PHG Foundation

Commentators have suggested that when we consider the global burden of disease, the amounts spent on genomics research are morally indefensible. The money would be better spent, they argue, on simple preventive measures for diseases such as malaria or HIV/AIDS.

Obviously, the question of whether genomics research can be justified from the perspective of global health is largely empirical. However, there are also ethical issues that we must address if we are to understand these debates. In this article, I want to outline some of these issues.

Philosophers draw a distinction between 'prudential' arguments, which claim that we have an obligation to help the poor because doing so helps us, and 'moral' arguments, which claim that we should help the poor regardless of the consequences for ourselves.

One answer to the challenge of 'global justice' is to deny that we have any kind of interest or obligation in the global burden of disease: justice is always local, and charity begins (and ends) at home. However, such a response is inadequate. It is prudentially inadequate because, as SARS and Asian Bird Flu demonstrate, in a globalised world the health problems of the developing world cannot easily be contained. The local response may also seem morally inadequate. Even if we think that our most important obligations are to our loved ones or our countrymen, it is surely wrong to ignore the plight of the global poor merely on the grounds that they are far away.

In arguments for greater global justice, the prudential and the moral arguments often run side-by-side. We are told that global poverty threatens us and that we have general moral duties not to harm others, for example through unfair trade. However, if we distinguish the two forms of argument, we find an interesting result. Arguments that we have a prudential interest in helping the global poor are likely to generate minimal accounts of our global obligations; roughly that we ought to focus on globally communicable diseases. From this 'prudential' standpoint, it may indeed seem that money spent on other aspects of genomics research is wasted.

However, if we take the stronger 'moral' line of argument, and assume that everyone is entitled to a decent level of health, then, given that genetic factors are important determinants of good health (acting together with environmental factors), we might justify continued research into genomics as part of our overall aim of global health equity.

Of course, given limited resources it may be the case that, from a cost-effectiveness standpoint, we ought to spend less on genomics than we do now. Yet, in general, an argument that all are entitled to a decent level of health as a matter of justice provides stronger ground for a claim to the global importance of genomics research than a claim that we ought to take an interest in the health of the global poor when their ill-health threatens us. Therefore, defending genomics research in the global context may rest either on a determined 'localism' or on a commitment to global health equity, but is unlikely to gain much succour from prudential considerations.

If we are serious about our moral obligations to the global poor, then genomics research may be justifiable. However, it also seems clear that if we are serious about such an obligation, we may have to make some changes to the research we pursue and the distribution of the benefits of that research.

This raises a second question: I have argued that 'we' have an obligation to the global poor, but who are 'we'? After all, it is easy to say that patterns of research and distribution could be improved, but who should ensure that we make such changes, and who should bear the costs of such changes?

It seems that pharmaceutical companies have certain commercial obligations that makes it difficult to justify a demand that they simply change course for 'moral' reasons. Similarly, individual scientists within companies and organisations may have little power to determine exactly what they work on, and how the fruits of their research are distributed. Individual citizens have even less direct control over what gets researched or how the fruits of research are distributed.

Therefore, it seems the most sensible answer is to say that the obligation to care for the health of the global poor falls on each of us to campaign for legislation that provides incentives for research into, and equitable distribution of, treatments that benefit both us and the global poor, including research into genomics.



Stephen John is Lecturer in Public Health Ethics in Department of History and Philosophy of Science, University of Cambridge, and Cambridge Genetics Knowledge Park. Contact him at sdj22@cam.ac.uk



July 2005


This article first appeared in Biolines, a monthly biotechnology column emphasising legal, ethical and social issues.