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A taxonomy of multinational ethical and methodological standards for clinical trials of therapeutic interventions
  1. Carol M Ashton1,
  2. Nelda P Wray1,
  3. Anna F Jarman1,
  4. Jacob M Kolman2,
  5. Danielle M Wenner1,
  6. Baruch A Brody2
  1. 1Department of Surgery, The Methodist Hospital Research Institute, The Methodist Hospital, Houston, Texas, USA
  2. 2Center for Ethics, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
  1. Correspondence to Dr Carol M Ashton, 6550 Fannin Street, SM1661, Houston, TX 77030, USA; cashton{at}


Background If trials of therapeutic interventions are to serve society's interests, they must be of high methodological quality and must satisfy moral commitments to human subjects. The authors set out to develop a clinical-trials compendium in which standards for the ethical treatment of human subjects are integrated with standards for research methods.

Methods The authors rank-ordered the world's nations and chose the 31 with >700 active trials as of 24 July 2008. Governmental and other authoritative entities of the 31 countries were searched, and 1004 English-language documents containing ethical and/or methodological standards for clinical trials were identified. The authors extracted standards from 144 of those: 50 designated as ‘core’, 39 addressing trials of invasive procedures and a 5% sample (N=55) of the remainder. As the integrating framework for the standards we developed a coherent taxonomy encompassing all elements of a trial's stages.

Findings Review of the 144 documents yielded nearly 15 000 discrete standards. After duplicates were removed, 5903 substantive standards remained, distributed in the taxonomy as follows: initiation, 1401 standards, 8 divisions; design, 1869 standards, 16 divisions; conduct, 1473 standards, 8 divisions; analysing and reporting results, 997 standards, four divisions; and post-trial standards, 168 standards, 5 divisions.

Conclusions The overwhelming number of source documents and standards uncovered in this study was not anticipated beforehand and confirms the extraordinary complexity of the clinical trials enterprise. This taxonomy of multinational ethical and methodological standards may help trialists and overseers improve the quality of clinical trials, particularly given the globalisation of clinical research.

  • Clinical trials
  • research ethics
  • research methods
  • scientific research

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  • The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

  • Funding This research was supported by Award Number R01CA134995 from the National Cancer Institute of the United States.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Institutional Review Boards of The Methodist Hospital Research Institute and Baylor College of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.