The title of my talk has to do with changing ethical standards.
I feel as though I belong in the Ice Ages in research, because I began
my research in the Solomon Islands in the southwestern Pacific 35 years
ago. I reprinted the foreword to my book from 1975 for you, which
gives a little of the sense of how I entered communities at that time,
and how I was accepted into the groups there. In terms of being an
example of a successful research collaboration, there's no question there
are things that I've done in the past that I would never do today.
And in fact, I don't think the sort of research that I began 35 years ago
could be begun in the same way today. So, one of the major points
of my talk today, I think this is important, is the contextualization of
ethical questions in a time, as well as in a political circumstance, and
with the particular populations involved.
There's also no question, just to reiterate -- probably the most important
thing that everyone has said, including this morning with Frank Dukepoo
– that if there's going to be any kind of successful research collaboration,
trust is the underlying issue. How that's achieved and how
it's maintained over the long run, again, is open to some question.
Another issue that is very important that has not been explicitly mentioned
today, is the issue of empowerment. That is, in many cases
where research collaborations involve populations that are not part of
a dominant community, whether it's within the United States or outside,
is that there's suspicion between a more dominant research-oriented population
and a subject population that has to be dealt with, or minimized.
The real issue that I can talk about is how ethical standards have changed
so radically. When I first began my fieldwork in Papua New Guinea
in 1966, it was still under Australian control. The clearance I had
to receive came only from the local Australian administrator, and his primary
advice consisted of two items. First, I could not pay subjects for
their time or cooperation (it would confuse them when the medical/malarial
service wanted to collect blood smears and give shots). Second, I
should refrain from criticizing the Australian administration, which was
then beginning the preparations for self-government and independence.
He also strongly urged me to contact local leaders and discuss plans, but
also strongly urged me to contact local leaders and discuss plans, but
nothing formal was required. I then went to an area I was interested
in and began to discuss my ideas for the survey with local missionaries
and leaders. I was referred to a particular village and resident,
who led me to his home. He helped me describe to people there what
I hoped to do, and when. I then appeared with my baggage on the appointed
date, rent a house for a week or two, and asked to talk to people more
formally about what I proposed to do. Usually in the evening, a community
meeting would occur, where I described my project, what they might be concerned
about, and what their opinions were about the project. If they didn’t
want to participate, I moved on (this happened in one case). Ordinarily,
this discussion went on for two or three hours. At some point in
the successful encounters, people would say, “Alright, you can go ahead.”
After the first village, these meetings followed a fairly regular formula,
as I became more fluent in Tok Pisin, and as people heard about my project.
I sat around and talked for two or three days with the adults, mostly
around dinnertime and afterwards, about what it was I really wanted to
do, which was essentially population history. I wanted to try and
see how they were different from other people on that island; it seemed
to me their situation was very different, from the situation in the United
States. There were many different languages spoken on the island;
there was the sense that there was a lot of variation from one area to
the next, and that was of interest to people in my part of the world.
And after a while, after two or three days, people said, "Yes, you can
go ahead." And so I began, by taking fingerprints and measuring people,
and finally taking blood samples. And then it became easier to do
this as I went through 18 to 20 villages over a period of ten months.
And the results were published in a book, and I made sure that the book
was returned to various offices in the country. And probably the
most important thing I did was to go back after three years, and of course,
in that part of the world, as is so common elsewhere, the first time you
come to an area you're a visitor, and the second time, you're a member
of the group. And so the research collaborations continued.
I've been back into these areas eight times over the last 30 years.
Now, what's happened subsequently, in the post-independence period,
which was very shortly after my first field trip, was that, when I came
back, I discovered that I had to establish an affiliation -- besides what
went on in the United States with IRBs -- in the new independent countries,
in Papua New Guinea in particular. There was a Medical Research Institute
which had developed, and all foreign researchers were required to become
associates of the Medical Research Institute, which effectively acted as
a control on the kinds of research that were done. It was essentially
a second IRB representing the local interests of the developing nation.
They had to provide research permissions saying it was approved, from the
community, saying that I was a known quantity and it was allright for me
to come; also from the local provincial government, which had been established,
which is rather like a state government, as well as their health offices.
And it also had to pass a national health review board. Their conditions
for allowing foreign researchers were that any research project had to
have potential health benefits, either real or potential -- for the nation
and for the population involved; that certain requirements for group and
individual informed consent were to be met; and that there was a definite
effort made to establish training of local people in terms of research
collaborators. These are issues that have come up in discussions
here before. But they were all very new at the time for me.
So in a certain sense, what was lacking, very much lacking in the first
instance has become instituted -- this whole issue of informed consent
-- if you still have the likelihood of inadequate informed consent on an
individual basis, when you can say people are still not in the informed
situation that you would prefer, in terms of being able to say, "I understand
the research potential, I understand the costs and benefits of your research,
and under these circumstances I will or will not allow participation in
this project," you have almost a surrogate or a substitution of a second,
local, IRB representing what you hope is the interests of the population
and individuals in that area, in terms of the secondary or national scientific
review board. Now, this is all imperfect. I think we talked
about the difficulties in establishing perfection in terms of informed
consent, but it does show a very definite progression in what I hope is
the right direction. There is no question, however, that you could
ask, why did people, in the first place, allow me to come in? And
I've thought about that a lot, because I wasn't coming in under a coercive
situation. And it has a lot to do with the political context of the
I was very fortunate in being an American. You may say that this
is misleading, but as an American, and unlike some of the situations we've
been talking about, I had a rather special stance versus Australians and
other foreign investigators. Because of the history of the Solomon
Islands during in the Second World War, it was a positive thing being an
American, and also to be the first American foreigner to want to live in
a community, to spend time and sleep, eat, and so on, in a community; that
clearly had a positive value to it for the various populations that were
involved, and for the sorts of research that came out. The fact of
publication of a monograph with people's photographs, talking about their
population relationships within the island and between the islands, gave
people a definite sense of self-importance. I don't know how to say
it any other way.
So finally -- I want to say some things that I think are very important
to keep in mind, that I think are more applicable generally. If you
always think you are going to have to come back to an area for further
research, you are much more likely to do what is required to satisfy people.
Particular standards change from one time to the next. That implies
that you will do what is necessary to require, to develop a sense of continuing
trust and a continuing relationship. With regard to this business
about cost-benefit analysis--obviously, it's important to try and discuss
the relative costs and benefits of your own specific research proposal.
But there may be very different cost-benefit considerations on the part,
not only of the community but of the larger community that you're associated
with; in this case, the national government. So for example, oftentimes
I was in the situation where we'd go to the regional health office and
say, "This is what we want to do, this is what we're interested in, but
we will be in a rural community, and what would you like us to find out
-- what can we do for you? We have these confidences," and sometimes
the response would be, "We'd really like to know the prevalence of AIDS
or HIV infection in the area," and we'd say, "Well, we have that capacity
to find that out, but we don't think it's going to be very high or significant
but we can do it for you," and they'd say, "Okay, we'd like to know."
So there can be various kinds of arrangements and cost-benefit considerations
for different levels of group negotiations.
Also, I think there's no question but that what you're really should
do in the end, by hopefully training collaborators, is replacing yourself.
And in this part of the world, the Southwest Pacific, there is the model
of the old, Roman Catholic mission where it was at first a group of French
and German missionaries who came into this area, who missionized the population
and educated an elite. These were replaced subsequently by trained
and educated local people, who became priests and so on, and now there
are no more foreign missionaries. In the same way, what's happening
in the health profession in this part of the world is that slowly, but
very clearly, physicians and medical researchers are being trained locally
and will replace people like me in the future. And that will probably
be the ultimate solution of these problems of empowerment and group inequality.
*This talk has been edited for web publishing by the author.