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EDITOR'S CHOICE: Richard Smith My last choice BMJ 2004; 329: 0-g [Full text]

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We have no control

Neville W Goodman   (30 July 2004)

Ride more than thou goest

John Hoey   (30 July 2004)

Ethics Committees should facilitate research

Dr.Naseem A. Qureshi MD, IMAPA, LMIPS   (1 August 2004)

Medical journals should collaborate with research ethics committees

Kayvan Shokrollahi   (3 August 2004)

We have no control 30 July 2004
Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol, BS10 5NB Send response to journal: Re: We have no control	Richard Smith says that research ethics committees have spun out of control. Not quite: we no longer have control. We have been comprehensively taken over by the bureaucracy of COREC (Central Office for Research Ethics Committees), which, prompted by various central directives and statutes, has showered us with forms and procedures that we must follow or be damned. Richard Nicholson has written a number of times about this in the journal he edits (Bulletin of Medical Ethics) and elsewhere, as have I [1],and no doubt others. Just one anecdote will suffice to show how the system stifles rather than enlightens. Our committee used to be able to write to applicants before our committee meetings, asking for information or giving suggestions. At committee, we would already have responses from most applicants, and could then make our decision about approval. Of course, other issues could come up in committee that required further information from the applicant. We are no longer allowed to do this because we are allowed only "one bite at the ethical cherry", and any further issues raised in committee would be a second bite. Applicants now come to committee without any idea of what they may be asked. Unsurprisingly, they are often unable to give quick answers in what is uncomfortably similar to an examination viva voce, and the whole affair is unsatisfactory and inefficient. COREC tell us that ethics committees must be "fit for purpose", and thus must follow the regulations. However, the purpose intended seems to be to follow the regulations, rather than to reach good ethical decisions expeditiously. 1 Goodman NW. Will the new rules for research ethics committees lead to better decisions? J Roy Soc Med 2004;97:198-9. Competing interests: Chair of a Research Ethics Committee
Ride more than thou goest 30 July 2004
John Hoey, Editor, CMAJ Ottawa, Canada Send response to journal: Re: Ride more than thou goest	Dear Richard, What a wonderful time we’ve all had! Traipsing along behind you I’ve learned so much about editing and what editor can be. You’ve made my job easier, funnier, lighter and, yes, heavier. By example, you’ve challenged us and moved us towards an edge that must always remain indistinct and dangerous. It’s been a glorious ride trying to keep up with you and the BMJ over the years of your editorship and especially since you leapt onto the WEB. John Competing interests: None declared
Ethics Committees should facilitate research 1 August 2004
Dr.Naseem A. Qureshi MD, IMAPA, LMIPS, Medical Director(A), Director CME&R Buraidah Mental Health Hospital, Postcode:2292, Saudi Arabia Send response to journal: Re: Ethics Committees should facilitate research	Sir: Medical history had revealed in the past that in the name of research patients rights had been violated in an uncontrolled fashion worldwide. Unfortunately, this trend still continues to be with us. As a constructive response to these continuing health consumers rights violations, medical ethics committees consisting of highly intellectual, medical people including patients came into being in order to protect both the rights of the patients and researchers, streamlining the research protocols, and plugging any ethical loopholes, overall all good for the health institution and by extension the nation. Besides other important roles of ethics committees, they also help in identifying fake research globally. Notably, research team has to do some paper work, which should not be perceived as a burden. Both proper documentation and restoration of data also help in protecting the interests of involved partners in research. Ethics committees should facilitate the research-basic as well as applied- rather than impede it. Most importantly medical advisers to politicians who are also on ethics committees should contribute positively to the research endeavors of research communities around the world. Finally, it is wise to know that innovations and advanced developments in medical sciences would be dwarfed by about 33% without proper research, which will also have adverse effects on clinical practice and continuing education. Dear Dr.Richard, your last choice reminds all of us-medical fraternity-that we must work together for the benefits of patients in particular and mankind in general without committing any flagrancies in patients and human rights. Reference: Richard Smith. My last choice. BMJ 2004; 329: 0-g Competing interests: None declared
Medical journals should collaborate with research ethics committees 3 August 2004
Kayvan Shokrollahi, Trust Surgeon Dept Plastic Surgery, Radcliffe Infirmary, Oxford, OX2 6HE Send response to journal: Re: Medical journals should collaborate with research ethics committees	Dear Sir- Recent articles and responses in the BMJ have brought to the fore a number of issues of concern in achieving the right balance in ethical research without an overly obstructive approach. Unfortunately there are legal and other constraints, which contribute to the current infrastructure for ethical approval. What needs to happen first is for more clinicians and researchers to set aside enough time, with the support of their departments, to become involved in ethics committees, thereby gaining more insight into the process and placing them in a position to help steer future changes. One way forward would be for journals to collaborate with ethics committees such that ethical approval, peer review, and acceptance for publication occur at the same time, at one sitting, and in advance. In this way, there would be a one-off hurdle for researchers, scientific and ethical scrutiny would be symbiotic and efficient, and papers would be published on the basis of good science and not results. The BMJ would be in a position to take a lead in at least trying this approach. Although there is educational value in the process of undertaking and publishing research, the “publish or perish” mentality may have to go. Obstacles in the path of dubious research projects “just for the CV”, perhaps better described sometimes as utter rubbish, may not be such a bad thing. Whatever the future holds, what is certain is that there needs to be a platform of open debate and discussion with all appropriate and involved parties on this issue. Again, the BMJ would be in a strong position to invite all key players to participate to create a balanced forum where discussion can lead to actual change. Competing interests: I am an expert member of the Oxfordshire research ethics committee and a final year (part time) law student. The opinions expressed are my own.