Michale for your information each and every subject has Professional Ethics. It is not new. During studies we learn that let it be doctor, engineer, lawyer, merchant etc.etc, I believe all countries follow that. Amazing thing when come to practice it differs from person to person. As mentioned by James and Max variety of examples come across if we dig the history. Eg. take planetary motion, Kepler and Galileo are rejected for suggesting earth moves around the Sun.

We have to go with time. Truth always be realized though it takes time.

“Facts do not cease to exist because they are ignored" Aldous Huxley

"Truth is generally the best vindication against slander" Abraham Lincoln

"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident"Arthur Schopenhauer

Excellent question. I think that ethics emerge from the pure nature of man before being polluted by environment (the broad definition of environment). Man is born with the right ethics whatever his religion or ideology, but when he is exposed to environment, those pure ethics may become polluted. Religions and philosophers try to protect Man behavior from going wrong. Ethics becomes theoretical when Man surrender to his physical and psychological needs such as food, drink, position, money (competition), on the other hand, ethics becomes a way of life when people complement each other (cooperation). In brief: we need to build our world on cooperation NOT on competition.

@Ahmed, I agree that environmental exposure breaks down ethical considerations of man.

It, however, seems almost innate for people to NOT consult ethical framework when making decisions; people, just pretty much, naturally ignore ethics.

Michael, yes it is innate when it is healthy, but it is essential to be framed afterwards. For example, suppose you are hungry and do not have any food, then you may think to steal food to eat, but when your innate is framed by the ethics of honesty you will react in a better way. I want to say that if we leave our desires and organic and psychological needs behave naturally, then we will become close and like other creatures and far from humanity. If natural ethics control behavior of all people on the earth, then you will not find hungry , or ignorant people for example, and every thing will become distributed equally.

I do agree with Ahmed in that, "Man is born with the right ethics whatever his religion or ideology," the rest (environment) depends on the earnest with which one hold one's ethical values. Most people from India tell it is difficult to survive in temperate regions (where wine/alcohol is part of daily life) without alcohol. However, there are people who, living there their whole life, never touched alcohol or tried to establish illicit relations.

To say ethics is purely a theoretical discipline is not justified. Earlier than Greeks who discussed ethics or before there was any philosophical discourse of anything, ethics had evolved in practice through experience what is good for people or bad. It emerged from practice from evolutionary point of view. From religious point of view the firs man and the first prophet or from other religious point of views first couple came on the Earth with elaborate instructions how they have to behave on the Earth. From the point of view, ethics as practice was result of learning in community or groups of people. From the religious point of view it was practice according to revealed guidance.

Even in this corrupt world, these are people with ethical values that some skeleton of system ethical behaviour is in operation otherwise there might have been anarchy, everybody cutting throat of anybody else. It is still going on but not so overtly because unethical people in any society are not held in esteem.

@Mohammad

I agree that ethics can be applied and can be practice by people. What I was initially arguing was "should ethics be regarded as a theoretical discipline"

Theoretical discipline is one that rarely used in application.

My justification was that humans in reality do not look to ethical solutions when making decisions. Humans tend tend act contradictory; poor ethical behavior while discussing beautiful theories of ethics.

So is ethics"just something we discuss and do not apply?

@Ahmed,

I agree that ethical standards when maintained can prevent unethical behavior.

However, innate ethics and response is variable. Some people tend to be more innately good than others. Some people tend to respond better to environmental stress than others.

For example, for one person the feeling of hunger may break down his or her ethical considerations. For another person, the feeling of hunger may strength the belief.

In extreme situations, most people throw ethics out the window. Or when ethics conflicts with what they need to accomplish.

Most people would comprise ethical standards when hungry. And with the constant hunger in this world, ethics, is, therefore, not really a factor.

Michael,

I do not agree with this saying:"In extreme situations, most people throw ethics out the window"

It is difficult to judge and say "most". I think that it is not an absolute issue, it is a relative issue, and it depends as you said on many variables. But two main variables give the highest percentage of the answer: strength of Ideology and strength of the challenge. If the ideology is strong enough, then you win, but if the challenge is stronger than the ideology, then you lose. For example, political prisoners in many parts of the world make battles of hunger strike for months, and at the end they win and get what they struggle for, because of strong ideology and belief. This issue is also related directly to your vision and message in this life.

May be it would be interesting to consider an example in science. Let's say you have lack of innovative or "good" proposals, and you have a good position to get funding. I mean just suppose that can happen! There is a neighbor lab where the PI is starting with a very good series of proposals and because he/she is very new in the research community, this PI is having a hard time founding financing. If in your experience realize that those excellent ideas would help very much improve your own work, what would you do? Take all ideas and do not put your neighbor even as a citation in your work? Discredit your neighbor saying those ideas were yours? Introduce your neighbor to a good source of financing stating from your privileged position how a good scientist he is? Propose a collaborative work in which both you and your neighbor would be equally benefited? I have more examples if you want!

Paula,

I think that a serious confrontation between ethics and desires will start. If your ideology is empty of ethics, then your desires will win and you will ignore your neighbor or even fight him, but if your ideology is full of ethics, then you will either share your neighbor of leave it all for him.

Yes, Ahmed. A number of them also died for their cause for not taking food to be treated at par as POW. However, humans are humans, ethical laws should not be so harsh not to close all escape routes. For a hungry person for several days, it is generally thought to satisfy one's hunger taking something proscribed.

@Paula,

Be it me I shall take the course, "Introduce your neighbor to a good source of financing stating from your privileged position how a good scientist he is?" which I have done several time to encourage my young colleagues in the department or in other departments and universities. Perhaps, in the East our selfish gene at least in academia is suppressed to some extent.

@Ahmed.I am defining extreme situations such as war, famine or poverty. These situations are the ultimate test of ethical ideology. In other situations, acting ethically is easy; especially when required.

In cases of war, we have seen how unethically humans will act. Humans will do anything to become the victor; including killing of innocent, torturing, spying, raping. In cases of famine, theft rates go up and some people would murder for food. The poorest areas are often those with the most crimes. In these circumstances, ethics seems to be Nullified.

I am arguing that most humans in these circumstance tend to not act ethically.

I agree it is not an absolute issue; depends on the individual. However, trends and similarities of responses can be noted. So, all humans are not that different.

@Paula,

That is a good real world example. Most scientist would assist in funding and then demand co-authorship. Nothing is done for free! I, off course, would act totally ethically and help that PI in all possible ways ;)

Ethics seems to go out the window when it conflicts with self-interest, which happens often in the real world; ethics is theoretical.

Of course all the ones who did this will not tell us hehe! I love your answers and I would have done the same courtesy to my fellow scientists but I tell you, I know cases that actually were in the opposite way with the support of all the collegiates just because of fear of losing their position. How about that? Unbelievable, right?

Pretty unbelievable

Wow! What an intro on this question. Ethics and Professionalism is a topic area that I have taught for the better part of four decades, and is embedded in some state licensing laws as required periodically for license renewal. I serve today on an international regulatory committee for the hearing health field, in which we codify ethics into statutory effects when deemed necessary. I tend to take the more libertarian view and try to discourage getting into too much regulation...far better to me is to help professionals parse through the issues through various theoretical vantage points (Virtue, Consequential, Rights, Intuitive, Deontological) and build consensus so that we are more self-regulating. Some basic ethics need to be built into the law, to protect both consumers and professionals. But when too much is codified into statutory effect we find abuse, stifled creativity in serving the public, and an overwrought system that cascades into minutiae (i.e., a parking ticket taking on the color of a serious felony). Looking forward to gaining more perspective from commenters on this question.

PS- on the self-interest aspect, we see it writ large in today's political and regulatory climate--exemption of favored groups from the laws, oversubsidization of individuals and corporate interests, propping up of economically unfeasible ventures, entitlement mentality, etc. Probably the worst offenders of all are those who get through regulations that allow them to hide deleterious changes to the food supply, statistical manipulation of medication outcomes, and promised bail outs to industries affected by politician initiated policies. All of these, in my opinion, fit into the framework of what Michael describes.

I myself am really sad that there is so much competition in science, either for grants or for political position that it has been little by little migrating towards a deadly butchery race. It is like the Olympics became Roller ball all the way down. I wish there would be ethics, gentlemen behavior and stuff, but what I see many times is missbehavior... That makes me sad and I would rather be a classroom teacher than be part of that. For good honest people is so difficult to keep their heads out of the dirt that they just go to other country, reaching for better luck. Nevertheless the bad thing is that people that already has roots in a place, has no choice than deal with all those unethical behaviors the best they can. But it is not easy.

Probably the biggest ethical question of all in science is: Is it still objective and useful if there is conflict of interest in funding? Paula raises the question of jockeying for grants, but who is granting the grants? What do they have to gain or lose by the outcomes of their investment? Indeed, do they look at their grants as investments upon which they expect to profit?

What a question!! Interesting answers.

There should be always variation; then only it is world, otherwise no meaning. Many head many minds. All cannot think in the same way. It depends on nature of person, how he born and brought up. Time wait for none, keep on moving......authenticate for each and everything. The meaning of the word ethics varies from person to person.

Professional ethics, a topic covered in all subjects tells what to do and what not to do. Do you think everybody follow that for eg. lawyer defendant and opponent, goes against other whose evidence is good that case wins irrespective of ethics.

Nice Quotes

I do not believe in immortality of the individual, and I consider ethics to be an exclusively human concern with no superhuman authority behind it- Albert Einstein

A man without ethics is a wild beast loosed upon this world- Albert Camus

Hey Michael! I would consider still good for the big shark to help the young scientist with expectations of coauthorship. Then, it is true, nothing was done for free. Anyway both would have had recognized participation, at least. But what happened in this case was simply abuse.

@Paula. I agree. Of all the professionals, Scientist should be the ones to step up to the ethical plate; you except unethical behavior from lawyers, not scholars or people searching for truth.

The concept of "nothing for free" is harsh, but fair. The senior investigator by demanding co-authorship for obtaining funding would be completely ethical and commonplace in academics; the project could have never been published without the senior scientist's help.

I also believe that many junior investigators would offer co-authorship for helping obtaining without thinking twice.

@Max.

It is shocking to see the amount of corruption in Research.

Conflict of interest in obtaining/distributing grants, it is completely unethical.

Although conflict of interest is probably common place in grant reviewing process; one scientist on RG noted that in India it is excepted for grant reviewers to be named as a co-author as a sign of thanks. Additionally, grants are typically distributed to the reviewers or committee members. This acts as a real deterrent to scientist.

In these environments, science cannot thrive.

@Jetty, love the Einstein Quote. Humans are innately moral.

Yes, Michael, transparency in funding is really quite necessary or we end up with the system we have today where money too often dictates outcomes. In true scientific form, few of the recent superficial but unsafe drugs would have made it to market. Instead, each expansion of the knowledge base would have us closer to resolving underlying causes of disease. In a truly ethical world the aim would be to get people healthy not just manage symptomology while underlying causes (diet, hydration, heavy metals, lifestyle, etc.) rage on undeterred.

Not only research field, corruption is everywhere, in all fields. Put a question where we do not find corruption that takes time to find out. Perhaps we should not generalize the statement that all are corrupted. The world is still existing, means there are people who follow ethics and values. That is why I said it depends on nature of person, circumstances etc. As you said all humans are innately moral, I too agree when the difference is coming? Whom should we blame, is it society or circumstances or fame or money; the root cause of everything!?! It would be a big debate if we talk about ethics and corruption, it will not end. In this corrupted society even you are honest people do not appreciate honest people have their own problems. You might have come across in history eg.Jesus and many others.

"A person should not be too honest. Straight trees are cut first and Honest people are screwed first"- Chanakya (Indian politician, strategist and writer, 350 BC-275 BC)

Interesting take, Jetty. Of course, I believe that no reasonable person would paint a field with such a broad brush as to state that all research is corrupt. The scientific method, like veterinary medicine, is really quite honest by design. When we apply many of the medical and modern dietary practices onto animals as we do humans, we see the same skyrocketing rates of disease, only moreso and at faster rates. The difference is that humans can be induced to taking more of the same medicine to control side effects of other medicines and think they are getting better. The same with true science: it can be replicated, it controls for every known variable, and, in medicine, it stays that way...the longview, if you will. It is the research that only takes the short view (as does almost all fast track, short trialed drug research today) that shows any benefit, and often barely above placebo effect. But the longview of statins, DMII drugs, anticoagulants, SSRI/SNRIs, antipsychotics, opiates, and NSAIs lead en masse to terrible health effects--so the big dollar "research" stays far, far away from the longview. I really don't call this corruption until the ones pointing out these inconvenient facts are crucified on the cross of heresay. THEN, those that should know better have been corrupted.

@Jetty, corruption is in every field. It is shocking to see so much politics in fields like research.

As far as corrupting the individual: it depends on the person. For some it may be circumstance, society, family. Some type of external force that promotes compromising of ethical standards.

@Max, Modern medicine is not that horrible; life expectancy in countries with "western diet" is higher than ever. Life in the United states as increased by 16 percent since the 1950's.

The biggest problem with "modern medicine" is that it is expensive; which, is due to the complex diseases being developed. A ton of research goes into understanding these diseases + developing drugs to combat. Plus, all of the associated risk of clinical intervention and the inevitable bureaucracy to manage the network behind the scene drives up cost.

Additionally, most Americans simply do want to change dietary habits; so pushing drugs is a most. People want to eat Mcdonalds everyday, and be free of heart disease.

If most people took care of their health, modern medicine would not needed.

Michael, I agree that people have been induced to the shortcut in diet, acknowledging at the same time that much of the change to the food supply has largely been foisted upon them. The rates of chronic disease in the US are higher than anywhere I travel in the world on lecture assignments, and getting worse. My biggest contention with American medicine is its reliance on targeting superficial symptoms while, in practice, ignoring the real causes of chronic disease. The propensity to fast track drugs through 4-8 week trials leaves the great knowns in long term effects largely disregarded--the classes of meds I named above really do present terrible long term effects made worse by pretending the drugs have corrected the problem. Meanwhile, we have in our popuaton 62 million substance abusers, a good deal created by medicine itself, in our midst and growing by leaps and bounds. The business of medicine is not a good one, as I am sure you agree, nor is the business of Food that has lulled our fast paced society into worse states of health. Undoing the mess is where ethics becomes theory and the practice of it, well, fought quietly tooth and nail.

Regarding life expectancy, the Japanese, where I lecture and research a great deal, have much lower rates of chronic disease, are reportedly the skinniest people on earth and outlive Americans by 12-15 years (when mortality rates are equalized), and of course their diet is far from ideal with lard still a staple, but there are certain factors in their diet that relieve them somewhat of the fate of our country. And I do agree that many of the innovations of modern medicine are quite good--it is the everyday practice of medicine that has devolved to what I call McSick Care where chronic conditions are made acute by treating them as if they are acute.

@Max, in the case of ethics of our healthcare system, a distinction in obligations should be made between patients, providers, insurance companies, drug companies, food companies. Each has responsibilities for maintaining the "health of the nation."

In this whole system, the "demanders" are the patients. Patients ultimately consume the drugs and foods provider by the suppliers in the system. Attached is an interested article demonstrating the concept; Mcdonald's went out of business in barbados//Jamaica b/c of the locals distaste with fastfood. "We like to eat healthy. Mcdonald's is bland."

If most patients lived like Jack Lalanne, much of the demand for current drugs and fast foods would subside. Similar arguments could be applied to the mortgage crisis just experienced in the US.

Patient advocacy should be of high concern.

http://www.uncommoncaribbean.com/2010/04/01/mcdonalds-failure-in-barbados-hides-in-plain-sight/

Totally agree, Michael--that is why I reserve about 20 of my annual 60 or so lectures for consumers, to enlighten them to the facts affecting their health through diet and lifestyle. Of course, there are many others starting to do this, and we are seeing an almost wholesale desertion of demand in certain sectors of the population and growing. The more people take charge of their health the more the corporate entities strive to meet those changes--in some cases the purported "changes" border on fraud as only cosmetic changes are made too often. But, like the Whole Foods Stores etc. and reciprocal changes in healthcare (I am thinking of clinic chains like the highly Cancers Centers of America, although I see some others--MD Anderson and Mao making changes, also). It is a quiet movement to say the least, but an enlightened population, I feel, is key to substantial changes in a positive direction. The vast group already hooked in the substance abuse lifestyle have become the number one utilizers of healthcare today and is also growing. Hoping for up close and personal changes coming to that group, also--we are working hard on that, but it has been an uphill battle. To us, knowledge is light and increase in knowledge shines a brighter light on the plight of modern society; hopefully, enough for all to eventually see. But you are correct and I appreciate your insights.

@Mohammad Firoz Khan: To say ethics is purely a theoretical discipline is not justified. Earlier than Greeks who discussed ethics or before there was any philosophical discourse of anything, ethics had evolved in practice through experience what is good for people or bad. It emerged from practice from evolutionary point of view.

Agreed! You might be interested in what is known as virtue ethics, which describes the character of a moral agent as a driving force for ethical behaviour. This form of ethics can be traced back to Socrates (see attached image).

Socrates (469 BC – 399 BC) was one of the first Greek philosophers to encourage both scholars and the common citizen to turn their attention from the outside world to the condition of humankind. In this view, knowledge having a bearing on human life was placed highest, all other knowledge being secondary. Self-knowledge was considered necessary for success and inherently an essential good. A self-aware person will act completely within his capabilities to his pinnacle, while an ignorant person will flounder and encounter difficulty. To Socrates, a person must become aware of every fact (and its context) relevant to his existence, if he wishes to attain self-knowledge. He posited that people will naturally do what is good, if they know what is right.

For more about virtue ethics mentioned in the previous post, see

http://en.wikipedia.org/wiki/Ethics

@James, ethics CAN be brought into application, but is it?

James is correct in his historical review, but the fate of Socrates is one that too clearly illustrates the problems when truth clashes with the Zeitgeist of the times. Likewise with many, many others throughout history, Leonardo Davinci, et al---not a very pretty outcome when applied.

Michale for your information each and every subject has Professional Ethics. It is not new. During studies we learn that let it be doctor, engineer, lawyer, merchant etc.etc, I believe all countries follow that. Amazing thing when come to practice it differs from person to person. As mentioned by James and Max variety of examples come across if we dig the history. Eg. take planetary motion, Kepler and Galileo are rejected for suggesting earth moves around the Sun.

We have to go with time. Truth always be realized though it takes time.

“Facts do not cease to exist because they are ignored" Aldous Huxley

"Truth is generally the best vindication against slander" Abraham Lincoln

"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident"Arthur Schopenhauer

Well stated, Jetty, Ghandi said it best and knew his history. Happy New Year to you and all our friends on RG!

@Jetty. For example you mention, 10 examples can be conjured up that demonstrate where humans have ignore humanity; these are facts as well.

Despite Huxley's beautiful conviction of truth and suppression, If you read "Brave New World" you will find racist slander littered throughout the text; the offensive and racist language of the text lead it to be the 3rd most banned book in the United States. Huxley seemed to ignore "facts" of humanity in face of his spiritual exploration when writing "brave new world."

Facts seem to demonstrate that when ethics conflicts with the wants and needs of humans, that ethics seems to be ignored.

Jetty,

Good post!

Michael,

A thoughtful post. You write: ...when ethics conflicts with the wants and needs of humans, that ethics seems to be ignored.

One can observe that exceptions do make a rule. One can also conjecture but not prove

Conjecture: Every person in every situation makes an ethical choice.

@James, I agree that assertions do make facts; anybody can make a conjecture about anything. However, certain conjectures have more facts or reason behind them than others.

Conjecture: all conjecture offers some light on any subject, and have some tangential cases where they can be proven to be true.

The question may be asked, how likely is a conjecture to be true.

The fact that in every situation a person makes an ethical choice is not likely to be true; even the most immoral people commit acts of kindness while committing acts of violence; people commit actions that are not consistent with their own moral code.

For example,

Person A commits X action and thinks it is moral for Z reason. Then commits action Y that is immoral under Z reasoning.

Conclusion: Either the person adopt anew moral code(unlikely if the person is sane) or is not consulting his current ethical code. Assumption: moral code of a person is difficult to change.

Most people after committing immoral acts, killing/raping, admit to its wrongness after years of thinking about it.

Many People commit actions that are most likely not justifiable under any ethical system; either are not consulting ethics or have a twisted since of ethics(unlikely if sane and have demonstrated an understanding previously of common ethical standards.)

What you guys mentioned is correct

Rather saying "man is slave to his stomach” we can say “human is slave to his needs".

What I was saying from the beginning is attitude of person, circumstances matters a lot in each and every situation.

Something seriously lacking in nearly every scientific discussion is an understanding of context. The opening questions for this discussion tend to lump ethics into five different contexts all at once.

The discussion of the meaning of the word, "ethics," can be expertly integrated into a discussion about the application of ethics on a macro scale (community) or a micro scale (individual), and evaluate the *purpose* of ethics and its *application* in various situations, but that is not happening here.

Context is important because in our language we often use the same word, but with the intent to focus on a different point from someone else. One person could be making an argument about the purpose of ethics on a micro scale while another is arguing about how to apply ethics on a macro scale and the arguments just go on and on without resolution.

Sometimes (not in this discussion), I think I have observed certain personalities, which intentionally, or not, obfuscate the discussion by playing with puns (I have been guilty of this).

In order to have a meaningful scientific discussion, the concept of context has to be clearly understood by all involved, and the question must clearly present the context of the inquiry.

Questions about the nature of ethics and morality are very important in science and we need to seriously come to a clear consensus about them.

David brings in an important point relative to context and purpose. On a macrolevel, the operational word today is "translational" bringing the consensus of evidence into policy and practice. This can bring all kinds of conflicts of interest, resulting in heavily vested therapies being lopped aside in favor of more effective but less costly ones. A good example is diabetes, in which we are finding (about the time an entire cottage industry has been built up around the current DMII model) that through multifaceted papproaches (exercise, dietary changes, hydration, resolution of ongoing subclinical infections, and nonsurgical repair of unhealed injuries, and avoidance of unhealthy substances) that perhaps 90% of DMII cases can be resolved...without medication, without endless tests and medical consultations.

The practical effect of translating research into practice in this case will mean someone loses a lot of money and jobs are lost. In fact, if the entire arsenal of findings regarding metabolism, immunology, and the gentle modalities, that the entire infrastructure of chronic disease as a business will be massively be disrupted. Lower blood pressure by drinking more water? Osteoarthritis overcome by dietary and lifestyle changes? Depression, inflammatory disease, and obesity as pandemic maladies virtually whittled to size by changes in all of the foregoing? To protect the many and various kingdoms of treatment devised to serve a rapidly expanding market, and then to have it shrink overnight...well, we can't have that!

@Max,problems concerning type 2 diabetes is that people are not willing to undergo reverse lifestyle conditions; 1/3 of american population is obese, 2/3 is overweight. Obesity is the reason behind the diabetes epidemic. Without lifestyle alterations, drug intervention becomes become necessary. The only way people can literally have their cake and eat it 2, is via drugs.

In my humble opinion, nobody is forced to utilize the services of modern medicine!!!! If people lived healthy lives and took care of their bodies the services would never be utilized. A person with diabetes has to take some responsibility in the matter

@David, I agree. In many discussions one person is making X argument about Y and another person is making X argument about V and yet they are fighting over M.

What concepts are being debated has to be clearly established in any argument. Additionally, adequate background information is a most.

Yes, and amazingly when they want to make the changes they still falter because of so many obstacles in today's food supply (GMO high fructose, for example, food preparation, etc.). Yet, with guidance and their own determination, we find that 90%+ of patients at our clinic can completely overcome their diabetes. They inevitably wean off the DMII insulin-inspiring drugs, as well as the other meds that actually contribute to DMII as those markers also improve.

@Max.

Diseases fall into 2 categories. Those that the patient can control the onset and those that patient cannot.

Look at this scenario that involves diseases that can be controlled by the patient,

Person smokes cigarettes everyday for 10 years. Develops lung cancer. Racks up a 200,000 bill for the cancer drugs and treatments. Maybe smokes while undergoing treatments.

Who is to blame for the problem? Patient, drug companies, doctors, or the cigarette companies?

Sorry to say it, but it is the patient. It is widely known that smoking causes lung cancer.

This scenario can be applied to hundreds of other diseases.

From a behavioral standpoint, advocacy needs to take place to change the lifestyle habits of people to prevent diseases that can be prevented!

Modern medicine is used for unpreventable diseases and those diseases that fit the mold described above.

Old saying,

"You cannot force anybody to learn, and you sure as hell cannot stop anybody determined to learn."

Absolutely agree. I guess we attract a high number of motivated people. Most have been down the conventional treatment route and have decided to take the bull by the horns and improve their health once and for all. I believe that out of perhaps 2000 patients we have a couple still struggling with smoking. But the rest have become conquering heroes in their own right and made phenomenal changes in their lives. Thanks for the input--I know it seems overwhelming and never-ending--and it is both--but there are many success stories in the making that we rarely hear about.

Sorry to be so slow responding to a request from Michael Mannen to participate in this discussion.  Ethics is an active and critical element of all research activities performed in academic centers in the U.S. today.  Before any young person can participate in research at my center (and most others) they must read a text on research conduct ethics and pass a test.  The text starts with the Helsinki agreement based upon the universal understanding that the medical research conducted by the Nazis during WW II on unwilling research subjects was grossly unethical.  So also was research performed in the U.S. at Tuskeegee and Willowbrook (Staten Island NY) hospitals.

All funded research in the U.S. must meet ethical standards of informed consent by federal law..  Richard Evans "The Third Reich at War" contains a detailed and grim summary of this experimentation.

On a second topic, I must disagree with Michael.  Lung cancer caused by smoking is directly attributable to the tobacco industry.  Although the information that cigarette smoking is carcinogenic is widely available, tobacco advertising unethically suggesting that smoking is a fun, safe and socially acceptable activity is far more widely available, since the tobacco companies outspend the U.S. federal government approximately 30:1 on this issue.  Furthermore, almost all adult smokers first experimented with cigarettes and became nicotine addicted when they were children or adolescents i.e. before the age "of reason".  In this sense, lung cancer is a pediatric disease.  The classic case is that of Marie Evans, a black child from Roxbury MA who was given free samples of mentholated cigarettes at age 8.  She died of lung cancer many years later and a MA court awarded her family a large amount of money to compensate them for her loss.

Yes, we have ethical challenges all the way around. From a medical community that buys the pharma line that fill depleted bones with osteoclasts (dead cells) somehow improves bone density in the long term to the promoters of substances like tobacco, alcohol, and marijuana as if little serious harm is done by using them. As reserachers and scholars we need to call questionable and expedient research findings for what they are even if a multibillion dollar cottage industry is built around the health offenders we encounter. Smoking causes cancer, osteoporosis, tooth loss, cardiovascular destruction, neuropathy, mitochondrial and DNA damage, and early aging and death. There is not one good virtue to promote there. The same for many of the medications promoted today when used in the long-term and in place of going to underlying causes and addressing those. When we get honest about health and start telling the truth to the public about the things we research, like what has happened to public water supplies, the processed and genetically modified food industry, risky pharmaceuticals and psychopharmaceuticals, heavy metals in the environment, and the like, the public will then know what to do and will significantly diiminish the huge burden they place on economies and nations the world over once they see past the schemes that contibuted to their health status. Most chronic disease is avoidable if consumers are equipped with the truth.