As researchers of the observable universe, scientists often
have a major impact on society through their work. Scientists drive progress by doing research to
explain certain events, patterns and phenomena happening in the world. In doing
so, they create new knowledge and established facts. At times, scientific research and discoveries
can alter or even overturn preconceived notions about a particular subject. In
this way, scientists are often perceived as commanding a special power and
authority. Consequently, they have a special responsibility to consider the
implications and consequences of their work. Especially where human subjects
are concerned, scientists have a duty to be socially and ethically responsible
in designing their research. A flawed or biased study design can lead to skewed
interpretations, and subsequently, results which are misleading can create harmful
negative social impacts.
The question I wish to raise here is related to an academic
paper that was published by a group of researchers mainly from the Universiti
Malaya, and widely circulated around the time of the heated debate on the
“foreign cook ban” issue in Malaysia. The policy was announced by the Human
Resources Minister M. Kulasegaran on 23 June to emulate a similar ban
implemented in Penang back in 2016. The controversial paper, titled
‘Microorganisms as an indicator of hygiene status among migrant food handlers
in Peninsular Malaysia’[1],
was widely shared by supporters of the ban policy, as evidence to justify the
rationale of the new government ruling.
On the same day, the Star published an article featuring an interview
with lead researcher Assoc Prof Dr Siti Nursheena Mohd Zain[2]. Quoting the article’s first
line: “Almost all foreign workers tested in a study were found to be carrying
microbes which could cause food poisoning and even death, and a small
percentage of them harboured antibiotic resistant bacteria, said researchers”. Even
if it was unintended, many felt that the researchers had played into
discrimination, by casting doubts on the hygiene standards of ‘almost all’
foreign workers in the food and beverage (F&B) industry. A majority of
migrant-supporting organisations that I spoke to were understandably furious at
the paper, especially for the fact that it had rapidly gained traction for
supposedly ‘proving’ the need for the foreign cook ban policy.
However, even after a backlash of public criticism, the
researchers staunchly defended their position, stating that their study was not
meant to divide between foreign and local workers[3]
and was not served as a comparative study.
After reading the paper, I believe the main problem lies with
the way the study was designed. Significantly, the researchers had not included
control groups to offer parallel analysis and possible alternative explanations
of the experimental results, such as local food handlers, migrant workers in
non-F&B industry and/or restaurant patrons. Neither did they include
negative control group (a group in which no response is expected) such as food
handlers who had just performed proper sanitisation steps.
Why are control groups so important in this case? First and
foremost, from a social context, singling out foreign migrant food handlers solely as having ‘bad hygiene’ is both
unfair and unethical.
Furthermore, it is also questionable to compare the workers
based on their country of origin, as the study had done. Given the large
standard deviation for each group’s result, it is unfair to assume that
individuals from any particular nationality are more ‘unhygienic’ than others,
since within each group there is already a big variation in individual personal
hygiene. In other words, some cleaner individuals would be discriminated along
with their countrymen, simply because the study highlighted the effect of
country of origin.
On 14 July, Penang health committee chairman Dr Afif Bahardin
issued a public statement confirming that a majority of the foreigners in the
state had fulfilled the typhoid jabs requirement[4].
“Instead, it was a majority of the locals employed who did not get the typhoid
jabs. This is a problem.“ he said. In fact, given that Section 34(g) of the Food
Act 1983 and Regulation 31 of the Food Hygiene Regulation 2009 stipulate all
food handlers to undergo medical examination to ensure the person is free from
carrying food-borne diseases, local employees should theoretically not
encounter such problems. His statement highlights the missed opportunity of the
researchers for excluding local food handlers as a control group, since food
hygiene issues are likely highly pervasive and personal, logically do not
discriminate on the basis of nationality.
Interestingly, despite its questionable study design, the
controversial research paper had in fact been funded by several government and
university research grants, and had received full ethical approval. In this
light, it is pertinent that we should talk about research ethics and social
responsibility.
The following are four golden rules of research ethics that
any responsible researcher should apply to his or her work:
i)
respect for persons: obtained informed consent
and the voluntary goodwill/trust from subjects before performing research
ii)
beneficence: ensure the study design is robust
and beneficial to study subjects
iii)
non-maleficence: there should not be any intent
of harm, either physically or mentally, to the subjects
iv)
justice: the findings should be seen as
just/fair to the subjects, not biased due to participant selection
In this case, the researchers should have considered how the
results of their study would be interpreted, in light of the sensitive (or some
say, xenophobic) sentiment against foreign workers in Malaysia. While there may
not have been the intent to cause harm, the study’s highly publicised
unfavourable findings have subjected foreign workers to public prejudice, in
extreme cases, even hatred. Such sentiments are highly damaging, especially
when they still have to carry out their duties day-in-day-out for a living. On
top of this, the combined threat of impending stricter health regulations and
higher frequency of spot checks by the authorities have created a cloud of fear
looming over the foreign worker community. These are the social consequences of
a poorly designed research.
It is high time that the Malaysian Medical Research and
Ethics Committee (MREC) look into such scientific research ethical issues. The
controversial migrant workers’ hygiene standards paper is a good case example
highlighting the shortcomings in ethical evaluation of scientific studies.
Perhaps the MREC should consider displaying all research study proposals
(including those that have been approved) on an online domain for open public
scrutiny. In this way, the public would be able to give feedback, objections,
and suggest amendments, even after formal evaluation is done and approval
given.
[1] http://journals.sagepub.com/doi/abs/10.1177/1010539517735856
[2] https://www.thestar.com.my/news/nation/2018/06/23/bad-hygiene-offers-food-for-thought-govt-urged-to-check-practices-that-lead-to-health-hazards/
[3] https://www.thestar.com.my/news/nation/2018/07/09/researchers-study-not-meant-to-divide/
[4] https://www.thestar.com.my/metro/metro-news/2018/07/14/bad-hygiene-sees-eateries-shut-some-of-the-outlets-found-to-have-rat-and-cockroach-droppings/
The edited article titled 'Unethical to single out foreign workers as being 'unhygienic'' is published here at The Malaysian Insight, Voices, July 31, 2018.
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