Nanotechnology: science fiction? Or next challenge for the ethics committee?

The year is 2027. Barbara Belmont has life-threatening bacterial sepsis (infection of the blood stream) and purulent abscesses in several organs. The causative germ is staphylococcus aureus, so-called because laboratory colonies of staph aureus are a golden yellow color.

In the pre-antibiotic era no treatment was effective for this condition. Now (in 2027), it is the post-antibiotic era. Overuse of antibiotics for several decades gave almost all known bacteria a wonderful opportunity to develop resistant strains. Developing resistance is a natural adaptive capability that involves evolutionary changes in a bacterial cell's metabolic processes.

For example: penicillin once killed staph aureus by interfering with synthesis of its all important protective cell wall, without which a staph cell is as vulnerable as we would be without our skin. Today, in 2027, tiny metabolic factories inside each staph cell merely ignore penicillin, having over the years developed an alternate assembly line for making cell walls.

No matter. Today, in 2027, the treatment of choice for bacterial infections is no longer antibiotics. There is a new way to disrupt a bacterium's intracellular metabolic mechanisms. It is the age of nanomedicine.

Doctors introduce into Barbara's body billions of tiny nanorobots, sub-atom size particles designed to enter bacterial cells on a search and destroy mission, much like a Pac-Man computer game. The nanorobots disrupt, confuse, interfere with, and eventually annihilate each staphylococcal cell's tiny metabolic factory.

These nanorobots or nanoparticles are themselves products of other nanorobots known as replicators They are designed and manufactured to visit their devastating blows only to staph cells.

Barbara's temperature drops from 105 degrees Fahrenheit to a normal 98.6. Using techniques that have remained essentially the same for two centuries, Barbara's abscesses are surgically drained.

Within a few days, Barbara recovers. She is discharged home and resumes her usual activities of daily living. Her life is restored to normal. Normal, that is, except for the existence in her blood stream and vital organs of billions of tiny foreign nanorobots.

Nano what?

Nanomedicine is one application of nanotechnology. A nanometer is one billionth of a meter; that is, about one billionth the length of a yardstick. Complex chemicophysical, subatomic size particles inside the cells of nature's basic building blocks measure 100 nanometers or less. Nanotechnology is a combination of chemistry and engineering, a new science that works with these nanoparticles.

Within a few decades, tiny nanomachines, thousands of which would fit into the period at the end of this sentence, may be able to construct hard goods at the molecular level, again revolutionizing industry. Famine could be eradicated by fabricating foods using nanotechnology.

Nanomedicine applications include treating cancer and infectious disease, understanding and influencing the aging process, enhancing human intelligence, and sending tiny nanorobot surgeons into a person's body to operate without producing scars.

Nanotechnology, including nanomedicine, is not yet a reality. At the same time, it is not totally science fiction. In 2000, President Bill Clinton requested $227 million to fund a National Nanotechnology Initiative.

The National Institutes of Health has established eight Nanomedicine Development Centers, centerpieces of the NIH Nanomedicine Roadmap Initiative. (1) Researchers have successfully tested in mice a nanocell system that delivers chemotherapeutic agents to a cancerous site in the mouse's body, and DNA nanoparticles have been used to accomplish gene transfer in patients/research subjects with cystic fibrosis. (2)

Ethicists agree that nanotechnology, including nanomedicine, raises many troublesome issues. Nanoparticles might be engineered that, introduced into the human body, provide information about us that is useful for medical purposes.

Any practicing physician will tell you that it would be wonderful to develop a diagnostic system of direct observation, instead of having to rely on one unreliable historian (patient) after another. However, might this capability not require a whole new definition of "the right to privacy?"

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Are there limits within which human enhancement is acceptable? What if tiny nanofactories are put to work re-engineering our bodies to resist various diseases, but also to enhance human cognitive functions and/or muscular strength? Does the term "master race" then rear its ugly head?

If we discover that we can arrest the aging process at some point, should we?

Where's the social and economic justice? What causes for the common good will have to go underfunded if funding for nanotechnology becomes a high priority?

Though ethicists generally agree that such concerns must be addressed, starting now, they disagree about how to address them. Some say a brand new ethics will have to be developed--new schools of thought, new ethical principles, new moral values--to deal with nanotechnology.

Other ethicists say, "What's new?" The Hastings Center, a leading bioethics think tank, sees challenges to "values we have long embraced ... autonomy, beneficence, fairness, efficiency, and environmental preservation." (2)

The French Centre National de la Recherche Scientifique (3) recommends an eight-part plan for dealing with ethical aspects of nanoscience and nanotechnology, including nanomedicine. The eight-part plan includes (paraphrased):

1. Conduct forums for discussion, gatherings of representatives from manufacturing companies, consumer associations, patients' associations, and government to consider ethical aspects of nanotechnology.

2. Include awareness of and education about ethical aspects in training/education of research workers.

3. Produce short ethics guides for research scientists.

4. In research facilities, set up ethics forums for internal discussions of ethical aspects related to current projects. Scientists, engineers, and technicians should exchange views and share interests with individuals working in the humanities and social sciences.

5. Increase awareness of and stimulate interest in nanotechnology in the humanistic and social science community.

6. Establish mechanisms for detecting and arbitrating conflicts of interest between nanotech scientific projects and industry. As part of this effort, ensure transparency of the source of funding of nanotechnology research projects.

7. Educate the public about expected benefits of nanoscience and nanotechnology, including nanomedicine, without hiding the fact that possible harm can result from applications of nanoscience. Dare to consider even fantasies to which nanoscience might give rise.

8. Establish permanent groups for dialogue/debate at the local, national and international level.

What does the emergence of nanomedicine mean for U.S. hospitals, physicians and medical education, nurses and other currently indispensable health care professionals, patients and the community of potential patients and taxpayers, insurance companies, institutional providers, and the hospital ethics committee?

No one knows.

One thing is clear, however. The future always starts now. That is, the future usually depends on the nature and direction of first steps taken along paths either carefully chosen or forced upon us by our own decisions and actions.

Ignoring abuses of nanomedicine could be another nail in the coffin of the Socratic and Aristotelian notion that with careful thought and determined will it is indeed possible to keep society civilized.

Richard E. Thompson, MD, is former vice president of the Illinois Hospital Association, taught ethics at St. Petersburg College and Missouri State University, and is author of Think Before You Believe, Xlibris, 2005. He can be reached at [e-mail].

References

1. www.nihroadmap.nih.gov, The NIH Nanomedicine Roadmap Initiative.

2. Litton P. "Nanoethics? What's New?" Hastings Center Report 37(1):22-5, January/February 2007.

3. www.cnrs.fr

This column is an excerpt from Chapter 18, Nanotechnology, in So, You're on the Ethics Committee? A Primer and Practical Guidebook, Tampa, Fla., American College of Physician Executives, 2006.

By Richard E. Thompson, MD

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