EVENT: Symposium on Academic Publishing and the Futures of Research

Image taken from page 213 of 'Queen Mab. A novel'
The Centre for Values, Ethics and the Law in Medicine (VELiM) is hosting an event on the academic publishing industry and the commercialization of knowledge production.

In recent years there has been a lot of self-reflection about the effects of neoliberalism on the university and the practices of teaching and research. This symposium will focus on academic publishing and the impacts of paywalls on academic practices, but also democratic access to knowledge required for policy-making and informed public debate.

Speaking to The Guardian, Dr Claire Hooker outlined some of the concerns associated with current academic publishing practice, saying:

There are people out there who are worried about the effects of medicines, or who want to know more about the evidence informing the health policies that affect them, but they can’t find the answers because they hit a paywall.

Professor Paul Komesaroff (Monash), who will also be part of the symposium, argues that more open and democratic models of publishing are needed. According to Komesaroff, scholars are looking for these models. However, it appears that the current institutional arrangements and intensives make it difficult to imagine alternatives.

The symposium looks to explores some of these alternatives. For more information see the below.

Reclaiming the Knowledge Commons
The Ethics of Academic Publishing and the Futures of Research

Type: Seminar
Date: Wednesday 26 August 2015
Time: 9.00 AM to 4.00 PM
Venue: State Library, Mitchell Wing
Cost: Free
Click here to book

Speakers include: Emeritus Professor Stephen Leeder, Professor Paul Komesaroff, Associate Professor Andrew Bonnell, Dr John Byron, JoAnne Sparks, Dr Virginia Barbour, Rosalia Garcia (SAGE), and Professor Christopher Wright.
Chair: Dr Claire Hooker

The symposium will comprise four sessions:

  • 9:00-10:30 Session 1: Corporatization and the commercialization of knowledge
  • 11:00-12:00 Session 2: Democratizing knowledge or selling the farm? The emergence and challenges of ‘Open Access’
  • 12:00-1:00 Session 3:  Dissolving barriers – and boundaries: Scholars and the possibilities of the new digital knowledge commons
  • 2:00-4:00 Session 4: Taking up the challenge of ethical academic publication

Catering is provided

For more information please contact;
Centre for Values, Ethics and the Law in Medicine
T +61 410 161841 | E velim.event@sydney.edu.au

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On Not “Getting Out of the Way”: A Reflection on Steven Pinker’s Critique of Bioethics

Title:

Last week well known psychologist, linguist and author Steven Pinker published an op-ed in the Boston Globe, under the title “The Moral Imperative for Bioethics”.*

The article begins with an explicit mention of the CRISP-Cas9 technique for “editing” genomes, and a brief tour through the many diseases which modern medicine and biotechnology is seeking to treat. He goes on to say that research in these areas is essential, a point he frames in terms of reducing the global burden of disease. He then says:

Biomedical research, then, promises vast increases in life, health, and flourishing. Just imagine how much happier you would be if a prematurely deceased loved one were alive, or a debilitated one were vigorous — and multiply that good by several billion, in perpetuity. Given this potential bonanza, the primary moral goal for today’s bioethics can be summarized in a single sentence.

Get out of the way.

Now this is pretty striking, and unsurprisingly many commentators, including myself, were furious. However, I thought I would let the dust settle and see what emerged from the discussion on social media, an email discussion list I am a member of and elsewhere. The stories in Nature and PopSci were reasonable, and Alice Domurat Dreger, Julian Savulescu, Stuart Rennie, Christopher Mayes, Matthew Beard and Russell Blackford make good points.

One point of common ground here, and indeed with Pinker, is that there really is a problem with much bioethics regulation – the processes of research governance and ethics committee oversight. It can be slow, cumbersome, unpredictable, perverse, contradictory and so on. But even so, no one is suggesting we dispense with it altogether – only that it be improved. Pinker himself says:

Of course, individuals must be protected from identifiable harm, but we already have ample safeguards for the safety and informed consent of patients and research subjects.

He also points out, later on in his article, that biomedical technologies which sometimes seemed very promising often fail:

Biomedical research in particular is defiantly unpredictable. The silver-bullet cancer cures of yesterday’s newsmagazine covers, like interferon and angiogenesis inhibitors, disappointed the breathless expectations, as have elixirs such as antioxidants, Vioxx, and hormone replacement therapy.

It is interesting that several of the technologies he mentions didn’t just fail, their failure was often covered up by manufacturers and the regulatory system designed to catch these failures arguably didn’t intervene quickly enough. He doesn’t mention this however; his argument the quasi-libertarian one that scientists should be allowed freedom to explore and innovate without excess regulation. He is less good at noticing the ways in which such innovation takes place in economic conditions which make regulation essential to cope with market failures.

He has two basic arguments for the need for bioethics to get out of the way:

First, slowing down research has a massive human cost. Even a one-year delay in implementing an effective treatment could spell death, suffering, or disability for millions of people.

And:

Second, technological prediction beyond a horizon of a few years is so futile that any policy based on it is almost certain to do more harm than good.

To the first, while on its face it looks plausible, if his second argument is valid, then the problem is we just don’t know whether the research we are doing now actually will save all those lives. Indeed, by investing in this research and not that we may be wasting all those lives he points to. We just don’t know. As to the second, it is almost trivially true, but nonetheless these predictions are what policy-makers and research funders and investors (not forgetting the rest of us) have to make. But he says:

In the other direction, treatments that were decried in their time as paving the road to hell, including vaccination, transfusions, anesthesia, artificial insemination, organ transplants, and in-vitro fertilization, have become unexceptional boons to human well-being.

In other words, some of our bets paid off, some didn’t, and sometimes some of us bet the wrong way on the basis of moral objections which in hindsight look ridiculous. It’s not clear to me why bets the wrong way on other grounds than moral ones get a free pass, but only moral qualms get mocked in this way. I am sure we can make a list of bets the wrong way where moral qualms ought to have played a part and didn’t so we ended up with disastrous consequences for millions. Again, he doesn’t talk about that. The trouble with consequentialist (or decision theoretic?) reasoning of Pinker’s type is that you have to count all the consequences of all the options, not just the ones which favour your own biases. Indeed, if you are going to be a consequentialist you have to be rather good at predicting outcomes (not as bad as he says we are, in other words). But in any case, he reserves special opprobrium for moral reasoning, thus:

Biomedical advances will always be incremental and hard-won, and foreseeable harms can be dealt with as they arise. The human body is staggeringly complex, vulnerable to entropy, shaped by evolution for youthful vigor at the expense of longevity, and governed by intricate feedback loops which ensure that any intervention will be compensated for by other parts of the system. Biomedical research will always be closer to Sisyphus than a runaway train — and the last thing we need is a lobby of so-called ethicists helping to push the rock down the hill.

My initial reaction to the Pinker article was heated. I have spent my entire working life as a bioethicist (roughly speaking, from my first postdoc, as I was not in bioethics as a graduate student or before) with people claiming that what I do is variously a waste of time, a waste of money, ideologically suspect (from any and all directions), intellectually sloppy and so on. Sometimes these criticisms have been levelled at me personally (fine, I can bite back if I need to, and I’m not perfect and sometimes the criticisms have been fair), sometimes at my work (that’s the academic life, I can take it) and sometimes they have been levelled at me and my peers _merely_ because of presumed attitudes, beliefs and values I must have simply because I am a “bioethicist” and “this is what bioethicists think”. Sociologists often do this (not all sociologists…) and historians of medicine often do this (not all historians…). It’s tiresome. If someone wants to know what _I_ think there are various ways of finding out, but a priori judgements of what I “must” think because I am a bioethicist really… get my goat.

My initial reaction to Pinker’s article was that it was an egregious piece of grandstanding which if it had come from the wilder shores of twitter we’d call trolling. However, that would be to attribute motives and intentions to Pinker I cannot verify. What I can say is that it is in a reasonably well established genre of writing which appears quite frequently in the professional medical press (for example, an unsigned editorial about 15 years ago in the Lancet titled “the ethics industry”), and it is perfectly reasonable and sensible to look at the writing as a genre piece, focus on its rhetoric, implied audience and so on. We should also look directly at the arguments, and when I’d cooled off and read Julian and Alice’s pieces I can see that there are arguments in Pinker’s article which have merit and I agree with them. But still, the rhetoric matters. Just as if I am parking my car and someone comes up in my face and shouts “get out of the way” I am liable to take that as a verbal assault even if he then gives me some good and compelling reasons why I might like to move my car a little. This person knows the effect of getting in my face and shouting at me, and it has little to do with the merit of his argumentation. Authors of style guides are pretty good at knowing how rhetoric works too. So are linguists and psychologists.

Never mind. I will get over it. I don’t have to take it personally, after all I don’t recognise myself in his description of bioethicists, so presumably he’s not talking about me anyway. (He wouldn’t know me from Adam).

Turning once more to the arguments, the one argument which has not been touched on directly, and I think is important, is that he says bioethics should not thwart:

…research that has likely benefits now or in the near future by sowing panic about speculative harms in the distant future. These include perverse analogies with nuclear weapons and Nazi atrocities, science-fiction dystopias like “Brave New World’’ and “Gattaca,’’ and freak-show scenarios like armies of cloned Hitlers, people selling their eyeballs on eBay, or warehouses of zombies to supply people with spare organs. Of course, individuals must be protected from identifiable harm, but we already have ample safeguards for the safety and informed consent of patients and research subjects.

Several commentators have questioned whether we can be that sanguine about how well bioethics does the latter. But it’s the former that bothers me. He’s making an asymmetrical argument: we should discount hypotheticals about bad things; but instead be guided by hypotheticals about good things. To my way of thinking they are no less hypothetical. There’s a branch of the sociology of knowledge which explores this in some detail, the sociology of expectations, and one of the main findings in that field is the biomedicine relies on creating narratives about plausible social futures of technologies in order to attract investors and research funders, persuade regulators and so on. No one, nowadays at least, ever chucks money at researchers saying, go and do something interesting, tell us when you’re done.

So my more general point is that bioethics is _precisely_ a way of telling stories about new technologies and exploring them and seeing what we make of them. There are other ways to do this – for example, as Pinker’s own example shows, making films, writing novels and stories, and so on. Or indeed writing business plans, IPOs and suchlike. This is how humans think stuff through. It’s part and parcel of how we make technologies. It’s not an extraneous factor, that can be shoved out of the way. So, once again, rhetoric matters, and not as a bit of optional packaging, but as part of the real work itself.

Some day I am going to write a book about this. Maybe I should thank Pinker for getting my introduction going with a bang.

Richard Ashcroft

Professor of Bioethics
School of Law

Queen Mary University of London

@qmulbioethics

*Pinker has since made further comments found here.

Richard visited VELIM in February 2005 while he was on an Australian Bicentennial Fellow visiting the Centre for Applied Philosophy and Public Ethics, University of Melbourne. He and Dr Ainsley Newson were colleagues at Imperial College London.

Profiting from asylum-seeker detention: Time to divest

Christopher Mayes and Ian Kerridge

On the 25th May 2015 the Royal Australasian College of Physicians (RACP) called on the Australian Government to end mandatory detention and release asylum seekers from offshore processing centres. President of the RACP, Laureate Professor Nicholas Talley outlined the College’s Refugee and Asylum Seeker Health Position Statement, which calls for:

  • more rigorous health assessments for asylum seekers on arrival;
  • better access to healthcare for asylum seekers and refugees in the community;
  • increased support services for refugees; and
  • an immediate end to mandatory detention and the release of all asylum seekers into the Australian community.

Physicians and health care professionals have witnessed first-hand the trauma of asylum-seekers in detention and have repeatedly made public the insufficient medical care available in these facilities. Professor Talley states that “Our Fellows have been inside the detention facilities. We have treated refugees and asylum seekers during their detention and after their release into the community…These people are not numbers, they are our patients.”

A time to boycott?

In September 2014 the Medical Journal of Australia published an article questioning whether the asylum-seeker policy and conditions were so bad that health professionals should boycott working in them. This article was widely reported in the mainstream media and raised awareness of the ethical and medical compromises forced upon health professionals.

Accommodation in the Nauru offshore processing facility.

Accommodation in the Nauru offshore processing facility. Source: Wikimedia Commons, licensed under the Creative Commons Attribution 2.0 Generic

As others have argued, however, while a targeted boycott campaign should be considered, refusing to provide medical care to asylum seekers would only harm the already harmed. health professionals have an ethical obligation to their patients. As Professor Talley notes “we are duty bound to speak on behalf of our patients – especially since their human rights are increasingly seen as optional.” And it may be only when health professionals see for themselves the conditions in which asylum seekers are kept, and the standards of health care they receive, that they will be motivated to speak out against injustice and advocate for better and more humane care.

Time to divest

Compounding the ethical and medical harms resulting from mandatory detention is the fact that the Australian Government spends $3.3 billion a year to maintain this policy. This money is used to pay contractors and publicly listed companies to run and operate detention facilities.

Of these, the greatest beneficiary is Transfield Services. Transfield Services’s share price spiked after it was awarded a new contract to run the detention facilities on Manus Islands. Although the share price soon declined, mandatory detention makes companies like Transfield Services appear like a good investment option.

The superannuation fund, HESTA, invests in Transfield Services. At present HESTA is a significant shareholder in Transfield Services.[1] Considering that HESTA is the superannuation for the health and community services industry it is troubling that they are using the retirement savings of physicians, nurses, allied health practitioners and social workers to invest in a company that profits from the mandatory detention of asylum seekers.

Fifteen of Australia’s peak health organisations have publicly condemned the Australian Government’s asylum-seeker policy. Yet, many of the members of these organizations may unwittingly be financially entangled with the very system they condemn. Rather than calling for health professionals to boycott working in detention centres, there is a campaign for health professionals with their super with HESTA to call on HESTA to divest from Transfield Services.

A multi-pronged strategy is needed to resist and disrupt the detention industry. Political and ethical arguments are essential to convince politicians and the public that mandatory detention should be abandoned. However, it is also important to recognize that detention is a business – that profits and financial gains are being made through the asylum seeker polices and that we may be unknowingly supporting and profiting from these businesses and policies ourselves.

It is time to divest.

[1] As of 27 February 2015, HESTA holds just under 5% of shares in Transfield Services with over 23.5 million shares. http://asxcomnewspdfs.fairfaxmedia.com.au/2015/03/02/01604569-575220267.pdf

Academics on the payroll: the advertising you don’t see

By Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney

In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.


Academic medical researchers are hot property for companies marketing pharmaceuticals, complementary medicines, medical devices, fitness equipment, weight loss products, “health foods” and other health-related goods and services. Their opinions are highly respected by the general public, and their endorsement in the media of a product can help to ensure consumers and patients purchase it, or at least discuss it with their “health care provider”.

But this raises a question: why would an academic researcher choose to endorse a health-related product in the general media?

The most worrying explanation is that the academic is being employed by the company to speak favourably about its product. Such commercial relationships are rarely made transparent and rely on a public perception that academics are objective observers and commentators. For the most part, however, this is unlikely to be the case.

A far more likely explanation is that any academic endorsement occurs in the context of a long and mutually productive relationship with the company concerned. Academics are frequently targeted by companies on the grounds that they provide authority and act as “key opinion leaders” who are able to influence the opinions, beliefs and behaviours of others in both professional and public arenas.

This relationship with industry is frequently one of many. Academics who comment on products have frequently partnered with the company in its clinical trials of the product; put his or her name to the resulting academic publications; provided strategic advice on how to have the product regulated and perhaps subsidised by the government; or given talks to other academics and clinicians about the research (if not the product itself). Continue reading