Variability among institutional review boards' decisions within the context of a multicenter trial

BACKGROUND

Institutional review boards (IRBs) are given discretion to interpret and apply the federal regulations governing the protection of human subjects in research.

OBJECTIVE

To determine the extent of the variability among different IRBs on their approved research practices and informed consent forms within the context of a multicenter trial that used a common protocol.

DESIGN

Descriptive analysis of survey information and informed consent forms.

SETTING AND PARTICIPANTS

Sixteen IRBs from the institutions participating in a multicenter trial comparing lower vs. traditional tidal volume ventilation in patients with acute lung injury.

MEASUREMENTS

Analysis of survey information on IRBs' approved research practices. Analysis of informed consent forms for the presence and the adequacy of description of each basic element of informed consent specified in the federal regulations. Reading levels of informed consent forms.

MAIN RESULTS

Surveys and IRB-approved consent forms were obtained from all of the contacted IRBs (n = 16). Variability was observed among several of the research practices; one IRB waived the requirement for informed consent, five IRBs permitted telephone consent, and three IRBs allowed prisoners to be enrolled. Three consent forms contained all of the basic elements of informed consent outlined in the federal regulations, and 13 forms had varying numbers of these elements absent (six forms without one element, four without two, one without three, and two without four). Reading levels of the consent forms ranged from grades 8.2 to 13.4 (mean +/- sd was 11.6 +/- 1.2 grade level).

CONCLUSIONS

Within a multicenter trial, IRBs reviewing a common protocol varied in several of their approved research practices and in the extent to which the basic elements of informed consent were included in their consent forms.

In the midst of confusion lies opportunity: fostering quality science in dietary supplement research

The Office of Dietary Supplements (ODS) was established at the National Institutes of Health (NIH) by Congress through the Dietary Supplement Health and Education Act (DSHEA) of 1994. The mission of the ODS is to strengthen knowledge and understanding of dietary supplements by evaluating scientific information, stimulating and supporting research, disseminating research results and educating the public, all in an effort to foster an enhanced quality of life and health for the U.S. population. In pursuit of this mission, ODS takes into account an array of dietary supplement ingredients and products. This includes vitamin and mineral supplements and botanicals, as well as non-nutrient supplements. Toward that end, ODS has taken a number of steps. In collaboration with other Institutes and Centers at NIH, ODS has established a network of Dietary Supplement Research Centers around the country that provide the focus for multidisciplinary research efforts; it supports research activities and scientific conferences, it supports evidence-based reviews of supplements, and it maintains a public database of scientific literature on dietary supplements. The lack of credible information from well-controlled studies of many dietary supplements raises issues of caution and concern. The ODS is committed to providing and disseminating accurate and reliable scientific information on dietary supplements.

Protection of human research subjects. Department of Health and Human Services (DHHS). Final rule

The Department of Health and Human Services (DHHS) is amending its human subjects protection regulations. These regulations provide additional protections for pregnant women and human fetuses involved in research and pertains to human in vitro fertilization. The rule continues the special protections for pregnant women and human fetuses that have existed since 1975. The rule enhances the opportunity for participation of pregnant women in research by promoting a policy of presumed inclusion, by permitting the pregnant woman to be the sole decision maker with regard to her participation in research, and by exempting from the regulations six categories of research. The rule also provides a mechanism for the Secretary of HHS to conduct or fund research not otherwise approvable after consultation with an expert panel and public review and comment.

Academic otolaryngology in the new millennium: Are we falling behind?

OBJECTIVE

To determine if differences in publication rates have evolved over the past 3 decades for academic otolaryngologists.

METHODS

Three random samples with 50 academic otolaryngologists each were studied. These otolaryngologists completed training in 1 of the 3 time periods (1970-74, 1980-84, 1990-94) studied. Articles published within the first 5 years after graduation were tabulated and statistically analyzed.

RESULTS

Academic otolaryngologists graduating in the 1970s, 1980s, and 1990s averaged 8.7, 8.9, and 6.4 publications during their first 5 years of academic practice, respectively. The first 2 cohorts averaged 5.4 and 5.7 publications in the 4 major otolaryngology journals, versus 3.3 for 1990s graduates. Basic science publications increased for 1990s graduates over those of the 1970s and 1980s graduates. The percentage of first author articles remained stable. Despite these trends, only the drop in case reports was statistically significant (P = 0.023, ANOVA).

CONCLUSION

Trends may be developing that predict decreasing publication rates for newly trained otolaryngologists entering academic practice.

An HIV vaccine: how and when?

The best long-term hope for controlling the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic is a safe, effective and affordable preventive vaccine, but its development has encountered unprecedented scientific challenges. The first phase I trial of an HIV vaccine was conducted in 1987. Subsequently, more than 30 candidate vaccines have been tested in over 60 phase I/II trials, involving approximately 10 000 healthy volunteers. Most of these trials have been conducted in the USA and Europe, but several have also been conducted in developing countries. The first phase III trials began in the USA in 1998 and in Thailand in 1999 to assess the efficacy of the first generation of HIV vaccines (based on the HIV envelope protein, gp120); the results will be available within the next 1-2 years. To accelerate the development of an HIV vaccine, additional candidate vaccines must be evaluated in parallel in both industrialized and developing countries. This will require international collaboration and coordination and critical ethical issues will need to be addressed. To ensure that future HIV vaccines contribute to the overall HIV/AIDS prevention effort, we should begin planning now on how best to use them.

Privacy, families, and human subject protections: some lessons from pedigree research

Studies that involve getting information from people about other people, including pedigree studies, create obligations to those other people. Defining them as "human subjects," however, does not solve the ethical problems and will, in some cases, make important lines of study impractical or even impossible. The more important task is to define what the ethical obligations are and how to ensure that they are carried out. Some heuristics based on the study of families with inherited Alzheimer's disease suggest that consultation with family members and attention to confidentiality should more directly address the ethical problems than try to treat families merely as collections of people with individual rights. The individual-based approach will necessarily fail when different family members differ in their judgments about the risks and benefits of disclosing information, which will, in turn, lead to the most restrictive individual controlling what others in the family can disclose. This solution is unlikely to be supported in practice by families or researchers or to be sanctioned by the courts. The current policy of the federal Office for Human Research Protections, based on an interpretation of the definition "human subject," is incoherent and will need to be changed, preferably through a process that involves broad debate among all stakeholders but most particularly involving members of families being studied.

Third-party rights and risks: a forum on informed consent of persons affected by the study of human subjects--conditions, experiences, and concerns in a Nordic country

In Denmark, health research using personal information can be conducted only with permission from a regional scientific ethical committee and the national Data Protection Office. There are no rules applying to the rights and risks of third parties. In this article, the implications for third-party rights and risks of the type and level of involvement of the subjects are discussed from a Danish point of view. Particular emphasis is put on the current conditions, experiences, and concerns with regard to use of already registered personal information, which in the Nordic countries offers unique opportunities for large-scale, longitudinal, population-based studies also involving third parties. These opportunities have recently been challenged by a European Community Directive, with which all member states must comply, requiring informed consent on every transaction of personal data, but through a political process, it was possible to obtain a series of amendments allowing the special register-based research to continue. Crucial arguments favoring the amendments were that no damage has been observed so far and that such research has no interest in the individual data, only in the statistical distributions and associations. Finally, the article suggests that the rights and risks of third parties might be considered on the basis of use: third-party information provided by the subject only as a source of such information distinct from use of the information as an integral part of the subjects' information about themselves and their lives.

Family history information in biomedical research

Family history information has been widely used in biomedical research for many years. Ethical concerns have recently been raised about the collection of such information. This article reviews the major roles played by family history information in biomedical research, explores what "private" means in the context of the collection of such information, examines the possible sources of harm from the collection of family history information, and discusses the implications of the possible special restrictions on "sensitive" family history information about psychiatric and drug use disorders. Family history information is vital to many aspects of biomedical research, especially human molecular and epidemiologic genetics. Substantial uncertainty remains about who "owns" family history information, and in several cases, such as childhood sexual abuse, it is hard to justify the position that "third-party" consent is needed. In many instances, the risk to third-party subjects can be minimized by safeguards to confidentiality and data integrity. Adding special restrictions for the collection of family history information on psychiatric and drug abuse disorders may reinforce stigma and substantially burden researchers examining these vital public health problems.

Federal regulations and the future of research in human and medical genetics

Recent events in genetics research have generated questions about the efficacy of federal regulations that govern the conduct of biomedical research, particularly genetics research. The regulatory definitions of "human subject" and "private information" that have governed the conduct of research for two decades are presently under scrutiny because of ambiguities created by the methods of family studies in human and medical genetics. Geneticists customarily collect family history information for the purposes of tracking and characterizing genes in large families. Amassing family history information usually entails asking human subjects about the health status of collateral relatives. Whether these relatives should be regarded as human subjects for the purposes of giving informed consent is the issue that has triggered wide debate and an exhaustive re-examination of federal regulations and guidelines. The purpose of this article is threefold. First, a review of the development of current federal regulations provides a foundation and a point of departure for resolving current issues in genetics research. Second, a review of customary practices in genetics research furthers thought regarding regulations or guidelines to address specific issues in genetics. Third, it asserts that any new regulations or guidelines must provide appropriate protections for human subjects and their families while simultaneously supporting appropriate activities in genetics research.

A consumer perspective on informed consent and third-party issues

Our two children were diagnosed with a rare genetic disorder, which led us to establish a research foundation. This led to in-depth consideration of issues surrounding informed consent from a consumer perspective. Third-party issues arose as central to the formulation of ethical policy in the establishment of a blood and tissue bank and an epidemiologic study. We suggest that a number of myths--privacy is possible, samples can be stripped of identifiers, humans are subjects, voluntary informed consent is attainable, genetics is about the individual only, genetic information is different than other medical information, research is altruistic, the public will learn truths about genetic research via media, and research is culturally competent--make it difficult to resolve the issues intrinsic to informed consent. A number of important elements could make policy decisions less complicated. These include conducting culturally competent research; conveying noncoercive hope, not hype; contacting the voluntary informant only; asking the informant to extend contact to other family members; requiring a comprehensive informed consent process for all contacted; and engaging in state-of-the-art data protections. There is a need for a "Genomic Hippocratic Oath," creating an ethical basis for research similar to the one vowed by health care professionals. Establishing ethical policies as a result of the collaboration of policy makers, researchers, and consumers will allow research to progress ethically at a rapid rate. If regulations are oppressive, they will thwart research; if they are too lenient, participants will not receive protections needed to participate safely.

Pedigrees, propaganda, and paranoia: family studies in a historical context

This article reviews the uses of family studies carried out in the early 20th century under the banner of eugenics, a companion discipline to early genetics. It explores how, in an attempt to analyze and quantify purportedly biologic bases of social problems, the eugenicists constructed pedigree charts of notoriously "defective" families. Investigation of individuals with suspect traits formed the basis for instruction of field workers who linked those traits to larger groups. The resulting eugenic family studies provided a "scientific" face for a popular hereditarian mythology that claimed to explain all social failure in systematic terms. The eugenicists were successful in fueling public fear about the growing "army of idiots and imbeciles" graphically depicted in their pedigree charts. Their success was the result of a finely crafted educational program--propaganda that reduced science to simplistic terms. The tendency to oversimplify concepts of genetic causation and the rush to amplify the significance of research findings through the popular media is also apparent today. What begins as publicity has the potential to be transformed into propaganda. Although many in the scientific community are understandably reluctant to revisit the abuses of the past, that community must confront the history of eugenics as a necessary antidote to the genetic hype that surrounds us.