Ever since Galileo used a technical device for his scientific endeavors in astronomy, science and technology have been inextricably fused in a symbiotic relationship that has led to an unprecedented expansion of knowledge and instrumental power. It is not surprising that this development made technoscience increasingly dependent on external circumstances. The freedom of scientific activity, still a cherished goal, has been subject to critical analysis and to the reluctant acceptance that external contingencies can constitute the necessary material support, but also the source of unwanted pressure that modern science must deal with. Science can be understood as pursuing its goals in the wake of side-constraints that have become transcendental to it, that is, they are unavoidable conditions that make science possible. Side-constraints are boundaries within which a scientific goal is pursued.
Since the beginnings of modern science, when limits imposed on science were embodied by the authority of the Church, contingencies have increased due to three factors. One is the already mentioned fusion with technology which, being always an applied activity, must take into account the social environment where it unfolds. A second reason that limits the expansion of technoscience is the growing influence of political, economic, environmental policies. Finally, recent decades have witnessed an increased emphasis of research focused on the life sciences, to the point that one can speak of biotechnoscience as a realm where risks and benefits need to be more critically monitored. Two additional factors that influence the degree of freedom science may enjoy are the internal ethics of professional scientists and the truth validation of scientific knowledge. Scientific explanations will be true if and as long the scientific community accepts them as such (Peirce) and provided they conform to current forms of deliberation and style of thinking (Fleck). Professional ethics of research and the validation of truth claims are intrinsic and therefore unalterable limitations of scientific activity, only to be mentioned in this paper.
Side-constraints that are external to science are contextual in nature and therefore more or less unavoidable; they vary from one society to another and throughout time. It is therefore more than probable that science in affluent societies will show a different pattern of side constraints than Third World nations. Economic constraints limit the amount of material resources available and, perhaps more important, show sponsors to ear-mark their support by requiring the pursuance of specific research topics, e.g., military financing of nanotechnology. Economic constraints become abusive when vested interests dominate and condition their support by imposing a certain line of research and dictating what should be investigated and how research results are to be handled. Closely related to economic side-constraints are those set by pragmatism, represented by the quest to obtain patent-worthy results or to seek knowledge that will make products more attractive to the market. Considering that trials have migrated from universities and research institutes to commercial COMs =commercial research institutions and SMOs= site management organizations, it is hardly surprising that the for profit motive of science becomes predominant. Social discrimination constitutes a third side-constraint, when studies are designed to support preconceived prejudices - the search for a gene of homosexuality - or research arbitrarily selects certain groups or topics, e.g. neglect of female pathology or paucity of studies linking poverty with disease. Social discrimination on a large scale is best illustrated by the fact that some highly damaging epidemics like malaria are receiving little scientific attention, having become part of a group of similarly unattended diseases known as “neglected diseases”. A fourth cluster of side constraints comes from public issues that try to reinforce certain forms of political power, like Nazi Germany`s development of “racial” biology, the search for correlations between race and IQ, or the focus of public health on bioterrorism. Political aims have also influenced scientific activity when competitive factors are at issue: nuclear arms races, development of satellites and space-ships. Ethical evaluation and priority-setting will try to influence research policies towards promising therapeutic lines of investigation or, to the contrary, divert efforts from such research as appears to some extent threatening: cloning, nanotechnology, biological weapons. The Asilomar moratorium on genetic research is an example of ethical constraint. Ethical issues that become ideological lose all credibility, exercising a form of unacceptable censorship, as has been applied to embryonic stem cell research. Any social practice, science included, is abused when limitations are issued on the basis of beliefs that are not universally shared and therefore cannot be imposed. Dogmatic positions are the enemies of scientific freedom, as they are of any other social activity like teaching, the arts or politics.
Although inevitable, side constraints are amenable to negotiation, so that highly qualified scientists and prestigious centers of research may liberate themselves from contextual policies and allowed to determine their own research agenda. By the same token, less developed countries will face limitations not only inherent to scientific activity per se, but also to an exacerbated influence of political, social and economic factors. Poor countries have become the preferred turf of First World sponsors that relocate their research interests in regions where ethical controls are less demanding and research subjects are easier to recruit. The external funding of such studies reflects the interests of sponsors and often leave little or no benefits to local research subjects and communities. Consequently the scientific concerns of neglected host countries must be met by their own research efforts in order to broach local problems and needs. Local science thus comes under an additional side-constraint, namely the need to finance research that is relevant to its society. Criteria of relevance must be applied to set a priority ranking, since resources will only be available for the more immediate and pressing problems. Relevance is a much resisted side-constraint to scientific activities, especially by external sponsors who set their own priorities in oblivion of local host needs. Scientist working in disadvantaged settings will often become accomplices in neglecting the local relevance of their research efforts, focusing as they do in securing grant monies and participating in the quest for prestige and peer recognition obtained by publishing in journals of high impact. Of direct concern to the ethics of research is the opposition to ranking and funding research projects according to relevance because, it is argued, there is no objective way of doing so. The relevance of a project can be gauged in two ways. An investigation can be directly pertinent to a pressing social problem, as exemplified by epidemiological studies in a country plagued by some highly prevalent disease. This is the kind of external relevance that can be readily evaluated and classified as social relevance. On the other hand, when evaluating a research project in the less practical, say archaeology or musicology, relevance can be judged if peer reviewers recognize that a project will be significant in the advancement of the discipline: cognitive relevance. Admitting that this is not a fool-proof approach, it nevertheless can qualify as an attempt to acknowledge that societies have a right to evaluate what is being done with their money, and it brings us back to the essence of science, which is not the impudent curiosity that got Adam thrown out of Paradise, nor the pure admiration for nature that inspired Aristotele, but a strategy to improve man’s adaptation and survival in a world that may not be hostile, but is utterly indifferent to human concerns.
The increasing migration of scientific projects to less developed host countries, raises some ethical questions concerning the recruitment of research subjects, especially considering a number of papers that are suggesting a universal obligation to participate in research programs. Some believe that research aims at the common wealth and ought to be generally supported, to the point that even incompetent human beings are to be recruited as research subjects. Another argument suggest that in nations where citizens enjoy the benefits of a national health system, they are under the moral obligation to participate in research efforts. Harris advocates universal participation based on two arguments: everybody should take part in projects aimed at averting harm and producing benefits. Secondly, since medical advances benefit all those who eventually will need them, it is only fair to collaborate in their development, lest one be at fault as a free-rider. The logic of these arguments has been put to task, and some additional objections arise from the vantage point of disadvantaged populations. Science pursues interests that not necessarily include the common wealth. Such occurrences as the 90:10 divide of resources and research goals, the existence of neglected diseases, the tendency to pursue lucrative patents and “me too” drugs, make evident the predominance of vested interests that cannot claim universal support. Furthermore, research sponsors have been unwilling to share benefits with the individuals and communities that have been instrumental to their research results. If universal participation is expected, it should enjoy the retribution of an equally generalized sharing of benefits.
Coming back to the original title of this round table discussion, “The geopolitics and the future of genetic, regenerative and reproductive medicine, an initial remark is that there is no geopolitics of medicine but rather a geostrategy”. Rather than prospective policies, strategies are short term choices of utilitarian goals, which immediately brings up the question equality, between those that benefit from these goals and those who do not. When medical research and practice seem to aim beyond therapeutics objectives, a semantic analysis is required to either dismiss from the medical realm all non therapeutic aims, or to expand the arena of medical concerns to include such interventions as physiologic or even genetic enhancement: Is enhancement to be seen as genetic medicine? Is sex selection a form of reproductive medicine? Does prolongation of life expectancy belong in the realm of regenerative medicine? If they are medical endeavors, shouldn’t priorities be set regarding the urgency of disease control? If they are scientific non-medical endeavors, shouldn’t the relevance of medical versus non-medical biological interventions be evaluated? Can we neglect the question of relevance if we are confident that science is the answer and that a great number of pressing questions remain unsolved? Unless we hold on to an infinite optimism à la Bacon, expecting science to eventually untangle all the problems that plague mankind and to develop ways of solving them, it will be necessary to continue performing science as usual, that is, pursuing specific interests, and accepting certain unavoidable side-constraints. Ideology should not interfere with science, but stake-holders need to accept that the common wealth is not to be neglected in the name of private interests. Hopefully, they will consider what classical utilitarianism is about, namely, that the best be done for the most.