Jeremy Sherr – blind to ethics and reason
Posted by gimpy on January 26, 2009
After reporting on the actions of the homeopath Jeremy Sherr who is carrying out unethical experiments on terminally ill AIDS patients in Tanzania my blog has become inundated with homeopaths supporting his actions. These range from those I have never heard of to Dana Ullman, an extremely prominent and notorious writer on homeopathy, and incidentally one who has some experience of the heavy hand of the law as a result of practicing homeoapthy. Not one supporter of homeoapthy appears to have a problem with Sherr’s actions.
Perhaps I have been remiss in not making clear the international norms for medical research, and research on AIDS specificially. First off there is the Declaration of Helsinki, the World Medical Association’s document guiding the use of human patients in medical research. These are its basic principles for medical research:
- It is the duty of the physician in medical research to protect the life, health, privacy, and dignity of the human subject.
- Medical research involving human subjects must conform to generally accepted scientific principles, be based on a thorough knowledge of the scientific literature, other relevant sources of information, and on adequate laboratory and, where appropriate, animal experimentation.
- Appropriate caution must be exercised in the conduct of research which may affect the environment, and the welfare of animals used for research must be respected.
- The design and performance of each experimental procedure involving human subjects should be clearly formulated in an experimental protocol. This protocol should be submitted for consideration, comment, guidance, and where appropriate, approval to a specially appointed ethical review committee, which must be independent of the investigator, the sponsor or any other kind of undue influence. This independent committee should be in conformity with the laws and regulations of the country in which the research experiment is performed. The committee has the right to monitor ongoing trials. The researcher has the obligation to provide monitoring information to the committee, especially any serious adverse events. The researcher should also submit to the committee, for review, information regarding funding, sponsors, institutional affiliations, other potential conflicts of interest and incentives for subjects.
- The research protocol should always contain a statement of the ethical considerations involved and should indicate that there is compliance with the principles enunciated in this Declaration.
- Medical research involving human subjects should be conducted only by scientifically qualified persons and under the supervision of a clinically competent medical person. The responsibility for the human subject must always rest with a medically qualified person and never rest on the subject of the research, even though the subject has given consent.
- Every medical research project involving human subjects should be preceded by careful assessment of predictable risks and burdens in comparison with foreseeable benefits to the subject or to others. This does not preclude the participation of healthy volunteers in medical research. The design of all studies should be publicly available.
- Physicians should abstain from engaging in research projects involving human subjects unless they are confident that the risks involved have been adequately assessed and can be satisfactorily managed. Physicians should cease any investigation if the risks are found to outweigh the potential benefits or if there is conclusive proof of positive and beneficial results.
- Medical research involving human subjects should only be conducted if the importance of the objective outweighs the inherent risks and burdens to the subject. This is especially important when the human subjects are healthy volunteers.
- Medical research is only justified if there is a reasonable likelihood that the populations in which the research is carried out stand to benefit from the results of the research.
- The subjects must be volunteers and informed participants in the research project.
- The right of research subjects to safeguard their integrity must always be respected. Every precaution should be taken to respect the privacy of the subject, the confidentiality of the patient’s information and to minimize the impact of the study on the subject’s physical and mental integrity and on the personality of the subject.
- In any research on human beings, each potential subject must be adequately informed of the aims, methods, sources of funding, any possible conflicts of interest, institutional affiliations of the researcher, the anticipated benefits and potential risks of the study and the discomfort it may entail. The subject should be informed of the right to abstain from participation in the study or to withdraw consent to participate at any time without reprisal. After ensuring that the subject has understood the information, the physician should then obtain the subject’s freely-given informed consent, preferably in writing. If the consent cannot be obtained in writing, the non-written consent must be formally documented and witnessed.
- When obtaining informed consent for the research project the physician should be particularly cautious if the subject is in a dependent relationship with the physician or may consent under duress. In that case the informed consent should be obtained by a well-informed physician who is not engaged in the investigation and who is completely independent of this relationship.
- For a research subject who is legally incompetent, physically or mentally incapable of giving consent or is a legally incompetent minor, the investigator must obtain informed consent from the legally authorized representative in accordance with applicable law. These groups should not be included in research unless the research is necessary to promote the health of the population represented and this research cannot instead be performed on legally competent persons.
- When a subject deemed legally incompetent, such as a minor child, is able to give assent to decisions about participation in research, the investigator must obtain that assent in addition to the consent of the legally authorized representative.
- Research on individuals from whom it is not possible to obtain consent, including proxy or advance consent, should be done only if the physical/mental condition that prevents obtaining informed consent is a necessary characteristic of the research population. The specific reasons for involving research subjects with a condition that renders them unable to give informed consent should be stated in the experimental protocol for consideration and approval of the review committee. The protocol should state that consent to remain in the research should be obtained as soon as possible from the individual or a legally authorized surrogate.
- Both authors and publishers have ethical obligations. In publication of the results of research, the investigators are obliged to preserve the accuracy of the results. Negative as well as positive results should be published or otherwise publicly available. Sources of funding, institutional affiliations and any possible conflicts of interest should be declared in the publication. Reports of experimentation not in accordance with the principles laid down in this Declaration should not be accepted for publication.
Jeremy Sherr’s actions do not fit these principles. In addition to the Declaration of Helsinki, the UN have issued ethical guidelines covering research aimed at preventing AIDS, something Sherr claims homeopathy can do. These following Guidance Points are taken from the document and represent a summary of the relevant chapters:
Guidance Point 2: Community Participation
To ensure the ethical and scientific quality and outcome of proposed research, its relevance to the affected community, and its acceptance by the affected community, researchers and trial sponsors should consult communities through a transparent and meaningful participatory process which involves them in an early and sustained manner in the design, development, implementation, monitoring, and distribution of results of biomedical HIV prevention trials.
Guidance Point 3: Capacity Building
Development partners and relevant international organisations should collaborate with and support countries in strategies to enhance capacity so that countries and communities in which trials are being considered can practice meaningful self-determination in decisions about the scientific and ethical conduct of biomedical HIV prevention trials and can function as equal partners with trial sponsors, local and external researchers, and others in a collaborative process.
Guidance Point 4: Scientific and Ethical Review
Researchers and trial sponsors should carry out biomedical HIV prevention trials only in countries and communities that have appropriate capacity to conduct independent and competent scientific and ethical review.
Guidance Point 6: Research Protocols and Study Populations
In order to conduct biomedical HIV prevention trials in an ethically acceptable manner, researchers and relevant oversight entities should ensure that the research protocol is scientifically appropriate and that the interventions used in the experimental and control arms are ethically justifiable.
Guidance Point 7: Recruitment of Participants
In order to conduct biomedical HIV prevention trials in an ethically acceptable manner, participation of individuals should be voluntary and the selection of participating communities and individuals must be fair and justified in terms of the scientific goals of the research.
Guidance Point 8: Vulnerable Populations
The research protocol should describe the social contexts of a proposed research population (country or community) that create conditions for possible exploitation or increased vulnerability among potential trial participants, as well as the steps that will be taken to overcome these and protect the rights, the dignity, the safety, and the welfare of the participants.
Guidance Point 11: Potential Harms
Research protocols should specify, as fully as reasonably possible, the nature, magnitude, and probability of all potential harms resulting from participation in a biomedical HIV prevention trial, as well as the modalities by which to minimise the harms and mitigate or remedy them.
Guidance Point 13: Standard of Prevention
Researchers, research staff, and trial sponsors should ensure, as an integral component of the research protocol, that appropriate counselling and access to all state of the art HIV risk reduction methods are provided to participants throughout the duration of the biomedical HIV prevention trial. New HIV risk-reduction methods should be added, based on consultation among all research stakeholders including the community, as they are scientifically validated or as they are approved by relevant authorities.
Guidance Point 15: Control Groups
Participants in both the control arm and the intervention arm should receive all established effective HIV risk reduction measures. The use of a placebo control arm is ethically acceptable in a biomedical HIV prevention trial only when there is no HIV prevention modality of the type being studied that has been shown to be effective in comparable populations.
Guidance Point 16: Informed Consent
Each volunteer being screened for eligibility for participation in a biomedical HIV prevention trial should provide voluntary informed consent based on complete, accurate, and appropriately conveyed and understood information before s/he is actually enrolled in the trial. Researchers and research staff should take efforts to ensure throughout the trial that participants continue to understand and to participate freely as the trial progresses. Informed consent, with pre- and post-test counselling, should also be obtained for any testing for HIV status conducted before, during, and after the trial.
Again it is clear that Sherr does not fit these principles. I apologise for this lengthy post but these are all points which will need to be referred to in the subsequent storm which will hit my comments box. This storm will be the result of the following email sent out by Jeremy Sherr to his supporters:
My homoeopathic friends,
In the past few days the Tanzanian AIDS project and I have become the target of the “anti homoeopathy” attackers in the UK. They have posted on both my blog, the “gimpyblog” http://gimpyblog.wordpress.com/ and others with inflammatory speculation and erroneous conclusions about the Homoeopathy AIDS project.
We would like to bring this to the attention of the larger homoeopathic community. As many of you know, there has been an ongoing campaign to discredit and annihilate homoeopathy in the UK by posting false information and unfounded and inflammatory opinions. Their battlefield has now expanded to Tanzania.
In the attacks on the Tanzanian AIDS project they took parts of my blog and previous interviews from my website archives and contrived a story in order to further their desire to malign homoeopathy. They allege that I am persuading patients to use homoeopathy in place of ARVs, which is totally untrue. They claim that any research of homoeopathy is unethical as there is no proof that homoeopathy works. They even went so far as to claim that my treating AIDS patients in Tanzania with homoeopathy will lead to mass murder. These accusations are not only malicious, they are libelous.
Their tactics were not confined to regurgitation their thoughts online. One follower even phoned a UK organization that supports the AIDS project and also contacted UK and Tanzanian government officials, claiming that there was an ‘unethical’ project taking place.
I am urging the global homoeopathic community to rise up in solidarity.
This is a tiny but dedicated faction who uses the internet blogs and the media to amplify their spurious attacks.
They have stated that they are determined to kill homoeopathy.
They have had negative impact on the availability of homoeopathy in the UK and are responsible for the closing of homoeopathy hospitals and clinics as a direct consequence of their campaign.
Here are some ways to show your support for the work of all homoeopaths worldwide and for the Tanzanian AIDS clinic.
1. MEET THEM ON THEIR OWN GROUND: Flood their blogs http://gimpyblog.wordpress.com/ with posts on the benefits of homeopathy, using examples of your own experiences. They can argue endlessly about the theory, but what do they say to the hundreds of thousands of people who have had improved health?
2. USE THE INTERNET TO AMPLIFY HOMOEOPATHY’S VOICE.
Go to my blog and post your supportive comments on http://www.jeremysjournalfromafrica.blogspot.com
Let anyone visiting the blog see the overwhelming support for this project and homoeopathy in general. To learn more about the project, see my website http://www.dynamis.edu
3. PUT A STOP TO THESE ATTACKS. Homoeopathy is our beloved profession, our mission in life. Respond vigorously to any attempts to intimidate practitioners or to denigrate your passion to bring our gentle healing to others, wherever they may live.
Meanwhile, I am returning to Tanzania to continue treating AIDS patients. In my first six weeks I have treated 100 AIDS patients with very promising results. We have a clinic administrator in the north where a high percent of the people have AIDS and where there are very few medical institutions. The situation is worse than I could ever have imagined, worse than anything shown on television or written in books. The patients are eager to use homoeopathy and I am eager to help them.
I and my colleagues are fully committed to establishing a treatment, teaching and research center in Tanzania. This is homoeopathy’s chance to shine. Please join us!
I will not address this email point by point, it will further add to the tedium of writing this blog post, but I will make these points.
Jeremy Sherr is a liar. He claimed support from Muhumbili University and the University of Maryland, neither of these instituitions claim any knowledge of or support for Sherr’s activities. Sherr also claims on his blog that he was not planning trials, this may be true now but only after he edited to remove mention of proposed trials. You can find his original blog posts at semiskimmed.net.
Jeremy Sherr shows no remorse, no consideration for the views of his critics and continued contempt for established ethical standards. His email contains no engagement with arguments against his actions, just exhortations for his supporters to share their admiration for him on my blog. Despite all that raised against him, the condemnation from Muhumbili University, the concerns expressed to his charitable backers, the Homeopathy Action Trust, and to the UN he persists in his folly. I have made attempts to contact Sherr and will send him the blog but I have had no reply so far, nor am I expecting one. I am considering what approach to take next now that I am certain Sherr will not listen to reason and nor will his supporters.