Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-19T07:21:37.276Z Has data issue: false hasContentIssue false

Conflicts among Multinational Ethical and Scientific Standards for Clinical Trials of Therapeutic Interventions

Published online by Cambridge University Press:  01 January 2021

Extract

There has been a growing concern over establishing norms that ensure the ethically acceptable and scientifically sound conduct of clinical trials. Among the leading norms internationally are the World Medical Association's Declaration of Helsinki, guidelines by the Council for International Organizations of Medical Sciences (CIOMS), the International Conference on Harmonization's standards for industry (ICH), and the CONSORT group's reporting norms (Consolidated Standards of Reporting Trials), in addition to the influential U.S. Federal Common Rule, Food and Drug Administration's (FDA) body of regulations, and information sheets by the Department of Health and Human Services. There are also many norms published at more local levels by official agencies and professional groups.

Any account of international standards should cover both scientific and ethical norms at once – the two are conceptually intertwined. Recent sources recognize that “[s]cientifically unsound research on human subjects is unethical in that it exposes research subjects to risks without possible benefit.”

Type
Independent
Copyright
Copyright © American Society of Law, Medicine and Ethics 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Appendix References

National Health and Medical Research Council, Australian Research Council, and Australian Vice-Chancellors' Committee, National Statement on Ethical Conduct in Human Research, Australian Government, 2007: At 36.Google Scholar
National Health Service, Association of the British Pharmaceutical Industry, BioIndustry Association, “NHS-ABPI-BIA Clinical Trial Agreement 2006 version – Scotland (Clinical Trial Agreement for Pharmaceutical and Biopharmaceutical Industry Sponsored Research in Scottish Health Boards),” (a contractual agreement template): At 6, available at <http://www.cso.scot.nhs.uk/SuppScience/MCTA_NHS-ABPI-BIA_Scot.pdf> (last visited May 16, 2011).+(last+visited+May+16,+2011).>Google Scholar
World Medical Assocation, “Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects,” (last updated October 2008), available at <http://www.wma.net/en/30publications/10policies/b3/index.html> (last visited May 16, 2011).+(last+visited+May+16,+2011).>Google Scholar
See National Health Service, et. al., supra note 15, at 6.Google Scholar
International Conference on Harmonisation (ICH) Steering Committee, ICH Harmonised Tripartite Guideline: Guideline for Good Clinical Practice E6(R1), Step 4 version (1996): At 17, available at <http://private.ich.org/LOB/media/MEDIA482.pdf> (last visited May 16, 2011); Statens Legemiddelverk (Norwegian Medicines Agency), “FOR 2003-09-24 nr 1202: Regulation relating to clinical trials on medicinal products for human use,” (Norwegian Government, 2003): At section 4–1, available at <http://www.legemiddelverket.no/upload/116328/FOR%202003-09-24%20nr%201202%20english.pdf> (last visited May 16, 2011); U.S. Food and Drug Administration, “A Guide to Informed Consent,” (FDA Information Sheets, 1998), available at <http://www.fda.gov/RegulatoryInformation/Guidances/ucm126431.htm> (last visited May 16, 2011); US Food and Drug Administration, “Sponsor – Investigator – IRB Interrelationship,” (FDA Information Sheets, 1998), available at <http://www.fda.gov/RegulatoryInformation/Guidances/ucm126425.htm> (last visited May 16, 2011); see Penslar, , supra note 10, at chapter 3, section D; see 21 C.F.R. 50.25 (a) (5) (1996).Google Scholar
See Penslar, , supra note 10, at chapter 3, section D and chapter 5, section B; see U.S. Food and Drug Administration, “A Guide to Informed Consent” and “Sponsor – Investigator – IRB Interrelationship,” supra note 18.Google Scholar
See Penslar, , supra note 10, chapter 5, section B.Google Scholar
See U.S. Food and Drug Administration, “A Guide to Informed Consent,” supra note 18.Google Scholar
See Lakemedelsverket, supra note 2, at 13.Google Scholar
European Parliament and the Council of the European Union, Directive 2001/20/EC, preamble section 16 (Apr. 4 2001), available at <http://www.eortc.org/Services/Doc/clinical-EU-directive-04-April-01.pdf> (last visited December 19 2010).+(last+visited+December+19+2010).>Google Scholar
See National Health Service, et. al., supra note 15, at 10.Google Scholar
National Patient Safety Agency (National Research Ethics Service, National Health Service of UK), Standard Operating Procedures for Research Ethics Committees, ver. 3.5 (May 2008), at 246, available at <http://www.nres.npsa.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=27101> (last visited May 16, 2011); Medicines and Healthcare Products Regulatory Agency (UK), “Medical devices research: Communications between MHRA and RECs,” (Apr. 2008): At para. 23, available at <www.nres.npsa.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=11474> (last visited May 16, 2011); European Commission, Detailed guidance on the application format and documentation to be submitted in an application for an Ethics Committee opinion on the clinical trial on medicinal products for human use, (EC, 2006): At 9, available at <http://ec.europa.eu/health/files/eudralex/vol-10/12_ec_guideline_20060216_en.pdf> (last visited May 16, 2011)+(last+visited+May+16,+2011);+Medicines+and+Healthcare+Products+Regulatory+Agency+(UK),+“Medical+devices+research:+Communications+between+MHRA+and+RECs,”+(Apr.+2008):+At+para.+23,+available+at++(last+visited+May+16,+2011);+European+Commission,+Detailed+guidance+on+the+application+format+and+documentation+to+be+submitted+in+an+application+for+an+Ethics+Committee+opinion+on+the+clinical+trial+on+medicinal+products+for+human+use,+(EC,+2006):+At+9,+available+at++(last+visited+May+16,+2011)>Google Scholar
See European Commission, supra note 26, at 9.Google Scholar
21 C.F.R. 812.35 (1998).CrossRefGoogle Scholar
American College of Surgeons Oncology Group, “Standard Operating Procedures: Institutional Review Board Approval,” (ACOSOG, 2003): At 4, available through <https://www.acosog.org>; REB Secretariat, Health Canada, Ethical Review of Research Involving Human Subjects: Administrative and Policy Procedure Manual for Health Canada Research Ethics Board (REB), (Health Canada, 2006): At 34, available at <http://www.hc-sc.gc.ca/sr-sr/alt_formats/hpb-dgps/pdf/pubs/advice-avis/reb-cer-eng.pdf> (last visited May 16, 2011); Swissmedic (Swiss Agency for Therapeutic Products), “Clinical Trials of Medical Devices” (fact sheet; Swissmedic, 2008): At 3, available at <http://www.swissmedic.ch/leitfaden/00027/index.html?lang=en&download=NHzLpZeg7t,lnp6I0NTU042l2Z6ln1ad1IZn4Z2qZpnO2Yuq2Z6gpJCDdXt,gmym162epYbg2c_JjKbNoKSn6A> (last visited May 16, 2011).;+REB+Secretariat,+Health+Canada,+Ethical+Review+of+Research+Involving+Human+Subjects:+Administrative+and+Policy+Procedure+Manual+for+Health+Canada+Research+Ethics+Board+(REB),+(Health+Canada,+2006):+At+34,+available+at++(last+visited+May+16,+2011);+Swissmedic+(Swiss+Agency+for+Therapeutic+Products),+“Clinical+Trials+of+Medical+Devices”+(fact+sheet;+Swissmedic,+2008):+At+3,+available+at++(last+visited+May+16,+2011).>Google Scholar
21 C.F.R. 312.30(b)(2)(i)(b) (2009); see World Medical Association, supra note 16.Google Scholar
See International Conference on Harmonisation (E6), supra note 18, at 14.Google Scholar
See National Patient Safety Agency, supra note 26, at 17.Google Scholar
US Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research, Center for Biologics Evaluation and Research, Center for Devices and Radiologic Health, Center for Food Safety and Nutrition, et al., Guidance for Industry: Computerized Systems Used In Clinical Trials, (US DHHS/FDA/CDER/CBER/CDRH/CFSAN/CVM/ORA, 1999), available at <http://www.fda.gov/RegulatoryInformation/Guidances/ucm126402.htm> (last visited May 16, 2011).+(last+visited+May+16,+2011).>Google Scholar
See Lakemedelsverket, supra note 2, at 16.Google Scholar
See International Conference on Harmonisation (E6), supra note 18, at 25.Google Scholar
American Academy of Orthopaedic Surgeons, Guide to Professionalism and Ethics in the Practice of Orthopaedic Surgery (AAOS, 2008): At 115, available at <http://www.aaos.org/about/papers/ethics/ethicalpractguide.pdf> (last visited May 16, 2011); see South African Orthopaedic Association, supra note 4.+(last+visited+May+16,+2011);+see+South+African+Orthopaedic+Association,+supra+note+4.>Google Scholar
European Parliament and the Council of the European Union, Directive 20015/28/EC (Apr. 8, 2005): Article 17, available at <http://ec.europa.eu/health/files/eudralex/vol-1/dir_2005_28/dir_2005_28_en.pdf> (last visited May 16, 2011).+(last+visited+May+16,+2011).>Google Scholar
See Committee for Ethics and Medico-Legal Affairs, supra note 13, at 14.Google Scholar
See National Health and Medical Research Council, supra note 14, at 36.Google Scholar
See International Conference on Harmonisation (E6), supra note 18, at 22.Google Scholar
Id, 18–19.Google Scholar
21 C.F.R. 312.62(c) (2002).Google Scholar
21 C.F.R. 812.140(d) (1998).Google Scholar
See International Conference on Harmonisation (E6), supra note 18, at 22.Google Scholar
21 C.F.R. 312.57(c) (2002).CrossRefGoogle Scholar
U.S. Department of Health and Human Services, “Investigator Responsibilities, FAQs,” available at <http://answers.hhs.gov/ohrp/categories/1567> (last visited May 16, 2011).+(last+visited+May+16,+2011).>Google Scholar
See European Parliament (2005), supra note 39, article 17.Google Scholar
See Swissmedic, supra note 29, at 4.Google Scholar
Statni Ustav pro Kontrolu Leciv (State Institute for Drug Control, Czech Republic), ZP-21 Inspection of the Conduct of Clinical Evaluations on Medical Devices in the Premises of Healthcare Providers, (Czech Government, 2004): At 6 and 9, available at <http://www.sukl.cz/uploads/Pokyny_a_formulare_anglicky/ZP_21.pdf> (last visited May 16, 2011).+(last+visited+May+16,+2011).>Google Scholar
See Swissmedic, supra note 29, at 4.Google Scholar
See Statens Legemiddelverk, supra note 18, at section 5–3.Google Scholar
Id.; see Lakemedelsverket, supra note 2, at 24.Google Scholar
See Polish Government, supra note 3, article 47.Google Scholar
Department for Constitutional Affairs, Mental Capacity Act 2005 Code of Practice (United Kingdom Government, 2007): At 202, available at <http://webarchive.nationalarchives.gov.uk/+/http://www.dca.gov.uk/legal-policy/mental-capacity/mca-cp.pdf> (last visited May 16, 2011).+(last+visited+May+16,+2011).>Google Scholar
Royal College of Physicians, Guidelines on the Practice of Ethics Committees in Medical Research with Human Participants, 4th edition (London: RCP, 2007): At 40; see Lakemedelsverket, Laakelaitos, supra note 2, at 8.Google Scholar
See American College of Surgeons Oncology Group, supra note 29, at 1; see REB Secretariat, Health Canada, supra note 29, at 26.Google Scholar
See Lakemedelsverket, supra note 2, at 12.Google Scholar
See Council for International Organizations of Medical Sciences, supra note 6.Google Scholar
Penslar, R.L., IRB Guidebook, (Office for Human Research Protections, United States Deptartment of Health and Human Services, 1993): At chapter 4, section E, available at <http://www.hhs.gov/ohrp/irb/irb_guidebook.htm> (last visited May 16, 2011).Google Scholar
See American Academy of Orthopaedic Surgeons, supra note 38, at 112; see South African Orthopaedic Association, supra note 4.Google Scholar
Council of Europe Bioethics Division, Additional Protocol to the Convention on Human Rights and Biomedicine, Concerning Biomedical Research, European Treaty Series 195, available at <http://conventions.coe.int/treaty/en/treaties/html/195.htm> (last visited Dec. 19 2010).+(last+visited+Dec.+19+2010).>Google Scholar
See Council for International Organizations of Medical Sciences, supra note 6.Google Scholar
See Royal College of Physicians, supra note 60, at 39.Google Scholar
Higgins, J.P.T. Green, S., eds., Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 [updated Sept. 2006], in The Cochrane Library, Issue 4 (Chichester, UK: John Wiley & Sons, Ltd., 2006): At section 6.3, available at <http://www.cochrane.org/sites/default/files/uploads/Handbook4.2.6Sep2006.pdf> (last visited May 16, 2011).Google Scholar
McConnell, T., “The Inalienable Right to Withdraw from Research,” Journal of Law, Medicine & Ethics 38 (2010): At 840–846.CrossRefGoogle Scholar
The Nuremberg Code [from Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law No. 10. Nuremberg, October 1946-April 1949. Washington, D.C.: U.S. G.P.O., 1949–1953.], available at <http://ohsr.od.nih.gov/guidelines/nuremberg.html> (last visited May 16, 2011).+(last+visited+May+16,+2011).>Google Scholar
Jonas, H., “Philosophical Reflections on Experimenting with Human Subjects,” in Freund, P. A., ed., Experimentation with human subjects (New York: George Braziller Inc., 1969): 131; Murphy, T. F., “Self-Experimentation: The Peruvian Medical Student” and “Self-Experimentation: Cancerous Tissue,” in Case Studies in Biomedical Research Ethics (Cambridge: MIT Press, 2004): At 110–113.Google Scholar
Division of Biostatistics, Office of Surveillance and Biometrics, Center for Devices and Radiologic Health, U.S. Food and Drug Administration, “Chapter III – Design of a Clinical Trial, Section I – Trial Site and Investigator,” in Statistical Guidance for Clinical Trials of Non Diagnostic Medical Devices (FDA, 1996), available at <http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm106757.htm> (last visited May 16, 2011); see World Medical Association, supra note 16.+(last+visited+May+16,+2011);+see+World+Medical+Association,+supra+note+16.>Google Scholar
See Royal College of Physicians, supra note 60, at 38.Google Scholar
See Royal Australasian College of Physicians, supra note 11, at 44–45.Google Scholar
See American College of Surgeons Oncology Group, supra note 29, at 4.Google Scholar
See National Patient Safety Agency, supra note 26, at 176.Google Scholar
National Patient Safety Agency (National Research Ethics Service, National Health Service of UK), Approval for Medical Devices Research, ver. 2 (March 2008), at 25, available at <http://www.nres.npsa.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=11473> (last visited May 16, 2011).+(last+visited+May+16,+2011).>Google Scholar

References

Council for International Organizations of Medical Sciences, CIOMS International Ethical Guidelines for Biomedical Research Involving Human Subjects, World Health Organization, Geneva, 2002, available at <http://www.cioms.ch/publications/guidelines/guidelines_nov_2002_blurb.htm> (last visited January 16, 2012); Emanuel, E. J. Wendler, D. Grady, C., “What Makes Clinical Research Ethical?” JAMA 283, no. 20 (2000): 27012711, at 2704.Google Scholar
Halpern, S. D. Karlawish, J. H. Berlin, J. A., “The Continuing Unethical Conduct of Underpowered Clinical Trials,” JAMA 288, no. 17 (2002): 358362; Hall, J. C. Mills, B. Nguyen, H. Hall, J. L., “Methodologic Standards in Surgical Trials,” Surgery 119, no. 4 (1996): 466–472; Ruiz-Canela, M. de Irala-Estevez, J. Martinez-Gonzalez, M. A. Gomez-Gracia, E. Fernandez-Crehuet, J., “Methodological Quality and Reporting of Ethical Requirements in Clinical Trials,” Journal of Medical Ethics 27, no. 3 (2001): 172–176; Jacquier, I. Boutron, I. Moher, D. Roy, C. Ravaud, P., “The Reporting of Randomized Clinical Trials Using a Surgical Intervention Is in Need of Immediate Improvement: A Systematic Review,” Annals of Surgery 244, no. 5 (2006): 677–683; Balasubramanian, S. P. Wiener, M. Alshameeri, Z. Tiruvoipati, R. Elbourne, D. Reed, M. W., “Standards of Reporting of Randomized Controlled Trials in General Surgery: Can We Do Better?” Annals of Surgery 244, no. 5 (2006): 663–667.CrossRefGoogle Scholar
Ashton, C. M. Wray, N. P. Jarman, A. F. Kolman, J. M. Wenner, D. M. Brody, B. A., “A Taxonomy of Multinational Ethical and Methodological Standards for Clinical Trials of Therapeutic Interventions,” Journal of Medical Ethics 37, no. 6 (June 2011): 368373.CrossRefGoogle Scholar
Emanuel, E. J. Grady, C. Crouch, R. A. et al., eds., The Oxford Textbook of Clinical Research Ethics (Oxford: Oxford University Press, 2008).Google Scholar
Ashton, C. M. Wray, N. P. Jarman, A. F. Kolman, J. M. Wenner, D. M. Brody, B. A., “Ethics and Methods in Surgical Trials,” Journal of Medical Ethics 35, no. 9 (September 2009): 579583; see Ashton, et al., supra note 3.CrossRefGoogle Scholar
National Health and Medical Research Council, Australian Research Council, and Australian Vice-Chancellors' Committee, National Statement on Ethical Conduct in Human Research, Australian Government, 2007: At 75; see Council for International Organizations of Medical Sciences, supra note 1.Google Scholar
Department of Health (South Africa), “Appendix A: Ethical Considerations for HIV/AIDS Clinical and Epidemiological Research,” in Ethics in Health Research: Principles, Structures and Processes, Department of Health, South African Government, 2004, at 48–54, available at <http://www.doh.gov.za/docs/factsheets/guidelines/ethnics/app1.pdf> (last visited January 16, 2012); see Council for International Organizations of Medical Sciences, supra note 1; see National Health and Medical Research Council et al., supra note 8, at 73.+(last+visited+January+16,+2012);+see+Council+for+International+Organizations+of+Medical+Sciences,+supra+note+1;+see+National+Health+and+Medical+Research+Council+et+al.,+supra+note+8,+at+73.>Google Scholar
National Patient Safety Agency (National Research Ethics Service, National Health Service of UK), Standard Operating Procedures for Research Ethics Committees, version 3.5, May 2008, at 173, available at <http://www.nres.npsa.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=27101> (last visited January 16, 2012; NOTE: The endorsed version has changed since the writing of this paper, but not in ways pertinent to discussion).+(last+visited+January+16,+2012;+NOTE:+The+endorsed+version+has+changed+since+the+writing+of+this+paper,+but+not+in+ways+pertinent+to+discussion).>Google Scholar
21 C.F.R. 812.150(a)(4) (1997).Google Scholar
Penslar, R. L., IRB Guidebook, Office for Human Research Protections, United States Dept. of Health and Human Services, 1993, at chapter 3, section C, available at <http://www.hhs.gov/ohrp/archive/irb/irb_guidebook.htm> (last visited January 16, 2012); see Council for International Organizations of Medical Sciences, supra note 1.Google Scholar
See Council for International Organizations of Medical Sciences, supra note 1.Google Scholar
European Parliament and the Council of the European Union, Directive 2001/20/EC (April 4, 2001), preamble section (4), available at <http://www.eortc.org/Services/Doc/clinical-EU-directive-04-April-01.pdf> (last visited May 16, 2011).+(last+visited+May+16,+2011).>Google Scholar
See Penslar, , supra note 12, at chapter 4, section H.Google Scholar
Department for Constitutional Affairs, Mental Capacity Act 2005 Code of Practice (United Kingdom Government, 2007): At 202, available at <http://webarchive.nationalarchives.gov.uk/+/http://www.dca.gov.uk/legal-policy/mental-capacity/mca-cp.pdf> (last visited January 16, 2011).+(last+visited+January+16,+2011).>Google Scholar
See Penslar, , supra note 12, at chapter 3, section C.Google Scholar
LeBlanc, T. W. Wheeler, J. L. Abernethy, A. P., “Research in End-of-Life Settings: An Ethical Inquiry,” Journal of Pain and Palliative Care Pharmacotherapy 24, no. 3 (2010): 244250.CrossRefGoogle Scholar
International Conference on Harmonisation (ICH) Steering Committee, ICH Harmonised Tripartite Guideline: Guideline for Good Clinical Practice E6(R1), Step 4 version, 1996, at 17, available at <http://private.ich.org/LOB/media/MEDIA482.pdf> (last visited January 16, 2012).+(last+visited+January+16,+2012).>Google Scholar
Lakemedelsverket (Swedish Medical Products Agency), Medical Products Agency's Provisions and Guidelines on the Clinical Trials of Medicinal Products, Swedish Government, 1997, at 14, available through <http://www.lakemedelsverket.se/> (last visited January 16, 2012).+(last+visited+January+16,+2012).>Google Scholar
See National Patient Safety Agency, supra note 10, at 220.Google Scholar
Council of Europe Bioethics Division, Additional Protocol to the Convention on Human Rights and Biomedicine, Concerning Biomedical Research, European Treaty Series 195, article 15(2. ii), available at <http://conventions.coe.int/treaty/en/treaties/html/195.htm> (last visited January 16, 2012); Swiss Federal Council, “Federal Law on Medicinal Products and Medical Devices (Law on Therapeutic Products),” Swiss Government translation, 2001, article 55, available through <http://www.swissmedic.ch> (last visited January 16, 2012); Statens Legemiddelverk (Norwegian Medicines Agency), “FOR 2003-09-24 nr 1202: Regulation Relating to Clinical Trials on Medicinal Products for Human Use,” Norwegian Government, 2003, at section 4–3, available at <http://www.legemiddelverket.no/upload/116328/FOR%202003-09-24%20nr%201202%20english.pdf> (last visited January 16, 2012); see International Conference on Harmonisation (E6), supra note 19, at 17; see Department for Constitutional Affairs, supra note 16, at 207; see European Parliament, supra note 14, article 5(e); see Council for International Organizations of Medical Sciences, supra note 1; see National Health and Medical Research Council et al., supra note 8, at 62.+(last+visited+January+16,+2012);+Swiss+Federal+Council,+“Federal+Law+on+Medicinal+Products+and+Medical+Devices+(Law+on+Therapeutic+Products),”+Swiss+Government+translation,+2001,+article+55,+available+through++(last+visited+January+16,+2012);+Statens+Legemiddelverk+(Norwegian+Medicines+Agency),+“FOR+2003-09-24+nr+1202:+Regulation+Relating+to+Clinical+Trials+on+Medicinal+Products+for+Human+Use,”+Norwegian+Government,+2003,+at+section+4–3,+available+at++(last+visited+January+16,+2012);+see+International+Conference+on+Harmonisation+(E6),+supra+note+19,+at+17;+see+Department+for+Constitutional+Affairs,+supra+note+16,+at+207;+see+European+Parliament,+supra+note+14,+article+5(e);+see+Council+for+International+Organizations+of+Medical+Sciences,+supra+note+1;+see+National+Health+and+Medical+Research+Council+et+al.,+supra+note+8,+at+62.>Google Scholar
See Council for International Organizations of Medical Sciences, supra note 1.Google Scholar
See Council of Europe Bioethics Division, supra note 22, article 15(2.ii).Google Scholar
National Health and Medical Research Council et al., supra note 8, at 62.Google Scholar
See Statens Legemiddelverk, supra note 22, at section 4–2; see Department for Constitutional Affairs, supra note 16, at 210; European Parliament, supra note 14, article 4(i).Google Scholar
European Parliament and the Council of the European Union, Directive 2005/28/EC (Apr. 8, 2005): Article 2, available at <http://ec.europa.eu/health/files/eudralex/vol-1/dir_2005_28/dir_2005_28_en.pdf> (last visited January 16, 2012); World Medical Association, “Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects,” last updated October 2008, available at <http://www.wma.net/en/30publications/10policies/b3/index.html> (last visited January 16, 2012); see International Conference on Harmonisation (E6), supra note 19, at 9; see Council of Europe Bioethics Division, supra note 22, at article 3.+(last+visited+January+16,+2012);+World+Medical+Association,+“Declaration+of+Helsinki+–+Ethical+Principles+for+Medical+Research+Involving+Human+Subjects,”+last+updated+October+2008,+available+at++(last+visited+January+16,+2012);+see+International+Conference+on+Harmonisation+(E6),+supra+note+19,+at+9;+see+Council+of+Europe+Bioethics+Division,+supra+note+22,+at+article+3.>Google Scholar
See Penslar, , supra note 12, at chapter 3, section A (emphasis added).Google Scholar
U.S. Food and Drug Administration, “Payment to Research Subjects,” FDA Information Sheets, 1998, available at <http://www.fda.gov/RegulatoryInformation/Guidances/ucm126429.htm> (last visited January 16, 2012); Royal College of Physicians, Guidelines on the Practice of Ethics Committees in Medical Research with Human Participants, 4th ed. (London: RCP, 2007): At 77.+(last+visited+January+16,+2012);+Royal+College+of+Physicians,+Guidelines+on+the+Practice+of+Ethics+Committees+in+Medical+Research+with+Human+Participants,+4th+ed.+(London:+RCP,+2007):+At+77.>Google Scholar
Dickert, N. Grady, C., “Incentives for Research Participants,” in Emanuel, et al., supra note 4, at 386–396.Google Scholar
European Commission, Detailed Guidance on the Application Format and Documentation to Be Submitted in an Application for an Ethics Committee Opinion on the Clinical Trial on Medicinal Products for Human Use, EC, 2006, at 8, available at <http://ec.europa.eu/health/files/eudralex/vol-10/12_ec_guideline_20060216_en.pdf> (last visited January 16, 2012); see European Parliament, supra note 14, article 6(4).+(last+visited+January+16,+2012);+see+European+Parliament,+supra+note+14,+article+6(4).>Google Scholar
See European Parliament, supra note 14, article 5(i).Google Scholar
National Health Service, Association of the British Pharmaceutical Industry, BioIndustry Association, “NHS-ABPI-BIA Clinical Trial Agreement 2006 Version – Scotland (Clinical Trial Agreement for Pharmaceutical and Biopharmaceutical Industry Sponsored Research in Scottish Health Boards),” a contractual agreement template, at 23–26, available at <http://www.cso.scot.nhs.uk/SuppScience/MCTA_NHS-ABPI-BIA_Scot.pdf> (last visited January 16, 2012); see Swiss Federal Council, supra note 22, at article 54.+(last+visited+January+16,+2012);+see+Swiss+Federal+Council,+supra+note+22,+at+article+54.>Google Scholar
See National Health and Medical Research Council et al., supra note 8, at 38.Google Scholar
Hungarian Government, “Act XCV of 2005 on Medicinal Products for Human Use and on the Amendment of Other Regulations Related to Medicinal Products,” at section 21(1)(c), available at <http://net.jogtar.hu/jr/gen/getdoc.cgi?docid=a0500095.tv&dbnum=62> (last visited January 16, 2012).+(last+visited+January+16,+2012).>Google Scholar
See Council for International Organizations of Medical Sciences, supra note 1.Google Scholar
See International Conference on Harmonisation (E6), supra note 19, at 23.Google Scholar
See Department of Health (South Africa), supra note 9, at 50.Google Scholar
See National Health Service et. al., supra note 35.Google Scholar
45 C.F.R. 46.116 (2005).Google Scholar
45 C.F.R. 46.116(a)(6) (2005).Google Scholar
U.S. Food and Drug Administration, “A Guide to Informed Consent,” FDA Information Sheets, 1998, available at <http://www.fda.gov/RegulatoryInformation/Guidances/ucm126431.htm> (last visited January 16, 2012); 21 C.F.R. 50.20 (1999); see Penslar, , supra note 12, at chapter 5, section B.+(last+visited+January+16,+2012);+21+C.F.R.+50.20+(1999);+see+Penslar,+,+supra+note+12,+at+chapter+5,+section+B.>Google Scholar
See Penslar, , supra note 12, at chapter 3, section B (emphasis added).Google Scholar
Sulmasy, D. P. Astrow, A. B. He, M. K. et al., “The Culture of Faith and Hope: Patients' Justifications for Their High Estimations of Expected Therapeutic Benefit When Enrolling in Early Phase Oncology trials,” Cancer 116, no. 15 (August 2010): 37023711.CrossRefGoogle Scholar
See Royal College of Physicians, supra note 29, at 39.Google Scholar
Adamson, J. Cockayne, S. Puffer, S. Torgerson, D.J., “Review of Randomised Trials Using the Post-Randomised Consent (Zelen's) Design,” Contemporary Clinical Trials 27, no. 4 (August 2006): 305319.CrossRefGoogle Scholar
See Penslar, , supra note 12, at chapter 4, section H; see International Conference on Harmonisation (E6), supra note 19, at 16.Google Scholar
See Royal College of Physicians, supra note 29, at 44.Google Scholar
Committee for Ethics and Medico-Legal Affairs, World Federation of Neurosurgical Societies, “Statement of Ethics in Neurosurgery,” revised August 2007, at 12, available at <http://www.wfns.org/filebin/WFNS%20Statement%20of%20Ethics%20in%20NS%20Mar%202008.pdf> (last visited January 16, 2012).+(last+visited+January+16,+2012).>Google Scholar
Ashcroft, R. E., “The Declaration of Helsinki,” in Emanuel, et al., supra note 4, at 141–148; see Royal College of Physicians, supra note 29, at 49.Google Scholar
National Bioethics Committee (Italy), “Opinion of the National Bioethics Committee on the European Protocol on Biomedical Research,” November 19, 1999, available at <http://www.governo.it/bioetica/eng/opinions/protocol.html> (last visited January 16, 2012).+(last+visited+January+16,+2012).>Google Scholar
See National Health and Medical Research Council et al., supra note 8, at 35.Google Scholar
See Council of Europe Bioethics Division, supra note 22, article 23(3); see Council for International Organizations of Medical Sciences, supra note 1; see World Medical Association, supra note 27; see Penslar, , supra note 12, at chapter 4, section H; see Department of Health (South Africa), supra note 9, at 50; see Royal College of Physicians, supra note 29, at 49.Google Scholar
International Conference on Harmonisation (ICH) Steering Committee, ICH Harmonised Tripartite Guideline: Choice of Control Group and Related Issues in Clinical Trials E10, Step 4 Version (2000), at 7–8, available at <http://www.ich.org/fileadmin/Public_Web_Site/ICH_Products/Guidelines/Efficacy/E10/Step4/E10_Guideline.pdf> (last visited January 16, 2012).+(last+visited+January+16,+2012).>Google Scholar
U.S. Food and Drug Administration, “Drug Study Designs,” FDA Information Sheets, 1998, available at <http://www.fda.gov/RegulatoryInformation/Guidances/ucm126501.htm> (last visited January 16, 2012).+(last+visited+January+16,+2012).>Google Scholar
US Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research, Center for Biologics Evaluation and Research, Center for Devices and Radiologic Health, Guidance for Industry Clinical Development Programs for Drugs, Devices, and Biological Products for the Treatment of Rheumatoid Arthritis (RA), US DHHS/FDA/CDER/CBER/CDRH, 1999, at 23, available at <http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm071579.pdf> (last visited January 16, 2012).+(last+visited+January+16,+2012).>Google Scholar
See Department of Health (South Africa), supra note 9, at 50.Google Scholar
Council of Europe Bioethics Division, supra note 22, article 23(10); see U.S. Food and Drug Administration, supra note 5 7.Google Scholar
See Council for International Organizations of Medical Sciences, supra note 1.Google Scholar
See World Medical Association, supra note 27.Google Scholar
International Conference on Harmonisation (ICH) Steering Committee, ICH Harmonised Tripartite Guideline: General Considerations for Clinical Trials E8, Step 4 Version (1997), at 9, available at <http://www.ich.org/fileadmin/Public_Web_Site/ICH_Products/Guidelines/Efficacy/E8/Step4/E8_Guideline.pdf> (last visited January 16, 2012); International Conference on Harmonisation (ICH) Steering Committee, ICH Harmonised Tripartite Guideline: Statistical Principles for Clinical Trials E9, Step 4 Version (1998), at 16 and 31, available at <http://www.ich.org/fileadmin/Public_Web_Site/ICH_Products/Guidelines/Efficacy/E9/Step4/E9_Guideline.pdf> (last visited January 16, 2012).+(last+visited+January+16,+2012);+International+Conference+on+Harmonisation+(ICH)+Steering+Committee,+ICH+Harmonised+Tripartite+Guideline:+Statistical+Principles+for+Clinical+Trials+E9,+Step+4+Version+(1998),+at+16+and+31,+available+at++(last+visited+January+16,+2012).>Google Scholar
See Royal College of Physicians, supra note 29, at 36.Google Scholar
See International Conference on Harmonisation (E9), supra note 63, at 16.Google Scholar
National Cancer Institute, “The Monitoring Process,” available at <http://www.cancer.gov/clinicaltrials/education/monitoring-safety-of-trials/page5> (last visited January 16, 2012) (emphasis added).+(last+visited+January+16,+2012)+(emphasis+added).>Google Scholar
See World Medical Association, supra note 27; see International Conference on Harmonisation (E9), supra note 63, at 19–20.Google Scholar
Freedman, B., “Placebo-Controlled Trials and the Logic of Clinical Purpose,” IRB: Ethics and Human Research 12, no. 6 (1990): 16, at 5.CrossRefGoogle Scholar
See Penslar, , supra note 12, at chapter 4, section H.Google Scholar
See US Department of Health and Human Services et al., supra note 58, at 21.Google Scholar
Royal Australasian College of Physicians, Guidelines for Ethical Relationships between Physicians and Industry, 3rd ed. (Sydney: RACP, 2006): At 48, available at <http://www.racp.edu.au/page/policy-and-advocacy/ethics> (last visited January 16, 2012).+(last+visited+January+16,+2012).>Google Scholar
U.S. Food and Drug Administration, “Exception from Informed Consent for Studies Conducted in Emergency Settings: Regulatory Language and Excerpts from Preamble,” FDA Information Sheets, 1998, available at <http://www.fda.gov/RegulatoryInformation/Guidances/ucm126482.htm> (last visited January 16, 2012).+(last+visited+January+16,+2012).>Google Scholar
See Committee for Ethics and Medico-Legal Affairs, supra note 51, at 13.Google Scholar
International Conference on Harmonisation (ICH) Steering Committee, ICH Harmonised Tripartite Guideline: Structure and Content of Clinical Study Reports E3, Step 4 version (1995): At 1, available at <http://www.ich.org/fileadmin/Public_Web_Site/ICH_Products/Guidelines/Efficacy/E3/Step4/E3_Guideline.pdf> (last visited January 16, 2012).+(last+visited+January+16,+2012).>Google Scholar
See Lakemedelsverket, supra note 20, at 24.Google Scholar
See Council for International Organizations of Medical Sciences, supra note 1.Google Scholar
Agence française de sécurité sanitaire (French Government), “The Installation and Control in France of Clinical Trials relating to Medical Devices and In Vitro Diagnostic Medical Devices,” at section 5.1, available at <http://www.afssaps.fr/var/afssaps_site/storage/original/application/a10417152b7fe-4628a2426e9031410be.pdf> (last visited January 16, 2012).+(last+visited+January+16,+2012).>Google Scholar
21 C.F.R. 312.60 (1996); see Department of Health (South Africa), supra note 9, at 49.Google Scholar
See Royal Australasian College of Physicians, supra note 73, at 36.Google Scholar
See National Health and Medical Research Council et al., supra note 8, at 63.Google Scholar
Kim, S. Y. Schrock, L. Wilson, R. M. et al., “An Approach to Evaluating the Therapeutic Misconception,” IRB: Ethics and Human Research 31, no. 5 (September-October 2009): 714; see Sulmasy, et al., supra note 46.Google Scholar
American Society of Hospital Pharmacists, “ASHP Statement on Pharmaceutical Research in Organized Health-Care Settings,” American Journal of Hospital Pharmacy 48 (1991): 1781.Google Scholar
Laakelaitos Lakemedelsverket (National Agency for Medicines, Finland), “Normative Guideline 1/2004, 12/30/2004 and 1/2007: Clinical Investigations on Medical Devices” Finnish Government, 2007, at sect. 2.3, available at <http://firstclinical.com/regdocs/doc/?showpage=7&db=INT_Finland_Clinical_Investigations_Devices> (last visited January 18, 2012); see Lakemedelsverket, supra note 20, at 9; see International Conference on Harmonisation (E6), supra note 19, at 13 (thanks to a reviewer for noting this overlooked standard).+(last+visited+January+18,+2012);+see+Lakemedelsverket,+supra+note+20,+at+9;+see+International+Conference+on+Harmonisation+(E6),+supra+note+19,+at+13+(thanks+to+a+reviewer+for+noting+this+overlooked+standard).>Google Scholar
Grant, G. R., “Surgical Innovation and Research,” in Emanuel, et al., supra note 4, at 367–374.Google Scholar
Bethel, M. Holman, R. Haffner, S. Califf, R. Huntsman-Labed, A. Hua, T. McMurray, J., “Determining the Most Appropriate Components for a Composite Clinical Trial Outcome,” American Heart Journal 156, no. 4 (October 2008): 633640.CrossRefGoogle Scholar
Halpern, S. D., “Towards Evidence Based Bioethics,” BMJ 15, no. 331 (October 2005): 901903; Schonfeld, T. L. Brown, J. S. Weniger, M. Gordon, B., “Research Involving the Homeless: Arguments against Payment-in-Kind (PinK),” IRB: Ethics and Human Research 25, no. 5 (September-October 2003): 17–20.CrossRefGoogle Scholar
Referring to Council of Europe Bioethics Division, supra note 22.Google Scholar
76 FR 44528.Google Scholar
See Penslar, , supra note 12, main page.Google Scholar