An Aug. 1, 2014 article by Guizhi Zhu (University of Florida), Lei Mei ((Hunan University; China), and Weihong Tan (University of Florida) for The Scientist provides an overview of the latest and greatest regarding nanomedicine while underscoring the persistence of certain medical metaphors. This overview features a prediction and a relatively benign (pun intended) metaphor,
Both the academic community and the pharmaceutical industry are making increasing investments of time and money in nanotherapeutics. Nearly 50 biomedical products incorporating nanoparticles are already on the market, and many more are moving through the pipeline, with dozens in Phase 2 or Phase 3 clinical trials. Drugmakers are well on their way to realizing the prediction of Christopher Guiffre, chief business officer at the Cambridge, Massachusetts–based nanotherapeutics company Cerulean Pharma, who last November forecast, “Five years from now every pharma will have a nano program.”
Technologies that enable improved cancer detection are constantly racing against the diseases they aim to diagnose, and when survival depends on early intervention, losing this race can be fatal. [emphasis mine] While detecting cancer biomarkers is the key to early diagnosis, the number of bona fide biomarkers that reliably reveal the presence of cancerous cells is low. To overcome this challenge, researchers are developing functional nanomaterials for more sensitive detection of intracellular metabolites, tumor cell–membrane proteins, and even cancer cells that are circulating in the bloodstream. (See “Fighting Cancer with Nanomedicine,” The Scientist, April 2014.)
So, the first metaphor ‘racing’ gives the reader a sense of urgency, the next ones, including “fighting cancer’, provoke a somewhat different state of mind,
Eye on the target
The prototype of targeted drug delivery can be traced back to the concept of a “magic bullet,” proposed by chemotherapy pioneer and 1908 Nobel laureate Paul Ehrlich. [emphasis mine] E[hrlich envisioned a drug that could selectively target a disease-causing organism or diseased cells, leaving healthy tissue unharmed. A century later, researchers are developing many types of nanoscale “magic bullets” that can specifically deliver drugs into target cells or tissues.
It would seem we might be in a state of war as you ‘fight cancer’ with your ‘eyes on the target’ as you ‘shoot magic bullets’ in time to celebrate the 100th anniversary of the start to World War I.
Kostas Kostarelos wrote a Nov. 29, 2013 posting for the Guardian Science Blogs where he (professor of nanomedicine at the University of Manchester and director of the university’s Nanomedicine Lab) discussed war metaphors in medicine and possible unintended consequences (Note: A link has been removed). Here’s his discussion about the metaphors,
Almost every night I have watched the news these past few months my senses have been assaulted by unpleasant, at times distressing, images of war: missiles, killings and chemical bombs in Syria, Kenya, the USA. I wake up the next morning, trying to forget what I watched the night before, and going to work with our researchers to develop the next potential high-tech cure for cancer, thinking: “does what we do matter at all … ?”
So I was intrigued by an article that will be published in one of the scientific journals in our field entitled: “Nanomedicine metaphors: from war to care”. The next lab meeting we had was very awkward, because I was constantly thinking that indeed a lot of the words we were using to communicate our science were directly imported from the language of war. Targeting, stealth nanoparticle, smart bomb, elimination, triggered release, cell death. I struggled to find alternative language.
… Hollywood analogies and simplistic interpretations about “good” and “bad” may be inaccurate, but they do seem appropriate and convincing.
I must say, however, that even in pathology, modern medicine increasingly considers the disease to be part of our body, often leading to successful treatment not by “eradication” and “elimination” but by holistic management of a chronic condition. The case of HIV therapeutics is perhaps the brightest example of such revisionist thinking, which has transformed the disease from a “death sentence” in the early years after its discovery to a nonlethal chronic infection today.
Kostarelos then contrasts the less warlike ‘modern medicine’ metaphors with nanomedicine,
In nanomedicine, which is the application of nanotechnologies and nanomaterials to design medical treatments, the war imagery is even more prevalent. Two of the most clinically successful and intensively studied technologies that operate at the nanoscale are “stealth” and “targeted” medicines. “Stealth” refers to a hydrophilic (water-loving) shield built around a molecule or nanoparticle, made from polymers, that minimises its recognition by the body’s defence mechanisms. “Targeting” refers to the specific binding of certain molecules (such as antibodies, peptides and others) to receptors (or other proteins) present only at the surface of diseased cells. The literature in nanomedicine is abundant with both “stealthing”, “targeting” and combinations thereof.
Kostarelos then asks this question,
The question I keep asking myself since I read the article about war metaphors in nanomedicine has been whether we are using terminology in a simplistic, single-minded manner that could stifle creative and out-of-the-box thinking.
Intriguing unintended consequences, yes?
Getting back to The Scientist article, which I found quite informative and interesting, its ‘war metaphors’ seem to extend even to some of the artwork accompanying the article,Is that a capsule or a bullet? Regardless, this * article provides a good overview of the research.
* The word ‘a’ was removed on Aug. 8, 2014.