By David Tuller, DrPH
Last month I wrote to the director of legal services at the University of Bristol seeking information about documents from a study conducted by investigators from the institution. The study, published by BMJ Open in 2011, was called â€œUnidentified Chronic Fatigue Syndrome/myalgic encephalomyelitis (CFS/ME) is a major cause of school absence: surveillance outcomes from school-based clinics.â€
More than a year ago, I had sought consent forms and other documents from Bristol through a freedom of information request. In response, Bristol noted that this was a â€œpilot clinical serviceâ€ and â€œa clinical projectâ€ and that the university held none of the study documents. Yet the specialist service for pediatric CFS/ME in Bath, the medical unit that ran the â€œclinical project,â€ also informed me that it did not hold the documents and suggested I needed to contact the university.
This run-around triggered my e-mail to the legal services director in early March. My goal in touching base again with Bristol about this matter was to double-check that the universityâ€™s first answer was correctâ€”that it did not, in fact, have any documents.
On March 28, I received the following e-mail:
Dear Dr Tuller,
We have been asked to respond to your email of 5th March…
We can confirm our original responseÂ that the University does not hold the information requested. If you were to submit another Freedom of Information request, you would receive the same answer.
University of Bristol
Today, I sent the following e-mail to the director of legal services:
As you know, I have been seeking documents about a studyÂ conducted by Bristol investigators and published by BMJ Open in 2011. The study was called â€œUnidentified Chronic Fatigue Syndrome/myalgic encephalomyelitis (CFS/ME) is a major cause of school absence: surveillance outcomes from school-based clinics.â€
When I submitted a freedom of information request to Bristol more than a year ago, I was told the study involved a “pilot clinical service” and that the university did not hold the documents. But when I appealed to the Bath clinical service that conducted the pilot program, I was referred back to the university. Now Bristolâ€™s FOI office has re-confirmed that the university does not hold documents related to this study. I find this inability to locate key documents for a study conducted by Bristol investigators to be perplexing.
Also, my e-mail to you last month included these questions: â€œIf these documents are definitely not at Bristol, do you know where they might be? If not, would you be able to find out and let me know?â€ I did not notice an answer to these questions in the e-mail from Bristolâ€™s FOI team. Presumably the Bristol investigators themselvesÂ mightÂ know the location of any such documents.
So hereâ€™s the situation: To collect data for this study, a Bristol investigator conducted in-person interviews with children. Yet no one seems able to find consent forms for this form of data collection among minors. Given my unsuccessful efforts to access these forms or even find out who holds them, would it be fair to assume the study might have been conducted without obtaining informed consent from participants? Can you suggest other possible explanations?Â
This assumption might make sense in light of the decision to exempt the study from ethical review by calling it â€œservice evaluationâ€ rather than â€œresearch.â€ The school absence study included a hypothesis and generalizable conclusions as well as in-person data collection. These are all well-known hallmarks of â€œresearch.â€ In contrast, â€œservice evaluationâ€ generally relies on anonymized secondary data sets and is exempt from ethical review. The process of ethical review includes a review of consent forms. So perhaps it should not be surprising that a study conducted without undergoing ethical review might also bypass the process of obtaining informed consent.
In exempting the study from ethical review, the investigators cited a letter from a research ethics committee involving an unrelated pediatric data collection strategy. In my reporting, I have identified ten additional studies from the team of Bristol investigatorsÂ that similarly exempted themselves from ethical review based on the same research ethics committee letter. Some of these studies involved adults, so it is unclear why experienced investigators would consider them exempt from ethical review based on a research ethics committee letterÂ specificallyÂ about pediatric data collection. Â
When I initially raised concerns about the school absence study, no one appeared to take the matter seriouslyâ€”certainly not BMJ Open. (I have ccâ€™d BMJ editorial director Fiona Godlee, who is aware of my concern about this paper. I have also ccâ€™d Darren Jones MP, Carol Monaghan MP and Nicky Morgan MP, key members of the cross-party parliamentary coalition that has expressed concerns about the methodological and ethical flaws of research in this field.)Â
The apparent lack of institutional responsibility is what prompted me to communicate with the Health Research Authority, the arm of the National Health Service that oversees research ethics practices. As I learned from the HRA (and reported on Virology Blog in January), Bristol is now conducting an investigation into multiple studies that exempted themselves from ethical review citing this single REC letter. According to the HRA, this investigation is â€œindependent.â€
Can you provide any information about when Bristol plans to finish this investigation? Can you provide any information about the size and composition of the panel assessing these studies? Does the panel include one or more Bristol faculty members or others affiliated with Bristol? If yes, how many?Â
And a couple of related questions: Is the university concerned that this investigation so closely follows last yearâ€™s research misconduct scandal involving Abderrahmane Kaidi, a Bristol cancer biologist who resigned in disgrace in September? Does Bristol believe these twin episodes might suggest a problem with governance and oversight policies?
Thank you very much for any additional information you can provide.
David Tuller, DrPH
Senior Fellow in Journalism and Public Health
Center for Global Public Health
University of California, Berkeley
Post-script: In my e-mail to the legal services director, I mistakenly wrote “Darrell Jones MP” instead of “Darren Jones MP.” I sent the recipients a subsequent e-mail to correct the error.