23 May 2007

Casuistry and Internet Research

A news item yesterday raises questions about two topics of interest to this blog--casuistry and internet research.

The question about casuistry is this. Suppose you must decide a difficult ethical case, and you receive conflicting advice about its resolution. Must you act on the advice most likely to be correct (probiliorism), or the advice which is least problematic if wrong (tutiorism), or is it enough if you act on advice which has substantial merit (probabilism), even if another view would reasonably be judged more likely?

Here's the analogy from yesterday's news. Suppose a pharmaceutical company conducts several clinical trials for a new drug. All of them are ostensibly well-designed, but only one, and maybe not the best study of the group, gives evidence that the drug is effective. May the pharmaceutical company then claim that the drug is effective on the basis of that single study (cf. probabilism), or must it either conduct a meta-analysis of the various studies (probiliorism) or favor that study which (say) also attributes the worst side-effects to the drug (tutiorism)?

Now in casuistry probabilism has generally been judged the most sensible opinion. (Please don't raise here the problem of a regress, as opinion is also divided as to which view about casuistry should be followed!) Yet in pharmaceutical research the law seems to be tilting, rather, toward tutiorism. At least, in 2004 GlaxoSmithKline agreed to post on the internet the results of all its clinical trials for any drug, after it was prosecuted by New York Attorney General Eliot Spitzer for consumer fraud:

Mr. Spitzer filed suit in June against GlaxoSmithKline, contending that it committed fraud by publicizing the results of only one of five trials studying the effect of its antidepressant, Paxil, in children. That single study showed mixed results. The others not only failed to show any benefit for the drug in children but demonstrated that children taking Paxil were more likely to become suicidal than those taking a placebo.
And the market apparently favors probabiliorism. Two days ago the New England Journal of Medicine published online a study by Dr. Steven Nissen, who used the GlaxoSmithKline database of clinical trials for its drug Avandia to conduct a meta-analysis and found that the studies, taken all together, suggest a link between Avandia and heart attacks. The following day GlaxoSmithKline's share price fell 7%.

The related question about internet research is this: For which academic disciplines is it already the case that facility with the internet is indispensable for responsible research, and, is ancient philosophy (or classics generally) such a discipline?

The question is raised because Dr. Nissen said that he had discovered the GlaxoSmithKline database, which was not widely-advertised, only through a Google search!
Through a Google (nasdaq: GOOG - news - people ) search, Nissen found a Web site put up by Glaxo that contained results from all of its clinical trials. The site had been created as a result of a settlement with former New York Attorney General Elliot Spitzer. He found the 42 studies, and he and statistician Kathy Wolski did the analysis and wrote the paper in a matter of days