Ethical decisions must be made at every phase of a research study. Codes of ethics provide guidance on behaviors that are permissible or nonpermissible for research investigators. In contemporary science, investigators are required to have regular training on the responsible research conduct relevant to studies involving human subjects and animals. Despite this training, ethical lapses occur. This chapter explores some of the basic issues, including ethical mandates on what should be done, what must be done, and what must not be done. We consider the history of serious ethical concerns, such as the Tuskegee experiment. The chapter also reviews historical milestones such as the Belmont report, the Declaration of Helsinki, and the establishment of the Common Rule that is applied for research funded by US federal agencies. Further, the chapter explores challenges relevant to the reporting of conflicts of interests, imperfections in institutional review boards (IRBs), and ethical challenges in studies that use placebos. Among a range of research methods, randomized controlled trials tend to encounter the greatest number of ethical concerns.

After reviewing a wide range of topics, we conclude that good science requires greater efforts to manage biases and to promote the ethical conduct of research. An important problem is the belief that randomized controlled trials (RCTs) are exempt from systematic bias. Throughout the book, we acknowledge the importance of RCTs, but also emphasize that they are not immune from systematic bias. A second lesson concerns conflict of interest, which must always be taken seriously. Most large RCTs are sponsored by for-profit pharmaceutical companies. We identify leverage points to address these problems. These include cultivating equipoise – the position that research investigators enter a study with the understanding that either a positive, negative, or null result is of value. We return to several other themes prominent throughout this book, including the reporting of research findings and serious problems with our system of peer review. The book concludes with recommendations for reducing conflicts of interest, improving transparency, and reimagining the peer review system.

Dinah Craik’s 1851 novella The Half-Caste tells the story of how a half-Indian heiress, Zillah Le Poer, faces manipulative attempts by the greedy British side of her family to control her fortune, which she thwarts by marrying her older Scottish guardian. This reading of Craik’s novel examines the production of race at a period when dominant British imperialism was believed to depend largely on hierarchies of race allegedly constructed by heredity. Walters argues that Craik describes how new racial identities can be produced by the ‘affective capacity of brown, Eurasian, female bodies to feel connection with, and dependence on, white women’, with resulting implications for racial hierarchies, and for Empire itself. The chapter examines the idea of race in part as a function of feeling and reveals a ‘slippage between affective and racially scientific methods of assessing difference’.

This chapter explores how policymakers and practitioners in settings beyond the sites of evaluation might make use of evidence from realist trials and systematic reviews, plus local needs assessment, to identify the best candidate interventions for their local contexts. To do this, local decision-makers need to assess how likely are interventions to achieve benefits in their contexts. This is partly a matter of assessing whether interventions are likely to be feasible, accessible and acceptable in their settings, which will be influenced by local capacity and norms. It is also a matter of assessing whether intervention mechanisms will be triggered and whether these are likely to generate beneficial outcomes. This will be influenced by what aetiological mechanisms are generating adverse outcomes in the context and hence what vulnerabilities exist which the intervention may be able to address. It will also be influenced by whether the local context provides affordances so that potential beneficiaries may be able to benefit from the intervention. Thinking through these issues should enable local policymakers and practitioners to decide whether such interventions could be delivered immediately at scale, be implementing but only within evaluated pilot studies or be rejected in favour of other interventions.