The President of the 5,500 member American Medical Writers Association (AMWA) wrote a letter to the editor of the New York Times yesterday addressing the ethics raised by Merck’s suspected use of ghostwriters saying

While ghostwriting (the undisclosed contribution of a medical writer) is unethical in scientific publications, the use of professional medical writers may be appropriate and ethical.

Medical Writers’ Ethics - New York Times

I looked at the AMWA’s online code of ethics. It’s not bad. First, it exists. Second it is short. But unfortunately it is not always clear and confuses ethical and prudential issues.

For example, it doesn’t identify ghostwriting as unethical as far as I can tell. The closest it comes is saying that medical writers “should refuse to participate in assignments that require unethical or questionable practices.” and that “Biomedical communicators should expect and accept fair and reasonable remuneration and acknowledgment for their services.” You might be able to infer that undisclosed contributions are a violation, but it is not clear to me.

Some of the other principles are even more vague.

Principle 8, says “Biomedical communicators should consider their membership in AMWA an honor and a trust.” How would someone know if they were giving enough consideration?

Principle 5 says “Biomedical communicators should expand and perfect their professional knowledge and communications skills.” Suppose a member does nothing to expand their professional knowledge this year. Would they be in violation of this ethic? Would they be acting unethically? Prudentially, learning and skills development are good ideas, but this would not be an ethic (a matter of right and wrong) in my book.

The real harm in a vague code that includes prudential issues is that it turns ethical analysis into situational judgment calls. Useful ethical codes provide clear guidance for ethically sensitive situations. They should represent deep thinking about the important issues prior to them occurring to ease the burden of thinking when applying them. They should give members/employees the clear support they need to push back when faced with pressures to do the wrong thing. The AMWA code could do better. Makes me wonder if the Merck ghostwriters were members of the AMWA?

Blogged with the Flock Browser

Tags: codeof ethics, merck vioxx ethics, ghostwriting, clint korver, ethics for the real world

In Pope Benedict’s address to President George w. Bush at the White House yesterday he presented his ideas on how people should think about ethically sensitive decisions.

“As the nation faces the increasingly complex political and ethical issues of our time, I am confident that the American people will find in their religious beliefs a precious source of insight and an inspiration to pursue reasoned, responsible and respectful dialogue in the effort to build a more humane and free society.”

Base decisions on moral principles, pope says - Yahoo! News

Besides agreeing with his basic premise, I find two additional things remarkable. First, he doesn’t say those religious beliefs must be Cathloic or even Christian. All major religions agree that you should not lie, steal, or hurt innocent people. These are all good places to start in thinking about an ethical decision.

Second, he doesn’t claim that religion should be the only ethical touchstone. He only claims it is an important one. He leaves the door open for other ethical touchstones, which I believe is appropriate given all of the other important influences in our lives.

Tags: ethics, Pope Benedict, ethical decision making, touchstones

Moralization is the process of wanting to enforce your ethics to others. For example, most people feel that rape and murder are immoral acts and should be punished. Our society codifies moralizations such as these through our legal system. Our collective sense of right and wrong bind us together as a community. Unfortunately, our collective inner voices are not always reliable.

Psychologists, such as Steven Pinker from Harvard, have recently discovered that moralization invokes a unique psychological state compared to simply having an opinion. According to his article The Moral Instinct in the New York Times cognitive scientists at Princeton have used an M.R.I. to show that different parts of a person’s brain lights up when they engage in moralization.

What triggers the frontal lobe to begin to moralize is still under investigation. According to anthropologists like Richard Shweder and Alan Fiske, who survey moral concerns across many cultures, common triggers include harm, fiarness, community (or group loyalty), authority and purity.

The punch line in Professor Pinker’s article is that moral sense (our inner voice if you will), can be mislead. It shows how

… our psychological makeup can get in the way of our arriving at the most defensible moral conclusions. The moral sense, we are learning, is as vulnerable to illusions as the other senses. It is apt to confuse morality per se with purity, status and conformity. It tends to reframe practical problems as moral crusades and thus see their solution in punitive aggression. It imposes taboos that make certain ideas indiscussible. And it has the nasty habit of always putting the self on the side of the angels.

The Moral Instinct - New York Times

He sites numerous examples where people have strong moralization feelings about sex, government, commerce, religion, diet and others that they are not able to explain. They just know. They know because the idea makes them shudder. This is a dangerous measure of morality.

People have shuddered at all kinds of morally irrelevant violations of purity in their culture: touching an untouchable, drinking from the same water fountain as a Negro, allowing Jewish blood to mix with Aryan blood, tolerating sodomy between consenting men. And if our ancestors’ repugnance had carried the day, we never would have had autopsies, vaccinations, blood transfusions, artificial insemination, organ transplants and in vitro fertilization, all of which were denounced as immoral when they were new.

The Moral Instinct - New York Times

Bottom line — our inner voice is not sufficient for developing our personal ethical code. It is the place to start, but it must be tempered by the wisdom of our ethical role models and sound reasoning.

Tags: ethicalcode, morals, ethics, Steven Pinker, inner voice, moralization