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Raghunathan S. Returning research results to individuals who are incarcerated in the USA. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-109493. [PMID: 37857508 DOI: 10.1136/jme-2023-109493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
The return of research results to populations and individuals is increasingly recognised as both important but ethically complicated. In the USA, there are few studies or detailed evidence-based practices on the return of research results to individuals who are incarcerated. In general, return of research results is not required with some exceptions; however, there are reasons to believe that in many cases returning results is most consistent with the ethical conduct of research. With individuals who are incarcerated, specific considerations for this historically disadvantaged population should be addressed. These are privacy, therapeutic misconception, paternalism, actionability and communication. If research results are returned, the initial consent process should consider thoroughness regarding privacy rights, the researchers' role, clarity around next steps and communication methods. Prison leadership should be key stakeholders in the process to streamline communication. Returning research results can be a method to counter historical and current paternalism in the carceral setting, while shifting the culture on how research is understood and conducted in carceral settings. The decision to return results should balance benefits, risks and research ethics. Further research is needed to identify and implement optimal approaches for returning results in this population.
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Affiliation(s)
- Sahana Raghunathan
- The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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2
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Wurcel AG, Kraus C, Johnson O, Zaller ND, Ray B, Spaulding AC, Flynn T, Quinn C, Day R, Akiyama MJ, Del Pozo B, Meyer F, Glenn JE. Stakeholder-engaged research is necessary across the criminal-legal spectrum. J Clin Transl Sci 2022; 7:e5. [PMID: 36755540 PMCID: PMC9879908 DOI: 10.1017/cts.2022.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/23/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
People with lived experience of incarceration have higher rates of morbidity and mortality compared to people without history of incarceration. Research conducted unethically in prisons and jails led to increased scrutiny of research to ensure the needs of those studied are protected. One consequence of increased restrictions on research with criminal-legal involved populations is reluctance to engage in research evaluations of healthcare for people who are incarcerated and people who have lived experience of incarceration. Ethical research can be done in partnership with people with lived experience of incarceration and other key stakeholders and should be encouraged. In this article, we describe how stakeholder engagement can be accomplished in this setting, and further, how such engagement leads to impactful research that can be disseminated and implemented across disciplines and communities. The goal is to build trust across the spectrum of people who work, live in, or are impacted by the criminal-legal system, with the purpose of moving toward health equity.
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Affiliation(s)
- Alysse G. Wurcel
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
| | - Christina Kraus
- Tufts University Medical Student, JCOIN LEAP Scholar, Boston, MA, USA
| | - O’Dell Johnson
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Bradley Ray
- RTI International, Division for Applied Justice Research, 3040 Cornwallis Road, Research Triangle Park, NC27709, USA
| | - Anne C. Spaulding
- Associate Professor of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tara Flynn
- Assistant Deputy Superintendent Health Services, Norfolk County Sheriff’s Office, Dedham, MA, USA
| | | | - Ronald Day
- The Fortune Society, Vice President of Programs and Research, Long Island City, New York, USA
| | - Matthew J. Akiyama
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Fred Meyer
- Deputy Chief (Retired), Las Vegas Metropolitan Police Department, Las Vegas, NV, USA
| | - Jason E. Glenn
- Department of History and Philosophy of Medicine, University of Kansas Medical Center, Kansas, USA
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3
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James JE. Is It Ethical to Mandate Vaccination among Incarcerated Persons? Consider Enforcement and Ask People Living in Prisons and Jails. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:W7-W8. [PMID: 35723578 DOI: 10.1080/15265161.2022.2089290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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4
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Kolarcik CL, Bledsoe MJ, O'Leary TJ. Returning Individual Research Results to Vulnerable Individuals. THE AMERICAN JOURNAL OF PATHOLOGY 2022; 192:1218-1229. [PMID: 35750259 DOI: 10.1016/j.ajpath.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
Although issues associated with returning individual research results to study participants have been well explored, these issues have been less thoroughly investigated in vulnerable individuals and populations. Considerations regarding return of research results to these individuals and populations, including how best to ensure truly informed consent, how to minimize the risks and benefits of the return of research results, and how best to ensure justice may differ from those of the population at large. This article discusses the issues and challenges associated with the return of individual research results (such as genomic, proteomic, or other biomarker data) to potentially vulnerable individuals and populations, including those who may be vulnerable for cognitive, communicative, institutional, social, deferential, medical, economic, or social reasons. It explores factors that should be considered in the design, conduct, and oversight of ethically responsible research involving the return of research results to vulnerable individuals and populations and discuss recommendations for those engaged in this work.
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Affiliation(s)
- Christi L Kolarcik
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Timothy J O'Leary
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia; Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland.
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Whichard C, Schaefer DR, Kreager DA. Charting the Hidden City: Collecting Prison Social Network Data. SOCIAL NETWORKS 2022; 69:170-179. [PMID: 35935534 PMCID: PMC9347477 DOI: 10.1016/j.socnet.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Christian AB, Grigorian A, Mo J, Yeates EO, Dolich M, Chin TL, Schubl SD, Kuza CM, Lekawa M, Nahmias J. Comparative Outcomes for Trauma Patients in Prison and the General Population. Am Surg 2022; 88:1954-1961. [PMID: 35282696 DOI: 10.1177/00031348221078984] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prisoners are a vulnerable population, and there are few contemporary studies that consider trauma patient outcomes within the prisoner population. Therefore, we sought to provide a descriptive analysis of prisoners involved in trauma and evaluate whether a healthcare disparity exists. We hypothesized that prisoners and non-prisoners have a similar risk of mortality and in-hospital complications after trauma. METHODS The Trauma Quality Improvement Program (2015-2016) was queried for trauma patients based upon location inside or outside of prison at the time of injury. A multivariable logistic regression analysis was performed to compare these groups for risk of mortality-the primary outcome. RESULTS From 593,818 trauma patients, 1115 were located in prison. Compared to non-prisoners, prisoner trauma patients had no significant difference in mortality (5.1 vs 6.0%, P = .204). However, after adjusting for covariates, prisoners had a shorter length of stay (LOS) (mean days, 6.3 vs 7.8, P < .001), shorter intensive care unit (ICU) LOS (mean days, 5.44 vs 5.89, P = .004), and fewer complications, including lower rates of drug/alcohol withdrawal (.4% vs 1.1%, P = .030), pneumonia (.5 vs 1.6%, P = .004), and urinary tract infections (.0 vs 1.1%, P < .001). Upon performing a multivariable logistic regression model, prisoner trauma patients had a similar associated risk of mortality compared to non-prisoners (OR 1.61, CI .52-4.94, P = .409). DISCUSSION Our results suggest that prisoner trauma patients at least receive equivalent treatment in terms of mortality and may have better outcomes when considering some complications. Future prospective studies are needed to confirm these results and explore other factors, which impact prisoner patient outcomes.
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Affiliation(s)
- A B Christian
- Department of Surgery, 8788University of California Irvine, Orange, CA, USA
| | - A Grigorian
- Department of Surgery, 8788University of California Irvine, Orange, CA, USA
| | - J Mo
- Department of Surgery, 8788University of California Irvine, Orange, CA, USA
| | - E O Yeates
- Department of Surgery, 8788University of California Irvine, Orange, CA, USA
| | - M Dolich
- Department of Surgery, 8788University of California Irvine, Orange, CA, USA
| | - T L Chin
- Department of Surgery, 8788University of California Irvine, Orange, CA, USA
| | - S D Schubl
- Department of Surgery, 8788University of California Irvine, Orange, CA, USA
| | - C M Kuza
- Department of Anesthesia, 12223University of Southern California, Los Angeles, CA, USA
| | - M Lekawa
- Department of Surgery, 8788University of California Irvine, Orange, CA, USA
| | - J Nahmias
- Department of Surgery, 8788University of California Irvine, Orange, CA, USA
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7
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When Regional Anesthesia Met Pharmacokinetics. Anesthesiology 2022; 136:588-593. [PMID: 35171978 DOI: 10.1097/aln.0000000000004143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pharmacokinetics of Local Anaesthetic Agents. By Tucker GT, Mather LE. Br J Anaesth 1975; 47(suppl 1):213-24 Information derived from measurements of blood concentrations of local anaesthetics can be extended by the application of pharmacokinetic analysis. A better understanding of quantitative aspects of the disposition and absorption of these drugs should assist the anaesthetist in deciding the optimal agent and dosage for regional block techniques.
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Douglas AD, Zaidi MY, Maatman TK, Choi JN, Meagher AD. Caring for Incarcerated Patients: Can it Ever be Equal? JOURNAL OF SURGICAL EDUCATION 2021; 78:e154-e160. [PMID: 34284945 DOI: 10.1016/j.jsurg.2021.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/27/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Incarcerated patients represent one of the most vulnerable populations in the United States healthcare system. Studying disparities in care they receive, however, has been difficult due to a history of abuse at the hands of medical researchers rendering this population excluded from most current medical research. Due to incarceration, these patients are frequently maintained in shackles and under constant guard when receiving healthcare. There is a paucity of literature on the influence these measures exert on healthcare workers and the care they provide. Our study aimed to measure surgical trainee's perception of health inequities and disparities in incarcerated individuals undergoing surgical care. METHODS An anonymous cross-sectional survey was administered at our single institution to all general surgery trainees assessing perceptions in delivering care to incarcerated patients within our hospital system. The survey consisted of 10 items, nine of which were yes or no responses, and 1 open-ended text question. Survey results were averaged, and percentages were reported. RESULTS Of all current general surgery residents (n = 60), 40 (66%) completed the survey. Almost all respondents (n = 39, 97.5%) have cared for a patient that was incarcerated or in police custody. Most respondents (n = 25, 62.5%) have operated on an incarcerated patient with an armed guard present in the operating room. Similarly, most respondents (n = 26, 65%) have cared for a patient intubated and sedated that was shackled to a bed. The majority of respondents (n = 30, 75%) recalled incidents where a trauma patient was actively questioned by law enforcement during the primary/secondary survey during initial trauma evaluation. At the time of hospital discharge, a quarter (n = 10, 25%) of respondents reported being unable to prescribe all of the medications that a non-imprisoned patient would receive with the same condition. In addition, 18 (45%) respondents felt they were unable to arrange outpatient follow-up with physical or occupational therapy and/or the patient's primary/consulting physician due to patient's incarcerated status. Strikingly, half of respondents (n = 19, 47.5%) believed that the incarcerated patient received substandard care, and the majority of respondents (n = 28, 72%) agreed that the holding areas for incarcerated patients in the emergency room provide substandard patient care. CONCLUSIONS The current status of caring for incarcerated patients within our system represents an urgent and needed area for quality improvement. Surgical trainees report difficulty caring for these patients, and they perceive these individuals receive substandard care. Though our cross-sectional study did not assess the origin of this disparity, the challenges trainees face in caring for incarcerated patients, from assessment to diagnosis and treatment, as well as in follow-up signals an area requiring further research and study.
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Affiliation(s)
| | - Mohammad Y Zaidi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana`
| | - Thomas K Maatman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana`
| | - Jennifer N Choi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana`
| | - Ashley D Meagher
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana`.
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9
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Sade RM, Carpenter AJ, D'Amico TA, Drake DH, Entwistle JW, Ray S, Tweddell JS. Unethical Studies on Transplantation in Cardiothoracic Surgery Journals. Ann Thorac Surg 2021; 112:1746-1752. [PMID: 34654543 DOI: 10.1016/j.athoracsur.2021.07.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/25/2021] [Accepted: 07/25/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Robert M Sade
- Department of Surgery, Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, South Carolina.
| | - Andrea J Carpenter
- Division of Thoracic Surgery, University of Texas Health Science Center, San Antonio, Texas
| | - Thomas A D'Amico
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Daniel H Drake
- Department of Surgery, Munson Healthcare, Traverse City, Michigan
| | - John W Entwistle
- Division of Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Shuddhadeb Ray
- Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, Missouri
| | - James S Tweddell
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, Ohio
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10
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Sade RM, Carpenter AJ, D'Amico TA, Drake DH, Entwistle JW, Ray S, Tweddell JS. Unethical studies on transplantation in cardiothoracic surgery journals. J Thorac Cardiovasc Surg 2021; 162:1647-1653. [PMID: 34654563 DOI: 10.1016/j.jtcvs.2021.07.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/25/2021] [Accepted: 07/25/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Robert M Sade
- Department of Surgery, Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, SC.
| | - Andrea J Carpenter
- Division of Thoracic Surgery, University of Texas Health Science Center, San Antonio, Tex
| | - Thomas A D'Amico
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Daniel H Drake
- Department of Surgery, Munson Healthcare, Traverse City, Mich
| | - John W Entwistle
- Division of Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, Pa
| | - Shuddhadeb Ray
- Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, Mo
| | - James S Tweddell
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, Ohio
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11
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Jacobsen AP, Robledo-Gil T, Nahas-Vigon JH, Epstein JA, Berger ZD, Sufrin CB. Care for Incarcerated Patients Hospitalized with COVID-19. J Gen Intern Med 2021; 36:2094-2099. [PMID: 33954889 PMCID: PMC8099390 DOI: 10.1007/s11606-021-06861-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/26/2021] [Indexed: 01/29/2023]
Abstract
The COVID-19 pandemic has reshaped health care delivery for all patients but has distinctly affected the most marginalized people in society. Incarcerated patients are both more likely to be infected and more likely to die from COVID-19. There is a paucity of guidance for the care of incarcerated patients hospitalized with COVID-19. This article will discuss how patient privacy, adequate communication, and advance care planning are rights that incarcerated patients may not experience during this pandemic. We highlight the role of compassionate release and note how COVID-19 may affect this prospect. A number of pragmatic recommendations are made to attenuate the discrepancy in hospital care experienced by those admitted from prisons and jails. Physicians must be familiar with the relevant hospital policies, be prepared to adapt their practices in order to overcome barriers to care, such as continuous shackling, and advocate to change these policies when they conflict with patient care. Stigma, isolation, and concerns over staff safety are shared experiences for COVID-19 and incarcerated patients, but incarcerated patients have been experiencing this treatment long before the current pandemic. It is crucial that the internist demand the equitable care that we seek for all our patients.
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Affiliation(s)
- Alan P Jacobsen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Talia Robledo-Gil
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jordan H Nahas-Vigon
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeremy A Epstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zackary D Berger
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carolyn B Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Simpson PL, Guthrie J, Jones J, Butler T. Identifying research priorities to improve the health of incarcerated populations: results of citizens' juries in Australian prisons. LANCET PUBLIC HEALTH 2021; 6:e771-e779. [PMID: 34115972 DOI: 10.1016/s2468-2667(21)00050-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 12/12/2022]
Abstract
Health disparities in incarcerated populations should guide investment in the health care and research of these communities. Although users of health-care services are important in providing input into decisions about research, the voices of people in prison are absent regarding research into their health. In this Health Policy paper, we present priorities for research into the health of people in prison according to people in prison themselves. By use of a deliberative research approach, citizens' juries were conducted in six prisons (three men's and three women's prisons) in Australia. Participants were selected following submissions of expression of interest forms that were distributed within the prisons. Prerecorded information by experts in the health of incarcerated people was shown to participants. Participants deliberated for up to 4 h before agreeing on five research priorities. All citizens' juries endorsed mental health as a number one research priority. Prison health-care services, alcohol and other drug use, education, and infectious diseases were identified as research priorities by most citizens' juries. Focal points within priorities included serious mental illness; grief and trauma; medication management; health-care service access, quality, and resources; drug withdrawal and peer support; prison-based needle and syringe programmes; and health and life skills education. If endeavours in research priority setting are to consider health equity goals, the views of our most health affected citizens need to be included.
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Affiliation(s)
- Paul L Simpson
- School of Population Health, University of New South Wales (UNSW Sydney), Sydney, NSW, Australia.
| | - Jill Guthrie
- Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Jocelyn Jones
- National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Tony Butler
- School of Population Health, University of New South Wales (UNSW Sydney), Sydney, NSW, Australia
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Kattner P, Zeiler K, Herbener VJ, Ferla-Brühl KL, Kassubek R, Grunert M, Burster T, Brühl O, Weber AS, Strobel H, Karpel-Massler G, Ott S, Hagedorn A, Tews D, Schulz A, Prasad V, Siegelin MD, Nonnenmacher L, Fischer-Posovszky P, Halatsch ME, Debatin KM, Westhoff MA. What Animal Cancers teach us about Human Biology. Theranostics 2021; 11:6682-6702. [PMID: 34093847 PMCID: PMC8171098 DOI: 10.7150/thno.56623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/09/2021] [Indexed: 12/30/2022] Open
Abstract
Cancers in animals present a large, underutilized reservoir of biomedical information with critical implication for human oncology and medicine in general. Discussing two distinct areas of tumour biology in non-human hosts, we highlight the importance of these findings for our current understanding of cancer, before proposing a coordinated strategy to harvest biomedical information from non-human resources and translate it into a clinical setting. First, infectious cancers that can be transmitted as allografts between individual hosts, have been identified in four distinct, unrelated groups, dogs, Tasmanian devils, Syrian hamsters and, surprisingly, marine bivalves. These malignancies might hold the key to improving our understanding of the interaction between tumour cell and immune system and, thus, allow us to devise novel treatment strategies that enhance anti-cancer immunosurveillance, as well as suggesting more effective organ and stem cell transplantation strategies. The existence of these malignancies also highlights the need for increased scrutiny when considering the existence of infectious cancers in humans. Second, it has long been understood that no linear relationship exists between the number of cells within an organism and the cancer incidence rate. To resolve what is known as Peto's Paradox, additional anticancer strategies within different species have to be postulated. These naturally occurring idiosyncrasies to avoid carcinogenesis represent novel potential therapeutic strategies.
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Affiliation(s)
- Patricia Kattner
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Katharina Zeiler
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
- Department of Neurosurgery, University Medical Center Ulm, Ulm, Germany
| | - Verena J. Herbener
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | | | | | - Michael Grunert
- Department of Nuclear Medicine, German Armed Forces Hospital of Ulm, Ulm, Germany
- Department of Nuclear Medicine, University Medical Center Ulm, Ulm, Germany
| | - Timo Burster
- Department of Biology, School of Sciences and Humanities, Nazarbayev University, Nur-Sultan, Kazakhstan Republic
| | - Oliver Brühl
- Laboratorio Analisi Sicilia Catania, Lentini; SR, Italy
| | - Anna Sarah Weber
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Hannah Strobel
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Georg Karpel-Massler
- Department of Neurosurgery, University Medical Center Ulm, Ulm, Germany
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Sibylle Ott
- Animal Research Center, University of Ulm, Ulm, Germany
| | | | - Daniel Tews
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center, Ulm, Germany
| | - Ansgar Schulz
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Vikas Prasad
- Department of Nuclear Medicine, University Medical Center Ulm, Ulm, Germany
| | - Markus D. Siegelin
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Lisa Nonnenmacher
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Pamela Fischer-Posovszky
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center, Ulm, Germany
| | | | - Klaus-Michael Debatin
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Mike-Andrew Westhoff
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
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14
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Hyatt JM, Lobmaier PP. Medication assisted treatment (MAT) in criminal justice settings as a double-edged sword: balancing novel addiction treatments and voluntary participation. HEALTH & JUSTICE 2020; 8:7. [PMID: 32172481 PMCID: PMC7071668 DOI: 10.1186/s40352-020-0106-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 01/16/2020] [Indexed: 06/10/2023]
Abstract
Medication-Assisted Treatment (MAT) provides an opportunity to address opioid addiction among justice-involved individuals, an often difficult to reach population. This potential has been increasingly recognized by agencies, policymakers and pharmaceutical companies. The result has been a marked increase in the number of drug courts, prisons and agencies in which MAT, notably with long-acting injectable medications, is offered. While this is a positive development, ensuring that vulnerable individuals are in a position voluntarily participation within the complex criminal justice environment is necessary. The unequal authority and agency inherent in the nature of these environments should be recognized. Therefore, rigorous protections, mirroring the goals of the consent processes required for medical or sociobehavorial research, should be employed when MAT is offered to protect individual autonomy.
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Affiliation(s)
- Jordan M. Hyatt
- Department of Criminology and Justice Studies, Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104 USA
| | - Philipp P. Lobmaier
- Norwegian Centre for Addiction Research, University of Oslo, Kirkeveien 166, building 49, Oslo, 0450 Norway
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15
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Metzger WG, Ehni HJ, Kremsner PG, Mordmüller BG. Experimental infections in humans-historical and ethical reflections. Trop Med Int Health 2019; 24:1384-1390. [PMID: 31654450 DOI: 10.1111/tmi.13320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Vaccine efficacy and prophylactic treatment of infections are tested best when the vaccinated or treated individual is challenged through deliberate infection with the respective pathogen. However, this trial design calls for particular ethical caution. Awareness of the history of challenge trials is indispensable, including trials that were problematic or even connected to abuse. We briefly introduce historical aspects of experimental infections in humans and the ethical debate around them and give estimates of the numbers of volunteers participating in human experimental infection models. Challenge models can offer a great chance and benefit for the development of medical interventions to fight infectious diseases, but only when they are appropriately controlled and regulated.
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Affiliation(s)
- W G Metzger
- Institute for Tropical Medicine, German Center for Infection Research, Eberhard Karls University Tübingen, Tübingen, Germany
| | - H-J Ehni
- Institute for Ethics and History of Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
| | - P G Kremsner
- Institute for Tropical Medicine, German Center for Infection Research, Eberhard Karls University Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - B G Mordmüller
- Institute for Tropical Medicine, German Center for Infection Research, Eberhard Karls University Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
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16
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Affiliation(s)
- Paul P Christopher
- Warren Alpert Medical School, Brown University, Providence, Rhode Island (P.P.C.)
| | - Michael D Stein
- School of Public Health, Boston University, Boston, Massachusetts (M.D.S.)
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Vernon LF. J. Marion Sims, MD: Why He and His Accomplishments Need to Continue to be Recognized a Commentary and Historical Review. J Natl Med Assoc 2019; 111:436-446. [PMID: 30851980 DOI: 10.1016/j.jnma.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
This review provides a fresh perspective on the work of J. Marion Sims, an Antebellum era physician who invented the vaginally speculum that bears his name. His accent to become the "Father of Modern Gynecology" was his groundbreaking development of the surgical techniques for the repair for vesicovaginal fistula. Recent scholarship, however, has pointed to the dark side of Sims in that his techniques were perfected through his use of Black slave women as his research subjects. In addition, he has been criticized for his failure to use anesthesia during his research operations. This article argues that Sims's work needs to be understood in a broader historical context and within the broader framework of other forms of human experimentation that took place in the nineteenth and twentieth centuries. There is a strong argument that recent attempts to remove Sims from history also have the unintended consequence of removing the contributions of not only the Black slave women who were his subjects in the development of modern obstetrical medicine, but the important role Blacks played in the development of other medical procedures.
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18
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Williamson LD, Bigman CA. A systematic review of medical mistrust measures. PATIENT EDUCATION AND COUNSELING 2018; 101:1786-1794. [PMID: 29861339 DOI: 10.1016/j.pec.2018.05.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Medical mistrust is seen as a barrier to health promotion and addressing health disparities among marginalized populations. This study seeks to examine how medical mistrust has been measured as a step towards informing related health promotion efforts. METHODS A systematic review of medical mistrust scales was conducted using four major databases: PubMed, PsycINFO, ERIC, and Communication & Mass Media Complete. Databases were searched using the terms "medical mistrust scale" "medical mistrust" and "medical distrust." RESULTS The search returned 1595 non-duplicate citations; after inclusion and exclusion criteria were applied, 185 articles were retained and coded. Almost a quarter of studies used a single-item or a few items. Among validated scales, the Group-Based Medical Mistrust Scale, Medical Mistrust Index, and Health Care System Distrust Scale were most frequently used. There were important differences among these scales such as the object of mistrust (e.g., system, individual physician) and referent specificity (e.g., group). The measurement of medical mistrust varied by health topic and sample population. CONCLUSION These differences in scales and measurement should be considered in the context of intervention goals. PRACTICE IMPLICATIONS Researchers should be aware of differences in measures and choose appropriate measures for a given research question or intervention.
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Affiliation(s)
- Lillie D Williamson
- Department of Communication, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Cabral A Bigman
- Department of Communication, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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Hirschmann JV. From Squirrels to Biological Weapons: The Early History of Tularemia. Am J Med Sci 2018; 356:319-328. [PMID: 30146078 DOI: 10.1016/j.amjms.2018.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 11/26/2022]
Abstract
After George McCoy accidentally discovered a new infection in 1911 while investigating bubonic plague in squirrels, he transmitted the disease to experimental animals and isolated the causative organism. He called it Bacterium tularense, after Tulare County, California. In 1919, Edward Francis determined that an infection called "deer-fly fever" was the same disease, naming it "tularemia." He demonstrated that it occurred in wild rabbits and inadvertently showed that it was highly infectious, for he and all his laboratory assistants contracted the illness. This characteristic led to studies of its potential as a biological weapon, including involuntary human experimentation by Japan among civilian, political and military prisoners, and its probable use in warfare during World War II. Later, in the United States, voluntary human experimentation occurred in the 1950s-1960s with penitentiary inmates and non-combatant soldiers. Soviet Union scientists allegedly developed a vaccine-resistant strain, which they tested as a biological weapon in 1982-1983.
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Affiliation(s)
- J V Hirschmann
- Department of Medicine, University of Washington, Seattle, Washington.
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20
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Ahalt C, Haney C, Kinner S, Williams B. Balancing the Rights to Protection and Participation: A Call for Expanded Access to Ethically Conducted Correctional Health Research. J Gen Intern Med 2018; 33:764-768. [PMID: 29404944 PMCID: PMC5910351 DOI: 10.1007/s11606-018-4318-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/14/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
Abstract
Incarcerated individuals, over 95% of whom are eventually released, experience high burdens of chronic disease and behavioral health and social risk factors. Understanding the health needs of this population is critical to ensuring that general medicine physicians in prisons and in the community are adequately prepared to meet those needs. However, people in prison are significantly underrepresented in health research. In response to historical exploitation of prisoners in medical experimentation, federal guidelines appropriately require additional oversight for, and limit the scope of, research in prisons. Yet, according to a 2006 Institute of Medicine report, these requirements have produced inconsistent local regulations that often limit opportunities for incarcerated individuals to participate in research, and can slow the development of innovative medical interventions to improve their health. In this article, we describe the historical context surrounding regulations on research involving individuals in prison, the harms that can arise from excessive limitations to research in such settings, and the benefits of greater access to ethically conducted research in prison. We conclude with recommended actions that can be taken by general medicine researchers, correctional leaders, and policymakers to achieve consistent access to health research for incarcerated populations.
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Affiliation(s)
- Cyrus Ahalt
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Craig Haney
- Psychology Department, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Stuart Kinner
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia.,Griffith Criminology Institute, Griffith University, Nathan, Australia.,Mater Research Institute, University of Queensland, Brisbane, Australia.,School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Brie Williams
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA.
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21
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Brown P. Ethical challenges to research in the criminal justice system. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2018; 28:5-12. [PMID: 29417659 DOI: 10.1002/cbm.2061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/19/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Penelope Brown
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
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22
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Ahalt C, Sudore R, Bolano M, Metzger L, Darby AM, Williams B. "Teach-to-Goal" to Better Assess Informed Consent Comprehension among Incarcerated Clinical Research Participants. AMA J Ethics 2017; 19:862-872. [PMID: 28905727 DOI: 10.1001/journalofethics.2017.19.9.peer3-1709] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Correctional health research requires important safeguards to ensure that research participation is ethically conducted. In addition to having disproportionately low educational attainment and low literacy, incarcerated people suffer from health-related conditions that can affect cognition (e.g., traumatic brain injury, substance use disorders, mental illness). Yet modified informed consent processes that assess participants' comprehension of the risks and benefits of participation are not required by relevant federal guidelines. A push to assess comprehension of informed consent documents is particularly timely given an increase in demand for correctional health research in the context of criminal justice reform. We argue that comprehension assessments can identify persons who should be excluded from research and help those who will ultimately participate in studies better understand the risks and benefits of their participation.
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Affiliation(s)
- Cyrus Ahalt
- A researcher and policy analyst in the Department of Medicine at the University of California, San Francisco
| | - Rebecca Sudore
- A professor of medicine at the University of California, San Francisco, where she serves as a geriatrician, palliative medicine physician, and clinician investigator
| | - Marielle Bolano
- A fourth-year medical student at the University of California, Davis School of Medicine, and worked at the University of California, San Francisco Division of Geriatrics as a research assistant
| | - Lia Metzger
- An assistant clinical research coordinator for the Division of Geriatrics at the University of California, San Francisco
| | - Anna M Darby
- A second-year emergency medicine resident at Los Angeles County + USC Medical Center, where she works in the dedicated Jail Emergency Department that serves Los Angeles County, and worked as a litigation assistant at the Prison Law Office advocating for prisoners' health care needs and as a National Institute on Aging Medical Student Training in Aging Research Fellow at the University of California, San Francisco
| | - Brie Williams
- A professor of medicine in the Division of Geriatrics at the University of California, San Francisco
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23
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Bott QD. ASHP Guidelines on Pharmacy Services in Correctional Facilities. Am J Health Syst Pharm 2016; 73:1784-1790. [PMID: 27769974 DOI: 10.2146/ajhp160143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Quinn D. Bott
- U.S. Public Health Service, United States Penitentiary/FPC Leavenworth, Leavenworth, KS
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24
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Kamalo PD, Manda-Taylor L, Rennie S. Appropriateness of no-fault compensation for research-related injuries from an African perspective: an appeal for action by African countries. JOURNAL OF MEDICAL ETHICS 2016; 42:528-533. [PMID: 27259545 DOI: 10.1136/medethics-2014-102246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 05/07/2016] [Indexed: 06/05/2023]
Abstract
Compensation for research-related injuries (RRIs) remains a challenge in the current environment of global collaborative biomedical research as exemplified by the continued reluctance of the US government, a major player in international biomedical research, to enact regulation for mandatory compensation for RRIs. This stance is in stark contrast to the mandatory compensation policies adopted by other democracies like the European Union (EU) countries. These positions taken by the USA and the EU create a nexus of confusion when research is exported to low-income and middle-income countries which have no laws guiding compensation for RRIs. In this paper, we begin by exploring the background to policies concerning RRIs, how they reflect on the traditional dispute resolution mechanisms in African societies, and how this compares with the no-fault compensation model. We then explore the underlying African ethical framework of Ubuntu in the sub-Saharan region, guiding traditional practices of dispute resolution and compensation, and how this framework can help to form the moral justification for no-fault compensation as the preferred compensation model for RRIs for African countries. Finally, we call upon countries in the African Union (AU), to adopt a no-fault policy for compensation of RRIs, and enact it into a regulatory requirement for insurance-based no-fault compensation for biomedical research, which will then be enforced by member states of the AU.
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Affiliation(s)
- Patrick Dongosolo Kamalo
- Department of Surgery, University of Malawi-College of Medicine, Blantyre, Malawi Centre for Medical Ethics and Law, Stellenbosch University, Cape Town, South Africa
| | - Lucinda Manda-Taylor
- School of Public Health and Family Medicine, Centre for Bioethics in Eastern and Southern Africa (CEBESA), College of Medicine, University of Malawi, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Stuart Rennie
- Department of Social Medicine and UNC Bioethics Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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25
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Christopher PP, Stein MD, Johnson JE, Rich JD, Friedmann PD, Clarke J, Lidz CW. Exploitation of Prisoners in Clinical Research: Perceptions of Study Participants. IRB 2016; 38:7-12. [PMID: 26964404 PMCID: PMC4793400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper discusses findings of a study examining whether prisoners view their participation in clinical research studies as exploitative. Perspectives of seventy prisoners who were enrolled in one of six different clinical studies were analyzed. A minority of participants agreed with statements suggestive of potential exploitation. All but one participant believed that prisoners should have greater access to research. On balance, these data provide reassurance that prisoners in this sample do not view their involvement in clinical research as inappropriately exploitative.
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26
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Balasingam S, Horby P, Wilder-Smith A. The potential for a controlled human infection platform in Singapore. Singapore Med J 2015; 55:456-61. [PMID: 25273928 DOI: 10.11622/smedj.2014114] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
For over 100 years, controlled human infection (CHI) studies have been performed to advance the understanding of the pathogenesis, treatment and prevention of infectious diseases. This methodology has seen a resurgence, as it offers an efficient model for selecting the most promising agents for further development from available candidates. CHI studies are utilised to bridge safety and immunogenicity testing and phase II/III efficacy studies. However, as this platform is not currently utilised in Asia, opportunities to study therapeutics and vaccines for infections that are important in Asia are missed. This review examines the regulatory differences for CHI studies between countries and summarises other regulatory differences in clinical trials as a whole. We found that the regulations that would apply to CHI studies in Singapore closely mirror those in the United Kingdom, and conclude that the regulatory and ethical guidelines in Singapore are compatible with the conduct of CHI studies.
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Affiliation(s)
- Shobana Balasingam
- Department of Microbiology, National University of Singapore, Centre for Life Sciences, 28 Medical Drive,Singapore 117456.
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27
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Welch MJ, Lally R, Miller JE, Pittman S, Brodsky L, Caplan AL, Uhlenbrauck G, Louzao DM, Fischer JH, Wilfond B. The ethics and regulatory landscape of including vulnerable populations in pragmatic clinical trials. Clin Trials 2015. [PMID: 26374681 DOI: 10.1177/174074515597701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Policies have been developed to protect vulnerable populations in clinical research, including the US federal research regulations (45 Code of Federal Regulations 46 Subparts B, C, and D). These policies generally recognize vulnerable populations to include pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons. The aim has been to protect these populations from harm, often by creating regulatory and ethical checks that may limit their participation in many clinical trials. The recent increase in pragmatic clinical trials raises at least two questions about this approach. First, is exclusion itself a harm to vulnerable populations, as these groups may be denied access to understanding how health interventions work for them in clinical settings? Second, are groups considered vulnerable in traditional clinical trials also vulnerable in pragmatic clinical trials? We argue first that excluding vulnerable subjects from participation in pragmatic clinical trials can be harmful by preventing acquisition of data to meaningfully inform clinical decision-making in the future. Second, we argue that protections for vulnerable subjects in traditional clinical trial settings may not be translatable, feasible, or even ethical to apply in pragmatic clinical trials. We conclude by offering specific recommendations for appropriately protecting vulnerable research subjects in pragmatic clinical trials, focusing on pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons.
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Affiliation(s)
- Mary Jane Welch
- Human Subjects' Protection, College of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Rachel Lally
- Columbia University Medical Center, New York, NY, USA
| | - Jennifer E Miller
- Kenan Institute for Ethics, Duke University, Durham, NC, USA Edmond J. Safra Center for Ethics, Harvard University, Cambridge, MA, USA Division of Medical Ethics, NYU Langone Medical Center, New York, NY, USA
| | - Stephanie Pittman
- Human Subjects' Protection, Rush University Medical Center, Chicago, IL, USA
| | - Lynda Brodsky
- Cook County Health & Hospitals System, Chicago, IL, USA
| | - Arthur L Caplan
- Division of Medical Ethics, NYU Langone Medical Center, New York, NY, USA
| | - Gina Uhlenbrauck
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Darcy M Louzao
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | - Benjamin Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, WA, USA Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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28
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Welch MJ, Lally R, Miller JE, Pittman S, Brodsky L, Caplan AL, Uhlenbrauck G, Louzao DM, Fischer JH, Wilfond B. The ethics and regulatory landscape of including vulnerable populations in pragmatic clinical trials. Clin Trials 2015; 12:503-10. [PMID: 26374681 DOI: 10.1177/1740774515597701] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Policies have been developed to protect vulnerable populations in clinical research, including the US federal research regulations (45 Code of Federal Regulations 46 Subparts B, C, and D). These policies generally recognize vulnerable populations to include pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons. The aim has been to protect these populations from harm, often by creating regulatory and ethical checks that may limit their participation in many clinical trials. The recent increase in pragmatic clinical trials raises at least two questions about this approach. First, is exclusion itself a harm to vulnerable populations, as these groups may be denied access to understanding how health interventions work for them in clinical settings? Second, are groups considered vulnerable in traditional clinical trials also vulnerable in pragmatic clinical trials? We argue first that excluding vulnerable subjects from participation in pragmatic clinical trials can be harmful by preventing acquisition of data to meaningfully inform clinical decision-making in the future. Second, we argue that protections for vulnerable subjects in traditional clinical trial settings may not be translatable, feasible, or even ethical to apply in pragmatic clinical trials. We conclude by offering specific recommendations for appropriately protecting vulnerable research subjects in pragmatic clinical trials, focusing on pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons.
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Affiliation(s)
- Mary Jane Welch
- Human Subjects' Protection, College of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Rachel Lally
- Columbia University Medical Center, New York, NY, USA
| | - Jennifer E Miller
- Kenan Institute for Ethics, Duke University, Durham, NC, USA Edmond J. Safra Center for Ethics, Harvard University, Cambridge, MA, USA Division of Medical Ethics, NYU Langone Medical Center, New York, NY, USA
| | - Stephanie Pittman
- Human Subjects' Protection, Rush University Medical Center, Chicago, IL, USA
| | - Lynda Brodsky
- Cook County Health & Hospitals System, Chicago, IL, USA
| | - Arthur L Caplan
- Division of Medical Ethics, NYU Langone Medical Center, New York, NY, USA
| | - Gina Uhlenbrauck
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Darcy M Louzao
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | - Benjamin Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, WA, USA Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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29
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Quinn CR. General considerations for research with vulnerable populations: ten lessons for success. HEALTH & JUSTICE 2015; 3:1. [PMCID: PMC5151796 DOI: 10.1186/s40352-014-0013-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/23/2014] [Indexed: 06/03/2023]
Abstract
Background This paper offers practical insights for researchers who conduct studies with vulnerable populations, including those using secondary data sources from government entities. Methods/Design The paper is based on the approval process to secure secondary government data from a Midwestern county juvenile probation department and the state courts for the author’s dissertation study. Discussion This paper proposes general considerations and ten lessons learned to successfully conduct research with vulnerable populations and/or their information.
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Affiliation(s)
- Camille R Quinn
- Department of Psychiatry, School of Medicine & Dentistry, 300 Crittenden Boulevard Box PSYCH, Rochester, NY 14642 USA
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30
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Hicks R. Ethical and regulatory considerations in the design of traumatic brain injury clinical studies. HANDBOOK OF CLINICAL NEUROLOGY 2015; 128:743-59. [PMID: 25701918 DOI: 10.1016/b978-0-444-63521-1.00046-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Research is essential for improving outcomes after traumatic brain injury (TBI). However, the ubiquity, variability, and nature of TBI create many ethical issues and accompanying regulations for research. To capture the complexity and importance of designing and conducting TBI research within the framework of key ethical principles, a few highly relevant topics are highlighted. The selected topics are: (1) research conducted in emergency settings; (2) maintaining equipoise in TBI clinical trials; (3) TBI research on vulnerable populations; and (4) ethical considerations for sharing data. The topics aim to demonstrate the dynamic and multifaceted challenges of TBI research, and also to stress the value of addressing these challenges with the key ethical principles of respect, beneficence, and justice. Much has been accomplished to ensure that TBI research meets the highest ethical standards and has fair and enforceable regulations, but important challenges remain and continued efforts are needed by all members of the TBI research community.
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Affiliation(s)
- Ramona Hicks
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
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31
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Johnson ME, Brems C, Bergman AL, Mills ME, Eldridge GD. Knowledge of Federal Regulations for Mental Health Research Involving Prisoners. AJOB Empir Bioeth 2014; 6:12-18. [PMID: 26495325 DOI: 10.1080/23294515.2014.995837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Given their vulnerability to coercion and exploitation, prisoners who participate in research are protected by Office for Human Research Protections (OHRP) regulations designed to ensure their safety and wellbeing. Knowledge of these regulations is essential for researchers who conduct and institutional review boards (IRBs) that oversee mental health research in correctional settings. METHODS We explored depth of knowledge of OHRP regulations by surveying a nationwide sample of: (1) mental health researchers who have conducted research in correctional settings; (2) mental health researchers who have conducted research in non-correctional settings; (3) IRB members who have overseen mental health research in correctional settings; (4) IRB members who have overseen mental health research in in non-correctional settings; and (5) IRB prisoner representatives. Participants responded to a 10-item knowledge questionnaire based on OHRP regulations. RESULTS 1,256 participants provided usable data (44.9% response rate). Results revealed limited knowledge of OHRP regulations, with a mean across groups of 44.1% correct answers. IRB Prisoner representatives, IRB members, and researchers with correctional experience demonstrated the highest levels of knowledge; however, even these participants were able to correctly answer only approximately 50% of the items. CONCLUSIONS Although awareness that prisoners are a protected population and that different regulatory procedures apply to research with them is likely to be universal among researchers and IRB members, our findings reveal limited mastery of the specific OHRP regulations that are essential knowledge for researchers who conduct and IRB members who oversee mental health research in correctional settings. Given well-documented health and healthcare disparities, prisoners could potentially benefit greatly from mental health research; increasing knowledge of the OHRP regulations among researchers and IRB members is a crucial step toward meeting this important public health goal.
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Affiliation(s)
| | | | | | - Michael E Mills
- Department of Psychology Loyola Marymount University (Los Angeles)
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32
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Cuerda-Galindo E, Sierra-Valentí X, González-López E, López-Muñoz F. Syphilis and Human Experimentation From the First Appearance of the Disease to World War II: A Historical Perspective and Reflections on Ethics. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2013.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gee J, Bertrand-Godfrey B. Researching the psychological therapies in prison: considerations and future recommendations. Int J Prison Health 2014; 10:118-31. [DOI: 10.1108/ijph-06-2013-0030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The psychological therapies are widely considered within the forensic literature as holding a useful role in the prison system, however, despite this, very little research into the psychological therapies has taken place. Further, where research is carried out, it is often associated with the need for evidence-based practice (EBP), involving quantification and randomization. The paper aims to discuss these issues.
Design/methodology/approach
– This paper will initially introduce the importance of research into the psychological therapies in prison, followed by a consideration of EBP which can be thought of as the current movement governing research in the psychological therapies in the UK.
Findings
– However, in providing a focused critique of EBP, particularly within prisons, this paper will attempt to pave the way for a consideration of alternative research methodologies and resultant methods in researching the psychological therapies in prisons in the UK.
Originality/value
– Through this it is argued that research within the prison setting should act not to promote interventions and create an evidence-based as such, but to provide an accessible body of knowledge for the psychological therapists working in prisons in the UK.
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34
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Cuerda-Galindo E, Sierra-Valentí X, González-López E, López-Muñoz F. Syphilis and human experimentation from the first appearance of the disease to World War II: a historical perspective and reflections on ethics. ACTAS DERMO-SIFILIOGRAFICAS 2013; 105:762-7. [PMID: 24268559 DOI: 10.1016/j.ad.2013.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 09/05/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022] Open
Abstract
Physicians have conducted research on syphilis for centuries, seeking to understand its etiology and the means of transmission as well as find ways to prevent and cure the disease. Their research practices often strayed from today's ethical standards. In this paper we review ethical aspects of the long history of research on syphilis with emphasis on the experiments performed in the 20th century. The description of research around the time of World War II covers medical experiments carried out in US prisons and in the experimentation centers established by Japanese doctors in occupied territory, as well as experiments in Nazi Germany and the treatment of syphilitics there.
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Affiliation(s)
- E Cuerda-Galindo
- Departamento de Anatomía y Embriología Humana, Universidad Rey Juan Carlos, Madrid, España.
| | | | | | - F López-Muñoz
- Facultad de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, España
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35
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Cislo AM, Trestman R. Challenges and solutions for conducting research in correctional settings: the U.S. experience. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2013; 36:304-310. [PMID: 23683885 DOI: 10.1016/j.ijlp.2013.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Through the mid-1970s, most new drug clinical trials were conducted in America's jails and prisons. Due to the extensive human rights violations acknowledged at that time, laws were enacted that essentially brought corrections-based research to a halt. The Code of Federal Regulations, 45 CFR 46 subpart C, specifies the limitations upon research with correctional populations that are currently in place. These guidelines both informed the ethical conduct of research and arguably created a significant problem in today's correctional environment - prisoners are under-studied. We know far less about the health and health care needs of people under conditions of incarceration than those in the community. Linked with the extraordinary explosion over the last 20 years in the population of America's jails and prisons and with a disproportionate number of mentally ill inmates, inadequate knowledge currently exists to guide clinical decision-making. Over the last decade, a gradually growing body of work, ethically developed and clinically focused, has been evolving. This article presents the challenges of conducting correctional research in health and healthcare delivery. Legal, ethical, and pragmatic barriers are reviewed. Further, practical solutions that allow meaningful research to be conducted are presented. Such research can create a foundation for developing both public policy and clinical practice.
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Affiliation(s)
- Andrew M Cislo
- Correctional Managed Health Care, University of Connecticut Health Center, 99 Ash Street, Second Floor, East Hartford, CT 06108, United States.
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HIV prevention, structural change and social values: the need for an explicit normative approach. J Int AIDS Soc 2012; 15 Suppl 1:1-10. [PMID: 22713355 PMCID: PMC3499876 DOI: 10.7448/ias.15.3.17367] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 04/01/2012] [Accepted: 04/29/2012] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The fact that HIV prevention often deals with politicised sexual and drug taking behaviour is well known, but structural HIV prevention interventions in particular can involve alteration of social arrangements over which there may be further contested values at stake. As such, normative frameworks are required to inform HIV prevention decisions and avoid conflicts between social goals. METHODS This paper provides a conceptual review and discussion of the normative issues surrounding structural HIV prevention strategies. It applies political and ethical concepts to explore the contested nature of HIV planning and suggests conceptual frameworks to inform future structural HIV responses. RESULTS HIV prevention is an activity that cannot be pursued without making value judgements; it is inherently political. Appeals to health outcomes alone are insufficient when intervention strategies have broader social impacts, or when incidence reduction can be achieved at the expense of other social values such as freedom, equality, or economic growth. This is illustrated by the widespread unacceptability of forced isolation which may be efficacious in preventing spread of infectious agents, but conflicts with other social values. CONCLUSIONS While no universal value system exists, the capability approach provides one potential framework to help overcome seeming contradictions or value trade-offs in structural HIV prevention approaches. However, even within the capability approach, valuations must still be made. Making normative values explicit in decision making processes is required to ensure transparency, accountability, and representativeness of the public interest, while ensuring structural HIV prevention efforts align with broader social development goals as well.
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Edens JF, Epstein M, Stiles PG, Poythress NG. Voluntary consent in correctional settings: do offenders feel coerced to participate in research? BEHAVIORAL SCIENCES & THE LAW 2011; 29:771-795. [PMID: 22086664 DOI: 10.1002/bsl.1014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A major ethical concern in research with criminal offenders is the potential for abuse due to coercive influences that may adversely affect offenders' capacity to give voluntary consent to participate in research conducted in correctional settings. Despite this concern, to date there have been almost no systematic scientific investigations of the extent to which offenders themselves perceive that coercion occurs in these settings or that it is likely to influence their decisions about research participation. In a sample of over 600 ethnically diverse men and women recruited from various prisons and community corrections facilities in Texas and Florida, we used a vignette-based survey concerning a hypothetical research project to measure and compare offenders' global perceptions of coercive processes, as well as the differential salience and perceived coercive influence of specific factors (e.g., coercion by other inmates, inducements from staff). Somewhat surprisingly, across multiple outcome measures our participants on average reported relatively little in the way of significant coercive influences on their capacity to make voluntary decisions concerning research participation. Implications and directions for future research on coercive influences in offender research are discussed.
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Affiliation(s)
- John F Edens
- Department of Psychology, Texas A&M University, TAMU 4235, College Station, TX 77843, USA.
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Christopher PP, Candilis PJ, Rich JD, Lidz CW. An Empirical Ethics Agenda for Psychiatric Research Involving Prisoners. AJOB PRIMARY RESEARCH 2011; 2:18-25. [PMID: 25309805 PMCID: PMC4191925 DOI: 10.1080/21507716.2011.627082] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
In the past 30 years, the incarcerated population in the United States has more than quadrupled to 2.3 million adults. With an alarmingly high prevalence of mental illness, substance use, and other serious health conditions compounding their curtailed autonomy, prisoners constitute perhaps the nation's most disadvantaged group. Scientifically rigorous research involving prisoners holds the potential to inform and enlighten correctional policy and to improve their treatment. At the same time, prisoner research presents significant ethical challenges to investigators and institutional review boards (IRBs) alike, by subjecting participants to conditions that potentially undermine the validity of their informed consent. In 2006, the Institute of Medicine Committee on Ethical Considerations for Revisions to the Department of Health and Human Services (DHHS) Regulations for Protection of Prisoners Involved in Research recommended both further protections and a more permissive approach to research review that would allow inmates greater access to potentially beneficial research. These recommendations have sparked renewed debate about the ethical trade-offs inherent to prisoner research. In this article, the authors review the major justifications for research with prisoner subjects and the associated ethical concerns, and argue that the field of empirical ethics has much to offer to the debate. They then propose a framework for prioritizing future empirical ethics inquiry on this understudied topic.
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Affiliation(s)
| | | | - Josiah D Rich
- Alpert Medical School, Brown University, and The Miriam Hospital
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Comfort N. The prisoner as model organism: malaria research at Stateville Penitentiary. STUDIES IN HISTORY AND PHILOSOPHY OF BIOLOGICAL AND BIOMEDICAL SCIENCES 2009; 40:190-203. [PMID: 19720327 PMCID: PMC2789481 DOI: 10.1016/j.shpsc.2009.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2008] [Revised: 01/16/2009] [Indexed: 05/28/2023]
Abstract
In a military-sponsored research project begun during the Second World War, inmates of the Stateville Penitentiary in Illinois were infected with malaria and treated with experimental drugs that sometimes had vicious side effects. They were made into reservoirs for the disease and they provided a food supply for the mosquito cultures. They acted as secretaries and technicians, recording data on one another, administering malarious mosquito bites and experimental drugs to one another, and helping decide who was admitted to the project and who became eligible for early parole as a result of his participation. Thus, the prisoners were not simply research subjects; they were deeply constitutive of the research project. Because a prisoner's time on the project was counted as part of his sentence, and because serving on the project could shorten one's sentence, the project must be seen as simultaneously serving the functions of research and punishment. Michel Foucault wrote about such 'mixed mechanisms' in his Discipline and punish. His shining example of such a 'transparent' and subtle style of punishment was the panopticon, Jeremy Bentham's architectural invention of prison cellblocks arrayed around a central guard tower. Stateville prison was designed on Bentham's model; Foucault featured it in his own discussion. This paper, then, explores the power relations in this highly idiosyncratic experimental system, in which the various roles of model organism, reagent, and technician are all occupied by sentient beings who move among them fluidly. This, I argue, created an environment in the Stateville hospital wing more panoptic than that in the cellblocks. Research and punishment were completely interpenetrating, and mutually reinforcing.
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Affiliation(s)
- Nathaniel Comfort
- Department of History of Medicine, Johns Hopkins University, Baltimore, MD 21205-2113, USA.
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Wakai S, Shelton D, Trestman RL, Kesten K. Conducting research in corrections: challenges and solutions. BEHAVIORAL SCIENCES & THE LAW 2009; 27:743-752. [PMID: 19743521 DOI: 10.1002/bsl.894] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Research in correctional settings has progressed from the exploitation of a vulnerable population in the years prior to 1978 to its current overly protective and restrictive state. With the considerable growth in the numbers of inmates with medical and mental health care needs, developing effective interventions to serve this population is paramount. There now appear to be signs of interest in and support for research with inmates by correctional agencies, academia, and health care organizations. Innes (2003) has articulated the following strategies for implementing research in prison: (1) gather stakeholders; (2) include one or more experienced research collaborators; (3) consider obtaining technical assistance from a university or the National Institute of Corrections (NIC); (4) define potential opportunities/interests that support the institution's mission; (5) develop a relationship with an IRB; (6) pilot a small proposal that is of interest and potential value to the organization. The authors illustrate the implementation of a study in a correctional system that uses these strategies.
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Affiliation(s)
- Sara Wakai
- Center for Correctional Mental Health Services Research, Department of Medicine-MC6210, University of Connecticut Health Center, Farmington, CT 06032, USA.
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Abstract
Research involving prisoners repeatedly went astray during the last century, culminating in the cruel medical experiments inside the Nazi concentration camps that gave rise to the Nuremberg Code. However, prisoners continued to become victims of scientific exploitation by the rapidly evolving biomedical research industry. The common roots of these abuses were the flawed philosophy that the needs of the society outweigh the needs of the individual and the researchers' view that prisoners are cheap, easy to motivate and stable research subjects. Prisoners are vulnerable to exploitation and abuse by research because their freedom for consent can easily be undermined, and because of learning disabilities, illiteracy and language barriers prevailing within prisoner populations. Therefore, penal laws of some countries supported by a number of internationally agreed documents prohibit research involving prisoners completely. However, prisoners must also be regarded as vulnerable to the specific health problems in prisons, e.g. transmissible diseases, mental disorders and suicide - problems that need to be addressed by research involving prisoners. Additionally, the participation of prisoner patients in research they directly can benefit from should be provided. Hence, it must be a common objective to find the right balance between protection from exploitation and access to research beneficial to prisoners.
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Affiliation(s)
- Jörg Pont
- Medizinische Universität Wien and Médecins Sans Frontières, Austria.
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Appelbaum KL. Correctional Mental Health Research: Opportunities and Barriers. JOURNAL OF CORRECTIONAL HEALTH CARE 2008. [DOI: 10.1177/1078345808322607] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kenneth L. Appelbaum
- Center for Health Policy and Research, Commonwealth Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
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Elger BS. Research involving prisoners: consensus and controversies in international and European regulations. BIOETHICS 2008; 22:224-238. [PMID: 18405321 DOI: 10.1111/j.1467-8519.2008.00634.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This article examines international and European regulations on research involving prisoners for consensus, differences, and their consequences, and offers a critical evaluation of the various approaches. Agreement exists that prisoners are at risk of coercion, which might interfere with their ability to provide voluntary informed consent to research. Controversy exists about the magnitude of this risk and the consequences that should follow from this risk. Two strategies are proposed for a method of protecting prisoners that does not lead to discrimination: first, more caution to assure non-coerced consent and second, restrictions on the type of research. Most regulations stress the importance of the principle of equivalence of healthcare in places of detention as part of an efficient protection against research risks and discrimination. All the presented approaches have shortcomings. While 'over-use' of prisoners for research as compared to the general population is ethically unjustified, not granting prisoners access to studies beneficial to their own health because of over-strict regulations is equally unjustified. A middle solution should be preferred, one that grants a minimum of protection together with the lowest possible barriers. Research that does not entail a direct benefit for the individual detainee should be restricted to types of research that have a benefit for detainees as a group and that are of low risk. What will ultimately protect prisoners best, while producing the greatest benefit for them, is access to the same healthcare available to members of the community including research as a true option.
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Affiliation(s)
- Bernice S Elger
- Centre universitaire romand de médecine légale, University of Geneva, Switzerland.
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Kerpel-Fronius S. [Influence of the Nuremberg physicians' trials--beginning a new era in the ethical judging of human experiments]. Orv Hetil 2008; 149:195-201. [PMID: 18218586 DOI: 10.1556/oh.2008.28282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This short historical review attempts to shed light on the tortuous road on which society moved toward the general acceptance of the idea of experimenting on human beings. Unfortunately people had to realize that under antihuman or lenient political leadership, some physicians might apply their knowledge against their fellow beings, or might endanger them while pursuing their scientific goals. For this reason, it became necessary to codify the ethical requirements of medical experiments. This was done first by the Prussian government in 1900. The historical significance of the Nuremberg physicians' trials is that, by recognizing the enormous scientific importance of human experiments, they led to the formulation of general ethical principles governing human studies, which became known as the Nuremberg Code. Broad, international regulations were developed as the consequence of the trial. Unfortunately human experiments performed on prison inmates were judged at the trial as ethically acceptable, provided an informed consent was signed. Misusing this possibility many unethical experiments were done primarily in the US after the war. The great indignation due to ethical misconduct in prison trials and the highly unethical Tuskegee experiments performed on black Americans' suffering from syphilis, led much later to the organization of independent ethics committees. Through these committees, society exercises supervision of human trials. However, in case of severely ill patients the physician might be left alone to make a quick, and ethically correct, decision corresponding to the situation. In the final analysis the safety and ethical protection of research subjects remain the joint responsibility of society and of the experimenting physicians.
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Affiliation(s)
- Sándor Kerpel-Fronius
- Semmelweis Egyetem, Altalános Orvostudományi Kar, Farmakológiai és Farmakoterápiás Intézet Budapest Pf. 370 1445
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Kass NE, Myers R, Fuchs EJ, Carson KA, Flexner C. Balancing justice and autonomy in clinical research with healthy volunteers. Clin Pharmacol Ther 2007; 82:219-27. [PMID: 17410122 DOI: 10.1038/sj.clpt.6100192] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In clinical research, ethics review generally first examines whether study risks are reasonable in light of benefits provided. Through informed consent, then, prospective subjects consider whether the risk/benefit balance and procedures are reasonable for them. Unique ethics issues emerge in clinical research with healthy volunteers. Certain types of studies only recruit healthy volunteers as participants. Phase 1 studies, for example, including first time in human studies of investigational drugs and vaccines, generally are conducted in healthy volunteers. Although such research carries inherent and often unknown risks, healthy subjects provide the most efficient target population in which to conduct such research, as these volunteers generally are free of concurrent diseases or medications that could confound interpretation of toxicity. Other studies enrolling healthy volunteers often are simply looking for the most scientifically sound population for the study of normal human physiology.
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Affiliation(s)
- N E Kass
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Berman Institute of Bioethics, Baltimore, Maryland, USA.
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Health Research Behind Bars: A Brief Guide to Research in Jails and Prisons. PUBLIC HEALTH BEHIND BARS 2007. [PMCID: PMC7120758 DOI: 10.1007/978-0-387-71695-4_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
While most people make staying out of jail and prison a priority, a growing number of researchers are eager to get into correctional facilities in order to study the criminal justice system, the causes and consequences of incarceration, and the role of corrections in our society. For health researchers and their collaborators, the audience for this chapter, correctional facilities offer several unique advantages: a population at high risk of many health problems including infectious and chronic diseases, substance abuse, and mental health problems; social and physical environments that can enhance or impede well-being; a setting that is a focal point for the class, racial/ethnic, and gender differences that divide the United States; a site where health and mental health services and prevention programs are offered and can be evaluated; a controlled environment for administration of treatments such as directly observed therapy for tuberculosis; and a stopping point in the cycle of incarceration and reentry that so profoundly affects community well-being.
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Affiliation(s)
- Allan Gaw
- Clinical Trials Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, Scotland, UK.
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