Peer review: Selecting the best science

The major challenge facing today’s biomedical researchers is the increasing competition for available funds. The competitive review process, through which the National Institutes of Health (NIH) awards grants, is built upon review by a committee of expert scientists. The NIH is firmly committed to ensuring that its peer review system is fair and objective. Wendy Baldwin, Ph.D., is Deputy Director for Extramural Research, National Institutes of Health. This paper is based on a presentation at a workshop, “Advances in Peer Review Research”, American Association for the Advancement of Science Meeting, Baltimore, MD, February 9, 1996.     

Guidelines for training in the ethical conduct of scientific research

Historically, scientists in training have learned the rules of ethical conduct by the example of their advisors and other senior scientists and by practice. This paper is intended to serve as a guide for the beginning scientist to some fundamental principles of scientific research ethics. The paper focuses less on issues of outright dishonesty or fraud, and more on the positive aspects of ethical scientific behavior; in other words, what a scientist should do to maintain a high level of ethical conduct in research. There are a number of fairly specific rules, guidelines, or commonly accepted operating principles that have evolved for the ethical conduct of science. In order to discuss this code of ethics, this paper is divided into sections dealing with specific areas of scientific ethics. These areas are: data collection and storage, ownership of data, confidentiality, communication, authorship, collaboration, the peer review system, and rules of dealing with ethical complaints. Illustrative case histories are presented to provide examples of the type of ethical dispute or problem being discussed. If scientific trainees learn the accepted rules of behavior that govern the conduct of science, ethical problems that arise out of ignorance, misunderstanding, or poor communication can be avoided.     

Confidentiality and paradox: the location of ethical space

Implicit in Jung's alchemical metaphor of the vas bene clausum is the idea of an analytic frame with a space inside it for something vital, a relationship between two selves, to develop. For this to happen, analysts must respect their patients' rights to confidentiality. The paper explores the analyst's state of mind and the intrapsychic processes that are constellated when struggling with ethical dilemmas about issues of confidentiality in analytic work. The author suggests that at times when analysts consider breaking confidentiality, there is often a disturbing inner conflict between their moral principles (codes of ethics) and their internal personal ethical attitude. At these difficult moments, the mutuality of the work and the vas bene clausum can be significantly disrupted. The analyst tries to find a third position, a mental and emotional ethical space where the subjective and the objective, the ethical and the unethical can become more companionable bedfellows.     

Watch Your Step: The New York Times,Breaching Confidentiality,and 12-Step Programs

Twelve-step programs such as Alcoholics Anonymous and Narcotics Anonymous invite members to trust that what is said in meetings remains confidential. However, the New York Times, a prominent and influential newspaper, has breached that confidentiality, offering both a precedent and a rationale to other media including newspapers, cable news programs, internet news blogs, and so on. This prominent breach may influence not only other news media but also the trust that 12-step members have in their programs.     

美方专家观点:未来的挑战——信任是临床试验的核心

信任是医患关系的一个基本特征,是社会和医生之间的隐性合同的一部分。合同要求双方的期望值。病人会告诉医生他们内心深处的个人隐私,信任医生会为他们保守秘密,允许医生在他们生病和悲伤时进入家里和医院。但是,要做到这些,医生必须维持包括关爱、保密和承诺的伦理标准。因为信任就像个很小但却很珍贵的宝石－很难得到,又很容易失去,失去之后想要在找回来极为困难。     

Guidelines for Writing Letters to Patients

Patient letters provide a permanent record of the genetic counseling that was provided and are unique in medical care; rarely do other health care providers send summaries written specifically to their patients and families. We surveyed genetic counseling training program directors and found that while the acquisition of patient letter-writing skills was considered important, there were no specific guidelines made available to students. To develop letter-writing guidelines, we evaluated patient letters, reviewed references on professional correspondence, surveyed the medical literature, and worked with a writing consultant. The guidelines we subsequently developed and present here include a format for writing patient letters, suggestions on presenting medical information in understandable terms, and wording considerations. These patient letter-writing guidelines are intended to serve as a guide for teaching students this important skill and as a resource for practicing health care professionals.     

Therapist responses to requests for disclosure of therapeutic records: An introductory study

This paper describes a questionnaire survey of therapists in the UK who have been subject to requests for disclosure of client records as part of a legal process. Therapist responses are outlined in terms of the perceived effect of such disclosure on the client, therapist and the therapeutic relationship. Negative effects included the experience of exposure of sensitive client material in an adversarial legal system, of powerful emotional responses by therapists, and a sense of feeling professionally de‐skilled in an unfamiliar and often challenging legal environment. Positive effects for the client included the achievement of valued outcomes such as compensation, and, for the therapist, the facilitation of support for the client in this process. These findings are discussed in terms of a contrast between therapist perceptions of consensual and contested disclosure. In the former, therapist and client are in agreement about the restorative value and outcome of disclosure. In contested disclosure, the process is experienced as disrupting therapeutic privacy, undermining professional self‐confidence and introducing an unwelcome element of critical re‐evaluation of client motives for undertaking therapy.     

Writing about patients III: Comparisons of attitudes and practices of analysts residing outside and within the USA

When analysts write about patients, they find themselves in a position of conflict. Their first loyalty is to their patients and maintaining confidentiality. However, they are also committed to advancing scientific knowledge in the psychoanalytic field. The attitudes and practices of 36 analysts residing outside the USA, who published articles using clinical material from their patients, are reported. Their attitudes and practices are compared with those of 30 author-analysts residing within the USA, who had been previously interviewed. Among the 66 analysts, geographic region was not a basis for distinguishing differences in attitudes or practices. Slightly more than twice as many analysts use only disguised material as regularly ask permission of their patients to write about them. The decision to use only disguise is somewhat more frequent for analysts who reside outside the USA than for those living within it. Analysts around the world are increasingly concerned about the accessibility of published material. More analysts have come to believe that it is necessary to ask permission before publishing material. Some analysts also believe that the request itself, and the patients reading written material about themselves, focus issues that are central to patients' characters and confl icts that can then be explored analytically.     

Guard dogs of perception: the corporate takeover of science

The belief that science is "a driver of growth in the knowledge economy" has led in recent decades to increasing encouragement by government of the involvement of industry and of commerce in the sponsorship and direction of research in universities, and to the increasing influence of industrial representatives on advisory panels associated with the publicly funded scientific research councils. By extending the doctrine of commercial confidentiality into university laboratories, inconvenient findings have been suppressed, and both free endeavour and free speech undermined. This has narrowed our scientific horizons and compromised government advisors. It is argued that scientific freedom is a guarantor of our wider liberties. Science, which tells us who we are and how we can live better, is being distorted so twisting our understanding of the ways in which we might progress, shutting off alternatives to existing models of development. Business now stands as a guard dog at the gates of perception. Only the inquiries which suit its needs are allowed to pass.