Research Ethics

1
Research Ethics

• Dr Richard Nicholson
• Bulletin of Medical Ethics
• London

2
Previous research ethics issues

• research with children
• Declaration of Helsinki
• conflicts of interest
• can informed consent exist?
• participant payments
• are research ethics committees any use?

3
Now

• Only one question to address
• Is it ethical to do any medical research?

4
Our world changed in 2005

• Predictions of when Arctic Ocean would be clear
  of ice during the summer
• 2004 by 2100
• 2005 by 2030
• 2007 2013
• 2008 2010

5
Climate change

• Is exponential
• Is not linear
• Is the result of Man putting too much carbon
  dioxide into the atmosphere

6
Why exponential?

• About 30 natural feedback mechanisms,all
  positive, e.g.
• albedo effect
• methane release
• water vapour
• nitrous oxide release

7
Radiative forcing

• Excess of energy absorbed by Earth over that
  radiated back into space
• At present, 1 2 watts per square metre
• As Earth warms, more energy is radiated back
  into space

8
New equilibrium

• Linear models suggested new equilibrium (ie
  radiative forcing 0) was possible with a
  temperature rise of 20C, and carbon dioxide
  concentration of 450ppm
• New calculations show that radiative forcing
  would then be 2.6 w/sqmie. global heating would
  be runaway

9
Atmospheric carbon dioxide

• Pre-industrial revolution 280ppm
• Now 385ppm
• Including equivalent effect of other greenhouse
  gases 435ppm
• Current rate of rise 3.5ppmpa
• Safe total level nowthought to be 300 - 350ppm

10
What does this mean?

• If we are lucky, we have about five years in
  which to stop the rise in atmospheric carbon
  dioxide, and to start its reduction.
• That will require about a 98 reduction in rich
  country carbon dioxide emissions, and the use of
  any technology we have to remove atmospheric
  carbon dioxide.

11
What would failure mean?

• Many positive feedback mechanisms would kick in,
  and nothing that humans could do would prevent
  runaway global heating.
• Some calculations now suggest that runaway
  global heating might cause a rise in the Earths
  average temperature of 160C.
• The 6th mass extinction would follow

12
Overconsumption

• Spending on healthcare in OECD countries is now
  12 of global GDP
• By virtue of wealth, OECD countries are mostly
  the healthiest in the world
• OECD countries spend 70 times as much per capita
  on healthcare as rest of world

13
Life expectancy

• Rose by 30 years in 20th century in West
• 18 months childhood immunisation
• 24 months all the rest of healthcare
• 26.5 years social factors clean water,
  better drains, clean air, food storage,
  better housing

14
Health spend vs life expectancy

• United States 4,500 76.8years
• Switzerland 3,570 79.9
• United Kingdom 1,750 77.0
• Singapore 810 78.4
• Slovakia 210 73.3
• Vietnam 21 69.1

15
Dangerous health care

• Big Pharma is second most lethal industry in
  developed world, after tobacco
• In US alone, 120,000 deaths per annum from
  prescribed drugs
• In UK, US and Australia, deaths from medical
  mishaps account for 5 of all deaths

16
Two paradoxes

• Healthcare spending in rich countries is
  increasing as evidence of its dangers and
  ineffectiveness increases
• The more effort we put into saving individual
  lives, the more likely we are to doom the human
  race to extinction

17
Utopianisms

• Christianity and other religions
• Socialism / communism
• Free market capitalism
• Techno-utopianism, including medicine
• Last two are based on false notion thatMore
  Better

18
Climate change and medicine

• Provision of healthcare in most OECD countries is
  a major contributor to carbon dioxide emissions
• If climate change is to be tackled success-fully,
  healthcare provision will have to be radically
  reduced, and made sustainable

19
Four horsemen

• Climate change
• Reduction in water availability
• Reduction in oil availability
• Overpopulation

20
Possible changes in medicine

• Close most hospitals, and concentrate on
  good-quality primary care
• Reverse the brain drain and send redundant health
  workers to developing countries
• Outlaw assisted reproduction
• Stop medical research undertaken for utopian or
  financial reasons WHO 10/90

21
Gaia hypothesis

• Earths biosphere is a living and
  self-regulating entity
• New viral illnesses - AIDS, avian flu, etc may
  be Gaias way of fighting too many humans
• Does it make sense to fight Gaia?

22
Individuals vs humanity

• What is more important
• - maintaining our wealth and economies for
  20-30 years until climate change wipes them out,
  or
• - trying to ensure that as much as possible of
  the human race survives?

23
Individuals vs humanity

• Is modern Western man now so selfish that it
  would be better for the Earth if he did not
  survive?
• Is it possible to maintain democratic liberties
  and individual freedom of choice, and for
  humanity to survive?

24
Medical ethics

• Medical ethics has tinkered with ideas of how
  much is a human worth, and whether humans are of
  equal value.
• Now it has a major task to say how much is the
  human race worth, and is it worth saving in light
  of the damage it does to the Earth

25
A final paradox

• If we miss this last opportunity to control
  global heating, the best hope for the survival of
  the human race would be all-out nuclear warfare