AHRP Recommendations for the protection of children in clinical research


THE ALLIANCE FOR HUMAN RESEARCH PROTECTION (AHRP)

Contact: Vera Hassner Sharav
Tel. No: 212-595-8974

E-mail: veracare at ahrp dot org
John H. Noble, Jr., Ph.D
Tel. No: 703-425-2120

PRESS RELEASE – October 21, 2002

AHRP Recommendations for the protection of children in clinical research

(1) Federal regulations are predicated on our moral responsibility to protect children – who are not volunteers – from being subjected to medical or behavioral experiments that are not in their best interest. Thus, federal regulations – 45 CFR 46 Sub-part D – restrict the use of children in medical experiments involving greater than minimal risk, if there is no potential medical benefit for them or their condition.

(2) Inasmuch as drugs have unwanted side-effects, and medical research involves risks of harm, only children whose narrowly defined currently diagnosed medical conditions can potentially be helped, should be recruited to test drugs or other medical devices or procedures.

(3) Legislation for the protection of children’s health and welfare should put the burden of proof on those seeking to conduct research on minors under the age of eighteen (18), to establish the existence of "compelling circumstances" that justify such research on children. Investigators must provide the criteria for demonstrating that the benefits of the research outweigh severity, duration, frequency and likelihood of the risks. Children must be assured that current “best medical practice” standards of treatment will be compared to any new or experimental treatment, and that those consenting on their behalf can be held accountable for making research decisions that are in the child’s best interest.

(4) Children should not be recruited for experiments involving greater than minimal risk on the basis of vague speculations about them being "at risk" of some unproven condition that may or may not ever materialize. Rigorous standards must be established for each study involving children so that the level “of risk” can be objectively defined by demonstrable, existing factors. Investigators must demonstrate that the nature, severity, duration, and frequency of the risk is greater than the intervention proposed.

(5) All clinical trials involving the use of children, as previously defined, should provide no-fault insurance coverage for both short-term and long-term adverse effects that may arise from or in the course of participation in the stated clinical trials. [1]

(6) The pool of child subjects must not constitute an unfair burden on disadvantaged families who may not have access to current “best practice” standards of treatment in their community. Thus, care must be taken to ensure that the population from which sick children shall be recruited represents families from diverse socio-economic strata. When children are sought from a specific ethnic or socio-economic population, evidence must be provided demonstrating that the condition under study disproportionately affects that specific population.[2]

(7) The recruitment of children with financial enticements to their parents and caregivers should be prohibited.

(8) The record demonstrates that the current system of review of both the scientific and ethical components of research protocols involving sick children, have failed to protect children such as nine-month old Gage Stevens or eight year old Jennifer Munger from harmful experiments that killed them. [3] Therefore,

A. There is a need for oversight by a "Children Protection Committee" in addition to review by an institutional review board (IRB) that would serve as the child subjects’ advocates, monitoring their selection, assessing the reasonableness of their parents’ consent, the adequacy of disclosure in the informed consent documents, and monitoring their continued willingness to participate in the research. [4]

B. The majority of the Children Protection Committee (51%) should be drawn from the community, among them representatives from the same socio-economic strata as the children in the specific clinical trial.

(9) All of the members of the ethics review board and the Children Protection Committee should be vetted for complete absence of conflicts of interest.

(10) The expenses for the process of safeguarding children’s best interest in research – including community members who are involved in implementing the research review and monitoring process – should be paid from a government fund established for that purpose. The government should, in turn, be authorized to recapture its costs, including oversight of all pediatric research, by way of reimbursement from the drug or medical device manufacturers who are eventually licensed to market such drugs or medical devices that result from approved pediatric research.

[1] This is the identical phrasing of the language of state and federal workers’ compensation laws that provide such no-fault insurance coverage to virtually all employees of U.S. businesses.

[2] This requirement reflects the ethical principle articulated in the Belmont Report relating to justice; namely, equal sharing of the burden and benefit of research.

[3] Willman, D. Los Angeles Times, Dec. 20, 2000, front page; Moss, M. Wall Street Journal, June 12, 1996, front page.

[4] The recommendation for a Children Protection Committee had been proposed by the Department of Health Education and Welfare in 1973 but never adopted. See 28 Fed. Reg. 31, 738 (1973)