A blog from the Centre for Research Ethics & Bioethics (CRB)

Month: March 2012

Introspective genomics and the significance of one

As a philosopher, I am familiar with the image of the solitary thinker who studies the human mind though introspective study of his own. A recent article in the journal Cell reminds me of that image, but in unexpected “genomic” guise.

To achieve statistical significance, medical researchers typically engage large numbers of research subjects. The paper in Cell, however, has only one research subject: the lead author of the paper, Michael Snyder.

Snyder and colleagues studied how his body functioned molecularly and genetically over a 14-month period. Samples from Snyder were taken on 20 separate occasions. A personal “omics profile” was made by integrating information about his genomic sequence with other molecular patterns gathered from the samples, as these patterns changed over time.

Early results indicated that Snyder was genetically disposed to type 2 diabetes. Strangely enough, the disease began to develop during the course of the study. Snyder could follow in detail how two virus infections and the diabetes developed molecularly and genetically in his body.

Snyder changed his life style to handle his diabetes. When he informed his life-insurance company about the disease, however, his premiums became dramatically more expensive.

The introspective paper illustrates the potential usefulness, as well as the risks, of what has been dubbed “personalized medicine.” Here I want speculate, though, on how this new paradigm in medicine challenges scientific and intellectual ideals.

When philosophers introspectively studied the human mind, they took for granted that what they found within themselves was shared by all humans. The general could be found completely instantiated in the particular.

The particular was for philosophers no more than a mirror of the general. What they saw in the mirror was not the individual mirror (it was intellectually invisible). What they saw in the mirror was a reflection of the general (and only the general was intellectually visible).

That simple image of the relation between the particular and the general was discarded with Darwin’s theory of the origin of species. A species has no essence shared by all individuals. Therefore, to achieve scientific generality about what is human, you cannot rely on one human subject only. You need many subjects, and statistics, to achieve intellectual vison of general facts.

A noteworthy feature of the paper under discussion is that we seem partly to have returned to the era of introspective research. We return to it, however, without the discarded notion of the particular as mirror of the general.

New molecular techniques seem to open up for study of what previously were simply individual cases without significance in themselves. For personalized medicine, each subject unfolds as a universe; as a world full of significant processes.

By studying the “genomic universe” of one person and following it over a period of time time, Snyder and colleagues could discern processes that would have been invisible if they had superimposed data from several distinct research subjects.

This new significance of the particular is fascinating and novel from an intellectual perspective. Has the traditional contempt for the particular case been overcome in personalized medicine?

Speaking personally as a philosopher, I cannot avoid seeing this aspect of personalized medicine as congenial with certain philosophical tendencies.

I am thinking of tendencies to investigate (and compare) particular cases without magnifying them on a wall of philosophical abstraction, as if only the general was intellectually visible. I am thinking of serious attempts to overcome the traditional contempt for the particular case.

We seem to have arrived at a new conception of one and many; at a new conception of the particular case as visible and worthy of study.

Pär Segerdahl

We challenge habits of thought : the Ethics Blog

Bioethics is not a community of interests

There is a persistent image of bioethics as being in symbiosis with the powerful interests of medical research and the pharmaceutical industry.

Examples that could confirm such suspicions multiply, unfortunately, since pharmaceutical companies have begun to hire bioethicists as consultants. After critique, Glenn McGee, the former editor of the American Journal of Bioethics, recently resigned from a Texas based stem-cell company.

There obviously is a real risk that bioethicists end up representing powerful interests. Everyone who claims to be a bioethicist should be attentive to this question:

  • “Has my thinking become unjust and partial?”

In their academic setting, however, bioethicists not only can but should be driven by this question of truthfulness. You not only can but should weigh a multitude of values and perspectives against each other. You not only can change your mind, but should always consider the need to do so.

Openness strengthens you as a bioethicist.

This would not be the case if you represented a company, an organization, or an authority. In such positions, it is predetermined which views, which interests and which regulations you have a professional duty to look after. If you don’t disseminate the right views or look after the right interests, you are disloyal to your organization and should consider quitting.

It is the other way round with bioethics as an academic activity. If you protect privileged views as if you belonged to a community of interests, if you reason one-dimensionally without allowing opposed perspectives to be seen – then you should consider quitting.

If the functionary of an organization asks, with a pounding heart, “Have I become disloyal?”, the ethicist’s worrying question is, “Have I become loyal?”

If bioethics is vulnerable to accusations of partiality, then, it is because ethical thinking presupposes an openness that typically is absent within communities of interest (and they abound).

This ethical openness, paradoxically, may lay behind some of the accusations that bioethics legitimizes power. For ethical openness hardly is politically radical or ideologically rigid.

Where political organizations protect certain interests and work towards particular goals, ethical thinking has a responsibility to highlight other values that might be undermined if the organization got all the power it hopes to attain.

There seems to be certain tension between ethical openness and political radicalness. Ethics might seem to maintain status quo… from the point of view of various forms of political activism. Ethics might seem to protect power… from the point of view of communities of interest that strive to achieve commendable but limited goals.

There are so many good causes. There are so many groups with commendable interests. Dare I add that even industry and research have values that can deserve our attention?

My own belief is that the open-mindedness with which the best forms of bioethics can be associated – the difficult art of doing justice to many possibilities where there is a temptation to defend a rigid position – can have a profound democratic function.

Voices that strive to be impartial are important.

Pär Segerdahl

We think about bioethics : www.ethicsblog.crb.uu.se

Personalized medicine against the diabetes epidemic?

When promising technologies see the light, it can be difficult to make sound predictions about their future utility.

Technical breakthroughs that promise to transform society tend to bewitch the mind. Their tremendous potential begs for interpretation by more dreamlike imaginary powers.

When nuclear power was young, for example, the impact this new technology promised to have on society was interpreted by some in the futuristic imagery of nuclear reactors in every car, in every house, and in every kitchen range.

For a short while, every human energy problem seemed to have a nuclear solution.

Today, new gene sequencing technology is beginning to transform how we think about medicine. Personalized medicine is just around the corner. It promises to adapt both prevention and treatment of disease to the individual’s genome.

– How far can this promising new form of medicine be taken?

Two investigators from Albert Einstein College of Medicine recently suggested personalized medicine as a solution to the obesity and diabetes epidemic in the US and other parts of the world… where eating habits call for alarm.

The authors’ argue that costly prevention efforts could be targeted at those individuals whose genomes make them most likely to benefit. Such a personalized approach to the diabetes epidemic is suggested not only for the US, but also for developing countries where diabetes is spreading rapidly and public health resources are scarce.

I’m certain that personalized medicine will be very useful both in prevention and treatment of diabetes. But is it reasonable as a solution to the diabetes epidemic?

I may be wrong. But I cannot avoid seeing the suggestion as an attempt to “find a personalized medicine solution to every human health problem.”

Instead of targeting high risk individuals, and doing so generation after generation while we continue to expose them to the same dangerous eating habits that low-risk individuals adopt (and are enticed to adopt), why not consider efforts (like those of Jamie Oliver) to change globally spreading eating habits?

I admit that my judgment may be wrong and that I fail to understand the potential in this particular case.

What is the answer to the obesity and diabetes epidemic? Revolutionary medicine or a food revolution?

Pär Segerdahl

We like challenging questions - the ethics blog

After-birth abortion as a logical scale exercise

How should one respond when ethicists publish arguments in favor of infanticide?

In the current issue of Journal of Medical Ethics, two philosophers argue that what they call “after-birth abortion” should be permissible in all cases where abortion is (even when the newborn is healthy).

Not surprisingly, soon after BioEdge covered the article, the news spread on the internet… and the authors of the article unfortunately even received death threats.

If you know the spirit of much current academic philosophy, you will not be surprised to know that the authors defended themselves by statements like:

  • “This was a theoretical and academic article.”
  • “I’m not in favour of infanticide. I’m just using logical arguments.”
  • “It was intended for an academic community.”
  • “I don’t think people outside bioethics should learn anything from this article.”

The editor of JME, Julian Savulescu, defended the decision to publish by emphasizing that JME “supports sound rational argument.”

In a similar vein, the philosopher John Harris, who developed basically the same rational considerations in support of infanticide, felt a need to clarify his position. He never defended infanticide as a policy proposal. – What did he do, then?

He engaged in “intellectual discussions.”

What I find remarkable is how some of our most significant human ideals – logic and rationality – seem to have acquired a technical and esoteric meaning for at least some professional philosophers.

Traditionally, if you build on logic and rationality, then your intellectual considerations ought to concern the whole of humanity. Your conclusions deserve to be taken seriously by anyone with an interest in the matter.

The article on after-birth abortion, however, is JUST using logical arguments. It is ONLY presenting a sound rational argument. It is MERELY an intellectual discussion. To me, this sounds like a contradiction in terms.

Moreover, because of this “merely” logical nature of the argument, it concerns no one except a select part of the academic community.

Still, logic and rationality are awe-inspiring ideals with a long human history. Philosophers draw heavily on the prestige of these ideals when they explain the seriousness of their arguments in a free liberal society.

When people in this free society are troubled by the formal reasoning, however, some philosophers seem surprised by this unwelcome attention from “outsiders” and explain that it is only a logical scale exercise, composed years ago by eminent philosophers like Singer, Tooley and Harris, before academic journals were accessible on the internet.

I repeat my question: how should one respond when ethicists publish what they present as “rational arguments” in favor of infanticide?

My answer is that one should take them seriously when they explain that one shouldn’t take their logical conclusions too seriously. Still, there is reason for concern, because the ideals they approach so technically are prestigious notions with a binding character for most of us.

Many persons think they should listen carefully when arguments are logical and rational.

Moreover, JME is not a purely philosophical journal. It is read by people with real and practical concerns. They are probably unaware that many professional philosophers, who seem to be discussing real issues, are only doing logical scale exercises.

This mechanized approach to the task of thinking, presented on days with better self-confidence as the epitome of what it means to be “serious and well-reasoned,” is what ought to concern us. It is problematic even when conclusions are less sensational.

Pär Segerdahl

Following the news - the ethics blog