Medical Ethics

March 4th, 2009 at 2:00 pm by David Farrar

An article full of revelations appeared on Monday by Shaun Holt on medical ethics in NZ. He explains:

As an experienced medical researcher and an ex-member of an ethics committee, I am likely to know about the ethical requirements of medical research. Last year I submitted an application for a simple study to see if honey could help treat a common skin infection in children that is otherwise very difficult to treat. Only 15 children were required for the study, and all the caregivers had to do was to apply the honey, cover with a dressing and see if it seemed to help.

Sounds about as simple as you can get. It is 1,000 miles away from let’s not treat this women for cervical cancer so we can see how effective the treatment is.

In order to apply to the ethics committee, I had to consult a Maori provider to make sure there were no cultural issues if any Maori children took part and see a justice of the peace to sign a statutory declaration.

The application itself needed around 9000 words to complete and over 350 pages had to be submitted. For a study which could not be any simpler and had almost no chance of causing any harm, the application process took longer than doing the study would have.

This is the first stage of distress. Consulting a Maori health provider should not be mandatory – common sense should apply. And God forbid how you need 350 pages for such a simple study. Think of not only the cost to the healthcare system, but also the research that never happens due to such bureaucracy.

The study was rejected by the committee and around 40 points were raised, most of which were either wrong or not relevant to the ethics of the study. For example, I was told to consult at least two more Maori health providers and to have systems in place for interpreters, even though the study was to be undertaken by a few GPs who would ask their own patients with this condition if they wanted to take part.

Almost enough to make you weep.

It is no surprise he writes:

Medical researchers are hugely frustrated by the quality of the ethical reviews of their proposals, the work required for an application and the time taken for the responses and approvals. One of our leading orthopaedic surgeons has said the greatest impediment to medical research here is the growth of the ethics committee process.

We owe Dr Holt our thanks for speaking up. Hopefully the powers that be  will take note.

Hat Tip: MacDoctor

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10 Responses to “Medical Ethics”

  1. MyNameIsJack (2,415 comments) says:

    david, maori must be consulted because if there is any commercial value from this study, there will be some maori somewhere who can tell you which of the mob on the first whackos knew about before the whiteman and slide a brown palm out to be crossed with silver.

    of course, if there is no commercial benefit, another maori can be found to say “Nah, we’d already tried it and knew it didn’t work”.

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  2. KiwiGreg (3,211 comments) says:

    Talk to any Hort scientist about the difficulties of getting genetic material to work with. We are killing research in this country.

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  3. Peter Cresswell (48 comments) says:

    If you like Shaun’s OpEd in the Herald, then you’re gonna love his blog: http://naturalremediesthatwork.blogspot.com/

    Add it to your regular reading. :-)

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  4. Bryan Spondre (225 comments) says:

    Are Maori from some other planet ? Otherwise I can’t see how they are so different from the rest of us that they need to be consulted every time somebody wants to fart in this country :-)

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  5. MacDoctor (66 comments) says:

    The point Shaun is making is that the study he was trying to get approved was a tiny GP-run pilot. It should have required a one-page submission and had approval within a week. You can just imagine the costly process involved in getting going a full, randomised, double-blind trial with a couple of thousand participants.

    And the so-called “fast-forward” fund would have added another layer of bureaucracy. Whoopy.

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  6. gd (2,286 comments) says:

    see the great article on the Death of Common Sense over at No Minister, It appeared in the London Times and should be compulsory reading for every politican civil servant regulator and lawyer.

    All would lean much from it

    Thats if it can penetrate their numb brain skulls

    And in the case above just think how many clipped the ticket paid for by the taxpayer.

    Its all part of an obscence disgusting gravy train that got to pulled into the station and broken up and melted down for scrap.

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  7. Ratbiter (1,265 comments) says:

    You’d think the parents of any Maori children asked to participate would just tell their GP if the idea of applying honey to a skin infection was offensive for some cultural reason.

    Showing some respect for the Maori culture is not unreasonable. But having to consult THREE Maori health providers to make sure you get the right advice on something so simple seems WAY O.T.T. (in my humble opinion.)

    It’s not as though the doctor is proposing a trial of Hei Tiki shaped suppositories or something like that which would seem offensive even to Pakeha like me!

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  8. sally (26 comments) says:

    Yup! It is a huge problem battling the petty bureacrats and the PC Maori brigade. My husband is a surgeon and has all but given up tryingt to do medical research in NZ because of the red tape and political interfering to apease Maori. My husband had a research plan rejected a few years ago because he couldn’t come up with a Maori angle that showed how Maori would benefit from his research. When he retorted that the particular afflication he wanted to study didn’t appear to have a race bias and that the whole point of research was not to come up with pre-approved outcomes, he was shown the door.

    Don’t worry a American university hospital has offered to fund and approve his research when he is ready to go ahead…. but the intellectual propery will be theirs and not NZs,and we wonder why we have a brain drain?

    Another medical friend and colleague also has been to hell and back to secure research approval for diabetes research. A real insult to his manna was having to listen to a grossly obese, barefoot, semi-literate Maori ‘kaumatua’ dismiss his application because he was sick of Maori being made to ‘feel bad’ about their poor health and he failed to see how this diabetes research was going to make Maori ‘feel better’. But don’t worry Kiwiblog readers you will be relieved to know that yet another pesky white male doctor has left NZ shores and has been working in a $5 milion endowed diabetes research unit in Australia for the last five years, much of the funding has come from the govt department specifically that focuses on Aborigines and Torres Strait Islanders because of their high rate of diabetes -irony no?

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  9. shshsh (3 comments) says:

    Sally (and others) – many thanks for the feedback. I’m drafting a follow-up paper to the NZ Medical Journal and will give people like yourself the chance to contribute. I’ve had a huge amount of support. Please send any comments to me at holtshaun@gmail.com, your comments can be either on the record or anonymous – whichever you prefer. Cheers. Shaun Holt

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  10. wally (63 comments) says:

    the maori approval thing is usually just a ticket clipping exercise (cost $200 – $300 per maori “expert” consulted) and a time delay (usually about 4 weeks) but can be complicated as others have pointed out.
    my main problem with ethics committes is that most committee members, viewing life from their ivory towers, have an antagonistic view of the commercial aspects of clinical trials. they believe it is immoral for researchers to make money out of doing research. in fact, there are some extremely well set up units that earn NZ tens of millions of export dollars per year. however the ethics committees, at times, seem to be actively obstructing this work and, i believe, cost the country millions of dollars in lost earnings.

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