ON ETC Group, NANOTECH RX: Medical applications of nanoscale... - MILDLY RECOMMENDED

ON ETC Group, NANOTECH RX: Medical applications of nano-scale technologies: What impact on marginalized communities? September 12, 2006 http://www.etcgroup.org/en/materials/publications.html?id=593 - MILDLY RECOMMENDED.

OK. Now you are thinking what's wrong with Berube, has he mellowed? No, he hasn't. Maybe ETC is growing up.

This publication has something worth reading. We have developed a lot of pharmaceuticals for Western diseases and we have done little for the diseases ravaging developing communities (p. 26). This is often made worse when we admit that a lot of the raw materials we use to build our pharmaceutical have come from the developing community, sometimes involving 20th century piracy of sorts. I want to add another - we are testing too many of our drugs in developing communities when the results offer too few benefits to the experimental subject communities. On these notes, ETC is on point.

The crux of this report is the concerns that medical innovations (like those ushered in by applied nanoscience) would "further concentrate the power of the pharmaceutical industry and have little relevance for addressing health and poverty in marginalized countries (p. 2)." I have a few problems with this thesis. First, I an unconvinced but for applied nanoscience the pharmaceutical industry would be less concentrated (weak antecedent). Second, I am not sure what role nanomedicine should play in poverty reduction per se. The fallacy of this claim mostly has to do with the fact that health and poverty reduction are not trade offs. While it might behoove us to do more to improve health in developing communities, it does not make sense to stop that initiative and focus on poverty reduction when both need to occur. In addition, there is little justification how advanced in nanomedicine are trading off with poverty reduction programs.

The authors are probably correct when they argues Big Pharma is still only collaborating with start-ups, but they could have added that start-ups are bought out by big corporations and that should lead to a concentrated nanopharma industry. There are reasons that may be good and bad though that is not examined.

I did enjoy that references to two companies having pulled "nano" from their names. While I have not verified this (and will), this phenomena could be important for lots of reasons, esp. avoiding the pall of risk associated with Magic Nano and even Samsung's NanoSilver products. By the way the two companies were allegedly Nanopaharma Corporation becoming Mersana Therapeutics and Nanocure to Avidimer Therapeutics (p. 6). There is a nice table on p. 6 on FDA Approved Nano Drugs/Medical Products (some of which I mentioned in an earlier blog).

I was less pleased having to reread the McKinlay minimal-impact thesis (pp. 10-11). Nice study and very interesting. While there is little doubt that poverty reduction and ensuing improvements in water quality and hygiene have a tremendous effect on health, we do get to a point when Western medicine does have an impact. The curve flattens on poverty reduction as antecedent to general health as which point the Western medicine variable kicks in. This reminds me of Ivan Illich's treatise Medical Nemesis (1976).

I was less impressed by the claims of increased reactivity of titanium dioxide (Veronesi, see earlier blog) and concluding they "can cause damage to brain microglia" (p. 12) without addressing exposure.

If you are interested in human enhancement and ethics, you might find pp. 14-22 interesting. We have a re-examination of Wolbring's ability-divide and a interesting list HyPE applications (I enjoyed their acronym HyPEs for human performance enhancement technologies for personal reasons mostly, see NanoHype 2006). In my book, I discuss some luxury applications of nanoscience, such as anti-balding therapies, etc.

On pp. 30-35, there is an interesting discussion on partnerships and orphan drug production. It include a review of a drug under development to fight malaria (artemisinin) and another as a microbicide for HIV/AIDS and other sexually transmitted diseases (Viva-Gel). Both of these are particularly relevant to developing communities. In both cases, the authors resort to fear mongering to make their point. They build a phantom of IP challenges to frustrate getting artemisinin to market and add whether it will be affordable. From my point of view, let's develop it and take our chances. There are other ways to deal with these issues than deciding not to develop the anti-malarial at all. Remarks notwitstanding, the table on p. 35 is every informative and addresses a subject that needs more explication here and elsewhere (I may get to it soon).

Pages 36-41 discuss some advances in nanomedicine which while in development for Western markets may have some developing community relevance.

I totally agree with ETC on the application of nanoscience for potable water in developing communities, but I don't think this is a case against nanotechnology per se (false dichotomy). The assumption is that "high-tech medical technologies can inadvertently push-aside existing, low-technology interventions" (p. 44) which while theoretically fascinating is anecdotally impoverished. I totaly disagree on the model of the precautionary principle as the basis for regulation and refer the reader to the Maynard article mentioned in one of the previous blogs. In terms of IP, we have a major problem that evades a simple solution. Industry needs an incentive to develop technologies. Government as technology incubator has not fared well and every dollar spent for technology may trade off with another spent elsewhere, like a poverty reduction program. North-South consultation and legally-binding multilateral approach to technology assessment while interesting not only needs further development but also a total change in philosophy and human sensibility, neither coming anytime soon.

We need to do many things simultaneously and it is ridiculously naive to assume an industry driven by the profit motive will become truly altruistic and develop technologies, like nanomedicine, for an unprofitable market. At best, industry will develop technologies for consumption and some trickle down will occur. Simultaneously, we need another mechanism to assist those markets which are capital-poor and that is the purvey of philanthropy and government. The negative income tax and income redistribution models have been shelved. We should not shelve nanotechnology because there are other things that need to be done unless nanotechnology is the reason those other things, like poverty reduction programs, are not happening.

Back to water, the carbon nanotubes used in filtering technologies in the West will have applications in developing communities. This constitutes a prime faciae case for trickle down. Is this enough? Of course, it is not. However, railing against all things nano will not necessarily do anything for the developing communities beyond Western markets.

I am reminded of Vonnegut's "Harrison Bergeron" (1961). [It is one of my favorite short stories]. The gist of the story is to flatten the curve in such as way that exceptionality is discouraged. This is achieved by handicapping the most intelligent, athletic or beautiful members of society down, a process central to the society which is overseen by the United States Handicapper General. For example, talented dancers wear ankle weights so not to embarrass average ones, etc. I vote for progress and exception and not for ETC's mission as Handicapper General.