Thursday, April 19, 2012

Cross-Cultural Dialogue: The Key to Enhancing Research Protections

by Elisa Hurley, PhD, Education Director

Last month, I had the opportunity to attend the second Asia Pacific Research Ethics Conference (APREC), which took place March 7-9 in Singapore. The meeting was organized by the National Healthcare Group (NHG), and PRIM&R was proud to serve as the meeting’s co-sponsor, as we did for the first APREC in September 2010. The three-day meeting brought together representatives from institutional review boards (IRBs), ethics committees, research and academic institutions, national health authorities, and the pharmaceutical industry, who hailed mostly from the Asia Pacific region, but represented more than 25 countries as diverse as Australia, Turkey, Qatar, and East Timor.

I wore several hats while at APREC; I served as the liaison between PRIM&R and NHG, staffed PRIM&R’s exhibit booth, and taught my first IRB 201 course.  It was a very full, very stimulating few days, and throughout my time there I was struck by how similar the issues are that human research protections professionals struggle with across the globe, even when the specific sets of regulations that govern them, the structures in which review happens, and the cultures in which the research takes place are quite different.

One perhaps unsurprising commonality I discovered was the need for more and better IRB education.  Attendees from the Philippines, Thailand, Malaysia, and Saudi Arabia approached me, eagerly seeking resources they could use to educate their IRB members and staff.  This sounds familiar, does it not?  As PRIM&R’s education director, I was excited but also overwhelmed by this need.  There is clearly still a lot more work to be done to ensure affordable, efficient, high-quality education is available to human research protections professionals everywhere. 

There were other commonalities as well:
  • Professor Ryuichi Ida from Kyoto University explained that research ethics committees universally struggle with the issue of length of time for protocol review, regardless of their structure.
  • Assistant professor Peter Sainsbury from the University of Sydney echoed the issues raised in the US Department of Health and Human Services Advance Notice of Proposed Rulemaking; he highlighted challenges surrounding the review of research in public health and the social and behavioral sciences using guidelines and systems of ethical review that were originally drafted with biomedical research in mind. 
  • Professor Ezekiel Emanuel from the University of Pennsylvania gave a thought-provoking and characteristically provocative keynote address in which he laid out a method of assessing risk that does not vary by culture. He did, however, stress that since the harms of everyday life do vary—for example, the chances of being bit by a car are much higher in some countries than others—risk assessment must be sensitive to local contexts.
Dr. Ezekiel’s comments on the importance of local context were aptly reflected in my own experience at the conference. As a first-time instructor of IRB 201, I spent the months leading up to the conference preparing diligently. I was particularly proud of the case studies and interactive discussions I had planned throughout the day. The lively discussions that unfolded among small groups seemed to promise a lively conversation on a larger scale, but when it came time for attendees to share, silence. The chatter had disappeared, and try as I might, I could not coax any of the 75 participants to participate. Having been a teacher, I first thought I might try letting the silence linger for a bit—in a North American classroom, this usually forces some brave or impatient soul who cannot stand the silence any longer to raise his or her hand. It turns out this technique does not work with a primarily Asian audience. Five excruciatingly long and awkward silences later, and I had learned an incredibly valuable lesson that will not be soon forgotten about the importance of cultural competence in any cross-cultural enterprise.  

I returned from Singapore and my very first trip to Asia with a deeper appreciation for the value of bringing people from multiple countries, cultures, and backgrounds together in the shared pursuit of enhancing research. I welcome you to share your own experiences fostering cross-cultural dialogue about research protections in the comments section.

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