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Inclusion of Culturally and Linguistically Diverse populations in Clinical Trials:0

 

Nik Zeps
AHRECS Consultant

Clinical trials have enormous value to society as they provide the most robust means of working out whether or not particular treatments used to improve the health of our population work or not. Governments have a stated objective to increase participation in clinical trials based upon a series of assumptions that extend beyond their utility as a means to derive the highest level of reliable evidence about the efficacy and safety of interventions. One of these is that those people who are included derive a tangible benefit from doing so. Whilst this may not be true in all cases, after all up to 50% of people may receive an inferior treatment by definition, there is the potential for people to derive individual benefit, and it is often stated that those involved in a trial receive a higher standard of care than those not included. Certainly, the additional testing and closer scrutiny of people on a trial may equate in some instances to better care, but this should not be seen as a major driver as it could be argued that equitable care should be available as a universal right. A less discussed benefit is the connectedness and satisfaction that people may derive from making a tangible contribution to society through participation in clinical research. Furthermore, there may be indeterminate peer group benefits even if an individual does not benefit.

In an Australian study Smith et al (1) found that CALD people whose preferred language was not-English (PLNE) had the lowest participation rates in clinical trials. Whilst CALD people whose preferred language was English (PLE) had greater levels of enrollment than the PLNE group, they were still underrepresented by population. This has been described across the world and is identified as a pressing concern (2).  Understanding why this is the case is important for a number of reasons. In multiculturally diverse countries like Australia, testing interventions where a significant proportion of the population are not included could result in evidence that is not applicable to those people. This spans across biological differences which may be relevant to drug efficacy or toxicity through to interventions such as screening that may fail to be useful in those populations. Where there is evidence that participation in a clinical trial may present specific advantages there is also the issue of injustice through exclusion of a particular group or groups of persons. Certainly, from an implementation perspective, not including a diverse group of participants and analyzing for cultural and behavioral acceptability may mean that even if an intervention has merit it fails to be taken up.

The reasons for non-inclusion are likely more complex than those of language barriers, although having protocols for clinical trials that specifically exclude people who don’t have higher levels of proficiency in English do not help. It would seem that the language barrier could be soluble through providing greater resources to enable translation services, particular in areas with a clear need for this. Certainly, multi-national trials already have PICFs in multiple languages and these could be readily deployed through use of innovative technologies including eConsent processes.[1] Funders of clinical trials could make it a requirement for such inclusivity and back it up through provision of specific funding for this in any grants they award. Legal means to enforce this, whilst possible, are unlikely to drive systemic change and could have the unintended consequence of making it harder to do any trials at all in an environment already subject to extreme financial pressures.

However, a major reason for low levels of participation in clinical trials may be attributed to equity of access to clinical services in the first place. It is hard to recruit people from the general population into clinical trials, but even harder if specific members of the population don’t come to the health service in the first place. There is relatively little research on this topic and it would seem logical to do this as a priority in parallel with examining why people fail to participate in clinical trials due to language barriers. Perhaps clinical trials are simply the canary alerting us to broader inequities that need greater research and investment. Research into solutions to these inequities is accordingly a priority and may solve clinical trial participation rates as a consequence.

References

  1. Smith A, Agar M, Delaney G, Descallar J, Dobell-Brown K, Grand M, et al. Lower trial participation by culturally and linguistically diverse (CALD) cancer patients is largely due to language barriers. Asia Pac J Clin Oncol. 2018;14(1):52-60.
  2. Clark LT, Watkins L, Pina IL, Elmer M, Akinboboye O, Gorham M, et al. Increasing Diversity in Clinical Trials: Overcoming Critical Barriers. Curr Probl Cardiol. 2019;44(5):148-72.

Nik Zeps participated in the CCV forum at the COSA ASM. A full report of the workshop and research by the CCV and MCCabe centre is forthcoming.

[1] https://ctiq.com.au/wp-content/uploads/eConsent-in-Clinical-Trials-compressed.pdf

This post may be cited as:

Zeps, N. (4 December 2019) Inclusion of Culturally and Linguistically Diverse populations in Clinical Trials. Research Ethics Monthly. Retrieved from: https://ahrecs.com/human-research-ethics/inclusion-of-culturally-and-linguistically-diverse-populations-in-clinical-trials

The F-word, or how to fight fires in the research literature0

 

Professor Jennifer Byrne | University of Sydney Medical School and Children’s Hospital at Westmead

 

At home, I am constantly fighting the F-word. Channelling my mother, I find myself saying things like ‘don’t use that word’, ‘not here’, ‘not in this house’. As you can probably gather, it’s a losing battle.

Research has its own F-words – ‘falsification’, ‘fabrication’, different colours of the overarching F-word, ‘fraud’. Unlike the regular F-word, most researchers assume that there’s not much need to use the research versions. Research fraud is considered comfortably rare, the actions of a few outliers. This is the ‘bad apple’ view of research fraud – that fraudsters are different, and born, not made. These rare individuals produce papers that eventually act as spot fires, damaging their fields, or even burning them to the ground. However, as most researchers are not affected, the research enterprise tends to just shrug its collective shoulders, and carry on.

But, of course, there’s a second explanation for research fraud – the so-called ‘bad barrel’ hypothesis – that research fraud can be provoked by poorly regulated, extreme pressure environments. This is a less comfortable idea, because this implies that regular people might be tempted to cheat if subjected to the right (or wrong) conditions. Such environments could result in more affected papers, about more topics, published in more journals. This would give rise to more fires within the literature, and more scientific casualties. But again, these types of environments are not considered to be common, or widespread.

But what if the pressure to publish becomes more widely and acutely applied? The use of publication quotas has been described in different settings as being associated with an uptick in numbers of questionable publications (Hvistendahl 2013; Djuric 2015; Tian et al. 2016). When publication expectations harden into quotas, more researchers may feel forced to choose between their principles and their (next) positions.

This issue has been recently discussed in the context of China (Hvistendahl 2013; Tian et al. 2016), a population juggernaut with scientific ambitions to match. China’s research output has risen dramatically over recent years, and at the same time, reports of research integrity problems have also filtered into the literature. In biomedicine, these issues again have been linked with publication quotas in both academia and clinical medicine (Tian et al. 2016). A form of contract cheating has been alleged to exist in the form of paper mills, or for-profit organisations that provide research content for publications (Hvistendahl 2013; Liu and Chen 2018). Paper mill services allegedly extend to providing completed manuscripts to which authors or teams can add their names (Hvistendahl 2013; Liu and Chen 2018).

I fell into thinking about paper mills by accident, as a result of comparing five very similar papers that were found to contain serious errors, questioning whether some of the reported experiments could have been performed (Byrne and Labbé 2017). With my colleague Dr Cyril Labbé, we are now knee deep in analysing papers with similar errors (Byrne and Labbé 2017; Labbé et al. 2019), suggesting that a worrying number of papers may have been produced with some kind of undeclared help.

It is said that to catch a thief, you need to learn to think like one. So if I were running a paper mill, and wanted to hide many questionable papers in the biomedical literature, what would I do? The answer would be to publish papers on many low-profile topics, using many authors, across many low-impact journals, over many years.

In terms of available topics, we believe that the paper mills may have struck gold by mining the contents of the human genome (Byrne et al. 2019). Humans carry 40,000 different genes of two main types, the so-called coding and non-coding genes. Most human genes have not been studied in any detail, so they provide many publication opportunities in fields where there are few experts to pay attention.

Human genes can also be linked to cancer, allowing individual genes to be examined in different cancer types, multiplying the number of papers that can be produced for each gene (Byrne and Labbé 2017). Non-coding genes are known to regulate coding genes, so non-coding and coding genes can also be combined, again in different cancer types.

The resulting repetitive manuscripts can be distributed between many research groups, and then diluted across the many journals that publish papers examining gene function in cancer (Byrne et al. 2019). The lack of content experts for these genes, or poor reviewing standards, may help these manuscripts to pass into the literature (Byrne et al. 2019). And as long as these papers are not detected, and demand continues, such manuscripts can be produced over many years. So rather than having a few isolated fires, we could be witnessing a situation where many parts of the biomedical literature are silently, solidly burning.

When dealing with fires, I have learned a few things from years of mandatory fire training. In the event of a laboratory fire, we are taught to ‘remove’, ‘alert’, ‘contain’, and ‘extinguish’. I believe that these approaches are also needed to fight fires in the research literature.

We can start by ‘alerting’ the research and publishing communities to manuscript and publication features of concern. If manuscripts are produced to a pattern, they should show similarities in terms of formatting, experimental techniques, language and/or figure appearance (Byrne and Labbé 2017). Furthermore, if manuscripts are produced in a large numbers, they could appear simplistic, with thin justifications to study individual genes, and almost non-existent links between genes and diseases (Byrne et al. 2019). But most importantly, manuscripts produced en masse will likely contain mistakes, and these may constitute an Achilles heel to enable their detection (Labbé et al. 2019).

Acting on reports of unusual shared features and errors will help to ‘contain’ the numbers and influence of these publications. Detailed, effective screening by publishers and journals may detect more problematic manuscripts before they are published. Dedicated funding would encourage active surveillance of the literature by researchers, leading to more reports of publications of concern. Where these concerns are upheld, individual publications can be contained through published expressions of concern, and/or ‘extinguished’ through retraction.

At the same time, we must identify and ‘remove’ the fuels that drive systematic research fraud. Institutions should remove both unrealistic publication requirements, and monetary incentives to publish. Similarly, research communities and funding bodies need to ask whether neglected fields are being targeted for low value, questionable research. Supporting functional studies of under-studied genes could help to remove this particular type of fuel (Byrne et al. 2019).

And while removing, alerting, containing and extinguishing, we should not shy away from thinking about and using any necessary F-words. Thinking that research fraud shouldn’t be discussed will only help this to continue (Byrne 2019).

The alternative could be using the other F-word in ways that I don’t want to think about.

References

Byrne JA (2019). We need to talk about systematic fraud. Nature. 566: 9.

Byrne JA, Grima N, Capes-Davis A, Labbé C (2019). The possibility of systematic research fraud targeting under-studied human genes: causes, consequences and potential solutions. Biomarker Insights. 14: 1-12.

Byrne JA, Labbé C (2017). Striking similarities between publications from China describing single gene knockdown experiments in human cancer cell lines. Scientometrics. 110: 1471-93.

Djuric D (2015). Penetrating the omerta of predatory publishing: The Romanian connection. Sci Engineer Ethics. 21: 183–202.

Hvistendahl M (2013). China’s publication bazaar. Science. 342: 1035–1039.

Labbé C, Grima N, Gautier T, Favier B, Byrne JA (2019). Semi-automated fact-checking of nucleotide sequence reagents in biomedical research publications: the Seek & Blastn tool. PLOS ONE. 14: e0213266.

Liu X, Chen X (2018). Journal retractions: some unique features of research misconduct in China. J Scholar Pub. 49: 305–319.

Tian M, Su Y, Ru X (2016). Perish or publish in China: Pressures on young Chinese scholars to publish in internationally indexed journals. Publications. 4: 9.

This post may be cited as:
Byrne, J. (18 July 2019) The F-word, or how to fight fires in the research literature. Research Ethics Monthly. Retrieved from: https://ahrecs.com/research-integrity/the-f-word-or-how-to-fight-fires-in-the-research-literature

We respect you… we just don’t need to hear from you any more: Should the consumer and their community participate in research as partners instead of just being subjects?1

 

By
Dr Gary Allen| Senior Policy Officer, Office for Research Griffith University | Ambassador Council the Hopkins Centre|
Ambassador MS Qld | Member Labor Enabled| Senior Consultant AHRECS

Associate Professor Carolyn Ehrlich| the Hopkins Centre| Research fellow at Griffith University

On behalf of the consumer inclusion in ethics research project, The Hopkins Centre, Griffith University

Much has already been said about the significance of the 2018 update to the Australian Code for the Responsible Conduct of Research. The Australian Code describes the national framework for the responsible conception, design, conduct, governance and reporting of research. Collectively this is referred to as research integrity. The Australian Code has changed from a 37-page book of detailed and prescriptive rules to a six-page book of high-level principles and responsibilities.

This is not another piece arguing the pros and cons of the flexibility of principles or the certainty of a single national standard.

Instead, this is a discussion about an important idea, which was present in the 2007 version of the Australian Code, but that was discarded without explanation or acknowledgement in the 2018 update. This important idea relates to consumer and community participation and its extension to consumer and community involvement in research.

At provision 1.13 of the 2007 version of the Australian Code there was a simple statement that Australian research institutions and researchers should encourage and facilitate consumer and community participation in research. The provision was included in the 2007 version as one part of the implementation of the Statement on Consumer and Community Participation in Health and Medical Research (NHMRC and Consumers’ Health Forum of Australia Inc, 2002) and went on to underpin the updated version of that statement, which was released in September 2016.  The absence from the 2018 version of the Australian Code of even a brief reference to consumer/community participation in research is (or SHOULD be) a significant cause for concern.

That brief encouragement provided support for consumer-guided designs, research participants as co-researchers and action research across most disciplines. With a few sentences, it mainstreamed the Statement on Consumer and Community Participation in Health and Medical Research and reinforced the importance of consumers and communities beyond ‘just’ research subjects in medical research.

Examples of that participation include the role of consumers and community members:

  1. On a reference/advisory group (including providing lived-experience with regard to the focus, objectives and deliverables of a project)
  2. As co-researchers
  3. In providing lived-experience into the significance of risks, harms and burdens, and the degree to which the risks are justified by the anticipated benefits (see Pär Segerdah 2019).
  4. In providing valuable insights for service/clinical decisions (see Carlini 2019 for an example).

A real example of this working well is of Cancer Australia which mandates the inclusion of consumers in their funding scheme, both in terms of applicants articulating how consumers are engaged (in the ways outlined above and also as reviewers and members of the review panels that evaluate grants). The inclusion of consumers improves projects immeasurably.  Cooperative cancer trials groups have a consumer advisory panel or committee. It would be unimaginable to do cancer trials without consumer involvement in their design. Such community participation is also evident in the recently approved research strategy at Epworth Health.

The above matters (such as whether a project is addressing a genuine community need and whether the risks of the project are justified by its benefits) can be especially significant for vulnerable individuals, especially persons living with ‘invisible conditions’, whereby people may have symptoms or disabilities that might not be immediately obvious to others, and/or when the ‘subjects’ of research are vulnerable, over-researched, or historically disenfranchised. Rather than protecting them from harm, and without a clear mandate for involving them more fully in the co-design and co-production of research that directly impacts their lives, there is a real risk of unintended consequences whereby these people may become even more disenfranchised, over-researched and vulnerable research ‘subjects’.

It is important to acknowledge that the 2016 Statement remains in place, the National Statement on Ethical Conduct in Human Research (2007 updated 2018) continues to articulate the core values of justice and respect, and the new Chapter 3.1 of the 2018 update of the National Statement on Ethical Conductmentions co-researcher designs. More specifically, paragraphs 1.1(a) and 2.1.5 identify community engagement as an important element in research design and planning. The omission from the Australian Code (2018) is out of step with the National Safety and Quality Health Service Standard which calls (2012 p15) for consumer and community involvement in deliberations about risk.

What is a concern now is that the overarching Australian Code for the Responsible Conduct of Research no longer urges publicly-funded research institutions to encourage consumer and community participation in research beyond them being the subjects of research.  On balance, this appears to be inconsistent with other relevant national research standards issued by the same agencies as the Code.

Those voices and perspectives were around before the 2007 version of the Australian Code and hopefully, they will continue to be into the future. That is true because it is becoming more widely accepted that consumers, such as people living with a chronic disease or disability and their carers, have a valuable perspective and a voice that should be listened to. One way a research project can have impact is by heeding those voices and meeting the needs of those Australians. However, in the 2018 update of the Australian Code, there is no longer an obligation on Australian institutions and researchers to encourage and facilitate consumer and community participation in research.

But will the same amount and scope of consumer and community-engaged research be conducted without that encouragement in the Australian Code?

It seems we are about to find out. We just wished there had been a national discussion about that change first – including targeted engagement with the populations who are now no longer encouraged to collaboratively participate in research, and who will potentially be relegated back to a position of being a subject within researcher designed projects and studies.

One way the current situation could be addressed would be in a good practice guide. The Australian Code (2018) is complemented with good practice guides, which suggest how institutions and researchers should interpret and apply the Australian Code’s principles and responsibilities to their practice. A good practice guide for collaborative research could reinforce the importance of consumer and community participation in research.

REFERENCES

Carlini, J. (18 January 2018) Consumer Co-design for End of Life Care Discharge Project. Research Ethics Monthly. Retrieved from: https://ahrecs.com/human-research-ethics/consumer-co-design-for-end-of-life-care-discharge-project

NHMRC(2007) Australian Code for the Responsible Conduct of Research

NHMRC(2007 updated 2018) National Statement on Ethical Conduct in Human Research

NHMRC (2016) Statement on Consumer and Community Involvement in Health and Medical Research

NHMRC (2018) Australian Code for the Responsible Conduct of Research

NSQHS (2012) National Safety and Quality Health Service Standards

Pär Segerdah (2019) Ask the patients about the benefits and the risks. The Ethics Blog. Retrieved from: https://ethicsblog.crb.uu.se/2019/01/16/ask-the-patients-about-the-benefits-and-the-risks/

ACKNOWLEDGEMENTS

With grateful thanks to the following people for their contributions:

Delena Amsters, QHealth
Mark Israel, AHRECS
Mandy Nielsen, QHealth
Michael Norwood, Griffith University
Maddy Slattery, Griffith University
Colin Thomson AM, AHRECS
Nik Zeps, AHRECS, Epworth Healthcare

This post may be cited as:
Allen, G. & Ehrlich, C. (21 June 2019) We respect you… we just don’t need to hear from you any more: Should the consumer and their community participate in research as partners instead of just being subjects? Research Ethics Monthly. Retrieved from: https://ahrecs.com/research-integrity/we-respect-you-we-just-dont-need-to-hear-from-you-any-more-should-the-consumer-and-their-community-participate-in-research-as-partners-instead-of-just-being-subjects

Reflections on chairing a human research ethics committee0

 

Prof Colin Thomson AM

Chairing an HREC can be complicated, demanding, stressful and tiring but also stimulating, rewarding, satisfying and hugely enjoyable. In this article, I reflect on my experience of being a chair of four HRECs in universities, public health organisations and public sector agencies. Of course I accept, from watching a number of other committees, the ways chairs guide committees to their decisions vary widely, express different personal experiences and can be affected by an institutional environment. As a result, these reflections are not intended to appear as a set of instructions for other chairs.

 

The invitation

So, where to begin? One point is at the invitation: am I equipped to take on this role and what do I need to know about the committee and the institution it advises? An HREC chair requires some exposure and familiarity with the ideas that are central to the ethics of human research and a sense of what reaching a decision in an ethics review requires. Ethics committees are unlike typical administrative committees in some significant aspects. The central difference is the nature of the subject matter and the decisions that need to be made: of their nature, they are less definitive than administrative decisions but share, with those, the need for adequate reasons and justification. In this tension between ethical judgement and adequate justification lies their challenge.

AHRECS offers a coaching service for Chairs (and for HRECs/RECs).  This involves observations of 3 committee meetings, meetings with specialist  consultants and a written report. Email coaching@ahrecs.com to find out more.

Other personal considerations include not only do I have the time but what is important to me in the role? For me, this has not been one consideration but a blend. The intellectual challenge of sound ethical analysis, appreciation of the creativity and skill of good research design and the refinement of inter-personal skills: all harnessed toward enabling ethically sound human research.

 

Decision-making

HREC decisions are rarely clear approvals or rejections but tend to be conditional: of the ‘not yet approved’ kind. Notification of those decisions should provide clear reasons and  practical advice: committees show respect for researchers by providing reasons for the outcome and advice about responding. At the same time, outcomes should fairly reflect the position that the committee has come to – and this can be difficult.

I have always found it challenging recapping and summarising fairly and accurately what different members of the committee have said and blending those into a reasonably clear outcome that the HREC can agree to at the meeting. Doing so is much easier after the meeting when settling the minutes and providing advice to applicants. But are such clarifications what the committee has agreed to or are they expressing a chair’s preference for the outcomes?

One discussion strategy that I watched with admiration in in one committee and tried, with some success, to emulate was to follow the same order of issue category for each proposal:

  1. does the proposal have value and validity and, if not, what do we need to know to be satisfied that it does?
  2. what risks to participants or others does the project involve; how is it planned they will be mitigated and are we satisfied with the level of mitigated risk?
  3. how are participants being recruited and how is their consent being sought, gained and recorded?
  4. are there issues of fairness in the imposition of burdens of participation on a particular population?

This worked well because members who, for example, would always have questions about consent, knew that they did not need to raise them at the start of the discussion of that proposal because that subject matter would be addressed in due course.

It also made it easier to recap the committee’s discussion. Sometimes it can be useful to do this at the conclusion of the discussion of each category – doing so meant that I did not have to remember all that was said 15 minutes ago or rely on notes taken while I was listening. Further, I found that it could be as inclusive as starting with an open invitation for ‘any comments’ and also avoided disordered and repetitive discussion.

I did find that acceptance of such a structure by a committee used to lack of structure took longer and required constant reinforcement. I came to realise that it was practice, rather than prescription, that generated acceptance of the strategy but maintained a relaxed and comfortable informality.

 

Working with an HREC

Here, a skill that comes with getting to know a committee well is knowing who to refer to, of whom to ask questions, who is likely a waste time with irrelevant matters and how to courteously persuade them to desist. These are generic chairperson skills but the nature of discussion at an ethics committee can make them more sensitive because ethics opens a wide arena for personal yet legitimate and relevant opinions. Dismissing one of these requires tactical use of reasoned ethical analysis lest it be treated as merely personal.

A central feature of an effective chair is to have the ongoing confidence and support of all members of the HREC, even if there are differences of opinion as to proposed outcomes of a review. I have chosen not to introduce each application with my own analysis and my recommended conclusions. My preference has been for discussion and development of a consensus view rather than to aim for an outcome that, in anticipation, I would have preferred. Doing so reduces the risk of closing down discussion and, depending on the relative status or perceived status of the chair vis-vis other members, chilling some members’ input.

I learned very early that I lacked depth in a number of perspectives that are intended to be reflected in the composition of the committee. This is of central importance: the decision is a decision of the whole committee and one that the whole committee can agree to. Frequently, the outcome I foresaw in reviewing an application in preparation for a meeting was not the one that the HREC reached. In preparing for meetings, as a result of these experiences, I would identify issues that, in my view, needed more attention from the researcher but I learned to remain open to other issues that had not occurred to me.

Following a meeting in which such an outcome is reached, the ongoing challenge is to explain to an often disgruntled researcher why the committee reached that view and why further refinement or modification of the application is needed for approval. Here, the burden often falls on the chair and the HREC executive officer. However, where the difference between a researcher and the committee lies in, for example, the traditions of the research discipline involved, I have tried to include the appropriate researcher member of the HREC in order to demonstrate respect to the researcher and to the committee.

There is a tension between the authority that a chair is often seen to have and the humility that a chair needs to bring to the role. The authority of the chair is not the same as the authority of the committee, even if some researchers think that it is or should be. Because it is essential that a committee be seen to be the decision-maker, explaining those decisions often requires more input than just from the chair.

 

The background of a chair

Would these challenges be reduced if, unlike me, chairs were also active researchers? From a committee point of view a researcher-chair is likely to generate considerable respect from the members of the HREC but, because of her very expertise, may also chill contributions from those with far less research awareness. From an institutional point of view, appointment of a researcher does add status to the committee which is, in many people’s eyes, essentially a research activity. However, any researcher chair will have disciplinary boundaries and it can be difficult to represent the committee’s ‘not yet approved’ decisions to researchers from completely different fields. In my experience, this has generated unintended tensions for some chairs.

This raises another more general issue as to whether a chair should be an institutional employee or external to the institution. There are benefits and shortcomings in each. An internal chair will know the institutional landscape and culture and can bring stature to the committee: the appointment itself can testify to the importance that the institution attaches to the HREC. The shortcomings will often be related to research fields, as noted above. For external chairs, the degree of independence can also add to the status of the HREC, particularly where the reputation, professional status or achievements of the chair can signal to committee members and researchers the importance the institution places on the committee’s role. On the other hand, an external chair will usually have limited knowledge of an institution, of its ethos and its culture and this can limit effective communication: particularly in outreach activities.

Beyond the HREC processes, chairs can make significant and valuable contributions to an institution’s research culture by representing the HREC at governing body meetings; participating in outreach activities to promote awareness of (and debunk myths about) a committee and participate in professional development in human research ethics.

 

Enjoying meetings

My final comment echoes the final quality that I suggested at the beginning of this short reflection. HREC meetings should be enjoyable: it is a place where thoughtful, committed and articulate people come together and, so long as they respect and are willing to listen to one another’s points of view, can be an environment in which intelligent and enjoyable, even light-hearted (but not cynical), conversation adds to the fulfilment of an important and worthwhile role.

Contributor
Prof. Colin Thomson AM | Senior Consultant AHRECS | AHRECS profile | colin.thomson@ahrecs.com

This post may be cited as:
Thomson, C. (23 April 2019) Reflections on chairing a human research ethics committee. Research Ethics Monthly. Retrieved from: https://ahrecs.com/human-research-ethics/reflections-on-chairing-a-human-research-ethics-committee

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