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Patel RA, Ungar RA, Pyke AL, Adimoelja A, Chakraborty M, Cotter DJ, Freund M, Goddard P, Gomez-Stafford J, Greenwald E, Higgs E, Hunter N, MacKenzie TMG, Narain A, Gjorgjieva T, Martschenko DO. Increasing equity in science requires better ethics training: A course by trainees, for trainees. Cell Genom 2024; 4:100554. [PMID: 38697124 PMCID: PMC11099339 DOI: 10.1016/j.xgen.2024.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/23/2024] [Accepted: 04/06/2024] [Indexed: 05/04/2024]
Abstract
Despite the profound impacts of scientific research, few scientists have received the necessary training to productively discuss the ethical and societal implications of their work. To address this critical gap, we-a group of predominantly human genetics trainees-developed a course on genetics, ethics, and society. We intend for this course to serve as a template for other institutions and scientific disciplines. Our curriculum positions human genetics within its historical and societal context and encourages students to evaluate how societal norms and structures impact the conduct of scientific research. We demonstrate the utility of this course via surveys of enrolled students and provide resources and strategies for others hoping to teach a similar course. We conclude by arguing that if we are to work toward rectifying the inequities and injustices produced by our field, we must first learn to view our own research as impacting and being impacted by society.
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Affiliation(s)
- Roshni A Patel
- Department of Genetics, Stanford University, Stanford, CA 94305, USA.
| | - Rachel A Ungar
- Department of Genetics, Stanford University, Stanford, CA 94305, USA.
| | - Alanna L Pyke
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Alvina Adimoelja
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | | | - Daniel J Cotter
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Malika Freund
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Pagé Goddard
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Justin Gomez-Stafford
- Department of Hematology and Oncology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Emily Greenwald
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Emily Higgs
- Department of Cardiovascular Genetics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Naiomi Hunter
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Tim M G MacKenzie
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Anjali Narain
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Tamara Gjorgjieva
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Daphne O Martschenko
- Center for Biomedical Ethics, Stanford University, Stanford, CA 94305, USA; Department of Pediatrics, Stanford University, Stanford, CA 94305, USA
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2
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Bobier C. Equitable Participant Selection Concerns for First-In-Human Whole-Eye Transplantation. Am J Bioeth 2024; 24:98-100. [PMID: 38635434 DOI: 10.1080/15265161.2024.2328284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
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3
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Staunton C, Shabani M, Mascalzoni D, Mežinska S, Slokenberga S. Ethical and social reflections on the proposed European Health Data Space. Eur J Hum Genet 2024; 32:498-505. [PMID: 38355959 PMCID: PMC11061131 DOI: 10.1038/s41431-024-01543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 11/08/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
The COVID-19 pandemic demonstrated the benefits of international data sharing. Data sharing enabled the health care policy makers to make decisions based on real-time data, it enabled the tracking of the virus, and importantly it enabled the development of vaccines that were crucial to mitigating the impact of the virus. This data sharing is not the norm as data sharing needs to navigate complex ethical and legal rules, and in particular, the fragmented application of the General Data Protection Regulation (GDPR). The introduction of the draft regulation for a European Health Data Space (EHDS) in May 2022 seeks to address some of these legal issues. If passed, it will create an obligation to share electronic health data for certain secondary purposes. While there is a clear need to address the legal complexities involved with data sharing, it is critical that any proposed reforms are in line with ethical principles and the expectations of the data subjects. In this paper we offer a critique of the EHDS and offer some recommendations for this evolving regulatory space.
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Affiliation(s)
- Ciara Staunton
- Institute for Biomedicine, Eurac Research, Bolzano, Italy.
- School of Law, University of Kwazulunatal, Durban, South Africa.
| | - Mahsa Shabani
- Faculty of Law and Criminology, Ghent University, Gent, Belgium
| | - Deborah Mascalzoni
- Institute for Biomedicine, Eurac Research, Bolzano, Italy
- Department of Public Health and Caring Science, Uppsala University, CRB, P.O. Box 256, 751 05, Uppsala, Sweden
| | - Signe Mežinska
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
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4
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Mao H, Garza-Villarreal EA, Moy L, Hussain T, Scott AD, Lupo JM, Zhou XJ, Fleischer CC. Ethical Considerations for MRI Research in Human Subjects in the Era of Precision Medicine. J Magn Reson Imaging 2024; 59:1864-1866. [PMID: 37606080 DOI: 10.1002/jmri.28969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023] Open
Affiliation(s)
- Hui Mao
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Eduardo A Garza-Villarreal
- Instituto de Neurobiología, Universidad Nacional Autónoma de México campus Juriquilla, Querétaro, Mexico
| | - Linda Moy
- Department of Radiology and Center for Advanced Imaging Innovation and Research, Grossman School of Medicine, New York University, New York, New York, USA
| | - Tarique Hussain
- Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andrew D Scott
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Janine M Lupo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Xiaohong Joe Zhou
- Department of Radiology and Center for Magnetic Resonance Research, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Candace C Fleischer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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Martin S, Ancillotti M, Slokenberga S, Matar A. A comparative ethical analysis of the Egyptian clinical research law. BMC Med Ethics 2024; 25:48. [PMID: 38689214 PMCID: PMC11059645 DOI: 10.1186/s12910-024-01040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND In this study, we examined the ethical implications of Egypt's new clinical trial law, employing the ethical framework proposed by Emanuel et al. and comparing it to various national and supranational laws. This analysis is crucial as Egypt, considered a high-growth pharmaceutical market, has become an attractive location for clinical trials, offering insights into the ethical implementation of bioethical regulations in a large population country with a robust healthcare infrastructure and predominantly treatment-naïve patients. METHODS We conducted a comparative analysis of Egyptian law with regulations from Sweden and France, including the EU Clinical Trials Regulation, considering ethical human subject research criteria, and used a directed approach to qualitative content analysis to examine the laws and regulations. This study involved extensive peer scrutiny, frequent debriefing sessions, and collaboration with legal experts with relevant international legal expertise to ensure rigorous analysis and interpretation of the laws. RESULTS On the rating of the seven different principles (social and scientific values, scientific validity, fair selection of participants, risk-benefit ratio, independent review, informed consent and respect for participants) Egypt, France, and EU regulations had comparable scores. Specific principles (Social Value, Scientific Value, and Fair selection of participants) were challenging to directly identify due to certain regulations embodying 'implicit' principles more than explicitly stated ones. CONCLUSION The analysis underscores Egypt's alignment with internationally recognized ethical principles, as outlined by Emanuel et al., through its comparison with French, Swedish, and EU regulations, emphasizing the critical need for Egypt to continuously refine its ethical regulations to safeguard participant protection and research integrity. Key issues identified include the necessity to clarify and standardize the concept of social value in research, alongside concerns regarding the expertise and impartiality of ethical review boards, pointing towards a broader agenda for enhancing research ethics in Egypt and beyond.
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Affiliation(s)
- Sylvia Martin
- Center for Research and Bioethics, Uppsala University, Uppsala, Sweden.
| | - Mirko Ancillotti
- Center for Research and Bioethics, Uppsala University, Uppsala, Sweden
| | | | - Amal Matar
- Center for Research and Bioethics, Uppsala University, Uppsala, Sweden
- Clinical Immunology and Transfusion Medicine Department, Uppsala University Hospital, Uppsala, Sweden
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Dolley S, Norman T, McNair D, Hartman D. A maturity model for the scientific review of clinical trial designs and their informativeness. Trials 2024; 25:271. [PMID: 38641848 PMCID: PMC11027356 DOI: 10.1186/s13063-024-08099-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/07/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Informativeness, in the context of clinical trials, defines whether a study's results definitively answer its research questions with meaningful next steps. Many clinical trials end uninformatively. Clinical trial protocols are required to go through reviews in regulatory and ethical domains: areas that focus on specifics outside of trial design, biostatistics, and research methods. Private foundations and government funders rarely require focused scientific design reviews for these areas. There are no documented standards and processes, or even best practices, toward a capability for funders to perform scientific design reviews after their peer review process prior to a funding commitment. MAIN BODY Considering the investment in and standardization of ethical and regulatory reviews, and the prevalence of studies never finishing or failing to provide definitive results, it may be that scientific reviews of trial designs with a focus on informativeness offer the best chance for improved outcomes and return-on-investment in clinical trials. A maturity model is a helpful tool for knowledge transfer to help grow capabilities in a new area or for those looking to perform a self-assessment in an existing area. Such a model is offered for scientific design reviews of clinical trial protocols. This maturity model includes 11 process areas and 5 maturity levels. Each of the 55 process area levels is populated with descriptions on a continuum toward an optimal state to improve trial protocols in the areas of risk of failure or uninformativeness. CONCLUSION This tool allows for prescriptive guidance on next investments to improve attributes of post-funding reviews of trials, with a focus on informativeness. Traditional pre-funding peer review has limited capacity for trial design review, especially for detailed biostatistical and methodological review. Select non-industry funders have begun to explore or invest in post-funding review programs of grantee protocols, based on exemplars of such programs. Funders with a desire to meet fiduciary responsibilities and mission goals can use the described model to enhance efforts supporting trial participant commitment and faster cures.
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Affiliation(s)
- S Dolley
- Open Global Health, 710 12th St South, Ste 2523, Arlington, VA, 22202, USA.
| | - T Norman
- The Bill & Melinda Gates Foundation, 500 Fifth Ave. North, Seattle, WA, 98109, USA
| | - D McNair
- The Bill & Melinda Gates Foundation, 500 Fifth Ave. North, Seattle, WA, 98109, USA
| | - D Hartman
- The Bill & Melinda Gates Foundation, 500 Fifth Ave. North, Seattle, WA, 98109, USA
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Saavedra JM, Lefferts EC, Song BK, Lee DC. The associations of daily steps and body mass index with incident gastroesophageal reflux disease in older adults. Front Sports Act Living 2024; 6:1384845. [PMID: 38645729 PMCID: PMC11026570 DOI: 10.3389/fspor.2024.1384845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/26/2024] [Indexed: 04/23/2024] Open
Abstract
Background High body mass index (BMI) is a major risk factor of gastroesophageal reflux disease (GERD), a prevalent morbidity of older adulthood linked to lower quality of life and an increased risk of esophageal cancers. Daily stepping behavior, the most common physical activity of older adulthood, is associated with an array of favorable health outcomes, sometimes independent of high BMI. Whether stepping behavior is associated with the incidence of GERD independently or in combination with BMI is currently unclear. Materials and methods We followed 442 individuals (58.4% female) aged 65-91 years enrolled in the Physical Activity and Aging Study. Baseline steps were obtained by pedometer and categorized by tertiles (lower, middle, upper), while BMI was categorized into normal weight, overweight, and obesity. To explore joint associations, daily steps were dichotomized into "high steps" (middle/upper tertiles) and "low steps" (lower tertile), while BMI was dichotomized into normal weight and overweight/obesity. The joint exposure categories included "low steps and overweight/obesity," "low steps and normal weight," "high steps and overweight/obesity," and "high steps and normal weight." Results We identified 35 (7.9%) cases of GERD over a mean follow-up of 2.5 years. Compared to the lower tertile of steps, the hazard ratios (HRs) [95% confidence intervals (95% CIs)] of GERD were 0.44 (0.20-0.96) and 0.17 (0.05-0.54) for the middle and upper tertiles, respectively, after adjusting for confounders (including BMI). Compared to normal weight, the HRs (95% CIs) of GERD were 1.35 (0.54-3.37) and 3.00 (1.19-7.55) for overweight and obesity, respectively, after adjusting for confounders (including steps). In a joint analysis, compared to "low steps and overweight/obesity," the HRs (95% CIs) of GERD were 0.32 (0.10-1.00), 0.23 (0.10-0.54), and 0.20 (0.07-0.58) for "low steps and normal weight," "high steps and overweight/obesity," and "high steps and normal weight," respectively. Conclusion Higher daily steps were associated with a lower risk of GERD in older adults, independent of BMI. Since accumulating steps through walking is an achievable and acceptable modality of physical activity in older adulthood, future lifestyle interventions designed to achieve high daily steps counts may have favorable implications for the development of GERD in older adults of any BMI status.
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Affiliation(s)
- Joey M. Saavedra
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | | | - Bong Kil Song
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
| | - Duck-chul Lee
- Department of Kinesiology, Iowa State University, Ames, IA, United States
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Saylor KW, Joffe S. Enhancing social value considerations in prioritising publicly funded biomedical research: the vital role of peer review. J Med Ethics 2024; 50:253-257. [PMID: 37225413 DOI: 10.1136/jme-2022-108883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
The main goal of publicly funded biomedical research is to generate social value through the creation and application of knowledge that can improve the well-being of current and future people. Prioritising research with the greatest potential social value is crucial for good stewardship of limited public resources and ensuring ethical involvement of research participants. At the National Institutes of Health (NIH), peer reviewers hold the expertise and responsibility for social value assessment and resulting prioritisation at the project level. However, previous research has shown that peer reviewers place more emphasis on a study's methods ('Approach') than on its potential social value (best approximated by the criterion of 'Significance'). Lower weighting of Significance may be due to reviewers' views on the relative importance of social value, their belief that social value is evaluated at other stages of the research priority-setting process or the lack of guidance on how to approach the challenging task of assessing expected social value. The NIH is currently revising its review criteria and how these criteria contribute to overall scores. To elevate the role of social value in priority setting, the agency should support empirical research on how peer reviewers approach the assessment of social value, provide more specific guidance for reviewing social value and experiment with alternative reviewer assignment strategies. These recommendations would help ensure that funding priorities align with the NIH's mission and the obligation of taxpayer-funded research to contribute to the public good.
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Affiliation(s)
- Katherine W Saylor
- Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven Joffe
- Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Azria E, Haaser T, Schmitz T, Froeliger A, Bouchghoul H, Madar H, Pineles BL, Sentilhes L. The ethics of induction of labor at 39 weeks in low-risk nulliparas in research and clinical practice. Am J Obstet Gynecol 2024; 230:S775-S782. [PMID: 37633577 DOI: 10.1016/j.ajog.2023.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 08/28/2023]
Abstract
The "A Randomized Trial of Induction Versus Expectant Management" trial (ARRIVE trial) published in 2018 suggested that induction of labor can be considered a "reasonable option" for low-risk nulliparous women at ≥39 weeks of gestation. The study results led some professional societies to endorse the option for elective induction of labor at 39 weeks of gestation in low-risk nulliparas, and this has begun to change obstetrical practice. The ARRIVE trial provided valuable information supporting the benefits of induction of labor; however, the trial is insufficient to serve as the primary justification for widespread elective induction of labor at 39 weeks of gestation in low-risk nulliparas because of concerns about external validity. Thus, the French ARRIVE trial was designed to test the hypothesis in a different setting that elective induction of labor at 39 weeks of gestation in low-risk nulliparas leads to a lower cesarean delivery rate than expectant management. This ongoing trial has been criticized as "pseudoscientific" and telling "women where, when, and how to give birth." We reject these allegations and extensively examine the ethical framework that should govern clinical and research interventions, including elective induction of labor at 39 weeks of gestation in low-risk nulliparas. This study aimed to discuss the ethical issues that emerge from randomized trials of elective induction of labor at 39 weeks of gestation in low-risk nulliparas and the ethics of the clinical practice itself. The analysis of existing evidence shows the importance of further research on induction of labor at 39 weeks of gestation in low-risk women. Certain aspects of research ethics in this area, particularly the consent of pregnant women in a context where autonomy remains fragile, call for vigilance. In addition, we emphasize that childbirth is not only a medical object but also a social phenomenon that cannot be regarded only from the perspective of a health risk to be managed by clinical research. Further research on this issue is needed to allow pregnant women to make informed decisions, and the results should be integrated with social issues. The perspective of women is required in constructing, evaluating, and implementing medical interventions in childbirth, such as induction of labor at 39 weeks of gestation.
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Affiliation(s)
- Elie Azria
- Maternity Unit, Hospital Paris Saint-Joseph, FHU PREMA, Paris, France; Obstetrical Perinatal and Pediatric Epidemiology Research Team, CRESS, EPOPé, INSERM, INRA, Université de Paris Cité, Paris, France
| | - Thibaud Haaser
- Health and Research Ethics Centre, University Hospital of Bordeaux, Bordeaux, France; Sciences, Philosophie, Humanités, Université de Bordeaux-Université Bordeaux-Montaigne, Domaine Universitaire, Pessac, France
| | - Thomas Schmitz
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, CRESS, EPOPé, INSERM, INRA, Université de Paris Cité, Paris, France; Department of Obstetrics and Gynaecology, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Alizée Froeliger
- Department of Obstetrics and Gynecology, University Hospital of Bordeaux, Bordeaux, France
| | - Hanane Bouchghoul
- Department of Obstetrics and Gynecology, University Hospital of Bordeaux, Bordeaux, France
| | - Hugo Madar
- Department of Obstetrics and Gynecology, University Hospital of Bordeaux, Bordeaux, France
| | - Beth L Pineles
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, University Hospital of Bordeaux, Bordeaux, France.
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Braun E. Mitochondrial replacement techniques for treating infertility. J Med Ethics 2024:jme-2023-109660. [PMID: 38383152 DOI: 10.1136/jme-2023-109660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
Mitochondrial replacement techniques (MRTs) usually aim to prevent the genetic transmission of maternally inherited mitochondrial diseases. Until now, only the UK and Australia have implemented specific legal regulations of MRTs. In both countries, clinical trials on these techniques are only permissible for cases with a high risk of severe mitochondrial disease in the offspring. However, these techniques can also be applied to treat infertility, especially for older women with impaired oocyte quality. In some countries without legal regulation of these techniques, MRTs are already offered for this purpose. Yet, this application of MRTs has received insufficient attention in the bioethical literature so far.In this paper, I examine whether there are ethical reasons to prohibit trials on MRTs in the context of infertility when they are permitted for preventing mitochondrial disease. Allowing MRTs in one context but not the other might be justified either because their application in the context of mitochondrial disease (1) is supported by a more convincing evidence base, (2) has a higher potential benefit or (3) has a lower risk. I compare both applications of MRTs with respect to these three factors. I conclude that there is no convincing reason to prohibit clinical trials on MRTs for infertility when they are permitted in the context of mitochondrial disease.
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Affiliation(s)
- Esther Braun
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
- Department of Philosophy, University of Oxford, Oxford, UK
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11
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Prescher H, Vercler CJ. Ethical Principles in Plastic Surgery Research. Semin Plast Surg 2024; 38:74-80. [PMID: 38495066 PMCID: PMC10942840 DOI: 10.1055/s-0043-1778045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Research is an integral part of medical progress that leads to better understanding of disease processes and the development of therapies to improve patient care. The medical community has an obligation and societal responsibility to review its practices and advance its knowledge to optimize care for those who entrust it with their health and well-being. While ultimately intended to benefit patients specifically and society as a whole, every laboratory and clinical investigation inherently carries an element of uncertainty and has attendant risks. These can have unintended and, at times, harmful consequences that cannot justify the knowledge gained. In order to mitigate these risks and protect human subjects involved in clinical research studies, a basic framework of ethical principles has been developed to guide responsible experimental design, execution, and data dissemination. This article provides a review of these principles and the historical context from which they were derived and explores the persistent challenges and cognitive biases that can increase susceptibility to unethical research practices.
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Affiliation(s)
- Hannes Prescher
- Division of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
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12
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Hendriks S, Althaus J, Atkinson MA, Baschat AA, Berkman BE, Grady C, Wasserman D, Wendler D, Miller JL. Precarious hope: Ethical considerations for offering experimental fetal therapies outside of research after initial studies in humans. Prenat Diagn 2024; 44:180-186. [PMID: 38069681 DOI: 10.1002/pd.6474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/24/2023] [Accepted: 11/20/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Risks and benefits of experimental fetal therapies can remain uncertain after initial clinical studies, especially long-term effects. Nevertheless, pregnant individuals may request them, hoping to benefit their future child. Guidance about offering experimental fetal therapies outside research (as "innovative therapy") is limited, despite their ethical complexity. We propose points for clinicians and reviewers to consider when deciding whether and how to offer experimental fetal therapies as innovative therapies after initial clinical studies. METHOD We used conceptual analysis and a current case to develop points for consideration, grounded in broader debates on innovative therapy and the unique challenges associated with experimental fetal therapies. RESULTS Clinicians should evaluate whether offering experimental fetal therapies as innovative therapy is appropriate for a pregnant individual and their fetus. The anticipated risk-benefit ratio for the fetus should be favorable. For the pregnant individual, risks may outweigh benefits, within reasonable limits. Medical resources should be sufficient to ensure appropriate care. Clinicians should support pregnant individuals in making informed choices. Clinicians offering innovative therapies with more than minimal risk should collect and report data on outcomes. Independent review should take place. CONCLUSION Considering these points may advance the interests of fetuses, future children, and their families.
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Affiliation(s)
- Saskia Hendriks
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - Janyne Althaus
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, Maryland, USA
| | - Meredith A Atkinson
- Department of Pediatrics, Division of Nephrology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ahmet A Baschat
- Department of Gynecology and Obstetrics, Center for Fetal Therapy, Johns Hopkins University, Baltimore, Maryland, USA
| | - Benjamin E Berkman
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
- National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Christine Grady
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - David Wasserman
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - David Wendler
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - Jena L Miller
- Department of Gynecology and Obstetrics, Center for Fetal Therapy, Johns Hopkins University, Baltimore, Maryland, USA
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13
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Xing Y, Wang X, Zhang C, Yuan W, Chen X, Luan W. Characteristics and duties of clinical research nurses: a scoping review. Front Med (Lausanne) 2024; 11:1333230. [PMID: 38304098 PMCID: PMC10830629 DOI: 10.3389/fmed.2024.1333230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024] Open
Abstract
Introduction The characteristics and duties of clinical research nurses (CRNs) are constantly developing and changing with the progress of medical technology and increasing needs in patient care. With the continuous deepening and standardization of clinical trials, the importance and status of CRNs during the whole process of clinical trials are also increasingly valued. Methods A scoping review of studies related to the characteristics and duties of CRNs was conducted to clarify relevant roles and concepts. An electronic search was conducted on three English databases (PubMed, Web of Science, Embase) and two Chinese databases (CNKI and Wanfang database) in December 2023. Two authors independently screened the literature, extracted information from the included literature, and summarized and reported the findings. Results A total of 26 articles published between 1991 and 2023 were analyzed, and four characteristics of CRNs were identified as participants and managers of clinical trials, caregivers and protectors of subjects, coordinators of research teams, and educators. Basic knowledge, skills and literacy, communication and coordination ability, and advanced research ability are the competencies required for CRNs. Conclusion Further studies should focus on the importance of various characteristics of CRNs, so as to improve the quality of clinical trials and promote clinical evidence-based practice.
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Affiliation(s)
- Ying Xing
- Nursing Department, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai, China
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Xinxin Wang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Chengrui Zhang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Weian Yuan
- GCP Center, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai, China
| | - Xinlin Chen
- Hospital Management Office of Shanghai University of TCM, Shanghai, China
| | - Wei Luan
- Nursing Department, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai, China
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14
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Tian Z, Liu Y, Zhu D, Cao B, Cui M. Changes in Intestinal Flora and Serum Metabolites Pre- and Post-Antitumor Drug Therapy in Patients with Non-Small Cell Lung Cancer. J Clin Med 2024; 13:529. [PMID: 38256661 PMCID: PMC10816336 DOI: 10.3390/jcm13020529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE this study aimed to identify the relationships between gut microbiota, metabolism, and non-small cell lung cancer (NSCLC) treatment outcomes, which are presently unclear. METHODS in this single-center prospective cohort study, we investigated changes in the gut microbiota and serum metabolite profile in 60 patients with NSCLC after four cycles of anticancer therapy. RESULTS The microbial landscape of the gut exhibited a surge in Proteobacteria and Verrucomicrobiota populations, alongside a decline in Firmicutes, Actinobacteriota, and Bacteroidota. Furthermore, a significant shift in the prevalence of certain bacterial genera was noted, with an increase in Escherichia/Shigella and Klebsiella, contrasted by a reduction in Bifidobacterium. Metabolomic analysis uncovered significant changes in lipid abundances, with certain metabolic pathways markedly altered post-treatment. Correlation assessments identified strong links between certain gut microbial genera and serum metabolite concentrations. Despite these findings, a subgroup analysis delineating patient responses to therapy revealed no significant shifts in the gut microbiome's composition after four cycles of treatment. CONCLUSIONS This study emphasizes the critical role of gut microbiota changes in NSCLC patients during anticancer treatment. These insights pave the way for managing treatment complications and inform future research to improve patient care by understanding and addressing these microbiota changes.
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Affiliation(s)
- Zhenyu Tian
- Department of Cardiology, Institute of Vascular Medicine, Peking University Third Hospital, Beijing 100191, China; (Z.T.); (D.Z.)
| | - Yan’e Liu
- Department of Cancer Chemotherapy and Radiation, Peking University Third Hospital, Beijing 100191, China;
| | - Dan Zhu
- Department of Cardiology, Institute of Vascular Medicine, Peking University Third Hospital, Beijing 100191, China; (Z.T.); (D.Z.)
| | - Baoshan Cao
- Department of Cancer Chemotherapy and Radiation, Peking University Third Hospital, Beijing 100191, China;
| | - Ming Cui
- Department of Cardiology, Institute of Vascular Medicine, Peking University Third Hospital, Beijing 100191, China; (Z.T.); (D.Z.)
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15
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van Rijssel TI, van Thiel GJMW, Gardarsdottir H, van Delden JJM. Which Benefits Can Justify Risks in Research? Am J Bioeth 2024:1-11. [PMID: 38181217 DOI: 10.1080/15265161.2023.2296404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
Research ethics committees (RECs) evaluate whether the risk-benefit ratio of a study is acceptable. Decentralized clinical trials (DCTs) are a novel approach for conducting clinical trials that potentially bring important benefits for research, including several collateral benefits. The position of collateral benefits in risk-benefit assessments is currently unclear. DCTs raise therefore questions about how these benefits should be assessed. This paper aims to reconsider the different types of research benefits, and their position in risk-benefit assessments. We first propose a categorization of research benefits, based on the types of benefits that can be distinguished from the literature and ethical guidelines. Secondly, we will reconsider the position of collateral benefits. We argue that these benefits are not fundamentally different from other benefits of research and can therefore be included in risk-benefit assessments of DCTs.
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16
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John London A, Karlawish J, Largent EA, Phillips Hey S, McCarthy EP. Algorithmic identification of persons with dementia for research recruitment: ethical considerations. Inform Health Soc Care 2024; 49:28-41. [PMID: 38196387 PMCID: PMC11001531 DOI: 10.1080/17538157.2023.2299881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Underdiagnosis, misdiagnosis, and patterns of social inequality that translate into unequal access to health systems all pose barriers to identifying and recruiting diverse and representative populations into research on Alzheimer's disease and Alzheimer's disease related dementias. In response, some have turned to algorithms to identify patients living with dementia using information that is associated with this condition but that is not as specific as a diagnosis. This paper explains six ethical issues associated with the use of such algorithms including the generation of new, sensitive, identifiable medical information for research purposes without participant consent, issues of justice and equity, risk, and ethical communication. It concludes with a discussion of strategies for addressing these issues and prompting valuable research.
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Affiliation(s)
- Alex John London
- Center for Ethics and Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Jason Karlawish
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Emily A. Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Ellen P. McCarthy
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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17
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Wu C, Wang N, Wang Q, Wang C, Wei Z, Wu Z, Yu S, Jiang X. Participants' understanding of informed consent in clinical trials: A systematic review and updated meta-analysis. PLoS One 2024; 19:e0295784. [PMID: 38166097 PMCID: PMC10760836 DOI: 10.1371/journal.pone.0295784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/29/2023] [Indexed: 01/04/2024] Open
Abstract
Obtaining written informed consent from participants before enrolment in a study is essential. A previous study showed that only 50% of the participants in clinical trials understood the components of informed consent, and the methods of participants' understanding of informed consent were controversial. This updated meta-analysis aimed to estimate the proportion of participants in clinical trials who understand the different informed consent components. PubMed, EMBASE, the Cochrane Library, and Scopus were searched till April 2023. Therapeutic misconception, ability to name one risk, knowing that treatments were being compared, and understanding the nature of the study, the purpose of the study, the risks and side-effects, the direct benefits, placebo, randomization, voluntariness, freedom to withdraw, the availability of alternative treatment if withdrawn from the trial, confidentiality, compensation, or comprehension were evaluated. This meta-analysis included 117 studies (155 datasets; 22,118 participants). The understanding of the risks and side-effects was investigated in the largest number of studies (n = 100), whereas comparehension was investigated in the smallest number (n = 11). The highest proportions were 97.5%(95% confidence interval (CI): 97.1-97.9) for confidentiality, 95.9% (95% confidence interval (CI): 95.4-96.4) for compensation, 91.4% (95% CI: 90.7-92.1) for the nature of study, 68.1% (95% CI: 51.6-84.6) for knowing that treatments were being compared, and 67.3% (95% CI: 56.6-78) for voluntary nature of participants. The smallest proportions were the concept of placebo (4.8%, 95%CI: 4.4-5.2) and randomization(39.4%, 95%CI: 38.3-40.4). Our findings suggested that most participants understood the fundamental components of informed consent (study confidentiality, nature, compensation, voluntariness, and freedom to withdraw). The understanding of other components, such as placebo and randomization was less satisfactory.
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Affiliation(s)
- Chengai Wu
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Na Wang
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Qianqian Wang
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Chao Wang
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Zhenjie Wei
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Zhimin Wu
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Shunan Yu
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xieyuan Jiang
- Beijing Jishuitan Hospital, Capital Medical University, Beijing Research Institute of Traumatology and Orthopaedics, Beijing, China
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18
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Warner E, Marron JM, Peppercorn JM, Abel GA, Hantel A. Shifting from Equality toward Equity: Addressing Disparities in Research Participation for Clinical Cancer Research. J Clin Ethics 2024; 35:8-22. [PMID: 38373334 PMCID: PMC10983799 DOI: 10.1086/728144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
AbstractThere is societal consensus that cancer clinical trial participation is unjust because some sociodemographic groups have been systematically underrepresented. Despite this, neither a definition nor an ethical explication for the justice norm of equity has been clearly articulated in this setting, leading to confusion over its application and goals. Herein we define equity as acknowledging sociodemographic circumstances and apportioning resource and opportunity allocation to eliminate disparities in outcomes, and we explore the issues and tensions this norm generates through practical examples. We assess how equality-based enrollment structures in clinical cancer research have perpetuated historical disparities and what equity-based alternatives are necessary to achieve representativeness and an expansive conception of participatory justice in clinical cancer research. This framework addresses the breadth from normative to applied by defining the justice norm of equity and translating it into practical strategies for addressing participation disparities in clinical cancer research.
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19
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Ueda D, Kakinuma T, Fujita S, Kamagata K, Fushimi Y, Ito R, Matsui Y, Nozaki T, Nakaura T, Fujima N, Tatsugami F, Yanagawa M, Hirata K, Yamada A, Tsuboyama T, Kawamura M, Fujioka T, Naganawa S. Fairness of artificial intelligence in healthcare: review and recommendations. Jpn J Radiol 2024; 42:3-15. [PMID: 37540463 PMCID: PMC10764412 DOI: 10.1007/s11604-023-01474-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/17/2023] [Indexed: 08/05/2023]
Abstract
In this review, we address the issue of fairness in the clinical integration of artificial intelligence (AI) in the medical field. As the clinical adoption of deep learning algorithms, a subfield of AI, progresses, concerns have arisen regarding the impact of AI biases and discrimination on patient health. This review aims to provide a comprehensive overview of concerns associated with AI fairness; discuss strategies to mitigate AI biases; and emphasize the need for cooperation among physicians, AI researchers, AI developers, policymakers, and patients to ensure equitable AI integration. First, we define and introduce the concept of fairness in AI applications in healthcare and radiology, emphasizing the benefits and challenges of incorporating AI into clinical practice. Next, we delve into concerns regarding fairness in healthcare, addressing the various causes of biases in AI and potential concerns such as misdiagnosis, unequal access to treatment, and ethical considerations. We then outline strategies for addressing fairness, such as the importance of diverse and representative data and algorithm audits. Additionally, we discuss ethical and legal considerations such as data privacy, responsibility, accountability, transparency, and explainability in AI. Finally, we present the Fairness of Artificial Intelligence Recommendations in healthcare (FAIR) statement to offer best practices. Through these efforts, we aim to provide a foundation for discussing the responsible and equitable implementation and deployment of AI in healthcare.
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Affiliation(s)
- Daiju Ueda
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan.
| | | | - Shohei Fujita
- Department of Radiology, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Sakyoku, Kyoto, Japan
| | - Rintaro Ito
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Kita-ku, Okayama, Japan
| | - Taiki Nozaki
- Department of Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medicine, Chuo-ku, Kumamoto, Japan
| | - Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Fuminari Tatsugami
- Department of Diagnostic Radiology, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Masahiro Yanagawa
- Department of Radiology, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Kenji Hirata
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Hokkaido, Japan
| | - Akira Yamada
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takahiro Tsuboyama
- Department of Radiology, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tomoyuki Fujioka
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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20
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Rohrig A, Morrison J, Kleinwaks G, Pugh J, McShane H, Savulescu J. Exploring the ethics of tuberculosis human challenge models. J Med Ethics 2023:jme-2023-109234. [PMID: 38159935 DOI: 10.1136/jme-2023-109234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/28/2023] [Indexed: 01/03/2024]
Abstract
We extend recent conversation about the ethics of human challenge trials to tuberculosis (TB). TB challenge studies could accelerate vaccine development, but ethical concerns regarding risks to trial participants and third parties have been a limiting factor. We analyse the expected social value and risks of different challenge models, concluding that if a TB challenge trial has between a 10% and a 50% chance of leading to the authorisation and near-universal delivery of a more effective vaccine 3-5 years earlier, then the trial would save between 26 400 and 1 100 000 lives over the next 10 years. We also identify five important ethical considerations that differentiate TB from recent human challenge trials: an exceptionally high disease burden with no highly effective vaccine; heightened third party risk following the trial, and, partly for that reason, uniquely stringent biosafety requirements for the trial; risks associated with best available TB treatments; and difficulties with TB disease detection. We argue that there is good reason to consider conducting challenge trials with attenuated strains like Bacillus Calmette-Guérin or attenuated Mycobacterium tuberculosis.
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Affiliation(s)
- Abie Rohrig
- Columbia University, New York, New York, USA
- 1Day Sooner, Baltimore, Maryland, USA
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | | | | | - Jonathan Pugh
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Helen McShane
- Jenner Institute, University of Oxford Nuffield Department of Medicine, Oxford, Oxfordshire, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Biomedical Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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21
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D'Souza J, Samuel G. Clinical Research Risks, Climate Change, and Human Health. JAMA 2023; 330:2247-2248. [PMID: 38010720 DOI: 10.1001/jama.2023.23724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
This Viewpoint discusses ways in which clinical research directly and indirectly contributes to anthropogenic climate change, highlights the need for increased scientific soundness and value in research, and calls for the development of tools for calculating the environmental impact of studies and a strategy for ensuring that research does not compromise the rights and welfare of nonparticipants and future generations.
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Affiliation(s)
- Jeff D'Souza
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Program for Ethics and Care Ecologies (PEaCE), Hamilton Health Sciences, Toronto, Ontario, Canada
| | - Gabrielle Samuel
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
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22
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Zhang TR. Ethics of 'Counting Me In': framing the implications of direct-to-patient genomics research. J Med Ethics 2023; 50:45-49. [PMID: 37130755 DOI: 10.1136/jme-2022-108741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/03/2023] [Indexed: 05/04/2023]
Abstract
Count Me In (CMI) was launched in 2015 as a patient-driven research initiative aimed at accelerating the study of cancer genomics through direct participant engagement, electronic consent and open-access data sharing. It is an example of a large-scale direct-to-patient (DTP) research project which has since enrolled thousands of individuals. Within the broad scope of 'citizen science', DTP genomics research is defined here as a specific form of 'top-down' research endeavour developed and overseen by institutions within the traditional human subjects research context; in novel ways, it engages and recruits patients with defined diseases, consents them for medical information and biospecimens sharing, and stores and disseminates genomic information. Importantly, these projects simultaneously aim to empower participants in the research process while increasing sample size, particularly in rare disease states. Using CMI as a case study, this paper discusses how DTP genomics research raises new questions in the context of traditional human subjects research ethics, including issues surrounding participant selection, remote consent, privacy and return of results. It aims to demonstrate how current research ethics frameworks may be insufficient in this context, and that institutions, institutional review boards and investigators should be aware of these gaps and their role in ensuring the conduct of ethical, novel forms of research together with participants. Ultimately, a broader question is raised of whether the rhetoric of participatory genomics research advocates for an ethic of personal and social duty for contributing to the advancement of generalisable knowledge about health and disease.
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Affiliation(s)
- Tenny R Zhang
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, USA
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23
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Doernberg S, Truog R. Spheres of Morality: The Ethical Codes of the Medical Profession. Am J Bioeth 2023; 23:8-22. [PMID: 36607309 DOI: 10.1080/15265161.2022.2160514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The medical profession contains five "spheres of morality": clinical care, clinical research, scientific knowledge, population health, and the market. These distinct sets of normative commitments require physicians to act in different ways depending on the ends of the activity in question. For example, a physician-scientist emphasizes patients' well-being in clinic, prioritizes the scientific method in lab, and seeks to maximize shareholder returns as a board member of a pharmaceutical firm. Physicians increasingly occupy multiple roles in healthcare and move between them frequently, creating the possibility of conflict between the ethical obligations of their various roles. This paper examines the entire moral landscape of medicine through the lens of role morality. It develops a novel framework that helps physicians recognize how their moral commitments depend on the nature and context of the situation, clarifies ethical conflicts that physicians face, and concludes with ideas for resolving these conflicts.
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24
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Rhodes R. Competing Duties and Professional Roles. Am J Bioeth 2023; 23:25-28. [PMID: 38010682 DOI: 10.1080/15265161.2023.2272934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
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25
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Chapman CR, Quinn GP, Natri HM, Berrios C, Dwyer P, Owens K, Heraty S, Caplan AL. Consideration and Disclosure of Group Risks in Genomics and Other Data-Centric Research: Does the Common Rule Need Revision? Am J Bioeth 2023:1-14. [PMID: 38010648 DOI: 10.1080/15265161.2023.2276161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Harms and risks to groups and third-parties can be significant in the context of research, particularly in data-centric studies involving genomic, artificial intelligence, and/or machine learning technologies. This article explores whether and how United States federal regulations should be adapted to better align with current ethical thinking and protect group interests. Three aspects of the Common Rule deserve attention and reconsideration with respect to group interests: institutional review board (IRB) assessment of the risks/benefits of research; disclosure requirements in the informed consent process; and criteria for waivers of informed consent. In accordance with respect for persons and communities, investigators and IRBs should systematically consider potential group harm when designing and reviewing protocols, respectively. Research participants should be informed about any potential group harm in the consent process. We call for additional public discussion, empirical research, and normative analysis on these issues to determine the right regulatory and policy path forward.
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Affiliation(s)
| | | | | | - Courtney Berrios
- Children's Mercy Kansas City
- University of Missouri-Kansas City School of Medicine
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26
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Ritchie M, Gillen DL, Grill JD. Estimating attrition in mild-to-moderate Alzheimer's disease and mild cognitive impairment clinical trials. Alzheimers Res Ther 2023; 15:203. [PMID: 37990339 PMCID: PMC10662394 DOI: 10.1186/s13195-023-01352-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Participant retention is a key factor that affects clinical trial integrity. Trial protocols estimate attrition as a function of sample size calculations. Alzheimer's disease (AD) is an area of active treatment development. We aimed to quantify the association between trial duration and completion rates and provide guidance for estimating attrition in AD trial protocols. METHODS Using the Alzforum and ClinicalTrials.gov databases, we analyzed retention data from 125 mild-to-moderate AD and 12 mild cognitive impairment (MCI) clinical trials. We compared the rates of completion between trial arms (active vs. control) and ran regression models to test the hypothesis that trials with longer study duration have lower trial completion using all available data and restricting to placebo data. Our primary outcome was the odds of trial completion for a 6-month increase in trial duration. From the regression model, we estimated the proportion of participants completing 6-, 12-, and 18-month trials. RESULTS We found that 21 (17%) mild-to-moderate AD trials and 1 (8%) MCI trial demonstrated greater dropout in treatment compared to placebo arms. For every 6-month increase in trial duration, there was a 27% decrease in the odds of trial completion (OR = 0.73; 95% CI 0.66, 0.81; p < 0.001) among participants in mild-to-moderate AD trials and a 55% decrease (OR = 0.45; 95% CI 0.36, 0.57; p < 0.001) among participants in MCI trials. The proportion of participants in the placebo group completing 6-, 12-, and 18-month trials were estimated to be 85.2%, 80.0%, and 73.3% for mild-to-moderate AD trials and 91.9%, 84.2%, and 71.3% for MCI trials, respectively. CONCLUSIONS Longer duration trials may be underpowered to demonstrate estimated treatment effects and may suffer from a greater risk of bias than do shorter trials.
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Affiliation(s)
- Marina Ritchie
- UC Irvine Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, 92697, USA.
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, 92697, USA.
| | - Daniel L Gillen
- UC Irvine Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, 92697, USA
- Department of Statistics, University of California, Irvine, Irvine, CA, 92697, USA
| | - Joshua D Grill
- UC Irvine Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, 92697, USA
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, 92697, USA
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Foláyan MO, Haire B. What's trust got to do with research: why not accountability? Front Res Metr Anal 2023; 8:1237742. [PMID: 38025960 PMCID: PMC10679329 DOI: 10.3389/frma.2023.1237742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
This paper explores the intricate dynamics of trust, power, and vulnerability in the relationship between researchers and study participants/communities in the field of bioethics. The power and knowledge imbalances between researchers and participants create a structural vulnerability for the latter. While trust-building is important between researchers and study participants/communities, the consenting process can be challenging, often burdening participants with power abrogation. Trust can be breached. The paper highlights the contractual nature of the research relationship and argues that trust alone cannot prevent exploitation as power imbalances and vulnerabilities persist. To protect participants, bioethics guidance documents promote accountability and ethical compliance. These documents uphold fairness in the researcher-participant relationship and safeguard the interests of socially vulnerable participants. The paper also highlights the role of shared decision-making and inclusive deliberation with diverse stakeholders and recommends that efforts should be made by researchers to clarify roles and responsibilities, while research regulatory agents should transform the research-participant relationship into a legal-based contract governed by accountability principles. While trust remains important, alternative mechanisms may be needed to ensure ethical research practices and protect the interests of participants and communities. Striking a balance between trust and accountability is crucial in this regard.
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Affiliation(s)
| | - Bridget Haire
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Ulrich CM, Ratcliffe SJ, Hochheimer CJ, Zhou Q, Huang L, Gordon T, Knafl K, Richmond T, Schapira MM, Miller V, Mao JJ, Naylor M, Grady C. Informed Consent among Clinical Trial Participants with Different Cancer Diagnoses. AJOB Empir Bioeth 2023:1-13. [PMID: 37921867 DOI: 10.1080/23294515.2023.2262992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
IMPORTANCE Informed consent is essential to ethical, rigorous research and is important to recruitment and retention in cancer trials. OBJECTIVE To examine cancer clinical trial (CCT) participants' perceptions of informed consent processes and variations in perceptions by cancer type. DESIGN AND SETTING AND PARTICIPANTS Cross-sectional survey from mixed-methods study at National Cancer Institute-designated Northeast comprehensive cancer center. Open-ended and forced-choice items addressed: (1) enrollment and informed consent experiences and (2) decision-making processes, including risk-benefit assessment. Eligibility: CCT participant with gastro-intestinal or genitourinary, hematologic-lymphatic malignancies, lung cancer, and breast or gynecological cancer (N = 334). MAIN OUTCOME MEASURES Percentages satisfied with consent process and information provided; and assessing participation's perceptions of risks/benefits. Multivariable logistic or ordinal regression examined differences by cancer type. RESULTS Most patient-participants felt well informed by the consent process (more than 90% overall and by cancer type) and. most (87.4%) reported that the consent form provided all the information they wanted, although nearly half (44.8%) reported that they read the form somewhat carefully or less. More than half (57.9%) said that talking to research staff (i.e., the consent process) had a greater impact on participation decisions than reading the consent form (2.1%). A third (31.1%) were very sure of joining in research studies before the informed consent process (almost half of lung cancer patients did-47.1%). Most patients personally assessed the risks and benefits before consenting. However, trust in physicians played an important role in the decision to enroll in CCT. CONCLUSIONS AND RELEVANCE Cancer patients rely less on written features of the informed consent process than on information obtained from the research staff and their own physicians. Research should focus on information and communication strategies that support informed consent from referring physicians, researchers, and others to improve patient risk-benefit assessment and decision-making.
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Affiliation(s)
- Connie M Ulrich
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | - Qiuping Zhou
- George Washington University, Washington, District of Columbia, USA
| | - Liming Huang
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Thomas Gordon
- University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Kathleen Knafl
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Therese Richmond
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Marilyn M Schapira
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Victoria Miller
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mary Naylor
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Christine Grady
- National Institutes of Health, Clinical Center Department of Bioethics, Bethesda, Maryland, USA
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Green JM, Rosenfeld S. Conflicts of interest in institutional review boards are a threat to ethical research. Nat Med 2023; 29:2701-2703. [PMID: 37488292 DOI: 10.1038/s41591-023-02442-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Affiliation(s)
- Jonathan M Green
- Office of Intramural Research, National Institutes of Health, Bethesda, MD, USA.
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30
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Zhang Z, Ng Ming Sheng S, Kempen JH, Fabiani C, Arora A, Gupta V, Tsui E, Cimino L, Symes RJ, Dell J, Finger RP, Heinz C, Agrawal R. Uveitis Registries - A Digital Tool for Patient Care, Education, Research, and Collaboration. Ocul Immunol Inflamm 2023; 31:1859-1869. [PMID: 36328530 DOI: 10.1080/09273948.2022.2140062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Clinical registries are increasingly important in research and clinical advancement. This review explores and compares current uveitis registries and recommends future directions on how uveitis registries can complement one another for synergistic effect and benefit. METHODS From a systematic search, 861 citations were screened for longitudinal, non-interventional, and multicenter uveitis-specific registries. Additional registries were identified via consultations with uveitis experts. Characteristics of all registries were analyzed and compared. RESULTS Four registries were identified: Treatment Exit Options for Non-infectious Uveitis, AutoInflammatory Disease Alliance International Registry, Ocular Autoimmune Systemic Inflammatory Infectious Study, and Fight Uveitis Blindness!. Despite certain differences, these registries have the overarching goal of collecting large quantities of real-world, high-quality patient data to improve the understanding of uveitis. CONCLUSION The four uveitis registries share similar goals and collect clinical data from overlapping geographical regions. There is vast potential for collaboration, including data sharing to further augment datasets for analysis.
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Affiliation(s)
- Zheting Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sean Ng Ming Sheng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and MyungSung Medical School, Boston Massachusetts, USA
- Department of Ophthalmology, Addis Ababa University Faculty of Medicine, Addis Ababa, Ethiopia
- Sight for Souls, Bellevue, Washington, USA
| | - Claudia Fabiani
- Ophthalmology Unit,Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Atul Arora
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Edmund Tsui
- Stein Eye Institute, David Geffen of Medicine at UCLA, Los Angeles, California, USA
| | - Luca Cimino
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, University of Modena and Reggio Emilia, Modena, Italy
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Richard J Symes
- Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Jennifer Dell
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Carsten Heinz
- Department of Ophthalmology, St. Franziskus Hospital Münster, Münster, Germany
- Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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31
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Wu L, Kong X. A study on the normative path of ethics review in China: based on the perspective of Panopticism. Front Med (Lausanne) 2023; 10:1268046. [PMID: 37964888 PMCID: PMC10641727 DOI: 10.3389/fmed.2023.1268046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/17/2023] [Indexed: 11/16/2023] Open
Abstract
Modern biomedical technology is in an era of dramatic development, which brings unprecedented challenges to the work of ethics review and provides a turning point for the construction of ethics review system. The current ethics review committee (ERC) in China is executed with low efficiency and quality, which can hardly meet the current needs of biomedical research involving human beings. This paper summarizes the main connotations and roles of the sign system technique and the discipline mechanism through the idea of Foucault's Panopticism, and proposes to incorporate the Panopticism into the construction of the ethics review system and establish the sign system and discipline mechanism of ethics review, in order to build an ethics review system and the operation system of the ethics review committee suitable for China's national conditions.
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Affiliation(s)
| | - Xiangjin Kong
- College of Humanities and Social Sciences, Dalian Medical University, Dalian, China
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Dickert NW, Devireddy CM. Honest Deception: The Importance of Sham-Controlled Trials. JACC Cardiovasc Interv 2023; 16:2558-2560. [PMID: 37879809 DOI: 10.1016/j.jcin.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Neal W Dickert
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA; Emory Health Services Research Center, Atlanta, Georgia, USA.
| | - Chandan M Devireddy
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Levy L, Ebadi H, Smith AP, Taiclet L, Pouratian N, Feinsinger A. Disentangling Function from Benefit: Participant Perspectives from an Early Feasibility Trial for a Novel Visual Cortical Prosthesis. AJOB Neurosci 2023:1-19. [PMID: 37812142 PMCID: PMC11001790 DOI: 10.1080/21507740.2023.2257152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Visual cortical prostheses (VCPs) have the potential to provide artificial vision for visually impaired persons. However, the nature and utility of this form of vision is not yet fully understood. Participants in the early feasibility trial for the Orion VCP were interviewed to gain insight into their experiences using artificial vision, their motivations for participation, as well as their expectations and assessments of risks and benefits. Analyzed using principles of grounded theory and an interpretive description approach, these interviews yielded six themes, including: the irreducibility of benefit to device functionality, mixed expectations for short-term device functionality and long-term technological advancement of visual prostheses, and a broad range of risks, concerns, and fears related to trial participation. We argue that these narratives motivate a nuanced set of ethical considerations related to the complex relationship between functionality and benefit, the intersection of user experience with disability justice, and the import of expectations and indirect risks on consent.
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Affiliation(s)
- Lilyana Levy
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Hamasa Ebadi
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ally Peabody Smith
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Lauren Taiclet
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Nader Pouratian
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ashley Feinsinger
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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34
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Chapman CR. Ethical, legal, and social implications of genetic risk prediction for multifactorial disease: a narrative review identifying concerns about interpretation and use of polygenic scores. J Community Genet 2023; 14:441-452. [PMID: 36529843 PMCID: PMC10576696 DOI: 10.1007/s12687-022-00625-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022] Open
Abstract
Advances in genomics have enabled the development of polygenic scores (PGS), sometimes called polygenic risk scores, in the context of multifactorial diseases and disorders such as cancer, cardiovascular disease, and schizophrenia. PGS estimate an individual's genetic predisposition, as compared to other members of a population, for conditions which are influenced by both genetic and environmental factors. There is significant interest in using genetic risk prediction afforded through PGS in public health, clinical care, and research settings, yet many acknowledge the need to thoughtfully consider and address ethical, legal, and social implications (ELSI). To contribute to this effort, this paper reports on a narrative review of the literature, with the aim of identifying and categorizing ELSI relating to genetic risk prediction in the context of multifactorial disease, which have been raised by scholars in the field. Ninety-two articles, spanning from 1977 to 2021, met the inclusion criteria for this study. Identified ELSI included potential benefits, challenges and risks that focused on concerns about interpretation and use, and ethical obligations to maximize benefits, minimize risks, promote justice, and support autonomy. This research will support geneticists, clinicians, genetic counselors, patients, patient advocates, and policymakers in recognizing and addressing ethical concerns associated with PGS; it will also guide future empirical and normative research.
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Affiliation(s)
- Carolyn Riley Chapman
- Department of Population Health (Division of Medical Ethics), NYU Grossman School of Medicine, New York, NY, USA.
- Center for Human Genetics and Genomics, NYU Grossman School of Medicine, Science Building, 435 E. 30th St, 8th Floor, New York, NY, 10016, USA.
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35
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Selvaggi G, Maltese G, Kölby L, Elander A, Tarnow P, Kljajić M. Ethical Considerations in Surgery for Single-suture Craniosynostosis. J Craniofac Surg 2023; 34:1922-1926. [PMID: 37552119 DOI: 10.1097/scs.0000000000009590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/19/2023] [Indexed: 08/09/2023] Open
Abstract
Singe-suture craniosynostosis (SSC) describes the premature fusion of one cranial suture, which restricts cranial growth and consequently results in unaffected regions presenting a compensatory expansion. Surgery can redistribute intracranial volume, reduce the risk of elevated intracranial pressure, and improve head shape, potentially leading to improved neurocognitive function and social acceptance. However, there is limited evidence that surgery for SSC improves neurocognitive function and social acceptance. Given the inherent surgical risks and uncertainty of outcomes, the conditions under which this surgery should be allowed remain uncertain. Here, we discuss ethical questions regarding the permissibility of surgery, value of neurocognitive function and social acceptance, research ethics associated with SSC, patient autonomy and parental roles, and the process of recommending surgery and obtaining consent. Because surgery for SSC has become a routine procedure, its practice now presents a relatively low risk of complications. Furthermore, having acquired an understanding of the risks associated with this surgery, such knowledge fulfils the principle of non-maleficence although not beneficence. Thus, we advocate that surgery should only be offered within Institutional Review Board-approved research projects. In these situations, decisions concerning enrollment in scientific research involves health care providers and parents or guardians of the child, with the former acting as gate-keepers upon recognition of a lack of coping skills on the part of the parent or guardian in dealing with unforeseen outcomes. To minimize associated surgical risks and maximize its benefits, there exists a moral obligation to refer patients only to highly specialized centers.
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Affiliation(s)
- Gennaro Selvaggi
- University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Peyro-Saint-Paul L, Gaillard C, Paris A, Gourio C, Zerger C, Ficheux M, Grandazzi G, Parienti JJ, Morello R. Compensating patients in trials: Perspectives from an ethical committee versus sponsor. Eur J Clin Invest 2023; 53:e14044. [PMID: 37345217 DOI: 10.1111/eci.14044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND According to European clinical research legislation, no undue influence, including financial incentives, should be used to encourage participation in clinical trials. Financial compensation should be based on the inconvenience experienced by patients and is determined by the sponsor. OBJECTIVES The objective of this study was to assess the adequacy of patients' financial compensation by obtaining an external ethical opinion compared to the actual compensation provided. METHODS We randomly selected and reviewed 50 clinical drug trials, including 25 academic and 25 industry-sponsored studies. An external ethics group consisting of three members from French ethics committees, blinded to the actual compensation and the sponsor, retrospectively reviewed the study characteristics and assessed whether financial compensation was appropriate. Cohen's Kappa test measured agreement between actual compensation and the ethics group's opinion, and the McNemar test measured discrepancies. RESULTS There was no agreement between the actual financial compensation and the ethics group's opinion (K = -.07; 95% CI = [-.16-.02]). More discrepancies were found in favour of financial compensation according to the ethics group than provided by sponsors (12 vs. 2, p = .016). The ethics group recommended financial compensation in 12 out of 50 studies (24%), which were studies with a higher number of additional visits (p = .004) and were more frequently sponsored by industry (p = .008). Sponsors only provided financial compensation in 2 out of 50 studies (4%). CONCLUSION Patients are rarely compensated despite the perceived inconvenience. Both sponsors and ethics members struggle to determine the need for financial compensation, indicating a need for more precise recommendations for both parties.
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Affiliation(s)
- Laure Peyro-Saint-Paul
- Pharmacovigilant, Responsable de lunite de vigilance des essais cliniques (UVEC), Direction de la Recherche et de l'innovation, CHU Caen Normandie, Caen, France
| | - Cathy Gaillard
- Pharmacovigilant, Responsable de lunite de vigilance des essais cliniques (UVEC), Direction de la Recherche et de l'innovation, CHU Caen Normandie, Caen, France
| | | | - Charlotte Gourio
- Pharmacovigilant, Responsable de lunite de vigilance des essais cliniques (UVEC), Direction de la Recherche et de l'innovation, CHU Caen Normandie, Caen, France
| | - Céleste Zerger
- Université Paris Descartes Faculté de Médecine, Paris, France
| | - Maxence Ficheux
- Pharmacovigilant, Responsable de lunite de vigilance des essais cliniques (UVEC), Direction de la Recherche et de l'innovation, CHU Caen Normandie, Caen, France
| | | | | | - Rémy Morello
- Pharmacovigilant, Responsable de lunite de vigilance des essais cliniques (UVEC), Direction de la Recherche et de l'innovation, CHU Caen Normandie, Caen, France
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Kamisato A, Hong H, Okubo S. Public Awareness of Medical Research Terminology in Japan, and the Accuracy of Physicians' Predictions regarding that Awareness. Asian Bioeth Rev 2023; 15:397-416. [PMID: 37808447 PMCID: PMC10555973 DOI: 10.1007/s41649-023-00247-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/31/2023] Open
Abstract
One of the ethical principles of medical research involving human subjects is obtaining proper informed consent (IC). However, if the participants' actual awareness of medical research terminology is lower than the researchers' prediction of that awareness, it may cause difficulty obtaining proper IC. Therefore, this study aims to clarify the presence of "perception gaps" and then discuss IC-related issues and measures based on the insights obtained. We conducted two online surveys: a "public survey" to understand the Japanese public's awareness of 11 medical research terms and a "physicians' survey" to investigate physicians' predictions regarding public awareness. In the "public survey," for each term, respondents were instructed to select their situation from "understand," "have heard," or "have never heard." In the "physicians' survey," respondents were asked to estimate the proportions of the general public who would "have understood," "have heard," or "have never heard" by using an 11-step scale. We analyzed separately in two age groups to understand the age-related difference. We received 1002 valid responses for the "public survey" and 275 for the "physicians' survey." Of the public respondents, more than 80% had never heard of terms such as interventional study, prospective clinical study, cohort study, Phase I clinical trial, or double-blind study. Concurrently, physicians overestimated general public awareness of the terms placebo, cohort study, double-blind study, and randomized clinical trial (in the group of people under 60). The results revealed the perception gap between the general public and physicians which raise serious concerns about obtaining proper IC from clinical research participants. Supplementary Information The online version contains supplementary material available at 10.1007/s41649-023-00247-4.
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Affiliation(s)
- Ayako Kamisato
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hyunsoo Hong
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Suguru Okubo
- Ritsumeikan University, Kyoto, Japan
- BMS Yokohama Inc., Yokohama, Kanagawa Japan
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Bigford GE, Betancourt LF, Charlifue S, Nash MS. Therapeutic Lifestyle Intervention Targeting Enhanced Cardiometabolic Health and Function for Persons with Chronic Spinal Cord Injury in Caregiver/Care-Receiver Co-Treatment: A Study Protocol of a Multisite Randomized Controlled Trial. Int J Environ Res Public Health 2023; 20:6819. [PMID: 37835090 PMCID: PMC10572441 DOI: 10.3390/ijerph20196819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Chronic spinal cord injury (SCI) significantly accelerates morbidity and mortality, partly due to the increased risk of cardiometabolic diseases (CMD), including neurogenic obesity, dyslipidemia, and impaired glucose metabolism. While exercise and dietary interventions have shown some transient benefits in reducing CMD risk, they often fail to improve clinically relevant disease markers and cardiovascular events. Moreover, SCI also places caregiving demands on their caregivers, who themselves experience health and functional decline. This underscores the need for more substantial interventions that incorporate appropriate physical activity, heart-healthy nutrition, and behavioral support tailored to the SCI population. OBJECTIVES This randomized clinical trial (RCT) protocol will (1) assess the health and functional effects, user acceptance, and satisfaction of a 6-month comprehensive therapeutic lifestyle intervention (TLI) adapted from the National Diabetes Prevention Program (DPP) for individuals with chronic SCI and (2) examine the impact of a complementary caregiver program on the health and function of SCI caregivers and evaluate user acceptance and satisfaction. Caregivers (linked with their partners) will be randomized to 'behavioral support' or 'control condition'. METHODS Dyadic couples comprise individuals with SCI (18-65 years, >1-year post-injury, ASIA Impairment Scale A-C, injury levels C5-L1) and non-disabled SCI caregivers (18-65 years). Both groups undergo lock-step circuit resistance training, a calorie-restricted Mediterranean-style diet, and 16 educational sessions focused on diet/exercise goals, self-monitoring, psychological and social challenges, cognitive behavioral therapy, and motivational interviewing. The outcome measures encompass the cardiometabolic risks, cardiorespiratory fitness, inflammatory stress, multidimensional function, pain, life quality, independence, self-efficacy, program acceptance, and life satisfaction for SCI participants. The caregiver outcomes include multidimensional function, pain, quality of life, independence, and perceived caregiver burden. DISCUSSION/CONCLUSIONS This study evaluates the effects and durability of a structured, multi-modal intervention on health and function. The results and intervention material will be disseminated to professionals and consumers for broader implementation. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02853149 Registered 2 August 2016.
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Affiliation(s)
- Gregory E. Bigford
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (L.F.B.); (M.S.N.)
| | - Luisa F. Betancourt
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (L.F.B.); (M.S.N.)
| | | | - Mark S. Nash
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (L.F.B.); (M.S.N.)
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33101, USA
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Kraft SA, Duenas DM, Shah SK. Patient priorities for fulfilling the principle of respect in research: findings from a modified Delphi study. BMC Med Ethics 2023; 24:73. [PMID: 37735658 PMCID: PMC10512546 DOI: 10.1186/s12910-023-00954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Standard interpretations of the ethical principle of respect for persons have not incorporated the views and values of patients, especially patients from groups underrepresented in research. This limits the ability of research ethics scholarship, guidance, and oversight to support inclusive, patient-centered research. This study aimed to identify the practical approaches that patients in community-based settings value most for conveying respect in genomics research. METHODS We conducted a 3-round, web-based survey using the modified Delphi technique to identify areas of agreement among English-speaking patients at primary care clinics in Washington State and Idaho who had a personal or family history of cancer. In Round 1, respondents rated the importance of 17 items, identified in prior qualitative work, for feeling respected. In Round 2, respondents re-rated each item after reviewing overall group ratings. In Round 3, respondents ranked a subset of the 8 most highly rated items. We calculated each item's mean and median rankings in Round 3 to identify which approaches were most important for feeling respected in research. RESULTS Forty-one patients consented to the survey, 21 (51%) completed Round 1, and 18 (86% of Round 1) completed each of Rounds 2 and 3. Two sets of rankings were excluded from analysis as speed of response suggested they had not completed the Round 3 ranking task. Respondents prioritized provision of study information to support decision-making (mean ranking 2.6 out of 8; median ranking 1.5) and interactions with research staff characterized by kindness, patience, and a lack of judgment (mean ranking 2.8; median ranking 2) as the most important approaches for conveying respect. CONCLUSIONS Informed consent and interpersonal interactions are key ways that research participants experience respect. These can be supported by other approaches to respecting participants, especially when consent and/or direct interactions are infeasible. Future work should continue to engage with patients in community-based settings to identify best practices for research without consent and examine unique perspectives across clinical and demographic groups in different types of research.
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Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, 1900 Ninth Ave., M/S JMB-6, Seattle, WA, 98101, USA.
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, 1900 Ninth Ave., M/S JMB-6, Seattle, WA, 98101, USA
| | - Seema K Shah
- Lurie Children's Hospital, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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de Jongh D, Thom RL, Cronin AJ, Bunnik EM, Massey EK. Clinical Translation of Bio-Artificial Pancreas Therapies: Ethical, Legal and Psychosocial Interdisciplinary Considerations and Key Recommendations. Transpl Int 2023; 36:11705. [PMID: 37789914 PMCID: PMC10543913 DOI: 10.3389/ti.2023.11705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023]
Abstract
The field of regenerative medicine offers potential therapies for Type 1 Diabetes, whereby metabolically active cellular components are combined with synthetic medical devices. These therapies are sometimes referred to as "bioartificial pancreases." For these emerging and rapidly developing therapies to be clinically translated to patients, researchers must overcome not just scientific hurdles, but also navigate complex legal, ethical and psychosocial issues. In this article, we first provide an introductory overview of the key legal, ethical and psychosocial considerations identified in the existing literature and identify areas where research is currently lacking. We then highlight two principal areas of concern in which these discrete disciplines significantly overlap: 1) individual autonomy and 2) access and equality. Using the example of beta-cell provenance, we demonstrate how, by harnessing an interdisciplinary approach we can address these key areas of concern. Moreover, we provide practical recommendations to researchers, clinicians, and policymakers which will help to facilitate the clinical translation of this cutting-edge technology for Type 1 Diabetes patients. Finally, we emphasize the importance of exploring patient perspectives to ensure their responsible and acceptable translation from bench to body.
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Affiliation(s)
- Dide de Jongh
- Department of Nephrology and Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Rebecca L. Thom
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College, London, United Kingdom
| | - Antonia J. Cronin
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College, London, United Kingdom
| | - Eline M. Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Emma K. Massey
- Department of Nephrology and Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
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Al-Ruhaili I, Al-Huseini S, Al-Kaabi S, Mahadevan S, Al-Sibani N, Al Balushi N, Islam MM, Jose S, Mehr GK, Al-Adawi S. An Evaluation of the Effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) for the Management of Treatment-Resistant Depression with Somatic Attributes: A Hospital-Based Study in Oman. Brain Sci 2023; 13:1289. [PMID: 37759890 PMCID: PMC10526207 DOI: 10.3390/brainsci13091289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Depressive illnesses in non-Western societies are often masked by somatic attributes that are sometimes impervious to pharmacological agents. This study explores the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for people experiencing treatment-resistant depression (TRD) accompanied by physical symptoms. Data were obtained from a prospective study conducted among patients with TRD and some somatic manifestations who underwent 20 sessions of rTMS intervention from January to June 2020. The Hamilton Rating Scale for Depression (HAMD) was used for clinical evaluation. Data were analysed using descriptive and inferential techniques (multiple logistic regression) in SPSS. Among the 49 participants (mean age: 42.5 ± 13.3), there was a significant reduction in posttreatment HAMD scores compared to baseline (t = 10.819, p < 0.0001, and 95% CI = 8.574-12.488), indicating a clinical response. Approximately 37% of the patients responded to treatment, with higher response rates among men and those who remained in urban areas, had a history of alcohol use, and were subjected to the standard 10 HZ protocol. After adjusting for all extraneous variables, the rTMS protocol emerged as the only significant predictor of response to the rTMS intervention. To our knowledge, this is the first study to examine the effectiveness of rTMS in the treatment of somatic depression.
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Affiliation(s)
- Intisar Al-Ruhaili
- Psychiatry Residency Program, Oman Medical Specialty Board, Muscat 130, Oman;
| | - Salim Al-Huseini
- Department of Psychiatry, Al Masarra Hospital, Ministry of Health, Muscat 113, Oman; (S.A.-H.); (S.A.-K.)
| | - Said Al-Kaabi
- Department of Psychiatry, Al Masarra Hospital, Ministry of Health, Muscat 113, Oman; (S.A.-H.); (S.A.-K.)
| | - Sangeetha Mahadevan
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (N.A.B.)
| | - Nasser Al-Sibani
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (N.A.B.)
| | - Naser Al Balushi
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (N.A.B.)
| | - M. Mazharul Islam
- Department of Statistics, College of Science, Sultan Qaboos University, Muscat 123, Oman;
| | - Sachin Jose
- Studies and Research Section, Oman Medical Specialty Board, Muscat 130, Oman;
| | - Gilda Kiani Mehr
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran 14588-89694, Iran;
| | - Samir Al-Adawi
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (N.A.B.)
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Adams A, Cendales LC, Cooper DKC, Cozzi E, Gill J, Judd E, Katz E, Kirk AD, Fishman JA, Reese PP, Wall A, Markmann JF. American Society of Transplant Surgeons-American Society of Transplantation report of FDA meeting on regulatory expectations for xenotransplantation products. Am J Transplant 2023; 23:1290-1299. [PMID: 37217005 DOI: 10.1016/j.ajt.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023]
Abstract
In June 2022, the US Food and Drug Administration Center for Biologics Evaluation and Research held the 73rd meeting of the Cellular, Tissue, and Gene Therapies Advisory Committee for public discussion of regulatory expectations for xenotransplantation products. The members of a joint American Society of Transplant Surgeons/American Society of Transplantation committee on xenotransplantation compiled a meeting summary focusing on 7 topics believed to be key by the committee: (1) preclinical evidence supporting progression to a clinical trial, (2) porcine kidney function, (3) ethical aspects, (4) design of initial clinical trials, (5) infectious disease issues, (6) industry perspectives, and (7) regulatory oversight.
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Affiliation(s)
- Andrew Adams
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Linda C Cendales
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - David K C Cooper
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emanuele Cozzi
- Department of Cardiothoracic and Vascular Surgery, University of Padua, Padua, Italy
| | - John Gill
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Judd
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Allan D Kirk
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Jay A Fishman
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA; Transplant Infectious Disease and Compromised Host Program and MGH Transplant Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter P Reese
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Anji Wall
- Division of Abdominal Transplantation, Baylor University Medical Center, Dallas, Texas, USA
| | - James F Markmann
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Binko MA, Reitz KM, Chaer RA, Haga LM, Go C, Alie-Cusson FS, Tzeng E, Eslami MH, Sridharan ND. Selective Publication within Vascular Surgery: Characteristics of Discontinued and Unpublished Randomized Clinical Trials. Ann Vasc Surg 2023; 95:251-261. [PMID: 37311508 DOI: 10.1016/j.avsg.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Discontinued and unpublished randomized clinical trials (RCTs) are common resulting in biased publication and loss of potential knowledge. The magnitude of selective publication within vascular surgery remains unknown. METHODS RCT relevant to vascular surgery registered (01/01/2010-10/31/2019) on ClinicalTrials.gov were included. Trials ending normally with conclusion of participant treatment and examination were considered completed whereas discontinued trials stopped early. Publications were identified through automatically indexed PubMed citations on ClinicalTrials.gov or manually identified on PubMed or Google Scholar >30 months after the completion date, the date the final participant was examined, allowing time for publication. RESULTS Of 108 RCT (n = 37, 837), 22.2% (24/108) were discontinued, including 16.7% (4/24) stopped prior to and 83.3% (20/24) after starting enrollment. Only 28.4% of estimated enrollment was achieved for all discontinued RCT. Nineteen (79.2%) investigators provided a reason for discontinuation, which most commonly included poor enrollment (45.8%), inadequate supplies or funding (12.5%), and trial design concerns (8.3%). Of the 20 trials terminated following enrollment, 20.0% (4/20) were published in peer-reviewed journals and 80.0% (16/20) failed to reach publication. Of the 77.8% trials completed, 75.0% (63/84) were published and 25.0% (21/84) remain unpublished. In a multivariate regression of completed trials, industry funding was significantly associated with decreased likelihood of peer-reviewed publication (OR = 0.18, (95% CI 0.05-0.71), P = 0.01). Of the discontinued and completed trials remaining unpublished, 62.5% and 61.9% failed to report results on ClinicalTrials.gov, respectively, encompassing a total of 4,788 enrollees without publicly available results. CONCLUSIONS Nearly 25% of registered vascular RCT were discontinued. Of completed RCT, 25% remain unpublished with industry funding associated with decreased likelihood of publication. This study identifies opportunities to report all findings for completed and discontinued vascular surgery RCT, whether industry sponsored, or investigator initiated.
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Affiliation(s)
- Mary A Binko
- School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Katherine M Reitz
- Division of Vascular Surgery, Department of Surgery, UPMC, Pittsburgh, PA
| | - Rabih A Chaer
- Division of Vascular Surgery, Department of Surgery, UPMC, Pittsburgh, PA
| | - Lindsey M Haga
- Division of Vascular Surgery, Department of Surgery, UPMC, Pittsburgh, PA
| | - Catherine Go
- Division of Vascular Surgery, Department of Surgery, UPMC, Pittsburgh, PA
| | | | - Edith Tzeng
- Division of Vascular Surgery, Department of Surgery, UPMC, Pittsburgh, PA
| | - Mohammad H Eslami
- Division of Vascular Surgery, Department of Surgery, UPMC, Pittsburgh, PA
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Garland A, Morain S, Sugarman J. Do Clinicians Have a Duty to Participate in Pragmatic Clinical Trials? Am J Bioeth 2023; 23:22-32. [PMID: 36449269 PMCID: PMC10355327 DOI: 10.1080/15265161.2022.2146784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Clinicians have good moral and professional reasons to contribute to pragmatic clinical trials (PCTs). We argue that clinicians have a defeasible duty to participate in this research that takes place in usual care settings and does not involve substantive deviation from their ordinary care practices. However, a variety of countervailing reasons may excuse clinicians from this duty in particular cases. Yet because there is a moral default in favor of participating, clinicians who wish to opt out of this research must justify their refusal. Reasons to refuse include that the trial is badly designed in some way, that the trial activities will violate the clinician's conscience, or that the trial will impose excessive burdens on the clinician.
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Pacyna J, Tilburt J. Ethical Pragmatic Clinical Trials Require the Virtue of Cultivated Uneasiness. Am J Bioeth 2023; 23:36-38. [PMID: 37450513 DOI: 10.1080/15265161.2023.2217114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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Wightman A, Filler G, Díaz-González de Ferris ME. The urgent need for conducting clinical trials in pediatric nephrology globally. Pediatr Nephrol 2023; 38:2499-2506. [PMID: 36738331 DOI: 10.1007/s00467-023-05877-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/27/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Aaron Wightman
- Department of Pediatrics, Divisions of Nephrology, Bioethics and Palliative Care, University of Washington School of Medicine, Seattle, WA, USA
| | - Guido Filler
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A 5W9, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, N5A 5A5, Canada
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A 5W9, Canada
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada
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Sidaway M, Collett C, Kolstoe SE. Evidence from UK Research Ethics Committee members on what makes a good research ethics review, and what can be improved. PLoS One 2023; 18:e0288083. [PMID: 37399215 DOI: 10.1371/journal.pone.0288083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023] Open
Abstract
The rapid development of vaccines and other innovative medical technologies in response to the COVID-19 pandemic required streamlined and efficient ethics and governance processes. In the UK the Health Research Authority (HRA) oversees and coordinates a number of the relevant research governance processes including the independent ethics review of research projects. The HRA was instrumental in facilitating the rapid review and approval of COVID-19 projects, and following the end of the pandemic, have been keen to integrate new ways of working into the UK Health Departments' Research Ethics Service. In January 2022 the HRA commissioned a public consultation that identified strong public support for alternative ethics review processes. Here we report feedback from 151 current research ethics committee members conducted at three annual training events, where we asked members to critically reflect on their ethics review activities, and to share new ideas or ways of working. The results showed a high regard for good quality discussion among members with diverse experience. Good chairing, organisation, feedback and the opportunity for reflection on ways of working were considered key. Areas for improvement included the consistency of information provided to committees by researchers, and better structuring of discussions by allowing signposting of the key issues that ethics committee members might need to consider.
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Affiliation(s)
- Mark Sidaway
- Health Research Authority, Stratford, London, United Kingdom
| | - Clive Collett
- Health Research Authority, Stratford, London, United Kingdom
| | - Simon Erik Kolstoe
- School of Health and Care Professions, University of Portsmouth, Portsmouth, United Kingdom
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Chattopadhyay S, de Kok B. Making research ethics work for global health: towards a more agile and collaborative approach. BMJ Glob Health 2023; 8:e011415. [PMID: 37451687 PMCID: PMC10351231 DOI: 10.1136/bmjgh-2022-011415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/06/2023] [Indexed: 07/18/2023] Open
Abstract
In this reflective essay, we seek to engage in a constructive dialogue with scholars across medicine, public health and anthropology on research ethics practices. Drawing on anthropological research and ethical dilemmas that our colleagues and we encountered as medical anthropologists, we reflect on presumed and institutionalised 'best' practices such as mandatory written informed consent, and problematise how they are implemented in interdisciplinary global health research projects. We demonstrate that mandatory, individualised, written, informed consent may be unsuitable in many contexts and also identify reasons why tensions between professionals in interdisciplinary teams may arise when decisions about ethics procedures are taken. We propose alternatives to written informed consent that acknowledge research governance requirements and contextual realities and leave more room for ethnographic approaches. Beyond informed consent, we also explore the situatedness of ethical practices when working in contexts where decision-making around health is clearly a shared concern. We use vignettes based on our own and colleagues' experiences to illustrate our arguments, using the collective 'we' instead of 'I' in our vignettes to protect our research participants, partners and interlocutors. We propose a decolonial, plural and vernacular approach to informed consent specifically, and research ethics more broadly. We contend that ethics procedures and frameworks need to become more agile, decolonial, pluralised and vernacularised to enable achieving congruence between communities' ideas of social justice and institutional ethics. We argue that global health research can benefit from anthropology's engagement with situated ethics and consent that is relational, negotiated and processual; and accountability that is not only bureaucratic but also constructive. In doing so, we hope to broaden ethical praxis so that the best outcomes that are also just, fair and equitable can be achieved for all stakeholders.
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Affiliation(s)
| | - Bregje de Kok
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
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Ketchum FB, Chin NA, Erickson C, Lambrou NH, Basche K, Gleason CE, Clark L. The importance of the dyad: Participant perspectives on sharing biomarker results in Alzheimer's disease research. Alzheimers Dement (N Y) 2023; 9:e12416. [PMID: 37583545 PMCID: PMC10423755 DOI: 10.1002/trc2.12416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND In the asymptomatic "preclinical" phase of Alzheimer's disease (AD), abnormal biomarkers indicate risk for developing cognitive impairment. Biomarker information is increasingly being disclosed to participants in research settings, and biomarker testing and results disclosure will be implemented in clinical settings in the future. Biomarker disclosure has potential psychosocial benefits and harms, impacting affected individuals and their support person(s). Limited data are available about with whom research participants share their results, information that will be necessary to develop disclosure protocols and post-disclosure resources. Additionally, existing research has been conducted in largely White cohorts, limiting applicability to future clinical populations. METHODS We enrolled a diverse cohort of 329 adults (184 non-Hispanic White and 145 Black/African American individuals) who previously participated in AD research. After reviewing a vignette describing a hypothetical biomarker research study, participants indicated their anticipated willingness to share biomarker results with loved ones, and what reactions they anticipated from others. Using mixed-methods analysis, we identified responses related to willingness to share results. RESULTS A majority (78.7%) were willing to share their results with support persons. Many (59.6%) felt it would not be difficult to share, and most (90.6%) believed their loved ones would be supportive. The most common reasons for sharing were to prepare for possible future AD (41.0% of respondents), while the most common reason for not sharing was to avoid worrying loved ones (4.8% of respondents). A total of 7.3% of respondents related reasons regarding being unsure about sharing. DISCUSSION Participants' interest in sharing results supports integrating support persons into AD biomarker research, and may help maximize potential benefits for participants. Communicating with this "dyad" of research participant and support person(s) may improve involvement in research, and help prepare for implementation of clinical biomarker testing by clarifying communication preferences and the influence of support persons on psychosocial outcomes.
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Affiliation(s)
- Fred B. Ketchum
- Department of NeurologySchool of Medicine and Public HealthUniversity of WisconsinMadisonWisconsinUSA
| | - Nathaniel A. Chin
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
| | - Claire Erickson
- Department of Medical Ethics and Health PolicyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Nickolas H. Lambrou
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Kristin Basche
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Carey E. Gleason
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
- Geriatric ResearchEducation and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Lindsay Clark
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
- Geriatric ResearchEducation and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
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Parkinson B. We need to talk about research ethics committees (RECs). Evid Based Nurs 2023; 26:85-86. [PMID: 37137674 DOI: 10.1136/ebnurs-2023-103748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Ben Parkinson
- Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
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