Ethical People

The ICMR has laid down guidelines for ethics in clinical research. It is expected that these guidelines are followed strictly. Any violation is liable to criminal proceedings against the violator. But I don't think it should be necessary to put this fear into the minds of researchers. Doctors should be ethical people and should always do the right thing for their patients. Three days ago I found out that both the premises are wrong. The fear element does not work. And not all researchers are ethical people. We had one professor who was so ethical that when I circulated a questionnaire to the resident about what they lacked in their work environment and time for food, sleep and relaxation, this professor put up a front of a couple of resident doctors to resist this questionnaire, and publicly said that it should have been put up after obtaining permission from Ethics Committee. 95% residents shot down this front and responded, hoping I would do something to improve their life. I did. This professor tried to get rid of me somehow, but failed, and finally left looking for greener pastures. Two days ago an ICMR doctoral student came to see me for starting a new project. "I would like to start data collection on patients from tomorrow" she said. "Have you obtained permission of our Ethics Committee?" I asked. I knew the answer would be negative, because the application form needed my forwarding signature, and I had not signed any such form. "We have ICMR's permission" she said. "We do not need permission of your ethics committee." "You are wrong" I said mildly. "For doing research on our hospital patients, you need permission of our ethics committee." "But the previous study we did here was done without such permission. It was Dr. XXXXX from your department who gave us patients." XXXXX was the same doctor who did this and all other ICMR studies. I knew no such permission had been obtained that time, because I had been the chief that time too, and I had not signed any such application. "That was most unethical on part of the said doctor" I said. "I do not want to initiate any inquiry into what has happened, unless someone complains about it. But you will not do anything unethical with my knowledge." That student left with a promise to be ethical and has not returned. I wonder what kept the said doctor from obtaining ethics committee permission. Today I found another example of this phenomenon. I had written about use of spinal anesthesia for laparoscopy in our OTs. The anesthetists had vehemently denied repeatedly that it was a research project and had maintained that it was a service. Today I picked up a patient's records file and a sheaf of papers dropped out of the anesthetists' folder under the file. I picked up those papers, and found that they were informed consent forms for spinal anesthesia trial for laparoscopy patients. The chief anesthetist was different this time, but the trial was the same. "We have ethics committee permission for this" the anesthetist said. If they had permission for conducting the trial on my patients, it was necessary to involve me too. They had lied about it. I wonder what drives people to lie in academic matters.