16 October 1997 Volume 389 Issue no 6652

T rust and the bioethics industry

Radical developments in biology often appear to represent new conflicts with moral principles. Such perceptions are frequently misconceived, but independent consideration of ethical implications is beneficial.

here has been something both reassuring and disturbing about the conviction with which the leaders of virtually every advanced industrialized nation have taken a strong public stance against the cloning of human beings, reflected most recently in last weekends statement from the summit meeting of the 40 member states of the Council of Europe (see page 656). The reassuring part has been their desire to confirm a commitment to human values that could, at least in theory, be challenged by the unrestrained application of certain biomedical advances. The disturbing aspect is the extent to which an eagerness to grab the moral high ground risks short-circuiting two important debates: about the many positive aspects of the science involved, and about the most effective ways of integrating public concern into a viable science policy. One interpretation of the anti-cloning warnings of individuals ranging from US President Bill Clinton to Federico Mayor, the director-general of Unesco, is that they reflect a growing global distrust of the religious, political and scientific institutions traditionally responsible for addressing moral and ethical issues. Further evidence for this comes from the rapid rise of the professional discipline of bioethics. Until recently restricted to debates on the activities of the medical profession, this has since established itself as a new and influential expression of public concern about the many ways in which modern genetics and related fields will impinge on our lives (see pages 658663). There is, of course, a danger in overreacting to public concerns, particularly when these may be little more than off-the-cuff responses to an unexpected development such as the announcement of the cloning of Dolly the sheep. Excessively rigid legislation could stifle potentially important research with beneficial implications; such was the message of members of the Federation of American Societies of Experimental Biology, who recently volunteered to accept a moratorium on human cloning as such. And others, such as those opposed in principle to abortion or animal experiments, may seek to exploit the concern for their own dogmatic ends.

But there is also a danger of another kind, namely that politicians and others may be tempted to resort to traditional institutional remedies, such as expert advisory panels and tough-sounding legislation, without recognizing the extent to which these are no longer sufficient to secure public trust. One of the key lessons to emerge from recent debates about social risk is that trust cannot be assumed to be created by reassurance from on high or by quoting the conclusions of scientific experts. Rather, it is created through a complex set of social interactions with participants ranging from laboratory researchers to journalists whose outcome no single authority is in a position to determine or control. This shift has important implications for the way in which we measure, represent and seek to manage risks, from human cloning to AIDS. The traditional sciences still have a critical role to play in establishing some of the parameters in such debates; solutions based on a misinterpretation of experimental evidence are almost bound to fail. But the process of risk management, as a report published earlier this year by the US National Academy of Sciences points out, is not a linear one built on scientific arguments, but a complex, iterative process in which many actors and disciplines must be involved. Where does bioethics fit in? It would be as wrong to look on bioethics as a source of answers to difficult social questions as it would be to pretend that such answers will emerge from a purely scientific analysis or technical risk assessment. But, as our survey highlights, bioethicists do have several important functions. One is to provide a vehicle for analysis away from the spotlight of immediate political pressure claims by scientists that a particular development, representing significant new power to manipulate nature, in itself carries no new ethical implications require independent scrutiny. A second is to formulate questions and concerns as a result of this analysis in a language that can, in parallel with scientific arguments, be integrated into the policy-making process. In doing so, bioethics can, perhaps most importantly, help to forge a new, democratic discourse about science in which the voices of all have their appropriate place.

Vaccines at risk
An imaginative attempt to tap Asian resources for the benefit of the developing world deserves more support.

adly, the developed world seems to be so unwilling to donate money to the prevention of disease in the developing world that backers of two worthy initiatives to develop vaccines for children may end up fighting over the same small pot of funds (see page 655). Promoters of the International Vaccine Institute in Seoul, who realized that there is new money in the (until recently) booming economies of Asia, have succeeded in winning substantial Korean government support for the institutes construction and 30 per cent of its running costs. But some officials of the World Health Organization (WHO) are concerned that, in pursuing the remaining $10 million or so a year that will be needed to run it, the new institute may eat into the small $30-million pie of the WHO-backed Childrens Vaccine Initia-

tive which is itself responsible for the institute. Both initiatives seek to provide vaccines to prevent disease in children with, in the case of the Seoul institute, a focus on the developing world, and in particular Asia. Is the world so poor it cannot afford the $40 million required to support both initiatives? There were some understandable but misguided concerns that the institute was a Korean attempt to tap into Western vaccine technology for the benefit of Korean industry. But the establishment of a distinguished international board of trustees to oversee the institute and a clear statement that it will not engage in the sale of vaccines should dispel such fears. The developed world, including Japan and the United States, should chip in with support.
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NATURE | VOL 389 | 16 OCTOBER 1997