The Ethics Police?

The Struggle to Make Human Research Safe

Robert Klitzman

Investigates the hidden world of IRBs as they face increasing pressures, responsibilities and criticism from many sides
Examines issues, offers data, and provides insights that have never been presented in a book before concerning the inside world of IRBs: how they make decisions and view the controversies they now face
Explores how the potential future risks vs. benefits of studies actually get weighed, what complexities and ambiguities arise, and how these are dealt with
Discusses how the quality of science in studies is assessed and weighed in relation to ethics, how conflicts of interest play out in science and ethics, and how government agencies, researchers, and universities all affect the ethical reviews of studies

The Ethics Police?

The Struggle to Make Human Research Safe

Robert Klitzman

Description

Research on human beings saves countless lives, but has at times harmed the participants. To what degree then should government regulate science, and how? The horrors of Nazi concentration camp experiments and the egregious Tuskegee syphilis study led the US government, in 1974, to establish Research Ethics Committees, known as Institutional Review Boards (IRBs) to oversee research on humans. The US now has over 4,000 IRBs, which examine yearly tens of billions of dollars of research — all studies on people involving diseases, from cancer to autism, and behavior. Yet ethical violations persist.

At the same time, critics have increasingly attacked these committees for delaying or blocking important studies. Partly, science is changing, and the current system has not kept up. Since the regulations were first conceived 40 years ago, research has burgeoned 30-fold. Studies often now include not a single university, but multiple institutions, and 40 separate IRBs thus need to approve a single project. One committee might approve a study quickly, while others require major changes, altering the scientific design, and making the comparison of data between sites difficult.

Crucial dilemmas thus emerge of whether the current system should be changed, and if so, how. Yet we must first understand the status quo to know how to improve it. Unfortunately, these committees operate behind closed doors, and have received relatively little in-depth investigation. Robert Klitzman thus interviewed 45 IRB leaders and members about how they make decisions. What he heard consistently surprised him.

This book reveals what Klitzman learned, providing rare glimpses into the conflicts and complexities these individuals face, defining science, assessing possible future risks and benefits of studies, and deciding how much to trust researchers — illuminating, more broadly, how we view and interpret ethics in our lives today, and perceive and use power.

These committees reflect many of the most vital tensions of our time - concerning science and human values, individual freedom, government control, and industry greed. Ultimately, as patients, scientists, or subjects, the decisions of these men and women affect us all.

The Ethics Police?

The Struggle to Make Human Research Safe

Robert Klitzman

Part I: Introduction
Chapter 1: Protecting the People We Experiment On
Part II: Who IRBs Are
Chapter 2: "Inside the Black Box": Becoming and Being IRB Members
Part III: What IRBs Do: The Contents of IRB Decisions
Chapter 3: Weighing Risks and Benefits and Undue Inducement
Chapter 4: Defining Research and How Good It Needs To Be
Chapter 5: What to Tell Subjects: Battles Over Consent Forms
Chapter 6: From "Nitpicky" to "User-Friendly": Inter-IRB Variations and Their Causes
Part IV: IRBs vs. Institutions: The Contexts of Decisions
Chapter 7: Federal Agencies vs. Local IRBs
Chapter 8: The Roles of Industry
Chapter 9: The Local Ecologies of Institutions
Part V: IRBs vs. Researchers
Chapter 10: Trusting vs. Policing Researchers
Chapter 11: Bad Behavior: Research Integrity
Chapter 12: Researchers Abroad: Studies in the Developing World
Part VI: The Future
Chapter 13: Changing National Policies
Chapter 14: Conclusions: Other Changes
Appendices
Appendix A: Additional Methodological Information
Appendix B: Semi-Structured Interview
Appendix C: List of Acronyms
Acknowledgements

The Ethics Police?

The Struggle to Make Human Research Safe

Robert Klitzman

Author Information

Robert Klitzman

Robert Klitzman, MD, is a Professor of Clinical Psychiatry in the College of Physicians and Surgeons and the Joseph Mailman School of Public Health, and the Director of the Masters of Bioethics Program at Columbia University. He has conducted research and written about a variety of bioethical issues, and has authored or co-authored over 100 articles, and seven books, including Am I My Genes?: Confronting Fate and Family Secrets in the Age of Genetic Testing; When Doctors Become Patients; Mortal Secrets: Truth and Lies in the Age of AIDS; Being Positive; A Year-long Night: Tales of a Medical Internship; The Trembling Mountain: A Personal Account of Kuru, Cannibals, and Mad Cow Disease; and In a House of Dreams and Glass: Becoming a Psychiatrist. His work has appeared in JAMA, Science, and elsewhere, and also has written for the New York Times, Newsweek, The Nation, and other publications.

The Ethics Police?

The Struggle to Make Human Research Safe

Robert Klitzman

Reviews and Awards

"The book succeeds in providing readers with an insight into a system that operates 'at complex intersections of science, politics, sociology, psychology, money and ethics'. Klitzman conveys how making human research safe is a difficult balancing act between the public's eagerness for treatments and the research community's propensity to respond." - Klaus Mitchell, Bionews.org.uk

"In this intelligent, rigorous book, Robert Klitzman looks at the morality of morality-at how the bodies set up to protect research subjects can end up injuring us all. This examination of our confused notions of safety, honesty, and transparency demonstrates that none of these is simple, and that in striving toward any one, we easily betray the others. It is a book about how seeking to do the right thing can lead to justice, and about how equally often it fails to do so." - Andrew Solomon, author of The Noonday Demon and Far From The Tree

"Few institutions in America are as powerful and yet as invisible to the public as scientific Institutional Review Boards (IRBs). In this important, pioneering book, Robert Klitzman details the challenges facing IRBs today and offers concrete proposals about how they might function better tomorrow." - Howard Gardner, Hobbs Professor of Cognition and Education, Harvard Graduate School of Education

"In this intelligent, rigorous book, Robert Kiltzman looks at the morality of morality" - at how the bodies set up to protect research subjects can end up injuring us all. This examination of our confused notions of safety, honesty, and transparency demonstrates that none of these is simple, and that in striving toward any one, we easily betray the others. It is a book about how seeking to do the right thing can lead to justice, and about how equally often it fails to do so.

"Protection of participants is an important" - and inescapable

"Robert Klitzman has opened wide the door on the arcane world of institutional review boards (IRBs) and interviewed their members, chairpersons and administrators. He reports on what they think about their own power and performance and their influence on the conduct of research. Based on these perspectives, Klitzman makes the case that IRBs should be shifted to a more humanistic model that recognizes the complex psychological, social and cultural forces that influence their decisions. This is an important insight into this little understood but essential institution." - Robert J. Levine, MD, Yale University

The Ethics Police?

The Struggle to Make Human Research Safe

Robert Klitzman

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