Overall, Bayer lamented that the IRB system has "turned itself into an object of ridicule and sometimes contempt in a way that I think is dangerous to those who believe in the ethical conduct of research."
Particularly choice is Bayer's description of the CITI Program, a widely used online training course in research ethics, which Columbia University requires researchers to complete every three years.
(This passage appears at 6:33 in the video for session 4. I have used the video recording to correct the transcript in a few places. In particular, on the video, and in the captioning, it is clear that Bayer used the term "doxology," though the official transcript reads "ontology." UPDATE, 10 June 2011: After I pointed out the errors to the Commission staff, they were speedily corrected.)
I, like everyone else at the Mailman School of Public Health have to take an online test to guarantee that I have read the right things and understand the right things. I did it several years ago and just last month I was told we now have to do it every three years, so I had to do it again. I have to tell you, it is the most insulting experience to sit in front of a screen, to download a text and then a series of questions to which there is only one right answer, and if God forbid you think that there may be an ambiguity or an uncertainty, you get the answer wrong. What has happened, and I listen to people talk about taking these tests, and they talk about it the way Russian social scientists used to talk about having to learn the right Marxist [doxology] in the old Soviet Union. They have to learn something, spit it back and give the right answer, and if you don't get a good enough score, you can't do research, you have to take the test again.
How it happened that we came to think educating people about doing research in an ethical way became so contorted that it becomes like the joke about how kids used to learn the Pledge of Allegiance and they didn't know what any of the words meant, and so they garbled it up in some funny way and you would hear versions of what the Pledge of Allegiance is. It is like that when people talk about ethics of research as they -- look what you can do is you can download the text, put the question in front of you, read the text, find the answer. That's not education. And the reason I see it as a matter of concern is what it does is it raises contempt for the idea of education and becoming kind of sensitive to ethical complexities. And that's not where I think we should be going. It is in some way analogous to what has happened to the issue of privacy and the HIPAA regulations and the incessant plethora of pieces of paper from banks and insurance companies, printed and typed, I certainly can't read anymore, that tell you about their privacy protections. What do people think? All this privacy protection stuff is junk. Because it has become utterly bureaucratized.
So, what’s the challenge it seems to me to this commission? There are many big issues about what kinds of research internationally and globally in a world that is increasingly unequal is ethical, but it seems to me -- it seems to me that it is time to revisit in a fundamental way both the institutions we've created, how they function, and how we educate people about fundamental ethical issues in research.
I don't deny that there are certain fundamental things one can read and learn. One takes drivers test, one has to learn what a left hand signal is and what a right hand signal is. But there is something off when people see the entire process, not as something they feel proud about, but as something they experience as, in a way mortifyingly stupid, and stupefying -- that is what it is, stupefying.
In subsequent questioning, commissioner John Arras asked about alternatives.
Here is the problem. We're in a situation where we want mass education of people in a kind of fine tuned ethics of research and clearly the notion of these mechanistic web lessons is not the answer. But I'm wondering what is? Clearly, we want everybody to take your seminars at Columbia University for an entire semester. So I mean that would really do the trick, I think, right? But, so that's clearly not going to happen, right? It's incredibly hard to make room in a medical school curriculum for ethics and I think that my hunch is that the medical establishment allows us these pathetic web based tutorials, you know, in a grudging kind of way. You’re taking up our valuable time, right? So the question is in between a seminar at Columbia and these web tutorials, what kinds of alternatives can we imagine?
Professionally I feel a bit like a kibitzer here. But here is the -- I think it would be good to look around the world, look to Western Europe, look to Canada. Whatever. It seems to me that we're not the only nation confronting this question of how best to kind of instantiate a respect for the ethics of research. It may be, it just may be that other people have come up with an answer we might learn from. And again I don't know what they have done, and I don't know how far it's gone, but certainly in the context of Europe, in the context of Canada, Australia, we might actually see something that is different from what we're doing that might be educated.
I don't know how much he will find abroad, but the Commission should take a look at L. L. Wynn's efforts at Macquarie University to devise online training that allows for nuance. Closer to home, the Commission could explore the value of two-day workshops in specific disciplines, like those offered at Princeton. And there are other possibilities along these lines, such as assembling bibliographies of the most important works in research ethics for each discipline and requring researchers to read them. None would require a semester-long seminar.
Bayer is right that many researchers hold ethics review in contempt. And he was right to trace much of that contempt to the terrible first impression made when smart researchers are compellted to complete an insulting, pathetic, mortifyingly stupid online tutorial.