Two articles in the New York Times raise a disturbing question regarding the ethics of cancer treatment in this country.  The first on ovarian cancer treatment noted that despite significantly better survival data with intraperitoneal chemotherapy (IP) over intravenous chemotherapy (IV) for ovarian cancer, most oncologists were still using IV chemotherapy. The reason given is that IP chemotherapy is more difficult to give, and more labor intensive, but is not reimbursed at a higher rate.  That is, physicians are routinely withholding the more effective treatment for economic reasons.  Another recent article describes how oncologists tend to choose more expensive chemotherapy even when it is not more effective because they are paid a percentage of the drug’s cost. 

It is an often-repeated truism that physician behavior will follow economic incentives perfectly—if you wish to reduce physician procedures capitate patient care, if you wish to increase patient procedures, pay physicians on a fee-for-service basis.  While this has been empirically demonstrated, it is a bit hard to accept that this adage remains true even when physicians seems to be crossing the line into unethical behavior in order to follow the almighty dollar.  The IP chemotherapy issue is most troubling because it represents physicians giving care they know to be inferior because the better treatment costs more to deliver, and this reduces their own income.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

The responsible conduct of research (RCR) (a.k.a. as research integrity) captures a range of ethical norms and practices which include research misconduct (generally defined as fabrication, falsification and plagiarism), authorship and publication ethics, the ethics of peer review, proper data management, mentoring, conflicts of interest, animal ethics, and the ethics of research involving humans. In some cases, topics such as animal ethics and the ethics of research involving humans are subfields of their own due to the extensive scholarship devoted to them. RCR has received considerable attention in many nations. For example, students and faculty may be required to receive education and training in RCR, several scholars study and perform research on research integrity, and many countries have developed policies to govern research integrity (Resnik and Master, 2013; Master, 2012). Yet most educational initiatives and research on research integrity center on the natural and applied sciences including, biomedical science, clinical research, engineering, and psychology. Fewer research integrity policies, education, and research is devoted to philosophy or law, or for multi or interdisciplinary fields such as bioethics.

I have previously argued that bioethicists need to pay closer attention to issues of research integrity. Why is this important? I define bioethics as an interdisciplinary field where scholars from philosophy, law, science, medicine, social science, nursing and anthropology come together to work on a common set of normative questions using a range of methods and theoretical lenses. By focusing efforts towards understanding research integrity practice, we will better understand the epistemic dimensions of our field, enhance integrity in bioethics scholarship, and be able to evaluate bioethicists more fairly. In turn, these efforts are likely to promote greater trust in bioethics by other academic scholars, among bioethicists, and the general public. Yet the field of bioethics has not paid close enough attention as it relates to research integrity issues of its own scholarship. Let’s focus on authorship as an example since this is one area that has most recently received some attention.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

Last month, I discussed a research integrity case making international headlines of an iPS cell study conducted by a researcher Hisashi Moriguchi who had allegedly falsified or fabricated data, provided false institutional affiliation, plagiarized work, and had questionable publication practices. In this post, I want to outline a few of the lessons we can learn from this case.

I think Péter Kakuk said it best when he wrote that the Hwang cloning scandal “might shed light on the often neglected benefits of the 'social control of science'".  As a trained scientist, I can say that I used to believe that many of the safeguards felt more like impediments to research progress. As a bioethics researcher, I still feel there are kinks in the system of ethical oversight and there is evidence to support this view. However, I also believe that the ethical safeguards are in place to promote the responsible conduct of research and ensure that research is performed by upholding the utmost standards of integrity. In every issue of Nature or Science there is some report of research misconduct or misbehavior. There have been studies done in the US and many other nations about the frequency of misconduct. Yet despite such reports, I feel many scientists still believe there are too many research hurdles only to catch a few bad apples. This view needs to shift.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

This blog will have two parts. In this first entry, I present will discuss a recent case of stem cell fraud and the subsequent blog entry will discuss possible lessons to learn appearing next month.

The tale begins when Woo-Suk Hwang, a once celebrated hero of South Korea, claimed to have made the first, patient-specific human embryonic stem cell (hES) line through a technique called somatic cell nuclear transfer (commonly referred to as research or therapeutic cloning). This study was soon after proven to be fraudulent. Not to get into too many details, but this technique requires obtaining ova from women providers, enucleating its genetic material, and placing the nucleus from a somatic cell and parthenogenically activating the egg. This initiates embryonic development and at about day 3-4 of development (where the embryo is at the blastocyst stage), hES cells can be isolated from the inner cell mass of blastocysts. This incredible feat in stem cell research was published in Science in 2004 and another study in 2005. In 2006, Hwang was discredited for fabricating results and after an investigation, he was convicted for embezzlement and bioethical allegations. He embezzled approximately 830 million won (US $700,000) of government funds and apparently used 2,200 eggs obtained from his female postgraduate students and junior researchers. All wasted!

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.