The most vocal and unequivocal opponent of nanotechnology – the ETC group – has turned its attention to nanomedicine, with a new report Nanotech Rx taking a sceptical look at the recent shift of emphasis we’ve seen towards medical applications of nanotechnology. The report, though, makes more sense as a critique of modern medicine in general rather than making many specific points about nanotechnology. Particularly in the context of health in the third world, the main thrust of the case is that enthusiasts of technocentric medicine have systematically underplayed the importance of non-technological factors (hygiene, better food, etc) on improving general health. As they say, “the global health crisis doesn’t stem from a lack of science innovation or medical technologies; the root problem is poverty and inequality. New medical technologies are irrelevant for poor people if they aren’t accessible or affordable.” However, in an important advance from ETC’s previous blanket opposition to nanotechnology, they do concede that “nanotech R&D related to water is potentially significant for the developing world. Access to clean water could make a greater contribution to global health than any single medical intervention.”
The debate about human enhancement also gets substantial discussion, with a point of view strongly influenced by disability rights activist Gregor Wolbring. (Newcomers to this debate could do a lot worse than to start with the recent Demos pamphlet, Better Humans? which collects essays by those from a variety of points of view, including Wolbring himself.) ETC correctly identifies the crypto-transhumanist position taken in some recent government publications, and gets succinctly to the nub of the matter as follows: “Certain personality traits (e.g., shyness), physical traits (e.g., “average” strength or height), cognitive traits (e.g., “normal” intelligence) will be deemed undesirable and correctable (and gradually unacceptable, not to be tolerated). The line between enhancement and therapy – already blurry – will be completely obliterated. “ I agree that there’s a lot to be concerned about here, but the issue as it now stands doesn’t have a lot to do with nanotechnology – current points of controversy include the use of SSRIs to “treat” shyness, and modafinil to allow soldiers to go without sleep. However, in the future nanotechnology certainly will be increasingly important in permitting human enhancement, in areas such as the development of interfaces with the brain and in regenerative medicine, and so it’s not unreasonable to flag the area as one to watch.
Naturally, the evils of big pharma get a lot of play. There are the well publicised difficulties big pharma seems to have in maintaining their accustomed level of innovation, the large marketing budgets and the concentration on “me-too” drugs for the ailments of the rich west, and the increasing trend to outsource clinical trials to third world countries. Again, these are all very valid concerns, but they don’t seem to have a great deal of direct relevance to nanotechnology.
In the context of the third world, one of the most telling criticisms of the global pharmaceutical industry has been the lack of R&D spend on diseases that affect the poor. Things have recently changed greatly for the better, thanks to Bill and Melinda and their ilk. ETC recognise the importance of public private partnerships of the kind supported by organisations like the Bill and Melinda Gates foundation, despite some evident distaste that this money has come from the disproportionately rich. “Ten years ago, there was not a single PPP devoted to the development of “orphan drugs” – medicines to treat diseases with little or no financial profit potential – and today there are more than 63 drug development projects aimed at diseases prevalent in the global South.” As an example of a Bill and Melinda supported project, ETC quote a project to develop a new synthetic route to the anti-malarial agent artemisinin. This is problematic for ETC, as the project uses synthetic biology, to which ETC is instinctively opposed; yet since artemisinin-based combination treatments seem to be the only effective way of overcoming the problem of drug resistant malaria, it seems difficult to argue that these treatments shouldn’t be universally available.
The sections of the report that are directly concerned with those areas of nanomedicine that are currently receiving the most emphasis seem rather weak. The section on the use of nanotechnology for drug delivery section discusses only one example, a long way from the clinic, and doesn’t really make any comments at all on the current big drive to develop new anti-cancer therapies based on nanotechnology. I’m also surprised that ETC don’t talk more about the current hopes for the widespread application of nanotechnology in diagnostics and sensor devices, not least because this raises some important issues about the degree to which diagnosis can be simply equated to the presence or absence of some biochemical marker.
At the end of all this, ETC are still maintaining their demand for a “moratorium on nanotechnology”, though this seems at odds with statements like this: “Nanotech R&D devoted to safe water and sustainable energy could be a more effective investment to address fundamental health issues.” I actually find more to agree with in this report than in previous ETC reports. And yet I’m left with the feeling that, even more than in previous reports, ETC has not managed to get to the essence of what makes nanotechnology special.