Foresight Update 38 Page 2

Inside Foresight

by Chris Peterson

By the time you see this Update, the extra Fall Gathering that Foresight squeezed into September will have been held. (You should have received a couple of email notices on this; if not, please let us know your current email address.)

You'll notice from the program that the emphasis was on social issues: Openness in the Realms of "Stuff" and Bits: Confronting the Complexity Challenge in Meatspace, Infospace, Peoplespace. Yes, we did a capsule update on nanotechnology, courtesy of Ralph Merkle, and there was discussion of some major advances of relevance to extending the human lifespan from Bruce Ames and Greg Stock. But most of the group's time was focused on societal-level problems and potential solutions.

Technological Upsides vs. Downsides

Often the reason for this focus is unclear to those new to Foresight, who tend to view it as a nanotechnology promotion organization, similar to the role the former L5 Society—now the unfortunately named "National" Space Society—played for space development and settlement. Longer-term members know this is not so: unlike space development, which has only minor downsides, if any, nanotechnology and the other powerful technologies tracked by Foresight have some big potential problems associated with them. In addition to speeding up technological benefits, our goal is to mitigate or, in the best case, head off the associated problems.

Foresight's work in communicating the benefits has been going well. If you track coverage of nanotechnology in the media—and it's hard to miss these days—you'll recognize our meme-set, which shows up again and again. Medical applications, computational applications, environmental applications, even space applications—these are often mentioned, using Foresight-originated terminology.

Our efforts to get nanotechnology's benefits to happen are buttressed by powerful forces: both the natural human drive to develop new tools, and the just-as-natural human drive for personal profit. These have far more influence than Foresight can have, overall, but we see from the use of our terminology that we have had a key role in getting across the upside of nanotechnology.

Heading off the Downside: A Messy Task

Compared to doing R&D, or even compared to founding a new company, attempting to anticipate and lessen the problems associated with a coming powerful technology is "messy." It involves analysis of human interactions, human institutions, and trying to project what these will look like many years from now, in a situation which has yet to be fully defined. Hard to model, to put it mildly.

Yet model it we must. Somehow we need to look ahead one, or two, or three decades and try to envision which institutions will need to work well in order to avoid botching up the increasingly-bizarre technologies now on the way. Then, we need to picture a process that could lead up to such healthy institutions. Then, we identify which actions can be taken now to make that process happen. Then, we actually implement those actions, continually updating our views as the passing of time makes unfolding reality available as a corrective.

Sound impossibly ambitious? It would be, if one of us tried to do it individually, but that's not what's happening here. We have all of human history to draw from, and fabulous new tools such as the Web, to enable us to work together more easily than has ever been possible before. It is the Web, and related tools soon to come, that give us the most hope for success in this effort, along with the Foresight community—one of the most talented and hardworking group of folks ever convened.

This last issue may seem to be stretching the bounds of what Foresight should be concerned with, but here's a case for looking at it. The legal system in force when nanotechnology arrives will matter tremendously. Major problems with it—such as the big problems with IP already happening—will undermine our efforts to get policymakers (read: those in power) to move toward sensible policies. Do we really want the software patent problem to spread to nanotechnology—or should we try to fix the IP system now? Put that way, Foresight's incentives are clearer.

Most of you reading this column missed the 1999 Fall Gathering where we tacked these challenges. You are invited to join us next spring, to take another shot at these issues, and review how we've done on them to date. The current plan is to meet May 19-21, but this date depends on contract negotiations now in progress; watch your email and Update for the official announcement. Then come join us in working on these ambitious—but enjoyable—goals.

An Interview with Robert A. Freitas Jr.

Author Robert A. Freitas Jr. spoke with Update Editor Richard Terra on the publication of the first volume of Nanomedicine.

I believe the first time I ever thought about atomic-scale engineered objects was in 1977-78, when I was working on my first treatise-length book project. In that book, I wrote about using molecular electronic components to create a computer system with 10 billion 'microneurons' in the space of few microns — small enough to hide inside a bacterium. Of course, I never explored the consequences of this observation — I believe Arthur C. Clarke once called this class of error in futurist thinking the "failure of nerve".

During my NASA work on self-replicating machines in the early 1980s, I wondered how small machine replicators might be made. I studied the emerging micromachine technology, but didn't pay enough attention to Engines of Creation when it came out in 1986. Then, in early 1994, after 8 years of very pragmatic, very busy, and very non-blue-sky activities, I happened to pick up and read a copy of Unbounding the Future. Suddenly the light came on. I immediately read Nanosystems, and it confirmed what I then already suspected based on my own knowledge — namely, that the technical case for molecular nanotechnology is very solid.

As soon as I'd fully absorbed Eric Drexler's "bottom-up" paradigm, I immediately realized that medicine would be the single most important application area of nanotechnology. Not only would human comfort, safety, and pleasure be vastly improved, but nanomedicine could dramatically extend the lifespan of the individual human being and greatly expand the possibilities of the human form. Like many in the Foresight community, I have a great intellectual curiosity about many things that may take decades or even centuries to unfold. I have a deep interest in the future of the human experiment, in all of its fascinating dimensions. And nanomedicine can allow each one of us, personally, to survive long enough — not merely to see that distant future, but to participate directly in it. What could possibly be more exciting than that?

Once nanomedicine becomes available, we'll each have all the time we need to pursue our many other (non-medical) interests. But until nanomedicine becomes available, nobody can have any reasonable expectation that they will live long enough to pursue their longest-term and most interesting goals to fruition. Thus the development of nanomedicine looms like a toll-gate, separating each one of us from the rest of our lives. Nanomedicine is the serious futurist's sine qua non. It is our gateway to all that will be, and all that we can become. That's why I personally regard it as my top priority.

I spent half a year reading every nanotechnology-related book, paper, and article I could lay my hands on. Back in 1994, the technical discussion was still mired in debates over whether or not nanotechnology was possible at all, and the popular discussion mostly dealt with general objectives or with hoped-for capabilities, without a lot of technical content and with very few specifics.

So I joined the Foresight Institute and studied every issue of Update all the way back to Issue No. 1. Then I started asking around: Is anyone doing a book? Where are the nanomedicine papers? Where are the serious medical nanorobot designs? I was astounded to discover that there weren't any. Worse, none were in progress and none were planned. This task needed doing, and I finally realized that if nobody else was going to do it, it was going to have to be me.

Talk a bit about your background. What's helped you prepare to be able to write a work like Nanomedicine?

I started with a broad educational background — university degrees in physics, psychology, and law. I've always been intrigued by medicine. Nanomedicine is actually the third large-scale, treatise-length project I've done — though with its multiple volumes, it is the biggest by far.

I've done some traditional hands-on scientific experimental work — most recently some Nanomedicine-related electron microscopy work. I've also spent a lot of my time pursuing what Eric Drexler calls "theoretical applied" research — such as my work for NASA on self-replicating machine systems in the early 1980s.

Finally, in 1995-96 I researched and wrote, and in 1998 finally published, what is apparently the first technical medical nanodevice design paper ["Exploratory Design in Medical Nanotechnology: A Mechanical Artificial Red Cell," in Artificial Cells, Blood Substitutes, and Immobilization Biotechnology, Volume 26, # 4, 1998, pp 411430; an expanded version appears on the Foresight web site]. The paper described nanorobots which may serve as artificial mechanical red blood cells, called "respirocytes." This early design exercise was extremely helpful in illuminating many new topics and basic capabilities that would need to be addressed in the book. The criticisms and comments I received from four traditional medical referees were also very educational.

You've been working on Nanomedicine since 1994. How far along are you toward completing the entire trilogy? Any estimates on when Volumes II & III will be published?

Volume I comes out on 15 October 1999. The tentative schedule is for Volume II to be out by 2002, and Volume III in 2005. I realize the long wait will be frustrating for many, and especially for me. But the problem is that I'm exploring largely uncharted territory, trying to assemble a primitive map of the terrain while avoiding the intellectual equivalent of quicksand and wild animals. There aren't any street signs or rest stops along the road — heck, there aren't many roads. Even working 16-hour days like I do, the process takes years.

You're trying to reach a very diverse set of audiences with Nanomedicine. Who is the intended audience for Volume I? For subsequent volumes?

Nanomedicine was originally going to be a single volume, but I soon realized that the field would be even more interdisciplinary than molecular manufacturing, in part because of the many essential interfaces between mechanical nanosystems and living systems. Also, I needed to consider all major aspects of nanomedical device design and operations. So I had a lot of very different topics, and diverse audiences, to deal with.

My solution was to expand the work to three volumes, with each volume speaking to a slightly different audience. Volume I, for example, describes basic capabilities common to all medical nanodevices, written in the language of the physical and biological sciences — not the language of clinical medicine. Volume II will deal with device control and configuration, biocompatibility and safety, and basic nanomedical component devices and simple systems, and speaks mainly to systems and control engineers, research physiologists, clinical laboratory analysts, biotechnologists, and biomedical engineers doing applied research. Volume III describes specific treatments and procedures, using technical language and concepts that are most familiar and comfortable to the traditional medical community.

Do you think the wide ranging, comprehensive nature of the trilogy will put some readers off? Make the work less accessible?

Rather than putting readers off, I believe this three-volume approach will make Nanomedicine more accessible to the broadest possible audience. That's because the trilogy, when complete, will offer people of widely varying interests and backgrounds at least one easy entry point into the discussion. There will be at least one volume that uses language that is most familiar to them. As they become better informed and wish to delve deeper, the structure invites them to explore other related disciplines that they might otherwise ignore or avoid.

What kind of reaction are you hoping for in the target audience(s)? The medical community in general? What reaction are you expecting?

Enough groundwork has been done in MNT generally so that the overall reception of Nanomedicine should be guardedly favorable. I've tried to state my assumptions clearly, and formulate my results using explicit, if fairly simple, mathematical expressions. I ask only for a fair hearing on the merits, and a thorough review and constructive criticism of the ideas presented, so that everyone may have confidence that we're on solid ground before we move ahead to the next step in the medical nanotechnology development process.

The medical community? I'm hoping they will read and fully absorb at least the first two chapters, and then defer final judgement on the rest until Volumes II and III come out, where many important clinical issues such as biocompatibility and device safety will be addressed. There they'll discover that I'm a fanatic about device safety. However, as Eric Drexler points out in his Foreword to Nanomedicine, realistically there will only be some small fraction of the traditional medical community that "gets it" right off the bat. The book's intended audience is technical and professional people who are seriously interested in the future of medical technology. Many practicing physicians do not — and quite correctly should not — fit this description.

Even after seven years, there are still some segments of the nano-scale research community struggling to absorb the implications of Drexler's Nanosystems. How do you think researchers in other areas of nanoscience will respond to Nanomedicine, which offers very explicit long-term objectives for their work? Will they find it an exciting motivation, or dismiss it as too speculative and distant to be a factor in the here-and-now direction of current research?

I think we'll get some of both reactions, because concise statements of purpose are often intellectually divisive. It is important to have a clearly articulated and detailed long-term vision. The younger members of the nanoscience community might be more likely to regard nanomedicine as an exciting long-term goal, since they, with decades of professional life still ahead of them, may have more open space in their conceptual universe and be better able to integrate novel objectives into their personal long-term career agendas. They can readily envision living long enough to witness that which is "distant." At the other extreme, a nanoscience researcher who is nearing retirement may have accumulated over a busy and productive lifetime a densely filled conceptual universe that may be too tightly-packed to allow the insertion of truly outside-the-box concepts. Such people have already nearly completed their life's work, and thus may have little motivation or need to adjust their worldview.

To those inclined to be dismissive, I would ask them to view Nanomedicine as an opportunity in disguise. Any here-and-now research will be better supported, whether by private or public sources, to the extent that the broader community providing the funds can clearly see major and direct benefits for themselves and for those about whom they care. Whether distant or not, Nanomedicine contributes to the cross-pollination of hitherto disparate fields and forges new links among them. For example, engineering disciplines previously having no apparent connection with medicine may suddenly gain access to new funding sources from the health technology sector because an important new purpose for the work can now be demonstrated.

In many ways, the model of health care you propose involves a more personal and more deeply involved relationship between doctors and their patients than is generally the case today. Do you think the medical community will welcome this potential of a return to a mode where physicians treat whole persons, rather than just their conditions or body parts?

I think that this aspect of nanomedicine will resonate well within the traditional medical community, and especially with general practitioners. At least in the U.S., there has been an explosion of new "personal" service industries. And so we may once again see the "personal doctor" — what a novel concept! I think most patients will be quite pleased with this.

Naturally, the biggest concern in today's medical environment is money — who will pay for all this fancy new nanomedicine, and how much will it cost? In Chapter 2 of the book, I argue that it is a rational expectation, though not yet provable, that nanorobotic therapeutic agents need cost no more per dose than most of today's specialty drugs. And gram-for-gram, medical nanorobots will be many orders of magnitude more effective, more versatile, safer, and faster-acting than today's drugs, and recyclable to boot. So on a dollars-per-cure basis, nanomedical treatments could be extraordinarily cheap.

How do you think readers will respond to the more radical potential applications and impacts of nanomedicine? Will they be willing to accept and consider the power for people to transform themselves? What changes will need to occur within the professional medical community and, more broadly, society in general, to accommodate this view of health, medical technology, and a more fluid human image? Who is going to need the most help in understanding and adjusting to the implications of developing and/or mature nanomedicine?

You may laugh, but I know some readers will complain that Nanomedicine is too conservative! Such readers should rest assured that I'm probably already familiar with their favorite radical application, and will have something to say about it either in Volume II or, more likely, in Volume III.

Young people today have embraced tattooing, body piercing, and outre' hair styles far more enthusiastically than any other generation in U.S. history. For their parents, plastic surgery, liposuction, cosmetics, tanning salons, diet clinics and physical fitness centers are booming enterprises. So people of most ages are already favorably predisposed towards transforming themselves, as long as three crucial elements are present: (1) it is affordable, (2) it is entirely their own personal choice, and (3) it is perceived to have immediate benefits that are greatly desired. I think nanomedicine may find a similar general acceptance, and for the exact same three reasons, but also because it adds a fourth, and very important, element to the list: (4) in most cases, it is completely reversible.

"Nanomedicine can allow each one of us, personally, to survive long enough — not merely to see that distant future, but to participate directly in it. What could possibly be more exciting than that?"

The medical community itself may need the most help in adjusting to a more interactive practice of medicine. Many doctors are not accustomed to treating patients as diagnosticians and decisionmakers. Precise medical recordkeeping will become essential, since no two patients can be assumed to be physiologically equivalent. There will be many new and difficult ethical issues to be resolved. Improved counseling and communication skills may need to be learned by practitioners. But almost without a doubt, it will be the most exciting time in human history to be a physician.

How effective do you think Nanomedicine will be in broadening the acceptance of the core concepts of advanced molecular nanotechnology in general? What do you think the effect will be on the awareness and support (or opposition) to developing nanotechnology among the general public, as the potential applications to medicine become more widely known?

In his Afterword to my book, Ralph Merkle of Xerox PARC talks about backward chaining and entraining people's perceptions and objectives toward a common goal or vision, in this case the application of advanced molecular nanotechnology to medicine. I hope Nanomedicine will be successful in accomplishing, or at least initiating, this process.

The public reaction is difficult to predict. History suggests that initial resistance to a novel approach is usually quickly overcome by any new medical technology that offers clear, safe, and immediate benefits to patients. If nanomedicine can fulfill that promise, then its eventual development and public acceptance seems almost inevitable. And any positive results achieved by nanomedicine should reflect favorably on the larger nanotechnology enterprise.

Nanomedicine will be freely available as an Adobe Acrobat PDF file in a few months, and you are encouraging constructive feedback, criticism and discussion. Why was this done?

The main reason we're doing this is to promote a broader discussion of the technical issues, and a rapid assessment by the worldwide biomedical and engineering community. We want to be certain that the foundations of nanomedicine are solid as we move forward into more detailed device design in the years ahead.

Obviously, you've already chosen how you personally will work toward seeing molecular nanotechnology in general developed, and more specifically be applied to medicine. What sorts of action can you recommend to others who would like to support the development of medical nanotechnology?

There are two ways people can support the development of medical nanotechnology — the direct approach, and the indirect approach. Both can be very important.

Doing research yourself is the direct way. College and graduate students who are still planning their biomedical careers can chart pathways best calculated to keep them in the thick of the action in the years ahead. Young investigators can seek grants for new research, or adjust ongoing programs, to better support the goals and objectives of nanomedicine. More established principal investigators can initiate major programs in important and relevant new directions.

The indirect approach is less arduous but can be equally satisfying on many levels. The idea here is that you donate your personal time, or some small subset of your company's resources (e.g., a surplus computer), or your public speaking skills, or, perhaps most importantly, your money, to support individuals and organizations like Foresight Institute and IMM that are either doing the good work themselves, or are directly funding individuals and other organizations who are.

I would strongly urge anyone who is interested in nanotechnology in general, or nanomedicine in particular, to become involved either directly or indirectly, and to support any efforts that appear to be of merit. If your efforts hasten the arrival of nanomedicine by even one month, who knows whose lives may be saved in that time? Perhaps your own, or that of someone you love.

Assuming you've even had time or energy to consider the question, what's next? After you complete Nanomedicine, where will you be turning your attention and efforts? Do you foresee writing any popular works on the medical applications of nanotechnology?

Originally, the book was going to be a single volume — a semi-popular treatment along the lines of the old-style Scientific American articles. But my early research on the respirocytes convinced me that there were a vast number of unresolved engineering issues in medical nanorobot design that could only be properly addressed in a purely technical book, which then evolved into the currently-planned 3-volume set.

After the technical trilogy is complete, I want to go back in the "popular" direction. So my next goal will be to write a 1-volume popular version of the Nanomedicine trilogy, heavy on crowd-pleasing artwork and presenting the basic conceptual memes involved — perhaps producing something with the potential to become a New York Times "bestseller".

Foresight Update 38

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Inside Foresight

by Chris Peterson

Technological Upsides vs. Downsides

Heading off the Downside: A Messy Task

An Interview with Robert A. Freitas Jr.

Foresight Programs