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Beyond the question of placebo controls: ethical issues in psychopharmacological drug studies

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Abstract

Rationale

There is a broad range of complex ethical issues in the conduct of psychopharmacological drug studies that go beyond the question of the ethics of placebo controls. However, our empirical knowledge with respect to these issues is very limited. This review, although not exhaustive, highlights an array of ethical issues that arose from discussions within the NIMH Human Subjects Research Council Workgroup.

Objectives

To delineate issues in psychopharmacological drug studies that require debate and would benefit from research leading to the development of empirically-supported guidelines.

Methods

Information included in this report was drawn from the first author's participation as chair of the NIMH Human Subjects Research Council Workgroup, guidelines for the ethical conduct of research proposed by professional organizations to which the first and third author belong, and relevant research literature.

Results

We have focused on general issues relating to informed consent, research with special populations, and long-term treatment studies. Additionally, we raise issues relevant to large research-oriented institutions.

Conclusions

The essential ethical challenge in psychopharmacological trials is to balance risks and benefits in the context of the needs and capacities of individual research subjects. The IRB system must become evidence-based and not rely on unproven assumptions. Specific research studies should be undertaken to address many of the issues of informed consent and research ethics postulated in this paper.

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Acknowledgements

This research was supported, in part, by National Institute of Mental Health grants MH29618 (Dr. Frank), MH30915 (Drs. Kupfer and Frank). The first author also acknowledges the multiple contributions to this report that arose from discussions with Drs. Charles Nemeroff, A. John Rush, Robert Levine, Laura Roberts, Arthur Kaplan, Paul Weaver and Mr. James McNulty, all members of the NIMH Human Subjects Research Council Workgroup and Dr. David Shore who staffed the Workgroup.

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Authors and Affiliations

  1. Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA

    Ellen Frank, Danielle M. Novick & David J. Kupfer

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  1. Ellen Frank
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  2. Danielle M. Novick
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  3. David J. Kupfer
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Correspondence to Ellen Frank.

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Frank, E., Novick, D.M. & Kupfer, D.J. Beyond the question of placebo controls: ethical issues in psychopharmacological drug studies. Psychopharmacology 171, 19–26 (2003). https://doi.org/10.1007/s00213-003-1477-z

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  • DOI: https://doi.org/10.1007/s00213-003-1477-z

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