Examining the role of U.S. scientists in research conducted at China's historically abusive treatment centers
Fu Lixin, an exhausted Chinese woman, made a momentary bad decision. A friend had offered her a "special cigarette," and instead of saying no, she took it. But the next day, she told the New York Times, policemen arrived at her door. "My friend had been arrested and turned me in," she said. "It was a drug test. I failed on the spot."
Drug use in any context carries risks, but users in China face a unique set of challenges. Even though it was Lixin's first time, and she didn't have a record, she was immediately taken to a detention center.
At any given time, over 300,000 people are locked up in mandatory drug detention in China.
At any given time, over 300,000 people are locked up in mandatory drug detention in China like the one where Lixin was held. Police often pick people up off the streets and take them immediately into custody, keeping them in "treatment" for years at a time. Although it's difficult to track down standard practices -- many of the centers allow neither rights monitors nor press -- it's believed that these programs offer no clinical care and don't conduct patient evaluations.
"All drug detention is, is work. We get up at five in the morning to make shoes. We work all day and into the night. That's all it is," a former Chinese drug detainee told Human Rights Watch (HRW) in 2009. Du, another patient of a Chinese treatment program, echoed the complaint, saying, "The detox center is a factory. We work every day, until late in the night, even if we are sick, even if we have AIDS."
In fact, treatment often contributes to unsafe behaviors; another former detainee told HRW, "I'm sure I was infected [with HIV] while I was in detention. We would all use one needle; this needle would go around the whole place."
So it came as a surprise to Joe Amon, Director of the Health and Human Rights Division at Human Rights Watch, when a recent issue of Science magazine published a study conducted in China in two detention centers without mentioning this context. The paper, titled "A Memory Retrieval-Extinction Procedure to Prevent Drug Craving and Relapse," was conducted on rats as well as human drug-users in Beijing.
The findings themselves were quite interesting, demonstrating a mental technique that could be used to help prevent relapse in former addicts. The authors state that the participants gave informed consent, gaining approval from the Peking University Health Center review board, but Mr. Amon questions the validity of the claim, noting that the Beijing Ankang Hospital and the Tian-Tang-He Drug Rehabilitation center have historically been compulsory programs staffed with more police officers than doctors. Amon began to question the researchers' description of detained drug users as "patients" and the detention centers as "hospitals." It's difficult, Amon says, to determine if "informed consent" in such a setting can be truly voluntary.
Although in the past few years China has dramatically increased the availability of methadone in community-based treatment centers, treatment options remain inadequate. Amon explained, "In China, police can pick up anyone based on profiling, and force them to take a urine test." If the sample comes back positive, he said, "People are then taken straight to a detention center, where they are usually kept for two years or more." Previous detainees' ID cards -- used in China for many common activities, like checking into a hotel -- are marked, and police, seeking to meet strict quotas, are allowed to track former addicts' IDs and demand urine samples at any point.
Patients in these centers do not have basic human rights protections, including the right to due process, the right to privacy, and the right to be free from compulsory treatment. In closed settings such as administrative detention centers, Amon reiterated, research deserves more than the usual amount of oversight -- not, as in this case, no independent monitoring at all.
The Chinese authors of the study defend their work in Science, saying in a written response, "We saw no indication of the abuses Amon describes." They explain their work used subjects who they say were "court mandated" -- but as drug abuse in China isn't considered a criminal offense, drug users are usually sent to detention centers without any formal trial, never seeing the inside of a courtroom. The scientists don't specifically describe the care the study's subjects received, simply stating that all detention centers provide comprehensive care and citing a state media news account quoting a detention center official. Without independent monitoring, it is uncertain what the facts may be.