This background text was prompted by an article in the Journal of Medical Ethics by Udo Schuklenk questioning ethical implications of scientific dissent.
George Perry led this live discussion on 10 March 2004. Readers are invited to submit additional comments by using our Comments form at the bottom of the page.
By Gabrielle Strobel and Tom Fagan
As children, most of us have witnessed the disgruntled kid who, being dissatisfied with the way the game was progressing, took away the ball in search of other players he could more easily manipulate. But in adult life—and especially in science—that doesn't happen. Or does it? Some scientific "dissidents," as Udo Schuklenk from the University of Witwatersrand in South Africa calls them in this month's Journal of Medical Ethics, may engage in similar behavior when, failing to get their views past the anonymous peer review system, they profess their opinions in the public arena, where the players are ill-equipped to make sound judgments.
Such scientific gamesmanship can have the potential to be fatal, contends Schuklenk, and he uses the AIDS epidemic sweeping across the developing world as an example of how scientific dissent can go terribly wrong. In his letter, he explains how public health policy in South Africa has been undermined by people who share the fringe view that HIV does not cause AIDS. (Peter Duesberg at the University of California, Berkeley, championed this discredited view nearly 20 years ago.) This policy endangers the lives of millions of South African HIV carriers, their sex partners, and unborn children, Schuklenk points out.
HIV/AIDS is an extreme example. Even so, Schuklenk wonders if it offers general lessons. He agrees that fundamental tenets of democracy rightly protect the expression of minority views. At the same time, he suggests that minority scientists ought not to take their views public, in part because lay audiences lack the expertise to understand the complexities of many scientific arguments and to judge their merits. His plea is made poignant by his confession of having subscribed to the Duesberg camp until he saw retroviral therapies save the lives of friends.
"Professionals in the biomedical sciences who hold the minority view have particular professional ethical obligations to refrain from campaigning publicly among lay audiences for support for their professional views," Schuklenk writes. "These reasons have to do with the idea that professionals ought to serve the public good. The public good is not served by scientists whose views have been rejected by their peers, and who are trying to 'win' the scientifically lost case in the lay public's domain. It also seems professionally irresponsible to impose the 'truth' of one's views on a lay audience while knowing full well that this audience is not equipped to evaluate the scientific merits or otherwise of one's arguments," he continues.
Paul Copeland, from the Bioethics Research Center, University of Otago, New Zealand, offers a counterpoint in an accompanying commentary. "Minorities who disagree with the 'scientific consensus' must be allowed to air their views," he writes. To Copeland, the issue boils down to science versus clinical practice. As far as government responsibility is concerned, the question of "how does it work" need not enter the picture; rather, the question "does the treatment protocol improve outcomes or not," is the gold standard. Hence, in the face of overwhelming evidence that retroviral therapy works for AIDS, concern over what causes the disease is irrelevant. Why, then, was retroviral therapy discouraged by the South African government? Dissident claims about HIV lend support to such a policy, but Copeland ascribes this decision to political reasons.
What about other research areas? Clearly, the South African experience is a separate one. Even so, do your hear echoes of the broader question behind this ethics discussion in Alzheimer's disease research, as well? How much attention should one pay to dissenting views? How many dissenting views are healthy? To what extent do they encourage broader thinking or distract from a more promising line that deserves undivided focus? Also, where do you voice your opinion when peer review rejects you, and how do you obtain funding? How should funding be distributed fairly between mainstream and dissenting projects?
It leads back to a questioning of peer review, but also of the role of the Alzheimer Research Forum as a meta-journal and marketplace of scientific opinions.
Let us know what you think. Surely Alzheimer's disease, with its many views outside of the mainstream hypotheses, stimulates lively debate. At what point does a scientific view mature into a consensus view? Is it true, or a scientific adage, that most consensus views began as out-of-the-box ideas that prevailed despite initial rejection by peer review? How do we distinguish an inconvenient idea that may grow into a widely accepted hypothesis from poorly supported, gratuitous dissent? Should dissenting opinions appear strictly in peer-reviewed scientific literature? Your thoughts are welcome, minority or not.—Tom Fagan and Gabrielle Strobel.
Schuklenk U. Professional responsibilities of biomedical scientists in public discourse. JME 2004;30:53-60. Abstract
Copeland PS. Professional responsibilities of biomedical scientists in public discourse. JME 2004;30:61-62.
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