Monday, October 08, 2018

Sokal on steroids: Why hoax papers submitted successfully to academic journals proves nothing (ok, little)

A trio of authors has, during a 12 months period, submitted - by their own account - 20 manuscripts to academic journals they broadly identify as being in disciplines or fields of study associated with 'academic grievance studies'. From what I gather they are not too terribly fond of social constructionist colleagues in their own academic disciplines, and presumably other disciplines. Let me say at the outset that I am sympathetic to some of their concerns. They rightly lament that what they broadly label as 'academic grievance studies' has led to thought crimes prosecutions of sorts (just think about the Hypatia controversy involving an article by Rebecca Tuvel - mob justice might be one way to describe what happened to Tuvel). Ironically, Hypatia is again among the offending journals, which is interesting in so far as it isn't a journal entirely dedicated to publishing social constructivist content, another bugbear of the initiators of the Sokal-on-steroids hoax.

In any case, they apparently spend their while producing 20 hoax articles that they planned to submit to top journals in different disciplines or areas of study that they find disagreeable. I am genuinely curious whether this research project was submitted to their institution's ethical review committee, because it uncontroversially involved involuntary human research participants (identifiable journal editors, reviewers).

Here's the result of their efforts: Of these 20 papers 7 were accepted, 6 were rejected outright, and the rest were somewhat in-play, including a number that received a revise and resubmit verdict. The hoax initiators claim that two papers received a verdict of 'revise and resubmit' that they took to mean 'usually results in publication.' For what it's worth, at the journals I co-edit this verdict means renewed external review with the possibility of an outright rejection. So, no, not 'usually results in publication.' I wonder whether this interpretation is self-serving in so far as they needed to, of course, bolster their case as good as they could.

At the end of the day, they had 20 submissions, 7 acceptances.

I agree with the team of hoaxters that this constitutes egg on the faces of the editors of those journals, and more so, on their reviewers' faces. It's embarrassing.

I read a few comments on this project along the lines that in STEM subjects journals also face large numbers of retractions each year, and so it's not surprising that terrible content also passes peer review in humanities' areas. While that is true, it shouldn't distract from the fact that well-established, influential journals were coaxed here into accepting garbage. Of course, that matters!

My problems really lie elsewhere. One is that a study where n=20 doesn't demonstrate that a particular discipline has methodological problems. It simply means that - when all is said and done -  7 crappy papers were accepted by non-specialist journal editors based on their reviewers' recommendations. Big whoop! Frankly, this shows us that on this occasion reviewers failed. On 7(!) occasions. We do not know whether the same would have transpired if hundreds of such papers had been submitted to the same journals. It's one such paper per journal. Talking anecdotal, this is as anecdotal as it gets.

Let me be honest here, as an editor of journals that rarely if ever publish social constructionist papers, I could also be accepting papers that succeeded in fooling our peer reviewers. I don't have the subject expertise to be confident in evaluating all the manuscripts that are submitted to my journals. I rely on - these days - mostly reluctant reviewers who hopefully provide me with good (sometimes excellent, detailed) comments and recommendations. I rely on competent reviewers being diligent. I rely on colleagues I ask to review a manuscript to come back to me if they do not consider themselves competent. I rely on unpaid reviewers spending a considerable amount of time doing their job, when they could spend that time writing their own papers, or on a grant application, or a job application, or they could simply spend time with their loved ones. Not all of them, all the time, deliver a reliable review. Big whoop. If a faulty paper gets published (and it hasn't happened to us yet), I'm confident, over time responses to such a paper would eventually show where the paper we published went wrong, and why. A case in point is this Editorial I wrote. One of the articles flagged there was making false empirical claims, it has since been retracted. The article in question passed external peer review, but it is clear that the reviewers took the empirical claims made by the authors to be true, referenced as they were. It turns out that that was a mistake. 

All of that happens without hoaxters wasting my time and that of our reviewers.

The hoaxter trio takes these 7 accepted manuscripts as evidence for the methodological failings of what they refer to as 'social constructivism'or 'radical constructivism'. They apparently 'corrupt' scholarship.

The thing is, that might well be true, and social constructivism scholarship is truly a naked emperor. Unfortunately, pointing to 7 anecdotal papers as evidence that that is the case, is plain ludicrous. As far as I can see, there wasn't even a control group (say, 20 manuscripts submitted to analytical journals, 20 manuscripts submitted to STEM subjects).

To my mind, if you wish to criticize social constructivism (and much critical that I wholeheartedly agree with has been published over the last few decades) don't avail yourself of childish activities like these kinds of hoaxes. Show by means of analysis and argument that, and why, the social constructivism emperor is naked.

The process of producing and publishing peer reviewed academic content relies on an assumption of good intent and genuineness among authors. Obviously, this is not justified in all cases, that's where critical responses and retractions come in handy. The last thing needed is a cottage industry of 'gotcha authors' like our hoaxter trio. They could and should have spend their time producing one sound academic paper taking on social constructivism, placing it in a top-notch journal, and subsequently enjoying the fireworks of rebuttal and response. That's how progress in the academy is facilitated.

I have sat on this for a good week, because I wasn't sure whether I should bother writing a response. On the one hand I share many of their concerns, on the other hand, this was such a time wasting pointless exercise, it boggles the mind smart people would have resorted to that sort of thing.











Ethics Violations: Canadian Medical Association exits World Medical Association

The Canadian Medical Association (CMA) has left the World Medical Association (WMA) because of ethics failings of its new President, Dr Leonid Eidelman. Apparently Eidelman's inaugural speech was in parts plagiarised from content produced, among others, by Dr Christopher Simpson, a former President of the Canadian Medical Association. As far as Eidelman is concerned, he says his speech was written by speech writers, and he was unaware of the plagiarism.

Let me just say that Eidelman ought to resign, whether or not his speech was written by others. He delivered plagiarized content as if it was his own, so the fact that he used speech writers is irrelevant, he remains responsible for what he says. The WMA did not force Eidelman to resign, it did not fire him.

The thing with the WMA is this: ethics failings are kind of power for the cause. That's what it does. It is a morally bankrupt organization, and it has been a morally bankrupt organization for a long time.  Its plagiarizing current President, by comparison, nearly falls into the category of 'good guy'.

In 1992 it wisely chose to elect a Nazi war criminal as its President, Dr Hans Sewering. Sewering was reportedly a member of the SS and the Nazi party. He signed death warrants for some 900 children with disabilities who were then murdered in a Nazi extermination centre.

In 2010 the WMA elected Ketan Desai to is President. He was found guilty by the High Court of Delhi of corruption and abuse of power in 2001.  The High Court ordered his removal from his job as President of the Medical Council of India. Investigators had charged him with seeking a massive bribe from a private medical college in return for approving admissions of students for the 2010-2011 academic year.

So, the WMA has a knack for picking the wrong people. The only thing that is odd about the CMA's timing is that they chose to resign their membership from the WMA over a comparably trifling matter, namely a vanity speech giving by its incoming President. Desai's failings were apparently of no concern at the time to the CMA.

The CMA's President, Dr Gigi Osler is quoted in the Toronto Star newspaper, '“We must continue to hold ourselves to a high standard of professionalism and ethical behaviour,” said Osler. “We are going to strive to uphold honesty, humility, integrity and prudence.”

This, of course, is the same medical association whose views on professionalism are akin to that of a trade union rather than that of a proud professional association. Dr Jeff Blackmer, the Director of the Canadian Medical Association’s Ethics Office wrote on behalf of the association that medical doctors are neither obliged to provide abortion services, nor are they obliged to transfer patients on to doctors they know will provide abortions to women seeking one. He holds the same view on medical aid in dying, and - one wonders - on what other medical services. Of course, doctors are monopoly providers of this service, abortion is legal in Canada, and pregnant women are entitled to receive that service free of charge (ie publicly funded) from said monopoly providers. The CMA's take is that the refusal to provide or transfer is perfectly compatible with professional conduct, when, by definition, that isn't the case.

Apparently Eidelman and Blackmer got into a bit of a bunfight over Eidelman lecturing the CMA over its support for medical aid in dying. Blackmer rightly criticises Eidelman for claiming that the CMA thought assisted dying is comparable in terms of its seriousness to prescribing antibiotics.

It appears to be the case that the WMA has again managed to appoint a reactionary doctor with questionable ethics as its President. One does wonder why anyone would take too seriously any longer its pronouncements on matters medical ethics. In its conduct it really is not dissimilar to the Roman Catholic Church. There is a lot of hand waving and posturing, but when it comes to actual conduct, it disqualifies itself as an arbiter of matters ethics.

So, kudos to the CMA for leaving the WMA; even though the point in time is ill-chosen, it was a long overdue decision.








Tuesday, August 14, 2018

2018 Google Scholar Metrics for Bioethics Journals

Quite possibly the below table will be displayed in odd ways on your screen. 

Usual CoI blurb applies. I co-edit two of the journals in this list. List up-dated August 2018. Any mistakes are my own, please alert me if you discover discrepancies between what I am reporting and what you're able to find on google scholar.


                                                                                                                           h5               h5-median

  1. Nursing Ethics                                                                              37          51
  2. Journal of Medical Ethics                                                             33          40
  3. Journal of Law, Medicine and Ethics                                             32          40
  4. Science and Engineering Ethics                                                        30           45
  5. The American Journal of Bioethics                                              30         41
  6. bmc medical ethics                                                                       28           38
  7. Bioethics                                                                                       26         37       
  8. Medicine, Health Care and Philosophy                                        24         28
  9. Neuroethics                                                                                   22         37
  10. Hastings Center Report                                                                 22          30
  11. Journal of Bioethical Inquiry                                                                   19        22
  12.  American Journal of Bioethics Neuroscience                              18            26
  13.  Journal of Medicine and Philosophy                                            18          25
  14. Journal of Empirical Research on Human Research Ethics         18          21
  15. Developing World Bioethics                                                                  16          21
  16. Nursing Philosophy                                                                        16      18
  17. Health Care Analysis                                                                     15       22
  18. Cambridge Quarterly of Healthcare Ethics                                            15          20
  19. Public Health Ethics                                                                               14          17
  20. Theoretical Medicine and Bioethics                                                       13          21
  21. NanoEthics                                                                                             13         18
  22. Indian Journal of Medical Ethics                                                     13       17
  23. Kennedy Institute of Ethics Journal                                                13          17
  24. The Journal of Clinical Ethics                                                        12          19
  25. Journal of Medical Ethics and History of Medicine                         12         19 
  26. Perspectives in Biology and Medicine                                                12        15
  27. Narrative Inquiry in Bioethics                                                                11              15
  28. HEC Forum                                                                                     10         17
  29. Ethik in der Medizin                                                                         10           13
  30. American Journal of Bioethics Empirical Bioethics                                8          10
  31. International Journal of Feminist Approaches to Bioethics              8         10
  32. Monash Bioethics Review                                                                7            12
  33. South African Journal of Bioethics and Law                                         7             9
  34. JAHR - European Journal of Bioethics                                             5           9
  35. Asian Bioethics Review                                                                   5           7
  36. The New Bioethics                                                                           5            7
  37. Christian Bioethics                                                                            5           6
  38. National Catholic Bioethics Quarterly                                              4             6
  39. Journal international de bioethique                                                         4             5




*h5-index is the h-index for articles published in the last 5 complete years. It is the largest number h such that h articles published in 2013-2017 have at least h citations each
**h5-median for a publication is the median number of citations for the articles that make up its h5-index

Sunday, August 12, 2018

Trying to travel on American Airlines from Rio de Janeiro to Miami

Here's a tale of what goes wrong when airlines are so busy saving money on staff that they forget about their secondary function, namely carrying passengers in a timely fashion from A to B. Their primary function, admittedly, is to maximize profits for their shareholders...

So, here is what happened to me and a Boeing 777 full of passengers, it shows organizational as well as professional failings on various levels.

I was supposed to leave on flight AA 905 from Rio de Janeiro (GIG) to Miami (MIA). Scheduled departure August 09 8:40pm for a 4:30 am arrival on August 10. The plane would have sat on the tarmac pretty much all day, from its early am arrival from either JFK or MIA. Keep that in the back of your mind as you read-on.

We board on-time, everyone is ready for an on-time departure. There were some issues with an odd bloke who wandered about the cabin while the plane was taxiing. Anyhow, so it began: They had engine problems. An external aircon unit had to be deployed, because it got quickly boiling hot in the cabin. The initially talkative Captain on this flight disappeared soon completely. Keep that also in mind as you read-on.

For a number of hours passengers endured a complete communications break-down. At no time were we told what the problem was, whether or not it could be fixed, and/or how long it would realistically take. We were fed continuous misinformation like 'we will be airborne momentarily', 'the unacceptable temperature in the cabin will decrease rapidly after the second engine comes on' (that engine never came on). That was after the Captain made a brief appearance uttering things like we would have to wait for paperwork to be completed, and that that would take about 45 minutes. Right after that that much talked about second engine failed to come on and it got really hot. As I said, the Captain was missing in communications action ever since.

Passengers became irate because of the communications break-down caused by the Captain in charge. The flight attendants made-do with the false information they had been given and passengers rightly did not believe a word they uttered any longer. I did feel sorry for them, because none of that was their fault, but they bore the brunt of passenger anger.

Discipline on the plane began to break-down. People were told that they could leave if they wanted to. Some people left, others started arguing with the flight attendants, refusing to leave or sit down until they would be promised that their luggage would be unloaded. The flight attendants could not promise that, so there these passengers were, not leaving, not sitting down. Perhaps cognizant of the PR disasters security personnel on planes cause, nobody forced these passengers to either sit down or get off the bus.

Eventually we were told that *really* we were ready for departure, if people would please just sit down so that we could leave. Sadly the majority of passengers did not respond to that directive anymore. Some wanted to get off, but not without their luggage, others just stood in the aisles and were angry in a directionless way, a few sensible people tried to coax standing passengers to take their seats, without much success. I wonder whether mass hysteria looks like this. None of this made any sense to me. Well, we did not leave on his occasion because of the breakdown in cabin discipline that was a direct result of American Airlines staff feeding us misinformation for many hours. I just sat down in my seat and watched movies, while watching the drama unfold around me.  

I carefully monitored my app, waiting for the inevitable, the cancellation of the flight. The inevitable happened, my flight was rescheduled for the next day's afternoon. Interestingly, I had the flight cancellation information before the flight attendants. You do wonder whether they are the absolutely last people on the planet to be informed about anything that's going on on their flights. We were bused to a downtown hotel and picked up the next morning at 11 am for a 3:30 pm departure. All that was fairly professional, and while the hotel was basic, I have no complaints.

At the airport we duly checked in, boom, shortly after we cleared security and customs, came the message that the flight was delayed to 1:30 am, and that we would be bused back to a hotel. I trust you appreciate the staggering incompetence, on an organizational level, that would be required to result in such an activity. Apparently they had no crew to staff that flight. Well, *that* American Airlines surely would have known prior to dragging people in several coaches from the hotel to the airport. Incidentally, this pointless leasing of coaches and drivers to ferry passengers forth and back between the airport and the hotel is unlikely to contribute to the primary reason for existing of listed companies, profit maximization. I won't even go into the self-inflicted reputational damage.

On the bright side, this seasoned traveler didn't like the idea at all, of sharing the flight with all those angry passengers, so I re-booked myself on the regular 8:40pm flight. Sensibly American Airlines had allocated our disaster flight crew to this flight, so they would not have to face those furious passengers  again. I was somewhat less assured, to be honest. And there he was, our cheerful, talkative Captain from said disaster flight. I knew, of course, should there be a problem, he would just dive for cover and be nowhere to be seen or heard.

I think there are several lessons in this:

1) check your planes (especially if they sit on the tarmac for a day) prior to boarding.
2) communicate precisely to your passengers what the nature of the issue is, how long it might take, and admit uncertainty if you are uncertain (nothing is worse for trust and discipline if it becomes obvious that information provided is patently false, and was known to be false when it was provided).
3) maintain discipline in the cabin.
4) ensure the Captain shows themselve to be in charge.

If these rules had been followed we would have almost certainly departed that evening.

I still do not know whether that flight left at 1:30 am, because by the time my flight left it had disappeared from the airport departure information displays. On a cheerful note, the 777 I had rebooked myself on had newer seats. I slept definitely better than on my flight to Rio. Not that you wanted to know.

August 14, 2018update: AA initially told me that I had no case for compensation because the above issue was caused by weather. When I pointed out to them that none of what I described had anything to do with weather, they promised to look at their records again.  They followed up on this with an apology and the offer of a 250 $ voucher of 15k miles.  I accepted the travel voucher. Case closed.






Monday, May 28, 2018

Bioethics culture wars – 2018 edition: Alfie Evans

Here's my current Editorial in Bioethics

When health‐related tragedy befalls newborns, bioethical culture warriors are never far behind. The sad case of Alfie Evans1 seemingly opened up renewed campaign opportunities, and every opportunist, from the leader of the Roman Catholic Church to the Italian government, as well as a line‐up of minor academics, newspaper columnists and social media warriors, chimed in to score political points.
Publication cover imageAlfie Evans was as 23‐month‐old toddler suffering from a degenerative brain disease that led tragically to him eventually being in a semi‐vegetative state extending over more than a year. The specialists caring for him at the UK's Alder Hey Children's Hospital concluded that the boy suffered a ‘catastrophic degradation of his brain tissue’, and they asked for court permission to withdraw ventilator support, because in their considered judgement continuing ventilator support was not in the child's best interest. The parents fought the clinical judgement, both in the courts, and on social media. They travelled to Rome to meet the leader of, presumably, their church, the Pope. The Pope duly tweeted his support for the family, in line with his organization's categorical stance on the maintenance of human life, regardless of its quality. Among others, senior Brazilian staff members of the same organization issued a video message demanding that the UK government pay for the continuing futile care of Alfie Evans.2 Obviously Brazil's religious warriors had little else to do in their own backyard. Assuntina Morresi, a biochemistry professor and a member of the Italian government's National Bioethics Committee, posted a photo of the entrance to a German Nazi concentration camp with the accompanying headline: ‘Gran Bretagna oggi’ (Great Britain today).3 Professor Morresi is not alone: in a commentary, Charles Camosy, a theologian at a Catholic college in New York City, also tried to put the case in historical perspective by raising the spectre of the Catholic Church objecting to the Nazi euthanasia program for the disabled.4 Unsurprisingly these kinds of ahistorical missives are published in media aimed squarely at ideological fellow travellers, they are ideological echo chamber activities designed to mobilize one's troops. There is invariably much talk about disrespect of the disabled, as if there is no difference between a disabled child living a life worth living and a child whose brain has been irreversibly catastrophically damaged. Add to that a liberal amount of second guessing and questioning of the clinical judgement made by clinicians involved first‐hand in the care of the toddler by academics, activists and religious lobbyists with no clinical qualifications and no first‐hand knowledge of the facts of the matter.

Enter stage right: Ted Cruz. Not unexpectedly the United States’ best‐known culture warrior, Texas Senator Ted Cruz stepped into the fray with his own press release, likely less directed at Britain and more directed at his donors. He wrote (inter alia), that what was happening in the UK was a ‘grim reminder that systems of socialized medicine like the NHS vest the state with power over human lives, transforming citizens into subjects.’ This is utter nonsense, and, even if it were true, it's unclear how Cruz's preferred private healthcare system would change that situation, given that in a private healthcare system a for‐profit entity would decide how much money would be made available for the care of particular patients. Futile care typically is justifiably not funded ad infinitum by for‐profit health insurance companies either. Still, this minor detail got lost in the agitation and propaganda efforts by conservative U.S. politicians weighing in on this case.5

Remarkably, the government of Italy issued a citizenship certificate for the toddler to enable him to be treated in a Catholic hospital. Sensing how inappropriate this action was, the Italian Embassy in the UK stressed that the citizenship was merely meant as a signal to the court that the country would be willing to take him in should the UK court let him be transferred. That, of course, was denied by the court, precisely because nothing would have been gained for the boy by this activity.

A predictable consequence of the flurry of activism across the globe was that a sufficiently large number of activists was motivated to try to storm the hospital where the boy was cared for. Yes, they tried to storm the hospital! They even, for a brief period, managed to block an ambulance from entering the hospital. Without any sense of proportion, they call(ed) themselves Alfie's Army. No, I'm not kidding, army! Not terribly surprising: if you genuinely think that you are fighting a crime akin to the holocaust you will think about it in fairly militant terms. Agitation and propaganda have consequences.

I appreciate that well‐meaning people can hold different views on cases like this. One could, for instance, argue that if parents – or their supporters – are willing to pay for futile care provided to patients like Alfie Evans, the state should leave it to parents to decide what is in their children's best interest. It is not a view I would support, because I would be concerned that parents in such situations are vulnerable to making choices that satisfy their own psychological needs, potentially at great cost to the children whose best interest takes a backseat. If futile care is joined by additional suffering visited upon the patient (it is unlikely this was the case with this patient), such decisions should not be left to parents alone to decide. It is arguably unfair to leave grieving and distressed parents with the burden that such decisions entail. However, this certainly is a legitimate question to ask and it is one where well‐meaning, well‐informed people can agree to disagree.

What is unacceptable for anyone who wishes to engage in these debates, is to abuse such catastrophically ill children for their own ideological conquests and culture wars. Nothing of what happened in Britain (and other countries like it) has anything at all to do with what happened in Nazi Germany. Such ahistorical comparisons are deeply offensive to the victims of the holocaust.

UK bioethicist Iain Brassington, to my mind, hit the nail on its head when he wrote in a commentary, ‘what we see here is a child being bounced around to satisfy the desires of a number of adults.’6 Politicians, leaders of global religious organizations, and academics ideologically aligned with the latter have reason to reflect on the morality of their own actions, that is the abuse of tragedies like Alfie Evans to promote their own ideological agendas.

Footnotes

Thursday, April 12, 2018

Back to blogging - stuff is happening :)

I have been pretty quiet on the blogging frontiers during the last few months. I have been juggling various manuscripts, including a book manuscript, as well as teaching, so basically I was too tired to blog much (well, too tired to blog at all).

Anyhow, so here's an update:

Issue CoverRuth Chadwick and I managed to send a first rough draft of our textbook to Wiley to have it externally reviewed. It will need quite a bit more work, but we hope to get this done during the summer months.

I have a lengthy review article on the ethics of Conscientious Objection accommodation in the British Medical Journal. You can find it here. 

The title is: Conscientious objection in medicine: accommodation versus professionalism and the public good.


IssuesI also, jointly with Justine Dembo and Jonathan Reggler have an Open Access paper in the Canadian Journal of Psychiatry on medical aid in dying and depression. You can find it here.

The title is: 'For their own good': A Response to Popular Arguments Against Permitting Medical Aid in Dying (MAID) where Mental Illness Is the Sole Underlying Condition.


There is also a completed book chapter to report in a Palgrave MacMillan handbook on, I think, political philosophy. I did that jointly with an undergraduate student at Queen's, Benjamin Zolf.

And there are various Editorial type papers, including (in German) this one on the use of ethical deliberation in the decision-making on public health policy.

How can we ensure that the global south benefits from and contributes to the field of bioethics?

Here's a re-post of my Editorial in the current issue of Developing World Bioethics. I will update toward the end of the Editorial relevant information about the upcoming IAB World Congress in India, as some things (like the location) have changed since the Editorial was published.

There has been a legitimate debate going on for many years about the question of how we can ensure that colleagues in the global south can both benefit from journals such as this, as well as contribute constructively to it.

Cover imageThe issue of access to subscription‐based journals has been litigated ad nauseam and I do think global publishers have done by and large a decent job in terms of implementing with WHO and other agencies myriad access themes available to those countries too resource‐constrained to afford regular subscriptions.1

Some authors disagree, insisting that only Open Access journals, a supposedly superior business model, can address the access problem adequately. And they are right, Open Access journals, by definition, pose no access problems of the kind subscription‐based journals pose. Sadly, having your cake and eating it too rarely works in the real world, and so these authors, having resolved the access to academic research problem, are faced with a different problem they did not have before. Open Access journals can only survive as viable enterprises if a sufficiently high number of authors pay what are often expensive article processing charges, or APCs. These journals often offer their equivalent to the access schemes subscription‐based journals have put in place, namely differential fees or fee waivers for those who absolutely cannot afford to pay.

Short of asking academics to exploit themselves by volunteering to produce and disseminate academic journals and their content, reliably, over decades, someone will have to pay for the resource intensive production of journals and to ensure the reliable availability of their content.

I have yet to see from those complaining about access problems realistic solutions to this challenge. They mostly, and typically correctly identify the problem, but beyond grandstanding they offer no answers. They expect someone else to sort things out for them.

As I said, authors in the global south can access our content either by means of the access schemes mentioned earlier, or by simply emailing the authors of content they are interested in and by asking those authors for a complimentary electronic copy of their article. Nobody would decline such a request.

I do think that a much greater challenge is to enable scholars from the global south to participate in international conferences and workshops both to share their own knowledge, but also to learn from colleagues and to network with a view to establishing research partnerships and the like.

I suspect you will know Facebook. I posted a photo from a workshop I had organised in the summer of 2017 in the UK, on the most recent version of the Council for International Organizations of Medical Sciences (CIOMS) research ethics guidelines. Not unexpectedly a colleague, located in an upmarket London‐based university, harangued me for the lack of diversity, perhaps most significantly, the evident lack of attendees from the global south. That colleague was right: only two of the 25 or so workshop delegates came from the Caribbean, while everyone else came from countries of the global north. Of course, I had virtually no funding to organise said workshop, and everyone who travelled there paid their own way. Nobody's flight was covered by me. I did have inquiries from various colleagues in the global south who would have loved to attend, but quickly gave up on the idea due to lack of funds for their travel expenses. The colleague who criticized me quite publicly, naturally, had no funds to offer either. It is always easier to criticize than to contribute meaningfully to change. The same, as I tried to show, holds true for academics who refuse to acknowledge the cost involved in producing academic journals.

Some constructive attempts have been made to have a more globally representative group of conference goers presenting at and attending international bioethics events. A successful example of this is the Global Forum on Bioethics and Research. The GFBR has been around for a longish time. It's funded mostly by the UK's Wellcome Trust, the Gates Foundation, the US NIH Fogarty International Center and the UK's Medical Research Council. I had a quick look at the GFBR's website, with a view to finding out who governs it, and who decides on the composition of speakers and attendees of its meetings, given that its funders reside essentially in the USA and the UK. It seems to me as if the majority of those people are either staff members of these funding organisations, or are past/current grant recipients.2 There appear to be very few truly independent scholars from the global south among those in charge of organising these global events.
I don't think that this is the result of any kind of malicious intent. It's likely a function of ‘who do we know who could serve on that steering committee who is from Africa, Asia etc’, and who does one know? Well, the answer is likely to be: ‘someone we have funded before’.
However, that alone does not address the question of whether or not the meetings are failures when it comes to the question of participants from the global south. Here are the criteria the GBFR uses to determine who among the applicants will be invited3 :

  • Country of origin: GFBR would like to ensure a representative distribution of delegates from different regions;
  • Background /current area of expertise: GFBR is aimed at anyone involved or interested in health research ethics, including researchers, policy‐makers and community representatives. GFBR seeks representation from many different disciplines;
  • Membership of an IRB/REC: Membership of an Institutional Review Board / Research Ethics Committee is not a prerequisite for attending GFBR, but may be taken into consideration;
  • Experience of ethics: GFBR encourage s a mixture of ‘old’ and ‘new’ faces at each forum so that participants can productively discuss issues of concern to them and gain from the perspectives of others. Applicants need not be experts in ethics;
  • Reasons for attending the meeting: GFBR seeks participants who will be able to actively contribute to the meeting and who expect to impact on research ethics and/or pursue a career in research ethics in their own country.
While there is the inevitable number of people who presumably just have to be at every such meeting (let's call them ‘old’ faces), the GFBR has succeeded in terms of attracting a fairly wide range of delegates from the global south to its meetings over the last few years. It's a small (and expensive) meeting, designed to host about 80 delegates, but it's probably a meeting as good as they come on the global bioethics scene. I truly wish there were more such events on the global bioethics events’ calendar. I do encourage you to give thought to how this sort of event can be replicated, for other areas of bioethics, ie. not the typically well‐funded area of research ethics but, say, for reproductive health, global health, and so on and so forth.

Let me end this editorial by encouraging you to attend the next World Congress of the International Association of Bioethics. It will be held in Bangalore from 4–7 December 2018 under the theme Health for all in an unequal world: obligations of global bioethics and is locally hosted by SAMA, the resource group for women's health, the Forum for Medical Ethics Society, and, of course, the IAB.4 With a bit of luck (and planning) there might be a plenary dedicated to figuring out how to enable more delegates from the global south to attend such events. Why don't you propose to organise such a plenary to the India‐based hosts of the event? They might consider it quite seriously.

Notes

Bioethics - Expanding Scope

Exciting changes are coming to Bioethics. Our publisher has, essentially, removed the page limitations on our budget. That provides us, of course, with growth opportunities. We have decided, informally, to begin reviewing papers that are primarily empirical in nature and/or that are primarily legal analyses. In the past we rejected such manuscripts, typically, as desk-rejects (ie the decision was made by us Editors without further review). We will now be able to accommodate such manuscripts, provided they have significant implications for bioethics. To facilitate the competent review of such submissions we have secured in-principle agreement from two colleagues in our field, who are in the process of being appointed as Associate Editors to the journal's Editorial Board. Once that paperwork between them and the publisher is sorted out, we will formally announce who is joining the team at the journal. At that point in time our informal current arrangement will become our formal new policy. 



Monday, January 29, 2018

VW, Mercedes, BMW and those experiments

So, the three largest German car manufacturers are for obvious and for good reasons targets of everyone's scorn these days. VW in particular is known to have manipulated its diesel engine equipped cars so that when they were tested the engines were relatively clean as far as their nitrogen   oxide pollution is concerned. Once on the road these cars actually generated more pollution than many trucks. In 2012 reportedly over 72 000 Europeans died prematurely because of nitrogen oxide pollution caused by these cars. No argument there.

VW, BMW and Mercedes (Daimler) set up a research outfit designed to investigate the impact of this pollution on humans and the environment. As is the case with these sorts of agitprop outlets, they have an impressive name. The European Research Group on Environment and Health in the Transport Sector it was. The cigarette manufacturing industry had a similar research institute, its aim was, of course, to show that cigarettes have not been shown to cause cancer, and to produce citable evidence (ideally published in scientific leading journals) for the industry's lobbyists.

As is usually the case, there was a whole gaggle of university professors more than willing to lend their names to that enterprise, and so were prestigious research institutes, attached to universities. They accepted contracts from the German car industry research outfit. Among their research were two kinds of trials that are widely condemned today, albeit for reasons that are not quite obvious, at least not when it comes to the trial involving human participants.

The first kind of trial include 10 monkeys. They were put in an airtight room  where they watched cartoons. Meanwhile exhausts from a manipulated VW Beetle with a diesel engine were pumped into the room.  That was then compared against the missions of a 1999 Ford engine.  The finding propagated at the time by the industry research outfit: Diesel engine exhausts, even in high concentrations, do not cause lasting damage to monkeys.

The main criticism mounted against this research (apart from the obvious question whether it is ethical to subject monkeys to that kind of research in the first place - a very reasonable criticism that I think is persuasive) seems to be that we knew already that these exhausts are dangerous, so the companies should have better focused on reducing emissions rather than on trying to show that they're not a health risk.

In any case, the research was based on a fraudulent set-up, the monkeys were subjected to nitrogen oxide concentrations far below what VW diesel engines emitted at the time in the real world. It is unlikely that the researchers who were contracted to undertake this research were aware of the manipulation. The research was undertaken at the Lovelace Respiratory Research Institute in the United States.

The main criticism here should be that highly evolved non-human animals were utilised for research purposes that were not even research purposes. The health impact of a 1999 Ford exhaust was compared against that of a non-existent (aka manipulated) 2012 VW diesel engine. These monkeys were subjected to the risk of bodily harm for no scientific reason at all.

Well, it does not end there. The European Research Group on Environment and Health in the Transport Sector commissioned another experiment, this time involving 25 or so health volunteers at a German university hospital. The study received ethics approval, no VW diesel engine was thankfully involved on this occasion, manipulated or otherwise. The researchers aimed to determine what the health implications of different levels of nitrogen oxide concentrations in the workplace environment/air would be on those trial participants. The trial participants were subjected to those nitrogen oxide concentrations for 3 hours. The study concluded that there were no significant health implications. However, the authors of this study were also quite explicit  about the limitations of their findings. Their summary contains a longish list of caveats, including the warning that a 3 hour test tells us nothing about the effects of chronic exposure (ie the real world).

This study received the required ethics approval, the trial participants were healthy volunteers who gave first person informed consent to trial participation. It is unclear to me here why German politicians and board members of VW, BMW and Mercedes are falling over one another to condemn this research. It seems to me that no fraud was committed, and the question seems scientifically sound.




Sunday, January 21, 2018

The trouble with Public Health: HIV/AIDS in Canada as a case in point

It has been known among HIV/AIDS specialists for many years that infected people are for all practical intent and purposes unable to transmit the virus on to their sex partners, provided they consistently take anti-HIV medicines that render the amount of the virus in their bloodstream undetectable. Common sense would have suggested that Public Health authorities should have acted on this knowledge and ensured that it is deployed in such a way that it contributes toward the maximisation of desirable public health objectives, in this case, obviously the reduction in number of new infections. Public Health agencies should have revamped existing policies demanding that infected people disclose their HIV status to their sex partners to no disclosure required where ‘your viral load is undetectable for 12 months’ or some such figure. This would have dramatically increased the attractiveness of getting tested, of getting infected people discovered in a more timely fashion, getting them treated in a more timely fashion, and ultimately getting their viral load to undetectable in a more timely fashion. The predictable result of this policy change: A significant reduction in new HIV infections. Common sense and Public Health are sadly all too often residing in different realities.
Nothing of this sort occurred during the last few years. HIV infected people with undetectable viral loads were prosecuted for not disclosing their status. Public Health agencies, when given a chance, would disclose their HIV status to their sex partners. The contact tracing Public Health surveillance machine remained in overdrive in countries such as Canada. About 200 carriers of the virus were prosecuted over the years in that country alone. None of this served the public health objective just outlined, and none of this was evidence driven. Rather, it was driven by views on HIV/AIDS that may have had a place in the 1980s to early 1990s when AIDS was considered as a serious public health concern. Today, with negligibly low new infections rates, it is worth asking why HIV remains high on the agenda of Public Health agencies. HIV is clearly not a public health concern in Canada and most other countries of the global north. My suspicion is that the threat of prosecution serves purposes unrelated to HIV, they serve to control consenting adults’ sexual behaviours.
Much is made of the fact that an estimated 1:5 Canadians who are infected with the virus are unaware of their infection. What is typically not mentioned by the same Public Health officials is that they have gone out of their way to make it difficult for Canadians who are HIV infected to find out about their infection. Because the contact tracing government Public Health agencies want to know about each infected Canadian, by name and address, they cannot permit people at risk to test themselves with tests they can conveniently buy down south in the United States in every pharmacy. Unsurprisingly, a different government agency, the drug approval regulator Health Canada, has swung into action and threatened people with prosecution who import and resell reliable, US FDA approved, HIV self-tests into Canada, lest they would find out whether they are infected and Public Health not having their names and addresses on their records. You might not be surprised to learn that while STI testing and treatment is ostensibly free and anonymous at the country's Public Health agencies, in reality patients must show their provincial health insurance cards or else they are out of luck if they carry an STI but fail to provide the said card. The UK's NHS unsurprisingly manages public health in a manner somewhat more focused on infection control than administration.
It is no surprise then that in a country where government surveillance has been prioritised over and at the same time conflated with public health, people at risk of HIV infections remain reluctant to get tested. They have no reason to trust Public Health to act in a timely fashion in response to evidence.
In late 2017, Canada's federal government noticed after much studying what has been known for years about HIV transmission risk and undetectable viral loads. Both federal and provincial justice ministers appear to be finally acting in response to the existing evidence. Prosecutions of HIV infected people with undetectable viral loads who do not disclose their status to their sex partners are likely to be a thing of the past in that country.1
The main lesson I am suggesting we take away from this episode of HIV/AIDS prevention in Canada is to ask that Public Health agencies' policies should be held to public health outcomes, otherwise they serve no purpose. The cavalier approach to civil liberties taken not only by Canada's Public Health agencies, one that was not evidence based for many years, must be replaced by a policy approach based transparently on the latest scientific evidence. A golden rule in most public health ethics documents is that limitations on civil rights (in this case ownership of one's confidential health information) must be justified by significant benefits in public health outcomes, i.e., the public interest. HIV disclosure policies executed by Public Health agencies have failed this test for a very long time. Public Health agencies in Canada in particular have lost trust and support among people at risk of HIV infection because they lost sight of public health outcomes while focusing on Public Health administration and control. A paradigmatic case of how not to implement efficient infection control policies.

Footnote

  1. 1
    Harris, K. (2017, December 1). Liberals want to limit prosecutions of people who do not reveal status to sex partners. CBC NEWS. Retrieved from http://www.cbc.ca/news/politics/liberals-hiv-criminalization-1.4428395

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