ETHICS IN ORTHODONTICS

Publish or perishWho publishes and who

perishes?
Peter M. Greco
Philadelphia, Pa

n your continued attempt to remain current in your

specialty, you strive to read every journal that arrives
at your ofce. You cannot help but notice that many
articles are authored by our international colleagues.
Several of these investigations involve exhaustive human
study protocols that might have been impossible to conduct in the United States because of our rigorous institutional review criteria. You wonder whether there is a need
for increased awareness of human rights in research.
Many of the current guidelines for human research
evolved after the Second World War. Although Germany
had enacted regulations for human experimentation in
1931, the Nazi regime obscured the demarcation between politics and research when thousands of prisoners
from varied backgrounds were subjected to brutal, meticulously planned experiments. Over 2 dozen types of
experiments were conducted involving the torture and
death of people, as investigators observed the effects
of intentionally induced injury and disease, supposedly
to develop interventions for these maladies.
As a result of the postwar trials, the Nuremburg Code
was developed as an ethical standard to safeguard the
autonomy of subjects: the freedom of choice to consider
participation in an experiment after disclosure of its benets and harm. Several additional guidelines were subsequently developed, including the Declaration of Helsinki
(1964) and later the International Ethical Guidelines for
Biomedical Research Involving Human Subjects (1993)
by the World Health Organization and the Council for International Organizations of Medical Sciences. The intent
of the latter document was to protect members of world
cultures from human rights abuses in experimentation.
Yet, as demonstrated in Germany, guidelines can
have little inuence on human research ethics. Respect
for human rights in research appears to increase in the
most democratic and politically stable countries,
whereas nations governed by highly authoritative, dictatorial governments tend to display the least respect for
such rights.1 Even the impact of institutional review
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boards here might occasionally be insufcient to deter

the abuse of experimental subjects.
What can the scientic community do to encourage
human dignity and safety in research? First, journal editors
and referees must be highly critical by questioning or
rejecting studies that appear to exploit subjects. The study
must have a sound scientic design, and the benets to
the subjects must certainly outweigh the risks. Procedures
that are not used for therapy should be avoided. For
example, exposing a subject to multiple radiographs in
a shorter period of time or at higher doses than are typically diagnostic would be of questionable ethical practice.
Ethicists have long debated whether data generated
by unethical procedures are bad science and are therefore illegitimate. One argument against this contention
is that there appears to be no relationship between the
validity of scientic ndings and the level of ethics
from which the data were derived. Yet, the use of results
gathered without subject autonomy could encourage
the production of additional data from future studies
that disrespect human rights.2
A second method of encouraging ethical research is
to consult and emulate constructive institutions such
as the Fogarty International Center of the National Institute of Health. This organization propagates international research of sound scientic design by educating
scholars in ethical research tactics. Our specialty can
learn from the example of these organizations in developing respect for human subjects.
One of the most objective measures of scholarship is
to contribute to knowledge through research, followed
by subsequent publication. But we should never sacrice
human safety and respect for ethics for the sake of scientic acclaim. The most universal objective we must remember in conducting human research is one of the
most powerful rules of all time: to treat others as you
would want them to treat you.
REFERENCES
1. Neumayer E. Do international human rights treaties improve respect
for human rights? J Conict Resolution 2005;49:925-53.
2. Brannigan MC, Boss JA. Human animal experimentation. In: King K,
Williams M, editors. Healthcare ethics in a diverse society. Mountain
View, Calif: Mayeld Publishing; 2001. p. 327-408.