The coronavirus pandemic reopens the debate about the ethics of experimentation
The shutdown of nonessential businesses could cost the US economy nearly $6 trillion per year of shutdown, according to new analysis. Consequently, health and business sector innovation that allows a return to normality will yield potentially massive returns. This forces us to reconsider the legal and ethical barriers that society places on innovation.
Once upon a time, scientists could treat the world as their petri dish, resulting in distinctly unethical experiments. Sometimes, the intention was good, such as when 18th century surgeon James Lind experimented on how to treat scurvy-afflicted sailors in the British navy, without adhering to modern-informed consent protocols. Other times, the research was entirely nefarious, such as when British military scientists exposed Indian and British soldiers to mustard gas in the run up to World War II to evaluate the chemical weapon for use against Japan.
Similar episodes led to the first issuance of international guidance on the ethics of medical research involving subjects – the 1947 Nuremberg Code. There have been many subsequent revisions regarding what sorts of experiments society is willing to tolerate. Over the last 30 years, the rules have stabilized, and scholars conducting research on human subjects, more or less, are aware of red lines regarding experiment design. Institutional review boards within research institutions, backed by strong government oversight, and a legal system that allows civil lawsuits ensure that scholars largely respect those red lines.
The coronavirus threatens to change the calculus. The above estimates of the economic damage caused by the lockdown—taken from a new study by University of Chicago professor Casey Mulligan—are eye-watering. Moreover, since these figures are averages, they understate the total damage; in practice, since the effects of the coronavirus are uneven—some people lose their job and income, while others do not—the government is forced to increase social insurance, leading to higher levels of future taxation, exacerbating the economic pain. These factors push the net impact up to $7 trillion per year, equal to $15,000 per household per quarter, according to Mulligan’s analysis.
In light of the stakes, the world’s greatest medical minds are assiduously looking for treatments, cures, and vaccines. Moreover, even those working outside the medical domain are trying to innovate. This can be as simple as designing masks that are attractive enough for people to want to wear them, or as complex as advanced contact tracing apps that collect data in a manner that protects people’s privacy.
The problem that Mulligan identifies is that many of the protections we have in place for human subjects are formulated in a non-crisis environment, whereas we are now in one of the biggest crises in the last century. The US Food and Drug Administration, the primary body that regulates new drugs, has certain emergency measures in place, but they allow far less flexibility than in other countries, where experimental treatments have yielded some success.
Moreover, the lockdown itself is preventing significant amounts of experimentation by businesses. For example, airlines will be in a much better position to gauge the effectiveness of different air filtration systems or seating arrangements in combating the spread of the disease if they are actually able to fly and test them. However, most fleets are grounded as their prospective passengers are banned from traveling.
The key feature of ethical experimentation is informed consent—those taking part do so voluntarily, based on reasonably accurate information regarding the goals of the study, the likely consequences, and the available alternatives. The large costs of the current crisis do not justify a relaxation of informed consent. However, they should make us reconsider the constraints that we place on research conducted on those willing to provide informed consent.
For example, we have a lot of data on which characteristics make someone likely to survive the coronavirus. Among those who have negligibly small risks of death, there are some who would quite happily try experimental vaccines, or willingly contract the disease, either in exchange for a material benefit, or simply as a service to society. They would be willing to fly in an airplane or dine in a restaurant to provide data on transmission.
Yet rules and regulations largely prevent such experiments. Perhaps now is the right time to relax such constraints, both the legal ones in the form or regulations, and the ethical ones taking the form of admonishing and defenestrating the scholars and subjects who take part in such trials.
At the heart of the issue is a belief in the potential of human innovation on the one hand, and, on the other hand, an appreciation of the great hardship that many are facing at present—and are likely to face for the coming years—because of the catastrophic economic fallout. Voltaire indirectly expressed these sentiments when he quipped: “Our wretched species is so made that those who walk on the well-trodden path always throw stones at those who are showing a new road.”
Omar Al-Ubaydli (@omareconomics) is a researcher at Derasat, Bahrain.