1
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Sič A, Gazibara T. What do medical students think of own participation as subjects in clinical trials? J Eval Clin Pract 2024. [PMID: 39031644 DOI: 10.1111/jep.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/02/2024] [Indexed: 07/22/2024]
Abstract
RATIONALE AND AIM Testing of new drugs through clinical trials is essential in efforts to increase generalizable knowledge. Little is known about the medical students' perception of their participation as research subjects in clinical trials. The aim of this study was to examine the willingness and attitudes of medical students towards participation as volunteer subjects in clinical trials. METHODS A cross-sectional study was conducted among 297 medical students in years 4, 5 and 6 at the University of Belgrade, from October to December 2023. Participants completed a pen-and-paper questionnaire including demographic characteristics, opinions on their participation in clinical trials, and attitudes towards clinical trials in general. The validity of the attitude scale was verified. RESULTS One in five medical students expressed a positive opinion about their participation in clinical trials, with the majority (about one-half) remaining undecided. General attitudes of students about research and their participation were positive. Students with prior blood donation experience were more willing to participate. Lower socioeconomic status and volunteering experience were also associated with stronger positive attitudes towards clinical trials in general. CONCLUSION Most students were undecided about their participation, but their attitudes towards clinical trials in general were positive. Positive attitudes towards clinical trials did not uniformly translate to the willingness for personal participation. Promotion of blood donation and volunteering at universities could help to increase the interest in clinical trials as volunteer subjects.
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Affiliation(s)
- Aleksandar Sič
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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2
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Aslam Z, Asim M, Javaid I, Rasheed F, Akhter MN. Analyzing risky behaviors among different minority and majority race in teenagers in the USA using latent classes. Front Behav Neurosci 2023; 17:1089434. [PMID: 36865773 PMCID: PMC9971590 DOI: 10.3389/fnbeh.2023.1089434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023] Open
Abstract
Objective: This study is to ascertain any inconsistencies in the trend of co-occurrence by sex of teenage health risk behavior patterns such as smoking, behaviors contributing to deliberate and unintentional injuries, risky sexual behavior, and sedentary lifestyle. Methods: The study's purpose was accomplished using Youth Risk Behavior Surveillance System (YRBSS) 2013 data. A Latent Class Analysis (LCA) was conducted for the entire sample of teenagers as well as separately for each sex. Results: In this subset of youths, marijuana use was acknowledged by more than half of them, and smoking cigarettes was far more likely. More than half of the individuals in this subset engaged in risky sexual practices, like not using a condom during their most recent encounter. Males were split into three categories based on their involvement in risky behavior, while females were split into four subgroups. Conclusion: Regardless of gender, various risk behaviors among teenagers are connected. However, gender variations in the higher risk of particular trends, such as mood disorders and depression among females, underline the significance of creating treatments that take adolescent demographics into account.
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Affiliation(s)
- Zeeshan Aslam
- Nishtar Institute of Dentistry (NID), Multan, Pakistan,Nishtar Medical University, Multan, Pakistan,*Correspondence: Zeeshan Aslam
| | | | - Iqra Javaid
- CMH Lahore Medical and Dental College, Lahore, Pakistan
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Walker RL, MacKay D, Waltz M, Lyerly AD, Fisher JA. Ethical Criteria for Improved Human Subject Protections in Phase I Healthy Volunteer Trials. Ethics Hum Res 2022; 44:2-21. [PMID: 36047278 PMCID: PMC9931499 DOI: 10.1002/eahr.500139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Phase I healthy volunteer trials test the safety and tolerability of investigational pharmaceuticals. In them, participants are exposed to study-drug risks without the possibility of direct medical benefit and typically must spend days or weeks in a residential research facility. Monetary payments are used to incentivize enrollment and compensate participants for their time. Together, these features of phase I healthy volunteer trials create a research context that differs markedly from most other clinical research, including by enrolling disproportionate numbers of economically disadvantaged people of color as participants. Due to these unique trial features and participation patterns, traditional biomedical research oversight offers inadequate ethical and policy guidance for phase I healthy volunteer research. This article details five ethical criteria crafted to be responsive to the particularities of this type of research: translational science value, fair opportunity and burden sharing, fair compensation for service, experiential welfare, and enhanced voice and recourse.
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Affiliation(s)
- Rebecca L Walker
- Professor of social medicine and of philosophy at the University of North Carolina at Chapel Hill
| | - Douglas MacKay
- Associate professor of public policy at the University of North Carolina at Chapel Hill
| | - Margaret Waltz
- Research associate in the Department of Social Medicine at the University of North Carolina at Chapel Hill
| | - Anne D Lyerly
- Professor of social medicine and on the core faculty in the Center for Bioethics at the University of North Carolina at Chapel Hill
| | - Jill A Fisher
- Professor of social medicine and on the core faculty in the Center for Bioethics at the University of North Carolina at Chapel Hill
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4
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Moore KT, Fossler MJ, Younis I. The Importance of Participant Tracking When Conducting Clinical Pharmacology Drug Trials. J Clin Pharmacol 2022; 62:1465-1467. [PMID: 36031876 DOI: 10.1002/jcph.2135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Kenneth T Moore
- Janssen Research & Development, LLC, Global Clinical Pharmacology, 1125 Trenton-Harbourton Rd, Titusville, New Jersey, USA
| | - Michael J Fossler
- Janssen Research & Development, LLC, Global Clinical Pharmacology, 1125 Trenton-Harbourton Rd, Titusville, New Jersey, USA
| | - Islam Younis
- Janssen Research & Development, LLC, Global Clinical Pharmacology, 1125 Trenton-Harbourton Rd, Titusville, New Jersey, USA
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Chi PC, Owino EA, Jao I, Bejon P, Kapulu M, Marsh V, Kamuya D. Ethical considerations around volunteer payments in a malaria human infection study in Kenya: an embedded empirical ethics study. BMC Med Ethics 2022; 23:46. [PMID: 35443642 PMCID: PMC9019790 DOI: 10.1186/s12910-022-00783-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
Human Infection Studies (HIS) have emerged as an important research approach with the potential to fast track the global development of vaccines and treatments for infectious diseases, including in low resource settings. Given the high level of burdens involved in many HIS, particularly prolonged residency and biological sampling requirements, it can be challenging to identify levels of study payments that provide adequate compensation but avoid 'undue' levels of inducement to participate. Through this embedded ethics study, involving 97 healthy volunteers and other research stakeholders in a malaria HIS programme in Kenya, and using in-depth interviews, focus group discussions and observations during and after a malaria HIS, we give a grounded account of ethical issues emerging in relation to study payments in this setting. While careful community, national, international scientific and ethics review processes meant that risks of serious harm were highly unlikely, the levels of motivation to join HIS seen could raise concerns about study payments being too high. Particular value was placed on the reliability, rather than level, of study payment in this setting, where subsistence livelihoods are common. Study volunteers were generally clear about the study aims at the point of recruitment, and this knowledge was retained over a year later, although most reported experiencing more burdens than anticipated at enrolment. Strict study screening procedures, regular clinical and laboratory monitoring of volunteers, with prompt treatment with antimalarial at predetermined endpoints suggested that the risks of serious harm were highly unlikely. Ethical concerns emerged in relation to volunteers' attempts to conceal symptoms, hoping to prolong residency periods and increase study payments; and volunteers making decisions that compromised important family relationships and personal values. Our findings support an interpretation that, although study volunteers were keen to join the study to access cash payments, they also paid attention to other features of the study and the general clinical research landscape, including levels of risk associated with study participation. Overall, our analysis shows that the ethical concerns emerging from the study payments can be addressed through practical measures, hinged on reducing burdens and strengthening communication, raising important issues for research policy and planning.
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Affiliation(s)
- Primus Che Chi
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
| | - Esther Awuor Owino
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Irene Jao
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Philip Bejon
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
| | - Melissa Kapulu
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
| | - Vicki Marsh
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
| | - Dorcas Kamuya
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
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6
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Kalbaugh CA, Kalbaugh JM, McManus L, Fisher JA. Healthy volunteers in US phase I clinical trials: Sociodemographic characteristics and participation over time. PLoS One 2021; 16:e0256994. [PMID: 34492044 PMCID: PMC8423261 DOI: 10.1371/journal.pone.0256994] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increasing the diversity of research participants is an important focus of clinical trials. However, little is known regarding who enrolls as healthy volunteers in Phase I clinical trials, which test the safety and tolerability of investigational new drugs. Despite the risk, healthy volunteers can derive no medical benefit from their participation, and they are financially compensated for enrolling. OBJECTIVE This study's purpose is to describe sociodemographic characteristics and clinical trial participation histories of healthy people who enroll in US Phase I trials. METHODS The HealthyVOICES Project (HVP) is a longitudinal study of healthy individuals who have enrolled in Phase I trials. We describe self-reported sociodemographic information and Phase I trial history from HVP recruitment (May-December 2013) through the project's end three years later (December 2016). Trial experiences are presented as medians and quartiles. RESULTS The HVP included 178 participants. Nearly three-fourths of participants were male, and two-thirds were classified as racial and ethnic minorities. We found that some groups of participants were more likely to have completed a greater number of clinical trials over a longer timeframe than others. Those groups included participants who were male, Black, Hispanic, 30-39-years-old, unemployed, had received vocational training in a trade, or had annual household incomes of less than $25,000. Additionally, the greater the number of clinical trials participants had completed, the more likely they were to continue screening for new trials over the course of three years. Participants who pursued clinical trials as a full-time job participated in the greatest number of trials and were the most likely to continuing screening over time. IMPLICATIONS Participation as a healthy volunteer in US Phase I trials is driven by social inequalities. Disadvantaged groups tend to participate in a greater number of clinical trials and participate longer than more privileged groups.
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Affiliation(s)
- Corey A. Kalbaugh
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States of America
- Department of Bioengineering, Clemson University, Clemson, SC, United States of America
| | - Julianne M. Kalbaugh
- Department of Social Medicine and Center for Bioethics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Lisa McManus
- Department of Sociology, Wake Technical Community College, Raleigh, NC, United States of America
| | - Jill A. Fisher
- Department of Social Medicine and Center for Bioethics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Perni S, Moy B, Nipp RD. Disparities in phase 1 cancer clinical trial enrollment. Cancer 2021; 127:4464-4469. [PMID: 34379799 DOI: 10.1002/cncr.33853] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/06/2021] [Accepted: 07/23/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Phase 1 trials are increasingly important in the molecularly driven era of oncology, but few studies have examined phase 1 participation disparities. The authors of this study investigated factors associated with phase 1 versus phase 2/3 trial enrollment. METHODS They authors conducted a cross-sectional study using serial samples of patients age ≥18 years enrolling on cancer trials from October 2011 to November 2014 at an academic cancer center. They used univariable and multivariable logistic regression models to analyze sociodemographic and clinical associations with phase 1 versus phase 2/3 trial enrollment. RESULTS Among 3103 patients enrolled in cancer trials, 2657 unique patients participated in phase 1/2/3 trials. For patients enrolled in phase 1 (n = 1401) versus phase 2/3 (n = 1256) trials, we found no significant differences by age, insurance status, marital status, and income. Overall, 1216 (93%) White, 72 (6%) Asian, and 21 (2%) Black patients enrolled on phase 1 trials, whereas 1068 (93%) White, 40 (3%) Asian, and 43 (4%) Black patients enrolled on phase 2/3 trials. Adjusting for age, sex, race, ethnicity, insurance status, marital status, income, cancer type, disease status, travel distance, and trial year, compared with White patients, Black patients had lower phase 1 enrollment (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.25-0.82), as did Hispanic/Latino (OR, 0.25; 95% CI, 0.08-0.79) and male patients (OR, 0.77; 95% CI, 0.62-0.94). Asian patients had higher phase 1 enrollment (OR, 1.38; 95% CI, 0.88-2.16). CONCLUSIONS Disparities in phase 1 versus phase 2/3 cancer clinical trial enrollment underscore the urgent need for interventions addressing inequities in early-phase trial participation. LAY SUMMARY Phase 1 trials are of increasing importance in oncology. The authors of the study analyzed all patients enrolling on cancer clinical trials at a large academic cancer center from October 2011 to November 2014. Among the 2657 trial participants, when age, sex, race, ethnicity, insurance status, marital status, income, cancer type, disease status, travel distance, and trial year were taken into account, Black, Hispanic/Latino, and male patients were less likely to enroll on phase 1 trials versus phase 2/3 trials. These findings suggest a need for targeted interventions to improve access to and education about phase 1 trials for Black and Hispanic/Latino patients.
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Affiliation(s)
- Subha Perni
- Harvard Radiation Oncology Program, Massachusetts General Hospital and Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Beverly Moy
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan D Nipp
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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8
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Lynch HF, Darton TC, Levy J, McCormick F, Ogbogu U, Payne RO, Roth AE, Shah AJ, Smiley T, Largent EA. Promoting Ethical Payment in Human Infection Challenge Studies. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:11-31. [PMID: 33541252 DOI: 10.1080/15265161.2020.1854368] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
To prepare for potential human infection challenge studies (HICS) involving SARS-CoV-2, we convened a multidisciplinary working group to address ethical questions regarding whether and how much SARS-CoV-2 HICS participants should be paid. Because the goals of paying HICS participants, as well as the relevant ethical concerns, are the same as those arising for other types of clinical research, the same basic framework for ethical payment can apply. This framework divides payment into reimbursement, compensation, and incentives, focusing on fairness and promoting adequate recruitment and retention as counterweights to concerns about undue inducement. Within the basic framework, several factors are especially salient for HICS, and for SARS-CoV-2 HICS in particular, including the nature of participant confinement, anticipated discomfort, risks and uncertainty, participant motivations, and trust. These factors are reflected in a payment worksheet created to help sponsors, researchers, and ethics reviewers systematically develop and assess ethically justifiable payment amounts.
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Mtunthama Toto N, Gooding K, Kapumba BM, Jambo K, Rylance J, Burr S, Morton B, Gordon SB, Manda-Taylor L. "At first, I was very afraid"-a qualitative description of participants' views and experiences in the first Human Infection Study in Malawi. Wellcome Open Res 2021; 6:89. [PMID: 35187267 PMCID: PMC8825950 DOI: 10.12688/wellcomeopenres.16587.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Human infection studies (HIS) involve deliberately infecting healthy volunteers with a pathogen in a controlled environment to understand infection and support the development of effective vaccines or treatments. HIS research is expanding to many low and middle-income settings to accelerate vaccine development. Given the implementation of the first HIS research to establish the experimental human pneumococcal carriage model's feasibility, we sought to understand the participant's opinions and experiences. Methods: We used a qualitative, descriptive approach to understand participants perceptions and experiences on HIS participation. Sixteen healthy adult participants were invited to participate in in-depth exit interviews to discuss their experiences, motivations and concerns. Results: Our findings showed that the likelihood of participation in HIS research rests on three essential conditions: motivation to participate, compensation and advocacy. The motivation and decision to participate was based on reasons including altruism, patriotism, monetary and material incentives, and while compensation was deemed appropriate, concerns about unanticipated research-related risks were raised. Participant advocate groups were recommended for increasing awareness and educating others in the broader community about HIS research. Conclusions: Participants' experiences of HIS in Malawi provide the basis of what can be acceptable in HIS research in lower-income countries and areas where study procedures could be adjusted.
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Affiliation(s)
- Neema Mtunthama Toto
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
| | | | - Blessings M. Kapumba
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
| | - Kondwani Jambo
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Jamie Rylance
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Sarah Burr
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Ben Morton
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Stephen B. Gordon
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
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10
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Mtunthama Toto N, Gooding K, Kapumba BM, Jambo K, Rylance J, Burr S, Morton B, Gordon SB, Manda-Taylor L. "At first, I was very afraid"-a qualitative description of participants' views and experiences in the first Human Infection Study in Malawi. Wellcome Open Res 2021; 6:89. [PMID: 35187267 PMCID: PMC8825950 DOI: 10.12688/wellcomeopenres.16587.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Human infection studies (HIS) involve deliberately infecting healthy volunteers with a pathogen in a controlled environment to understand infection and support the development of effective vaccines or treatments. HIS research is expanding to many low and middle-income settings to accelerate vaccine development. Given the implementation of the first HIS research to establish the experimental human pneumococcal carriage model's feasibility, we sought to understand the participant's opinions and experiences. Methods: We used a qualitative, descriptive approach to understand participants perceptions and experiences on HIS participation. Sixteen healthy adult participants were invited to participate in in-depth exit interviews to discuss their experiences, motivations and concerns. Results: Our findings showed that the likelihood of participation in HIS research rests on three essential conditions: motivation to participate, compensation and advocacy. The motivation and decision to participate was based on reasons including altruism, patriotism, monetary and material incentives, and while compensation was deemed appropriate, concerns about unanticipated research-related risks were raised. Participant advocate groups were recommended for increasing awareness and educating others in the broader community about HIS research. Conclusions: Participants' experiences of HIS in Malawi provide the basis of what can be acceptable in HIS research in lower-income countries and areas where study procedures could be adjusted.
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Affiliation(s)
- Neema Mtunthama Toto
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
| | | | - Blessings M. Kapumba
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
| | - Kondwani Jambo
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Jamie Rylance
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Sarah Burr
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Ben Morton
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Stephen B. Gordon
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, +265, Malawi
- Clinical Services, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
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Fisher JA, Wood MM, Monahan T. Speculating on Precarious Income: Finance Cultures and the Risky Strategies of Healthy Volunteers in Clinical Drug Trials. JOURNAL OF CULTURAL ECONOMY 2020; 14:464-484. [PMID: 34239602 PMCID: PMC8259560 DOI: 10.1080/17530350.2020.1850504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/05/2020] [Indexed: 06/13/2023]
Abstract
Speculation has become a normalized occupational strategy and quotidian economic rationality that extends throughout society. Although there are many contemporary articulations of speculation, this article focuses on contract labor as a domain of financialization. Seen through this lens, contract labor can be understood as a speculative investment strategy wherein individuals leverage whatever assets they have at their disposal-savings, time, bodily health-to capture economic advantages. In particular, we explore the speculative practices of healthy individuals who enroll in pharmaceutical drug trials as their primary or critical source of income. Mobilizing speculative logics to maximize the money they can earn from their clinical trial participation, these contract workers employ what we term a future-income-over-immediate-pay calculus. This speculative calculus valorizes fictional projections of significant long-term future income over present financial opportunities. For the economically precarious individuals in our study, we argue that rather than effectively increasing their income, speculation on contract work serves a compensatory function, providing an important-but ultimately inadequate-sense of control over market conditions that thrive upon workers' economic insecurity.
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Affiliation(s)
- Jill A Fisher
- Department of Social Medicine & Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Megan M Wood
- Department of Communication, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Torin Monahan
- Department of Communication, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Wang Z, Chen G, Liu X, Liu C, Song Q, Wang J. The motivations, barriers, and sociodemographic characteristics of healthy Chinese volunteers in phase I research. Eur J Clin Pharmacol 2020; 77:557-568. [PMID: 33188452 DOI: 10.1007/s00228-020-03040-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the motivations, barriers, and sociodemographic characteristics of healthy Chinese volunteers in phase I research and to demonstrate the factors influencing their willingness to participate in subsequent trials. METHODS Healthy subjects who participated in seven phase I trials at two centres were invited to participate in the cross-sectional survey at discharge by anonymously and voluntarily completing the self-administered questionnaire. RESULTS From 442 subjects asked to complete the questionnaire, a response rate of 94.8% (419) was obtained, and 72.8% of the respondents had participated in a mean of 2.0 ± 1.3 previous studies. Over 90% of the subjects indicated that the main motivations to participate trials were to help more people, to contribute to scientific research, and to obtain money. The top 5 barriers were time inconvenience, advertisement sources, potential risks associated with the drug, privacy, and the route of drug administration. Nearly half (49.6%) of the subjects were willing to participate in the next trial. The factors impacting the willingness of the subjects to participate in subsequent trials were gender, screening frequency, enrolment frequency, level of understanding of the research, two motivating factors (to make money and receive a free check-up), and ten barriers (e.g. risk, distance, living conditions, and trust). CONCLUSIONS The majority of healthy Chinese subjects were young, were less well educated, had low income levels, and had poor medical insurance coverage. Given the multiple sources of motivation and complex barriers to trial participation, investigators and recruitment staff should consider ethics aspects to guarantee volunteer safety and well-being.
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Affiliation(s)
- Zejuan Wang
- Department of Clinical Pharmacology, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, People's Republic of China
| | - Gang Chen
- Department of Clinical Pharmacology, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, People's Republic of China
| | - Xiaona Liu
- Department of Clinical Pharmacology, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, People's Republic of China
| | - Chen Liu
- Phase I Clinical Trial Centre, Beijing Shijitan Hospital, Capital Medical University, 10 Tieyi Road, Haidian District, Beijing, 100038, People's Republic of China
| | - Qingkun Song
- Department of Science and Technology, Beijing Shijitan Hospital, Capital Medical University, 10 Tieyi Road, Haidian District, Beijing, 100038, People's Republic of China
| | - Jin Wang
- Department of Clinical Pharmacology, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, People's Republic of China.
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13
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Monahan T, Fisher JA. Sacrificial Labour: Social Inequality, Identity Work, and the Damaging Pursuit of Elusive Futures. WORK, EMPLOYMENT & SOCIETY : A JOURNAL OF THE BRITISH SOCIOLOGICAL ASSOCIATION 2020; 34:441-456. [PMID: 32431474 PMCID: PMC7236897 DOI: 10.1177/0950017019885069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article explores the relationship between personal sacrifice and identity work within conditions of profound structural insecurity. We develop the concept of sacrificial labour to describe how individual self-sacrifice aligns workers' identities to the needs of organizations while gradually foreclosing the actualization of individuals' desired future selves. Drawing upon qualitative data from a longitudinal study of healthy individuals who enrol in paid clinical trials for the pharmaceutical industry, we make two contributions to the identity-work literature. First, we argue that the ongoing project of building stable and secure identities may become damaging when structural and cultural conditions defy even provisional, fragile attainment of this goal. Second, we reflect on how racialization and social marginalization erode identities and constrain possibilities for identity recuperation. Whereas the identity-work literature often focuses on the agential accomplishments of individuals, we provide a troubling account of how persistent social and economic inequalities confound identity realization efforts.
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Affiliation(s)
- Torin Monahan
- The University of North Carolina at Chapel Hill, USA
| | - Jill A Fisher
- The University of North Carolina at Chapel Hill, USA
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Fisher JA, Monahan T, Walker RL. Picking and Choosing Among Phase I Trials : A Qualitative Examination of How Healthy Volunteers Understand Study Risks. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:535-549. [PMID: 31713712 PMCID: PMC6938537 DOI: 10.1007/s11673-019-09946-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
This article empirically examines how healthy volunteers evaluate and make sense of the risks of phase I clinical drug trials. This is an ethically important topic because healthy volunteers are exposed to risk but can gain no medical benefit from their trial participation. Based on in-depth qualitative interviews with 178 healthy volunteers enrolled in various clinical trials, we found that participants focus on myriad characteristics of clinical trials when assessing risk and making enrolment decisions. These factors include the short-term and long-term effects; required medical procedures; the type of trial, including its design, therapeutic area of investigation, and dosage of the drug; the amount of compensation; and trust in the research clinic. In making determinations about the study risks, participants rely on information provided during the consent process, their own and others' experiences in clinical trials, and comparisons among studies. Our findings indicate that the informed consent process succeeds in communicating well about certain types of risk information while simultaneously creating lacunae that are problematically filled by participants through their collective experiences and assumptions about risk. We discuss the ethical implications of these findings and make recommendations for improving the consent process in healthy volunteer trials.
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Affiliation(s)
- Jill A. Fisher
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, CB 7240, Chapel Hill, NC 27599-7240 USA
| | - Torin Monahan
- Department of Communication, University of North Carolina at Chapel Hill, CB 3285, Chapel Hill, NC 27599-3285 USA
| | - Rebecca L. Walker
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, CB 7240, Chapel Hill, NC 27599-7240 USA
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Fisher JA. Commentary on Zvonareva et al.: Exploring the many meanings of "professional" in research participation. Clin Trials 2019; 16:571-573. [PMID: 31588783 DOI: 10.1177/1740774519877850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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McManus L, Davis A, Forcier RL, Fisher JA. Appraising Harm in Phase I Trials: Healthy Volunteers' Accounts of Adverse Events. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2019; 47:323-333. [PMID: 31298107 PMCID: PMC6661148 DOI: 10.1177/1073110519857289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
While risk of harm is an important focus for whether clinical research on humans can and should proceed, there is uncertainty about what constitutes harm to a trial participant. In Phase I trials on healthy volunteers, the purpose of the research is to document and measure safety concerns associated with investigational drugs, and participants are financially compensated for their enrollment in these studies. In this article, we investigate how characterizations of harm are narrated by healthy volunteers in the context of the adverse events (AEs) they experience during clinical trials. Drawing upon qualitative research, we find that participants largely minimize, deny, or re-attribute the cause of these AEs. We illustrate how participants' interpretations of AEs may be shaped both by the clinical trial environment and their economic motivation to participate. While these narratives are emblematic of the larger ambiguity surrounding harm in the context of clinical trial participation, we argue that these interpretations also problematically maintain the narrative of the safety of clinical trials, the ethics of testing investigational drugs on healthy people, and the rigor of data collected in the specter of such ambiguity.
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Affiliation(s)
- Lisa McManus
- Lisa McManus is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She is a Ph.D. candidate in Sociology at North Carolina State University in Raleigh, NC, where she received her M.S. in 2012. Arlene M. Davis, J.D., is an associate professor at the University of North Carolina at Chapel Hill. She has more than 20 years of experience as a researcher on studies examining the ethical dimensions of study design, participation, and data collection. She has also served on institutional review boards and taught research ethics in a variety of settings as a faculty member in the Department of Social Medicine and Center for Bioethics at the UNC School of Medicine. Rebecca L. Forcier is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She received her B.A. in 2015 from Duke University in Durham, NC. Jill A. Fisher, Ph.D., is an associate professor in the Department of Social Medicine and Center for Bioethics at the University of North Carolina at Chapel Hill. She received her Ph.D. in 2005 in Science and Technology Studies from Rensselaer Polytechnic Institute in Troy, NY
| | - Arlene Davis
- Lisa McManus is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She is a Ph.D. candidate in Sociology at North Carolina State University in Raleigh, NC, where she received her M.S. in 2012. Arlene M. Davis, J.D., is an associate professor at the University of North Carolina at Chapel Hill. She has more than 20 years of experience as a researcher on studies examining the ethical dimensions of study design, participation, and data collection. She has also served on institutional review boards and taught research ethics in a variety of settings as a faculty member in the Department of Social Medicine and Center for Bioethics at the UNC School of Medicine. Rebecca L. Forcier is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She received her B.A. in 2015 from Duke University in Durham, NC. Jill A. Fisher, Ph.D., is an associate professor in the Department of Social Medicine and Center for Bioethics at the University of North Carolina at Chapel Hill. She received her Ph.D. in 2005 in Science and Technology Studies from Rensselaer Polytechnic Institute in Troy, NY
| | - Rebecca L Forcier
- Lisa McManus is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She is a Ph.D. candidate in Sociology at North Carolina State University in Raleigh, NC, where she received her M.S. in 2012. Arlene M. Davis, J.D., is an associate professor at the University of North Carolina at Chapel Hill. She has more than 20 years of experience as a researcher on studies examining the ethical dimensions of study design, participation, and data collection. She has also served on institutional review boards and taught research ethics in a variety of settings as a faculty member in the Department of Social Medicine and Center for Bioethics at the UNC School of Medicine. Rebecca L. Forcier is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She received her B.A. in 2015 from Duke University in Durham, NC. Jill A. Fisher, Ph.D., is an associate professor in the Department of Social Medicine and Center for Bioethics at the University of North Carolina at Chapel Hill. She received her Ph.D. in 2005 in Science and Technology Studies from Rensselaer Polytechnic Institute in Troy, NY
| | - Jill A Fisher
- Lisa McManus is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She is a Ph.D. candidate in Sociology at North Carolina State University in Raleigh, NC, where she received her M.S. in 2012. Arlene M. Davis, J.D., is an associate professor at the University of North Carolina at Chapel Hill. She has more than 20 years of experience as a researcher on studies examining the ethical dimensions of study design, participation, and data collection. She has also served on institutional review boards and taught research ethics in a variety of settings as a faculty member in the Department of Social Medicine and Center for Bioethics at the UNC School of Medicine. Rebecca L. Forcier is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She received her B.A. in 2015 from Duke University in Durham, NC. Jill A. Fisher, Ph.D., is an associate professor in the Department of Social Medicine and Center for Bioethics at the University of North Carolina at Chapel Hill. She received her Ph.D. in 2005 in Science and Technology Studies from Rensselaer Polytechnic Institute in Troy, NY
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Walker RL, Fisher JA. "My Body is One of the Best Commodities": Exploring the Ethics of Commodification in Phase I Healthy Volunteer Clinical Trials. KENNEDY INSTITUTE OF ETHICS JOURNAL 2019; 29:305-331. [PMID: 31983696 PMCID: PMC6989025 DOI: 10.1353/ken.2019.0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
In phase I clinical trials, healthy volunteers are dosed with investigational drugs and subjected to blood draws and other bodily monitoring procedures while they are confined to clinic spaces. In exchange, they are paid. These participants are, in a direct sense, selling access to their bodies for pharmaceutical companies and their associates to run drugs through. However, commodification is rarely investigated as an ethical dimension of phase I trial participation. We address this gap in the literature by bringing the voices of phase I healthy volunteers into conversation with philosophical perspectives on body commodification. Querying the intersection of commodification and phase I clinical trials illuminates important features of healthy volunteers' experiences, disentangles commodification from a dominant narrative about exploitation, and brings focus to the question of what, if any, market norms will best protect the multiple ways in which healthy volunteers' welfare is impacted by clinical trial participation.
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