Bioethics.net

Craig Klugman, Ph.D.

In the 1970s, Benson Snyder at MIT published a book called “The Hidden Curriculum” where he claimed that students’ lack of educational progress and anxiety is caused by the unstated messages they observe at the university. These messages come from tacit social norms, unwritten obligations, and modeled behavior that contradicts what students are formally told. In 1994, Frederic William Hafferty wrote in Academic Medicine that he questions the value of teaching ethics in the formal instructional time in the pre-clinical medical curriculum. He stated that students really learn their ethics, behavior and professional identity by observing their superiors in the clinic.

This hidden medical curriculum has been well studied and remarked on in conferences, books, and even the New York Times. However, several recent conversations have me thinking that a hidden curriculum might also be at work in the research enterprise. The first incident was in a conference about translational research. For those who are not aware of this movement, the concept is to move benchside research to the bedside as marketable products as quickly, efficiently, and cheaply as possible. The mantra is that the only research worth doing is that which is commercializable, i.e. that creates a product that earns money (patent license fees for the university and researcher, and sales money for the company that produces the drug or device).

At this conference, a newly hired administrator of a university system was lecturing on the barriers to translational research. The first obstacle was “Ethics.” I was taken aback and later approached this speaker, asking if she meant that “deep thought, critical thinking, and reflection were barriers to research.” She said that’s not what she meant but that in industry “ethics” was a synonym for “IRBs and regulations.” The second incident was a conversation with a statistician who explained that things such as ethics and accountability lacked value in research because they could not be easily measured. I did get on my soapbox and explain that not everything of value can be assigned a number to be measured, counted, or assigned a dollar value.

In the first conversation, ethics viewed as rules, review, and regulation are a barrier and in the second, ethics is irrelevant because it does not easily have a number attached to it. Together these made me wonder if there is a hidden curriculum at work in the new world of research. In 2002, Kelly Fryer-Edwards suggested such a concept. She wrote about the hidden research curriculum, “there are implicit practices and behaviors that have become the norm.” As examples she offers honorary authorship and investing in companies in which researchers have a relationship or interest. Ironically, today researchers are encouraged to develop financial ties with companies and to form start-ups to market their discoveries. The 2011 creation of a new NIH institute, the National Center for Advancing Translational Sciences, shows that research culture has firmly moved in this direction.

The hidden research curriculum in the 11 years since Fryer-Edwards published has become more embedded. It is rooted in the language of the market—that the only things worth pursuing are those with a number attached, a number that affects the bottom line. The (not-so) hidden message is that if something cannot be marketed or counted than it has less worth, or no worth. In one graduate seminar I attended students read an article that said if your idea is not marketable then you should not pursue it. I wonder what would have happened if Watson and Crick had been told to abandon their work on DNA because it would not raise the university’s and some company’s profit. From this perspective, ethics and the humanities “lack real value” because it cannot be sold, traded or leveraged. Given this, I am not surprised that “ethics” is viewed as nothing more than following regulations and going through an IRB review: You can count how many required trainings you have completed and whether you checked off all the boxes for an IRB review. But critical thinking? There’s no box for that.

The hidden research curriculum poses a risk not only to the critical thinking skills of future scholars, but it also undermines the value of careful thought, reflection, and humanism that were the basis of the Scientific Revolution.

Fryer-Edwards suggests teaching skills of identifying, reasoning, and acting to combat the hidden curriculum. Today there is a great deal of research ethics classroom teaching such as responsible conduct of research courses, HIPAA privacy training, and even regulatory instruction that is required of most researchers. The change in the last ten years is that the research culture and U.S. society has had a shift in a direction that simply feels traditional ethics is an obstacle and that the hidden hand of the market will make everything turn out all right: The market determines the ethical.

Despite nearly two decades of working on the hidden medical curriculum, not much has changed. More classes, more tests, and more regulations have not been the answer. Reversing the trend in the hidden research curriculum will be equally if not more difficult. After all, in research there is big money involved for investigators, universities, private corporations, and future stockholders. A change will require a paradigmatic shift: Universities will have to stop seeing discoveries as a means to lucrative patents that replace money governments have cut. The attitudes of researchers, the incentives for research, and the benefit of unethical work (that may lead to faster time to market) must be curtailed.

As Francis Bacon said in De Augmentis (1623), “Lastly, I would address one general admonition to all: that they consider what are the true ends of knowledge, and that they seek it not either for pleasure of the mind, or for contention, or for superiority to others, or for profit, or fame, or power, or any of these inferior things: but for the benefit and use of life; and that they perfect and govern it in charity.”