The Institutional Review Board (IRB) and its functions

1. The Institutional Review Board (IRB) and its functions Anthony K. Wutoh, Ph.D., R.Ph. Associate Dean & Professor Former Chairman, HU IRB School of Pharmacy College of Pharmacy, Nursing and Allied Health Sciences

2. Howard University IRB

3. What is your image of the IRB? Who can we frustrate today?

4. Brown University, 2007 “approval process too slow” “impedes research”

6. The government mandated purpose of IRBs • The singular purpose of the Howard University IRB, as mandated by Federal Law, is to protect the rights and welfare of human research participants recruited to participate in research activities conducted under the auspices of Howard University. • This purpose can not be outweighed by any other consideration (i.e. time, money, research publications, graduation, etc.)

7. Why were/are IRBs needed? • Tuskegee Syphilis Study (Alabama, 1932-1972) • Nazi Experiments (1930s-1940s) • Stanley Milgram's experiment ."Obedience and Individual Responsibility" (Yale, 1961-1963) • Willowbrook Study (New York, 1963-1966) • Tearoom sex (Washington Univ., 1960s) • Research conducted in prisoners, children and other vulnerable populations

9. More Recent Violations • In a totally unprecedented flurry of enforcement activity, the National Institutes of Health (NIH) Office for Protection from Research Risks (OPRR) stopped research at Rush-Presbyterian-St. Luke's Medical Center (AP 1998), the West Los Angeles Veterans Affairs Medical Center (Monmaney 1999; Hilts 1999a), Duke University (Stout 1999; Weiss 1999), the University of Illinois at Chicago (Guerrero and Herguth 1999; Grahnke and Ritter 1999), the University of Colorado (Hubler 1999), Virginia Commonwealth University (Mathews 2000), and most recently, the University of Alabama at Birmingham (Hansen and Spencer 2000; Hilts 2000). • While there have been some substantive concerns relating to subject enrollment and informed consent, most of these sanctions have been levied because of sloppy and inadequate operation of institutional review boards (IRBs) and slow or inadequate response to OPRR's concerns.

10. Violations • Researchers at Stanford University were permitted by the state in 1997 to test the use of Depakote in incarcerated adolescent males to see if the drug would reduce aggressive behavior (Weber 1999). • Researchers at the New York State Psychiatric Institute, the Mount Sinai School of Medicine, and the Research Foundation of the City University of New York came under fire for giving fenfluramine to young children, many of whom were Hispanic or African American. The children were at-risk younger siblings of child offenders identified by the researchers through court records (Hilts 1998a; Waldman 1999; Bernstein 1999). • In the early 1990s, plastic surgeons at the Manhattan Eye, Ear, and Throat Hospital performed a study in which different surgical face-lift techniques were used on the opposite sides of patients' faces without securing IRB approval and without express patient consent (Hilts 1998b).

11. Jesse Gelsinger and Gene Therapy (U. of Penn.) • In 1999-2000 the Food and Drug Administration stopped all gene therapy trials at the University of Pennsylvania, because of alleged shortcomings and violations of protocols, revealed in an audit .prompted by the death of Jesse Gelsinger • Gelsinger suffered from Ornithine transcarbamylase (OTC) deficiency, a rare metabolic disorder. • Gelsinger's death also prompted a revelation of at least six deaths in other gene therapy trials that had not been reported to the NIH, in violation of the law, because the investigators determined the deaths were caused by the subjects' disease and not the experimental therapy. • Several institutions and foundations sponsoring genetic therapy research halted trials because of concerns about patient safety. The public hearings also spurred the reporting to NIH of 652 adverse events in trials using modified adenoviruses (as used in the Penn trial), compared to only 39 that had been reported promptly as required by law. • Issues - Conflict of interest, did not meet the inclusion criteria, consent forms did not adequately discuss risks.

12. Research Regulations • In 1979, the federal government developed regulations of ethical principals underlying the current regulations and standards that are contained in the Belmont Report. • It was the capstone of the National Commission for the Protection of Human participants of Biomedical and Behavioral Research. It outlines the ethical principals upon which the ethics of a research study are evaluated in the United States. • The Belmont Report embodies the moral consensus upon which stand our present US Federal regulations governing the ethics of human participants research conduct with Federal funds from the majority of Federal agencies. • Our present regulations formulize The Belmont Report's requirements for informed consent and establish another Commission recommendation that formalized and extended the existing peer review system of that time, which has matured into the Institutional Review Board (IRB) system that we have today.

13. Historical Overview • The protection of the rights and privacy of human participants involved in research activities is mandated by federal law.  • The National Research Act Public Law 99-158, The Health Research Extension Act of 1985, and the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research provide guidelines for research with human participants to ensure their protection in the design and conduct of research. • These federal regulations require that any institution requesting and receiving funds from a federal department or agency for research involving human participants must assure that such research is reviewed and approved by the institution's institutional review board (IRB). 

14. Research Approved Most faculty regarded the new streamlined IRB Process as an improvement

15. Recent Changes in the IRB • Reorganization of the Office of the Vice President for Research & Compliance • New Associate Vice President for Research Compliance – Dr. Yonette Thomas • Addition of 10 new IRB members from various disciplines to aid in efficiency • Addition of new staff members

16. Purpose of the IRB at Howard University • Review research proposals, projects, and activities that involve human participants; • Determine for each activity or proposed activity if human participants will be placed at risk; • if risk is involved, determine if the importance of the knowledge to be gained warrants allowing the participant to accept the risks; • Oversee protection of rights and welfare of participants. • Assess whether the researcher(s) is/are qualified to conduct research involving human participants.

17. In General • Applies to funded and unfunded research • Submission of a protocol and approval by the IRB is mandatory for any faculty, staff or student who will interact with a human being for purposes of conducting research • Research may not begin before approval from the IRB is given

18. IRB Membership • EachIRB shall have at least five members, with varying backgrounds to promote complete and adequate review of research activities commonly conducted by the institution. • Each IRB shall include at least one member whose primary concerns are in the scientific area and at least one member whose primary concerns are in nonscientific areas. • Each IRB shall include at least one member who is not otherwise affiliated with the institution and who is not part of the immediate family of a person who is affiliated with the institution. • No IRB may have a member participate in the IRB's initial or continuing review of any project in which the member has a conflicting interest, except to provide information requested by the IRB. • Every nondiscriminatory effort will be made to ensure that no IRB consists entirely of men or entirely of women, including the institution's consideration of qualified persons of both sexes, so long as no selection is made to the IRB on the basis of gender. No IRB may consist entirely of members of one profession.

19. Howard University IRB Membership

20. What type of research requires review? • Research which involves the administration of drugs or other substances to participants • Research involving pregnant women and/or fetuses in utero • Research involving participants with life-threatening physical conditions • Research involving physically intrusive procedures • Research which previous experience (by the particular investigator or other investigators) has shown to create a potential of risk to participants • Research which potentially could put the participant at risk for legal or civil liability or invade a participant's privacy in regard to sensitive aspects of his/her behavior (e.g., illegal conduct, drug use, sexual behavior, alcohol use).

21. What about survey research or questionnaires? • Research which involves the interviewing of participants requires review by the IRB for several reasons; • The IRB must insure the risks do not outweigh the benefits of this research • The IRB must review potential questionnaires and items for inappropriate or potentially harmful items • Certain populations may be at risk for psychological harm (for example; crime/rape victims, Post traumatic stress disorder (PTSD), etc. • The investigator must be qualified to administer these items. • Potential risk of disclosure of identity/confidentiality

22. What types of Research could possibly be exempted? • Research in which the risks of harm reasonably anticipated are not greater than those ordinarily encountered in daily life or during the performance of routine procedures in education and/or in the practice of psychology and medicine • Research on the effectiveness of educational, classroom, and/or instructional strategies, provided that these strategies are familiar, and nonintrusive in their implementation • Research using educational tests (cognitive, diagnostic, aptitude, achievement) if participants' identities are thoroughly protected • Research using survey procedures or interview procedures where participants' identities are thoroughly protected and their answers do not participant them to criminal and civil liability • Research involving the collection or study of existing data, documents, records, specimens, or other products, if these sources are publicly available or the information is recorded by the investigator in such a manner that the participants cannot be identified directly or indirectly. • Remember – The IRB, not the investigator, decides upon the exemption status of a protocol

23. IRB Review of Research All research projects are categorized into one of three categories for the IRB review process. Each category is different in the level of scrutiny and submission procedures. The IRB is responsible for making the final decision of which category a research project falls under. • Full • Expedited • Exempt • Research Not Involving Human Subjects

24. Full Review • One or more Committee member(s) are assigned to review the complete protocol or amendment, consent form, Investigational Drug/Device Brochure and any other protocol materials.  • These Primary & Secondary Reviewers summarize the protocol or amendment to the Full Committee at a convened meeting and answer questions during the discussion.

25. Expedited Review • Protocols, amendments, or continuing reviews that meet specific federal criteria qualify for an expedited review.  • The complete protocol, consent form, and any other protocol materials receive review and approval by a Committee Chair. • Expedited does not mean “fast” it is a federal term used for research that must meet specific criteria (DHHS 45 CFR 46.110)

26. Exempt from IRB Review • Committee review is not required for certain categories of research activities that involve little or no risk to human subjects.  • To determine if your research qualifies for exemption from formal committee review, complete the “Protocol Exemption Review and Determination Checklist.”  • Only the IRB can make the determination of Exempt, this cannot be determined by researchers!

27. IRB Review and Determination of “Research Not Involving Human Subjects” • There is some research that involves coded private information or specimens that do not involve human subjects. • When conducting research using data or specimens, the level of review by the IRB depends primarily on one factor: whether the data or specimens are identifiable to the principal investigator or key personnel. • Determinations of whether research involving coded private information or biological specimens is considered to be “human subjects research” must be made by the IRB, not the investigator. 

28. Types of Review • Initial • Continuing Review • Amendments • Safety Information or Unanticipated Problems to Subjects or Others • Noncompliance

29. Criteria for IRB Approval • Risks are Minimized (Consistent with a sound research design and does not unnecessarily expose subjects to risk) • Risks are Reasonable in Relation to Benefits • Selection of Subjects is Equitable • Informed Consent will be Sought for Each Prospective Subject • Informed Consent will Be Documented • Research Plan Adequately Provides for Monitoring the Data Collected to Ensure Safety of the Subjects • Research Plan Adequately Protects the Privacy of Subjects and Maintains Confidentiality • When some or all of the subjects are likely to be vulnerable to coercion or undue influence, additional safeguards need to be included in the protocol to protect the rights and welfare of these subjects.

30. The IRB has the authority to: • Approve • Require modifications prior to approval • Table • Disapprove all research activities including proposed changes in previously approved human subject research.

31. Informed Consent • Information – includes research procedure, purpose, risks, benefits, alternatives, etc. • Comprehension– function of intelligence, rationality, maturity and language, presentation of information must be adapted to the subject’s capacity • Voluntariness –requires conditions free of coercion and undue influence

32. Consent Form Required Elements • Statement that the study involves research • Research is described • Description of Risks • Description of Benefits • Disclosure of Alternatives • Confidentiality • If more than minimal risk, compensation and/or medical treatment • Participation is voluntary • Whom to Contact

33. Additional Elements of Informed Consent • Unforeseeable risks • Early termination • Additional costs to subjects • Consequences of a subject's decision to withdraw from study participation • Disclosing new findings which may impact a subject's willingness to continue participation • Number of subjects involved

34. Informed Consent Process • Informed Consent is more than just the IRB-approved document • Initial • Ongoing

35. Initial Informed Consent • Take the time at the initial discussion with subjects so that they have a thorough understanding of what they are making a commitment towards • Test subject comprehension • Research versus standard of care procedures • Time commitment • Randomization • Alternatives • Potential costs • Risks and Benefits • Taking time upfront with potential subjects most likely will improve subject understanding and improve retention

36. Ongoing Consent • Every time you have an encounter with a subject gives researchers an opportunity to continue the informed consent process • Discuss new information that may impact a subject’s willingness to continue study participation (i.e., new known risks, benefits, alternatives, changes in study design, etc.) • Remind subject of study goals and objectives this will improve subject compliance with the protocol and improve retention of subjects

37. Information IRB Review Process

38. Some research can not be exempted!!!!

39. Summary…Take home message • The IRB is a key element in the conduct of human participant research at the University. • But, it is the primary responsibility of the IRB to safeguard the rights and safety of human participants. It is not necessarily the role of the IRB to expedite research at the University at the expense of safety and human rights.

40. References • The Committees on Human Research University of Vermont • http://muse.jhu.edu/journals/journal_of_health_politics_policy_and_law/v025/25.5merz.html • desu.edu/research/osp/forms/IRBpresentation.ppt • education.ua.edu/ncate/documents/IRB%20Fall%202005%20update.ppt • http://web.missouri.edu/~bondesonw/Laud.html

41. Isn’t the IRB Great?!?!? I love the IRB