At the Intersection of Science and Human Rights

Inmates sew at a compulsory drug rehabilitation centre in Kunming.

A study by Xue et al, published in Science‘s 13 April 2012 issue, tested an experimental treatment for addiction on 66 former heroin users confined at two detention centers in Beijing.

According to Reuters:

Studies published by Science must have approval from an ethics board; the Chinese scientists say their study had such approval from Peking University.

BUT…

Again quoting Reuters:

Joseph Amon, director of the health and human rights division at Human Rights Watch, charged in [a] letter that in both [detention centers] addicts are ‘detained without due process’ and, he told Reuters, ‘held in a closed institution where monitoring of human rights abuses is not allowed.’ It is not clear from the study whether the addicts ‘were voluntary patients’ at the facilities or forcibly held, Amon said in his letter.

Mr. Amon, who is also an associate in the department of epidemiology at the Bloomberg School of Public Health at Johns Hopkins University and a lecturer in public and international affairs at Princeton University, is correct. Arrest for illegal drug use in China can lead to compulsory treatment (for a minimum of 2 years) at detention centers that function as de facto penal colonies where inmates are fed substandard food and denied basic medical care. The detentions are enforced by police, where the drug user has no opportunity to have a trial, face a judge, or raise an appeal. When a drug user leaves detention, the problems do not end there: their having been arrested for drug use is noted on their national identification card, making future employment difficult and leaving them vulnerable to frequent and humiliating searches by police.

This is not a rare phenomenon: according to a May 2009 report by the Joint United Nations Programme on HIV/AIDS (UNAIDS), half a million people are confined in drug detention centers in China at any given time. Most reports indicate that “treatment” during detention looks like punishment, exploitation, or merely lame, consisting of unpaid labor in chicken farms or shoe factories, or in the form of untested “therapies” like sandbox play, art, or boxing.

The study by Xue et al was conducted at Beijing Ankang and Tiantanghe Drug Rehabilitation Centers, but these are two of the facilities that have raised concerns about human rights violations over the past years.

‘The journal is not an investigative body,’ a spokeswoman for Science told Reuters. ‘On the basis of the authors’ response as well as (the editors’) own internal review, which included a science ethicist, the concerns about human rights seem to have been addressed, and the paper remains in good standing at this time.’

Daniel Wikler, a bioethicist at the Harvard School of Public Health in Boston, publicly commented:

Human Rights Watch has published valuable reports on inhumane treatment of drug addicts in many lands, including both China and the United States…But why brand the experiment by Xue et al as unethical?… Mr. Amon’s objections to the Xue et al study do not amount to much. He seems to be using the publication of the study as a means of drawing attention to wrongs in China’s treatment of addicts… it would be a shame if Mr. Amon’s letter tarnished the reputation of Chinese and U.S. scientists who seem to have conducted an innocuous (but valuable) experiment… [emphasis added]

Wikler is a frequent lecturer on ethics and health in the PRC and Hong Kong and holds honorary appointments at two Beijing research institutions, but he is no expert on the Chinese government’s attitude toward human rights and the rule of law. It seems at least equally plausible that Mr. Amon is using the wrongs in China’s treatment of addicts as a means of drawing attention to the unethical nature of the Xue et al experiment.

Inmates take an oath to resist drugs at a mandatory rehab center in Wuhan, China. (Stringer Shanghai/Reuters).

The authors of the study included 11 scientists at Peking University, led by Yan-Xue Xue, and two scientists, David Epstein and Yavin Shaham, at the National Institute on Drug Abuse (NIDA), which is part of the U.S. National Institutes of Health. The NIDA declined to allow the two U.S. scientists to speak about the study. And the two NIDA researchers did not sign the response, nor did three of the Beijing University scientists. So the response to Amon’s letter published by Science in their 3 August 2012 issue was actually signed by only eight authors, all from Peking University, out of the total of 13.

In the authors’ response, the scientists explain that their work used subjects who they say were “court mandated” — but as noted before, drug users are usually sent to detention centers without any formal trial, never seeing the inside of a courtroom, because drug abuse in China isn’t considered a criminal offense. They dismiss Amon’s charges by stating, “The human rights violations mentioned by Amon would have violated China’s new National Narcotics Control Law and Chinese law in general…Patients who work are always paid. This provision has been put into effect for many years, and recently has been written in the National Narcotics Control Law, which bans forced labor.” This sounds like something written by the Chinese Communist Party (CCP). Such naivete about China’s respect for fundamental freedoms and human rights is disturbing. Chinese laws hardly justify confidence in the humane treatment of their study subjects.

There is a well-known saying in China that makes despotic officials (such as those staffing detention centers) happy: “the heaven is high and the emperor, far away”; therefore even if the central government is good and has formulated good laws, regulations, rules, codes, policies, etc., a despotic official may still do whatever he wants. China is too large and the central government is too far away to be aware of their malpractices; while the God who always upholds justice, is too high away to meddle.

In institutional settings, where conformity and compliance are rewarded, people may not feel that they have a real choice. Prisoners are aware that behavior is continuously monitored and assessed, and that this can have very real consequences.

As a scientist, I am appalled at the glib way the AAAS addresses human rights concerns. With drug user detainees in such circumstances in China, is voluntary informed consent of participants really possible? Are researchers who conduct research in these facilities complicit in the ill-treatment of drug users at the hands of Chinese authorities? I believe so.

Although the NIDA didn’t provide direct funding for the study, it did contribute financial support for the paper by paying the salaries of Epstein and Shaham. In a statement released to the Associated Press on April 22, the NIDA explained that its scientists “advised on the experimental design of the preclinical studies, and were involved in the data analyses and in the preparation of the manuscript.” Science magazine’s guidelines, as well as the NIDA’s code of conduct and standard scientific protocol, state that all co-authors are responsible for the sum total of any article published in its pages. By allowing their names to be published on the study, Epstein and Shaham took responsibility for the entire contents of the report, including the ethics of the research. Since these two scientists were significant enough contributors to the research to warrant authorship, should the study have also been reviewed under the (rather stringent) U.S. regulations governing prisoner research? I believe so. If it had been, would it have passed muster? I believe not. For one thing, under American law, federally funded research on inmates must be approved by a panel that includes at least one prisoner who volunteers to serve (see Title 45 CFR Part 46.304(b)).

I strongly urge Science magazine to retract this study for not adhering to standards protective of human subjects; verification of compliance with human rights standards should be obtained from third-party sources, not affiliated in any way with the CCP (which includes Peking University), as a matter of policy whenever considering publication of such studies from China.

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