36 Autumn-winter 2009/HesaMag #01 Special report 25/30 Nanos in the human body – Medical perspectives and ethical concerns
Healthcare is a priority focus of nanotechnology research, where the convergence of nanosciences, molecular and cell biology, and medicine can act to deliver improvements in human health and quality of life. It is an appealing prospect; but as with any new technology, there are both ethical and health and safety issues to be addressed, especially where applications in human bodies are concerned.
Aída Maria Ponce Del Castillo ETUI Researcher
Nanotechnologies can be seen as a Other developments are the generation “tool-kit” that enables different life sciences of nanomaterials that could be applied to im- to work together to produce new tools for di- prove tissue regeneration, like restoring car- agnosis and treatments. tilage function to overcome arthritis, in vitro Advances in nanotechnology harbour engineered organ patches or biomaterials for many potential uses in medicine. They will in situ regeneration of bones. Nanotechnol- help increase our understanding of the hu- ogy could also help in the fight against cancer, 1. National Nanotechnology man body, its mechanisms and diseases, and by developing nanomaterial systems to attack Initiative 2003, how to restore it to health. and destroy tumours. Workshop Report on One possible application will be to cus- Their multiple properties give nanoma- Nanobiotechnology, tomise medical treatment through personal- terials a wide spectrum of medical uses; some Virginia, p. 39. Liposomes for drug delivery ised medicine delivery, where patients will have a biocidal activity used in self-cleaning in some cases of cancer be given the precise, controlled dose of their surfaces. Recent research has investigated the therapy; nano-magnetic 2 specific medication at the right time. Nan- properties of fullerene compounds as antivi- particles for magnetic otechnologies will enable the development ral agents to eliminate pathogens and bacteria resonance imaging and of nanostructures to deliver drug molecules in place of long-term antibiotic treatments3. nanomaterials for void filler directly into the cells. Nanoparticles can act Nano-tool kits are also being developed and dental restoration have as drug-carriers or Trojan horses by encap- that will use nano-robots to monitor health been recently approved sulating the medication, travelling around inside a patient or to act at the sub-cellular in the USA. Engineering and Physical Sciences the body indiscriminately and delivering the level where a disease occurs. Nano-robots Research Council 2008, medication to the patient at the molecule lev- could be introduced through the vascular sys- Nanotechnology for el at the required dose when it is needed1. tem, and could be programmed and guided Healthcare, p. 3. by a surgeon to identify the molecular origins of severe diseases like Alzheimer’s or Parkin- 2. Fullerene is one of the son’s, or to perform intra-cellular surgery4. four types of naturally- Behind this ostensibly rosy prospect, occurring forms of carbon. Its architectural structure however, loom ethical and health and safety Nanotechnology could resembles a football, or the issues that any new technology raises, and geodesic domes designed also help in the fight which must be addressed to make a reasoned by the architect and assessment of what is in view. philosopher R. Buckminster against cancer, by On ethical aspects, there is a wide-rang- Fuller; C60 is the most ing discussion of the potential risks of nano- common, and consists of 60 developing nanomaterial materials and nanotechnologies for humans, carbon atoms. Fullerenes as little is still known about how they interact were discovered as recently as 1985, and their most with the human body in terms of toxicity and systems to attack and striking properties ― high carcinogenicity. This lack of knowledge is one symmetry, stability and destroy tumours. reason why specific regulations are needed to versatility ― give them a control the use of nanotechnologies. wide range of applications. 37 Autumn-winter 2009/HesaMag #01 Special report 26/30
What is a nano-device?
Very tiny objects could be manufactured and inserted in the organs of the body for a specific purpose. They are small enough to enter the body, travel around, enter the cells and interact with DNA and proteins. Some examples of nano-devices or nano-implants are the so-called smart pills, organ replace- ments, neural interfaces, and brain implants. They would offer a good way to treat neurological dysfunctions, cancers and other diseases and disabilities.
Nano-devices might help to cure some diseases or deliver treatments; they could provide drug delivery, photodynamic therapy, or read the genetic code and detect errors. Other examples are titanium-bases micro-needles to control drug delivery, carbon nanotubes that trace the shape of the DNA and make a map, and quantum dots as sensors.
Their ability to penetrate cell membranes allows some nanoparticles to enter the human body, travel easily through the bloodstream and deposit in organs. Skin, lungs and the in- testine are likely to be the first entry route for such nanomaterials into the human body. Nano-applications, by contrast, are tiny devices deliberately inserted into the human body as a tool for tracking, diagnosis or treat- ment delivery without handling or exposure Nanomedicine opens up of the patient. untold prospects, but A big aim is to develop a single, multi- at what price for the integrity of humankind, purpose nano-device that will be able to as- personal free agency sist in imaging inside the body, recognize pre- and respect for privacy? Image: © Belga, NSP cancerous or cancerous cells, release a drug that targets only those cells, and report back on the effectiveness of the treatment. Nano-applications in humans should There are two key considerations when deliver a better quality of life and health, but implementing nano-devices. One relates to there are inherent risks in the development of the individual or patient who must specifical- any new technology. The ethical issues must ly consent to having the device implanted in be considered to gain a more rounded view of their body. The other is how the nano-device what the consequences might be, and how so- itself reacts once in the organism, its effects ciety can respond to them. Ethical concerns and safety. have been raised in the sphere of health care For the individual, the risks and adverse in relation to implanting nano-devices and outcomes of agreeing to a nano-implant raise the possibility for human enhancement of- issues of autonomy – control over one’s body fered by the use of nanotechnologies. – privacy, data protection, and informed con- 3. Freitas, RA 2005, sent. It also has wider societal implications, What is nanomedicine? Nano-implants in the human body raising questions of prudence and distribu- Nanomedicine: Nanotech. tive justice. Biol. Med. 1, p. 2-9. Nanotechnology could change the face On the technical side, the small size and of medical implants by allowing miniature complexity of nano-devices means that their 4. Freitas, RA 2005, devices to be further reduced in size and in- behaviour inside the human body may be Nanotechnology, serted in the human body to cure and repair unpredictable and uncontrollable, having un- nanomedicine and nanosurgery, International damaged cells using nano-materials that known effects that could cause a health prob- Journal of Surgery, Vol. 3, have improved biocompatibility and physi- lem. Future nanomaterials used in biomedical Issue 4, p. 243-246. ological integration with human tissue. applications must be biologically compatible, 38 Autumn-winter 2009/HesaMag #01 Special report 27/30
Lab-on-a-chip inside battle suits soldiers exposed to toxic agents and biological hazards by sampling one of their cells. The results Battlefield hospitals are not easily come by, so the can be available within 10 minutes. Institute for Soldiers Technologies based in Massa- chusetts, USA, is researching ways of improving the Another battle suit project is nano-enabled survival of soldiers in combat. Its exploration of the material and devices to far-forward medical treat- use of nanomaterials, has led it to develop laborato- ment and drug delivery, like splinting wounds ries on chips that will be fitted into battle suits. or preventing adverse movements after head or neck injury, and materials and devices to enable This lab-on-a-chip consists of nano-devices that controlled release of medication. carry out rapid, real-time medical monitoring of
5. Harris, J 2007, ment or any technology with health benefits Enhancing Evolution. The ethical case of making until we are in the position to provide equita- better people, Oxfordshire, ble and universal access. The more beneficial Princeton University Press. the technology, whether it be therapeutic or Professor John Harris, enhancing, the greater moral imperative for British philosopher at the wide and equitable access"5. The complexity University of Manchester, of the issue, however, lies in ensuring safety defends a libertarian (of treatments and effects) and universal ac- position on bioethical issues. cess, among other matters that must be ad- dressed in order to justify enhancements. Human enhancement means the aug- mentation, improvement, enrichment or addition of human functions, sensorial per- formances (physical and performance excel- as well as functional within biological fluids tions about health, life and humanness. New lence); the modification of physical appear- and tissues, mainly because some cannot be technologies that can act within the human ance (beauty perfection), the augmentation detected by the immune system, making it es- body make it possible to alter and eventually of memory or intelligence (cognitive enrich- sential that they behave safely. transform it in different ways. ment), or the improvement in mood and per- The implementation of nanotechnolo- Transcending the limitations of hu- sonality (greater contentment). gies in healthcare systems will be fairly com- manness to become a super-being has moved It may also involve the insertion of de- plex and costly, mainly because this technolo- from the realm of science to that of literature vices or human-machine interfaces and the gy requires expertise and precise biomedical and films. Modern writers like Mary Shel- extension of life, prolonging productive life equipment that may not be easily available. ley with Frankenstein (1818); Aldous Huxley and delaying the decline in faculties that ac- The question is, therefore, if nano-based with Brave New World (1932); George Orwell companies old age. treatments do become available for curing or with 1984 (1949) and Isaac Asimov’s Robot If the right technique is applied and the treating diseases, how many people would be series, have brought ideas of perfect societies complex scientific issues are overcome, hu- able to benefit from them? Will they be avail- or improved individuals into the popular con- man enhancement can be a real possibility. able to everyone? How many countries will be sciousness. On the big screen, films like The The best example is therapy. Generally speak- willing to implement this new technology in Boys from Brazil (1978); Gattaca (1997) and ing, the aim of a therapy is to cure or treat a their health systems and medical centres? The Island (2005) have also excited the public condition, while the aim of human enhance- These technologies will have far-reach- imagination with issues about communitar- ment is to improve the – generally, healthy – ing therapeutic uses of genuine potential ben- ian eugenics. organism above its normal capacities. A ther- efit, but it will be a small step to go far beyond Enhancing the body or mind could be apy may go further than its purposes of just treatment of disease or disability towards an seen as the ultimate goal for humans. A ma- curing a disease to become an enhancement end that faces society with another scenario – jor proponent of human enhancement, the by increasing the individual’s general capabil- that of enhancement. controversial British philosopher John Har- ities and health. For instance, it might be pos- ris, argues that the idea of improving humans sible to go from correcting eyesight to enhanc- Human enhancement is not just promising but should be seen as a ing vision outside of the normal parameters. duty. He argues that humans have the capacity Current thinking is around prospects Human enhancement – the idea of improv- to decide what enhancing techniques are best for enhancing memory, attention, muscle ing human characteristics and capacities – is for themselves, and emphasises that "there is strength, speed and sight. Other possible sce- a vast topic that embraces ethical considera- no moral case for delaying access to any treat- narios include boosting physical abilities to 39 Autumn-winter 2009/HesaMag #01 Special report 28/30
6. Jonas, H 1984, The achieve perfect performances in competitive Imperative of responsibility. sports, or endowing people with new capabil- In search of an ethics for ities by adding new genes to the DNA code or the technological age, eliminating "wrong" ones. Chicago, The University of One fear about nanotechnology-based It is not unfeasible that Chicago. enhancement is its scope for altering human DNA through a modification to the genetic over the long term, a code or gene expression which could remain in the DNA and be passed on down the gen- DNA modification could erations. These changes could have an impact on the genetic variability of human evolution. be handed down the It is still too soon to tell for sure what the effects of such interventions may be, but generations. it is not unfeasible that over the long term, a DNA modification could be handed down the The ethical debate generations, with no certainty as to whether and values, which would involve a complex it could be inherited safely or with errors of re-organisation of society. The issue of ethics in nanotechnology is not some kind. Whatever the outcome of the in- In a scenario where some individuals about future-gazing. The point of an ethical tervention, could the unwanted effects be were changed while others remained "natu- discussion is to develop a responsible attitude controlled, or the mistakes corrected? The ral", unchanged, society might become sub- towards the future of society and humanity concern is about the risk of modifying human divided into classes of human: the enhanced as a whole, enabling future generations to in- traits and even human nature – a step to be vs. the unenhanced; or the controllers and herit a better environment in a holistic sense. taken with caution. the controlled. So enhancement raises the is- The idea of a responsible future has Also, altering parameters in human sue of power, of the balance between the new been widely developed by Hans Jonas, a Ger- beings could change our understanding of technologies, individual choices and genetic man philosopher, in his critical theory of eth- what it is to be human – in sum, creating a tendencies. ical responsibility for including new technol- new conception of the human body, of health For planned design to take over from ogies in society, and the relationship of man and physical condition, and of the meaning the genetic lottery or natural traits could to modern technology, trying to anticipate of life. The end result could be a progressive subjugate certain human values that should the consequences of the technological choices redesigning of the human condition. New so- be preserved – strengthening the sense of re- that society makes: "ethics of the future"6. cial parameters will most probably require sponsibility, of what humans are, solidarity This article has offered some exam- changes to social organisation, laws, culture with others, and fostering society. ples of possible nanotechnology applications in health care. The power and complexity of these technologies means that the potential consequences need to be assessed to avoid harm and misuse. A nanowalker robot built with DNA Application of those techniques may in- volve many ethical issues, and the funding for New York University and China’s Nanjing University have developed a nano- nanotechnology projects must give weight to robot made of strands of DNA that walks on two legs each of ten nanome- the health and ethical aspects. Safety is cer- tres long. The robot reportedly has the ability to alter and exchange pieces tainly a major one. Are the risks measurable? of genetic code, because it is small enough to work on a molecular scale. The general concern is whether the technolo- gies will be safe in use, whether there are po- It measures approximately 150 x 50 x 8 nanometres; its legs are each 36 tential risks or unwanted effects, and what bases long and are linked to each other by DNA. To make the foot take hold steps would be taken to avoid misuse. of the sidewalk, researchers added a "set strand" — complementary to both It is not only patient awareness that strands — that zips the foot to the foothold. To make the robot walk, they needs to be raised – there is also concern then added an "unset strand" to unzip the foot. The released foot then about nurses and hospital staff who carry out grabs another set strand to move forward and zip up to its next hold on the various procedures involving high exposure track. A new set strand unzips the foot to allow it to step backwards. to radiation and hospital waste, for example. Some hospital personnel are routinely ex- The legs, called cassettes, store different pieces of information; while DNA posed to radiation on a daily basis. Specific has previously filled that niche, other species such as proteins and chemical exposure measures, information and ade- components could theoretically be placed in them. The niche could poten- quate training need to be provided for newly- tially serve as a factory for assembling the building blocks of new materials. developed nano-related therapies. With this capability, it has the potential to develop new synthetic fibres, ad- There is also a lack of knowledge about vance the encryption of information, and improve DNA-scaffolded computer chemical risks, because the physical phenom- assembly. But first, the researchers have to figure out how to make their tiny ena at nano-level are not yet fully understood. robot carry something, like a single atom. Research into nano-developments and tech- niques must address the need for nanomate- rials to be introduced safely into the human body, explore the interactions of biocompat- ibility and possible toxicity. The body of research publications on the possibility that some nanoparticles might penetrate the organs has led some scientists to propose that a database of health risks be 40 Autumn-winter 2009/HesaMag #01 Special report 29/30
we have to interfere with natural evolution, No-one should have the and to what extent can it be done – what are humans capable of? power to determine how All our actions and omissions have con- sequences for the future. Many international others should be, what declarations and agreements recognize the need to safeguard future generations. Our ac- traits they should have. tions may not be primarily directed towards harming successor generations, but they have the potential to affect them. This means tak- ing responsibility for what we do today, and not leaving others to pick up the cost. An ethical assessment of issues around nanotechnology applications will provide so- compiled, linking the different nanomateri- ciety with information, knowledge and tools als to their interaction, impact and possible to respond to possible perils. It will also help consequences on different cells, tissues or to construct a framework for assessing nan- organs. otechnologies and nanosciences. If these technologies are to be applied But preventive action may help people in health systems, there should be structural to manage their health and enhance their reforms of healthcare programmes to make quality of life by themselves. An individual’s them available to the community. Nanote- best chance of leading a healthy life comes chnologies should enable the delivery of bet- from the sense of responsibility of their own ter healthcare; the cost of nano-applications, well-being and lifestyle education. Nanotech- public and private research funding and risk nology development and the education of the assessment are issues here. public need to go hand in hand. Developing countries or regions that are The purpose of analysing ethical as- not benefiting from nanotechnology might pects of nanotechnologies is to develop aware- even need to be given help, in order to fur- ness and a critical approach to the possible ther the common good of humanity. But some benefits and risks of potential applications. regulation of this would be a wise precaution. One key issue is providing people with the One ethical issue under debate overlay- knowledge to give fully-informed consent to ing the economic impact is the possibility of a the nano-applications that might affect their widening social and economic divide caused health. Society must be able to have a holistic 7. Habermas, J 2003, The by access to these technologies. The hypoth- vision of the meaning of the human body, and future of human nature, esis of two species of humans was mentioned make choices about health and life. Cambridge. earlier, differentiating the technological • “haves” and “have-nots”. Questions of distributive justice, fair- ness and autonomy must be seriously ad- dressed. Individual selfhood is a complex Read more concept, embracing protection of the identity, self-determination, belonging and relation- — Berger, F et al. 2008, Ethical, legal and social aspects of brain-implants using ships, which are fundamental human rights. nano-scale materials and techniques, Nanoethics, 2. Where human identity is concerned, — HM Hoet, P, Brüshke-Hohlfeld, I et al. 2004, Nanoparticles- known and each human being has the right to have their unknown health risks, Journal of Nanobiotechnology, 2 (12). own characteristics, signifying that no-one — National Cancer Institute 2005, Understanding cancer series: nanodevices, should have the power to determine how oth-