CMAJ • September 9, 2008; 179 (6). doi:10.1503/cmaj.1080086.
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters

A question of ethics

Stephen Kish, PhD

Human Neurochemical Pathology Laboratory, Centre for Addiction and Mental Health, Toronto, Ont.

[The author responds:]

The investigation about which Mark Dubé raises concerns involved treatment for patients addicted to opiate drugs in which a surgical lesion was made in a brain region (nucleus accumbens) considered to influence addiction to abused drugs.1 The study reported partial success of the procedure.

Dubé feels that the study should not have been cited because the investigation was conducted in China and at a military-affiliated hospital (Tangdu Hospital) and, therefore, there would be ethical problems concerning lack of consent. As a point of clarification, my understanding from my Chinese colleagues is that it is likely that most patients at Tangdu Hospital in China are from the public.

I chose to cite the article in my review2 because the article stated explicitly that patients underwent surgery "of their own free will"1 and because I do not feel that the fact that a human study is conducted in China is sufficient grounds to dismiss the findings. I recognize that there will be those who feel that such consent cannot be freely given in China. I note that the same group described their consent process in more detail in a subsequent article: "All patients gave written informed consent according to the Declaration of Helsinki, and the study was approved by the local ethics committee."3

The data from the study that I cited in my review were presented at the 2003 meeting of the American Society for Stereotactic and Functional Neurosurgery and published as a full article in the society's journal as part of the conference proceedings.2 The Tangdu Hospital group's other study discussed above was published in the same journal.3 I mention this only parenthetically; I do not mean to imply that only human studies published in Western journals should be considered for citation.

In my review, I expressed my opinion that the findings from the article in question are preliminary. I did not cite the article as providing a potential strategy for treatment of drug addiction but only as providing limited evidence suggesting possible involvement of one brain region in drug addiction.

Footnotes

Competing interests: None declared.


REFERENCES

  1. Gao G, Wang X, He S, et al. Clinical study for alleviating opiate drug psychological dependence by a method of ablating the nucleus accumbens with stereotactic surgery. Sterotact Funct Neurosurg 2003;81:96–104.[CrossRef][Medline]
  2. Kish SJ. Pharmacologic mechanisms of crystal meth. CMAJ 2008;178:1679–82.[Abstract/Free Full Text]
  3. Guo H, Gao G, Wang X, et al. Effects of bilateral deep brain stimulation of the subthalamic nucleus on olfactory function in Parkinson's disease patients. Stereotact Funct Neurosurg 2008:86:237–44.




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