My mum and dad were both teachers and had high expectations for my brother and me to work hard in school. They also pushed us to do all sorts of summer jobs as soon as we became sixteen. My brother would spend his summers at the local meat packing factory, a gruesome job which would prompt many of his co-workers to become vegetarian. I was lucky to have more varied experiences, ranging from helping out with the census to overseeing the local polling station to working in restaurants and shops.
In most places, I had a very good time, interrupted only by a handful of bad experiences. Lack of dignity here would come in the form of being publicly embarrassed. At my very first job, in a gelateria, the owner had a penchant for colourful language, best employed to lambast me for things that had little to do with me. Later on, lack of dignity would mean seeing my self-esteem and ambitions being challenged and, at an extreme, being treated unfairly. In the planning office job at the local bank (a dream according to my family), there was little for me to do. They put an Excel manual on my desk and suggested I could read it. For three months, I read. But this, I felt, was not what I had graduated for. Giving my resignation to the HR person, I was told that my ambitions to move to the UK were laughable.
Arriving in London, the clerk at the job centre advised me to remove my engineering degree from my CV. Add back those ice cream parlour experiences, he said and helped me find a job in an Irish pub. Eventually, I added my degree back to my CV, moved on to consulting, and ended up working for a firm specialising in forecasting for pharma clients. This is the place where I started to reflect on dignity from the perspective of patients and physicians. I remember attending some interviews with GPs discussing new anticoagulants, drugs that prevent blood clots. The standard of care at the time was Warfarin, a drug previously marketed as rat poison, which requires careful monitoring. The interviews revealed that patients would not want to give up their routine checks at the Warfarin clinics, as these were opportunities to meet with others. Newer drugs might have been easier to manage, but they might have deprived the patients of important social interactions.
I was lucky to be able to continue to explore the context of pharmaceuticals in my research. My collaborators and I have been looking at selective reporting of clinical trials, and studies that are run to find out whether a certain medicine is effective and safe for the market. Unfortunately, much time and resources are wasted in these trials, among others, due to biases in publication and reporting. For example, studies with positive results are more likely to be published, and for those studies that are published, positive and statistically significant outcomes are more likely to be included in the final publication. These biases pose serious threats to the integrity of scientific research, but they also severely diminish the dignities of trial participants, who consent to participate in clinical trials with an expectation to contribute to advances in treatment and research. The scientific community needs to think carefully about how it might incentivise researchers to bend the rules of scientific conduct (e.g., by resorting to questionable publication and reporting practices) and how these incentives might be realigned towards more dignity and better science.
