Protection of Human Research Subjects Theresia Yiallourou Nora Leonardi Ulrike Kettenberger November 19 th 2010

Goals and Principles of Research in Humans „Research in humans differs from other research in that the subject has decision-making power and must be treated with respect. The long history, even in the name of science of one group of humans exploiting another has made it necessary to establish elaborate rules and procedures to protect human participants in research.“ Korenman, Teaching the Responsible Conduct of Research in Humans, 1994

Codes and Regulations 1947: Nuremberg Code – First international Code of research ethics 1964: Declaration of Helsinki – First international agreement recommending ethical standards for clinical research 1979: Belmont Report – Ethical principles and guidelines for the protection of human subjects in research (US)

3 Fundamental Principles of Research Ethics Respect for persons JusticeBeneficence

1 - Respect for Persons Each individual: Is unique and free Has the right and capacity to decide Has value and dignity Has the right to informed consent

2 - Beneficence Researchers must: Protect physical, mental and social well- being Retain the community perspective Maximize possible benefits and minimize possible harms

3 - Justice Researchers must: Ensure a fair distribution of risks and benefits Conduct equitable recruitment of research participants Provide special protection for vulnerable groups

Questions for You to Think About Was this study ethical? In what ways were the 3 fundamental principles of research ethics respected/violated?

The Tuskegee Study of Untreated Syphilis in the Negro Male ( ) The PHS examines the progression of untreated syphilis in African-Americans: – Subject group: 616 African-American men (412 diagnosed with syphilis and 204 controls) True nature of the study never explained to patients Dr. I. Schatz first medical professional to formally object to the study on moral grounds in 1965 Only in 1972 Investigations and revelations of journalist J. Heller brought study to immediate end

The Willowbrook Case – Deliberate Infection of Mentally Retarded Children with Hepatitis ( ) Willowbrook State School in Staten Island: institution for mentally retarded children Regular outbreaks of hepatitis due to horrible hygienic conditions –> creation of a medical study to understand the natural history of infectious hepatitis and to test the effects of gamma globulin in preventing or combating the disease Deliberate infection of some new residents (children) by feeding them infected feces or giving injections Parents were unable to admit their child to Willowbrook without agreeing to the study

CIA medics accused of ‘interrogation research’ on detainees - June 2010 Human-rights advocacy group alleges CIA medics conducted human research on prisoners in US custody: – Waterboarding practices – Simultaneous vs sequential application of interrogation techniques – Effects of sleep deprivation Relies on previously classified data (heavily redacted documents) No evidence lawfulness of monitoring assessed by Office of Legal Counsel Lacks actual data Wadman, Nature 2010

3 Fundamental Principles - Summary Respect for persons Recognition of personal autonomy and dignity, special protection of those with diminished autonomy Beneficence Protect persons from harm by maximizing anticipated benefits and minimizing possible risks of harm Justice Fair distribution of benefits and burdens of research