Written in response to what he recognizes as the problematic philosophical underpinnings of “orthodox research ethics,” Alex John London’s For the Common Good reimagines what is called for in any effort to create a better system of oversight and regulation in biomedical research. London weaves a common thread — justice — through this historical and critical account of the practice of research ethics and its organization of stakeholders, institutions and regulations. By introducing the idea of “a common good” London reframes the narrative and responsibilities of the research ethics field to demonstrate that scientific research and regard for the rights and welfare of individuals are not mutually exclusive. This impressive monograph encourages its readers to push past the limitations of traditional research ethics to consider the context in which the discipline is embedded. That is, rather than settling for analysis at the level of researchers and research participants alone, London encourages us to expand our inquiry to encompass a wider array of stakeholders who co-labor in the social undertaking of biomedical knowledge production. London accomplishes the difficult task of upstream analysis — turning his attention to the conditions and assumptions which create ethical dilemmas rather than applying a retrospective ethical salve to injuries near-guaranteed by a broken system. As opposed to the limited domain of orthodox research ethics (researchers, participants, and the institutional bodies which regulate interaction between the two) London also considers the role and contributions of affected communities, pharmaceutical firms, philanthropic organizations, and journal editors among others. London organizes the book into three parts — focusing first on the flawed foundation of research ethics, then homing in on the ethical nuances of domestic and international research. For the Common Good reads as simultaneously an indictment of orthodox research ethics and an invitation to consider an alternate framework.

According to London, the aim of orthodox research ethics is to safeguard research participants from excess harms at the hands of researchers, generally through regulation of study protocols by Institutional Review Boards (IRBs). London refers to this arrangement as the “IRB triangle.” Orthodox research ethics locates the “moral epicenter of research” at the center of this triangle, drastically limiting the scope of the field and dismissing broader questions and other stakeholders as outside the purview of the field. While certainly an important safeguarding practice, orthodox research ethics as it stands lacks any mechanism with which it could ask questions such as: Will this research produce knowledge that is socially valuable? Who is it meant to benefit? Who could it harm? And, perhaps most damningly, how should it be funded?

In failing to ask these essential questions, research ethics finds itself in the role of putting out fires that could have been avoided if the collective imagination surrounding biomedical research were more truly informed by philosophically robust ideals of justice. Research ethics has, since its inception, been somewhat of a reactionary enterprise. That is, often, if not always, research ethics is moderating and legislating around harms to research subjects by researchers. The field’s foundational codes, declarations, and trials were a direct response to crimes committed by Nazi experimenters, and the field has continued to develop against the backdrop of public outcry against ethical breaches: the Jewish Chronic Disease Hospital study, in which researchers injected cancer cells into geriatric patients who did not previously have cancer; the publication of Henry Beecher’s “Ethics and Clinical Research,” which highlighted 22 examples of what Beecher saw as ethics violations in research; and the Tuskegee Syphilis Study, in which the National Public Health Service studied the progression of syphilis in Black men in Tuskegee, Alabama. This fraught history and the never-ending battle to contain harms while maximizing scientific gains has at times seemed to pit biomedical research against the welfare of research participants. However, London argues that this does not have to be the case, as it is not human participation in research that is inherently problematic, but rather the regrettable severance of research from broader social aims. Drawing on Rawls, London distinguishes between a philosophical concept of justice and differing conceptions of justice, positing that despite diversity in substantive values, life goals, and how to facilitate their attainment, “every person can recognize themselves as sharing a more basic or generic interest in being able to form, pursue and revise a life plan of their own” (London, 15). In this way, London claims that there are universalizable social aims that can and should undergird both research aims and their oversight.

London’s project hinges on the idea that “the same concern for the common good that grounds an imperative to conduct scientifically sound research in the face of uncertainty and conflicting judgment grounds an equally strong imperative to ensure that this undertaking is organized on terms that respect its various stakeholders’ claim to be treated as free and equal persons” (London, xvi). While we generally agree with the aims of the project, it remains unclear how, even under perfect circumstances, the philosophical framework London proposes would translate into material reform. In a practical sense, the text calls for more than intervention at the level of reforming processes, such as altering the ways in which studies ensure their participants’ informed consent. Instead, London pushes us to reimagine relationships between stakeholders in shared knowledge production, including a more expansive understanding of who the stakeholders are, so that the fundamentals of a practical research ethics can shift toward common goals. London admits, and we concur, that this book is not a set of directions for spot treating every individual issue in research ethics, but rather a philosophical framework which allows us to transcend our currently imagined restraints to formulate a new perspective on the problems in research ethics. We find London’s approach to disentangling the philosophical from the bureaucratic intriguing, and remain wary of reform to structures which are currently far from what would be required to facilitate London’s proposed framework. While conflicts on the ground frequently do so pit the aims of research against participant welfare, and it remains unclear how to get from where we are to where we need to be in order for London’s scaffolding to be set into place, For the Common Good shows that research ethics need not continue to be a reactionary enterprise.