August 4, 2015 Over the weekend, the popular philosopher Steven Pinker published an opinion piece in the Boston Globe titled “The moral imperative for bioethics,” which has set off a flurry of blog posts and ripostes about the nature and purpose of bioethical review. In the original piece, Pinker writes that ethics systems governing clinical trials and other forms of biomedical research, when they thwart or delay new studies, have an unspoken ethical cost of their own:

“Some say that it’s simple prudence to pause and consider the long-term implications of research before it rushes headlong into changing the human condition. But this is an illusion… [S]lowing down research has a massive human cost. Even a one-year delay in implementing an effective treatment could spell death, suffering, or disability for millions of people.”

Many readers have taken the piece as an attack on all of bioethics ― perhaps because of unartful wording, or because Pinker did not take the time to enumerate any examples of ethical review he sees as worthwhile. Among the most indignant responses come from Wesley J. Smith at the National Review, and Matthew Beard, an ethicist at the University of New South Wales Canberra, who offers a quick historical overview of how medical ethics emerged as a field, as well as a critique of utilitarianism as a framework for deciding what forms of ethical review are desirable.

Other observers, like Julian Savulescu at Practical Ethics, have taken the opportunity to level more specific criticisms of certain practices and systems in bioethics. Savulescu highlights deaths in clinical trials that followed misguided ethical reviews, but also writes that the ethics review system “fails in another way – by obstructing good research… [H]uge amounts of bureaucracy and red tape delay research and raise it [sic] costs.”

Alice Dreger, a science historian and advocate for justice in medicine, adds a nuanced defense of Pinker and his intentions, in which she considers bioethics as a worthy but sometimes inefficient enterprise. “Steve’s obviously factually wrong about there being ample safeguards,” she writes, responding to one line in Pinker’s piece about the review systems that protect participants in scientific research from harm. But she adds that:

“I guess, in the end, that’s a judgment call based on what you see at a population level as acceptable risk to informed consent and safety. A lot of us (myself included) might set the acceptable level very, very low. Steve seems comfortable where it is. He might change his mind if he did the kind of work Carl [Elliott, of the University of Minnesota’s Center for Bioethics] and I do.”

It seems that ultimately all participants in this conversation would agree there’s an important role for ethical review in any scientific study that will involve human subjects, but the passion stirred up by Pinker’s post is a reminder that there is little consensus on whether current systems go too far or not far enough. As other aspects of clinical research evolve, now might be an appropriate time to reevaluate the institutional reviews, consenting processes, priorities and safeguards involved in setting up new trials with new generations of therapeutics.