Enhancement Medicine: The final Frontier

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Enhancement MedicineThe final Frontier

• Gregor Wolbring
• www.bioethicsanddisability.org/start.html
• E-mail gwolbrin_at_ucalgary.ca

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Agenda

• To give some background on
• the status of emerging and converging
  technologies such as Nanotechnology,
  Biotechnology, Informationtechnology and
  Cognitive sciences (NBIC) as they relate to
  NBIC-medicine
• The impact of NBIC on the very concept of health,
  disease, disability and wellbeing,
• The impact of the concept of health, disease,
  disability and wellbeing, on the direction of
  research and development of NBIC
• The dynamic around medicalization and the new
  field of enhancement medicine
• The impact of the above dynamics on health
  promotion, health research and public health
  

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Fields of Medicine

• Curative Medicine
• Preventive Medicine
• Palliative Medicine
• NBIC Therapeutic Medicine
• NBIC Enhancement Medicine

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NBIC-Medicine definition

• medical intervention at the molecular scale for
  curing disease or repairing damaged tissues, such
  as bone, muscle, or nerve. i
• the study of biotechnology, pharmacy and
  biosensors at the cellular level.ii
• the application of nanoscale principles to
  biomedical technology,
• the comprehensive monitoring, control,
  construction, repair, defense, and improvement of
  all human biological systems, working from the
  molecular level, using engineered nanodevices and
  nanostructures
• the science and technology of diagnosing,
  treating, and preventing disease and traumatic
  injury, of relieving pain, and of preserving and
  improving human health, using molecular tools and
  molecular knowledge of the human body iii
• the employment of molecular machine systems to
  address medical problems, using molecular
  knowledge to maintain and improve human health at
  the molecular scale. iii

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NBIC-Medicine Taxonomy
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NBIC-medicine Taxonomy (Canada)
Nanomedicine Taxonomy Briefing Paper, by Neil
Gordon and Uri Sagman http//www.regenerativemedic
ine.ca/nanomed/Nanomedicine20Taxonomy20(Feb2020
03).PDF
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NBIC medicine
US NANOTECHNOLOGY HEALTH CARE PRODUCTS DEMAND(million dollars) US NANOTECHNOLOGY HEALTH CARE PRODUCTS DEMAND(million dollars) US NANOTECHNOLOGY HEALTH CARE PRODUCTS DEMAND(million dollars) US NANOTECHNOLOGY HEALTH CARE PRODUCTS DEMAND(million dollars) US NANOTECHNOLOGY HEALTH CARE PRODUCTS DEMAND(million dollars) US NANOTECHNOLOGY HEALTH CARE PRODUCTS DEMAND(million dollars)
Annual Growth Annual Growth Annual Growth Annual Growth Annual Growth Annual Growth
Item 2004 2009 2014 09/04 20/04
Nanotech Health Care Product Demand 906 6500 27700 48 35
Pharmaceuticals 406 3000 16600 49 39
Diagnostics 465 1100 2200 19 14
Medical Supplies Devices 35 2400 8900 133 50
i US NANOTECHNOLOGY HEALTH CARE PRODUCT DEMAND
TO REACH 6.5 BILLION IN 2009 lthttp//www.the-info
shop.com/press/fd29054_en.shtmlgt
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NBIC-Medicine/NBIC-enhancement

• Bionic Implants
• Couples' nervous system linked by implants in
  limbs. 06.07.2004 http//www.nzherald.co.nz/index.
  cfm?ObjectID3576668
• When Kevin Warwick lifted his finger, his wife
  Irena felt as if a bolt of lightning ran down her
  palm and into her own finger. In what they
  billed as the first direct link between nervous
  systems, the couple had electrodes surgically
  implanted in their arms and linked by radio
  signals to a computer. Blindfolded for the
  experiment, they could feel when their spouse's
  finger moved
• Bionic Ear Cochlear Implants Applications And
  Developments Utillising Nanotechnology
  http//www.azonano.com/details.asp?ArticleID976
• Bionic Eyes for the Blind
• http//www.seeingwithsound.com/retinal.htm
  Bionic Eyes Ceramic Microdetectors That May
  Cure Blindness http//www.azom.com/details.asp?Art
  icleID1544 Bionic eye offers new window on the
  world, Sunday 10.10.2004, CET 0453
  http//www.swissinfo.org/sen/Swissinfo.html?siteSe
  ct511sid4415302

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NBIC-Medicine/NBIC-enhancement
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NBIC-Medicine/NBIC-enhancement

• Chips Coming to a Brain Near You - (Wired News
  October 22, 2004)http//www.wired.com/news/medtec
  h/0,1286,65422,00.htmlIn this era of high-tech
  memory management, next in line to get that
  memory upgrade isn't your computer, it's you.
  Theodore W. Berger, director of the Center for
  Neural Engineering at the University of Southern
  California, is creating a silicon chip implant
  that mimics the hippocampus, an area of the brain
  known for creating memories. If successful, the
  artificial brain prosthesis could replace its
  biological counterpart, enabling people who
  suffer from memory disorders to regain the
  ability to store new memories. And it's no longer
  a question of "if" but "when."

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NBIC-Medicine/NBIC-enhancement
12
NBIC-Medicine/NBIC-enhancement
13
NBIC-Medicine/NBIC-enhancement
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Where do we go from here?

• How to deal most effectively with the needs of
  the marginalized?
• How to define the problem of ill health and the
  solutions to the problem?
• Can one draw a line between therapy and
  enhancement?
• Can one draw a line between therapeutic and non
  therapeutic enhancement?
• How to decide on RD priorities?
• How to govern science and technology?

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Where do we go from here?

• Responses to surveys indicate that 'health is
  what matter most' to a large proportion of the
  world's population.
• 'The enjoyment of the highest attainable standard
  of health is one of the fundamental rights of
  every human being without distinction of race,
  religion, political belief, economic or social
  condition
• Constitution of the World Health Organization,
  1946
• The Universal Declaration of Human Rights Article
  25-1 states Everyone has the right to a
  standard of living adequate for the health and
  well-being of himself.

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Where do we go from here? Health-related human
rights treaties

• WHO Constitution (WHO, 1946)
• Universal Declaration of Human Rights (1948)
• International Covenant on Economic, Social and
  Cultural Rights (ICESCR, 1966)
• International Convention on the Elimination of
  All Forms of Racial Discrimination (ICERD, 1963)
• Convention on the Elimination of All Forms of
  Discrimination Against Women (Womens
  Convention, 1979)
• Convention against Torture and Other Cruel,
  Inhuman or Degrading Treatment or Punishment
  (Torture Convention or CAT)
• Convention on the Rights of the Child (CRC, 1989)
• International Convention on the Protection of the
  Rights of All Migrant Workers and Family Members
  (MWC, 1990).
• Universal Declaration on the rights of people
  with Disabilities (forthcoming)

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The Road to Enhancement Medicine The concept of
health/Relationship between health and wellbeing

• Two contradictory models exist concerning the
  relationship between "health" and "wellbeing".
• The first, the WHO model considers different
  domains of well-being as determinants of the
  umbrella term health which is reflected in the
  WHO definition of health, wherein health is
  defined as "a state of complete physical, mental
  and social well-being and not merely the absence
  of disease or infirmity. In this model the
  term health through the different wellbeing
  determinants combines the areas of medical
  health and social health under the term
  health.
• Many do not adhere to the WHO definition of
  health and do not treat wellbeing as a
  determinant of health They follow a second the
  non-WHO model of health and wellbeing that sets
  "wellbeing" as the umbrella term, and defines
  health as "the absence of disease and illness".
  This model limits the term health to mean
  medical health/medical illness. Health is
  used to cover the domain of "medical" determinant
  of "wellbeing." Social health is not covered
  anymore under the term health. The social
  determinants of wellbeing are covered by other
  determinants and indicators.
• Which hierarchy one uses -- a)Well-being as a
  determinant of health (WHO scenario), b) Medical
  health as a determinant of well being (Non WHO
  scenario)

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The Road to Enhancement Medicine Model of
health and disease

• Within the medical model of health and disease,
  health is limited to cover medical health and
  is characterized as the normative functioning of
  biological systems based on the homo sapiens
  species-typical, normative frameworks whereas
  disease/ illness is defined as the sub-normative
  functioning of biological systems.
• Locating the cause of and solution for ill
  medical health comes in two flavours.
• Medical determinants of medical health place the
  cause of sub-normative functioning within the
  individuals biological system leading to medical
  interventions towards the species typical norm on
  the level of the individuals (medical,
  individualistic cures).
• Social determinants of medical health identify
  external factors as the cause of the ill medical
  health the sub-normative functioning of the
  individual. This includes, for example,
  contaminated water that leads to bacterial or
  parasitic infections, or job insecurity that
  contributes to stress and heart disease.

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The Road to Enhancement Medicine Social models
of health and disease
Unfortunately, this version of the medical model
is often misleadingly referred to as the "social
model of health" or as the "social determinants
of health". It is misleading because the model
addresses social factors contributing to ill
medical health/"medical illness". If one
follows the WHO definition of Health, a real
social model of health would not just cover
social determinants of medical health but would
also cover "social determinants" relating to the
social wellbeing the social health of a person
who is not medically ill. One can be in bad
social health without having to be in bad medical
health.
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The Road to Enhancement Medicine The new kid on
the block the transhumanist/enhancement model of
health
a model in which human performance enhancement
beyond species typical boundaries is part of the
concept of health characterizing health no longer
as normative functioning of biological systems
but optimum functioning. Within the
transhumanist/enhancement model of health, 7 the
concept of health no longer has the endpoint that
someone is healthy if the biological systems
function within species-typical, normative
frameworks. Within the transhumanist/enhancement
model the human body no matter how
conventionally medically healthy is defined
as limited and defective in need of constant
improvement made possible by new technologies
appearing on the horizon (a little bit like the
constant software upgrades we do on our
computers). Good health in this model is the
concept of having obtained maximum (at any given
time) enhancement (improvement) of ones
abilities, functioning and body
structure. Disease, in this case, is identified
in accordance with a negative self-perception
(confined to the normal human body) of ones
non-enhanced body. Medical and technological
interventions on the level of the individual that
add new abilities to the human body or improve on
existing abilities are seen as necessary
remedies.Enhancement medicine is the new field
providing the remedy through surgery,
pharmaceuticals, implants and other means.
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The Road to Enhancement Medicine A Word on
the concept of disability/impairment
In general people use the term "disability"
interchangeable with terms such as "impairment",
"disease", "illness", "chronic disease" and
"defect". However I and others perceive the
meaning of the term disability as being different
from the meaning of the terms impairment, defect,
illness and chronic disease. The WHO
International Classification of Functioning (
ICF) for example states Disability is
characterized as the outcome or result of a
complex relationship between an individuals
health condition and personal factors, and of the
external factors that represent the circumstances
in which the individual lives.13 and "
Impairments are defined as "problems in body
function or structure such as a significant
deviation or loss."13 Interestingly the ICF
definition of Disability achieves different
meanings depending on how one defines the term
health condition in that definition. I also see
terms such as differently able being a
replacement for the term impairment not for the
term disability. I perceive Disability to
mean Peoples societal experience related to
their impairment, defect, illness and chronic
disease(medical,transhumanist/enhancement model)
or Peoples societal experience due to their as
subnormative perceived non normative functioning
(social model) Within a human rights framework
language one could say Disability means People
who are discriminated against due to their
impairment, defect, illness, chronic disease (
medical, transhumanist/enhancement model) or
People who are discriminated against due to
their as subnormative perceived non normative
functioning (social model)
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The Road to Enhancement Medicine
Transhumanist/enhancement of disability/impairme
nt
The transhumanist model of health and disease
sees every human body as defective and in need of
improvement (above species-typical boundaries)
leading to the transhumanist model of
disability/impairment where every unenhanced
human being is, by definition, disabled in the
impairment /patient sense. The only way out of
the impairment/patient label is to enhance
oneself beyond species typical boundaries.
Everyone who cant afford the enhancement of
their body will be labeled as impaired.
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The Road to Enhancement Medicine Enhancement
Step 1 Make people feel bad about themselves
The number of people with at least one of four
major medical conditions has increased
dramatically in the past decade because of
changes in the definitions of disease." The new
definitions ultimately label 75 percent of the
adult U.S. population as diseased i Suddenly
sick A special report by Susan Kelleher and Duff
Wilson June 26 - June 30, 2005
lthttp//seattletimes.nwsource.com/news/health/sudd
enlysick/ The annual report on Americans'
health found that just over 44 percent of all
Americans take at least one prescription drug,
and 16.5 percent take at least three.
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The Road to Enhancement Medicine Enhancement
Step 1 Make people feel bad about themselves
According to a 2005 report by the Canadian
Institute for Health Informationiincreased drug
spending in Canada relates to the volume of drug
use and the entry of new drugs (typically
introduced to the market at higher prices) and
not an increase in prize of the old drugs a
conclusion which was also reached by the Standing
Senate Committee on Social Affairs, Science and
Technology which states that prescription
drug spending could be attributed to increased
utilization of existing drugs (50), sales of new
drugs in their first full year (32) and price
increases of existing drugs (18).ii
Medicalization may help feed unhealthy
obsessions with health, obscure or mystify
sociological or political explanations for health
problems, and focus undue attention on
pharmacological, individualized, or
privatized solutions.iii People in America
feel much less well than those in Bihar, India,
though their life expectancy is much better (p
860). i
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The Road to Enhancement Medicine Enhancement
Step 2 Add Enhancement to the Mix
"'I believe in transhumanism' once there are
enough people who can truly say that, the human
species will be on the threshold of a new kind of
existence, as different from ours as ours is from
that of Peking man. It will at last be
consciously fulfilling its real destiny." Julian
Huxley First Director-General of UNESCO i The
transhumanization of medicalization moves the
dynamic of medicalization one step further by
adding the enhancement of body appearance and
functioning above species typical norms and
boundaries to the mix. Although many maintain
that a line can be drawn between therapy
and enhancementi this might not be as easy as
it sounds if not impossible. Many therapies have
enhancement aspects to them. Many enhancements
can be classified as therapies and many
therapeutic interventions can and are used
later on for non therapeutic purposes. More
variations of human body structure
and functioning are labeled as deviations as
diseases (dynamic of medicalization).
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The consequences of the transhumanist/enhancement
model
If one cant prevent enhancements a few problems
are imminent which one has to deal with, However
as the debate around the issues and the
governance of science and technology is
structured in the moment it is unlikely that it
can deal with any of the below problems. a) The
generation of an ability divide (trickle down
concept really does not hold true) b) One can
expect a worsening of a gap between the rich and
poor countries and within the rich and poor
people of every country c) The concept of
responsibility. d) Cost explosion e) Enhancement
Medicine f) Disabled people drift towards the
Transhumanist/enhancement model g) Enhancements
will lead to an increase of people perceived as
impaired h) Decrease in self esteem Rat race
of abilities i)The promotion of synthetic
biology
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The consequences of the transhumanist/enhancement
model
j) Change in Concept of Personhood (sentient
being) k) It might lead to the reality that
basic medical good with no performance
productivity upsite will be deinsured/ seen as
futile care and enhanced medical goods with a
performance productivity upsite will become
insured. To quote Murray the designer of the
Disability Adjusted life years In fact, as
shown above the results are quite consistent
across groups that individuals prefer,
after appropriate deliberation, to extend the
life of healthy individuals rather than those in
a health state worse than perfect health
(p.726). i A bias flowing from the last quote,
which one can act on increasingly is to favour
"enhancement medicine" over "curative
medicine". l) The separation of consciousness and
human body (where is the soul? Organ based
memory? m) Who will still follow denominations
which are against a working immortality? Will
the Church become the Church for the people not
being able to afford immortality? For what
purpose? To fight for an equitable access to
immortality? Would the poor even be a member of
the Church if they know that the Church wont
help them gain Immortality?
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The consequences of the transhumanist/enhancement
model
When we hear the term, we usually think of
biodiversity in foods or animals. But it applies
to humans as well. In some sense, the notion of
biodiversity clashes with the transhumanist
paradigm. To the degree that biodiversity defends
the existence of and prolonging the lives of all
forms of sentience, it negates the doctrine of
species improvement on the grounds that it isn't
always in good interests for life itself. If
becoming "better" is about streamlining and
selecting various physical and mental attributes
over others, other cognizant forms will be left
behind. Respect for biodiversity thus negates the
hierarchy of "ability" so idolized by the human
species. For example, disabled persons' lack of
"ability" is what defines how they are perceived,
rather than personal characteristics. One of the
critiques of transhumanism as espoused by Dr.
Gregor Wolbring is that it serves to represent
disabled persons as "defective products" on the
ladder of "ability".1 1 http//www.betterhuman
s.com/Resources/Encyclopedia/article.aspx?articleI
D2002-06-09-1
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If you have any questions after the talk e-mail
me at gwolbrin_at_ucalgary.ca