Skip to main content
SpringerLink
Log in

Freitas on Disease in Nanomedicine: Implications for Ethics

  • Original Paper
  • Published:
NanoEthics Aims and scope Submit manuscript

Abstract

This paper critically examines the volitional normative model of disease and its underlying nanotechnologic vision of medicine both defended by Robert Freitas. Having provided an account of this vision, we explicate the highlight of the model, which is a concept of disease based on individual values and preferences. The model’s normative positions are then critiqued based on our argument that the epistemic basis of Freitas’s vision of nanotechnologic medicine and, by extension, of his volitional normative model of disease is scientifically flawed. An ethical and social critique of the model is then conducted on the basis of the model’s implicit ethical underpinnings. We argue that Freitas fails to justify the normativity of his model by not addressing the ethical issues that permeate it, one of which is the question of responsibility regarding the development of medical nanotechnology and the practice of new forms of medicine such as the one he envisions. We conclude that, due to its radically individualistic position, the model implies an unjustified view of nanoethics and relegates this field of ethics to the periphery of discussions of nanomedicine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. Nanotechnology is the collective term for a number of technologies that utilize the unique properties of material structures at a length scale of 1–100 nm (a nanometer is one-billionth of a meter) to engineer, manipulate and manufacture materials at that scale (i.e., at the atomic, molecular or macromolecular levels). [22]: 3, 13

  2. Freitas defines nanomedicine as ‘the application of nanotechnology to medicine,’ and specifically, as ‘the process of diagnosing, treating, and preventing disease and traumatic injury, relieving pain, and preserving and improving human health, using molecular tools and molecular knowledge of the human body.’ [17]: 2

  3. In any case, Freitas’s definition of nanomedicine does not (explicitly) include monitoring capabilities. As we discuss later, monitoring systems are interesting because of their important ethical and health policy implications connected with the values of patient autonomy and privacy.

  4. It is worth noting that, according to Freitas, ‘molecular technologic medicine’ grows out of ‘molecular scientific medicine,’ the (current) historical stage in medicine’s development, which is characterized by vigorous scientific investigation of disease causation at the molecular level and the growth of fundamental knowledge of the body. [18]: 162

  5. According to Freitas new chromosomes will be ‘manufactured to order, outside of your body…Your individual genome is used as the blueprint.’ (An individual’s genome is the total sum of his/her hereditary information encoded in the individual’s DNA—with the exception of certain types of virus whose genome is encoded in RNA.) [18]: 164

  6. A phenotype is a property that is actually observed in an organism, and genotype is the organism’s full genetic makeup or DNA structure (i.e., an individual’s genome) which provides the genetic instructions for the production of the individual’s set of phenotypes.

  7. ‘Comprised’ is Freitas’s problematic word choice reflective of a reductionist approach to the human body’s constitutive parts that matter for Freitas, i.e., only proteins. However, to be biologically (and linguistically) accurate, the body is also comprised of other important parts, i.e., lipids, carbohydrates, nucleoproteins and other molecules, which Freitas only mentions in passing earlier in the paper. [18]: 162

  8. The referent of ‘molecular reference structures’ is never clarified in Freitas’s paper, yet the context makes it safe to infer that the term applies to the catalogued protein molecules of the human body.

  9. The genotype–phenotype relationship is thus crucial in deciding health and disease on the volitional normative model, but only on this abstract, theoretical level. In section II we will see that the biological complexities involved in this relationship are not sufficiently taken into consideration.

  10. Biological systems should be thought of as entire organisms or major systemic structures of organisms, or, in the relevant case of medical interest, individual human beings.

  11. The intuition of disease as a systems failure, which Freitas mentions comes from Nick Bostrom, means ‘a failure of a system to perform in the mode that is one of the system’s operating modes’ and, to place it in the context of the volitional normative model of disease, this failure refers to ‘the particular mode that the subject informedly prefers.’ [18]: 169

  12. Functional failure accounts are well recognized in the literature on theories and concepts of disease including those of Agich, Boorse, deVito, Engelhardt, and Nordenfelt [2, 3, 10, 13, 15, 23].

  13. Controversies over community attitudes and values in the ascription of disease language are legion, but they are overlooked by Freitas who privileges individual choice over other considerations. Examples include the controversy over cochlear implants [32] as well as the inclusion of premenstrual syndrome ([1]; [24]; [25]; [29]: 227–230) and homosexuality ([8]; [29]: 204–210; [30]) within the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM).

  14. In this discussion, the normative priority of volition is highlighted by the person’s intention to commit suicide (a case of no disease ascription) as well as by his desire to seek an antidote, a case of becoming ‘voluntarily diseased’ (our italics). Nowhere does Freitas acknowledge that individual autonomy, which is the principle underlying voluntary disease, is a contested norm fraught with many problems in its application in ethical theory and applied ethics. [18]: 168–9

  15. Suffice it to simply mention that the major stages of gene expression—transcription and translation—are both preceded by a dynamic remodeling of DNA that exposes the genes that will be expressed. For a thorough discussion of the gene expression stages, see Watson et al. [33]

  16. For a discussion of genetic mapping in human disease, see Altshuler, Daly and Lander [4].

  17. The normal human body contains ten times more microbial cells than human cells, representing hundreds of different species, and these microbiomes are essential for the body’s nutrition and in preventing colonization by pathogenic agents. For a discussion of an exemplary microbiome and the co-evolved biological mutualism between it and the human intestine, see Bäckhed et al. [5]

  18. See note 9

  19. In his brief list of errors that may influence protein synthesis, Freitas mentions ‘exogenous error’ explained as ‘external interference by disease agents with the design or execution of the biological program,’ but never ponders on how this important problem can be resolved by simply taking into account molecular reference structures. [18]: 167

  20. An additional skepticism about these engineering–based therapeutic aspirations involves the extreme difficulty involved in the self-assembly of complex nanorobotic systems. Freitas recognizes this issue but quickly discharges it based on theoretical feedback generated via computational models and only one experimental case of assembling a silicon–based nanomechanism. [18]: 162–3

  21. In the concluding sentence of his paper, Freitas concedes that ‘societal conflict resolution laws, institutions, and traditions will need beefing up.’ [18]: 170

  22. Note 21 alludes precisely to this point.

  23. Freitas uses this example to make an autonomy–related point concerning the individual’s capacity to understand pertinent information about the implications of his choices, except that there is hardly a trace of an informed consent discussion in the example. [18]: 168

  24. Only at the end of his paper does Freitas acknowledge ‘the interesting question’ in ‘the relationship between the desires of the individual and the need for public safety’ by simply remarking that it is ‘a policy matter.’ [18]: 169

  25. Freitas observes, in passing, that ‘The new disease model, if applied to nanomedicine, might make it easier for one person’s desired functioning to come into conflict with another person’s desired functioning,’ but that such a problem should be relegated to societal conflict resolution laws and institutions. [18]: 170

  26. Improper decisions, in Freitas’s view, are due to unconscious states, young age, or irrational desires, especially as reflected in individuals’ favoring ‘increasingly “unnatural” elective nanomedical interventions,’ in which case some kind of action (that Freitas does not define) should be taken. [18]: 168–9

References

  1. Abplanalp J (1983) Premenstrual syndrome: a selective review. In: Golub S (ed) Lifting the curse of menstruation: a feminist appraisal of the influence of menstruation on women’s lives. The Haworth, New York, p 107

    Google Scholar 

  2. Agich GJ (1983) Disease and value: a rejection of the value–neutrality thesis. Theor Med 4:27–41

    Article  Google Scholar 

  3. Agich GJ (1997) Toward a pragmatic theory of disease. In: Humber JM, Almeder RF (eds) What is disease? Humana, Totowa, pp 221–246

    Google Scholar 

  4. Altshuler D, Daly MJ, Lander ES (2008) Genetic mapping in human disease. Science 322:881–888

    Article  Google Scholar 

  5. Bäckhed F, Ley RE, Sonnenburg JL, Peterson DA, Gordon JL (2005) Host–bacterial mutualism in the human intestine. Science 307:1915–1920

    Article  Google Scholar 

  6. Bainbridge WS et al (2006) Ethical considerations in the advance of nanotechnology. In: Foster LE (ed) Nanotechnology: science, innovation and opportunity. Prentice Hall PTR, Upper Saddle River, pp 233–245

    Google Scholar 

  7. Bawa R, Johnson S (2007) The ethical dimensions of nanomedicine. Med Clin North Am 91:881–887

    Article  Google Scholar 

  8. Bayer R (1981) Homosexuality and American psychiatry: the politics of diagnosis. Basic Books, New York

    Google Scholar 

  9. Boenink M (2009) Molecular medicine and concepts of disease: the ethical value of a conceptual analysis of emerging biomedical technologies. Med Health Care Philos 13:11–23

    Article  Google Scholar 

  10. Boorse C (1977) Health as a theoretical concept. Philos Sci 44:542–573

    Article  Google Scholar 

  11. Breggin L, Carothers L (2006) Governing uncertainty: the nanotechnology environmental, health, and safety challenge. Columbia J Environ Law 31:285–329

    Google Scholar 

  12. Brune H, Ernst H, Grunwald A et al (2006) Nanotechnology: assessment and perspectives (ethics of science and technology assessment). Springer – Verlag, Berlin

    Google Scholar 

  13. deVito S (2000) On the value–neutrality of the concepts of health and disease: unto the breach again. J Med Philos 25:539–567

    Article  Google Scholar 

  14. Dupuy J-P (2007) Some pitfalls in the philosophical foundations of nanoethics. J Med Philos 32:237–261

    Article  Google Scholar 

  15. Engelhardt HT Jr (1981) The concepts of health and disease. In: Caplan AL, Engelhardt HT Jr, McCartney JJ (eds) Concepts of health and disease: interdisciplinary perspectives. Addison-Wesley, Houston, pp 31–45

    Google Scholar 

  16. Feynman R (1960) There’s plenty of room at the bottom. Engineering and Science 23:22–36

    Google Scholar 

  17. Freitas AR Jr (2005) What is nanomedicine? Nanomed Nanotechnol Biol Med 1:2–9

    Article  Google Scholar 

  18. Freitas AR Jr (2007) Personal choice in the coming era of nanomedicine. In: Allhoff F, Lin P, Moor J, Weckert J (eds) Nanoethics: the ethical and social implications of nanotechnology. John Wiley & Sons, Inc., Hoboken, pp 161–172

    Google Scholar 

  19. Khushf G (2007) An agenda for future debate on concepts of health and disease. Med Health Care Philos 10:19–27

    Article  Google Scholar 

  20. Lenk C, Biller-Andorno N (2007) Nanomedicine – emerging or re-emerging ethical issues? Med Health Care Philos 10:173–184

    Article  Google Scholar 

  21. Minard ME, Jain AK, Barton MC (2009) Analysis of epigenetic alterations to chromatin during development. Genesis 47:559–572

    Article  Google Scholar 

  22. National Research Council of the National Academies (2009) Committee for review of the federal strategy to address environmental, health, and safety research needs for engineered nanoscale materials. Review of the federal strategy for nanotechnology–related environmental, health, and safety research. The National Academies Press, Washington, DC

    Google Scholar 

  23. Nordenfelt L (2007) The concepts of health and illness revisited. Med Health Care Philos 10:5–10

    Article  Google Scholar 

  24. Offman A, Kleinplatz PJ. (2004) Does PMDD belong in the DSM? Challenging the medicalization of women’s bodies. The Canadian Journal of Human Sexuality 13(1):17–24

    Google Scholar 

  25. Richardson JTE (2004) The premenstrual syndrome: a brief history. In: Caplan AL, McCartney JJ, Sisti DA (eds) Health, disease, and illness: concepts in medicine. Georgetown University Press, Washington, DC, pp 176–186

    Google Scholar 

  26. Roco MC (2003) Nanotechnology: convergence with modern biology and medicine. Curr Opin Biotechnol 14:337–346

    Article  Google Scholar 

  27. Roco MC (2005) Converging technologies: nanotechnology and biomedicine. In: Malsch NH (ed) Biomedical nanotechnology. Taylor & Francis, London, pp xi–xix

    Google Scholar 

  28. Roco MC, Bainbridge WS (2003) Converging technologies for improving human performance: nanotechnology, biotechnology, information technology and cognitive science. Kluwer Academic, Dordrecht

    Google Scholar 

  29. Sadler JZ (2005) Values and psychiatric diagnosis. Oxford University Press, Oxford

    Google Scholar 

  30. Spitzer RL (1981) The diagnostic status of homosexuality in DSM–III: a reformulation of the issues. Am J Psychiatry 138:210–215

    Google Scholar 

  31. Thomas K, Sayre P (2005) Research strategies for safety evaluation of nanomaterials, Part I: evaluating the human health implications of exposure to nanoscale materials. Toxicol Sci 87:316–321

    Article  Google Scholar 

  32. Tucker BP (1998) Deaf culture, cochlear implants, and elective disability. Hastings Cent Rep 28:6–14

    Google Scholar 

  33. Watson J et al (2008) Molecular biology of the gene, 6th edn. Pearson/Benjamin Cummings, San Francisco

    Google Scholar 

Download references

Acknowledgments

This research was supported, in part, by a National Science Foundation Sub-Grant from the Center of Nanoengineering of Polymeric Biomedical Devices at Ohio State University.

The authors wish to thank Neocles Leontis for his feedback on their biological account of gene expression/protein synthesis and two anonymous reviewers of the journal for their encouragement and valuable criticism.

Author information

Authors and Affiliations

  1. Bowling Green State University, Bowling Green, OH, USA

    Vassiliki L. Leontis & George J. Agich

Authors
  1. Vassiliki L. Leontis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George J. Agich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vassiliki L. Leontis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leontis, V.L., Agich, G.J. Freitas on Disease in Nanomedicine: Implications for Ethics. Nanoethics 4, 205–214 (2010). https://doi.org/10.1007/s11569-010-0092-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11569-010-0092-9

Keywords

Search

Navigation