1. The Ethics Unwrapped video on conflicts of interest states, in part, that “sometimes, individuals have incentives that conflict with their professional responsibilities, often in ways that are not transparent to the public or even in their own minds. These conflicts of interest produce serious economic and social problems.” How are the facts in this case study relevant to this statement?
2. At the end of the day, are the factors described in this case study (wealth, fame, promotion, etc.) unique to Wakefield’s situation or do these factors commonly impact the decision-making of academic researchers? If so, how?
3. The Ethics Unwrapped video on the self-serving bias points out that because of this bias, people have a tendency to gather, process, and even remember information in ways that advance their self-interest and support their pre-existing views. What facts in the case study might cause Andrew Wakefield to be impacted by the self-serving bias?
4. As mentioned, the self-serving bias inclines people to process information in a self-serving way. One relevant influence is the confirmation bias, which is the tendency of people’s minds to seek out information that supports views they already hold and to interpret evidence in ways that support those views. The Ethics Unwrapped video on the confirmation bias gives this example: when physicians have an idea about a patient’s diagnosis, they may focus on evidence that supports their theory while undervaluing evidence that supports an equally plausible alternative diagnosis. Do you see evidence of the confirmation bias in the facts spelled out in the case study? Explain.
5. Nick Chadwick was a researcher on Wakefield’s team. When Chadwick applied tests the team had developed for amplifying measles DNA, he was unable to find the virus where Wakefield’s theories indicated it should be found. This did not please Wakefield. As Chadwick said: “He tended to believe, you know, positive data that fitted with his hypothesis and then disregard the negative data.” Does this quotation provide evidence that Wakefield was affected by the confirmation bias? Explain. Consider these quotations from Deer’s book:
- Wakefield’s mother said: “He’s very like my father. If he believed in something, he would have gone to the ends of the earth to go on believing.”
- John March, a veterinary vaccine specialist who was part of Barr’s team to analyze the evidence, found that there was no viable legal case. March said that he was asked to sign a confidentiality agreement to ensure that the evidence would never be published, adding: “It was almost like it had become a religion. And if you got a result that you didn’t like, you ignored that result and carried on.”
- Scientist Hugh Fudenberg turned away Wakefield’s attempt to form a joint business, later saying that he didn’t like Wakefield’s priorities: “He wanted to prove he was right. That was his main motive. To prove he was right. He kept at it through thick and thin. He was about just money too much.”
6. In one study of the confirmation bias done by Professors Ditto and Lopez, subjects were given a strip of paper and told they could use it to test to see whether they had a particular fictitious medical condition. Some subjects were told that if they put their saliva on the paper and it did not change color, then they did not have the condition (which portended pancreatic issues later in life). These people generally would touch the paper to their saliva, see that it didn’t change color (because, unknown to them, it was just a strip of plain yellow construction paper) and go on their way happy with the result. Other subjects were told that if they touched the paper to their saliva and it did not change color, that meant that they did have the unfortunate condition. These subjects tended to touch the paper to their saliva, see that it didn’t change color and then, not being happy with this result, would typically touch the paper to their saliva several more times, hoping for a different result. In the course of your work (maybe as a researcher, maybe in another role) you may face a situation where a particular outcome of an experiment (or a program or a plan) will be a good development for your career. How will you guard against a subconscious desire to interpret ambiguous evidence in a one-sided manner that benefits you?
7. What special qualities might immunize you from the self-serving bias? Does this buffer seem a realistic one to you? Explain.
8. Wakefield had visions of a Nobel Prize and a dream of being the world’s leading gastroenterologist. Yet, as Brian Deer points out, as Wakefield started his infamous study that was ultimately published in The Lancet:
…he’d been nobody: a doctor without patients at a third-rate London hospital and medical school. He’d been a laboratory gastroenterologist, a former trainee gut surgeon, most relevantly defined by what he wasn’t. He wasn’t a virologist, immunologist, or epidemiologist. He wasn’t a neurologist, psychologist, or psychiatrist. He wasn’t a pediatrician or clinician.
How might the overconfidence bias have played a role in the chaos that Wakefield created with his “study”? How does that square with what Deer says about Wakefield above? Explain.
9. Cain, Loewenstein, and Moore hypothesized that disclosure of conflicts of interest could worsen rather than improve financial advisors’ performance in two ways. First, while having to disclose conflicts of interest might incentivize financial advisors to consciously try to improve the accuracy of their recommendations, they might also be tempted to provide even more biased advice knowing that their clients would perhaps discount their advice somewhat due to the disclosure of the conflict (this is called “strategic exaggeration”). Second, after doing a good thing (disclosing conflicts of interest), financial advisors might unconsciously grant themselves permission to lower their normal standards by providing even more biased advice (this is called “moral licensing”). Cain and colleagues tested their theory experimentally and found just such a result. If you are a researcher, describe how you will guard against strategic exaggeration and moral licensing after you disclose your conflicts of interest. If you are in another role (in your career or as a student), how might strategic exaggeration and moral licensing impact you?
10. How might researchers who wrongly, but perhaps sincerely, believe that they are on the trail of the true cause of the recent rise in autism diagnoses give themselves moral license to stretch the truth and to relax research protocols in order to convince the world of the accuracy of their findings that they so strongly believe? What rationalizations might these researchers use to justify their actions?
11. Once Wakefield had held a couple of press conferences announcing that his findings supported the theory he was touting, would it have been difficult for him to later admit error? Deer thought so. Do you agree with the implications of his statement below? Explain.
[Wakefield] was being paid at hourly rates to advance his “syndrome” in Barr’s lawsuit. If he didn’t find fault with the solicitor’s target product, his lavish personal fees would stop. He’d filed for two patents claiming single measles shots. And, with [his mentor Dr. Roy] Pounder, he already announced to the world, in Pulse [a magazine for doctors], evidence that “confirm our suspicions.”
12. People can be unconsciously impacted by factors such as the self-serving bias, the confirmation bias, the overconfidence bias, and the like. But sometimes, wrongdoing can be conscious and intentional. Which is it with Wakefield? Do you believe Wakefield was influenced by subtle psychological factors (as well all are), or do you think his actions were more intentional? Consider the comments below, and support your reasoning.
a. The Lancet’s editorial board concluded:
Who perpetrated this fraud? There is no doubt that it was Wakefield. Is it possible that he was wrong, but not dishonest: that he was so incompetent that he was unable to fairly describe the project, or to report even one of the 12 children’s cases accurately? No. A great deal of thought and effort must have gone into drafting the paper to achieve the results he wanted: the discrepancies all led in one direction; misreporting was gross.
b. And journalist Brian Deer, who found Wakefield to be “incapable of embarrassment” and possessing “no conscience.”
13. How could Wakefield have possibly believed that the disclosure rules of the “Uniform Requirements” did not apply to him? How could he have not joined ten of his eleven co-authors in retracting the article in The Lancet? Are these decisions indications that he is an intentional fraud, or that he is just more susceptible to these various biases than most of the rest of us? Explain.