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Institutional Review Board for Human Research (IRB) Human Subject Protections. Susan Sonne, PharmD, BCPP Chair, MUSC IRB II. Nuremberg Code. first major control on research in any nation prescribed 1948 as part of trial of a Nazi Physician

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institutional review board for human research irb human subject protections

Institutional Review Board for Human Research (IRB)Human Subject Protections

Susan Sonne, PharmD, BCPP

Chair, MUSC IRB II

nuremberg code
Nuremberg Code
  • first major control on research in any nation
  • prescribed 1948 as part of trial of a Nazi Physician
  • willfully harmful research on unwilling human subjects
jewish chronic disease hospital study
Jewish Chronic Disease Hospital Study
  • July 1963
  • Injection of live cancer cells into 22 patients
  • No written consent
  • Some verbally informed – “involved in experiment”
  • Never told being given live cancer cells
  • Guilty of fraud, deceit, unprofessional conduct
the declaration of helsinki
The Declaration of Helsinki
  • Produced 1961, adapted 1964
  • Informed consent = ethical research
  • Basis for FDA policy
willowbrook state school
Willowbrook State School
  • Study began 1956
  • Institution for “mentally defective” children
  • Study designed to contribute to understanding etiology of infectious hepatitis and test effects of gamma globulin in preventing disease.
  • First subjects fed extracts of infected stool
  • Public attention 1971
national research act of 1974
National Research Act of 1974

Created National commission for the protection of Human Subjects of Biomedical and Behavioral research.

Charge was to:

Identify basic ethical principles that should underlie conduct of biomedical and behavioral research involving human subjects

more specifically consider
More specifically, consider

Boundaries between research and practice

Role of assessment of risk-benefit

Selection of subjects

Nature and definition of informed consent

Result was 1976 Belmont report

slide8

Good Clinical Practice

Why have this training?

the tuskegee syphilis study
The Tuskegee Syphilis Study
  • 1932 to 1972
  • 399 African American Males were denied treatment for syphilis
  • Study conducted by U.S. Public Health Service
from president clinton
From President Clinton
  • "Although these regulations [Protection of Human Subjects, Code of Federal Regulations, Title 45, Part 46} provide the framework for protecting human subjects in research, we must exercise constant care and ensure that these regulations are strictly enforced by departments and agencies. Therefore, I direct each department and agency of Government to review present practices to assure compliance with the Federal Policy for the Protection of Human Subjects and to cease immediately sponsoring or conducting any experiments involving humans that do not fully comply with the Federal Policy." -Bill Clinton, 1994
  • “The people who ran the study at Tuskegee diminished the stature of man by abandoning the most basic ethical precepts. They forgot their pledge to heal and repair. They had the power to heal the survivors and all the others and they did not. Today, all we can do is apologize….” – Bill Clinton, 1997
ohrp suspensions
OHRP Suspensions
  • During the last 6-7 years, OHRP has suspended all human research at the following institutions:
    • University of Illinois, Chicago Campus
    • University of Colorado
    • Duke University
    • Johns Hopkins
    • University of Pennsylvania
    • And others
general rule for human subject protection
General Rule for Human Subject Protection

Any element of research?

Yes

Undergo review

irb purpose
IRB Purpose
  • To protect the rights and welfare of human research subjects
  • Authority to approve, require modification and disapprove any research involving human subjects
slide14

Institutional Review Board

  • responsible to verify
        • Safety
        • Integrity
        • Human rights
        • Public reassurance
        • Scientific content
the belmont report
The Belmont Report
  • 3 Basic Principles for Protection of Human Subjects:
    • Respect
      • voluntary informed consent
      • privacy
      • protections for vulnerable populations
    • Beneficence
    • Justice
beneficence
Beneficence
  • Persons treated in an ethical manner
  • Protecting them from harm
  • Helping to secure their well being
justice
Justice
  • Who ought to receive the benefits of research and bear the burden of research?
  • Equals ought to be treated equally
  • Fairness in distribution
  • What is deserved
criteria for approval
Criteria for Approval
  • Risks are minimized
  • Reasonable risk:benefit ratio
  • Equitable selection of subjects
  • Informed consent obtained appropriately
  • Informed consent adequately documented
  • Monitor data to insure safety
  • Protect confidentiality
  • No coercion
slide19

Informed Consent

  • Essential to ethical conduct of clinical investigation
  • Potential subject chooses whether or not they will participate
  • Obtained after full information is given and understood
  • Explanation of study objective, potential benefits, risks, inconveniences, subject’s rights and responsibilities
slide20

Informed Consent

    • Introduction
    • Purpose of the Study
    • Procedures
    • Potential Risks and Discomforts
    • Anticipated Benefits to Subjects
    • Anticipated Benefits to Society
    • Alternative to Participation
    • Emergency Care and Compensation for Injury
    • Payment for Participation
    • Financial Obligation
    • Privacy and Confidentiality
    • Participation and Withdrawal
    • Rights of Research Subjects
    • Signatures
slide21

The Mountain of Responsibility

FDA

Sponsor

Investigator

  • Protecting Participants
  • Implementing Study
  • Reporting Accurately

Research Team

Coord, RA, etc

slide22

Investigator Obligations

  • Conducts a clinical investigation
  • Responsible for
          • All procedures conducted
          • All data collected
  • May delegate work in conducting study but they retain responsibility
slide23

Investigators – and by delegation all study staff responsibilities

  • To protect the rights of participants
  • To obtain informed consent from each participant
  • To keep specific records and issue specific orders
  • To assure that the IRB is provided information for initial and continuing review of the study
useful regulatory policy material
Useful Regulatory/Policy Material
  • MUSC IRB
  • http://research.musc.edu/ori/irb/home
  • Office for Human Research Protections
  • http://www.hhs.gov/ohrp/
  • Food & Drug Administration
  • http://www.fda.gov/oc/ohrt/irbs/default.htm