Impact case study database

Impact on and via the Nuffield Council on Bioethics

Chambers’ research at the University of Cambridge led to an invitation from the Nuffield Council on Bioethics to be a member of its Working Party on Cosmetic Procedures, which produced a report in 2017 titled Cosmetic Procedures: Ethical Issues [E1]. Chambers’ academic work on feminism, gender, appearance, and choice has directly affected both her invitation to join the Working Party and the content of the report itself. Katharine Wright, the Assistant Director at the Nuffield Council confirms the nature and significance of Chambers’ contributions to their report on cosmetic procedures [E2]:

[Chambers] contributed substantially to the ethical analysis that underpins the practical policy recommendations contained within the report, particularly with reference to the importance of avoiding simplistic distinctions between ‘therapeutic’ and ‘cosmetic’ interventions, and the need to look more closely at the way social norms underpin many apparently therapeutic demands for interventions. Clare’s existing work in this area is cited in the report, and she was generous in sharing her thinking with the working group in discussion, and in helping formulate a consensus response.

Clare has also been active in disseminating our work since publication, including through citing the report in her own publications; and presenting the ethics framework of our report at a 2017 Royal Society of Medicine conference on ‘Changing the image of cosmetic surgery’.

The Cosmetic Procedures report included a number of recommendations to the Advertising Standards Authority (ASA) to improve its regulation of advertising that could increase social pressure to conform to an unrealistic body shape. These recommendations, partly based on Chambers’ ethical analysis of the way that social norms influence choice of surgery [E1], have had impact on the ASA, which has responded by publishing online advice to advertisers that they ‘should ensure that they don’t portray particular body types in an irresponsible manner’ [E3]. The British Association of Aesthetic Plastic Surgeons has also publicly supported Nuffield’s recommendation that the ASA play a more proactive role in regulating advertisement of cosmetic procedures [E3].

The report has also had significant influence on the lobbying activity of the Nuffield Council, some of which has been led by Chambers herself. In recognition of her ongoing work with the Nuffield Council, she was appointed a Council member in March 2020. On 23 September 2020, Chambers gave evidence on behalf of the Nuffield Council to the Women and Equalities Select Committee Inquiry into Body Image. Among other things, Chambers drew attention to a number of Nuffield Council recommendations and was asked to provide more details in writing to the Committee [E8]. On 24 November 2020 she also contributed to a meeting of the All-Party Parliamentary Group Inquiry on Beauty, Ethics, and Well-Being.

Nuffield’s one-year update on the impact of their report [E3] also notes a range of other consequent lobbying activity undertaken by Nuffield, including: meetings with government ministers; formal submissions to Government departments, parliamentary committees, and regulatory bodies; meetings with non-governmental policy bodies; and questions raised in the House of Lords and the House of Commons.

Impact on non-academic medical professionals

Chambers has presented her work directly to non-academic audiences including clinicians, regulators, policy makers, activists, and lawyers. She has given three separate lectures, covering questions of freedom and social influence in the choice to undergo cosmetic surgery, to professional associations of cosmetic and plastic surgeons: twice to the British Association of Plastic, Reconstructive, and Aesthetic Surgeons (BAPRAS) in 2019, and once to the Royal Society of Medicine in October 2017. Her talks questioned whether the choice to undergo cosmetic surgery is really a free choice, and highlighted problems with the role that social norms play in the motivations of cosmetic surgery patients. In total these lectures were attended by more than 400 leading surgeons, clinical practitioners, and industry figures (including the CEO of the largest cosmetic surgery company in the UK) [E4].

The President of BAPRAS has spoken highly of Chambers’ work and its impact on the profession. He writes:

‘Without Dr Chambers's work many surgeons would not have thought to question the motivations of their patients, but would have seen their role as fundamentally to deliver the patients' requests for surgery. Many of our members have now modified their practice to include longer consultations, with deeper investigation into the patients' aims and hopes, and a greater willingness to explore alternatives to surgery together with their patients.’ Mark Henley [E4]

Public engagement, leading to impact on UK law

In addition to her work with policymakers and practitioners, Chambers has undertaken extensive public engagement work based both on her research on beauty norms and cosmetic surgery, and on her research on marriage. Her public engagement regarding the former has included a radio essay entitled ‘Rethinking the Body’ for Rethink, a BBC series of radio essays discussing how the world should change after the coronavirus pandemic. Since its first broadcast on 24/5/2020, this essay has been featured and prompted further discussion on Radio 4’s Woman’s Hour (25/6/2020) and Radio 5 Live’s Stephen Nolan Show (29/6/2020). Public engagement undertaken by Chambers around her book Against Marriage has included articles for The New Statesman, Times Literary Supplement, and Aeon (the latter the most read Aeon article in the week of its publication, with 101,414 views and 4,522 Facebook shares [E5]); interviews in El País and on podcasts Talking Politics, Public Intellectual, and Philosophy 24/7, and a wide range of public talks at e.g. the Hay Festival Segovia (Spanish twin of the Hay-on-Wye Festival), the Bigg Books speaker series in Newcastle upon Tyne, and the University of Cambridge Festival of Ideas [E6].

One particularly significant consequence of this consciousness-raising work was that Chambers’ research on marriage shaped Rebecca Steinfeld’s and Charles Keidan’s legal and political campaign to legalise different-sex civil partnerships. In 2018, the Supreme Court ruled unanimously in favour of Steinfeld and Keidan in their case against the terms of the Civil Partnership Act 2004, which created the legal institution of civil partnerships for same-sex couples but not for different-sex couples. As a result, different-sex civil partnerships became legal on 31 December 2019.

The arguments made in Chambers’ book Against Marriage were particularly significant for the campaign, and helped to improve Steinfeld and Keidan’s strategy on their way to success with the Supreme Court:

‘Clare Chambers's work has definitely influenced our thinking and campaigning for Equal Civil Partnerships. […] It also encouraged us to widen the campaign strategy to focus on choice and family stability more generally, something that helped us build the cross-party consensus that was so crucial to the ultimate legislative success of our campaign. And as we drew the campaign to a close, I used the final media opportunities to push for that deeper conversation. For example, I recorded a Woman's Hour interview that was broadcast on New Year’s Eve 2019, as we were forming our civil partnership, with Clare's work in mind.’

Co-founder of the Campaign for Equal Civil Partnerships in the UK [E7]

UK policy: ethics and governance of AI

From 2017, UK Parliament and Government undertook a programme of activity to scope and implement world-leading AI governance. LCFI played a significant role in this policy process. LCFI’s biggest impact during this time was its influence on the creation and direction of a new governance body created by the UK Government – the Centre for Data Ethics and Innovation (CDEI) – the world’s first national advisory body for AI.

LCFI was partly responsible for the inclusion of AI governance in the remit of the CDEI. In its report on AI, the House of Commons Science and Technology Committee agreed with Price’s suggestion of a governance body [E1, para 65], and recommended to the Government that ‘a standing Commission on Artificial Intelligence be established’ [E1, para 73]. The LCFI team also made the case for a new AI governance body in their Written Evidence to the House of Lords Select Committee on AI [E2], and had several discussions with civil servants. LCFI researchers were consulted several times by the team within DCMS (Department for Digital, Culture, Media, and Sport) who were developing the remit for the new Centre.

Though LCFI was one of many organisations lobbying for this new form of governance, the Centre’s engagement with the government team responsible for developing CDEI had a distinct influence on its existence and its remit:

‘LCFI – and Stephen Cave especially – provided critical help to my team during its early phase of work to establish the need for a new Government body. He helped identify the nature of the ethical challenges associated with AI and heavily shaped CDEI's early programme of work. He and his team participated in a number of roundtables and contributed to a discussion paper on 'targeting' that helped us scope out the key policy questions in this space. Stephen was consistently insightful, constructive and practical – and made a real difference to the set up and design of the Centre for Data Ethics and Innovation.’

Cora Govett, Deputy Director, Digital Regulation and Markets, UK Government’s Department of Digital, Culture, Media, and Sport [E3]

Research Policy in the UK and China: work with the Nuffield Foundation

Over six months between 2017 and 2018, the Nuffield Foundation convened a partnership of leading UK research policy organisations and research funders to address the need for agreed ethical frameworks for the use of new technologies. This consultation resulted in the Ada Lovelace Institute (Ada), an independent research institute with a GBP5 million five-year research fund to be used to examine ethical and social issues arising from the use of data, algorithms, and AI.

LCFI played a significant role in the consultation, deploying the team’s research expertise in the challenges of AI governance to shape the policy and strategy of Ada. LCFI’s contribution to Ada’s policy included new research commissioned by Nuffield to scope the appropriate remit for Ada’s work [R4]. Tim Gardam, Chief Executive of the Nuffield Foundation, writes:

‘The approach Nuffield took to developing Ada’s remit was initially shaped by contributions from the Director of the LCFI at a Royal Society seminar […] Following the seminar, the Nuffield Foundation funded a research project from LCFI […] Its purpose was to inform the thinking of the Ada Lovelace Institute in its first months. LCFI’s conclusions are now reflected in the Institute’s mission statement and strategy.’ [E4]

The LCFI team have also worked with the Nuffield Foundation to develop their partnerships with AI research and development organisations overseas. In November 2019, LCFI launched a new bilateral China-UK Research Centre for AI Ethics and Governance, in collaboration with Prof Yi Zeng of the Institute of Automation at the Chinese Academic of Sciences. The success of this joint venture thus far, and its potential for further research, has had a significant influence at the Nuffield Foundation, and as a result they are now investing resources into developing other similar collaborations in AI research between the UK and China [E4]. Ada’s partnership with LCFI on global comparative research is reflected in Ada’s 2019-20 Strategy [E10, p.11], and the influence of LCFI is also confirmed in Gardam’s testimonial statement [E4].

International policy

Elsewhere, LCFI research has had considerable impact on public policy debates and strategies for AI. Over 30 national and international AI strategies have been announced in the last five years. The Centre has contributed to the drafting process for several of these. Examples include:

• In Singapore, the LCFI team has collaborated on a series of events with the Centre for Strategic Futures, based in the office of Singapore’s PM. One workshop in 2018 on Risk and Artificial Intelligence helped a number of Singapore policy stakeholders navigate the new governance system introduced that year by the Singapore government (influence of LCFI in this regard confirmed by a statement from the Singapore PM’s office **[E5]**). This also played a role in the development of Singapore’s Model AI Governance Framework in 2019.

• In virtue of LCFI’s research expertise, the UN requested that members of LCFI lead one of the four tracks at the UN’s AI for Good Summit, which brought together over 30 UN agencies to discuss global AI policy. The immediate impact of the LCFI involvement in the AI for Good Summit was that LCFI research set the agenda for discussion among all UN stakeholders in AI policy debate, focussing specifically on issues around trust in AI technology [E6]

• LCFI research on AI applications of philosophy of mind and ethics has been cited by the Vatican’s Working Group on Robotics (part of the Pontifical Academy for Life) in a report on the Vatican’s event in 2020 to mark the new Rome Call for AI Ethics, a statement regarding the need for human-centric AI ethics [E7, fn.4 and 21].

Impact on the AI industry

LCFI research has also had an impact on company policy within the AI industry, both within the UK and internationally. In February 2018, LCFI hosted experts in AI and security at a workshop held in Oxford. Participants included Google, Microsoft, Deepmind, and OpenAI, a research laboratory based in San Francisco. One outcome of this workshop, and other interactions with OpenAI, was influence on their April 2018 Charter. The Charter references the importance of avoiding competitive development races, echoing concerns raised by LCFI researchers at the workshop and in published outputs [R1; E11]. The Centre has also contributed to the work of Digital Catapult, a UK government innovation agency for the digital industry, helping computing start-up companies. In September 2018, Digital Catapult launched a new AI Ethics Framework for AI start-ups, partly influenced by contributions from LCFI researchers [E12].

In addition to impact on ethics and governance in company policy, LCFI researchers have worked with AI company GoodAI to run an innovation competition to inspire and influence AI developers and prompt responsible AI research and development. GoodAI has chosen the Animal-AI Olympics [R7] as its General AI Challenge for 2019 [E8]. Olga Afanasjeva, COO at GoodAI, told the team:

‘Before the Animal-AI Olympics we were lacking a comprehensive curriculum for AI which would be based on state-of-the-art techniques in measuring animal intelligence…The project also provides a publicly available benchmark for adaptive behavior in a realistic setting. We expect this new opportunity for comparing results between different scientific teams to be a driver for research in the areas of transfer learning, curriculum learning and self-supervised learning. The Animal-AI Olympics environment is now added to our research roadmap and will play an instrumental role in our work in the future.’ [E8]

Participant developers have also confirmed the significance of the Olympics for their work. Dymtro Bobrenko, Machine Learning Engineer for Samsung Electronics, told the team: ‘Animal-AI Olympics gave us a unique opportunity to benchmark our Motion Planning algorithms by competing with the world's best solutions in current domain. Currently, there is no standardized benchmark for Motion Planning and AI in general, and without Animal-AI competition it would be difficult to evaluate our algorithms objectively.’ [E9]

Building the field of existential risk

CSER has been at the forefront of a developing area of academic and non-academic research into existential risk, influencing several new non-academic research centres, think tanks, and funding initiatives. It has organised two international conferences and over 35 expert workshops bringing together CSER researchers and other academics with representatives from national governments, international governing bodies, third sector organisations, think tanks, and technologists. CSER has also hosted over 60 visitors. Thanks to the profile of CSER’s work among this emerging research and policy community, the team have been consulted by many new non-academic research centres as they found and establish the remit for their own work on existential risk. CSER has influenced:

• The Future of Life Institute: a volunteer-run research and outreach organisation based in Boston, USA, working to mitigate existential risk [E1]

• The Nuclear Threat Initiative (NTI): CSER researchers contributed to a collaboration between the St Catharine’s College Biorisk Initiative (BioRISC) and NTI, which Lord Browne (former UK Defence Secretary and NTI Vice-Chair) says has ‘significantly increased their respective influences on biosecurity policy leadership in the Euro-Atlantic space’ [E2]

• The Global Challenges Foundation (GCF): in 2019, CSER was commissioned by GCF to write two reports charting the current international governance of global catastrophic risk and its main drivers, contributing to GCF’s policy research and its recommendations to improve global risk governance [E3]

UK Future Generations APPG and Bill

One of the most tangible consequences of CSER policy engagement has been the creation of a new UK All-Party Parliamentary Group (APPG) for Future Generations, and the drafting of a new Future Generations Bill. A 2018 paper in a Futures special issue (edited by Currie), co-authored by Natalie Jones (then a Cambridge PhD student and CSER research affiliate), and supervised by CSER researchers, specifically recommended establishing an APPG for Future Generations. On the basis of this recommendation, CSER researchers created that APPG in collaboration with MPs and peers from across the political spectrum. CSER hosted the APPG’s secretariat in its first year. Since 2019 Belfield has acted as the liaison between CSER and the APPG [E4]. In the words of the coordinator and secretariat member of the APPG: ‘Without CSER’s research on representing future generations, the APPG for Future Generations would not exist’ [E4]. The APPG has held five events in Parliament on the theme ‘Managing Technological Risks’, which have featured talks from CSER researchers Shahar Avin, Simon Beard, Catherine Rhodes, and Julius Weitzdörfer. Simon Beard also wrote the APPG report summarising findings from the event series [E4].

The APPG’s activity is already having an effect in UK parliament and policymaking circles. In late 2019, the APPG (in collaboration with CSER) launched an Inquiry into ‘Long-termism in Policy-making’. The APPG has informed key individuals in the UK Government (e.g. advising civil servants at the Department for Digital, Culture, Media and Sport) and it has been mentioned in Parliamentary debates. CSER and the APPG continue to work collaboratively, with Haydn Belfield as primary liaison [E4]. Together they have advised on the creation and direction of the Today For Tomorrow cross-party campaign. This campaign includes a draft Future Generations Bill, led by Lord John Bird. Lord Bird joined the APPG as co-Chair in Feb 2019, and visited the CSER team in Cambridge on 1 Mar 2019 to discuss the launch of the campaign and the Bill. CSER researchers advised on the drafting on the Bill, and some of the recommendations of the CSER paper in Futures have been included in it. Lord Bird has confirmed that without the Centre’s work his campaign would not have started, and draft bill would not exist [E5].

Putting existential risk on the global policy agenda

The CSER team also regularly organises, and is invited to, conferences, workshops, and ad hoc meetings with UK and international policymakers. CSER researchers have thereby put the topic of existential risk on the agenda of high-level policy meetings, and have made specific recommendations for policy across a range of risks. Examples of this form of policy impact include:

• A significant influence on the European Commission’s White Paper on Artificial Intelligence: A European Approach to Excellence and Trust, specifically via two written submissions, alongside extensive discussions with the Commission’s High-Level Expert Group [E6]

• Attendance at invitation-only policy stakeholder events: e.g., a policy conference on Modern Deterrence at Ditchley Park in November 2018 attended by Shahar Avin, and a policy meeting in November 2018 on high impact bio-threats held at Wilton Park [E7]

• Contributions to UN negotiations on Lethal Autonomous Weapons Systems (2018), and to the Biological Weapons Convention annual meeting of states parties (2017 and 2018) [E8]

• Inspiring the Finnish government to commission the report Existential Risk: Diplomacy and Governance [E9]

One particularly notable example of CSER’s engagement in policy issues is Sir Partha Dasgupta’s work at the Vatican. In May 2014, Sir Partha co-organised a major workshop with the Pontifical Academy of Sciences . After the workshop, Sir Partha spoke to the Pope directly and encouraged him to include climate change in his speeches and to urge people to be better stewards of the planet. The workshop underpinned a major report [R6] published in April 2015 by the Vatican, which listed Dasgupta as one of its four corresponding authors in recognition of his contributions. The report in turn partly informed the May 2015 Laudato si’ Papal Encyclical, which focussed on the impending threat of climate change [E10]. Sir Partha is now leading the UK Government’s independent ‘Dasgupta Review: The Economics of Biodiversity’.

AI risks: forecasting, prevention, and mitigation

CSER’s research output The Malicious Use of Artificial Intelligence: Forecasting, Prevention, and Mitigation [R5], is the first major report to examine emerging risks at the intersection of artificial intelligence, cybersecurity, physical security and information manipulation. It is a collaborative report co-written with the Future of Humanity Institute, Oxford. It has been cited in reports from the UK House of Lords and the US Government Departments, and has received praise from policy-makers, technologists, a UK Minister, the Commander of the Australian Defence College, and the former President of the Association for the Advancement of Artificial Intelligence (AAAI) [E11].

This report has influenced policy discussions around AI and security. One example of this was a workshop series (prompted by the report) on ‘Epistemic Security’, investigating the changing threat landscape of information campaigns and propaganda given current advances in machine learning. These workshops were co-organised by CSER, the Alan Turing Institute, and the Defence Science and Technology Laboratory (Dstl, the UK government’s leading experts in technology and security).

Malicious Use is changing the behaviour of non-academic AI research organisations. It encourages greater care and patience in the publication of results, and suggests that pre-publication risk assessments may be necessary in some circumstances. Since the report’s publication, OpenAI (a major AI research company) has started to implement this new norm. In early 2019, it delayed publication of some of its results in accordance with the CSER recommendation. This decision started a widespread debate – with consequent behaviour change – across the AI community [E12]. Members of the CSER team subsequently worked with Partnership on AI – the leading non-profit coalition of AI technologists – to develop a more detailed report on AI Publication Norms for use by AI research companies [E12].

Overview: Kassell’s collaboration with the developer Nyamyam, and Curry’s collaboration with the developer All Seeing Eye - both facilitated by The Wellcome Trust - have together established an influential template for the role of historical scholarship in developing new game content, and for broader links between academia and the gaming industry. These collaborations derive jointly from the HPS Department’s culture of engagement, from its research priorities focused on medical and environmental topics, and from its policy of encouraging exploratory conversations with individuals and institutions outside of academia.

Astrologaster

Nyamyam (http://nyamyam.com/\) released the game Astrologaster, a comedy written in the stars in May 2019. It takes inspiration from Simon Forman’s casebooks. The Casebooks Project team - led by Professor Lauren Kassell and funded by The Wellcome Trust - acted as historical consultants for the game. Jennifer Schneidereit, developer at Nyamyam, summarises Kassell’s contribution:

‘Astrologaster was inspired by Professor Lauren Kassell's research and would not exist without her. Her work enabled us to understand Elizabethan medical encounters and made it possible for us to design a game that captured historical social dynamics. … Astrologaster is the first game to be developed in dialogue with a historical research project. It establishes a new model for making games. The industry is concerned about a tendency towards homogeneity. Interactions like this one foster the production of innovative work.’ [E8]

Forging new computer game genres. An article in Prospect notes Kassell’s role not merely in developing this specific game, but in laying out a new and more sophisticated genre for computer games in general. It profiled Schneidereit, noting that:

‘[Schneidereit’s] latest game, currently in development, is Astrologaster, a period comedy developed with the writer Katharine Neil that draws on the work of the Cambridge academic Lauren Kassell. … It’s a fascinating mixture of historical enthusiasm and subversive modern comedy, which its creator intends to offer “an interesting and unusual look at history; at the little people, not the kings and queens.” It’s also about as far away in spirit from the Hollywood-Grecian bluster of Assassin’s Creed: Odyssey as you can imagine.’ [E1]

A later article in THE focuses on Astrologaster as an example of a game that is having impact by transforming how academics think about what it means to make their work accessible [E2]. That article quotes Iain Dodgeon, director of OKRE (Opening Knowledge across Research and Entertainment, a new UK-based organisation bringing the research and entertainment sectors closer together) making the case that ‘Games can help you relate to research through direct experience’: Astrologaster is one of Dodgeon’s primary examples.

Grounding game play in history. Since meeting the team from Nyamyam at a Wellcome-organised workshop in September 2014, Kassell’s Casebooks team has provided selections of material from Forman’s casebooks and information about his methods and suggested further readings. They commented on Nyamyam’s drafts of successful funding applications from the European Union’s Creative Europe Media and The Wellcome Trust. They read drafts of the character summaries, storylines and scripts and provided feedback about their historical accuracy, encouraging the uses of humour and deliberate anachronism, rather than romanticised nostalgia, to challenge players to think about meanings of health and illness. From the perspective of Casebooks, working on Astrologaster contributed to their thinking about the performative nature of the casebooks; about how to (re)present the casebooks in the project’s search interface; and about innovative ways to communicate the history of medicine to both academic and non-academic audiences.

Delivering historical research to new audiences. The game was on Shack News’s list of the twenty most anticipated indie games of 2019 [E3]. It received four-star reviews from the LA Times and the Guardian, and has been praised in the gaming press and in playthroughs. It was later one of just five games to feature in the Guardian’s roundup of culture in 2019 that might ‘make you feel less terrible about the UK election’ [E4, E5]. Playthroughs of Astrologaster have been watched by over 1 million people. Games players have made hundreds of positive comments about the game at Nyamyam’s twitter feed: for example one Tweeter writes: ‘How am I only just discovering Astrologaster? It combines my two loves – gaming and medical history! This is perfect!!” or @Blackcom666 who tweeted, ‘I’ve finally played #astrologaster and oh, wow! The audio quality, the art direction, the researches and style behind the writing. It’s an amazing game which manages to surprise me … Great job to the team @nyamyamgame’ [E6].

Generating charitable funding. As of July 2020, [Text Redacted for Publication] people have purchased the game and generated revenue directly for Nyamyam. However, this number is dwarfed by the 800,000 people who have purchased Astrologaster as part of a large bundle of games made available (for a minimum donation of USD5) at itch.io in aid of racial justice and equality. The bundle as a whole has now raised in excess of USD8 million for the chosen charities. [E7]

Seed

Seed took shape with support from the Epic Games and The Wellcome Trust, the two sponsors of the 'Developing Beyond' competition. In February 2017 All-Seeing Eye was chosen as a semi-finalist and awarded USD15,000. In July 2017 they were selected as one of three finalists and awarded a further USD60,000. In February 2018, the game (which remains in prototype as of July 2020) took the top prize and USD150,000 at the final judging [E9].

The Associate Creative Director of All Seeing Eye gives Curry decisive credit for the game’s success:

‘Helen acted as a scientific/historical advisor directly informing several of the key mechanics in the experience. It is no exaggeration to say that our winning of the competition was as a direct result of our collaboration, her work and research input.’ [E10; see also E11]

The impact of Curry's work with All Seeing Eye's Seed, achieved through hands-on collaboration, game play and media coverage, has been to create a research-based game experience, to engage wider audiences in the history and science of plant breeding, to encourage games developers in science-based gaming and novel forms of collaboration, and to demonstrate to scientists the potential of games for communicating ideas.

Bringing reality to virtual reality. All Seeing Eye submitted a proposal for a game involving experimental plant breeding to the first round of the competition in early 2017. At this point Curry, an established expert in the history of plant breeding was engaged as a collaborator in the project at the recommendation of The Wellcome Trust. Curry shared her knowledge of the history of amateur plant breeding with All Seeing Eye, offering a more relevant starting point for developing the background narrative of Seed than that of contemporary laboratory-based genetic engineering, as had initially been planned. Curry also devised basic plant breeding scenarios based on real-life examples that the designers incorporated into the game.

Transforming game development. Curry’s collaboration offered a new model for how a developer could generate revenue in collaboration with academics. As described in a THE article, 'Although Mr Kay had initially envisaged a high-tech virtual reality environment for his game, he soon realised that Dr Curry’s research provided him with a much more unusual aesthetic along with many intriguing details… “We have taken that historic period and such stories to create beautiful visual vignettes,” Mr Kay explained' [E11].

As a result of this, Curry’s work has had impact on further revenue-generating ventures, such as All Seeing Eye’s virtual reality recreation of the ‘Dambusters’ mission (now installed at the RAF museum in Hendon). Olie Kay explains:

‘In working on Seed with Helen it was evident how historical and scientific consultation/collaboration could be enormously beneficial to our working practices and have a real impact on not only how a project developed, but also the end result. As such we were emboldened to collaborate with several researchers for our Dambusters who again were instrumental to the success of the project.’ [E10]

The high academic profile and the interdisciplinary nature of Alexandrova’s work has created opportunities to apply her research to two practical problems: choice of outcome measures and responsible practices for defining well-being. Alexandrova’s research has helped a number of organisations tackle these two problems, with impact in the international technology industry, local and global charity work, and NATO policy.

4.1 Outcome measures for Autonomous and Intelligent Systems developers

In 2017 Alexandrova advised the Well-being Committee of the Institute of Electrical and Electronic Engineers (IEEE – the world’s largest professional association for electronic engineers) for their Global Initiative on Ethics of Autonomous and Intelligent Systems (A/IS). The goal of that committee was to introduce well-being metrics to A/IS developers – a community estimated to number almost 500,000 over 160 countries [E2] – and to make a case for using these metrics to evaluate impact of A/IS technologies. Alexandrova argued in favour of retaining a rich set of multiple conceptions of well-being and drafted the relevant sections of the Ethically Aligned Design, First Edition (EAD1e) report, drawing explicitly on her own earlier research.

The significance of Alexandrova’s influence on the document has been confirmed by the Executive Director of this initiative. He refers to Alexandrova’s book [R5] as the justification for recommending to A/IS developers a library of well-being indicators to be used with judiciousness and respect for context:

‘I note in particular that the views you defended in your book A philosophy for the science of well-being influenced the direction we took in our document, that is emphasizing that there is no single best measure and concept of well-being, but different ones (often in unison) are appropriate depending on context. This is a valuable and distinctive aspect of our report that would not have been there without your input.’ [E1]

This document has now been published and is gaining influence elsewhere in the technology community. The Executive Director’s letter confirms that at the date of his writing (Dec 2018) EAD1e had been mentioned in dozens of academic documents, in AI-oriented policy from the UK and EU, and publications from corporations such as IBM. It had also influenced the creation of 14 Standards Working Groups, including a new IEEE working group focussing explicitly on well-being issues directly related to EAD1e. [E1]

The importance of the document is affirmed by users from IBM, OECD, the VETRI foundation, and NGO People Centred Internet [E2]. A member of staff from AI Design Practices, IBM, has commented that ‘As an AI designer and AI ethics advocate at IBM, I'll be using EAD1e in scaling best practices for thousands of designers and developers. The guidance materials coming out of this will help our teams re-evaluate their current design and development processes. It's vital to bring in different perspectives whenever we make decisions on what is or isn't ethical – IEEE's focus on interdisciplinary collaboration makes this work accessible to anyone working with AI.’ [E2]

4.2 Child well-being and NATO

The prominence of Alexandrova’s research on child well-being [e.g. R3] has resulted in multiple positive citations of this work in the NATO Science and Technology Organisation report Impact of military life on children from military families, a blueprint for improving programs and support for military parents and their children [E3]. The report asserts that its results will, ‘assist the military organizations and services providers in identifying the most effective ways of providing support to children to adapt and cope with the demands of a military lifestyle’. The framework that NATO has developed for this draws explicitly on Alexandrova’s research with Raghavan.

Alexandrova’s research on child well-being has also influenced definitions of well-being used by child-protection professionals. Her research set the framework for a stakeholder symposium held at Washington University in St Louis, including among other organisations Vision for Children at Risk, a local community organisation. One of the consequences of the symposium was a new definition of child well-being adopted by Vision for Children at Risk, which incorporated Alexandrova and Raghavan’s suggestion that child well-being includes the ability to relate to the world as children [E4]

4.3 Measuring outcomes with young people

In 2019 Alexandrova was contacted by Centre 33 to collaborate on a project to improve the organisation’s outcome measurement. Centre 33 is a young people’s charity that works with over 2000 young people annually across Cambridgeshire and Peterborough offering free support regarding mental health, homelessness, and young carers [E5]. As a result of Alexandrova’s work, Centre 33 have paid closer attention to non-qualitative outcomes that can be used to capture the effects of their work that would not otherwise be measured. As stated in a testimonial letter from Centre 33: ‘Anna’s research provided an important and incredibly helpful tool for us to critically evaluate our own outcomes, as well as explore new ones’ [E6]. Further collaborative work between Alexandrova and Centre 33, which aims to build a bespoke outcome measurement tool for the organisation’s youth work, will be undertaken later in 2021.

4.4 Responsible practices for defining well-being

Alexandrova is regularly asked to speak to non-academic audiences about the importance of a pluralistic approach to well-being. For example, in May 2020 she spoke to 953 attendees at a WHO Health and Culture Webinar on the role of culture in defining well-being [E7]. She has also acted as a consultant on well-being measurement for non-academic organisations. In 2018 Alexandrova contributed to the work of US health and well-being consultancy the Metropolitan Group (MG). One of MG’s regular clients is the Robert Wood Johnson Foundation (RWJF) – the US’s largest philanthropic organisation dedicated solely to health – which contracted MG to develop a global well-being research and action strategy. The Vice President at MG, commented: ‘Anna’s views on the necessity of maintaining multiple indicators of well-being informed our thinking about the agenda for and participants in a convening we were planning [for RWJF]. We especially appreciated her perspective on the need to root decisions in local context and to supplement cost-benefit analysis with well-being data.’ [E8]

Metropolitan Group have since implemented these insights in their work with RWJF to convene ‘global leaders to explore how to make well-being the driver for policies’ [E9]. The RWJF conference included government advisors, NGO and think tank directors, and researchers from the OECD and the WHO [E7], and the resulting report reflected Alexandrova’s advice that local cultural context is essential to the design of valuable well-being measures (one of four main considerations highlighted in the report [E10]).

1. Primodos

Overview: Lewens’s and Olszynko-Gryn’s work on the Hormonal Pregnancy Test (HPT) Primodos contributed to the launch of an official review of the regulatory handling of these tests, and their work informed the deliberations of the official review panel. Key beneficiaries here include the review panel itself, members of the All Party Parliamentary Group (APPG) dedicated to HPTs, and members of the Association for Children Damaged by Hormone Pregnancy Tests.

The Primodos pregnancy test has been the subject of ongoing controversy on the grounds that it is regarded by some as the ‘forgotten thalidomide’. For these reasons it has been the subject of repeated calls for official government inquiries. A report was finally completed on Hormone Pregnancy Tests in 2017 by the Medicines and Healthcare products Regulatory Agency’s (MHRA’s) Expert Working Group (EWG), partly on the basis of evidence submitted by Olszynko-Gryn [E1] [E2]. However the EWG’s report was widely criticised for a range of inadequacies, including those highlighted by Olszynko-Gryn and Lewens.

Olszynko-Gryn organised an international conference in Cambridge (where Lewens spoke on Primodos and the precautionary principle) that brought together academic experts, practising lawyers, and patient groups, many of whom were critical of the EWG’s approach [E3]. Lewens and Olszynko-Gryn also collaborated with the Sky News documentary film-maker Jason Farrell in the production of a film highlighting various shortcomings in the initial EWG report. The film was then screened in parliament—including a Q & A session for parliamentarians where Olszynko-Gryn was a participant—prior to the parliamentary debates discussing the need for further review. Olszynko-Gryn and Lewens contributed to meetings of the APPG on Hormone Pregnancy Tests, and they liaised closely with the campaigning group ACDHPT (Association for Children Damaged by Hormone Pregnancy Tests), to highlight a series of issues around the historical presentation of Primodos’s use, and the framework for risk governance and risk communication. In these ways, their interventions were instrumental in building parliamentary support in favour of further inquiry into Primodos.

Partly thanks to these interventions, a new official review was launched in February 2018. This was the Independent Medicines and Medical Devices Safety Review (IMMDSR), led by Baroness Cumberlege, which reported on 8^th July 2020. Yasmin Qureshi MP, Chair of the All-Party Parliamentary Group on Hormone Pregnancy Tests, confirms the role of Lewens and Olszynko-Gryn in the APPG, and in securing the new IMMDSR:

‘The advice they gave … was instrumental in informing our MPs’ successful calls in parliament for the launch of a new inquiry. [It] is not an exaggeration to say that Jesse and Tim’s research played a key role in the launch of the…Cumberlege Inquiry…’ [E4]

Both Olszynko-Gryn and Lewens went on to play roles in the new review. Olszynko-Gryn gave evidence at an oral hearing of the IMMDSR on 26^th November 2018, and Lewens submitted written evidence to the inquiry [E5, E6]. He argued that, ‘even when causal links [between Primodos and birth defects] are not established in a clear way—indeed, even when they are highly questionable—it can still be reasonable to take regulatory action in a precautionary manner. This is especially true when the value of a technology is in question, and when safe alternatives are available’ [E6]. Lewens’s basic argument was endorsed in the key finding of the Cumberlege report regarding Primodos: ‘Given the concerns raised, the non-essential nature of HPTs and the provision of risk-free alternative tests, we consider that the CSD [Committee on Safety of Drugs] focus should not have been whether or not to issue a warning. They should have recommended the withdrawal of the indication for use as a pregnancy test in 1967’ ([E7]; emphasis in original) .

Olszynko-Gryn and Lewens have also benefited the activities of the ACDHPT. Marie Lyon, the group’s Chair, has written that ‘The impact of the evidence provided by both Tim and Jesse undoubtedly played a huge part in the incredible and unexpected conclusions of the IMMDS report. This is the first time in more than 40 years that the failures of the Government Regulators in the 1960's &70s, have been identified and acknowledged in an Independent Government Review…ACDHPT owe a huge debt of gratitude for their continuing support.’ [E8]

1. Astra Zeneca

Overview: Lewens’s work on medical risk led to an invitation to join AstraZeneca’s new AWERB (Animal Welfare Ethical Review Body). He has given training courses for AZ researchers, and has influenced the overall culture of care throughout the company. Key beneficiaries here include members of the AZ research community.

In 2017 Lewens was invited to join AZ’s new Animal Welfare Ethical Review Board (AWERB) based on his track record of work on medical ethics and medical risk. Lewens has had a significant impact on the constitution and operation of the AWERB. In particular, Lewens’s longstanding research on the interpenetration of science and values has informed the committee’s own approach to the tight links it draws between ethical approval and scientific validity. He has also given two bespoke training courses on medical ethics and medical risk for AWERB members. The acting Chair of the AZ AWERB comments thus:

‘His impact on the AWERB group, has been considerable and has reached through into the AZ organisation in Cambridge. … His regular contributions to committee meetings have also resulted in an enlarged remit for the AWERB group. In particular, … he has helped us to articulate the importance of attending to the wellbeing of those who conduct research, in addition to the more usual focus on the animals. This has had concrete impact in terms of our renewed attention across the company to the ‘culture of care’ in place for our research staff.’ [E9]

1. Inherited Genetic Disorders

Overview: Lewens’s research on regulatory governance for risk has led to a role in the work of the International Commission on the Clinical Use of Human Germline Genome Editing; his earlier work with the Nuffield Council on Bioethics gave rise to decisive contributions to parliamentary debates on the legalisation of mitochondrial ‘donation’ technologies.

In February 2020, Lewens accepted an invitation from the International Commission on the Clinical Use of Human Germline Genome Editing to comment in detail on an early draft of their report on Heritable Human Germline Engineering [E10]. This joint report of the US National Academies and the UK Royal Society aims to provide a global translational framework for the potential use of germline genetic interventions. The report is expected to have considerable international regulatory influence, in part because its publication will be timed to feed into the WHO Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing.

Lewens’s reputation in these matters derived from his earlier work with the Nuffield Council on Bioethics. The Nuffield Council Report on Mitochondrial DNA Disorders, co-authored by Lewens in 2012, expressed approval of two new experimental IVF techniques. Lewens was a member of the working party that authored this report, and he played a leading role in drafting the ethical framework within it. This involvement was confirmed by Council Director Hugh Whittall:

‘…[T]he role that Tim Lewens played in the preparation and drafting of this important report was particularly notable. His work in developing the ethical considerations, and especially in addressing issues around identity in relation to genetic therapies, formed a very substantial part of the arguments that sit at the heart of the report. His further contribution in applying these ethical discussions to the novel case of potential treatments for mitochondrial disorders was also critical to the success of this report.’ [E11]

Lewens’s work in authoring the Nuffield Council report pre-dates the REF review period; however, the impact of that work continued into the current period via the report’s influence on parliamentary debate and subsequent new legislation (Human Fertilisation and Embryology (Mitochondrial Donation) Regulations 2015). Following Parliamentary debates in both chambers, where parliamentarians repeatedly drew attention to the Council’s positive ethical verdict with respect to mitochondrial donation [E12], both of the technologies endorsed by the report were approved in legislation passed in February 2015.