Solutions follow perceptions: NBIC and the concept of health, medicine, disability and disease.

• Author: Wolbring, Gregor
• Position: Nanotechnology, Biotechnology, Information Technology and Cognitive Science

Nanotechnology, the art of manipulating materials on an atomic or molecular scale, (1) enables a new paradigm of science and technology that sees different technologies converging at the nanoscale, namely (a) nanoscience and nanotechnology; (b) biotechnology and biomedicine; (c) information technology; and (d) cognitive science ("NBIC" (nano-bio-info-cogno)). This paradigm derives from the fact that living systems are governed by molecular behavior at the nanometer scale, where chemistry, physics, biology, and computer science all now converge.

The National Nanotech Initiative (US) envisions applications for the converging of NBIC in areas such as the environment, energy, water, weapons and other military applications, globalization, agriculture and health (more efficient diagnostics and genetic testing; cognitive enhancement; life extension; enhancing human performances in general), (2) each of which comes with its own sales pitches, social consequences, problems and implications. This paper will look at the area of NBIC-medicine and its relationship to disabled people.

NBIC - Health, Disabled People and Improving Human Life

"What do we want from NBIC? How do advances in NBIC change and influence our self-perception, our self-identity, the quality of our lives and our ability to pursue 'the good life'?" Answering these questions requires an examination of the complex interdependent fabric of perceptions, values and choices within different cultural, economic, ethical, spiritual and moral frameworks. In the case of NBIC-medicine it is important to investigate the understanding that society and individuals have of the concept of health and disease. Furthermore, as so-called disabled people are often highlighted as the beneficiaries of NBIC-medicine products, we have to ask ourselves what perception of disabled people and what concept of disability, a concept more contentious than is commonly recognized, guides NBIC research and development, and what role disabled people are playing in this process.

What Is Health? What Is a Disease? What Methods to Use to Remedy the Situation?

Three main models for health and disease (the medical, the social and the transhumanist) can be identified. 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 interventions on the level of the individual are seen as the remedy of choice.

On a global scale, the disability-adjusted life year (DALY) has emerged as a new measure of the burden of disease. However, it becomes increasingly clear that the DALY concept that is so far based on the purely medical model of health and disease is flawed. DALY treats, for example, paraplegia in developed and developing countries the same, independent of societal parameters. In developed countries many people with paraplegia have wheelchairs and the loss of mobility is therefore reduced. In developing countries many do not have wheelchairs, and their mobility is severely restricted. Furthermore, wheelchairs alone are of no use unless the environment is designed to cater to them. So the provision of a wheelchair in one context would not have the same effect that it would have in another. It seems we need an additional model or a broader understanding of the concepts of health and disease.

The social model of health and disease still follows the sub-normative functioning of a person, but it differs from the medical model by questioning the exclusive focus on medical remedies of individuals. According to the Jakarta Declaration on Leading Health Promotion into the 21st Century, (3) pre-requisites for health are 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. Above all, poverty is the greatest threat to health. The Ottawa Charter states: "[p]olitical, economic, social, cultural, environmental, behavioural and biological factors can all favour health or be harmful to it." (4)

If we look at the primary conditions leading to a global burden of disease it seems that this burden can be diminished a lot by including environmental, societal and other contextual interventions. In the poorest regions of the world, childhood and maternal underweight, unsafe sex, unsafe water, sanitation and hygiene, indoor smoke from solid fuels and various micronutrient deficiencies are major contributors to loss of healthy life. In both developing and developed regions, alcohol, tobacco, high blood pressure and high cholesterol were major causes of disease burden. The four...