1
|
Bompart F, Fisher JA, Allen E, Sevene E, Kumar N, Chew CK, Fink V, Lanzerath D, Hirsch F. The VolREthics initiative to protect the well-being of healthy volunteers in biomedical research. Nat Med 2023; 29:2393-2394. [PMID: 37580535 DOI: 10.1038/s41591-023-02490-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- François Bompart
- INSERM, Paris, France
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Jill A Fisher
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Elizabeth Allen
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
- The Global Health Network, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Esperança Sevene
- Department of Physiologic Science, Clinical Pharmacology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Nandini Kumar
- Forum for Ethics Review Committees in India, Mumbai, India
| | | | | | - Dirk Lanzerath
- European Network of Research Ethics Committees Network, Bonn, Germany
| | | |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
The ethical anatomy of payment for research participants. MEDICINE, HEALTH CARE AND PHILOSOPHY 2022; 25:449-464. [PMID: 35610403 PMCID: PMC9427899 DOI: 10.1007/s11019-022-10092-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/18/2022]
Abstract
In contrast to most publications on the ethics of paying research subjects, which start by identifying and analyzing major ethical concerns raised by the practice (in particular, risks of undue inducement and exploitation) and end with a set of—more or less well-justified—ethical recommendations for using payment schemes immune to these problems, this paper offers a systematic, principle-based ethical analysis of the practice. It argues that researchers have a prima facie moral obligation to offer payment to research subjects, which stems from the principle of social beneficence. This principle constitutes an ethical “spine” of the practice. Other ethical principles of research ethics (respect for autonomy, individual beneficence, and justice/fairness) make up an ethical “skeleton” of morally sound payment schemes by providing additional moral reasons for offering participants (1) recompense for reasonable expenses; and (2a) remuneration conceptualized as a reward for their valuable contribution, provided (i) it meets standards of equality, adequacy and non-exploitation, and (ii) it is not overly attractive (i.e., it does not constitute undue inducement for participation or retention, and does not encourage deceptive behaviors); or (2b) remuneration conceptualized as a market-driven price, provided (i) it is necessary and designed to help the study achieve its social and scientific goals, (ii) it does not reinforce wider social injustices and inequalities; (iii) it meets the requirement of non-exploitation; and (iv) it is not overly attractive. The principle of justice provides a strong ethical reason for not offering recompenses for lost wages (or loss of other reasonably expected profits).
Collapse
|
4
|
Gelinas L, Morrell W, White SA, Bierer BE. Online Research Participant Communication: Balancing Benefits and Risks. Ethics Hum Res 2021; 43:2-10. [PMID: 34196504 DOI: 10.1002/eahr.500094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Online communication has emerged as an important vehicle for participant interaction during the course of clinical research. At the same time, such communication has been identified as a source of risks both for participants and the scientific integrity of clinical trials. Although strategies for mitigating these risks have become a focus in the research community, missing from the discussion has been a sustained and sympathetic effort to understand the various benefits of online communication for participants themselves. In this article, we provide a taxonomy of the benefits of online communication for participants and argue that attempts to mitigate the risks of online communication by discouraging or placing limits on such communication are generally unadvisable. Instead, we advance a context-sensitive approach that emphasizes education and several actionable recommendations for preserving the benefits of online participant communities while mitigating the risks.
Collapse
Affiliation(s)
- Luke Gelinas
- IRB chairperson at Advarra and a senior advisor at the Multi-Regional Clinical Trials Center of Brigham & Women's Hospital and Harvard University
| | - Walker Morrell
- Project manager at the Multi-Regional Clinical Trials Center of Brigham & Women's Hospital and Harvard University
| | - Sarah A White
- Executive director of the Multi-Regional Clinical Trials Center at Brigham & Women's Hospital and Harvard University
| | - Barbara E Bierer
- Professor of medicine at the Multi-Regional Clinical Trials Center of Brigham & Women's Hospital and Harvard University
| |
Collapse
|
5
|
Devine EG, Pingitore AM, Margiotta KN, Hadaway NA, Reid K, Peebles K, Hyun JW. Frequency of concealment, fabrication and falsification of study data by deceptive subjects. Contemp Clin Trials Commun 2021; 21:100713. [PMID: 33604482 PMCID: PMC7876535 DOI: 10.1016/j.conctc.2021.100713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/29/2020] [Accepted: 01/15/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Many studies have found evidence that research subjects engage in deceptive practices while participating in health-related studies. Little is known, however, about how often subjects use deception and the percentage of studies a typical subject will contaminate with false data. This study examined the frequency of use of different types of deception among a sample of subjects who admit to using deception. Methods A sample of 59 subjects who had participated in at least two health-related studies in the past 12 months and admitted to using deception in at least one were interviewed. Subjects were asked a series of questions about concealing information and fabricating information to gain entry into studies. Subjects were also asked about falsifying data after being enrolled in a health-related study. All study data reported pertains to only subjects who reported using deception in health-related studies and is based on subjects’ study participation only within the last 12 months from the date of the interview. Results Subjects who conceal information in order to enroll in trials reported using concealment in about two thirds (67%) of the trials they participated in over the past 12 months. On average, these subjects’ use of concealment was highest for mental health information (58% of studies) and physical health information (57% of studies). The average frequency of fabricating information in order to enroll in trials was 53% with exaggerating health symptoms (45% of studies) and pretending to have a health condition (39% of studies) as the two most widely used strategies. Subjects who falsify study data after enrollment reported doing so 40% of the time. These subjects falsely reported improvement in the health condition being studied in 38% of the trials they took part in. Subjects who admitted to throwing away study medication to create the appearance of compliance reported doing so 32% of the time. Limitations Although this study provides evidence that subjects who admit to using deception contaminate a high percentage of studies, larger and more geographically diverse samples are needed to understand the full extent of the problem of deceptive subjects in research. Regional economic, cultural, or organizational factors may be related to the rate of subjects using deception. It is also possible that this sample underrepresents the use of deception as there are likely subjects who use deception that would be unwilling to admit the extent of this behavior. Conclusion Deceptive subject's behavior poses a threat to the integrity of research findings. Given that deceptive subjects contaminate a high percentage of studies they take part in by concealing information, fabricating information, and falsifying study data after enrollment, efforts to identify and exclude these subjects is important to the integrity of research findings. Strategies to exclude deceptive subjects from health research should be used to inform study designs. Widespread adoption of research subject identity registries could greatly reduce the scope of studies that a single deceptive subject could contaminate. Technological solutions that provide an objective measure of medication compliance may be valuable tools for limiting fraudulent reports of compliance.
Collapse
Affiliation(s)
- Eric G Devine
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Alyssa M Pingitore
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Kathryn N Margiotta
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Natalia A Hadaway
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Kathleen Reid
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Kristina Peebles
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Jae Won Hyun
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Bhattacharya S. Should we pay more to participants involved in research projects? Med Leg J 2019; 87:201-203. [PMID: 31697213 DOI: 10.1177/0025817219881971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Inducements for research participants are considered controversial. Researchers face an ethical dilemma if they offer money as an inducement when enrolling volunteers for their study. Do these payments invalidate the consent process and make this unethical? Should the results of such studies be considered invalid? A recent publication by Persad and colleagues supports differential payment to volunteers, based upon their level of involvement, from an ethical perspective. Our current response to this article explores a few more areas of controversy and attempts to clarify them.
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Walker RL, Cottingham MD, Fisher JA. Serial Participation and the Ethics of Phase 1 Healthy Volunteer Research. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2019; 43:83-114. [PMID: 29342285 PMCID: PMC5901090 DOI: 10.1093/jmp/jhx033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Phase 1 healthy volunteer clinical trials-which financially compensate subjects in tests of drug toxicity levels and side effects-appear to place pressure on each joint of the moral framework justifying research. In this article, we review concerns about phase 1 trials as they have been framed in the bioethics literature, including undue inducement and coercion, unjust exploitation, and worries about compromised data validity. We then revisit these concerns in light of the lived experiences of serial participants who are income-dependent on phase 1 trials. We show how participant experiences shift attention from discrete exchanges, behaviors, and events in the research enterprise to the ongoing and dynamic patterns of serial participation in which individual decision-making is embedded in collective social and economic conditions and shaped by institutional policies. We argue in particular for the ethical significance of structurally diminished voluntariness, routine powerlessness in setting the terms of exchange, and incentive structures that may promote pharmaceutical interests but encourage phase 1 healthy volunteers to skirt important rules.
Collapse
Affiliation(s)
- Rebecca L Walker
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Jill A Fisher
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
10
|
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]
|
11
|
Różyńska J. Passivity, Research Risks, and Worker-Type Protections for Research Subjects. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:46-48. [PMID: 31419200 DOI: 10.1080/15265161.2019.1630510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
|
12
|
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.
Collapse
|
13
|
McManus L, Davis A, Forcier RL, Fisher JA. Appraising Harm in Phase I Trials: Healthy Volunteers' Accounts of Adverse Events. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2019; 47:323-333. [PMID: 31298107 PMCID: PMC6661148 DOI: 10.1177/1073110519857289] [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: 06/10/2023]
Abstract
While risk of harm is an important focus for whether clinical research on humans can and should proceed, there is uncertainty about what constitutes harm to a trial participant. In Phase I trials on healthy volunteers, the purpose of the research is to document and measure safety concerns associated with investigational drugs, and participants are financially compensated for their enrollment in these studies. In this article, we investigate how characterizations of harm are narrated by healthy volunteers in the context of the adverse events (AEs) they experience during clinical trials. Drawing upon qualitative research, we find that participants largely minimize, deny, or re-attribute the cause of these AEs. We illustrate how participants' interpretations of AEs may be shaped both by the clinical trial environment and their economic motivation to participate. While these narratives are emblematic of the larger ambiguity surrounding harm in the context of clinical trial participation, we argue that these interpretations also problematically maintain the narrative of the safety of clinical trials, the ethics of testing investigational drugs on healthy people, and the rigor of data collected in the specter of such ambiguity.
Collapse
Affiliation(s)
- Lisa McManus
- Lisa McManus is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She is a Ph.D. candidate in Sociology at North Carolina State University in Raleigh, NC, where she received her M.S. in 2012. Arlene M. Davis, J.D., is an associate professor at the University of North Carolina at Chapel Hill. She has more than 20 years of experience as a researcher on studies examining the ethical dimensions of study design, participation, and data collection. She has also served on institutional review boards and taught research ethics in a variety of settings as a faculty member in the Department of Social Medicine and Center for Bioethics at the UNC School of Medicine. Rebecca L. Forcier is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She received her B.A. in 2015 from Duke University in Durham, NC. Jill A. Fisher, Ph.D., is an associate professor in the Department of Social Medicine and Center for Bioethics at the University of North Carolina at Chapel Hill. She received her Ph.D. in 2005 in Science and Technology Studies from Rensselaer Polytechnic Institute in Troy, NY
| | - Arlene Davis
- Lisa McManus is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She is a Ph.D. candidate in Sociology at North Carolina State University in Raleigh, NC, where she received her M.S. in 2012. Arlene M. Davis, J.D., is an associate professor at the University of North Carolina at Chapel Hill. She has more than 20 years of experience as a researcher on studies examining the ethical dimensions of study design, participation, and data collection. She has also served on institutional review boards and taught research ethics in a variety of settings as a faculty member in the Department of Social Medicine and Center for Bioethics at the UNC School of Medicine. Rebecca L. Forcier is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She received her B.A. in 2015 from Duke University in Durham, NC. Jill A. Fisher, Ph.D., is an associate professor in the Department of Social Medicine and Center for Bioethics at the University of North Carolina at Chapel Hill. She received her Ph.D. in 2005 in Science and Technology Studies from Rensselaer Polytechnic Institute in Troy, NY
| | - Rebecca L Forcier
- Lisa McManus is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She is a Ph.D. candidate in Sociology at North Carolina State University in Raleigh, NC, where she received her M.S. in 2012. Arlene M. Davis, J.D., is an associate professor at the University of North Carolina at Chapel Hill. She has more than 20 years of experience as a researcher on studies examining the ethical dimensions of study design, participation, and data collection. She has also served on institutional review boards and taught research ethics in a variety of settings as a faculty member in the Department of Social Medicine and Center for Bioethics at the UNC School of Medicine. Rebecca L. Forcier is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She received her B.A. in 2015 from Duke University in Durham, NC. Jill A. Fisher, Ph.D., is an associate professor in the Department of Social Medicine and Center for Bioethics at the University of North Carolina at Chapel Hill. She received her Ph.D. in 2005 in Science and Technology Studies from Rensselaer Polytechnic Institute in Troy, NY
| | - Jill A Fisher
- Lisa McManus is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She is a Ph.D. candidate in Sociology at North Carolina State University in Raleigh, NC, where she received her M.S. in 2012. Arlene M. Davis, J.D., is an associate professor at the University of North Carolina at Chapel Hill. She has more than 20 years of experience as a researcher on studies examining the ethical dimensions of study design, participation, and data collection. She has also served on institutional review boards and taught research ethics in a variety of settings as a faculty member in the Department of Social Medicine and Center for Bioethics at the UNC School of Medicine. Rebecca L. Forcier is a research assistant in the Department of Social Medicine at the UNC School of Medicine. She received her B.A. in 2015 from Duke University in Durham, NC. Jill A. Fisher, Ph.D., is an associate professor in the Department of Social Medicine and Center for Bioethics at the University of North Carolina at Chapel Hill. She received her Ph.D. in 2005 in Science and Technology Studies from Rensselaer Polytechnic Institute in Troy, NY
| |
Collapse
|
14
|
Resnik DB. Are Payments to Human Research Subjects Ethically Suspect? JOURNAL OF CLINICAL RESEARCH BEST PRACTICES 2019; 15:2374. [PMID: 32148470 PMCID: PMC7059779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Bioethicists and institutional review boards often worry that paying human subjects too much money for research participation might compromise informed consent by coercing or unduly influencing individuals to enroll in studies against their better judgment. However, empirical research does not support the hypothesis that payments adversely impact judgment and decision-making concerning research participation, and the opposite problem - underpayment - also raises significant ethical concerns, such as exploitation, and under-enrollment. In this article, I argue that our ethical qualms about the negative impact of money on decisions concerning research participation are largely unfounded and reflect more general concerns about the need to avoid repeating abuses of human subjects that occurred in the past. I shall also argue that the best way to promote the rights and welfare of human research subjects is to treat them as competent adults who have the capacity to make wise choices involving money. What this argument means in practice is that offering human subjects money for their participation should not be regarded as ethically suspect, absent substantial evidence to the contrary.
Collapse
Affiliation(s)
- David B Resnik
- Bioethicist and IRB Chair at the National Institute of Environmental Health Science, National Institutes of Health
| |
Collapse
|
15
|
Siegel JT, Navarro M. A conceptual replication examining the risk of overtly listing eligibility criteria on Amazon’s Mechanical Turk. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2019. [DOI: 10.1111/jasp.12580] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jason T. Siegel
- School of Social Science, Policy & Evaluation Claremont Graduate University Claremont California
| | - Mario Navarro
- School of Social Science, Policy & Evaluation Claremont Graduate University Claremont California
| |
Collapse
|
16
|
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: 16] [Impact Index Per Article: 2.7] [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.
Collapse
Affiliation(s)
| | - Lisa McManus
- University of North Carolina at Chapel Hill (USA)
- North Carolina State University (USA)
| | | | | | | | | | | |
Collapse
|
17
|
Lynch HF, Largent EA, Joffe S, DeMichele AM. Protecting clinical trial participants and study integrity in the age of social media. Cancer 2018; 124:4610-4617. [PMID: 30329153 DOI: 10.1002/cncr.31748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/03/2018] [Accepted: 05/30/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Holly Fernandez Lynch
- Department of Medical Ethics and Health PolicyUniversity of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Emily A. Largent
- Department of Medical Ethics and Health PolicyUniversity of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Steven Joffe
- Department of Medical Ethics and Health PolicyUniversity of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
- Division of OncologyChildren’s Hospital of Philadelphia Philadelphia Pennsylvania
| | - Angela M. DeMichele
- Division of Hematology‐OncologyUniversity of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Lee CP, Holmes T, Neri E, Kushida CA. Deception in clinical trials and its impact on recruitment and adherence of study participants. Contemp Clin Trials 2018; 72:146-157. [PMID: 30138717 DOI: 10.1016/j.cct.2018.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/27/2018] [Accepted: 08/14/2018] [Indexed: 11/27/2022]
Abstract
Deceptive practices by participants in clinical research are prevalent. It has been shown that as high as 75% of participants withheld information to avoid exclusion from studies. Self-reported adherence has been found to be largely inaccurate. Overcoming deception is a critical issue, since the safety of study participants, the integrity of research data and research resources are at risk. In this review article, we examine deception from the perspective of investigators conducting clinical trials; we describe the types (concealment, fabrication, drug holidays and collusion), prevalence, risks, and predictors of deception, and propose an approach to reduce the impact of deception, especially on adherence, in clinical trials.
Collapse
Affiliation(s)
- Chuen Peng Lee
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore.
| | - Tyson Holmes
- Stanford University Human Immune Monitoring Center, Institute for Immunity Transplantation and Infection, Stanford University School of Medicine, Stanford, United States
| | - Eric Neri
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - Clete A Kushida
- Stanford Sleep Medicine Center, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 450 Broadway Street, MC 5704, Pavilion C, 2nd Floor, Redwood City, CA 94063-5704, United States
| |
Collapse
|
20
|
McManus L, Fisher JA. To report or not to report: Exploring healthy volunteers' rationales for disclosing adverse events in Phase I drug trials. AJOB Empir Bioeth 2018; 9:82-90. [PMID: 29693508 PMCID: PMC5976538 DOI: 10.1080/23294515.2018.1469552] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND Phase I trials test the safety and tolerability of investigational drugs and often use healthy volunteers as research participants. Adverse events (AEs) are collected in part through participants' self-reports of any symptoms they experience during the trial. In some cases, experiencing AEs can result in trial participation being terminated. Because of the economic incentives underlying their motivation to participate, there is concern that healthy volunteers routinely fail to report AEs and thereby jeopardize the validity of the trial results. METHODS We interviewed 131 U.S. healthy volunteers about their experiences with AEs, including their rationales for reporting or failing to report symptoms. RESULTS We found that participants have three primary rationales for their AE reporting behavior: economic, health-oriented, and data integrity. Participants often make decisions about whether to report AEs on a case-by-case basis, evaluating what effects reporting or not reporting might have on the compensation they receive from the trial, the risk to their health, and the results of the particular clinical trial. Participants' interpretations of clinic policies, staff behaviors, and personal or vicarious experiences with reporting AEs also shape reporting decisions. CONCLUSIONS Our findings demonstrate that participants' reporting behavior is more complex than previous portraits of healthy volunteers have suggested. Rather than finding participants who were so focused on the financial compensation that they were willing to subvert trial results, our study indicates that participants are willing in most cases to forgo their full compensation if they believe not reporting their symptoms jeopardizes their own safety or the validity of the research.
Collapse
Affiliation(s)
- Lisa McManus
- a Department of Sociology & Anthropology , North Carolina State University
- b Center for Bioethics and Department of Social Medicine , University of North Carolina at Chapel Hill
| | - Jill A Fisher
- b Center for Bioethics and Department of Social Medicine , University of North Carolina at Chapel Hill
| |
Collapse
|
21
|
McCaul ME, Wand GS. Detecting Deception in Our Research Participants: Are Your Participants Who You Think They Are? Alcohol Clin Exp Res 2017; 42:230-237. [PMID: 29286543 DOI: 10.1111/acer.13556] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/09/2017] [Indexed: 12/20/2022]
Abstract
There is increasing awareness of the potential negative impacts of participant deception on research, including possibly undermining reliability and reproducibility of study findings. These deceptive individuals set their personal interests above the rules of study participation, thereby jeopardizing data quality as well as placing themselves and others at risk. The costs of participant deception are numerous. Overall, it reduces statistical power and may even result in false conclusions about efficacy and safety. To date, most studies have not utilized sufficient methods to detect rule-breaking subjects. The purpose of this article is to bring to the attention of alcohol and other drug researchers issues involving deceptive participants. The review will suggest alcohol-specific as well as more general strategies to identify and thereby minimize enrollment of these deceptive participants. Specifically, we will identify strategies that are employed in different phases of human alcohol research and advance approaches that may be helpful to the field in reducing these contaminants. As a field, we need to be more proactive in identifying the deceptive participant even at the cost of more burdensome study enrollment. In light of the systemic nature and multipronged damage that this emerging pattern of deception inflicts on clinical research, it is imperative that we each assume greater responsibility for our role in mitigating this source of research contamination.
Collapse
Affiliation(s)
- Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Medicine , The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gary S Wand
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Medicine , The Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
22
|
Hamidovic A. Targeting Mediators of Smoking Persistence with Intranasal Insulin. Front Pharmacol 2017; 8:706. [PMID: 29085297 PMCID: PMC5649209 DOI: 10.3389/fphar.2017.00706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/21/2017] [Indexed: 12/23/2022] Open
Abstract
Rapid-acting, non-irritating nasal treatment options for smoking cessation pharmacotherapy are lacking. The halt in development is due, in part, to difficulty in delivering compounds across the blood brain barrier. Recently, in both human and animal models, insulin was shown to be capable of being transported to the cerebrospinal fluid and various brain regions via the “nose-to-brain” pathway, which bypasses the blood brain barrier, but is not free of its own unique, though different from blood brain barrier, challenges. This review will first evaluate and critique pharmacokinetic and pharmacodynamic evidence of intranasal insulin (i.e., nose-to-brain) delivery. As intranasal insulin has been shown in clinical trials to be effective in reducing nicotine cravings, in the remainder of the review, hypothesis-generating literature for additional mediators (i.e., other than the already shown nicotine craving) of smoking persistence will be reviewed. In particular, weight gain, impulsive behavior, and anhedonia have been shown to contribute to the inability to quit smoking. For each of these, after reviewing how the mediator promotes smoking, intranasal insulin literature from animal and clinical models will be critiqued in assessing whether a hypothesis may be generated that intranasal insulin may alleviate it, thereby potentially contributing to a successful smoking cessation outcome.
Collapse
Affiliation(s)
- Ajna Hamidovic
- Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| |
Collapse
|
23
|
Gantz I, Sokolova L, Jain L, Iredale C, O'Neill EA, Wei Z, Lam R, Suryawanshi S, Kaufman KD, Engel SS, Lai E. Use of Prohibited Medication, a Potentially Overlooked Confounder in Clinical Trials: Omarigliptin (Once-weekly DPP-4 Inhibitor) Monotherapy Trial in 18- to 45-year-olds. Clin Ther 2017; 39:2024-2037. [PMID: 28923291 DOI: 10.1016/j.clinthera.2017.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/20/2017] [Accepted: 08/11/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The objective of this clinical trial was to assess the efficacy and safety of omarigliptin monotherapy in young adult patients with type 2 diabetes mellitus (T2DM). Unexpected efficacy results in this trial led to a series of investigations that identified the use of prohibited medication by a substantial number of trial patients. METHODS Patients with T2DM who were ≥18 to <45 years of age and either drug-naive or not on an antihyperglycemic agent for ≥12 weeks with inadequate glycemic control were randomized in a double-blind manner to receive omarigliptin 25 mg once weekly (n = 102) or placebo once weekly (n = 101) for 24 weeks. The objectives of the trial were to assess the effect of treatment with omarigliptin on glycemic parameters, including levels of glycosylated hemoglobin (HbA1c), 2-hour postmeal glucose, and fasting plasma glucose, and to assess the safety and tolerability of omarigliptin. Additional investigations into trial conduct included the measurement of drug levels for omarigliptin and metformin in blood samples collected for future biomedical research, available for approximately one half of the patients. FINDINGS The mean age of trial participants was 39.2 years, approximately 60% were male, mean body mass index was 32.5 kg/m2, and mean duration of diabetes was 3.1 years. The mean baseline HbA1c value was 7.9% in the omarigliptin group and 8.1% in the placebo group. After 24 weeks, the least squares mean change (95% CI) in HbA1c value from baseline was -0.33% (-0.60 to -0.06) in the omarigliptin group and -0.45% (-0.72 to -0.18) in the placebo group, with a between-group difference of 0.12% (-0.26 to 0.49; P = 0.535). Similarly, no between-group difference was observed for the other glycemic parameters (2-hour postmeal glucose and fasting plasma glucose levels). No issues were identified in drug allocation, dispensing or supply, patient compliance with trial medication, sample handling or analysis, or site trial conduct that explained the observed results. Measurement of drug levels from future biomedical research samples uncovered the use, with no investigator knowledge, of an antihyperglycemic agent that was prohibited by the protocol (ie, metformin) by 42.4% (39 of 92) of patients. Metformin was used by more patients in the placebo group (57% [25 of 44]) than in the omarigliptin group (29% [14 of 48]). IMPLICATIONS The use of prohibited metformin in a trial of a dipeptidyl peptidase-4 inhibitor, omarigliptin, introduced a confounding factor that invalidated the results of the trial. This behavior may have been encouraged in the trial by protocol-specified self-monitoring of blood glucose levels. Use of prohibited medication may be an underappreciated confounder in clinical trial research. TRIAL REGISTRATIONS MK-3102-028 (US); ClinicalTrials.gov identifier, NCT01814748; EudraCT number, 2012-004303-12 (EU).
Collapse
Affiliation(s)
- Ira Gantz
- Merck & Co, Inc, Kenilworth, New Jersey.
| | - Liubov Sokolova
- V.P. Komisarenko Institute of Endocrinology and Metabolism, Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | | | | | | | - Ziwen Wei
- Merck & Co, Inc, Kenilworth, New Jersey
| | | | | | | | | | - Eseng Lai
- Merck & Co, Inc, Kenilworth, New Jersey
| |
Collapse
|
24
|
Pavletic A, Pao M. Safety, Science, or Both? Deceptive Healthy Volunteers: Psychiatric Conditions Uncovered by Objective Methods of Screening. PSYCHOSOMATICS 2017; 58:657-663. [PMID: 28651795 DOI: 10.1016/j.psym.2017.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/03/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Adriana Pavletic
- National Institute of Mental Health, Office of the Clinical Director, Bethesda, Maryland 20892, USA
| | - Maryland Pao
- National Institute of Mental Health, Office of the Clinical Director, Bethesda, Maryland 20892, USA.
| |
Collapse
|
25
|
Devine EG, Peebles KR, Martini V. Strategies to exclude subjects who conceal and fabricate information when enrolling in clinical trials. Contemp Clin Trials Commun 2016; 5:67-71. [PMID: 29740622 PMCID: PMC5936691 DOI: 10.1016/j.conctc.2016.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/14/2016] [Accepted: 12/12/2016] [Indexed: 11/17/2022] Open
Abstract
Clinical trials within the US face an increasing challenge with the recruitment of quality candidates. One readily available group of subjects that have high rates of participation in clinical research are subjects who enroll in multiple trials for the purpose of generating income through study payments. Aside from issues of safety and generalizability, evidence suggests that these subjects employ methods of deception to qualify for the strict entrance criteria of some studies, including concealing information and fabricating information. Including these subjects in research poses a significant risk to the integrity of data quality and study designs. Strategies to limit enrollment of subjects whose motivation is generating income have not been systematically addressed in the literature. The present paper is intended to provide investigators with a range of strategies for developing and implementing a study protocol with protections to minimize the enrollment of subjects whose primary motivation for enrolling is to generate income. This multifaceted approach includes recommendations for advertising strategies, payment strategies, telephone screening strategies, and baseline screening strategies. The approach also includes recommendations for attending to inconsistent study data and subject motivation. Implementing these strategies may be more or less important depending upon the vulnerability of the study design to subject deception. Although these strategies may help researchers exclude subjects with a higher rate of deceptive practices, widespread adoption of subject registries would go a long way to decrease the chances of subjects enrolling in multiple studies or more than once in the same study.
Collapse
Affiliation(s)
- Eric G. Devine
- Corresponding author. Department of Psychiatry, Boston University School of Medicine, Suite 1150, Doctors Office Building, 720 Harrison Avenue, Boston, MA, 02118, USA.
| | | | | |
Collapse
|
26
|
Kahn SA, Rubin DT. When Subjects Violate the Research Covenant: Lessons Learned from a Failed Clinical Trial of Fecal Microbiota Transplantation. Am J Gastroenterol 2016; 111:1508-1510. [PMID: 27166127 DOI: 10.1038/ajg.2016.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Stacy A Kahn
- Inflammatory Bowel Disease Center, The University of Chicago Medicine, Chicago, Illinois, USA.,The MacLean Center for Clinical Medical Ethics, The University of Chicago Medicine, Chicago, Illinois, USA.,Section of Pediatric Gastroenterology, Hepatology, & Nutrition, The University of Chicago Medicine, Chicago, Illinois, USA
| | - David T Rubin
- Inflammatory Bowel Disease Center, The University of Chicago Medicine, Chicago, Illinois, USA.,The MacLean Center for Clinical Medical Ethics, The University of Chicago Medicine, Chicago, Illinois, USA
| |
Collapse
|
27
|
Dresser R. Commentary on Zvonareva et al. Clin Trials 2015; 12:654-6. [PMID: 26555682 DOI: 10.1177/1740774515596983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
28
|
Abstract
Study participants who fabricate, falsify, or fail to disclose important information can undermine the integrity of clinical trials, with negative consequences for both future patients and the participants themselves. What can investigators do to address the problem?
Collapse
Affiliation(s)
- David B Resnik
- From the National Institute of Environmental Health Sciences (D.B.R.) and the National Institute on Drug Abuse (D.J.M.), National Institutes of Health, Bethesda, MD
| | | |
Collapse
|
29
|
Edelblute HB, Fisher JA. Using "clinical trial diaries" to track patterns of participation for serial healthy volunteers in U.S. phase I studies. J Empir Res Hum Res Ethics 2015; 10:65-75. [PMID: 25742668 DOI: 10.1177/1556264614568280] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Phase I testing of investigational drugs relies on healthy volunteers as research participants. Many U.S. healthy volunteers enroll repeatedly in clinical trials for the financial compensation. Serial participants are incentivized to ignore restrictions on their participation, and no centralized clinical trial registry prevents dual enrollment. Little is currently known about how healthy volunteers participate in studies over time, hampering the development of policies to protect this group. We detail a methodology developed as part of a longitudinal study to track in real-time healthy volunteers' Phase I participation. Illustrating these data through three case studies, we document how healthy volunteers use strategies, such as qualifying for studies at more than one clinic and traveling significant distances, to maximize their participation. Our findings suggest that "clinical trial diaries" can generate critical information about serial research participation and point to ethical issues unique to healthy volunteers' involvement in Phase I clinical trials.
Collapse
|
30
|
Abstract
There are competing ethical concerns when it comes to designing any clinical research study. Clinical trials of possible treatments for Ebola virus are no exception. If anything, the competing ethical concerns are exacerbated in trying to find answers to a deadly, rapidly spreading, infectious disease. The primary goal of current research is to identify experimental therapies that can cure Ebola or cure it with reasonable probability in infected individuals. Pursuit of that goal must be methodologically sound, practical and consistent with prevailing norms governing human subjects research. Some maintain that only randomized controlled trials (RCTs) with a placebo or standard-of-care arm can meet these conditions. We maintain that there are alternative trial designs that can do so as well and that sometimes these are preferable to RCTs.
Collapse
|