Saturday, May 12, 2012

The ethics of drug addiction research in China

Reports about what goes on in 'drug rehabilitation centers' in China have been dribbling into the media for some time now. Arrest for illegal drug use in China can lead to compulsory treatment (for a minimum of 2 years) at detention centers that, according to a New York Times piece in 2010, function as de facto penal colonies where inmates are fed substandard food and denied basic medical care. The detentions are enforced by police, where the drug user has no opportunity to have a trial, face a judge or raise an appeal. When a drug user leaves detention, the problems do not end there: their having been arrested for drug use is noted on their national identification card, making future employment difficult and leaving them vulnerable to frequent and humiliating searches by police. This is not a rare phenomenon: according to the Joint United Nations Programme on HIV/AIDS (UNAIDS, 2010), half a million people are confined in drug detention centers in China at any given time. Perhaps it would be marginally better if those with drug addictions received effective treatment during thier detention, but the most reports point in the other direction: 'treatment' may come in the form of unpaid labor in chicken farms or shoe factories, or in the form of untested 'therapies' like sandbox play, art, or boxing. The 'treatment' looks like punishment, exploitation, or merely lame.  

Question: would it be ethical to conduct research with drug user detainees in such circumstances? In the abstract, those with substance abuse problems are vulnerable persons in poor health, and it would be good to have research on effective interventions to combat drug addiction. But in practice, it gets complicated. The journal Science recently published an article entitled 'A memory retrieval-extinction system to prevent drug craving and relapse'. The study was conducted at Beijing Ankang and Tiantanghe Drug Rehabilitation Centers, but these are two of the facilities that have raised concerns about human rights violations over the past years. Human Rights Watch has published a Letter to the Editor in Science that raises concerns about research being done within institutions suspected of human rights abuse. Should a new intervention be tested against the local standard of care, where there are serious doubts about the effectiveness of that care? In these circumstances, is voluntary informed consent of participants really possible? Are researchers who conduct research in these facilities complicit in the ill-treatment of drug users at the hands of Chinese authorities? 

The story is made murkier by the involvement of the US National Institute for Drug Abuse (NIDA) in the study. Two of the authors on the study are from the NIDA, who apparently helped with data analysis and the writing of the article. Since they were significant enough contributors to the research to warrant authorship, should the study have also been reviewed under the (rather stringent) US regulations governing prisoner research, and if it did, would it have passed muster? It will be interesting to see how this case evolves as the facts become clearer. 

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Blog hiatus

I have been away from the Global Bioethics blog for longer than usual. It was a matter of converging demands: the end of the semester and teaching duties, plus the grant-writing season was in full swing. The latter is a form of temporary insanity, short-term OCD: your life is consumed not only by designing a proposal, collaboratively with others (and all the give and take that involves), but the mad paper chase of getting up-to-date CVs, writing budgets, budget justifications, scopes of work, letters of support, progress reports, and much else besides, and then packaging it all in the right way to submit it all to the funding authorities, whose pockets are getting shallower all the time. Those who think that academia is all about cushy tenured positions for life with guaranteed income ought to take a look in the trenches at (what I call) us soft money monkeys, i.e. those who spend an inordinate amount of time and energy cobbling together enough soft (grant) money to stay at least 75% employed -- you lose your medical insurance coverage if you drop further than that. But that is over, for the moment, and this blog needs feeding.