President Obama’s Ebola ethics dilemma is merely a headline — a critical case that illustrates a much broader problem with medical research and particularly vaccine development in the United States and worldwide. One of the choices that we have made as a nation is to pursue a market economy in nearly all sectors. One of the realities of that choice is that the market does not support the underdog — the few who lack critical resources to react to threatening environmental changes. As a result, when we rely on a market-based system to drive medical research that may not be profitable in the short term or even medium term, that system is unlikely to respond to potential future threats — no matter how high the potential cost — if there is not a reasonable promise of economic return in the end. As many scholars have noted in the past, the system is designed to yield a flood of drugs to treat high cholesterol and erectile dysfunction, but barely a trickle of vaccines for rare but deadly viruses. This Ebola case is not altogether different from the case of research for a vaccine for AIDS, documented so nicely by Jon Cohen in his 2001 book Shots in the Dark: The Wayward Search for an AIDS Vaccine.
I suggest that the real ethical dilemma here is not whether to fast-track approval and production of the Ebola treatment that has been used experimentally, but whether medical research should be funded by a predominantly market-driven system with the work of critical drug discovery left to the underfunded public sector. Yes, we have the National Institutes of Health (NIH) and a few other federal research systems in place to fund critical research that might not fare well in the market system. But as we have seen with the AIDS vaccine, and indeed with an Ebola vaccine, the federal research machine — the only vehicle we have at present to investigate science without a near-term promise of profit — cannot possibly support the volume of inquiry that is necessary to unlock vaccine secrets for challenging emerging viruses.
{mosads}Moreover, time and again we have witnessed the exponential success of collaboration in leading to scientific discovery in pharmaceuticals, energy and nearly every other sector. It seems, then, that the ethical dilemma is really not about this particular Ebola drug, but around our entire drug discovery program. It is ethically unjust that our drug discovery system relies on limited lab resources at the NIH for critical molecular discovery. It is ethically unjust that a market-driven system requires deep levels of secrecy among researchers in the private sector for patent protection of potentially life-saving therapies that may never realize life-saving potential without the opportunity for meaningful collaboration. It is ethically unjust that the vast majority of ideas for molecular development go unexplored because our current system is not designed to support innovative thinkers outside of the established system. And it is ethically unjust that this system has arisen without the deliberative input of the public that stands to benefit from scientific success — or lose from scientific inertia.
When President Obama suggested that we let science be a guide for decision-making, I could not agree more. But I qualify my agreement by understanding science to mean a collaborative system that encourages idea sharing, wide exploration for discovery, and meaningful deliberative involvement of the public to ensure that science remains a public good, in a system that provides the best possible opportunity for science to yield good for the public.
Ross, DNP, is a nurse practitioner in cardiac electrophysiology at Arizona Arrhythmia Consultants and a faculty member at Arizona State University. She teaches in the Doctor of Nursing Practice program, as well as the Master’s in Science and Technology Policy program. In addition to faculty responsibilities, she is also a Ph.D. student in Human and Social Dimensions of Science and Technology, where she studies complex healthcare systems and the social construction of new therapeutic technologies.