IRB and the Aging Physician

There have been a series of adverse outcomes in clinical trials being conducted at your hospital. The Medical Director who has headed the Institutional Review Board (IRB) has been doing so for the past 20 years. After further investigation, legal counsel has informed you that the protocols have not been followed, and in many instances, patients have not been provided adequate informed consent. You have also heard rumors that the Medical Director, now aged 71, has noticeably slowed in recent years and at times seems forgetful.
For this Discussion, reflect on the scenario presented. Then, consider how you as a current or future healthcare administration leader might address the issues with IRB in the scenario. Think about what steps might be needed to make an IRB valid and to ensure that research conforms to IRB protocol.
Post an explanation of what steps you, as a current or future healthcare administration leader, might take to address the issues with IRB as presented in the scenario. Explain what steps are needed to make an IRB valid and how you would ensure that research in a health services organization conforms to proper IRB protocol. Be specific and provide examples.

 

Sample Solution

regimes.
In many non-democratic countries today, an abundance of wealth held by the ruling elites compared with poverty among the masses helps dictatorships resist democratisation. Often, the ruling elites spend large portions of the funds available to them on suppressing resistance, for example, “China reportedly employs two million censors to police the internet (Bennett and Naim 2015)”[4], while in Peru under Fujimori, “the regime paid more than $36 million a year to the main television channels to skew their coverage, and reportedly offered one channel a $19 million bribe (McMillan and Zoido 2004, pp.82-5)”[4]. This has an opportunity cost; spending on investment and development of industries is foregone, often leaving the citizens of a non-democratic regime stuck in the early stages of Walter Rostow’s 5 Stages of Growth Theory, as shown in Figure 2, which can leave countries primary- or secondary-sector dependent and under-developed. As John Harriss describes, such “economic development [is] conducive to democratisation, partly because [it] strengthens the ‘moderate’ middle class”[5]: a social group of people who are better educated and financially-placed to resist being ‘bought-off’ by a dictator. Emerging middle classes therefore diminish the extent to which non-democratic leaders can bribe their winning coalition with private goods, as the prospect of doing so becomes increasingly expensive as the size and wealth of the middle classes grow as a result of development, while the loyalty norm weakens too.
We may also see a rise in post-materialist values as the population becomes wealthier, since “after a period of sharply rising economic and physical security, one would expect to find substantial differences [in] value priorities, […] for example, post-materialists […] are markedly more tolerant of homosexuality”[6]. This could erode the extent to which the population would be morally willing to accept such bribes, regardless of magnitude. Subsequently, economic development might lead to the demise of such a regime.

An additional economic explanation could be the ‘resource curse’, which suggests that countries “with abundant reserves of non-renewable mineral resources, such as Nigerian oil [and] DRC gold […] produce less diversified and less competitive economies, more income inequality [and] heightened danger of state capture and rent-seeking by ruling elites”[25]. This is because the revenue streams in these countries are so concentrated to the elites and ruling classes, providing only menial low-paid labour to politically-insignificant lower classes. Moreover, since they are prim

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