Research ethics committees: Need for harmonization at the national level, the global and Indian perspective

Ethical review procedures in international internet-based intervention studies

International internet-based studies could be accessible by participants from various countries worldwide. However, the jurisdiction of research ethics committees (RECs) or institutional review boards (IRBs) is bound to geographical state or country borders. How can researchers deal with the geographical boundaries in the jurisdiction of RECs/IRBs versus the worldwide, open character of international internet-based research? Should ethical approval be sought in each country where participants will be recruited? In this paper, we want to share our challenges in setting up the ethical review procedures in an international internet-based mHealth intervention study, to further the discussion on ethical procedures in internet-based research.

Record linkage of population-based cohort data from minors with national register data: a scoping review and comparative legal analysis of four European countries

Background: The GDPR was implemented to build an overarching framework for personal data protection across the EU/EEA. Linkage of data directly collected from cohort participants, potentially serving as a prominent tool for health research, must respect data protection rules and privacy rights. Our objective was to investigate law possibilities of linking cohort data of minors with routinely collected education and health data comparing EU/EEA member states. Methods: A legal comparative analysis and scoping review was conducted of openly accessible published laws and regulations in EUR-Lex and national law databases on GDPR's implementation in Portugal, Finland, Norway, and the Netherlands and its connected national regulations purposing record linkage for health research that have been implemented up until April 30, 2021. Results: The GDPR does not ensure total uniformity in data protection legislation across member states offering flexibility for national legislation. Exceptions to process personal data, e.g., public interest and scientific research, must be laid down in EU/EEA or national law. Differences in national interpretation caused obstacles in cross-national research and record linkage: Portugal requires written consent and ethical approval; Finland allows linkage mostly without consent through the national Social and Health Data Permit Authority; Norway when based on regional ethics committee's approval and adequate information technology safeguarding confidentiality; the Netherlands mainly bases linkage on the opt-out system and Data Protection Impact Assessment. Conclusions: Though the GDPR is the most important legal framework, national legislation execution matters most when linking cohort data with routinely collected health and education data. As national interpretation varies, legal intervention balancing individual right to informational self-determination and public good is gravely needed for health research. More harmonization across EU/EEA could be helpful but should not be detrimental in those member states which already opened a leeway for registries and research for the public good without explicit consent.

Ethics Committees in Ayurvedic PG institutions: Losing opportunities of making an impact

Ethics is a crucial component of medical practice world over and also an indispensable part of medical research. Ethics in medical practice primarily refers to not harming the patients by the proposed interventions; similarly ethics in research refers to assuring optimal care of the participants and causing no harm to them on account of research. Ethics in research has come a long way from its voluntarily application on moral grounds to a mandatory condition regulated by the state of law. Ethics Committees (ECs) have been erected at research institutions to safeguard the interest of patients, to ensure their safety during any such trial and to assure the accountability of the researcher in case of any unforeseen event. Such committees therefore have a noble role to play in the form of promoting ethical practices in research. Ayurvedic clinical research also follows the similar path by erecting ECs at its research institutions. However, in reality, such committees are found much away from the principle of their inception and method of functioning. In the absence of accountability and clear objectivity, such ECs at Ayurvedic research institutions are not serving any purpose. This article critically examines the positioning of ECs at Ayurveda research institutions and suggests pragmatic mechanisms to ensure their role in improving the quality of research in Ayurveda.

Barriers and Attitudes to Research Among Residents in Plastic and Reconstructive Surgery: A National Multicenter Cross-Sectional Study

OBJECTIVE

Research sets the foundation for developing plastic surgeons who think critically and approach clinical practice with an inquisitive mind. The objective of this study was to characterize current attitudes and perceived barriers towards conducting research during residency.

DESIGN

A validated 36-item questionnaire was developed by a national task-force of Canadian plastic surgery trainees. The survey was distributed to all 13 plastic surgery programs in Canada. Data was collected for a period of 2 months in the form of multiple choice, Likert scales and short answers.

RESULTS

The response rate was 64% (95/149) with representation from all 13 plastic surgery programs across Canada. The top three perceived barriers to conducting research were lack of time (83%), insufficient access to research supervisors and mentors (42%) and the research ethics process (38%). More than 70% of residents were interested in conducting research during residency and 74% of programs have a research requirement integrated into their curriculum. Despite this, less than half of residents (47%) believed that their program fosters a culture that promotes research. This was attributed to multiple factors, including a lack of internal research funding (78%), limited access to a research methods or clinical trials unit (78%), and insufficient research training (68%). University research ranking had no correlation with residents' scholarly output or their perceptions towards research barriers.

CONCLUSION

Canadian Plastic Surgery residents identified several important factors considered to be barriers to research. Programs can use these findings to address barriers and improve the integration of research throughout residency training.

Ethics Committees in India: Past, present and future

Following watershed amendments in Schedule Y India's star rose rather rapidly on the clinical research (especially clinical trials) horizon. Just as dramatic was the fall of this empire. At the centre of these events has been the participant and indirectly, the Ethics Committee (EC) that is established primarily to protect this individual. This paper traces the evolution of the concept of ECs in India, examines the current state of these committees in the country and suggests the way forward.

Ethics committees and the changed clinical research environment in India in 2016: A perspective!

Introduction:

Institutional and Independent Ethics Committees (ECs) have as their primary mission the protection of human research subjects. The Central Drugs Standard Control Organization has in the period 2013–2016 introduced several new regulations and amendments to existing regulations overseeing the conduct of Research in India. Several of these have direct effect on the functioning of the EC from a review, approval, and oversight mechanism.

Methodology:

The Ethics Council of Indian Society for Clinical Research conducted a questionnaire survey among EC members to understand the impact of these changes in their functioning. The domains surveyed included awareness about recent changes/amendments and impacts, serious adverse events (SAEs) and compensation, informed consent and audio-video recording, monitoring and auditing of research, and future working of ECs.

Results:

Seventy-nine percent of ECs are of the opinion that the new regulations/guidelines will add to their existing burden in the process of review and approval, providing subject protection and research oversight. Even though 68% of ECs stated that they are comfortable with SAE assessment and compensation determination, they state that there is variability in calculation of compensation amount using the formulae. An overwhelming majority (80%) of ECs stated that they were not in favor of centralized EC for providing review, approval, and oversight of clinical studies.

Discussion:

Ethics Committees act as local regulator for clinical trials at sites providing Human Subject protection. The survey captures the contemporary issues faced by the ECs and also raises important questions on the ease of doing research, oversight of approved research, and administrative burden on the EC.

Conclusion:

Recent changes in regulations have on the one hand empowered Ethics committees but brought in challenges in the way that they provide oversight and monitor research carried out at the site.

A Study of Assessing Errors and Completeness of Research Application Forms Submitted to Instituitional Ethics Committee (IEC) of a Tertiary Care Hospital

INTRODUCTION

Application form of research work is an essential requirement which is required to be submitted along with the research proposal to the Ethics Committee (EC).

AIM

To check the completeness and to find the errors in application forms submitted to the EC of a tertiary care hospital.

MATERIALS AND METHODS

The application forms of research projects submitted to the Institutional Review Board (IRB), Government Medical College, Bhavnagar, Gujarat, India from January 2014 to June 2015 were analysed for completeness and errors, with respect to the following - type of study, information about study investigators, sample size, study participants, title of the studies, signatures of all investigators, regulatory approval, recruitment procedure, compensation to study participants, informed consent process, information about sponsor, declaration of conflict of interest, plans for storage and maintenance of data, patient information sheet, informed consent forms and study related documents.

RESULTS

Total 100 application forms were analysed. Among them, 98 were academic and 2 were industrial studies. Majority of academic studies were of basic science type. In 63.26% studies, type of study was not mentioned in title. Age group of subjects was not mentioned in 8.16% application forms. In 34.6% informed consent, benefits of the study were not mentioned. Signature of investigators/co-investigators/Head of the Department was missing in 3.06% cases.

CONCLUSION

Our study recommends that the efficiency and speed of review will increase if investigator will increase vigilance regarding filling of application forms. Regular meetings will be helpful to solve the problems related to content of application forms. The uniformity in functioning of EC can be achieved if common application form for all ECs is there.

Research ethics committees in the regulation of clinical research: comparison of Finland to England, Canada, and the United States

Background

The aim of this paper is to compare common features and variation in the work of research ethics committees (RECs) in Finland to three other countries – England, Canada, the United States of America (USA) – in the late 2000s.

Methods

Several approaches and data sources were used, including semi- or unstructured interviews of experts, documents, previous reports, presentations in meetings and observations. A theoretical framework was created and data from various sources synthesized.

Results

In Finland, RECs were regulated by a medical research law, whereas in the other countries many related laws and rules guided RECs; drug trials had specific additional rules. In England and the USA, there was a REC control body. In all countries, members were voluntary and included lay-persons, and payment arrangements varied. Patient protection was the main ethics criteria, but other criteria (research advancement, availability of results, payments, detailed fulfilment of legislation) varied. In all countries, RECs had been given administrative duties. Variations by country included the mandate, practical arrangements, handling of multi-site research, explicitness of proportionate handlings, judging scientific quality, time-limits for decisions, following of projects, role in institute protection, handling conflicts of interests, handling of projects without informed consent, and quality assurance research. The division of work between REC members and secretariats varied in checking of formalities. In England, quality assurance of REC work was thorough, fairly thorough in the USA, and not performed in Finland.

Conclusions

The work of RECs in the four countries varied notably. Various deficiencies in the system require action, for which international comparison can provide useful insights.

Electronic supplementary material

The online version of this article (doi:10.1186/s12961-016-0078-3) contains supplementary material, which is available to authorized users.

Barriers to and facilitators of interventions to counter publication bias: thematic analysis of scholarly articles and stakeholder interviews

BACKGROUND

When the nature and direction of research results affect their chances of publication, a distortion of the evidence base - termed publication bias - results. Despite considerable recent efforts to implement measures to reduce the non-publication of trials, publication bias is still a major problem in medical research. The objective of our study was to identify barriers to and facilitators of interventions to prevent or reduce publication bias.

METHODS

We systematically reviewed the scholarly literature and extracted data from articles. Further, we performed semi-structured interviews with stakeholders. We performed an inductive thematic analysis to identify barriers to and facilitators of interventions to counter publication bias.

RESULTS

The systematic review identified 39 articles. Thirty-four of 89 invited interview partners agreed to be interviewed. We clustered interventions into four categories: prospective trial registration, incentives for reporting in peer-reviewed journals or research reports, public availability of individual patient-level data, and peer-review/editorial processes. Barriers we identified included economic and personal interests, lack of financial resources for a global comprehensive trial registry, and different legal systems. Facilitators identified included: raising awareness of the effects of publication bias, providing incentives to make data publically available, and implementing laws to enforce prospective registration and reporting of clinical trial results.

CONCLUSIONS

Publication bias is a complex problem that reflects the complex system in which it occurs. The cooperation amongst stakeholders to increase public awareness of the problem, better tailoring of incentives to publish, and ultimately legislative regulations have the greatest potential for reducing publication bias.