Conflict between Research and Ethics Within the last fifty years there has been growing concern about the conflict which exists between medical research and the ethical issues related to this issue. Concern has been growing if only for the numerous cases which have come to the fore about the unethical ways in which medical research has been conducted to the detriment of many participants in this research. A review of the medical literature will reveal that there are accepted pillars which guide the conduct of medical research on human beings, in light of the impact of the work of the medical profession on global health and well being. The Belmont Report which was prepared by the United States National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, on April 18, 1979 cited three ethical principles related to the conduct of research with human subjects. These three principles include the following: 1. Autonomy. 2. Beneficence. 3. Justice. Autonomy Autonomy relates to the responsibility entrusted upon the researcher to ensure that each participant in the research process has all of the required information in order to make an informed decision as to whether to participate or not. Autonomy then presupposes that there is full disclosure to the participant of the possible risks or health hazards related to participation. Beneficience Beneficience speaks to the need to ensure that the medical researcher endeavors to maximize the benefits to be gained by the participant while minimizing any possible harm which can come to him/her. Justice Inherent in the concept of justice, is the need to ensure that there is equity in the selection of all participants with due regard being given to the differences which exist in cultural groups, individuals and communities. Inherent in the need to uphold the major pillars related to research on human beings, is also the need to guard against unethical practices in the research design especially if the subjects are socially disadvantaged. The conduct of any good piece of research requires the researcher to be cognizant of issues of reliability and validity, representativeness of the sample, research methodology and confidentiality. More so with medical research which involves the lives of the participants, safety is to be given paramount importance. Safety must not be a feature at the start of the research alone but must be an integral part of the entire research process. The consent of the patient to participate in the process is critical to the success of the overall research. It is preferable, as far as possible, that consent is given in writing. Approaches to obtaining informed consent can vary from territory to territory, as the literature has revealed that in territories which may have high levels of illiteracy, and different social structures, informed consent can be verbal as obtained from a tribal chief, elder or community as a whole. Again, this consent has to be a linear process and should not be done for mere formality to appease participants. Participant s must feel that their opinion is important and valued and the Researcher’s main focus is not merely on advancing medical research. The Researcher must also communicate how confidential information arising from the patient –physician relationship will be treated and divulged and if it is to be divulged, to whom and under what circumstances and the possible consequences for the breach of confidentiality. Related to the issue of patient consent is the need to also discuss how any unforeseen occurrences will be handled by the Researcher and the mechanism to meet the possible financial burdens of the participant. Due care must be taken with respect to the wording of consent documents, so that they are simply written and can be understood by the average citizen. One school of thought speaks to the need to regulate by law the participation of persons in medical or other types of research, another view has been expressed that informed consent depends on the nature of the research to conducted. The writer is of the view that even if the need for consent is legislated, this legislation can become ineffective in the absence of rigorous enforcement. Notwithstanding the inherent conflict which can exist between medical research and ethical issues, one can not deny the major advancements made in the medical field which only redound to the benefit of the world’s population, more specifically patients and medical professionals. It is not uncommon to read about cures for ailments once thought to be incurable and new life given to patients when vital organs fail. The Tuskegee Syphilis Study which was initiated in 1932 by the United States Public Health Service was aimed at recording the incidence of syphilis in the black population of Macon County, Alabama. In essence, the study called to account the unethical manner in which the study was undertaken as the participants were not communicated the correct reasons for their treatment, and were blatantly denied treatment for their diagnosed condition. This approach directly questions the issue of the lack of informed consent and the possible harmful consequences referred to above as some of the important ethical issues in conducting research on human subjects. Due to the outright violation of the rights of the participants in the Tuskegee study, medical research practices were revisited by the American Medical Association and a National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was created as a result of the enactment of the National Research Act. This action in the United States spawned the proliferation of Research Ethics Committees whose roles and responsibilities include, inter alia: 1. Undertaking independent ethical review of major medical research with a view to ensuring compliance with standards. 2. Regulating the medical research field in order to safeguard human life. 3. Facilitating meaningful research. 4. Ensuring that qualified medical personnel undertake medical research and there is confidentiality of data and information. 5. Shielding the medical fraternity from unwarranted criticism. In essence, Research Ethics Committees perform an overall watch dog role. In outlining the roles and responsibilities of these committees, it is important to treat with the issue of effectiveness of these Committees. In reality, the level of successful operation of Ethics and any other Committee is a function of the quality and level of commitment of the human resources assigned to the undertaking. If the resources and the funding mechanisms are not in place, then the ability of the Committees to add value would soon be compromised. If I were in a position of power, the managerial approach that I would take to create the balance between ethics and medical research would be as follows: 1. Convene a panel of international experts in the field of medical research who report to the highest level of the political directorate. The team should be multi disciplinary in the field of medicine. 2. Enact enabling legislation with appropriate Regulations to govern how medical research should be conducted. 3. Enforce the relevant legislation by ensuring that the necessary administrative machinery is in place. 4. Fine and blacklist medical research bodies which breach ethical principles. In conclusion, it can be said that it is possible to advance the cause of medical research while protecting the well being of the citizenry and the possibility of achieving this task is entwined in the availability of the appropriate legal and regulatory framework which must be enforceable. REFERENCES 1. Doumbo, Ogobara K. (February 2005). It Takes a Village: Medical Research and Ethics in Mali. Science, Vol.307.no. 5710, pp.679-681. Retrieved December 7, 2005 from http:// www.sciencemag.org/gcg/content/full/307/510/679. 2. Final Report of the Tuskegee Syphilis Study Legacy Committee – May 20, 1996. Retrieved December, 7, 2005 from http:// www.healthsystem.virginia.edu. 3. Levine, Jeff. (September 2003). Ethics and Medical Research Can Go Hand in Hand. Retrieved December, 7, 2005 from http:/ / www.webmd.com/content/Article27/1728_61279.htm. 4. The Role of Research Ethics Committees: Assessment of the Ethics of Research. Retrieved December, 7, 2005 from http://www.mrc.ac.za/ethics/committees.htm.