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Research Ethics

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Previous research ethics issues. research with children ... Stop medical research undertaken for utopian or financial reasons WHO 10/90. Gaia hypothesis ... – PowerPoint PPT presentation

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Title: 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
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