Rethinking research ethics committees in low- and medium-income countries

Abstract

Key historical landmark research malpractice scandals that shocked the international community (Nazi doctors’ experiments, Tuskegee study, Jewish chronic disease experiments, Krugman’s Willowbrook hepatitis study) were the origin of the institution of ethics review prior to carrying out research involving humans. Nonetheless, it is plausible that unethical research is ongoing or may have been conducted in recent times that has escaped public notice, especially in the vulnerable low- and middle-income country contexts. The basic constitution of these committees at some point has not been clearly defined, with most scientists declaring political maneuvers at times. These committees today are characterized by bureaucratic bottlenecks, financial interests, inadequate training in research ethics, and lack of control and coordination of their functions. Compulsory and adequate research ethics training for researchers and ethical committee members could guarantee trust, and appreciation of the utmost importance of the latter. The independence of protocol review should be guaranteed as much as possible so that the process attains its set goals. It might be too simplistic, and hypocritical, to allow ethics committees to continue to function on an ‘altruistic’ basis. Governments must strengthen the roles of national ethics committees – their independence, oversight roles, and as monitoring and evaluation bodies for smaller research ethics committees. Funding and objective constitution of board members is critical. Only then would research ethics committees be metamorphosed from the ‘bad guys’ to the trusted friends. The fear is preventing the research ethics committee from being seen and thus becoming an ethical oxymoron.