The future of nanomedicine looks promising, but only if we learn from the past.

Abstract

The revolution in nanotechnology has brought with it a nanotechnological way of seeing the world. (1) By opening the black box of nanotechnology, scientists have changed the way we envision future developments in medicine, manufacturing, computing, and robotics, to name a few examples. However, much of the public, including physicians, are poorly prepared for this revolution, and require a new way of understanding these advances, assessing risks and benefits, and appreciating the potential impacts of nanomedicine on healthcare. In the field of nanomedicine, these issues will become particularly relevant due to the increasing politicisation of the nanotechnology debate, and subsequent calls for new regulations by non-governmental organisations and other concerned actors. (2) In short, the future of nanomedicine depends on the degree to which nanotechnology as a whole garners wide-scale public support. At this point in time, the risks and benefits associated with developments in nanomedicine are largely hypothetical and illustrative of larger questions that accompany new technological developments. Early developments in nuclear medicine and biotechnology provide us with lessons for assessing the likely impact of nanotechnology on medicine. The development of nuclear technology for military purposes during World War II changed dramatically the tone of the 20th Century. (3) Not only did the deployment of nuclear weapons by the United States of America end the war, but it ushered in a new era of international competition in the form of an arms race. Civilian applications of nuclear technology were developed in the 1950s and 1960s with the advent of nuclear reactors for electricity production, and with the development of radioisotopes and refinements in medical imaging technology. Although nuclear reactor developments have stalled in many parts of the world, the medical applications that came from an improved understanding of the atom occupy an important role in the history of medicine, and have generally been well-accepted by patients. This acceptance of nuclear medicine by patients, and physicians alike, has come about primarily due to the demonstrable benefits of this technology, and from a growing general acceptance of other technologies that expose us to different kinds of electromagnetic radiation (e.g., microwave ovens, cellular telephones, wireless internet). In the case of biotechnology, the story is somewhat different. Biotechnology has followed a more turbulent path. There are two main reasons why biotechnology has failed to capture wide-scale public support. (4) First, the benefit-to-risk ratio from innovations in agricultural biotechnology is poorly balanced for consumers. Consumers of genetically modified food have been offered food with traits that confer primarily herbicide-tolerance and insecticidal properties. The benefits of these technologies flow primarily to producers rather than consumers. Consequently, it should be of little surprise that consumers resist food that provides little direct benefit, and some level of risk (even if theoretical). Second, the public, especially in European countries where BSE (mad cow disease) became a public relations problem, continues to show a decline in trust in science and in governmental regulation. Trust is difficult to build and easy to lose. The development of innovations in biotechnology has been hampered by this lack of trust due to public concerns about the adequacy of the regulatory process, its openness and transparency, and potential conflicts of interest arising from government, industry and university partnerships. To avoid some of these pitfalls, developers and advocates of nanomedicine need to consider the following observations. A serious mistake made by many proponents of biotechnology was a failure to consider risk and benefit simultaneously. This mistake is especially prominent amongst industrial actors who hyped the benefits of the biotechnology revolution