Fraudulent human embryonic stem cell research in South Korea: lessons learned

Using the consolidated framework for implementation research to guide a pilot of implementing an institution level patient informed consent process for clinical research at an outpatient setting

BACKGROUND

In Singapore, research teams seek informed patient consent on an ad hoc basis for specific clinical studies and there is typically a role separation between operational and research staff. With the enactment of the Human Biomedical Research Act, there is increased emphasis on compliance with consent-taking processes and research documentation. To optimize resource use and facilitate long-term research sustainability at our institution, this study aimed to design and pilot an institution level informed consent workflow (the "intervention") that is integrated with clinic operations.

METHODS

We used the Consolidated Framework for Implementation Research (CFIR) as the underpinning theoretical framework and conducted the study in three stages: Stage 1, CFIR constructs were used to systematically identify barriers and facilitators of intervention implementation, and a simple time-and-motion study of the patient journey was used to inform the design of the intervention; Stage 2, implementation strategies were selected and mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy; Stage 3, we piloted and adapted the implementation process at two outpatient clinics and evaluated implementation effectiveness through patient participation rates.

RESULTS

We identified 15 relevant CFIR constructs. Implementation strategies selected to address these constructs were targeted at three groups of stakeholders: institution leadership (develop relationships, involve executive boards, identify and prepare champions), clinic management team (develop relationships, identify and prepare champions, obtain support and commitment, educate stakeholders), and clinic operations staff (develop relationships, assess readiness, conduct training, cyclical tests of change, model and simulate change, capture and share local knowledge, obtain and use feedback). Time-and-motion study in clinics identified the pre-consultation timepoint as the most appropriate for the intervention. The implementation process was adapted according to clinic operations staff and service needs. At the conclusion of the pilot, 78.3% of eligible patients provided institution level informed consent via the integrated workflow implemented.

CONCLUSIONS

Our findings support the feasibility of implementing an institution level informed consent workflow that integrates with service operations at the outpatient setting to optimize healthcare resources for research. The CFIR provided a useful framework to identify barriers and facilitators in the design of the intervention and its implementation process.

Creative regulatory practices to develop stem-cell technology: the way forward for Malaysia

Malaysia aspires to develop regenerative medicine through stem-cell technology. It needs a regulatory system that could facilitate development and prevent unethical practices. A comparative legal analysis on the regulation of stem-cell technology, with a focus on stem-cell research in Malaysia and selected Commonwealth countries that are experienced in regulating this complex technology, demonstrates that the selected Commonwealth countries have adopted a hybrid of different regulatory mechanisms. This paper argues that Malaysia should consider adopting a similar approach to equip relevant authorities with different regulatory mechanisms that are able to promote innovation in stem-cell research activities and cultivate a successful and profitable regenerative medicine industry in the future. Such a strategic action can produce an optimal regulatory outcome and help Malaysia to realize its aspiration.

Dishonest Academic Conduct: From the Perspective of the Utility Function

Dishonest academic conduct has aroused extensive attention in academic circles. To explore how scholars make decisions according to the principle of maximal utility, the author has constructed the general utility function based on the expected utility theory. The concrete utility functions of different types of scholars were deduced. They are as follows: risk neutral, risk averse, and risk preference. Following this, the assignment method was adopted to analyze and compare the scholars' utilities of academic conduct. It was concluded that changing the values of risk costs, internal condemnation costs, academic benefits, and the subjective estimation of penalties following dishonest academic conduct can lead to changes in the utility of academic dishonesty. The results of the current study suggest that within scientific research, measures to prevent and govern dishonest academic conduct should be formulated according to the various effects of the above four variables.

Educating about biomedical research ethics

This article examines the global and worsening problem of research misconduct as it relates to bio-medico-legal education. While research misconduct has serious legal implications, few adequate legal remedies exist to deal with it. With respect to teaching, research ethics education should be mandatory for biomedical students and physicians. Although teaching alone will not prevent misconduct, it promotes integrity, accountability, and responsibility in research. Policies and law enforcement should send a clear message that researchers should adhere to the highest standards of ethics in research. It is vital that researchers and physicians understand basic aspects of law and the legal system in order to develop understanding of the medico-legal issues not just in the legal context, but with a sound grounding in ethics, social and theoretical contexts so that they can practice good medicine. Routine and holistic research ethics education across the curriculum for medical students and resident physicians, and continuing medical education for practicing doctors, are probably the best ways to accomplish this goal.

Ethical modernization: research misconduct and research ethics reforms in Korea following the Hwang affair

The Hwang affair, a dramatic and far reaching instance of scientific fraud, shocked the world. This collective national failure prompted various organizations in Korea, including universities, regulatory agencies, and research associations, to engage in self-criticism and research ethics reforms. This paper aims, first, to document and review research misconduct perpetrated by Hwang and members of his research team, with particular attention to the agencies that failed to regulate and then supervise Hwang's research. The paper then examines the research ethics reforms introduced in the wake of this international scandal. After reviewing American and European research governance structures and policies, policy makers developed a mixed model mindful of its Korean context. The third part of the paper examines how research ethics reform is proactive (a response to shocking scientific misconduct and ensuing external criticism from the press and society) as well as reactive (identification of and adherence to national or international ethics standards). The last part deals with Korean society's response to the Hwang affair, which had the effect of a moral atomic bomb and has led to broad ethical reform in Korean society. We conceptualize this change as ethical modernization, through which the Korean public corrects the failures of a growth-oriented economic model for social progress, and attempts to create a more trustworthy and ethical society.

Towards the responsible conduct of scientific research: is ethics education enough?

Much of the discourse on 'beyond the laboratory door' biosecurity to date has focused on the need to raise awareness among the scientific community of the risks posed by the rapid advancement of biotechnology in recent decades. While education is undoubtedly important, a growing body of evidence suggests that ethics education does not necessarily translate into ethical behaviour. This trend has already been reported in clinical settings, where research has highlighted doctors' own reports of ethically dubious practices and challenges when confronted with moral dilemmas in their everyday work. The purpose of this paper is to critically evaluate the practical value of ethics education and show why it is an essential, although insufficient, measure for promoting a culture of responsible conduct of research. We conclude by highlighting the importance of continuing professional development as a way of maintaining life scientists' engagement with biosecurity issues and supporting them in active roles in the effective implementation of the Biological and Toxin Weapons Convention (BWC).

Perspective: The case for research justice: inclusion of patients with limited English proficiency in clinical research

Persons with limited English proficiency (LEP) constitute a growing portion of the U.S. population, yet they are underrepresented in clinical research. This inherently limits the societal benefits of the research and its generalizability to ethnic populations living in the United States. To illustrate the complexity associated with including LEP participants in clinical research, the authors critically evaluated LEP consent requirements posted on the Web sites of 134 academic health centers in March 2008. They found wide variability with regard to consent policies and striking interinstitutional differences in posted IRB policies and attitudes toward consent of LEP patients in research. The authors argue this variation highlights competing concerns between autonomy and justice. Outcomes-based justice requires inclusion of LEP patients in the research, yet the consent process is often resource-intensive and complex. The authors suggest that more uniform and specific guidance from federal agencies for enrollment of LEP patients in clinical research be established and that this guidance explicitly recalibrate the current balance between autonomy and justice. Investigators and institutional review boards should also develop streamlined best practices to reduce unnecessary effort and expense associated with recruitment of LEP individuals. LEP individuals should have fair access to clinical research in order to fully realize individual and societal benefits of their participation and to ensure the generalizability of scientific discovery.

Research integrity in China: problems and prospects

In little more than 30 years, China has recovered from the intellectual stagnation brought about by the Cultural Revolution to become a global leader in science and technology. Like other leading countries in science and technology, China has encountered some ethical problems related to the conduct of research. China's leaders have taken some steps to respond to these problems, such as developing ethics policies and establishing oversight committees. To keep moving forward, China needs to continue to take effective action to promote research integrity. Some of the challenges China faces include additional policy development, promoting education in responsible conduct of research, protecting whistle-blowers, and cultivating an ethical research environment.

A theoretical comparison of the models of prevention of research misconduct

The current methods of dealing with research misconduct involve detection and rectification after the incident has already occurred. This method of monitoring scientific integrity exerts considerable negative effects on the concerned persons and is also wasteful of time and resources. Time has arrived for research administrators to focus seriously on prevention of misconduct. In this article, preventive models suggested earlier by Weed and Reason have been combined to arrive at six models of prevention. This is an effort to streamline the thinking regarding misconduct prevention, so that the advantages and disadvantages of each can be weighed and the method most appropriate for the institute chosen.

"Just one animal among many?" Existential phenomenology, ethics, and stem cell research

Stem cell research and associated or derivative biotechnologies are proceeding at a pace that has left bioethics behind as a discipline that is more or less reactionary to their developments. Further, much of the available ethical deliberation remains determined by the conceptual framework of late modern metaphysics and the correlative ethical theories of utilitarianism and deontology. Lacking, to any meaningful extent, is a sustained engagement with ontological and epistemological critiques, such as with "postmodern" thinking like that of Heidegger's existential phenomenology. Some basic "Heideggerian" conceptual strategies are reviewed here as a way of remedying this deficiency and adding to ethical deliberation about current stem cell research practices.

International standards for research integrity: An idea whose time has come?

A movement to promulgate international ethics standards covering areas of conduct other than research with human subjects has now begun to gain momentum. This commentary explains why it is important to develop international research integrity standards and some of the problems that must be overcome to bring them to fruition.