Ethics Committees: Structure, Roles, and Issues

Ethical issues and the role of the ethics committees during COVID-19 research in pandemic era: a focus on an Italian ethics committee

Independent Research Ethics Committees (RECs) are responsible for protecting the rights and safety of participants involved in research studies. They also promote the values of research ethics and ensure the quality of clinical studies. In emergencies, we expect a significant increase in research activities but it is crucial to maintain both the quality of studies and respect for participants' rights. At the onset of the SARS-CoV-2 pandemic, the World Health Organization recommended an "expedited" approach to REC approvals. This was intended to streamline and optimize review procedures to prevent delays in research that is critical for responding to the global emergency. The authors evaluated the activity of the Inter-company Ethics Committee (IEC) of Turin, Italy, from January 2020 to December 2022 comparing COVID-19-related protocols with those that were not related to COVID-19. Statistical analyses were applied to find if there were statistically significant differences in variables' distributions between the two groups of studies. The characteristics of the protocols (total 1,667), including study design, funding, and enrollment of minors, were analyzed. Statistical differences were found for three variables: study type, financial support, and distribution of revised protocols by applicants' medical specialties. The findings underscore the need for careful attention to ethical principles during emergencies, especially given the large number of projects reviewed by the EC. Various challenges were faced, including the demand for expedited approval of proposed studies, the necessity of recognizing the social value of COVID-19 studies while ensuring proper planning and scientific validity, the need to review studies unrelated to COVID-19, and the obligation to protect the dignity and rights of research participants. It is essential to ensure that the standards for ethical review remain uncompromised.

The 2024 Revision of the Declaration of Helsinki and the Future Directions of Korea's Bioethics and Safety Act

In October 2024, the World Medical Association's Declaration of Helsinki (DoH) underwent comprehensive updates that incorporated feedback from global experts and stakeholders. The revised DoH continues to serve as a cornerstone for international and national regulations on medical research ethics. This paper aims to delve into the 2024 amendments to DoH and assesses their impact on South Korea's Bioethics and Safety Act (Bioethics Act). This paper analyses the congruences and gaps between the revised DoH and the current Bioethics Act, examining the alignment and gaps between the current Bioethics Act and the revised DoH. This study identified necessary revisions to enhance the ethical conduct of medical research in Korea in accordance with international standards. A comparison between the principles of the revised DoH and the provisions of the Bioethics Act revealed essential adjustments required to align the Bioethics Act with updated ethical guidelines. These findings underscore the broader implications for Korea's regulatory framework on human research ethics, emphasizing the need for a strategic integration of global ethical standards into the country's legal structure. The revised DoH emphasizes the active role of research participants and the fair inclusion of vulnerable groups. In Korea, the Bioethics Act, last revised in 2013, aligns closely with the DoH but requires further updates to reflect the 2024 amendments.

Healthcare Professionals' Knowledge, Views, and Perceptions of the Roles and Functions of Research Ethics Committees: A Web-Based Cross-Sectional Survey

BACKGROUND

This survey examined healthcare professionals' knowledge, views, and perceptions of the responsibilities and functions of Research Ethics Committees (RECs). The study aimed to analyze ethical principles and operational issues faced by RECs and guide researchers, journal editors, and publishers on publication ethics notes.

METHODS

A cross-sectional survey was conducted using the SurveyMonkey.com platform to assess healthcare professionals' knowledge, views, and practices concerning RECs' responsibilities, functions, and roles. The survey focused on REC definitions, functions, research types that require REC approval, and research protocols' evaluation time frames. It also reflected on ethics considerations and REC adaptations during the coronavirus disease 2019 (COVID-19) pandemic, REC member qualifications, evaluation periods, and additional challenges confronting RECs. Convenience sampling was adopted, and the survey was distributed via social media platforms.

RESULTS

The survey was based on an analysis of questionnaires filled by 182 responders (104 females [57.1%] and 76 males [41.8%]), with a median age of 36. The survey respondents were from 28 different countries. The top three countries with most responders were Kazakhstan (n = 83), Türkiye (n = 33) and Poland (n = 10). Most participants (n = 128, 70.3%) were familiar with the definition of RECs and recognized the importance of REC approval for clinical trials and interventional research. Research study protocols should be submitted for REC evaluation and approval during the planning phase, according to 145 responders (79.7%). Participants emphasized the significance of formal ethics training for REC members. The involvement in research approved by RECs was also viewed as an important precondition for membering RECs. Participants suggested online submissions (n = 127, 69.8%), virtual meetings (n = 99, 54.4%), and fast evaluation schedules for low-risk research protocols (n = 77, 42.3%) during the COVID-19 pandemic.

CONCLUSION

Healthcare professionals comprehend the basics of REC duties and responsibilities. However, improvements in the consistency and efficiency of ethics evaluations are still warranted. The COVID-19 pandemic stressed the importance of adaptive REC procedures; researchers, editors, and publishers learned a vitally important lesson. More efforts are warranted to increase REC member training, simplify administrative procedures, and define standard operating procedures in times of crisis. Continuous progress in these areas will allow RECs to maintain high ethical standards while supporting productive research. Editors and publishers will greatly benefit from related advances in research ethics considerations.

Leveraging artificial intelligence to detect ethical concerns in medical research: a case study

BACKGROUND

Institutional review boards (IRBs) have been criticised for delays in approvals for research proposals due to inadequate or inexperienced IRB staff. Artificial intelligence (AI), particularly large language models (LLMs), has significant potential to assist IRB members in a prompt and efficient reviewing process.

METHODS

Four LLMs were evaluated on whether they could identify potential ethical issues in seven validated case studies. The LLMs were prompted with queries related to the proposed eligibility criteria of the study participants, vulnerability issues, information to be disclosed in the informed consent document (ICD), risk-benefit assessment and justification of the use of a placebo. Another query was issued to the LLMs to generate ICDs for these case scenarios.

RESULTS

All four LLMs were able to provide answers to the queries related to all seven cases. In general, the responses were homogeneous with respect to most elements. LLMs performed suboptimally in identifying the suitability of the placebo arm, risk mitigation strategies and potential risks to study participants in certain case studies with a single prompt. However, multiple prompts led to better outputs in all of these domains. Each of the LLMs included all of the fundamental elements of the ICD for all case scenarios. Use of jargon, understatement of benefits and failure to state potential risks were the key observations in the AI-generated ICD.

CONCLUSION

It is likely that LLMs can enhance the identification of potential ethical issues in clinical research, and they can be used as an adjunct tool to prescreen research proposals and enhance the efficiency of an IRB.

Diversity of central nervous system manifestations in Sjogren's Disease: a case-based review

Sjogren's disease (SjD) is a chronic and disabling autoimmune disease, predominantly characterized by dryness of the mouth and eyes, resulting from lymphocytic infiltration of exocrine glands. While these are the most prominent symptoms, extra-glandular manifestations are also common. Studies suggest that up to 70% of SjD patients experience neurological symptoms, which interestingly often precede the hallmark dryness. Although every structure of the nervous system can be affected, disorders of peripheral nervous system (PNS) are more common than central nervous system (CNS) involvement. The CNS manifestations can range from subtle to severe, with some patients experiencing a rapid progression of symptoms. The literature documents cases where patients initially diagnosed with Creutzfeldt-Jakob disease, neurosarcoidosis, temporary hemiplegia, neuromyelitis optica, or epilepsy were ultimately diagnosed as having SjD. Here, we present five SjD patient cases, each with a different manifestation of CNS involvement, along with an overview of the current understanding of CNS disorders in the course of the disease. In four cases, the neurological manifestations appeared before the onset of sicca symptoms. In one patient, diagnosis was delayed by 15 years due to an atypical presentation. After receiving immunosuppression, all patients experienced notable alleviation of their symptoms.

Knowledge, Attitude and Perception of Research Ethics and Research Ethics Committees among Post-Graduate Residents of Neurosciences - A Nationwide Analysis from Pakistan

Objectives

To assess the knowledge, attitude and perception of post-graduate residents of neurosciences towards research ethics (RE) and research ethics committees (RECs).

Methods

This prospective cross-sectional survey-based study was conducted by the Punjab Institute of Neurosciences, targeting post-graduate neuroscience residents throughout Pakistan during January and February, 2024. An English-language general questionnaire, designed to assess knowledge, attitudes, and perceptions of RE and RECs, was adapted to reflect local conditions. The collected responses were analyzed using the Statistical Package for Social Sciences (SPSS) to determine measures of central tendency, percentages, and frequencies.

Results

Out of 241 residents, 64.3% were males. Sixty-eight percent respondents were from neurosurgery and 32% were from the field of neurology. Approximately 47% responses were from the province of Punjab. More than half (51.5%) of participants acknowledged the existence of a REC within their institution. A similar proportion (52.3%) claimed familiarity with ethical guidelines for research involving human subjects, only a slight majority (48.5%) demonstrated awareness of the specific functions carried out by RECs. Meanwhile, 44.5% expressed concerns that undergoing review by a REC could potentially delay research and pose additional challenges for researchers. Additionally, 27.4% of respondents admitted to considering the fabrication of data or results as acceptable.

Conclusion

Our research uncovered a significant correlation between participants' perceptions of RE and RECs and their comprehension of ethical principles. These findings indicate that medical postgraduates with a deeper understanding or awareness of research ethics principles and RECs tend to hold more robust attitudes toward these aspects.

Ethical Aspects of Human Genome Research in Sports-A Narrative Review

Human genome research in sports raises complex ethical considerations regarding the intersection of genetics and athletic performance. Pursuing genetic enhancements must uphold fairness, equality, and respect for human dignity. This narrative review explores the ethical dimensions of human genome research in sports, its potential implications on athletes, and the integrity of sports. As a narrative review, this study synthesizes the existing literature and expert insights to examine the ethical aspects of human genome research in sports. This study extensively examined the current literature on genetics, sports performance, ethical concerns, human rights, and legal regulations within the European context. The literature was searched using the SPORTDiscus, Scopus, Google Scholar, and PubMed databases. Exploring human genome research in sports reveals significant ethical implications, including potential genetic discrimination, impacts on human rights, and creating a genetic underclass of athletes. There are also definite benefits surrounding genetic testing. In conclusion, this review contends that integrating ethical considerations into developing and applying genetic technologies in sports is crucial to upholding fundamental principles of fairness, equality, and respect for human dignity. It stresses the importance of open and inclusive dialogue about the potential consequences of genetic advancements on athletic performance, future generations, and the integrity of sports.

CAse-BAsed REview sTandards (CABARET): Considerations for Authors, Reviewers, and Editors

The publication landscape for case reports has undergone a significant shift, with many high-impact journals deprioritizing or ceasing their publication altogether. This trend has led to the emergence of case-based reviews as an alternative to traditional case reports. Several factors drive this shift. Case-based reviews offer a more comprehensive synthesis of the literature compared to single case reports. They employ systematic search methodologies, reducing the risk of excluding relevant data, and providing robust evidence. From a publisher's perspective, case-based reviews have a greater potential for citation. While recommendations exist for writing traditional case reports, such as the CAse REports (CARE) guidelines, there is a lack of published recommendations for composing case-based reviews. This review aims to address this gap by providing guidance on drafting high-quality case-based reviews.

Government Initiatives for Research Ethics During COVID-19 Pandemic in Korea

BACKGROUND

Despite the growing necessity for government-led policy changes on clinical research ethics during pandemic, the scope of previous literature is limited to Korean government's pandemic response strategies or reflections of research ethics at the level of institutions and academic societies. This paper examines the proactive policy changes and responses by the South Korean government in addressing the challenges and issues of research ethics against the backdrop of the urgency of rapid development and emergency supply of medical products during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

We conducted searches of various government documents, using predetermined keywords related to research ethics and integrity during the COVID-19 pandemic. Only documents issued by governments or public institutions were included. A total of 24 documents were selected for analysis. They were divided into two phases: the first phase for urgent response (January 2020-February 2021) and the second phase (March 2021-February 2023) for long-term preparedness.

RESULTS

The Korean government recommended several measures of research governance to accelerate the ethical review of COVID-related research to be shortened less than one week: the joint operation of Institutional Review Boards (IRBs), exempted or expedited review by a special review committee, guidelines for urgent reviews, and designation of the Korean Academy of Medical Sciences as the supervising agency for the Clinical Trial Safety Support Institution as well as the Central IRB. It allowed temporary non-face-to-face methods for informed consent process (telephone explanations and a photo of the original signed consent) and clinical trials (telephone counselling and prescription, proxy prescription, and drug delivery and supply to clinical trial participants, and online ethics training).

CONCLUSION

As a result of South Korea's commitment to ethical principles in their pandemic response, the medical system did not experience collapses due to the pandemic, and pandemic research was conducted with careful ethical considerations. The pandemic ethics immunization during the Middle East respiratory syndrome epidemic in 2015 laid the foundation for prompt government initiatives that ensured both pandemic research ethics and pandemic response ethics.

A Simple Guide to Randomized Controlled Trials

Randomized controlled trials represent the cornerstone for the regulatory approval of drugs and evidence-based medicine and policy. Compared with observational studies random assignment of participants to each study arm guarantees an equal distribution of potential confounders thus achieving impartiality in the evaluation of between group differences and allowing for causal inferences to be drawn. These complex and costly medical experiments are tightly regulated and require substantial planning with great attention to several methodological aspects ranging from allocation concealment and blinding to sample size estimation, statistical analysis, and handling of protocol deviations. This brief guide offers useful insights into the design, conduct, and interpretation of clinical trial findings for beginners.

Research Integrity: Where We Are and Where We Are Heading

The concept of research integrity (RI) refers to a set of moral and ethical standards that serve as the foundation for the execution of research activities. Integrity in research is the incorporation of principles of honesty, transparency, and respect for ethical standards and norms throughout all stages of the research endeavor, encompassing study design, data collecting, analysis, reporting, and publishing. The preservation of RI is of utmost importance to uphold the credibility and amplify the influence of scientific research while also preventing and dealing with instances of scientific misconduct. Researchers, institutions, journals, and readers share responsibilities for preserving RI. Researchers must adhere to the highest ethical standards. Institutions have a role in establishing an atmosphere that supports integrity ideals while also providing useful guidance, instruction, and assistance to researchers. Editors and reviewers act as protectors, upholding quality and ethical standards in the dissemination of research results through publishing. Readers play a key role in the detection and reporting of fraudulent activity by critically evaluating content. The struggle against scientific misconduct has multiple dimensions and is continuous. It requires a collaborative effort and adherence to the principles of honesty, transparency, and rigorous science. By supporting a culture of RI, the scientific community may preserve its core principles and continue to contribute appropriately to society's well-being. It not only aids present research but also lays the foundation for future scientific advancements.