Monitoring research ethical committees.

Monitoring research ethical committeesThe profession must establish effective mechanisms with teeth, before the government imposes them Over 30 years have passed since concern began to surface in Britain about the ethical aspects of medical research.Ethics committees have proliferated, guidelines been agreed, proto- cols devised-yet recent evidence suggests that the ethical control of medical research remains inconsistent and ineffec- tive.Why should this be, and what should be done?The ethical aspects of clinical research came to attention in the late 1950s and early '60s, with published reports of non- therapeutic research on patients who seemed not to have been asked for full consent.Both society and medicine are indebted to three doctors -reviled at the time by some of their colleagues-for publicising their views: Hugh Clegg, then editor of the BM7, the architect of the Declaration of Helsinki, H K Beecher, professor of research in anaesthesia at Harvard University, who published Experimentation in Man, and M H Pappworth, a British physician, who produced his no less influential book Human Guinea Pigs eight years later.1-3 By today's standards the response to the debate was swift.As early as 1964 the Medical Research Council issued a statement of general guidance4; two years later the United States Public Health Service went further, declining to support projects unless they had first been reviewed by a committee of fellow professionals.At the same time, in Britain, the Ministry of Health suggested that hospitals should organise review boards, but on an informal basis,6 and this was echoed by the Royal College of Physicians.7 It was not until 14 years later, in 1984, however, that the college produced detailed guidelines on their composition and mode of working.8Sadly, the evidence is that sensible suggestions about the structure and process of ethics committees have been widely ignored.9''And, despite their realistic details about how committees should work, neither oftwo recent publications-