Ethical reasoning and epidemiological studies

Medical research scientists in public health and other areas routinely make ethical value judgments, even if they're not aware of it, according to a new Weill Cornell Medical College research study.

And not only do these judgments not lead to bias necessarily, but they can make for better research.

Published in the current issue of European Journal of Epidemiology, the paper finds that the framing of the research question, identification of the problem, as well as the design and methodology of the study are all subject to value judgments by investigators.

To illustrate this point, the study focuses on how value judgments are made in epidemiological research of racial health disparities.

"Epidemiologists must endorse particular public policy aims of the research in order to make methodological decisions throughout the research process. In the case of research into racial disparities, the researcher decides how to define race -- whether by genetic markers or by census data. Both definitions are valid on their own, but in deciding which one to use, the scientist makes value assumptions about which would best promote the social aims of the research, such as eliminating racial disparities," says Dr. Inmaculada de Melo-Martín, the study's co-author and associate professor in the Division of Medical Ethics in the Department of Public Health at Weill Cornell Medical College.

"Also, scientists make value judgments in deciding which areas of research to pursue. For example, if the recommendations likely to result from additional genetic research are already part of standard medical practice, or if the new drugs resulting from genetic research would likely be too expensive for minority groups, then genetic research may not be the most effective way of trying to decrease racial health disparities," notes Dr. de Melo-Martín.

"In fact, many medical research scientists make these value judgments without being aware of it -- while at the same time wrongly believing any such value-laden decisions automatically lead to bias. In order to change this misperception, we recommend that training in epidemiology and other fields offer some instruction related to the ethical and social dimensions of research," adds Dr. de Melo-Martín.

"The paper makes a compelling argument for integrating ethical reasoning into epidemiological studies in order to make explicit the value judgments that can distort analysis," says Dr. Joseph J. Fins, chief of the division of medical ethics and professor of medicine and public health at Weill Cornell Medical College.

The study was co-authored by Dr. Kristen K. Intemann of Montana State University in Bozeman, Mont.

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