Bioethics Crisis Looms Unless NIH Changes Course, Critics Warn

By RICHARD MONASTERSKY

The nation is adrift when it comes to the academic field of bioethics,
according to two prominent medical officials, who call on the National
Institutes of Health to chart a strategic plan for training more
people in that area and for conducting more research into ethical
aspects of medicine.

The dearth of leadership and support for that work erodes public trust
in government-supported medical-research programs, which pour billions
of dollars into academic medical centers, according to the officials,
who published two separate commentaries in the June issue of Academic
Medicine.

In response to those essays, Raynard S. Kington, deputy director of
the NIH, told The Chronicle on Tuesday that "we recognize that this is
important for the whole biomedical-research enterprise, and we need to
strengthen our support for bioethics training and research." He said
the agency was studying the issue.

The public criticism of the NIH comes from one current and one former
official there: Ezekiel Emanuel, chair of the department of bioethics
at the NIH, and Judith A. Salerno, executive officer of the Institute
of Medicine, who was until December the deputy director of the
National Institute on Aging, part of the NIH.

Younger Bioethicists Needed

In his commentary, Dr. Emanuel wrote that at the NIH, "overall support
of bioethics can be described as small, if not minuscule." He also
charged that "there is no strategic plan for supporting bioethics at
the NIH."

With many leading bioethicists nearing retirement age, the
insufficient support for training new researchers will leave many
academic medical centers scrambling to find qualified experts in that
field, he said. From 1998 to 2003, the NIH provided grants to 19 young
scientists for work in bioethics. That number will need to increase by
a factor of at least five to keep up with demand, Dr. Emanuel wrote.

In an interview, he said, "We need a strategic plan to develop
bioethicists. We need to commit ourselves to doing something about
bioethics in a sustained way—not just here today, gone tomorrow."

The nation should also increase its support for research on bioethical
topics like how to improve informed-consent procedures and whether
research subjects should be paid, he said.

A 'Crazy Quilt of Programs'

In her commentary, Dr. Salerno calls on the NIH to provide leadership
"by developing a national agenda for bioethics training and research."
Now, she said, there is a "crazy quilt of programs and courses in
bioethics."

Because of the legacy of the Tuskegee Syphilis Study and other
biomedical scandals, there is considerable public mistrust of clinical
research, Dr. Salerno said in an interview. "Every time there is some
problem involving a human subject in research, we lose ground with the
public," she said. Strengthening scholarship and training in bioethics
will help reassure the public about biomedical research, she said.

Other bioethicists agreed with the assessments by Dr. Salerno and Dr.
Emanuel.

Jeremy Sugarman, a professor of bioethics and medicine at the Johns
Hopkins University, said, "There is a clear need for additional
funding mechanisms to do basic research and training in bioethics."

James M. Dubois, a professor of health-care ethics at Saint Louis
University, said, "There are very few bioethicists who are well
trained in social-science methodologies and can gather the kind of
data that is really needed to inform bioethical discussions."

Dr. Kington, of the NIH, said the agency was forming an agencywide
working group to develop recommendations concerning research and
training. The coordination effort may not result in more support,
however. "We have to identify what the gaps are," he said. "We're not
starting with the premise that we need more money."