Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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academic freedom
- Jacqueline M Atkinson (4 October 2004)
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Welfare of patients and clinicians: academic freedom is vital
- Brenda L. Gallie, David Healy and Nancy Olivieri (28 October 2004)
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Internal mechanisms for Academic Freedom Disputes
- James G Wright, John H. Wedge (4 November 2004)
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Jacqueline M Atkinson, senior lecturer university of glasgow
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Dear Sir Wright and Wedge (2nd Oct) contend that the academic freedom of clinical academics is constrained by the ‘primacy of patient welfare’ and that this puts them in a different position to non-clinical academics. Whilst supporting patient welfare as a constraining influence I would suggest that the position of many other academics is more similar than they may think. Academic freedom can be seen to have two broad aspects: 1) the freedom to research whatever the academic wishes and 2) the freedom to interpret/ draw conclusions based on data free from outside influence. The first ‘freedom’ was lost, at least in Britain, by all academics by the research assessment exercise (RAE). Even academics in disciplines which do not require outside funding, and are not subject to constraints which Alcolado (2nd Oct) points to such as GMC Guidelines, LRECS and hospital R&D committees, (philosophy as an example) will find themselves expected to conform to the research themes of their department. Research which does not, and is seen as peripheral by either the department of the RAE panel will be ignored, leading to side-lining of the academic with consequent impact on employment. It is true, that this research could be pursued outside working hours in a way which other research cannot, but this does not necessarily negate the point of loss of freedom within the academic post. For everyone else the ability to attract funds places limits on the freedom of research whatever one chooses. Again the RAE has an impact – funding from some sources counts more than others do. And virtually all funding is subject to the priorities of the funders, which may or may not be influenced by political interest. The second freedom is arguably the more important. Patient safety may be compromised by inappropriate conclusions being drawn, but this will form part of the scientific debate that is central to all research. And patient safety can be compromised by non-academic clinicians whose practice is compromised by other interests- for example links with the drug industry. All researchers/academics have a duty not to exploit or harm those who participate in their research, or place the public at risk whilst carrying out their research. As Universities move to require ethical approval for all research involving humans (including information on them) this becomes ever more clear. A different issue is the use to which some research is put, whether this is direct research to improve weapons or research which can be used in a variety of ways, including those harmful to the public. Finally there are the issues of competence, unacceptable behaviour and so forth that the authors raise. Arguably all researchers, in any (practical) discipline can only carry out research ethically and safely if they have the appropriate skills so to do. A physicist who lacks the skills to safely use and electron microscope with/should be stopped; a chemist whose substance abuse problems makes them a danger in the lab will/should be stopped; a zoologist whose indifference to the welfare of animal subjects will/should be stopped; and so forth. Unacceptable behaviour, to research participants or other members of the department can lead to complaints and disciplinary action, which might have an impact on research. Medicine’s particular role has meant that ethical guidelines for research have lead other disciplines. Rather than seek to see itself as apart it would maybe more helpful to engage in the wider discussions on ethical research, public safety and the use of research. Jacqueline M Atkinson PhD Public Health and Health Policy 1Lilybank gardens Glasgow G12 *RZ Competing interests: None declared |
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Brenda L. Gallie, Professor University Health Network M5G 2M9, David Healy and Nancy Olivieri
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"Clinicians and patients' welfare: where does academic freedom fit in?"
by JGWright and JHWedge
BMJ2004:329:795-796 _______________________________________________________________________ We commend BMJ for fostering awareness of academic freedom. The answer to Wright and Wedge's question is clear – academic freedom is vital to the welfare of both patients and clinicians. In their introductory scenario, Wright and Wedge illustrate the confusion about academic freedom at the University of Toronto. They say that the academic freedom of a surgeon would be breached if her privileges were withdrawn by the chief of surgery due to concerns about clinical competence. If appropriate processes determined that the surgeon was indeed incompetent, academic freedom would of course be no defense. However, if the processes determined that the surgeon was competent, then a different process would be required to determine if her dismissal constituted a breach of her academic freedom. Wright and Wedge pose their scenario asymmetrically. The question of incompetence might also be directed toward a department chief, whose clinical practices might be seriously out-of-date and whose actions against a younger colleague might not have patient welfare as their primary motivation. The asymmetry is all the more curious in light of two internationally reported cases of denial of academic freedom that occurred at their own University.1 2 In each of these cases, the faculty member expressed his/her scientific opinion that there was potential for harm from a particular drug. The drug in each case was manufactured by a company expected to make large donations to the University and hospitals. The two faculty members were then dismissed or otherwise severely penalized, following accusations of incompetence by their department chiefs. Both faculty members were subsequently vindicated, in one case by independent public inquiries, in the other through actions of drug regulatory agencies in the UK, Canada and the USA. Wright and Wedge imply that academic freedom must be more confined in the clinical setting, where patient safety must come first, than elsewhere on campus. It seems to us that quite the opposite is true: where can freedom to speak out possibly be more important than in the clinical arena? And absolutely the most important places to protect academic freedom must be in university hospitals treating the most vulnerable members of society, such as children and the mentally ill. In fact, academic freedom for all faculty members has always been subject to constraints, such as the common law, codes for handling radioactive material or toxic chemicals and human rights codes, which apply to engineering professors no less than clinical professors. Far from being unappreciated as Wright and Wedge suggest, the responsibilities accompanying academic freedom, such as adhering to accepted norms of scientific integrity and conducting one's work in a safe and ethical manner, are widely accepted. The increasing commercial presence in medical science and education makes vigilance over patient welfare more important than ever.3 It is the individual clinician, guided by ethics and scientific integrity, and having academic freedom, who will disclose to her patients and other clinical scientists the risks of treatment, as happened in the Toronto cases cited above. Wright and Wedge appear uninformed on the nature of employment dispute resolution through arbitral or judicial processes. Those in authority have the power to dismiss, remove privileges or impose other discipline. The affected person may seek review and redress through arbitration or the courts, depending on the context. Although experts may be called to give testimony, the decision is made by an experienced arbitrator or judge who understands due process and relevant law, and has experience in detecting bias and assessing credibility, but typically has no direct expertise in the particular employment or contract situation. The authors propose instead an adjudicative body "with sufficient expertise ... on issues of clinical competence and commitment" to deal with alleged breaches of academic freedom. Issues of competence and commitment are highly susceptible to individual and scientific bias. This is why the technical experts should be the witnesses, for one party or the other, but the adjudicator should be experienced in deciding matters of conflict and bias. The protection afforded by the Wright-Wedge proposal is illusory. ______________________________________ 1. Thompson J, Baird P, Downie J. The Olivieri Report: the complete text of the report of the committee of inquiry commissioned by the Canadian Association of University Teachers. Toronto: James Lorimer & Co., 2001. Involvements of author JHWedge and his two acknowledged advisors WCarter and PSinger are noted in this 570-page report. 2. Healy DI. Conflicting interests in Toronto: anatomy of a controversy at the interface of academia and industry. Perspect Biol Med 2002;45(2):250 -63. 3. Elliott C. Pharma goes to the laundry. Hastings Centre Report 2004;34(5): 18-23. Competing interests: None declared |
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James G Wright, Professor Hospital for Sick Children, John H. Wedge
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We appreciate the comments of Drs. Gallie, Healy and Olivieri who reaffirm several of the important messages of our article. We quote from their letter: 1. "Academic freedom is vital to the welfare of both patients and
clinicians."
A remaining issue is the adjudication of disputes. Judicial processes remain an option when all other avenues have been exhausted. However, short of using judges for every potential dispute, we argued in our article that dispute resolution mechanisms internal to academic health centers should be developed that involve individuals with expertise on issues of clinical competence and commitment and that these processes be completed prior to moving to an external body. Competing interests: None declared |
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