CHEST Medical Writing Tips of the Month:010 治験審査委員会(IRB)に提出する治験申請書の書き方

 今回のテーマは、堅い。しかし、「2009年02月26日[木]その論文を書く前に、倫理を(3)ナチスの裁き」でも書いたが、倫理のない科学はない。倫理のあるがあるとしたら、それは危険。

 不完全な個だから、組織的には「正」の手順を踏むための叡智を。


治験審査委員会(IRB)に提出する
治験申請書の書き方

Writing an Application for a Human Subjects Institutional Review Board*
(CHEST 2006; 130:1605-1607)

The formula for success through the IRB review and approval processes can be summarized as follows: simplify, use simplified language that is easy to understand; justify, provide rationale for the study, the design, the risk to subjects; protect, make clear the many ways that the protection of subjects is provided throughout the research experience; complete, provide complete detailed information in all areas of the required documents; and be consistent, achieve consistency of the information provided in each section and across study-related documents. In this way, investigators writing for an IRB are sure to explain in simple terms the reason for the research and its risks to human subjects, and to clearly demonstrate how those subjects will be protected from risk.

(要旨)IRB審査を通過する秘訣は、以下。
* 簡潔 - 理解しやすく簡潔な言葉を使用する
* 正当化 - 研究、デザイン、被験者のリスクの論理的根拠を述べる
* 保護 - 研究期間を通して被験者を保護するあらゆる方法を明確にする
* 完全性 - 必要な書類のすべての部分に詳細な情報を完全に含める
* 一貫性 - 各セクションおよび研究関連書類全体に記載する情報を統一させる


そして、倫理の歴史的な経過は、以下が引用されている。

Human subjects institutional review boards (IRBs) were created as a direct result of ethical concerns about the preservation of autonomy, beneficence, nonmaleficence, and justice pertaining to research in human subjects. These concerns actually began during the Nuremberg trials during which medical experimentation on prisoners of war by Nazi doctors became apparent. Following the creation of the Nuremberg Code of 1945, an international code of ethics was formulated in the Declaration of Helsinki in 1964.

→ 
ヒト対象研究の自律性の尊重、善行、無危害、公正の保護は、ニュルンベルグ裁判からはじまる。ナチスの医師による戦争捕虜の人体実験から、1945年にニュルンベルグ綱領が採択、1964年にはヘルシンキ宣言で国際的倫理綱領が制定。


In the United States, rules and regulations of the Public Health Service led to the creation of IRBs in the 1970s. Further regulations, including the Code of Federal Regulations Protection of Human Subjects (45CFR Part 46), are the direct result of various abuses of patient rights, such as those that occurred during the 30-year government-sponsored Tuskegee syphilis study, during which 300 black men with syphilis were followed up longitudinally, yet were untreated, despite the recognized effectiveness of antibiotic treatment for this disease that had been discovered. In conjunction with the regulations under 45CFR46, are the US Food and Drug Administration (FDA) regulations under Title 21, which convey additional requirements and oversight for the protection of human subjects engaged in research that relates to food, drugs, biological agents, and devices.


 米国では、公衆衛生局(Public Health Service)の規定が1970年代IRB設置につながる。
 梅毒に羅患した黒人男性300人を長期にわたって治療をせずに経過観察をしたタスキギー梅毒研究Tuskegee syphilis studyなどから30年をかけて、「被験者の保護」(Code of Federal Regulations Protection of Human Subjects, 45CFR Part 46)などの規則が制定。
*45CFR46に定められた規則と併せて、第21編(Title 21)の元に成文化されたFDA規則集がある。

気づき)
・倫理は、人権を侵してきた様々な反省から
・経緯が理解の支えになる
・今、足りない倫理は何か?


これから)医療安全委員会、利益相反のディスカッション、城西大学教授と面談