The Research Imperative

Curse or cure?

Bioethicist Daniel Callahan defines the "research imperative" as the drive to seek knowledge through research, either for its own sake or as a means to some worthy practical end. This coming Monday at the Biotechnology Industry Organization's annual conference in Chicago, he and I will be on a panel discussing whether the research imperative is "a curse or a cure." Callahan gets to damn research as a curse, while I get to celebrate cures.

OK, the title is a bit over the top. After all, even Callahan agrees that biomedical research is a good, but he argues that it needs to be a lower priority than it is today in America.

First, Callahan argues against the notion that biomedical research is a moral imperative. He properly points out that no person has a duty to become a researcher nor to pay for any particular research. If a person chooses to become a painter, a soccer player, an investment banker, a physicist or a journalist, she does not deprive another person of what he or she is in justice due. And if she chooses to spend her money on a house, feeding the poor, or traveling, again, she has deprived no one of what they may reasonably demand of her. Interestingly, while Callahan is correct that no one has a moral duty to do research or pay for it, he implies that people do have a positive moral duty to supply others with goods like education, access to health care, and better housing. The difference? He doesn't really explain.

In any case, it is very clear that Callahan thinks that too much money is being spent on biomedical research in the United States. Why too much? Because most Americans now get to live their three score and ten in relatively good health. That is, unlike their ancestors a century ago, they live long enough to have families, productive careers, pay their taxes and die content. That should be enough.

On the other hand, Callahan does argue that biomedical research to prevent and cure infectious diseases may be close to a moral imperative. Why? Because those diseases cut down young people who have not had a chance for full lives. "To my mind, premature death is something to be worked against," says Callahan. But research on cures for the diseases of old age is less important. "It would be a good thing to cure cancer, heart disease and the like, but it seems to me in terms of social priority, I would want to argue that they have a comparatively low priority," says Callahan. He declares, "I guess to me the fundamental question is, what are the appropriate goals for medicine at this stage in history given the fact that we have already made great progress, given the fact that most people now die in old age, rather than as young people?"

He's right. In modern societies, infectious disease plays a relatively small role in killing off younger people: If all the things that kill people in the United States before age fifty were eliminated, average life expectancy—now 77.6 years—would increase by only three and a half years.

But Americans, by their purchases in the marketplace and their advocacy in the halls of Congress for setting budget priorities, have already answered Callahan's question about the appropriate goals of medicine—full speed ahead with biomedical research! Americans are supportive of research aimed at curing the diseases of old age precisely because more of us get to our golden years. In fact, dying before age 75 is now considered by most Americans to be "premature." Even young people favor research because they realize that they will one day be old, so cures developed for old people now will be available for them when they need them. (Not to mention that some young people may actually like to avoid having their parents and grandparents disappear into the undiscovered country.) Also, spending on biomedical research, both private and public, enjoys widespread public support because health is something we, as members of a liberal pluralist society, can all agree is an essential precondition for anyone to pursue any of the diverse ends they think make for a good life.

Callahan despairs that the more healthy life Americans enjoy, the more we want. He inveighs against this "abolition of fatalism," nostalgically noting, "In the past we reconciled ourselves to aging and death because we could do nothing." He adds, "It seems to me that the whole trajectory of modern medical research has been basically to treat [death] as if it were an accident. As far as I know, there are no fatal diseases that the NIH (National Institutes of Health) finds acceptable. The NIH is not in favor of immortality, at least officially, but there are no diseases that kill people that it is prepared to tolerate."

Sounds about right to me.