Precautionary principle stifles discovery

Strengthening conservation science as a crisis discipline by addressing challenges of precaution, privilege, and individualism

Conservation science deals with crises and supports policy interventions devised to mitigate highly uncertain threats that pose irreversible harm. When conventional policy tools, such as quantitative risk assessments, are insufficient, the precautionary principle provides a practical framework and range of robust heuristics. Yet, precaution is often resisted in many policy arenas, especially those involving powerful self-interests, and this resistance is compounded by structures of privilege and competitive individualism in science. We describe key drivers and effects of such resistance in conservation science. These include a loss of rigor under uncertainty, an erosion of crisis response capabilities, and a further reinforcement of privileged interests in conservation politics. We recommend open acknowledgement of the pressures exerted by power inside science; greater recognition for the value of the precautionary principle under uncertainty; deliberate measures to resist competitive individualism; support for blind review, open science, and data sharing; and a shift from hierarchical multidisciplinarity toward more egalitarian transdisciplinarity to accelerate advances in conservation science. Article impact statement: Precautionary principle, privilege structures among disciplines, and culture of individualism link to effective conservation policy making.

How Should the Precautionary Principle Apply to Pregnant Women in Clinical Research?

The precautionary principle is often invoked in relation to pregnant women and may be one of the underlying reasons for their continuous underrepresentation in clinical research. The principle is appealing, because potential fetal harm as a result of research participation is considered to be serious and irreversible. In our paper, we explore through conceptual analysis whether and if so how the precautionary principle should apply to pregnant women. We argue that the principle is a decision-making strategy underlying risk-benefit decisions in clinical research, which can be applied to pregnant women. However, the current application is a strong one, leading to the promotion of absolute exclusion or, less often, absolute inclusion of pregnant women. In order to change this paralyzing situation, a shift toward weak precautionary thinking is necessary. Instead of automatic extreme precaution, a balance will be found between harms and potential benefits of including pregnant women in clinical research.

Is the Precautionary Principle Really Incoherent?

The Precautionary Principle has been an increasingly important principle in international treaties since the 1980s. Through varying formulations, it states that when an activity can lead to a catastrophe for human health or the environment, measures should be taken to prevent it even if the cause-and-effect relationship is not fully established scientifically. The Precautionary Principle has been critically discussed from many sides. This article concentrates on a theoretical argument by Peterson (2006) according to which the Precautionary Principle is incoherent with other desiderata of rational decision making, and thus cannot be used as a decision rule that selects an action among several ones. I claim here that Peterson's argument fails to establish the incoherence of the Precautionary Principle, by attacking three of its premises. I argue (i) that Peterson's treatment of uncertainties lacks generality, (ii) that his Archimedian condition is problematic for incommensurability reasons, and (iii) that his explication of the Precautionary Principle is not adequate. This leads me to conjecture that the Precautionary Principle can be envisaged as a coherent decision rule, again.

The Precautionary Principle and the Tolerability of Blood Transfusion Risks

Tolerance for blood transfusion risks is very low, as evidenced by the implementation of expensive blood tests and the rejection of gay men as blood donors. Is this low risk tolerance supported by the precautionary principle, as defenders of such policies claim? We discuss three constraints on applying (any version of) the precautionary principle and show that respecting these implies tolerating certain risks. Consistency means that the precautionary principle cannot prescribe precautions that it must simultaneously forbid taking, considering the harms they might cause. Avoiding counterproductivity requires rejecting precautions that cause more harm than they prevent. Proportionality forbids taking precautions that are more harmful than adequate alternatives. When applying these constraints, we argue, attention should not be restricted to harms that are human caused or that affect human health or the environment. Tolerating transfusion risks can be justified if available precautions have serious side effects, such as high social or economic costs.

The stigmatization dilemma in public health policy--the case of MRSA in Denmark

BACKGROUND

Multi-resistant bacteria pose an increasing and significant public health risk. As awareness of the severity of the problem grows, it is likely that it will become the target for a range of public health interventions. Some of these can intentionally or unintentionally lead to stigmatization of groups of citizens.

DISCUSSION

The article describes the phenomenon of stigmatization within the health care area by discussing the concept in relation to AIDS and psychiatric diagnosis. It unfolds the ethical aspects of using stigmatization as a public health instrument to affect unwanted behaviours e.g. smoking. Moreover it discusses stigmatization as an unintended albeit expected side effect of public health instruments potentially used to counter the challenge of multi-resistant bacteria with particular reference to the Danish case of the growing problems with Methicillin-resistant Staphylococcus aureus (MRSA) within pig production. We argue that using stigmatization as a direct means to achieve public health outcomes is almost always ethically illegitimate. Autonomy and dignity considerations count against it, and the cost-benefit analysis that might by some be taken to outweigh these considerations will be fundamentally uncertain. We further argue that interventions where stigmatization is a side-effect need to fulfil requirements of proportionality, and that they may fall prey to 'the stigmatization dilemma', i.e. the dilemma that arises when all policy options are potentially stigmatizing but stigmatize different groups. When this dilemma obtains the decision-maker should choose the intervention that does not lead to permanent stigmatization and that stigmatizes as few as possible, as briefly as possible, and as little as possible.

Qualitative assessment of patients' attitudes and expectations toward BCIs and implications for future technology development

Brain-computer-interfaces (BCIs) are important for the next generation of neuro-prosthesis innovations. Only few pilot projects have tested patients' abilities to control BCIs as well as their satisfaction with the offered technologies. On the one hand, little is known about patients' moral attitudes toward the benefit-risk-ratio of BCIs as well as their needs, priorities, and expectations. On the other hand, ethics experts intensively discuss the general risks of BCIs as well as the limits of neuro-enhancement. To our knowledge, we present here the first qualitative interview study with ten chronic patients matching the potential user categories for motor and communication BCIs to assess their practical and moral attitudes toward this technology. The interviews reveal practical and moral attitudes toward motor BCIs that can impact future technology development. We discuss our empirical findings on patients' perspectives and compare them to neuroscientists' and ethicists' perspectives. Our analysis indicates only partial overlap between the potential users' and the experts' assessments of BCI-technology. It points out the importance of considering the needs and desires of the targeted patient group. Based on our findings, we suggest a multi-fold approach to the development of clinical BCIs, rooted in the participatory technology-development. We conclude that clinical BCI development needs to be explored in a disease-related and culturally sensitive way.

Analyzing precautionary regulation: do precaution, science, and innovation go together?

In this article we argue that the precautionary principle, as applied to the regulation of science and technology, cannot be considered in any general manner inconsistent with the norms and methods of scientific knowledge generation and justification. Moreover, it does not necessarily curtail scientific-technological innovation. Our argument flows from a differentiated view of what precaution in regulation means. We first characterize several of the most relevant interpretations given to the precautionary principle in academic debate and regulatory practice. We then use examples of actual precaution-based regulation to show that, even though science can have varying functions in different circumstances and frames, all of those interpretations recur to scientific method and knowledge, and tend to imply innovation in methods, products, and processes. In fact, the interplay of regulation and innovation in precautionary policy, at least in the case of the interpretations of precaution that our analysis takes into account, could be understood as a way of reconciling the two fundamental science and technology policy functions of promotion and control.

Ethics of clinical science in a public health emergency: drug discovery at the bedside

Clinical research under the usual regulatory constraints may be difficult or even impossible in a public health emergency. Regulators must seek to strike a good balance in granting as wide therapeutic access to new drugs as possible at the same time as gathering sound evidence of safety and effectiveness. To inform current policy, I reexamine the philosophical rationale for restricting new medicines to clinical trials, at any stage and for any population of patients (which resides in the precautionary principle), to show that its objective to protect public health, now or in the future, could soon be defeated in a pandemic. Providing wider therapeutic access and coordinating observations and natural experiments, including service delivery by cluster (wedged cluster trials), may provide such a balance. However, there are important questions of fairness to resolve before any such research can proceed.

The principle of proportionality revisited: interpretations and applications

The principle of proportionality is used in many different contexts. Some of these uses and contexts are first briefly indicated. This paper focusses on the use of this principle as a moral principle. I argue that under certain conditions the principle of proportionality is helpful as a guide in decision-making. But it needs to be clarified and to be used with some flexibility as a context-dependent principle. Several interpretations of the principle are distinguished, using three conditions as a starting point: importance of objective, relevance of means, and most favourable option. The principle is then tested against an example, which suggests that a fourth condition, focusing on non-excessiveness, needs to be added. I will distinguish between three main interpretations of the principle, some primarily with uses in research ethics, others with uses in other areas of bioethics, for instance in comparisons of therapeutic means and ends. The relations between the principle of proportionality and the precautionary principle are explored in the following section. It is concluded that the principles are different and may even clash. In the next section the principle of proportionality is applied to some medical examples drawn from research ethics and bioethics. In concluding, the status of the principle of proportionality as a moral principle is discussed. What has been achieved so far and what remains to be done is finally summarized.

Embryo futures and stem cell research: the management of informed uncertainty

In the social worlds of assisted conception and stem cell science, uncertainties proliferate and particular framings of the future may be highly strategic. In this article we explore meanings and articulations of the future using data from our study of ethical and social issues implicated by the donation of embryos to human embryonic stem cell research in three linked assisted conception units and stem cell laboratories in the UK. Framings of the future in this field inform the professional management of uncertainty and we explore some of the tensions this involves in practice. The bifurcation of choices for donating embryos into accepting informed uncertainty or not donating at all was identified through the research process of interviews and ethics discussion groups. Professional staff accounts in this study contained moral orientations that valued ideas such as engendering patient trust by offering full information, the sense of collective ownership of the National Heath Service and publicly funded science and ideas for how donors might be able to give restricted consent as a third option.

Environmental contaminants and children's health: Cause for concern, time for action

The present paper provides an outline of the developmental and behavioural characteristics that make children, especially the fetus and young child, more vulnerable to contaminants than adults. The major categories of contaminants are briefly described. The evidence for their possible effects on neurobehavioural development; immune, endocrine and respiratory systems; childhood cancer based on research studies with animals; children exposed to catastrophic 'accidents' involving overdose exposures; and pregnant women and children from communities with high 'background' levels of contamination who participated in studies is reviewed. While the data are worrisome, especially for children living in northern and certain urban communities, much remains to be learned about possible subtle effects and the potential for long term effects of the current background contamination experienced by the majority of Canadian children before its significance to their health can be fully evaluated. The present regulatory processes, which are based on risk assessment, are so cumbersome and costly that the great majority of chemicals in use have not been fully evaluated, and the ingenuity of new chemical production continually exceeds the capacity to test the new chemicals. Moreover, despite past insistence on scientific proof of adverse effects and safety, unanticipated effects have occurred that will threaten the sustainability of human life unless more effective control measures are taken to limit the release of toxic substances and persistent chemicals into the environment. Therefore, the shortcomings of risk assessment are discussed, and the precautionary principle, which is used in some countries and is proposed for use internationally as an alternative measure that may offer improved control for the future, is outlined. Finally, opportunities for physician action are suggested.

Between same-sex marriages and the Large Hadron Collider: making sense of the precautionary principle

The Precautionary Principle is a guide to coping with scientific uncertainties in the assessment and management of risks. In recent years, it has moved to the forefront of debates in policy and applied ethics, becoming a key normative tool in policy discussions in such diverse areas as medical and scientific research, health and safety regulation, environmental regulation, product development, international trade, and even judicial review. The principle has attracted critics who claim that it is fundamentally incoherent, too vague to guide policy, and makes demands that are logically and scientifically impossible. In this paper we will answer these criticisms by formulating guidelines for its application that ensure its coherence as a useful normative guide in applied and policy ethics debates. We will also provide analyses of cases that demonstrate how our version of the principle functions in practice.

Alternatives to statistical hypothesis testing in ecology: a guide to self teaching

Statistical methods emphasizing formal hypothesis testing have dominated the analyses used by ecologists to gain insight from data. Here, we review alternatives to hypothesis testing including techniques for parameter estimation and model selection using likelihood and Bayesian techniques. These methods emphasize evaluation of weight of evidence for multiple hypotheses, multimodel inference, and use of prior information in analysis. We provide a tutorial for maximum likelihood estimation of model parameters and model selection using information theoretics, including a brief treatment of procedures for model comparison, model averaging, and use of data from multiple sources. We discuss the advantages of likelihood estimation, Bayesian analysis, and meta-analysis as ways to accumulate understanding across multiple studies. These statistical methods hold promise for new insight in ecology by encouraging thoughtful model building as part of inquiry, providing a unified framework for the empirical analysis of theoretical models, and by facilitating the formal accumulation of evidence bearing on fundamental questions.

Transnational models for regulation of nanotechnology

Like all technologies, nanotechnology will inevitably present risks, whether they result from unintentional effects of otherwise beneficial applications, or from the malevolent misuse of technology. Increasingly, risks from new and emerging technologies are being regulated at the international level, although governments and private experts are only beginning to consider the appropriate international responses to nanotechnology. In this paper, we explore both the potential risks posed by nanotechnology and potential regulatory frameworks that law may impose. In so doing, we also explore the various rationales for international regulation including the potential for cross-boundary harms, sharing of regulatory expertise and resources, controlling protectionism and trade conflicts, avoiding a "race to the bottom" in which governments seek economic advantage through lax regulation, and limiting the "nano divide" between North and South. Finally, we examine some models for international regulation and offer tentative thoughts on the prospects for each.

Nanotechnology: the challenge of regulating known unknowns

Media reports of the health hazards posed by nano-sized particles (NSPs) have turned a white hot spotlight on the risks of nanotechnology. Worried about the risks posed to workers producing nano-materials, the Washington Post has labeled nanotechnology a "seat-of-the-pants occupational health experiment." This article examines our emerging knowledge base about the hazards of two types of exposure: inhalation of NSPs and topical application of products containing NSPs. It argues that a clear-eyed evaluation of the benefits and risks of nanotechnology is made extremely difficult by the marriage of a complex science with a venture capitalist-like hype. It then suggests that, absent additional statutory authority, governmental regulators cannot readily address the risks posed by these products. This regulatory inaction leaves a significant role for the private insurance market, a role that regulators should support in tangible ways outlined in the article.

The Precautionary Principle and Pharmaceutical Risk Management

Although it is often vigorously contested and has several different formulations, the precautionary principle has in recent decades guided environmental policy making in the face of scientific uncertainty. Originating from a criticism of traditional risk assessment, the key element of the precautionary principle is the justification for acting in the face of uncertain knowledge about risks. In the light of its growing invocation in various areas that are related to public health and recently in relation to drug safety issues, this article presents an introductory review of the main elements of the precautionary principle and some arguments conveyed by its advocates and opponents. A comparison of the characteristics of pharmaceutical risk management and environmental policy making (i.e. the setting within which the precautionary principle evolved), indicates that several important differences exist. If believed to be of relevance, in order to avoid arbitrary and unpredictable decision making, both the interpretation and possible application of the precautionary principle need to be adapted to the conditions of pharmaceutical risk management.

Gene therapy in the clinic: whose risks?

Current experience with gene therapy for X-linked severe combined immunodeficiency disorder (X-SCID) suggests that we might now be at the point where it can be considered the 'standard of care'. This therapy carries an unquantified risk of leukaemia, raising important questions for regulators. How dangerous does a potentially curative therapy for a fatal illness need to be before we call it unsafe. How uncertain does a risk need to be for us to regard a therapy as still 'experimental'? Whose interests should prevail? Here I argue that in X-SCID it is the parents and children whom we should listen to first and foremost. How far does this patient-centred approach to licensing therapies extend? Can it be given a rational basis?

The precautionary principle also applies to public health actions

The precautionary principle asserts that the burden of proof for potentially harmful actions by industry or government rests on the assurance of safety and that when there are threats of serious damage, scientific uncertainty must be resolved in favor of prevention. Yet we in public health are sometimes guilty of not adhering to this principle. Examples of actions with unintended negative consequences include the addition of methyl tert-butyl ether to gasoline in the United States to decrease air pollution, the drilling of tube wells in Bangladesh to avoid surface water microbial contamination, and villagewide parenteral antischistosomiasis therapy in Egypt. Each of these actions had unintended negative consequences. Lessons include the importance of multidisciplinary approaches to public health and the value of risk-benefit analysis, of public health surveillance, and of a functioning tort system-all of which contribute to effective precautionary approaches.

The role of toxicology in evaluating priorities in environmental health

It is easy to assume that the straightforward explanation of a rational standpoint, based on sound scientific information, will inform public debate in areas of hazard evaluation. However, although toxicology generally provides the basic data that give reassurance, it is also used as a methodology for hazard identification. Once a hazard has been identified, pressure groups will present data that suit their case and ignore those that do not. Any pretence at analysis is abandoned, as shown by the recent MMR (measles--mumps--rubella) vaccine debate in the UK. Toxicologists should not suppose that comparative evaluations of risk, based on data, will result in a rational choice about environmental interventions -- data are few and opinions are a matter of faith. Thus, we might have to be protagonists in a propaganda war for science if irrational misuse of resources is to be avoided.