{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T16:52:52Z","timestamp":1786467172573,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Bioethics"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Ethical human subjects research must have an acceptable risk\u2010benefit ratio, which requires that the net risks participants face be proportionate to the research's social value. Yet existing scholarship does not explain what makes risks proportionate to social value. Here, I distinguish internal and external senses of proportionality and argue that it is internal proportionality that is the proper object of IRB\/REC review. I propose understanding internal proportionality in terms of a literal ratio of expected health effects; I also argue against the alternative of attempting to assess proportionality through intuitive comparisons. I illustrate the potential implications of this account through a discussion of the proposal to engage in controlled human infection studies with the novel coronavirus. This case highlights that trials with enormous numbers of potential beneficiaries can be internally proportional even when they are very unlikely to succeed.<\/jats:p>","DOI":"10.1111\/bioe.70109","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T15:25:27Z","timestamp":1780327527000},"page":"707-716","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When Is Social Value Proportionate to Research Risks?"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4879-2070","authenticated-orcid":false,"given":"Robert","family":"Steel","sequence":"first","affiliation":[{"name":"Clinical Center Department of Bioethics US National Institutes of Health Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"e_1_2_15_2_1","unstructured":"\u201cPart 46\u2014Protection of Human Subjects \u201d US Code of Federal Regulations https:\/\/www.ecfr.gov\/current\/title-45\/subtitle-A\/subchapter-A\/part-46."},{"key":"e_1_2_15_3_1","unstructured":"National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research The Belmont Report U.S. Department of Health and Human Services https:\/\/www.hhs.gov\/ohrp\/regulations-and-policy\/belmont-report\/read-the-belmont-report\/index.html."},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiaa152"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2020.04.039.10.1093\/infdis\/jiaa152"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiaa314"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2021189117"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2021.2614"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.abc1076"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.abc9380"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.20.2701"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1353\/ken.2011.0007"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/nm0604-570"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2634"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2018.1523490"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/phe\/phab031"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.1353\/hcr.2007.0044"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0275823"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2024.2371119"},{"key":"e_1_2_15_20_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0277792"},{"key":"e_1_2_15_21_1","unstructured":"J.Kaufman \u201cAtruistic Kidney Donation \u201d accessed August 31 2025 https:\/\/www.jefftk.com\/p\/altruistic-kidney-donation."},{"key":"e_1_2_15_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/bioe.12794"},{"key":"e_1_2_15_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/risa.13726"},{"key":"e_1_2_15_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-01780-9"},{"key":"e_1_2_15_25_1","unstructured":"\u201c14.9 Million Excess Deaths Associated With the COVID\u201019 Pandemic in 2020 and 2021 \u201d World Health Organization May 5 2022 https:\/\/www.who.int\/news\/item\/05-05-2022-14.9-million-excess-deaths-were-associated-with-the-covid-19-pandemic-in-2020-and-2021."},{"key":"e_1_2_15_26_1","unstructured":"\u201cHow Hard Is It to Win The Lottery? 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