Ethical challenges in conducting pediatric environmental health research

Ethical challenges in conducting pediatric environmental health research

Neurotoxicology and Teratology 24 (2002) 443 www.elsevier.com/locate/neutera Commentary Ethical challenges in conducting pediatric environmental hea...

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Neurotoxicology and Teratology 24 (2002) 443 www.elsevier.com/locate/neutera

Commentary

Ethical challenges in conducting pediatric environmental health research Introduction David C. Bellinger*, Kim N. Dietrich Neuroepidemiology Unit, Children’s Hospital, Farley Basement Box 127, 300 Longwood Avenue, 02115 Boston, MA, USA Received 3 April 2002; accepted 4 April 2002

The pediatric environmental health community was rocked last August when the Maryland Court of Appeals delivered harsh words in a ruling pertaining to a community intervention trial, conducted in Baltimore by investigators from the Kennedy– Krieger Institute, comparing the efficacy of different strategies for reducing lead hazards in the homes of young children. Comparing the trial to the infamous Tuskegee study [2], the Court seemed, to many interested bystanders, to miss an obvious point of great importance. With the best of intentions, the Kennedy– Krieger researchers were attempting to identify economical but effective solutions to a problem for which the political will to pursue a lasting solution is, as it has always been, sorely lacking. In this issue, Robert Nelson provides a cogent summary of the key points of the case from the standpoint of an Institutional Review Board, illustrating how complex and subtle the pertinent issues really are. Because the principles underlying the ruling, if widely applied, could have enormous implications for how pediatric environmental health research can be conducted, we thought it an appropriate time to organize a discussion of these implications within our community. We did not intend this to be a referendum on legal aspects of the Kennedy –Krieger study, as these are still being litigated, but rather a more general discussion on ethical issues in the conduct of pediatric environmental health, using the Kennedy –Krieger study ruling as a starting point. Therefore, we

solicited comments from individuals of diverse background, including bioethicists, environmental health researchers, clinicians, members of nongovernmental organizations concerned with lead poisoning and with housing safety, and child and community advocates. Anyone expecting to find simple solutions to the issues raised will, of course, be disappointed. In the current regulatory climate, however, investigators who wish to carry out environmental health research studies have little choice but to engage the ethical challenges head-on. As others have observed [1], an ineluctable tension exists at the intersection of bioethics and public health. Bioethical systems, largely worked out in the context of clinical medicine, generally focus on the individual and his or her rights, whereas public health focuses on populations and more universalist conceptions of the ‘‘common good.’’ It remains to be determined how, or whether, the canons of human subject protection will need to be amended in light of this tension.

References [1] D. Callahan, B. Jennings, Ethics and public health: Forging a strong relationship, Am. J. Public Health 92 (2002) 169 – 176. [2] A.L. Fairchild, R. Bayer, Uses and abuses of Tuskegee, Science 284 (1999) 919 – 921.

* Corresponding author. Tel.: +1-617-355-6565; fax: +1-617-566-0785. E-mail address: [email protected] (D.C. Bellinger). 0892-0362/02/$ – see front matter D 2002 Elsevier Science Inc. All rights reserved. PII: S 0 8 9 2 - 0 3 6 2 ( 0 2 ) 0 0 2 3 5 - 0