SOME years ago the Nobel laureate Joshua Lederberg remarked to me that 鈥渢hose who do not support medical research will have the blood of those who die on their hands鈥�. I was left wondering if he was right about that. Is a legislator or member of parliament who supports an increased education budget at the expense of medical research to be held responsible for avoidable deaths? I puzzled over that question.
I was reminded of this when debates began breaking out in the 1990s on a variety of research problems. Critics of strict regulation of research involving human subjects complained that it was stifling life-saving investigation. The pharmaceutical industry defended its high prices on the grounds that it had a moral obligation to do the expensive research that would cure disease and relieve suffering. Supporters of embryonic stem cell research said that there was an ethical duty to pursue a line of study that could eventually save thousands, even millions, of lives.
Such arguments seem to me a misuse of what can be called the research imperative. By that term I mean the perceived obligation to carry out medical research to improve health and forestall death. It is as if such research has some overriding moral priority, capable of nudging aside ethical difficulties as obstructionist hand-wringing, paying no attention to appropriate social priorities.
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The research imperative can be understood as a striking manifestation of the human desire to know and to use science to improve the human condition. But like a number of good things that can go sour if we do not take care, it is a claim that can act as a kind of moral and social bully.
How then might we best characterise scientific, and particularly medical, research? My answer is this: do not think of it as an overriding imperative but as a moral and social good 鈥� well worth pursuing but always to be compared with a wide range of other social goods that a society must also pursue. A well-functioning society needs some scientific research, but it also needs money to be spent on education, on the welfare needs of the poor and dependent, on job creation, and on environmental threats.
No single one of those needs is inherently less or more important than any other. It is by no means evident that the death and suffering disease can bring 鈥� a function of our bodies 鈥� are necessarily worse than those same evils when visited upon us by poverty, war, crime and familial violence. (I happen to think the latter are worse). Research is, then, a high good, but not one that automatically trumps all others.
People often claim that the real issue is to find the right balance between the research imperative and its drive to relieve suffering, on the one hand, and the moral and social objections to particular lines of research, on the other. Too often, however, the aim of balance is pre-empted by a claim that the research is a 鈥渘ecessity鈥� strong enough to dilute any qualms about it 鈥� as happens with the use of embryos in stem cell research. The debate about research on human subjects is nearly a century old, yet you can still hear voices discussing the harm done by excessive deference to patient rights.
But in the case of embryonic stem cell research, other approaches to treating degenerative diseases can be, and are being, pursued. To say that such research is highly promising is not the same as saying that it is necessary or unavoidable, as has often been claimed. In the case of research on human subjects, the world consensus 鈥� now backed by international codes and every major research organisation 鈥� is that medical research cannot take place at all without informed consent from competent persons. In short, there can be no 鈥渂alancing鈥�, and claims about lives to be saved are decisively rejected.
There is now a well-recognised danger that media or researchers鈥� hype of potential cures for various dread diseases, and the inflated language of great breakthroughs just over the horizon, can do the research enterprise great harm. We can recognise, though, that publicity does bring attention, funding, public interest and prestige. It cannot be wholly ignored. Even so when pushed too far, shading off into puffery, it becomes harmful, and creates at the least a jaded and sceptical public.
The use of the language of moral necessity for medical research presents similar or perhaps even worse hazards. It can add a spurious patina of high morality to what in the end is nothing but the pleading of special interest groups. It can skew the drive for better health away from the behavioural, social and economic causes of illnesses to excessive investment in biological research. Behavioural research on poor health habits, a well-known source of illness, has never commanded money in the same way genetic research does.
And the language of moral necessity can leave the impression, sometimes arrogant and self-righteous, that research has a kind of sacred status 鈥� the engine of progress 鈥� that transcends moral concerns, other social priorities, and any and all kinds of precautionary principles.