Research versus practice: The dilemmas of research ethics in the era of learning health‐care systems

In this article we attempt to answer the question of how the ethical and conceptual framework (ECF) for a learning health‐care system (LHS) affects some of the main controversies in research ethics by addressing five key problems of research ethics: (a) What is the difference between practice and research? (b) What is the relationship between research ethics and clinical ethics? (c) What is the ethical relevance of the principle of clinical equipoise? (d) Does participation in research require a higher standard of informed consent than the practice of medicine? and (e) What ethical principle should take precedence in medicine? These questions allow us to construct two opposite idealized positions on the distinction between research and practice: the integration model and the segregation model of research and practice. We then compare the ECF for an LHS with these two idealized positions. We argue that the ECF for a LHS does not, in fact, solve these problems, but that it is a third, separate position in the relationship between research ethics and clinical ethics. Moreover, we suggest that the ECF for a LHS raises new ethical problems that require additional ethical analysis and justification. Our article contributes to the discussion on the relationship between research ethics and clinical ethics, revealing that although a learning health‐care system may significantly change the landscape of health care, some ethical dilemmas still require resolving on both theoretical and policy‐making levels.     

提高稻田氮素生态效益的施肥技术

田间试验结果表明,在有水层下把氮肥撒施在土表的“习惯施肥法”易引起氨挥发和硝化-反硝化的N素损失,基肥“全层混施”或“犁沟深施”、追肥“以水带N”的“改进施肥法”可以避免“习惯施肥法”的上述缺点,提高N肥利用率20—30％,提高N肥增产效率25％左右。该施肥法可减少大气和水体环境的污染,且有益于人类社会和增加土壤N素肥力,是一项提高N素生态效益的施肥技术。