I think the regulatory guidances here are pretty black and white. 'No research procedures prior to IRB approval of research procedures' seems crystal clear.
In addition, since the research involves review of personally identifiable medical records, it seems very unlikely that this 'retrospective chart review' would qualify for 'exemption' (there are a very limited number of 'exemption' types and very specific rules), or be classified as 'not involving human subjects'. The latter situation can occur when a third party ('honest broker') retrieves and completely de-identifies data or biospecimens. Based on your description, it seems more likely that the research would qualify for a 'waiver of the requirement for informed consent'.
I work at an institution that requires that I also conform to these rules, and I would not participate in the research. I am surprised, based on your description and the possible continuing nature of the problem, that research compliance is not involved.
Original Message:
Sent: 07-15-2024 13:48
From: Christopher Ryan
Subject: ethical dilemma
I am re-visiting the ASA statement on ethical statistical practice and finding much helpful guidance in it.
As an academic family physician for my first 30 working years,
1) I always try to make encounters educational,
2) I try to look out for the interests of the "lowest" folks on the med ed hiearchy, which in this case is the Fellow. Imbalances of power are real in med ed.
3) and I always come back to a touchstone of clinical practice: "all care is negotiated." I think this fits well with the theme expressed by several discussants, about figuring out mutually-agreeable solutions and finding a way forward, while preserving limits.
In the interim, I had an interesting conversation with the IRB official. Seems this is not this particular PI's first go-round with these issues.. They have been impervious to previous educational interventions by the research admin folks.
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Christopher Ryan
Clinical Associate Professor of Family Medicine
SUNY Upstate Clinical Campus
Original Message:
Sent: 07-15-2024 13:07
From: Michiko Wolcott
Subject: ethical dilemma
First of all, congratulations on the upcoming retirement :-)
My rule of thumb around ethics has always been: if it does not feel right, it probably is not (especially if the feel is of nagging nature). This has not failed me. So, I would not proceed as is if you're not comfortable.
That said, there is also an opportunity here as a few people have already pointed out, be it an opportunity to educate, course-correct, come up with alternative solutions, etc. In one of the section's Pathways to Promotions webinars last year, I talked about presenting options rather than answering with a no as a singular response. What are the things you are willing to do? Then I would think along the lines of "I will not do this, but here are some things we can do (and still preserve my integrity)." This can make the working relationship a little easier by showing that you are willing to work with them and that you've given that a careful thought. If they reject that, they were not likely to change their mind anyway; it's a different problem, and you move on. I have walked away from a number of engagements this way, and I am at peace having protected my own integrity.
FWIW: As a Certified Management Consultant, I abide by and am evaluated on ethics by the standards by the Institute of Management Consultants - its Code of Ethics is a useful guide for matters that are not strictly statistical in nature, so I post it here: https://imcusa.org/about/ethics/code-of-ethics/
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Michiko Wolcott
Principal Consultant
Msight Analytics
Original Message:
Sent: 07-15-2024 10:35
From: Christopher Ryan
Subject: ethical dilemma
Hello. I'm just a year into my budding solo consulting business (finally retiring from day job in 2 weeks!) and already I face an ethical dilemma.
A fellow at another medical university asked me to help with a project. Fellows in this program are required to do some sort of scholarly project. Fellow's deadline (end of fellowship) is December. The attending physician is the PI. Their goals are (1) submission to a conference by mid-October, and (2) hopefully publication thereafter. By the fellow's telling, the in-house statistical consultants did not have the bandwith to help.
Briefly, this would be a historical cohort study based on retrospective review of electronic medical records.
Last we'd left it, Fellow was awaiting IRB approval. I said great, get back in touch when that's obtained, and we can get started.
Some months went by. Fellow and Attending just got back in touch with me. Turns out they had assembled a team and had already abstracted records and stored data in a very messy Excel spreadsheet (of course!). That was done as IRB process was underway, but before IRB approval. (I suspect the IRB submission was rather delayed.) Institutional policy is as customary: "all research must be sumbitted . . . before the study is conducted, including recruitment and data collection." The gist of the IRB determination was "We don't offer retrospective approvals. If we'd had the opportunity to review it prospectively, we believe we would have found it Exempt. . . . Any publication must include a statement that the study did not receive prospective IRB review."
There has also been brief reference to grant funding, so I wonder what the grantor's IRB requirements are.
I'm skeptical about getting an abstract accepted for a conference, or a manuscript accepted for a journal, given the IRB determination above.
I have many reservations about participating in this. I don't want to get involved with a project that did not adhere to ethical principles and regulations, both internal and external. It also just seems a bit "loose" in execution. On the other hand, I want to support the Fellow. I don't know what sort of guidance and training Fellow received in how to execute this project. Fellow should not suffer if that was inadequate.
Appreciate any thoughts/perspectives.
Thanks.
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Christopher Ryan
Clinical Associate Professor of Family Medicine
SUNY Upstate Clinical Campus
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