Publication: an ethical imperative

Abstract

Publication of medical research is both a monitor of the researcher's ethics and an audit of the local or regional ethics committee that approved it. Selectivity of publication or of the intention to publish lessens this audit. Opinions differ about what is ethically allowable in clinical and benchtop medical research. Ethical permission and ethical monitoring of medical research are subject to a hierarchy of pyramidal controls, starting in hospital and ending with the local, institutional, or regional ethics committee. Currently, such committees function with widely varying degrees of efficiency and quality of output, and with differing viewpoints on many ethical issues. Without an a priori insistence by institutional ethics committees that there be an intention to publish all medical research involving human subjects, ethics committees cannot routinely be subject to the scrutiny or audit which they themselves demand of researchers. Divergent views on many ethical aspects of medical research are held not only by individuals1 2 3 4 5 6 7 8 9 10 11 but by institutional ethics committees12 and by the broader informed public as well.13 14 15 16 17 Some ethics committees are startled by what others allow, and some committees, by contrast, are seen as overly conservative. Only a fraction of this divergence of collective viewpoints of ethics committees is ever printed. One celebrated exception was widespread comment about the recent study of HIV in children in Zaire—a study approved by the French national ethics committee but not by the United States National Institutes of Health.14 15 Local or regional ethics committees and institutional ethics committees undoubtedly function “at present with variable performance.”11 Such ethics committees act as watchdogs of patients' rights, but who watches over ethics committees? The best way in which institutional ethics committees can open their deliberations to …