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An essay on the mill of refinement, can we take off?
Most of the improvements would be beneficial for a society desperate for cures or treatments that benefit the population identified as sick or disabled. " Some few of these improvements are developed for particular populations 'healthy', who have specialized requirements, such as soldiers in combat. Although improvements are intended ostensibly limited consumption, the trend is that its use will increase dramatically after its introduction, and soon goes beyond the population that justified in the first instance, their development.
goes further and shows that the introduction of improvements may alter the social perception of what is abnormal and / or acceptable. And he says: "In the absence of disease, there is no reason to define a treatment threshold. For example, how to justify the treatment of a child whose growth horizon is of 1.60 meters, and not that of another child whose maximum height of 1.61? The most serious is that the use of GH [growth hormone] in very short children can create an endless cycle of new setbacks, the increases in the high end of very short stature children involve the reclassification of many children previously normal (low stature but high horizons that exceed these thresholds), which will be labeled as "idiopathic low." This may be a circumstance in which the treatment of a group of children create a state of "illness" in a group previously "healthy". " [Emphasis added.]
Unfortunately, growth hormone is not the only case in which technology performance improvements, when administered in the absence of disease, create a population "affected" was once considered healthy. Consider the following examples:
* Gene Therapy * Update height Unfortunately, growth hormone is not the only case in which technology performance improvements, when administered in the absence of disease, create a population "affected" was once considered healthy. Consider the following examples:
memory * Improved visual cognitive Implant
* Insert gene happiness charm
* Training in partnership * Implant gene for the assessment of broccoli
* transcranial magnetic stimulation (TMS its acronym in English): This is a procedure that stimulates areas of the brain from the outside, through the use of an electromagnetic field. The TMS can help reveal the roles of active parts (or off) of the brain, but is considered as a potential treatment for brain disorders, including Parkinson's disease or depression. * Training in partnership * Implant gene for the assessment of broccoli
Along with the TMS, is converted sleep deprivation in lifestyle for those seeking a competitive advantage and can afford treatment or medication? And the workers, such as bus drivers, will they be forced to undergo "therapy" of sleep deprivation in order to stay tuned for more hours? What are the social (and health) of an army of "undead" private company or a perennially sleep?
The New York Times recently noted that in the past five years, the U.S. Naval Academy has provided corrective eye surgery, free of charge, to all midshipmen (the eye can benefit from it) .66 Less than 30 percent of the class of 2006 refused to undergo surgery (the number of denials is shrinking every year.) An unintended consequence is that referred to the Naval Academy could not meet its share of submarine officers in any of these five years.
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BANG: What does nano convergence. Will it lead that humans best? 101
Some of us are used to take pictures, send to a friend, search the Google-all on our cell phones, or phones. But this ethos "all-in-one" goes beyond the field of communications and information technology. At least five years ago we heard that there are plans to retrofit high-level practice of science and technology through technological convergence, and it will be possible by nanotech advances. The ultimate goal is to intervene in all macro-level phenomena including social, biological and environmental-control to achieve nanoscale phenomena.
The search for a "core technology" that gives humans control over nature is not new. Its roots go back at least to the New Atlantis, Francis Bacon (published in 1627), 102 in which he describes a utopia on a fantastic island, Bensalem, where possible, for example "do for art ... trees and flowers that are up or slow down their own stations, and emerging and mature more quickly ... giving larger and sweeter fruits, or a different flavor, color, odor and figure ... and make various plants
rise in soil mixtures seeded ... and have a tree or other plant to become ".103 technological resources to appear the flora and fauna of Bensalem are not random or unpredictable but controlled (" none of this happens by accident, but we know in advance what material or mixture, what kind of creatures emerge ") .104 In language that will sound familiar to readers of the U.S. National Science Foundation (NSF for its acronym in English), the ultimate goal of Utopia "the knowledge of the causes ... and widening the boundaries of human empire, to make all things possible ".105
Compare, For example, the utopian vision of technological convergence that drives the NSF, nearly four centuries later: "envision the bond of humanity driven by a virtual brain that interconnects the communities of the land in search of intellectual understanding and conquest of nature ".106 Nanotechnology-controlling matter through manipulation of atoms, "Biotechnology can converge with life-controlling, manipulating genes, they may converge with computer-controlling through manipulation of data bits," can converge with Cognitive and Neurological Science, which controls the mind manipulating neurons.
"human life expectancy was of only 37 in 1800. Our ability to reschedule this expectation iology dramatically increase once again. But the progress will be much faster. In 15 years we will be adding a year annually for life expectancy. My advice: take care themselves to the old *, for a time, and may perhaps fully experience the wonderful next century. "Ray Kurzweil," reprogramming Biology, Scientific American, July 2006.
(* The health maintenance regimen of Kurzweil is far from being "old." He writes that he takes 250 supplements a day therapeutic injections applied every week is taken, routine blood samples, hair and saliva to monitor their body's levels of nutrients, hormones and collateral metabólicos.1)
In Canada this convergence is called systemic bio-synthesis [BioSystemics Synthesis] .108 Without necessarily share the enthusiasm of the government, civil society arrived in his own name for the convergence of technologies and known as BANG-Bits, Atoms, Neurons, Genes, which are the operational units "NBIC technologies ".109 One of the theoretical claims of this convergence is that it could develop a treatment for Alzheimer's disease. Suppose we discover, after digging through mountains of data, a natural compound that exists in very small quantities in the Amazon can indeed be effective in curing certain neurological disorders. That using recombinant DNA technology, researchers can produce the compound in large quantities. Nanoscale devices that allow the drug (free and produced using information technology and biotech) can be supplied to the damaged neurons in the brain. Although not all convergence products will require all components of BANG, almost all use one or more technologies enabled or refined through nanotechnology. Other examples of this convergence is the implantation of nanoscale materials to replace bone damaged by arthritis, manipulating the neurons to be able to control the movements of a computer cursor, the cognition install devices that increase the capacity of our brains store and use information.
A pilot project report forecasting science and technology [Science & Technology Foresight Pilot Project], sponsored by the National Research Council of Canada [Canada's National Rsearch Council], identified five characteristics that make BANG technologies particularly consistent in their logic: they are convergent (which means they can be combined with each other but also can be applied across many industries and research disciplines) are fundamental and replicative ("each of these technologies have some ability to reproduce themselves), 110 distributed (because individuals can use them) and are of public interest (which means that all of them "involve many promises, but at the same time can be very disruptive.") Since the U.S. government-and subsequently the governments of Europe and Canada, considered BANG from point of view of "refined human performance", become crucial debates about the ethical, social and economic human performance refinement and extension of life expectancy.
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Goal 1: Eradicate extreme poverty and hunger
(Goal 2) Between 1990 and 2015 to reduce by half the proportion of hungry people.
Goal 4: Reduce child mortality
(Goal 5) Between 1990 and 2015 to reduce by two thirds the mortality rate of children under five years.
Goal 5: Improve maternal health
(Goal 6): Between 1990 and 2015 to reduce by three quarters the maternal mortality ratio.
Goal 6: Combat HIV / AIDS, malaria and other diseases (Goal 7) By 2015 have ended and begun to reverse the spread of HIV / AIDS.
Goal 7: Ensure environmental sustainability
(Goal 10) By 2015, reduce the proportion of people without sustainable access to safe water and safe sanitation. (Target 11) Have achieved by 2020 a significant improvement in the lives of at least 100 million slum dwellers.
Goal 8: Develop a global partnership for development
(Meta 17) In cooperation with pharmaceutical companies, provide access to essential medicines affordable in developing countries.
Adapted from http://www.who.int/mdg/goals/en/
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What role will nano-enabled medicine to cure disease and poverty in the South global?
According to a press release from the Joint Centre for Bioethics at the University of Toronto (March 31, 2005), "Some day soon, in a remote community in the developing world, a health worker will put a drop of blood from a patient in a piece of plastic about the size of a dime. Within minutes you will have the full diagnosis, including common test battery, plus the analysis of infectious diseases such as malaria or HIV / AIDS, hormonal imbalances and even something like cancer. This amazing piece of plastic called lab on a chip and is one of the revolutionary products and processes currently emerging from nanotechnology research with the potential to transform the lives of thousands of millions of the world's most vulnerable ".111
In September 2000, the United Nations adopted eight Millennium Development Goals (MDG, or MDG by its acronym in English) and 18 goals - a "map" to eradicate hunger and poverty and to ensure the health and environmental sustainability, especially of the poorest in the world by 2015. United Nations identifies three MDGs-eight (of 18) goals relate to health care (see Box 3). The "task force on science, technology and innovation" [UN Millennium Project's Task Force on Science, Technology and Innovation], part of the United Nations Millennium Project, sees nanotechnology as an important tool to achieve the ODM.112 Many others - scientists, researchers, entrepreneurs, market analysts and experts in rural development between them, agree that the technologies nanoscale offer the potential to improve global health - including the world desarrollo.113 Proponents believe that nanotechnology could play an important role in remedying the health of the global South, not only live in treating patients with novel vaccines and therapies from the nanoscopic level, but indirectly, easing the conditions that lead to diseases such as unsafe drinking water. Current research in nanoscale source filters and nano-particles that remove water contaminants are frequently cited examples to invoke the potential contributions of nanotechnology to health in the developing world. The ETC Group acknowledges that nanotechnology research and development related to water are potentially significant for the developing world. Access to clean water could be a much greater contribution to global health than any particular medical intervention.
Nanotechnology research related to water and its political and economic context require further study and examine the ETC Group (in a separate report) research and development in nanotechnology related to water. In this report, however, we confine our analysis to the Nanomedicine drugs and devices for detection, diagnosis and treatment of diseases at molecular. In September 2000, the United Nations adopted eight Millennium Development Goals (MDG, or MDG by its acronym in English) and 18 goals - a "map" to eradicate hunger and poverty and to ensure the health and environmental sustainability, especially of the poorest in the world by 2015. United Nations identifies three MDGs-eight (of 18) goals relate to health care (see Box 3). The "task force on science, technology and innovation" [UN Millennium Project's Task Force on Science, Technology and Innovation], part of the United Nations Millennium Project, sees nanotechnology as an important tool to achieve the ODM.112 Many others - scientists, researchers, entrepreneurs, market analysts and experts in rural development between them, agree that the technologies nanoscale offer the potential to improve global health - including the world desarrollo.113 Proponents believe that nanotechnology could play an important role in remedying the health of the global South, not only live in treating patients with novel vaccines and therapies from the nanoscopic level, but indirectly, easing the conditions that lead to diseases such as unsafe drinking water. Current research in nanoscale source filters and nano-particles that remove water contaminants are frequently cited examples to invoke the potential contributions of nanotechnology to health in the developing world. The ETC Group acknowledges that nanotechnology research and development related to water are potentially significant for the developing world. Access to clean water could be a much greater contribution to global health than any particular medical intervention.
believe that the global health crisis does not stem from a lack of scientific innovation and medical technology: the root of the problem is poverty and inequality. New medical technologies are irrelevant to poor people if they are not accessible or affordable. Scientific innovation is meaningless if marginalized people have no access to treatment or existing technologies. Doctors Without Borders says that pharmaceutical companies pay more attention to obtain patents in developing countries that supply drugs
esenciales.114
As said Rights Commission Intellectual Property, Innovation and Public Health, World Health Organization in April 2006: "The current government policies and strategies of companies, including its financing mechanisms and incentives, in developed and developing countries alike, no have generated sufficient biomedical innovation as it is relevant to most developing countries. New treatments, and even existing ones, are still beyond the reach of those who necesitan.115 For example, one third of the world's population lack regular access to essential medicines. In parts of Africa and Asia this figure rises more than half the esenciales.114
población116
Designing microbes for produce a malaria drug that is inexpensive is one of the causes celebres of synthetic biology, a convergence of biotechnology and engineering laboratory building systems running specific tasks. Malaria afflicts 300 to 500 million people and kills more than a million annually: (58 percent of malaria cases occur among the poorest 20 percent of the world's population-especially children who live in 
África.143
África.143 With support from the Bill and Melinda Gates Foundation, Jay Keasling, professor of chemical engineering at the University of California at Berkeley and director of its center of synthetic biology is building a microbial chemical factory that will manufacture artemisinin, a powerful agent for malaria.
Artemisinin, a natural product extracted from the leaves of a plant known as sweet wormwood or sweet wormwood in various treaties and popular knowledge systems, or Artemisia annua as classification, is an effective treatment against all strains of malaria. The Chinese knew this shrub as a medicinal plant for over 2000 years. Naturally derived artemisinin is scarce. Many experts believe that it is technically possible to grow enough of the sweet wormwood to produce artemisinin to combat malaria everyone mundo.144 suffer in the chemical synthesis of the drug is slow and costosa.145 In 2004, the Berkeley laboratory where he works Keasling, along with innovation company (Amyris) and the Institute for OneWorld Health (nonprofit) received from the Bill and Melinda Gates Foundation donated $ 43 million for five years to develop a version of artemisinin derived from microbes. Keasling's lab is now designing metabolic pathways designed a yeast (Saccharomyces cerevisiae) to produce intermediate products needed in developing the artemisinina.146 The laboratory and produces acid artemisinic, which is one step away from artemisinin itself. According to Keasling, the next step will require chemical wisdom so that the final product will not arrive soon, it may take ten years before that microbes artemisinic acid distils enough to cure malaria at global.147 If researchers require ten years more to achieve what they propose, how this approach may cost artemisinin-based production of synthetic biology? If, finally, design microbes can produce a treatment for malaria, is it accessible or affordable product? The University of California at Berkeley has awarded OneWorld Health and Amyris a royalty-free license to develop treatment against malaria. Keasling says Amyris will produce the drug at cost and the non-profit (One World Health) will execute the work necessary to overcome the regulatory hurdles. Amyris hopes to use the same technology platform to produce other more profitable drugs. According to the company's website: "The team of scientists and engineers Amyris now tries to sell drugs and other goods of high value fine chemicals extracted from the forests and oceans of the world and to develop these compounds in synthetic microbes." 148
<50-80> However, researchers may be trapped in a complex web of intellectual property rights in both processes and products related to the production of artemisinin - which could force them to negotiate royalties and license fees to many patent holders. Recall, for example, the much publicized case of golden rice with added vitamin A that is trying to remedy nutritional deficiencies of the poor South. Even with public funding, in 2000 researchers developed the Golden Rice (encallejonados of some 70 patents in dispute) had to deliver the giant project agrochemical multinational AstraZeneca (now Syngenta). The controversial golden rice market is still pending.
VivaGel: miniaturization microbicide microbicides The term refers to a range of compounds that are now under development and aims to reduce or prevent transmission of HIV and other sexually transmitted diseases when applied topically. Worldwide more than 7 000 women are infected with HIV every day. Some of the people who campaign after the health of women are promoting the development of microbicides because they could put in the hands of women a safe protection, affordable and accesible.149 Microbicides are not commercially available but almost twenty of them being tested in clinical trials. One of vaginal microbicides now being tested in humans, VivaGel (Starpharma), is based on nanoscale molecules called dendrimers, synthetic molecules, three-dimensional branching parts. The active ingredient in VivaGel functions as a "Velcro" molecular (velcro style) which prevents the action of HIV and herpes genital adhering to receptors on the surface of the virus, which prevents the attach to host cells trying infectar.150 VivaGel is a topical microbicide that has the potential to prevent transmission of HIV and other sexually transmitted diseases when applied the vagina before sex. In animal studies, the main ingredient of VivaGel also acted as a contraceptive eficaz.151 Market analysts say that if VivaGel can protect against sexually transmitted diseases and pregnancy may be a potential competitor to condones.152 VivaGel is the first dendrimer that goes through the process of FDA approval and testing is done today populations in various parts of mundo.153
In 2005, the National Institutes of Public Health was awarded to Starpharma U.S. (based in Melbourne, Australia) the amount of $ 20.3 million to support development in the interests VivaGel of HIV prevention. In April 2006, these same institutions announced they will fund a clinical trial to test the use of VivaGel in the prevention of genital herpes. But ultimately, are they safe, affordable and accessible these vaginal microbicides to those most in need? (Sex workers in Nigeria, which currently apply lemon juice in the vagina in an attempt to protect themselves from contracting HIV, does have access to this protection technology in the near future? 154 Those who are working towards the health of women and suggest that there is a simple technology, low cost (condoms), easy to distribute and store - but condoms are still scarce. For example, in 2003, grants paid the equivalent of one condom per year for every man of reproductive age living in the world desarrollo.155
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The first list of WHO essential drugs (now known as EML English, for short, and Castilian as LME), published in 1977, was described as "a peaceful revolution in international public health" .139 The list established the principle that some medicines were more useful than others, and that many essential medicines are often unaffordable for people who need them. Today, most countries maintain national lists of essential drugs. The lists are important because they guide the efforts of the public sector in its pursuit of supply of medicines, and programs that reimburse the cost of medicines donations of medicines and local production of drugs.
the last 29 years, the Non Gub., The nonprofit aid agencies and intergovernmental agencies have widely adopted policies for essential medicines. But from the beginning, the pharmaceutical industry opposed the concept of the LME and considered it an interference against market forces, a threat to private sector operations.
95 percent). For example, of the 35 countries of the Americas, 21 are of little to medium access, while 14 have medium to high.
The following table compares Africa's access to essential medicines as directed by the first WHO global report 1988, and up dated in 2004. According to WHO, 47 percent of Africa's population lacks essential drugs. From 45 countries, 16 show no improvement or deterioration (between the mid-eighties and late nineties), of whom all but one, have a very low access to essential medicines.
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There is a "fundamental mismatch" between human needs and innovation científica.117 The vast majority of commercial drugs is not relevant to tropical diseases. Only one percent of drugs coming to market between 1974 and 2004 was developed specifically for tropical diseases and tuberculosis.118
* Health, poverty and the environment are inextricably linked. According to WHO, unhealthy environments (unsafe water, poor sanitation and other environmental factors) cause nearly one-third of all deaths and diseases in developing countries desarrollo.119 Infectious diarrhea kills 1.8 million people per year, almost all children. 88 percent of the global burden of infectious diarrhea is caused by sanitation, hygiene and water little seguras.120 * The global South accounts for more than 80 percent of the population, but only about 10 percent of drug sales. In 2005, Africa had 1.1 percent of global pharmaceutical market. ( North America, Europe and Japan have 86 percent of that market.) 121
Today, the formal systems of health care are highly dependent on As medical innovation and technology designed primarily to respond to health markets in OECD countries. Research and development of medicine in these countries are based, first and foremost, in pursuit of profits of the pharmaceutical industry, not the needs or the development of human beings. Ninety percent of research and development on health is devoted to conditions affecting only 10 percent of the population. For example, malaria now accounts for 3.1 percent of the global disease burden but only 0.3 percent of investment in research related to health issues and development (268 million dollars). If the malaria research with the average fund other research would receive more than 3 300 million per year-more than 10 times the funding that currently recibe.122 But it would be biased to suggest that the pharmaceutical industry is a engine of innovation related to public health in OECD countries. In recent decades, the pharmaceutical industry has abruptly lost their innovative drive. Often they are the government and university laboratories who conduct innovative research, which then acquire farmacéuticas.123 large firms in the United States at least one third of drugs marketed by big drug companies obtained licenses from universities or small companies biotecnología.124 After decades of mergers and acquisitions, the drug industry is consolidated in the hands of very few and large corporations. In the last ten years has increased the controversy about the role of monopoly patents on making drugs are unaffordable for poor people, and creating barriers to access to medicine crucial to saving lives . Reaffirmed in Doha safeguards have not come true and are rapidly eroded rich as governments undertake bilateral trade agreements that impose more stringent patent laws beyond the requirements set by the WTO.
In 2004, the 98 most important companies involved in the drugs had combined sales of 415 billion dollars, the top ten absorbed 59 percent of the market global.125 Instead of developing new compounds, the companies make minor modifications existing drugs and take advantage of government policies inspired by the industries, which enable companies to extend the life of drug patents by those who make a profit. For example, the 78 drugs approved by the management agency of U.S. food and medicines, the Food & Drug Administration (FDA) in 2002, only 17 contained new active ingredients, and only seven were classified by the FDA as improvements in medicine existentes.126 The 71 other drugs are drugs "me too", ie, remodeling of older medicines that are no better than other products that are already on the market. (It is as if the companies say: I also want to profit from this product.) Companies are seeking to stop the development of cheaper generics, which often is paying generic manufacturers to delay the sale of the product competitivo.127
Typically, drug companies try to justify their high prices by pointing to the huge costs of research and development unit. In fact, drug companies spend far more on "marketing and administration" than on research, development and manufacturing. The health researcher Marcia Angell estimated marketing costs of major drug companies reached 54 billion dollars in 2001 -30 percent of industry inputs, which are the order of 179 billion dollars. 128 This includes, for example, spending on direct advertising the consumer, the cost of employing 88 000 sales representatives who visit the offices, plus free samples and gifts they give to doctors, advertising in magazines and marketing and promotion disguised as "educational."
But reaffirmed in Doha safeguards have not come true and erode rapidly as wealthy governments undertake bilateral trade agreements that impose more stringent patent laws beyond the requirements set by the WTO, thus undermining the Doha Declaration. The U.S. government, for example, vigorously promotes bilateral trade agreements or regional forcing poor countries to recognize a regime known as "TRIPS-plus" provisions whose purpose is to extend the patent monopolies of big pharmaceutical companies, which limit the use of compulsory licensing mechanisms and access to generic drugs baratos.131
"
Companies developing improvements in human performance, with very expensive technology, may seek acceptance by offering them as "therapy" for the benefit of the poor in the developing world. The most likely scenario is that the human performance improvement will increase the disparities between rich and poor, both in the North and the global South. The market introduction of nanomedicines starts at the same time accelerates the dissociation of clinical
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think global health as a "Grand Challenge"?
According to Science, in the last seven years have been spent over 35 billion dollars to combat diseases that disproportionately affect pobres.156 A huge portion of that money comes from the rich disproportionately. Since 1999, the world's richest man, Bill Gates, has donated, through the Bill and Melinda Gates Foundation-6 billion dollars, which in broad terms is equated with the WHO budget for the same period. 157 In June 2006, the super-wealthy investor Warren Buffet (according to some the second richest man in the world) announced plans to transfer about 31 billion dollars of its 44 000 million to the Gates Foundation donate eventually double the assets of caridad.158 According to The Economist, is the rapid creation of wealth (there are now 691 000 billionaires in the world when ten years ago had 432) and an unequal distribution Today wealth that explains the enthusiasm for philanthropy deep bolsillos.159
Wealthy donors often align with global campaigns, billboards and large format involving governments, corporations, associations and foundations in areas public and private [Public-Private Partnerships, or PPP]. Goals can be as ambitious as it is wide involvement: "Make Poverty History" or "Curb Malaria, for example. The PPP is seen as a way to enforce what the P in "public" has failed and what the P in "private" has no incentive. Ten years ago, PPP had no one to be devoted to the development of "orphan drugs"-drugs that have little or no potential for financial gain, and there are now over 63 drug development projects aimed at remedying the diseases prevalent in the South global.160 prospects proceeds from the sale of "orphan drugs" has not changed, but well-endowed philanthropic foundations and to a lesser extent, governments have offered to pharmaceutical companies an array so sweet that it is impossible to refuse: the foundations and governments to provide cash and technology companies provide drug development and infrastructure for clinical trials. According to Science, for large pharmaceutical benefits model "zero profit, zero loss" include "a good public image and his introduction to the markets of developing countries, as well as make contact with researchers who help anywhere." 161 According
Eldis (entity of the Institute of Development Studies, Essex), requires about 600 million dollars over the next ten years to develop a microbicide, replicable, to remain on the shelves (in good condition) a reasonable and attractive for usuarios.162 Ideally, microbicides would give women more likely to protect themselves against HIV without having to rely on the cooperation of their partners. But gender inequality is the root of the problem, unless it is in front, a new technology may not offer a simple solution. Those working for women find that money be spent better if applied programs of empowerment of women, aimed at increasing their income and ability to assume control over their own lives. There are also numerous health and safety issues surrounding the development of microbicides, especially in the global South where the living conditions of already poor, can complicate a safe and effective. Based on historical trends, there is concern that political pressures to adopt effective microbicide could undermine the necessary rigorous testing process, and that vulnerable populations of women end up being guinea pigs (for example, one of the first tests microbicide clinical [not Starpharma] held among sex workers actually increased the incidence of HIV infection in these women) .163
global health initiatives
Table 4 provides details of seven global health initiatives-all financed through partnerships of public and private spheres. Although statistics regarding the incidence of disease in the global South can only be described in very dark-the average life expectancy has fallen in 38 countries since 1999, especially by the spread of HIV, 165 two million children die each year from diseases preventable by vaccination, 166 a child dies of malaria every 30 seconds in Africa subsahariana167 and over 8 million people become sick with infectious TB each año168-it would be unfair to rule out any of these initiatives as a categorical failure, given the daunting challenges and the relatively early stage of projects . Only one of the initiatives has over ten years and five have less than five years. (The possible exception is the program to hinder the malaria known as Roll Back Malaria Programme, the British Medical Journal in 2004 described as "a failed health initiative, due to their inability to make available in the poorest communities essential tools to combat malaria, mosquito nets, insecticides, medicines based on artemisinina.169) 
Moreover, it would be irresponsible to state that some of these categorical programs are successful. None of the initiatives is above criticism, although some are more prone to problems than others. In June 2006, The New York Times shed light on certain failures related to the fight against malaria: The Global Fund has yet to deliver at least one of the 1.8 million nets promised in Uganda in 2004, the World Bank does not have staff working in spite of malaria in 2000 claimed had halved deaths from malaria in Africa, only 8 percent of the budget for malaria in 2004 by the U.S. Agency for International Development (known worldwide by its acronym in English: USAID) was used in medicines , mosquito nets and insecticides. Requires about 600 million dollars over the next ten years to develop a microbicide, replicable, to remain on the shelves (in good condition) a reasonable and attractive to users.
Table 4: Global Health Initiatives current Focus Initiative Release Year Donor funds pledged, committed or spent in dollars Grand Challenges in Global Health Initiative170
Applying science and technology to health problems in the developing world
Gates Foundation, Wellcome Trust, the Canadian Institutes of Health Research and the Foundation
for U.S. health institutes 481.6 million
2002 governments, Gates Foundation, Hewlett Foundation, United Nations Foundation , Novartis, Statoil and other 8 600 000 000
Global Alliance for Vaccines and Immunization (GAVI)
Fund and develop vaccines for children 1999
WHO, UNICEF, World Bank, NGOs, the Gates Foundation, governments, vaccine industry (Wyeth, Chiron
Several PPP (partnerships of public and private) to develop drugs, vaccines, diagnostics, microbicides, treatment. Ode Development treatments, vaccines and diagnostics Undated
Several governments, foundations, philanthropists, corporations
1 200 million
Multi-Country HIV / AIDS Program Financing improve existing efforts in the prevention and treatment by governments and community
2000 World Bank
Multi-Country HIV / AIDS Program Financing improve existing efforts in the prevention and treatment by governments and community
2000 World Bank
1 100 million
International AIDS Vaccine Initiative Research and development of AIDS vaccine
1996 World Bank / Global Forum for Health Governments Research, Becton, Dickinson and Co.,
Foundation Gates, Continental Airlines, Deutsche AIDS-Stiftung, DHL, Google, Otto Haas Charitable Trust # 2, Pfizer, Rockefeller Foundation, Until There's A Cure Foundation, and other
100 000 000 International AIDS Vaccine Initiative Research and development of AIDS vaccine
1996 World Bank / Global Forum for Health Governments Research, Becton, Dickinson and Co.,
Foundation Gates, Continental Airlines, Deutsche AIDS-Stiftung, DHL, Google, Otto Haas Charitable Trust # 2, Pfizer, Rockefeller Foundation, Until There's A Cure Foundation, and other
Roll Back Malaria Treatment and Prevention Partnership
1998 Governments, World Bank, UN agencies, academic institutes, academics, NGOs, corporations, individuals
1998 Governments, World Bank, UN agencies, academic institutes, academics, NGOs, corporations, individuals
150 million. 171
Sources: Science January 13, 2006, p. 163, ETC Group
Sources: Science January 13, 2006, p. 163, ETC Group
The bulk of its budget was used in meetings and share consultoría.172 In general, criticism of health initiatives include high-profile mismanagement (corruption rampant in some cases), duplication, inefficiency, shortness of mindedness and lack of an "architecture" capable of uniting the global esfuerzos.173 In a time of increasing enthusiasm for the potential of nanomedicine to solve the major health challenges in the world, it is important to emphasize that any innovation will make these structural problems disappear.
"The nanotechnology cancer imaging to reduce uncertainty promises that lead to a more sensitive and accurate detection in the early stages of the disease ... These efforts erased the boundaries between what we call what we call detection and therapy. "
Adrian Lee, Professor of Medicine, Baylor College of Medicine "The nanotechnology cancer imaging to reduce uncertainty promises that lead to a more sensitive and accurate detection in the early stages of the disease ... These efforts erased the boundaries between what we call what we call detection and therapy. "
One of the most publicized areas of research in Nanomedicine involves nanoproyectiles use of gold to detect and treat cancerous tumors. The bulk of its budget was used in meetings and share consultoría.172 In general, criticism of health initiatives include high-profile bad handling (corruption rampant in some cases), duplication, inefficiency, short-sightedness and lack of an "architecture" capable of uniting the global esfuerzos.173 In a time of increasing enthusiasm for the potential of nanomedicine to resolve major health challenges in the world, it is important to emphasize that no innovaciónhará that these structural problems disappear.
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Nanomedicine Applications
(drug delivery, imaging and diagnostics).
are vast potential applications of nanotechnology in the field of medicine. In this section we provide examples that reflect the most intensive areas of nanomedicine research and develop hand and finger current (involving commercial products): targeted delivery of drugs, therapies, nano-enabled, and diagnostic imaging. We decided not to make an exhaustive list of possible applications (for there are hundreds) but to offer some samples of Nanomedicine applications in each area. It should be noted that the supply of drugs, imaging and diagnosis are not always distinct sectors. In cancer research, the ultimate goal is to develop multifunctional nanoscale devices that act as imaging and therapeutic agent anticancerosa.174
1. Targeted drug delivery gold nano-shells. One of the most publicized areas of research in Nanomedicine involves using gold nano-shells to detect and treat cancerous tumors. Here we have a case where the detection and therapy overlap: The nano-shells are imaging agents that also function as therapeutic agents. Although the idea of \u200b\u200bnano-shells are back in the early fifties, its creation was delayed for several decades until it was possible to design nanoscale engineered partículas.175 In the nineties, Naomi Halas, Rice University (Houston, EU), has developed nano-shells of gold. In 2002, she and her colleague, Jennifer West, Rice also formed an innovative company called Nanoespectra Biosciences Inc. Since then, the company has received more than $ 5 million in funding to develop medical applications of nano-shells Gold (including more than 3 million from federal funds) 176 data is expected to lead to human tests for early 2007,177
The Halas nano-shells are particles of silica (glass) completely covered with gold, built from a few million atoms. Can occur in a range of sizes, with diameters less than 100 nm or as large as several hundred nanometers. The manufacturing of nano-shells requires Nanomedicine engineer to finely calibrate the nanoscale thickness of gold plating, and thus exhibit the desired optical properties. When injected into the bloodstream, naturally congregate tumor sites, so no need to redirect. When tumors grow, creating sometimes very fast, many blood vessels. As such, these vessels are often poor, which allows nanoproyectiles run off between the "cracks" and reach the vascular tumor.
detect tumors and bomb making use of their surrounding vascular defects known as permeability and retention effect accented "or EPR effect. Halas describes a nano-shell as a lens nanoscale, in essence, it captures the light and then focuses itself around misma.178 When handling tamaño de los nano-proyectiles —del núcleo de vidrio y de su recubrimiento de oro—, es posible alterar la forma en que absorben la luz. En la detección y la terapia del cáncer el objetivo es “calibrar” los nano-proyectiles para que interactúen con luz cercana al infrarrojo (conocida comúnmente como NIR por sus siglas en inglés).179 Cuando se les expone a una luz NIR, los nano-proyectiles actúan como un enjambre de luciérnagas que iluminan el área donde se congregan (los sitios tumorales).
Una vez que los nano-proyectiles completaron sus tareas imagenológicas, se vuelven agentes terapéuticos. Si se alumbra con un láser near infrared to the tumor site from outside the body (the light can travel through the tissues more than 10 inches), the nano-shells absorb light and focus on the tumor. The area surrounding the nano-shells are heated and "cook" the tumor to its dissipation. This is not so different from the science experiment that we illustrated in childhood: The nano-shell works like a magnifying glass, the laser is the sun and the tumor is heated as a blade of grass.
In 2005, Halas described the shocking results of cancer treatment with nano-shells applied in mice: "Once [the nano-shells] are Instead, the infrared light is launched from outside the skin and goes to the tumor site. This involves using a laser manual, very simple to use, and only three minutes enough ... In studies with mice we have observed complete remission of tumors in the space of ten days. We used two control groups and their tumors continued to grow dramatically until the end. But mice that were treated with nano-shells survived the study and had a 100 percent survival, persisted. That test was done in 2003. Almost two years ago. So it seems that most of these mice will die of old age. "180 Halas highlights the fact that the nano-shells were leave "toxic traces in the body, while the conventional chemotherapeutic agents themselves. Nanospectra's Web site states that "long-term studies do not indicate any toxicity or effects on the immune system" .181 These statements should be inspected in great detail as it is very likely that nanoproyectiles to settle permanently in the body, and not clear, until now, how can excrete.
Medical products incorporating nanoscale silver are among the first commercial success of nanotechnology. Although the antimicrobial properties of silver are known for thousands of years, the increase in surface area of \u200b\u200bnano-particles of silver designed with engineering Nanomedicine (1 to 100 nm) makes them more chemically reactive and highlighted its therapeutic properties.
Nucryst Pharmaceuticals (a subsidiary of Westaim Corporation) manufactures coatings for wounds and burns nanometer silver impregnated to fight infection and inflammation. Silver kills bacteria and viruses by blocking the electron transport microbes and offset cell replication when in contact with DNA. Silver ions (atoms that have an electrical charge due to change in the number of electrons) can disrupt funciones.182 microbial structures and problematic side is that high levels of silver ions released by prolonged periods of time, can also kill cells, so exposure should be controlled ellos.183
Smith & Nephew, a medical equipment firms in the world's largest, sells coatings wounds with silver layer in thirty countries Nucryst with the name of Acticoat. The growing demand for antimicrobial coatings due to that very quickly, several bacteria are becoming resistant to antibiotics. Smith & Nephew Acticoat states that is effective against 150 pathogens, including some microorganisms resistentes.184
Johnson & Johnson, Bristol-Myers Squibb and Medline Industries, among other companies, marketed as medical products based on nanoscale silver. But the wound coverings are just the beginning. Since it is estimated that bacterial infections related to hospitalization are the fifth leading cause of death in the United States, the companies intend to nanoscale silver lining with the surgical instruments, bed sheets and curtains of hospitales.185 In December 2005 the FDA granted approval of a catheter (a tube for transporting liquid) coated with antimicrobial silver for implantation into the body humano.186
coatings silver nanoscale devices are also used as antimicrobials in consumer products like refrigerators finish, brushes, containers for storing food and clothing. SmartSilver antimicrobial socks are sold to soldiers in U.S. military stores, and researchers develop fabrics with nanoscale silver coatings are described as "self-cleaning" .187 A new washing machine commercially released by Samsung (called SilverCare) injects silver ions to the wash water and rinse. Samsung claims that the silver ions penetrate the fabric and kill bacteria without hot water or bleach. Specialists in water treatment at municipal level are wondering if the nanoscopic silver washing machines can cause serious problems if the silver particles are discharged into drains and kill plankton, thereby disrupting the chain alimenticia.188 A request to early 2006 by the American Association of dependencies in favor of clean water [National Association of Clean Water Agencies] Environmental Protection Agency of the U.S. government considered in June 2006 review and classification of products containing silver nano-particles such as pesticides, that is, with the ability to kill vegetal.189 life
3. Nano-particles applied to biomedical imaging and diagnosis Quantum dots Nanomedicine designed engineered and used in electronics (in computers and flat screen TVs) but have not received approval for use in therapy or diagnosis, largely because there concern that are potentially toxic. Research current evidence suggests that "under certain conditions, quantum dots can pose risks to human health or environmental" .191 The inner core of most quantum dots are made of cadmium and selenium, which are known to cause (in low concentrations) of acute and chronic poisoning in vertebrates.
In an attempt to make quantum dots are safe and biologically compatible, its core and inner shell are encapsulated within a bioactive coating that "functionalized"-and makes them suitable for molecular imaging and drug delivery , for example. However, if the outer degrades, it can expose the toxic core. Quantum dots can remain within cells for weeks or months, but we know almost nothing about how these nanoparticles are metabolized within the body or what their routes excreción.192 A recent toxicological review of quantum dots by Ron Hardman researcher at Duke University (North Carolina, USA), concludes that it is easy to identify problems involving quantum dots because, as with the nano-particles in general, even those that are chemically similar may have features physical and toxicological drastically different. Quantum dots with the size, shape and composition of metallic core and its outer shell can be a factor in determining toxicity. The result is that "each type of quantum dot must be characterized individually to determine their toxic potential" .193
"carbon points?
Researchers at Clemson University (South Carolina, USA), recently developed a new type of quantum dot from carbon, and suspect it may be more benign than the composite particles of cadmium, selenium or plomo.194 When carbon nanoparticles are covered with special polymers, flash brightly when exposed to light. Researchers believe that the photoluminescence may be due to the presence of "pockets" that trap energy or holes on its surface.
Verigene system uses different techniques to detect DNA and proteins, but both systems use gold nanoparticles to create highly selective and sensitive probes. When the polls are combined with a sample, they can only go to-and link-building with additional genetic. The system is capable of identifying genetic markers in a single test.
Nano-medical sensors.
Researchers at the University of Illinois developed a tiny implantable device that would allow diabetics to monitor glucose levels sangre.196 removed without sensors are made of carbon nanotubes of pure carbon molecules shaped cylinder that naturally fluoresce when illuminated infrared light. The aim is to develop a sensor that can be implanted just under the skin and to provide an optical signal when illuminated infrared light. In essence, the more glucose there is in the body, most brilliant flash nanotubes. Implantable glucose sensors are only the first step. The researchers hope that someday develop other sensors for a wide range of biochemicals such as hormones, cholesterol, or the presence of drugs.
Tissue Engineering
In April 2006, researchers reported that the first urinary bladders grown in the laboratory and transplanted to seven children and young adults and worked effectively for nearly four años.201 Washington Post described the feat as the Holy Grail of medicine: "the first crop of replacements that work, bodies to remedy poor people ".202 These bladder transplants are carried out experimentally, and have not received U.S. FDA approval. The company that is commercializing the technology of transplants, Tengion has not disclosed the estimated cost of a transplant as well. Transplanted bladders grown from the patient's own cells marks the beginning of an era of "rejuvenation medicine" in which the organs that are not working properly, due to illness or age, can be replaced with models that work better. Some futurists expect to amass a collection of parts, including hearts, in anticipation of the inevitable decline of cuerpo.203
nanoescalar.204
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