Lessons in conflict of interest: the construction of the martyrdom of David Healy and the dilemma of bioethics

Bioethics journals have lagged behind medical and science journals in exploring the threat of conflict of interest (COI) to the integrity of publications. Some recent discussions of COI that have occurred in the bioethics literature are reviewed. Discussions of what has been termed the "Healy affair" unintentionally demonstrate that the direct and indirect influence of undisclosed COI may come from those who call for protection from the undue influence of industry. Paradoxically, the nature and tone of current discussions may serve to dull sensitivities to what is indeed a serious set of issues facing bioethics. Some proposals are presented to address COI and other challenges to the integrity of bioethics and its journals. COI is too important a topic to be left to ideologues, and there is no substitute for readers' caution and skepticism as tools in dealing with the full range of biases that exist in published papers.     

Is There Social Consensus Regarding Researcher Conflicts of Interest?

Consensus around what constitutes researcher conflicts of interest (COIs) and awareness of their influence on our research are two critical steps in ensuring the integrity of our science. In this research, data were collected from individual scholars via 2 surveys 5 years apart and from journals and associations to examine the level of social consensus and moral awareness among scholars, journals, and associations regarding researcher COIs. Although we observed increases in level of social consensus and moral awareness between 2012 and 2017, results still revealed limited agreement about what relationships constitute a COI and limited awareness about the presence of and the ethical issues surrounding COIs. Although all journals and associations we examined supported COI disclosure, most did not provide researchers with detailed COI-related information, guidance, or disclosure tools. Limited social consensus and moral awareness regarding COIs is problematic because it inhibits the recognition, disclosure, and management of COIs and limits ethical decision making. We need to continue and enhance discussions about COIs and aim to create consensus and awareness where we do not have it with the goal of reducing potential scientific misconduct related to COIs.     

A Draft Model Aggregated Code of Ethics for Bioethicists

Bioethicists function in an environment in which their peers—healthcare executives, lawyers, nurses, physicians—assert the integrity of their fields through codes of professional ethics. Is it time for bioethics to assert its integrity by developing a code of ethics? Answering in the affirmative, this paper lays out a case by reviewing the historical nature and function of professional codes of ethics. Arguing that professional codes are aggregative enterprises growing in response to a field's historical experiences, it asserts that bioethics now needs to assert its integrity and independence and has already developed a body of formal statements that could be aggregated to create a comprehensive code of ethics for bioethics. A Draft Model Aggregated Code of Ethics for Bioethicists is offered in the hope that analysis and criticism of this draft code will promote further discussion of the nature and content of a code of ethics for bioethicists.     

Bioethics' Gender

I argue that the field of bioethics is gendered feminine, but that the methods it uses to resist this gender identity pose real harm to actual women. Starting with an explanation of what I take ‘gender’ to be, I enumerate four drawbacks to being gendered feminine. I then argue that bioethics suffers from three of the same four drawbacks. I show how the field escapes the fourth disadvantage by adopting a masculine persona that inflicts damage on women, and conclude by urging bioethicists to reflect on their complicity in abusive power systems such as gender, race and class.     

Clinical Discussions

Abstract

According to its stated aims the International Forum of Psychoanalysis will especially promote presentations of clinical material and discussions of psychoanalytic methods and transactions. In order to live up to our objective we wish to introduce a special section devoted to this field, starting with this issue. It is our hope that the section will become a forum for a more lively exchange of experiences, observations and ideas than what is usually found in psychoanalytic journals. We therefore renew our call for papers suitable for the kind of discussion presented below. The question of confidentiality has, of course, to be carefully solved.     

Mad Scientist: The Unique Case of a Published Delusion

In 1951, entomologist Jay Traver published in the Proceedings of the Entomological Society of Washington her personal experiences with a mite infestation of her scalp that resisted all treatment and was undetectable to anyone other than herself. Traver is recognized as having suffered from Delusory Parasitosis: her paper shows her to be a textbook case of the condition. The Traver paper is unique in the scientific literature in that its conclusions may be based on data that was unconsciously fabricated by the author’s mind. The paper may merit retraction on the grounds of error or even scientific misconduct “by reason of insanity,” but such a retraction raises the issue of discrimination against the mentally ill. This article asks what responsibilities journals have when faced with delusions disguised as science, what right editors have to question the sanity of an author, and what should be done about the Traver paper itself. By placing higher emphasis on article content than author identity, scientific integrity is maintained and a balance is struck between avoiding discrimination against the mentally ill and not preventing patients from seeking needed treatment.     

Reproducible research in sport and exercise psychology: The role of sample sizes

ObjectivesWe aim to introduce the discussion on the crisis of confidence to sport and exercise psychology. We focus on an important aspect of this debate, the impact of sample sizes, by assessing sample sizes within sport and exercise psychology. Researchers have argued that publications in psychological research contain numerous false-positive findings and inflated effect sizes due to small sample sizes.MethodWe analyse the four leading journals in sport and exercise psychology regarding sample sizes of all quantitative studies published in these journals between 2009 and 2013. Subsequently, we conduct power analyses.ResultsA substantial proportion of published studies does not have sufficient power to detect effect sizes typical for psychological research. Sample sizes and power vary between research designs. Although many correlational studies have adequate sample sizes, experimental studies are often underpowered to detect small-to-medium effects.ConclusionsAs sample sizes are small, research in sport and exercise psychology may suffer from false-positive results and inflated effect sizes, while at the same time failing to detect meaningful small effects. Larger sample sizes are warranted, particularly in experimental studies.     

Who is buying bioethics research?

Growing ties to private industry have prompted many to question the impartiality of academic bioethicists who receive financial support from for-profit corporations in exchange for ethics-related services and research. To the extent that corporate sponsors may view bioethics as little more than a way to strengthen public relations or avoid potential controversy, close ties to industry may pose serious threats to professional independence. New sources of support from private industry may also divert bioethicists from pursuing topics of greater social importance, such as the needs of medically underserved communities. To inform ongoing debates about the financing of bioethics and its transparency to those concerned about potential sources of bias, we examined funding disclosures appearing in original research reports in major bioethics journals. Reviewing research published over a 15-year period, we found little evidence that for-profit corporations are influencing bioethics research directly. Instead, we found evidence that a great number of organizations, both public and private, support bioethics research. These findings suggest that worries about the cooption of bioethics research by a few interested stakeholders are greatly overstated and undersupported by available data.     

Conflict of interest policies in science and medical journals: Editorial practices and author disclosures

This study examines the extent to which scientific and biomedical journals have adopted conflict of interest (COI) policies for authors, and whether the adoption and content of such policies leads to the publishing of authors’ financial interest disclosure statements by such journals. In particular, it reports the results of a survey of journal editors about their practices regarding COI disclosures. About 16 percent of 1396 highly ranked scientific and biomedical journals had COI policies in effect during 1997. Less than 1 percent of the articles published during that year in the journals with COI policies contained any disclosures of author personal financial interests while nearly 66 percent of the journals had zero disclosures of author personal financial interests. Nearly three fourths of journal editors surveyed usually publish author disclosure statements suggesting that low rates of personal financial disclosures are either a result of low rates of author financial interest in the subject matter of their publications or poor compliance by authors to the journals’ COI policies.     

The Insularity of Anglophone Philosophy: Quantitative Analyses

Abstract

We present evidence that mainstream Anglophone philosophy is insular in the sense that participants in this academic tradition tend mostly to cite or interact with other participants in this academic tradition, while having little academic interaction with philosophers writing in other languages. Among our evidence: In a sample of articles from elite Anglophone philosophy journals, 97% of citations are citations of work originally written in English; 96% of members of editorial boards of elite Anglophone philosophy journals are housed in majority-Anglophone countries; and only one of the 100 most-cited recent authors in the Stanford Encyclopedia of Philosophy spent most of his career in non-Anglophone countries writing primarily in a language other than English. In contrast, philosophy articles published in elite Chinese-language and Spanish-language journals cite from a range of linguistic traditions, as do non-English-language articles in a convenience sample of established European-language journals. We also find evidence that work in English has more influence on work in other languages than vice versa and that when non-Anglophone philosophers cite recent work outside of their own linguistic tradition it tends to be work in English.     

Flow,Diversity, Form,and Influence of Political Talk in Social‐Media‐Based Public Forums

By investigating social‐media‐based public forums and using network and content analyses, this study explores how political discussions flow, how diverse they are, and what forms of political discussions are influential. The results suggest that the flow of political discussions is not notably centralized and cliquish. Participants refer primarily to the remarks of like‐minded fellow citizens. Political discussions are more emotional than cognitive and express more anger than anxiety, but it appears that cognitive discussions are more influential than emotional ones. Among cognitive components, assertive and strong discussions have greater influence than analytical ones. These results have implications for the practice of citizenship and the theory of selective exposure as well as for future directions in political communication research.     

A Presuppositional Approach to Conceptual Schemes

Abstract

The current discussions of conceptual schemes and related topics are misguided; for they have been focused too much on the truth-conditional notions of meaning/concepts and translation/interpretation in Tarski’s style. It is exactly due to such a Quinean interpretation of the notion of conceptual schemes that the very notion of conceptual schemes falls prey to Davidson’s attack. I argue that what should concern us in the discussions of conceptual schemes and related issues, following the initiatives of I. Hacking, T. Kuhn, and N. Rescher, is not the truth-values of assertions, but rather the truth-value-status of the sentences used to make the assertions. This is because the genuine conceptual innovation between alternative theories/languages does not lie in differences in determining the truth-values of their sentences, but turns on whether these sentences have truth-values when considered within the context of a competing one. The core of conceptual relativism does not consist in the claim that different conceptual schemes may yield incommensurable truth claims, but rather that different conceptual schemes may yield incompatible truth-value-status and therefore lead to distinct perceptions of reality. Conceptual schemes are no longer seen as sentential languages consisting of a set of sentences accepted as true, but rather seen as metaphysical presuppositions of presuppositional languages.     

Bioethics and Pastoral Concern: Some Possible New Directions in Pastoral Theology

This special issue of the journal is comprised of papers given at a conference in May 2011 at the University of Texas Health Science Center at Houston on the theme of “Social Justice and the Health Professions.” This article offers the following rationale for this special issue in particular and for pastoral theologians to contribute to bioethics in general: (1) two contemporary theological thinkers in bioethics, Karen Lebacqz and Lisa Cahill, argue that theological discussions of justice broaden and deepen discussions of justice in mainstream bioethics—thus the focus on social justice provides an area for interdisciplinary and intersectional work; (2) pastoral theologians have not, to a great extent, contributed to discussions of religion and bioethics—this has been the territory of theological ethicists, especially during the 1970s; (3) one influential pastoral theologian, Bonnie Miller-McLemore, has called for (a) a broader concern for health in pastoral theology beyond psychological health and (b) more disciplinary approaches within pastoral theology beyond psychology so as to attend to “the living human web”; and (4) one way to advance the theological contributions in bioethics is by inviting pastoral theologians to focus on matters of social justice (an established area of intersection) as identified by health professionals, thus providing (a) new areas for inquiry and (b) new theological perspectives in bioethics. This article also suggests that pastoral theologians can contribute to bioethics by focusing on both “macro” issues (issues relating to structures and groups) and “micro” issues (issues relating to persons and experiences) as a way of pursuing the topic of justice in bioethics. The bulk of this article focuses on “macro” issues, but, in closing, the author articulates how he has been addressing “micro” issues in his own work. The author argues that both of these approaches—“macro” and “micro”—are legitimate ways for pastoral theologians to express pastoral concerns in bioethics.     

Wilāyah (authority and governance) and its implications for Islamic bioethics: a Sunni Māturīdi perspective

Juridical councils that render rulings on bioethical issues for Muslims living in non-Muslim lands may have limited familiarity with the foundational concept of wilāyah (authority and governance) and its implications for their authority and functioning. This paper delineates a Sunni Māturīdi perspective on the concept of wilāyah, describes how levels of wilāyah correlate to levels of responsibility and enforceability, and describes the implications of wilāyah when applied to Islamic bioethical decision making. Muslim health practitioners and patients living in the absence of political wilāyah may be tempted to apply pragmatic and context-focused approaches to address bioethical dilemmas without a full appreciation of significant implications in the afterlife. Academic wilāyah requires believers to seek authentication of uncertain actions through scholarly opinions. Fulfilling this academic obligation naturally leads to additional mutually beneficial discussions between Islamic scholars, healthcare professionals, and patients. Furthermore, an understanding derived from a Māturīdi perspective provides a framework for Islamic scholars and Muslim health care professionals to generate original contributions to mainstream bioethics and public policy discussions.     

Bad gifts,community standards,and the disciplining of Theravāda monks

ABSTRACT

The act of giving is among the most fundamental acts within the Buddhist world, particularly in the Theravāda communities of Southeast Asia. In many of these communities, lay followers give food and other dāna (merit-making gifts), providing monastics with the ‘requisites’ that they need to survive. Yet there is relatively little discussion within Buddhist or scholarly communities about what should be given, with formulaic lists representing the majority of discussions about these gifts. However, sometimes, the gifts given to monastics are not always appropriate, even bad. What to do in those cases is not always clear. In this article, I explore the ways in which monks in Thailand and Southwest China think about gifts that are not good. What becomes clear is that, despite the prevailing view that discipline is a universal process based on the vinaya (disciplinary code of Buddhism), monks have different views about what constitutes a ‘bad gift’ and what to do about it. I argue that paying attention to bad gifts allows us to see that lay communities have significant voice—although this is often implicit rather than explicit—about what constitutes ‘proper’ monastic behavior.     

Maqasid al-Shariah as a Complementary Framework for Conventional Bioethics: Application in Malaysian Assisted Reproductive Technology (ART) Fatwa

Rapid development in the area of assisted reproductive technology (ART), has benefited mankind by addressing reproductive problems. However, the emergence of new technologies and techniques raises various issues and discussions among physicians and the masses, especially on issues related to bioethics. Apart from solutions provided using conventional bioethics framework, solutions can also be derived via a complementary framework of bioethics based on the Higher Objectives of the Divine Law (Maqasid al-Shariah) in tackling these problems. This approach in the Islamic World has been applied and localised in the Malaysian context. Thus, this paper highlights a conceptual theoretical framework for solving current bioethical issues, with a special focus on ART in the Malaysian context, and compares this theory with conventional theories of bioethics.     

Sporting Integrity,Coherence, and Being True to the Spirit of a Game

Abstract

The term ‘sporting integrity’ is widely used in the normative assessment of sports. The term, however, suffers from a lack of conceptual precision. Alfred Archer’s ‘coherence-view’ of sporting integrity goes a long way to help clarify what ‘sporting integrity’ actually means and the specific institutional and individual obligations that it generates. Archer argues that ‘sporting integrity’ essentially means that the constraints athletes face ‘cohere’, in the sense of applying consistent inefficiencies between athletic competitors. For example, those who use performance enhancing drugs (PEDs) are less constrained than those who do not use PEDs, and thus PED use undermines sporting integrity. This paper presents the argument that over and above competitive coherence, sporting integrity means living up to the ‘spirit’ or ‘ethos’ of a game. The implications of this view are that a sport could have ‘coherent’ competitive constraints and still lack sporting integrity; additionally, a sport could have ‘incoherent’ competitive constraints and still demonstrate sporting integrity. These implications are drawn out relative to the three specific cases that Archer uses to illustrate his coherence view; namely, PED use in professional cycling, ‘tanking’ in Olympic badminton, and the prospect of allowing the Rangers Football Club entrance into the Scottish Premier League without playing through and first winning/qualifying in the lesser leagues.     

ISLAM AND BIOETHICS IN THE CONTEXT OF “RELIGION AND SCIENCE”

This paper places “Islam and bioethics” within the framework of “religion and science” discourse. It thus may be seen as a complement to the paper by Henk ten Have ( 2013 ) with which this thematic section in Zygon: Journal of Religion and Science opens, which places “Islam and bioethics” in the context of contemporary bioethics. It turns out that in Zygon there have been more submitted articles on Islam and bioethics than on any other Islam‐related topic. This may be a consequence of the global nature of the bioethical issues, driven by advancement in science and technology, which allows for conversation across cultural and religious boundaries even when the normative references and argumentative methods are tradition‐specific.