WINSTON-SALEM, N.C. – The faked work of the Korean stem cell scientists, the shading of the truth in laboratory analyses that make results seem better than they are or withholding data that raises questions about a blockbuster drug are among the challenges to be confronted in an ethics course being developed at Wake Forest University School of Medicine.
The new course for graduate students at the medical school, nearly all of whom are destined for careers in research, will begin in late summer, 2006.
“New ethical situations face us that did not exist a few short years ago,” said Charles Eldridge, Ph. D., professor of physiology and pharmacology and one of the course directors.
He said that while educational programs have been created to teach the responsible conduct of research, “a major void for our students has been is the lack of discussion and deliberations about the underlying ethical and social controversies within science and engineering.”
Creation of the ethics course is being funded by a three-year, $200,000 grant from the National Science Foundation (NSF), one of five approved nationwide. The project’s co-director is Nancy Jones, Ph.D., associate professor of pathology, who also serves on an 11-member Advisory Committee on Human Research Protection for the U.S. Department of Health and Human Services.
The course will use problem-based learning, a method pioneered at Wake Forest, in which the students work in small groups studying cases under the guidance of faculty facilitators.
“As a teacher, we find that the case-study method works really well, and in fact works better than the traditional standup lecture because cases are more realistic and compelling,” said Eldridge. “We have to show these young people that they are entering a world of not just complex technology, but also of challenging ethical and social decisions – and consequences.”
Each case will use a “real world” example. While some may pose easily recognized conflicts, such as altering results, others will include more subtle decisions, such as how much to reveal in a research grant application. The course will also include before and after tests “not only on their knowledge of the rules, but their attitudes about the rules and about science and society,” he said.
“There are two things in ethics: knowing the rules and living with the rules.”
For instance, he said, all drugs have side effects. Some side effects may be known before release of a drug, yet others don’t turn up until many thousands of people have taken the drug, and some may not show up for many years. Some manufacturers make a point of describing known side effects, while others downplay or even conceal some side effects.
Because many graduate students will pursue careers with pharmaceutical companies, a case might place students in the role of scientific advisor to the president of a major pharmaceutical company. “You have found that perhaps two in a million people could die from the side effects of this drug. And yet it is a drug that could save thousands of other lives. What do you say to the president?”
One good example he cited is the case of Viagra, where the manufacturer emphasized early the possibility that certain individuals with heart problems “could be at real risk from this drug.” The manufacturer, Pfizer Inc., was forthright about the problems and yet still had a blockbuster drug. “They didn’t hide the potential risks.”
“On the other hand is the Vioxx situation. Our students need to recognize how ethics can trump science and that poor ethical decisions can actually restrain progress in health care.”
Another problem area is plagiarism. “Everybody would say that plagiarism of another person’s work is wrong, but what about plagiarizing yourself? You write a lot of papers and you’re preaching the same basic sermon many times, so is it OK to lift your own words from one paper and put them in another?”
Eldridge said the overall goal of the course is to teach graduate students, most of whom are candidates for doctoral degrees, “how to recognize ethical issues within science and engineering and to use sound ethical reasoning to address these issues throughout their careers.”
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Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university’s School of Medicine. U.S. News & World Report ranks Wake Forest University School of Medicine 30th in primary care, 41st in research and 14th in geriatrics training among the nation's medical schools. It ranks 32nd in research funding by the National Institutes of Health. Almost 150 members of the medical school faculty are listed in Best Doctors in America.