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Drewett GP. The Case for Human Challenge Trials in COVID-19. JOURNAL OF BIOETHICAL INQUIRY 2023:10.1007/s11673-023-10309-9. [PMID: 37721594 DOI: 10.1007/s11673-023-10309-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/12/2023] [Indexed: 09/19/2023]
Abstract
The COVID-19 pandemic has necessitated rapid research to aid in the understanding of the disease and the development of novel therapeutics. One option is to conduct controlled human infection trials (CHITs). In this article I examine the history of deliberate human infection and CHITs and their utilization prior to the COVID-19 pandemic, key ethical considerations of CHITs in the COVID-19 setting, an analysis of the World Health Organization's (WHO) Key criteria for the ethical acceptability of COVID-19 human challenge studies, and a review of the two COVID-19 CHITs that have already commenced, their compliance with the WHO criteria and other ethical considerations.
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Affiliation(s)
- George P Drewett
- Melbourne Law School, University of Melbourne, Parkville, VIC, Australia.
- The Northern Hospital, Epping, VIC, Australia.
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2
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Waltz M, Davis AM, Fisher JA. "Death and Taxes": Why Financial Compensation for Research Participants is an Economic and Legal Risk. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2023; 51:413-425. [PMID: 37655582 PMCID: PMC10879932 DOI: 10.1017/jme.2023.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
In the US, research payments are technically taxable income. This article argues that tax liability is a form of possible economic and legal risk of paid research participation. Findings are presented from empirical research on Phase I healthy volunteer trials. The article concludes by discussing the implications of these findings for the informed consent process, as well as for broader ethical issues in whether and how payments for research participation should be regulated.
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Walker RL, MacKay D, Waltz M, Lyerly AD, Fisher JA. Ethical Criteria for Improved Human Subject Protections in Phase I Healthy Volunteer Trials. Ethics Hum Res 2022; 44:2-21. [PMID: 36047278 PMCID: PMC9931499 DOI: 10.1002/eahr.500139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Phase I healthy volunteer trials test the safety and tolerability of investigational pharmaceuticals. In them, participants are exposed to study-drug risks without the possibility of direct medical benefit and typically must spend days or weeks in a residential research facility. Monetary payments are used to incentivize enrollment and compensate participants for their time. Together, these features of phase I healthy volunteer trials create a research context that differs markedly from most other clinical research, including by enrolling disproportionate numbers of economically disadvantaged people of color as participants. Due to these unique trial features and participation patterns, traditional biomedical research oversight offers inadequate ethical and policy guidance for phase I healthy volunteer research. This article details five ethical criteria crafted to be responsive to the particularities of this type of research: translational science value, fair opportunity and burden sharing, fair compensation for service, experiential welfare, and enhanced voice and recourse.
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Affiliation(s)
- Rebecca L Walker
- Professor of social medicine and of philosophy at the University of North Carolina at Chapel Hill
| | - Douglas MacKay
- Associate professor of public policy at the University of North Carolina at Chapel Hill
| | - Margaret Waltz
- Research associate in the Department of Social Medicine at the University of North Carolina at Chapel Hill
| | - Anne D Lyerly
- Professor of social medicine and on the core faculty in the Center for Bioethics at the University of North Carolina at Chapel Hill
| | - Jill A Fisher
- Professor of social medicine and on the core faculty in the Center for Bioethics at the University of North Carolina at Chapel Hill
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Cottingham MD, Fisher JA. Gendered Logics of Biomedical Research: Women in U.S. Phase I Clinical Trials. SOCIAL PROBLEMS 2022; 69:492-509. [PMID: 35449716 PMCID: PMC9017784 DOI: 10.1093/socpro/spaa035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Despite the importance of including diverse populations in biomedical research, women remain underrepresented as healthy volunteers in the testing of investigational drugs in Phase I trials. Contributing significantly to this are restrictions that pharmaceutical companies place on the participation of women of so-called childbearing potential. These restrictions have far-reaching effects on biomedical science and the public health of women. Using 191 interviews collected over 3 years, this article explores the experiences of 47 women who navigate restrictions on their participation in U.S. Phase I trials. Women in this context face a number of contradictory criteria when trying to enroll, which can curtail their participation, justify additional surveillance, and deny pregnant women reproductive agency. The pharmaceutical industry's putative protections for hypothetical fetuses exacerbate inequalities and attenuate a thorough investigation of the safety of their drugs for public consumption. We use the framework of "anticipatory motherhood" within a gendered organizations approach to make sense of women's experiences in this context.
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Kalbaugh CA, Kalbaugh JM, McManus L, Fisher JA. Healthy volunteers in US phase I clinical trials: Sociodemographic characteristics and participation over time. PLoS One 2021; 16:e0256994. [PMID: 34492044 PMCID: PMC8423261 DOI: 10.1371/journal.pone.0256994] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increasing the diversity of research participants is an important focus of clinical trials. However, little is known regarding who enrolls as healthy volunteers in Phase I clinical trials, which test the safety and tolerability of investigational new drugs. Despite the risk, healthy volunteers can derive no medical benefit from their participation, and they are financially compensated for enrolling. OBJECTIVE This study's purpose is to describe sociodemographic characteristics and clinical trial participation histories of healthy people who enroll in US Phase I trials. METHODS The HealthyVOICES Project (HVP) is a longitudinal study of healthy individuals who have enrolled in Phase I trials. We describe self-reported sociodemographic information and Phase I trial history from HVP recruitment (May-December 2013) through the project's end three years later (December 2016). Trial experiences are presented as medians and quartiles. RESULTS The HVP included 178 participants. Nearly three-fourths of participants were male, and two-thirds were classified as racial and ethnic minorities. We found that some groups of participants were more likely to have completed a greater number of clinical trials over a longer timeframe than others. Those groups included participants who were male, Black, Hispanic, 30-39-years-old, unemployed, had received vocational training in a trade, or had annual household incomes of less than $25,000. Additionally, the greater the number of clinical trials participants had completed, the more likely they were to continue screening for new trials over the course of three years. Participants who pursued clinical trials as a full-time job participated in the greatest number of trials and were the most likely to continuing screening over time. IMPLICATIONS Participation as a healthy volunteer in US Phase I trials is driven by social inequalities. Disadvantaged groups tend to participate in a greater number of clinical trials and participate longer than more privileged groups.
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Affiliation(s)
- Corey A. Kalbaugh
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States of America
- Department of Bioengineering, Clemson University, Clemson, SC, United States of America
| | - Julianne M. Kalbaugh
- Department of Social Medicine and Center for Bioethics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Lisa McManus
- Department of Sociology, Wake Technical Community College, Raleigh, NC, United States of America
| | - Jill A. Fisher
- Department of Social Medicine and Center for Bioethics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Jaffe K, Korthuis T, Richardson L. 'This could be my last chance': Therapeutic optimism in a randomised controlled trial for substance use disorders. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1286-1300. [PMID: 34117637 DOI: 10.1111/1467-9566.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/21/2021] [Accepted: 04/26/2021] [Indexed: 06/12/2023]
Abstract
In randomised controlled trials (RCTs), 'therapeutic optimism' describes a participant's belief they will benefit from the study treatment, despite the express goal of RCTs to test unknown aspects of interventions. Harbouring such expectations may interfere with RCT participation experiences, particularly among marginalised populations, such as people with substance use disorders (PSUD) who may experience social and structural barriers to participation that also increase their vulnerability to therapeutic optimism. However, little research explores therapeutic optimism within substance use trials. Thus, we conducted a nested qualitative study within an RCT testing a treatment for alcohol and opioid use disorders in HIV clinics. Using interviews with 22 participants in Vancouver, Canada, analysis revealed themes relevant to therapeutic optimism, that were specifically linked to intrinsic (e.g. health-related) or extrinsic motivations (e.g. stipend). First, compared to extrinsically motivated participants, intrinsically motivated participants held high expectations for the trial and attributed greater agency to the study medication. Second, intrinsically motivated participants expressing therapeutic optimism anticipated marked changes in their lives from the study/medication. Finally, some participants predicted the treatment would solve substance-related issues in their communities. These findings highlight the interplay between therapeutic optimism and complex interpretations of RCT objectives among PSUD.
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Affiliation(s)
- Kaitlyn Jaffe
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Sociology, University of British Columbia, Vancouver, BC, Canada
| | - Todd Korthuis
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Sociology, University of British Columbia, Vancouver, BC, Canada
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Fisher JA, McManus L, Kalbaugh JM, Walker RL. Phase I trial compensation: How much do healthy volunteers actually earn from clinical trial enrollment? Clin Trials 2021; 18:477-487. [PMID: 33938244 PMCID: PMC8290991 DOI: 10.1177/17407745211011069] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background/aims Financial compensation for research participation is a major focus of ethical concern regarding human subject recruitment. Phase I trials are sometimes considered to be a lucrative source of income for healthy volunteers, encouraging some people to become “professional guinea pigs.” Yet, little is known about how much these clinical trials actually pay and how much healthy volunteers earn from them. Methods As part of a mixed-methods, longitudinal study of healthy volunteers, we required participants to complete clinical trial diaries, or surveys that captured detailed information about screening and enrollment in Phase I trials. Over a 3-year period, participants provided information online or via telephone about each clinical trial for which they screened (e.g. the clinic name, the study’s therapeutic area, the length of the trial, the number of nights spent in the clinic, and the study compensation), and whether they qualified for trial inclusion. Clinical trial diaries generated data about whether participants continued to screen for and enroll in clinical trials and how much money they earned from their participation. Results 131 participants routinely completed clinical trial diaries or confirmed that they had not screened for any new clinical trials. Together, these participants screened for 1001 clinical trials at 73 research facilities during a 3-year period. Overall, the median clinical trial compensation was US$3070 (range = US$150–US$13,000). Participants seeking new healthy volunteer trials tended to screen for three studies per year, participate in one or two studies, and earn roughly US$4000 annually. Participants who were unemployed earned the most income from clinical trials compared to those with full-time or part-time jobs, and those individuals whom we label “occupational” participants because of their persistent pursuit of clinical trials earned more than people who screened occasionally. Notably, the median annual trial compensation was well below US$10,000 for all employment groups, and most occupational healthy volunteers also earned less than US$10,000 each year. The 10% of participants who earned the most had a median annual income of US$18,885 from clinical trials, and there was significant volatility in these individuals’ earnings from year to year. Conclusion Despite the perception that Phase I enrollment can generate significant earnings, it was exceedingly rare for anyone in this study to make more than US$20,000 in a single year, and unusual to earn even between US$10,000 and US$20,000. From an ethics perspective, individual trials might appear to unduly induce enrollment by offering significant sums of money, but given our findings, the larger problem for low-income participants may be the unrealistic perception that clinical trials alone could be a way of earning a living.
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Affiliation(s)
- Jill A Fisher
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa McManus
- Wake Technical Community College, Raleigh, NC, USA
| | | | - Rebecca L Walker
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Fisher JA, Wood MM, Monahan T. Speculating on Precarious Income: Finance Cultures and the Risky Strategies of Healthy Volunteers in Clinical Drug Trials. JOURNAL OF CULTURAL ECONOMY 2020; 14:464-484. [PMID: 34239602 PMCID: PMC8259560 DOI: 10.1080/17530350.2020.1850504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/05/2020] [Indexed: 06/13/2023]
Abstract
Speculation has become a normalized occupational strategy and quotidian economic rationality that extends throughout society. Although there are many contemporary articulations of speculation, this article focuses on contract labor as a domain of financialization. Seen through this lens, contract labor can be understood as a speculative investment strategy wherein individuals leverage whatever assets they have at their disposal-savings, time, bodily health-to capture economic advantages. In particular, we explore the speculative practices of healthy individuals who enroll in pharmaceutical drug trials as their primary or critical source of income. Mobilizing speculative logics to maximize the money they can earn from their clinical trial participation, these contract workers employ what we term a future-income-over-immediate-pay calculus. This speculative calculus valorizes fictional projections of significant long-term future income over present financial opportunities. For the economically precarious individuals in our study, we argue that rather than effectively increasing their income, speculation on contract work serves a compensatory function, providing an important-but ultimately inadequate-sense of control over market conditions that thrive upon workers' economic insecurity.
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Affiliation(s)
- Jill A Fisher
- Department of Social Medicine & Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Megan M Wood
- Department of Communication, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Torin Monahan
- Department of Communication, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Holm S. Controlled human infection with SARS-CoV-2 to study COVID-19 vaccines and treatments: bioethics in Utopia. JOURNAL OF MEDICAL ETHICS 2020; 46:569-573. [PMID: 32616623 PMCID: PMC7371481 DOI: 10.1136/medethics-2020-106476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 05/05/2023]
Abstract
A number of papers have appeared recently arguing for the conclusion that it is ethically acceptable to infect healthy volunteers with severe acute respiratory syndrome coronavirus 2 as part of research projects aimed at developing COVID-19 vaccines or treatments. This position has also been endorsed in a statement by a working group for the WHO. The papers generally argue that controlled human infection (CHI) is ethically acceptable if (1) the risks to participants are low and therefore acceptable, (2) the scientific quality of the research is high, (3) the research has high social value, (4) participants give full informed consent, and (5) there is fair selection of participants. All five conditions are necessary premises in the overall argument that such research is ethically acceptable. The arguments concerning risk and informed consent have already been critically discussed in the literature. This paper therefore looks specifically at the arguments relating to condition 3 'high social value' and condition 5 'fair selection of participants' and shows that whereas they may be valid, they are not sound. It is highly unlikely that the conditions that are necessary for ethical CHI trials to take place will be fulfilled. Most, if not all, CHI trials will thus be well intentioned but unethical.
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Affiliation(s)
- Søren Holm
- CSEP, Department of Law, School of Social Sciences, The University of Manchester, Manchester, UK
- Center for Medical Ethics, HELSAM, Universitetet i Oslo, Oslo, Norway
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10
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Abstract
Vaccine trials for infectious diseases take place in a milieu of trust in which scientists, regulatory institutions, and volunteers trust each other to play traditional roles. This milieu of trust emerges from a combination of preexisting linkages embedded in the local and national political context. Using the case of failed vaccine trials in Hohoe, Ghana, we explore this milieu of trust by employing the concept of tandems of trust and control, with a particular focus on the perceived characteristics of the disease and the linkages formed. An analysis of qualitative interviews collected in Hohoe following the West Africa Ebola outbreak of 2014-2016 shows that the trust/control nexus in vaccine trials precedes the implementation of those trials, while both the characteristics of Ebola and the political context shaped the formation and breakdown of relationships in the trial network.
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Monahan T, Fisher JA. Sacrificial Labour: Social Inequality, Identity Work, and the Damaging Pursuit of Elusive Futures. WORK, EMPLOYMENT & SOCIETY : A JOURNAL OF THE BRITISH SOCIOLOGICAL ASSOCIATION 2020; 34:441-456. [PMID: 32431474 PMCID: PMC7236897 DOI: 10.1177/0950017019885069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article explores the relationship between personal sacrifice and identity work within conditions of profound structural insecurity. We develop the concept of sacrificial labour to describe how individual self-sacrifice aligns workers' identities to the needs of organizations while gradually foreclosing the actualization of individuals' desired future selves. Drawing upon qualitative data from a longitudinal study of healthy individuals who enrol in paid clinical trials for the pharmaceutical industry, we make two contributions to the identity-work literature. First, we argue that the ongoing project of building stable and secure identities may become damaging when structural and cultural conditions defy even provisional, fragile attainment of this goal. Second, we reflect on how racialization and social marginalization erode identities and constrain possibilities for identity recuperation. Whereas the identity-work literature often focuses on the agential accomplishments of individuals, we provide a troubling account of how persistent social and economic inequalities confound identity realization efforts.
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Affiliation(s)
- Torin Monahan
- The University of North Carolina at Chapel Hill, USA
| | - Jill A Fisher
- The University of North Carolina at Chapel Hill, USA
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12
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Abstract
New precarious work practices are emerging in the post-industrial labor market together with subjects that are fit to cope with them. The literature on neoliberal governmentality theorizes how individuals are made to embrace a subjectivity that enforces competition, personal responsibility, and autonomy. However, few studies so far have investigated how such subjectivities may be resisted. Building on a study of freelance journalists, this article investigates the question of resistance. Although these professionals are indeed governed by a neoliberal regime, the findings illustrate how they also attempt to resist by enacting alternative subjectivities. The freelance journalists engage in resistance by organizing professional communities and boycotting exploitative copyright contracts, reduce and refuse work, lower the quality on delivered jobs, and quit freelance journalism altogether. By doing so, they refuse personal responsibility for their situation, they spend their time not generating economic value, and they enact a subjectivity of collaborator rather than competitor. This study thus illustrates how individuals who are poised to embrace a subjectivity as ‘entrepreneurial subjects par excellence’ are, despite everything, still able to engage in practices that constitute subject positions that denaturalize and challenge entrepreneurial subjectivity, even if the immediate outcomes of such resistance may be ambiguous at best. The study adds to the recent literature on resistance, particularly to the discussion about what it is one resists and against whom resistance is aimed, by showing how more traditional notions of resistance may intermingle and interact with more recent ideas related to refusal and exit movements.
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Mwale S. 'Becoming-with' a repeat healthy volunteer: Managing and negotiating trust among repeat healthy volunteers in commercial clinical drug trials. Soc Sci Med 2019; 245:112670. [PMID: 31786462 DOI: 10.1016/j.socscimed.2019.112670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 11/03/2019] [Accepted: 11/07/2019] [Indexed: 01/10/2023]
Abstract
Recent sociological research has raised important sociological and ethical questions about the role of financial rewards in terms of healthy volunteer involvement in clinical trials. Research suggests that it would be parochial to assume financial rewards alone are sufficient to explain repeat healthy volunteering. This paper explores other factors that might explain repeat healthy volunteering behaviours in phase I clinical drug trials. Drawing on qualitative research with healthy volunteers, the paper argues that while healthy volunteers make rational decisions to take part in drug trials, understanding how they become repeat volunteers requires considering varied relationships and networks involved. Drawing on Deleuze's concept of 'event' and 'becoming-with', the paper illustrates the relational, processual and embodied nature of trust in repeat healthy volunteer involvement in clinical drug trials. The paper concludes that repeat healthy volunteering is a constant flux of negotiating trust and mistrust. The paper contributes to sociological debates about trust and public engagement with technological innovations to illustrate trust among healthy volunteers as processual and changeable.
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Affiliation(s)
- Shadreck Mwale
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, BSMS Teaching Building 216, University of Sussex, Brighton, East Sussex, BN1 9PX, UK.
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Zvonareva O, Pimenov I, Kutishenko N, Mareev I, Martsevich S, Kulikov E. Informal professionalization of healthy participants in phase I clinical trials in Russia. Clin Trials 2019; 16:563-570. [PMID: 31647322 PMCID: PMC6906536 DOI: 10.1177/1740774519877851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Previous social science research has shown how some healthy phase I trial
participants identify themselves as workers and rely on trials as a major
source of income. The term “professionalization” has been used to denote
this phenomenon. Purpose: We aim to examine a component of healthy trial participants’
professionalization that has not yet been systematically studied: how repeat
phase I trial participants develop and claim expertise that distinguishes
them from others and makes them uniquely positioned to perform high-quality
clinical trial labor. We also aim to explain the significance of these
research results for protection of healthy participants in phase I
trials. Methods: This qualitative exploratory study was conducted in Russia, in two phase I
trial units. It involved semi-structured interviews with 28 healthy trial
participants with varying lengths of experience in trials, observations of
work done in trial units, and interpretive conversations with investigative
staff. Results: Interviewed healthy individuals who repeatedly participate in phase I trials
describe developing knowledge and skills that involve appreciating the
meaning of trial procedures, coming up with techniques to efficiently follow
them, organizing themselves and others in the course of a trial, and sharing
tacit ways of doing trial work well with other less experienced
participants. Our results suggest that a prerequisite for such
expertise-centered professionalization is the emergence of a positive
identity linked to seeing value in trial participation work. A crucial
component of professionalization thus understood is the development of a
work ethic that entails caring about results and being reliable partners for
investigators. Limitations: The attitudes and behaviors presented in this article are not suggested to be
universally shared among healthy trial participants, but rather represent a
particular instance of professionalization that coexists with other views
and tactics. Conclusions: A way of better protecting healthy trial participants begins with recognizing
their skills, knowledge, and the centrality of the contribution they are
making to pharmaceutical research. Currently, the expertise of experienced
trial participants is recognized on the work floor only; therefore, the
professionalization we described is informal. Yet, the informal
professionalization process is inherently risky as it does not involve any
change in the formal conditions of trial participants’ work. Instituting
formal measures for protecting healthy trial participants as skilled workers
combined with recognition of their expertise is essential.
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Affiliation(s)
- Olga Zvonareva
- Department of Health, Ethics and Society, Maastricht University, Maastricht, The Netherlands.,StrAU "Integrative Approaches to Public Health and Health Care", Siberian State Medical University, Tomsk, The Russian Federation.,Research Centre for Policy Analysis and Studies of Technologies (PAST-Centre), National Research Tomsk State University, Tomsk, The Russian Federation
| | - Igor Pimenov
- StrAU "Integrative Approaches to Public Health and Health Care", Siberian State Medical University, Tomsk, The Russian Federation
| | - Natalia Kutishenko
- Department of Preventive Pharmacotherapy, National Medical Research Center for Preventive Medicine, Moscow, The Russian Federation
| | - Igor Mareev
- Laboratory of Physiology, Clinical and Molecular Pharmacology, Goldberg Research Institute of Pharmacology and Regenerative Medicine, Tomsk, The Russian Federation
| | - Sergey Martsevich
- Department of Preventive Pharmacotherapy, National Medical Research Center for Preventive Medicine, Moscow, The Russian Federation
| | - Evgeny Kulikov
- StrAU "Integrative Approaches to Public Health and Health Care", Siberian State Medical University, Tomsk, The Russian Federation
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15
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Fisher JA. Commentary on Zvonareva et al.: Exploring the many meanings of "professional" in research participation. Clin Trials 2019; 16:571-573. [PMID: 31588783 DOI: 10.1177/1740774519877850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Smids J, Nyholm S. Is Being "Paid to Endure" Compatible With Autonomy? Paid Research Participation and Five (Rather Than Four) Goods of Work. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:41-43. [PMID: 31419199 DOI: 10.1080/15265161.2019.1630502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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17
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Malmqvist E. "Paid to Endure": Paid Research Participation, Passivity, and the Goods of Work. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:11-20. [PMID: 31419192 DOI: 10.1080/15265161.2019.1630498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A growing literature documents the existence of individuals who make a living by participating in phase I clinical trials for money. Several scholars have noted that the concerns about risks, consent, and exploitation raised by this phenomenon apply to many (other) jobs, too, and therefore proposed improving subject protections by regulating phase I trial participation as work. This article contributes to the debate over this proposal by exploring a largely neglected worry. Unlike most (other) workers, subjects are not paid to produce or achieve anything but to have things done to them. I argue that this passivity is problematic for reasons of distributive justice. Specifically, it fails to enable subjects to realize what Gheaus and Herzog call "the goods of work"-a failure not offset by adequate opportunities to realize these goods outside of the research context. I also consider whether granting subjects worker-type protections would accommodate this concern.
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Manton KJ, Gauld CS, White KM, Griffin PM, Elliott SL. Qualitative study investigating the underlying motivations of healthy participants in phase I clinical trials. BMJ Open 2019; 9:e024224. [PMID: 30647042 PMCID: PMC6340482 DOI: 10.1136/bmjopen-2018-024224] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES If patients are to reap the benefits of continued drug development, an understanding of why healthy participants take part in phase I clinical trials is imperative. The current study aimed to explore the nature of these underlying motivations which may, in turn, improve the overall participant experience and assist in the development of more effective recruitment and retention strategies. DESIGN This study used a qualitative design based on the theory of planned behaviour. Specifically, it explored healthy participants' underlying behavioural, control and normative beliefs which influence their participation in phase I clinical trials. SETTING This study took place at a company that specialises in conducting phase I and phase II clinical trials in the Australian state of Queensland. PARTICIPANTS Participants (n=31) were either currently undergoing a phase I clinical trial or had previously taken part in a phase I clinical trial. RESULTS Results showed that the motivations were varied and not solely centred on financial gains. Reported advantages of participation included altruism, while inconvenience was most often reported as a disadvantage. Friends were reported as those most likely to approve, while one's mother was reported as most likely to disapprove. Having a suitable time frame/flexible scheduling and feeling comfortable taking part in the trial were both the most commonly reported facilitators, while inflexible scheduling/time commitment was the most commonly reported barrier. CONCLUSIONS Practical implications included the need for organisations involved in clinical trials to be mindful of inflexible scheduling and exploring the possibility of making educational materials available to family members who may be concerned about the risks associated with participation. Overall, it is anticipated that the results of this study will improve the understanding of factors that influence phase I clinical trial participation which may, ultimately, help develop new therapeutics to improve patient health.
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Affiliation(s)
- Kerry J Manton
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Cassandra S Gauld
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Accident Research and Road Safety, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katherine M White
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Paul M Griffin
- Q-Pharm, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Mater Health Services and Mater Medical Research Institute, Brisbane, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Suzanne L Elliott
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Gallipoli Medical Research Centre, Brisbane, Queensland, Australia
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19
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Walker RL, Fisher JA. "My Body is One of the Best Commodities": Exploring the Ethics of Commodification in Phase I Healthy Volunteer Clinical Trials. KENNEDY INSTITUTE OF ETHICS JOURNAL 2019; 29:305-331. [PMID: 31983696 PMCID: PMC6989025 DOI: 10.1353/ken.2019.0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
In phase I clinical trials, healthy volunteers are dosed with investigational drugs and subjected to blood draws and other bodily monitoring procedures while they are confined to clinic spaces. In exchange, they are paid. These participants are, in a direct sense, selling access to their bodies for pharmaceutical companies and their associates to run drugs through. However, commodification is rarely investigated as an ethical dimension of phase I trial participation. We address this gap in the literature by bringing the voices of phase I healthy volunteers into conversation with philosophical perspectives on body commodification. Querying the intersection of commodification and phase I clinical trials illuminates important features of healthy volunteers' experiences, disentangles commodification from a dominant narrative about exploitation, and brings focus to the question of what, if any, market norms will best protect the multiple ways in which healthy volunteers' welfare is impacted by clinical trial participation.
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20
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Healthy Volunteers for Clinical Trials in Resource-Poor Settings: National Registries Can Address Ethical and Safety Concerns. Camb Q Healthc Ethics 2018. [PMCID: PMC6317110 DOI: 10.1017/s0963180118000476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Healthy volunteers (HVs) who participate in clinical trials are a vulnerable group that deserves specific protection. We assessed the number and types of studies that involve HVs around the world and outline the methodological barriers to their analysis. We found that tens of thousands of HVs are involved every year in clinical trials in a large variety of countries and that the overwhelming majority of studies are not “first-in-human” but pharmacokinetic studies. The two cornerstones for both ethical and safe participation of HVs in clinical trials are properly obtained informed consent and a minimization of exposure to risk, in particular by avoiding concealed participation in multiple trials. To minimize the risk of exploitation of HVs and their exposure to risk, we propose ways to ensure genuine informed consent, and advocate setting up national healthy volunteer registries as established in France and the U.K.
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21
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Fisher JA, McManus L, Wood MM, Cottingham MD, Kalbaugh JM, Monahan T, Walker RL. Healthy Volunteers' Perceptions of the Benefits of Their Participation in Phase I Clinical Trials. J Empir Res Hum Res Ethics 2018; 13:494-510. [PMID: 30296882 PMCID: PMC6235676 DOI: 10.1177/1556264618804962] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Other than the financial motivations for enrolling in Phase I trials, research on how healthy volunteers perceive the benefits of their trial participation is scant. Using qualitative interviews conducted with 178 U.S. healthy volunteers enrolled in Phase I trials, we investigated how participants described the benefits of their study involvement, including, but not limited to, the financial compensation, and we analyzed how these perceptions varied based on participants' sociodemographic characteristics and clinical trial history. We found that participants detailed economic, societal, and noneconomic personal benefits. We also found differences in participants' perceived benefits based on gender, age, ethnicity, educational attainment, employment status, and number of clinical trials completed. Our study indicates that many healthy volunteers believe they gain more than just the financial compensation when they accept the risks of Phase I participation.
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Affiliation(s)
| | - Lisa McManus
- University of North Carolina at Chapel Hill (USA)
- North Carolina State University (USA)
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22
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Fisher JA, McManus L, Cottingham MD, Kalbaugh JM, Wood MM, Monahan T, Walker RL. Healthy volunteers' perceptions of risk in US Phase I clinical trials: A mixed-methods study. PLoS Med 2018; 15:e1002698. [PMID: 30457992 PMCID: PMC6245523 DOI: 10.1371/journal.pmed.1002698] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 10/22/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is limited research on healthy volunteers' perceptions of the risks of Phase I clinical trials. In order to contribute empirically to long-standing ethical concerns about healthy volunteers' involvement in drug development, it is crucial to assess how these participants understand trial risks. The objectives of this study were to investigate (1) participants' views of the overall risks of Phase I trials, (2) their views of the risk of personally being harmed in a trial, and (3) how risk perceptions vary across participants' clinical trial history and sociodemographic characteristics. METHODS AND FINDINGS We qualitatively and quantitatively analyzed semi-structured interviews conducted with 178 healthy volunteers who had participated in a diverse range of Phase I trials in the United States. Participants had collective experience in a reported 1,948 Phase I trials (mean = 10.9; median = 5), and they were interviewed as part of a longitudinal study of healthy volunteers' risk perceptions, their trial enrollment decisions, and their routine health behaviors. Participants' qualitative responses were coded, analyzed, and subsequently quantified in order to assess correlations between their risk perceptions and demographics, such as their race/ethnicity, gender, age, educational attainment, employment status, and household income. We found that healthy volunteers often viewed the overall risks of Phase I trials differently than their own personal risk of harm. The majority of our participants thought that Phase I trials were medium, high, or extremely high risk (118 of 178), but most nonetheless felt that they were personally safe from harm (97 of 178). We also found that healthy volunteers in their first year of clinical trial participation, racial and ethnic minority participants, and Hispanic participants tended to view the overall trial risks as high (respectively, Jonckheere-Terpstra, -2.433, p = 0.015; Fisher exact test, p = 0.016; Fisher exact test, p = 0.008), but these groups did not differ in regard to their perceptions of personal risk of harm (respectively, chi-squared, 3.578, p = 0.059; chi-squared, 0.845, p = 0.358; chi-squared, 1.667, p = 0.197). The main limitation of our study comes from quantitatively aggregating data from in-depth interviews, which required the research team to interpret participants' nonstandardized risk narratives. CONCLUSIONS Our study demonstrates that healthy volunteers are generally aware of and reflective about Phase I trial risks. The discrepancy in healthy volunteers' views of overall and personal risk sheds light on why healthy volunteers might continue to enroll in clinical trials, even when they view trials on the whole as risky.
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Affiliation(s)
- Jill A. Fisher
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lisa McManus
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Sociology and Anthropology, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Marci D. Cottingham
- Department of Sociology, University of Amsterdam, Amsterdam, the Netherlands
| | - Julianne M. Kalbaugh
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Megan M. Wood
- Department of Communication, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Torin Monahan
- Department of Communication, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Rebecca L. Walker
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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23
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Williams Q, Fisher JA. Captive to the Clinic: Phase I Clinical Trials as Temporal Total Institutions. SOCIOLOGICAL INQUIRY 2018; 88:724-748. [PMID: 30546162 PMCID: PMC6287918 DOI: 10.1111/soin.12228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This article develops the concept of temporal total institutions to describe how and why individuals voluntarily submit to highly-controlled and often dehumanizing environments. We focus empirically on Phase I clinical trials, which offer compensation to healthy people in exchange for testing investigational pharmaceuticals. Analyzing the experiences of 67 U.S. healthy volunteers, we illustrate how comparisons between Phase I trials and prison are salient to participants as they reflect on their confinement in research facilities and their interactions with other participants and research staff. We argue that conditions of contemporary economic insecurity and/or poverty facilitate the existence of coercive temporal total institutions by undermining voluntariness. Phase I clinics take advantage of the steady supply of individuals who will submit to the organization's demands out of hope that the income gained will be transformative for their lives.
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24
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Cottingham MD, Kalbaugh JM, Swezey T, Fisher JA. Exceptional Risk: Healthy Volunteers' Perceptions of HIV/AIDS Clinical Trials. J Acquir Immune Defic Syndr 2018; 79 Suppl 1:S30-S36. [PMID: 30222703 PMCID: PMC6373478 DOI: 10.1097/qai.0000000000001818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As with all early-stage testing of investigational drugs, clinical trials targeting HIV/AIDS can pose unknown risks to research subjects. Unlike sick participants seeking a therapeutic benefit, the motivations and barriers for healthy volunteers are more complex and understudied. Drawing on interviews and clinical trial data from 178 healthy volunteers, we examine how they perceive HIV/AIDS studies in the early stages of testing. A subset of healthy volunteers see phase I HIV/AIDS studies as particularly risky for reasons ranging from fear of catching the disease or having long-lasting and uncomfortable side effects to inexplicable fears that they cannot even articulate. Some participants have had past negative experiences in such trials that inform these views, but others cite information from staff and other participants as influential. Healthy volunteers' general fears concerning AIDS also shape their views of participating in phase I HIV/AIDS clinical trials.
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Affiliation(s)
| | - Julianne M. Kalbaugh
- Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Teresa Swezey
- Duke Clinical Research Institute, Duke University, Durham, NC
| | - Jill A. Fisher
- Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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25
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Lamkin M, Elliott C. Avoiding Exploitation in Phase I Clinical Trials: More than (Un)Just Compensation. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:52-63. [PMID: 30026654 PMCID: PMC6047746 DOI: 10.1177/1073110518766008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Lowering compensation to research subjects to protect them from “undue inducement” is a misguided attempt to shoehorn a concern about exploitation into the framework of autonomy. We suggest that oversight bodies should be less concerned about undue influence than about exploitation of subjects. Avoiding exploitation in human subjects research requires not only increasing compensation, but enhancing the dignity of research participation.
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Affiliation(s)
- Matt Lamkin
- Associate Professor at the University of Tulsa College of Law. He earned an A.B. degree in Sociology at Princeton University (Princeton, NJ), a J.D. at Northwestern University Law School (Chicago, IL), and an M.A. in Bioethics at the University of Minnesota (Minneapolis, MN), and served as a Fellow at Stanford Law School's Center for Law and the Biosciences.A professor in the Center for Bioethics and the Department of Pediatrics and an affiliate faculty member in the Department of Philosophy and the School of Journalism and Mass Communications at the University of Minnesota. He has a Ph.D. in philosophy from Glasgow University (Glasgow, Scotland), an M.D. from the Medical University of South Carolina (Charleston, SC), and a B.S. from Davidson College (Davidson, NC)
| | - Carl Elliott
- Associate Professor at the University of Tulsa College of Law. He earned an A.B. degree in Sociology at Princeton University (Princeton, NJ), a J.D. at Northwestern University Law School (Chicago, IL), and an M.A. in Bioethics at the University of Minnesota (Minneapolis, MN), and served as a Fellow at Stanford Law School's Center for Law and the Biosciences.A professor in the Center for Bioethics and the Department of Pediatrics and an affiliate faculty member in the Department of Philosophy and the School of Journalism and Mass Communications at the University of Minnesota. He has a Ph.D. in philosophy from Glasgow University (Glasgow, Scotland), an M.D. from the Medical University of South Carolina (Charleston, SC), and a B.S. from Davidson College (Davidson, NC)
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26
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Elliott C. Commentary on Grady et al.: Using poor, uninsured minorities to test the safety of experimental drugs. Clin Trials 2017; 14:547-550. [PMID: 28747074 DOI: 10.1177/1740774517722126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Carl Elliott
- Center for Bioethics, Academic Health Center, University of Minnesota, Minneapolis, MN, USA
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27
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Abstract
The last 15 years have witnessed renewed interest in resistance in and around organizations. In this essay, we offer a conceptual framework to thematize this burgeoning conceptual and empirical terrain. We critically explore scholarship that examines resistance in terms of its manifestations and political intent or impact. We offer four fields of possibility for resistance scholarship: individual infrapolitics, collective infrapolitics, insubordination, and insurrection (the “four I’s” of resistance). We conclude by considering the relationship between resistance theory and praxis, and pose four questions, or provocations, for stimulating future resistance research and practice.
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Affiliation(s)
| | | | - Ignasi Martí
- Emlyon Business School, France and ESADE-Ramon Llull University, Spain
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28
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Abstract
OBJECTIVES The aim of the study was to explore women's motivations for participating in a clinical trial and to evaluate how financial compensation impacts women's explanations for participation. DESIGN, SETTING AND PARTICIPANTS Semistructured interviews were conducted face to face or by telephone with 25 of 220 women who participated in a pragmatic randomised trial for app-administered self-care acupressure for dysmenorrhoea (AKUD). Of these 25 women, 10 had entered AKUD knowing they would receive a financial compensation of €30. A purposive sampling strategy was used. RESULTS Women had a long history of seeking help and were unsatisfied with the options available, namely painkillers and oral contraceptives. While interviewees were open to painkillers, they were uneasy about taking them on a monthly basis. The AKUD trial offered the possibility to find an alternative solution. A second reason for participation was the desire to add a new treatment to routine medical care, for which the interviewees considered randomised trials a prerequisite. The financial incentive was a subsidiary motivation in the interviewees' narratives. CONCLUSIONS Our results contribute to the ongoing discussion of the impact of financial compensation on research participants' assessment of risk. The interviewed women considered all research participants able to make their own choices regarding trial participation, even in the face of financial compensation or payment of study participants. Furthermore, the importance of clinical trials providing new treatments that could change medical practice might be an overlooked reason for trial participation and could be used in future recruitment strategies.
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Affiliation(s)
- Susanne Blödt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia M Witt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Christine Holmberg
- Institute of Public Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
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29
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McNeill FG. “Original Venda hustler”: symbols, generational difference and the construction of ethnicity in post-apartheid South Africa. ANTHROPOLOGY SOUTHERN AFRICA 2016. [DOI: 10.1080/23323256.2016.1209725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Fraser G. McNeill
- Department of Anthropology and Archaeology, University of Pretoria, Pretoria, South Africa
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30
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Cottingham MD, Fisher JA. Risk and Emotion Among Healthy Volunteers in Clinical Trials. SOCIAL PSYCHOLOGY QUARTERLY 2016; 79:222-242. [PMID: 28867852 DOI: 10.1177/0190272516657655] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Theorized as objective or constructed, risk is recognized as unequally distributed across social hierarchies. Yet the process by which social forces shape risk and risk emotions remains unknown. The pharmaceutical industry depends on healthy individuals to voluntarily test early-stage, investigational drugs in exchange for financial compensation. Emblematic of risk in late modernity, Phase I testing is a rich site for examining how class and race shape configurations of emotion and risk. Using interview data from 178 healthy trial participants, this article examines emotion and risk as mutually constituting processes linked to biographical context and social structure. Biographical events like economic insecurity and incarceration influence how risk is felt by providing comparative experiences of felt risk and felt benefits. Such events, in turn, are structured by class-based and racial inequalities, linking class and race positions to primary emotional experiences of risk.
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Affiliation(s)
- Marci D Cottingham
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Jill A Fisher
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, NC, USA
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