The Social Conditions for Nanomedicine: Disruption,Systems,and Lock-In

Speaking of the convergence of nanotechnology, biomedicine, information technology, and cognitive science (NBIC), James Canton anticipates “disruptions on a scale no civilization has ever seen before.” Canton J. , “Designing the Future: NBIC Technologies and Human Performance Enhancement,” Annals of the New York Academy of Science 1013 (2004): 186–198. A more general discussion of the need to anticipate the disruptions and mitigate their effects is found in Roco M. and Bainbridge W. S. , eds., Social Implications of Nanoscience and Nanotechnology (Dordrecht: Kluwer Academic Publishers, 2001).

The problem of anticipating disruptions is recognized by Roco and Bainbridge in their introduction to supra note 1, at 12–13. They note that “[t]he process of innovation that will produce nanotechnology and diffuse its benefits into society are complex and only partially understood.” “Perhaps the greatest difficulty in predicting the societal impacts of new technologies has to do with the fact that once the technical and commercial feasibility of an innovation is demonstrated, subsequent developments may be as much in the hands of users as in those of the innovators. The diffusion and impact of technological innovations often depends on the development of complementary technologies and of the user network. As a result, new technologies can affect society in ways that were not intended by those who initiated them.”

This tension between the conventional/continuous and the radical/discontinuous is partly a function of the influence of older, more transhumanist notions of nanotechnology associated with Eric Drexler and the Foresight Institute; see e.g., Drexler K. E. , Engines of Creation: The Coming Era of Nanotechnology (New York: Anchor Books, Doubleday, 1986) and Drexler K.E. , Nanosystems: Molecular Machinery, Manufacturing, and Computation (New York: John Wiley and Sons, 1992). Foresight Institute documents on disruption can be found at <www.foresight.org> (last visited October 2, 2006). Much of the work of the Center for Responsible Nanotechnology seeks to address these anticipated radical disruptions. Their work can be found at <http://crnano.org/> (last visited October 2, 2006). However, even in current scientific literature, these two strands are clearly manifest. The Canton citation in supra note 1, with its emphasis on human enhancement and radical disruption, is published with prominent scientific contributions. The first issue of Nanomedicine: Nanotechnology, Biology, Medicine, a new journal by Elsevier Press, prominently featured an essay by Freitas Robert , a leading representative of the Drexler vision. It is thus extremely difficult to disentangle more conventional and radical notions of nanotechnology. In the end, it is perhaps better to speak of near-term, mid-term and long-term visions, with an increasingly radical notion of disruption emerging as one moves to the long term.

Representative citations on these developments in nanomedicine include Bogunia-Kubik K. Sugisaka M. , “From Molecular Biology to Nanotechnology and Nanomedicine,” BioSystems 65 (2002): 123–138; Gertner M. , “Nanotechnology and Its Impact on Clinical Medicine,” Nanotechnology Law and Business 1, no 2 (2004): 147–155; U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Cancer Nanotechnology Plan: A Strategic Initiative to Transform Clinical Oncology and Basic Research Through the Directed Application of Nanotechnology (July 2004); Gordon N. and Sagman U. , Canadian NanoBusiness Alliance, Briefing Paper: Nanomedicine Taxonomy (Canadian Institutes of Health Research & Canadian NanoBusiness Alliance, 2003); European Commission, European Technology Platform on Nanomedicine – Nanotechnology for Health: Vision Paper and Basis for a Strategic Research Agenda for NanoMedicine (Luxembourg: Office for Official Publications of the European Communities, September 2005).

See National Cancer Institute, supra note 4, and additional documents available at the NCI Alliance for Nanotechnology in Cancer website, at <http://nano.cancer.gov> (last visited October 2, 2006). A bibliography of scientific publications is available at <http://nano.cancer.gov/resource_center/scientifc_bibliography.asp> (last visited October 2, 2006). The NCI Alliance for Nanotechnology in Cancer was formed in September 2004: “The Alliance is designed to accelerate the application of nanotechnology to the major challenges in clinical oncology and basic cancer research to support the NCI Challenge Goal of eliminating suffering and death due to cancer by 2015,” at <http://nano.cancer.gov/about_alliance/CCNE_QA.pdf> (last visited October 2, 2006).

Christensen C. M. , The Innovator's Dilemma (Collins Business Essentials, 1997); Christensen C. M. and Raynor M. E. , The Innovator's Solution (Cambridge: Harvard Business School Publishing Company, 2003). Christensen C. M. Verlinden M. , and Westerman G , “Disruption, Disintegration and the Dissipation of Differentiability,” Industrial and Corporate Change 11, no. 5 (2002): 955–993. Bower J. L. and Christensen C. M. , “Disruptive Technologies: Catching the Wave,” Harvard Business Review 72, no. 1 (1995): 43–53.

Christensen C. M. Bohmer R. , and Kenagy J. , “Will Disruptive Innovations Cure Health Care?” Harvard Business Review 78, no. 5 (2000): 102–111.

Christensen , and Christensen and Raynor , supra note 6.

After Christensen Verlinden and Westerman , supra note 6.

Christensen Bohmer , and Kenagy , supra note 7.

After Christensen Bohmer , and Kenagy , supra note 7.

Some classics on the development of the steam engine and locomotive can be found in the online Steam Engine Library, available at <http://www.history.rochester.edu/steam> (last visited October 2, 2006). See also McGowan C. , Rail, Steam, and Speed: The “Rocket” and the Birth of Steam Locomotion (Columbia University Press, 2004).

The development of telegraph, electrical power, and radio are nicely presented in an old classic, Tunzelmann G. W. , Electricity in Modern Life (New York: P.F. Collier and Son, 1913). A more modern history, with greater discussion of the systems integral to the development of the telegraph, can be found in Coe L. , The Telegraph: A History of Morse's Invention and its Predecessors in the United States (Jefferson, NC: McFarland and Company, 2003). For a recent history of radio with attention to systems aspects, see Sarkar T. , History of Wireless (Hoboken: Wiley – IEEE Press, 2006).

Agar J. , Turing and the Universal Machine: The Making of the Modern Computer (Kallista, Australia: Totem Books, 2001) and Agar J. , The Government Machine: A Revolutionary History of the Computer (Cambridge: MIT Press, 2003) highlight the mathematical and systems/social aspects of computer development.

To give just one example, Francis Ronalds published a small book on experiments, titled “Description of an Electrical Telegraph, and of some other Electrical Apparatus” in 1816. In that work, he provides valuable ideas and instruments for a telegraph, including a telegraphic code. But he also provides a vision: “Ronalds proposed that telegraph offices should be established throughout the kingdom. “Why,” he says, “has no serious trial yet been made of the qualifications of so diligent a courier? And, if he should be proved competent to the task, why should not our kings hold counsels at Brighton with their ministers in London? Why should not our government govern at Portsmouth almost as promptly as in Downing Street? Why should our defaulters escape by the default of our foggy climate? And, since our piteous inamorati are not Alphei, why should they add to the torments of absence those dilatory torments, pens, ink, paper, and posts? Let us have electrical conversazione offices communicating with each other all over the kingdom if we can.” Cited in Tunzelmann , supra note 13, at 107.

Lamb J. P. , Perfecting the American Steam Locomotive (Bloomington: Indiana University Press, 2003), considers this vital link between the development of the steam engine and the mechanical engineering profession, with special attention to the perfecting of the locomotive.

A nice overview of the contrast between the means/end reasoning associated with “technical rationality” and the more complex, iterative adjustment integral to creative design can be found in Schon D. , The Reflective Practitioner: How Professionals Think in Action (Basic Books, 1983).

Thompson's role in the development of the transatlantic telegraph is outlined in Smith C. and Wise M. N. , Energy and Empire: A Biographical Study of Lord Kelvin (Cambridge: Cambridge University Press, 1989). Von Nuemann's role in the development of the computer is summarized in chapter 8 of Davis M. , Engines of Logic: Mathematicians and the Origin of the Computer (New York/London: W.W. Norton and Company, 2000).

A general review of the phenomenon of path dependence can be found in Arthur W. B. , Increasing Returns and Path Dependence in the Economy (Ann Arbor: University of Michigan Press, 1994). Liebowitz S. J. and Margolis S. E. provide a taxonomy of three kinds of path dependence and a general criticism of the literature in “Path Dependence, Lock-In, and History,” in Journal of Law, Economics, and Organization 11 (1995): 205–226. While there is much valuable in their overview, they are too quick to defend traditional notions of market efficiency and not careful enough in their appreciation of those unique features that are highlighted by people like Arthur; for example, they dismiss VHS victory over Beta by arguing that people generally valued the longer time available on the VHS. This is far from the complete story. They also do not consider how a technology and systems are jointly established (high end disruption), nor do they sufficiently consider how larger social/political initiatives provide the conditions that favor specific technologies.

The QWERTY case study is provided in David P. A. , “Clio and the Economics of QWERTY,” American Economic Review 75 (1985): 332–337; and Krugman P. , Peddling Prosperity (New York: Norton, 1994). The use of this case example to illustrate in-efficient lock-in is criticized in Liebowitz S. J. and Margolis S. E. , “The Fable of the Keys,” Journal of Law and Economics 33, no. 1 (1990): 1–25. Today the technological constraints that lead to lock-in are lowered, because computers can easily accommodate both new and old keyboard designs. If an alternate keyboard layout were shown superior, it would be easy to train the next generation of people on the alternate layout without any need for retraining the current generation, and computers could have a simple icon for selection of keyboard design. However, there are still barriers associated with common use, since someone trained on an alternate keyboard design would often find themselves in situations where their own keyboard layout was not available.

A nice review of the impact of such regulation on the health care markets can be found in Epstein R. , Mortal Peril: Our Inalienable Right to Health Care? (New York: Basic Books, 2000).

Vosburgh K. G. and Newbower R. S. , “Moore's Law, Disruptive Technologies, and the Clinician,” Studies in Health Technology & Informatics 85 (2002): 8–13; and Pilarski L. M. , “Sensitive detection Using Microfluidics Technology of Single Cell PCR Products from High and Low Abundance Igh VDJ Templates in Multiple Myeloma,” Journal of Immunological Methods 305, no. 1 (2005): 94–105.

Satava R. M. and Wolf R. K. , “Disruptive Visions: Biosurgery,” Surgical Endoscopy 17, no. 11 (2003):1833–6; Satava R. M. , “Disruptive Visions: A Robot is not a Machine…Systems Integration for Surgeons,” Surgical Endoscopy 18, no. 4 (2004): 617–20.

See the references in supra notes 4 and 5.

Kohn L. Corrigan J. Donaldson M. , eds., To Err is Human: Building a Safer Health System (Washington, DC: National Academy Press, 2000); Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century (Washington, DC: National Academy Press, 2001).