Sunday, July 18, 2010

The Ebb of Personal Morality

This morning on a new PBS program that I commend to your attention, Need to Know, I listened to a reasoned discussion of the problem of what amounts to corruption in the alliance between pharmaceutical companies and physicians/scientists.

If you think about it, it is obvious that if my company (and I) will be more enriched by hiding scientific information indicating that our drugs may be unsafe or ineffective (or both), I may be more inclined to do so. (By the way, let’s say that we do 20 studies and our treatment shows up as significantly effective in only 1 of these – that will happen by chance. But if we report only on that one study, it will seem like something worth taking, and paying for.) Similarly, if I am a physician or scientist on the payroll of (or enjoying speaking fees from) a pharmaceutical company, saying nice things about their medications, and recommending them to others, will of course be in my financial interest.

What this morning’s interviewee (Jerome Kassirer, MD, former editor-in-chief of the New England Journal of Medicine) recommended was not increased government oversight, but rather holding individuals accountable for their unethical behavior. Without fear of consequences, and shielded from their consciences by being part of a large organization, people are likely to do what feels rewarding now, and blind themselves to the larger or longer-term effects.

One place we could look for evidence of that, I’m sure (but, by the way, not bothering to do a literature search for the purpose of this blog that 3 people read), is in social psychology. If everyone around me is doing something, and it is embraced (either overtly or with a wink) by the organization of which I am a part, it will be much easier for me to rationalize my behavior, even if in the back of my mind I know it’s not the right thing to do.

We have only to look at the ongoing, worldwide economic crisis, which some economist say threatens to hit again in a second wave, or to the latest devastating environmental crisis in the Gulf (amid the echoes of “Drill, Baby, Drill”), to find one example after another of human beings blinding themselves to the very serious eventual impact of their irresponsible behavior because of the intoxication of immediate gain (more money for me, more recognition, more power, more stuff, more euphoria).

As is my wont, I will now note the obvious parallels to addictive behavior. It is often said that, in addiction, the brain gets neurologically “hijacked.” People go to great lengths to protect a pattern of behavior and sensation, as if it were necessary to their survival. Their choices are ruled by immediate rewards (and fear of immediate unpleasantness); longer-term and more momentous consequences are rationalized away or simply ignored in the service of maintaining the addiction. Of course, in the long run, no one’s life is meaningfully enriched by intoxication, euphoria, escape, riches, fame, or power. But, for us humans, it appears that this is how the game is played.

Since the addict (like other human beings) tends not to be guided toward rational, “good” behavior by his or her own instincts, it is usually necessary for him or her to develop what I (and, I’m sure, others) call “healthy fear” in order to summon the initial motivation to take steps toward recovery. The activities often referred to as “enabling” are the behaviors of those surrounding alcoholics/addicts who cushion them from the negative consequences of their actions. When the alcoholic/addict finally gets to the point of having more fear of what will happen if s/he continues to drink (or drug or gamble, etc.) than the existing fear of what will happen if s/he does not – that is often the moment when the first efforts toward change are made. (Not much different for the sedentary overeater who suddenly goes to the nutritionist and the gym after having a heart attack.)

Once in recovery, addicts often eventually need to come to terms with things they did while actively addicted that were foolish, hurtful, unethical, etc. Their retroactive guilt and shame can sometimes trigger cravings to return to their substance for relief. Those who participate in 12-step groups get some help in addressing and resolving the guilt through some of the steps specifically focused on self-examination and reparation. (Others, of course, may go through a similar process in other ways, such as psychotherapy – I don’t think we have a pill for that yet.)

People behave best, it seems, when they are subject to a strong sense of personal responsibility for their choices. I am not suggesting that personal choice and free will are the only, or even primary, factors contributing to how people behave, but that a sense of personal accountability, closely connected with “healthy fear,” may be the only or best route toward doing what’s best for ourselves, our communities, our country and world. Researchers who fabricate or distort scientific findings, or hide contrary results, should be subject to losing their careers. Corporate workers (from the top executives who green-light projects or ignore unprofitable information to the front-line workers who run studies or sell mortgages or check the mechanical integrity of oil wells or Big Dig tunnels) will never change their behavior if only the corporate entity is sanctioned, while individuals continue to be rewarded. Promoting a sense of individual moral responsibility may be the big challenge of our time, if we are to avoid becoming the victims of our own largely primitive brains.