For passengers and patients, accountability key to safety

October 25, 2001|By William R. Brody

IN THE wake of any tragedy, including the suicide-terrorist attacks on the World Trade Center and Pentagon, people seek to assign blame.

Congress already has begun singling out airport security systems for not detecting weapons on the airplane hijackers.

The U.S. Senate wants Washington to take control of all airport security. That would mean federalizing and training a bureaucracy of 20,000 airport security inspectors.

Is that the most effective and efficient way? I think not.

Transportation Secretary Norman Y. Mineta agrees. He has rejected federalization and instead wants Washington to take a strong oversight role. This would include setting tough performance standards for those hired to screen passengers and luggage. After 18 months, his department would conduct an airport-by-airport evaluation.

That is a sensible, real-world approach. It recognizes the lessons that private-sector businesses have learned over the past three decades. The nation's best-run corporations have discovered that pushing authority for safety up the chain of command generally leads to a degradation -- not an improvement -- of security .

Only when individuals at the lowest level of an organization are empowered and held responsible for safety and quality does the performance improve.

The same kind of debate is taking place over human research. The tragic death of a volunteer research patient last summer at the Johns Hopkins Asthma and Allergy Center, and a small number of incidents at other academic medical centers, have led to an increased supervisory role by the federal government.

While heightened federal oversight of clinical research is an essential component in protecting human subjects, it is ultimately up to the hospitals to ensure that their procedures meet the highest safety standards.

Direct oversight of clinical research is the responsibility of Institutional Review Boards composed of experts and lay citizens. They have the authority for approving projects involving human subjects. At Johns Hopkins, for instance, we have examined all of our internal procedures and have set new standards of rigorous review. This is in response to demands by the federal Office of Human Research Protection that shortcomings be corrected and safeguards improved.

It is Washington's job to hold academic research centers like Johns Hopkins accountable for maintaining these rigorous standards and, on a periodic basis, to assess how well local research centers are doing.

In both clinical research and airport security, the answer is not more governmental presence but increased local accountability. Everyone has a role. We must be partners, not adversaries, in this quest for safety and security.

The writer is a physician and president of the Johns Hopkins University.

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