Abstract

The progressive growth in nanotechnology approaches to diagnostics and therapeutics, especially for cancer, necessitates training physicians in nanoethics. This article explains why it is critical for medical education to include instruction in nanotechnology, nanomedicine, nanotoxicology, and nanoethics and suggests basic concepts educators can use to infuse curricula with this content.

Introduction

As it continues to evolve to meet the needs of the next generation of clinicians, medical education should incorporate new interventions and diagnostics, among them nanotechnology applications. Nanotechnology is a science built on fundamental changes in material properties because of unique chemical, physical, mechanical, and optical properties that occur when particle size falls into the nanorange. The nanoscale ranges from 1 to 100 nm, as that is the size at which many of the special properties particular to the nanoscale arise, although most unique properties arise below 30 nm.¹ However, the entire 1 to 999 nm range is sometimes included under the heading of nanotechnology. Optical properties of some materials (eg, the fluorescence signature of quantum dots and the color of nanogold) are determined simply by the size of the nanoparticles, not by the choice of material.² At this scale, surface chemistry and charge dramatically increase bioimaging and biosensing capabilities.^3,4 In addition, nanoparticle size, shape, and surface charge can dictate how nanoparticles are processed and signals are amplified in the body.^5-9

Although nanotechnology has brought together the fields of materials science, engineering, and medicine in the development of diagnostic and treatment options in medicine and surgery,¹⁰ nanomedicine and nanotechnology have not been included in recent influential publications on medical education reform such as the Association of American Medical College and the Howard Hughes Medical Institute's "Scientific Foundations For Future Physicians."¹¹ However, it is imperative that the next generation of physicians understand these developments so that they can be better prepared to provide consultation to scientists about potential applications, integrate nanotechnology-based therapeutic choices into practice, and respond to ethical challenges.¹² This article explains why it is critical for medical education to include instruction in nanotechnology, nanomedicine, nanotoxicology, and nanoethics and suggests basic concepts educators can use to infuse curricula with this content.

The Importance of Nanotechnology to Medicine

While its use is still early, nanotechnology promises to revolutionize medical care. The number of nanotechnology-based drugs, devices, and diagnostics clinically available and in clinical trials is growing rapidly. Many of the early applications of nanotechnology have been in the field of drug delivery and have allowed for new agents with improved pharmacologic or pharmacodynamics profiles. Underlying these advances is the enhanced permeability and retention effect (EPR) in solid tumors, which allows for the passive or active accumulation of nanoformulated drugs at the site of solid tumors at higher levels than in the rest of the body.¹³ Major clinical examples of such drugs include US Food and Drug Administration (FDA)-approved cancer nanochemotherapeutics such as nanoparticle albumin-bound paclitaxel,¹⁴ liposomal doxorubicin,¹⁵ liposomal daunorubicin,¹⁶ liposomal daunorubicin-cytarabine,¹⁶ and liposomal vincristine.¹⁷ Emerging applications of nanotechnology for treating cancer include more targeted approaches, stimuli-responsive delivery agents, combinatorial approaches, gene therapeutics, and immunotherapies.^18-21 Additionally, there are hundreds of new technologies in preclinical development.²²

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