by Wendy Tate, PSM, CIP
I live in Tucson, AZ. Located 60 miles north of the US-Mexico border, 1 million people and the University of Arizona call Tucson home. Tucson is known as a large city with a small-town feel. On Saturday, January 8, 2011, when a single individual shot 19 people, including my congresswoman, Gabrielle Giffords, this small town became the center of the nation’s focus.
Like many of you, I have been keeping up on the medical updates regarding Rep. Giffords. As I hear about the amazing feat of surviving a point-blank gunshot to the head, I am reminded of two areas of science that have driven medical care to the point that surviving such a traumatic event is even a possibility: combat care and research. The relationship between combat care and emergency medicine is clear, but now, I would like to focus on research and its role during these events.
This is a time when research is put to the test. Emergency response requires methods that are quick and effective. While research studies often allow for careful and methodical procedures in controlled situations, the field has real-world expectations that are often not as forgiving. Emergency medical personnel perform cutting-edge procedures to try not only save a person’s life, but to preserve its quality. Psychologists utilize revamped testing and counseling methodologies to help victims cope with their experiences. Like everything in life, affected populations’ responses cannot be predicted accurately 100 percent of the time. Research results must be robust enough that when they are made into standard practice, they hold up to the variability that life guarantees.
At the same time research results are validated in the field, researchers are tested. Tragic events provide a plethora of opportunities to study everything from medical and environmental technologies to human responses and emotions. While the purpose of research is to answer a scientific question, researchers must remember the populations with whom they are working, and the delicacy of the situation that they are approaching.
Communities that have experienced a devastating event are vulnerable for a substantial period of time, making informed consent difficult, if not impossible. While the research subjects may be competent and cognitive, they are no doubt still vulnerable. Researchers must build safeguards into their protocols to ensure that unnecessary risks are not introduced. Asking questions that seem to have minimal risk may cause psychological damage, therefore having a greater risk. Asking a person who just finished watching a war movie what emotions and images come to mind when hearing the sound of a gunshot is much different than asking a person who recently witnessed a shooting in real life.
Our community is vulnerable right now. I have no doubt that our IRB will be seeing research proposals looking at the fallout of this past weekend’s events, and that research on tragedies such as this produce good findings. However, I know that the IRB will be very concerned about what research subjects are asked to do.
This event has become part of Tucson’s local context for research, even though the reason behind this tragedy had nothing to do with research. Everyone involved, researchers, IRB members, human research protection programs, research administration, and the community at large must take a stand and only allow research that follows the ethical principles of the Belmont Report. Respect for persons must be upheld, especially when those persons are in a vulnerable situation and may not have the capacity to decide what is best for them. Risks, including psychological, must be minimized; and no risk is justifiable when there is no potential for benefit. Justice must be preserved. Individuals and communities should not be asked to participate in research if there is no benefit to their population. They must reap from the contribution that they make.
I want to close this article by thanking my colleagues across the United States. Over the last two days, members of my office have received several e-mails and phone calls sending well-wishes and condolences to our community. We cherish them all, and thank you for keeping us in your thoughts and prayers