Cover

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pp. 1-1

Title Page, Series Page, Copyright, Dedication

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pp. 2-7

Contents

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pp. vii-viii

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Foreword

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pp. ix-x

The Milbank Memorial Fund is an endowed national foundation that engages in nonpartisan analysis, study, research, and communication on significant issues in health policy. The fund makes available the results of its work in meetings with decision makers, reports, articles, and books. ...

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Acknowledgments

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pp. xi-xii

This is a book I simply could not have written without the help of people who tutored me at the start and then read the results of my efforts at the end. I have lived long enough to understand that experts and gurus disagree, often flamboyantly. But I was lucky to find experts who welcome an exchange of views ...

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Introduction: An Imperative?

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pp. 1-10

Recent years have seen an almost unprecedented level of excitement about medical research. The dramatic increases in the annual budget of the National Institutes of Health (NIH), running 10 to 15 percent a year, even as many other federal agencies’ budgets are being cut, reflect that excitement. ...

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1. The Emergence and Growth of the Research Imperative

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pp. 11-35

My first visit to Monticello, Thomas Jefferson’s remarkable Virginia home and enduring avocation, showed me far more than I expected. Like everyone else who has read about him, I was aware of the breadth and complexity of his mind: science, politics, history, law, agriculture, architecture, and philosophy just begin the list of topics that engaged him. ...

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2. Protecting the Integrity of Science

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pp. 36-56

The research drive has the deepest possible roots, a defining part of what it means to be human. It helps us know ourselves, the nature of which we are a part, the ills of the body and mind. That drive now also connotes power and money and prestige, set within a network of politics, profits, and personalities ...

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3. Is Research a Moral Obligation?

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pp. 57-84

In 1959 Congress passed a “health for peace” bill, behind which was a view of disease and disability as “the common enemy of all nations and peoples.”1 In 1970 President Nixon declared a “war” against cancer. Speaking of a proposal in Great Britain in 2000 to allow stem cell research to go forward, ...

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4. Curing the Sick, Helping the Suffering, Enhancing the Well

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pp. 85-113

The knowledge that biomedical research can bring, and the translation of that knowledge into clinical application, offers a proven way of making progress against the waywardness of the body and mind, assaulted from the inside and the outside by hostile agents of death, pain, and disability. ...

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5. Assessing Risks and Benefits

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pp. 114-132

The research imperative is a demand of human nature and an enormous social benefit. The drive for knowledge and the understanding it brings deserve strong public support. Even so, in its present manifestation, that imperative shows growing signs here and there of overreaching for success, ...

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6. Using Humans for Research

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pp. 133-164

When I was a philosophy graduate student I sought relief one day from the tedium of it all by wandering about the library where I worked, looking for something, anything, to wake me up. Close at hand were the proceedings of the Nuremberg trial in 1947, bringing to judgment the doctors turned killers in the service of the Nazi regime. ...

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7. Pluralism, Balance, and Controversy

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pp. 165-200

Hardly anyone denies that medical research may along with bringing great benefits also on occasion open the way to harm, medical or social. What is to be done when debates about that possibility break out? The history of research, medical and otherwise, has notoriously been marked by controversies. ...

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8. Doing Good and Doing Well

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pp. 201-234

There is nothing in business quite like the pharmaceutical industry. Enormously profitable, it is as widely praised as it is widely despised. It holds within its hands great health benefits and the power to corrupt in their pursuit. It brilliantly defends its turf and ruthlessly exploits its opportunities. ...

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9. Advocacy and Priorities for Research

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pp. 235-258

Although federal support for medical research has had its peaks and valleys, few governmental programs have been as enduringly popular. The crown jewel of that research is the National Institutes of Health, and of late the enthusiasm for its work has had uncommon bipartisan support in Congress. ...

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10. Research and the Public Interest

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pp. 259-276

The aim of medical research is to better understand the human body and mind, and to make use of that knowledge to improve human health. My argument has been that the very importance of that research, its power to attract good scientists, to excite the public, to reduce pain and suffering, to turn a profit, ...

Notes

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pp. 277-308

Index

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pp. 309-329

Production Notes

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pp. 343-343