Monday, August 06, 2012

Update: ethics of drug addiction research in China

When we last left off with this story, Human Rights Watch (HRW) raised questions about a published research study conducted among Chinese drug users in what are called local 'drug rehabilitation centers'. The main questions raised by HRW were: (a) did the study population include participants who are receiving compulsory treatment at the centers by court order or were there also volunteers? (b) do persons at the drug rehabilitation centers receive internationally recognized standard of care for their addictions, as international research ethics codes require? (c) if the conditions in such centers (as some allege) human rights abuses including forced labor, should researchers be conducting studies with detainees in such facilities at all? (d) why, if co-authors of the study included investigators from the US National Institute of Drug Abuse (NIDA), was the study apparently not reviewed by a research ethics committee in the United States?

There is a response by the research team to these concerns in the Letter to the Editor section in Science this week that looks anything but adequate. The responses basically come to the following: (a) we did not see any abuses take place (b) the participants did not mention any of the alleged abuses (c) if there were abuses, this would have violated Chinese law (d) the study was approved by the ethics committee of the Peking University Health Center (e) only the court-mandated drug users who gave their consent, and told they could refuse to be in the study, were enrolled (f) those enrolled in the study were offered cognitive behavioral therapy (CBT), and withdrawing from the study did not entail losing their eligibility for the usual treatment offered in Beijing treatment centers. All of this is capped off by a description of Beijing drug treatment centers that is positively glowing, and does not cohere with investigative reports of the same centers.

The research team's response is unlikely to satisfy those who question the ethics of these studies. Abuses could be taking place, even if researchers did not see them, and even if participants (for good reason) did not mention them. These treatment centers could be breaking Chinese law, and if so, the fact that the study was approved by the ethics committee in Beijing just shows the limitations of ethics review. That the research participants consented and told they could refuse to participate is a necessary but not sufficient condition of this study (and any study) being ethical. Offering CBT is fine, but the question is what is the standard of the usual treatment in such centers? If it is lousy care, then participants may join the study purely to receive what they should get at a treatment center anyway: is participation then 'voluntary'? And as for the concerns about the nature of the involvement of NIDA in the study, there is no response at all.

Some bioethicists in the US and China believe that human rights activists have been unfairly criticizing an innocuous and useful study just to highlight conditions in Chinese drug treatment centers. But this is part of the question: should even innocuous and useful studies be conducted in sites where (allegedly) human rights abuses are taking place? Can the ethics of research studies and the environment in which they are conducted be easily disentangled?


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