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MAGNETIC NANOPARTICLES FOR CANCER DIAGNOSIS AND
TREATMENT: A QUESTION OF ETHICS
Andrew Clark asc55@pitt.edu
THE CANCER EPIDEMIC
According to the American Cancer Society, cancer is the
leading cause of death in the United States of America, as it
accounts for approximately one in every four deaths. Each
year, about one million people develop cancer and early
detection is important for an increased rate of survival [1].
Throughout the last decade, the use of nanoparticles, which
have sizes less than 100nm, has grown immensely. They have
proven successful in treating cancer and providing patients
with therapy, as well as regenerating lost organ tissues [2].
THE ETHICAL DEBATE
Davis Health Care Systems has recently contacted
Trenton Hospital about their new technology, magnetic
nanoparticles, which will aid in the early detection of cancer.
I, as the lead engineer for Trenton Hospital, have been
designated to determine whether or not Trenton Hospital
should purchase the technology. Within this paper, I will look
into the applications of this technology and the whether or not
the magnetic nanoparticles are ethical. The magnetic
nanoparticles will be used in vivo (the study of biological
systems within their original systems) and used in conjunction
with Magnetic Resonance Imaging (MRI) [3]. Davis Health
Care Systems plans to sell them as a contrast agent for
noninvasive MRI, as well as a targeting system for certain
diseases. Moreover, Davis Health Care Systems claims that
genetic material conjugated with magnetic nanoparticles may
even treat some forms of cancer [3]. However, the lack of
testing on the side effects of the iron oxide core of these
nanoparticles, as well the scarcity of medical evidence on the
capabilities of these technologies question the ethics of Davis
Health Care Systems.
The lack of testing sparks my curiosity on the ethical
approach to magnetic nanoparticles in clinical use. The inner
core of magnetic nanoparticles consists of iron oxide [4].
Through testing of iron oxide alone inside the human body,
many adverse effects occur. Testing has shown that iron
oxide alone may cause inflammation to exposed areas, cause
damage to chromosomes, impair mitochondrial function, and
start the formation of apoptotic bodies [3][4]. Apoptotic
bodies are cells that are programmed to die after a certain time
interval. However, research has shown that most of the
adverse effects of iron oxide will only occur if more than 60
mg of iron per kilogram of species’ weight is ingested [5].
The few in vivo tests of magnetic nanoparticles in humans
with less than 60 mg iron per kilogram have shown no side
University of Pittsburgh, Swanson School of Engineering 1
Submission Date 2013-10-29
effects [5]. By not explaining the limited research on iron
oxide to the body, Davis Health Care Systems is voluntarily
omitting facts from the public, which directly violates the
National Society of Professional Engineers (NSPE) Code of
Ethics and its Professional Obligations [6]. In addition, Davis
Health Care Systems is claiming successful treatment of some
tumors with genetic material conjugated with magnetic
nanoparticles. What they fail to admit, is that the only testing
on genetic material conjugated nanoparticles has been on
mice. This technology has not been tested on humans, and
therefore was not tested to engineering and the Food and Drug
Association standards. Nevertheless, I believe that the
magnetic nanoparticles may help in image guided cell
tracking for cancer diagnosis and when they are conjugated
with genetic material, they may treat cancer. If the intended
results of magnetic nanoparticles are proven valid, David
Health Care Systems will completely enhance the health and
safety of all human beings.
MAGNETIC NANOPARTICLES
APPLICATIONS
The two main functions of David Health Care Systems’
magnetic nanoparticles are image guided cell tracking for
early cancer diagnosis and genetic material conjugated with
the nanoparticles for cancer treatment. I will now further
explain the capabilities of the technology and the lack of an
ethical approach involved.
Image Guided Cell Tracking
Image guided cell tracking is the use of magnetic
nanoparticles as a contrast agent in conjunction with MRI.
During this process, magnetic nanoparticles would be injected
into the blood stream of an individual [4]. The small size of
the magnetic nanoparticles make them a perfect candidate for
cancer theranostics, or the imaging and diagnostics of cancer.
Since blood vessels in tumors are irregular, dilated, and leaky,
injected nanoparticles will easily enter the tumor [7].
Moreover, poor lymphatic drainage near the affected area
allows for a high retention rate of the magnetic nanoparticles
[7]. Once the magnetic nanoparticles are within the tumor,
they become perfect contrast agents over soft tissue during a
MRI
because
of
their
superparamagnetism.
Superparamagnetic means that the nanoparticles do not have
their own magnetic field, yet when they are activated by an
external magnetic field, they will conform to the external
Andrew Clark
technology is not ethical by Guillano Franco’s standards.
Franco believes that if a patient is put under unknown risks
during treatment, then the study or technology is unethical [9].
On the other hand, restricting the use of technology that may
help society may also be considered unethical. Kevin Smith
says in his article in Bioethics, “…the application of scientific
knowledge has led to major benefits in terms of human
welfare. Thus it would be ethically unacceptable to restrict
scientific enquiry” [10]. Smith makes a significant case
which makes me question myself on whether it would be
ethical for me not to sell the magnetic nanoparticles.
Although the Davis Health Care System’s may lead to
benefits in human welfare, I believe the unknown risks lack
of testing outweigh the negatives, and therefore this
technology is unethical.
field. This characteristic allows very precise imaging on a
MRI [7].
Another characteristic of magnetic nanoparticles which
enhances the imaging and diagnostics of cancer is selective
localization. Different targeting moieties, or parts of
molecules, have the capability to target selective tumors and
attach to them [7]. Therefore, a MRI will easily discover the
tumor. A huge positive to these magnetic nanoparticles is the
lower dosage of iron oxide needed. Only 3 mg per kilogram
of patient’s weight is necessary [7].
I have researched three studies where magnetic
nanoparticles are paired with targeting moieties. The first
study included an iron oxide core with ATF Peptide on the
coating of the nanoparticle. This test was able to detect
pancreatic cancer at sizes as small as 0.5-1.0mm3. In addition,
this test was able to distinguish between chronic pancreatitis
and pancreatic tumors by the intensity of the contrast of the
MRI [7]. The second test I studied used nanoparticles with an
iron oxide core and a targeting moiety of Ab antiserum. This
test proved an 83% increase in contrast strength of the MRI a
day after injection on breast cancer [7]. The last case I
researched involved another iron oxide inner core magnetic
nanoparticle. This nanoparticle consists of a targeting moiety
of P1c and was studied on liver cancer. This test proved the
highest tumor-to-muscle contrast, only 12 hours after
injection [7]. Every test portrayed very useful applications of
the magnetic nanoparticles Davis Health Care Systems wants
to sell Trenton Hospital. However, each of these tests were
performed on mice, not humans.
On the other hand, I have found one case where magnetic
nanoparticles with an iron oxide core and a targeting moiety
have been tested on humans. In fact, a nanoparticle is already
used in clinical practice. This nanoparticle contains dextran
as its targeting moiety and specifically works on lymph nodes.
Fermoxtran-10 is injected intravenously and immediately
attaches to malignant lymph nodes [8]. A very high contrast
is observed when a malignant lymph node with Fermoxtran10 is viewed under MRI. Fermoxtran-10 has been proven to
have very few negative results on humans [8].
Although testing on magnetic nanoparticles with targeting
moieties has proven very successful in cancer theranostics, I
do not believe the sale of Davis Health Care Systems’
magnetic nanoparticle would be ethical. Most of the
successful results of magnetic nanoparticles have been
observed in mice, not humans. This lack of testing may prove
detrimental to the safety, health, and welfare of the public.
However, Fermoxtran-10 proves a clear example of the
possible ways magnetic nanoparticles can enhance the health
of the public. It is very possible that that the Davis Health
Care Systems’ magnetic nanoparticle may be safe, but the
lack of testing makes the sale of their product unethical. In
fact, by failing to completely test their product, Davis Health
Care Systems in not abiding by engineering standards, and
thus breaking NSPE Code of Ethics [6]. I have yet to find
research, or any conclusive evidence of the risks of Davis
Health Care Systems’ magnetic nanoparticle; hence, this
Genetic Material Conjugated with Magnetic
Nanoparticles
Davis Health Care Systems also makes a claim that
genetic material conjugated with the magnetic nanoparticles
will be able to treat certain types of cancer. This claim would
be very significant for medicine, as patients would no longer
need chemotherapy if this worked. In order for the magnetic
nanoparticles to be able to not only help in the theranostics of
cancer, but also treat it, the magnetic nanoparticles must
contain both genetic material and a targeting moiety (a piece
of genetic material) [3].
I have researched three different studies on magnetic
nanoparticles conjugated with genetic material for cancer
treatment. The first case I studied tested Green Fluorescent
Protein (GFP) on tumor cells in mice. Magnetic nanoparticles
were conjugated with interfering RNA (iRNA) and injected
into the tumors on the mice. The iRNA significantly silenced
the fluorescence of the GFP on the tumors, which means the
GFP was degraded by the iRNA [3]. The second case I
researched studied the anti-apoptotic gene birc5. The birc5
gene inhibits apoptosis in most cancers. The study took
siRNA, a version of iRNA, conjugated with magnetic
nanoparticles and injected them into many different types of
tumor cells in mice. Results showed a significant decrease in
the birc5 gene, and apoptosis in the tumor cells rapidly
increased [3]. The last study I researched conjugated
dedrimers with magnetic nanoparticles and injected them into
in vitro (the study of cells outside of their original biological
system) human glioblastoma (brain tumor) cells. The
dendrimers on the magnetic nanoparticles attached to the
epidermal growth factor receptors (allow tumors to spread).
The epidermal growth factor receptors were measured to
decrease 70-80%, which significantly slowed the spread of
the tumor [3]. Each study portrays significant evidence but
none of the studies can conclude the treatment of cancer in
humans.
Although these studies are very successful on mice and
human in vitro cells, I believe the sale of Davis Health Care
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Andrew Clark
Systems’ magnetic nanoparticle would be unethical. By not
coming to conclusive results portraying their magnetic
nanoparticles’ success at treating cancer, Davis Health Care
Systems is violating the Biomedical Engineering Society’s
Code of Ethics [11]. Davis Health Care Systems is publishing
not proper and accurate results. However, if Davis Health
Care Systems continues to research their new technology in
treatment and find that it can, in fact, treat cancer, I believe
that the safety, health, and welfare of humanity would be
significantly enhanced.
false results from a product. Matthias Rath, a biomedical
engineer in Germany, claimed he found vitamins that cured
HIV. He sold thousands of bottles in South Africa off of this
claim. Numerous studies found that his vitamins did not
affect HIV in a person at all and he was eventually sued for a
half million dollars [12]. If Trenton Hospital were to sell the
magnetic nanoparticles, we may get sued and go bankrupt, or
even worse, every doctor working at the hospital may lose
their medical licenses. Not only is the sale of Davis Health
Care Systems’ magnetic nanoparticles unethical, but it also
puts the future of patients and doctors alike in jeopardy. I will
not allow Trenton Hospital to purchase the magnetic
nanoparticles from Davis Health Care Systems until more
conclusive results on the theranostics and treatment of cancer
are achieved.
THE CODE OF ETHICS
As I looked into the Davis Health Care Systems debate,
I focused on the National Society of Professional Engineers’
and the Biomedical Engineering Society’s Codes of Ethics.
In both cases, these Codes provide a set of moral obligations
that engineers, and even more specifically, biomedical
engineers need to follow.
The Code of Ethics for the National Society of
Professional Engineers contains six canons, with in depth
descriptions of each. Two of the six canons seem to be
relevant to the aforementioned debate. The first canon reads,
“Hold paramount the safety, health, and welfare of the public”
[6]. The lack of testing on the side effects of the iron oxide
core of the magnetic nanoparticles may put the public at risk,
which would violate this canon. In addition, the sixth canon
may be infringed by Davis Health Care Systems. This canon
reads, “Conduct themselves honorably, responsibly, ethically,
and lawfully so as to enhance the honor, reputation, and
usefulness of the profession” [6]. Claiming capabilities of
magnetic nanoparticles that have very little supporting
evidence may directly violate the honor of Davis Health Care
Systems.
Similar to the National Society of Professional
Engineers’ code of ethics, the Biomedical Engineering
Society’s code of ethics explains the importance of
maintaining the safety and health of the public. Through eight
main codes, the BMES describes necessary obligations that
biomedical engineers must follow. Davis Health Care
Systems does not oblige by the first code, which explains the
necessity of keeping and enhancing public safety, when they
have such a significant lack of testing on the side effects of
their product [11].
In addition, labeling magnetic
nanoparticles as treatment would violate the BMES Code of
Ethics as well. The Code states, “Publish and/or present
properly credited results of research accurately and clearly”
[11]. The lack of evidence proving Davis Health Care
Systems claim forces me to deem their product unethical for
sale. However, they do have good intentions, as they are
trying to enhance the health and safety of the public by finding
routes of early cancer diagnosis.
If we, as Trenton Hospital, were to buy and sell the
Davis Health Care Systems’ magnetic nanoparticles, our
ethics would be just as much in question. In fact, a recent
article describes what can happen to a vendor when they claim
REFERENCES
[1] N. Howlader (23 October 2012). “Cancer Prevalence:
How Many People Have Cancer?” American Cancer
Society. (Online article).
http://www.cancer.org/cancer/cancerbasics/cancerprevalence
[2] C. Teck Lim. (16 September 2010). “Micro and
nanotechnology for biological and biomedical applications.”
Sprinkler Link. (Online article).
http://link.springer.com/article/10.1007%2Fs11517-0100677-z/fulltext.html
[3] M. Yigit. (25 January 2012). “Magnetic
Nanoparticles for Cancer Diagnosis and Therapy.” Springer
Link. (Online article).
http://link.springer.com/article/10.1007%2Fs11095-0120679-7/fulltext.html
[4] X. Chi (January 2012). “Nanoprobes for in vitro
diagnostics of cancer and infectious diseases.” Biomaterials.
(Journal Article). Volume 33 Issue 1 pp. 189-206.
[5] M. Colombo (8 December 2011). “Biological
Applications of Magnetic Nanoparticles.” RSC Publishing.
(Online article).
http://pubs.rsc.org/en/content/articlepdf/2012/cs/c2cs15337h
[6] (22 October 2013). “NSPE Code of Ethics for
Engineers.” National Society for Professional Engineers.
(PDF). http://www.nspe.org/Ethics/CodeofEthics/index.html
[7] J. Gallo. (21 June 2013). “Magnetic Nanoparticles as
Contrast Agents in the Diagnosis and Treatment of Cancer.”
RSC Publishing. (Online article).
http://pubs.rsc.org/en/content/articlehtml/2013/cs/c3cs60149
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[8] M. Wang. (August 2010). “Targeting Nanoparticles
to Cancer.” Pharmacological Research. (Journal Article).
Volume 62 Issue 2 pp. 90-99.
[12] S. Boseley (12 September 2008). “Fall of the Doctor
Who Said his Vitamins Would Cure AIDS.” The Guardian.
(Online article).
http://www.theguardian.com/world/2008/sep/12/matthiasrat
h.aids2
[9] G. Franco (4 November 2011). “Occupational Health
Practice and Exposure to Nanoparticles: Reconciling
Scientific Evidence, Ethical Aspects, and Legal
Requirements.” Archives of Environmental & Occupational
Health. (Journal Article). Volume 66 Issue 4.
ADDITIONAL SOURCES
Michael Crichton (November 2003). “Prey.” Avon Books.
(Novel).
[10] K. Smith (9 September 2013). “Synthetic Biology:
A Utilitarian Perspective.” Bioethics. (Journal Article).
Volume 27 Issue 8 pp. 453-463.
ACKNOWLEDGMENTS
I would like to acknowledge the abundant resources
available at the University of Pittsburgh. In addition, I would
like to thank Anna Thomas, Siddhartha Dash, and my
roommate, Rahul Rege, for inspiring me to write this paper.
[11] (February 2004). “Biomedical Engineering Society
Code of Ethics.” Biomedical Engineering Society. (PDF).
http://bmes.org/files/2004%20Approved%20%20Code%20o
f%20Ethics%282%29.pdf
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