research, ethics, governance: the evolving regulatory landscape jonathan montgomery professor of...
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Shaping tomorrow’s thinking
Research, Ethics, Governance: the evolving regulatory landscape
Jonathan MontgomeryProfessor of Healthcare Law,University of Southampton
Chair, Health Research Authority
Shaping tomorrow’s thinking
History• Nuremberg principles
– now WMA Helsinki Declaration• Henry Beecher & Maurice Pappworth
– Ethical review• North Staffordshire babies
– Research Governance • Sponsor and organisational responsibilities
• Sector scandals– Alder Hey & Human Tissue Act 2004
Shaping tomorrow’s thinking
A new context
• From malfeasance to non-feasance– 2002 46% of EU products in clinical trials
being developed in UK. 2007 24%– 2004 global market share of patients in
trials 6%. 2008 2-3% (AMS Report)• Public expectations
– Evidence-based care– Data usage
• Recession
Shaping tomorrow’s thinking
• Estimated health + GDP gain for £1 invested in CVD research is 39p each year in perpetuity
Shaping tomorrow’s thinking
Shaping tomorrow’s thinking
Main problems
• Delays and duplications in getting permissions
• Complexity and inconsistency• Lack of proportionality in clinical
trials• Inappropriate restriction on use of
patient data• Unsupportive NHS culture
Shaping tomorrow’s thinking
Four Principles
• Safeguard well-being of participants• Facilitate high quality research to
public benefit• Proportionate, efficient, co-ordinated• Maintain and build confidence in the
conduct and value of health research through independence, transparency, accountability and consistency
Shaping tomorrow’s thinking
Solutions…
• Health Research Agency– National research governance checks– Single ethical approvals system
• Improving clinical trials– Consistent interpretation of EU Directive– Revision if necessary
• Access to patient data• Cultural change
Shaping tomorrow’s thinking
Public support
• UK Biobank has recruited 500,000 without difficulty
• Wellcome Trust survey of 1,000– 71% would give blood or tissue sample
for research– 62% willing to test new treatment for
disease from which they were suffering• Reasonably wide support for use of
date for research with consent
Shaping tomorrow’s thinking
Shaping tomorrow’s thinking
Consultation
• Clarified Patients’ rights
• To be informed about data usage• Objections to use beyond personal
care – to be considered– Told why wishes cannot be followed ,
including legal basis
Shaping tomorrow’s thinking
Consultation
• NHS commits (pledges)– Ensure data available to support care– Anonymise patient data & use to
support research and improve care for others
– Where identifiable has to be used, chance to object where possible
– Inform you of research in which you may be eligible to participate
Shaping tomorrow’s thinking
The HRA Vision
• For the UK to be a great place to do research, where more money invested in research goes into carrying out relevant, good quality research
• Duties to protect and promote the interests of patients and the public
Shaping tomorrow’s thinking
Interests to promote
• Evidence-based care– Care and research complementary not
contradictory • Collaborators as ‘investors’ who
deserve the best returns we can deliver
• Choices that are participants value– More than the right to say yes or no
Shaping tomorrow’s thinking
Protection• REC opinions
– Independence of considerations of projects crucial
– Process values: consistent, transparent, timely
• NREAP – Service to researchers not just RECs– Membership supplemented– HRA Board not an arbiter of ‘Ethics’
• Proportionality?
Shaping tomorrow’s thinking
HRA as a service provider• Who are we serving?
– Work on understanding public attitudes to risk
– Commitment to responding• Identifying and addressing problems
– Steering group for projects– IRAS dataset – fitness for purpose– HRA Assessment
Shaping tomorrow’s thinking
The Law
• Health and Social Care Act 2012– Duties to promote research and use of
evidence
• Draft Care and Support Bill– HRA as NDPB
• Clinical Trials
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