What Price Better Health? Hazards of the Research Imperative

  • Daniel Callahan
University of California Press: 2003. 335 pp. $29.99, £19.95

This book is intended for a wide general audience, but if you are a biomedical scientist, you would be well advised to read it. For the philosopher Daniel Callahan presents what might just be the strongest case for putting you out of business.

Callahan founded the Hastings Center, a bioethics research centre in New York state, and was its director for three decades. For much of that time he has wondered about the value of biomedical research. What Price Better Health? constitutes the crescendo of his dissatisfaction with the biomedical enterprise.

Biomedical research has set itself up inside an unassailable moral fortress, argues Callahan. Its main moral weapon is what he dubs the 'research imperative' — the idea that research must proceed regardless of the cost or risk. No downside can trump the research imperative, because a cure for all that ails us, and possibly a potion to stave off death itself, could be contained within the next grant proposal, embedded in the next biotech start-up, or just around the corner of the next widely touted new idea (be it fetal-tissue research, gene therapy, embryo research, xenografting, artificial organs, stem-cell research or genomics, for example). What hope is there for those who want to challenge the way that biomedical research is done, when to do so they must stand in the way of the research imperative, and thus in the path of progress?

In this book, Callahan attempts to slay the dragon of the research imperative with two main arguments. First, he says that the research imperative has completely corrupted biomedical science. Second, he argues that the research imperative is no imperative at all.

In chapter after chapter he argues that the price of biomedical science's drive to find cures for everything is corruption. The integrity of science in terms of honesty, openness and cooperation has completely frayed. The rights of humans in research are constantly being compromised or ignored. Conflicts of interest abound. Advocacy groups, regulatory bodies and government commissions simply roll over and play dead in the face of the promises of the research juggernaut. And lording over the whole unseemly mess, he says, is the bloated, greedy figure of the pharmaceutical industry, which earns huge profits while addicting us to drugs that don't work or that we don't really need.

Not only is the price exacted by obeisance to the research imperative far too high, but the imperative itself is a mirage. Callahan argues that there is no moral obligation to undertake biomedical research. First, he says that we have no duty to try and improve things for our descendants. Then he adds that although health is an important goal, it is far from being the only good that we have an obligation to produce.

So does he make his case? Should we try to shut down the US National Institutes of Health (NIH), INSERM (France's national biomedical agency), Britain's Medical Research Council and the pharmaceutical industry before they destroy us? Should we abandon the quest for eternal vigorous life and come to stoical grips with our finitude and frailty? Callahan displays a real mastery of policy and history but, despite his efforts, the research imperative does not yield to his rhetorical sword.

Is it really the case that the research imperative has a Svengali-like effect on all who hear its dulcet tones? Hardly. Even in the United States, whose government funding constitutes a good chunk of the world's share of biomedical research and development (R&D), the total expenditure on biomedical research, even though it has grown over the past decade, is barely a detectable blip in the US economy.

Last year the US government spent more than $2 trillion in total, of which $107 billion went on R&D. More than half of that amount went on military and defence-related research. The NIH budget was roughly $27 billion but a sizeable chunk of that was targeted at research on topics relating to bioterrorism and national security. Contrary to Callahan's view that Americans are digging deep into their wallets in egomaniacal hope of eternal life, their actual expenditure seems to show that they are well aware that there are lots of other things to spend money on, and they do.

What about the duty to make things better for those who will follow us? It is true that moral theories do not posit an obligation to improve the lot of those who have not yet been born. But we do have an obligation to try and make things better for our own children, and biomedical research is a crucial element of how that obligation should be discharged.

More to the point, we may also have a duty to support biomedical research because we choose to benefit from the fruits of past research. If I use a hearing aid, take insulin for my diabetes, walk using an artificial hip, wear a pacemaker, see through eyes shaped by laser surgery, and vaccinate myself against diseases, then I am benefiting from previous investments in biomedical research. It would seem that, unless I want to act as a 'free rider', I owe a debt to the investments of my forebears that must be discharged by continuing to support biomedical research. Fair play demands that I pay for what I benefit from.

If we do have a duty to do research, that brings us to the other part of Callahan's argument: has the biomedical research imperative crushed key values and core moral principles? Here Callahan's argument has some traction. Things are not as they should be in terms of internal values in biomedicine. Repairs are certainly in order.

Surprisingly, though, Callahan offers no comment on one of the most potent threats to scientific integrity and values — the power of government-sponsored military and anti-terror research to undermine the integrity of science. This is not a new problem but recent events have raised its profile. In the United States and Europe, some of the greatest threats to key scientific values come from the desire of government to keep secret the work that it funds in the name of national security.

But having said that, do proponents of biomedical research really wield the research-imperative weapon in the way that Callahan maintains? Most biomedical researchers are keenly alert to the obligations to treat human and animal subjects respectfully and with dignity. They understand the tensions imposed by private funding on the ethos of their work. And they are open to listening to and taking seriously the objections of those who fret about where biomedical technology might take us. And so they should. Despite Callahan's hyperbole about the power of the biomedical research juggernaut, critics have scored some victories. The genetic modification of plants and animals is moving much more slowly than proponents would like; stem-cell, embryo and cloning research are being subjected to close scrutiny; and efforts to advance xenografting and the creation of artificial hearts have come more or less to a grinding halt for a variety of ethical and social reasons.

Callahan has written an important book. The research imperative may not be quite as invulnerable as he thinks, but it is certainly imperative that the case he makes against it be given the close and thoughtful attention that his book provokes.