Issue 72 Contents
From Monologue to Dialogue
engaging with the public on emerging issues in biomedical research
This is an extract from a longer review of public engagement in the development and regulation of emerging technologies that was prepared by Janet Salisbury and Barbara Nicholas (consultant bioethicist, New Zealand) in 2005. The full text of the review is at http://www.biotext.com.au/other/other.htm#comm
The rapid pace of biomedical science over the past 20–30 years has been accompanied by increasing levels of concern among the general public, fuelled by controversies such as radioactive waste, bovine spongiform encephalopathy (BSE, or ‘mad cow’ disease), mobile phones and genetically modified (GM) food. In addition, some emerging biotechnologies challenge our core values about who we are and how we want our society to be.
As these tensions emerged in the 1990s (particularly in the UK after the BSE disaster), governments allocated large-scale public spending to programs of public science education (science centres, festivals, education programs, TV and radio shows, media presentation of all kinds) and the profession of science communication was launched. These initiatives, referred to as ‘public understanding of science’ (or PUS), were based on a ‘deficit’, model of science communication — or a belief that public sympathy for science would be increased if people knew more about it. Despite all the activity, however, by 2000, public mistrust of science was deepening.
Faced with this worsening situation, especially with respect to GM food, in 2000 the UK government commissioned the House of Lords Select Committee on Science and Technology to conduct an inquiry. The report of the inquiry,Science and Society, marked a turning point in science communication worldwide (UK House of Lords Select Committee on Science and Technology, 2000). A key finding of the inquiry was that educational activities were no longer enough to engage an increasingly sceptical and less deferential public. Instead, the report recommended the need for a dialogue, where those seeking to promote science also listen to the concerns of the public, particularly when ethical questions arise. The report identified the following key issues:
The perceived purpose of science is crucial to the public response.
People question all authority, including scientific authority.
People place more trust in science that is seen as ‘independent’.
A culture of governmental and institutional secrecy in the United Kingdom invites suspicion.
Some issues currently treated by decision makers as scientific issues involve many other factors besides science. Framing the problem in a way that excludes moral, social, ethical and other concerns invites hostility.
What the public finds acceptable often fails to correspond with the objective risks as understood by science. This may relate to the degree to which individuals feel in control and able to make their own choices.
A variety of values underlie people’s attitudes to science. Bringing these values into the debate and reconciling them are significant challenges for the policy maker.
The Science in Society report was followed by a plethora of activity and other reports from the UK. In one study by the Office of Science and Technology and the Wellcome Trust (2000), people were asked about their overall attitude towards science, about the benefits versus the harms, and about the control of science. The study concluded that the public:
are interested in science but concerned about harmful effects,
are sceptical of political motives and the government’s ability to enforce regulations,
want scientists to listen more to what ordinary people think.
In the same year, the UK Department of Trade and Industry (2000) published a White Paper —Excellence and Opportunity: A Science Innovation Policy for the 21st Century. The paper praised the scientists who take part in expert scientific advisory committees but, in line with the findings of the Science and Society report, noted:
...science is too important to be left only to scientists. Their knowledge and their assessment of risks is only one dimension of the challenge for society. When science raises profound ethical and social issues, the whole of society needs to take part in the debate.
Since these reports, there has been a considerable activity in the UK, European Union, and elsewhere to promote the recommendations of the Science in Society report. Many approaches for public engagement in active debate and dialogue have been discussed and trialled. These are discussed further in the full version of this review (see above).
The dialogue, or public engagement in science (PES), model aims to stimulate and inform debate and include the community in a decision-making process that takes account of the opinions, expertise and values of all parties. Some key differences between the deficit model and the dialogue model are shown in the table below.
Developing Public Policy
When is a dialogue between scientists and the public most likely to happen? One place when representatives of different community stakeholder groups come together to discuss emerging technologies. That is, when government decisions are made about (a) what research to support and (b) what new technologies to accept into society, and in what ways. We have called this the ‘science–policy interface’. The development of science and science policies in biomedical areas is complex. To use the emerging technologies wisely, society must weigh up benefits, assess risks and make decisions about what is acceptable and what is not. Regulatory agencies around the world have struggled to find a path that allows the ethical development of appropriate new technologies while maintaining public confidence. Some key stakeholders in this process are:
researchers, including both those undertaking basic research (such as biochemistry, microbiology, and immunology) and those involved in applied research (such as clinical trials),
practitioners (such as GPs, medical specialists, dentists, physiotherapists and so on, who want to use the new technologies),
science funders (both public funders, such as the National Health and Medical Research Council, and private funders, such as biotechnology and pharmaceutical companies),
health consumers (that is, people who have medical conditions that could potentially be treated using the new technologies),
special interest groups,
the general public,
regulators (that is, government decision makers).
The key issues that these groups need to consider are:
ethical issues relating to the new technology,
how well it works,
how safe it is,
its cost effectiveness compared to other technologies,
its socioeconomic impact.
Consideration of these issues is also affected by timescales as it can take many years for a piece of scientific research to be translated into a recognisable result (usually around 10 years). Governments operate in a three-year cycle and the media and public tend to operate in the ‘here and now’.
Through the political and government decision-making processes, the regulators have to balance all these inputs and considerations to develop the most appropriate policies and regulations. This is a very difficult job and would be greatly helped by strong input from an involved public rather than a standoff with a distrustful and antagonistic community.
However, most of the stakeholders come to the table with a narrow perspective and have limited experience of what it is actually like to balance opposing views or find consensus in order to make a decision that will be accepted by all parties. When people are placed in this situation, they are often surprised by how hard it is. This was illustrated anecdotally in a series of public workshops held in the UK. Participants were split up into small workgroups to discuss different bioscience topics. The consultants running the workshops reported that when one participant suggested that things were getting difficult for his particular workgroup, another remarked that this must be what it was like in ‘real life’ (The Wellcome Trust 1998).
Overall, the following conclusions have emerged as a result of the ‘science and society’ debate and subsequent activities:
Public understanding of science per se does not increase sympathy for new technologies.
Denial of risks and uncertainties, or exaggeration of benefits, undermines the credibility of science.
Ethical values need to be explored within a broad social, rather than narrow scientific, context.
Awareness of scientific methods and limitations encourages realistic expectations.
Genuine dialogue would build public ownership of science and develop trust in scientists and regulators.
The public may be sceptical about public engagement if it appears to be a token process that allows them to express their views without any clarity about how this will influence the ultimate decision-making process. This highlights the need for careful planning of public consultation processes to clarify objectives and manage expectations.
Central to this process is for scientists to accept that ‘dialogue’ is not just another way of convincing the public to support science. Genuine dialogue involves all parties being open to change. There are undoubtedly perceived dangers for scientists in this approach as the science community and associated technology developers may have to modify what they are doing in response to the public debate. But there are also risks in not involving the public: bioethical issues are important to the public, and its response to emerging technologies can stop research in its tracks, as occurred in Europe for genetically modified food and in Australia for cloned embryonic stem cell research.
Ultimately, most people recognise that science has the potential to solve problems and improve human lives, as it has in the past (such as through improved medical care, increased food production and so on). However, many emerging technologies have associated risks and side effects. While a standoff persists between science and society, community discussion of these issues can be far too easily derailed and distorted by adversarial media coverage, commercial interests and political posturing. Therefore, I believe that the short-term risks to scientists of entering into a considered and genuine dialogue with the public would be more than offset by the long-term gains to both science and society that such a cooperative approach could bring. v
House of Lords Select Committee on Science and Technology (2000). Science and Society, United Kingdom Parliament, February 2000.
OST (UK Office of Science and Technology) and the Wellcome Trust (2000). Science and the Public: A Review of Science Communication and Public Attitudes to Science in Britain, October 2000.
Parliamentary Office of Science and Technology (2001). Open Channels: Public Dialogue in Science and Technology, Report 153, March 2001.
UK Department of Trade and Industry (2000). Excellence and Opportunity: A Science Innovation Policy for the 21st Century, White Paper, Office of Science and Technology, July 2000.
Wellcome Trust (1998). Public Perspectives on Human Cloning, Medicine in Society Programme, Wellcome Trust, London.
Janet Salisbury, Biotext Pty Ltd, 113 Hopetoun
Circuit, Yarralumla ACT 2600
Australia, Tel: +61 2 6282 2280
Issue 72 Contents