Human Rights Group Questions Ethics of Chinese Drug Treatment Study

A Chinese research team's study of drug addiction treatments published inScience on 13 April is coming under fire from Human Rights Watch (HRW), the New York City-based advocacy group. This week's issue of Science contains a letter from the group accusing the Chinese team of not making it clear whether their research subjects were held "without due process" in compulsory treatment centers and subjected to "forced labor." But a response from the study authors describes their considerable efforts to ensure that the research was conducted in an ethical manner, and bioethicists based in both the United States and China have also defended the Chinese researchers, calling the accusations unfair.

The researchers, led by Yan-Xue Xue of Peking University in Beijing, tested a psychological technique for reducing cravings in drug addicts that can threaten a relapse into drug abuse. Those cravings are usually triggered by specific environmental cues, such as the sight of a syringe, spoon, and tourniquet for a heroin addict. The Chinese team's goal was to weaken the link between those environmental cues and the memories of drug abuse, thus reducing the craving.

The study did two sets of experiments, first with rats and then with humans. (Only the human experiments are being criticized.) The research involved about 60 former heroin addicts at drug treatment centers in Beijing.

For the past several years, HRW has been investigating human rights abuses in China involving medical research on prisoners. The researchers recruited their subjects from Beijing Ankang Hospital and Tian-Tang-He Drug Rehabilitation Center. But according to HRW's Joseph Amon, the researchers in their paper are "mischaracterizing" reality. Because arrested drug addicts are routinely committed to compulsory treatment in those institutions, Amon argues that the "hospital" is really a detention center and what the researchers describe as patients are actually detainees*. He questions whether informed consent is possible with such a population.

The study was funded in part by the U.S. National Institute on Drug Abuse (NIDA). In an e-mail to Science, Amon writes that "NIDA should conduct an independent investigation of the research and denounce the arbitrary detention of the roughly 200,000 people currently in compulsory drug detention centers in China."

In their published reply, which also appears in this week's issue of Science, the authors write, "We saw no indication of the abuses Amon describes … [and] confidential interviews with the study participants did not reveal any examples of abuses they encountered." The letter notes that the study, funded by the Chinese Natural Science Foundation, "received approval from the Human Investigation Committee of the Peking University Health Center." The subjects were told that "they had the right to withdraw their consent and quit the study at any time," the researchers write.

Bioethicists contacted by ScienceInsider say that the Chinese researchers are blameless. "Human Rights Watch has published valuable reports on inhumane treatment of drug addicts in many lands, including both China and the United States," writes Daniel Wikler, a bioethicist at the Harvard School of Public Health in Boston. "Reforms are urgently needed. But why brand the experiment by Xue et al. as unethical?"

"Mr. Amon's objections to the Xue et al. study do not amount to much," according to Wikler. "He seems to be using the publication of the study as a means of drawing attention to wrongs in China's treatment of addicts. That may be a cause worthy of support, but it would be a shame if Mr. Amon's letter tarnished the reputation of Chinese and U.S. scientists who seem to have conducted an innocuous (but valuable) experiment that, perhaps paradoxically, could point to a remarkably noninvasive, gentle technique for helping drug addicts worldwide avoid relapse—the holy grail of addiction research for many decades." Wikler notes that his father, Abraham Wikler, was a pioneer in this area of drug addiction treatment.

The view of Renzong Qiu, a bioethicist at the Chinese Academy of Social Sciences in Beijing, is similar. "The research the authors conducted is of social value and there is no possible harm beyond the minimum. I am sorry to say Amon's criticism is unfair."

But Amon is not backing down. In an e-mail to ScienceInsider, he writes:

They have not fully addressed my concerns. They have not addressed the fact that individuals in the study were being held in arbitrary detention. Study subjects were detained without due process—they had no lawyer, saw no judge, had no opportunity to appeal their forced treatment. The researchers can say that no abuses were occurring but these centers are closed to independent human rights monitors and they apparently did not ask specific questions of abusive treatment.

*This item has been corrected to indicate that Joseph Amon did not call the research subjects "prisoners" and the facility they reside in a "prison," but rather that he considers them detainees in a detention center.