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Frouté P. Chapitre 1. Essais cliniques et bioéthique en Inde. JOURNAL INTERNATIONAL DE BIOETHIQUE ET D'ETHIQUE DES SCIENCES 2024; 34:11-26. [PMID: 38423971 DOI: 10.3917/jibes.343.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Since the 1990s, the pharmaceutical industry has been a major contributor to the economic growth of India. India is the world’s largest vaccines producer, and it attracts foreign direct investors who are relocating production capacities and research activities to develop new drugs in India. India, however, suffers from a lack of trust due to repeated scandals over clinical trials. Some of these scandals have led to economic sanctions, such as the withdrawal of hundreds of generic drugs from consumption in Europe in 2015. These measures followed irregularities detected in clinical trials carried out on volunteers. While India has taken steps to reform the bioethical institutions responsible for the control of clinical trials, we show in this contribution that loopholes persist. Two periods can be distinguished. The first period, between the early 2000s and 2013, gathers a significant growth in the number of clinical trials with a growth in bioethical scandals. It led the Indian government, under pressure from the civil society and the Supreme Court, to take action to curb clinical trials and to reform bioethical institutions. The second period, from 2013 to 2021, is characterised by an increase in the number of clinical trials in a context of strengthening the efficiency of bioethical institutions. We show that the increase in clinical trials is mainly due to the implementation of the TRIPs agreements on generic drugs. This development put another pressure on national vigilance authorities which remain undersized with respect to the magnitude of the Indian clinical trials market. It also highlights again the structural frailties of the Indian Federal System.
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Kambhampati SBS, Menon J, Maini L. Ethics in Research and Publications. Indian J Orthop 2023; 57:1722-1734. [PMID: 37881290 PMCID: PMC10593663 DOI: 10.1007/s43465-023-00971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/01/2023] [Indexed: 10/27/2023]
Abstract
Background The purpose of this study is to present a comprehensive overview of the ethical issues and the processes involved in research and publishing in India. The study examines the present ethical norms, guidelines, frameworks and developments in India, providing insights into the nation's current status of research and recommendations for publication. This document will be a useful starting point and reference document for those embarking on research and publication in Orthopaedics in India. Materials A survey of the literature was done, which included scholarly papers, reports, rules, and policies pertaining to Indian publishing norms and research ethics. the document starts with a general introduction to ethics, followed by the evolution of ethics in research and the current International as well as Indian codes of ethics. Subsequently, the discussion is divided into two broad headings of ethics in research and ethics in publishing. Under each heading, there are many specific areas in orthopaedics that would require the application of a unique set of ethics. These areas are discussed separately as subheadings. Results and Discussion The review draws attention to the complexity of ethical issues in Indian and international research and publishing in orthopaedics. Where available, specific guidelines about the topic in India or international guidelines are discussed. The importance of informed consent, data integrity, plagiarism, authorship disputes, and conflicts of interest are only a few of the key results. It is obvious that ethical norms and regulations, such as those offered by the University Grants Commission (UGC), the Indian Council of Medical Research (ICMR), and the Council of Publication Ethics (COPE) are crucial in determining how research is conducted and how papers are published. The types of studies discussed include research in humans and animals, research with stem cells, metal implants and devices, orthobiologics, Artificial Intelligence, Robotics, computer modelling, virtual reality, 3D printing and bioprinting, tissue banking and data management. The roles of different personnel in research and publications are discussed. Conclusions Ethics in research and publishing play a crucial role in establishing the authority and standard of scholarly work in India. This study underlines the key concepts of ethics that guide various types of studies and the publication process. It also highlights the requirement for frameworks and guidelines for certain unique areas of research in orthopaedics.
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Affiliation(s)
- Srinivas B. S. Kambhampati
- Sri Dhaatri Orthopaedic, Maternity and Gynaecology Center, SKDGOC, Vijayawada, Andhra Pradesh 531127 India
| | - Jagdish Menon
- Department of Orthopaedics, JIPMER, Puducherry, India
| | - Lalit Maini
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
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Halwai A, Vaswani V. Post-approval process: A challenge for ethics committees. Perspect Clin Res 2023; 14:139-145. [PMID: 37554242 PMCID: PMC10405536 DOI: 10.4103/picr.picr_214_22] [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: 10/05/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 08/10/2023] Open
Abstract
Context Ethics committees (ECs) work toward upholding rights, dignity, safety, and well-being of research participants. They are also tasked with conducting oversight pre- and post-approval. ECs face various challenges in their functioning. Post-approval oversight is one of the major challenges, and various studies have stressed the importance of post-approval oversight. Aims The aim of this study was to explore the challenges in the post-approval processes that are faced by the ECs and to suggest solutions to the most common challenges. Methods We conducted a quantitative study contacting member secretaries of different ECs using an online Google Forms questionnaire. The questionnaire consisted of three domains and included questions about the description of the EC, conduct of post-approval activities, and challenges encountered during the post-approval process. Results and Conclusion We received responses from 61 member secretaries. We were able to identify challenges faced by the EC members in the post-approval process in the areas of site monitoring visit, review of post-approval submission (nonsubmission/incomplete submission/late submission of documents by PI, long time taken by reviewers, nonavailability of reviewers, nonadherence to timeline and too much paperwork), review of serious adverse events, and review of protocol deviations. Our study also noted the difference between accredited/assessed (National Accreditation Board for Hospitals and Healthcare Providers/Forum for Ethical Review Committees in the Asian and Western Pacific Region) ECs versus registered (Central Drugs Standard Control Organisation/Department of Health Research only) ECs by comparing the challenges.
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Affiliation(s)
- Aarti Halwai
- Former MSc (Research Ethics) Scholar, YU-FIC Research Ethics Master’s Program for India, Yenepoya Deemed to be University, Mangalore, India
| | - Vina Vaswani
- Director, Centre for Ethics, Program Director, YU-FIC Masters in Research Ethics for India, Yenepoya Deemed to be University, Mangalore, India
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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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Chawla V, Aggarwal R, Goyal K, Sokhal N, Shetty G, Sharma AK, Lal P, Kumar S, Misra M, Kumar A. Implementing a Nationwide Simulation-Based Training Program in Managing Sick Surgical Patients. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03740-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Shetty YC, Tripathi R, Marathe PA, Jalgaonkar S, Gajbhiye S, Katkar J. A Retrospective Study of Ethics Committee Monitoring Checklists of the Audiovisual Consent Process: An Ethical Perspective. Cureus 2023; 15:e34433. [PMID: 36874722 PMCID: PMC9979097 DOI: 10.7759/cureus.34433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
Clinical trial regulations for new drugs in India released a gazette notification for obtaining audiovisual (AV) consent from all trial participants in November 2013. The reports of AV recordings of the studies from October 2013 to February 2017 submitted to the institutional ethics committee were analyzed in view of the Indian regulations on AV consenting. The reports of AV recording were checked: number of AV consents for each project, adequacy of AV recording, number of persons in the video, informed consent document elements (ICD) covered as per Schedule Y, confirmation of understanding by the participant, the time taken to complete the procedure, maintenance of confidentiality, and whether reconsent was taken. Seven studies of AV consent were monitored. Eighty-five (85) AV-consented and filled checklists were evaluated. The AV recording was not clear in 31/85, ICD elements were missing in 49/85 consents, time taken to complete the procedure was 20.03 ± 10.83 with the number of pages being 14.24 ± 7.52 (R= 0.29 p<0.041). In 19/85 consents, privacy was not maintained and on 22 occasions, reconsent were taken. There were deficits found in the AV consent process.
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Affiliation(s)
- Yashashri C Shetty
- Pharmacology and Therapeutics, Seth GS (Gordhandas Sunderdas) Medical College & KEM (King Edward Memorial) Hospital, Mumbai, IND
| | - Raakhi Tripathi
- Pharmacology and Therapeutics, Seth GS (Gordhandas Sunderdas) Medical College & KEM (King Edward Memorial) Hospital, Mumbai, IND
| | - Padmaja A Marathe
- Pharmacology and Therapeutics, Seth GS (Gordhandas Sunderdas) Medical College & KEM (King Edward Memorial) Hospital, Mumbai, IND
| | - Sharmila Jalgaonkar
- Pharmacology and Therapeutics, Seth GS (Gordhandas Sunderdas) Medical College & KEM (King Edward Memorial) Hospital, Mumbai, IND
| | - Snehalata Gajbhiye
- Pharmacology and Therapeutics, Seth GS (Gordhandas Sunderdas) Medical College & KEM (King Edward Memorial) Hospital, Mumbai, IND
| | - Janhavi Katkar
- Institutional Ethics Committee, Seth GS (Gordhandas Sunderdas) Medical College & KEM (King Edward Memorial) Hospital, Mumbai, IND
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GOGTAY N. Medical research in India: Fit and fine or frail and vulnerable? THE NATIONAL MEDICAL JOURNAL OF INDIA 2022; 35:129-131. [DOI: 10.25259/nmji-35-3-129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Complexity of clinical trial operationalisation in India. Lancet Glob Health 2022; 10:e953. [PMID: 35714642 PMCID: PMC9258997 DOI: 10.1016/s2214-109x(22)00209-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/19/2022] [Indexed: 01/19/2023]
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Chakraborty I, Shreya A, Mendiratta J, Bhan A, Saberwal G. An analysis of deficiencies in the ethics committee data of certain interventional trials registered with the Clinical Trials Registry-India. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000617. [PMID: 36962581 PMCID: PMC10021301 DOI: 10.1371/journal.pgph.0000617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/27/2022] [Indexed: 03/26/2023]
Abstract
There is widespread agreement that clinical trials should be registered in a public registry, preferably before the trial commences. It is also important that details of each trial in the public record are complete and accurate. In this study, we examined the trial sites and ethics committee (EC) data for 1359 recent Phase 2 or Phase 3 interventional trials registered with Clinical Trials Registry-India (CTRI), to identify categories of problems that prevent the clear identification of which EC approved a given site. We created an SQLite database that hosted the relevant CTRI records, and queried this database, as needed. We identified two broad categories of problems: those pertaining to the understanding of an individual trial and those to adopting a data analytics approach for a large number of trials. Overall, about 30 problems were identified, such as an EC not being listed; an uninformative name of the EC that precluded its clear identification; ambiguity in which EC supervised a particular site; repetition of a site or an EC; the use of a given acronym for different organizations; site name not clearly listed, etc. The large number of problems with the data in the EC or site field creates a challenge to link particular sites with particular ECs, especially if a programme is used to find the matches. We make a few suggestions on how the situation could be improved. Most importantly, list the EC registration number for each EC, merge the site and EC tables so that it is clear which EC is linked to which site; and implement logic rules that would prevent a trial from being registered unless certain conditions were met. This will raise user confidence in CTRI EC data, and enable data based public policy and inferences. This will also contribute to increased transparency, and trust, in clinical trials, and their oversight, in India.
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Affiliation(s)
| | - Adya Shreya
- Institute of Bioinformatics and Applied Biotechnology, Bengaluru, India
| | | | - Anant Bhan
- Centre for Ethics, Yenepoya (deemed to be University), Mangaluru, India
| | - Gayatri Saberwal
- Institute of Bioinformatics and Applied Biotechnology, Bengaluru, India
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Paramasivan S, Davies P, Richards A, Wade J, Rooshenas L, Mills N, Realpe A, Raj JP, Subramani S, Ives J, Huxtable R, Blazeby JM, Donovan JL. What empirical research has been undertaken on the ethics of clinical research in India? A systematic scoping review and narrative synthesis. BMJ Glob Health 2021; 6:e004729. [PMID: 34006518 PMCID: PMC8137180 DOI: 10.1136/bmjgh-2020-004729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/13/2021] [Accepted: 02/24/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The post-2005 rise in clinical trials and clinical research conducted in India was accompanied by frequent reports of unethical practices, leading to a series of regulatory changes. We conducted a systematic scoping review to obtain an overview of empirical research pertaining to the ethics of clinical trials/research in India. METHODS Our search strategy combined terms related to ethics/bioethics, informed consent, clinical trials/research and India, across nine databases, up to November 2019. Peer-reviewed research exploring ethical aspects of clinical trials/research in India with any stakeholder groups was included. We developed an evidence map, undertook a narrative synthesis and identified research gaps. A consultation exercise with stakeholders in India helped contextualise the review and identify additional research priorities. RESULTS Titles/Abstracts of 9699 articles were screened, full text of 282 obtained and 80 were included. Research on the ethics of clinical trials/research covered a wide range of topics, often conducted with little to no funding. Studies predominantly examined what lay (patients/public) and professional participants (eg, healthcare staff/students/faculty) know about topics such as research ethics or understand from the information given to obtain their consent for research participation. Easily accessible groups, namely ethics committee members and healthcare students were frequently researched. Research gaps included developing a better understanding of the recruitment-informed consent process, including the doctor-patient interaction, in multiple contexts and exploring issues of equity and justice in clinical trials/research. CONCLUSION The review demonstrates that while a wide range of topics have been studied in India, the focus is largely on assessing knowledge levels across different population groups. This is a useful starting point, but fundamental questions remain unanswered about informed consent processes and broader issues of inequity that pervade the clinical trials/research landscape. A priority-setting exercise and appropriate funding mechanisms to support researchers in India would help improve the clinical trials/research ecosystem.
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Affiliation(s)
- Sangeetha Paramasivan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, NIHR ARC West, Bristol, UK
| | - Philippa Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council (MRC) ConDuCT-II Trials Methodology Hub, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison Richards
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council (MRC) ConDuCT-II Trials Methodology Hub, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julia Wade
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Leila Rooshenas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, NIHR ARC West, Bristol, UK
| | - Nicola Mills
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, NIHR ARC West, Bristol, UK
| | - Alba Realpe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, NIHR ARC West, Bristol, UK
| | - Jeffrey Pradeep Raj
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Supriya Subramani
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Jonathan Ives
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
| | - Richard Huxtable
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
| | - Jane M Blazeby
- University Hospitals Bristol NHS Foundation Trust, NIHR ARC West, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Jenny L Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, NIHR ARC West, Bristol, UK
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Oo ZZ, Wun M, Oo YTN, Mya KS, Silverman HJ. Assessing Research Ethics Committees in Myanmar: Results of a Self-Assessment Tool. Asian Bioeth Rev 2021; 12:37-49. [PMID: 33456547 DOI: 10.1007/s41649-020-00113-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Human subject research has increased in Myanmar since 2010 and accordingly, the establishment of research ethics committees (RECs) have increased to review these research studies. However, characteristics that reflect the operations of RECs in Myanmar have not been assessed. Objectives To assess the structures and processes of RECs at Medical Institutions in Myanmar. Methods We used a self-assessment tool for RECs operating in low and middle-income countries. This tool consists of the following ten domains: organizational aspects, membership and ethics training, submission arrangements and materials, meeting minutes, policies referring to review procedures, review of specific protocol and informed consent items, communication a decision, continuing review, REC resources, and institutional commitment. We distributed this self-administered questionnaire to RECs from 15 Medical Institutions in Myanmar and one representative from each REC completed this questionnaire and returned it anonymously. We used descriptive, bivariate, and multivariate statistics to analyse the data. Results Out of maximum 200 points, the total mean score for Myanmar Medical Institutions was 112.6 ± 12.77, which is lower compared to the aggregate mean score of 137.4 ± 35.8 obtained from RECs in other countries. Domains in which the average percentage score was less than 60% included organizational commitment, membership and ethics training, continuing review and REC resources. Many RECs have a diverse membership and appropriate gender balance but, lacked essential policies. Conclusion The results show that for Myanmar RECs there is significant room for improvement in their "structures and processes" as well as the extent of institutionl commitment. The self-assessment tool proved to be valuable method to assess the quality of RECs.
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Affiliation(s)
- Zaw Zaw Oo
- University of Medicine 2, Yangon, Ministry of Health and Sports, Yangon, Myanmar
| | - Min Wun
- Department of Medical Research, Myanmar Ministry of Health and Sports, Yangon, Myanmar
| | - Yin Thet Nu Oo
- Department of Medical Research, Myanmar Ministry of Health and Sports, Yangon, Myanmar
| | - Kyaw Swa Mya
- University of Public Health, Ministry of Health and Sports, Yangon, Myanmar
| | - Henry J Silverman
- Department of Medicine, University of Maryland School of Medicine, Baltimore, USA
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Sivanandan S, Jain K, Plakkal N, Bahl M, Sahoo T, Mukherjee S, Gupta YK, Agarwal R. Issues, challenges, and the way forward in conducting clinical trials among neonates: investigators' perspective. J Perinatol 2019; 39:20-30. [PMID: 31485015 PMCID: PMC8075906 DOI: 10.1038/s41372-019-0469-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Clinical trials are essential to test the safety and efficacy of new treatments in any population. The paucity of drug trials especially in the neonatal population has led to the widespread use of unlicensed or off-label medications, exposing them to the risks of drug toxicity and ineffective treatment. Ethical and operational challenges are no longer considered valid excuses for not conducting drug trials in neonates. We recently participated in a combined phase-2 and phase-3 trial investigating a new indigenous goat lung surfactant extract (GLSE) for the treatment of respiratory distress syndrome (RDS) in preterm neonates. In this article, we share pertinent challenges faced by us during the trial to better inform and foster-positive discussion among drug developers, administrators, regulatory authorities, patient advocacy groups, and researchers. Also, we provide many tools developed for the GLSE trial that can be modified and used by prospective trialists.
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Affiliation(s)
- Sindhu Sivanandan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kajal Jain
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nishad Plakkal
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Monika Bahl
- Clinical Development Services Agency, Faridabad, India
| | - Tanushree Sahoo
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shirshendu Mukherjee
- Grand Challenges India, Biotechnology Industry Research Assistance Council, New Delhi, India
| | | | - Ramesh Agarwal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Desai BS, Dixit AS, Gota VS. Central institutional ethics committee needed to facilitate timely review of multicenter clinical trials. J Postgrad Med 2019; 65:107-109. [PMID: 30924443 PMCID: PMC6515773 DOI: 10.4103/jpgm.jpgm_428_18] [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] [Indexed: 11/30/2022] Open
Abstract
A multicenter trial in India undergoes review by Institutional Ethics Committees (IECs) of all participating institutions. The failure to obtain approval even from a single institution's IEC creates a situation of inequitable access to clinical trials. The dichotomy in decisions of different IECs is attributed to lack of standardization and accountability in their functioning. The registration of IECs with Central Drugs Standard Control Organization notwithstanding, the current model of IEC review has failed to ensure uniformity in IEC decisions in multicenter trials. Alternative models that allow central review of multicenter clinical trials should be explored.
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Affiliation(s)
- B S Desai
- Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - A S Dixit
- Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - V S Gota
- Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
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Nishandar TB, Birajdar AR, Gogtay NJ, Thatte UM. Current status of standardized, quality and ethical oversight of clinical research in the country: An audit of the Central Drugs Standard Control Organization (registration of ethics committees) and national accreditation board for hospital and healthcare providers (accreditation) databases. Perspect Clin Res 2019; 10:84-90. [PMID: 31008075 PMCID: PMC6463500 DOI: 10.4103/picr.picr_93_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The Prof. Ranjit Roy Chaudhury committee report recommended the accreditation of Institutional Ethics Committees (IECs). Rule 122DD of the Drugs and Cosmetics Act (and Rules) mandates that only registered ECs can accord approval for regulatory studies. We evaluated the current status of registered, reregistered, and accredited ECs in the country to assess the impact of both the recommendation and rule. Materials and Methods: Websites of stakeholders-the Central Drugs Standard Control Organization (CDSCO), National Accreditation Board for Hospitals and Healthcare Providers (NABH) were assessed. Information on registration status was then compared with regulatory clinical trials in the Clinical Trials Registry of India, population demographics of all states, and the Medical Council of India recognized postgraduate medical colleges in the various states. Results: A total of 1268 ECs were registered with CDSCO. Of these, 1008 (79.5%) were institutional and 256 (20.18%) independent ECs. A total of 499/1268 (39.4%) ECs were reregistered. Of which 449/499 (90%) were institutional and 50/499 (10%) were independent. Institutional ECs were five times more likely to be reregistered with CDSCO relative to independent ECs (cOR 4.52 [3.12, 6.54], P < 0.0001). A total of 15/233 (7%) applications to NABH had received accreditation. A wide skew was seen in the distribution of ECs across various states as also their oversight of regulatory clinical trials. Conclusions: Registration and reregistration of ECs along with accreditation is not commensurate with the needs of the country at this time and must be vigorously promoted.
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Affiliation(s)
- Tushar Bhimrao Nishandar
- Department of Clinical Pharmacology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Amit Ravindra Birajdar
- Department of Clinical Pharmacology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nithya J Gogtay
- Department of Clinical Pharmacology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Urmila M Thatte
- Department of Clinical Pharmacology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Hanley BP, Bains W, Church G. Review of Scientific Self-Experimentation: Ethics History, Regulation, Scenarios, and Views Among Ethics Committees and Prominent Scientists. Rejuvenation Res 2018; 22:31-42. [PMID: 29926769 DOI: 10.1089/rej.2018.2059] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We examine self-experimentation ethics history and practice, related law, use scenarios in universities and industry, and attitudes. We show through analysis of the historical development of medical ethics and regulation, from Hippocrates through Good Clinical Practice that there are no ethical barriers to self-experimentation. When the self-experimenter is a true investigator, there is no other party to be protected from unethical behavior. We discuss the n-of-1 issue in self-experiments, and make suggestions for improving experiment design. We discuss real-world scenarios of self-experimentation: at universities, for independent single-subject investigators, investigator/employees at pharmaceutical firms, and nonscientist self-experimenters. Our survey of ethics committees regarding policy and review for self-experimenting investigators show that approximately one-third of ethics committee respondents had a policy regarding self-experimentation, and one-third did not require ethical committee review of proposed experiments. There was no relationship between having a policy and asking for review. We also surveyed member attitudes to, and experiences of, self-experimentation among members of the National Academy of Sciences, Royal Society, and European Academy of Sciences. To our knowledge, this survey is the first breakdown of self-experiments into impact-relevant type classifications, and represents an advance in the field. Half of our scientist respondents performed self-experiments, and roughly one-fifth had conducted serious self-experiments. Most responders thought self-experiments were valuable, however, biologics injections, radiation exposure, and surgical implants had negative ratings greater than positive. We conclude that self-experimenters should not have attempts made to terminate them, bar them from use of facilities, nor be barred from using themselves or their tissues except in exceptional circumstances. Organizational uncertainty over the ethical and regulatory status of self-experimentation, and resulting fear of consequences is unjustified and may be blocking a route to human experiments that practicing scientists widely consider appropriate, and which historical precedent has shown is valuable.
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Affiliation(s)
| | - William Bains
- 2 Rufus Scientific Ltd., Hertsfordshire, United Kingdom
| | - George Church
- 3 Department of Genetics, Harvard Medical School, Boston, Massachusetts
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Bhatt A. Future of Indian clinical trials: Moving forward from hyped potential to human protection. Perspect Clin Res 2017; 8:2-4. [PMID: 28194330 PMCID: PMC5299800 DOI: 10.4103/2229-3485.198553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Arun Bhatt
- Consultant - Clinical Research and Development, Mumbai, Maharashtra, India
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