Special Issues in Clinical Research: Conflict of Interest, Post Trial Drug Access and Use of Placebo in Clinical Trials
Abstract:
The aim of this study is to identify ethical issues
and challenges in clinical research in India. This study provides clear picture
of special ethical issues in clinical research such as conflict of interest,
post trial access to investigational product and use of placebo. We examined
clinical research professional perceptions on those issues.
Individuals (N=385) working in field of clinical
research in India have participated in the study. This study involves self
administered survey research for collection of data and information from
participants through their responses. The survey questionnaire was validated by
colleagues and guides and experts in the field. The survey elicited responses
based on general experience and opinions of clinical research professionals.
Participants were given the option to complete the survey on the internet.
Surveys completed via the internet were stored in Microsoft excel. For data
analysis SPSS software have been used and descriptive analysis have been
conducted.
A total of 389 surveys were received, of which 385
were considered complete and used for this analysis. The respondents were from
India, currently working in clinical research field. Demographic information
pertaining to respondents such as education, type of organization age,
experience etc have been collected, whether they had ethics training ever, and
if yes which type of training they had. The data shows that majority have
responded that they are not favouring post trial access to investigational
product or it is not ethical. Further to that, participants were asked to
select reasons for their opinion on post trial access to investigational
product. If participant believes that post trial access to investigational drug
is ethical, they have selected applicable reasons for their opinion. Majority
of respondents favour use of placebo in clinical trials in general. If
participant is favouring the use of placebo, further they have provided their
opinion on possible steps to be taken care of in placebo controlled trial.
Participants has been asked to rate the factors which can promote or causes
conflict of interests in clinical trials. As per data, financial gain is the most
affecting factor causing conflict of interests. Comparing responses employer
wise, CROs, ECs and Study sites are rating “recruitment target” more than
sponsors. The data shows that industry influence, patent or other commercial
benefits are not highly affecting.
KEY WORDS
Placebo, Conflict of interest, post trial access,
ethics
References:
1. Adequate
and well-controlled studies. Code of Federal Regulations, 21 Part 314.126.
Revised as of 1 April 2000. Washington, DC: U.S. Government Printing Office;
2000.
2. Amery
W, Dony J. A clinical trial design avoiding undue placebo treatment. J Clin
Pharmacol. 1975;15:674-.9.
3. Benatar
SR, Fleischer T. Ethical and policy implications of clinical drug trials
conducted in developing countries. Harvard Health Pol Rev. 2005;6(1):97-105.
4. Council
for International Organizations of Medical Sciences (CI- OMS), in collaboration
with the World Health Organization (WHO). International Ethical Guidelines for
Biomedical Research Involving Human Subjects. CIOMS, Geneva; 2002.
5. Cohen
M, O’Neill M, Joffres M, Upshur G, Mills E. Reporting of informed consent,
standard of care and post-trial obligations in global randomized intervention
trials: a systematic survey of registered trials. Dev World Bioeth. 2008;9(4):74-80.
6. Ethical
and policy issues in research involving human participants. Vol. 1. Bethesda,
Md.: National Bioethics Advisory Commission, August 2001.
https://bioethicsarchive.georgetown.edu/nbac/human/overvol2.html, accessed on
20 Sep 2014.
7. Ellenberg
S, Temple T. Placebo-controlled trials and active-control trials in the
evaluation of new treatments. Part 2: Practical issues and specific cases. Ann
Intern Med. 2000;133:464-70.
8. Ezekiel
J. Emanuel, Ending Concerns About Undue Inducement, 32 J.L. MED. & ETHICS
100 (2004) (Abstract).
9. Grady
C. Ethics of international research: what does responsiveness means? Ethics J
Am Med Assoc. 2006;8(4):235-40.
10. Hillman
J, Joseph A, Mabel R, Sunshine H, Kennedy D, Noelher M. Frequency and costs of
diagnostic imaging in office practice: a comparison of self referring and
radiologist referring physicians. N Engl J Med 1990;323:1504-8.
11. Helen
Frankish, WVMA Postpones Decision to Amend Declaration of Helsinki, 362 THE
LANCET 963 (2003) (Abstract).
12. International
Conference on Harmonization: choice of control group in clinical trials.
Federal Register. 1999;64:51767-80.
13. Jones
B, Jarvis P, Lewis A, Ebbutt F. Trials to assess equivalence: the importance of
rigorous methods. BMJ. 1996;313:36-9. 32. Martin T, John D, Reynolds M, Andrew
M, Henry M, When placebo controlled trials are essential and equivalence trials
are inadequate. BMJ. 1998;317:875-80.
14. Jintanat
Ananworanich et al., Creation of a Drug Fund for Post-Clinical Trial Access to
Antiretrovirals, 364 THE LANCET 101 (2004) (Abstract).
15. Levinsky
G. Sounding Board. Nonfinancial conflicts of interest in research. N Engl J Med
2002;347:759.761.
16. Marshall
E. Penn report, agency heads home in on clinical research. Science
2000;288:1558-9.
17. New
Delhi: ICMR; 2006. Ethical guidelines for biomedical research on human
participants.
18. Participants
in the 2001 Conference on Ethical Aspects of Research in Developing Countries.
Moral Standards for Research in Developing Countries. From “Reasonable
Availability to “Fair benefits”. Hastings Center Report 2004;34(3):2-11.
19. (Pace
C, Grady C, Wendler D, Bebchuk D, Tavel A, McNay A, et al. For the ESPRIT
Group. Post-trial access to tested interventions: The views of IRB/REC chair,
investigators, and research participants in a multinational HIV/AIDS study.
AIDS Res Hum Retroviruses. 2006;22(9):837-41 (Abstract).
20. P.
G. De Roy, Helsinki and the Declaration of Helsinki, 50 WORLD MED.J. 9 (2004)
(Abstract).
21. Resnik
DB. The ethics of HIV research in developing nations. Bioethics. 1998
Oct;12(4):286-306.
22. Rochon
A, Gurwitz H, Cheung M, Hayes A, Chalmers C. Evaluating the quality of articles
published in journal supplements compared with the quality of those published
in the parent journal. JAMA 1994;272: 108-13. 7. Elks L. Conflict of interest
and the physician-researcher. J Lab Clin Med 1995; 126:19-23.
23. Sachs
B. Going from principles to rules in research ethics. Bioethics. 2011;25:9.20.
24. Sanmukhani
J, Tripathi B. Ethics in clinical research: The Indian perspective. Indian J
Pharm Sci.2011;73:125.30.
25. Sackett
L, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine:
what it is and what it isn’t. BMJ. 1996; 312:71-2.
26. Steinbrook
R. Protecting research subjects . the crisis at Johns Hopkins. N Engl J Med
2002;346:716-20.
27. Sofaer
N, Strech D. Reasons why post-trial access to trial drugs should, or need not
be ensured to research participants: A systematic review. Public Health Ethics.
2011;4:160.84.
28. Shaffer
N, Yebei N, Ballidawa B, Sidle E, Greene Y, Meslin M, et al. Equitable
treatment for HIV/AIDS clinical trials participants: A focus group study of
patients, clinician researchers and administrators in western Kenya. J Med
Ethics. 2006;32(1):55-60.
29. Sofaer
N, Thiessen C, Goold D, Ballou J, Getz A, Koski G, et al. Subjects’ views of
obligations to ensure post-trial access to drugs, care and information:
qualitative results from the Experiences of Participants in Clinical Trials
(EPIC) study. J Med Ethics. 2009;35:183-8.
30. Temple
T, Ellenberg S. Placebo-controlled trials and active-control trials in the
evaluation of new treatments. Part 1: Ethical and scientific issues. Ann Intern
Med. 2000;133:455-63.
31. Thompson
F. Understanding financial conflicts of interest. N Engl J Med. 1993;
329:573-6.
32. Wilkinson
P. “Self referral”: a potential conflict of interest. BMJ 1993;306:1083-4.
33. Weinfurt
P, Hall A, King P, et al. Sounding Board: disclosure of financial relationships
to participants in clinical research. N Engl J Med 2009;361:916.921.