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Horton R, Lucassen A. Ethical Considerations in Research with Genomic Data. New Bioeth 2023; 29:37-51. [PMID: 35484929 DOI: 10.1080/20502877.2022.2060590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Our ability to generate genomic data is currently well ahead of our ability to understand what they mean, raising challenges about how best to engage with them. This article considers ethical aspects of work with such data, focussing on research contexts that are intertwined with clinical care. We discuss the identifying nature of genomic data, the medical information intrinsic within them, and their linking of people within a biological family. We go on to consider what this means for consent, the importance of thoughtful sharing of genomic data, the challenge of constructing meaningful findings, and the legacy of unequal representation in genomic datasets. We argue that the ongoing success of genomic data research relies on public trust in the enterprise: to justify this trust, we need to ensure robust stewarding, and wide engagement about the ethical issues inherent in such practices.
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Affiliation(s)
- Rachel Horton
- Centre for Personalised Medicine, St Anne's College, University of Oxford, Oxford, UK.,Clinical Ethics, Law and Society, University of Southampton, Southampton, UK
| | - Anneke Lucassen
- Centre for Personalised Medicine, St Anne's College, University of Oxford, Oxford, UK.,Clinical Ethics, Law and Society, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
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Cloatre E, Urquiza-Haas N. Misdirection and the Regulation of Herbalism in France and England. SCIENCE & TECHNOLOGY STUDIES (TAMPERE, FINLAND) 2022; 35:30-51. [PMID: 38919880 PMCID: PMC7616117 DOI: 10.23987/sts.110353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
In this paper, we propose to explore how the regulation of herbalism, in France and in England, rests on series of 'misdirections,' with the coexistence of law and herbalism depending on multiple magical illusions. Attempts to regulate herbalists, and the responses they invite, involve multiple sleights of hands both by the law and by herbalists. Herbalists perform misdirections to maintain an illusion of legality, even where they bend legal rules that they deem incompatible with their practice. But far from being the only, or even the most effective, tricksters, herbalists are only one set of performers in a more complex layering of legal illusions. The regulatory and legal infrastructure itself relies on misdirections enacted through everyday legal procedures that trick the general public into believing that the law is 'acting' to protect vulnerable consumers from dangerous healers and their medicines, while the effects of its actions may be to tolerate, or indeed produce, zones of illegal, or 'barely legal,' practices. At the same time, this performance is enabled by playing a disappearing act, in which the knowledge of herbalists, and the demands of their users, are disappeared behind the screen of apparent legal protection. Drawing attention away from competing claims to knowledge, and towards its protective intervention, the legal system thereby embeds misdirections of its own kind.
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Smith H, Budworth L, Grindey C, Hague I, Hamer N, Kislov R, van der Graaf P, Langley J. Co-production practice and future research priorities in United Kingdom-funded applied health research: a scoping review. Health Res Policy Syst 2022; 20:36. [PMID: 35366898 PMCID: PMC8976994 DOI: 10.1186/s12961-022-00838-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Interest in and use of co-production in healthcare services and research is growing. Previous reviews have summarized co-production approaches in use, collated outcomes and effects of co-production, and focused on replicability and reporting, but none have critically reflected on how co-production in applied health research might be evolving and the implications of this for future research. We conducted this scoping review to systematically map recent literature on co-production in applied health research in the United Kingdom to inform co-production practice and guide future methodological research. METHODS This scoping review was performed using established methods. We created an evidence map to show the extent and nature of the literature on co-production and applied health research, based on which we described the characteristics of the articles and scope of the literature and summarized conceptualizations of co-production and how it was implemented. We extracted implications for co-production practice or future research and conducted a content analysis of this information to identify lessons for the practice of co-production and themes for future methodological research. RESULTS Nineteen articles reporting co-produced complex interventions and 64 reporting co-production in applied health research met the inclusion criteria. Lessons for the practice of co-production and requirements for co-production to become more embedded in organizational structures included (1) the capacity to implement co-produced interventions, (2) the skill set needed for co-production, (3) multiple levels of engagement and negotiation, and (4) funding and institutional arrangements for meaningful co-production. Themes for future research on co-production included (1) who to involve in co-production and how, (2) evaluating outcomes of co-production, (3) the language and practice of co-production, (4) documenting costs and challenges, and (5) vital components or best practice for co-production. CONCLUSION Researchers are operationalizing co-production in various ways, often without the necessary financial and organizational support required and the right conditions for success. We argue for accepting the diversity in approaches to co-production, call on researchers to be clearer in their reporting of these approaches, and make suggestions for what researchers should record. To support co-production of research, changes to entrenched academic and scientific practices are needed. Protocol registration details: The protocol for the scoping review was registered with protocols.io on 19 October 2021: https://dx.doi.org/10.17504/protocols.io.by7epzje .
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Affiliation(s)
- Helen Smith
- NIHR Applied Research Collaboration Yorkshire and Humber, Bradford, United Kingdom. .,Bradford Institute for Health Research, Bradford, United Kingdom.
| | - Luke Budworth
- NIHR Applied Research Collaboration Yorkshire and Humber, Bradford, United Kingdom.,Bradford Institute for Health Research, Bradford, United Kingdom
| | - Chloe Grindey
- NIHR Applied Research Collaboration Yorkshire and Humber, Bradford, United Kingdom.,Bradford Institute for Health Research, Bradford, United Kingdom
| | - Isabel Hague
- NIHR Applied Research Collaboration Yorkshire and Humber, Bradford, United Kingdom.,Bradford Institute for Health Research, Bradford, United Kingdom
| | - Natalie Hamer
- Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Roman Kislov
- Faculty of Business and Law Manchester, Metropolitan University, Manchester, United Kingdom.,School of Health Sciences, The University of Manchester, Manchester, United Kingdom.,NIHR Applied Research Collaboration Greater Manchester, Manchester, United Kingdom
| | - Peter van der Graaf
- NIHR Applied Research Collaboration North East and North Cumbria, Cumbria, United Kingdom.,School of Health and Life Sciences, Teeside University, Middlesbrough, United Kingdom
| | - Joe Langley
- Lab4Living, Sheffield Hallam University, Sheffield, United Kingdom
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Maindal HT, Timm A, Dahl-Petersen IK, Davidsen E, Hillersdal L, Jensen NH, Thøgersen M, Jensen DM, Ovesen P, Damm P, Kampmann U, Vinter CA, Mathiesen ER, Nielsen KK. Systematically developing a family-based health promotion intervention for women with prior gestational diabetes based on evidence, theory and co-production: the Face-it study. BMC Public Health 2021; 21:1616. [PMID: 34479526 PMCID: PMC8418002 DOI: 10.1186/s12889-021-11655-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women with prior gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes; however, this risk can be reduced by engaging in positive health behaviours e.g. healthy diet and regular physical activity. As such behaviours are difficult to obtain and maintain there is a need to develop sustainable behavioural interventions following GDM. We aimed to report the process of systematically developing a health promotion intervention to increase quality of life and reduce diabetes risk among women with prior GDM and their families. We distil general lessons about developing complex interventions through co-production and discuss our extensions to intervention development frameworks. METHODS The development process draws on the Medical Research Council UK Development of complex interventions in primary care framework and an adaptation of a three-stage framework proposed by Hawkins et al. From May 2017 to May 2019, we iteratively developed the Face-it intervention in four stages: 1) Evidence review, qualitative research and stakeholder consultations; 2) Co-production of the intervention content; 3) Prototyping, feasibility- and pilot-testing and 4) Core outcome development. In all stages, we involved stakeholders from three study sites. RESULTS During stage 1, we identified the target areas for health promotion in families where the mother had prior GDM, including applying a broad understanding of health and a multilevel and multi-determinant approach. We pinpointed municipal health visitors as deliverers and the potential of using digital technology. In stage 2, we tested intervention content and delivery methods. A health pedagogic dialogue tool and a digital health app were co-adapted as the main intervention components. In stage 3, the intervention content and delivery were further adapted in the local context of the three study sites. Suggestions for intervention manuals were refined to optimise flexibility, delivery, sequencing of activities and from this, specific training manuals were developed. Finally, at stage 4, all stakeholders were involved in developing realistic and relevant evaluation outcomes. CONCLUSIONS This comprehensive description of the development of the Face-it intervention provides an example of how to co-produce and prototype a complex intervention balancing evidence and local conditions. The thorough, four-stage development is expected to create ownership and feasibility among intervention participants, deliverers and local stakeholders. TRIAL REGISTRATION ClinicalTrials.gov NCT03997773 , registered retrospectively on 25 June 2019.
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Affiliation(s)
- Helle Terkildsen Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark. .,Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.
| | - Anne Timm
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Emma Davidsen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Line Hillersdal
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | | | - Maja Thøgersen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Per Ovesen
- Department of Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Christina Anne Vinter
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Center for Pregnant Women with Diabetes, Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
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Humboldt-Dachroeden S, Rubin O, Sylvester Frid-Nielsen S. The state of One Health research across disciplines and sectors - a bibliometric analysis. One Health 2020; 10:100146. [PMID: 32835067 PMCID: PMC7274982 DOI: 10.1016/j.onehlt.2020.100146] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/03/2020] [Indexed: 01/24/2023] Open
Abstract
There is a growing interest in One Health, reflected by the rising number of publications relating to One Health literature, but also through zoonotic disease outbreaks becoming more frequent, such as Ebola, Zika virus and COVID-19. This paper uses bibliometric analysis to explore the state of One Health in academic literature, to visualise the characteristics and trends within the field through a network analysis of citation patterns and bibliographic links. The analysis focuses on publication trends, co-citation network of scientific journals, co-citation network of authors, and co-occurrence of keywords. The bibliometric analysis showed an increasing interest for One Health in academic research. However, it revealed some thematic and disciplinary shortcomings, in particular with respect to the inclusion of environmental themes and social science insights pertaining to the implementation of One Health policies. The analysis indicated that there is a need for more applicable approaches to strengthen intersectoral collaboration and knowledge sharing. Silos between the disciplines of human medicine, veterinary medicine and environment still persist. Engaging researchers with different expertise and disciplinary backgrounds will facilitate a more comprehensive perspective where the human-animal-environment interface is not researched as separate entities but as a coherent whole. Further, journals dedicated to One Health or interdisciplinary research provide scholars the possibility to publish multifaceted research. These journals are uniquely positioned to bridge between fields, strengthen interdisciplinary research and create room for social science approaches alongside of medical and natural sciences.
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Affiliation(s)
| | - Olivier Rubin
- Department of Social Science and Business, Roskilde University, Roskilde, Denmark
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Horton R, Lucassen A. Genomic testing in healthcare: a hybrid space where clinical practice and research need to co-exist. Expert Rev Mol Diagn 2019; 19:963-967. [PMID: 31603004 PMCID: PMC6817952 DOI: 10.1080/14737159.2019.1672540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/23/2019] [Indexed: 01/05/2023]
Abstract
Introduction: Clinical practice and research are traditionally seen as distinct activities that are governed by different principles and processes. Innovative technologies such as genomic testing challenge this model, involving many activities that cannot be easily categorized as purely research, or purely clinical care. Areas covered: We discuss the interdependence of research and clinical practice in the context of genomics, for example, when determining the significance of rare genetic variants, or diagnosing newly described rare diseases. We highlight the potential of the symbiotic relationship between clinical practice and research. Expert opinion: In the context of genomics, it is not appropriate to treat clinical practice and research as entirely separable. Forcing binary categorization of activities as one or the other risks losing the many benefits that derive from their integration. We need to explore the hybrid area where clinical practice and research coincide, developing governance that allows us to maximize its potential, rather than insisting that hybrid clinical-research activities conform to processes built for 'pure clinical practice' or 'pure research'. We argue the need for a renegotiation of the contract around genomic testing, recognizing, valuing and facilitating the hybrid space where clinical practice and research co-exist.
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Affiliation(s)
- Rachel Horton
- Clinical Ethics and Law at Southampton (CELS), Faculty of Medicine, University of Southampton, UK
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Anneke Lucassen
- Clinical Ethics and Law at Southampton (CELS), Faculty of Medicine, University of Southampton, UK
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
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