Clinical research is necessary to advance medical knowledge and to test new drugs or devices. It is therefore vital to society, and ethically imperative, that clinical studies be performed if patients are to have access to safe and effective treatments. However, clinical research by its very nature involves risk. Subjects who volunteer in clinical studies may receive no benefit; in fact, they may be seriously harmed or even die as a result of their participation. Indeed, research-related injuries and deaths, though relatively few in number (1), have become the subject of much controversy in recent years (2). Thus, the protection of human research subjects must be given the highest priority by researchers, their institutions, and the government and regulatory bodies charged with overseeing the clinical research process. Central to this process is the institutional review board (IRB) in the United States (U.S.), or research ethics board as it is known in Canada. (For the purpose of this paper, the term "IRB" will be used to refer to both American and Canadian boards.) The IRB has frequently been referred to as the "first line of defense" in research subject protection (3), yet the specific roles and responsibilities of this board and its members are not clear (4). Defining these roles and responsibilities is more important now than ever before, for several reasons.
References
Office of Inspector General. Protecting Human Research Subjects: Status of Recommendations. Washington, D.C. Department of Health and Human Services, 2000.
Drennan KB. Have the ultimate benefits of clinical trials been maligned beyond repair? DDT 6(12): 597-599; 2001
Lemonick MD, Goldstein A. At your own risk. Time 159(16): 40-49; 2002
Hirtle M, Lemmons T, Sprumont D. A comparative analysis of research ethics review mechanisms and the ICH Good Clinical Practice guideline. Eur J Health Law 7: 265-292; 2000.
No author listed. Anticipating a clinical investigator shortfall. Centerwatch 8(April): 1,5-13; 2001
Office of Inspector General. Institutional Review Boards: A Time for Reform. Washington, D.C. U.S. Department of Health and Human Services, 1998.
Burman WJ, Reves RR, Cohn DL et al. Breaking the camel's back: multicenter clinical trials and local institutional review boards. Ann Intern Med 134: 152-157; 2001
Levine RJ. The crisis in institutional review boards. Ann Intern Med 134: 161-163; 2001
Phillips DF. Institutional review boards under stress: will they explode or will they change? JAMA 276: 1623-1625; 1996
McDonald M. The governance of health research involving human subjects. Law Commission of Canada. Ottawa, Ontario, 2000.
Weijer C, Shapiro S, Fuks A et al. Monitoring clinical research: an obligation unfulfilled. CMAJ 152(12): 1973-80; 1995
Thorne, D. Researchers put patients at risk. Edmonton Journal. September 28: B3; 2002
Bevan J. Toward the regulation of research ethics boards. Can J Anesth. 49(9): 900-906; 2002
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Institutional Review Boards: Report and Recommendations of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Federal Register 43(30 November): 56186, 1978.
Holder AR. Liability and the IRB member: the legal aspects. IRB 1(3): 7-8; 1979
Robertson v. McGee, No. 01CV00G0H(M) (N.D. Okla. Filed January 29, 2001.)
Freedman B and Glass KC. Weiss v. Solomon: a case study in institutional responsibility for clinical research. Law Med Health Care. 18(4): 395-403; 1990
Lemmens T, Freedman B. Ethics review for sale? Conflicts of interest and commercial research review boards. Milbank Q 78(4): 547-84; 2000
Edgar H and Rothman DJ. The institutional review board and beyond: future challenges to the ethics of human experimentation. Milbank Q. 73(4): 489-506; 1995
Anderlik MR, Elster N. Lawsuits against IRBs: accountability or incongruity? J Law Med Ethics 29(2): 220-228; 2001
Foubister V. Clinical trial patients sue IRB members. Amednews.com. February 26; 2001
Abate T. Special report: experiments on humans. San Francisco Chronicle. August 5; 2002
Stolberg SG. The biotech death of Jesse Gelsinger. N Y Times Mag Nov 28: 136-140, 149-150; 1999
Smaglik P. Asthma study death spurs inquiry. Nature 138(5): 36; 2001
Shamp J. Agency halts federally funded Duke research on new patients. Herald-Sun (Durham NC). May 12: A1; 1999
Kolata G. U.S. suspends human research at Johns Hopkins after death. New York Times. July 20: A1, A18; 2001
Weiss v. Solomon. (1989). R.J.Q. 731.
Kus v. Sherman Hospital. (1995). 268 Ill App 3d 771,644 NE2d1214,1216.
Cassel C, Stock MC, Wood A, Zapol W, Hellman S. Report of Johns Hopkins University External Review Committee, Aug. 8. 2001.
Protection of Human Subjects, 45 C.F.R. 56, IRB membership, § 107. (4-1-00 Edition).
Protection of Human Subjects, 45 C.F.R. 56, IRB functions and operations, § 108. (4-1-00 Edition).
Office of Inspector General. Institutional Review Boards: The Emergence of Independent Boards. Washington, D.C.: U.S. Department of Health and Human Services, 1998.
Cho MK, Billings P. Conflict of interest and institutional review boards. J Investig Med 45(4): 154-9; 1997
Christian MC, Goldberg JL. A central institutional review board for multi-institutional trials. N Engl J Med 346(18): 1405-1408; 2002
Stair TO, Reed CR, Radeos MS et al. Variation in institutional review board responses to a standard protocol for a multicenter clinical trial. Acad Emerg Med 8:636-641; 2001
Gordon B, Prentice E. Continuing Review of Research Involving Human Subjects: Approach to the Problem and Remaining Areas of Concern. IRB 19(2): 8-11; 1997
Medical Research Council of Canada, 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. Ottawa: Minister of Supply and Services, 1998.
Pilon S. When less is more - a new look at research monitoring. BMC News and Views 1:6; 2000
Institute of Medicine. Responsible Research: A Systems Approach to Protecting Research Participants. The National Academies, Washington D.C., October 3, 2002.