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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