Research subject advocates: To whom are they loyal?

Having potential research subjects select their own RSAs does not eliminate the possibility of conflict of interest. In theory, a subject's legal representative or person holding durable power of attorney for health care likely knows the person best; however, the chosen RSA's personal motives for accepting the role of RSA should still be scrutinized. Certainly, an RSA should not have personal or financial ties with either the research team or the product/technology under investigation. Such relationships could impair the RSA's objectivity and cause the RSA to inflate or deflate trial risks and benefits or skew the goals of the trial. Potential RSAs should be required to disclose all actual and potential conflicts of interest to the principal investigator, and these should be reviewed by the institutional review board. The board should decide if the conflicts will have an impact on the objectivity of the potential RSA and if there are ways to reduce or eliminate the potential conflict. If the review board accepts these potential conflicts, they should be disclosed to the research subject, who would remain free to eliminate the potential RSA from contention and select someone else.