What do cancer researchers owe cancer patients?

As promised, today I'm returning to this essay (PDF) by Scott E. Kern about the sorry state of cancer researchers at Johns Hopkins to consider the assumptions he seems to be making about what cancer patients can demand from researchers (or any other members of society), and on what basis.

Let's review the paragraph of Kern's essay that dropped his framing of the ethical issue like an anvil:

During the survey period, off-site laypersons offer comments on my observations. “Don’t the people with families have a right to a career in cancer research also?” I choose not to answer. How would I? Do the patients have a duty to provide this “right”, perhaps by entering suspended animation? Should I note that examining other measures of passion, such as breadth of reading and fund of knowledge, may raise the same concern and that “time” is likely only a surrogate measure? Should I note that productive scientists with adorable family lives may have “earned” their positions rather than acquiring them as a “right”? Which of the other professions can adopt a country-club mentality, restricting their activities largely to a 35–40 hour week? Don’t people with families have a right to be police? Lawyers? Astronauts? Entrepreneurs?

There's a bit of weirdness here that I will note and then set aside, namely formulating the question as one of whether people with families have a right to a career in cancer research, rather than whether cancer researchers have a right to have families (or any other parts of their lives that exist beyond their careers).

Framing it this way, it's hard not to suspect that Kern is the guy on the search committee who is poised to torpedo the job application of any researcher with the temerity to show any evidence of a life that might need balancing with work -- the guy on the search committee who is open about wanting to hire workaholics who have no place else to go but the lab and thus can be expected to yield a higher research output for the same salary. Talented applicants with families (or aspirations to have them), or even hobbies, are a bad risk to a guy like this. And besides, if they need that other stuff too, how serious can they be about research?

If Hopkins has a policy of screening out applicants for research positions on the basis that they have families, or hobbies, or interests that they intend to pursue beyond their work duties, I'm sure that they make this policy clear in their job advertisements. Surely, this would be the sort of information a university would want to share with job seekers.

For our discussion here, let's start with what I take to be the less odd formulation of the question: Do cancer researchers have a right to a life outside of work?

Kern's suggestion is that this "right," when exercised by researchers, is something that cancer patients end up paying for with their lives (unless they go into suspended animation while cancer researchers are spending time with their families or puttering around their gardens).

The big question, then, is what the researcher's obligations are to the cancer patient -- or to society in general.

For that matter, what are society's obligations to the cancer patient? What are society's obligations to researchers? And what are the cancer patient's obligations in all of this?

I've written before about the assertion that scientists are morally obligated to practice science (including conducting research). I'll quote some of the big reasons offered to bolster this assertion from my earlier post:

  • society has paid for the training the scientists have received (through federal funding of research projects, training programs, etc.)
  • society has pressing needs that can best (only?) be addressed if scientific research is conducted
  • those few members of society who have specialized skills that are needed to address particular societal needs have a duty to use those skills to address those needs (i.e., if you can do research and most other people can’t, then to the extent that society as a whole needs the research that you can do, you ought to do it)

Needless to say, finding cures and treatments for cancer would be among those societal needs.

This is the whole Spider Man thing: with great power comes great responsibility, and scientific researchers have great power. If cancer researchers won't help find cures and treatments for cancer, who else can?

Here, I think we should pause to note that there may well be an ethically relevant difference between offering help and doing everything you possibly can. It's one thing to donate a hundred bucks to charity and quite another to give all your money and sell all your worldly goods in order to donate the proceeds. It's a different thing for a healthy person to donate one kidney than to donate both kidneys plus the heart and lungs.

In other words, there is help you can provide, but there seems also to be a level of help that it would be wrong for anyone else to demand of you.*

And once we recognize that such a line exists, I think we have to recognize that the needs of cancer patients do not -- and should not -- trump every other interest of other individuals or of society as a whole. If a cancer patient cannot lay claim to the heart and lungs of a cancer researcher, then neither can that cancer patient lay claim to every moment of a cancer researcher's time.

Indeed, in this argument of duties that spring from ability, it seems fair to ask why it is not the responsibility of everyone who might get cancer to train as a cancer researcher and contribute to the search for a cure. Why should tuning out in high school science classes, or deciding to pursue a degree in engineering or business or literature, excuse one from responsibility here? (And imagine how hard it's going to be to get kids to study for their AP Chemistry or AP Biology classes when word gets out that their success is setting them up for a career where they ought never to take a day off, go to the beach, or cultivate friendships outside the workplace. Nerds can connect the dots.)

Surely anyone willing to argue that cancer researchers owe it to cancer patients to work the kind of hours Kern seems to think would be appropriate ought to be asking what cancer patients -- and the precancerous -- owe here.

Does Kern think researchers owe all their waking hours to the task because there are so few of them who can do this research? Reports from job seekers over the past several years suggest that there are plenty of other trained scientists who could do this research but have not secured employment as cancer researchers. Some may be employed in other research fields. Others, despite their best efforts, may not have secured research positions at all. What are their obligations here? Ought those employed in other research areas to abandon their current research to work on cancer, departments and funders be damned? Ought those who are not employed in a research field to be conducting their own cancer research anyway, without benefit of institution or facilities, research funding or remuneration?

Why would we feel scientific research skills, in particular, should make the individuals who have them so subject to the needs of others, even to the exclusion of their own needs?

Verily, if scientific researchers and the special skills they have are so very vital to providing for the needs of other members of society -- vital enough that people like Kern feel it's appropriate to harangue them for wanting any time out of the lab -- doesn't society owe it to its members to give researchers every resource they need for the task? Maybe even to create conditions in which everyone with the talent and skills to solve the scientific problems society wants solved can apply those skills and talents -- and live a reasonably satisfying life while doing so?

My hunch is that most cancer patients would actually be less likely than Kern to regard cancer researchers as of merely instrumental value. I'm inclined to think that someone fighting a potentially life-threatening disease would be reluctant to deny someone else the opportunity to spend time with loved ones or to savor an experience that makes life worth living. To the extent that cancer researchers do sacrifice some aspects of the rest of their life to make progress on their work, I reckon most cancer patients appreciate these sacrifices. If more is needed for cancer patients, it seems reasonable to place this burden on society as a whole -- teeming with potential cancer patients and their relatives and friends -- to enable more (and more effective) cancer research to go on without enslaving the people qualified to conduct it, or writing off their interests in their own human flourishing.

Kern might spend some time talking with cancer patients about what they value in their lives -- maybe even using this to help him extrapolate some of the things his fellow researchers might value in their lives -- rather than just using them to prop up his appeal to pity.

*Possibly there is also a level of help that it would be wrong for you to provide because it harms you in a fundamental and/or irreparable way.

12 responses so far

  • I work in a clinical cancer center, so while I do spend most of my time locked away in the lab, I do have a bit of exposure to actual live cancer patients. Several years ago, I was in an elevator full of said cancer patients at 4:30pm on a Friday. Noticing the ID badge that I am required to wear says "GRADUATE MEDICAL STUDENT" across it, a woman asked if I was a medical student. I corrected her that I am a graduate student in the department of oncology, and she started ranting about how dare I go home on a Friday afternoon while her sister is dying of cancer in the hospital.

    Much to my surprise, the others on the elevator -- family members of patients and patients themselves -- all started defending me, discussing how everyone is entitled to time off, and thanking me for all the work I do helping others with cancer. My experience with the majority of cancer patients, and my own opinion as a cancer survivor myself, is that researchers should never be expected to sacrifice their own life for the sake of research.

  • The vacuity of Kern's dumshit position is even more starkly emphasized if you consider what ethical duty those who *aren't* currently cancer researchers owe to cancer patients. Is every scientist who doesn't study cancer failing to fulfill an obligation to cancer patients by having chosen to study something else? Is the fucken garbage man failing to fulfill an obligation to cancer patients by not having become a cancer researcher instead of a garbage man? Heart disease kills more people than cancer. Is every cancer researcher actually a horrible ethically bankrupt asshole for not being a heart disease researcher instead?

  • Janne says:

    Science is a job. It's a rewarding, fulfilling job, true, but a job. If it wasn't, then you would not need to pay people to do it*. And like any job we have a set of agreements between the one who works and the one that funds the work, including legal frameworks (maternity leave, mandatory vacation days, maximum work hours and so on), the employment contract and local rules. None of those agreements say that you need to devote your life to your work. In fact, if any of them explicitly said that, you'd get a serious drop in qualified applicants together with a fun and rewarding increase in legal suits. That just leaves a moral dimension.

    But there is no moral dimension to consider here, really. As you point out, there's plenty of qualified people out there not able to find employment in cancer research as it is. If cancer research really is a moral imperative then I'm sure all necessary money to hire three shifts of researchers will be forthcoming from doctor Kern. After all, asking people to work around the clock is plainly illegal (and not productive), while hiring more people is both legal and much more effective, making it by far the better, more efficient solution for everyone.

    That's what we do with other people who we depend on for life-and-death situations after all. We don't ask firemen, or rescue pilots, or nurses or even physicians to dedicate their entire life to work (outside of time-limited crises of course). Most places have strict laws in place to limit their work hours, in fact, to avoid the inevitable mistakes and accidents caused by overly long work hours.

    * To some extent you don't need to pay; many of us would likely be doing science in some form as a hobby. But we would be doing the stuff we find fun, not necessarily the stuff funding agencies find worthy, and I bet many of us would not take high-impact publishing and other secondary goals very seriously any more.

  • Zuska says:

    Kern is a douchehound who's probably had an army of women at home and underlings at work tending to his every need for so long he has no freakin' clue what it takes to actually make life work beyond getting up in the morning, driving to work, and flogging said underlings.

    I want to know why he's wasting so much time pacing the halls and counting heads instead of doing something more productive, like curing cancer.

  • et says:

    Do researchers who work more hours do "better" or more productive research than those who work normal hours?

    Are hours in lab/at work precisely correlated to results?

  • D. C. Sessions says:

    Are hours in lab/at work precisely correlated to results?

    Diminishing returns apply to any human endeavor. Somewhere around 50 hours per week you see a real knee in the curve. Sixty or so can be pretty productive for sprints, but long term it's best to keep to fifty or less unless quality is not an issue.

    There's actually a fair bit of research on this (the things you learn in management programs!)

  • muteKi says:

    I have to admit, that issue -- that there's diminishing returns -- is honestly my biggest balking at the many poorly-reasoned points Kern puts forth.

    There's a reason I don't stay awake 24 hours a day, and it's not because I wouldn't if I could.

  • Thomas says:

    " It’s one thing to donate a hundred bucks to charity and quite another to give all your money and sell all your worldly goods in order to donate the proceeds."

    It certainly is, but this is something that it seems difficult to get ethical theories to recognize -- that is (from my relatively unlettered view of philosophical approaches to ethics) it seems surprisingly difficult to produce ethical axioms that do demand that you give a hundred bucks but also then allow you stop.

    On the other hand, if you really wanted to stop suffering and extend life as your only goal, then rather than working on cancer research you'd probably be better off working on something that paid more and then donating all the money to a well-run charity working in the Third World. After all, it's not as if we have any good reason to believe that the current research approaches to cancer treatment will be at all successful, so much of the time that Kern wants spent could well be wasted even without worrying about diminishing returns.

  • Pinko Punko says:

    I don't agree with Kern's piece save a feeling that lack of passion of some in the profession seems more pronounced. Maybe it is the fact that people are treated as disposable. However, he also could have had it with lazy grad students.

  • David says:

    The odds that increasing the work hours of cancer researchers would lead to a breakthrough are vanishingly low. Only hiring research-focused people with no outside lives would not likely yield better results so the proposal is stupid. But more importantly, the proposal might lead to divorce, depression, psychological deprivation for the children of researchers, and the ocassional suicide. Kerns made his proposal without considering the harm done, and that's unethical.

  • Let's not forget the old adage about too many cooks in the kitchen. Others have already mentioned how overwork can retard progress, but having too many people working on a redundant task can do the same. How can we be sure that we can do better? Perhaps we have just the right amount of people working just the right amount of time, in which case things are moving as fast as they can. If so, then there is no moral dilemma, because nothing can be done better. But we already know for a fact that there are too many separate institutions working on a cancer cure and stepping on each other's toes because they want the patent and the cash for it, so why the hell isn't Kern going after THEM, where he has a legitimate argument? Attacking those that donate their time to a cure is rather cruel.
    There's also a nihilistic argument that asks what worth the patient has in society, but I won't argue it because it's kind of mean.

  • [...] The whole thing ends up implicitly promoting a St. Kern style of science (for those who may not remember dear St. Kern, here are a few of the many great pieces on that story). [...]