Medical Research: An Ethical Breakdown / NYT Editorial
Posted Apr 16 2013 3:54pm
From today's NY Times on yet another medical research project (performed at 23 top academic medical centers) that was done sloppily, missing a standard-care arm, and failed to provide truly informed consent... performed on unconsenting very low birthweight newborns, who were at extremely high risk of a bad outcome, but who might also lead a normal life
Despite reforms to protect patients from being harmed by medical research in recent decades, 23 academic institutions authorized a research project that failed to meet the most basic standard : providing an informed consent document to parents that accurately described the risks and benefits of the research to be conducted on extremely premature babies.
This failure was startling, and deplorable. Federal officials have rightly demanded that the University of Alabama at Birmingham, the lead institution, and Stanford, Duke and Yale, among others, take corrective action to prevent a recurrence. Such actions, which must be approved by federal officials, could include requiring investigators to undergo additional training in the ethical conduct of research, enhancing oversight by institutional boards that monitor research and notifying parents of the ethical breach.
The study involved more than 1,300 premature babies, born between 24 weeks and 27 weeks of gestation. The underdeveloped lungs in such babies are often unable to extract enough oxygen from the air to nourish the brain, so doctors often supply extra oxygen.
The danger is that too much oxygen can cause severe eye damage and blindness, whereas too little can lead to brain damage and death. The current standard of care calls for the blood to be saturated with 85 percent to 95 percent oxygen, but the researchers sought to pinpoint a more exact range that would minimize eye damage without increasing the risk of death.
The study, financed by the National Institutes of Health, was conducted between 2004 and 2009 and published in 2010 . The researchers randomly divided the 1,300 babies into two groups; one got oxygen at the low end of the range, while the other got oxygen at the high end of the range. The parents were asked to sign consent forms that had been approved at all 23 medical centers by the institutional review boards that are supposed to ensure ethical conduct of federally supported research.
But, in this case, the federal Office for Human Research Protections concluded that the consent forms failed to reveal that there was a greater risk of dying in the low-oxygen group and a greater risk of severe eye damage in the high oxygen group. The form also stated that, because both groups would receive oxygen within the standard of care, there would be no predictable increase in risk no matter which group a baby was in.
But the federal agency found that many infants could have faced greater risks by participating. For example, if a baby whose clinical needs might ordinarily have led doctors to deliver a relatively high level of oxygen was enrolled in the study, the infant might be randomly assigned to receive lower levels of oxygen. The Department of Health and Human Services needs to investigate how this breakdown occurred. And if the institutions do not offer strong reforms, the agency can suspend their ability to conduct federally financed research on human subjects.