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Two Of Four Co-Drafters Of ISEE Ethics Guidelines Weigh-In On Revelations of Conflicting Interests And Suggest  Way Forward

To the Editor

Thank you for your coverage of issues of critical importance to our profession in the January/February 2014 issue of the Epidemiology Monitor, entitled “Ethics Turmoil in Epidemiology”.  Ethics violations and conflicting interests, while always present, appear to have escalated over the past decade, and it is imperative that we develop a framework for addressing these issues.

As a start, I suggest that we return to the core values of our profession.  If you examine the mission statements of virtually every school of public health, department of epidemiology, or public health agency, you will note that they contain the terms a) advance the health of the public; b) promote wellness; c) improve human health. 

Simple Question

Thus, in evaluating ethical conduct, the primary question is quite simple:  Is the individual or institution engaging in an activity, or taking a position, that is deleterious (potentially or directly) to the health of the public, or does not promote or improve public health?  If the answer is yes, then these activities inherently conflict with the basic tenets and mission of our field.  A sense of betrayal and wrongdoing ensues, because there is an inherent assumption that professionals and institutions in the field of public health are devoted to the improvement of public health, and will not engage in activities, or take positions, which would have any other goal than to protect and promote health and well-being.

Role of Money

We must accept the fact that the role and influence of money is ubiquitous, and not surprising, since every professional, and every institution, requires funding in order to survive. (In the case of governmental agencies, add the role of political pressures).  There is rarely true independence in carrying out our work.  Professionals have a right to perform work for industry, and institutions may accept funding from industry. However, it has been shown that research conclusions and policy positions can be and often are influenced by the source of funding and/or political considerations. There is, therefore, a widely-recognized need for transparency in declaring affiliations and funding support – and this extends to institutions and public health agencies.

Ethics Code

Ethical expectations and codes of professional/institutional conduct have already been developed.  For example, The International Society for Environmental Epidemiology (ISEE) has adopted Ethics Guidelines for Environmental Epidemiologists, (revised over a three-year period by a subcommittee of the ISEE Ethics & Philosophy Committee, and accepted by the ISEE Governing Council in 2012.  These guidelines may be found on the ISEE website:
(http://tinyurl.com/l6f2u8a) and in summary form in Environmental Health Perspectives (Environ Health Perspect 120:a299-a301 (2012).  http://tinyurl.com/m5v5etz
[online 01 August 2012).  We acknowledge, however, that guidelines are not sufficient to protect against powerful forces that may influence human judgment and behavior.

Recommendations

We must establish forums for open and ongoing public dialogue about these issues, including a mechanism for exposing cases of ethics breaches.  There should be a strong professional and public mandate for adherence to a basic code of ethics on the part of all stakeholders.  Public health institutions and agencies must lead by example; they must adhere to these principles in their relationships with outside funders, and must insist on a standard of conduct and transparency on the part of professionals within their organizations.

Shira Kramer, MHS, PhD
President
Epidemiology International
Hunt Valley, MD

To the Editor:

Thank you for your thorough reporting, driven by a balanced range of well-formulated questions, on the topic “Ethics Turmoil in Epidemiology” (Epi Mon Jan-Feb 2014). I commend you for bringing this conversation to the forefront for epidemiologists.

After a challenging several years spent through the mid-1980s convincing our profession’s leadership to address the topic of ethics, we have, since the late 1990s, ethics guidelines for epidemiologists and several of its subspecialty areas. And, since then, in 2012, we have revised guidelines from the International Society for Environmental Epidemiology (ISEE). To paraphrase one well-placed epidemiologist quoted in your report, we have guidelines up the kazoo, but no mechanism for their enforcement.

Enforcement Problem

In our professional organizations, there is, at this time no infrastructure through which enforcement could be applied; nor are there the financial means to do so. All that we have at our disposal is the application of peer pressure to keep one another on track, in relation both to the research and practice domains of our field. The public trusts us to take our mission seriously; we trust one another to adhere to our mission in epidemiology. Our mission proclaims, among other things, that we will aspire to protecting the public interest over any other interest.   

Speaking Truth To Power

We owe a great debt of gratitude to David Heath at the Center for Public Integrity in Washington, DC, for exposing Buffler’s “other side”, and to Kathleen Ruff, for her ability in forcing issues of transparency and accountability.

Without people like Heath and Ruff, I suggest that evil (bad professional conduct) would know no bounds, in part because people, including professionals, tend not to confront those who do ill, and we are also fearful, given our institutional structures and processes, of challenging power. So,  we must welcome the role of people who are independent and working to defend the public interest, such as Heath and Ruff, because it is only through speaking truth to power that our democratic processes are sustained, enriched, and, indeed, strengthened. It is thanks to such people that our attention has been drawn to the need to better fulfill our collective mission.

On Human Frailty

Clearly, the profession of epidemiology has mechanisms to acknowledge the good conduct of people like Buffler and Boffetta, but no mechanisms to manage their bad/questionable conduct. Instead of allowing our profession to become less relevant to the public interest and thereby see less public support for our discipline, or, perhaps through our inaction, “inviting” government to intervene in potentially intrusive ways in how our profession is organized and functions, I suggest that first we need to recognize human frailty for what it is. There are those among us, and indeed above us, whose motivation allows them to justify replacing the public interest with their own self-interest, perhaps with a heavy dose of greed to fuel their zealousness. Guidelines/codes will never be of help to such people in controlling their behaviors; and, certainly not when institutions are complicit in unethical  conduct on the part of such colleagues. If we see “money as being the root of all evil” in the world, let us apply it by “following the money” to expose the relationships between our colleagues and our institutions.

The Way Forward

Over my career, I have strived to promote guidelines for socializing our students to normative practices that serve the public interest by appealing to their sense of morality, to better ensure integrity in science. But, this, now well-demonstrated, does not always work. To be more effective in delivering on our mission, there are several actions that we might want to propose in order to prevent a loss of public support, or even the possibility of government intrusion in our profession, in light of these two exposés. In addition to peer pressure, holding scientists publicly accountable when they act unethically is something that we can do.

Recommendations

True democracy can function with only a well-informed public, one informed not by corporate science designed to foment uncertainty through, for instance, generating "junk science", but by science conducted with integrity in the public interest. It is true that refutation is essential for advancing science. But, our applied science has been infiltrated by junk science, and this, in turn, is influencing litigation and public policy. If we are to take our role as professionals seriously, I recommend that a substantially improved federal science, technology and innovation strategy should, among

other things:

·         offer incentives to not-for-profit professional organizations/societies (like the IJPC-SE at <www.jpc-se.org>) in support of capacity building to expose junk science, particularly where applied science works at the nexus of policy; and

·         introduce disincentives (i.e., regulatory penalties) for those found to be engaging in the production of junk science.

While not all “corporate” science is bad science, we need now to stand up to global moneyed  influences to ensure greater balance in our mission to protect the public interest.

Colin L. Soskolne, PhD
Professor Emeritus, University of Alberta, Edmonton, Alberta, Canada
Adjunct Professor, Faculty of Health, University of Canberra, ACT, Australia


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