Thursday, June 14, 2018

Thinking about science upon entering the field. Part III: Ethics and Responsibilities

Here is the third of a four-part series of posts by Tristan Cofer, a graduate student in chemical ecology here at Penn State.  He has been thinking about the profession he is being trained for, and the broader setting in which it is taking place, and into which he will have a place:

Growing up in a medical household, I remember being more than just a little impressed by, what seemed to me, to be the many responsibilities that physicians were expected to have towards their patients. Serving on call every third or fourth night, working weekends and holidays, and, not to mention, the years spent in school or as a resident and intern, seemed to me to go beyond the so–called Hippocratic imperative to ‘first, do no harm’, and instead to border on an ethical mandate that one should always strive to do the most good. I am no doubt, engaging in some hero worship here, and I concede that the extent to which this mandate actually informs a physician’s conduct (much less whether it really exists) is debatable. However, I would argue that for many people, myself included, ‘good medicine’, by and large, means medicine that does the most good.

This relationship between healthcare and ethical responsibility is perhaps unsurprising given the influence that physicians have over our, and our loved ones’, mental and physical wellbeing. Simply put, we want to know that the people that we trust with the things that are most important to us are indeed trustworthy. That being said, I find it somewhat curious that, by comparison, we in the scientific community are not held to a similar ethical standard. This, to me, begs the often-unconsidered, if not outwardly ignored, question: What are our social responsibilities as scientists?

Science, like medicine, is embedded in the culture(s) in which it is practiced. It is a humanistic enterprise in that we as humans undertake it, and like all everything we do, it comes with baggage that oftentimes remains unchecked. I wouldn’t claim here that scientists give no consideration to the social frameworks in which they work (that would be both unfair and untrue); only that, based on my own experiences thus far in graduate school, discussions about a scientist’s social responsibilities have been mostly self-interested, concerning internal matters such as research ethics and the like. These conversations are no doubt valuable, in that we need to know that our colleagues are doing work that we can trust and build on; however, they hardly encourage one to think beyond their rather limited responsibilities to our chosen profession.

How much, for instance, should we expect our research to reflect the public’s values and interests? Because research is typically funded by tax-payer dollars, one might argue that, by extension, it is also carried out in their name. Is it, therefore, ethically reprehensible to conduct research that does not directly benefit the public in some way? Are we not also obligated to set research objectives with minority or special interests groups in mind? What happens when our interests conflict with the public’s? For example, can we defend using public funding to conduct research in evolutionary biology, knowing that some groups vehemently oppose teaching evolutionary theory?

Moreover, how should we deal with situations in which our internal responsibilities to ‘Science’ and our external responsibilities to the public are at odds with each other? Is it permissible to develop technologies that can quite literally change the world, without considering the people with whom we share it? Is this even possible? Are we even the best candidates to answer these questions, or should we consult ‘outsiders’ from the humanities and elsewhere in our discussions concerning the questions mentioned above? These discussions may seem like an unnecessary hindrance to scientific advancement, and perhaps they are. But maybe, that’s what we need.

Admittedly, I might be barking up the wrong tree here. Yes, Science has the potential to greatly benefit and harm the public, but so too do politics, business, and any other enterprise with deep pockets and a global reach. As a friend, much smarter than myself, once told me, maybe ‘Science is no more than a good way to keep smart people off the street’. At the end of the day, we all need to make a living, and conversations like these have the potential to make that harder to do. For better or worse, there is considerable pressure (both external and self-imposed) on scientists to do whatever they need to in order to bring in grants, publish to get tenure and advance their careers, and appease the powers-that-be to protect their self-interests. Most people either don’t want to, or can’t, risk rocking the proverbial boat—especially when there is little precedent to do so.

A new biomedical insight?

Here is a thoughtful and timely quote:
". . . . as no single disease can be fully understood in a living person; for every living person has his individual peculiarities and always has his own peculiar, new, complex complaints unknown to medicine—not a disease of the lungs, of the kidneys, of the skin, of the heart, and so on, as described in medical books, but a disease that consists of one out of the innumerable combinations of ailments of those organs. This simple reflection can never occur to doctors . . . . because it is the work of their life to undertake the cure of disease, because it is for that that they are paid, and on that they have wasted the best years of their life.  And what is more, that reflection could not occur to the doctors because they saw that they unquestionably were of use . . .  not because they made the patient swallow drugs, mostly injurious (the injury done by them was hardly perceptible because they were given in such small doses). They were of use, were needed, were indispensable in fact (for the same reason that there have always been, and always will be, reputed healers, witches, homÅ“opaths and allopaths), because they satisfied the moral cravings of the patient . . . . They satisfied that eternal human need of hope for relief, that need for sympathetic action that is felt in the presence of suffering, that need that is shown in its simplest form in the little child, who must have the place rubbed when it has hurt itself. The child . . . . feels better for the kissing and rubbing. The child cannot believe that these stronger, cleverer creatures have not the power to relieve its pain. . . ."
The language seems a bit arcane, and this is a translation, but its cogency as a justification for today's Big Data feeding frenzy is clear.  People who are ill, or facing death, will naturally grasp at whatever straws may be offered them.  In one way or another, this has been written about even back to Hippocrates.

Of course, palliation or cure of what disorders can be eased or cured should be the first order and obligation of medicine.  Where nothing like that is clearly known, trials of possible treatments are surely in order, if the patient understands at least the basic nature of the research, for example, that some are being given placebos while others the treatment under investigation.  Science doesn't know everything, and we often must learn the hard way, by trial and error.

Given that, perhaps the most important job of responsible science is to temper its claims, and to offer doses of the reality that life is a temporary arrangement, and that we need to get the most out of that bit of it to which we are privileged to have.  So research investment should be focused on tractable, definable problems, not grandiose open-ended schemes.  But promises of the latter are nothing new to society (in medicine or other realms of life).

The problem with false promises, by preachers of any type, is that they mislead the gullible, and in many cases this is known by those making the promises--or could and should be known.  The role of false promise in religion is perhaps debatable, but its role in science, while understandable given human ego and the struggle for attention, careers, and funding, is toxic.  People suffering, of poverty, hardship, or disease, seek and deserve solace.  But science needs to be protected from the temptations of huckstering, so that it can do its very important business as objectively as is humanly possible. 

By the way, the quote is from about 150 years ago, from War and Peace, Tolstoy's 1869 masterpiece about the nature of causation in human affairs.