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Sridharan K, Sivaramakrishnan G. Leveraging artificial intelligence to detect ethical concerns in medical research: a case study. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109767. [PMID: 38408853 DOI: 10.1136/jme-2023-109767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Institutional review boards (IRBs) have been criticised for delays in approvals for research proposals due to inadequate or inexperienced IRB staff. Artificial intelligence (AI), particularly large language models (LLMs), has significant potential to assist IRB members in a prompt and efficient reviewing process. METHODS Four LLMs were evaluated on whether they could identify potential ethical issues in seven validated case studies. The LLMs were prompted with queries related to the proposed eligibility criteria of the study participants, vulnerability issues, information to be disclosed in the informed consent document (ICD), risk-benefit assessment and justification of the use of a placebo. Another query was issued to the LLMs to generate ICDs for these case scenarios. RESULTS All four LLMs were able to provide answers to the queries related to all seven cases. In general, the responses were homogeneous with respect to most elements. LLMs performed suboptimally in identifying the suitability of the placebo arm, risk mitigation strategies and potential risks to study participants in certain case studies with a single prompt. However, multiple prompts led to better outputs in all of these domains. Each of the LLMs included all of the fundamental elements of the ICD for all case scenarios. Use of jargon, understatement of benefits and failure to state potential risks were the key observations in the AI-generated ICD. CONCLUSION It is likely that LLMs can enhance the identification of potential ethical issues in clinical research, and they can be used as an adjunct tool to prescreen research proposals and enhance the efficiency of an IRB.
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Affiliation(s)
- Kannan Sridharan
- Department of Pharmacology & Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
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2
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Foreman D. Lessons from studies of medication reduction in psychosis: giving participants accurate information about risk in psychiatric research trials. J Psychiatry Neurosci 2024; 49:E81-E86. [PMID: 38428969 PMCID: PMC10911823 DOI: 10.1503/jpn.230137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 03/03/2024] Open
Abstract
All research needs ethical regulation, which is institutionalized in research ethics committees. The patient information sheet, approved by a research ethics committee, sets out what patients need to know to make an informed choice about research participation. However, guidance from research ethics committees is much less explicit about risk communication. In this commentary, the balance of risk in the patient information sheets from protocols of 2 randomized controlled trials (RCTs) of medication reduction in psychosis was compared with numbers needed to treat and harm from the literature. The patient information sheet omitted risk of excess death and incomplete recovery following relapse, and overestimated the anticipated benefits. All of these risks were demonstrated in the published results of 1 of the 2 RCTs. Quantifying and tabulating risk might improve patient information sheets.
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Affiliation(s)
- David Foreman
- From the Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology & Neuroscience, London, UK
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3
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McKay F, Williams BJ, Prestwich G, Bansal D, Treanor D, Hallowell N. Artificial intelligence and medical research databases: ethical review by data access committees. BMC Med Ethics 2023; 24:49. [PMID: 37422629 PMCID: PMC10329342 DOI: 10.1186/s12910-023-00927-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/22/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND It has been argued that ethics review committees-e.g., Research Ethics Committees, Institutional Review Boards, etc.- have weaknesses in reviewing big data and artificial intelligence research. For instance, they may, due to the novelty of the area, lack the relevant expertise for judging collective risks and benefits of such research, or they may exempt it from review in instances involving de-identified data. MAIN BODY Focusing on the example of medical research databases we highlight here ethical issues around de-identified data sharing which motivate the need for review where oversight by ethics committees is weak. Though some argue for ethics committee reform to overcome these weaknesses, it is unclear whether or when that will happen. Hence, we argue that ethical review can be done by data access committees, since they have de facto purview of big data and artificial intelligence projects, relevant technical expertise and governance knowledge, and already take on some functions of ethical review. That said, like ethics committees, they may have functional weaknesses in their review capabilities. To strengthen that function, data access committees must think clearly about the kinds of ethical expertise, both professional and lay, that they draw upon to support their work. CONCLUSION Data access committees can undertake ethical review of medical research databases provided they enhance that review function through professional and lay ethical expertise.
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Affiliation(s)
- Francis McKay
- Population Health Sciences Institute, University of Newcastle, NE2 4AX Newcastle Upon Tyne, UK
| | - Bethany J. Williams
- National Pathology Imaging Co-operative, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF UK
| | - Graham Prestwich
- Yorkshire and Humber Academic Health Science Network, Unit 1, Calder Close, Calder Park, Wakefield, WF4 3BA UK
| | - Daljeet Bansal
- National Pathology Imaging Co-operative, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF UK
| | - Darren Treanor
- National Pathology Imaging Co-operative, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF UK
- Department of Pathology, University of Leeds, Leeds, UK
- Department of Clinical Pathology, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Nina Hallowell
- The Ethox Centre and the Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF UK
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Mehta P, Zimba O, Gasparyan AY, Seiil B, Yessirkepov M. Ethics Committees: Structure, Roles, and Issues. J Korean Med Sci 2023; 38:e198. [PMID: 37365729 DOI: 10.3346/jkms.2023.38.e198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023] Open
Abstract
An Ethics Committee (EC) is an independent body composed of members with expertise in both scientific and nonscientific arenas which functions to ensure the protection of human rights and the well-being of research subjects based on six basic principles of autonomy, justice, beneficence, nonmaleficence, confidentiality, and honesty. MEDLINE, Scopus, and Directory of Open Access Journals were searched for studies relevant to this topic. This review is focused on the types of research articles that need EC approval, the submission process, and exemptions. It further highlights the constitution of ECs, their duties, the review process, and the assessment of the risk-benefit of the proposed research including privacy issues. It's pertinent for academicians and researchers to abide by the rules and regulations put forth by ECs for upholding of human rights and protecting research subjects primarily, as well as avoiding other issues like retraction of publications. Despite various issues of cost, backlogs, lack of expertise, lesser representation of laypersons, need for multiple approvals for multisite projects, conflicts of interest, and monitoring of ongoing research for the continued safety of participants, the ECs form the central force in regulating research and participant safety. Data safety and monitoring boards complement the ECs for carrying out continuous monitoring for better protection of research subjects. The establishment of ECs has ensured safe study designs, the safety of human subjects along with the protection of researchers from before the initiation until the completion of a study.
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Affiliation(s)
- Pankti Mehta
- Department of Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, India.
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Krakow, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, UK
| | - Birzhan Seiil
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
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5
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Labib K, Tijdink J, Sijtsma K, Bouter L, Evans N, Widdershoven G. How to combine rules and commitment in fostering research integrity? Account Res 2023:1-27. [PMID: 36927256 DOI: 10.1080/08989621.2023.2191192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Research integrity (RI) is crucial for trustworthy research. Rules are important in setting RI standards and improving research practice, but they can lead to increased bureaucracy; without commensurate commitment amongst researchers toward RI, they are unlikely to improve research practices. In this paper, we explore how to combine rules and commitment in fostering RI. Research institutions can govern RI using markets (using incentives), bureaucracies (using rules), and network processes (through commitment and agreements). Based on Habermas' Theory of Communicative Action, we argue that network processes, as part of the lifeworld, can legitimize systems - that is, market or bureaucratic governance modes. This can regulate and support RI practices in an efficient way. Systems can also become dominant and repress consensus processes. Fostering RI requires a balance between network, market and bureaucratic governance modes. We analyze the institutional response to a serious RI case to illustrate how network processes can be combined with bureaucratic rules. Specifically, we analyze how the Science Committee established at Tilburg University in 2012 has navigated different governance modes, resulting in a normatively grounded and efficient approach to fostering RI. Based on this case, we formulate recommendations to research institutions on how to combine rules and commitment.
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Affiliation(s)
- Krishma Labib
- Department of Ethics, Law and Humanities, Amsterdam Public Health Institute, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Joeri Tijdink
- Department of Ethics, Law and Humanities, Amsterdam Public Health Institute, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Philosophy, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Klaas Sijtsma
- School of Social and Behavioral Sciences, Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
| | - Lex Bouter
- Department of Philosophy, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Natalie Evans
- Department of Ethics, Law and Humanities, Amsterdam Public Health Institute, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Guy Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam Public Health Institute, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Chaudhry I, Thurtle V, Foday E, Leather AJM, Samai M, Wurie H, Parmar D. Strengthening ethics committees for health-related research in sub-Saharan Africa: a scoping review. BMJ Open 2022; 12:e062847. [PMID: 36410802 PMCID: PMC9680187 DOI: 10.1136/bmjopen-2022-062847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Health-related research in sub-Saharan Africa (SSA) has grown over the years. However, concerns have been raised about the state of research ethics committees (RECs). This scoping review examines the literature on RECs for health-related research in SSA and identifies strategies that have been applied to strengthen the RECs. It focuses on three aspects of RECs: regulatory governance and leadership, administrative and financial capacity and technical capacity of members. DESIGN A scoping review of published literature, including grey literature, was conducted using the Joanna Briggs Institute approach. DATA SOURCES BioOne, CINAHL, Embase (via Ovid), Education Abstracts, Global Health, Google Scholar, Jstor, OpenEdition (French), Philosopher's Index, PsycINFO, PubMed, Science Citation and Expanded Index (Web of Science), reference lists of included studies and specific grey literature sources. ELIGIBILITY CRITERIA We included empirical studies on RECs for health-related research in SSA, covering topics on REC leadership and governance, administrative and financial capacity and the technical capacity of REC members. We included studies published between 01 January 2000 and 18 February 2022 and written in English, French, Portuguese or Swahili. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened the records. Data were extracted by one reviewer and cross-checked by another. Owing to the heterogeneity of included studies, thematic analysis was used. RESULTS We included 54 studies. The findings show that most RECs in SSA work under significant administrative and financial constraints, with few opportunities for capacity building for committee members. This has an impact on the quality of reviews and the overall performance of RECs. Although most countries have national governance systems for RECs, they lack regulations on accountability, transparency and monitoring of RECs. CONCLUSIONS This review provides a comprehensive overview of the literature on RECs for health-related research in SSA and contributes to our understanding of how RECs can be strengthened.
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Affiliation(s)
- Iqra Chaudhry
- Department of Population Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Val Thurtle
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, King's College London, London, UK
| | - Edward Foday
- Sierra Leone Ethics and Scientific Review Committee, Directorate of Training and Research, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Andrew J M Leather
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, King's College London, London, UK
| | - Mohamed Samai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Divya Parmar
- Department of Population Health, School of Life Course and Population Sciences, King's College London, London, UK
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, King's College London, London, UK
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7
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Sakaida Y, Ota K, Sone C. The role of nursing members in research ethics committees in Japan. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:813-824. [PMID: 36544601 PMCID: PMC9748317 DOI: 10.18999/nagjms.84.4.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/13/2022] [Indexed: 12/24/2022]
Abstract
The International Council of Nurses (2012) and the Council for International Organizations of Medical Sciences (2016) determined and published ethical standards relevant to nursing researchers and practitioners; based on these standards, nurses are expected to participate in committees where decisions on ethical issues are made. While clinical practitioners and nursing educators actively serve on research ethics committees, their precise role in these platforms has yet to be elucidated. In this study, medical, humanities/social science, lay, and nursing members in research ethics committees across Japan were invited to participate in a semi-structured interview; data were analyzed through a qualitative analysis method. Specifically, we interviewed 23 research ethics committee members in Japan to clarify the role of nursing members in the committee. Our qualitative analysis yielded six themes: share perspectives and experiences in nursing, protect research participants, evaluate the research design, represent the voice of research participants, confirm the informed consent documents and ascertain research participants' free will. The analyses revealed a slight difference between what other committee members expected of the role of nursing members and nursing members' recognition of their own role. Nursing members make an important and independent contribution to ethics committees on deliberations and decision-making regarding research ethics. Within the context of research ethics committees, member selection and training are essential issues, and this study contributes to the literature by showing how these topics relate to the role of the research ethics committees and of their members.
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Affiliation(s)
- Yuki Sakaida
- Faculty of Nursing, Gifu Shotoku Gakuen University, Gifu, Japan
,Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsumasa Ota
- Faculty of Human Care at Numazu, Tohto University, Numazu, Japan
| | - Chikako Sone
- Department of Gerontological Nursing, Nagano College of Nursing, Komagane, Japan
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8
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Haaser T, Bouteloup V, Berdaï D, Saux MC. The Multidimensional Nature of Research Ethics: Letters Issued by a French Research Ethics Committee Included Similar Proportions of Ethical and Scientific Queries. J Empir Res Hum Res Ethics 2022; 17:242-253. [PMID: 35414297 DOI: 10.1177/15562646221093218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Debate is ongoing concerning the activities and functioning of Research Ethics Committees (REC), especially a possible science-or-ethics dichotomy in research ethics review. We retrospectively analyzed 145 letters issued by a French REC over 18 months. All queries were classified in three levels: qualification (definition of the problem), category (aggregation of broader topics) and finally fields (ethical, scientific, or administrative). Overall, 971 queries were identified, of which 407 (42%), 379 (39%), and 135 (14%) were deemed ethical, scientific, and administrative queries, respectively. The most frequent concern was about participants' information. The main influencing factor was the profession of the reporting readers-scientific queries were more frequently raised by a methodologist, whereas ethical queries were more frequently raised by an ethicist. These results indicate that research ethics review is a multidimensional task that should be considered a collaborative effort.
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Affiliation(s)
- Thibaud Haaser
- Service d'Oncologie Radiothérapie, Hôpital Haut Lévêque, 158435Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,EA 4574 "Sciences, Philosophie, Humanités" Université de Bordeaux - Université Bordeaux Montaigne, Pessac, France.,Comité de Protection des Personnes Sud-Ouest et Outre-Mer III, Service de Pharmacologie Clinique, Hôpital Pellegrin, 158435Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Vincent Bouteloup
- Comité de Protection des Personnes Sud-Ouest et Outre-Mer III, Service de Pharmacologie Clinique, Hôpital Pellegrin, 158435Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Bordeaux Health Population, Inserm 1219, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux - CHU de Bordeaux, Bordeaux, France
| | - Driss Berdaï
- Comité de Protection des Personnes Sud-Ouest et Outre-Mer III, Service de Pharmacologie Clinique, Hôpital Pellegrin, 158435Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Service de Pharmacologie Clinique, Hôpital Pellegrin, 158435Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Marie-Claude Saux
- Comité de Protection des Personnes Sud-Ouest et Outre-Mer III, Service de Pharmacologie Clinique, Hôpital Pellegrin, 158435Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Faculté de Pharmacie, Université de Bordeaux, Bordeaux, France
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9
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Chalmers I, Glasziou P. Protecting the public from the adverse effects of confused research ethics. J R Soc Med 2021; 114:507-512. [PMID: 34698579 DOI: 10.1177/01410768211051720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Iain Chalmers
- Centre for Evidence-Based Medicine, Department of Primary Care, University of Oxford, Oxford OX2 6GG, UK
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast QLD 4229, Australia
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Shrestha C, Shrestha A, Joshi J, Karki S, Acharya S, Joshi S. Does teaching medical ethics ensure good knowledge, attitude, and reported practice? An ethical vignette-based cross-sectional survey among doctors in a tertiary teaching hospital in Nepal. BMC Med Ethics 2021; 22:109. [PMID: 34353314 PMCID: PMC8340509 DOI: 10.1186/s12910-021-00676-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Importance of awareness of medical ethics and its integration into medical curriculum has been frequently highlighted. Study 1 aimed to assess the knowledge, attitude, and reported practices of medical ethics among clinicians at Patan Academy of Health Sciences, a tertiary care teaching hospital in Nepal. Study 2 was conducted to assess whether there was a difference in knowledge, attitude, and reported practices of medical ethics among doctors who received formal medical ethics education during undergraduate studies and those who did not. METHODS Two cross-sectional surveys using self-administered questionnaires were conducted. Study 1 included 72 participants; interns, medical officers, and consultants working at Patan Academy of Health Sciences. Study 2 was a comparative study conducted among 54 medical officers who had received formal medical ethics education (Group 1) and 60 medical officers who did not (Group 2). RESULTS Participants who had completed post-graduate education had higher knowledge (p = 0.050), practice (p < 0.001), and overall combined scores (p = 0.011). Participants with ethics education had higher knowledge (p < 0.001), attitude (p = 0.001), practice (p < 0.001), and overall score (p < 0.001). Most participants preferred consulting colleagues if an ethical dilemma arose. Fewer participants had heard of the Declaration of Helsinki. Most participants thought doctors to be most capable of judging what is best for the patient (Study 1: 70.42%, Study 2 Group 1: 42.59%, Group 2: 80%). Case scenarios in which participants demonstrated poor practice were ethical issues concerning truth-telling, end-of-life decisions, treating HIV/AIDS patients, treating a minor, and reporting colleague's errors. CONCLUSIONS This study found that participants who have received medical ethics education have higher knowledge, attitude, and practice scores. The results further justify the need for medical ethics education to be a part of the core medical curriculum. A blame-free environment where seniors can be approached for advice should be created. Research ethics should also be given attention. During medical ethics training, ethical issues where doctors perform poorly should be given more priority and should be discussed in a country-specific context.
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Affiliation(s)
| | | | | | | | - Sajan Acharya
- New York Medical College/Metropolitan Hospital Center, New York, USA
| | - Suchita Joshi
- Department of Neonatology, Nepal Mediciti Hospital, Lalitpur, Nepal
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11
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Preston N, van Delden JJM, Ingravallo F, Hughes S, Hasselaar J, van der Heide A, Van den Block L, Dunleavy L, Groot M, Csikos A, Payne S. Ethical and research governance approval across Europe: Experiences from three European palliative care studies. Palliat Med 2020; 34:817-821. [PMID: 32186242 PMCID: PMC7521003 DOI: 10.1177/0269216320908774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Research requires high-quality ethical and governance scrutiny and approval. However, when research is conducted across different countries, this can cause challenges due to the differing ethico-legal framework requirements of ethical boards. There is no specific guidance for research which does not involve non-medicinal products. AIM To describe and address differences in ethical and research governance procedures applied by research ethics committees for non-pharmaceutical palliative care studies including adult participants in collaborative European studies. DESIGN An online survey analysed using descriptive statistics. SETTING/PARTICIPANTS Eighteen principal investigators in 11 countries conducting one of three European-funded studies. RESULTS There was variation in practice including whether ethical approval was required. The time to gain full approvals differed with the United Kingdom having governance procedures that took the longest time. Written consent was not required in all countries nor were data safety monitoring committees for trials. There were additional differences in relation to other data management issues. CONCLUSION Researchers need to take the differences in research approval procedures into account when planning studies. Future research is needed to establish European-wide recommendations for policy and practice that dovetail ethical procedures and enhance transnational research collaborations.
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Affiliation(s)
- Nancy Preston
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | | | | | - Sean Hughes
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | | | | | - Lieve Van den Block
- VUB-UGhent End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | | | - Agnes Csikos
- Institute of Primary Care, University of Pécs Medical School, Pécs, Hungary
| | - Sheila Payne
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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12
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Orzechowski M, Schochow M, Steger F. Clinical Ethics Consultation in the Transition Countries of Central and Eastern Europe. SCIENCE AND ENGINEERING ETHICS 2020; 26:833-850. [PMID: 31587148 DOI: 10.1007/s11948-019-00141-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
Since 1989, clinical ethics consultation in form of hospital ethics committees (HECs) was established in most of the transition countries of Central and Eastern Europe. Up to now, the similarities and differences between HECs in Central and Eastern Europe and their counterparts in the U.S. and Western Europe have not been determined. Through search in literature databases, we have identified studies that document the implementation of clinical ethics consultation in Central and Eastern Europe. These studies have been analyzed under the following aspects: mode of establishment of HECs, character of consultation they provide, and their composition. The results show that HECs in the transition countries of Central and Eastern Europe differ from their western-European or U.S. counterparts with regard to these three aspects. HECs were established because of centrally imposed legal regulations. Little initiatives in this area were taken by medical professionals interested in resolving emerging ethical issues. HECs in the transition countries concentrate mostly on review of research protocols or resolution of administrative conflicts in healthcare institutions. Moreover, integration of non-professional third parties in the workings of HECs is often neglected. We argue that these differences can be attributed to the historical background and the role of medicine in these countries under the communist regime. Political and organizational structures of healthcare as well as education of healthcare staff during this period influenced current functioning of clinical ethics consultation in the transition countries.
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Affiliation(s)
- Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Parkstraße 11, 89073, Ulm, Germany.
| | - Maximilian Schochow
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Parkstraße 11, 89073, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Parkstraße 11, 89073, Ulm, Germany
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13
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Scott AM, Kolstoe S, Ploem MCC, Hammatt Z, Glasziou P. Exempting low-risk health and medical research from ethics reviews: comparing Australia, the United Kingdom, the United States and the Netherlands. Health Res Policy Syst 2020; 18:11. [PMID: 31992320 PMCID: PMC6986069 DOI: 10.1186/s12961-019-0520-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disproportionate regulation of health and medical research contributes to research waste. Better understanding of exemptions of research from ethics review in different jurisdictions may help to guide modification of review processes and reduce research waste. Our aim was to identify examples of low-risk human health and medical research exempt from ethics reviews in Australia, the United Kingdom, the United States and the Netherlands. METHODS We examined documents providing national guidance on research ethics in each country, including those authored by the National Health and Medical Research Council (Australia), National Health Service (United Kingdom), the Office for Human Research Protections (United States) and the Central Committee on Research Involving Humans (the Netherlands). Examples and types of research projects exempt from ethics reviews were identified, and similar examples and types were grouped together. RESULTS Nine categories of research were exempt from ethics reviews across the four countries; these were existing data or specimen, questionnaire or survey, interview, post-marketing study, evaluation of public benefit or service programme, randomised controlled trials, research with staff in their professional role, audit and service evaluation, and other exemptions. Existing non-identifiable data and specimens were exempt in all countries. Four categories - evaluation of public benefit or service programme, randomised controlled trials, research with staff in their professional role, and audit and service evaluation - were exempted by one country each. The remaining categories were exempted by two or three countries. CONCLUSIONS Examples and types of research exempt from research ethics reviews varied considerably. Given the considerable costs and burdens on researchers and ethics committees, it would be worthwhile to develop and provide clearer guidance on exemptions, illustrated with examples, with transparent underpinning rationales.
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Affiliation(s)
- Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, QLD, 4226, Australia.
| | | | | | - Zoë Hammatt
- Z Consulting LLC, Denver, USA.,John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, QLD, 4226, Australia
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14
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Kleykamp BA, Gipson CD, Maynard OM, Treur JL, Oliver JA. Rethinking the Career Landscape for Nicotine and Tobacco Trainees and Early Career Professionals. Nicotine Tob Res 2019; 21:262-266. [PMID: 29660013 PMCID: PMC6610160 DOI: 10.1093/ntr/nty041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 03/06/2018] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Olivia M Maynard
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Jorien L Treur
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Jason A Oliver
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
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15
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Suárez Obando F, Reynales H, Urina M, Camacho J, Viteri M. Caracterización de un grupo de comités de ética en investigación en Colombia. PERSONA Y BIOÉTICA 2018. [DOI: 10.5294/pebi.2018.22.2.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
En las últimas décadas, los ensayos clínicos controlados patrocinados por la industria farmacéutica han aumentado de manera considerable, lo cual ha llevado a que sea necesario un mayor control y acompañamiento por parte de las entidades reguladoras, y de los comités de ética, para garantizar el adecuado cumplimiento de las normas éticas establecidas y de las buenas prácticas clínicas en general. En Colombia, el Instituto Nacional de Vigilancia de Medicamentos y Alimentos (Invima), la entidad reguladora en el país, reglamenta y vigila el funcionamiento de la investigación clínica con medicamentos. En el 2008, esta entidad emitió la Resolución 2378, normatividad bajo la cual se establecen y regulan los diferentes actores de la investigación en Colombia, incluidos los comités de ética. Después de varios años de vigencia de esta norma, es necesario conocer si los comités de ética en investigación en Colombia funcionan de acuerdo con esta normativa, y determinar el estado de la implementación de lo solicitado en la regulación. Con este objetivo se diseñó una encuesta para ser respondida en forma voluntaria y se obtuvo respuesta de 25 de los 69 comités certificados en Colombia. El análisis fue posible en 22 de ellos cuya información estaba completa. En comparación con estudios anteriores, se observaron cambios favorables en el desarrollo y la organización de acuerdo con la norma actual propuesta.
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16
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Dove ES, Garattini C. Expert perspectives on ethics review of international data-intensive research: Working towards mutual recognition. RESEARCH ETHICS REVIEW 2017. [DOI: 10.1177/1747016117711972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Life sciences research is increasingly international and data-intensive. Researchers work in multi-jurisdictional teams or formally established research consortia to exchange data and conduct research using computation of multiple sources and volumes of data at multiple sites and through multiple pathways. Despite the internationalization and data intensification of research, the same ethics review process as applies to single-site studies in one country tends to apply to multi-site studies in multiple countries. Because of the standard requirement for multi-jurisdictional or multi-site ethics review, international research projects are subjected to multiple ethics reviews of the same research protocol. Consequently, the reviews may be redundant and resource-consuming, whilst the opinions delivered by ethics committees may be inconsistent both within and across jurisdictions. In this article, we present findings based on interviews conducted with international experts in research ethics on the topic of ethics review mutual recognition. We explore the issues associated with ethics committee review of multi-jurisdictional data-intensive research projects, identifying current problems, real-life experiences, and potential solutions that are both bottom-up (via researchers, participants and publics) and top-down (via statutory regulation), as well as challenges in achieving both. On the whole, participants recommended multiple changes to the current ethics review regime for data-intensive international research with the aim of reducing inefficiency and inconsistency. But, the changes recommended differ in terms of degree and scope. In general, participants stressed that key drivers of success in a reformed system should be strong leadership (on the ground and in government) and demonstration of value.
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17
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Hanney SR, González-Block MA. Building health research systems: WHO is generating global perspectives, and who's celebrating national successes? Health Res Policy Syst 2016; 14:90. [PMID: 28031041 PMCID: PMC5198495 DOI: 10.1186/s12961-016-0160-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 11/21/2022] Open
Abstract
In 2016, England’s National Institute for Health Research (NIHR) celebrated its tenth anniversary as an innovative national health research system with a focus on meeting patients’ needs. This provides a good opportunity to reflect on how the creation of the NIHR has greatly enhanced important work, started in 1991, to develop a health research system in England that is embedded in the National Health Service. In 2004, WHO identified a range of functions that a national health research system should undertake to improve the health of populations. Health Research Policy and Systems (HRPS) has taken particular interest in the pioneering developments in the English health research system, where the comprehensive approach has covered most, if not all, of the functions identified by WHO. Furthermore, several significant recent developments in thinking about health research are relevant for the NIHR and have informed accounts of its achievements. These include recognition of the need to combat waste in health research, which had been identified as a global problem in successive papers in the Lancet, and an increasing emphasis on demonstrating impact. Here, pioneering evaluation of United Kingdom research, conducted through the impact case studies of the Research Excellence Framework, is particularly important. Analyses informed by these and other approaches identified many aspects of NIHR’s progress in combating waste, building and sustaining research capacity, creating centres of research excellence linked to leading healthcare institutions, developing research networks, involving patients and others in identifying research needs, and producing and adopting research findings that are improving health outcomes. The NIHR’s overall success, and an analysis of the remaining problems, might have lessons for other systems, notwithstanding important advances in many countries, as described in papers in HRPS and elsewhere. WHO’s recently established Global Observatory for Health Research and Development provides an opportunity to promote some of these lessons. To inform its work, the Observatory is sponsoring a thematic series of papers in HRPS focusing on health research issues such as funding flows, priority setting, capacity building, utilisation and equity. While important papers on these have been published, this series is still open to new submissions.
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Affiliation(s)
- Stephen R Hanney
- Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK.
| | - Miguel A González-Block
- Universidad Anáhuac, Av. Universidad Anáhuac 46, Lomas Anáhuac, 52786, Huixquilucan, Mexico City, Mexico
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