Recently a new trade association called the Neurotechnology Industry Organization (NIO) was formed, with membership ranging from pharmaceutical, medical device, and diagnostic companies to academic brain research centers, patient advocacy groups and research foundations to venture capital firms and strategic partners.
The FAQ of the NIO states that over 500 neurotechnology companies exist worldwide which work on diseases impacting 1.5 billion people worldwide and nearly 100 million Americans among them – “Alzheimer's disease, addiction, anxiety, depression, epilepsy, hearing loss, insomnia, multiple sclerosis, obesity, chronic pain, Parkinson's, schizophrenia and stroke.”
The FAQ judges the health care and lost income cost to be “$1.0 trillion annually worldwide, $300 billion annually in the U.S.”
In other words, one-third of the US population is a patient target for the NIO. This vision of the NIO reflects a very broad definition of the scope of neurological and psychiatric disease. With such a broad scope it is not surprising when a news release states that the neurotechnology industry is a $110 billion business. According to the highlights of the neurotechnology industry 2006 Report there are three sectors in the industry: neuropharmaceuticals with revenues of $93 billion and 7% annual growth; neurodevices with revenues of $3.4 billion and 21% annual growth; and neurodiagnostics with revenues of $13.5 billion and 11% annual growth. A list of companies covered in the report can be found here.
Besides the very broad definition of ‘neurological and psychiatric disease’ another issue is now emerging – the opportunity for neuroenhancement.
Zack Lynch, the founder of NIO said that the products of NIO members cover implants, brain-computer interfaces, brain scanners and diagnostic devices, cogniceuticals and emoticeuticals. This hints at the possibility that the focus is not just on fixing people with ‘neurological and psychiatric disease’ – restoring them to homo sapiens species typical functioning – but that neuro-enhancement could also be part of the game.
John Hind at the UK newspaper Observer describes cogniceuticals in his column, where Zack Lynch is cited as believing that the use of cogniceuticals and emoticeuticals will move into the mainstream between 2010-2040. Hind writes, “One pundit on businesspundit.com cheers, 'Competitive advantage will come not just from managing knowledge generated within your company, but by cogniceutically managing the ability of your employees to learn, think, be creative ...'”
It will be interesting to see whether the Neurotechnology Industry Organization views species typical cognitive functioning as a disease following the “transhumanist version of the concept of health” (1) leading to the “transhumanization of medicalization” (1) described in one of my previous columns, and the transhumanization of ableism in another.
“The Global Economic Burden of Disease”
It is logical for people who have the perception of disease described above to promote the idea of a global economic burden of disease, a concept which does not take into account social determinants. Indeed Zack Lynch believes this exceeds $1 trillion, and he is interested in “researching and writing a report on the Global Economic Burden of Neurological Diseases and Psychiatric Illnesses.”
Lynch’s Neurotechnology Industry Organization is more than willing to sponsor such a report. According to Lynch, there are a variety of components to a global economic burden of disease analysis – Disability Adjusted Life Years (DALYs) being one of the main ones. There is a extensive literature critiquing the DALYs (1), and I will cover them in a future column.
What are the consequences of a vision – taking into account the potential for disease intervention trading described in one of my previous columns – that looks at medical intervention while ignoring social determinants? It will lead to increased use of drugs and ‘medical devices’ globally with the objective of fixing “neurological and psychiatric conditions.” If the “transhumanization of medicalization” described above and elsewhere (1) occurs, almost every human might be defined as having a “neurological and psychiatric condition” and would be a potential client for neurotechnology. Where does that leave people who do not want to adhere to that norm?
Neurodiversity – Redefining “Disorders”
There are many people who reject the medical label related to their cognitive functioning that is placed on them by others. Indeed, many believe in the concept of neurodiversity, in which atypical (neurodivergent) neurological wiring is viewed as a normal human difference that is to be tolerated and respected as much as any other human difference. Hence the definition: neurodiversity n. the whole of human mental or psychological neurological structures or behaviors, seen as not necessarily problematic, but as alternate, acceptable forms of human biology.
Some people perceive their disorders, such as ADD, in a positive way.
The Choice is Yours
There is a lot to think about with respect to drugs. They are obviously big business. Past columns have covered the dynamic of medicalization in high-income countries, the consequences of focusing on just medical fixes for neglected diseases while ignoring underlying social determinants, and the impact of medicalization on low-income countries.
“An increase in use of existing drugs is seen as the number one cost driver for drug expenditures in many countries (1)(2)(3)(4)(5)(6)(7). New diseases, which have to be served by drugs (medicalization), and the ability of new drugs to enhance human performance (transhumanization of medicalization) will further enhance this trend.” (1)
So what do we do? Is the vision of the NIO sustainable? Is neuroenhancement sustainable? The choice is yours.
My thanks to Alexander Mont for commenting on an early draft of the column.
Gregor Wolbring is a biochemist, bioethicist, disability/vari-ability/ability studies scholar, and health policy and science and technology governance researcher at the University of Calgary. He is a member of the Center for Nanotechnology and Society at Arizona State University; Part Time Professor at Faculty of Law, University of Ottawa, Canada; Member CAC/ISO - Canadian Advisory Committees for the International Organization for Standardization section TC229 Nanotechnologies; Member of the editorial team for the Nanotechnology for Development portal of the Development Gateway Foundation; Chair of the Bioethics Taskforce of Disabled People's International; and former Member of the Executive of the Canadian Commission for UNESCO (2003-2007 maximum terms served). He publishes the Bioethics, Culture and Disability website, moderates a weblog for the International Network for Social Research on Disability, and authors a weblog on NBICS and its social implications.
1. Wolbring, G. HTA Initiative #23 The triangle of enhancement medicine, disabled people, and the concept of health: a new challenge for HTA, health research, and health policy. 2005. ISBN 1-894927-36-2 (print); ISBN 1-894927-37-0 (online); ISSN: 1706-7855.
2. Canadian Institute for Health Information. Table 1: Drug Expenditure Summary, by Province/Territory and Canada, in "Drug Spending to Reach Almost $22 Billion in 2004, Reports CIHI." 2004.
3. Canadian Institute for Health Information. Development of Drug Utilization Indicators: A Feasibility Study Using Existing Aggregated Administrative Databases. 1-55392-007-4. 2002.
4. The Standing Senate Committee on Social Affairs, Science and Technology Chair Kirby. The Health of Canadians – The Federal Role Interim Report Volume Two: Current Trends and Future Challenges. 2002.
5. Health Canada, National Forum on Health 1994 to 1997. Canada Health Action: Building on the Legacy - Volume I - The Final Report. 1997.
6. Coambes, R. B., et al. Review of the Literature on the Prevalence, Consequences, and Health Costs of Noncompliance and Inappropriate Use of Prescription Medication in Canada. University of Toronto Press. 1995.
7. Matthew Herper. "The Most Expensive Diseases." Forbes.com. 2005.
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