- Science, Policy, Values: Exploring the Nexus
The importance of science for guiding policy decisions has been an increasingly central feature of policy-making for much of the past century. But which science we have available to us and what counts as adequate science for policy-making shapes substantially the specific impact science has on policy decisions. Policy influences which science we pursue and how we pursue it in practice, as well as how science ultimately informs policy. Values inform our choices in these areas, as values shape the research agendas scientists pursue, the issues debated as we decide on policy, and what counts as sufficient warrant in any given case. And what we value is shaped by our empirical understanding of what is, what is possible, and what is feasible. The interrelationships between values (what we care about), policy (how our institutions and practices are structured), and science (our best source of empirical knowledge) requires careful philosophical attention. [End Page 475]
On June 26, 2013 at the University of Toronto, a workshop was held on this topic as part of the Biennial Conference of the Society for the Philosophy of Science in Practice (SPSP). The day-long affair was attended by over 70 participants, and demonstrated the value of looking carefully at the confluence of science, policy, and values. The ways in which institutional and legal structures (the result of policy decisions) influence science was made palpable. So too were concerns raised about some of those influences (for ethical- or social-value reasons). Often, further policy changes were part of the solutions proposed, sometimes with clear democratic impulses behind them. The nexus of science, values, and policy, carrying with it the normative issues from epistemology, ethics, and political theory, revealed its richness.
The papers gathered here were produced by speakers at the workshop and informed by the deliberations of that day. They each illuminate different aspects of the nexus of issues raised by the interrelationships among science, policy, and values, and together they provide a starting point for further theoretical development of our understanding of these issues.
The set begins with an examination of how policy (particularly policy with respect to drug approval studies) shapes the focus for the science that is done, and whether that policy regime is in line with our values. In his paper, “Hollow Hunt for Harms,” Jacob Stegenga raises a profound set of concerns with the contemporary medical research agenda. Stegenga argues that the way clinical research is conducted today systematically and deeply underestimates the harms of medical interventions. From language choices (such as “safety finding” or “side effect”) to indicate harms, to the value-laden nature of labeling something a harm, to the methods we use to evaluate patients, to the structure of clinical trials, Stegenga articulates the persistent challenges for identifying and discovering the harms associated with our medical treatments. Within the trial system, phase 1 trials (the first time something is given to humans) are a crucial location for discovering harms (that is the purpose of phase 1 trials), but results from these trials are rarely reported. This diminishes our ability, for example, to find possible patterns in harms that groups of chemicals might cause. Later trials, including randomized control trials, focus more on bolstering the case for positive benefits (by, e.g., the use of exclusion criteria in the selection of research subjects) rather than detecting “side effects.” And post-market monitoring is far too anemic of a process to robustly detect harms, Stegenga argues. Indeed, because post-market monitoring does not usually involve randomized trials, medical researchers and the policy institutions that regulate medicine are likely to ignore evidence arising from them. Worse still, what evidence is available is often never released. We are left with the judgment that our medical research system, as a matter of policy [End Page 476] and as a result of the choices made by researchers, is poorly structured to detect the harms of medicine. Researcher values (created by the incentives of the research endeavor) and policy combine to undermine our ability to know something we care deeply about.
The patterns and problems Stegenga diagnoses clearly rest with the policy framework in...