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Who exactly needs to get approval from an institutional review board (IRB)?

dynomight.net

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Re: Who exactly needs to get approval from an institutional review board (IRB)?

#101
post #83

Earlier quoted context omitted.

> Collecting clinical MRIs to do deep learning doesn't require an IRB Yes it does, but typically the IRB will waive consent and waive notification for those sorts of studies if the images can be de-identified. There's also HIPAA involved which may or may not require establishing a BAA depending on what's being done if the images can't be de-identified. This is particularly an issue with brain MRI because it is usuall…

I've worked in MRI AI both in academic and non-academic centers, including technology that has received 510K clearance. I admit it sounds pedantic, but I'm not discussing IRB *exemptions* that are sometimes required by an institution nor am I discussing BAAs. I was specifically talking about the specific IRB applications (which I've submitted and signed before) that the blog author was talking about. Yes, HIPAA and o…

MRI are Class II devices and until last year exemptions for IDE applications and for not obtaining written informed consent specifically excluded devices that by design or intent deposit energy in humans (regardless of overall study risk. Last year the FDA finally extended some power to IRBs to harmonize with HHS research regulations which have allowed IRBs to waive consent for minimal risk studies for a long time. But FDA directing you to an IRB rather than both an IRB and the FDA itself doesn't mean you're not dealing with an IRB.

FDA and human subject protections come from different laws with different legislative authority. The regulations are not the same except to the extent that the agencies themselves work to harmonize things. If you are doing anything covered by FDA you must follow FDA's regulations in addition to any other applicable human subjects research regulations. And because MRI scanners are Class II regulated devices it means that people are being scanned with a doctor's permission, an IRB's permission or the FDA's direct permission.

FDA "doesn't care" about SAR to the extent that they have published guidance that if you operate an approved MRI scanner within normal operating mode (which are settings defined by IEC that do not necessitate medical supervision), then the FDA will not automatically consider use of the scanner itself to elevate a study's risk (in the way that using something like a CT scanner with ionizing radiation would). Risk determination goes beyond whether or not the MRI itself is a risk though. For example a research study that diverts patients to MRI in a way that delays care in an emergent situation (say testing experimental sequences for stroke detection) is unlikely to overall qualify as minimal risk even if the scanner operates in normal mode because of other non-MRI risks associated with the study procedures.

Retrospective use of de-identified or anonymized medical records that already exist are of course a different thing because the risks to the patient are primarily privacy risks.

And you are correct the actual FDA labels of all the AI crap that's coming out are jokes compared to what a lot of sales bullshitters promise. But you better believe all the data submitted to the FDA by the MRI manufacturers support their accelerated acquisitions that use deep learning recons follow FDA's clinical trials regulations.

Re: Who exactly needs to get approval from an institutional review board (IRB)?

#102
post #66

Earlier quoted context omitted.

It took me a while to accept that the law is not a consistent system with hierarchical top-down rules that can be used to determine legality in an unambiguous way. If you're a software engineer and you're knee-deep in analyzing court cases to find out how to file some tax correctly, you're definitely overthinking it. The CPA was exactly correct.

Yeah but now I just switch my perspective from thinking of it as a formal deductive system to thinking of it as an optimization problem.

Chances are your CPA was not correct. CPAs routinely violate the law as a regular course of duty and the IRS is fine with it, even encourages it, because it gives them more revenue. If you are looking to go down a multi-year rabbit hole on this, then try to find the law that imposes any tax on __your__ domestic income.

(Hint* You can't)

Re: Who exactly needs to get approval from an institutional review board (IRB)?

#103
post #10

I mean tons of retrospective studies are literally "IRB exempt" (and highlighted as such in their methods) where no explicit consent is required or needed. Physicians doing case reviews don't need consent of the patient this work. Doing retrospective analyses for defining clinical phenotypes on patient data that has been aggregated isn't needed either. Collecting clinical MRIs to do deep learning doesn't require an I…

No, even IRB exempt studies need to be approved as IRB-exempt by the IRB. Funny isn't it? A lot of other things in your comment are wrong too btw.

Re: Who exactly needs to get approval from an institutional review board (IRB)?

#104
post #69

Earlier quoted context omitted.

> It's easy for people (especially the kinds of people who gravitate towards engineering) to get all worked up about the necessary implications of the regulations as-written I was once trying to figure out taxes owed on some RSUs granted in California that vested in North Carolina (and some other edge case that I can’t remember). Hoh boy. What a rabbit hole. I didn’t think the CPA that I hired to do my taxes handled…

>...In the real world, people usually attempt to solve problems by forming hypotheses and then testing them against the facts as they know them. When the facts confirm the hypotheses, they are accepted as true, although subject to re-evaluation as new evidence is discovered. This is a successful method of reasoning about scientific and other empirical matters because the physical world has a definite, unique structur…

Thanks for the link! I have been thinking a lot about topics related to this lately and this looks like an interesting read. Skimming through it I might not agree with all the ideas of the author I very much welcome new ideas about how to organize our society and our legal system. I have especially been thinking about how the legal system is mostly fiction and what makes it work is not so much what the laws say and what the punishments are for breaking them, but rather our shared belief in the system. And I think this is problematic because it takes away our agency to imagine other ways of doing things, we think our current legal system is the only possible system because it has to be. Thoughts of anything else would cause a collapse.

I have also been thinking about how basing morality on following laws is a bad idea. You should not be afraid of breaking laws or rules if they are stupid. All of modern workers rights, women's rights, etc are based on brave people of the past that were not afraid of breaking stupid laws of their time, why should today be any different.

Re: Who exactly needs to get approval from an institutional review board (IRB)?

#105
post #66

Earlier quoted context omitted.

It took me a while to accept that the law is not a consistent system with hierarchical top-down rules that can be used to determine legality in an unambiguous way. If you're a software engineer and you're knee-deep in analyzing court cases to find out how to file some tax correctly, you're definitely overthinking it. The CPA was exactly correct.

Yeah but now I just switch my perspective from thinking of it as a formal deductive system to thinking of it as an optimization problem.

Yes, that's right. It's a Bayesian Game and you are attempting to reduce risk to an acceptable level (not under paying) while minimizing loss (not over paying tax) with only partial information (what the results of a lawsuit would determine).

Re: Who exactly needs to get approval from an institutional review board (IRB)?

#106
As an academic researcher, it's most frustrating in that it feels like IRB scrutiny doesn't seem to align with risk.

I do accounting research. My human-subjects research involves surveying practitioners about their jobs, interviewing them about their experiences, and conducting very simple experiments online that ask them to make decisions. There is virtually 0 real risk to any participants of my studies. IRB does always give my studies "exempt" status, but it still has to be reviewed. And they will pester me about different things like where will store our data (Onedrive is fine, but dropbox is not for some reason). This process will typically take a couple weeks of back and forth.

Yet I have a friend who participated in a Kinesiology dissertation study where they were asked to do extremely strenuous physical activity. He fainted(!) at one point from the activity. And it seemed to them that there were relatively few safeguards from that happening. Now, I'm sure that study did have IRB approval, but it really got me thinking... are we really scrutinizing studies optimally?

Re: Who exactly needs to get approval from an institutional review board (IRB)?

#107
post #34

An article like this is interesting from a research (meta-research?) perspective, but I think the lack of relevant case law (nobody seems to have ever been prosecuted) really undermines the usefulness. It's easy for people (especially the kinds of people who gravitate towards engineering) to get all worked up about the necessary implications of the regulations as-written. But it's also important to remember that bein…

> It's easy for people (especially the kinds of people who gravitate towards engineering) to get all worked up about the necessary implications of the regulations as-written I was once trying to figure out taxes owed on some RSUs granted in California that vested in North Carolina (and some other edge case that I can’t remember). Hoh boy. What a rabbit hole. I didn’t think the CPA that I hired to do my taxes handled…

If you move from Germany to Brazil you might also hit edge cases.

Yes that is 2 different countries. But it is similar. States have their own laws.

You can't expect the law across 3 jurisdictions to work out every permutation and legislate for it. There are 52 (I guess more... lots of territories) * 51 permutations of moves so 2652 moves that are possible.

In addition you are talking RSUs and not some vanilla thing like claiming an expense.

Re: Who exactly needs to get approval from an institutional review board (IRB)?

#108

As an academic researcher, it's most frustrating in that it feels like IRB scrutiny doesn't seem to align with risk. I do accounting research. My human-subjects research involves surveying practitioners about their jobs, interviewing them about their experiences, and conducting very simple experiments online that ask them to make decisions. There is virtually 0 real risk to any participants of my studies. IRB does al…

We are not. Here's a great essay about the subject:

https://journals.sagepub.com/doi/abs/10.1177/174701611100700...

The author also has a blog about IRBs: http://www.institutionalreviewblog.com/?m=1

Re: Who exactly needs to get approval from an institutional review board (IRB)?

#109
post #29

The answer is no, you don't need permission, but you do incur a legal and ethical risk whenever you do research, and as such, the more you can do to strengthen the legal and ethical arguments in your defense, the better. IRBs are simply a way to say "I had an independent group of ethical and legal authority review my research and they thought it was ok".

It's hard to take the article seriously since

  1) It doesn't even reference the relevant law
  2) The relevant law is so simple and clear
42 USC 289(a) states:

"The Secretary shall by regulation require that each entity which applies for a grant, contract, or cooperative agreement under this chapter for any project or program which involves the conduct of biomedical or behavioral research involving human subjects submit in or with its application for such grant, contract, or cooperative agreement assurances satisfactory to the Secretary that it has established (in accordance with regulations which the Secretary shall prescribe) a board (to be known as an “Institutional Review Board”) to review biomedical and behavioral research involving human subjects conducted at or supported by such entity in order to protect the rights of the human subjects of such research."[1]

To put it succinctly this only relates to any entity which applies for a grant, contract, coop. agreement under chapter 6A of 42 USC.

This in no way relates to private research. It's easy to get hung up on regulation spaghetti code, but regulations cannot exceed the scope of the statutes, which in turn cannot exceed the authority of Congress.

Edit: add source [1] https://www.law.cornell.edu/uscode/text/42/289

Re: Who exactly needs to get approval from an institutional review board (IRB)?

#110
This is what good lawyers do: dig in to the sausage factory.

What's interesting is how agencies push the limits on what they can do. All agencies do this to one extent or another. And they obviously won't tell you if they're doing that to you or not.

Granted authority and actual authority are different. It's worth remembering that when dealing with any bureaucracy.

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