Reading trust between the lines. "Housekeeping work" and inequality in human-subjects review.

Who can you trust? In everyday life, people regularly distinguish between more and less trustworthy individuals. 1 In medical contexts, patients and research participants build impressions of the trustworthiness of caregivers and clinicians, and these impressions shape their decisions. 2 , 3 It is tempting to think that people in certain offi cial roles do not— or at least should not—allow these kinds of impressions to affect their decisions. Researchers might expect that members of human-subjects review committees, for example, would not take informal, impression-based factors into account when evaluating investigators’ study protocols. After all, the tasks of board members are well outlined in the regulations that describe and govern the work of human-subjects committees (known as institutional review boards [IRBs] in the United States, research ethics committees [RECs] in the United Kingdom, and research ethics boards [REBs] in Canada). 4 , 5 , 6 , 7 Trustworthiness is not an explicit criterion for the assessment of the risks of research for subjects. 8 , 9 Over the course of one year, I studied the full-board meetings of three IRBs and was surprised by the results: reviewboard members do evaluate investigators’ trustworthiness, and these evaluations have tangible consequences for investigators. Board members actively search for signs of investigators’ trustworthiness, and their informal judgments grow out of a seemingly mundane and benign processes in research review—what board members called “housekeeping work.” This article documents how housekeeping work creates advantages for some investigators while disadvantaging others.