1 00:00:05,560 --> 00:00:07,360 >>THANK YOU FOR JOINING US 2 00:00:07,360 --> 00:00:09,360 FOR THE AUGUST SESSION FOR THE 3 00:00:09,360 --> 00:00:12,360 EDUCATION SERIES. TODAY'S TITLE 4 00:00:12,360 --> 00:00:15,680 MORE ETHICS OR MORE COMPLIANCE, 5 00:00:15,680 --> 00:00:21,080 WHAT WAS DR. BEECHER TRYING TO 6 00:00:21,080 --> 00:00:22,640 TELL US? THIS PRESENTATION WILL 7 00:00:22,640 --> 00:00:24,320 BE ARCHIVED IN THE PAST SECTION 8 00:00:24,320 --> 00:00:25,760 OF THE VIDEO CAST SITE AND A 9 00:00:25,760 --> 00:00:27,680 LINK TO THE VIDEO CAST AS WELL 10 00:00:27,680 --> 00:00:29,680 AS THE SLIDES FROM THE SESSION 11 00:00:29,680 --> 00:00:33,480 WILL BE POSTED ON THE OHSRP 12 00:00:33,480 --> 00:00:34,560 WEBSITE IN THE PRESENTATION 13 00:00:34,560 --> 00:00:39,440 ARCHIVE SECTION OF THE OHSRP 14 00:00:39,440 --> 00:00:41,120 TRAINING PAGE IN ABOUT ONE TO 15 00:00:41,120 --> 00:00:43,160 TWO WEEKS. WE STRONGLY 16 00:00:43,160 --> 00:00:44,560 ENCOURAGE VIEWERS TO SUBMIT 17 00:00:44,560 --> 00:00:45,440 QUESTIONS THROUGHOUT THE SESSION 18 00:00:45,440 --> 00:00:47,840 BY CLICKING ON THE BOX BELOW THE 19 00:00:47,840 --> 00:00:50,680 VIDEO TITLED LIVE FEEDBACK LINK 20 00:00:50,680 --> 00:00:53,440 AND NOW THE DIRECTOR JONATHAN 21 00:00:53,440 --> 00:00:55,320 GREENE WILL INTRODUCE OUR 22 00:00:55,320 --> 00:00:55,800 SPEAKER. 23 00:00:55,800 --> 00:00:58,680 >>JONATHAN: THANKS, PEG I'M 24 00:00:58,680 --> 00:01:00,080 THRILLED TO INTRODUCE TODAY'S 25 00:01:00,080 --> 00:01:02,960 SPEAKER TO GIVE OUR SEMINAR 26 00:01:02,960 --> 00:01:03,920 SERIES TODAY. I HAVE KNOWN 27 00:01:03,920 --> 00:01:06,120 QUINCY FOR A NUMBER OF YEARS 28 00:01:06,120 --> 00:01:07,680 NOW. HE'S A REALLY GREAT FRIEND 29 00:01:07,680 --> 00:01:09,280 AND COLLEAGUE AND I'M JUST 30 00:01:09,280 --> 00:01:11,880 THRILLED THAT HE'S AGREED TO 31 00:01:11,880 --> 00:01:13,600 JOIN US TODAY. I AM GOING TO 32 00:01:13,600 --> 00:01:15,520 GIVE A LITTLE BIT OF HIGHLIGHTS 33 00:01:15,520 --> 00:01:17,960 FROM HIS BIO BUT IF I GO THROUGH 34 00:01:17,960 --> 00:01:20,120 HIS WHOLE BIO WE WON'T HAVE TIME 35 00:01:20,120 --> 00:01:22,840 FOR THE TALK. THE HIGH POINTS 36 00:01:22,840 --> 00:01:25,480 OF DR. BYRD SONG IS CURRENTLY 37 00:01:25,480 --> 00:01:27,320 THE VICE PRESIDENT AT VALID 38 00:01:27,320 --> 00:01:29,480 HEALTH IN JOHNSON CITY, 39 00:01:29,480 --> 00:01:31,880 TENNESSEE WHERE HE HAD 40 00:01:31,880 --> 00:01:34,840 PROGRAMMATIC OVERSIGHT OF ALL 41 00:01:34,840 --> 00:01:36,160 RESEARCH EFFORTS IN CONJUNCTION 42 00:01:36,160 --> 00:01:40,120 WITH THE SYSTEM CHAIR FOR 43 00:01:40,120 --> 00:01:43,320 CLINICAL RESEARCH. PRIOR TO 44 00:01:43,320 --> 00:01:45,600 COMING TO BALLAD, DR. BYRD SONG 45 00:01:45,600 --> 00:01:48,760 SERVED AS THE VICE PROVOST OF 46 00:01:48,760 --> 00:01:49,920 PUBLIC AFFAIRS IN NASHVILLE, 47 00:01:49,920 --> 00:01:52,760 TENNESSEE WHERE HE HAD A NUMBER 48 00:01:52,760 --> 00:01:56,640 OF ROLES OVERSEEING THE RESEARCH 49 00:01:56,640 --> 00:02:01,440 ENTERPRISE AND EDUCATIONAL 50 00:02:01,440 --> 00:02:02,880 ACTIVITIES. HE AND I BOTH SERVE 51 00:02:02,880 --> 00:02:06,360 ON THE BOARD OF DIRECTORS SO A 52 00:02:06,360 --> 00:02:08,400 HARP IS THE ORGANIZATION THAT 53 00:02:08,400 --> 00:02:09,600 ACCREDITS RESEARCH PROTECTION 54 00:02:09,600 --> 00:02:10,600 PROGRAMS WHERE HE'S JUST A 55 00:02:10,600 --> 00:02:13,720 REALLY AMAZING COLLEAGUE AND 56 00:02:13,720 --> 00:02:15,520 CONTRIBUTOR. AND THE ONE THING 57 00:02:15,520 --> 00:02:17,480 I HAVE REALLY LEARNED FROM -- 58 00:02:17,480 --> 00:02:19,360 I'VE LEARNED MANY THINGS FROM 59 00:02:19,360 --> 00:02:21,320 BEING WITH QUINCY BUT THE MOST 60 00:02:21,320 --> 00:02:23,960 IMPORTANT THING I'VE LEARNED IS 61 00:02:23,960 --> 00:02:28,200 WHEN HE SPEAKS IT'S TIME TO STOP 62 00:02:28,200 --> 00:02:30,120 AND LISTEN. AND NOT JUST STOP 63 00:02:30,120 --> 00:02:31,760 AND LISTEN AND PAUSE BUT REALLY 64 00:02:31,760 --> 00:02:34,280 THINK ABOUT IT BECAUSE WHEN 65 00:02:34,280 --> 00:02:35,360 QUINCY SPEAKS INEVITABLY IT'S 66 00:02:35,360 --> 00:02:36,240 SOMETHING REALLY IMPORTANT THAT 67 00:02:36,240 --> 00:02:37,840 I NEED TO HEAR AND THINK ABOUT. 68 00:02:37,840 --> 00:02:41,480 AND I AM SURE THAT WILL BE THE 69 00:02:41,480 --> 00:02:44,240 CASE WITH HIS PRESENTATION TODAY 70 00:02:44,240 --> 00:02:52,920 SO AGAIN, QUINCY, THANK YOU SO 71 00:02:52,920 --> 00:02:55,760 MUCH FOR SPEAKING TODAY. 72 00:02:55,760 --> 00:02:57,360 >>QUINCY: THANK YOU, JONATHAN 73 00:02:57,360 --> 00:02:58,760 AND THANK YOU, PEG FOR ARRANGING 74 00:02:58,760 --> 00:03:00,840 ME TO SPEAK WITH THIS AUDIENCE. 75 00:03:00,840 --> 00:03:03,080 BY WAY OF BACKGROUND 76 00:03:03,080 --> 00:03:04,760 ABOUT ME YOU'VE HEARD JONATHAN 77 00:03:04,760 --> 00:03:08,160 MENTION A FEW POINTS FROM MY 78 00:03:08,160 --> 00:03:09,360 BACKGROUND BUT I THINK IT'S 79 00:03:09,360 --> 00:03:11,920 IMPORTANT FOR YOU TO UNDERSTAND 80 00:03:11,920 --> 00:03:14,680 THE LENS FROM WHICH I AM GIVING 81 00:03:14,680 --> 00:03:15,840 THIS TALK. MY FIRST JOB IN 82 00:03:15,840 --> 00:03:17,280 HEALTH CARE WAS THE DIRECTOR OF 83 00:03:17,280 --> 00:03:20,360 AN IRB FOR A STANDALONE MEDICAL 84 00:03:20,360 --> 00:03:23,880 SCHOOL AND THE OPPORTUNITY TO 85 00:03:23,880 --> 00:03:26,800 PROTECT HUMAN RESEARCH 86 00:03:26,800 --> 00:03:29,440 PARTICIPANTS WAS SOMETHING I 87 00:03:29,440 --> 00:03:31,760 FOUND TO BE OVERWHELMING AND 88 00:03:31,760 --> 00:03:34,280 HUMBLING AND REWARDING AND I 89 00:03:34,280 --> 00:03:35,840 THOUGHT OF ALL THE ETHICAL WAYS 90 00:03:35,840 --> 00:03:37,720 THAT RESEARCH CAN BE DONE WHEN 91 00:03:37,720 --> 00:03:38,480 IT INVOLVED HUMAN BEINGS BUT 92 00:03:38,480 --> 00:03:41,720 AFTER I TOOK THIS JOB, I WAS 93 00:03:41,720 --> 00:03:43,520 GIVEN A REAM OF REGULATIONS, 94 00:03:43,520 --> 00:03:46,080 PAGES AND PAGES OF REGULATIONS 95 00:03:46,080 --> 00:03:48,640 FROM MY BOSS AND I THOUGHT TO 96 00:03:48,640 --> 00:03:49,720 MYSELF, WOW, I THOUGHT THIS WAS 97 00:03:49,720 --> 00:03:51,920 THE JOB THAT LOOKED AT THE 98 00:03:51,920 --> 00:03:53,920 ETHICS OF RESEARCH. INSTEAD IT 99 00:03:53,920 --> 00:03:55,520 TURNS OUT THAT THIS IS A JOB 100 00:03:55,520 --> 00:03:58,520 THAT LOOKS AT HOW WELL RESEARCH 101 00:03:58,520 --> 00:04:01,960 FOLLOW ASSET OF RULES THEN I 102 00:04:01,960 --> 00:04:03,880 BEGAN TO THINK TO MYSELF ARE 103 00:04:03,880 --> 00:04:07,880 THOSE TWO NECESSARILY MUTUALLY 104 00:04:07,880 --> 00:04:08,880 EXCLUSIVE. CAN RESEARCH 105 00:04:08,880 --> 00:04:10,320 INVOLVING HUMAN BEINGS BE DONE 106 00:04:10,320 --> 00:04:11,600 WITH AN ETHICAL REVIEW AND ALSO 107 00:04:11,600 --> 00:04:13,720 WITH A REVIEW THAT LOOKS MORE AT 108 00:04:13,720 --> 00:04:15,920 ALIGNMENT OF RESEARCH ACTIVITIES 109 00:04:15,920 --> 00:04:18,560 WITH A SET OF EXPECTATIONS AND A 110 00:04:18,560 --> 00:04:22,160 SET OF RULES? HENCE THIS TALK 111 00:04:22,160 --> 00:04:24,240 TODAY. MORE ETHICS OR MORE 112 00:04:24,240 --> 00:04:25,120 COMPLIANCE. AND WHAT WE'RE 113 00:04:25,120 --> 00:04:27,920 GOING TO USE IS SORT OF THE 114 00:04:27,920 --> 00:04:29,440 FOUNDATION FOR THIS DISCUSSION 115 00:04:29,440 --> 00:04:33,760 IS AN ARTICLE BY DR. HENRY 116 00:04:33,760 --> 00:04:35,920 BEECHER MOST OF YOU HAVE READ 117 00:04:35,920 --> 00:04:37,160 THIS ARTICLE, ETHICS AND 118 00:04:37,160 --> 00:04:40,320 RESEARCH IN THE NEW ENGLAND 119 00:04:40,320 --> 00:04:44,880 JOURNAL OF MEDICINE, 1966 AND 120 00:04:44,880 --> 00:04:46,840 THAT ARTICLE TALKED ABOUT ETHICS 121 00:04:46,840 --> 00:04:48,560 FROM THE STANDPOINT IN THAT 122 00:04:48,560 --> 00:04:50,520 THERE IS A WAY TO MAKE GOOD 123 00:04:50,520 --> 00:04:51,920 DECISIONS AROUND THE RESEARCH 124 00:04:51,920 --> 00:04:53,080 THAT WE CONDUCT AND AT THE SAME 125 00:04:53,080 --> 00:04:55,960 TIME, FOLLOW A SET OF 126 00:04:55,960 --> 00:04:56,880 EXPECTATIONS WHETHER WRITTEN OR 127 00:04:56,880 --> 00:05:01,680 MORE INFORMAL IN NATURE. SO 128 00:05:01,680 --> 00:05:03,560 WHAT WE'RE GOING TO TRY TO COVER 129 00:05:03,560 --> 00:05:05,600 OVER THE NEXT 40 MINUTES OR SO, 130 00:05:05,600 --> 00:05:07,880 WE'RE GOING TO LOOK AT THAT 131 00:05:07,880 --> 00:05:09,200 ARTICLE AGAIN. THE ETHICS AND 132 00:05:09,200 --> 00:05:11,160 CLINICAL RESEARCH ARTICLE BY 133 00:05:11,160 --> 00:05:13,240 DR. HENRY BEECHER. WE'RE GOING 134 00:05:13,240 --> 00:05:15,800 TO LOOK AT SOME QUESTIONS AROUND 135 00:05:15,800 --> 00:05:17,640 THAT EXPOSE. SOME OF THOSE 136 00:05:17,640 --> 00:05:18,520 QUESTIONS ARE GOING TO BE 137 00:05:18,520 --> 00:05:21,280 IMPORTANT FOR US TO ANSWER AS WE 138 00:05:21,280 --> 00:05:23,320 DIVE INTO THOSE ETHICS AND 139 00:05:23,320 --> 00:05:25,160 COMPLIANCE AND LASTLY IDENTIFY 140 00:05:25,160 --> 00:05:26,920 SOME HISTORICAL LESSONS WE 141 00:05:26,920 --> 00:05:28,200 LEARNED FROM THE BEECHER ARTICLE 142 00:05:28,200 --> 00:05:31,200 AND HOW THEY IMPACT WHAT WE DO 143 00:05:31,200 --> 00:05:31,920 PARTICULARLY IN THE CLINICAL 144 00:05:31,920 --> 00:05:35,920 TRIAL ENTERPRISE. SO, AS MANY 145 00:05:35,920 --> 00:05:38,560 OF YOU KNOW ACADEMIC MEDICINE IN 146 00:05:38,560 --> 00:05:40,320 THE WAY THAT IT'S CONDUCTED AND 147 00:05:40,320 --> 00:05:42,440 CARRY OUT TODAY, IT REALLY 148 00:05:42,440 --> 00:05:45,840 STARTED IN GERMANY. AND GERMANY 149 00:05:45,840 --> 00:05:48,600 WAS THE MODEL FOR HOW MEDICAL 150 00:05:48,600 --> 00:05:52,080 SCHOOLS WOULD CARRY OUT ITS 151 00:05:52,080 --> 00:05:54,520 ACTIVITY, JOHNS HOPKINS 152 00:05:54,520 --> 00:05:55,120 PATTERNED HIS MEDICAL SCHOOL 153 00:05:55,120 --> 00:05:56,680 AFTER THINGS THEY SAW IN GERMANY 154 00:05:56,680 --> 00:06:00,920 SO GERMANY BECAME A SEAT FOR 155 00:06:00,920 --> 00:06:02,960 ACADEMIC MEDICINE WOULD BE 156 00:06:02,960 --> 00:06:04,960 CREATED, THE HUB WHERE ACADEMIC 157 00:06:04,960 --> 00:06:07,880 MEDICINE WOULD GROW AND THE 158 00:06:07,880 --> 00:06:14,760 ENVIRONMENT WHERE IT WOULD 159 00:06:14,760 --> 00:06:16,840 FLOURISH AND RESEARCH BACK IN 160 00:06:16,840 --> 00:06:19,840 THE DAY WAS DONE ON HUMAN BEINGS 161 00:06:19,840 --> 00:06:23,080 AND THE MINISTER OF ININTERIOR 162 00:06:23,080 --> 00:06:24,240 ESTABLISHED A SET OF GUIDELINES 163 00:06:24,240 --> 00:06:25,880 KNOWING A LOT OF RESEARCH WOULD 164 00:06:25,880 --> 00:06:27,920 BE CONDUCTED BY THIS ACADEMIC 165 00:06:27,920 --> 00:06:30,440 MEDICAL FACULTY AND BY 166 00:06:30,440 --> 00:06:31,640 PHYSICIANS AND A SET OF 167 00:06:31,640 --> 00:06:32,960 GUIDELINES WERE DEVELOPED AND 168 00:06:32,960 --> 00:06:35,160 THEY WERE THREEFOLD AND THIS IS 169 00:06:35,160 --> 00:06:36,800 AN ABBREVIATED VERSION OF THE 170 00:06:36,800 --> 00:06:38,320 ENTIRE SET OF GUIDELINES BUT 171 00:06:38,320 --> 00:06:39,360 ESSENTIALLY THE GUIDELINES STATE 172 00:06:39,360 --> 00:06:43,040 THAT HAD THE GOAL OF THE 173 00:06:43,040 --> 00:06:44,960 RESEARCH MUST BE THERAPY. 174 00:06:44,960 --> 00:06:49,960 THAT INFORMED CONSENT SHOULD BE 175 00:06:49,960 --> 00:06:51,040 OBTAINED AND DOCUMENTED AND 176 00:06:51,040 --> 00:06:53,600 RURAL POPULATIONS SHOULD BE 177 00:06:53,600 --> 00:06:55,480 PROTECTED. SO WHEN YOU THINK 178 00:06:55,480 --> 00:06:56,120 ABOUT COMPLIANCE, YOU THINK 179 00:06:56,120 --> 00:06:58,360 ABOUT RULES, YOU THINK ABOUT 180 00:06:58,360 --> 00:07:00,480 REGULATIONS WE HAVE A SET OF 181 00:07:00,480 --> 00:07:04,000 RULES HERE THAT GOVERN HOW HUMAN 182 00:07:04,000 --> 00:07:05,560 RESEARCH IS DONE IN A POPULATION 183 00:07:05,560 --> 00:07:07,920 WHERE A LOT OF RESEARCH ON HUMAN 184 00:07:07,920 --> 00:07:11,880 BEINGS HAPPEN TO BE CONDUCTED. 185 00:07:11,880 --> 00:07:15,000 BUT UNFORTUNATELY GERMANY WAS 186 00:07:15,000 --> 00:07:19,680 ALSO THE PLACE OF OUR FIRST 187 00:07:19,680 --> 00:07:22,280 DOCUMENTED AND ARGUABLY ONE OF 188 00:07:22,280 --> 00:07:25,120 THE MOST EGREESHOUS EPISODES IN 189 00:07:25,120 --> 00:07:27,520 UNETHICAL RESEARCH INVOLVING 190 00:07:27,520 --> 00:07:29,080 HUMAN BEINGS WE'VE P EVER SEEN. 191 00:07:29,080 --> 00:07:34,120 IN 1933 THE NAZI REGIME 192 00:07:34,120 --> 00:07:35,120 ESTABLISHED THESE CONCENTRATION 193 00:07:35,120 --> 00:07:36,520 CAMPS AND MANY OF YOU KNOW THEY 194 00:07:36,520 --> 00:07:40,760 WERE DESIGNED TO TORTURE, WERE 195 00:07:40,760 --> 00:07:42,840 DESIGNED TO MISTREAT, WERE 196 00:07:42,840 --> 00:07:45,000 DESIGNED TO DESTROY WHAT THE 197 00:07:45,000 --> 00:07:47,080 NAZI REGIME REGARDED AS AN 198 00:07:47,080 --> 00:07:48,800 INFERIOR GROUP OF INDIVIDUALS. 199 00:07:48,800 --> 00:07:51,920 SO THE GOAL WAS TWOFOLD, RIGHT, 200 00:07:51,920 --> 00:07:55,320 TO PROMOTE THE SO-CALLED PERFECT 201 00:07:55,320 --> 00:07:57,040 ARIAN RACE AND THE SECOND PART 202 00:07:57,040 --> 00:07:58,840 WAS TO ELIMINATE ANYONE THAT WAS 203 00:07:58,840 --> 00:08:01,400 NOT PART OF THAT SO-CALLED 204 00:08:01,400 --> 00:08:03,440 PERFECT ARIAN RACE THREE 205 00:08:03,440 --> 00:08:05,240 CATEGORIES OF THESE RESEARCH 206 00:08:05,240 --> 00:08:07,560 PROJECTS, ONE WAS THE SURVIVAL 207 00:08:07,560 --> 00:08:10,640 OF AXIS PERSONNEL. SO IT WAS 208 00:08:10,640 --> 00:08:13,200 DESIGNED TO HELP INDIVIDUALS 209 00:08:13,200 --> 00:08:18,080 FROM ITALY MALY SHA, GERMAN 210 00:08:18,080 --> 00:08:19,920 MILITIA, JAPANESE MILITIA AND 211 00:08:19,920 --> 00:08:22,000 THERE WERE SPECIFIC THINGS THEY 212 00:08:22,000 --> 00:08:24,120 THOUGHT WOULD BE ENCOUNTERED BY 213 00:08:24,120 --> 00:08:26,600 THESE MILITARY PERSONNEL, 214 00:08:26,600 --> 00:08:28,440 FREEZING EXPERIMENTS, WHERE THEY 215 00:08:28,440 --> 00:08:30,200 WOULD EXPOSE PRISONER TO REALLY, 216 00:08:30,200 --> 00:08:32,200 REALLY LOW TEMPERATURES AND SEE 217 00:08:32,200 --> 00:08:34,360 HOW LONG IT WOULD TAKE THEIR 218 00:08:34,360 --> 00:08:36,840 BODY TO GO INTO HYPOTHERMIA. 219 00:08:36,840 --> 00:08:39,120 HOW LONG THEY COULD LIVE OFF OF 220 00:08:39,120 --> 00:08:40,680 SEAWATER. AND THE SECOND 221 00:08:40,680 --> 00:08:43,120 CATEGORY WAS DRUG AND TREATMENT 222 00:08:43,120 --> 00:08:45,080 TRIALS. THEY WOULD EXPOSE THESE 223 00:08:45,080 --> 00:08:47,360 PRISONERS TO GASES AND OTHER 224 00:08:47,360 --> 00:08:49,880 TYPES OF SITUATIONS AND THEN 225 00:08:49,880 --> 00:08:50,760 TEST ANTIDOTES FOR THEM BUT AT 226 00:08:50,760 --> 00:08:53,760 THE END OF THOSE TRIALS THE 227 00:08:53,760 --> 00:08:54,680 INDIVIDUALS WOULD BE CARTED OFF 228 00:08:54,680 --> 00:08:57,080 TO A GAS CHAMBER AND KILLED AND 229 00:08:57,080 --> 00:09:00,000 THEN LASTLY THE CATEGORY OF AS I 230 00:09:00,000 --> 00:09:03,040 MENTIONED BEFORE THE RACIAL 231 00:09:03,040 --> 00:09:04,800 IDEOLOGICAL TENETS OF THE NAZI 232 00:09:04,800 --> 00:09:07,640 WORLD VIEW AT THE TIME SO THEY 233 00:09:07,640 --> 00:09:10,080 DID STUDIES ON JEWISH TWINS AND 234 00:09:10,080 --> 00:09:13,000 WHAT THEY REFERRED TO AS 235 00:09:13,000 --> 00:09:14,040 GYPSIES, INDIVIDUALS FROM 236 00:09:14,040 --> 00:09:15,640 NORTHERN INDIA AND THEY HAD 237 00:09:15,640 --> 00:09:17,680 STUDIES TO ESTABLISH IS THE WORD 238 00:09:17,680 --> 00:09:21,120 THEY USED JEWISH RACIAL 239 00:09:21,120 --> 00:09:21,960 INFERIORITY. SO THE JEWISH 240 00:09:21,960 --> 00:09:24,760 WOULD BE IN THESE EXPERIMENTS, 241 00:09:24,760 --> 00:09:26,520 WOULD DIE AND THE RESEARCHER 242 00:09:26,520 --> 00:09:29,800 WOULD SAY, HEY, LOOK, THEY ARE 243 00:09:29,800 --> 00:09:31,120 INFERIOR BECAUSE LOOK AT WHAT 244 00:09:31,120 --> 00:09:32,440 HAPPENED TO THEM IN THIS 245 00:09:32,440 --> 00:09:34,600 EXPERIMENT AND THEN LASTLY MASS 246 00:09:34,600 --> 00:09:35,960 STERILIZATION. THIS WAS GOING 247 00:09:35,960 --> 00:09:37,240 ON IN GERMANY EVEN IN THE 248 00:09:37,240 --> 00:09:39,920 PRESENCE OF A SET OF GUIDELINES 249 00:09:39,920 --> 00:09:43,920 THAT SAID THAT INDIVIDUALS THAT 250 00:09:43,920 --> 00:09:45,120 PARTICIPATED AND SUBJECT 251 00:09:45,120 --> 00:09:46,280 RESEARCH SHOULD BE PROTECTED. 252 00:09:46,280 --> 00:09:47,680 SO THERE SEEMS TO BE A LITTLE 253 00:09:47,680 --> 00:09:51,080 BIT OF DISCONNECT FROM THIS VERY 254 00:09:51,080 --> 00:09:53,040 FIRST EPISODE. LET'S TAKE A 255 00:09:53,040 --> 00:09:55,160 DEEPER DIVE. WERE THE NAZI 256 00:09:55,160 --> 00:09:55,960 CONCENTRATION CAMP EXPERIMENTS 257 00:09:55,960 --> 00:09:59,600 DUE TO A LACK OF KNOWLEDGE OR 258 00:09:59,600 --> 00:10:03,160 WERE THEY DUE TO A LACK OF 259 00:10:03,160 --> 00:10:09,120 ETHICS? SO LET'S LOOK AT THAT. 260 00:10:09,120 --> 00:10:10,840 ARISTOTLE WHO WAS THE FATHER OF 261 00:10:10,840 --> 00:10:13,160 MODERN DAY ETHICS IF YOU WILL 262 00:10:13,160 --> 00:10:14,520 SAID THERE'S A DIFFERENCE 263 00:10:14,520 --> 00:10:15,920 BETWEEN GOODNESS OF INTELLECT 264 00:10:15,920 --> 00:10:18,480 AND GOODNESS OF CHARACTER. 265 00:10:18,480 --> 00:10:21,120 THEY'RE SIMILAR IN THAT BOTH ARE 266 00:10:21,120 --> 00:10:21,880 ADMIRABLE. GOOD IS GOOD. 267 00:10:21,880 --> 00:10:24,880 PRAISE WORTHINESS AND PRAISE 268 00:10:24,880 --> 00:10:25,920 WORTHINESS BUT THE DIFFERENCE IS 269 00:10:25,920 --> 00:10:27,120 ONE IS THE KNOWLEDGE OF THE 270 00:10:27,120 --> 00:10:28,600 RULES. THE OTHER IS THE 271 00:10:28,600 --> 00:10:31,440 OBEDIENCE TO THOSE RULES. ONE 272 00:10:31,440 --> 00:10:33,160 COMES FROM STUDYING AND THE 273 00:10:33,160 --> 00:10:37,280 OTHER COMES FROM DISCIPLINE. SO 274 00:10:37,280 --> 00:10:39,320 ARISTOTLE IS CERTAIN THAT ETHICS 275 00:10:39,320 --> 00:10:41,920 COMES FROM NOT JUST GOOD AND BAD 276 00:10:41,920 --> 00:10:43,680 BUT COMES WITH THE CARRYING OUT 277 00:10:43,680 --> 00:10:45,080 OR THE PRACTICE OF DOING THE 278 00:10:45,080 --> 00:10:47,080 RIGHT THING, NOT JUST THE 279 00:10:47,080 --> 00:10:49,240 PRINCIPLE OF DOING THE RIGHT 280 00:10:49,240 --> 00:10:51,160 THING. SO WHAT IS ETHICS? WHAT 281 00:10:51,160 --> 00:10:52,800 ARE WE REALLY TALKING ABOUT WHEN 282 00:10:52,800 --> 00:10:55,040 WE TALK ABOUT ETHICS? TODAY 283 00:10:55,040 --> 00:10:56,640 WE'RE GOING TO COMPARE ETHICS 284 00:10:56,640 --> 00:10:57,720 AND COMPLIANCE AND TALK ABOUT 285 00:10:57,720 --> 00:10:58,440 THE POTENTIAL CONVERGENCE 286 00:10:58,440 --> 00:10:59,920 BETWEEN THE TWO. WHAT IS IT 287 00:10:59,920 --> 00:11:02,120 THAT WE'RE REALLY TALKING ABOUT? 288 00:11:02,120 --> 00:11:04,000 THE BRANCH OF PHILOSOPHY THAT 289 00:11:04,000 --> 00:11:06,080 DEALS WITH VALUES. RELATED TO 290 00:11:06,080 --> 00:11:07,840 HUMAN CONDUCT, RESPECT TO RIGHT 291 00:11:07,840 --> 00:11:11,920 AND WRONG, RESPECT TO GOOD AND 292 00:11:11,920 --> 00:11:16,840 BAD AND ALSO THE KNOW -- KNOW 293 00:11:16,840 --> 00:11:19,040 DISAND THE ENDS OF THESE 294 00:11:19,040 --> 00:11:19,640 ACTIONS. 295 00:11:19,640 --> 00:11:22,480 IT DOESN'T MAKE A DIFFERENCE IF 296 00:11:22,480 --> 00:11:23,880 THE PERSON THAT DID THE WRONG IS 297 00:11:23,880 --> 00:11:25,320 GOOD OR IF THE PERSON THAT WAS 298 00:11:25,320 --> 00:11:28,040 WRONGED IS BAD OR IF THE BAD MAN 299 00:11:28,040 --> 00:11:32,880 WRONGED THE GOODMAN ARISTOTLE 300 00:11:32,880 --> 00:11:34,240 SAID IT DOESN'T MATTER. 301 00:11:34,240 --> 00:11:36,560 THE LAN LAW CAN ONLY LOOK AT THE 302 00:11:36,560 --> 00:11:37,600 DAMAGE THAT WAS DONE. 303 00:11:37,600 --> 00:11:38,600 SO LET'S TAKE THAT BACK TO WHAT 304 00:11:38,600 --> 00:11:41,120 WE MENTIONED AT THE 305 00:11:41,120 --> 00:11:42,320 CONCENTRATION CAMPS. SO WHEN 306 00:11:42,320 --> 00:11:44,800 WOE LOOK AT THE WRONG THAT WAS 307 00:11:44,800 --> 00:11:46,480 DONE YOU HAVE THE PERMISSIBLE 308 00:11:46,480 --> 00:11:47,720 MEDICAL EXPERIMENTS WHICH IS ONE 309 00:11:47,720 --> 00:11:49,040 OF THE WAYS THAT YOU CAN LOOK 310 00:11:49,040 --> 00:11:51,680 THIS UP. ALSO THE UNITED STATES 311 00:11:51,680 --> 00:11:53,640 OF AMERICA VERSUS KARL BRANDTH. 312 00:11:53,640 --> 00:11:56,200 YOU CAN LOOK UP ALL OF -- AT 313 00:11:56,200 --> 00:11:58,800 LEAST SOME OF THE SCENES ABOUT 314 00:11:58,800 --> 00:11:59,920 THOSE TWO SEARCHED TERMS. THERE 315 00:11:59,920 --> 00:12:03,320 ARE 23 DEFENDANTS. 16 WERE 316 00:12:03,320 --> 00:12:06,320 FOUND GUILTY AND OF THESE 16, 317 00:12:06,320 --> 00:12:07,800 THE MAJORITY OF THEM WERE 318 00:12:07,800 --> 00:12:11,000 EXECUTED. FOR THEIR CRIMES. IT 319 00:12:11,000 --> 00:12:12,760 WAS PART OF THE VERDICT OF A 320 00:12:12,760 --> 00:12:14,560 MURDER TRIAL. THESE INDIVIDUALS 321 00:12:14,560 --> 00:12:16,120 WERE NOT ON TRIAL FOR BEING 322 00:12:16,120 --> 00:12:17,200 UNETHICAL RESEARCHERS. THEY 323 00:12:17,200 --> 00:12:19,920 WERE ON TRIAL FOR MURDER. THE 324 00:12:19,920 --> 00:12:25,160 RESPONSE TO THE TRIAL WAS THE 325 00:12:25,160 --> 00:12:25,720 NUREMBERG CODE. THIS CODE 326 00:12:25,720 --> 00:12:26,960 BECAME THE OFFICIAL RESPONSE IN 327 00:12:26,960 --> 00:12:30,000 TERMS OF GUIDELINES, AND THEY 328 00:12:30,000 --> 00:12:32,120 ESTABLISHED INFORMED CONSENT, 329 00:12:32,120 --> 00:12:34,600 THE REQUIREMENTS FOR ABSENCE OF 330 00:12:34,600 --> 00:12:36,320 COERCION OR THE REQUIREMENTS 331 00:12:36,320 --> 00:12:38,920 AROUND RESEARCH DESIGN AND THE 332 00:12:38,920 --> 00:12:39,920 REQUIREMENT AROUND THIS HAS TO 333 00:12:39,920 --> 00:12:41,560 BE AROUND THE GOOD, PARTICULARLY 334 00:12:41,560 --> 00:12:42,680 NOT JUST THE GOOD OF THE SUBJECT 335 00:12:42,680 --> 00:12:47,000 BUT THE GREATER GOOD OF MANKIND, 336 00:12:47,000 --> 00:12:51,000 HUMANKIND. DR. ANDREW IVY WAS 337 00:12:51,000 --> 00:12:52,320 PRESENT AT THESE MEETINGS AND 338 00:12:52,320 --> 00:12:55,080 REPRESENTED THE AMERICAN MEDICAL 339 00:12:55,080 --> 00:12:57,320 ASSOCIATION DURING THE DOCTORS' 340 00:12:57,320 --> 00:12:58,840 TRIAL. WE HAVE GUIDELINES, WE 341 00:12:58,840 --> 00:13:01,480 HAVE UNETHICAL RESEARCH. THEN 342 00:13:01,480 --> 00:13:02,960 WE HAVE RESPONSE, THIS NUREMBERG 343 00:13:02,960 --> 00:13:05,400 CODE. SO WE'RE SEEING 344 00:13:05,400 --> 00:13:07,560 REGULATIONS BEING CREATED IN THE 345 00:13:07,560 --> 00:13:11,680 ABSENCE OF ETHICS. WE'RE 346 00:13:11,680 --> 00:13:13,040 STARTING TO SEE THIS CONVERGENCE 347 00:13:13,040 --> 00:13:15,160 SEEPING IN EVEN EARLY ON IN THE 348 00:13:15,160 --> 00:13:17,320 HISTORY OF HUMAN 349 00:13:17,320 --> 00:13:19,720 EXPERIMENTATION. SO AS WE LOOK 350 00:13:19,720 --> 00:13:21,360 A LITTLE FURTHER, THE QUESTION 351 00:13:21,360 --> 00:13:23,440 OF COMPLIANCE COMES INTO THIS 352 00:13:23,440 --> 00:13:26,680 CONVERSATION. SO WHERE ARE THE 353 00:13:26,680 --> 00:13:31,560 NAZI CONCENTRATION CAMP SET OF 354 00:13:31,560 --> 00:13:32,120 EXPERIMENTS AND EXAMPLE OF 355 00:13:32,120 --> 00:13:34,360 NONCOMPLIANCE SINCE THE NUR REM 356 00:13:34,360 --> 00:13:35,960 BURG CODE WAS WRITTEN AFTER THE 357 00:13:35,960 --> 00:13:38,280 EXPERIMENTS WERE CONDUCTED? 358 00:13:38,280 --> 00:13:41,280 WELL, ARISTOTLE SAYS THAT HE'S 359 00:13:41,280 --> 00:13:43,800 GAINED FROM PHILOSOPHY THAT HE 360 00:13:43,800 --> 00:13:45,520 DOES WITHOUT BEING COMMANDED 361 00:13:45,520 --> 00:13:46,560 WHAT OTHERS DO ONLY FROM THE 362 00:13:46,560 --> 00:13:49,560 FEAR OF THE LAW. AT A CERTAIN 363 00:13:49,560 --> 00:13:51,200 POINT, THERE'S CERTAIN THINGS 364 00:13:51,200 --> 00:13:52,840 THAT YOU JUST SHOULDN'T DO EVEN 365 00:13:52,840 --> 00:13:55,080 IF THERE'S NOT A LAW THAT 366 00:13:55,080 --> 00:13:55,960 PROHIBITS IT. AND THAT'S SORT 367 00:13:55,960 --> 00:13:59,600 OF WHAT WE'RE LOOKING AT WITH 368 00:13:59,600 --> 00:14:01,640 THE NAZI CONCENTRATION CAMP 369 00:14:01,640 --> 00:14:03,040 EXPERIMENTS SO WHAT IS 370 00:14:03,040 --> 00:14:05,240 COMPLIANCE THEN? WE TALKED 371 00:14:05,240 --> 00:14:06,520 ABOUT ETHICS AS RIGHT AND WRONG. 372 00:14:06,520 --> 00:14:11,920 WHAT IS COMPLIANCE? WELL, 373 00:14:11,920 --> 00:14:13,080 COMPLIANCE IS SIMPLY THE ACTION 374 00:14:13,080 --> 00:14:16,080 OF COMPLYING WITH THE RULE OR 375 00:14:16,080 --> 00:14:18,480 REQUEST. NOW THERE ARE A LOT OF 376 00:14:18,480 --> 00:14:20,160 RULES, ORDERS, REGULATIONS THAT 377 00:14:20,160 --> 00:14:22,800 GOVERN WHAT WE DO IN RESEARCH 378 00:14:22,800 --> 00:14:23,960 INVOLVING HUMAN BEINGS. SO 379 00:14:23,960 --> 00:14:25,360 COMPLIANCE TALKS ABOUT THE ACT 380 00:14:25,360 --> 00:14:28,480 OF FOLLOWING THOSE RULES AND OUR 381 00:14:28,480 --> 00:14:31,720 WORK. SO WE TALKED ABOUT ETHICS 382 00:14:31,720 --> 00:14:33,440 A FEW MINUTES AGO. WHICH IS THE 383 00:14:33,440 --> 00:14:35,600 RIGHT OR WRONG ABOUT HOW WE 384 00:14:35,600 --> 00:14:36,520 INTERACT WITH HUMANS THAT ARE 385 00:14:36,520 --> 00:14:38,800 INVOLVED IN RESEARCH. NOW WE'RE 386 00:14:38,800 --> 00:14:41,120 TALKING ABOUT THE ACT OF 387 00:14:41,120 --> 00:14:46,800 FOLLOWING RULES THAT GOVN -- 388 00:14:46,800 --> 00:14:48,120 GOVERN RESEARCH. SUBTLETIES IN 389 00:14:48,120 --> 00:14:50,560 BOTH OF THOSE BUT I THINK THE 390 00:14:50,560 --> 00:14:51,200 DIFFERENCES ARE BIG ENOUGH TO 391 00:14:51,200 --> 00:14:53,680 TAKE A DEEPER DIVE. IN 392 00:14:53,680 --> 00:14:55,280 ARISTOTLE WE TALK A LITTLE BIT 393 00:14:55,280 --> 00:14:56,640 ABOUT COMPLIANCE THIS IS WHERE I 394 00:14:56,640 --> 00:14:59,920 HAVE AN OPPORTUNITY TO ACCUSE 395 00:14:59,920 --> 00:15:01,440 ARISTOTLE OF DOUBLE TALK, THIS 396 00:15:01,440 --> 00:15:04,480 IS THE TIME I WOULD DO IT. HE 397 00:15:04,480 --> 00:15:06,600 SAYS HE DOES WHAT IS RIGHT 398 00:15:06,600 --> 00:15:07,920 WITHOUT THE FEAR OF THE LAW. 399 00:15:07,920 --> 00:15:11,760 NOW HE GOES ONTO SAY, EVEN THE 400 00:15:11,760 --> 00:15:12,800 BEST OF MEN IN AUTHORITY ARE 401 00:15:12,800 --> 00:15:14,840 LIABLE TO BE CORRUPTED BY 402 00:15:14,840 --> 00:15:17,320 PASSION. SO THEN WE MAY 403 00:15:17,320 --> 00:15:20,600 CONCLUDE THEN THAT THE LAW IS 404 00:15:20,600 --> 00:15:22,440 REASON WITHOUT PASSION. AND IT 405 00:15:22,440 --> 00:15:26,480 IS THEREFORE PREFERABLE TO ANY 406 00:15:26,480 --> 00:15:28,360 INDIVIDUAL. OKAY. SO ABOUT 407 00:15:28,360 --> 00:15:29,880 PHILOSOPHY HE DOES WHAT OTHERS 408 00:15:29,880 --> 00:15:32,000 DO WITH FEAR OF THE LAW BUT SAYS 409 00:15:32,000 --> 00:15:34,160 THE LAW IS PREFERABLE BECAUSE IT 410 00:15:34,160 --> 00:15:35,320 ALLOWS YOU TO HAVE REASON 411 00:15:35,320 --> 00:15:37,800 WITHOUT THE INFLUENCE OF 412 00:15:37,800 --> 00:15:39,680 PASSION. SO AT SOME POINT, WE 413 00:15:39,680 --> 00:15:42,040 HAVE TO THINK ABOUT WHAT IS IT 414 00:15:42,040 --> 00:15:44,040 THAT WE NEED TO PRIORITIZE? OR 415 00:15:44,040 --> 00:15:45,680 IF WE DON'T NEED TO PRIORITIZE 416 00:15:45,680 --> 00:15:48,000 EITHER, OR WE NEED TO FIND 417 00:15:48,000 --> 00:15:49,960 SOMEWAY TO PULL BOTH OF THESE 418 00:15:49,960 --> 00:15:51,480 SORT OF COMPETING THINGS OR AT 419 00:15:51,480 --> 00:15:54,920 LEAST ON THE SURFACE, SEEMINGLY 420 00:15:54,920 --> 00:15:58,400 COMPETING THINGS INTO ONE 421 00:15:58,400 --> 00:16:03,240 GENERALIZABLE THOUGHT. SO LET'S 422 00:16:03,240 --> 00:16:04,960 TURN OUR ATTENTION TO BEECHER. 423 00:16:04,960 --> 00:16:07,360 THIS ARTICLE MANY OF YOU HAVE 424 00:16:07,360 --> 00:16:09,800 READ AND AN ARTICLE I READ OFTEN 425 00:16:09,800 --> 00:16:14,680 TO REFOCUS ME ON WHAT IT IS THAT 426 00:16:14,680 --> 00:16:17,280 IS IMPORTANT TO OUR WORK. HE 427 00:16:17,280 --> 00:16:19,920 WAS A WORLD WAR II PHYSICIAN AND 428 00:16:19,920 --> 00:16:21,800 STUDIED THE NAZI MEDICAL 429 00:16:21,800 --> 00:16:23,720 EXPERIMENTS. HE STUDIED THEM 430 00:16:23,720 --> 00:16:24,880 FOR WHAT THE EXPERIMENTS WERE 431 00:16:24,880 --> 00:16:28,040 DESIGNED TO ACCOMPLISH BUT ALSO 432 00:16:28,040 --> 00:16:31,520 STUDIED THE HORRENDOUS THINKING 433 00:16:31,520 --> 00:16:32,400 BEHIND HUMAN EXPERIMENTATION 434 00:16:32,400 --> 00:16:34,080 THAT WAS DONE IN THE WAY THAT IT 435 00:16:34,080 --> 00:16:36,280 WAS DONE IN NAZI GERMANY AND 436 00:16:36,280 --> 00:16:41,040 DURING THE 50S AND 60S HE BECAME 437 00:16:41,040 --> 00:16:43,400 THE FORERUNNER IN THIS 438 00:16:43,400 --> 00:16:44,920 CONVERSATION ABOUT RUTHLESS 439 00:16:44,920 --> 00:16:46,800 ETHICS AND HE SUSPECTED THAT 440 00:16:46,800 --> 00:16:48,320 PEOPLE IN THE UNITED STATES WERE 441 00:16:48,320 --> 00:16:50,080 KILLED FOR SOME OF THE SAME 442 00:16:50,080 --> 00:16:52,440 THINGS THAT THE NAZI REGIME WERE 443 00:16:52,440 --> 00:16:55,560 GUILTY OF IN NUREMBERG. HE 444 00:16:55,560 --> 00:16:57,280 WROTE THE ARTICLE IN JUNE OF 445 00:16:57,280 --> 00:16:59,240 1966 AND THE ARTICLE SUMMARIZED 446 00:16:59,240 --> 00:17:02,440 22 EXAMPLES OF UNETHICAL HUMAN 447 00:17:02,440 --> 00:17:05,120 SUBJECTS RESEARCH. SO OUR FIRST 448 00:17:05,120 --> 00:17:07,320 QUESTION WE'LL LOOK AT, SO HE 449 00:17:07,320 --> 00:17:11,920 PUBLISHED 22 EXAMPLES IN THIS 450 00:17:11,920 --> 00:17:15,040 EXPOSE. DOCTOR DR. BEECHER ONLY 451 00:17:15,040 --> 00:17:18,080 FIND 22? TURNS OUT THAT 452 00:17:18,080 --> 00:17:19,360 BEECHER'S INITIAL REVIEW WAS 453 00:17:19,360 --> 00:17:21,400 BASED ON 17 STUDIES HE FOUND TO 454 00:17:21,400 --> 00:17:23,440 BE UNETHICAL. 455 00:17:23,440 --> 00:17:26,280 WHEN HE DID REFERENCING HE FOUND 456 00:17:26,280 --> 00:17:29,480 REFERENCES IN THESE 17 THAT LED 457 00:17:29,480 --> 00:17:33,520 HIM TO 50 ADDITIONAL UNETHICAL 458 00:17:33,520 --> 00:17:35,200 STUDIES. WHEN REFERENCING THESE 459 00:17:35,200 --> 00:17:38,320 HE FOUND AN ADDITIONAL 186 460 00:17:38,320 --> 00:17:39,920 POTENTIAL. SO YOU SEE HOW THIS 461 00:17:39,920 --> 00:17:42,680 COULD HAVE CONTINUED TO 462 00:17:42,680 --> 00:17:43,920 SNOWBALL. SO ALTHOUGH HE ONLY 463 00:17:43,920 --> 00:17:46,560 PUBLISHED 22 EXAMPLES, THERE 464 00:17:46,560 --> 00:17:48,200 WERE REFERENCES IN THESE 22 THAT 465 00:17:48,200 --> 00:17:50,520 LED TO POTENTIALLY CLOSE TO 200 466 00:17:50,520 --> 00:17:53,560 AND MAYBE EVEN MORE. SO THIS 467 00:17:53,560 --> 00:17:54,480 WAS SOMETHING THAT AT LEAST IN 468 00:17:54,480 --> 00:17:57,040 THE EYES OF BEECHER WAS NOT 469 00:17:57,040 --> 00:17:58,200 ISOLATED IN AND IT WAS A LOT 470 00:17:58,200 --> 00:18:02,200 MORE PERVASIVE THAN HE HAD 471 00:18:02,200 --> 00:18:07,920 ORIGINALLY THOUGHT. SO WHO DID 472 00:18:07,920 --> 00:18:10,000 DR. BEECH EVERY CALL OUT IN 473 00:18:10,000 --> 00:18:11,800 THESE EXPERIMENTS? THAT WOULD 474 00:18:11,800 --> 00:18:12,880 HAVE WOULD HAVE BEEN THE THING 475 00:18:12,880 --> 00:18:14,840 THAT REALLY MADE THIS JARRING TO 476 00:18:14,840 --> 00:18:16,960 THE MEDICAL COMMUNITY. WELL IT 477 00:18:16,960 --> 00:18:19,240 TURNED OUT HOE DIDN'T MENTION 478 00:18:19,240 --> 00:18:21,800 ANY OF THE INVESTIGATORS OR 479 00:18:21,800 --> 00:18:23,400 INSTITUTIONS. IN FACT THE 480 00:18:23,400 --> 00:18:25,000 ARTICLE ONLY HAD FIVE 481 00:18:25,000 --> 00:18:25,600 REFERENCES. FOUR OF THEM 482 00:18:25,600 --> 00:18:27,000 WEREN'T EVEN FROM THE UNITED 483 00:18:27,000 --> 00:18:28,720 STATES. AND ONE REFERENCE WAS 484 00:18:28,720 --> 00:18:31,560 ACTUALLY AN ARTICLE THAT HE HAD 485 00:18:31,560 --> 00:18:34,120 PREVIOUSLY WRITTEN ABOUT THIS 486 00:18:34,120 --> 00:18:38,520 RESEARCH ETHICS. HIS ARTICLE 487 00:18:38,520 --> 00:18:39,240 WAS NOT TO CALL OUT INDIVIDUALS 488 00:18:39,240 --> 00:18:41,320 OR INSTITUTIONS BUT TO CALL OUT 489 00:18:41,320 --> 00:18:44,880 THE ENTIRE INDUSTRY OF RESEARCH 490 00:18:44,880 --> 00:18:48,000 INVOLVING HUMAN BEINGS. SO WAS 491 00:18:48,000 --> 00:18:50,760 BEECHER JUST THIS ETHICAL 492 00:18:50,760 --> 00:18:52,160 RESEARCH AND HAD A STELLAR 493 00:18:52,160 --> 00:18:53,880 RECORD THAT MOTIVATED HIM TO DO 494 00:18:53,880 --> 00:18:54,960 THIS AND ORIGINALLY THAT'S WHAT 495 00:18:54,960 --> 00:18:56,320 I THOUGHT BUT IT TURNS OUT THAT 496 00:18:56,320 --> 00:18:59,600 WAS ACTUALLY THE OPPOSITE. HE 497 00:18:59,600 --> 00:19:03,600 CONDUCTED A STUDY IN 1948 THAT 498 00:19:03,600 --> 00:19:05,640 DID NOT HAVE BY HIS OWN 499 00:19:05,640 --> 00:19:07,800 ADMISSION DID NOT HAVE ADEQUATE 500 00:19:07,800 --> 00:19:09,560 INFORMED CONSENT SO WHAT BEECHER 501 00:19:09,560 --> 00:19:11,680 REALIZED WAS, SOMEONE THAT 502 00:19:11,680 --> 00:19:15,120 ACTUALLY CONSIDERED THEMSELVES 503 00:19:15,120 --> 00:19:18,040 TO BE AN ETHICAL AND CONSCIOUS 504 00:19:18,040 --> 00:19:19,400 RESEARCHER HAD A SITUATION IN 505 00:19:19,400 --> 00:19:22,120 HIS OWN LAB WHERE ETHICS WERE 506 00:19:22,120 --> 00:19:23,920 COMPROMISED IN THE INTEREST OF 507 00:19:23,920 --> 00:19:28,920 SCIENCE UNBEKNOWNST TO HIM. SO 508 00:19:28,920 --> 00:19:32,000 THESE ARE SOME OF THE EXAMPLES 509 00:19:32,000 --> 00:19:35,520 THAT WERE HIGHLIGHTED IN THE 510 00:19:35,520 --> 00:19:36,480 ARTICLE. TREATMENT WAS 511 00:19:36,480 --> 00:19:37,960 WITHHELD. THERE WERE STUDIES 512 00:19:37,960 --> 00:19:39,640 WHERE THE TREATMENT SIDE EFFECTS 513 00:19:39,640 --> 00:19:42,720 WERE LOOKED AT. SO TREATMENT 514 00:19:42,720 --> 00:19:45,040 WOULD BE GIVEN JUST TO SEE IF 515 00:19:45,040 --> 00:19:46,400 THE SIDE EFFECTS WOULD HARM THEM 516 00:19:46,400 --> 00:19:47,920 AND TO THE DEGREE THAT IT WOULD 517 00:19:47,920 --> 00:19:49,440 HARM THEM SO SOME OF THESE 518 00:19:49,440 --> 00:19:51,120 STUDIES WERE DONE WHERE YOU KNEW 519 00:19:51,120 --> 00:19:52,600 THE TREATMENT WOULD HAVE SIDE 520 00:19:52,600 --> 00:19:55,360 EFFECTS SO YOU GAVE MORE OF THE 521 00:19:55,360 --> 00:19:56,000 TREATMENT IN ORDER TO SEE IF IT 522 00:19:56,000 --> 00:19:57,560 WOULD INCREASE THE SIDE EFFECTS. 523 00:19:57,560 --> 00:19:59,160 THERE WERE STUDIES WHERE 524 00:19:59,160 --> 00:20:01,960 DISEASES WERE ACTUALLY INJECTED 525 00:20:01,960 --> 00:20:03,640 INTO INDIVIDUALS, WILLOWBROOK 526 00:20:03,640 --> 00:20:05,360 WITH HEPATITIS. THERE WERE ALSO 527 00:20:05,360 --> 00:20:07,040 STUDIES WHERE INJECTING 528 00:20:07,040 --> 00:20:11,200 SOMETHING TO TRIGGER THE DISEASE 529 00:20:11,200 --> 00:20:15,680 AND THERE WERE STUDIES WITH 530 00:20:15,680 --> 00:20:17,480 ANESTHESIA WHERE IT WAS GIVEN TO 531 00:20:17,480 --> 00:20:21,120 CAUSE HEART ATTACKS AND THEN YOU 532 00:20:21,120 --> 00:20:23,920 HAD DELIBERATE STIMULATION ON 533 00:20:23,920 --> 00:20:25,080 ORGANS AND TISSUES. SO THERE 534 00:20:25,080 --> 00:20:27,080 WERE DICEY STUDIES THAT WERE 535 00:20:27,080 --> 00:20:27,720 BROUGHT OUT AND MENTIONED IN 536 00:20:27,720 --> 00:20:30,360 THIS ARTICLE AND THESE ARE SOME 537 00:20:30,360 --> 00:20:32,760 SPECIFIC ARTICLES. THERE'S 538 00:20:32,760 --> 00:20:35,800 PLACEBO-CONTROLLED STUDIES OF 539 00:20:35,800 --> 00:20:37,640 STREP THROAT EVEN THOUGH 540 00:20:37,640 --> 00:20:41,240 PENICILLIN WAS GIVEN TO CURE AND 541 00:20:41,240 --> 00:20:42,920 TREAT STREP THROAT. TYPHOID 542 00:20:42,920 --> 00:20:44,840 FEVER INDIVIDUALS WERE FOLLOWED 543 00:20:44,840 --> 00:20:46,040 TO SEE WHAT WOULD HAPPEN IF YOU 544 00:20:46,040 --> 00:20:47,880 DIDN'T TREATMENT. THERE WERE 545 00:20:47,880 --> 00:20:50,200 ACNE STUDIES GIVEN TO THE TERM 546 00:20:50,200 --> 00:20:51,680 THEY WERE GIVEN AT THE TIME 547 00:20:51,680 --> 00:20:55,440 MENTALLY RETARDED JUVENILE 548 00:20:55,440 --> 00:20:57,360 DELINQUENT AND THIS IS THE 549 00:20:57,360 --> 00:20:58,880 LANGUAGE DIRECTLY FROM THE 550 00:20:58,880 --> 00:21:00,560 ARTICLE AND THESE INDIVIDUALS 551 00:21:00,560 --> 00:21:02,360 ARE VULNERABLE FOR MANY REASONS 552 00:21:02,360 --> 00:21:03,680 AND WERE GIVEN TEST ARTICLES 553 00:21:03,680 --> 00:21:05,200 THAT WERE NOT REALLY FOR ACNE 554 00:21:05,200 --> 00:21:06,640 BUT THAT WAS THE ONLY THING THAT 555 00:21:06,640 --> 00:21:08,600 THESE INDIVIDUALS HAD IN COMMON 556 00:21:08,600 --> 00:21:09,480 AND THEN THESE OTHER STUDIES 557 00:21:09,480 --> 00:21:13,520 THAT I MENTIONED BEFORE. SO 558 00:21:13,520 --> 00:21:15,400 THIS ARTICLE TALKED ABOUT SOME 559 00:21:15,400 --> 00:21:16,800 OF THE THINGS THAT MAKE US THE 560 00:21:16,800 --> 00:21:21,400 MOST NERVOUS ABOUT RESEARCH. IN 561 00:21:21,400 --> 00:21:31,920 HUMAN BEINGS. THIS WAS VERY, 562 00:21:39,960 --> 00:21:43,560 VERY ALARMING. SUBJECT ASSIGN 563 00:21:43,560 --> 00:21:43,880 ME 564 00:21:43,880 --> 00:21:48,760 ASSIGNMENT WERE EXPOSED TO RISK 565 00:21:48,760 --> 00:21:49,720 UNNECESSARILY. AND THEN THE BIG 566 00:21:49,720 --> 00:21:52,840 ONE T LACK OF ADEQUATE INFORMED 567 00:21:52,840 --> 00:21:53,120 CONSENT. 568 00:21:53,120 --> 00:21:55,000 SO THIS ARTICLE BROUGHT UP ALL 569 00:21:55,000 --> 00:21:57,280 THESE THINGS WE KNOW TO BE 570 00:21:57,280 --> 00:21:59,920 UNETHICAL IN OUR WORK IN DOING 571 00:21:59,920 --> 00:22:02,680 RESEARCH INVOLVING HUMAN BEINGS. 572 00:22:02,680 --> 00:22:09,240 ALL RIGHT. SO THE ARTICLE WAS 573 00:22:09,240 --> 00:22:11,640 ABOUT ETHICS. OKAY, BEECHER, 574 00:22:11,640 --> 00:22:13,160 WHAT ABOUT COMPLIANCE? WHERE 575 00:22:13,160 --> 00:22:14,520 DOES COMPLIANCE FIT INTO ALL OF 576 00:22:14,520 --> 00:22:17,280 THIS? WHERE DO THE RULES FIT 577 00:22:17,280 --> 00:22:18,920 IN? WHERE DO THE REGULATIONS 578 00:22:18,920 --> 00:22:21,440 FIT IN? WHERE DO THE ORDERS FIT 579 00:22:21,440 --> 00:22:23,040 INTO THIS CONVERSATION? BECAUSE 580 00:22:23,040 --> 00:22:25,120 THE UNETHICAL RESEARCH THAT'S 581 00:22:25,120 --> 00:22:27,480 BEING DONE IS HIGHLIGHTED BY 582 00:22:27,480 --> 00:22:30,720 BEECHER AS AN EXPOSE SO HOW DOES 583 00:22:30,720 --> 00:22:31,880 COMPLIANCE TAP INTO THIS 584 00:22:31,880 --> 00:22:32,440 CONVERSATION? 585 00:22:32,440 --> 00:22:33,760 WELL, IT TURNS OUT THAT THE 586 00:22:33,760 --> 00:22:39,080 RESPONSE TO THE BEECHER ARTICLE 587 00:22:39,080 --> 00:22:42,480 WERE SUBSTANTIAL. 1966 YOU HAVE 588 00:22:42,480 --> 00:22:49,680 THE U.S. SURGEON GENERAL POLICY 589 00:22:49,680 --> 00:22:51,240 STATEMENT. ALL SUBJECTS TO 590 00:22:51,240 --> 00:22:52,680 REVIEW THE INDEPENDENT 591 00:22:52,680 --> 00:22:55,000 PROSPECTIVE REVIEW. INFORMED 592 00:22:55,000 --> 00:22:57,360 CONSENT. NATIONAL RESEARCH ACT. 593 00:22:57,360 --> 00:23:02,040 PUBLIC LAW 93-348, FIRST SET OF 594 00:23:02,040 --> 00:23:05,040 OVERARCHING REGS. THE BELMONT 595 00:23:05,040 --> 00:23:06,720 REPORT. THE FIRST SET OF 596 00:23:06,720 --> 00:23:07,880 REGULATIONS TO ESTABLISH THE 597 00:23:07,880 --> 00:23:10,080 RULE SO THE RESPONSE TO BEECHER 598 00:23:10,080 --> 00:23:12,640 WHICH BROUGHT OUT UNETHICAL 599 00:23:12,640 --> 00:23:15,800 EXAMPLES OF RESEARCH. THE 600 00:23:15,800 --> 00:23:18,200 RESPONSE WAS LET'S PROVIDE SOME 601 00:23:18,200 --> 00:23:21,840 RULES THAT GOVERN THE RESEARCH. 602 00:23:21,840 --> 00:23:23,920 SO NOW WE HAVE UNETHICAL 603 00:23:23,920 --> 00:23:27,800 RESEARCH RESPONDED TO BY MORE 604 00:23:27,800 --> 00:23:31,320 REGULATIONS AND MORE COMPLIANCE. 605 00:23:31,320 --> 00:23:33,120 SO, WAS THAT THE PURPOSE OF 606 00:23:33,120 --> 00:23:36,280 BEECHER'S ARTICLE TO ENCOURAGE 607 00:23:36,280 --> 00:23:37,560 THE CLINICAL RESEARCH REGIME IN 608 00:23:37,560 --> 00:23:40,080 PARTICULAR TO INCREASE 609 00:23:40,080 --> 00:23:43,720 REGULATION AND OVERSIGHT? WELL, 610 00:23:43,720 --> 00:23:46,960 IT TURNS OUT, THAT THAT WOULD BE 611 00:23:46,960 --> 00:23:49,560 ANSWERED BY HOW ALL OF THIS 612 00:23:49,560 --> 00:23:51,040 PLAYED OUT BEFORE THE ARTICLE 613 00:23:51,040 --> 00:23:52,920 AND AFTER. SO LET'S LOOK AT 614 00:23:52,920 --> 00:23:55,680 BEFORE THE REGULATIONS. SO 615 00:23:55,680 --> 00:23:59,760 LET'S LOOK AT WHAT HAPPENED AT 616 00:23:59,760 --> 00:24:01,600 NUREMBERG AND THE ETHICAL 617 00:24:01,600 --> 00:24:03,080 CONSIDERATIONS THAT HAPPENED IN 618 00:24:03,080 --> 00:24:06,200 THE CONCENTRATION CAMPS. WAS 619 00:24:06,200 --> 00:24:09,320 THIS MEDICAL NECESSITY? 620 00:24:09,320 --> 00:24:09,920 SCIENTIFIC MERIT? BENEFITTED 621 00:24:09,920 --> 00:24:15,840 THE AXIS PERSONNEL AND THE 622 00:24:15,840 --> 00:24:18,920 JUSTIFICATION OF ARYAN 623 00:24:18,920 --> 00:24:20,880 SUPREMACY. THERE WAS NO 624 00:24:20,880 --> 00:24:22,280 SCIENTIFIC MERIT THAT HAD MERIT 625 00:24:22,280 --> 00:24:25,800 TO ALL OF SCIENCE. AND 626 00:24:25,800 --> 00:24:27,840 DEFINITELY NOT MEDICAL NECESSITY 627 00:24:27,840 --> 00:24:29,160 FOR INDIVIDUALS THAT WOULD BE 628 00:24:29,160 --> 00:24:32,640 PART OF THIS AUTONOMY. OF 629 00:24:32,640 --> 00:24:33,840 COURSE THERE WAS NONE. EVERYONE 630 00:24:33,840 --> 00:24:35,960 IN THESE EXPERIMENTS WERE 631 00:24:35,960 --> 00:24:38,520 PRISONERS, THEY HAD NO RIGHTS AT 632 00:24:38,520 --> 00:24:39,080 HUMAN BEINGS AND THEY WERE 633 00:24:39,080 --> 00:24:41,920 TREATED AND INTERACTED WITH AS 634 00:24:41,920 --> 00:24:43,880 SUCH. THE CONCEPT OF DOING NO 635 00:24:43,880 --> 00:24:46,800 HARM, WELL, OF COURSE, HARM WAS 636 00:24:46,800 --> 00:24:48,720 DONE. ALL THE RESEARCH SUBJECTS 637 00:24:48,720 --> 00:24:51,840 WERE SEVERELY INJURED OR 638 00:24:51,840 --> 00:24:53,560 MURDERED. NOBODY GOT OUT OF 639 00:24:53,560 --> 00:24:54,840 THESE CONCENTRATION CAMPS UP 640 00:24:54,840 --> 00:24:57,840 SCATHED SO THE CONCEPT OF 641 00:24:57,840 --> 00:24:59,720 ETHICAL PRINCIPLE WAS VIOLATED 642 00:24:59,720 --> 00:25:02,880 WITH IMPUNITY. DO GOOD? WELL, 643 00:25:02,880 --> 00:25:03,960 THERE'S NO GOOD DONE HERE. NONE 644 00:25:03,960 --> 00:25:06,440 OF THE EXPERIMENTS HAVE ANY 645 00:25:06,440 --> 00:25:09,320 PROSPECT FOR SUBJECT OR GREATER 646 00:25:09,320 --> 00:25:10,360 GOOD BENEFIT IT WAS TO BENEFIT A 647 00:25:10,360 --> 00:25:12,280 CERTAIN GROUP OF PEOPLE AND TO 648 00:25:12,280 --> 00:25:15,840 BENEFIT A NOTION FROM A CERTAIN 649 00:25:15,840 --> 00:25:18,320 STANCE THAT WAS DEFINITELY 650 00:25:18,320 --> 00:25:21,880 COMING FROM A STANCE OF 651 00:25:21,880 --> 00:25:23,520 SUPREMACY AND A STANCE OF 652 00:25:23,520 --> 00:25:25,240 ESTABLISHING INFERIORITY OF 653 00:25:25,240 --> 00:25:27,160 OTHERS AND LASTLY JUSTICE. OF 654 00:25:27,160 --> 00:25:29,960 COURSE THERE WAS NO JUSTICE 655 00:25:29,960 --> 00:25:36,800 HERE. ONLY USED THE PRISON -- 656 00:25:36,800 --> 00:25:37,600 PRISONERS AND THEY TOOK ON ALL 657 00:25:37,600 --> 00:25:39,240 THE RISK AND NONE OF THE 658 00:25:39,240 --> 00:25:39,920 BENEFIT. THERE'S ANOTHER 659 00:25:39,920 --> 00:25:41,440 INSTANCE THAT WE PROBABLY NEED 660 00:25:41,440 --> 00:25:43,040 TO LOOK AT THAT OCCURRED PRIOR 661 00:25:43,040 --> 00:25:45,560 TO THE BEECHER ARTICLE AND THEN 662 00:25:45,560 --> 00:25:46,680 EXTENDED A LITTLE BIT AFTER THE 663 00:25:46,680 --> 00:25:48,040 BEECHER ARTICLE WAS WRITTEN. 664 00:25:48,040 --> 00:25:51,880 AND THAT IS THE STUDY OF 665 00:25:51,880 --> 00:25:53,840 UNTREATED SYPHILIS IN THE NEGRO 666 00:25:53,840 --> 00:25:55,920 MALES. SINCE THEN IT WAS UP 667 00:25:55,920 --> 00:25:57,720 UPDATED TO THE REFERENCE OF THE 668 00:25:57,720 --> 00:25:59,920 INVOLVEMENT OF THE PUBLIC HEALTH 669 00:25:59,920 --> 00:26:03,080 SERVICE AND KNOWN AS THE U.S. 670 00:26:03,080 --> 00:26:05,360 PUBLIC HEALTH STUDY OF UNTREATED 671 00:26:05,360 --> 00:26:06,800 SYPHILIS AND THIS WAS A STUDY 672 00:26:06,800 --> 00:26:08,880 DONE BY A GROUP OF RESEARCHERS 673 00:26:08,880 --> 00:26:11,080 THAT HAD PREVIOUSLY INTERACTED 674 00:26:11,080 --> 00:26:15,160 WITH A COMMUNITY THAT WAS -- HAD 675 00:26:15,160 --> 00:26:19,920 VERY HIGH INCIDENCE OF SYPHILIS, 676 00:26:19,920 --> 00:26:23,280 40%. AND ONCE THEY RAN OUT OF 677 00:26:23,280 --> 00:26:25,000 MONEY TO GIVE TREATMENT THEY 678 00:26:25,000 --> 00:26:26,960 CAME BACK UNDER THE GUISE THAT 679 00:26:26,960 --> 00:26:28,960 THEY WERE CONTINUES TO TREAT 680 00:26:28,960 --> 00:26:30,840 THEM BUT THEY WERE ACTUALLY 681 00:26:30,840 --> 00:26:31,920 FOLLOWING THEM UNTREATED. 682 00:26:31,920 --> 00:26:35,040 AND THEY NEVER TOLD THE 683 00:26:35,040 --> 00:26:35,840 INDIVIDUALS THAT THEIR PURPOSE 684 00:26:35,840 --> 00:26:37,480 THERE HAD SHIFTED FROM TRYING TO 685 00:26:37,480 --> 00:26:41,400 TREAT THEM TO NOW WATCHING THEM 686 00:26:41,400 --> 00:26:43,000 UNTREATED. THE MINDSET DURING 687 00:26:43,000 --> 00:26:48,240 THIS TIME THE DOCTOR ROW 688 00:26:48,240 --> 00:26:50,400 REFLECTED THIS HE SAID THE 689 00:26:50,400 --> 00:26:51,920 SITUATION WAS IF YOU WERE SICK, 690 00:26:51,920 --> 00:26:53,360 AND YOU WERE A BLACK AMERICAN 691 00:26:53,360 --> 00:26:55,840 DURING THIS TIME, THE SCIENTIFIC 692 00:26:55,840 --> 00:26:56,600 COMMUNITY THOUGHT YOU WERE 693 00:26:56,600 --> 00:26:59,920 BETTER OFF SERVING THE 694 00:26:59,920 --> 00:27:02,120 SCIENTIFIC COMMUNITY AS SUBJECTS 695 00:27:02,120 --> 00:27:03,720 AND PARTICIPANTS AND RESEARCH 696 00:27:03,720 --> 00:27:04,320 EXPERIMENTS. 697 00:27:04,320 --> 00:27:08,480 SO EVEN THE MINDSET AROUND THIS 698 00:27:08,480 --> 00:27:10,520 WAS ONE OF LESS IMPORTANCE WAS 699 00:27:10,520 --> 00:27:11,760 ASSIGNED TO THIS POPULATION AND 700 00:27:11,760 --> 00:27:13,760 THIS RESEARCH WAS CONDUCTED IN A 701 00:27:13,760 --> 00:27:15,760 WAY THAT THAT LACK OF IMPORTANCE 702 00:27:15,760 --> 00:27:17,800 WAS EVIDENT THROUGHOUT THE 703 00:27:17,800 --> 00:27:19,880 ENTIRE STUDY. BUT LET'S LOOK AT 704 00:27:19,880 --> 00:27:22,520 THAT FROM A SCIENTIFIC 705 00:27:22,520 --> 00:27:25,040 STANDPOINT AND AN ETHICAL 706 00:27:25,040 --> 00:27:27,640 STANDPOINT. SO MEDICAL 707 00:27:27,640 --> 00:27:29,880 NECESSITY. THERE WAS MEDICAL 708 00:27:29,880 --> 00:27:31,920 NECESSITY FOR THIS STUDY. IN 709 00:27:31,920 --> 00:27:33,920 THE FACT THAT THERE NEEDED TO BE 710 00:27:33,920 --> 00:27:42,960 A RACIAL COMPARE TEAR, UNED 711 00:27:42,960 --> 00:27:45,120 SYPHILIS HAS BEEN LOOKED AT IN 712 00:27:45,120 --> 00:27:47,120 WHITE MALES AND HAD MORE 713 00:27:47,120 --> 00:27:47,920 NEUROLOGICAL SIDE EFFECTS 714 00:27:47,920 --> 00:27:50,000 WHEREAS BLACK MALES SHOW MORE 715 00:27:50,000 --> 00:27:53,240 CARDIAC EVENTS AND THEN ALSO IT 716 00:27:53,240 --> 00:27:54,960 WAS -- THERE WAS SCIENTIFIC 717 00:27:54,960 --> 00:27:57,000 MERIT BECAUSE THE INDIVIDUALS IN 718 00:27:57,000 --> 00:27:58,120 THE STUDY HAD NO TREATMENT AT 719 00:27:58,120 --> 00:28:00,480 ALL AND THEN DEVELOPED NO 720 00:28:00,480 --> 00:28:02,760 SYMPTOMS OF SYPHILIS, IN FACT, 721 00:28:02,760 --> 00:28:04,680 MANY OF THEM ACTUALLY HAD BETTER 722 00:28:04,680 --> 00:28:06,080 HEALTH OUTCOMES THAN THE ONES 723 00:28:06,080 --> 00:28:07,000 THAT THEY ACTUALLY TRIED TO 724 00:28:07,000 --> 00:28:08,520 TREAT SO THERE WAS A QUESTION 725 00:28:08,520 --> 00:28:10,720 OUT THERE ABOUT CAN SYPHILIS BE 726 00:28:10,720 --> 00:28:11,840 BETTER MANAGED IF YOU DON'T 727 00:28:11,840 --> 00:28:15,600 TREAT IT AT ALL? SO THE 728 00:28:15,600 --> 00:28:16,560 SCIENTIFIC QUESTION WAS AN 729 00:28:16,560 --> 00:28:18,280 IMPORTANT ONE TO HAVE AND PLUS 730 00:28:18,280 --> 00:28:20,960 SYPHILIS WAS AN STD AND THE 731 00:28:20,960 --> 00:28:21,840 PUBLIC HEALTH KNEW THE 732 00:28:21,840 --> 00:28:23,080 RESPONSIBLE THING TO DO WAS TO 733 00:28:23,080 --> 00:28:24,480 ANSWER QUESTIONS SURROUNDING IT. 734 00:28:24,480 --> 00:28:26,840 IN TERMS OF THE TIMING THE ENTRY 735 00:28:26,840 --> 00:28:29,040 INTO THE STUDY WAS VOLUNTARY BUT 736 00:28:29,040 --> 00:28:30,680 IT ACTUALLY WASN'T. THEY 737 00:28:30,680 --> 00:28:31,920 THOUGHT THAT THEY WERE ENTERING 738 00:28:31,920 --> 00:28:33,360 A TREATMENT PROGRAM. THEY DID 739 00:28:33,360 --> 00:28:35,000 NOT KNOW THEY WERE ENTERING A 740 00:28:35,000 --> 00:28:36,000 RESEARCH STUDY SO IT WAS 741 00:28:36,000 --> 00:28:39,480 DECEPTION AND THERE'S NO WAY YOU 742 00:28:39,480 --> 00:28:45,920 CAN HAVE THAT WITH DECEPTION. 743 00:28:45,920 --> 00:28:47,840 DO GOOD, THE BENEFITS WERE 744 00:28:47,840 --> 00:28:49,360 PRESENTED TO THEM IF THEY STAYED 745 00:28:49,360 --> 00:28:51,520 IN THE STUDY THEY WOULD GET FREE 746 00:28:51,520 --> 00:28:54,320 ROOM AND BOARD. SO GOOD 747 00:28:54,320 --> 00:28:55,600 HEALTH-WISE WAS NOT THERE BUT 748 00:28:55,600 --> 00:28:57,840 THEY SORT OF MASKED THESE 749 00:28:57,840 --> 00:28:59,440 BENEFITS BY TALKING ABOUT OTHER 750 00:28:59,440 --> 00:29:00,880 BENEFITS THEY KNEW THIS 751 00:29:00,880 --> 00:29:02,000 POPULATION WOULD REALLY LIKE BUT 752 00:29:02,000 --> 00:29:03,320 IN TERMS OF JUSTICE THAT'S WHERE 753 00:29:03,320 --> 00:29:04,920 THE STUDY REALLY FAILED BECAUSE 754 00:29:04,920 --> 00:29:07,920 IN TERMS OF SOCIAL JUSTICE, 755 00:29:07,920 --> 00:29:10,680 DIGNITY AND RESPECT, IT WAS 756 00:29:10,680 --> 00:29:11,880 NONEXISTENT IN THIS POPULATION 757 00:29:11,880 --> 00:29:14,840 AND SO THE ETHICS OF THE STUDY 758 00:29:14,840 --> 00:29:18,720 WERE MARGINAL AND THE ETHICS 759 00:29:18,720 --> 00:29:22,000 WERE IN A SITUATION WHERE 760 00:29:22,000 --> 00:29:24,440 NOTHING GOOD FROM ETHICS 761 00:29:24,440 --> 00:29:25,240 STANDPOINT COULD COME OUT OF 762 00:29:25,240 --> 00:29:27,760 THIS RESEARCH. BUT LET'S FAST 763 00:29:27,760 --> 00:29:29,600 FORWARD IT TO AFTER THE 764 00:29:29,600 --> 00:29:34,400 REGULATIONS AND AS RECENTLY AS 765 00:29:34,400 --> 00:29:38,160 2015/16 THERE WAS A STUDY OF 766 00:29:38,160 --> 00:29:38,920 INTERNAL MEDICINE INTERNS SO 767 00:29:38,920 --> 00:29:43,080 FIRST YEAR RESIDENTS. AND THE 768 00:29:43,080 --> 00:29:46,080 STUDY WAS TO SEE IF FIRST YEAR 769 00:29:46,080 --> 00:29:47,840 RESIDENTS COULD TAKE ON THE SAME 770 00:29:47,840 --> 00:29:49,760 WORKLOAD AS RESIDENTS IN THEIR 771 00:29:49,760 --> 00:29:51,000 SECOND, THIRD OR FOURTH YEAR AND 772 00:29:51,000 --> 00:29:54,960 WHAT THEY DID WAS THEY EXPOSED 773 00:29:54,960 --> 00:29:55,920 THESE RESIDENTS TO VERY, VERY 774 00:29:55,920 --> 00:29:59,400 LONG HOURS. VERY, VERY LONG 775 00:29:59,400 --> 00:30:03,840 HOURS AND THEY WERE OBSERVED 776 00:30:03,840 --> 00:30:05,280 TAKING ON THESE LONG HOURS FROM 777 00:30:05,280 --> 00:30:09,440 A REGULATORY STANDPOINT MANY DID 778 00:30:09,440 --> 00:30:10,920 NOT PARTICIPATE IN THIS RESEARCH 779 00:30:10,920 --> 00:30:14,440 AND AT THE MOST IT WOULD GET AN 780 00:30:14,440 --> 00:30:15,280 EXPEDITED REVIEW FROM ONE THAT 781 00:30:15,280 --> 00:30:17,080 WAS PART OF THE STUDY. LET'S 782 00:30:17,080 --> 00:30:19,880 LOOK AT THE ETHICAL 783 00:30:19,880 --> 00:30:21,680 CONSIDERATIONS. THE MEDICAL 784 00:30:21,680 --> 00:30:22,280 NECESSITY, THERE WAS CONCERN 785 00:30:22,280 --> 00:30:24,560 THAT INFLEXIBLE DUTY HOUR RULES 786 00:30:24,560 --> 00:30:26,560 IN MEDICAL RESIDENCY PROGRAMS 787 00:30:26,560 --> 00:30:28,480 WOULD ADVERSELY AFFECT THE 788 00:30:28,480 --> 00:30:30,120 TRAINING OF PHYSICIANS SO THEY 789 00:30:30,120 --> 00:30:30,720 NEEDED TO FIGURE OUT IF THERE 790 00:30:30,720 --> 00:30:34,160 WAS A WAY TO LOOK AT THOSE 791 00:30:34,160 --> 00:30:38,880 RULES. A AUTONOMY, NOT REALLY 792 00:30:38,880 --> 00:30:40,320 THESE RESIDENTS WERE VOLUNTARY 793 00:30:40,320 --> 00:30:42,520 IN THESE STUDIES AND SAID IF YOU 794 00:30:42,520 --> 00:30:43,960 WANT TO BE PART OF THIS 795 00:30:43,960 --> 00:30:46,200 RESIDENCY PROGRAM YOU HAVE TO BE 796 00:30:46,200 --> 00:30:48,560 PART OF THIS STUDY. DO NO HARM. 797 00:30:48,560 --> 00:30:51,680 BECAUSE OF THESE LONG HOURS 798 00:30:51,680 --> 00:30:53,680 THESE INDIVIDUALS EXPERIENCED 799 00:30:53,680 --> 00:30:55,760 PATIENT ERRORS BECAUSE OF 800 00:30:55,760 --> 00:30:57,240 PHYSICAL FATIGUE. THE RESIDENTS 801 00:30:57,240 --> 00:30:59,240 AND THE PATIENTS THEY TREATED 802 00:30:59,240 --> 00:31:00,800 WERE ALSO SUBJECT TO HARM AS 803 00:31:00,800 --> 00:31:03,360 WELL AND THEN DO GOOD. THE 804 00:31:03,360 --> 00:31:05,440 BENEFITS WERE REALLY TO TALK 805 00:31:05,440 --> 00:31:09,920 ABOUT HOW THEY WOULD STAND UP TO 806 00:31:09,920 --> 00:31:11,200 STANDARDS. AND NOT REALLY HOW 807 00:31:11,200 --> 00:31:14,600 THEY WOULD BE ABLE TO IMPACT THE 808 00:31:14,600 --> 00:31:15,920 PROFESSIONAL. SO LET'S LOOK AT 809 00:31:15,920 --> 00:31:18,320 THIS A LITTLE BIT MORE. SO DO 810 00:31:18,320 --> 00:31:21,640 WE HAVE OUR ANSWER YET? SHOULD 811 00:31:21,640 --> 00:31:23,240 THERE BE MORE ETHICS OR 812 00:31:23,240 --> 00:31:25,280 COMPLIANCE? SO THE REGULATIONS 813 00:31:25,280 --> 00:31:27,040 WERE WRITTEN IN LIGHT OF 814 00:31:27,040 --> 00:31:29,120 UNETHICAL RESEARCH. SO THE 815 00:31:29,120 --> 00:31:31,640 COMPLIANCE CAME IN THE ABSENCE 816 00:31:31,640 --> 00:31:34,880 OF THIS. THINGS LIKE COERCION, 817 00:31:34,880 --> 00:31:38,160 UNDUE INFLUENCE, DECEPTION, 818 00:31:38,160 --> 00:31:39,920 HARM, CAN FOCUS ON COMPLIANCE 819 00:31:39,920 --> 00:31:42,080 WITH REGULATIONS ALONE 820 00:31:42,080 --> 00:31:44,040 ADEQUATELY ADDRESS THE 821 00:31:44,040 --> 00:31:46,160 MEANINGFUL PROTECTION OF HUMAN 822 00:31:46,160 --> 00:31:49,920 SUBJECTS IN -- PARTICULARLY IN 823 00:31:49,920 --> 00:31:51,680 CLINICAL RESEARCH? SO LET'S 824 00:31:51,680 --> 00:31:55,680 LOOK AT WHAT BEECHER WAS REALLY 825 00:31:55,680 --> 00:31:57,560 TRYING TO TELL US. BEECHER 826 00:31:57,560 --> 00:31:59,280 SAID, THE INVESTIGATOR REALLY 827 00:31:59,280 --> 00:32:03,120 HOLDS THE KEY TO THIS, HE SAID 828 00:32:03,120 --> 00:32:09,560 THAT THE INVESTIGATOR -- TMORE 829 00:32:09,560 --> 00:32:11,920 RELIABLE SAFEGUARD IS THE 830 00:32:11,920 --> 00:32:16,520 PRESENCE OF AN INTELLIGENT 831 00:32:16,520 --> 00:32:18,480 INVESTIGATOR SO IF THE 832 00:32:18,480 --> 00:32:20,040 INVESTIGATOR IS ETHICAL THEN THE 833 00:32:20,040 --> 00:32:22,600 RESEARCH SHOULD FOLLOW IN AN 834 00:32:22,600 --> 00:32:25,000 ETHICAL WAY. AND HE ASSERTED 835 00:32:25,000 --> 00:32:27,920 THE RESEARCHERS ARE REALLY NOT 836 00:32:27,920 --> 00:32:29,800 MALICIOUS OR EVIL BUT THEY'RE, 837 00:32:29,800 --> 00:32:31,480 RATHER, THOUGHTLESS OR CARELESS 838 00:32:31,480 --> 00:32:33,880 SO THESE INCIDENTS OF UNETHICAL 839 00:32:33,880 --> 00:32:35,920 RESEARCH WERE NOT OKAY, 840 00:32:35,920 --> 00:32:36,560 INDIVIDUALS TRYING TO 841 00:32:36,560 --> 00:32:38,960 NECESSARILY DO HARM. IN SOME OF 842 00:32:38,960 --> 00:32:41,920 THE CASES THERE WAS EGREGIOUS 843 00:32:41,920 --> 00:32:43,160 MALICIOUS OR EVIL BUT SOME 844 00:32:43,160 --> 00:32:45,480 SITUATIONS WHERE THE PURSUIT OF 845 00:32:45,480 --> 00:32:46,960 ANSWERING THE QUESTION TOOK 846 00:32:46,960 --> 00:32:48,640 PRECEDENT OVER THE NEED TO 847 00:32:48,640 --> 00:32:51,920 PROTECT DIGNITY AND THE RESPECT 848 00:32:51,920 --> 00:32:53,920 OF INDIVIDUALS. BEECHER SAID 849 00:32:53,920 --> 00:32:55,560 THERE NEEDS TO BE MORE SELF 850 00:32:55,560 --> 00:32:56,800 SCRUTINY RATHER THAN PUBLIC 851 00:32:56,800 --> 00:32:58,840 REVIEW THAT'S ONE OF THE REASONS 852 00:32:58,840 --> 00:33:01,160 HE DIDN'T CITE ANY OF THE 853 00:33:01,160 --> 00:33:03,640 INVESTIGATORS IN HIS EXPOSE AND 854 00:33:03,640 --> 00:33:05,800 SAID THAT THE PROFESSION OF 855 00:33:05,800 --> 00:33:07,880 HUMAN SUBJECTS RESEARCH DID NOT 856 00:33:07,880 --> 00:33:09,720 NEED MORE OUTSIDE REGULATION. 857 00:33:09,720 --> 00:33:13,840 BUT BETTER MECHANISMS FOR 858 00:33:13,840 --> 00:33:14,840 SELF-REGULATION, SELF-POLICING 859 00:33:14,840 --> 00:33:17,080 AND ETHICAL DECISION-MAKING HE 860 00:33:17,080 --> 00:33:24,320 QUESTION -- DESIRED TO ROCK THE 861 00:33:24,320 --> 00:33:24,960 PROFES 862 00:33:24,960 --> 00:33:25,360 PROFESSION. 863 00:33:25,360 --> 00:33:27,000 REGULATIONS ARE THE FLOOR BUT 864 00:33:27,000 --> 00:33:28,640 THERE ISN'T ANY SUBSTITUTE OF 865 00:33:28,640 --> 00:33:31,800 GOOD JUDGMENT SO THAT'S WHERE WE 866 00:33:31,800 --> 00:33:33,520 SEE THE CONVERSIONINGS, 867 00:33:33,520 --> 00:33:35,840 REGULATIONS CREATE A FOUNDATION 868 00:33:35,840 --> 00:33:38,800 OF HOW WE FOLLOW A SET OF 869 00:33:38,800 --> 00:33:40,840 GUIDELINES. BUT WE HAVE TO DO 870 00:33:40,840 --> 00:33:42,280 THAT IN CONCERT WITH THE 871 00:33:42,280 --> 00:33:43,120 JUDGMENT. THAT'S WHERE THE 872 00:33:43,120 --> 00:33:45,120 ETHICAL DECISION-MAKING COMES 873 00:33:45,120 --> 00:33:47,480 IN. THERE'S SO MANY TIMES WHERE 874 00:33:47,480 --> 00:33:49,200 WE -- WHERE SOMETHING COMES UP 875 00:33:49,200 --> 00:33:50,360 IN HUMAN SUBJECT RESEARCH THAT 876 00:33:50,360 --> 00:33:51,960 THERE'S NOT A REGULATION THAT 877 00:33:51,960 --> 00:33:54,560 DIRECTLY ADDRESSES IT AND AT 878 00:33:54,560 --> 00:33:56,480 THAT POINT THAT'S WHERE THE GOOD 879 00:33:56,480 --> 00:34:01,800 JUDGMENT IS PARAMOUNT. USE 880 00:34:01,800 --> 00:34:05,320 ETHICAL DECISION-MAKING TO 881 00:34:05,320 --> 00:34:06,840 COMPLEMENT COMPLIANCE. IT'S NOT 882 00:34:06,840 --> 00:34:08,360 JUST WHAT THE RULES SAY BUT 883 00:34:08,360 --> 00:34:09,920 THINK ABOUT WHAT IS THE RIGHT 884 00:34:09,920 --> 00:34:13,080 THING TO DO. AND APPLY BOTH 885 00:34:13,080 --> 00:34:14,080 ETHICAL AND CONSIDERATIONS AND 886 00:34:14,080 --> 00:34:16,320 REGULATORY CONSIDERATIONS WHEN 887 00:34:16,320 --> 00:34:17,920 REVIEWING THESE HIGH RISK 888 00:34:17,920 --> 00:34:19,040 CLINICAL STUDIES BECAUSE THESE 889 00:34:19,040 --> 00:34:21,200 HELP US PUT US IN THE BEST 890 00:34:21,200 --> 00:34:22,960 POSSIBLE SITUATION WHERE WE CAN 891 00:34:22,960 --> 00:34:23,920 PROTECT THESE INDIVIDUALS. 892 00:34:23,920 --> 00:34:25,560 FOCUS ON OUTCOMES WHICH CONSIDER 893 00:34:25,560 --> 00:34:29,960 ALL THE STAKEHOLDERS. SO THE 894 00:34:29,960 --> 00:34:32,360 BOTTOM LINE, ANYONE CAN 895 00:34:32,360 --> 00:34:34,160 POTENTIALLY BE HARMED IN HARM'S 896 00:34:34,160 --> 00:34:36,960 WAY AS A SUBJECT RESEARCH. IT'S 897 00:34:36,960 --> 00:34:38,200 NOT ABOUT THE CATEGORY THEY'RE 898 00:34:38,200 --> 00:34:42,400 IN AND TO A LARGER RISK ABOUT 899 00:34:42,400 --> 00:34:44,480 THE CONTEXT. THE LACK OF 900 00:34:44,480 --> 00:34:45,160 INDEPENDENCE AND IMPORTANCE CAN 901 00:34:45,160 --> 00:34:46,600 BE ANYONE'S SITUATION AT ANY 902 00:34:46,600 --> 00:34:49,080 GIVEN TIME. RESPECT FOR PERSONS 903 00:34:49,080 --> 00:34:51,920 IS AN ETHICAL PRINCIPLE BUT IT'S 904 00:34:51,920 --> 00:34:54,560 MUCH MORE THAN OBTAINING 905 00:34:54,560 --> 00:34:55,920 INFORMED CONSENT. RESPECT FOR 906 00:34:55,920 --> 00:34:58,320 PERSONS TALKS ABOUT TRUST, TALKS 907 00:34:58,320 --> 00:35:00,600 ABOUT COMPASSION, TALKS ABOUT 908 00:35:00,600 --> 00:35:02,840 COMMUNICATION THAT IS BOTH 909 00:35:02,840 --> 00:35:05,960 ETHICAL IN NATURE BUT ALSO 910 00:35:05,960 --> 00:35:07,200 GARNERS AN ENVIRONMENT OF 911 00:35:07,200 --> 00:35:08,560 DIGNITY AND RESPECT. AND WE 912 00:35:08,560 --> 00:35:11,640 HAVE TO ALWAYS REMEMBER THE GOOD 913 00:35:11,640 --> 00:35:12,320 OF SCIENCE CAN NEVER BE 914 00:35:12,320 --> 00:35:13,480 CONSIDERED OVER THE IMPORTANCE 915 00:35:13,480 --> 00:35:15,480 OF HUMAN LIFE. ACCOUNTABILITY, 916 00:35:15,480 --> 00:35:18,480 RESPONSIBILITY BUT ALSO THAT 917 00:35:18,480 --> 00:35:19,280 ETHICAL JUDGMENT THAT SURROUNDS 918 00:35:19,280 --> 00:35:21,680 THESE DECISIONS THAT WE MAKE AND 919 00:35:21,680 --> 00:35:23,920 THEN LASTLY ETHICS AND 920 00:35:23,920 --> 00:35:25,960 COMPLIANCE ARE NOT MUTUALLY 921 00:35:25,960 --> 00:35:27,400 EXCLUSIVE. IRBS, ALTHOUGH 922 00:35:27,400 --> 00:35:29,560 THEY'RE FOLLOWING GUIDELINES AND 923 00:35:29,560 --> 00:35:30,960 REGULATIONS THEY CAN CONSIDER 924 00:35:30,960 --> 00:35:31,920 ETHICS IN CONCERT, IN CONCERT 925 00:35:31,920 --> 00:35:34,360 WITH FOLLOWING THOSE SETS OF 926 00:35:34,360 --> 00:35:39,360 GUIDELINES AND REGULATIONS. SO, 927 00:35:39,360 --> 00:35:41,080 AS ARISTOTLE SAID WITH REGARDS 928 00:35:41,080 --> 00:35:43,240 TO EXCELLENCE IS NOT ENOUGH TO 929 00:35:43,240 --> 00:35:45,200 KNOW WHAT TO DO, WE MUST TRY TO 930 00:35:45,200 --> 00:35:48,640 HAVE IT AND WE MUST USE IT. AND 931 00:35:48,640 --> 00:35:51,680 I JUST ENCOURAGE US CONTINUE TO 932 00:35:51,680 --> 00:35:54,200 BE STUDENTS OF THE REGULATIONS, 933 00:35:54,200 --> 00:35:56,640 BUT ALSO CONTINUE TO REFINE YOUR 934 00:35:56,640 --> 00:35:58,640 ABILITY TO MAKE ETHICAL 935 00:35:58,640 --> 00:35:59,720 DECISION-MAKING BECAUSE IT IS 936 00:35:59,720 --> 00:36:02,960 GOING TO TAKE BOTH COMPLIANCE 937 00:36:02,960 --> 00:36:06,040 AND ETHICS TO REALLY BE 938 00:36:06,040 --> 00:36:14,200 EXCELLENT IN THIS WORK AND I 939 00:36:14,200 --> 00:36:16,880 WILL NOW FIELD QUESTIONS AND 940 00:36:16,880 --> 00:36:17,240 DISCUSSIONS. 941 00:36:17,240 --> 00:36:18,800 >>PEG: THANK YOU, THAT WAS 942 00:36:18,800 --> 00:36:20,960 WONDERFUL. PLEASE THOSE WHO 943 00:36:20,960 --> 00:36:21,640 HAVE QUESTIONS IN THIS SESSION 944 00:36:21,640 --> 00:36:23,600 WE'D LOVE TO HEAR THEM. PLEASE 945 00:36:23,600 --> 00:36:27,240 PUT THEM IN THE BOX BELOW THE 946 00:36:27,240 --> 00:36:28,480 VIDEO ENTITLED LIVE FEEDBACK 947 00:36:28,480 --> 00:36:30,360 LINK AND HOPEFULLY THOSE WILL GO 948 00:36:30,360 --> 00:36:31,920 THROUGH QUICKLY. JONATHAN, DO 949 00:36:31,920 --> 00:36:33,720 YOU HAVE COMMENTS OR QUESTIONS? 950 00:36:33,720 --> 00:36:35,520 >>JONATHAN: I HAVE A COUPLE 951 00:36:35,520 --> 00:36:38,080 THOUGHTS SO THANK YOU, QUINCY. 952 00:36:38,080 --> 00:36:39,920 GREAT TALK. TRYING TO THINK OF 953 00:36:39,920 --> 00:36:41,200 HOW TO REALLY FORMULATE THIS. 954 00:36:41,200 --> 00:36:42,800 SO IT'S SORT OF A TWO PART 955 00:36:42,800 --> 00:36:45,600 RELATED ISSUE. I MEAN, SO ONE 956 00:36:45,600 --> 00:36:47,360 PART IS, DO WE HAVE A PROBLEM -- 957 00:36:47,360 --> 00:36:50,280 YOU KNOW, BEECHER WAS A 1966, 958 00:36:50,280 --> 00:36:53,200 YOU KNOW, WE HAVE THE -- THERE 959 00:36:53,200 --> 00:36:54,320 WAS THE OBVIOUS TUSKEGEE AND 960 00:36:54,320 --> 00:36:55,920 OTHER THINGS THAT YOU TALKED 961 00:36:55,920 --> 00:36:57,880 ABOUT BUT, I DON'T KNOW, HAVE WE 962 00:36:57,880 --> 00:37:00,920 FIXED THE PROBLEM? RIGHT? YOU 963 00:37:00,920 --> 00:37:02,760 KNOW, EVERYBODY TAKES THEIR 964 00:37:02,760 --> 00:37:04,720 TRAINING, EVERYBODY HAS THEIR 965 00:37:04,720 --> 00:37:06,320 IRB, YEAH, WE GET THIS AND THAT, 966 00:37:06,320 --> 00:37:08,880 WE'RE NOT FOLLOWING SOME RULES 967 00:37:08,880 --> 00:37:11,800 BUT HAVE WE REALLY -- DO WE 968 00:37:11,800 --> 00:37:14,040 STILL HAVE A PROBLEM? OR NOT 969 00:37:14,040 --> 00:37:15,920 AND THE SECOND THING KIND OF 970 00:37:15,920 --> 00:37:18,160 RELATED TO THIS IS THINKING 971 00:37:18,160 --> 00:37:22,000 ABOUT, YOU KNOW, HOW RESEARCH IS 972 00:37:22,000 --> 00:37:25,240 CHANGED AS AN ENTITY AND I DON'T 973 00:37:25,240 --> 00:37:27,280 MEAN JUST LIKE THE KIND OF 974 00:37:27,280 --> 00:37:28,440 RESEARCH BUT AND HOW YOU THINK 975 00:37:28,440 --> 00:37:30,560 THIS MIGHT IMPACT THINGS. 976 00:37:30,560 --> 00:37:32,400 RESEARCH IS NOW BIG BUSINESS. 977 00:37:32,400 --> 00:37:36,720 IT WASN'T SUCH BIG BUSINESS IN 978 00:37:36,720 --> 00:37:40,320 1966. RIGHT? INSTITUTIONS 979 00:37:40,320 --> 00:37:43,160 DEPEND UPON RESEARCH DOLLARS. 980 00:37:43,160 --> 00:37:45,720 TALL BIG SEGMENTS OF THE ECONOMY 981 00:37:45,720 --> 00:37:47,920 DEPEND ON THIS AND HOW HAS THAT 982 00:37:47,920 --> 00:37:50,120 CHANGED THINGS DO YOU THINK? 983 00:37:50,120 --> 00:37:51,280 >>QUINCY: GREAT. I WILL ANSWER 984 00:37:51,280 --> 00:37:53,160 THE FIRST QUESTION FIRST. HAVE 985 00:37:53,160 --> 00:37:55,120 WE FIXED THIS AND I WILL ANSWER 986 00:37:55,120 --> 00:37:56,400 THIS LIKE AN ADMINISTRATOR. I 987 00:37:56,400 --> 00:38:01,440 WILL SAY IT DEPENDS. SO WHAT I 988 00:38:01,440 --> 00:38:06,000 MEAN BY THAT IS, IRB ARE STILL 989 00:38:06,000 --> 00:38:07,840 WIRED TO THINK HOW DOES THIS 990 00:38:07,840 --> 00:38:11,120 PROJECT ALIGN WITH THE 991 00:38:11,120 --> 00:38:14,720 REGULATIONS? AND THAT IS -- 992 00:38:14,720 --> 00:38:18,200 THAT'S WHAT THEY NEED TO DO. I 993 00:38:18,200 --> 00:38:19,920 THINK WHAT'S STILL NEEDS SOME 994 00:38:19,920 --> 00:38:23,920 WORK, JONATHAN IS THE IRBS HAVE 995 00:38:23,920 --> 00:38:26,000 TO REMEMBER THE REASON THEY WERE 996 00:38:26,000 --> 00:38:28,120 CREATED AND THE REASON THEY WERE 997 00:38:28,120 --> 00:38:30,200 CREATED WAS TO PROTECT 998 00:38:30,200 --> 00:38:32,320 INDIVIDUALS THAT ARE 999 00:38:32,320 --> 00:38:35,240 PARTICIPATING IN RESEARCH. NOT 1000 00:38:35,240 --> 00:38:38,200 TO CHECK OFF BOXES THAT A 1001 00:38:38,200 --> 00:38:41,520 RESEARCH PROJECT MEETS 1002 00:38:41,520 --> 00:38:42,640 REGULATIONS. NOW, THE 1003 00:38:42,640 --> 00:38:44,800 REGULATIONS HAVE BEEN A GREAT 1004 00:38:44,800 --> 00:38:46,200 GUIDE BECAUSE REGULATIONS REALLY 1005 00:38:46,200 --> 00:38:49,000 HELP US TO BE ETHICAL BUT WHAT 1006 00:38:49,000 --> 00:38:51,840 IRBS CAN CONFUSE IS BECAUSE THIS 1007 00:38:51,840 --> 00:38:54,560 RESEARCH FOLLOWS A SET OF 1008 00:38:54,560 --> 00:38:56,880 GUIDELINES, DOES IT MAKE IT 1009 00:38:56,880 --> 00:39:00,840 DEFAULT ETHICAL? IT MAKES IT 1010 00:39:00,840 --> 00:39:03,840 COMPLIANT BUT DOESN'T 1011 00:39:03,840 --> 00:39:06,120 NECESSARILY DEFAULTILY MAKE IT 1012 00:39:06,120 --> 00:39:07,840 ETHICAL. IT DECREASES THE 1013 00:39:07,840 --> 00:39:10,480 LIKELIHOOD OF MAKING IT ETHICAL 1014 00:39:10,480 --> 00:39:12,040 IF IT IS FOLLOWING REGULATIONS 1015 00:39:12,040 --> 00:39:13,960 AND MOST OF THESE ARE CUT AND 1016 00:39:13,960 --> 00:39:15,680 DRY. THESE FOLLOW REGULATIONS 1017 00:39:15,680 --> 00:39:17,720 AND THIS IS WELL PUT TOGETHER, 1018 00:39:17,720 --> 00:39:19,480 IS ETHICAL AND IS COMPLIANT AND 1019 00:39:19,480 --> 00:39:21,800 WE'RE GOOD TO GO. IT'S ONLY IN 1020 00:39:21,800 --> 00:39:23,000 THOSE SITUATIONS WHERE, WHEN I 1021 00:39:23,000 --> 00:39:25,880 HEAR PEOPLE SAY, JONATHAN, WELL 1022 00:39:25,880 --> 00:39:27,560 THE REGULATIONS DON'T SAY I 1023 00:39:27,560 --> 00:39:29,880 CAN'T DO THIS. WHENEVER I HEAR 1024 00:39:29,880 --> 00:39:33,280 THAT, THAT'S WHEN I START TO 1025 00:39:33,280 --> 00:39:36,080 WORRY ABOUT US EFFECTIVELY 1026 00:39:36,080 --> 00:39:37,600 MAXIMIZING THAT CONVERGENCE 1027 00:39:37,600 --> 00:39:38,920 BETWEEN ETHICS AND COMPLIANCE. 1028 00:39:38,920 --> 00:39:41,120 IT'S SORT OF THAT JURY RASSIC 1029 00:39:41,120 --> 00:39:43,880 PARK, QUOTE, YOU THOUGHT ABOUT 1030 00:39:43,880 --> 00:39:45,480 WHETHER YOU COULD DO IT BUT YOU 1031 00:39:45,480 --> 00:39:49,320 DIDN'T THINK ABOUT WHETHER YOU 1032 00:39:49,320 --> 00:39:54,520 SHOULD. AND SO THAT IS WHERE 1033 00:39:54,520 --> 00:39:56,240 THAT CONVERGENCE COMES IN THOSE 1034 00:39:56,240 --> 00:39:58,600 SITUATIONS WHERE SOMEONE IS 1035 00:39:58,600 --> 00:39:59,920 QUESTIONING WHETHER THE 1036 00:39:59,920 --> 00:40:01,040 REGULATION PROHIBITS. THIS SO 1037 00:40:01,040 --> 00:40:03,920 WE CAN DO IT. THAT'S WHERE YOUR 1038 00:40:03,920 --> 00:40:04,600 ETHICAL DECISION-MAKING AND YOUR 1039 00:40:04,600 --> 00:40:07,800 JUDGMENT HAS TO BE IMMEDIATELY 1040 00:40:07,800 --> 00:40:10,840 PUT ON AND MAYBE YOU CAN. BUT 1041 00:40:10,840 --> 00:40:13,080 YOU HAVE TO PUT ON YOUR GOOD 1042 00:40:13,080 --> 00:40:15,880 JUDGMENT HAT AND YOUR COMPLIANCE 1043 00:40:15,880 --> 00:40:17,320 HAT ON STATEMENT, TO YOUR SECOND 1044 00:40:17,320 --> 00:40:18,640 QUESTION ABOUT THE BIG BUSINESS, 1045 00:40:18,640 --> 00:40:24,560 THE BIG BUSINESS IS REALLY 1046 00:40:24,560 --> 00:40:28,600 CHANGED WHAT MOTIVATES PEOPLE TO 1047 00:40:28,600 --> 00:40:31,800 EITHER PARTICIPATE AS 1048 00:40:31,800 --> 00:40:32,960 INVESTIGATORS EVEN HAS CHANGED 1049 00:40:32,960 --> 00:40:34,600 HOW ORGANIZATIONS ARE MOTIVATED 1050 00:40:34,600 --> 00:40:38,400 IN GETTING TO THE WHOLE THING 1051 00:40:38,400 --> 00:40:40,160 ABOUT INQUIRY AND DISCOVERY. 1052 00:40:40,160 --> 00:40:46,200 ONE OF THE, YOU KNOW, MOST 1053 00:40:46,200 --> 00:40:49,960 PUBLIC FACING EPISODES IN 1054 00:40:49,960 --> 00:40:51,040 INETHICAL RESEARCH IS JESSE AND 1055 00:40:51,040 --> 00:40:52,680 IF YOU THINK ABOUT WHAT WAS 1056 00:40:52,680 --> 00:40:54,960 BEHIND THAT IT WASN'T JUST ABOUT 1057 00:40:54,960 --> 00:40:56,600 SOMEONE BEING UNETHICAL. THERE 1058 00:40:56,600 --> 00:40:58,720 WAS A LOT OF MONEY THAT STOOD TO 1059 00:40:58,720 --> 00:41:01,680 BE GAINED IF THIS STUDY WAS 1060 00:41:01,680 --> 00:41:04,680 SUCCESSFUL. AND THERE WAS A 1061 00:41:04,680 --> 00:41:06,560 SITUATION WHERE THAT MONEY 1062 00:41:06,560 --> 00:41:09,560 ALMOST -- THE MISMANAGEMENT OF 1063 00:41:09,560 --> 00:41:13,160 THAT CONFLICT OF INTEREST CAUSED 1064 00:41:13,160 --> 00:41:23,680 A HUMAN SUBJECT TO BE -- THE 1065 00:41:25,120 --> 00:41:27,080 PRESSURE TO ENROLL SUBJECTS IN 1066 00:41:27,080 --> 00:41:31,080 THE CLINICAL RESEARCH WORLD, 1067 00:41:31,080 --> 00:41:33,400 RIGHT, I DON'T GET PAID AS A 1068 00:41:33,400 --> 00:41:35,000 SITE UNLESS I ENROLL, RIGHT? 1069 00:41:35,000 --> 00:41:37,360 AND THE MORE I ENROLL, JONATHAN 1070 00:41:37,360 --> 00:41:39,560 THE MORE I MAKE AT MY SITE THE 1071 00:41:39,560 --> 00:41:40,280 MORE LIKELY THAT COMPANY IS 1072 00:41:40,280 --> 00:41:41,840 GOING TO REACH OUT TO MY SITE 1073 00:41:41,840 --> 00:41:43,920 AGAIN TO ENROLL SO NOW YOU HAVE 1074 00:41:43,920 --> 00:41:46,040 THESE INFLUENCES THAT MAKE IT 1075 00:41:46,040 --> 00:41:49,160 EVEN MORE IMPORTANT FOR US TO 1076 00:41:49,160 --> 00:41:50,960 LEAN ON OUR COMPLIANCE EXPERTISE 1077 00:41:50,960 --> 00:41:53,480 BUT ALSO OUR ETHICS EXPERTISE 1078 00:41:53,480 --> 00:41:54,920 BECAUSE THERE'S A LOT OF THINGS 1079 00:41:54,920 --> 00:41:56,600 THAT CAN SLIP THROUGH THE CRACKS 1080 00:41:56,600 --> 00:41:59,920 IF WE'RE NOT CAREFUL BECAUSE WE 1081 00:41:59,920 --> 00:42:03,440 SEE THE MONETARY AND PRESTIGE 1082 00:42:03,440 --> 00:42:04,720 GAIN THAT COMES FROM THESE 1083 00:42:04,720 --> 00:42:07,680 THINGS. I THINK THOSE ARE GREAT 1084 00:42:07,680 --> 00:42:07,960 QUESTIONS. 1085 00:42:07,960 --> 00:42:09,440 >>PEG: OKAY WE DO HAVE A COUPLE 1086 00:42:09,440 --> 00:42:10,760 QUESTIONS HERE. 1087 00:42:10,760 --> 00:42:15,640 >>QUINCY: ALL RIGHT. GREAT. 1088 00:42:15,640 --> 00:42:16,200 >>PEG: STANDING BETWEEN AN 1089 00:42:16,200 --> 00:42:16,960 INVESTIG 1090 00:42:16,960 --> 00:42:17,600 INVESTIGATOR'S CONSIDERATIONS 1091 00:42:17,600 --> 00:42:18,160 ARE EXTERNAL PRESSURES, 1092 00:42:18,160 --> 00:42:19,920 PRESSURES TO PRODUCE RESEARCH, 1093 00:42:19,920 --> 00:42:21,200 PRESSURES TO MOVE PRODUCTS 1094 00:42:21,200 --> 00:42:22,320 THROUGH A PIPELINE, ET CETERA, 1095 00:42:22,320 --> 00:42:25,200 DO YOU HAVE RECOMMENDATIONS ON 1096 00:42:25,200 --> 00:42:26,280 HOW REGULATIONS COULD TARGET 1097 00:42:26,280 --> 00:42:27,800 THOSE PRESSURES RATHER THAN 1098 00:42:27,800 --> 00:42:31,320 TRYING TO RETROSPECTIVELY 1099 00:42:31,320 --> 00:42:34,440 ADDRESS PAST ETHICAL MISTAKES? 1100 00:42:34,440 --> 00:42:40,760 >>QUINCY: YEAH, SO REGULATIONS 1101 00:42:40,760 --> 00:42:47,920 HAVE THE SAME RULES. AND THE 1102 00:42:47,920 --> 00:42:51,400 REGULATIONS UNFORTUNATELY 1103 00:42:51,400 --> 00:42:54,040 PROTECT THE ENTITIES THAT CREATE 1104 00:42:54,040 --> 00:42:55,400 THEM MORE SO THAN THEY PROTECT 1105 00:42:55,400 --> 00:42:57,840 THE PEOPLE THAT THEY'RE DESIGNED 1106 00:42:57,840 --> 00:42:59,040 TO PROTECT. SO IF YOU THINK 1107 00:42:59,040 --> 00:43:03,200 ABOUT THE REGULATIONS AND THE 1108 00:43:03,200 --> 00:43:05,280 COMMON RULE, IT WAS, YOU KNOW, 1109 00:43:05,280 --> 00:43:08,640 THE COMMON RULE WAS WRITTEN 1110 00:43:08,640 --> 00:43:11,800 IN -- OSTENSIBLY WAS TO PROTECT 1111 00:43:11,800 --> 00:43:15,400 THE SUBJECT BUT ALSO PROTECTED 1112 00:43:15,400 --> 00:43:16,960 THE FUNDING AGENCIES THAT SAID, 1113 00:43:16,960 --> 00:43:19,840 HEY, EVEN IF THIS DOES OCCUR IT 1114 00:43:19,840 --> 00:43:22,560 WASN'T ON OUR DIME AND WE EVEN 1115 00:43:22,560 --> 00:43:24,080 SPECIFIED IF IT'S FUNDED BY THE 1116 00:43:24,080 --> 00:43:25,080 FEDERAL GOVERNMENT THAT'S -- 1117 00:43:25,080 --> 00:43:26,600 WHEN THESE REGULATIONS APPLY. 1118 00:43:26,600 --> 00:43:30,520 IT DIDN'T APPLY UNIVERSALLY TO 1119 00:43:30,520 --> 00:43:32,640 ANY HUMAN RESEARCH. TO ANSWER 1120 00:43:32,640 --> 00:43:34,520 YOUR QUESTION I THINK HOW 1121 00:43:34,520 --> 00:43:35,840 REGULATIONS CAN HELP IS REMOVE 1122 00:43:35,840 --> 00:43:41,040 SO MANY QUALIFIERS. AND MAKE IT 1123 00:43:41,040 --> 00:43:43,920 MORE ABOUT THE BENEFICIARY OF 1124 00:43:43,920 --> 00:43:45,960 THESE REGULATIONS TO -- THAT ARE 1125 00:43:45,960 --> 00:43:48,520 DESIGNED TO PROTECT THEM. THE 1126 00:43:48,520 --> 00:43:51,480 REGULATIONS NEED TO QUIT 1127 00:43:51,480 --> 00:43:52,560 FOCUSING SO MUCH ON WHO'S PAYING 1128 00:43:52,560 --> 00:43:56,120 FOR THE RESEARCH, FOCUS IT ON SO 1129 00:43:56,120 --> 00:43:58,600 MUCH ON WHO IS LIABLE FOR THE 1130 00:43:58,600 --> 00:43:59,400 RESEARCH, WHO GETS THE BLAME FOR 1131 00:43:59,400 --> 00:44:01,400 THE RESEARCH BEING UNETHICAL. 1132 00:44:01,400 --> 00:44:03,120 SPEND TIME ON THAT, SPEND JUST 1133 00:44:03,120 --> 00:44:05,600 AS MUCH TIME ON WHAT REGULATIONS 1134 00:44:05,600 --> 00:44:06,520 WILL ACTUALLY PROTECT THE 1135 00:44:06,520 --> 00:44:07,920 INDIVIDUALS THAT ARE GOING TO 1136 00:44:07,920 --> 00:44:10,320 PARTICIPATE IN RESEARCH. NOW I 1137 00:44:10,320 --> 00:44:12,000 THINK THAT WE HAVE A LITTLE WAYS 1138 00:44:12,000 --> 00:44:14,680 TO GO THERE. BUT RIGHT NOW THE 1139 00:44:14,680 --> 00:44:17,640 REGULATIONS I THINK SPEND TOO 1140 00:44:17,640 --> 00:44:19,800 MUCH TIME PROTECTING THE 1141 00:44:19,800 --> 00:44:23,920 REGULATORS AND NOT ENOUGH TIME 1142 00:44:23,920 --> 00:44:26,400 PROTECTING THE SUBJECTS. 1143 00:44:26,400 --> 00:44:27,920 >>PEG: OKAY. NEXT QUESTION IS 1144 00:44:27,920 --> 00:44:29,680 CAN A PROTOCOL FORM BE USED TO 1145 00:44:29,680 --> 00:44:31,840 PROMOTE ETHICS OR IS IT ALWAYS 1146 00:44:31,840 --> 00:44:34,160 JUST FOCUSED ON COMPLIANCE WITH 1147 00:44:34,160 --> 00:44:35,880 THE REGS? 1148 00:44:35,880 --> 00:44:39,080 >>QUINCY: MOST OF THE IRB 1149 00:44:39,080 --> 00:44:40,040 REFORM I SEE IS THEIR COMPLIANCE 1150 00:44:40,040 --> 00:44:43,920 FORMS SO THEY HAVE THE LIST OF 1151 00:44:43,920 --> 00:44:47,920 THE CRITERIA. GO THROUGH THE 1152 00:44:47,920 --> 00:44:50,560 CRITERIA FOR APPROVAL. SUBJECT 1153 00:44:50,560 --> 00:44:55,080 DESIGN IN SUCH A WAY THAT THE 1154 00:44:55,080 --> 00:44:57,240 RISKS ARE MINIMIZED IN RELATION 1155 00:44:57,240 --> 00:44:59,240 TO THE BENEFITS. INFORMED 1156 00:44:59,240 --> 00:45:03,520 CONCEPT IS DOCUMENT. BLAH BLAH 1157 00:45:03,520 --> 00:45:05,520 BLAH. IN EACH OF THOSE CRITERIA 1158 00:45:05,520 --> 00:45:07,400 I ASK THEM TO WRITE THE ETHICAL 1159 00:45:07,400 --> 00:45:08,440 CONSIDERATION AND HOW ETHICALLY 1160 00:45:08,440 --> 00:45:12,840 THE STUDY MEETS THAT CRITERIA. 1161 00:45:12,840 --> 00:45:14,640 LET ME GIVE YOU AN EXAMPLE. 1162 00:45:14,640 --> 00:45:16,280 INFORMED CONSENT, YES, IT'S 1163 00:45:16,280 --> 00:45:18,000 DOCUMENTED AS THE REGULATORY 1164 00:45:18,000 --> 00:45:19,000 INFORMED CONSENT. ETHICALLY 1165 00:45:19,000 --> 00:45:22,880 TALK ABOUT THE PROCESS. SO, IS 1166 00:45:22,880 --> 00:45:24,920 THE PROCESS BEING CONDUCTED IN 1167 00:45:24,920 --> 00:45:27,080 AN ENVIRONMENT THAT DOES NOT 1168 00:45:27,080 --> 00:45:28,880 UNDULY INFLUENCE? COERCE? 1169 00:45:28,880 --> 00:45:30,000 THESE THINGS ARE NOT SPELLED OUT 1170 00:45:30,000 --> 00:45:32,360 IN THE REGS, AT LEAST NOT IN A 1171 00:45:32,360 --> 00:45:34,440 SPECIFIC WAY. SO WHAT I HAVE 1172 00:45:34,440 --> 00:45:35,960 THEM DO IS I WRITE -- I HAVE 1173 00:45:35,960 --> 00:45:38,800 THEM LOOK AT BOTH THE REGULATORY 1174 00:45:38,800 --> 00:45:40,840 CONSIDERATION AND THE ETHICS 1175 00:45:40,840 --> 00:45:41,840 CONSIDERATION EVEN WHEN THEY 1176 00:45:41,840 --> 00:45:43,360 WERE TRYING TO FIGURE OUT 1177 00:45:43,360 --> 00:45:46,640 WHETHER OR NOT THIS RESEARCH 1178 00:45:46,640 --> 00:45:47,880 PROJECT MEETS THE CRITERIA FOR 1179 00:45:47,880 --> 00:45:50,280 APPROVAL AND THAT WAS RECEIVED 1180 00:45:50,280 --> 00:45:52,560 WELL BECAUSE IT MAKES THEM THINK 1181 00:45:52,560 --> 00:45:55,120 DOES THIS ALLOW ARE FROM THE 1182 00:45:55,120 --> 00:45:58,880 REGS BUT IS THIS REALLY ETHICAL 1183 00:45:58,880 --> 00:46:00,720 RESEARCH? GREAT QUESTION. 1184 00:46:00,720 --> 00:46:02,800 >>PEG: OKAY, WE HAVE ANOTHER 1185 00:46:02,800 --> 00:46:04,760 ONE THAT IS GOING TO BE 1186 00:46:04,760 --> 00:46:07,160 CHALLENGING HOW DO WE TEACH 1187 00:46:07,160 --> 00:46:09,120 ETHICAL THINKING? HOW DO WE 1188 00:46:09,120 --> 00:46:10,840 TEACH ETHICAL THINKING IN THE 1189 00:46:10,840 --> 00:46:13,000 CONTEXT OUTSIDE OF HUMAN 1190 00:46:13,000 --> 00:46:13,640 INTERACTION? BUT WITH PATIENT 1191 00:46:13,640 --> 00:46:17,680 AND HUMAN DATA, RESPONSES, 1192 00:46:17,680 --> 00:46:18,600 SAMPLES, ET CETERA? 1193 00:46:18,600 --> 00:46:23,080 >>QUINCY: SO HOW YOU TEACH 1194 00:46:23,080 --> 00:46:27,200 ETHICAL THINKING? SO THAT'S A 1195 00:46:27,200 --> 00:46:28,880 GREAT QUESTION. SO I DON'T KNOW 1196 00:46:28,880 --> 00:46:34,920 IF YOU CAN TEACH SOMEBODY TO BE 1197 00:46:34,920 --> 00:46:37,880 ETHICAL. THAT IS SOMETHING THAT 1198 00:46:37,880 --> 00:46:39,000 SOMEONE HAS TO BE ABLE TO WANT 1199 00:46:39,000 --> 00:46:40,920 TO DO. THAT'S WHY THE 1200 00:46:40,920 --> 00:46:42,160 COMPLIANCE IS SO IMPORTANT 1201 00:46:42,160 --> 00:46:43,400 BECAUSE COMPLIANCE MAKES YOU 1202 00:46:43,400 --> 00:46:46,600 FOLLOW A SET OF GUIDELINES. 1203 00:46:46,600 --> 00:46:47,920 WHAT WE CAN TEACH IS WE CAN 1204 00:46:47,920 --> 00:46:51,960 TEACH STRATEGIES FOR ETHICAL 1205 00:46:51,960 --> 00:46:53,360 DECISION-MAKING. WHICH IS A 1206 00:46:53,360 --> 00:46:54,640 LITTLE BIT DIFFERENT THAN 1207 00:46:54,640 --> 00:46:56,520 TEACHING SOMEONE TO BE ETHICAL. 1208 00:46:56,520 --> 00:46:57,920 STRATEGIES FOR ETHICAL 1209 00:46:57,920 --> 00:46:59,360 DECISION-MAKING MEAN HOW DO YOU 1210 00:46:59,360 --> 00:47:02,360 DEFINE A PROBLEM? HOW DO YOU 1211 00:47:02,360 --> 00:47:03,800 WEIGH THE ALTERNATIVE OPTIONS? 1212 00:47:03,800 --> 00:47:07,920 HOW DO YOU ARRIVE AT A DECISION? 1213 00:47:07,920 --> 00:47:11,920 HOW DO YOU CONSIDER STAKEHOLDERS 1214 00:47:11,920 --> 00:47:14,000 IN DECISIONS SO THERE'S A 1215 00:47:14,000 --> 00:47:14,920 METHODOLOGY IN THIS DECISION AND 1216 00:47:14,920 --> 00:47:16,760 I THINK THAT'S WHAT WE NEED TO 1217 00:47:16,760 --> 00:47:19,640 TEACH. THAT WAY AS INDIVIDUALS, 1218 00:47:19,640 --> 00:47:20,760 DESIGNED TO BE MORE ETHICAL 1219 00:47:20,760 --> 00:47:22,480 THERE'S A LIST OF STEPS THAT 1220 00:47:22,480 --> 00:47:23,440 THEY CAN TAKE THAT WILL PUT THEM 1221 00:47:23,440 --> 00:47:26,520 IN A BETTER POSITION RIGHT, TO 1222 00:47:26,520 --> 00:47:27,160 MAKE AN ETHICAL DECISION THAN 1223 00:47:27,160 --> 00:47:30,760 NOT. BUT IN TERMS OF TEACHING 1224 00:47:30,760 --> 00:47:33,880 SOMEONE ETHICAL THINKING, I 1225 00:47:33,880 --> 00:47:35,200 DON'T KNOW THAT THAT IS 1226 00:47:35,200 --> 00:47:39,840 POSSIBLE. BECAUSE EVERYONE HAS 1227 00:47:39,840 --> 00:47:41,720 THEIR OWN -- AND I'M GOING TO 1228 00:47:41,720 --> 00:47:43,800 GET A LITTLE TOUCHY-FEELY HERE 1229 00:47:43,800 --> 00:47:45,680 IF YOU DON'T MIND. EVERYONE HAS 1230 00:47:45,680 --> 00:47:46,960 THEIR OWN MORAL COMPASS THAT 1231 00:47:46,960 --> 00:47:48,800 GUIDES WHAT THEY DO. SO ALL I 1232 00:47:48,800 --> 00:47:51,480 CAN DO IS GIVE THEM STRATEGIES 1233 00:47:51,480 --> 00:47:55,200 AND STEPS TO TAP IN TO WHAT I 1234 00:47:55,200 --> 00:47:57,720 ASSUME TO BE AN APPROPRIATE 1235 00:47:57,720 --> 00:48:01,200 ETHICAL COMPASS TO BE A 1236 00:48:01,200 --> 00:48:03,680 RESEARCHER IN THIS SPACE. 1237 00:48:03,680 --> 00:48:04,960 >>PEG: OKAY, THANK YOU. 1238 00:48:04,960 --> 00:48:07,480 >>QUINCY: DID I SKIRT AROUND 1239 00:48:07,480 --> 00:48:08,560 THAT QUESTION ENOUGH FOR THAT? 1240 00:48:08,560 --> 00:48:10,840 >>PEG: I THINK IT'S A REALLY 1241 00:48:10,840 --> 00:48:11,720 TOUGH QUESTION. 1242 00:48:11,720 --> 00:48:13,400 >>QUINCY: YEAH, IT IS AND I 1243 00:48:13,400 --> 00:48:15,720 TEACH ETHICS, RIGHT, I TEACH 1244 00:48:15,720 --> 00:48:16,920 ETHICS IN HEALTH CARE, I TEACH 1245 00:48:16,920 --> 00:48:18,960 THAT COURSE AND, YEAH, AND I 1246 00:48:18,960 --> 00:48:21,280 TELL THEM, LOOK, AFTER YOU GET 1247 00:48:21,280 --> 00:48:23,000 THROUGH THIS COURSE, THIS COURSE 1248 00:48:23,000 --> 00:48:23,960 DOESN'T MAKE YOU MORE ETHICAL 1249 00:48:23,960 --> 00:48:26,320 BUT GIVES YOU THE TOOLS YOU NEED 1250 00:48:26,320 --> 00:48:27,600 TO MAKE DECISIONS THAT ARE IN 1251 00:48:27,600 --> 00:48:29,400 THE BEST INTEREST OF THE PEOPLE, 1252 00:48:29,400 --> 00:48:31,560 OF THE PATIENTS, THE BEST 1253 00:48:31,560 --> 00:48:32,880 INTEREST OF THE PROFESSION AND 1254 00:48:32,880 --> 00:48:36,560 JUST THE BEST INTEREST OF THE 1255 00:48:36,560 --> 00:48:37,360 GREATER GOOD. 1256 00:48:37,360 --> 00:48:39,360 >>JONATHAN: I AM GOING TO 1257 00:48:39,360 --> 00:48:40,600 EXERCISE CHAIR DISCRETION HERE. 1258 00:48:40,600 --> 00:48:44,440 AND SAY, JUST GIVE YOU SOMETHING 1259 00:48:44,440 --> 00:48:47,040 TO RESPOND TO BECAUSE I'VE BEEN 1260 00:48:47,040 --> 00:48:49,520 THINKING A LOT ABOUT RECENTLY. 1261 00:48:49,520 --> 00:48:51,520 SO YOU KNOW, I LOVE THAT QUOTE 1262 00:48:51,520 --> 00:48:53,200 FROM THE BEECHER PAPER. I THINK 1263 00:48:53,200 --> 00:48:56,800 ABOUT THAT A LOT THAT YOU'VE 1264 00:48:56,800 --> 00:48:58,680 SHOWED THAT THE MORE RELIABLE 1265 00:48:58,680 --> 00:49:01,000 PROTECTION IS THE RESPONSIBLE 1266 00:49:01,000 --> 00:49:04,480 INVESTIGATOR AND, YOU KNOW, SO 1267 00:49:04,480 --> 00:49:07,640 WHEN I THINK ABOUT HOW HUMAN 1268 00:49:07,640 --> 00:49:09,920 SUBJECTS RESEARCH IS CONDUCTED 1269 00:49:09,920 --> 00:49:12,240 ETHICALLY, OR PROPERLY AND HOW, 1270 00:49:12,240 --> 00:49:15,400 YOU KNOW, IRBS, WE CAN DO -- WE 1271 00:49:15,400 --> 00:49:17,080 CAN REVIEW HUNDREDS OF THOUSANDS 1272 00:49:17,080 --> 00:49:18,640 OF PROTOCOL, WHATEVER, WE CAN 1273 00:49:18,640 --> 00:49:20,520 READ THE PROTOCOL, WE CAN FIND 1274 00:49:20,520 --> 00:49:21,720 ANYTHING THAT LOOKS GREAT ON 1275 00:49:21,720 --> 00:49:23,160 PAPER BUT THE RUBBER HITS THE 1276 00:49:23,160 --> 00:49:27,200 ROAD AT THE BEDSIDE IT DOESN'T 1277 00:49:27,200 --> 00:49:31,360 MATTER WHAT THE IRB DOES IF THE 1278 00:49:31,360 --> 00:49:35,040 ACTIONS OF THE BEDSIDE ARE, YOU 1279 00:49:35,040 --> 00:49:36,160 KNOW, WHATEVER WORD WE WANT TO 1280 00:49:36,160 --> 00:49:39,240 PUT ON IT. NONCOMPLIANT, NOT 1281 00:49:39,240 --> 00:49:41,040 ETHICAL OR NOT IN THAT 1282 00:49:41,040 --> 00:49:44,480 INDIVIDUAL INTEREST AT THE TIME. 1283 00:49:44,480 --> 00:49:45,840 AND I THINK AS ONE OF THE OTHER 1284 00:49:45,840 --> 00:49:47,880 QUESTIONS SORT OF ELUDED TO, 1285 00:49:47,880 --> 00:49:50,000 THERE'S A LOT -- AND AS WE 1286 00:49:50,000 --> 00:49:50,880 TALKED, THERE ARE A LOT OF 1287 00:49:50,880 --> 00:49:52,000 PRESSURES ON THAT PERSON AT 1288 00:49:52,000 --> 00:49:56,320 THE -- ON THE INVESTIGATOR THAT 1289 00:49:56,320 --> 00:49:59,080 EVERYTHING FROM, YOU KNOW, A 1290 00:49:59,080 --> 00:50:03,480 GOOD SCIENTIST BELIEVES IN THEIR 1291 00:50:03,480 --> 00:50:05,680 HYPOTHESIS AND IT'S HARD TO ASK 1292 00:50:05,680 --> 00:50:08,600 THEM TO STEP ASIDE AND IF THEY 1293 00:50:08,600 --> 00:50:10,720 DON'T BELIEVE IN THEIR 1294 00:50:10,720 --> 00:50:11,880 HYPOTHESIS I DON'T WANT TO DO 1295 00:50:11,880 --> 00:50:13,040 THE EXPERIMENT EITHER. YOU GOT 1296 00:50:13,040 --> 00:50:15,880 THAT TOOK R FACTOR AND IT'S 1297 00:50:15,880 --> 00:50:19,040 PUBLISH OR PERISH. I DON'T GET 1298 00:50:19,040 --> 00:50:21,160 THIS PAPER, I DON'T GET THE NEXT 1299 00:50:21,160 --> 00:50:23,080 GRANT OR TENURE AND ALL OF THOSE 1300 00:50:23,080 --> 00:50:27,160 THINGS THAT ARE DISTORTED 1301 00:50:27,160 --> 00:50:27,920 INCENTIVES THAT CAN EVEN MAKE 1302 00:50:27,920 --> 00:50:31,640 GOOD PEOPLE INADVERTENTLY MAKE 1303 00:50:31,640 --> 00:50:32,400 BAD DECISIONS. 1304 00:50:32,400 --> 00:50:34,960 AND, YOU KNOW, IRBS CAN'T DO 1305 00:50:34,960 --> 00:50:36,400 ANYTHING ABOUT THAT. 1306 00:50:36,400 --> 00:50:37,320 >>QUINCY: THAT'S RIGHT. 1307 00:50:37,320 --> 00:50:38,800 >>JONATHAN: WE TEND TO THINK, 1308 00:50:38,800 --> 00:50:43,440 WELL, THE WHOLE THING FOR HUMAN 1309 00:50:43,440 --> 00:50:49,280 RESEARCH PROTECTIONS LIES IN THE 1310 00:50:49,280 --> 00:50:51,160 IRB BUT IT'S A WHOLE SYSTEM AND 1311 00:50:51,160 --> 00:50:55,720 I RECENTLY READ THE REPORT FROM 1312 00:50:55,720 --> 00:50:56,560 UNIVERSITY OF MADISON AND 1313 00:50:56,560 --> 00:50:59,120 SOMETHING STRUCK ME IMMEDIATELY 1314 00:50:59,120 --> 00:51:02,520 SO THEY COINED THIS TERM, HUMAN 1315 00:51:02,520 --> 00:51:05,120 RESEARCH PARTICIPANT PROTECTION 1316 00:51:05,120 --> 00:51:08,120 PROGRAMS. IT HAD THREE PS, NOW 1317 00:51:08,120 --> 00:51:11,840 WE ALL TALK ABOUT TWO P, HUMAN 1318 00:51:11,840 --> 00:51:14,240 RESEARCH PROTECTION PROGRAM. 1319 00:51:14,240 --> 00:51:16,440 LOST THAT THIRD P SOMEWHERE FROM 1320 00:51:16,440 --> 00:51:18,800 2003. BUT THEY, YOU KNOW, 1321 00:51:18,800 --> 00:51:19,880 REALLY NICELY TALKS ABOUT ALL OF 1322 00:51:19,880 --> 00:51:21,240 THE DIFFERENT ELEMENTS THAT WE 1323 00:51:21,240 --> 00:51:24,680 HAVE TO DO THAT RANGING -- THE 1324 00:51:24,680 --> 00:51:26,080 IRBS JUST WANT A STAB AT THIS 1325 00:51:26,080 --> 00:51:31,520 BUT THE ROLE OF THE 1326 00:51:31,520 --> 00:51:32,680 INVESTIGATOR, THE FUNDER, THE 1327 00:51:32,680 --> 00:51:34,640 ROLE OF RESEARCH AS IT'S BEING 1328 00:51:34,640 --> 00:51:36,440 DONE OF THE MONITORING, ALL OF 1329 00:51:36,440 --> 00:51:37,960 THESE THINGS THAT HAVE TO WORK 1330 00:51:37,960 --> 00:51:41,560 TOGETHER TO MAKE THIS REALLY 1331 00:51:41,560 --> 00:51:42,560 COMPLICATED AND IMPORTANT 1332 00:51:42,560 --> 00:51:44,880 ENDEAVOR WORK FOR EVERYBODY'S 1333 00:51:44,880 --> 00:51:45,920 INTEREST. AND DESPITE 1334 00:51:45,920 --> 00:51:46,600 EVERYTHING, PEOPLE ARE STILL 1335 00:51:46,600 --> 00:51:51,440 GOING TO GET HARMED. 1336 00:51:51,440 --> 00:51:52,840 >>QUINCY: YEAH, I THINK -- YOU 1337 00:51:52,840 --> 00:51:55,880 BRING UP A GOOD POINT, JONATHAN, 1338 00:51:55,880 --> 00:51:58,160 IRB CANNOT PROTECT THE SUBJECT. 1339 00:51:58,160 --> 00:52:02,280 AT LEAST NOT IN A DIRECT WAY. 1340 00:52:02,280 --> 00:52:04,920 RIGHT IN THE IRB REVIEWS HOW AN 1341 00:52:04,920 --> 00:52:05,520 INVESTIGATOR IS DESCRIBED AND 1342 00:52:05,520 --> 00:52:06,280 WHAT THEY'RE GOING TO DO TO 1343 00:52:06,280 --> 00:52:07,600 ANSWER THIS RESEARCH QUESTION 1344 00:52:07,600 --> 00:52:10,960 AND TO TEST THIS HYPOTHESIS AND 1345 00:52:10,960 --> 00:52:13,520 IRB ASSESSES WHETHER OR NOT WHAT 1346 00:52:13,520 --> 00:52:15,920 WAS DESCRIBED IF THAT 1347 00:52:15,920 --> 00:52:17,840 INVESTIGATOR, TO YOUR POINT, IF 1348 00:52:17,840 --> 00:52:19,960 THAT INVESTIGATOR DOES IT EXA 1349 00:52:19,960 --> 00:52:23,200 EXACTLY HOW THEY DESCRIBE IT TO 1350 00:52:23,200 --> 00:52:25,000 THE IRB THAT OPTIMIZING 1351 00:52:25,000 --> 00:52:26,800 PROTECTION OF THE HUMAN RESEARCH 1352 00:52:26,800 --> 00:52:27,560 PARTICIPANTS BUT THEN THEY LEAVE 1353 00:52:27,560 --> 00:52:30,320 THE IRB. RIGHT? SO THEY'RE NOT 1354 00:52:30,320 --> 00:52:31,720 IN THE PRESENCE OF THE IRB 1355 00:52:31,720 --> 00:52:33,720 ANYMORE NOW THE RUBBER IS 1356 00:52:33,720 --> 00:52:35,680 HITTING THE ROAD IS THAT 1357 00:52:35,680 --> 00:52:37,280 INVESTIGATOR GOING TO BE ABLE TO 1358 00:52:37,280 --> 00:52:38,720 DO WHAT THEY DESCRIBED TO THE 1359 00:52:38,720 --> 00:52:39,800 IRB THAT THEY'RE GOING TO DO AND 1360 00:52:39,800 --> 00:52:43,560 THEN WHAT IS THE IRB'S ROLE IN 1361 00:52:43,560 --> 00:52:44,360 POST-APPROVAL MONITORING TO MAKE 1362 00:52:44,360 --> 00:52:46,160 SURE THAT WHAT WAS DESCRIBED TO 1363 00:52:46,160 --> 00:52:47,920 THEM INITIALLY IS WHAT THEY'RE 1364 00:52:47,920 --> 00:52:49,480 ACTUALLY DOING? AND YOU DON'T 1365 00:52:49,480 --> 00:52:51,200 KNOW THAT. UNLESS YOU HAVE SOME 1366 00:52:51,200 --> 00:52:53,720 SORT OF A MECHANISM IN PLACE TO 1367 00:52:53,720 --> 00:52:54,880 EVALUATE THAT. BUT YOU BRING UP 1368 00:52:54,880 --> 00:52:56,560 AN EXCELLENT POINT BECAUSE, 1369 00:52:56,560 --> 00:52:58,280 YEAH, I WISH IT WAS THAT EASY, 1370 00:52:58,280 --> 00:52:59,920 THE IRB YOU JUST PROTECT 1371 00:52:59,920 --> 00:53:00,880 EVERYBODY BUT THEY CAN'T. 1372 00:53:00,880 --> 00:53:03,040 THAT'S NOT PRACTICAL. IT'S NOT 1373 00:53:03,040 --> 00:53:04,760 REALISTIC AND IT TAKES A 1374 00:53:04,760 --> 00:53:07,440 COMMUNITY OF PEOPLE THAT ARE 1375 00:53:07,440 --> 00:53:08,000 VESTED IN PROTECTING THESE 1376 00:53:08,000 --> 00:53:11,920 INDIVIDUALS FOR THIS TO WORK. 1377 00:53:11,920 --> 00:53:17,480 SO -- 1378 00:53:17,480 --> 00:53:22,000 >>PEG: CAN YOU SPEAK TO THE 1379 00:53:22,000 --> 00:53:25,160 INDIVIDUALS WHO PARTICIPATE IN 1380 00:53:25,160 --> 00:53:25,640 PEDIATRIC PARTICIPANTS? 1381 00:53:25,640 --> 00:53:26,920 >>QUINCY: THAT'S A WHOLE TALK. 1382 00:53:26,920 --> 00:53:33,440 THAT'S A HARD ONE. BECAUSE 1383 00:53:33,440 --> 00:53:34,200 CHILDREN ARE VERY, VERY 1384 00:53:34,200 --> 00:53:35,240 VULNERABLE. PARTICULARLY THE 1385 00:53:35,240 --> 00:53:37,680 YOUNGER THEY ARE THE MORE 1386 00:53:37,680 --> 00:53:38,680 VULNERABLE THEY ARE. THEY'RE 1387 00:53:38,680 --> 00:53:41,880 VULNERABLE FOR MANY REASONS. 1388 00:53:41,880 --> 00:53:43,000 THEY'RE VULNERABLE BECAUSE 1389 00:53:43,000 --> 00:53:43,840 THEY'RE CHILDREN, BUT THEY'RE 1390 00:53:43,840 --> 00:53:46,080 ALSO VULNERABLE BECAUSE THEY ARE 1391 00:53:46,080 --> 00:53:48,920 UNDER THE AUTHORITY OF PARENTS. 1392 00:53:48,920 --> 00:53:51,080 SO THEY CAN'T EVEN MAKE THEIR 1393 00:53:51,080 --> 00:53:52,600 OWN DECISIONS FROM A HEALTH CARE 1394 00:53:52,600 --> 00:53:53,360 PERSPECTIVE MUCH LESS FOR 1395 00:53:53,360 --> 00:53:55,480 RESEARCH PERSPECTIVE. SO WE PUT 1396 00:53:55,480 --> 00:53:57,240 THINGS IN PLACE TO HAVE THE 1397 00:53:57,240 --> 00:54:01,120 CHILD IF THEY ARE THE AGE OF 1398 00:54:01,120 --> 00:54:03,200 CONSENT, AND PARENTAL PERMISSION 1399 00:54:03,200 --> 00:54:06,600 TO PUT SOMETHING IN PLACE FOR 1400 00:54:06,600 --> 00:54:07,880 THEM. HERE'S THE FLIP SIDE OF 1401 00:54:07,880 --> 00:54:11,280 THIS, THIS IS WHY THIS GETS 1402 00:54:11,280 --> 00:54:14,480 DICEY. WE NEED ACTUALLY -- WE 1403 00:54:14,480 --> 00:54:17,840 ACTUALLY NEED MORE PEDIATRIC 1404 00:54:17,840 --> 00:54:20,720 RESEARCH AND HERE'S WHY BECAUSE 1405 00:54:20,720 --> 00:54:24,040 OF HOW WE GET MEDICINES -- HOW 1406 00:54:24,040 --> 00:54:26,480 WE PRESCRIBE MEDICINES TO 1407 00:54:26,480 --> 00:54:27,360 CHILDREN. HISTORICALLY AND 1408 00:54:27,360 --> 00:54:30,640 JONATHAN CAN SPEAK TO THIS TOO 1409 00:54:30,640 --> 00:54:32,400 HISTORICALLY IT'S BEEN DONE BY 1410 00:54:32,400 --> 00:54:34,880 EYEBALLING IT. AN ADULT GETS 1411 00:54:34,880 --> 00:54:37,400 THIS MANY MILLIGRAMS SO, HM, A 1412 00:54:37,400 --> 00:54:39,120 KID WILL GET HALF OF THIS BUT 1413 00:54:39,120 --> 00:54:42,040 THERE'S NO RESEARCH PEGGED TO 1414 00:54:42,040 --> 00:54:44,600 SAY THAT THIS WAS A SAFE DOSE IN 1415 00:54:44,600 --> 00:54:46,440 A CHILD. SO WE WENT FOR DECADES 1416 00:54:46,440 --> 00:54:51,920 AND DECADES EYEBALLING THINGS, 1417 00:54:51,920 --> 00:54:54,280 NEVER TESTING IT IN CHILDREN AND 1418 00:54:54,280 --> 00:54:56,320 CHILDREN WERE BEING HARMED 1419 00:54:56,320 --> 00:54:57,280 SEVERELY BECAUSE WE WERE 1420 00:54:57,280 --> 00:54:58,560 EYEBALLING TREATMENTS FOR THAT 1421 00:54:58,560 --> 00:55:01,240 SO ON THE ONE SIDE WE NEED TO DO 1422 00:55:01,240 --> 00:55:02,400 MORE RESEARCH AND WHAT IS SAFE 1423 00:55:02,400 --> 00:55:05,160 AND EFFECTIVE FOR THAT 1424 00:55:05,160 --> 00:55:05,840 POPULATION. BUT AT THE SAME 1425 00:55:05,840 --> 00:55:09,360 TIME, WE HAVE TO MAKE SURE THAT 1426 00:55:09,360 --> 00:55:10,840 THAT DESIRE TO GET MORE 1427 00:55:10,840 --> 00:55:13,920 QUESTIONS ANSWERED IN THAT 1428 00:55:13,920 --> 00:55:15,160 POPULATION DOESN'T MAKE THEM BE 1429 00:55:15,160 --> 00:55:17,800 MORE IN HARM'S WAY BECAUSE THEIR 1430 00:55:17,800 --> 00:55:19,880 STILL VULNERABLE ALTHOUGH WE 1431 00:55:19,880 --> 00:55:22,680 NEED TO GET THAT INFORMATION FOR 1432 00:55:22,680 --> 00:55:25,640 THE GREATER GOOD OF PEDIATRIC 1433 00:55:25,640 --> 00:55:26,560 POPULATIONS WE HAVE TO PROTECT 1434 00:55:26,560 --> 00:55:28,520 THOSE INDIVIDUALS EVEN MORE SO 1435 00:55:28,520 --> 00:55:29,160 THAT ARE ACTUALLY PARTICIPATING 1436 00:55:29,160 --> 00:55:31,280 IN THE RESEARCH. SO PEDIATRIC 1437 00:55:31,280 --> 00:55:35,360 RESEARCH, IT'S A COMPLICATED 1438 00:55:35,360 --> 00:55:36,360 SITUATION, RIGHT, AND 1439 00:55:36,360 --> 00:55:37,480 UNFORTUNATELY SOME OF THE 1440 00:55:37,480 --> 00:55:39,840 HISTORICAL UNETHICAL THINGS 1441 00:55:39,840 --> 00:55:41,880 INVOLVE CHILDREN EVEN IN THE 1442 00:55:41,880 --> 00:55:43,920 CONCENTRATION CAMPS. SOME OF 1443 00:55:43,920 --> 00:55:46,680 THE TWIN STUDIES WERE DONE IN 1444 00:55:46,680 --> 00:55:49,080 CHILDREN. AND WHAT HAPPENED IN 1445 00:55:49,080 --> 00:55:49,840 WILLOWBROOK, WHAT HAPPENED IN 1446 00:55:49,840 --> 00:55:51,880 THE DAVID RAYMER CASE AND WHAT 1447 00:55:51,880 --> 00:55:54,880 HAPPENED WITH MANY OF YOU 1448 00:55:54,880 --> 00:55:56,960 PROBABLY SAW THE DOCUMENTARY 1449 00:55:56,960 --> 00:55:59,200 THREE IDENTICAL STRANGERS. THEY 1450 00:55:59,200 --> 00:56:01,160 WERE BABIES WHEN THEY BECAME 1451 00:56:01,160 --> 00:56:02,520 PART OF THIS EXPERIMENT AND NO 1452 00:56:02,520 --> 00:56:04,560 ONE WAS THERE TO PROTECT THEM. 1453 00:56:04,560 --> 00:56:07,080 SO, YEAH, PEDIATRIC RESEARCH. 1454 00:56:07,080 --> 00:56:08,720 WE HAVE TO PROTECT THEM. BUT AT 1455 00:56:08,720 --> 00:56:11,600 THE SAME TIME, WE HAVE TO -- WE 1456 00:56:11,600 --> 00:56:15,800 CANNOT LET -- NOT LOSE SIGHT OF 1457 00:56:15,800 --> 00:56:16,960 THE IMPORTANCE OF DOING RESEARCH 1458 00:56:16,960 --> 00:56:20,080 IN PEDIATRIC POPULATIONS. 1459 00:56:20,080 --> 00:56:22,280 >>PEG: JONATHAN, ANYTHING ELSE 1460 00:56:22,280 --> 00:56:23,440 YOU WANT TO SAY ON THAT TOPIC? 1461 00:56:23,440 --> 00:56:26,080 >>JONATHAN: NO, LIKE I SAID, WE 1462 00:56:26,080 --> 00:56:29,080 COULD TALK FOR MANY HOURS ABOUT 1463 00:56:29,080 --> 00:56:32,280 THE CHALLENGES OF PEDIATRIC 1464 00:56:32,280 --> 00:56:34,920 RESEARCH. YES, WE HAVE TO DO IT 1465 00:56:34,920 --> 00:56:36,600 BUT WE HAVE TO DO IT WELL. 1466 00:56:36,600 --> 00:56:37,560 >>QUINCY: YEAH. YEAH. 1467 00:56:37,560 --> 00:56:38,160 >>JONATHAN: SO, ANYWAY, THANK 1468 00:56:38,160 --> 00:56:40,800 YOU. 1469 00:56:40,800 --> 00:56:41,840 >>PEG: GREAT, I THINK THAT'S 1470 00:56:41,840 --> 00:56:45,600 FOR OUR QUESTIONS TODAY. SO ON 1471 00:56:45,600 --> 00:56:49,560 BEHALF OF OUR OHSRP DR. GREEN 1472 00:56:49,560 --> 00:56:51,120 AND I WOULD LIKE TO THANK YOU 1473 00:56:51,120 --> 00:56:53,400 VERY MUCH FOR THIS. A VERY 1474 00:56:53,400 --> 00:56:55,880 THOUGHTFUL PROVOKING 1475 00:56:55,880 --> 00:56:56,240 PRESENTATION. 1476 00:56:56,240 --> 00:56:57,080 >>QUINCY: WELL THANK YOU, ALL, 1477 00:56:57,080 --> 00:56:58,640 FOR HAVING ME AND HOPEFULLY 1478 00:56:58,640 --> 00:56:59,880 WE'LL BE ABLE TO DO THIS AGAIN 1479 00:56:59,880 --> 00:57:00,640 IN THE FUTURE. 1480 00:57:00,640 --> 00:57:01,920 >>PEG: THAT WOULD BE GREAT, 1481 00:57:01,920 --> 00:57:14,280 THANK YOU. BYE-BYE.