Reasonable Expectations for Institutional Ethics Protections
One of the hallmarks of this thing we call “civilization” is the fact that the enforcement of norms isn’t just left entirely up to the judgment and resources of individuals: we implement our norms by building various kinds of institutions. But sometimes the existence of the most visible of those institutions makes it too easy forget just how much work is actually done by less-formal, less-visible institutions. A case in point is the way people look to formal institutions — things like journals and ethics boards — as panaceas in the realm of research ethics.
Last Sunday, Nancy blogged about the Kuklo case, which involved research falsification by a former US Army surgeon. The NY Times has this update: Discredited Research Study Stuns an Ex-Army Doctor’s Colleagues
What most interested me from this update was this line:
The Walter Reed episode also shows how medical journals may fail to conduct adequate due diligence on the studies they publish — information that other doctors rely on for guidance.
I’m not sure that’s right: it’s not at all clear to me that the journal involved in this case “failed”. This brings to mind a very good point that Nancy made with regard to the Coast IRB sting. Nancy pointed out that ethics boards necessarily have to trust researchers submitting protocols in a number of ways. Ethics boards are charged with exercising oversight, but they simply cannot verify every single detail. It’s literally impossible. The same goes for journals like the British Journal of Bone and Joint Surgery, which published Kuklos’s falsified research. By and large, the academic publication system runs on trust, as it must. And that trust is generally warranted: people are by-and-large honest. The exceptions, of course, can be very worrisome indeed. But in terms of the role of institutions such as journals and ethics boards, two specific points need to be made:
1) The first is that there is a sense in which the role of institutions is actually very small. So a bad end result doesn’t necessarily mean that result was attributable to a failure of formal institutions. In this case, there may have been a failure on the part of the Journal; but it may also have been a failure of training, mentoring, professional socialization, or even parenting. Maybe all of the above.
2) Second, fixing problems through trying to achieve perfection in the functioning of formal institutions is difficult, costly, and potentially invasive. By analogy: the only way to reduce crime to near zero is to put a cop on literally every street corner — an enormously costly and disruptive solution. So the key is not necessarily to leap from bad outcome to calling for overhaul of the institutions involved. The key is to look carefully at those institutions, ask what roles that are and are not likely to be good at playing, and do what we can to help them achieve an approximation of best practice.