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BIOETHICS
The
Bioethics Imperative XIII
Ethics
and the Literature: Citations
“Mokita”:
The truth we all know and agree not to talk about.
Scenario:
The librarian hears Professor Al Waysbe Hynd yell “Eureka!”
from a workstation in the university library. She wanders over asking,
“Hi, Al. What did you find?” “I just did a literature search
for adverse effects of this drug in treating children with the dreaded
snoutbreath disease. Because there aren’t any articles, I can treat
this kid without worrying.” “Al, do you have one more minute?
I’d like to check that you didn’t miss anything. What age group
you search with?” “Kids.” The librarian quickly proceeds
to enter the appropriate age group term instead of the word “kids.”
After she finds nearly 25 relevant references, Professor Hynd, shaking
and sheepish, says, “Gee, I might have killed that kid. Searching
is conceptual! All this time, I’ve seen only [female body parts]
and a keyboard…. I thought you gals were just typing.” Story
contributed by Tamara Turner, Seattle.
Unfortunately, this
is a true story told to me in a coffee shop by Tamara Turner, a retired
librarian and editor. She initiated the conversation saying, “ It’s
so nice to see someone actually reading an entire scientific article.”
My conversation with Tamara has sparked some ideas for the next few columns
on ethical use of the published and unpublished literature. I was late
in picking up my son, but I hope you will agree that it was worth it!
Dr. Hynd’s first
egregious ethical breach was to assume that an absence of data meant that
his next action was justified. For centuries, a primary tenet of science
has been that the absence of data does not prove the hypothesis: The only
way to do great and ethical science is to try your utmost to disprove
a clearly testable hypothesis. Dr. Hynd was ready to justify his course
of action in the absence of data and perhaps in the absence of a clear
logic tree or hypothesis. Try this alternative way of thinking: “If
I treat this kid without any data to back me up, what are the potential
ramifications for the kid, his family, and my career if it comes to the
attention of the ethical review board of the medical school and the university
that I treated a kid without an NIH-sanctioned, peer-reviewed (Stage 3)
protocol in place?”
Second, Dr. Hynd assumed
that he knew best how to find the information he needed. He did not try
the search with different terms or ask for someone to double-check his
findings. Again, a tenet of science is that, ostensibly, we scientists
are seeking truth, which implies that we are not gods; we have bad days
and blind spots, make mistakes, and always can learn more about what we
do. As truth seekers, we ascribe to having our work checked by peer review
and then written out clearly enough so that others can try to reproduce
it.
Third, Dr. Hynd did
not ask for help from the staff who worked at his institution. This is
analogous to wandering around lost instead of asking the locals for driving
directions. Furthermore, he assumed incompetence merely on the basis of
physical attributes, gender, and perhaps also title or position. He redeemed
himself greatly by learning and then voicing that learning immediately
to the party concerned. Significantly, he avoided being reactive, e.g.,
telling the librarian he didn’t have time or was not interested in
her input and had the largess and ethical foundation to become proactive
on the spot.
It is hard to admit
that you do not know something, especially if you think someone is “lesser”
than you or feel that you should have done your homework better. As truth
seekers, a.k.a. scientists, we are lifelong learners. I once asked one
of my mentors how he managed to talk to people less competent than he.
He said, “I just find that if I listen, everyone has something to
teach me.” His answer still humbles me because over time I have realized
that when one is insecure or in pain or “always behind” or in
any number of physical or mental states, one’s hearing has a tendency
to shut down.
Next: The lost
art of finding relevant citations.
Dina Mandoli
University of Washington, Seattle
mandoli@u.washington.edu
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