If states want to continue using inmates for medical research, they each should set up an independent advocate's office to assure that standards are maintained.
Just using the phrases "prison inmates" and "medical research" in the same sentence is enough to make you uneasy. But three years ago, for a variety of reasons, the Florida prison system decided to lift its ban on the use of inmates in medical research. Now a federal agency is questioning some of those clinical trials, saying they may have violated ethical standards.
There is hardly a more vulnerable group in our society than men and women behind bars. They depend entirely on the prison system for their quality of life and may be easily coerced to participate in medical studies with risks they don't understand. On the other hand, prisoners shouldn't be denied the opportunity to participate in trials of experimental medication that may truly be their only hope of surviving a deadly illness. To balance these concerns, medical experimentation should be allowed in prisons but only under the strictest supervision. Federal rules require that inmates be fully apprised of the risks, that no prisoner is offered better medical care or living conditions if he participates and that the studies must be reviewed by an advocate for the inmates.
According to the federal Office for Human Research Protections, some research on inmates sponsored by the University of Miami may have failed to meet these standards. Federal investigators were prompted to review the university's study after a St. Petersburg Times story reported some disturbing findings: HIV-positive inmates may have been pressured to participate; others joined to gain access to better medical care and conditions of confinement; and some inmates who signed the consent form didn't appear to understand the risks. In addition, the so-called inmate advocate for the study was Dr. David Thomas, the man in charge of health care for the prison system.
In fairness, the federal rules are complicated and OHRP didn't criticize only the University of Miami. A number of other universities were taken to task for the way they conducted research with prisoners. The worst offender, the University of Texas, has since suspended about 200 clinical trials using inmates.
At a time when prison populations are at an all-time high, state corrections officials are naturally attracted to medical studies as a way for drug companies and universities to underwrite the cost of care. Free health exams and medications, often for their sickest inmates, come as part of the package. Researchers are drawn to prison populations because inmates are easy to study; they tend not to drop out, and their environment is highly controlled. But these powerful incentives for the prison and medical establishments can be a dangerous mix for inmates.
If states want to continue this practice, each should establish an independent advocate's office _ one that isn't tied to the prison or university system in any way _ to oversee its operation. Only by enlisting full-time, professional watchdogs will the interests of prisoners be as fully considered as those of the bottom line.