The Price of Precaution and the Ethics of Risk

For once, I'll post some self-promotion here. After  quite an intense week of work, I today sent off the final manuscript for my forthcoming book, The Price of Precaution and the Ethics of Risk, due to be published  by Springer, in its International Library of Ethics, Law and Technology series, later this year. This is a partial explanation why you haven't seen any substantial posts here for a while, and I'm sorry to say that this will continue for a while, since I now move on to revising the manuscript to mine and Niklas Juth's forthcoming book on the ethics of screening in health care and medicine. But I hope to able to post a snippet or two now and then, and be back in full force in a few months.

Scientific discourse and social media

A few days ago, Nature published this interesting piece on how social media, blogs and particularly Twitter has quickly changed the context of academic publishing and "open review" (what we academics outside of natural science and biomedicine call public debate). Going by the article, it seems to me that the scientific world has a surprisingly hard time coming to grips with the situation that criticism of scientific publications can no longer be screened by editors and that scientific discussion, as a result, is no longer an activity reserved for a chosen few. Nevertheless, an interesting read with several engaging examples and opinions worth considering.

Article retraction in academic journals

Pertaining to my earlier post on an article retracted due to (what in all respects that matter is) plagiarism in a bioethics journal, here's an interesting piece by Ben Goldacre in today's Guardian on the general topic of the (lack of) policies for retraction notes.

Organ trade and the penal system: contrasting cases, pragmatics and structural effects

This is a piece on a complex of related issues that I find it difficult to form a coherent opinion about. Any suggestions are welcome!

Yesterday, it was reported (here, here, here, here, here, here, here, here and here) that two sisters, Jamie and Gladys Scott, serving life sentences in the state of Mississippi, USA, have had their sentences suspended and been released (under parole-like conditions) on the condition that one of them will donate one of her kidneys to the other one (who has been on dialysis for quite some time). The case has raised some controversy, commentators bringing up the issue of whether or not the sentence was fair in the first place, whether the court decision is really in compliance with US federal law (banning organ trade) and – not surprisingly – that the whole idea is immoral. My colleague, Arthur Caplan, argues today that the decision crosses an important moral line, where legal decisions are transformed into business contracts involving people's bodies. The president of the American Society of Transplantation, Dr. Maryl R. Johnson, reportedly said in a formal statement:

The decision to donate an organ should be a truly selfless act, free from coercion and not conditioned on financial or any other material gain

It is a bit interesting that such strong, absolutist statements are made at the same time as the pragmatic case for allowing a controlled system of organ trade has been building with continuing reports about the hideous free global black market in human organs and tissue.  Especially the strong condition of "true selflessness" seems to me to be totally out of place, since it rests on a simplistic picture of human motivation: generally, there are no "true" selfless acts, just as there are no "true" self-centered ones – the human motivational apparatus is much too sophisticated to allow such crude – albeit romantic – characterisations. However, the pragmatic case for (regulated) human organ/tissue trade has one weakness (besides the question-marks surrounding the prospects of successfully enforcing the control of prices, procedures, consent, et cetera): the possible structural effects of such a system. And, possibly if not probably, cases where the transfer of organs between people is connected to the criminal penal system make this sort of threat salient.

For several years now, reports about and criticism of exactly this sort of connection in China has been a repeated news item (here, here, here) – connecting to the organised harvesting of the organs of prisoners, some after having been executed under the death penalty, as part of the domestic organ "donation" system or for sale on the international market. Tasteless, unethical and discriminatory (regarding non-living "donors" targeting especially groups disliked by the Chinese totalitarian regime) as this practice is, the most worrying element is revealed when it is cross-referenced with the vast illegal market for human organs in and from China (here, here). While the practice of harvesting the organs of prisoners (executed or alive) mainly pose serious ethical issues (bad enough, you might think), it does not in itself undermine the confidence in Chinese legal security (which can be questioned on many other grounds, of course) and rule of law. However, with the vast and highly profitable black organ market in place, the Chinese organ harvesting practice suddenly attains devastating proportions also from this standpoint. The illegal organ trade (as most other illegal businesses) having such gigantic turn overs and profits, the assumption that the system of organised organ harvesting in Chinese prisons sooner or later will corrupt the Chinese criminal law and penal system is highly warranted.

So, how does this connect to the recent US case? Well, one connection, of course, is the mere fact that criminal legal and penal decisions are connected to issues of organ transplantation. In the case at hand, a particularly nasty ingredient is the open reference made by officials about what providing one of the sisters with dialysis cost the state of Mississippi. But even discounting for that, the ruling puts into question rule of law, since it conveys the impression that convicted offenders may buy themselves off by providing some sort of socially beneficial service. That is, those offenders who happen to have the resources at hand. It also – just as in the Chinese case – creates serious doubts about the voluntariness of the donation in question. But to my eye, the doubts about the workings of the criminal legal system are far more serious. Some of this could be tackled, of course, by having the US adopt a variant of the Chinese position, where transparent statutes are created according to which inmates may buy themselves reduced or slacked sentences by giving away their organs. Such a revision, however, would put US on a sub-cellar level as regards the basic principle of equality before the law. And, of course, in either case, it is now well known that the black market in human organs is highly present and operational also in the US, thus creating worries regarding corruption and undermining of the rule of law similar to the Chinese case.


Now, the pragmatic case for a regulated market for human organs rests on two pillars: (1) the existence of the black market and (2) the great amount of good that a better supply of organs for transplantation would do. Standing as they are, these two reasons seem to apply to ideas about connecting the system for organ donation and the penal system. If inmates are made to donate their organs this is a good thing according to (2), and if it is done in an open and controlled system this will help crippling the bad thing of (1). What troubles me is that the fact of (1) makes it less probable that the idea of a well-functioning controlled organ market is realistic. It makes a difference that the black market is already in place, since the incentives to channel the organ supply out of the controlled system and into the black market are so great. This, in turn, serves to undermine (2), since that reason now has to be balanced against the risk of having the basic functionality of the legal and penal system undermined. As bad as the shortage of organs for transplantation is, it is completely overshadowed by that sort of threat.

When Online Open Access is a Good Thing: Free 25 Year Anniversary Issue of the Journal Bioethics

Well, well, isn't this timely?

Just the day after I have been (seemingly) trashing online open access publication in the field of bioethics, we have an example of the very opposite of what I was talking about! Mind you, I did say that online, open access journals can be high quality, but that operations of the sort described in yesterday's post unfortunately function as the rotten apple that tends to spoil the barrel. So, perhaps the best way of being sure that an online, open access journal is top rate is when it is, in fact, a regular, well recognized, highly rated, non-open access journal that publishes occasional open access issues. Such as this one, I mean (ironically an issue of the very same journal that was the victim of the plagiarism described in yesterday's post) – the rest of what follows is a crosspost from Udo Schüklenk's Ethx Blog:

25 Years of Bioethics (the journal)

here's the ToC of our 25th anniversary issue. The commissioned
contributions have been made available in Open Access format, so no
subscription to the journal is required.

The content can be accessed here:

http://onlinelibrary.wiley.com/doi/10.1111/bioe.2011.25.issue-2/issuetoc


EDITORIAL (page ii)

UDO SCHÜKLENK

ARTICLES

PUBLISHING BIOETHICS AND BIOETHICS – REFLECTIONS ON ACADEMIC
PUBLISHING BY A JOURNAL EDITOR (pages 57–61)
UDO SCHÜKLENK

PERSONAL GENOMES: NO BAD NEWS? (pages 62–65)
RUTH CHADWICK

WAS BIOETHICS FOUNDED ON HISTORICAL AND CONCEPTUAL MISTAKES ABOUT
MEDICAL PATERNALISM? (pages 66–74)
LAURENCE B. MCCULLOUGH

LOOKING BACKWARDS, LOOKING FORWARD: HOPES FOR BIOETHICS' NEXT
TWENTY-FIVE YEARS (pages 75–82)
SUSAN SHERWIN

LOCALIZED PAST, GLOBALIZED FUTURE: TOWARDS AN EFFECTIVE BIOETHICAL
FRAMEWORK USING EXAMPLES FROM POPULATION GENETICS AND MEDICAL TOURISM
(pages 83–91)
HEATHER WIDDOWS

IN WHOSE INTEREST? POLICY AND POLITICS IN ASSISTED REPRODUCTION(pages 92–101)
ANNE DONCHIN

MORAL ENHANCEMENT AND FREEDOM (pages 102–111)
JOHN HARRIS

LITERATURE, HISTORY AND THE HUMANIZATION OF BIOETHICS (pages 112–118)
NATHAN EMMERICH

Deteriorating Bioethics, Plagiarism, Amateurism and Open Access

My research speciality, Bioethics (including medical and health care ethics (+ law and policy), research ethics of the life sciences (+ law and policy), public health ethics, and so on) has been an expanding, successful and increasingly influential international academic field since the early 1980's. While moral philosophers, like myself, have played an essential part in this process (people like Peter Singer, Michael Tooley, Rosalind Hursthouse, Dan Brock, Ruth Faden, Richard Hare, Judith Jarvis Thomson, Daniel Callahan, Jonathan Glover, Mary Anne Warren, Bonnie Steinbock, Tom Beauchamp and Frances Kamm come to mind), there has always been a consciousness in the field of the importance of having also far-reaching theoretical analyses being informed by accurate facts and up to date empirical research and theories. With time, more and more bioethics has come to be descriptive and empirical rather than theoretical and normative – applying some presupposed (as a rule not very well worked out) normative standard as a backdrop to investigating phenomena that are supposedly ethically relevant against that background (the endless series of studies of the practice of informed consent against the backdrop of "the four principles" is the most obvious example). Gradually, this development has led to a situation where more and more authors of bioethics papers lack any deeper education or training in the theoretical subtleties of the field (at best they have some sort of biomedical education topped up with a relevant ethics master or some-such, but often not even that). In parellel, more and more bioethics papers are being published not in the renowned specialised journals of the field, but in regular medical or health research journals and numerous new "open access" journals of uncertain repute.

Now, while I have been hearing more than just a few grumpy comments on this development among my more theoretically inclined colleagues, I am not of the opinion that it is necessarily for the worse. It may be viewed as a natural consequence of the success and relevance of the field that a division of labor is developing, where some concentrate on theoretical detail, analysis and innovation, others  doing the empirical investigations of relevance against the background of formulated theories and yet others engage in the tricky activity of moderating the application of bioethics research results in the context of policy making. However – and this is a big but – as in other areas of science and research, such developments are for the better only to the extent that the integrity of the field is not compromised as an upshot. Such a threat may arise in many ways, one of which being lack of intellectual contact and interaction between the "labor-parts" – for this reason, I'm a big supporter of multidisciplinary team research, where the theoretical, empirical and pragmatic sides of the field are forced to interact in the very process of doing the research. Another source of the threat is that the development brings into bioethics some bad habits and disgraceful ingredients that – alas – have been part of the biomedical research world for a long time. I'm thinking about things as journals with questionable quality standards and research fraud.

Quite recently, both of these sources of a threat against the integrity of bioethics research have been exemplified in the form of a multi-layer scandal in relation to a paper published in the "open access" journal BMC Medical Ethics. The paper in question, "End-of-life discontinuation of destination therapy with cardiac and ventilatory support medical devices: physician-assisted death or allowing the patient to die?" by Mohamed Y Rady and Joseph L Verheijde, was recently retracted because it was found to repeat substantial passages from a paper by Franklin Miller, Robert Truog and Dan Brock, published in the very well-seen journal Bioethics. At the research ethical blog Retraction Watch, Franklin Miller describes how BMC Medical Ethics conceded to retracting the article only after some substantial pressure from the legal department of Bioethics. Udo Schüklenk, editor in chief of Bioethics, demonstrated his outrage at the attitude of BMC Medical Ethics by cross-posting the Retraction Watch piece on his own Ethx Blog,  just a few days ago.


As noted in a further comment made at The k2p Blog, one of the main points made by Retraction Watch is that the BMC Medical Ethics retraction note is not honest about what has actually occurred. The note reads:

The authors have voluntarily retracted this article [1] and it is no longer available for online public display because portions of the article are similar to a previous publication [2]. While there was no intention to use pre-existing work without appropriate attribution, the authors nonetheless extend their apologies to Dr. Miller and all others concerned.

So, let me get this straight: The article plagiarised another article, but – then again – it didn't, since the plagiarisors claim that there was no intention to plagiarise. Well, how very odd then, that same (not) plagiarisors find reason to apologise to the (not) plagiarised authors.... eh....., for not plagiarising their article, I guess. As The k2p Blog puts it, "[w]hen is plagiarism not plagiarism?", immediately answering:

Apparently when the editor of the journal BMC Medical Ethics finds that a paper published in his own journal has copied large chunks from a different (competing?) Journal.

And, ending the post on a similar note:

...perhaps it is only plagiarism when other Journals copy material published in yours but not when others are copied and published in your Journal?

Amen. Together with Franklin Miller's account of the lack of willingness to even acknowledge any reason for retracting Rady's and Verheijde's paper in spite of irrefutable evidence, we here have as good an illustration as we want of the poverty that may result when "scientific journals" are able to mushroom under the protection of the presently sacred buzz-headings of "open access" and "online". As we all know, of course, this format for a journal is a financial prerequisite for having these sort of below sub-standard periodicals in the first place, at least as long as bioethics does not become tasty prey for the Big Pharma sponsored "manufactured scientific journal" industry, that have been scandalising biomedical scientific publication in recent years. 

Further evidence of the dungeon-like quality standard of BMC Medical Ethics is provided when inspecting it's website; priding itself as it is with a shining silver medallion at the top, announcing this fine journal's "unofficial impact factor" to be a handsome 1.93. Who's that when he's at home?, you may rightfully ask. The mystery clears, when clicking the shiny little badge – lo and behold:

Do journals published by BioMed Central have Impact Factors and are their citations tracked?
 
Yes; for any journal to have an Impact Factor, however, it must be tracked by Thomson Reuters (ISI) for three years. Although many BioMed Central journals are tracked by Thomson Reuters, others are still relatively new. The tables below show those journals that are already tracked by Thomson Reuters (ISI) and so already have Impact Factors, and journals that are due Impact Factors for which we have calculated their unofficial Impact Factors.

In short, BMC Medical Ethics does in fact not have an impact factor, but the management of the journal apparently hopes that it will one day receive one (to be precise, as transpires further down, some time in 2012). In the meantime, the same management has done its own little dabbling with its pocket calculator, coming up with the nice little "unofficial impact factor" that, just as so happens, holds out BMC Medical Ethics as a more influential journal in the field than longstanding leading periodals such as Journal of Medical Ethics, Bioethics, Theoretical Medicine and Bioethics, Health Care Analysis, Cambridge Quarterly of Health Care Ethics and Hastings Center Report. Truly impressive (footwork of a con-artist excuse for a scientific journal editor, that is)!

Now, although – as I said – the "open access" and "online" options opened up by the internet are presumably prerequisites for this sort of scam, it is of course quite possible to have journals that are both open access and online that meet the quality conditions one would expect of an academic journal. The problem is, with friends in the trade such as BMC Medical Ethics (and, one is prone to suspect, the whole Biomed Central lot) these journals need no enemies. The only way in which a researcher has any chance of deciding the actual quality is to inspect a sizable amount of paper and submit them to intense scrutiny. I can vividly hear the bitter laughs rattle the offices and rooms of my colleagues, as they ponder this suggestion for what to do with their precious time...

Well, I thought, then maybe I'll do it a bit for them! Because, as revealed by Udo Schüklenk, the retracted paper is in fact not fully retracted – or, to be precise, it is indeed still available through the BMC Medical Ethics server [RETROSPECTIVE NOTE: this has now been taken away, but the paper can still be accessed here], just not to be found via clicking a link in the table of contents. Not that we needed any more evidence of the morass that is BMC Medical Ethics, but there we are!

But anyhow, how about the paper itself? Well, you are all welcome to read it and make up your own minds, but to me this paper illustrates exactly the sort of threats to the integrity of bioethics research due to lack of adequate knowledge and skill mentioned earlier. Here allowed to be made public thanks to scam operations such as BMC Medical Ethics. The whole paper is based on the assumption that there is a comprehensive, sharp and self-evidently morally relevant distinction to be made between "active" killing ("physician assisted death") and "allowing" patients to die (without that assumption, the authors would be unable to make the argument they try to make and advance the thesis they want to advance). Recognize that one, perhaps? Isn't it one of those conceptual traps that are laid in the shallow rhetoric of high school debate contests that a minimally trained and educated bioethicist is supposed to spot and unpack instantly by applying some conceptual analytic ointment? Yes indeed, it is (and, as it happens, this is what Miller, Truog and Brock do in their paper). I'll tell you, Rady and Verheijde wouldn't have passed my basic course on medical ethics or bioethics theory. In spite of one of them waving the flag of an affiliation to a center for biomedical ethics, this is the indisputable work of amateurs whose only accomplishment is to send a stinking cloud of incompetence over my favored field of inquiry.