Biomilitarism and nanomedicine: Evil metaphors for the good of human health?
by Brigitte Nerlich
Editor's note: This is the third article in a series on the topic of nanotechnology. These unpublished articles were gathered by Chris Toumey, University of South Carolina NanoCenter, and are published here with permission. Here Dr. Nerlich explains how metaphors may help or hinder public understanding of the topic. Introduction
The promises of nanotechnology have been framed by a variety of future oriented metaphors, such as the metaphor of the fantastic voyage or the master builder. The former metaphor has been especially prominent in early framings of nanomedicine. But what happens when a real breakthrough happens? Is this fictional backdrop still used, or do other metaphors become more prominent, especially those used traditionally to talk about the work of medicine? And what does this mean for the public understanding of nanomedicine?
To investigate these issues, this article examines the metaphorical framing of one of many recent 'breakthroughs' in nanomedicine as a case study, namely the announcement of the first targeted nanoparticle delivering a chemotherapeutic drug to enter clinical trials, which, it is hoped, will alleviate prostate cancer while diminishing the side effects of chemotherapy. This achievement by a group of scientists working at the start-up company BIND Biosciences at the Massachusetts Institute of Technology (MIT) in Cambridge (MA), and led by Professor Robert Langer, was announced on November 4, 2009 in a press release by Emily Singer for MIT's Technology Review
('the authority on the future of technology'). It was then reported by Mark Henderson (chief science writer) in a one-page illustrated article on the third page of The Times
(London, UK) on November 5, 2009, followed by other coverage around the world. My intention is to trace the spread of metaphorical framing from its origins in Technology Review
through the various newspaper reports that followed it in order achieve some insights into the ethics of metaphorical framing.
(A note to the reader: the metaphors discussed in this paper are set in boldface
to make it easier for the reader to locate them in the text.)
Since the 1980s, many promises have been made about nanotechnology's abilities to alleviate human suffering and increase human health, with or without using the term 'nanomedicine". Broadly speaking, nanomedicine is the medical application of nanotechnology. The term nanomedicine seems to have first appeared in print as a specific chapter in Eric Drexler et al.'s 1991 book Unbounding the Future
. A search of the newspaper database Lexis Nexis reveals that the term was first used in English speaking news in an article for The Philadelphia Inquirer
on January 1, 1996 which claimed that “Nanomedicine will use very small mechanisms to target problem spots in our bodies. For example, a tiny bulldozer of sorts
would clear out cholesterol, like so much rubble, from arteries, making angioplasty obsolete.” The first targeted nanoparticle-drug delivery systems were developed in the 1980s, but it has been difficult to create systems that work consistently. However, talk of magic nano bullets
and images of nanobots
or of nanosubmarines
or, indeed, nanobulldozers
scouring the blood vessels or delivering drugs began to proliferate alongside the emergence of nanomedicine, and reached a crescendo in the early 2000s. Such words and associated images, both metaphorical and real, tried to convey the potentials of nanomedicine for the treatment of common diseases, especially heart disease and cancer.
The discovery announced on November 4, 2009 is, like much of modern research in nanotechnology and also synthetic biology, grounded in chemical engineering and based on self-assembling polymers. The novel nanoparticle, BIND 014, developed in this tradition, is described as follows in Technology Review
The core of BIND's nanoparticle is made up of biodegradable polymers PLA (polylactic acid) and PLGA (copolylactic acid/glycolic acid), which hold the desired drug in a molecular mesh, allowing it to slowly diffuse. The outer layer is made of polyethylene glycol, a molecule with water-like properties that lets the nanoparticle evade detection
by proteins and the white blood cells that eat pathogens
in the blood. That stealth coating
is also dotted with specially designed peptides that bind to the cell of interest, delivering the particle's payload
The article was entitled: “Stealthy
The title and brief description of BIND 014 already contain a host of metaphors. Reading this passage alone, the reader is drawn into imaging the nanoparticle as an agent, indeed a special agent, able to evade detection by the evil pathogen eating white blood cells and it does so because it has a stealth coat, which the reader can either imagine as something like an invisibility cloak à la Harry Potter or as a stealth coating à la B2 stealth bomber. Corpus and method
To establish a corpus of newspaper articles on BIND 014, the news database Lexis Nexis Professional was searched using a variety of search terms (nanoparticle, BIND 014, BIND Biosciences and "stealth"), but only revealed a very small number of articles (n=7) that covered this advance in all English speaking news. This small corpus was then coded according to the various metaphors that were used to frame this advance in nanomedicine and then analysed in terms of the implications such framing may have for science and society.
Sociologists of metaphor, such as Sabine Maasen, Peter Weingart, Iina Hellsten and myself have traced the dynamics of knowledge through various domains of science and society by focusing on metaphors that function across discourses. They suggest that metaphors are important not only because they facilitate understanding, but also because they do so by transporting meaning across the boundary of science and society. Consequently, metaphors have critical implications for science communication because they can have different resonances in different contexts. Metaphors can generate new insights, knowledge and understanding, but they can also create the illusion of insight, knowledge and understanding. This then has implications for the ethics and politics of science.
This article seeks to apply these insights to the study of metaphors, particularly militaristic metaphors, in reporting on advances in nanomedicine. One can justly deplore the use of militaristic metaphors in science and media communication and can call, perhaps unrealistically, for a liberation from such metaphors, as Susan Sontag did in her 1978 book lllness as Metaphor
. However, this is not the purpose here. Rather, the focus is on understanding how metaphors function in various settings, how they intersect with other sets of metaphors, how they may create a common ground between discourses, and how they function in the complex interplay of science and media. This is a critical analysis of how such metaphors are rendered plausible or acceptable in public discourse and the social and discursive consequences of their presence or absence.
According to the cognitive view of metaphor popularised by George Lakoff and Mark Johnson, metaphors help us understand an abstract or inherently unstructured subject matter in terms of a more concrete, more highly structured subject matter. Metaphors are not only linguistic, but cognitive phenomena. They are not only nice, but necessary for our thinking, acting and speaking and they are conceptual devices, rather than just rhetorical ones.
So-called conceptual metaphors, such as arguments are war (and their linguistic realisations, e.g. ”He spearheaded the debate”, “She shot down his argument”) are seen as mappings across at least two conceptual domains: the conceptual source domain (e.g. war) and the conceptual target domain (e.g. arguments). These mappings are not arbitrary. Rather, they are grounded in our everyday experience of the body and the world we live in. Our conceptual metaphor system is for the most part unconsciously and automatically accessed and processed. We only become conscious of it when highly poetic and novel metaphors are created. This mainly tacit use of metaphors has advantages in so far as they allow scientists, journalists and the public to share information quickly and effortlessly. But it can also have disadvantages, as it allows metaphors to go unscrutinised and to be employed and received uncritically.
For scientists, metaphors are indispensable tools for knowledge creation but also for popularising issues, promoting certain views over others and for legitimising specific scientific programmes. For journalists, metaphors are part of journalistic routines for the purposes of popularising, concretising and dramatising issues, in brief for making issues both newsworthy and interesting for the relevant audiences. Militaristic metaphors, such as Nanoparticles are Weapons, Nanoparticles are bullets or Nanoparticles are bombs are especially useful for journalists and commentators looking for dramatic ways to capture and keep their readers' attention. The same is increasingly the case for scientists trying to communicate with the same audience.Analysis
None of the newspaper articles devoted to BIND 014 used the first paragraph of the press release/article published in Technological Review
which evoked a "mad scientist" scenario:
In a small manufacturing space on a Cambridge, MA, street dotted with biotech companies, Greg Troiano tinkers with a series of gleaming metal vats interweaved with plastic tubes. The vats are designed to violently shake a mix of chemicals into precise nanostructures, and Troiano's task, as head of process development at start-up BIND Biosciences, is to make kilograms of the stuff--a novel drug-infused nanoparticle.
Most of the newspaper articles that followed talked about the nanoparticle as a smart
", a metaphor not used by the author of the original article, but a metaphor that has been used to describe targeted drug delivery systems for several years to evoke images of speed and efficiency (see Nordmann, 2004). This (smart) bomb metaphor aligns well with the very common medical metaphor of the magic bullet or silver bullet, which was in fact used by Professor Langer, one of the team involved in this breakthrough, in May 2009 in an interview for Scientific American
's World View section: “'The hope,' Langer says, 'is to have these "magic bullets
" that can home in on specific cells.'” The phrase magic bullet itself had first been used at the beginning of the twentieth century by Paul Ehrlich when he wrote (as quoted by Susan Aldridge):
If we picture an organism as infected by a certain species of bacterium, it will . . . be easy to effect a cure if substances have been discovered which have a specific affinity for these bacteria and act…on these alone. . . while they possess no affinity for the normal constituents of the body. . . such substances would then be . . . magic bullets
None of the articles used the "fantastic voyage" imagery that was so popular in the early years of nanotechnology. The metaphorical focus of almost all articles was on war and weaponry, in line with a type of military language that has been pervasive in medicine since the nineteenth century. War and competition metaphors have been a long-standing currency in medical discourse. From the times of Louis Pasteur onwards, dealing with bacteria or germs has been framed in terms of waging war, what Montgomery called "biomilitarism" in his 1996 book The Scientific Voice
. Dealing with cancer too has been pervasively framed by war, fight and battle metaphors. As George Annas, a bioethics professor, pointed out in his 1995 article on military metaphors:
Medicine is a battle
against death. Diseases attack the body, and physicians intervene.
We are almost constantly engaged in wars on various diseases,
such as cancer and AIDS. Physicians, who are mostly specialists
backed by allied health professionals and trained to be aggressive,
fight these invading diseases with weapons designed to knock
them out. Physicians give orders in the trenches and on the
front lines, using their armamentaria in search of breakthroughs.
Treatments are conventional or heroic, and the brave patients
This description was echoed and reinforced a decade later in a 2006 article on the war on disease and the war on terror by Ann Mongoven:
Perhaps nowhere in social discourse have war metaphors proliferated more influentially than in modern medicine. Historically, this metaphorical nexus coalesced as a result of two factors. One was 19th century developments in bacteriology that coopted “invasion” as a root metaphor. The other was the thick institutional linkage between medical research/training and the war effort during the world wars. In the medical world, we now bombard tumors that invade healthy tissue; we declare war against cancer; we battle death. We even describe the body's own immune system militaristically. For instance, we speak of immune defenses breaking down and of T-cells tracking invaders. The medical establishment is described as a military command, with cutting-edge researchers in the vanguard against disease and public health workers in the trenches.
Can nanomedicine and nanomedicine communication escape this pervasive and entrenched framing of modern medicine? It seems not. As we shall see, nano has become just one of the new weapons in medicine's armamentarium.
The main article reporting BIND's findings for The Times
was titled “Nano-weapon attacks
cancer by stealth
; Drug has "shrunk prostate tumours to zero”. Unlike the original article, the first paragraph develops the original article's stealth metaphor and says: “A nanotechnology therapy that attacks cancer with a "stealth smart bomb
" is to begin patient trials next year in the first clinical test of a pioneering approach to medicine, The Times
has learnt.” The article avoids the rather metaphor-laden paragraph of the original press release and is in general a rather more sober account of the new therapy. The metaphors that occur are mainly quotes of those used by Bind Biosciences, for example that of “packing drugs inside a "special delivery parcel
“, “its payload
, a common chemotherapy drug called docetaxel or Taxotere”, its “drug-filled "warhead
”, which is “covered with a "stealth coating
" of polyethylene glycol, which helps the particle to hide so that it is not attacked
by elements of the body's immune system such as antibodies and macrophage cells”, and finally “its smart targeting system
, in the form of enzymes attached to the outer coating known as targeting ligands.”, which is described by one of the scientists interviewed as “an anchor
, rather than a homing beacon
”. Alongside a very rich illustration of the whole process, the article then summarises how the therapy works:
- Treatment is injected and makes its way through body to prostate.
- Drug (docetaxel) is contained within a polymer matrix together with targeting ligands and PEG (polyethylene glycol) "stealth" coating.
- A surface layer of PEG protects drug from attack by the body's immune system.
- When it reaches tumour, targeting ligands bind the particle to the cancerous cells.
- The polymer matrix degrades, so the drug is released slowly.
- This targeting means that high doses of the drug accumulate at the cancer site, while sparing healthy tissue and reducing side-effects.
It should also be mentioned that on a side bar "In the news" on the front page of The Times, this article was announced under the title “Cancer "smart" drug” and mentions "stealth smart bombs" (the Northern Ireland edition's front page news section announcement was entitled “Nano-weapon hope for cancer patients”, as was the second run of the national edition).
The Times article rather than the original article was then used by newspapers around the world to report on these findings, but the response was not overwhelming. It seems that announcements about breakthroughs in nanomedicine are now quite common and have lost their novelty. The only other British national newspaper to report on the findings was, surprisingly, the Daily Express, which is, unlike The Times, a tabloid newspaper. The article was entitled "Smart bombs" that could smash cancer” and used essentially the same language, but ended the article with a warning about increasing awareness of the toxicological dangers inherent in cosmetics, a topic with which readers of this tabloid newspaper may be more familiar (11/06/2009). Just as Mark Henderson as Science Editor for The Times, Victoria Fletcher, the Daily Express Health Editor, developed the war metaphor framing further by not only talking about "attack", "target" and so on, but also of a “seek-and-destroy treatment”, which is a more military framing than "homing beacon".
It would also spare cancer sufferers from the devastating side-effects of the chemotherapy "blanket approach". While effective, this also kills healthy cells, causes hair loss and can make patients feel extremely ill.
To save the parcels from attack, they are dipped in a compound that makes them invisible to the body's immune system defender.
Asian News International picked up the Daily Express article and reported on the findings under the title “'Smart bombs' could kill tumours” (11/06/2009), an article repeated in The Hindustan Times. The Hindu relayed the Times article under the headline “'Smart bomb' to target cancer, evade body's immune system” (11/05/2009). It expands on the metaphors used there and introduces a new one, by saying that the 'stealth smart bomb' was “tuned to dodge the body's immune system”, a metaphor which it attributes to Professor Langer.
Under the byline Mark Henderson, The Australian published a shorter version of The Times article under the headline “Stealth tactics to hit cancer cells hard” (11/06/2009). A very different headline was used by the Courier Mail (Australia), namely “Elixir shrinks cancer” (11/06/2009) when relaying a shortened version of the Times article. Although such magical, alchemical metaphors are quite common when reporting on promised medical breakthroughs, such as stem cell therapies for example, this is the only such metaphor in our corpus, where journalists, on the whole, followed the metaphorical lead of the original.
The findings were also reported in Northern Ireland and in the Irish Republic. The Belfast Telegraph had a short paragraph on "Smart bomb" cancer trial in which it made reference to stealth smart bombs (11/05/2009) and the Irish Independent had a longer extract of The Times article under the headline “'Stealth smart bomb' to aid cancer therapy” (11/05/2009).
As is apparent, in the announcement of and reporting on BIND 014, military metaphors far outnumbered non-military ones such as "special parcel delivery", "anchor", "homing beacon" or "elixir". When looking more closely at the military metaphors used, some are so engrained in medical discourse that they have become literal. They have completely lost their metaphorical "charge" so to speak. These are metaphors such "targeting", "killing", "hitting", "attacking", and "defending". Other military metaphors are more alive, such as "smart bomb", "stealth bomb", "stealth tactics", "stealth coating", "blanket approach", "seek-and-destroy treatment" (a phrase well-known to the discourse used in fighting bacteria resistant to antibiotics, so-called superbugs), "warhead", and "payload", as well as "dodging", "sparing" and "smashing" — where the agent-like nature of the nanoparticle comes more to the fore — and, most obviously, nano-weapon and magic bullet.
The initial metaphorical framing used in the MIT press release was very successful and was replicated in almost all news articles reporting on this advance. This demonstrates again that scientists themselves, rather than journalists, tend to establish the parameters within which metaphorical framing of a scientific advance can occur. The original press release aligned developments in nanotechnology with a view that medicine is characterised by an arms race to find cures that can fight diseases. This view of medicine is entrenched in popular culture. Scientists using this framing tapped into a rich cultural resource and reinforced it in the process. This framing "makes sense" of nanomedicine in ways that are easily understood, in short, in terms of "what we all know" about medicine. As Roger Schank wrote in Tell Me a Story, “Understanding means finding a story you already know and saying, "Oh yeah, that one."... Once we have found (the) story, we stop processing.” And as Stephen Reese wrote in Framing Public Life, “Frames are organizing principles that are socially shared and persistent over time, that work symbolically to meaningfully structure the social world.” The military framing is one such shared story or shared cultural narrative that structures modern, Western, male, understandings of medicine and which structured both how scientists and journalists reported on BIND 014.
One can ask whether this framing just pertains to this particular breakthrough (a term that, itself, has its etymological roots in warfare) or whether other announcements in the field of nanomedicine share the same framing. More research is certainly needed here. However, a recent advance in nano-drug-delivery aimed at alleviating cancer was communicated by one of the scientists involved in the following way in an interview for MIT Media Relations on February 17, 2010: “Think of them [nanorods] like soldiers attacking an enemy base,” said Michael Sailor, a professor of chemistry and biochemistry at the University of California, San Diego. “The gold nanorods are the Special Forces, who come in first to mark the target. Then the Air Force flies in to deliver the laser-guided bomb. The devices are designed to minimize collateral damage to the rest of the body.”
But is this militaristic framing actually a good framing, both in terms of ethics and in terms of knowledge transfer?
The use of militaristic metaphors in science, policy and medicine has attracted a growing amount of criticism over the last two decades, with repeated calls for less problematic alternatives, and for greater attention to the implications of such framing in policy making and political discourse. Among the charges laid against militaristic metaphors in scientific and medical discourse are that they can motivate overly strong actions and can have unforeseen consequences such as the stigmatization of the ill or the promotion of shame and guilt amongst sufferers. Among policymakers and public health officials, military thinking concentrates on the physical, sees control as central, and encourages the expenditure of massive resources to achieve dominance, writes George Annas.
The consequences of this type of discourse can also be seen in comparable non-medical contexts, such as the disastrous UK response to the foot-and-mouth epidemic in 2001. One result of these concerns about military metaphors has been a series of calls to replace them with more attractive alternative metaphors. Annas proposes an ecological framework, Sontag suggests more absolute stripping away of metaphor altogether, and Susan Sherwin advocates choosing politically liberating metaphors.
Yet, the opacity of much scientific and medical knowledge to most non-specialists means that attempts to disseminate it outside its original context in the laboratory and academy unavoidably depend on metaphors. As a well-entrenched cultural resource, military metaphors continue to be a dominant framing device employed by governments, scientists, journalists, and the public. However, exactly because such metaphors are so compelling, ubiquitous, and seemingly natural, it is all the more important to scrutinize the role they play at the interfaces between science and society and nature and culture.
In the case of nanomedicine, military metaphors seem to have replaced the fantastic voyage metaphors which focused on size and shape of the drug delivery system and have shifted attention to its actions and functions instead. They have also shifted the focus from the 'extraordinary' (voyages) to the 'ordinary' (medicine), thereby contributing to the normalisation of nanomedicine and its integration into normal biomilitaristic medical discourse. Both metaphorical framings, those based on fantastic voyages and those based on military arsenals and actions, enable scientists to communicate relatively easily about nanomedicine and enable lay people to have the impression that they and the scientists they engage with know what they are talking about — they are telling the same story.
There are three questions that have to be asked: Is it the right story? Is the knowledge it conveys real or just an illusion? And, finally: Another question that is puzzling about the use of military metaphors in medicine is: Why have they become symbolisms of good rather than, what philosopher Paul Ricoeur in 1967 called, symbolisms of evil?
Brigitte Nerlich is Professor of Science, Language, and Society at the Institute for Science and Society (School of Sociology and Social Policy), at the University of Nottingham, UK. She may be reached at Brigitte.Nerlich@nottingham.ac.uk.
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