Connecting public dialogue with policy in nanomedicine

This article was first published in Nature Nanotechnology 3, 578-579 (October 2008) doi:10.1038/nnano.2008.288 Full text (subscription required).

The development of nanotechnology as a separate discipline has coincided with some important shifts in thinking in the science studies field about the communication of science and the relationship of science, technology and society. Because of this, we’ve seen an unprecedented interest in coupling the development of this science and technology with public dialogue and engagement, even as the potential impacts of nanotechnology remain speculative. In countries across the world, we have seen consensus conferences, focus groups and citizens’ juries deliberating about these impacts. These efforts have not been without criticism . Given the breadth, even diffuseness, of nanotechnology as a field, and the wide range of potential impacts it has sometimes been difficult to maintain a focus and to find issues that people can get a purchase on, with the result that the recommendations can end up seeming, to some, disappointingly generic. In any case, the complex and decentralised nature of scientific decision-making sometimes makes it difficult to see how these deliberations actually make a concrete difference on policy. Finally, there is in parts of the scientific community an undercurrent of unease that the involvement of the public represents an unacceptable dilution of the autonomy of the scientific enterprise. The results of a new public engagement exercise on the subject of nanotechnology for healthcare, carried out in the UK, directly address some of these criticisms, and offer some surprising and enlightening insights into potential public reactions to some of the predicted applications of nanotechnology in medicine.

This public dialogue, whose report is now publicly available , was commissioned by the UK’s lead funding agency for nanotechnology, the Engineering and Physical Sciences Research Council, as part of a wider consultation to decide how to frame a call for funding in the area of nanotechnology for medicine and healthcare. The connection to a policy decision, then, was clear – EPSRC would be deciding to support one or two sub-themes of nanomedicine, and the decision on which areas to concentrate on would be informed by the results of the public dialogue, together with other inputs from the research community, industry representatives and clinicians. These other inputs also helped provide a more concrete framework for the public dialogue, allowing the public to be presented with a menu of six possible areas of application of nanotechnology to medicine and healthcare. This clearly allowed there to be a more focused and engaged discussion than has taken place in other public engagement exercises.

The report reveals a number of interesting insights. Here are just a few of the broad conclusions. Firstly, it’s very clear that medicine and healthcare are regarded as very high priority areas for the application of nanotechnology, and there is very broad public support for funding in this area. But within this context of broad support, there’s a definite and strong preference for technologies that empower people to have more control over their own health and their own lives, rather than technologies that are perceived as reducing autonomy. There is concern about who benefits; while people are generally not opposed in principle to the involvement of business and the private sector in developing new technology, there is a concern that public investments in science should result in true public value.

In addition to this sort of general message, the dialogues did provide a clear steer about the relative priorities of the six potential application areas of nanotechnology for healthcare. While positive features were found for all six areas that were discussed, taking into account the balance of benefits and concerns, a clear rank order emerged. The highest priority was for applications of nanotechnology for prevention and early diagnosis of disease, with better-targeted drug delivery for serious diseases coming second. The biggest misgivings were reserved for the idea of combining diagnosis and therapy in a single, automatic device – “theranostics” – which was perceived as being potentially disempowering.

There are some potential sources of contention in the interactions of nanotechnology with society, so it has in the past disappointed some activists of various kinds that previous engagement exercises have produced some rather anodyne conclusions. That doesn’t seem to be the case here – this is certainly a report that won’t please everybody. Scientists should be pleased both by the general level of support that the public seems to give the nanotechnology enterprise, and by a specific rejection of an overly precautionary approach -“Overall, there was a view that there were inherent risks involved in developing new technologies and that if we were too careful with the development of nanotechnology then this could lead to the field stagnating and losing impetus.” On the hand, the fears of loss of control and disempowerment prompted by the idea of “theranostics” emerged as an important example where the visions of some scientists and technologists don’t align with the public’s aspirations for new technology. These issues of control and agency are likely to be important in a number of other potential applications of technology (one thinks of the promise of autonomous cars, for example) and deserve more general consideration. Opponents of what they say of the “corporatization” of public science will take comfort in the strong belief that publicly funded science should yield commensurate public benefit, while those who believe that private sector/public sector partnerships are highly effective ways of delivering such benefit clearly need to make that case more strongly.

This dialogue, then, does overcome some of the criticisms levelled at previous exercises – by setting the dialogue in the context of some rather concrete questions explicitly linked to a policy decision, it did produce some interesting results that were of significant help in setting research priorities. What, then, about the broader worries about tensions between the involvement of the public in decision-making in science policy and the principle of the autonomy of the scientific enterprise? One answer, of course, is that it is right in principle that the public have a voice in the direction of an activity that involves considerable amounts of taxpayers’ money, and that these exercises may help provide some public legitimacy for potentially controversial areas of science. The more provocative suggestion is that in the kind of highly interdisciplinary, application oriented research that is exemplified by nanomedicine, taking the results of public engagement seriously may lead to significantly better decision-making. This is the proposition that now needs testing.

Richard Jones, who advises the EPSRC about nanotechnology, was a member of the steering committee for the Public Dialogue on Nanotechnology for Healthcare discussed here.

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