Intended for healthcare professionals

Rapid response to:

Analysis And Comment Confidentiality and consent in medical research

Overcoming barriers to recruitment in health research

BMJ 2006; 333 doi: (Published 03 August 2006) Cite this as: BMJ 2006;333:300

Rapid Response:

Consent & social coercion

Hewison & Haines complain that asking potential research
participants to opt in reduces participation. They cite evidence that this
might sometimes be due to a lack of understanding by potential
participants of introductory information. The solution to this is to
provide better information to enable potential participants to make
informed decisions in private, not to press them in person either in
clinic or by telephone call. A recent experience as a hospital inpatient
reminded me of the powerful asymetry between professionals and patients,
and we should not underestimate how coercive an invitation in person or by
telephone might be. The authors as members of the public benefit from
regulations protecting them from commercial approaches of this kind, yet
argue that medical researchers should be able to pursue potential
participants. There is clearly a balance to be struck between civil
liberties and the common good; it is quite proper for researchers to be
enthusiastic, as it is for ethical committees to protect individual
privacy. Procedures should be measured and proportionate. An annonymous
and innocuous questionnaire can reasonably be posted with introduction and
explanation, with completion and return implying consent formed in
private. Formal opt in procedures are required to protect potential
participants from social coercion to take part in more onerous studies.
Furness in his rapid response comment to this paper has, in effect, argued
with a historical example that the ends justifies the means; this is a
slippery slope, and regulations change to reflect prevailing social
values. Current regulations and procedures for the ethical review of
proposed research are, in part, the direct result of earlier abuses;
legitimate and ethical researchers will, of course, carry on doing
excellent and ethically sound research on well informed and freely
participating subjects.

Competing interests:
Ethics committee chairperson, NHS consultant

Competing interests: No competing interests

09 September 2006
Frank M Bowman
Consultant Child & Adolescent Psychiatrist
CAMHS, Royal Bolton Hospital, Bolton BL4 0JR