Performance of research ethics committees in Spain. A prospective study of 100 applications for clinical trial protocols on medicines

OBJECTIVES

To review the characteristics and performance of research ethics committees in Spain in the evaluation of multicentre clinical trial drug protocols.

DESIGN

A prospective study of 100 applications.

SETTING

Forty-one committees reviewing clinical trial protocols, involving 50 hospitals in 25 cities.

MAIN MEASURES

Protocol-related features, characteristics of research ethics committees and evaluation dynamics.

RESULTS

The 100 applications involved 15 protocols (of which 12 were multinational) with 12 drugs. Committees met monthly (except one). They had a mean number of 12 members, requested a mean of six complete dossiers and nine additional copies of the protocol with a mean deadline of 14 days before the meeting. All applications were approved except three (two of the three were open-label long-term safety trials rejected by the same committee), which were approved by the other committees involved. The mean time from submission to approval was 64 days. The mean time from submission to arrival of the approval document at our offices was 85 days. Twenty-five committees raised queries for 38 of the 97 finally approved applications. Impact of evaluation fee, number of members, queries raised and experience of committees on timings were not statistically significant.

CONCLUSION

Obtaining ethical approval is time-consuming. There is much diversity in the research ethics committees' performance. A remarkable delay (> 20 days) exists between the decision and the arrival of the written approval, suggesting administrative or organisational problems.

Research ethics committees: a comparative study of assessment of ethical dilemmas

Research ethics committees (REC) constitute an important instrument for the regulation of biomedical research involving human beings. The purposes of this work were to study the ethical reasoning in RECs and to ascertain whether the composition of RECs has any bearing on the decisions subsequently made by them. We used a postal questionnaire, containing authentic cases of research ethical dilemmas, sent to the ten RECs in Sweden (n = 124) and to comparison groups consisting of 200 randomly selected medical researchers, 200 randomly selected healthcare politicians and 200 randomly selected district nurses. The average response rate was 68%. A difference was found in how REC members assess a project in comparison with researchers, healthcare politicians and district nurses. Differences depended on the type of project assessed. The study indicates that membership in RECs may exert a normative influence on its members. It is proposed that this investigation should be followed up by a study with a qualitative design.

How ethical dilemmas are resolved

The prevalence of ethics committees in long-term care facilities has been on the rise since 1970. This study explores the nature of these committees and how ethical dilemmas are resolved where there is no committee.

Research ethics committees: a regional approach

Guidelines for Institutional Review Boards (IRBs) or research ethics committees exist at national and international levels. These guidelines are based on ethical principles and establish an internationally acceptable standard for the review and conduct of medical research. Having attained a multinational consensus about what these fundamental guidelines should be, IRBs are left to interpret the guidelines and devise their own means of implementing them. Individual and community values bear on the interpretation of the guidelines so different IRBs attain different levels of effectiveness. In the Caribbean and Pan American regions there are few IRBs. Obstacles to the establishment and function of IRBs are exacerbated in developing regions like these by differences in language, literacy, and local value systems; education, administrative expertise, facilities, and access to information are also limited. A regional IRB network might facilitate more uniform ethical review in developing countries, and simplify IRB procedures.

Selecting subjects for participation in clinical research: one sphere of justice

Recent guidelines from the US National Institutes of Health (NIH) mandate the inclusion of adequate numbers of women in clinical trials. Ought such standards to apply internationally? Walzer's theory of justice is brought to bear on the problem, the first use of the theory in research ethics, and it argues for broad application of the principle of adequate representation. A number of practical conclusions for research ethics committees (RECs) are outlined. Eligibility criteria in clinical trials ought to be justified by trial designers. Research ethics committees ought to question criteria that seem to exclude unnecessarily women from research participation. The issue of adequate representation should be construed broadly, so as to include consideration of the representation of the elderly, persons with HIV, mental illness and substance abuse disorders in clinical research.

Scientific dishonesty: a Danish proposal for evaluation and prevention

The term scientific dishonesty covers the wide scope from consciously fraudulent actions to gross negligence and refers both to character trait and to actions. Scientific dishonesty may occur in any country, but reactions in Europe have been slow to emerge. On the basis of a thorough review, the Danish Medical Research Council therefore has made recommendations on how to handle and how to prevent scientific dishonesty. Suspected cases must be referred directly to a national committee chaired by a High Court judge. An ad hoc investigatory committee may be appointed in each case. If dishonesty is established, the institution then is asked to implement appropriate sanctions and to report on the actions taken to the national committee. Prevention of scientific dishonesty forms an essential part of good scientific practice and must have an impact on research training, requirements for data storage, guidelines for scientific publication, and criteria for evaluating grant proposals and promotions.

[Ethical evaluation of biomedical research]

Every human behaviour, therefore also biomedical research, implies a reference, either implicit or explicit, to ethic values. The expression "biomedical research" attains to the domain of two distinct fields, the scientific and the technical one and this distinction is important for its ethic implications. In fact, it was the great progress in the biotechnologies that in the early 70's stimulated the birth of a new discipline known as bioethics, that from its very start was meant to be the meeting point between culturers of the biological sciences and those of human sciences. Among the paradigms adopted by bioethics, those of Beauchamp and Childress, which refer to the principles of "beneficence" (well doing), "non maleficence" (not wrong doing), autonomy and justice, are still of great importance. Bioethics proposed to establish an inequivocal and shared language and to develop adequate and rigorous procedures of analysis. So, at various levels, international, national and local, those interesting tools of the trade, which are the ethics committees, have arose. In order for an ethic committee to function, one must guarantee from the start, the conditions of autonomy and representativeness of different knowledges and cultural options that characterize our complex society. It is also necessary that an ethics committee, rather than assuming a prescriptive role, should promote attention and reflection on the ethical aspects of biomedical research.

[Bioethics: history and problems]

This paper aims at describing the circumstances of the birth of bioethics. In the first section, the paper stresses some historical data supporting the widely diffused opinion according to which bioethics arose in the USA at the beginning of the Seventies. In the second, two of the most important factors in the birth of bioethics are discussed: namely, the possibilities opened by genetic engineering and the changes in the medical enterprise and health care ethics. In the third section the paper discusses one of the most important practical realization of bioethics: the creation of ethical committees.

Local research ethics committee approval for a national study in Scotland

The handling of research proposals by different ethics committees has been reported as varying widely from one district to another. Multicentre research projects are particularly liable to delay when dealing with several individual committees. We recently performed a nation-wide postal questionnaire study in Scotland on young patients with oral or oropharyngeal cancer. Our experience indicates that despite calls for standardization of the processes involved wide variations still exist between committees. Fifteen out of 19 committees approached had unique application forms, the number of copies of forms and other documentation required ranged from one to 20, and the time to final approval ranged from 39 to 182 days (mean of 90 days). Improved training and a standardized constitution of committee members is required. A uniform national application form and improved co-operation between neighbouring committees is needed.

Hospital ethics committees and nurses' participation

The hospital ethics committee's mandates of patient care review, policy formation, and education make them central to nurses and healthcare delivery. In a study examining nurses' communication exchange frequency and perceived effectiveness as members of hospital ethics committees, nurses represented the largest proportion, were moderately active, and rated their participation effectiveness the highest: they are more involved in discussions regarding patients than policy formation and education. Nurse administrators can provide strategies and education for nurses that enhance nurses' participation in all three committee functions. Policies affect patient care; therefore, policy decisions, too, benefit from nurses' participation.

Hospital ethics committees and the future of health care decision making

In an era of increased patient decision making and limited resources, the solving of ethical dilemmas requires more than the traditional top-down approach. This article examines the use of ethics committees in hospitals located in Alabama. A significant minority of the hospitals do not have committees, despite increasing calls for ethics committees in the literature and by regulatory and accreditation agencies. The article also describes the typical composition of a hospital ethics committee as well as the means by which hospitals without committees solve ethical problems.

Bioethics in pediatric neuromuscular disease

The increasing frequency with which bioethical issues arise in the medical care of pediatric patients with neuromuscular disease suggests a need for a working knowledge of the field for the clinical physician, Institutional Bioethics Committees are multidisciplinary groups that include medical, nursing, social service, legal, religious or chaplaincy, and community representation. The role and functioning of these committees vary widely according to institution. Inherent in the process of consent is that it must be an Informed consent. This requires that the person consenting has been given adequate information to understand and to appreciate the benefits and risks of the treatment. There are some instances in which consent by minor patients is necessary.

Determining the function of a hospital clinical ethics committee: making ethics work

The objective of this study was to identify ethical issues of greatest concern to hospital staff, and to establish perceptions regarding the optimal function of a Clinical Ethics Committee (CEC). The design involved a descriptive, cross-sectional study using a self-report questionnaire, which was sent to a random sample of medical, nursing, allied health, technical and administrative staff working at the John Hunter Hospital (a 650-bed, urban, teaching hospital in New South Wales) in September 1995. The questionnaires were sent to 565 staff and completed by 287: an overall compliance rate of 51%. Although the majority of staff supported the existence of the CEC in principle, approximately two-thirds were actually aware of its existence and less than 10% were aware of policies/guidelines produced by the CEC. Ethical issues of greatest concern to respondents were informed consent and confidentiality. Most believed that the main function of the CEC should be education and policy development; fewer supported a role in case consultation or case review, and even less believed that the CEC should take any role in resource allocation decisions. While there is a strong degree of support for the existence of a CEC, there is considerable variation in opinion regarding what should be its function and how it should be organized. The results of this study provide some insight into the issues associated with the emergence of CECs in an Australian context.