Nanomedicine, Volume I: Basic Capabilities
© 1999 Robert A. Freitas Jr. All Rights Reserved.
Robert A. Freitas Jr., Nanomedicine, Volume I: Basic Capabilities, Landes Bioscience, Georgetown, TX, 1999
As already noted (Section 1.3.1), living things in general and the human body in particular are awesome examples of a powerful and intricately woven natural molecular technology to which human engineers, in 1998, still aspire. But embracing Nature is not the same as finding her perfect. Today, the word "natural" has acquired a strong connotation of rightness, even of sanctity. For most of human history, notes biologist Steven Vogel,2022 "the natural and human worlds stood opposed. Nature was something to be tamed and utilized; we had the ordinary attitude of organisms toward other species. Nowadays the natural world intrudes far less but gets venerated far more. And why not? When one's meat is bought in a store, when locusts don't threaten one's corn crop, when central heating and plumbing are the norm, the aesthetics of nature hold greater appeal." And so we embrace the natural rectitude or moral superiority of nature's ways, a kind of pantheism which may be called ethical naturalism,2299 biophilia,2296 or naturophilia.
Many great minds have fallen prey to naturophilia. In the 4th century BC, Aristotle wrote2297 that "if one way be better than another, that you may be sure is Nature's way." In the 15th century, we have from Leonardo da Vinci:2298 "Human ingenuity may make various inventions, but it will never devise any inventions more beautiful, nor more simple, nor more to the purpose than Nature does; because in her inventions nothing is wanting and nothing is superfluous."
However, as Virginia Postrel notes in The Future and Its Enemies:2299 "If nature is itself a dynamic process rather than a static end, then there is no single form of `the natural.' An evolving, open-ended nature may impose practical constraints, but it cannot dictate eternal standards. It cannot determine what is good. The distinction between the artificial and the natural must lie not in their source -- human or not -- but in their characteristics, in the way they relate to the world around them."
According to the dictionary, "artificial" usually means "made by man, rather than occurring in nature." More usefully, Herbert Simon2301 defines the artificial as that which is designed, expresses goals, and possesses external purposes. The artificial is controlled and serves its creators' purposes, subject to the universal laws of physics. Kevin Kelly381 defines the natural as "out of control." Nature is evolved, not designed, and serves no goal or external purpose save its own survival. Nature, lacking intent, is amoral -- it simply is.2299 By building the artificial, observes Postrel, "we do not overthrow nature, but cooperate with it, using nature's own art to create new natural forms. Our artifice alters the path of nature, but it does not end it, for nature has no stopping point, no final shape. It is a process, not an end."
Some naturophilist writers have decried the increasing "medicalization of society" in which formerly natural functions have come to be regarded as medical conditions requiring intervention or treatment.2204,2302-2308 However, history suggests that naturophilia is usually undermined by any new medical technology that offers clear, safe, and immediate benefits to patients. For example, prior to 1842, intense pain was viewed as the natural outcome of being cut with a scalpel during surgery. It had always been so -- how could it ever be otherwise? The invention of anesthesia in 1842 (Section 188.8.131.52.2) suddenly altered this natural outcome and replaced it with a less painful artificial outcome, despite anguished cries from naturophiles within the medical community that eliminating pain might somehow diminish the human character.
Another example of a widely-accepted medicalization of normal function is childbirth, a quite natural activity that can nevertheless be very dangerous to the mother's health. Precise prehistoric death rates are unknown, although archeological evidence shows that Neandertal females tended to die before the age of 30 due to hazards of childbirth.2339,2340 In the worst 19th century maternity hospitals the natural death rate from childbirth was 9-10%, falling to a very artificial 0.4% rate in England by 1930 and to less than 0.01% in the U.S. during the 1990s. As a result, it now seems "natural" for a woman always to survive childbirth, even though the reverse may have been true for most of human history. Warns historian Roy Porter:2204 "We should certainly not hanker after some mythic golden age when women gave birth naturally, painlessly, and safely; the most appalling Western maternal death rate today is among the Faith Assembly religious sect in Indiana, who reject orthodox medicine and practice home births; their perinatal mortality is 92 times greater than in Indiana as a whole."
A disease seems "natural" to those who suffer from it when no treatment exists. But once a treatment is discovered and is widely employed, the disease becomes rare and its absence now becomes "natural." To those in the past, writes K.E. Drexler,9 "the idea of cutting people open with knives painlessly would have seemed miraculous, but surgical anesthesia is now routine. Likewise with bacterial infections and antibiotics, with the eradication of smallpox, and the vaccine for polio: each tamed a deadly terror, and each is now half-forgotten history. What amazes one generation seems obvious and even boring to the next. The first baby born after each breakthrough grows up wondering what all the excitement was about." In the next century, says Charles Sheffield,343 "our descendants will look on angiograms, upper and lower GIs, and biopsies the way we regard the prospect of surgery without anesthetics."
Future generations who take for granted an all-pervasive nanomedicine in their lives may look aghast upon the 20th century, wondering among other things how we managed to retain productive focus given the constant annoyance of our numerous undiagnosed minor disease states. Most of these diseases are not yet recognized as such, and many are still regarded as "natural" and not worthy of treatment. In a few decades, this may change. Some examples:
1. Addictions -- In 1998, many people laugh off seemingly harmless addictions to chocolate (chocoholics), fats or sugar (sweet tooth), food (gluttony), nicotine (smokers), caffeine (coffee and cola drinkers), work (workaholics), exercise (runner's high), telling falsehoods (pathological liars), gambling (wagerphilia), stealing (kleptomania), medical treatments (hypochondria), marriage (polygamy), power-seeking (domination), skydiving or bungee-jumping (thrillseeking), superstition (astrology), shopping (spendoholics), driving cars that kill 40,000 Americans per year (mobilophilia), unusual sexual preferences (bestiality), sexual activity (nymphomania, satyriasis), or pregnancy (gravidophilia). Without making any value judgements, it is highly likely that most or all of these addictions have genetic or physiological components which, once properly modified, can greatly reduce or eliminate the addiction if so desired. Many on the list are already suspected to have genetic components, much like schizophrenia, drug abuse, bulimia, and alcoholism (dipsomania).
2. Allergies and Intolerances -- A food allergy2997 is an allergic reaction to a particular food, although true food allergies are much rarer than is generally believed.1604 In the cases of milk, eggs, shellfish, nuts, wheat, soybeans, and chocolate, sufferers may lack an enzyme necessary for digesting the substance. In other cases, dust particles, plant pollens, pet danders, drugs, or foods may be allergens for natural IgE-mediated immunosensitivity. Intolerance, a much more common condition, is any undesirable effect of eating a particular food, including gastrointestinal distress, gas, nausea, diarrhea, or other problems. Urticaria (hives), angioedema and even mild anaphylaxis are common reactions to various drugs, insect stings or bites, allergy shots, or certain foods, particularly eggs, shellfish, nuts and fruits. Physical allergies to ordinary stimuli such as cold, sunlight, heat, pollen, pet dander, or minor injury can produce itching, skin blotches, pimples, and hives.
3. Minor Physical Annoyances -- In a world where most major medical maladies are readily treated, numerous minor medical conditions which today escape our notice will rise up from obscurity and present themselves annoyingly to our conscious minds, demanding attention. These conditions may be of several kinds. First is cosmetics, including small moles, freckles and blemishes on the skin; broken fingernails or unevenly-growing cuticles; minor skin reddenings or pimples; old childhood scars, wrinkled skin, birthmarks or stretch marks; unwanted hair growth in unusual places, or differential hair color or texture growing in patches; fingerprint patterns that are aesthetically unappealing; and mismatched leg lengths, hands with different left/right ring sizes, an asymmetrical face, or lopsided breasts. Second is minor aches and pains, which may include headaches; eyebrow hairs trapped in the eyeball conjunctiva; bent-hair pain (folliculalgia); dyspepsia; creaking limb joints and stomach growling; ingrown nails and hairs; earwax plugs and temporary tinnitis; chapped lips, canker sores and heat rashes; stuffy nose or gritty eyes upon rising in the morning; dermal chafing marks from elastic bands in clothing; minor flatulence; PMS (premenstrual syndrome); a leg or arm "falling asleep" in certain postures; nervous tics, itches, and twitches; uncracked knuckles, stiff neck, or backache; blocked middle ear following descent from high altitude; restless leg syndrome (akathisia); rotationally-induced dizziness, as on an amusement park ride; or rock-and-roll neck, wherein active musical performers or listeners bob their heads violently, rupturing small blood vessels in the neck. Third is minor physical or functional flaws, such as poor stream during male urination, female papillary leakage, colorblindness, snoring, unpleasant body odors, nosebleeds, declining visual or aural acuity, handedness (currently ~90% dextromanual, ~10% sinistromanual,3136,3137 mild strabismus (eyeball misalignment), bad moods (neurotransmitter imbalances), or post-intoxication hangover.
4. Undiscovered Infectious Agents -- Peptic ulcers once were thought to result from a stressful life, a purely natural response to a lifestyle choice. Then it was found that the major cause of ulcers is the presence of Helicobacter pylori bacteria in the stomach. Bacteria have been implicated in some cases of atherosclerosis2970 and Alzheimer's disease,2971 and nanobacteria have been proposed as possible nucleation sites for kidney stones.2149 Other seemingly natural but undesirable conditions may also be due to undiscovered microbial agents,3237 especially since bacteria outnumber tissue cells in our highly infested 20th century bodies by more than 10:1 (Section 8.5.1).
5. Unwanted Syndromes -- Syndromes are groups of related symptoms and signs of disordered function that define a disease whose cause remains unknown, that is, idiopathic. A good example is irritable bowel syndrome (IBS), which affects up to 20% of the adult U.S. population and includes symptoms of abdominal distention and pain, with more frequent and looser stools. Many are unaware they are afflicted. In 1998 there was no known cause or simple complete treatment for this still "natural" disease.3713-3717 Even more mysterious than IBS is our general activity level -- some people seem to have high-energy personalities, while others have more phlegmatic low-energy personalities. Either may be regarded as "natural," but nanomedicine can probably bring this ill-defined neurophysiological variable under human control. The need to sleep is another imperfectly understood syndrome. It is experienced by everyone and thus was universally regarded as "natural" in the 20th century. Physiological short sleepers2122 were unusual, insomnia or asomnia3273 was thought of as an abnormal state, and there were a few anecdotal but medically undocumented instances of total nonsomnia, such as the celebrated case of Al Herpin.2312
6. Psychological Traits -- Psychological traits which, if identified by a patient as undesirable, might be subject to genetic or physiological modification could include: sexual preference (6-10% of the adult population is homosexual);1604 shyness or boldness;2332 acquisitive or altruistic propensity; misanthropy or philanthropy; theistic or atheistic orientation; loquacity or dourness; childhood imprinting; criminal propensity (up to 1-5% of the population); various recognized personality disorders that affect ~10% of the population2122 such as antisocial, paranoid, schizotypal, histrionic, narcissistic, avoidant, dependent, obsessive-compulsive, and passive-aggressive disorders; panic attacks (experienced at least once by ~33% of all adults each year);1604 and phobic disorders such as social phobias (~13% of the population), specific phobias including fear of large animals (zoophobia), snakes (ophidiophobia), spiders (arachnophobia), needles (belonephobia,3272 ~10%), the dark (noctiphobia or scotophobia), or strangers (xenophobia) (total ~5.7%), the fear of blood or hemophobia (~5%), agoraphobia (~2.8%),1604 and other unusual phobias2223 such as the fears of certain colors (chromophobia), daylight (phengophobia), girls (parthenophobia), men (androphobia), stars in the sky (siderophobia), the number thirteen (triskaidekaphobia), and even the fear of developing a phobia (phobophobia).
The above sampling of minor afflictions, almost all considered "natural" in 1998, may come to be regarded as commonplace correctable medical conditions in the nanomedical era. By the time such petty annoyances are deemed worthy of immediate treatment, biotechnology and nanomedicine already will have defeated the most fearsome illnesses of the late 20th century2310 and will have moved on to other challenges.2311,2864,2973 Naturophiles may dissent, but the emerging trend from medical biotechnology is to characterize health, not as a static standard, but rather as a condition defined by the lives that people want to lead. Affirming the volitional normative model of disease (Section 1.2.2), Virginia Postrel concludes:2299
"Different goals will produce different choices about trade-offs and standards. What makes a condition unhealthy is not that it is unnatural but that it interferes with human purposes. Revering nature [would mean] sacrificing the purposes of individuals to preserve the world as given. It [would require] that we force people to live with biological conditions that trouble them, whether diseases such as cystic fibrosis or schizophrenia, disabilities such as myopia or crooked teeth, or simply less beauty, intelligence, happiness, or grace than could be achieved through artifice. In a world where it's no big deal to take hormone therapy, Viagra, or Prozac, to have a face lift, or to know a child's sex before birth, a world in which even such radical interventions as sex-change operations and heart transplants have failed to turn society upside down, it is extremely difficult to argue that medical innovations are dangerous simply because they fool Mother Nature."
Last updated on 5 February 2003