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09/17/2015

Is Bioethics Too Powerful?

by Craig Klugman, Ph.D.

In an August 2015 Boston Globe opinion piece, Steven Pinker—professor of psychology at Harvard—wrote that bioethics should “Get out of the way” of medical research and technological advancement. He states that bioethics “bog[s] down research in red tape, moratoria, or threats of prosecution base on nebulous but sweeping principles such as ‘dignity,’ ‘sacredness,’ or ‘social justice’.” He goes on to say that bioethics “thwarts” research by “sowing panic about speculative harms” such as making analogies to Nazi medical experiments or referring to science fiction.

In a companion piece, Sally Satel—a methadone clinic staff psychiatrist and scholar at the American Enterprise Institute (a conservative public policy think tank) —wrote in September 2015 that Pinker’s piece was a “live grenade lobbed into the field of bioethics.” Satel states that bioethicists should never give opinions, but should only “objectively delineate value conflicts intrinsic to the ethical dilemma at hand…bioethicists’ normative views should not be given greater weight.” An objective ethics? So far science has not found the ethics particle only us humans trying to do our best.

The crime that both seem to charge bioethics with is being too influential in the sphere of public and government opinion. [The following should be read with sarcasm:] In my Medical Humanities PhD program, I must have been excused from the course on Demagoguery and Undermining the Scientific Enterprise. As part of a small field, I think I would have had an inkling if we were purposely holding back progress or were part of a secret cabal controlling the government [again, more sarcasm].

An irony is that it was not so long ago that bioethics was being criticized for being in bed with pharmaceutical and medical technology firms, basically rubber stamping anything that was proposed. So is bioethics an impediment to progress or a lubricant? Logically, we can’t be both.

Both of these writers seem to be confusing bioethics—the study of moral and ethical issues in the life sciences—with compliance and regulation. The latter is the application of laws, government rules and guidelines to the conducting of [in this case] human subjects research. While bioethicists were involved with thinking about research ethics and protecting human subjects at the outset (e.g. Common Rule, Belmont Report and many of us sit on IRBs), modern human research is ruled by a new profession of certified institutional review board professionals. As I learned in an IRB meeting today, there are big differences in the way that those in IRB administration and in bioethics think—IRB professionals focus on the minutiae such as forms, signatures, and dotted Is, while bioethics is more concerned with the broader principles and concepts of protecting people.

Part of the problem with the “get out of the way” approach is that it removes any sense of reflection or consideration from research. What bioethics offers is an opportunity to think about the implications of research and technology on not only potential human subjects, but on the greater community. If Pinker thinks that all of the cases of research misconduct are in the past or in fiction, then he must not have read the news lately. I opened today’s newspaper to find story about a reanalysis of the 2001 study of Paxil that permitted the antidepressant to be prescribed to teenagers. The only problem is that in the real world, the drug seems to increase suicidal behavior. This new analysis shows that the original study had the data on this effect, but deemphasized that information. Whereas the original analysis stated that there was no difference on adverse effects (except for some cardiovascular issues), the reanalysis of the same data shows that not only was Paxil no more effective than placebo but that “there were clinically significant increases in harms, including suicidal ideation and behavior and other serious adverse events.”

Or consider the Hoffman Report released in July 2015 that investigates claims that in 2005-2006 the American Psychological Association was too closely aligned with the Department of Defense and may not have come out strongly enough opposed to torture. If Pinter is looking for a field to be critical of for having strong ties to influencing policy, he should be looking inside his own discipline.

Despite what Pinker says, the lessons of the past do have relevance to the actions and choices of today. Considering the past, reflecting on the present, and providing guidance in moral deliberation is the role of bioethics. Given this expertise, does the media seek out scholars in bioethics for comments on issues? Do government agencies seek input on policies and panels from thinkers in bioethics? The answer is Yes. But unlike the proposed “master plan to take over the world” [yes, more sarcasm], this is because the media and government comes to us. We did not seek out to become public figures, to wield influence nor did we encourage anyone to see our work as anything more than an exploration of issues.

Since its inception, bioethics has been willing to engage with the public by working on government task forces, speaking to officials, and educating the media. While other academic disciplines were focused inward on their own studies, our field site was the applied world of the life sciences and health practice professions. We filled a need in society, but we certainly did not create the need. The rewards are few and certainly rarely financial.

As for the claims about social justice, I counter Pinker and say that we have not been involved enough with social justice. Bioethics tends to focus more on cutting edge high technology than on whether schools can offer nutritious lunches. We live in a era with some of the greatest income and health inequities ever known to humanity. Bioethics has been criticized precisely for not commenting on these important social issues. With a handful of exceptions, not many in bioethics have written about health inequities, war, torture, climate change, poverty, education, access to care, or affordable housing. Just because the analysis draws on some philosophies of which you do not approve, or says that these are important issues and that disagrees with your personal or political opinion, does not make the analysis any less valid.

Satel states that she wants bioethics to respond to Pinker’s criticisms. Millie Solomon, president of The Hastings Center wrote an excellent response in The Boston Globe in August where she said “bioethicists do embrace science, but not indiscriminately.” Solomon stated, “Wisdom demands, and democracy requires, not stepping away, but standing up for thoughtful reflection and public engagement.” If there are voices trying to quiet us, then I am proud that we stand up to the bullies.

The resounding lack of attention to Pinker’s letter and Satel’s taunt is because they are not saying anything that we have not heard before. The live grenade must have been a dud. As Carly Fiorina taught us at the GOP debate Wednesday night, sometimes the best response is no response.

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