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The idea that we have an unlimited moral imperative to pursue medical research is deeply rooted in American society and medicine. In this provocative work, Daniel Callahan exposes the ways in which such a seemingly high and humane ideal can be corrupted and distorted into a harmful practice.
Medical research, with its power to attract money and political support, and its promise of cures for a wide range of medical burdens, has good and bad sides—which are often indistinguishable. In What Price Better Health?, Callahan teases out the distinctions and differences, revealing the difficulties that result when the research imperative is suffused with excessive zeal, adulterated by the profit motive, or used to justify cutting moral corners. Exploring the National Institutes of Health's annual budget, the inflated estimates of health care cost savings that result from research, the high prices charged by drug companies, the use and misuse of human subjects for medical testing, and the controversies surrounding human cloning and stem cell research, Callahan clarifies the fine line between doing good and doing harm in the name of medical progress. His work shows that medical research must be understood in light of other social and economic needs and how even the research imperative, dedicated to the highest human good, has its limits.
- Sales Rank: #2859435 in Books
- Published on: 2006-01-05
- Original language: English
- Number of items: 1
- Dimensions: 9.00" h x .75" w x 6.00" l, 1.01 pounds
- Binding: Paperback
- 341 pages
From The New England Journal of Medicine
This book is one of the most interesting and detailed among recent efforts to examine the history and modern scope of American medical research. It explores the development of policies that govern experimentation involving human subjects, the rise of medical research institutions and funding sources, the place of industry in promoting research and producing its technological offshoots, the role of the federal government in regulating research, and the philosophical, ethical, and policy issues that are raised by the research enterprise. Even if one does not agree with Callahan's view of the problems that the research establishment generates or with his recommendations for how to correct them, he is a splendid teacher who challenges one to think more crisply and deeply about the purpose and future of medical research. In medical circles, the term "research" evokes associations with intellectual accomplishment and social benefit. Although Callahan discusses these goods, his focus is on a darker side of research -- that is, research as it is pursued to excess by its participants and backers out of a belief in its overriding social importance and that damages the worth and influence of other social values and activities. The central premise of this book is that the pursuit of research has been elevated from a moral good to a moral requirement, one that creates what Callahan refers to in his book as "the research imperative." From seeing the advances that research-based medicine has made in combating disease, scientists and society have concluded that relief from illness is not enough, that only the conquest of illness will do, thus opening the way toward an even greater life span and enhanced biologic function. This conclusion is made possible by a persistent and expanding commitment to research. Callahan's prescription for the condition he has diagnosed is comprehensive oversight and setting of priorities for the research enterprise along with limitation of its promise of an unboundedly healthful future. This prescription requires, in essence, that excess be curbed by the creation of limits. For ordinary persons, Callahan counsels acceptance of such limits. For example, he would support research on preserving and restoring health but not on lengthening life -- "there is no social need to greatly extend life expectancy," he writes. For scientists, he counsels restraint -- not pursuing lines of investigation that threaten either important cost barriers or crucial social and moral values. When an enlargement of one aspect of social striving damages other worthy activities, restraint is justified. But appropriately applying this concept to the search for knowledge is procedurally difficult and conceptually murky. When science is not merely extending the content of an established paradigm but crossing its border into new territory, foreknowledge of where the research will lead ranges from uncertain to nonexistent. To forecast, much less govern, fundamental scientific directions is not now possible. And Callahan's approach to governance -- importing methods that deal with costs, benefits, and priorities from disciplines such as technology assessment and experiences such as the Oregon Medicaid rationing program -- is flawed. We have problems comparing and influencing the use of existing forms of technology with these methods. How much more difficult it would be to apply these methods to hypothetical innovations. Yet even if our predictive power with respect to scientific directions were to grow unpredictably (and research on this is needed), to what degree should society encumber its basic drive to discover how the world works? The problem is how to enhance human dignity through restraints, such as those that protect the rights of human research subjects, without damaging the cultural ethos that values transcending the present through the pursuit of knowledge. Callahan's book, as important and provocative as it is, does not resolve this dilemma but furthers the effort to engage with it. Stanley J. Reiser, M.D., Ph.D.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Review
"One of the foremost bioethicists of our age questions the central dogmas of biomedical research, namely that more science necessarily delivers a better life and that aging is a preventable disease. Callahan brilliantly deconstructs the myths behind medical research; his arguments and socratic inquiry will shake your complacency as it did my own."
From the Inside Flap
"This book is of special importance. Callahan brings together in one volume the history of biomedical research in the U.S., a discussion of the goals, process, and conduct of biomedical research, and a compelling proposal for reforming the balance between research and public health policies."--Dorothy Rice, coauthor of The Dynamics of Disability: Measuring and Monitoring Disability for Social Security Programs
"One of the foremost bioethicists of our age questions the central dogmas of biomedical research, namely that more science necessarily delivers a better life and that aging is a preventable disease. Callahan brilliantly deconstructs the myths behind medical research; his arguments and socratic inquiry will shake your complacency as it did my own."—Sheldon Krimsky, author of Science in the Private Interest
"This book is the fruit of many years of reflection by one who has been at the center of the bioethics movement in this country. Managing to be simultaneously readable and knowledgeable, Callahan has also not been afraid to be provocative. His book will be required reading for all who want to ponder the ethics of research."—Gilbert Meilaender, author of Body, Soul and Bioethics
Most helpful customer reviews
4 of 11 people found the following review helpful.
Corporate greed is the greater danger to healthcare
By A Customer
While Author Callahan's book highlights a critique of what could be termed the "politically correct" pursuit of research, there is a greater danger here that deserves more attention. Corporations are driving the research for pharmaceuticals and treatments that will maximize their stock price. Far more is compromised when healthcare is driven by profit than by excessive altruism.
Without doubt the healthcare system of the US is in great trouble. I just don't think Callahan has found the source of the biggest problem.
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