Paul Norbert W
Institut für Geschichte, Theorie und Ethik der Medizin, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2020 Nov;63(11):1424-1430. doi: 10.1007/s00103-020-03232-6. Epub 2020 Oct 16.
Novel immune therapies are more and more based on the molecular differentiation of disease patterns and related clinical studies are thus more often characterized by so-called adaptive study designs (umbrella or basket studies including platform studies), which are continuously adjusted based on novel results. This paper analyses new study designs beyond the often-postulated need for regulation in order to identify ethical problems based on typical structural features and to - whenever possible - suggest solutions. Additionally to the relationship between social and scientific values of a study as well as aspects of the scientific validity of new forms of evidence, the inclusion of study subjects under the condition of relative uncertainty, specific challenges in the process of ethical approval, as well as ethical and practical challenges in the process of informing patients and receiving informed consent will be addressed.
新型免疫疗法越来越基于疾病模式的分子分化,因此相关临床研究更多地以所谓的适应性研究设计(包括平台研究的伞形或篮子研究)为特征,这些设计会根据新结果不断调整。本文分析了除了经常假定的监管需求之外的新研究设计,以便根据典型结构特征识别伦理问题,并尽可能提出解决方案。除了研究的社会和科学价值之间的关系以及新证据形式的科学有效性方面之外,还将探讨在相对不确定的情况下纳入研究对象、伦理批准过程中的具体挑战,以及在告知患者和获得知情同意过程中的伦理和实际挑战。