Contents.................................................................................................................................. ii
Introduction.......................................................................................................................... 1
Purpose....................................................................................................................................... 2
Structure...................................................................................................................................... 2
Objectives................................................................................................................................... 3
Key Findings............................................................................................................................... 3
The
Evolution of Meaning, Models and Determinants of Health, Disease, Disability
and Well-being............................................................................................... 6
Step 1: Health a determinant of well-being
(Canadian scenario) or well-being a determinant of health (WHO scenario)?.................................................................................................................................... 6
Step 2: Determinants and models of health, disease,
well-being, and disability.................. 12
The first
generation: Medical model of health, disease, and well-being..................................................................... 12
The first
generation: medical model of disability/impairment....................................................................................... 13
The second
generation: social models of health and disease...................................................................................... 16
The second
generation: social model of disability......................................................................................................... 17
The third
generation: transhumanist/enhancement model of health, disease, and well-being................................ 19
The third
generation: the transhumanist/enhancement model of “disability/impairment”...................................... 20
The involvement of
disabled people in the debate around health concepts, models, and determinants 21
The debate around human body
structure and functioning enhancement 29
Arguments used
against enhancement..................................................................................... 30
Arguments to
justify enhancements......................................................................................... 32
Drawing a
line: therapy versus enhancement and therapeutic versus non-therapeutic
enhancements 33
Realization of the
transhumanist/enhancement model........................ 35
Step 1: Make “healthy” people feel bad about
themselves.................................................... 35
Direct-to-consumer
advertising......................................................................................................................................... 35
Medicalization
triggered by the availability of drugs.................................................................................................... 37
Medicalization
of aesthetics (body appearance)............................................................................................................ 39
Step 2: Add
enhancement to the mix....................................................................................... 41
Examples of
enhancements that could be seen as therapies and therapies that have
enhancement aspects...... 41
Examples of
therapeutic interventions that are used for non-therapeutic purposes................................................ 42
How to Evaluate................................................................................................................ 45
Step 1: What kind of assessment?............................................................................................ 45
Step 2: How to perform assessments....................................................................................... 45
The problem with evaluation, measuring, analysis, and
outcome tools................................... 53
QALY indicators........................................................................................................................................................... 56
The Triangle of Disabled
People/Concept of Health and Disease/Emerging Technologies....................................................................................................................... 58
The impact of science, technology,
and health research, including HTA, on disabled people 58
Perception of and
self-identity of disabled people......................................................................................................... 59
Self-perception of disabled people................................................................................................................................... 59
Perception of disabled people........................................................................................................................................... 60
A clash of perceptions and values................................................................................................................................... 61
Science and technology, disabled people, and
transhumanism................................................ 65
HTA and Disabled People........................................................................................................ 71
Evidence gathering, evaluation
tools, measuring tools, and disabled people......................... 74
Experimental and
quasi-experimental evidence/survey and administrative evidence............................................... 74
Qualitative research evidence............................................................................................................................................ 75
The
New Wave: Nanotechnology and its Convergence With Biotechnology, Information
Technology, and Cognitive Sciences (NBIC)........................ 87
Nanobiotechnology.................................................................................................................... 91
Nanomedicine451........................................................................................................................ 92
Nanomedicine taxonomy.................................................................................................................................................... 93
Nanosurgery455.............................................................................................................................................................. 99
Use of nanotechnology to fight cancer475....................................................................................................................... 99
Nano pharmaceutical technologies on the horizon:
Horizon Scanning.................................. 101
New nano-drug delivery systems................................................................................................................................... 102
Nanoparticles used for drug detoxification................................................................................................................... 106
New drugs: nanodrugs, pharmacogenomics, and
pharmacogenetics....................................................................... 107
NBIC products envisioned for
disabled people......................................................................... 113
Brain–machine interfaces................................................................................................................................................. 115
Bionic implants................................................................................................................................................................... 116
Bionic ear543,544.................................................................................................................................................................... 116
Bionic eyes547..................................................................................................................................................................... 117
Next generation autonomous wheelchair control......................................................................................................... 117
Bionic legs and arms......................................................................................................................................................... 117
Bionic knee......................................................................................................................................................................... 118
Neural prostheses.............................................................................................................................................................. 118
Spinal cord prostheses..................................................................................................................................................... 118
Speech................................................................................................................................................................................. 118
Cranial, neural, and other implants.................................................................................................................................. 118
Other areas.......................................................................................................................................................................... 119
Conclusion/The
Way Forward/Suggestions.................................................. 120
Key findings of this report............................................................................................................................................... 125
The Way Forward.................................................................................................................... 127
What should be done?
Ensuring equity in health care.......................................................... 127
The Canadian index of wellbeing (CIW) and this report........................................................ 128
What should be done? Alberta and this report...................................................................... 131
Getting on with better health care—the third way589................................................................................................... 131
Regional health authorities.............................................................................................................................................. 133
The Leduc-Nisku region 2005 Genuine Wealth Project and
this report599................................................................ 133
Alberta quality matrix for health of the Health
Quality Council of Alberta600.......................................................... 133
AHFMR............................................................................................................................................................................... 134
Alberta’s Office for Disability Issues603,604 and
this report.......................................................................................... 135
What should be done? Health Research................................................................................ 136
Health research priorities.................................................................................................................................................. 136
What should be done?
HTA and other assessments............................................................ 137
What should be done?
Governance of science and technology............................................ 138
What should be done?
The disabled people.......................................................................... 143
What should be done?
Global health..................................................................................... 145
This report and the just adopted “Bangkok Charter for
Health Promotion in a Globalized World” 146
The role of disabled people.............................................................................................................................................. 147
The concepts, models, and determinants of health...................................................................................................... 147
The Bangkok Charter and enhancement medicine
(transhumanist medicine, transhumanist model of health, transhumanist
determinants)...................................................................................................................................................................... 150
The Bangkok Charter and Canada.................................................................................................................................. 150
Conclusion.......................................................................................................................................................................... 150
This report and the just adopted “UNESCO Declaration on
Bioethics and Human Rights”617 151
Appendix A: Methods and Results of
the Author’s Database Searches of Different Keywords..................................................................................................... 153
REFERENCES.................................................................................................................. 162-216