Ever since the "age of enlightenment" dawned in the 17th century and emphasized an objective view of the natural world by means of the scientific method, free societies everywhere have prided themselves on making research findings from their laboratories readily available to all through the scientific literature. Such openness has had an incalculable beneficial effect on the advancement of science in all of its domains. Discoveries in one study often form the basis for novel lines of investigation by other research groups. The widespread accessibility to new findings has played a key role in the explosion of scientific knowledge that has occurred during the past three centuries.
Because of this cherished legacy of open access to new information, the scientific world was taken aback by the National Science Advisory Board for Biosecurity (NSABB) recommendation in late 2011 that manuscripts from two virology research groups – one at my home base, the University of Wisconsin-Madison, and the other at Rotterdam’s Erasmus Medical Centre – be revised prior to publication (Kawaoka Y: Flu transmission work is urgent. Nature 2012;482:155). The Board requested that the methodological details regarding the transmission of H5N1 virus in mammals be deleted from the manuscripts. The NSABB’s contention was that if such information became available to malefactors, it had the potential to be used for harmful rather than beneficial purposes.
Because of the lethality of the H5N1 virus in humans, these studies and future investigations engendered by them are of central importance. One only needs to recount the devastating effects of the "Spanish flu" that claimed up to 100 million lives early in the 20th century. Of the 570 known cases of H5N1 flu in humans, 60% have been fatal. All of these illnesses resulted from bird to human transmission. The key question the contentious investigations were attempting to answer is whether transmission of the virus is possible between mammals. The ferret that is evidently much like Homo sapiens when it comes to flu transmission was the experimental animal used.
The NSABB’s recommendation was highly controversial among scientists. Some supported a ban on such research until global guidelines could be developed for high-risk virus studies, while others contended that the benefits of making the detailed research findings widely available far outweighed the risks. They believed that even temporary suspension of research would delay the important scientific groundwork needed to be completed for H5N1 flu pandemic preparedness. The two involved scientists agreed to a voluntary ban on further investigations until guidelines were developed by the World Health Organization. These were published in 2012, and work on this key problem was resumed in laboratories able to meet the appropriate biosafety and biosecurity standards. Fortunately neither an increased number of cases nor an H5N1 flu pandemic developed in the interim.
The obvious ethical question underlying this imposed research moratorium is when, if ever, should free societies condone suppression of science? In the physical sciences that more frequently deal with matters of national security, such as weapons development, the boundaries of when to and when not to control research findings are much clearer. In contrast, when to impose limitations in the medical sciences is considerably murkier. In the example cited above, the NSABB felt compelled to act for two reasons. First, they wanted assurance that laboratories conducting this high-risk viral research met established biosafety and biosecurity standards. Few would question the appropriateness of such action. Second, they wished to prevent publication and thereby wide accessibility of newly acquired scientific information to avoid the remote possibility that it might be used for other than noble purposes. This consideration represents a much slipperier slope. In view of the virulence of the virus being tested, there is no doubt that H5N1 transmission studies are high risk. On the other hand, to withhold important, recently acquired information about this potentially deadly agent may impede research by other virologists who could contribute to eventual eradication of the threat, e.g., by development of an effective vaccine.
While the conundrum presented here has little to do with surgical science per se, it should make all of us in the greater scientific community ponder whether, when, and by whom limitations on communication of important research discoveries should be enforced. Offhand I cannot provide a scenario of a similar situation occurring within the surgical realm. However, seminal advancements in our craft have often depended on innovations in fields far removed from surgery. Only through the collective efforts of basic scientists and clinicians at the bedside and in the operating room can we unravel those secrets of nature so necessary to provide optimal care to our patients. How and when these discoveries are made available for the greater good does command our careful and thoughtful consideration.