China, drug rehabilitation and research ethics

Recently a research study conducted among drug users in China has been criticized by Human Rights Watch in the US. The study was published in Science. It studied ways of reducing drug cravings among heroin addicts in Chinese drug rehabilitation centers. Joseph Amon of Human Rights Watch criticized the study because it was not clear whether drug users who participated in the study where in the rehabilitation centers voluntarily or whether they received proven effective drug dependency treatment as part of their rehabilitation.

Human Rights Watch has previously criticized the conditions in Chinese drug rehabilitation centers. I will not comment on this criticism here. If one's position is that unfavorable conditions make all research in such centers unethical, irrespective of the nature of the study, then of course this study is also unethical. This is an extreme position, however, that would also make any prison research in the US unethical. It is widely agreed that US incarceration rates and policies do not conform to international standards; few would argue that this in and of itself makes all research in US prisons unethical.

There is nothing in the research procedures themselves that would even come close to being unethical. It is a noninvasive study where subjects were shown videos and their cravings measured by a questionnaire type study, using a visual analog scale. Informed consent was provided. The subjects were told that they did not have to participate in the study. Amon of Human Rights Watch has also not criticized the study as such, except for possibly a procedural violation, that it was not approved by the US NIH since investigators from NIDA (National Institute of Drug Abuse) are co-authors. It is unclear, however, whether even this would be required, as we are told that they were only involved in the writing of the paper for publication, and in any case is not a criticism of the content of the study.

The main question is therefore: Should useful and minimal risk research, of potential use to the research participants themselves, be allowed in places where alleged human rights violations take place? The answer to this question is obviously yes. Any other answer would prohibit all prison research in the US, and would prohibit lots of useful research on ways to improve human rights violations. This, of course, does not mean that all research in prisons or under less than ideal conditions are ethically acceptable. But we need to give specific reasons why or why not a study should be approved in these circumstances.

It is Joseph Amon who has behaved unethically by wrongfully accusing Chinese scientists of acting unethically. The same is true of a bioethicist such as Stuart Rennie in his blog, who repeats Amon's criticism, without attempting to give even a hint of an indication that anything specific happened in this study that could be labeled unethical. Both China and researchers are easy targets these days:  Amon and Rennie assume that since this is human subjects research, and especially since it is done in China, there must be something unethical about it. No need to point out anything specific.