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Archive | 2018

The Use of Non-human Primates in Research

Kate Chatfield; David B. Morton

The use of non-human primates in biomedical research is a contentious issue that raises serious ethical and practical concerns. In the European Union, where regulations on their use are very tight, the number of non-human primates used in research has been in decline over the past decade. However, this decline has been paralleled by an increase in numbers used elsewhere in the world, with less regard for some of the ethical issues (e.g. genetic manipulations). There is evidence that researchers from high-income countries (HICs), where regulations on the use of non-human primates are strict, may be tempted to conduct some of their experiments in countries where regulation is less strict, through new collaborative efforts. In collaborative ventures, equivalence in the application of ethical standards in animal research, regardless of location, is necessary to avoid this exploitation.


Bioethics | 2012

Is Homeopathy Really ‘Morally and Ethically Unacceptable’? A Critique of Pure Scientism

Lionel Milgrom; Kate Chatfield

In this short response we show that Kevin Smiths moral and ethical rejections of homeopathy(1) are fallacious and rest on questionable epistemology. Further, we suggest Smiths presumption of a utilitarian stance is an example of scientism encroaching into medicine.


Trials | 2017

The ethics of ‘Trials within Cohorts’ (TwiCs): 2nd international symposium

Clare Relton; Maarten J.P. Burbach; Clive Collett; James Flory; Sophie Gerlich; Søren Holm; Amanda Hunn; Scott Y. Kim; Linda Kwakkenbos; Anne May; Jon Nicholl; Danny Young-Afat; Shaun Treweek; Rudolf Uher; Tjeerd van Staa; Joanne van der Velden; Helena M. Verkooijen; Andrew J. Vickers; Sophie Welch; Merrick Zwarenstein; Scott Y. H. Kim; Zachary I. Goodman; Anne M. May; Danny A. Young-Afat; J.P.M. Burbach; Carla H. van Gils; Rieke van der Graaf; Laura C. Coates; William Tillett; David Torgerson

On 7-8 November 2016, 60 people with an interest in the ‘Trials within Cohorts’ (TwiCs) approach for randomised controlled trial design met in London. The purpose of this 2 TwiCs international symposium was to share perspectives and experiences on ethical aspects of the TwiCs design, discuss how TwiCs relate to the current ethical framework, provide a forum in which to discuss and debate ethical issues and identify future directions for conceptual and empirical research. The symposium was supported by the Wellcome Trust and the NIHR CLAHRC Yorkshire and Humber and organised by members of the TwiCs network led by Clare Relton and attended by people from the UK, the Netherlands, Norway, Canada and USA. The two-day symposium enabled an international group to meet and share experiences of the TwiCs design (also known as the ‘cohort multiple RCT design’), and to discuss plans for future research. Over the two days, invited plenary talks were interspersed by discussions, posters and mini presentations from bioethicists, triallists and health research regulators. Key findings of the symposium were: (1) It is possible to make a compelling case to ethics committees that TwiCs designs are appropriate and ethical; (2) The importance of wider considerations around the ethics of inefficient trial designs; and (3) some questions about the ethical requirements for content and timing of informed consent for a study using the TwiCs design need to be decided on a case-by-case basis. Main report On 7-8 November 2016, 60 people with an interest in the ‘Trials within Cohorts’ (TwiCs) design met in London for the 2 TwiCs international symposium. The symposium was supported by the Wellcome Trust and NIHR CLAHRC Yorkshire and Humber and organised by members of the TwiCs network led by Clare Relton. As well as UK participants, people came from the Netherlands, Norway, Canada and USA. Over the two days, the invited plenary talks were interspersed by discussions, posters and mini presentations from bioethicists, triallists and health research regulators.


Journal of Alternative and Complementary Medicine | 2011

Progress in the Placebo Debate for Homeopathy

Kate Chatfield

Since its inception 200 years ago, homeopathy has become one of the most popular and widely used forms of medicine in the world. Many reasons have been postulated for this, such as that it is a gentle form of medicine, that it is patient-centered, and that it is inexpensive; but surely such sustained acceptance over 2 centuries must also require that it be effective. Observational studies in the field of homeopathy demonstrate consistently that 70%–80% of patients benefit clinically from treatment by a homeopath, and hence its clinical effectiveness cannot be disputed. However, in spite of high levels of patient satisfaction and an excellent safety record, homeopathy receives more vocal resistance than any other form of alternative and complementary medicine. Homeopathy is not controversial because it doesn’t work. Homeopathy is controversial because homeopaths prescribe medicines that are highly diluted. The challenge is not about whether or not homeopathic treatment can improve health as we know that it can from the results of clinical outcome studies. The question is rather: Are homeopathic medicines different from placebo? The biggest challenge for homeopaths in the United Kingdom today is in demonstrating that their treatments are more than placebo medicine. This is an important question for homeopaths to address because, until it is answered satisfactorily, the development of homeopathy as a discipline will be stifled. Healthy development of homeopathy will only occur in a culture where homeopathy is accepted as an effective intervention. Until then, research that is aimed at improving practice will continue to be relinquished in favor of research that is aimed at proving efficacy. Some would have us believe that the placebo question has already been answered. In 2010, the House of Commons Science and Technology Committee published the results of their evidence check into homeopathy, which concluded that homeopathy is a placebo treatment that should not be funded through the National Health Service. In reaching this conclusion, the authors of this report have overlooked the body of evidence from placebo-controlled trials that support the hypothesis that homeopathic remedies have an effect over and above that of placebo. In fact, positive results from clinical trials of homeopathy are regularly dismissed as flukes, flawed by bias, or drawn from poorly designed studies. Moreover, the authors of the report accuse advocates of homeopathy of choosing ‘‘to rely on, and promulgate, selective approaches to the treatment of the evidence base’’ (page 20), which calls into question the usefulness of undertaking placebo-controlled clinical trials at all. In addition to the declaration that homeopathy is placebo medicine comes the relatively recent accusation that homeopaths are behaving unethically through the intentional prescription of placebos. This argument might carry some weight if it were clearly demonstrated that ultrahigh dilutions have no effect, but this is a field of active and ongoing investigation. The question of whether or not ultrahigh dilutions can have a physical effect is not resolved scientifically and still remains. It is currently being studied in a number of different ways, which shows that many scientists and medical researchers believe the phenomena worthy of investigation, and there is extensive ongoing debate and disagreement about the possibility of ultra high dilutions having an effect. The question has clearly not yet been resolved. With their use of the medical analyzer to test responses of the autonomic nervous system, Mishra et al. (in this issue) may have found a way to move research in this area forward. It appears that the medical analyzer offers a means of measuring a direct physiologic response to homeopathic medicines in an objective, rather than subjective, manner. If the results of this study are to be believed, then this may prove to be a landmark paper in the history of homeopathy. However, at this time I believe we should proceed with cautious optimism. The medical analyzer is a sensitive instrument that may detect physiologic changes in response to a wide range of stimuli. Initial results suggest that changes in heart rate and peripheral blood flow occurred in response to certain remedies and certain potencies, but this study is exploratory and includes only a small number of participants. The study protocol can be critiqued on a number of factors: for example, the sample size was small, there was no appropriate placebo control group and we don’t know how other potential variables were controlled. Nonetheless, the most significant aspect to emerge from this study is the possibility of a new technique and approach for testing and measuring the effects of highly diluted remedies directly on the human body. Furthermore, this method of testing would fit perfectly well into the ‘‘gold standard’’ of double-blind and placebo-controlled trial design that is currently demanded as objective proof of efficacy. In order to find out if the medical analyzer can be used to find a solution to the placebo debate, refinement and wider replication of the study is needed, preferably by an


Homeopathy | 2016

The publication in Homeopathy of studies involving animal experimentation.

Kate Chatfield; Robert T. Mathie; Leoni Villano Bonamin; Menachem Oberbaum; Peter Fisher

This editorial introduces a revised set of publication requirements for papers, submitted to Homeopathy, that involve animal experimentation. Journals that publish studies involving animal experimentation have a major role to play in the maintenance of ethical standards because researchers are reliant upon them for publication of their findings. With an increasing global trend towards greater transparency and accountability in animal experimentation, many academic journals, such as the British Journal of Pharmacology, 1 and 2 are taking action to improve reporting standards. In recognition of this need, members of Homeopathys Editorial Board have been working together to examine the scientific rationale and the most relevant ethical guidelines for the use of animals in research. In addition, they have examined existing published studies in homeopathy research and current practice within the broad domain of medical research. Each of these aspects has informed the revised publication policy, whose overarching objectives are to maximise the ethical standards and scientific quality of animal research in homeopathy, and thereby ultimately to avoid any unnecessary suffering of animals used in such research. The following description details the background that was considered, the rationale for this development, and the steps that will be taken.


Evidence-based Complementary and Alternative Medicine | 2018

Applying an Ethical Framework to Herbal Medicine

Kate Chatfield; Bahare Salehi; Javad Sharifi-Rad; Leila Afshar

Herbal medicines make a vital contribution to healthcare globally, but from production through to practice, there are ethical challenges that require attention. Ethical challenges are often analysed through application of an ethical framework because this can facilitate a consistent and structured approach. In healthcare, the most commonly used framework over recent decades has been that of the four principles: beneficence, nonmaleficence, autonomy, and justice. However, for various reasons that are explained, this approach to ethical analysis is not the most fitting for the global phenomenon of herbal medicine. In this paper, a relatively new moral framework that is based upon the globally accepted values of care, respect, honesty, and fairness is explored in relation to herbal medicine for the first time. Through application of this framework, the ethical challenges and actions needed to address them become clear, thus resulting in practical recommendations for enhancing ethical standards in herbal medicine.


Sustainability | 2017

The Responsible Research and Innovation (RRI) Maturity Model: Linking Theory and Practice

Bernd Carsten Stahl; Michael Obach; Emad Yaghmaei; Veikko Ikonen; Kate Chatfield; Alexander Brem


Homeopathy | 2007

Patients treated by homeopaths registered with the Society of Homeopaths: a pilot study

Clare Relton; Kate Chatfield; Hazel Partington; L Foulkes


Sustainability | 2017

Innovating Responsibly in ICT for Ageing: Drivers, Obstacles and Implementation

Kate Chatfield; Konstantinos Iatridis; Bernd Carsten Stahl; Nearchos Paspallis


Journal of Alternative and Complementary Medicine | 2011

“It's the consultation, stupid!”…isn’t it?

Lionel R. Milgrom; Kate Chatfield

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Robert T. Mathie

British Homeopathic Association

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Alexander Brem

University of Southern Denmark

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Emad Yaghmaei

University of Southern Denmark

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Veikko Ikonen

VTT Technical Research Centre of Finland

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Doris Schroeder

University of Central Lancashire

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Peter Fisher

University of Central Lancashire

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Clare Relton

University of Sheffield

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