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The ethics of “net-risk” pediatric research:Views of IRB members and the US public. INTERNATIONAL JOURNAL OF PEDIATRICS AND ADOLESCENT MEDICINE 2023. [DOI: 10.1016/j.ijpam.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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Schupmann W, Li X, Wendler D. Acceptable Risks in Pediatric Research: Views of the US Public. Pediatrics 2022; 149:184051. [PMID: 34961881 PMCID: PMC9647531 DOI: 10.1542/peds.2021-052687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Critics argue that it is unethical to expose children to research risks for the benefit of others, whereas many regulations permit "net-risk" pediatric research but only when the risks are minimal. In the present survey, we assessed whether the US public agrees with these views and whether the US public's views regarding the acceptability of net-risk pediatric research are influenced by its social value. METHODS A 15-minute survey of a nationally representative sample of US adults. Participants were randomly assigned to 1 of 4 hypothetical scenarios involving procedures that pose increasing levels of risk. To assess whether respondents' views on the acceptability of the risks is influenced by the social value of the research, in each of the 4 scenarios we described the respective procedure being used in 3 studies with increasing levels of social value. RESULTS A total 1658 of the 2508 individuals who were sent the survey link participated (response rate = 66.1%). Approximately 91% approved of a research blood draw in minors, and ∼69% approved of a research bone marrow biopsy. The proportion who indicated that the respective procedure was acceptable increased as the study's social value increased. This effect was significantly stronger for studies which pose greater risks compared with studies with lower risks (P < .001). CONCLUSIONS The vast majority of the US public supports net-risk pediatric research that poses minimal risk, and a majority supports net-risk pediatric research that poses somewhat greater risks, provided it has high social value. These findings offer important information for assessing when it is acceptable to conduct net-risk pediatric research.
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Affiliation(s)
| | - Xiaobai Li
- Biostatistics and Clinical Epidemiology Service, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - David Wendler
- Biostatistics and Clinical Epidemiology Service, National Institutes of Health Clinical Center, Bethesda, Maryland,Address correspondence to David Wendler, PhD, Department of Bioethics, National Institutes of Health Clinical Center, 10 Center Dr, Building 10, Room 1C118, Bethesda, MD 20892. E-mail:
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3
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Size and Taste Matters: Recent Progress in the Development of Age-Appropriate Medicines for Children. Pharmaceut Med 2017. [DOI: 10.1007/s40290-017-0218-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Rieder M, Hawcutt D. Design and conduct of early phase drug studies in children: challenges and opportunities. Br J Clin Pharmacol 2016; 82:1308-1314. [PMID: 27353241 PMCID: PMC5061783 DOI: 10.1111/bcp.13058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/03/2016] [Accepted: 06/12/2016] [Indexed: 12/14/2022] Open
Abstract
It has historically been very difficult to conduct early phase drug studies in children for a number of reasons related to ethics, acceptability, rarity, standardization, end points, safety, dosing and feasibility. Over the past decade there have been a number of developments including novel clinical trial design, in silico pharmacology and microdosing that have significantly enhanced the ability of investigators to conduct early phase drug studies in children. While the evolution of drug therapy is creating a series of new challenges, there has never been a better time for conducting drug studies in children.
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Affiliation(s)
- Michael Rieder
- Department of Paediatrics, Robarts Research Institute, University of Western Ontario, Canada.
- Department of Paediatrics, Western University, London, Ontario, Canada.
| | - Daniel Hawcutt
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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Wherrett DK, Chiang JL, Delamater AM, DiMeglio LA, Gitelman SE, Gottlieb PA, Herold KC, Lovell DJ, Orchard TJ, Ryan CM, Schatz DA, Wendler DS, Greenbaum CJ. Defining pathways for development of disease-modifying therapies in children with type 1 diabetes: a consensus report. Diabetes Care 2015; 38:1975-85. [PMID: 26404927 PMCID: PMC4876737 DOI: 10.2337/dc15-1429] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Emerging data suggest that type 1 diabetes is a more aggressive disease in children than in adults, with important differences in pathophysiology and clinical course. Therefore, the efficacy of disease-modifying therapies may be different in the two populations. Understanding the developmental and regulatory pathways for type 1 diabetes-modifying therapies in children will enable industry, academia, funders, advocacy groups, and regulators to translate new science to clinical care. This consensus report characterizes the fundamental differences in type 1 diabetes between children and adults and proposes a thoughtful approach to better understand the development and regulatory pathways for type 1 diabetes therapies.
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Affiliation(s)
- Diane K Wherrett
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | | | | | | | - Stephen E Gitelman
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Peter A Gottlieb
- Departments of Medicine and Pediatrics, University of Colorado, Denver, CO
| | - Kevan C Herold
- Department of Immunobiology, Yale University, New Haven, CT
| | - Daniel J Lovell
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Trevor J Orchard
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | | | - Desmond A Schatz
- Department of Pediatrics, University of Florida, Gainesville, FL
| | - David S Wendler
- Department of Bioethics, National Institutes of Health, Bethesda, MD
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Gruen ME, Jiamachello KN, Thomson A, Lascelles BDX. Clinical trials involving cats: what factors affect owner participation? J Feline Med Surg 2014; 16:727-35. [PMID: 24938313 DOI: 10.1177/1098612x14539499] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
STUDY RATIONALE Clinical trials are frequently hindered by difficulties in recruiting eligible participants, increasing the timeline and limiting generalizability of results. In veterinary medicine, where proxy enrollment is required, no studies have detailed what factors influence owner participation in clinical trials involving cats. We aimed to investigate these factors through a survey of owners at first opinion practices. PROTOCOL The survey was designed using feedback from a pilot study and input from clinical researchers. Owners were asked demographic questions and whether they would, would not, or were unsure about participating in a clinical trial with their cat. They then ranked the importance and influence of various factors on participation using a five-point Likert-type scale, and incentives from most to least encouraging. A total of 413 surveys were distributed to cat owners at four hospitals, two feline-only and two multi-species; 88.6% were completed. Data for importance and influence factors as well as incentive rankings were analyzed overall, and by hospital type, location and whether owners would consider participating. FINDINGS The most influential factors were trust in the organization, benefit to the cat and veterinarian recommendation. Importance and influence factors varied by willingness to participate. Ranked incentives were not significantly different across groups, with 'Free Services' ranked highest. RELEVANCE This study provides a first look at what factors influence participation in clinical trials with cats. Given the importance placed in the recommendation of veterinarians, continued work is needed to determine veterinarian-related factors affecting clinical trial participation. The results provide guidance towards improved clinical trial design, promotion and education.
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Affiliation(s)
- Margaret E Gruen
- Comparative Pain Research Laboratory, North Carolina State University College of Veterinary Medicine, USA Behavioral Medicine Service, North Carolina State University College of Veterinary Medicine, USA
| | - Katrina N Jiamachello
- Comparative Pain Research Laboratory, North Carolina State University College of Veterinary Medicine, USA
| | - Andrea Thomson
- Comparative Pain Research Laboratory, North Carolina State University College of Veterinary Medicine, USA
| | - B Duncan X Lascelles
- Comparative Pain Research Laboratory, North Carolina State University College of Veterinary Medicine, USA Center for Comparative Medicine and Translational Research, North Carolina State University College of Veterinary Medicine, USA
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Wendler D, Abdoler E, Wiener L, Grady C. Views of adolescents and parents on pediatric research without the potential for clinical benefit. Pediatrics 2012; 130:692-9. [PMID: 22966027 PMCID: PMC3457618 DOI: 10.1542/peds.2012-0068] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Critics argue that pediatric research without the potential for clinical benefit is unethical because it treats children as mere means, exposing those who cannot consent to risks for the benefit of others. The present survey was designed to assess whether this claim is consistent with the views of adolescents who actually participate in research, or their parents. METHODS Interviews were conducted with adolescents participating in research at the NIH Clinical Center or Seattle Children's Hospital, and their parents, from June 2008 through April 2010. RESULTS Interviews were completed with 177 of 186 adolescent/parent pairs (response rate= 95.2%). Overall, 90% of the adolescents and parents were willing to have the adolescent undergo a few extra blood draws, and 65% were willing to have the adolescent undergo an extra skin biopsy, for research purposes. The vast majority felt that the adolescents were making an important contribution to help others, and 80.8% of the adolescents felt proud to be doing so. Respondents overall were equally willing to have the adolescent face risks to help others in a research study or in a charitable activity. CONCLUSIONS The views and experiences of these respondents do not support the claim that pediatric research without the potential for clinical benefit treats subjects as mere means. Instead, the findings provide proof of principle for the claim that non-beneficial pediatric research involves a type of charitable activity which offers children the opportunity to contribute to a valuable project to help others.
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Affiliation(s)
- David Wendler
- Department of Bioethics, NIH Clinical Center, Building 10, Room 1C118, Bethesda, MD 20892, USA.
| | - Emily Abdoler
- Department of Bioethics, National Institutes of Health Clinical Center, and
| | - Lori Wiener
- Pediatric Branch, National Cancer Institute, Bethesda, Maryland
| | - Christine Grady
- Department of Bioethics, National Institutes of Health Clinical Center, and
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Wendler D. A new justification for pediatric research without the potential for clinical benefit. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2012; 12:23-31. [PMID: 22220955 DOI: 10.1080/15265161.2011.634482] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Pediatric research without the potential for clinical benefit is vital to improving pediatric medical care. This research also raises ethical concern and is regarded by courts and commentators as unethical. While at least 10 justifications have been proposed in response, all have fundamental limitations. This article describes and defends a new justification based on the fact that enrollment in clinical research offers children the opportunity to contribute to a valuable project. Contributing as children to valuable projects can benefit individuals in two ways. First, individuals may come to "embrace" the contributions they made as children. Second, contributing to valuable projects can lead to a better overall life. Because these potential benefits can outweigh small research risks, they provide a justification for pediatric research without the potential for clinical benefit, when it poses low risks and has the potential to benefit others in important ways.
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Knellwolf AL, Bauzon S, Alberighi ODC, Lutsar I, Bácsy E, Alfarez D, Panei P. Framework conditions facilitating paediatric clinical research. Ital J Pediatr 2011; 37:12. [PMID: 21345195 PMCID: PMC3055809 DOI: 10.1186/1824-7288-37-12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 02/23/2011] [Indexed: 12/05/2022] Open
Abstract
The use of unlicensed and "off-label" medicines in children is widespread. Between 50-80% of the medicines currently administered to children have neither been tested nor authorized for their use in the paediatric population which represents approximately 25% of the whole European population. On 26 January 2007, entered into force the European Regulation of Paediatric Medicines. It aims at the quality of research into medicines for children but without subjecting the paediatric population to unnecessary clinical trial. This article addresses ethical and legal issues arising from the regulation and makes recommendations for the framework conditions facilitating the development of clinical research with children.
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Affiliation(s)
- Anne-Laure Knellwolf
- Dept. of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Stéphane Bauzon
- Storia e Teoria del Diritto, Facoltà di Giurisprudenza, University of Rome "Tor Vergata", Rome, Italy
| | | | - Irja Lutsar
- Dept. of Microbiolgoy, University of Tartu, Tartu, Estonia
| | - Ernö Bácsy
- Medical Research Council of Hungary, Budapest, Hungary
| | - Deborah Alfarez
- ERA-NET Priority Medicines for Children Coordination, The Netherlands Organization for Health Research and Development, The Hague, The Netherlands
| | - Pietro Panei
- Dept. of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy
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Rabe H. The need for noninvasive biomarkers for drug safety in neonatal circulation. Biomark Med 2011; 4:771-6. [PMID: 20945992 DOI: 10.2217/bmm.10.88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The new EU Pediatric Drug Regulation covers the development of new drugs to include studies in children and newborn babies. An important part of the evaluation of a new drug will be data on efficacy and safety related to short-term and possible long-term effects. Owing to the special circumstances of studying drugs, especially in newborn babies, new, preferably noninvasive, biomarkers are required that can be used for assessment and monitoring in this vulnerable patient population. Feedback from expert groups and public stakeholders should be taken into account when introducing biomarkers into the study design. New noninvasive biomarkers for monitoring cardiovascular circulation in newborns will be used to illustrate an example of their practical use and implementation.
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Affiliation(s)
- Heike Rabe
- Department of Neonatology, Brighton & Sussex University Hospitals, Eastern Road, Brighton, BN2 5BE, UK.
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CQ Sources/Bibliography. Camb Q Healthc Ethics 2008. [DOI: 10.1017/s0963180108080389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
These CQ Sources were compiled by Bette Anton.
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Goldberg A, Frader J. Holding on and letting go: ethical issues regarding the care of children with cancer. Cancer Treat Res 2008; 140:173-194. [PMID: 18283776 DOI: 10.1007/978-0-387-73639-6_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Aviva Goldberg
- University of Manitoba, Department of Pediatrics, Winnipeg Children's Hospital, Canada
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Koh W, Sim J, Ahn W. Survey of Institutional Review Board Approval and Informed Consent in Clinical Research of Korean Anesthetic Society. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.6.753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Wonuk Koh
- Department of Anesthesiology and Pain Medicine, College of Medicine, University of Ulsan, Korea
| | - Jiyeon Sim
- Department of Anesthesiology and Pain Medicine, College of Medicine, University of Ulsan, Korea
| | - Wonsik Ahn
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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