Thursday, August 16, 2012

IRBs Impeded Harvard Dissertation on Addiction and Incarceration

Kimberly Sue, a medical anthropologist in Harvard's MD/PhD program, reports that IRB review can seem "a hassle, a nuisance or a stumbling block, as we seek to enact a more relevant and engaged era of anthropology."

[Kimberly Sue "Are IRBs a Stumbling Block for an Engaged Anthropology?" Somatosphere, 9 August 2012, . h/t Michelle Meyer]

Sue wants to study "the interstices of addiction and incarceration as they play out in the lives of women with opiate addiction here in Massachusetts as the 'War on Drugs' rages on." She considered writing her dissertation about South Africa, but "felt morally compelled to work here at home, in the epicenter of the world’s mass incarceration phenomenon." Unfortunately, the IRB system designed to protect prisoners has discouraged the research that could better their lot.

Sue explains:

With my IRBs (I have submitted several, to various institutions across the state in order to conduct my research), I have seen a wide-range of concerns related to vulnerability and to the special status of “prisoners.” For example, I was told by one IRB that if someone in my study who was not incarcerated (a group of women in the community with histories of opiate addiction) became incarcerated, I would have to inform the IRB “before her participation continues, since we must then apply the regulations regarding research involving prisoners.” Technical accounting aside, this woman’s “vulnerability”—in practical terms, her education, power, resources, life history, social supports—was probably unchanged from the days, months, even years before she became physically incarcerated. What does the reporting of someone’s changed status regarding incarceration to the IRB actually entail, practically speaking? Increased protections? More careful auditing? A greater awareness of the coercive potential of her continued participation in my study?

I also encountered some of the more typical “fieldwork” concerns and lack of general understanding of ethnographic methods. In response to my attempt at being honest about the nature of ethnographic engagement—saying that I hoped to conduct participant observation with my key informants as they sought treatment upon release from prison—the IRB asked me to “provide documentation of permission from those sites” (such as halfway houses or drug treatment programs that a woman might seek out). I felt somehow at fault for not explaining the nature of anthropological inquiry in adequate language for a lay audience: that it, that this research was prospective, longitudinal research tailored to individual women, and that a big part of my research was by nature contingent and situational.

One IRB wanted Sue to exclude the sicker individuals she encountered, even though "As an anthropologist particularly interested in those left behind, those least able to negotiate the world in an outwardly cohesive manner and those most 'vulnerable' to the vagaries of social injustices, [Sue] wanted to include—if not prioritize—their participation." Another wanted Sue to deploy "motivational interviewing," a counseling technique inapporpirate to observational anthropology.

It is not clear from Sue's essay how insistently these IRBs meddled. She writes, "Many of my colleagues have heard me talk about returning to finish my last year of medical school because I have been so overwhelmed by the magnitude and effort required by the research approval process." Does this mean that the IRBs delayed her dissertation by a whole year? Or just that she took advantage of some flexibility on staging her joint degree?

What is clear is that while Sue is not ready to call for the abolition of IRBs, she wants significant change.

We . . . must acknowledge the very real possibility that the over-protections of IRBs applied to “populations” here at home—as opposed to expedited or fairly cursory reviews of committees for work proposed abroad—could actually deter medical anthropologists from doing valuable work here at home. I think it is critical that we also be more honest and forthright about how IRBs can actually impede, slow down and alter our research (to be fair, they can potentially offer cross-disciplinary dialogue and helpful suggestions); more of us need to share openly the details of our experiences with IRBs in order to come up with practical techniques for advancing our collective research endeavors.

Digression: I've seen a lot of scholarly blogs and online journals over the past few years, and I can't recall any with designs as elegant as Maarten Ottens's design for Somatosphere. I'm particularly impressed that one can display suggested citations for each post in five different systems, and they appear automatically in the beautifully formatted PDFs one can download. (On the other hand, I can't square the suggested "Chicago citation" with the form for blog entries recommended by the Chicago Manual of Style, 16th. ed., sec. 14.246.)


Anonymous said...

The IRB is at the mercy of the federal government as it is charged with seeing that the Code of Federal Regulations is upheld for federal funded research at its institution. The regulations for research with prisoners require a different composition of the IRB (the majority of the board may have no relationship to the prision and a prisoner or prision representative must serve on the Board), and additional duties of the IRB. Don't blame the IRB for asking for information if a study that did not include prisoners at the outset has some subjects who are incarcerated during the course of the study. This isn't an arbitrary IRB rule but a requirement that is necessary so that the IRB doesn't land in hot water with the feds.

Zachary M. Schrag said...

Thanks for this comment. Sue's essay discusses the "IRB apparatus," the "IRB process," and the "IRB system," which I take to mean the regulations and their implementation together. Her experiences may complicate claims that existing regulations offer sufficient flexibility to facilitate ethical research.

Kimberly Sue said...

I have no problem with federal regulations mandating IRBs to monitor research involving prisoners or people who might become prisoners, but I wonder what the implications are besides a hassle for the researcher. I doubt that increasing reporting from the research level on up has any practical ethical implications for fieldwork.

Update: still mired since a committee convened for their August meeting last week. One major concern was that my questions might increase the risk of cravings (for drugs)-- one of those questions they expressed concern about was: "How do you feel on your drug of choice?" It's really a pretty basic, standard qualitative drug question. I was asked to explain why the question was necessary for my research (short answer--it's necessary for an anthropologist to try to understand the lived experience/subjectivities of drug users) and what steps I would take to minimize the risks that answering these questions could lead the subject to crave drugs.

Zachary M. Schrag said...

Many thanks for these comments and your original essay. IRBs have long been imagining that asking about trauma leads to trauma. Does yours have any evidence that asking about drug use leads to drug use? Or is this another bear taboo?

Kimberly Sue said...

I researched the question about craving by talking to a woman who is advising my project, who is many years in recovery from opiates. She scoffed at the notion that my questions would cause drug cravings more than what she encounters every day in the world. Just the thought of the upcoming weekend, seeing someone's protruding vein on an arm, passing by a sign on a freeway where she had once bought drugs--all of these can cause cravings. Having a cravings, of course, does not necessarily mean someone will go out and use. It's patronizing and out of touch with reality for the people on the IRB to think that my research questions are a significant risk for increased drug use.