Briefly Noted: Whitney, Bell, Elliott

Lacking time for full comment, I briefly note the publication of these two important, critical essays. Citations omitted from the quoted passages.

The Shell Game

[Whitney, Simon N. “The Shell Game: How Institutional Review Boards Shuffle Words.” Journal of Translational Medicine 12, no. 1 (August 14, 2014): 201. doi:10.1186/1479-5876-12-201.]

Popular IRB guides ignore . . . subtleties and mangle the standard definitions. One handbook claims that “coercion means that a person is to some degree forced, or at least strongly pushed, to do something that is not good for him or her to do. In discussions of research regulation the term ‘undue influence’ is often used to describe the concept of coercion”. This manual thus expands the narrow concept of coercion to include persuasion.

A second handbook agrees: “Coercion can be subtle: persuasion, argument, and personality can be used to compel an individual to act in a certain way…. Coercion—including all the subtle forms—has no place in research”. There is, of course, no such thing as subtle coercion. A guide to IRB management and function claims that in recruitment for clinical trials, “the possibilities for misinforming or disinforming potential subjects abound” and “the possibilities for inadvertent, unintentional coercion, or undue influence are also high”. Inadvertent or unintentional coercion is oxymoronic.

With encouragement from these guides, IRBs reject the standard meaning of the word and use “coercion” to refer to any statement, however innocuous, that might encourage trial participation. Some IRBs believe, for instance, that it is coercive for a consent form to mention that a study is funded by the National Institutes of Health.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.