Research resource flow, new technologies and the 10/90 gap in health research

 

Research resource flow, new technologies and the 10/90 gap in health research

By Dr. Gregor Wolbring [1]

for Forum 8 of the Global forum of health research and the ministerial summit on health research organized by the World Health Organization and hosted by the Mexican Government. Mexico City, 16-20 November 2004

 

 

Introduction

The Bangkok Declaration on Health Research for Development [2] reaffirms “that health is a basic human right” and “that Health research is essential for improvements not only in health but also in social and economic development”. It states that “social and health disparities, both within and between countries, are growing” and asks, that “given these global trends, a focus on social and gender equity should be central to health research.” It states that “health research, including the institutional arrangements, should be based on common underlying values” such as “a clear and strong ethical basis governing the design, conduct and use of research; the inclusion of a gender perspective; a commitment that knowledge derived from publicly funded research should be available and accessible to all; an understanding that research is an investment in human development; and a recognition that research should be inclusive, involving all stakeholders including civil society in partnerships at local, national, regional, and global levels. “ [3]

 

In this light, this paper explores the potential effects of nanotechnology and the converging of nanotechnology, biotechnology, information technology and cognitive neuro sciences (NBIC) on equity in health and health research and a governance model for inclusive health research that would meet the challenge of the Bangkok Declaration.

 

The state of emerging technologies

 

Science and technology (S & T) have had throughout history – and will have in the future – positive and negative consequences. S & T is not being developed and used in a value neutral environment and is the result of human activity imbued with intention and purpose and embodying the perspectives, purposes, prejudice, particular objectives and cultural, economical, ethical, moral frameworks of any given society in which the research takes place.

 

Nanotechnology is an emerging technology able to manipulate materials on an atomic or molecular scale [4] . Nanotechnology or nanosciences enables a new paradigm of science and technology which sees different technologies converging at the nanoscale namely (a) nanoscience and nanotechnology; (b) biotechnology and biomedicine, including genetic engineering; (c) information technology, including advanced computing and communications; (d) cognitive science, including cognitive neuroscience (“NBIC” nano-bio-info-cogno). The National Nanotech Initiative (USA) envisions applications for the converging of NBIC, in areas such as the environment, energy, water, weapons and other military applications, globalization, agriculture, space exploration, lifespan  extension, nanomedicine [5] (the preservation and improvement of human health using molecular tools and molecular knowledge of the human body [6] ) and enhancing human performances such as improving work efficiency and learning, enhancing individual sensory and cognitive capabilities and improving both individual and group creativity through the usage of highly effective communication techniques including brain-to-brain interactions and  human-machine interfaces. [7] Nanomedicine deserves specific monitoring as developments in this area will have great impact on health research.

 

The Bangkok Declaration on Health Research for Development [8] acknowledges that “rapid globalization, new understanding of human biology, and the information technology revolution pose new challenges and opportunities.”

 

I would argue that the converging of  NBIC-technologies not only gives new meaning to human biology, but also questions the very concepts of health and disease and what it means to be human [9] .

 

Two main models for health and disease (the medical, the social) have been part of the discourse of the governance of science and technology until now.

Within the medical model of health and disease, health is characterized as the normative functioning of biological systems, and disease is seen as the sub-normative functioning of biological systems. Medical/technological interventions on the level of the individuals are seen as the remedy of choice. On the global scale the disability-adjusted life year (DALY) emerged as a measure of the 'burden of disease' [10] to support this medical model of health and disease. However it has become increasingly clear that a purely medical model of health and disease and the concept of the DALY [11] are flawed. They result in too narrow a policy/research focus that fails to address health as a state of complete physical, mental and social well-being [12] , that ignores the co-requisites for health such as peace, shelter, education, social security, social relations, food, income, empowerment of women, a stable eco-system, sustainable resource use, social justice, respect for human rights and equity [13] and other key determinants of health, [14]  that  ascribe a "reduced value" to "lives lived with a disability"; equate disability with ill-health; and assume that "living with a disability" represents a net drain on society and that individuals with a disability lie somewhere between life and premature death. They also ignore the WHO aim “to ensure equal opportunities and promotion of human rights for people with disabilities, especially those who are poor”. [15]

 

A broader understanding of the concept of health and disease has since evolved. Increasingly, social determinants are included in evaluating health and disease. However even this broader understanding of health and disease still incorporates a devaluing concept of disability following a framework of normative and sub normative functioning of a person whereby normative and sub normative functioning is a reflection of individual or societal determinants, parameters. This is problematic in that rather than understanding human diversity as the norm and to be valued and protected, diversity and difference are labeled as non normative. Who and what is defined as the norm can vary depending on who or what is in vogue or considered valuable at any given time.

 

However aadvances in science and technology -- in particular the converging of nanotechnology, biotechnology, information technology and cognitive sciences (NBIC) - allow for a new definition of health itself (transhumanist model). NBIC ‘health products will make the addition of new -or improve on existing abilities of human beings- possible making it difficult if not impossible to distinguish between  ‘therapies towards a norm’ and ‘therapies which will exceed a norm leading to ‘improved’ norms and addition of new abilities to human beings

In accordance to the above, health is characterized not anymore as normative functioning but optimum functioning of biological systems and interpreted as the concept of feeling good about ones abilities, functioning and body structure. Disease in this case is identified in accordance with a negative self perception and a suboptimum functioning.

 

Under this transhumanist model, disabled people can opt to be fixed not only to a norm but also to be enhanced, augmented above the norm (e.g. giving bionic legs to amputees, which work better than the "normal" biological legs). This follows the transhumanist vision of today's so called "non-disabled" people who believe that every human body is defective -- the Transhumanist type. [16]   The transhumanist model is, in essence, a variation of the medical, individualistic, deficiency model.

 

 

The focus on a medical view of health, disability and disease and the increased ability of science and technology to intervene, change and modify characteristics of humans and their body, increases the tendency within the industry and society to medicalize/transhumanize the human body, its characteristics, and its problems. This model leads to a subjective understanding of health in which anyone can consider themselves as "unhealthy" and could demand treatment for themselves based on a self-identified need. It leads to those with the most persuasive voice and economic clout controlling the research agenda and its applications. It results in "individualized" medicine and technological solutions for the self-identified problems of those who can afford the "fix" -- the affluent.  The solutions that emerge from this model lead, among other things, to an increase in the 10/90 gap and a growing inequity between poor and rich.

 

 

Health Research [17] governance

 

 

According to the Bangkok Declaration on Health Research for Development [18] an effective health research system requires: coherent and coordinated health research strategies and actions; an effective governance system;  a revitalized effort from all involved in health research to generate new knowledge which addresses the problems of the world's disadvantaged and it is the responsibility of an active civil society through their governments and other channels to set the direction for the health research system, nurture and support health research, and ensure that the outcomes of research are used to benefit all their peoples and the global community.”

 

The ‘World Report on Knowledge for better Health, [19] to be discussed in Mexico City at the ministerial summit on health research, has 7 key messages:

“1. Science must be turned into action to improve people’s health; it must focus more on

the “how” rather than the “why”, “where” or “what”

2. Knowledge must be accessible to all, in a form which is useful and can be acted upon

by different people and groups

3. All countries must create an environment in which research for health is seen as a

systematic effort, and will thus flourish

4. Research must be conducted according to universal ethical standards thus ensuring

that it will improve equity in health

5. A broader, more inclusive view of health research is needed and civil society has a

vital part to play

6. Research is an investment, not a cost, and governments must spend on it

7. Action Plan needed-now!”

 

How can these 7 key messages be fulfilled?

 

The Commission on Macroeconomics and Health recommended an 80% increase in the health budget of low-income countries between 2001 and 2015 and a seven-fold increase in donor assistance to these countries for health over the same period, in its December 2001 Report. [20] Insert 5.4 shows a variety of recommendations given by a variety of groups. The Commission on Health Research for Development, convened in 1990, recommended that at least 2% of national health expenditures in low- and middle-income countries be allocated to health research and capacity building. [21] The executive summary of the 10/90 Report on Health Research 2003-2004 recommends:” Few priority-setting exercises for health and health research systematically take into account key actors and factors beyond the biomedical field (i.e. the individual, behavioral and community dimensions; sectors other than health which have a profound effect on the health status of a population; and macroeconomic policies); these dimensions need to be systematically included in the priority-setting exercises in the future, to ensure the most effective and efficient use of the limited resources available for health research. [22]

 

 

[23]

However so far very few of the recommendations have been met. As insert 6.7 [24] shows most low- and middle-income countries still have not met the target of allocating at least 2% of national health expenditures to health research and capacity building as recommended by the Commission on Health Research for Development in 1990. [25] It becomes apparent from Insert 6.4 [26] and the report: Resource flows in developing countries: selected country studies and practical examples by Andres de Francisco and Bienvenido Alano [27] that the majority of funding in R&D for health research comes from the developed countries and the industry.

 

In 1998 US$73.5 billion were spent in health R&D (or about 2.7 % of total health expenditures worldwide). Governments invested at least US$ 37 billion (50%), and the pharmaceutical industry US$30.5 billion (42%). Private, nonprofit and university funds provided the remaining US$6 billion (8 %). [28] The United States provided over half of this amount, investing US$19.5 billion. Japan contributed US$2.9 billion, Germany US$2.4 billion, France US$2.2 billion, the United Kingdom US$1.8 billion and Canada US$0.75 billion. Together, the G7 countries (including a rough estimate for Italy) accounted for 90% of total publicly funded health R&D in the high-income countries. All other high-income country governments together contributed US$3.5 billion.” [29]

 

 

 

Health Care Industry Statistics


 

National Health Expenditure Amounts, By Type of Expenditure, U.S.: Selected Calendar Years 1980-20121

In US$ Billions

 

Item

1980

1990

2000

2002

2003

2004

2010

2012

National Health Expenditures

$245.8

$696.0

$1,424.5

$1,547.6

$1,660.5

$1,778.8

$2,702.2

$3,079.8

Health Services and Supplies

$233.5

$669.6

$1,372.6

$1,492.9

$1,602.5

$1,717.2

$2,609.3

$2,974.6

Personal Health Care

$214.6

$609.4

$1,236.4

$1,331.4

$1,423.8

$1,526.4

$2,315.1

$2,639.1

Hospital Care

$101.5

$253.9

$451.2

$484.6

$511.2

$542.0

$770.9

$860.0

Professional Services

$67.3

$216.9

$462.4

$494.4

$529.6

$568.2

$872.7

$999.0

Physician and Clinical Services

$47.1

$157.5

$313.6

$334.0

$356.8

$381.4

$571.1

$646.4

Other Professional Services

$3.6

$18.2

$42.3

$44.8

$47.6

$51.3

$79.8

$90.9

Dental Services

$13.3

$31.5

$65.6

$70.1

$74.0

$78.2

$107.8

$118.3

Other Personal Health Care

$3.3

$9.6

$40.9

$45.5

$51.2

$57.3

$114.0

$143.4

Nursing Home and Home Health

$20.1

$65.3

$132.1

$139.9

$146.4

$154.2

$219.4

$247.7

Home Health Care

$2.4

$12.6

$33.2

$36.2

$38.3

$40.9

$60.4

$68.9

Nursing Home Care

$17.7

$52.7

$98.9

$103.7

$108.2

$113.3

$159.1

$178.8

Retail Outlet Sales of   Medical Products

$25.7

$73.3

$190.7

$212.5

$236.5

$262.0

$452.1

$532.4

Prescription Drugs

$12.0

$40.3

$140.6

$160.7

$182.1

$204.7

$373.3

$445.9

Other Medical Products

$13.7

$33.1

$50.1

$51.9

$54.4

$57.3

$78.8

$86.5

Durable Medical Equipment

$3.9

$10.6

$18.4

$19.3

$20.3

$21.6

$31.2

$34.8

Other Non-Durable Medical Products

$9.8

$22.5

$31.8

$32.6

$34.1

$35.7

$47.6

$51.7

Government Administration and Net Cost of Private Health Insurance

$12.1

$40.0

$89.7

$110.9

$123.9

$131.3

$197.3

$222.6

Government Public Health Activities

$6.7

$20.2

$46.4

$50.6

$54.8

$59.5

$96.9

$112.9

Investment

$12.3

$26.4

$52.0

$54.8

$58.0

$61.6

$93.0

$105.2

Research2

$5.5

$12.7

$32.8

$34.7

$36.8

$39.1

$61.9

$70.9

Construction

$6.8

$13.7

$19.2

$20.1

$21.2

$22.5

$31.1

$34.2

 Note: Numbers and percents may not add to totals because of rounding. Figures for 2002-2012 are forecasts.

1 The health spending projections were based on the 2001 version of the National Health Expenditures released in January 2003.

2 Research and development expenditures of drug companies and other manufacturers and providers of medical equipment and supplies are excluded from research expenditures. These research expenditures are implicitly included in the expenditure class in which the product falls, in that they are covered by the payment received for that product.

Sources: Centers for Medicare & Medicaid Services, Office of the Actuary.

[30]

 

 

Furthermore the report shows that: ”On a global basis, Latin American research publications focus mainly on biomedical and clinical research aspects, while studies on the health situation, health determinants and health services receive much less attention.” It goes on to state that, “Most of the research emerging from the South-East Asian countries studied was devoted to medical sciences, while health economics and social sciences received very little attention.” [31] The same is also true for rich countries. What we see is a preference for a very medical understanding of health and disease and a focus on medical solutions for the ‘medical root of ill health’, leading to an iincrease in the 10/90 gap and a growing inequity between poor and rich. One example of this 10/90 gap is that of 1393 new chemical entities marketed between 1975 and 1999, only 16 were for tropical diseases and tuberculosis, for which 99% of the global burden of disease is in low income countries and that there is a 13-fold greater chance of a drug being brought to market for central-nervous-system disorders or cancer than for a neglected disease. [32]   In 1993 just 10 countries accounted for 84% of global research and development expenditures and controlled 95% of the US patents of the past two decades. Moreover, more than 80% of patents granted in developing countries belong to residents of industrial countries. [33]

 

 

 

 

Health research and new technologies: the case of Biotechnology

Taking into account that the focus of health research is on the medical model of health and disease and that the pharmaceutical/biotechnology industry is responsible for 42% of health research, it comes as no surprise that biotechnology plays a big role in health research. In Canada genomic research is the biggest single ticket item of the Canadian Institutes of Health Research (CIHR). [34] A World Survey of Funding for Genomics Research [35] concludes that “the private sector (pharmaceutical, biotechnology, and genomic start-up firms) is a bigger funder of genomics than the public sector (government agencies and nonprofits organizations)” and “Seventy-six percent of publicly traded and 71 percent of privately held genomics firms are US-based (see table).  European and, to a lesser extent, Asian firms play a larger role among major pharmaceutical firms, but these remain almost exclusively in major developed economies, and much of the genomics even in foreign-owned firms is taking place in the United States.”

 

Government and Nonprofit Funding: Survey Results [36]

Funding in $US

(Listed in order of total funding for Year 2000)

 

1998

1999

2000 (est.)

National Human Genome Research Institute, NIH

210,891,000

270,733,000

326,391,000

Wellcome Trust

60,256,410

100,742,942

115,777,195

European Commission

21,344,717

104,602,510

89,968,511

US Department of Energy*

85,500,000

89,800,000

88,900,000

American Cancer Society

 

50,000,000

50,000,000

Knut and Alice Wallenberg Foundation

5,000,000

11,000,000

35,000,000

The SNP Consortium

 

28,000,000

22,000,000

Cancer Genome Anatomy, Mammalian Gene Collection, Genetic Annotation Initiative and related programs, National Cancer Institute (with co funding from other NIH institutes)

7,000,000

11,300,000

21,800,000

Howard Hughes Medical Institute

20,000,000

20,000,000

20,000,000

Kazusa DNA Research Institute

14,800,000

14,500,000

14,400,000

Imperial Cancer Research Fund

 

 

12,296,588

Centre National de Sequencage Genoscope

4,529,148

7,458,396

7,986,721

Katholieke Universiteit Leuven

5,000,000

5,100,000

5,200,000

Fondation Jean Dausset-CEPH

6,296,692

5,439,331

4,111,561

Merck Genome Research Institute#

3,700,000

 

 

National Institute of General Medical Sciences, NIH

3,000,000

3,200,000

3,500,000

Australian Genome Research Facility

610,687

1,615,385

1,666,667

Program in Medical Genomics, National Health and Medical Research Council (Australia)

319,331

165,993

649,425

Swedish Medical Research Council

 

 

200,000

Total

 

448,247,985

723,657,557

819,847,667

*Figures for US Department of Energy from the White House

#Figures for Merck Genome Research Institute from 1999 Corporate Philanthropy annual report

 

 

 

The World report on Genomic Funding concludes that private annual spending for genomics is substantially higher than the public sector funding, probably in the range of twice the government and nonprofit spending. [37]

R&D Figures from Publicly Traded Genomics Firms

($US millions)

 

1999

1998

1997

1996

1995

1994

1993

Total*

845.8

690.2

507.9

318.8

210.1

149.2

81.7

Big 4**

415.8

268.7

197.4

116.1

70.0

49.5

24.2

 

* R&D figures reported to the Securities and Exchange Commission (or in annual reports) for Abgenix, Aclara, Affymetrix, Aurora Biosciences, Axys, Biacore, Corixa, CuraGen, Diversa, Gene Logic, Genome Therapeutics, Genomic Solutions, Genset, Hyseq, Invitrogen, Lexicon Genetics, Life Technologies, LJL Biosystems, Lynx, Magainin, Maxygen, Myriad Genetics, Pathogenesis, Protein Design Labs, and Sequenom Inc.

** Celera, Human Genome Sciences, Incyte, and Millennium

 

Annual R&D spending reported to the US Securities and Exchange Commission by the four largest publicly traded firms that are primarily focused on genomics (Celera, Human Genome Sciences, Incyte, and Millennium) was over $415 million in 1999, and will likely be higher in 2000.  If we add R&D reported by another 25 publicly traded firms dedicated solely or substantially to genomics, [38] we reach $845 million in 1999. [39]

Spending on genomics in established biotechnology and pharmaceutical firms is likely of at least comparable magnitude.  Many established biotechnology or pharmaceutical firms have substantial genomics investments. [40]  

 

As biotech and pharma companies push for bigger shares of the market, it is not surprising that the manipulation of the genome is being promoted as a way to improve health in developing countries. [41]

 

Top 10 Biotechnologies for Improving Health in Developing Countries [42]

  1. Modified molecular technologies for affordable, simple diagnosis of infectious disease. more information>
  2. Recombinant technologies to develop vaccines against infectious diseases. more information>
  3. Technologies for more efficient drug and vaccine delivery systems. more information>
  4. Technologies for environmental improvement (sanitation, clean water, bioremediation). more information>
  5. Sequencing pathogen genomes to understand their biology and to identify new antimicrobials. more information>
  6. Female-controlled protection against sexually transmitted disease, both with and without contraceptive effect. more information>
  7. Bioinformatics to identify drug targets and to examine pathogen-host interactions. more information>
  8. Genetically modified crops with increased nutrients to counter specific deficiencies. more information>
  9. Recombinant technology to make therapeutic products (e.g. insulin, interferon’s) more affordable. more information>
  10. Combinatorial chemistry for drug discovery. more information>

 

 

However it might be prudent to a) ascertain whether biotech as it is governed, developed and sold in the moment can indeed reduce the 10/90 health research gap b) to look into the cost-effectiveness of expensive investments in biotech vs. low cost investments in basic health, clean water, sanitation, etc. etc. etc. to see whether the non affluent people are best served by biotech and c) to ascertain under what conditions biotech might be of use to the non-affluent.

 

 As the WHO Genomics and World Health report [43] states in its summary [44] :

 

• Any benefits that result from genomics research will be irrelevant to countries that do not have a functioning health care system in place.

 

• Advances in genomics for global health care must be assessed with respect to their relative value in the practice and delivery of health care compared with the costs and efficacy of current approaches to public health, disease control and the provision of basic preventive medicine and medical care.

 

• Conventional, tried and true approaches to medical research and medical practice must not be neglected while the medical potential of genomics is being explored.

 

• An overoptimistic picture of genetic research has emerged. The potential medical applications of genomics suggest they will lead to major advances in clinical practice but it is difficult to predict when that will happen.

 

• Some medical applications of the genome projects are already in use. The diagnosis, prevention and to some extent management of inherited diseases caused by a single defective gene is well advanced. Within the next few years, new diagnostic agents, vaccines and therapeutic agents will likely be available for communicable diseases. In the same time frame, breakthroughs in cancer and new treatments for chronic diseases are far less certain

 

 

And urges that

 

 • The time has come to plan how this technology and its potential clinical advances can be distributed fairly among the world’s population. Otherwise, this new field will simply widen the gap in health care between the rich and poor countries of the world.

• The current situation regarding the patenting of genes is promoting a culture of ownership that may lead to further inequalities in global health care.

• All forms of recombinant DNA technology, including modifying the genes of plants and animals, raise extremely important safety issues and require careful monitoring and control. The potential risks and hazards must never be underestimated. Effective regulatory systems are needed in countries where this work is in the early days of its development or has not yet been established.

• Societies must prepare themselves for the ethical complexities of this emerging

field of medicine.

• All sectors of society including politicians, health care professionals, educators and the public need to be educated about the fundamental principles of genetic research, its inherent risks and the ethical issues such research raises.

 

And as the World Survey of Funding for Genomics Research [45] states:” Absent explicit attention at the international level, the initial technological fruits of genomics are likely to consist primarily of therapeutic and diagnostic applications for conditions affecting large populations in rich countries.  Even more than for biomedical research in general, the skew of research funding is heavily toward the developed economies with large pharmaceutical markets.”

 

 

Health research and the next emerging field: Nanotechnology

 

Initial observations indicate that the dynamics around the new Nano and related technologies will lead to increases in the 10/90 health research gap as research dollars get diverted to support this industry and its exponential growth. Without a concomitant plan to ensure equitable distribution in benefits of these new technologies and in research expenditures to address the health needs of the world's majority, it is likely that these new technologies will serve the needs of the affluent few, consuming an increasing proportion of scarce health research dollars.

 

Nanotechnology is fast emerging as a leading technology and area for R&D investments. According to the 2004 European NanoBusiness Survey, 90% of companies believe that nanotechnology will have an influence on their business, 55% think this will happen within three years; 84% believe that nanotechnology will have a significant effect on their competitiveness. [46]  Based on a study by the NanoBusiness Alliance a newly minted US trade group), the present-day market for small technologies is around us$45.5 billion. That market will jump to us$700 billion around 2008 and exceed US $ 1 trillion probably well before 2015. [47] The USA National Science Foundation (NSF) estimates that the total market impact of nanotechnology on worldwide products and services will reach $1 trillion by 2015, that nanotechnology will generate between 800,000 and two million new jobs, and that half of all drugs will be made with nanotechnology by 2010. [48] Lux research states in their 2004 report: “The year 2004 marked a turning point for the field of nanotechnology. Over the past 12 months, several exponential trends in government spending, corporate research and development (R&D), scientific progress, media coverage, and investment have converged in parallel upon nanotechnology, yielding conditions ripe for extraordinary growth in the field.” [49] One indication of the maturation of the nanotechnology field is the increase in publications. In 1987, the scientific literature included about 200 “nano” references. By the end of 2001, there were roughly 7,700 “nano” citations for the year. In just the first six months of 2002 there were over 6,000 nano citations. [50]

 

 

[51]

 

 

Furthermore the numbers of patents (Chart 1.4, 1980-2004) and the mentioning of nanotechnology in the popular press (Chart 1.5, 1990-2004) also increased significantly. [52]

[53]

[54]

[55]

 

 

[56]

 

The global investment in nanotechnology – both private and public – is estimated between five and six billion dollars (US) per annum. [57] According to Bond, Japan plans to spent 1 billion $ on nanotechnology, Peoples republic of China more than 240 million by the central committee and the same amount or more by the local governments, Taiwan 112 million, Singapore 37 million, Korea 145 million, Prime minister Shimon Peres from Israel suggested 670 million for a nanotechnology initiative. [58]

 

[59]

 

A 2004 report by Lux research [60] finds 2004 Global Spending on Nanotechnology to exceed $8.6 Billion. Of this, government spending will account for over $4.6 billion, with:

           North America spending approximately $1.6 billion or 35%

           Asia spending approximately $1.6 billion or 35%

           Europe spending approximately $1.3 billion or 28%

           The rest of the world spending approximately $133 million or 2%

 

Meanwhile, corporations will spent an estimated $3.8 billion on nanotechnology research and development in 2004. This will be made up of:

           Approximately $1.7 billion by North American companies, equating to 46%

           Approximately $1.4 billion or 36% by Asian companies

           Approximately $650 million or 17% by European companies

           Less than 1% or $40 million for the rest of the world

 

The report also indicates that there has been a reduction in venture capital spending with firms investing only $79 million in nanotech companies in the first half of 2004, compared to $325 million in 2003 and $386 million in 2002. Total VC funding for nanotechnology for 2004 is estimated at about $200 million.

 

Lux Research expects 2004 will be the last year that governments outspend corporations on nanotechnology, as activity shifts from basic research to applications development. In 2004, established corporations will spend more than $3.8 billion globally on nanotechnology R&D. Approximately 1,500 total companies worldwide have now announced nanotechnology R&D plans. Eighty percent of them—approximately 1,200—are startups, 670 of which are in the United States. The U.S. government will spend nearly twice as much on nanotechnology in 2004 as it did on the Human Genome Project (HGP) in its peak year according to Lux research. [61] Taiwan anticipates its manufacturers to ship nano-enabled products topping the NT$1 trillion ($29.2 billion) mark by 2010.

 

The increase in funding for nanotechnology will very likely lead to cuts in other research areas. Furthermore, as with every emerging technology, the question arises as to how much money will be devoted to medicine -- in this case Nanomedicine -- and what will be its impact on health care and health research and the very concepts of health and disease? Will it further strengthen a medical and technological view of health and disease as biotechnology has done? [62]

 

As documented elsewhere in this paper, many products and consequences of nanotechnology will derive from its converging with other technologies (NanoBioInfoCogno). [63] The proposed NNI interagency collaborative activities is just one example of the increased importance of the convergence of different technologies, see below: 

 

Table 3. Examples of proposed NNI interagency collaborative activities

Agency

DOD

DOE

DOJ

EPA

NASA

NIH

NIST

NSF

Fundamental research

x

x

 

 

x

x

 

x

Nanostructured materials

x

x

 

x

x

x

x

x

Molecular electronics

x

 

 

 

x

 

x

x

Spin electronics

x

 

 

 

x

 

 

x

Lab-on-a-chip (nanocomponents)

x

x

x

 

x

x

x

x

Biosensors, bioinformatics

 

 

x

 

x

x

 

x

Bioengineering

x

x

 

 

 

x

 

x

Quantum computing

x

x

 

 

x

 

x

x

Measurements and standards for tools

x

x

 

x

 

x

x

x

Nanoscale theory, modeling, simulation

x

x

 

 

x

 

 

x

Environmental monitoring

 

x

 

x

x

 

 

x

Nanorobotics

 

x

 

 

x

 

 

x

Unmanned missions

x

 

 

 

x

 

 

 

International collaboration

x

x

x

x

x

x

x

x

Nanofabrication user facilities

 

x

 

x

x

x

x

x

 

Where does the research of Nanotechnology converging with other technologies (biotechnology, information technology and cognitive sciences) lead? [64]

Table 1 of footnote 66  shows that national defense is a big player in the development of nanotechnology research that looks not just at non human developments but also at the improvement of human capabilities, namely their soldiers. [65] The development of exoskeletons [66] and the development of human assisted neural devices (brain machine interfaces) [67] are just two projects funded by DARPA. Brain Machine interfaces are also pursued by the National Institute of Health [68]   

[69]

According to Dr. M.C. Roco, the Executive Director of the NNI of the USA and chair of the National Science and Technology Council's subcommittee on Nanoscale Science, Engineering and Technology, 25% of the funding will be in Nanobiotechnology. Since 1999, venture capitalists alone have devoted over $450 million to nanobiotechnology. [70]

 

Products have already been developed in three main areas. These include: 1)Bioanalysis; 2) Drug delivery; and 3) Therapeutics, biosensors and medical devices (e.g. nanotubes, nanowires, nanopore structures for single molecule detection, contrast reagents for MRI and X-rays, tissue engineered material such as nanobones, nanoporous material into retinal implants). [71] According to SRI Consulting Business Intelligence,

 

Today’s nanobiotechnology's greatest impact is in the development of bioanalytical research-technology platforms, such as nanoscale labels or tags to improve signal generation and detection in high-throughput, multiplexed biological assays. Leading medical application areas include material technologies for use as medical-device coatings and diagnostic contrast agents and nanoscale devices for biodetection and drug-delivery applications. Improved tools to characterize and manipulate the structure and function of living matter at the nanoscale could also inspire biology-based approaches to technology development and fabrication. For example, in medicine, researchers envision an ability to synthesize new molecules, to direct the self-assembly of individual biomolecules, or to create molecular-scale tools for in vivo sensing, diagnostics, analysis, therapy design, and drug delivery. Nanobiotechnology opportunities also span food, cosmetics, energy, and electronics applications. For example, improved understanding of nature's processes could facilitate the development of molecular-scale bio-based fabrication approaches for materials and electronics. [72]

 

Dr. Roco believes that nano-level products and devices are inevitable, as they require less space, less material and less energy. He predicts that over the next 10 to 15 years, semiconductors will operate at the nanoscale, one-half of all pharmaceuticals will depend on nanotechnology and nano-structured catalysts will be used in the petrochemical industry. [73] "Think tanks in Japan have estimated the commercial market for 'nano photo-catalyst' at about 40 billion yen (about US$ 367 million) this year. They project the market demand will grow to about 1 trillion yen (about US$ 9.2 billion) by 2005." [74]  

Nanobiotechnology [75] venture deals from 1998 to today are illustrative: 54% for drug discovery, 5% for drug delivery, 37% for diagnostics and 4 for biopharmaceuticals. [76]   The distribution of venture capital for nanotechnology from 1998-2003 saw 52% spent on Nanobiotechnology, 12% on material sciences, 32% on Nano-devices and 4% on Nano-tools. [77]

 

Nanomedicine:

Nanomedicine [78] , an offshoot of nanotechnology, refers to highly specific medical intervention at the molecular scale for curing disease or repairing damaged tissues, such as bone, muscle, or nerve. The National Institute of Health (USA) recently unveiled their Roadmap for Nanomedicine for the next 10 years. [79] Numerous applications for Nanomedicine (NBIC-Medicine) can be envisioned, in development or in use already. [80] The Alliance for NanoHealth [81] Houston, USA is the first collaborative research endeavor aimed solely at bridging the gaps between medicine, biology, materials science, public policy, and nanotechnology.

A nanotechnology working group was formed in the National Heart, Lung, and Blood Institute (USA) to look at nanotechnology and its applications to heart, lung, blood, and sleep (HLBS) diseases [82]

as it is believed that nanotechnology offers new opportunities for diagnosis and therapy of cardiovascular, pulmonary, and hematologic diseases and sleep disorders. [83]

In 1999, the term pharmaceutical nanotechnology showed up for the first time in the database PubMed of the National Library of Medicine.   In 2004 the international journal for pharmaceutics announced that it will add a section on pharmaceutical nanotechnology to their journal. In the pharmaceutical sciences, nanotechnology is being used in such diverse areas as:

 

1. Drug discovery (including combinatorial chemistry and synthesis on the molecular and

macromolecular scale),

2. Nanoanalysis including bioanalysis using miniaturized probes, microarrays and

lab-on-a-chip approaches,

3. Utilizing approaches used by the body in fluid

4. Drug delivery systems having sizes in the nanometer range (e.g. liposomes, nanoparticles, micro-emulsions, dendrimers, etc.)

5. Implantable devices that can sense blood levels and automatically administer drugs

6. Nanoscale biomaterials including biomimetics

7. Biological macromolecules (e.g. proteins, enzymes, DNA and RNA based nanostructures, molecular assemblies, biomolecules, cells, biochips, etc.)

8. Molecular sensors and biosensors, clinical diagnostic techniques.

9. Gene delivery and expression [84] .

The National Science Foundation (NSF) (USA) estimates that half of all drugs will be made with nanotechnology by 2010. [85]

However so far, most drugs developed have been for diseases of the rich. [86] Of 1393 new chemical entities marketed between 1975 and 1999, only 16 were for tropical diseases and tuberculosis, which make up 99% of the global burden of disease in low income countries [87] and there is a 13-fold greater chance of a drug being brought to market for central-nervous-system disorders or cancer than for a neglected disease; [88] Given this, it is questionable whether the 54% of Nanobiotechnology devoted to drug technology will be used to tackle diseases of the poor if today’s priorities aren’t changed.

 

 

Key issues that need to be addressed in order to unlock the potential of nanotechnology and converging technologies for the words majority

 

It seems that we could use the above cited quotes from the WHO Genomics and World Health report [89] [90] and replace biotechnology/genomics with nanotechnology and we have numerous issues which have to be addressed.  Furthermore Dr. M.C. Roco Senior Advisor for Nanotechnology at the NSF USA answering a Questionnaire for the USA, [91] which hosted a recent (June 2004) International Dialogue on Responsible R&D of Nanotechnology [92] came up with the following thoughts on key issues that need to be addressed in order to ensure the responsible development of nanotechnology and suggested measures to ensure the responsible development of nanotechnology (at national, regional, and global levels).

 

“3. Key issues that need to be addressed in order to ensure the responsible development of nanotechnology [93]

- Proper selection of R&D priorities for a balanced and equitable development of nanotechnology that includes research into its potential economic, social and legal implications

- Environmental, health and safety implications associated with nanostructured materials.

- Avoiding possible adverse EHS (environment/health/safety) aspects of nanotechnology by practicing “green chemistry” (clean processes and processing) and “environmentally benign manufacturing”

- Using nanotechnology to understand, measure, and reduce/control pollution from our current processes

- Ethical aspects related to the distribution of the benefits of nanotechnology

- Best mechanisms for communicating with the public

- Issues related to individual rights, such as privacy, have access to healthcare, and various topics at the confluence of nanotechnology, biotechnology, information technology, and cognitive sciences.

4. Suggested measures to ensure the responsible development of nanotechnology (at national, regional, and global levels) [94]

- Develop better understanding on environment, health and societal implications of

nanotechnology through continued support of R&D programs

- Promote exchange of information on the results of R&D on environment, health, and societal implications of nanotechnology. (For illustration, NSF sponsored the first workshop on Societal Implications of Nanoscience and Nanotechnology in 2000, and a joint EC-NSF workshop on the same topic was held in 2001. Follow-on to the 2000 workshop was held in December 2003, and several NNI grantees and research direction meetings were held in 2003-2004)

- Prepare “Best practices” statements for handling and use of engineered nanomaterials, particular in industrial or manufacturing environments and research laboratories

- Prepare “Best Practices” statements for protection and handling natural and process-by-product nanomaterials, such as those from combustion engines or welding

- Disseminate precompetitive research results and develop collaborative activities in order to advance broader goals such as water purification; energy conversion, storage, and transmission; and treatment of chronic illnesses

- Evaluate various issues in the broader societal context and from an international perspective

- Promote two-way interactions with the public at the local, national, and international levels.”

 

The  recent report “Nano-Bio-Info-Cogno-Socio-Anthro-Philo- Foresighting the New Technology Wave Converging Technologies“ Shaping the Future of European Societies  Geo-Eco-Urbo-Orbo-Macro-Micro-Nano”- [95] by the “Foresighting the NewTechnology Wave” Expert Group within the European Commission among others came up with the following recommendations (a selection):  

Text Box: 2. Harnessing the Dynamics of Convergence: New research agendas. 
Recommendation 7: Commission and Member States need to recognize and support the contributions of the social sciences and humanities in relation to CTs, with commitments especially to evolutionary anthropology, the economics of technological research and development, foresight methodologies and philosophy. 
• As CTs pursue the perfectibility of humans and society, evolutionary anthropology needs to study and communicate the meaning of seeming imperfection, diversity and human limitation. 
 • Reports and surveys about nanotechnology and converging technologies, including this one, make economic assumptions as they compare international expenditures and corporate profits, evaluate market potentials and consumer demand, or predict returns on public investment. These assumptions require careful scrutiny. 
 • Current Foresight methodologies should be expanded through a “Hindsight for Foresight” program. Innovation studies, history of technology, science and technology studies, technology assessment and philosophy of science will use historical knowledge and the analysis of international drivers of CTs to shift emphasis from the consideration of presumed outcomes to an evaluation of the visions that go into CT research. Case studies on scientific and technological development should be comparatively investigated to make transparent the underlying dynamics of ‘rational development.’ Technology assessment should be moved upstream also through the consideration of anthropological dimensions and the promoting or retarding effects of public resistance in the shaping of CTs. 
 • The construction of an artificial nature requires philosophical and social orientation and critique especially as it regards the foundation of ethics and societal values in concepts of freedom and human nature. It also may create new economic dependencies, opportunities and constraints for wealth-generation that need to be investigated. 
3. Developing a framework for CTEKS: The research and support environment. 
Recommendation 8: A permanent societal observatory should be established for real-time monitoring and assessment of international CT research, including CTEKS. 
Recommendation 10: The integration of social research into CT development should be promoted through Begleitforschung (“accompanying research” alongside science and technology R&D). 

4. Dealing with CTEKS: Ethics and social empowerment. 
Challenges: 
  To ensure the consideration of ethical concerns from the beginning and in advance of the developments of norms for CTEKS development through the EuroSpecs process. 
  While some approaches consider engineering of mind and brain, to promote in Europe engineering for the mind and improvements of the cognitive environment. 
  While some approaches to CTs promote an increasingly homogeneous technical culture, to pursue CTEKS as a tool for the development of local solutions that foster natural and cultural diversity. 
  To balance CT-based solutions against low-tech or no-tech policy alternatives. 
  To promote sustainable development, environmental awareness, precautionary approches. 
  To empower citizens and consumers to understand, use, and control CTs and to maintain a sense of ownership. 
Recommendation 12: Upon advice from the European Group on Ethics (EGE), the mandate for the ethical review of European research proposals should be expanded to include ethical and social dimensions of CTs. Funding organizations in Member States are asked to take similar steps. 
Recommendation 13: In the face of new models for participatory research governance, transparent decision making processes need to be developed and implemented. 
Recommendation 14: The question of intellectual property rights must be addressed proactively and on an international level. 
Recommendation 15: Member and Associated States are encouraged to stimulate national discussions of CTs and the CTEKS perspective. 
Recommendation 16: CT modules should be introduced at secondary and higher education levels to synergize disciplinary perspectives and to foster interaction between liberal arts and the sciences.

 

 

 

What to do now?

 

Clearly a focused research policy response is needed to clearly define priorities in the advancement and governance of science and technology to ensure that the emerging field of nanotechnology and its convergence with other technologies result in equal benefits to both the poor and the affluent and a closing of the 10/90 research gap and do not result in a widening of the 10/90 research gap.  Many existing reports, such as: “Key issues that need to be addressed in order to ensure the responsible development of nanotechnology,” [96] “Suggested measures to ensure the responsible development of nanotechnology (at national, regional, and global levels),” [97] the WHO Genomics and World Health report for the usage of biotechnologies, [98] the World Report on Knowledge for better Health, [99] the documents of the UNESCO World Conference on Sciences, [100] and the European Report on “Nano-Bio-Info-Cogno-Socio-Anthro-Philo-Geo-Eco-Urbo-Orbo-Macro-Micro-Nano”- [101] and my other paper for forum 8 [102] have excellent language and recommendations that could be drawn upon in this regard. Unfortunately, to date very little effort has been undertaken to follow through on these recommendations.  

 

What we need now are a) initiatives to implement the thoughts expressed in the above documents, b) ensure that all stakeholders are at the table and are fully involved, c) an inclusive ethics of governance of science and technology and d) better access to health care

 

 

Initiatives which might help implement the thoughts expressed in the above documents

 

There are some initiatives which come to mind which might a) help to achieve the goals envisioned in the above documents, b) diminish the 10’90 health research gap and c) might help to make the emerging technologies of use to the majority of the worlds population. 

 

a) Uri Sagman one of the founders of C-Sixty [103] a leading nanomedicine company pioneering biopharmaceutical applications of a unique class of small molecules known as fullerenes – focuses his efforts on the application of nanotechnology to problems of global scope, such as the nanowater initiative. [104]   This initiative should be extended to include also other options like biological filters and filters that can be built from natural resources in the country where the clean and/or desalienated water is needed.  Nano is only useful if it is cheaper and if there is a way to produce it in the country in need of clean water and sanitation.

 

b) Another initiative deals with the availability of bio tools. It proposes an open source movement for biological innovations. The "Center for the Application of Molecular Biology to International Agriculture" (CAMBIA) envisions its BIOS Initiative [105] (Biological Innovation for Open Society) as a tool to engage in collectively creating solutions for disadvantaged groups reflecting their own challenges using tools that meet their operating constraints, and which may be uniquely suited to these tasks. The BIOS initiative is designed to forge a new commons in enabling technology for biological innovations. According to CAMBIA, BIOS will:

• Explore and adapt new inclusive IP sharing mechanisms,

• Articulate and promulgate public-good norms in biological technologies, commission new democratising technologies and

• Promote new standards of utility in enabling technology.

 

BIOS will intervene with salient policy initiatives to increase fairness in access to the tools of innovation as a fundamental human right. It will acquire, commission and distribute inventions under new, public-good binding licenses and contracts to ensure the insulation of the new body of technology from appropriation.

 

c) The Global Forum for Health Research forum [106]  is positioned to help build a research agenda that would include a global assessment of which technological applications are needed and ideas and mechanisms for cutting down the 10/90 gap.

 

Health Research, emerging technologies and stakeholders

 

In any efforts to develop an informed and equitable research agenda, efforts are needed to ensure that all stakeholders are at the table and are fully involved. Historically, science and technology and health research have had huge implications, both good and bad, for disabled people and other marginalized groups such as the poor majority of the world. It is clear that this will continue to be the case for nano and other related technologies, yet to date these people and groups have had and still have little involvement in governance related to these technologies despite that many stressed the importance of exploring the social implications of nanotechnology. In general, disabled people are not part of consultations, governance bodies and are typically not seen as stakeholders (see my other paper for Mexico for more details on this issue [107] ).  

 

A network within the Global Forum which gives voice to the disadvantaged might go a long way to rectify this shortcoming. It is clearly difficult to identify and address inequities in health and health research if those most expert in these areas are not at the table. For example, the very concept of mental illness and the attached definition of the problem and the solutions is very contentious and has served to the detriment of people living with mental illness.  A better understanding of the issues and improvements in health and health equity are more likely if all perspectives are included in any deliberations about mental health research.

 

 

Ethics and science and technology

 

Bioethics theories are supposed to develop ethical principles that allow for the governance of science, technology and biomedical/health research. It is believed that many negative consequences of S&T for humankind could be avoided by using ethical principles to govern them.

 

Within the academic debate over bioethical issues, certain ethical principles are put forward time after time. These include the  principles of autonomy, beneficence, nonmaleficence, and justice; however, different philosophies and approaches to bioethics interpret the concept and boundaries of autonomy, beneficence, nonmaleficence and justice in different ways and come up with additional principles to define ethical behavior. These varieties in philosophies and principles give raise to different possibilities to govern science and technology.

 

How do we decide which philosophy, which ethics to use? It is assumed that the academic development of ethical principles is free from political interventions, but such is not the case (see, e.g. the research initiative funding system, and who is seen as an expert and used by policy makers). It is also not free from prejudiced judgments, as is often assumed. 

 

In the same way S&T is shaped by societal perspectives, so are ethics. Ethics also embody the perspectives, purposes, prejudices and objectives of society, and of powerful social groups within society. Because the academic discourse is not free of politics and prejudice, by itself this discourse cannot lead us to ethics with which we could govern science and technology for the good of everyone in society.

 

So far the ethics debate does not lead to more equity. We have to find a way to make ethics part of the public debate. So far, the framing of the ethics debate under serves the disadvantaged groups. This is a problem that has to be rectified if ethics are ever to become useful for closing the 10/90 gap and serve as a useful tool to help those whose voices are not already heard.

 

Better access to health care

 

Improved access to health care is a stated goal of WHO, and is echoed in the recommendations put forward by Dr. Roco. Nonetheless, little work has been done to rectify inequities in access. WHO estimates that between 1,300 and 2,500 million people - more than one-third of the world's population - have little or no access to "essential drugs" - defined by WHO as those "indispensable" drugs which "should be available at all times, in the proper dosage forms, to all segments of society". [108] Even in rich countries such as the USA the numbers of people without health insurance is increasing.

 

People Without Health Insurance for the Entire Year, U.S.:
2000, 2001 and 2002

In thousands

 

 

 

 

 

 

 

 

 

 

Characteristic

2002

2001

2000

Total Population (000)

Without Insurance (000)

Percent (%)

Total Population (000)

Without Insurance (000)

Percent (%)

Total Population (000)

Without Insurance (000)

Percent (%)

Total

285,933

43,574

15.2

282,082

41,207

14.6

274,087

39,280

14.3

Sex

Male

139,876

23,327

16.7

137,871

21,722

15.8

133,933

20,402

15.2

Female

146,057

20,246

13.9

144,211

19,485

13.5

140,154

18,877

13.5

Age

Under 18 years

73,312

8,531

11.6

72,628

8,509

11.7

72,553

8,405

11.6

18 to 24 years

27,438

8,128

29.6

27,312

7,673

28.1

26,965

7,350

27.3

25 to 34

39,243

9,769

24.9

38,670

9,051

23.4

37,440

7,926

21.2

35 to 44

44,074

7,781

17.7

44,284

7,131

16.1

44,780

6,938

15.5

45 to 64

67,633

9,106

13.5

65,419

8,571

13.1

61,824

7,819

12.6

65 years and over

34,234

258

0.8

33,769

272

0.8

32,978

245

0.7

Nativity

Native

252,463

32,388

12.8

249,629

30,364

12.2

246,629

29,219

11.8

Foreign Born

33,471

11,186

33.4

32,453

10,843

33.4

29,912

9,464

31.6

Household Income

Less than $25,000

62,979

14,776

23.5

62,209

14,474

23.3

61,067

13,889

22.7

$25,000 to $49,999

75,927

14,638

19.3

76,226

13,516

17.7

75,378

12,758

16.9

$50,000 to $74,999

58,622

6,904

11.8

58,114

6,595

11.3

59,311

6,502

11.0

$75,000 or more

88,406

7,256

8.2

85,532

6,623

7.7

80,784

5,534

6.9

Work Experience

Worked during year

142,918

25,679

18.0

142,474

24,230

17.0

140,408

22,806

16.2

Did not work

35,470

9,106

25.7

33,211

8,197

24.7

30,601

7,227

23.6

Source: U.S. Census Bureau, Current Population Survey, 2002 and 2003 Annual Social and Economic Supplements.

 

[109]

For the 400 million disabled people in developing countries -- 150 million of them between the ages of 10-24 [110] -- access to health care is a major barrier to their health, human rights, participation and inclusion in society. Access varies by country, but huge inequities exist in all countries; in some countries, just 2% of disabled people have access to health care [111] .

 

Trends toward an increased medicalization of human characteristic moving away from social determinants of health to more medical/transhumanist models of health will automatically attract funding for ideas, products that serve the affluent few. A rethinking in the very concept of health and disease is needed. Research funding is needed to identify the co-requisites of health for the marginalized world's majority and to tackle the roots of ill health and health inequities that lie in the social, economic and environmental domains.

 

 



[1] Dr. Gregor Wolbring is a member of the Executive of the Canadian Commission for UNESCO, a Biochemist at the University of Calgary, an Adjunct Assistant Professor for bioethical issues at the University of Calgary and University of Alberta both Canada and a consultant for bioethics, disability and governance of science and technology issues. Webpage: http://www.bioethicsanddisability.org ,e-mail:  gwolbrin@ucalgary.ca  

[2] Bangkok Declaration on Health Research for Development http://www.globalforumhealth.org/Non_compliant_pages/forum4/declaration.htm;

[3] I would add here that all disabled people are kept in mind under the concept of social equity and “involving all stakeholders.” For too long were disabled people just seen as people with defects, problems inherent to the person, directly caused by disease, trauma, other health conditions, or deviations from certain norms. For too long did health research and new developments in science and technology focus mostly on fixing disabled people neglecting the social determinants of ill health of disabled people and neglecting to find scientific and technological fixes for the social determinants of ill health of disabled people. For too long did we only give a voice to the disabled people who wanted to be fixed ignoring the ones who preferred the social determinants of their ill health to be fixed. It would also follow the recommendations of the two documents of the UNESCO World Conference on Sciences (WCS) from 1999 see paragraph 25, 34, 42 of the WCS declaration on science; http://www.unesco.org/science/wcs/eng/declaration_e.htm ; and 17, 59, 79, 81, 91 of  the WCS Science Agenda-Framework for Action: http://www.unesco.org/science/wcs/eng/framework.htm; see also see also my paper “Disabled people, science and technology and health research” for Forum 8 http://www.bioethicsanddisability.org/mexico1.html 

[5]   International Centre on Bioethics, Culture and Disability section on Nanotechnology (scroll down to Nanomedicine) http://www.bioethicsanddisability.org/nanotechnology.html ; Nanomedicine, Volume I: Basic Capabilities 1999 Robert A. Freitas Jr.; http://www.nanomedicine.com/NMI.htm; Nanomedicine, Volume IIA: Biocompatibility 2003 Robert A. Freitas Jr. http://www.nanomedicine.com/NMIIA.htm; .

[6] The National Institute for Health (NIH, USA) roadmap for Nanomedicine http://nihroadmap.nih.gov/nanomedicine/index.asp; Nanomedicine Taxonomy of the Canadian Institute for Health Research (CIHR); http://www.ornl.gov/doe/doe_nsrc_workshop/talks/4_Schloss.pdf;   http://www.regenerativemedicine.ca/nanomed/Nanomedicine%20Taxonomy%20(Feb%202003).PDF 

[7] M. Roco, W. Bainbridge eds., Converging Technologies for Improving Human Performance: Nanotechnology, Biotechnology, Information Technology and Cognitive Science, (Kluwer Academic Publishers, Dordrecht Hardbound,  2003, ISBN 1-4020-1254-3) also online at

http://www.wtec.org/ConvergingTechnologies/Report/NBIC_report.pdf ; Roco, M., 2000 NATIONAL NANOTECHNOLOGY INITIATIVE FROM VISION TO IMPLEMENTATION http://www.nsf.gov/home/crssprgm/nano/nni11600/sld008.htm ; National Nanotechnology Initiative More Products http://www.nano.gov/html/facts/MoreProds.htm   

National Nanotechnology Initiative Applications/Products http://www.nano.gov/html/facts/appsprod.html

[8] Bangkok Declaration on Health Research for Development http://www.globalforumhealth.org/Non_compliant_pages/forum4/declaration.htm;

[9] Wolbring, G. (2004) "Solutions follow perception: Nano-Bio-Info-Cogno-technology (NBIC) and the concept of health, medicine, disability and disease" in Alberta Health Law Review Volume 13 Wolbring (2004) Lecture at Arizona State University: March 3, 2004 "Confined to Your Legs: Self-Identity and the Nano-Bio-Info-Cogno-Technololgy Revolution" http://www.bioethicsanddisability.org/asu.html

[10] International Centre on Bioethics, Culture and Disability section on Health research/ QUALY/ DALY/ HEALY/ http://www.bioethicsanddisability.org/qualy.html

[11] see the DALY section of the International Centre for Bioethics, Culture and Disability http://www.bioethicsanddisability.org/qualy.html 

[12] WHO definition of health entered into force on 7 April 1948.

http://www.who.int/about/definition/en/

[13] Jakarta Declaration on Leading Health Promotion into the 21st Century  http://www.who.int/hpr/NPH/docs/jakarta_declaration_en.pdf 

[15] Disability, including management and rehabilitation April 8th 2004 executive board document EB114/4 Provisional agenda item 4.2 

http://policy.who.int/cgi-bin/om_isapi.dll?infobase=ebdoc-en&record={A5E6}&softpage=Document42

[16]   G.Wolbring "Disability rights approach to genetic discrimination" in J. Sandor, ed., Society and Genetic Information: Codes and Laws in the Genetic Era (CPS books Central European University Press, 2004 ISBN: 963924175X)

[17] Definition of Health Research used by the OECD and UNESCO: “ Research and experimental development comprises creative work undertaken on a systematic basis in order to increase the stock of knowledge, including knowledge of man, culture and society, and the use of this knowledge to devise new applications.” can be used to improve the health of individuals or groups. OECD. The Measurement of Scientific and Technological Activities, Proposed Standard Practice for Surveys of Research and

Experimental Development, Frascati Manual 1993, Paris, 1994.

[18] Bangkok Declaration on Health Research for Development http://www.globalforumhealth.org/Non_compliant_pages/forum4/declaration.htm;

[19] World Report on Knowledge for better Health http://www.who.int/rpc/meetings/en/WR2004AnnotatedOutline.pdf

[20] 10/90 Report on Health Research 2003-2004 © Global Forum for Health Research 2004

ISBN 2-940286-16-7 http://www.globalforumhealth.org/pages/index.asp http://www.globalforumhealth.org/filesupld/109004exec_summ.pdf

[21] Commission on Health Research for Development, 1990. Health Research: Essential Link to Equity in Development. New York,

Oxford University Press

[22] 10/90 Report on Health Research 2003-2004 © Global Forum for Health Research 2004

ISBN 2-940286-16-7 http://www.globalforumhealth.org/pages/index.asp http://www.globalforumhealth.org/filesupld/109004exec_summ.pdf

[23] The 10/90 Report on Health Research 2001-2002  Chapter 5. Priorities in health research page 96

 

http://www.globalforumhealth.org/FilesUpld/29.pdf

[24] Monitoring Financial Flows for Health Research 2001. xiv + 57 pages (English only). Complimentary publication ISBN 2-940286-05-1 The 10/90 Report on Health Research 2001-2002  Chapter 6. Monitoring financial flows  page 111 http://www.globalforumhealth.org/FilesUpld/30.pdf

[25] Commission on Health Research for Development, 1990. Health Research: Essential Link to Equity in Development. New York,

Oxford University Press

[26] The 10/90 Report on Health Research 2001-2002  Chapter 6. Monitoring financial flows  page 107 http://www.globalforumhealth.org/FilesUpld/30.pdf

[27] Resource flows in developing countries: selected country studies and practical examples. Andres de Francisco, Senior Public Health Specialist, Global Forum for Health Research, Geneva and Bienvenido Alano, President, Center for Economic Policy Research, Philippines  at Global Forum 4 http://www.globalforumhealth.org/non_compliant_pages/forum4/resourcealano.htm

[28] Session on Resource Flows into Health Research Catherine Michaud, Andres de Francisco, Alison Young, Louis Currat at Global Forum 4 http://www.globalforumhealth.org/non_compliant_pages/forum4/resourcedefrancisco.htm

[29] The 10/90 Report on Health Research 2001-2002  Chapter 6. Monitoring financial flows  page 107 http://www.globalforumhealth.org/FilesUpld/30.pdf

[30] Plunkett Research LTD 2004, HEALTH CARE, MANAGED CARE, BIOTECHNOLOGY, PHARMACEUTICALS, MEDICINE, MEDICAL MARKET RESEARCH, HEALTHCARE TRENDS & STATISTICS National Health Expenditure Amounts, By Type of Expenditure, U.S.: Selected Calendar Years 1980-20121 In US$ Billions http://www.plunkettresearch.com/health/health_statistics_2.htm

[31] The 10/90 Report on Health Research 2001-2002  Chapter 6. Monitoring financial flows  page 107 http://www.globalforumhealth.org/FilesUpld/30.pdf

[32] Drug development for neglected diseases: a deficient market and a public-health policy failure. Lancet,. 2002, Jun 22; 359(9324):2188-94. Trouiller et.al.

[33] Disability Tribune  Special Issue - Disability and bioethics  February 2000  http://www.independentliving.org/docs2/daa200002.html#Health

[34] Financing Health Research:The Canadian PerspectiveJanuary 14, 2003Alan BernsteinPresident, Canadian Institutes of Health Research http://www.vr.se/fileserver/index.asp?fil=PGGISMF5DX6J

[35] World Survey of Funding for Genomics Research Final Report to the Global Forum for Health Research and the World Health Organization September 2000 Robert Cook-Deegan, Carmie Chan, and Amber Johnson Stanford-in-Washington Program http://www.stanford.edu/class/siw198q/websites/genomics/finalrpt.htm and http://www.stanford.edu/class/siw198q/websites/genomics/WorldGenomics$SurveyFinalRpt25Sep00.doc

[36] The figures in the table report are from survey responses, except where noted.  The figures were reported to us in different currencies.  They have not been adjusted for inflation.  For 1998 and 1999, foreign currencies were adjusted by the Purchasing Power Parity (PPP) figures from the Office of Economic Cooperation and Development, Paris (http://www.oecd.org/) as part of its Principal Economic Indicators series.  A similar figure was not available for 2000, so figures were adjusted by currency exchange rates on August 31, 2000.  The original figures will be posted on the website in the original spreadsheet, so others can use the PPP figure to recalculate once it is available. http://www.stanford.edu/class/siw198q/websites/genomics/finalrpt.htm

[37] World Survey of Funding for Genomics Research Final Report to the Global Forum for Health Research and the World Health Organization September 2000 Robert Cook-Deegan, Carmie Chan, and Amber Johnson Stanford-in-Washington Program http://www.stanford.edu/class/siw198q/websites/genomics/finalrpt.htm and http://www.stanford.edu/class/siw198q/websites/genomics/WorldGenomics$SurveyFinalRpt25Sep00.doc

[38] Firms publicly traded in 1999 (therefore 1999 R&D spending reported): Abgenix, Aclara, Affymetrix, Aurora Biosciences, Axys, Biacore, Corixa, CuraGen, Diversa, Gene Logic, Genome Therapeutics, Genomic Solutions, Genset, Hyseq, Invitrogen, Lexicon Genetics, Life Technologies, LJL Biosystems, Lynx, Magainin, Maxygen, Myriad Genetics, Pathogenesis, Protein Design Labs, and Sequenom Inc.  R&D figures in spreadsheet form available at: http://www.stanford.edu/class/siw198q/websites/genomics/pubgenomicsR&D.xls.

[39] World Survey of Funding for Genomics Research Final Report to the Global Forum for Health Research and the World Health Organization September 2000 Robert Cook-Deegan, Carmie Chan, and Amber Johnson Stanford-in-Washington Program http://www.stanford.edu/class/siw198q/websites/genomics/finalrpt.htm

[40] All established biotechnology and pharmaceutical firms listed on the project website have at least four known collaborations with the genomics firms or with a major academic genomics center: Allergan, American Home Products (Incl. Genetics Institute and Wyeth-Ayerst), Amersham Pharmacia Biotech, Amgen, ArQule, Astra-Zeneca, Aventis, BASF, Bayer, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, DuPont/Dupont Merck, Genentech, Genzyme, Glaxo SmithKline, Hoffman-La Roche (Roche Holdings and others), J&J (Ortho, Janssen), Lilly, Merck, Novartis (incl. Institute of Functional Genomics), Novo-Nordisk, Otsuka, PE Corp and Applied Biosystems, Pfizer (including former Parke-Davis and Warner-Lambert), Pharmacia & Upjohn, Qiagen, and Schering-Plough (incl. Berlex).  List available at: http://www.stanford.edu/class/siw198q/websites/genomics/pharma-biotech.htm.

[41] Daar AS, Thorsteinsdottir H, Martin DK, Smith AC, Nast S, Singer PA: Top 10 biotechnologies for improving health in developing countries. Nat Genet 2002, 32:229-232 "Harnessing genomics to improve health in India" – an executive course to support genomics policy

Tara Acharya, Nandini K Kumar, Vasantha Muthuswamy, Abdallah S Daar and Peter A Singer, Health Research Policy and Systems 2004, 2:1  http://www.health-policy-systems.com/content/pdf/1478-4505-2-1.pdf; Status and Development of Biotechnology in India: An Analytical Overview http://www.ris.org.in/dp28_pap.pdf;  Genome Valley Hyderabad India http://www.genomevalley.org/initiatives.htm;  Africa Human Genome Initiative http://www.hsrc.ac.za/genome/profiles/

[42] Daar AS, Thorsteinsdottir H, Martin DK, Smith AC, Nast S, Singer PA: Top 10 biotechnologies for improving health in developing countries. Nat Genet 2002, 32:229-232.

[43] Genomics and World Health Report of the Advisory Committee on Health Research April 2002  http://www3.who.int/whosis/genomics/genomics_report.cfm World Heath Organization. Advisory Committee on Health Research. Summary of Genomics and World Health/a report of the Advisory Committee on Health Research. 1. Genomics 2. Genome 3. World health 4. Delivery of health care

5. Developing countries ISBN 92 4 154562 3 (NLM Classification: QZ 50)

[45] World Survey of Funding for Genomics Research Final Report to the Global Forum for Health Research and the World Health Organization September 2000 Robert Cook-Deegan, Carmie Chan, and Amber Johnson Stanford-in-Washington Program http://www.stanford.edu/class/siw198q/websites/genomics/finalrpt.htm and http://www.stanford.edu/class/siw198q/websites/genomics/WorldGenomics$SurveyFinalRpt25Sep00.doc

[47] The Big Down 2003 ETC group page 47 http://www.etcgroup.org/documents/TheBigDown.pdf

[50] The Big Down 2003 ETC group page 39 http://www.etcgroup.org/documents/TheBigDown.pdf

[51] The Big Down 2003 ETC group page 39 http://www.etcgroup.org/documents/TheBigDown.pdf

[54] Nanotechnology Opportunity Report, 2nd Edition Executive summary June 2003 http://www.cientifica.com/html/docs/Exec%20Summary.pdf see also Little science, big bucks.

DeFrancesco L. Nat Biotechnol. 2003 Oct;21(10):1127-9.

[55] Nanotechnology Opportunity Report, 2nd Edition Executive summary June 2003 http://www.cientifica.com/html/docs/Exec%20Summary.pdf see also Little science, big bucks.

DeFrancesco L. Nat Biotechnol. 2003 Oct;21(10):1127-9.

[56] Nanotechnology Opportunity Report, 2nd Edition Executive summary June 2003 http://www.cientifica.com/html/docs/Exec%20Summary.pdf see also Little science, big bucks.

DeFrancesco L. Nat Biotechnol. 2003 Oct;21(10):1127-9.

[57] ETC Group News Release Thursday, March 25, 2004, Jazzing up Jasmine: Atomically Modified Rice in Asia?http://www.etcgroup.org/documents/NRatomrice1.pdf; the European Nanobusiness Association put the numbers at 6 billion Euro a year http://www.nanoeurope.org/files/European%20Nanotech%20Funding.pdf

[58]   Bond PJ Vision for converging technologies and future society. Ann N Y Acad Sci. 2004 May;1013:17-24 for numbers of countries in the south investing see also page 64-67 in The Big Down 2003 ETC group http://www.etcgroup.org/documents/TheBigDown.pdf

[59] Questionnaire International Dialogue on Responsible R&D of Nanotechnology Reply by: Dr. M.C. Roco

Senior Advisor for Nanotechnology at NSF; Chair NSTC/NSET USA June 12, 2004 1. Nanotechnology R&D programs in USA http://www.nsf.gov/home/crssprgm/nano/mcr_04-0616_usandrespnano_meridian_3.pdf

[63] M. Roco, W. Bainbridge eds., Converging Technologies for Improving Human Performance: Nanotechnology, Biotechnology, Information Technology and Cognitive Science, (Kluwer Academic Publishers, Dordrecht Hardbound,  2003, ISBN 1-4020-1254-3) also online at

http://www.wtec.org/ConvergingTechnologies/Report/NBIC_report.pdf see also  “There are three, although I have a feeling that, under some future unified theory, they will turn out to be just one. The first is, of course, information technology…The second is biotechnology…And the third is nanotechnology.” then-Chairman and CEO of Monsanto Robert Shapiro, when asked what he believed were the most promising future technologies by Anonymous, “The biology of invention: A conversation with Stuart Kauffman and Robert Shapiro,” Cap Gemini Ernst & Young Center for Business Innovation, no. 4, Fall 2000, available on the Internet: quoted in The Big Down 2003 ETC group page 47 http://www.etcgroup.org/documents/TheBigDown.pdf

[64] How Nano is Europe? An Analysis of European Research Hotspots http://www.nanoeurope.org/files/EoI%20analysis.pdf

[65] International Centre for Bioethics, Culture and Disability webpage section on Bio/Nano Weapon/Warrior http://www.bioethicsanddisability.org/bioweapon.html; Institute for Soldier Nanotechnologies http://web.mit.edu/isn/

[66] Calgary Herald Page A10 Michelle Locke The Associated Press  Nothing's too heavy for BLEEX Exoskeleton a super strider Thursday, March 11, 2004 see also Berkeley robotic laboratory  http://www.me.berkeley.edu/hel/bleex.htm; 

[67] Human Assisted Neural Devices  The program will create new technologies for augmenting human performance through the ability to noninvasively access codes in the brain in real time and integrate them into peripheral device or system operations. http://www.darpa.mil/dso/thrust/biosci/brainmi.htm

[68] see for example that the United States Food & Drug Administration (FDA) has approved a pilot clinical trial with a investigational device, the BrainGate™ Neural Interface System.  The BrainGate™ System is designed to provide a means for people unable to use their hands to communicate with a computer directly with their thoughts.http://www.cyberkineticsinc.com/

[69] Questionnaire International Dialogue on Responsible R&D of Nanotechnology Reply by: Dr. M.C. Roco

Senior Advisor for Nanotechnology at NSF; Chair NSTC/NSET USA June 12, 2004 1. Nanotechnology R&D programs in USA http://www.nsf.gov/home/crssprgm/nano/mcr_04-0616_usandrespnano_meridian_3.pdf; see also Roco, M.,Government Nanotechnology Funding An International Outlook (NNI, Arlington,VA, USA, June 2003 http://www.nano.gov/html/res/IntlFundingRoco.htm and http://www.nsf.gov/home/crssprgm/nano/2005budget.htm

[70] ETC Group News Release Thursday, March 25, 2004, Jazzing up Jasmine: Atomically Modified Rice in Asia?http://www.etcgroup.org/documents/NRatomrice1.pdf; the European Nanobusiness Association put the numbers at 6 billion Euro a year http://www.nanoeurope.org/files/European%20Nanotech%20Funding.pdf ; for further webpages dealing with Nanotechnology funding see The Institute for Nanotechnology, Nanotechnology in Asia Pacific March 2004 http://www.nano.org.uk/Reports2004/AP_Sample.pdf; Invest in Taiwan, Nanotechnology

 Turning Today's Nanoscience Discoveries into Tomorrow's High Tech Realities

http://investintaiwan.nat.gov.tw/en/opp/nanotech.html; Responses to questionnaire on nanotechnology for different countries. Country identified in url http://www.nanotec.org.uk/evidence/Brazil.htm; http://www.nanotec.org.uk/evidence/Canada.htm; http://www.nanotec.org.uk/evidence/Germany.htm;  http://www.nanotec.org.uk/evidence/USA.pdf;

http://www.nanotec.org.uk/evidence/Poland.htm; http://www.nanotec.org.uk/evidence/Singapore.htm; http://www.nanotec.org.uk/evidence/Netherlands.htm; European Nanobusiness Association It's Ours to Lose: An analysis of European Commission Spending http://www.nanoeurope.org/files/European%20Nanotech%20Funding.pdf

[71] Commercializing nanotechnology. Mazzola L. Nat Biotechnol. 2003 Oct;21(10):1137-43

[72] SRI Consulting Business Intelligence Nanobiotechnology http://www.sric-bi.com/Explorer/NB.shtml#viewpoints  see also Commercializing nanotechnology. Mazzola L. Nat Biotechnol. 2003 Oct;21(10):1137-43; and http://www.nsf.gov/home/crssprgm/nano/nanotechbriefs03_10_03.pdf and some Nanotechnology product see http://www.etcgroup.org/documents/nanoproducts_EPA.pdf  and http://www.nanovip.com/directory/Products_and_applications/index.php and

[73] The American Society of Mechanical Engineers  June 2001 http://www.asmenews.org/archives/backissues/june01/features/nanolaw.html

[76] Investing in nanotechnology. Paull R, Wolfe J, Hebert P, Sinkula M Nat Biotechnol. 2003 Oct;21(10):1144-7 Figure 3a)

[77] Investing in nanotechnology. Paull R, Wolfe J, Hebert P, Sinkula M Nat Biotechnol. 2003 Oct;21(10):1144-7 Figure 3b)

[78] Nanomedicine Taxonomy, by Neil Gordon & Uri Sagman Canadian NanoBusiness Alliance http://www.regenerativemedicine.ca/nanomed/Nanomedicine%20Taxonomy%20(Feb%202003).PDF

[80] Expert Opin Biol Ther. 2003 Jul;3(4):655-63. Nanotechnology and medicine. Emerich DF, Thanos CG.; Nanotechnology section Nanomedicine Subsection  of the International Center for Bioethics Culture and  Disability http://www.bioethicsanddisability.org/nanotechnology.html; Commercializing nanotechnology. Mazzola L. Nat Biotechnol. 2003 Oct;21(10):1137-43; SRI Consulting Business Intelligence Nanobiotechnology http://www.sric-bi.com/Explorer/NB.shtml#viewpoints  see also Commercializing nanotechnology. Mazzola L. Nat Biotechnol. 2003 Oct;21(10):1137-43; and http://www.nsf.gov/home/crssprgm/nano/nanotechbriefs03_10_03.pdf and some Nanotechnology product see http://www.etcgroup.org/documents/nanoproducts_EPA.pdf  and http://www.nanovip.com/directory/Products_and_applications/index.php

[82] Recommendations of the National Heart, Lung, and Blood Institute Nanotechnology Working Group. Buxton DB, Lee SC, Wickline SA, Ferrari M; National Heart, Lung, and Blood Institute Nanotechnology Working Group. Circulation. 2003 Dec 2;108(22):2737-42

[83] Recommendations of the National Heart, Lung, and Blood Institute Nanotechnology Working Group. Buxton DB, Lee SC, Wickline SA, Ferrari M; National Heart, Lung, and Blood Institute Nanotechnology Working Group. Circulation. 2003 Dec 2;108(22):2737-42

[84] Editorial Pharmaceutical Nanotechnology: a new section in Int J Pharm. 2004 Aug 20;281(1-2):1.

[86] Drug development for neglected diseases: a deficient market and a public-health policy failure. Lancet,. 2002, Jun 22; 359(9324):2188-94. Trouiller et.al.

[87] Drug development for neglected diseases: a deficient market and a public-health policy failure. Lancet,. 2002, Jun 22; 359(9324):2188-94. Trouiller et.al.

[88] Drug development for neglected diseases: a deficient market and a public-health policy failure. Lancet,. 2002, Jun 22; 359(9324):2188-94. Trouiller et.al.

[89] Genomics and World Health Report of the Advisory Committee on Health Research April 2002  http://www3.who.int/whosis/genomics/genomics_report.cfm World Heath Organization. Advisory Committee on Health Research. Summary of Genomics and World Health/a report of the Advisory Committee on Health Research. 1. Genomics 2. Genome 3. World health 4. Delivery of health care

5. Developing countries ISBN 92 4 154562 3 (NLM Classification: QZ 50)

[91] Questionnaire International Dialogue on Responsible R&D of Nanotechnology Reply by: Dr. M.C. Roco

Senior Advisor for Nanotechnology at NSF; Chair NSTC/NSET USA June 12, 2004 1. Nanotechnology R&D programs in USA http://www.nsf.gov/home/crssprgm/nano/mcr_04-0616_usandrespnano_meridian_3.pdf

[92] International Dialog on Responsible R&D of Nanotechnology http://www.nsf.gov/home/crssprgm/nano/dialog.htm; for a list of participating countries see http://www.nsf.gov/home/crssprgm/nano/dialog04_listparticipantshort040618.doc  

[93] Questionnaire International Dialogue on Responsible R&D of Nanotechnology Reply by: Dr. M.C. Roco

Senior Advisor for Nanotechnology at NSF; Chair NSTC/NSET USA June 12, 2004 1. Nanotechnology R&D programs in USA http://www.nsf.gov/home/crssprgm/nano/mcr_04-0616_usandrespnano_meridian_3.pdf

[94] Questionnaire International Dialogue on Responsible R&D of Nanotechnology Reply by: Dr. M.C. Roco

Senior Advisor for Nanotechnology at NSF; Chair NSTC/NSET USA June 12, 2004 1. Nanotechnology R&D programs in USA http://www.nsf.gov/home/crssprgm/nano/mcr_04-0616_usandrespnano_meridian_3.pdf

[95] Nano-Bio-Info-Cogno-Socio-Anthro-Philo- HLEG Foresighting the New Technology Wave Converging Technologies – Shaping the Future of European Societies by Alfred Nordmann, Rapporteur Report 2004 Geo-Eco-Urbo-Orbo-Macro-Micro-Nano- http://europa.eu.int/comm/research/conferences/2004/ntw/index_en.html; http://europa.eu.int/comm/research/conferences/2004/ntw/pdf/final_report_en.pdf 

[96] Questionnaire International Dialogue on Responsible R&D of Nanotechnology Reply by: Dr. M.C. Roco

Senior Advisor for Nanotechnology at NSF; Chair NSTC/NSET USA June 12, 2004 1. Nanotechnology R&D programs in USA http://www.nsf.gov/home/crssprgm/nano/mcr_04-0616_usandrespnano_meridian_3.pdf

[97] Questionnaire International Dialogue on Responsible R&D of Nanotechnology Reply by: Dr. M.C. Roco

Senior Advisor for Nanotechnology at NSF; Chair NSTC/NSET USA June 12, 2004 1. Nanotechnology R&D programs in USA http://www.nsf.gov/home/crssprgm/nano/mcr_04-0616_usandrespnano_meridian_3.pdf

[98] Genomics and World Health Report of the Advisory Committee on Health Research April 2002  http://www3.who.int/whosis/genomics/genomics_report.cfm World Heath Organization. Advisory Committee on Health Research. Summary of Genomics and World Health/a report of the Advisory Committee on Health Research. 1. Genomics 2. Genome 3. World health 4. Delivery of health care

5. Developing countries ISBN 92 4 154562 3 (NLM Classification: QZ 50)

[99] World Report on Knowledge for better Health http://www.who.int/rpc/meetings/en/WR2004AnnotatedOutline.pdf

[100] UNESCO World Conference on Sciences  see among others paragraph 25, 34, 42 of the WCS declaration on science; http://www.unesco.org/science/wcs/eng/declaration_e.htm ; and  paragraphs 17, 59, 79, 81, 91 of  the WCS Science Agenda-Framework for Action: http://www.unesco.org/science/wcs/eng/framework.htm

[101] Nano-Bio-Info-Cogno-Socio-Anthro-Philo- HLEG Foresighting the New Technology Wave Converging Technologies – Shaping the Future of European Societies by Alfred Nordmann, Rapporteur Report 2004 Geo-Eco-Urbo-Orbo-Macro-Micro-Nano- http://europa.eu.int/comm/research/conferences/2004/ntw/index_en.html; http://europa.eu.int/comm/research/conferences/2004/ntw/pdf/final_report_en.pdf 

[102] Disabled people science and technology and health research http://www.bioethicsanddisability.org/mexico1.html

[104] Nanowater conference 2004 http://www.nanowater.org/conf.htm

[105] BIOS - Biological Innovation for Open Society an Open Source inspired Open Access regime for biological enabling technologies http://www.cambia.org/main/opensource.htm;  http://www.bios.net http://www.cambia.org/downloads/misuse_of_ip.pdf

[107] Disabled people, science and technology and health research http://www.bioethicsanddisability.org/mexico1.html

[108] 'Diseases, Drugs and Donors in the Third World', published in the October 1999 issue of 'Corner House', a research and solidarity group based in the U.K. Quoted in 'Health: TRIPS & WHO Further Marginalising the World's Poor' by Someshwar Singh, first published 1999, South-North Development Monitor, obtained on-line from Third World Network

[110] Adolescents and Youth with Disability: Issues and Challenges by Nora Ellen Groce, September 2003; http://wbln0018.worldbank.org/HDNet/HDdocs.nsf/View+to+Link+WebPages/644BB88B562E794D85256DCC00672C26?OpenDocument

[111] Disability Awareness in Action Disabled Women Resource Kit No. 6 http://www.independentliving.org/docs2/daa6.pdf