Hostname: page-component-848d4c4894-5nwft Total loading time: 0 Render date: 2024-05-13T00:37:46.371Z Has data issue: false hasContentIssue false

Beyond Human Subjects: Risk, Ethics, and Clinical Development of Nanomedicines

Published online by Cambridge University Press:  01 January 2021

Extract

Like all policies, contemporary human research policies are the product of their history. The scandals and traumas motivating their creation — the Nazi doctors trials, Tuskegee, the Milgram experiment on obedience — however different in their particulars, all share a common narrative: a scientist, pursuing valued social ends, runs roughshod over the personal interests of disadvantaged human subjects. From the Nuremberg code through the latest revisions of the Declaration of Helsinki, research ethics policies have sought to erect a sphere of protection around the latter.

As a consequence of this history, all major policies start with a well-rehearsed model of human investigations. Clinical research is viewed as an encounter between investigators and volunteers. The clinical investigator is given certain duties. The human volunteer has certain moral entitlements. What is ethically at stake in human investigations inheres in the nature and quality of the interactions between investigators and volunteers. These interactions involve an asymmetry because the investigator has privileged knowledge and influence.

Type
Symposium
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

There is limited language in research ethics policies that would condemn publication bias. For example, trial registration rules under FDAAA pertain only to clinical trials at phase 2 and above, and obligatory reporting pertains only to trials within a licensed indication; the Common Rule does not address publication. Paragraph 30 of Declaration of Helsinki urges publication of all results.Google Scholar
World Medical Association, “Declaration of Helsinki,” World Medical Journal 54, no. 4 (2008): 122–25.Google Scholar
Myllymäki, K., Revising the Declaration of Helsinki: An Insiders’ View,” in Frewer, A. and Schmidt, U., eds., History and Theory of Human Experimentation: The Declaration of Helsinki and Modern Medical Ethics (Stuttgart: Franz Steiner Verlag, 2007).Google Scholar
Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and Social Sciences and Humanities Research Council of Canada, “Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans,” December 2010.Google Scholar
Jonsen, A. R., “On the Origins and Future of the Belmont Report,” in Childress, J. F. Meslin, E. M., and Shapiro, H. T., eds., Belmont Revisited: Ethical Principles for Research with Human Subjects (Washington, D.C.: Georgetown University Press, 2005).Google Scholar
The National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research, “The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research,” edited by Department of Health, Education and Welfare, 1979.Google Scholar
U.S. Department of Health & Human Services, “Code of Federal Regulations: Title 45 – Public Welfare – Part 46 – Protection of Human Subjects, 45 CFR 46,” 2009.Google Scholar
See the National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research, supra note 6.Google Scholar
Resnik, D. B. and Sharp, R. R., “Protecting Third Parties in Human Subjects Research,” IRB 28, no. 4 (July-August, 2006): 17.Google Scholar
Kimmelman, J., “Medical Research, Risk, and Bystanders,” IRB 27, no. 4 (2005): 16.CrossRefGoogle Scholar
Schenk-Braat, E. A. van Mierlo, M. M. Wagemaker, G. Bangma, C. H., and Kaptein, L. C., “An Inventory of Shedding Data from Clinical Gene Therapy Trials,” Journal of Gene Medicine 9, no. 10 (October 2007): 910921.CrossRefGoogle Scholar
Tarantola, A. Abiteboul, D., and Rachline, A., “Infection Risks Following Accidental Exposure to Blood or Body Fluids in Health Care Workers: A Review of Pathogens Transmitted in Published Cases,” American Journal of Infection Control 34, no. 6 (2006): 367375; Openshaw, P. J. Alwan, W. H. Cherrie, A. H., and Record, F. M., “Accidental Infection of Laboratory Worker with Recombinant Vaccinia Virus,” The Lancet 338, no. 8764 (1991): 459.CrossRefGoogle Scholar
Murashov, V., “Occupational Exposure to Nanomedical Applications,” Wiley Interdisciplinary Reviews: Nanomedicine and Nanobiotechnology 1, no. 2 (2009): 203213.Google Scholar
Kimmelman, J., Lost in Translation: The Ethics and Policy of Human Gene Transfer (New York: Cambridge University Press, 2009).Google Scholar
Siegrist, M. Keller, C. Kastenholz, H. Frey, S., and Wiek, A., “Laypeople's and Experts’ Perception of Nanotechnology Hazards,” Risk Analysis 27, no. 1 (2007): 5969.CrossRefGoogle Scholar
London, A. J. Kimmelman, J., and Emborg, M. E., “Research Ethics: Beyond Access vs. Protection in Trials of Innovative Therapies,” Science 328, no. 5980 (2010): 829–30.CrossRefGoogle Scholar
Therasse, P. Arbuck, S. G. Eisenhauer, E. A. Wanders, J. Kaplan, R. S. Rubinstein, L. Verweij, J. Van Glabbeke, M. van Oosterom, A. T. Christian, M. C., and Gwyther, S. G., “New Guidelines to Evaluate the Response to Treatment in Solid Tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada,” Journal of the National Cancer Institute 92, no. 3 (2000): 205216.CrossRefGoogle Scholar
U.S. Department of Health & Human Services, National Institutes of Health, and National Cancer Institute, “Common Terminology Criteria for Adverse Events (C.T.C.A.E.), Version 4.03,” June 14, 2010.Google Scholar
Orkin, S. H. and Motulsky, A. G., “Report and Recommendations of the Panel to Assess the NIH Investment in Research on Gene Therapy,” edited by National Institutes of Health – Office of Biotechnology Activities, 1995.Google Scholar
See Kimmelman, , supra note 10.Google Scholar
Thomas, D. G. Klaessig, F. Harper, S. L. Fritts, M. Hoover, M. D. Gaheen, S. Stokes, T. H. Reznik-Zellen, R. Freund, E. T. Klemm, J. D. Paik, D. S., and Baker, N. A., “Informatics and Standards for Nanomedicine Technology,” Wiley Interdisciplinary Reviews: Nanomedicine and Nanobiotechnology 3, no. 5 (2011): 511532; Gaumet, M. Vargas, A. Gurny, R., and Delie, F., “Nanoparticles for Drug Delivery: The Need for Precision in Reporting Particle Size Parameters,” European Journal of Pharmaceutics and Biopharmaceutics 69, no. 1 (2008): 1–9.Google Scholar
European Medicines Agency, Human Medicines Development and Evaluation, 1st International Workshop on Nanomedicines 2010 Summary Report, available at <http://www.ema.europa.eu/docs/en_GB/document_library/Report/2010/10/WC500098380.pdf> (last visited November 13, 2012).+(last+visited+November+13,+2012).>Google Scholar
Bawa, R. and Johnson, S., “Emerging Issues in Nanomedicine and Ethics,” in Allhof, F. and Lin, P., eds., Nanotechnology & Society: Current and Emerging Ethical Issues (City of publication?: Springer Science + Business Media, 2009): At 207–223.Google Scholar
See Thomas, et al., supra note 21.Google Scholar
Thomas, D. G. Pappu, R. V., and Baker, N. A., “Nanoparticle Ontology for Cancer Nanotechnology Research,” Journal of Biomedical Informatics 44, no. 1 (February 2011): 5974; Maojo, V. Martin-Sanchez, F. Kulikowski, C. Rodriguez-Paton, A., and Fritts, M., “Nanoinformatics and DNA-Based Computing: Catalyzing Nanomedicine,” Pediatrics Research 67, no. 5 (May 2010): 481–489.CrossRefGoogle Scholar
Baun, A. and Hansen, S. F., “Environmental Challenges for Nanomedicine,” Nanomedicine (London) 3, no. 5 (2008): 605608.CrossRefGoogle Scholar
See Kimmelman, , supra note 10.Google Scholar
Kimmelman, J., “Missing the Forest: Further Thoughts on the Ethics of Bystander Risk in Medical Research,” Cambridge Quarterly of Healthcare Ethics 16, no. 4 (Fall 2007): 483490.CrossRefGoogle Scholar
Aultman, K. S. Walker, E. D. Gifford, F. Severson, D. W. Beard, C. B., and Scott, T. W., “Research Ethics: Managing Risks of Arthropod Vector Research,” Science 288, no. 5475 (2000): 23212322.CrossRefGoogle Scholar
See Kimmelman, , supra note 10, supra note 28.Google Scholar
King, N. M., “RAC Oversight of Gene Transfer Research: A Model Worth Extending?” Journal of Law, Medicine & Ethics 30, no. 3 (2002): 381389; Levine, C. Faden, R. Grady, C. Hammerschmidt, D. Eckenwiler, L., and Sugarman, J., “‘Special Scrutiny’: A Targeted Form of Research Protocol Review,” Annals of Internal Medicine 140, no. 3 (2004): 220–223.CrossRefGoogle Scholar
Paradise, J. Wolf, S. M. Kuzma, J. Kuzhabekova, A. Tisdale, A. W. Kokkoli, E., and Ramachandran, G., “Developing U.S. Oversight Strategies for Nanobiotechnology: Learning from Past Oversight Experiences,” Journal of Law, Medicine & Ethics 37, no. 4 (2009): 688705.CrossRefGoogle Scholar