The June 2008 issue of Academic Medicine published several articles relating to funding for bioethics. One, authored by Ezekiel Emanuel, the Director of Bioethics at NIH, lamented the poor state of NIH-funded bioethics projects and made several recommendations:
Despite the National Institute of Health's (NIH's) long tradition of engagement with and support of bioethics, the current support for bioethics is very small. Accordingly, trained bioethics researchers and bioethicists are in short supply, and fundamental ethical issues that relate to the NIH's mission go unexplored or insufficiently explored. A bioethics initiative with clearly articulated goals is needed, to increase the number and quality of "producer" bioethicists who would undertake innovative research and educate future generations of bioethicists and biomedical investigators.
The author articulates a fourfold strategy for increased NIH support of bioethics: (1) educate and mentor sufficient numbers of producer bioethicists in well-designed postdoctoral programs; (2) support junior researchers with an increase in established K awards targeted at bioethics; (3) commit sufficient resources to ensure high-quality empirical and analytical bioethics research; and (4) develop dedicated study sections composed of qualified bioethicists to review bioethics-related grant proposals. An office, center, or authoritative body within the NIH accountable for bioethics-related activities is recommended by the author, to develop a strategic plan and to be accountable for generating high-quality research and scholarship.
The full text article is available for free here. Though readers of this blog know I have serious reservations about the dominant traditions of bioethics scholarship and practice, I'm hardly opposed to increasing public investment in the field of inquiry. But in an insightful commentary on Bioethics Forum, Dan Callahan -- undoubtedly one of the fathers of bioethics -- voices some concerns I admit that I had not considered:
There is, one the one hand, a general call for more people for “basic research and training in bioethics” and a vague mention of new issues, but on the other hand there is the persistent invocation of human subjects research as the main example of where the important problems in bioethics lie. It is as if the main role of bioethicists in the work of the NIH, and more broadly perhaps, is that of carrying out IRB research and serving as members of IRBs.
Bioethics in that role reduces, in effect, to a kind of service industry for biomedical research.
I'll not subject the readers here to my views on IRBs, but, in my view, a more impoverished notion of research ethics would be difficult to imagine than the vision which posits ethicists as service officials for IRBs. Callahan continues, "While there are from time to time some knotty ethical problems, for the most part IRB work is regulatory in nature, insuring that federal ethical guidelines are being followed." This is in some respect true -- IRBs as have they evolved are mostly about regulatory compliance; but I and many, many other scholars believe that this evolution has not been a boon to cultivating ethical practice in research, and that IRBs -- or some other relevant body -- can and should aspire to much more than compliance activities.
Callahan's chief concern is that bioethics not be reduced to "research ethics," which he believes goes way beyond the protection of human participants:
Protecting human subjects is surely one of its important topics, but so also are issues of conflict-of-interest, the cost and financing of pharmaceutical research and marketing, priority setting in research (especially NIH priorities), the extent and limits of a putative moral obligation to carry out research, the assessment of potentially hazardous forms of research or hazardous outcomes of research, controversial lines of research in a pluralistic society, and enhancement research.
However, Callahan is concerned that increased NIH support for research ethics writ large may pose its own kind of conflict-of-interest:
How acceptable would be research aiming to show how research has historically raised health care costs, and was thus itself part of the present cost crisis, probably needing some curtailment?
In short, how would bioethicists fare if they may bite the hand of those who feed them, and how would a program that might turn out, at least in part, those whose research agenda took on the establishment itself actually last?
These are some excellent questions, perhaps analogous to Christopher Meyers' recent article on conflicts of interest within clinical ethics, and obviously relevant to my own interests in public health and prevention. And though he is a father of bioethics, Callahan is hardly unaware of the vigorous critiques of bioethics that have sprung up in the last decade or so. He legitimately notes that increased NIH support might strengthen some of these criticisms:
Bioethics as a field has long been seen, at least by some, as a handmaiden of mainline medicine and health care, uncritical at the most basic levels and expected to provide moral band aids at the intermediate levels. Much greater NIH support could intensify that kind of worry, perhaps with good reason.
Indeed. All good points. Thoughts?
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