Prüfung der wissenschaftlichen Qualität und biometriespezifischer Anforderungen durch die Ethikkommission?

Comprehensive survey among statistical members of medical ethics committees in Germany on their personal impression of completeness and correctness of biostatistical aspects of submitted study protocols

OBJECTIVES

To assess biostatistical quality of study protocols submitted to German medical ethics committees according to personal appraisal of their statistical members.

DESIGN

We conducted a web-based survey among biostatisticians who have been active as members in German medical ethics committees during the past 3 years.

SETTING

The study population was identified by a comprehensive web search on websites of German medical ethics committees.

PARTICIPANTS

The final list comprised 86 eligible persons. In total, 57 (66%) completed the survey.

QUESTIONNAIRE

The first item checked whether the inclusion criterion was met. The last item assessed satisfaction with the survey. Four items aimed to characterise the medical ethics committee in terms of type and location, one item asked for the urgency of biostatistical training addressed to the medical investigators. The main 2×12 items reported an individual assessment of the quality of biostatistical aspects in the submitted study protocols, while distinguishing studies according to the German Medicines Act (AMG)/German Act on Medical Devices (MPG) and studies non-regulated by these laws.

PRIMARY AND SECONDARY OUTCOME MEASURES

The individual assessment of the quality of biostatistical aspects corresponds to the primary objective. Thus, participants were asked to complete the sentence 'In x% of the submitted study protocols, the following problem occurs', where 12 different statistical problems were formulated. All other items assess secondary endpoints.

RESULTS

For all biostatistical aspects, 45 of 49 (91.8%) participants judged the quality of AMG/MPG study protocols much better than that of 'non-regulated' studies. The latter are in median affected 20%-60% more often by statistical problems. The highest need for training was reported for sample size calculation, missing values and multiple comparison procedures.

CONCLUSIONS

Biostatisticians being active in German medical ethics committees classify the biostatistical quality of study protocols as low for 'non-regulated' studies, whereas quality is much better for AMG/MPG studies.

[Current challenges in the assessment of ethical proposals-aspects of digitalization and personalization in the healthcare system]

The global aim of medical ethics committees is to judge the scientific quality and the integrity of the content of medical research projects (studies), thereby assessing the benefit-risk profile. Apart from judging content-related aspects and the legal correctness, the study design and the analysis strategy must also be assessed from a biostatistical point of view. This very sophisticated task is further complicated by the fact that medical research constantly faces new challenges.Within this work, current developments in medical research that directly impact the assessability of ethical proposals will be identified and discussed. The aim is to sensitize researchers to the opportunities and challenges of new developments.The work focusses on the topics of digitalization in the healthcare system and individualized medicine. The authors illustrate some problems resulting from these developments that affect the ethical justification of medical research projects. Problems related to medical as well as biostatistical aspects are presented and their direct implications on the legal justification and ethical and moral conceptual integrity are highlighted.New developments in medical research such as digitalization and individualized medicine offer new perspectives for optimized therapies. These promising developments must be further advanced. A critical view on the so far only poorly investigated consequences of embedding new data sources and study designs must urgently accompany this process. Transparency and clarity in formulating ethical proposals is thereby of utmost importance.

[The role of biostatistics in institutional review boards]

Research in humans is associated with risks. These risks are only justifiable if an independent institutional review board (IRB) has evaluated the planned research in terms of scientific integrity. Only scientifically sound research can be considered ethical. A biostatistician should be a member of the IRB to assure adequate evaluation of fundamental topics like design, sample size estimation, and statistical analysis of the study.This paper presents core biostatistical concepts following the current guidelines of the International Council of Harmonization (ICH E6 and ICH E9). We discuss important pitfalls based on examples from published clinical trials. Furthermore, we discuss new concepts like estimands and their relevance for biostatisticians working in IRBs. Finally, we discuss the role of biostatisticians in IRBs and present thoughts on the way they should be trained.

Conflicts of interest in Germany: a legal perspective

In spite of recent efforts to promote cooperation between universities and industry, Germany still lacks a sufficient legal framework for regulating potential conflicts of interest resulting from university-industry cooperation. Prospective regulation of conflicts of interest has to take into account specific constraints imposed by the German constitution. It has to follow stringent procedural and material requirements and carefully weigh the individual researcher's right to academic freedom against the public demand for objectivity in research. Because of this cautious consideration of the conflicting interests constitutionally mandated in Germany, a potential regulation legitimate in this country may serve as a model for other countries facing the need of the adoption of such a regulation.