Caspar Safarlou

This dissertation examines the overarching beliefs and values driving exposomics, an innovative research venture in environmental science. Inspired by the success that the Human Genome Project had in creating technology to sequence the entire human genome, many environmental epidemiologists saw the need to improve their ability to measure environmental exposures. The idea of the exposome spurred a lot of research activity: exposomics researchers created new cohorts, improved measurement technologies and data analytics, and published many hundreds of studies. However, exposomics lacks an identification of overarching beliefs and values that allows researchers to drive the field toward scientific and technological progress. In particular, more research needed to be done to map the values that are relevant to exposomics. Using a systematic literature review and focus groups, this dissertation essentially identifies these values as: research goals, research standards, research tools, the trade between researchers and participants, health at a population and an individual level, occupational health, forensic science, and justice (in various domains). On the basis of this map and a conceptual-ethical analysis, this dissertation identifies and evaluates the fundamental beliefs and values of exposomics. It defines exposomics as a research program in environmental health aimed at enabling a comprehensive and discovery-driven approach to identifying environmental determinants of human health. Exposomics should fundamentally value the creation of such a comprehensive and discovery-driven approach. To uphold this value, exposomics requires a view of human beings as agents with the authority to master the environment for the pursuit of human health.

As biomedical science progresses and novel ethical values and questions emerge, there is a practical need for professional ethicists to identify and address them. Responding to emerging ethical values and questions can require engaging with other people’s values and the ethical theories they hold. Parker discusses both the challenge and potential value of ethical disagreement for grappling with emerging ethical questions. He proposes adversarial cooperation as a novel strategy for dealing with these disagreements and helping achieve (among other things) ethical progress. Therefore, his proposal raises the following question: can one engage with such moral disagreements and make progress in ethics?[i]1 In Parker’s view, moral disagreement can be valuable for ethics research because engaging ‘‘productively and respectfully with seemingly intractable differences of values, commitments and interests’’ could bring ‘‘mutual understanding and more ethically robust positions.’’1 To enable such engagement, Parker proposes to reform bioethics and the expertise of bioethicists. Instead of bioethics training being focused primarily on argumentation and ethical theory, he holds that bioethicists should principally be trained to become mediators whose authority is ‘‘grounded in the ability to facilitate inclusive and trustworthy processes of moral deliberation.’’1 Why should bioethicists become mediators? By drawing on the concept of antagonistic cooperation, Parker seems to endorse an ‘‘irreducible cultural pluralism’’ where people’s values and their productive interaction arise from ‘‘lived experience and practical activity, not abstract theories.’’[ii]1 As a result, for Parker’s worldview, there seems to be no truth in ethics that bioethicists could discover through research.[iii] So what type of work is left for the bioethicist, if not investigating the ethically right course of action? In Parker’s framework, bioethicists can try to make the most of such irreducible value conflicts. How? Through mediating between people who ethically …

Background: Exposomics, the study of the exposome, is flourishing, but the field is not well defined. The term “exposome” refers to all environmental influences and associated biological responses throughout the lifespan. However, this definition is very similar to that of the term “environment”—the external elements and conditions that surround and affect the life and development of an organism. Consequently, the exposome seems to be nothing more than a synonym for the environment, and exposomics a synonym for environmental research. As a result, some have rebranded their “standard” environmental health research with the neologistic exposome term, whereas others ignore or seek to abandon the seemingly redundant concept of the exposome. Objectives: We argue that exposomics needs to sharpen its mission focus to counteract this apparent redundancy. Exposomics should be defined as a research program in environmental health aimed at enabling a comprehensive and discovery-driven approach to identifying environmental determinants of human health. Similar to the aim of the Human Genome Project, exposomics aims to analyze the complete complexity of exposures and their corresponding biological responses. Exposomics’ primary premise is that the existence of undiscovered, potentially interconnected, nongenetic (environmental) risk factors for health necessitates a comprehensive discovery-driven analysis approach. Discussion: We argue that exposomics researchers should adopt our reconceptualization of exposomics and focus on the productiveness and integrity of their research program: its purpose and principles. We suggest that exposomics researchers should coordinate the writing of reviews that assess the program’s productiveness and integrity, as well as provide a platform for exposomics researchers to define their vision for the field.

In recent years, exposome research has been put forward as the next frontier for the study of human health and disease. Exposome research entails the analysis of the totality of environmental exposures and their corresponding biological responses within the human body. Increasingly, this is operationalized by big-data approaches to map the effects of internal as well as external exposures using smart sensors and multiomics technologies. However, the ethical implications of exposome research are still only rarely discussed in the literature. Therefore, we conducted a systematic review of the academic literature regarding both the exposome and underlying research fields and approaches, to map the ethical aspects that are relevant to exposome research. We identify five ethical themes that are prominent in ethics discussions: the goals of exposome research, its standards, its tools, how it relates to study participants, and the consequences of its products. Furthermore, we provide a number of general principles for how future ethics research can best make use of our comprehensive overview of the ethical aspects of exposome research. Lastly, we highlight three aspects of exposome research that are most in need of ethical reflection: the actionability of its findings, the epidemiological or clinical norms applicable to exposome research, and the meaning and action–implications of bias.

This paper addresses Joseph Heath’s attempt to derive moral obligations from the conditions that are specified by the model of the perfectly competitive market. Through his market failures approach to business ethics he argues that firms should behave as if they are operating in a perfectly competitive market. However, I argue that this derivation of moral obligations runs counter to the metaethical principle that moral actions need to be voluntarily chosen from a set of alternatives. To the extent that Milton Friedman’s derivation follows the same lines, my objection is also applicable to his approach to business ethics. I bring out the fact that the conditions required by the model of the perfectly competitive market cannot be realized in the actual world and argue that this causes problems for any moral obligations that might follow. My objection is illustrated by an intuitive example of someone set to an impossible task. I also bring in a way that Heath could work around this objection, but I argue that this would imply the collapse of his approach into another kind of theory that he wishes to distinguish himself from. More deeply, I show that my metaethical objection has epistemological consequences that undermine the very basis of the model of the perfectly competitive market. I conclude by stating that we need a different conception of competition, pointing to the facts that such a perspective would need to take into account, and suggesting that the concept of rivalry is up to the job.

Exposome research is put forward as a major tool for solving the nature-versus-nurture debate because the exposome is said to represent “the nature of nurture.” Against this influential idea, we argue that the adoption of the nature-versus-nurture debate into the exposome research program is a mistake that needs to be undone to allow for a proper bioethical assessment of exposome research. We first argue that this adoption is originally based on an equivocation between the traditional nature-versus-nurture debate and a debate about disease prediction/etiology. Second, due to this mistake, exposome research is pushed to adopt a limited conception of agential control that is harmful to one's thinking about the good that exposome research can do for human health and wellbeing. To fully excise the nature-versus-nurture debate from exposome research, we argue that exposome researchers and bioethicists need to think about the exposome afresh from the perspective of actionability. We define the concept of actionability and related concepts and show how these can be used to analyze the ethical aspects of the exposome. In particular, we focus on refuting the popular “gun analogy” in exposome research, returning results to study participants and risk-taking in the context of a well-lived life.