Tuesday, July 17, 2007

Berube on NANOMEDICINE and the PUBLIC

Here's the draft of a brief opinion piece I have been writing. All input is appreciated.

THE PUBLIC ACCEPTANCE OF NANOMEDICINE: A PERSONAL PERSPECTIVE

David M. Berube

This opinion piece is drawn from some work under consideration by the Public Communication on Science and Technology (PCOST) Project at North Carolina State University with which I am associated. It suggests lines of future research based upon observations from a review of the academic literature in the fields of applied nanoscience and risk studies.

It’s a blessing as well as a curse. Applied nanoscience or nanotechnology brings great opportunities, but at the same time it scares the bejebus out of some people. Exactly how and why many people are apprehensive about nanotechnology remain difficult to discern at this time. Given the inherent ambiguity of the word “nanotechnology” with its nearly infinite applications and the weaknesses of deliberative polling methodologies, any claim made regarding public attitudes about nanotechnology should be critically, if not skeptically, evaluated. Nevertheless, this hasn’t stopped some critics from speaking on the public’s behalf and voicing powerful concerns about precaution and uncertainty.

The question surfaces whether patient consumers (read as the public) will be reluctant to embrace nanomedicine. As argued below, there seems little likelihood the field of medicine will have as much difficulty as other non-health commercial industries. One of the reasons has to be the rigorous process drugs and devices undergo before they are marketed. While some may criticize the FDA for their failures in this area, comparative to other potential applications, FDA regulation is reasonably acceptable. When something slips through, there are always the lawyers. Companies in the drugs and devices world understand the potential liability issues associated with the products they market and generally act prudently. The public will embrace nanomedicine due to the sense of ease drawn from the regulatory purview of the FDA and potential litigation against those who market unsafe medical products. Below I argue there is an additional motivator: the fear of death.

My second argument detailed below is this: there is some likelihood that advances in the field of nanomedicine and the diagnosis and treatment of disease will ease the way for other non-health-related commercial applications. A variation of the psychological concept of transference will be at work here.

First, we examine the biases associated with medical developments and their introduction into commerce. The feeling is generally called necrophobia and it is the fear of death and dead things. Fear of death is a dense concept and includes fear of the dying process, of the dead, of being destroyed, for significant others, of the unknown, of conscious death, for body after death, and of premature death. While excessive fear of death may be socio-pathological, some fear of death is a survival mechanism for the species. It ranks first of all the phobias and is shared in some sense by almost everyone. This fear instigates care and caution. For most of us, it animates our efforts to avoid unnecessary and excessively risky activities.

There is some evidence this fear may be intrinsic to our species, but more easily defended is the concept that we are taught to fear death. Most religions separate life and afterlife into distinct categories and the transition from one to the other is mystical, if not traumatic. We see death portrayed by the media as sad and grief-laden, and some of us experience epiphanies following a disturbing death - often by someone very close to us.

Fear of death is an important variable in health care delivery.[1] There is even some evidence fear and denial of death among medical professionals and the public is the basis of the belief that prolongation of life is the predominant goal of medicine.[2]

The introduction of a new technology, exotic or familiar, which serves to prolong life taps into our fear of death and dying. Sating this apprehension makes the adoption of this technology, including nanomedicine, more likely against the same technology associated with some less essential application, like stronger automobile bumpers and better performing baseball bats.

Second, consider a troubling phenomenon often associated with the generation of polling data on preferences toward applications of nanotechnology. More respondents opine about nanotechnology than can define it.

This is not wholly surprising. We know from perception studies that populations wishing to provide positive feedback to a survey will offer opinions they feel are likely to be anticipated by the survey question. This produces a range of false positive and negative results depending on the survey question and general subject of the survey itself.

Moreover, when respondents become befuddled with a question, instead of admitting ignorance they draw from a set of sensibilities they feel are related to the subject of the question, a form of reasoning by analogy. Some have suggested that when asked about nanotechnology respondents will equate it with biotechnology and transfer their feelings about biotechnology to nanotechnology. Others suggest they transfer sensibilities about health and safety issues. Still others suggest environmental risks as a source for the transference.[3]

This form of transference is fundamental in lists of important heuristics in perception. These phenomena are derivative of research on representativeness and set theory, as well as the availability and anchoring biases. When making decisions, individuals over-rely on generalizing from classes, availability of instances and scenarios, and adjustment from an anchor.[4]

Focalism is another name for this effect, and it is loosely related to the fallacy of composition in logic. Some might want to call it simply a hasty generalization.

Another phenomenon called contagion has been part of the debate over nanotechnology for some time. Those of us who carefully watch public pronouncements about the risks associated with nanotechnology have noticed a rhetorical device surfacing aside demands for more research about the health and safety implications of nanotechnologies. Speakers and commentators have added a powerfully negative scenario. They claim the effect of a single serious health and safety event might be sufficient to produce a contagion effect. This effect assumes the entire gamut of businesses and industries engaged in nanotechnology applications will wither with attendant economic losses to a spate of stakeholders.

This phenomenon is incredibly dense and complex, whereby in some instances it is noticeable while in others it is not. In addition, there are some examples testing the power of the contagion effect. For example, contagion phenomena occurred neither with the release of Kleinman’s Magic Nano (which was responsible for over a hundred reported cases of respiratory distress in Europe last year) nor with the Samsung SilverCare product line allegedly related to waste treatment difficulties this year. However, both of these examples did not receive substantial media attention, hence they were not amplified. While the Johnson & Johnson Tylenol tampering case from 1982 is cited as a counter-example, the blame in this instance was not the business but a miscreant. Recently, the food and personal care industries seem to have weathered gales of their own: salmonella tainted fresh spinach, E. coli-tainted green onions, melamine-tainted pet foods and fish feed, and ethyl glycol (an anti-freeze ingredient) tainted toothpastes in 2006 and 2007 as well, though in these instances blame was equally unclear and dissipated across long supply lines.

Generally contagion refers to the spillover of the effects of shocks from one or more firms to other firms. Most studies of contagion limit their analysis to how shock affects firms in the same industry, or "intra-industry" contagion. Most of the studies on contagion attempt to differentiate between a "pure" contagion effect and a signaling or information-based contagion effect. An example of a pure contagion effect would be the negative effects of a bank failure spilling over to other banks regardless of the cause of the bank failure. An example of a signaling contagion effect would be if a bank failure is caused by problems whose revelation is correlated across banks, and the correlated banks are impacted negatively.

Evidence supporting intra-industry contagion is fairly common and comes from studies of the credit default market[5] and other financial institutions. Evidence supporting inter- or extra-industry contagion is mostly limited to the financial industry as well. For example, studies on banks and life insurance companies[6] demonstrate some cross-industry cascade phenomena. Evidence crossing industries as diverse as cosmetics and food production is nearly impossible to find, but nanotechnology may be the exception. While a contagion event across a diverse industry might be difficult to prove, it is clearly not impossible. Indeed, in terms of a newly emerging industry with unclear boundaries such as nanotechnology, it might be plausible.

We have already learned the deficit theory of science literacy is fallacious. Providing more information about science to a subject does not equate to a more positive feeling toward a scientific artifact, like nanotechnology per se. Noteworthy to some, a recent study suggested that more information actually reduces positive responses (see Kahan).[7] However, there is an equally strong case that information can affect feelings, especially when mediated.[8] While Kahan et al’s finding remains very consistent with the observation that merely mentioning risk of a phenomenon will increase apprehensions by raising its saliency may be true; on some level mediated information can attenuate some of the power of the effect.

One of the hypotheses we have been studying involves a variation on the anchoring bias. The first feeling one develops about a phenomenon or artifact tends to anchor subsequent assessments. A negative experience or anchor is very difficult to erase or reduce. A positive anchor is difficult to degrade, though less so. Essentially, there is a bias toward the negative. We argue when the public has a feeling which is not based on understanding but drawn from an analogue feeling (such as: nanotechnology is like biotechnology so how I feel about biotechnology is much like how I should feel about nanotechnology), we might be able to rehabilitate the antecedent. For the example mentioned above, if the public develops a positive feeling about nanotechnology, it might help rehabilitate a less than positive feeling about biotechnology. By extension, we sense that a positive experience with nanotechnology in the present will affect feelings about nanotechnology in the future as well.

While this hypothesis needs to be tested, we anticipate that some of the first authentic applications of nanotechnology will make this case. Many, if not most, of current product releases have involved the use of nanoparticles in coatings, e.g., paint, and as reinforcement when associated with another media, e.g., carbon composites. We expect nanomedicine will be perceived as actual nanotechnology and may be willing to go as far as suggesting nanomedicine products will be perceived as archetypal for nanotechnology based on public expectations of major and breakthrough technological development in the field of medicine in general.

Nanomedicine may help anchor public sentiment positively. This should have some positive effects on feelings toward the subsequent introduction of products in nanomedicine (intra-industry contagion). Given the public positive response to exotic health technologies, the positive public feelings for nanomedicine may transfer to subsequent applications of nanotechnology in health and even outside of health (inter-industry contagion). If the public embraces applicatiosn in nanomedicine, follow-up applications in the food industry may be positively affected as well.

In final extension, if respondents to surveys about nanotechnology opine without an understanding of what nanotechnology and draw the warrant for their opinion from an analogue, then a positive feeling toward nanomedicine might help to rehabilitate the feelings toward the relevant analogue, such as biotechnology or environmental health and safety in general.

While this needs to be studied, there is some anecdotal evidence this point of view is plausible. Global warming concerns are rehabilitating our feelings toward nuclear fission power generation[9], and advances in bioengineering less expensive pharmaceuticals may be rehabilitating our feelings toward genetically modified foods. Opposition to "introducing genetically modified foods into the US food supply" has declined from 58 percent in 2001 to 47 percent today, an 11-point decrease.[10] On the other hand, the public’s attitudes toward genetically modified foods seem to be inversely related with the evolutionary ladder hence efforts to genetically modify animals might exacerbate negative attitudes toward genetically modified crops.[11]

In conclusion, we predict nanomedicine products will be welcomed by the public as a stay against the fear of death and we find some solace in this prognostication based on public responses toward biomedicine, especially recent opinion shifts toward stem cell research.[12] Furthermore, we envision a positive feeling toward nanomedicine products will make later introductions of nanomedicine products even more welcomed by the public. Finally, we hypothesize a positive feeling towards nanomedicine products may carry over to nanoproduct lines from other industries, and a positive feeling toward nanomedicine products may rehabilitate past held beliefs toward analogical products and other related phenomena.



[1] See. Seravalli EP. (1988). The dying patient, the physician, and the fear of death. New England Journal of Medicine. 319:1728-1730.
[2] Meier, D. E., R. S. Morrison, and C. K. Cassel. Improving Palliative Care. (1997). Annals of Internal Medicine. 127:225-230.
[3] See Kahan, D. M., Slovic, P., Braman, D., Gastil, J. & Cohen, G. L. (2007). Affect, values, and nanotechnology risk perceptions: An experimental investigation. Nanotechnology Risk Perceptions: The Influence of Affect and Values. Washington, DC: Woodrow Wilson International Center for Scholars, Center Project on Emerging Nanotechnologies. http://www.nanotechproject.org/108/survey-finds-emotional-reactions-to-nanotechnology. (accessed March 7, 2007).
[4] See Tversky, A. and D. Kahneman. (1974) Judgment under Uncertainty: Heuristics and Biases. Science. September. 184: 1124-1131.
[5] Zhang, G. (1995). Intra-Industry Credit Contagion: Evidence from the Credit Default Swap Market and the Stock Market. EFMA 2004 Basel Meetings Paper. March 1. Available at SSRN: http://ssrn.com/abstract=492682.
[6] Brewer, E. and W. E. Jackson. (2002). "Inter-Industry Contagion and the Competitive Effects of Financial Distress Announcements: Evidence from Commercial Banks and Life Insurance Companies." December. FRB of Chicago Working Paper No. 2002-23. Available at SSRN: http://ssrn.com/abstract=367180 or DOI: 10.2139/ssrn.367180. (accessed July 13, 2007).
[7] See Kahan et al. Op. cit.
[8] See Pidgeon, N., R. E. Kasperson, and P. Slovic, eds. (2003). The Social Amplification of Risk, Cambridge, UK: Cambridge UP.
[9] See W. Sweet. (2006). Kicking the Carbon Habit – Global Warming and the Case for Renewable and Nuclear Energy. NY: Columbia UP.
[10] Pew Initiative on Food and Biotechnology. (1994). Americans' Opinions About Genetically Modified Foods Remain Divided, But Majority Want A Strong Regulatory System: New Focus Groups and Poll Echo Earlier Findings; Public Still Uncomfortable with Shift from Plants to Animals. November 24. http://pewagbiotech.org/newsroom/releases/112404.php3.
[11] Ibid.
[12] See M. Wooley and S. Probst. (2005). Public Attitudes and Perceptions About Health-Related Research. Journal of the American Medical Association. 294:1380-1384.

Tuesday, July 10, 2007

Berube is back and writing.


I am back from holiday and from my trip to Paris. I am writing a piece on fear of death and implications for nanomedicine and another piece (as you are well aware) on silver.

A colleague of mine heard about my silver article and shared with me the advert included to the right and it shocked everyone in the office.

I have every intention of getting the silver article out in a month and will need to include the product from the right.