Ethical considerations for alcohol researchers in their relation towards policy makers

Alcohol policy research all over the world is often funded by national or local governments. Researchers involved may be confronted with several ethical questions. These questions can have quite a different character. Ethical questions may have a severe character that can be quite “clear” for the researchers involved. Miller et al. [1] for instance recently studied interference of funders, like governments or industrial and charitable organizations, in addiction research. Results show that activities occur such as censorship of research outputs, interference with the wording in reports and articles and interventions in when and how findings are released. Governments funding policy research may interfere in a way as described by Miller et al. [1]. but also less obvious ethical issues may occur: What if the research question is formulated in a “questionable” or “suggestive” way? What if policy makers deliberately ignore results of scientific research? The purpose of this contribution is to elaborate on these less obvious ethical issues, not primarily to give clear-cut answers but to raise consciousness and stimulate reflection and debate among researchers and policy makers.


Introduction
Alcohol policy research all over the world is often funded by national or local governments. Researchers involved may be confronted with several ethical questions. These questions can have quite a different character. Ethical questions may have a severe character that can be quite "clear" for the researchers involved. Miller et al. [1] for instance recently studied interference of funders, like governments or industrial and charitable organizations, in addiction research. Results show that activities occur such as censorship of research outputs, interference with the wording in reports and articles and interventions in when and how findings are released. Governments funding policy research may interfere in a way as described by Miller et al. [1]. but also less obvious ethical issues may occur: What if the research question is formulated in a "questionable" or "suggestive" way? What if policy makers deliberately ignore results of scientific research?
The purpose of this contribution is to elaborate on these less obvious ethical issues, not primarily to give clear-cut answers but to raise consciousness and stimulate reflection and debate among researchers and policy makers.

Policy makers and scientists-different points of departure
Scientists and policy makers have to deal with each other but they have different points of departure. Scientists generally aim to understand and explain human behaviour, for instance in relation to alcohol and drug use. Policy maker's main aim is to develop and implement policy that (from their ideological viewpoint) is helpful to society and prevents harm to society or its inhabitants. Policy makers for instance want to know whether the government can be held (partially) responsible for different causes of addiction and will realize that public opinion about the matter is mixed. In cases where people feel that genetic vulnerability is very important, they may think that the government is responsible for help and care. However, in cases where people think that having alcohol or drug related problems are a person's individual choice, they may feel that he or she has no right to public help and care.
Policy makers can have different legitimate reasons when they ask for scientific input. For instance, one may want to clarify questions or one may want to evaluate concrete interventions. It is also possible that they want to underpin their own opinions. In some cases, this can possibly lead to the research question being influenced in a "questionable" way.

What if the research question is influenced in a "questionable" way?
A policy maker may ask for a legitimization of his or her own opinion. As such this can be quite okay. One could say that this is just testing a hypothesis as we commonly do in research. However, in some cases, the formulation of the research question may be influenced by the policy maker to such an extent that the researcher may have the feeling that important information will be missed or will not be used. How should a researcher deal with such a situation?
Take for instance the policy issue whether heavy alcohol users or smokers should pay a higher insurance premium. At least in the Netherlands debates with regard to this question occur every now and then. For a policy maker this question is a complex one. The question arises what should prevail, self-determination and autonomy of the individual or the interests of society as a whole such as the costs of treatment. A policy maker may well ask for scientific research to underpin his or her point of view. But what if the policy maker asks to study possible ways to let heavy users pay a higher health premium, and he or she wants to include lifestyles/drugs that are not proven unhealthy? Alternatively, when the policy maker asks the researcher to use criteria or cut off points that are not supported by research and thus not realistic from a scientific point of view?

What if policy makers (deliberately) choose to neglect the results of scientific research?
Policy makers may deliberately neglect specific results of scientific research or even choose to use preventive measures proven less effective or even counterproductive. Again, the issue of heavy alcohol use may serve as an example. The prevention of heavy alcohol use among adolescents is on the agenda in many countries. Parents should have an important role in preventing heavy drinking. However, the contribution of parents alone may be too limited, and scientific evidence shows that some governmental measures are effective. Adding these may support parents in their preventive efforts. Again, however, one may ask in how far government interference on unhealthy lifestyles is justified. Policy makers are often not too eager to be very active in alcohol prevention perhaps partly because of mixed public feelings. And, if policy makers are active, public information and education are relatively popular measures for them to use. However, measures like these are known to be less effective or ineffective in changing behaviour and might sometimes even be counterproductive. Measures that are more effective aim to restrict the availability of alcohol [2][3][4][5]. In many countries, the government is not very active in imposing these less popular and more effective measures [6][7][8]. So, government interference seems needed for an effective

Journal of Alcoholism & Drug Dependence
prevention, but governments often fail to use the available effective measures.

Discussion
The purpose of this contribution is to elaborate on these less obvious ethical issues, not primarily to give clear-cut answers but to raise consciousness and stimulate reflection and debate among researchers and policy makers.
It is important to realize that the use of research evidence by policy makers is often limited. Many good reasons may lead to the decision not to use available scientific information. Information available may not be complete enough and/or research may be inconclusive. Policy makers often have limited power to act upon the results. Besides that, policy makers have other considerations to take into account. In addition to scientific information, norms and values are also very important for policy makers to be successful. In general, scientists should not be too quick to ask, "Why don't they listen to us". Often, this appears to be counterproductive and it seems preferable to have an on-going dialogue. Still, there are cases where researchers may want to raise questions on the decision of a policy maker not to use scientific information. Whether or not researchers "remain silent or raise their voice" may depend on different factors, e.g. personal matters, factors related to the "severity" of the issue at stake, and factors related to the context. Personal factors at stake for a researcher may be the fear of losing a job or income. In addition, contextual factors like understanding of the policy maker's decision from his or her position in the political playing field may play a role. It may be a very different situation when the policy maker makes a transparent decision not to follow scientific information because of accepted norms and values, as opposed to when he or she is acting out of self-interest. Of course, it is impossible to give unambiguous answers all the time. However, it is very important to be aware of these and other less obvious ethical considerations. The purpose of raising the questions above is to stimulate reflection and on-going debate among researchers and policymakers.

Role of Funding Sources
There was no external funding for this project.

Contributors
This project was fully collaborative between the three authors with respect to the conception and writing. All authors approve the text.