we sometimes criticize it

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Ambivalence abouthuman improvement

• Tension between desire for improving the human
  condition and fear of making it worse
• Dr. Jekyll and Mr. Hyde
• Frankenstein
• Tension between desire to make the natural state
  better and fear of tampering with nature
• Genetic engineering
• Artificial methods of reproduction
• Should we distinguish between the relief of
  disability and enhancement of the healthy state?

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Ambivalence abouthuman improvement

• Discomfort with changeIs it appropriate for
  children to be born with the same genes as one
  parent rather than through a combination of two
  parents genes (i.e., cloning)?
• History of abuseThe eugenics movement in the
  early part of the 20th Century (first
  sterilization law passed in 1907 in Indiana, Buck
  v. Bell (1927), Nazi experience (1930s-40s)). Is
  freely-chosen eugenics different?

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Ambivalence abouthuman improvement

• Concern for personal identityWhat will it mean
  for personal identity if we become dependent on
  technological interventions to see, hear, think
  and move? People might find it increasingly
  difficult to say which of their thoughts and
  actions still constitute a personal achievement.
  As people become more and more wired
  neurologically, will ones uniqueness dissipate?
  Is that so bad?

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Ambivalence abouthuman improvement

• Undermining of effortIf we can turn to
  nanotechnology, will we suffer a diminished drive
  to succeed. No pain, no gain? Or is this about
  not exposing the myth of success based on effort?
• Widening of socio-economic disparitiesWill the
  well-to-do have greater access to the benefits of
  nanomedicine, just as they do to the benefits of
  treatment for disability?

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Over-hyping?

• Over the next fifteen years we will see an
  acceleration of innovation, change, and
  disruptions on a scale no civilization has ever
  seen before. . . . Nanoscience is disruptively
  astounding for the potential it may hold to alter
  much of what we know.
• James Canton, 1013 Ann. N.Y. Acad. Sci. 186
  (2004)