Contents

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