1
|
Staunton C, Shabani M, Mascalzoni D, Mežinska S, Slokenberga S. Ethical and social reflections on the proposed European Health Data Space. Eur J Hum Genet 2024; 32:498-505. [PMID: 38355959 PMCID: PMC11061131 DOI: 10.1038/s41431-024-01543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 11/08/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
The COVID-19 pandemic demonstrated the benefits of international data sharing. Data sharing enabled the health care policy makers to make decisions based on real-time data, it enabled the tracking of the virus, and importantly it enabled the development of vaccines that were crucial to mitigating the impact of the virus. This data sharing is not the norm as data sharing needs to navigate complex ethical and legal rules, and in particular, the fragmented application of the General Data Protection Regulation (GDPR). The introduction of the draft regulation for a European Health Data Space (EHDS) in May 2022 seeks to address some of these legal issues. If passed, it will create an obligation to share electronic health data for certain secondary purposes. While there is a clear need to address the legal complexities involved with data sharing, it is critical that any proposed reforms are in line with ethical principles and the expectations of the data subjects. In this paper we offer a critique of the EHDS and offer some recommendations for this evolving regulatory space.
Collapse
Affiliation(s)
- Ciara Staunton
- Institute for Biomedicine, Eurac Research, Bolzano, Italy.
- School of Law, University of Kwazulunatal, Durban, South Africa.
| | - Mahsa Shabani
- Faculty of Law and Criminology, Ghent University, Gent, Belgium
| | - Deborah Mascalzoni
- Institute for Biomedicine, Eurac Research, Bolzano, Italy
- Department of Public Health and Caring Science, Uppsala University, CRB, P.O. Box 256, 751 05, Uppsala, Sweden
| | - Signe Mežinska
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | | |
Collapse
|
2
|
Nankya H, Wamala E, Alibu VP, Barugahare J. Community engagement in genetics and genomics research: a qualitative study of the perspectives of genetics and genomics researchers in Uganda. BMC Med Ethics 2024; 25:1. [PMID: 38166828 PMCID: PMC10763360 DOI: 10.1186/s12910-023-00995-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Generally, there is unanimity about the value of community engagement in health-related research. There is also a growing tendency to view genetics and genomics research (GGR) as a special category of research, the conduct of which including community engagement (CE) as needing additional caution. One of the motivations of this study was to establish how differently if at all, we should think about CE in GGR. AIM To assess the perspectives of genetics and genomics researchers in Uganda on CE in GGR. METHOD A cross-sectional qualitative study was conducted at Makerere University and Uganda Virus Research Institute. Twenty-five individuals participated, the majority being male (sixteen). Participants included nineteen genetics and genomics researchers (researchers and research coordinators), two CE officers, three nurses and one nursing counsellor. Data were collected using in-depth interviews and analyzed in a thematic manner using NVivo version 12 Plus. STUDY FINDINGS Thirteen of the respondents had conducted CE in their GGR in either a geographical and disease-specific community. Some respondents said CE principles are the same and there is no need for special consideration for CE in GGR. Others gave ethical issues in GGR that require special consideration for CE in such research and these were categorized into six themes: GGR is new to communities, Difficulty in communicating GGR by the researchers, Genes are shared in communities, Cultural sensitivities against GGR, Community attitude toward GGR, Some GGR studies take long to end, and Negotiation of research benefits. Special considerations for CE when conducting GGR were suggested and categorized into seven themes: creating awareness of GGR in communities, obtaining both community acceptance and individual consent, CE team composition, involve communities in solving GGR challenges, prolong CE in some GGR, develop guidelines for CE in GGR, and legal considerations on GGR. CONCLUSION GGR was characterized by special issues that require special CE considerations for such research.
Collapse
Affiliation(s)
- Harriet Nankya
- Department of Philosophy, College of Humanities and Social Sciences, Makerere University, P. O Box 7062, Kampala, Uganda.
| | - Edward Wamala
- Department of Philosophy, College of Humanities and Social Sciences, Makerere University, P. O Box 7062, Kampala, Uganda
| | - Vincent Pius Alibu
- Department of Biochemistry and Sports Science, College of Natural Sciences, Makerere University, P. O Box 7062, Kampala, Uganda
| | - John Barugahare
- Department of Philosophy, College of Humanities and Social Sciences, Makerere University, P. O Box 7062, Kampala, Uganda
| |
Collapse
|
3
|
Geiger J, Fuchs J, Starke M, Neumann M, Baber R, Nussbeck SY, Kiehntopf M, Specht C, Illig T, Hummel M, Jahns R. GBA/GBN-position on the feedback of incidental findings in biobank-based research: consensus-based workflow for hospital-based biobanks. Eur J Hum Genet 2023; 31:1066-1072. [PMID: 36732662 PMCID: PMC10474025 DOI: 10.1038/s41431-023-01299-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/12/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Incidental research findings pose a considerable challenge to hospital-based research biobanks since they are acting as intermediaries between healthcare and research. In a joint action the centralized biobank ibdw (Interdisciplinary Bank of Biomaterials and Data Wuerzburg) together with local authorities drafted a coherent concept to manage incidental research findings in full compliance with relevant ethical and data privacy regulations. The concept was developed and elaborated in close collaboration with the German Biobank Alliance (GBA). Comprehensive documentation of all steps guarantees the traceability of the process. By a mandatory assessment of the findings prior to re-identification of the individual concerned, unnecessary measures can be avoided. The individual's "right not to know" is respected according to the stipulations of the informed consent. As a general principle any communication with the individual occurs exclusively through the hospital and by competent physicians with appropriate knowledge and communication skills. We propose this scheme as a blueprint for reporting workflows for incidental research findings at hospital-based biobanks.
Collapse
Affiliation(s)
- Joerg Geiger
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Joerg Fuchs
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| | - Madeline Starke
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael Neumann
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ronny Baber
- Leipzig Medical Biobank, University Leipzig, Leipzig, Germany
| | - Sara Y Nussbeck
- University Medical Center Goettingen, Central Biobank, UMG, Goettingen, Germany
| | - Michael Kiehntopf
- Institute of Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena (IBBJ), Jena University Hospital, Jena, Germany
| | - Cornelia Specht
- German Biobank Node, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Michael Hummel
- German Biobank Node, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Roland Jahns
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| |
Collapse
|
4
|
Wolf SM, Green RC. Return of Results in Genomic Research Using Large-Scale or Whole Genome Sequencing: Toward a New Normal. Annu Rev Genomics Hum Genet 2023; 24:393-414. [PMID: 36913714 PMCID: PMC10497726 DOI: 10.1146/annurev-genom-101122-103209] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Genome sequencing is increasingly used in research and integrated into clinical care. In the research domain, large-scale analyses, including whole genome sequencing with variant interpretation and curation, virtually guarantee identification of variants that are pathogenic or likely pathogenic and actionable. Multiple guidelines recommend that findings associated with actionable conditions be offered to research participants in order to demonstrate respect for autonomy, reciprocity, and participant interests in health and privacy. Some recommendations go further and support offering a wider range of findings, including those that are not immediately actionable. In addition, entities covered by the US Health Insurance Portability and Accountability Act (HIPAA) may be required to provide a participant's raw genomic data on request. Despite these widely endorsed guidelines and requirements, the implementation of return of genomic results and data by researchers remains uneven. This article analyzes the ethical and legal foundations for researcher duties to offer adult participants their interpreted results and raw data as the new normal in genomic research.
Collapse
Affiliation(s)
- Susan M Wolf
- Law School and Medical School, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Robert C Green
- Genomes2People Research Program, Harvard Medical School, Mass General Brigham, Broad Institute, and Ariadne Labs, Boston, Massachusetts, USA;
| |
Collapse
|
5
|
White S, Mossfield T, Fleming J, Barlow-Stewart K, Ghedia S, Dickson R, Richards F, Bombard Y, Wiley V. Expanding the Australian Newborn Blood Spot Screening Program using genomic sequencing: do we want it and are we ready? Eur J Hum Genet 2023; 31:703-711. [PMID: 36935418 PMCID: PMC10250371 DOI: 10.1038/s41431-023-01311-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/12/2022] [Accepted: 01/31/2023] [Indexed: 03/21/2023] Open
Abstract
Since the introduction of genome sequencing in medicine, the factors involved in deciding how to integrate this technology into population screening programs such as Newborn Screening (NBS) have been widely debated. In Australia, participation in NBS is not mandatory, but over 99.9% of parents elect to uptake this screening. Gauging stakeholder attitudes towards potential changes to NBS is vital in maintaining this high participation rate. The current study aimed to determine the knowledge and attitudes of Australian parents and health professionals to the incorporation of genomic sequencing into NBS programs. Participants were surveyed online in 2016 using surveys adapted from previous studies. The majority of parents (90%) self-reported some knowledge of NBS, with 77% expressing an interest in NBS using the new technology. This was significantly lower than those who would utilise NBS using current technologies (99%). Although, many health professionals (62%) felt that new technologies should currently not be used as an adjunct to NBS, 79% foresaw the use of genomic sequencing in NBS by 2026. However, for genomic sequencing to be considered, practical and technical challenges as well as parent information needs were identified including the need for accurate interpretation of data; pre-and post-test counselling; and appropriate parental consent and opt-out process. Therefore, although some support for implementing genomic sequencing into Australian NBS does exist, there is a need for further investigation into the ethical, social, legal and practical implications of introducing this new technology as a replacement to current NBS methods.
Collapse
Affiliation(s)
- Stephanie White
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Tamara Mossfield
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
- Genea, Sydney CBD, Sydney, NSW, Australia
| | - Jane Fleming
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.
| | - Kristine Barlow-Stewart
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Sondhya Ghedia
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Rebecca Dickson
- Genea, Sydney CBD, Sydney, NSW, Australia
- Royal Hospital for Women, Sydney, NSW, Australia
| | - Fiona Richards
- Department of Clinical Genetics, Children's Hospital, Westmead, Sydney, NSW, Australia
| | - Yvonne Bombard
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Veronica Wiley
- NSW Newborn Screening Programme, The Children's Hospital at Westmead, Sydney, NSW, Australia
| |
Collapse
|
6
|
Galende-Domínguez I, Rivero-Lezcano OM. Ethical considerations about the collection of biological samples for genetic analysis in clinical trials. RESEARCH ETHICS 2023. [DOI: 10.1177/17470161231152077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Progress in precision medicine is being achieved through the design of clinical trials that use genetic biomarkers to guide stratification of patients and assignation to treatment or control groups. Genetic analysis of biomarkers is, therefore, essential to complete their objectives, and this involves the study of biological samples from donor patients that have been recruited according to criteria previously established in the design of the clinical trial. Nevertheless, it is becoming very common that, in the solicitation of biological samples, purposes that are beyond the objectives of the stated therapeutic trial research are introduced, like the development of ill-explained exploratory studies or the use in unspecified future research. In the digital era, the sequencing of patients’ DNA needs to be considered as a serious security matter, not only for the patients, but also for their relatives. Genetic information may be easily stored, even forever, in digital files. This engenders a permanent risk of being stolen or misused in many ways. Furthermore, re-identification of sample donors is technically feasible through their genetic data. For these reasons, genetic analysis of samples collected in clinical trials should be restricted to the accomplishment of their main objectives or well justified goals.
Collapse
Affiliation(s)
- Inés Galende-Domínguez
- Unidad de Apoyo SG Formación y ADS, Spain
- D.G. de Investigación, Docencia y Documentación
- Consejería de Sanidad, Comunidad de Madrid. Spain
| | - Octavio M Rivero-Lezcano
- Complejo Asistencial Universitario de León-Unidad de Investigación, Spain
- Gerencia Regional de Salud de Castilla y León (SACYL), Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Spain
- Institute of Biomedicine. University of León, Spain
| |
Collapse
|
7
|
No person left behind: Mapping the health policy landscape for genomics research in the Caribbean. LANCET REGIONAL HEALTH. AMERICAS 2022; 15:100367. [PMID: 36778076 PMCID: PMC9904062 DOI: 10.1016/j.lana.2022.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The Caribbean has long been an under-represented geographical region in the field of genomics research. Such under-representation may result in Caribbean people being underserved by precision medicine and other public health benefits of genomics. A collaboration among regional and international researchers aims to address this issue through the H3ECaribbean project (Human Heredity, Environment, and Health in the Caribbean), which builds on the lessons and success of H3Africa. The Caribbean project aims to target issues of social justice by encouraging the inclusion of diverse Caribbean communities in genomics research. This paper explores a framework for the ethical and socially acceptable conduct of genomics research in the Caribbean, taking account of the cultural peculiarities of the region. This is done in part by exploring research ethics issues identified in indigenous communities in North America, Small Island Developing States, and similar endeavours from the African continent. The framework provides guidance for interacting with local community leaders, as well as detailing steps for obtaining informed consent of all participants. Specifically, the authors outline the methods to ensure effective interaction and enforce full transparency with study participants to combat historical neglect when working with under-represented communities in the Caribbean.
Collapse
|
8
|
Dupras C, Bunnik EM. Toward a Framework for Assessing Privacy Risks in Multi-Omic Research and Databases. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:46-64. [PMID: 33433298 DOI: 10.1080/15265161.2020.1863516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While the accumulation and increased circulation of genomic data have captured much attention over the past decade, privacy risks raised by the diversification and integration of omics have been largely overlooked. In this paper, we propose the outline of a framework for assessing privacy risks in multi-omic research and databases. Following a comparison of privacy risks associated with genomic and epigenomic data, we dissect ten privacy risk-impacting omic data properties that affect either the risk of re-identification of research participants, or the sensitivity of the information potentially conveyed by biological data. We then propose a three-step approach for the assessment of privacy risks in the multi-omic era. Thus, we lay grounds for a data property-based, 'pan-omic' approach that moves away from genetic exceptionalism. We conclude by inviting our peers to refine these theoretical foundations, put them to the test in their respective fields, and translate our approach into practical guidance.
Collapse
|
9
|
Morain SR, Mathews DJH, Geller G, Bollinger J, Weinfurt K, Jarvik JG, May E, Sugarman J. Identification and management of pragmatic clinical trial collateral findings: A current understanding and directions for future research. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 9:100586. [PMID: 34600345 DOI: 10.1016/j.hjdsi.2021.100586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 08/26/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
Abstract
While the embedded nature of pragmatic clinical trials (PCTs) can improve the efficiency and relevance of research for multiple stakeholders, embedding research into ongoing clinical care can also involve ethical and regulatory challenges. An emergent challenge is the management of pragmatic clinical trial collateral findings (PCT-CFs). While PCT-CFs share some features with incidental or secondary findings that are encountered in conventional clinical trials and clinical care, the PCT context differs in ethically relevant ways that complicate PCT-CF identification and management. We report on the results of a two-year multi-method investigation of PCT-CFs. Overall, five core themes emerged: 1) the liminal nature of PCTs and the implications of this for PCT-CFs; 2) the context-specific nature of PCT-CF management; 3) the centrality of institutions; 4) the importance of prospective planning; and 5) patient expectations. Among the central lessons of this work are that prior ethics guidance from other settings cannot easily be adapted to address PCT-CFs, nor can a single approach readily accommodate all PCT-CFs. Moving forward, stakeholders, including researchers, institutions, ethics oversight bodies, and funders, should anticipate and plan for PCT-CFs in the design, conduct, and analysis of PCTs. Future scholarship is needed to examine experiences with PCT-CFs, and the practical and conceptual issues they raise for the future conduct of PCTs.
Collapse
Affiliation(s)
- Stephanie R Morain
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 310D, Houston, TX, 77030, USA; Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Ave, Baltimore, MD, 21205, USA.
| | - Debra J H Mathews
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Ave, Baltimore, MD, 21205, USA; Department of Genetic Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - Gail Geller
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Ave, Baltimore, MD, 21205, USA; Department of Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - Juli Bollinger
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Ave, Baltimore, MD, 21205, USA
| | - Kevin Weinfurt
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
| | - Jeffrey G Jarvik
- Departments of Radiology and Neurological Surgery and the Clinical Learning, Evidence and Research Center for Musculoskeletal Disorders, University of Washington School of Medicine, Box 359728, 325 Ninth Ave, Seattle, WA, 98104, USA
| | - Elizabeth May
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Ave, Baltimore, MD, 21205, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Ave, Baltimore, MD, 21205, USA; Department of Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA
| |
Collapse
|
10
|
Peltekova I, Buhas D, Stern L, Kirby E, Yusuf A, Elsabbagh M. Enhancing the Impact of Genomics Research in Autism through Integration of Research Results into Routine Care Pathways-A Case Series. J Pers Med 2021; 11:755. [PMID: 34442399 PMCID: PMC8400173 DOI: 10.3390/jpm11080755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/25/2021] [Accepted: 07/28/2021] [Indexed: 12/03/2022] Open
Abstract
The return of genetic results (RoR) to participants, enrolled as children, in autism research remains a complex process. Existing recommendations offer limited guidance on the use of genetic research results for clinical care. We highlight current challenges with RoR and illustrate how the use of a guiding framework drawn from existing literature facilitates RoR and the clinical integration of genetic research results. We report a case series (n = 16) involving the return of genetic results to participants in large genomics studies in Autism Spectrum Disorders (ASD). We outline the framework that guided RoR and facilitated integration into clinical care pathways. We highlight specific cases to illustrate challenges that were, or could have been, resolved through this framework. The case series demonstrates the ethical, clinical and practical difficulties of RoR in ASD genomic studies for participants enrolled as children. Challenges were resolved using pre-established framework to guide RoR and incorporate research genetic results into clinical care. We suggest that optimal use of genetic research results relies on their integration into individualized care pathways for participants. We offer a framework that attempts to bridge the gap between research and healthcare in ASD.
Collapse
Affiliation(s)
- Iskra Peltekova
- McGill University Health Centre, McGill University, Montreal, QC H3A 0G4, Canada; (D.B.); (L.S.); (M.E.)
- Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC M4A 3J1, Canada
| | - Daniela Buhas
- McGill University Health Centre, McGill University, Montreal, QC H3A 0G4, Canada; (D.B.); (L.S.); (M.E.)
- Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC M4A 3J1, Canada
| | - Lara Stern
- McGill University Health Centre, McGill University, Montreal, QC H3A 0G4, Canada; (D.B.); (L.S.); (M.E.)
- Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC M4A 3J1, Canada
| | - Emily Kirby
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada;
| | - Afiqah Yusuf
- Azrieli Centre for Autism Research, Montreal Neurological Institute, Montreal, QC H3A 2B4, Canada;
| | - Mayada Elsabbagh
- McGill University Health Centre, McGill University, Montreal, QC H3A 0G4, Canada; (D.B.); (L.S.); (M.E.)
- Azrieli Centre for Autism Research, Montreal Neurological Institute, Montreal, QC H3A 2B4, Canada;
| |
Collapse
|
11
|
Health-care practitioners' preferences for the return of secondary findings from next-generation sequencing: a discrete choice experiment. Genet Med 2020; 22:2011-2019. [PMID: 32820245 DOI: 10.1038/s41436-020-0927-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Health-care practitioners' (HCPs) preferences for returning secondary findings (SFs) will influence guideline compliance, shared decision-making, and patient health outcomes. This study aimed to estimate HCPs' preferences and willingness to support the return (WTSR) of SFs in Canada. METHODS A discrete choice experiment estimated HCPs' preferences for the following attributes: disease risk, clinical utility, health consequences, prior experience, and patient preference. We analyzed responses with an error component mixed logit model and predicted WTSR using scenario analyses. RESULTS Two hundred fifty participants of 583 completed the questionnaire (completion rate: 42.9%). WTSR was significantly influenced by patient preference and SF outcome characteristics. HCPs' WTSR was 78% (95% confidence interval: 74-81%) when returning SFs with available medical treatment, high penetrance, severe health consequences, and patient's preference for return. Genetics professionals had a higher WTSR than HCPs of other types when returning SFs with clinical utility and patient preference to know. HCPs >55 years of age were more likely to return SFs compared with younger HCPs. CONCLUSION This study identified factors that influence WTSR of SFs and indicates that HCPs make tradeoffs between patient preference and other outcome characteristics. The results can inform clinical scenarios and models aiming to understand shared decision-making, patient and family opportunity to benefit, and cost-effectiveness.
Collapse
|
12
|
Wang S, Bonomi L, Dai W, Chen F, Cheung C, Bloss CS, Cheng S, Jiang X. Big Data Privacy in Biomedical Research. IEEE TRANSACTIONS ON BIG DATA 2020; 6:296-308. [PMID: 32478127 PMCID: PMC7258042 DOI: 10.1109/tbdata.2016.2608848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Biomedical research often involves studying patient data that contain personal information. Inappropriate use of these data might lead to leakage of sensitive information, which can put patient privacy at risk. The problem of preserving patient privacy has received increasing attentions in the era of big data. Many privacy methods have been developed to protect against various attack models. This paper reviews relevant topics in the context of biomedical research. We discuss privacy preserving technologies related to (1) record linkage, (2) synthetic data generation, and (3) genomic data privacy. We also discuss the ethical implications of big data privacy in biomedicine and present challenges in future research directions for improving data privacy in biomedical research.
Collapse
Affiliation(s)
- Shuang Wang
- Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093
| | - Luca Bonomi
- Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093
| | - Wenrui Dai
- Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093
| | - Feng Chen
- Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093
| | - Cynthia Cheung
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093
| | - Cinnamon S Bloss
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093
| | - Samuel Cheng
- School of Electrical and Computer Engineering, University of Oklahoma, Tulsa, OK, 74135
| | - Xiaoqian Jiang
- Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093
| |
Collapse
|
13
|
Sobel ME, Dreyfus JC, Dillehay McKillip K, Kolarcik C, Muller WA, Scott MJ, Siegal GP, Wadosky K, O'Leary TJ. Return of Individual Research Results: A Guide for Biomedical Researchers Utilizing Human Biospecimens. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:918-933. [PMID: 32201265 DOI: 10.1016/j.ajpath.2020.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/17/2020] [Accepted: 01/24/2020] [Indexed: 12/20/2022]
Abstract
The recent movement toward returning individual research results to study subjects/participants generates ethical and legal challenges for laboratories performing research on human biospecimens. The concept of an individual's interest in knowing the results of testing on their tissue is pitted against individual and systemic risks and an established legal framework regulating the performance of laboratory testing for medical care purposes. This article discusses the rationale for returning individual research results to subjects, the potential risks associated with returning these results, and the legal framework in the United States that governs testing of identifiable human biospecimens. On the basis of these considerations, this article provides recommendations for investigators to consider when planning and executing human biospecimen research, with the objective of appropriately balancing the interests of research subjects, the need for ensuring integrity of the research process, and compliance with US laws and regulations.
Collapse
Affiliation(s)
- Mark E Sobel
- American Society for Investigative Pathology, Rockville, Maryland.
| | | | | | | | - William A Muller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Melanie J Scott
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gene P Siegal
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Timothy J O'Leary
- Veterans Health Administration, Washington, DC; University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
14
|
Evans BJ, Wolf SM. A FAUSTIAN BARGAIN THAT UNDERMINES RESEARCH PARTICIPANTS' PRIVACY RIGHTS AND RETURN OF RESULTS. FLORIDA LAW REVIEW 2019; 71:1281-1345. [PMID: 34305361 PMCID: PMC8302004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A 2018 committee report published by the highly respected National Academies of Science, Engineering, and Medicine (the Report) recommends stripping research participants of crucial data privacy rights and discarding decades of carefully deliberated consensus guidelines for the ethical return of results and data from research. This Article traces these disturbing recommendations to three root causes: (1) a statement of task that blocked careful and impartial analysis of a disputed legal matter central to the Report; (2) a piecemeal legal analysis that omitted relevant strands of law; and (3) the inappropriate conflation of two distinct concepts-the return of individual research results (the stated subject of the Report) and privacy-enabling individual access rights, which have a nearly fifty-year legal history long predating the modern debate about return of results. The Report's recommendations would erect new barriers to the return of results and, simultaneously, dial back a core data privacy right that Americans-including many research participants-currently enjoy. We urge extreme caution in implementing this Report's flawed recommendations. Congress has elevated the right to see one's personal information to the status of a civil right in many different data environments. Diminishing individual access in the research context erodes its status as a right more broadly.
Collapse
Affiliation(s)
- Barbara J Evans
- Center for Biotechnology and Law, Electrical and Computer Engineering, University of Houston
| | - Susan M Wolf
- Consortium on Law and Values in Health, Environment & the Life Sciences, University of Minnesota
| |
Collapse
|
15
|
Abstract
One of the recommendations of the Cancer Moonshot Blue Ribbon Panel report from 2016 was the creation of a national cancer data ecosystem. We review some of the approaches for building cancer data ecosystems and some of the progress that has been made. A data commons is the colocation of data with cloud computing infrastructure and commonly used software services, tools, and applications for managing, integrating, analyzing, and sharing data to create an interoperable resource for the research community. We discuss data commons and their potential role in cancer data ecosystems and, in particular, how multiple data commons can interoperate to form part of the foundation for a cancer data ecosystem.
Collapse
|
16
|
de Knijff P. From next generation sequencing to now generation sequencing in forensics. Forensic Sci Int Genet 2019; 38:175-180. [DOI: 10.1016/j.fsigen.2018.10.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/25/2018] [Accepted: 10/29/2018] [Indexed: 10/28/2022]
|
17
|
Abstract
As new, high-powered sequencing technologies are increasingly incorporated into genomics research, we believe that there has been a break point in how risks and benefits associated with genetic information are being characterized and understood. Genomic sequencing provides the potential benefit of a wealth of information, but also has the potential to alter how we conceptualize risks of sequencing. Until now, our conceptions of risks and benefits have been generally static, arising out of the early ethical, legal and social implications studies conducted in the context of targeted genetics. This paper investigates how the increasing availability of genetic information is changing views about risks and benefits, particularly examining our evolving understanding of psychosocial harms and our expanding conception of benefit. We argue that the lack of robust empirical evidence of psychosocial harms and the expanding view that benefits of genomic research include indirect familial benefit necessitate continued ethical, legal and social implications research.
Collapse
Affiliation(s)
- Anya ER Prince
- University of Iowa, College of Law, Iowa City, IA, 52242, USA
| | - Benjamin E Berkman
- National Institutes of Health, Clinical Center Department of Bioethics & National Human Genome Research Institute, Bethesda, MD, 20892, USA
| |
Collapse
|
18
|
Warner TD, Weil CJ, Andry C, Degenholtz HB, Parker L, Carithers LJ, Feige M, Wendler D, Pentz RD. Broad Consent for Research on Biospecimens: The Views of Actual Donors at Four U.S. Medical Centers. J Empir Res Hum Res Ethics 2018; 13:115-124. [PMID: 29390947 PMCID: PMC5869128 DOI: 10.1177/1556264617751204] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Commentators are concerned that broad consent may not provide biospecimen donors with sufficient information regarding possible future research uses of their tissue. We surveyed with interviews 302 cancer patients who had recently provided broad consent at four diverse academic medical centers. The majority of donors believed that the consent form provided them with sufficient information regarding future possible uses of their biospecimens. Donors expressed very positive views regarding tissue donation in general and endorsed the use of their biospecimens in future research across a wide range of contexts. Concerns regarding future uses were limited to for-profit research and research by investigators in other countries. These results support the use of broad consent to store and use biological samples in future research.
Collapse
Affiliation(s)
| | | | | | | | | | - Latarsha J. Carithers
- National Cancer Institute, National Institutes of Health (USA)
- Now at the National Institute of Dental & Craniofacial Research (USA)
| | - Michelle Feige
- Association for the Accreditation of Human Research Protection Programs, Inc. (USA)
| | | | - Rebecca D. Pentz
- Winship Cancer Institute, Emory University School of Medicine (USA)
| |
Collapse
|
19
|
Oberg JA, Ruiz J, Ali-Shaw T, Schlechtweg KA, Ricci A, Kung AL, Chung WK, Appelbaum PS, Glade Bender JL, Levine JM. Whole-Genome and Whole-Exome Sequencing in Pediatric Oncology: An Assessment of Parent and Young Adult Patient Knowledge, Attitudes, and Expectations. JCO Precis Oncol 2018; 2:1700104. [PMID: 32913997 DOI: 10.1200/po.17.00104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose The complexity of results generated from whole-genome sequencing (WGS) and whole-exome sequencing (WES) adds challenges to obtaining informed consent in pediatric oncology. Little is known about knowledge of WGS and WES in this population, and no validated tools exist in pediatric oncology. Methods We developed and psychometrically evaluated a novel WGS and WES knowledge questionnaire, the Precision in Pediatric Sequencing Knowledge Questionnaire (PIPseqKQ), to identify levels of understanding among parents and young adult cancer survivors (≥ 18 years old), off therapy for at least 1 year from a single-institution pediatric oncology outpatient clinic. Participants also completed health literacy and numeracy questionnaires. All participants provided written informed consent. Results One hundred eleven participants were enrolled: 76 were parents, and 35 were young adults. Of the total cohort, 77 (69%) were female, 63 (57%) self-identified as white, and 74 (67%) self-identified as non-Hispanic. Sixty-six (59%) had less than a college degree. Adequate health literacy (n = 87; 80%) and numeracy (n = 89; 80%) were demonstrated. Internal consistency was high (Cronbach's α = .88), and test-retest reliability was greater than the 0.7 minimum requirement. Scores were highest for genetic concepts related to health and cancer and lowest for WGS and WES concepts. Health literacy and educational attainment were significantly associated with PIPseqKQ scores. Overall, participants felt the benefits of WGS and WES outweighed the potential risks. Conclusion Parents and young adult cancer survivors have some genetics knowledge, but they lack knowledge about WGS and WES. The PIPseqKQ is a reliable tool that can identify deficits in knowledge, identify perceptions of risks and benefits of WGS and WES, and help clinicians tailor their consent discussions to best fit families. The PIPseqKQ also may inform the development of educational tools to better facilitate the informed consent process in pediatric oncology.
Collapse
Affiliation(s)
- Jennifer A Oberg
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Jenny Ruiz
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Trisha Ali-Shaw
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Kathryn A Schlechtweg
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Angela Ricci
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Andrew L Kung
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Wendy K Chung
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Paul S Appelbaum
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Julia L Glade Bender
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Jennifer M Levine
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| |
Collapse
|
20
|
Brunfeldt M, Teare H, Soini S, Kääriäinen H. Perceptions of legislation relating to the sharing of genomic biobank results with donors-a survey of BBMRI-ERIC biobanks. Eur J Hum Genet 2018; 26:324-329. [PMID: 29330544 PMCID: PMC5839019 DOI: 10.1038/s41431-017-0049-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/08/2017] [Accepted: 11/07/2017] [Indexed: 11/08/2022] Open
Abstract
Biobanks accumulate huge amounts of research findings, including participants' genomic data. Increasingly this leads to biobanks receiving research results that could be of clinical significance to biobank participants. The EU Horizon 2020 Project 'Genetics Clinic of the Future' surveyed European biobanks' perceptions of the legal and regulatory requirements for communicating individual research results to donors. The goal was to gain background knowledge for possible future guidelines, especially relating to the consent process. The Survey was implemented using a web-based Webropol tool. The questionnaire was sent at the end of 2015 to 351 European biobanks in 13 countries that are members of BBMRI-ERIC (Biobanking and Biomolecular Resources Research Infrastructure-European Research Infrastructure Consortium). Seventy-two biobanks responded to the survey, representing each of the 13 BBMRI Member States. Respondents were mainly individuals responsible for the governance of biobanks. The replies indicate that the majority of the respondents thought that their national legislation allowed them to contact participants to communicate results, and that research participants had the right to request their results. However, respondents' understanding of their national legislation varied even within member states. Our results indicate that legislation applied to biobanks in many countries may be scattered and difficult to interpret. In BBMRI-ERIC, there is an ongoing discussion about the need for European recommendations on sharing genomic biobank results with donors, which may pave the way for more coherent global guidelines. Our results form a basis for this work.
Collapse
Affiliation(s)
- Minna Brunfeldt
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Haartmaninkatu 8, Helsinki, Finland.
| | - Harriet Teare
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Helena Kääriäinen
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Haartmaninkatu 8, Helsinki, Finland
| |
Collapse
|
21
|
Heeney C, Kerr SM. Balancing the local and the universal in maintaining ethical access to a genomics biobank. BMC Med Ethics 2017; 18:80. [PMID: 29282045 PMCID: PMC5745812 DOI: 10.1186/s12910-017-0240-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 12/18/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Issues of balancing data accessibility with ethical considerations and governance of a genomics research biobank, Generation Scotland, are explored within the evolving policy landscape of the past ten years. During this time data sharing and open data access have become increasingly important topics in biomedical research. Decisions around data access are influenced by local arrangements for governance and practices such as linkage to health records, and the global through policies for biobanking and the sharing of data with large-scale biomedical research data resources and consortia. METHODS We use a literature review of policy relevant documents which apply to the conduct of biobanks in two areas: support for open access and the protection of data subjects and researchers managing a bioresource. We present examples of decision making within a biobank based upon observations of the Generation Scotland Access Committee. We reflect upon how the drive towards open access raises ethical dilemmas for established biorepositories containing data and samples from human subjects. RESULTS Despite much discussion in science policy literature about standardisation, the contextual aspects of biobanking are often overlooked. Using our engagement with GS we demonstrate the importance of local arrangements in the creation of a responsive ethical approach to biorepository governance. We argue that governance decisions regarding access to the biobank are intertwined with considerations about maintenance and viability at the local level. We show that in addition to the focus upon ever more universal and standardised practices, the local expertise gained in the management of such repositories must be supported. CONCLUSIONS A commitment to open access in genomics research has found almost universal backing in science and health policy circles, but repositories of data and samples from human subjects may have to operate under managed access, to protect privacy, align with participant consent and ensure that the resource can be managed in a sustainable way. Data access committees need to be reflexive and flexible, to cope with changing technology and opportunities and threats from the wider data sharing environment. To understand these interactions also involves nurturing what is particular about the biobank in its local context.
Collapse
Affiliation(s)
- Catherine Heeney
- Science, Technology and Innovation Studies, University of Edinburgh, High School Yards, Edinburgh, Scotland EH1 1LZ UK
| | - Shona M. Kerr
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, Scotland EH4 2XU UK
| |
Collapse
|
22
|
Bylstra Y, Lysaght T, Thrivikraman J, Watson S, Tan P. Ethical frameworks for obtaining informed consent in tumour profiling: an evidence-based case for Singapore. Hum Genomics 2017; 11:31. [PMID: 29221462 PMCID: PMC5723075 DOI: 10.1186/s40246-017-0127-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/30/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Genomic profiling of malignant tumours has assisted clinicians in providing targeted therapies for many serious cancer-related illnesses. Although the characterisation of somatic mutations is the primary aim of tumour profiling for treatment, germline mutations may also be detected given the heterogenous origin of mutations observed in tumours. Guidance documents address the return of germline findings that have health implications for patients and their genetic relations. However, the implications of discovering a potential but unconfirmed germline finding from tumour profiling are yet to be fully explored. Moreover, as tumour profiling is increasingly applied in oncology, robust ethical frameworks are required to encourage large-scale data sharing and data aggregation linking molecular data to clinical outcomes, to further understand the role of genetics in oncogenesis and to develop improved cancer therapies. RESULTS This paper reports on the results of empirical research that is broadly aimed at developing an ethical framework for obtaining informed consent to return results from tumour profiling tests and to share the biomolecular data sourced from tumour tissues of cancer patients. Specifically, qualitative data were gathered from 36 semi-structured interviews with cancer patients and oncology clinicians at a cancer treatment centre in Singapore. The interview data indicated that patients had a limited comprehension of cancer genetics and implications of tumour testing. Furthermore, oncology clinicians stated that they lacked the time to provide in depth explanations of the tumour profile tests. However, it was accepted from both patients and oncologist that the return potential germline variants and the sharing of de-identified tumour profiling data nationally and internationally should be discussed and provided as an option during the consent process. CONCLUSIONS Findings provide support for the return of tumour profiling results provided that they are accompanied with an adequate explanation from qualified personnel. They also support the use of broad consent regiments within an ethical framework that promotes trust and benefit sharing with stakeholders and provides accountability and transparency in the storage and sharing of biomolecular data for research.
Collapse
Affiliation(s)
- Yasmin Bylstra
- POLARIS, Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore.
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore, Singapore.
- Inherited Cardiac Clinic, National University Hospital, Singapore, Singapore.
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jyothi Thrivikraman
- POLARIS, Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Sangeetha Watson
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Patrick Tan
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore, Singapore
- Cancer and Stem Biology, Duke-NUS Medical School, Singapore, Singapore
- Biomedical Research Council, Agency for Science, Technology and Research, Singapore, Singapore
| |
Collapse
|
23
|
Abstract
From a research perspective, the interest in biobanking continues to intensify. Governments and industry have invested heavily in biobanks, as exemplified by initiatives like the United Kingdom Biobank and United States' Precision Medicine Initiative. But despite this enthusiasm, many profound legal and ethical challenges remain unresolved. Indeed, there continues to be disagreements about how best to obtain consent and the degree and nature of control that research participants retain over donated samples and health information. Emerging social trends-including concerns about commercialization and perceived rights of continuing control ("biorights")-seem likely to intensify these issues.
Collapse
Affiliation(s)
- Timothy Caulfield
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Alberta, Canada
| | - Blake Murdoch
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
24
|
Mackley MP, Capps B. Expect the unexpected: screening for secondary findings in clinical genomics research. Br Med Bull 2017; 122:109-122. [PMID: 28398474 DOI: 10.1093/bmb/ldx009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Due to decreasing cost, and increasing speed and precision, genomic sequencing in research is resulting in the generation of vast amounts of genetic data. The question of how to manage that information has been an area of significant debate. In particular, there has been much discussion around the issue of 'secondary findings' (SF)-findings unrelated to the research that have diagnostic significance. SOURCES OF DATA The following includes ethical commentaries, guidelines and policies in respect to large-scale clinical genomics studies. AREAS OF AGREEMENT Research participant autonomy and their informed consent are paramount-policies around SF must be made clear and participants must have the choice as to which results they wish to receive, if any. AREAS OF CONTROVERSY While many agree that clinically 'actionable' findings should be returned, some question whether they should be actively sought within a research protocol. GROWING POINTS SF present challenges to a growing field; diverse policies around their management have the potential to hinder collaboration and future research. AREAS TIMELY FOR DEVELOPING RESEARCH The impact of returning SF and accurate estimates of their clinical utility are needed to inform future protocol design.
Collapse
Affiliation(s)
- Michael P Mackley
- Radcliffe Department of Medicine, University of Oxford, Level 6 West Wing, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Benjamin Capps
- Department of Bioethics, Faculty of Medicine, Dalhousie University, 5849 University Avenue, Room C-312, CRC Bldg, PO Box 15000, Halifax NS, Canada B3H 4R2
| |
Collapse
|
25
|
Seo J, Ivanovich J, Goodman MS, Biesecker BB, Kaphingst KA. Information Topics of Greatest Interest for Return of Genome Sequencing Results among Women Diagnosed with Breast Cancer at a Young Age. J Genet Couns 2017; 26:511-521. [PMID: 27542972 PMCID: PMC5318287 DOI: 10.1007/s10897-016-0006-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/02/2016] [Indexed: 11/29/2022]
Abstract
We investigated what information women diagnosed with breast cancer at a young age would want to learn when genome sequencing results are returned. We conducted 60 semi-structured interviews with women diagnosed with breast cancer at age 40 or younger. We examined what specific information participants would want to learn across result types and for each type of result, as well as how much information they would want. Genome sequencing was not offered to participants as part of the study. Two coders independently coded interview transcripts; analysis was conducted using NVivo10. Across result types, participants wanted to learn about health implications, risk and prevalence in quantitative terms, causes of variants, and causes of diseases. Participants wanted to learn actionable information for variants affecting risk of preventable or treatable disease, medication response, and carrier status. The amount of desired information differed for variants affecting risk of unpreventable or untreatable disease, with uncertain significance, and not health-related. Women diagnosed with breast cancer at a young age recognize the value of genome sequencing results in identifying potential causes and effective treatments and expressed interest in using the information to help relatives and to further understand their other health risks. Our findings can inform the development of effective feedback strategies for genome sequencing that meet patients' information needs and preferences.
Collapse
Affiliation(s)
- Joann Seo
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA.
| | - Jennifer Ivanovich
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
| | - Melody S Goodman
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
| | - Barbara B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
26
|
Tarling TE, Lasser F, Carter C, Matzke LA, Dhugga G, Arora N, Dee S, LeBlanc J, Babinsky S, O'Donoghue S, Cheah S, Watson P, Vercauteren SM. Business Planning for a Campus-Wide Biobank. Biopreserv Biobank 2017; 15:37-45. [DOI: 10.1089/bio.2016.0077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Tamsin E. Tarling
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | | | - Candace Carter
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Office of Biobank Education and Research (OBER), University of British Columbia, Vancouver, Canada
| | - Lise A.M. Matzke
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Office of Biobank Education and Research (OBER), University of British Columbia, Vancouver, Canada
| | - Gurm Dhugga
- BC Children's Hospital Research Institute, Vancouver, Canada
| | - Nidhi Arora
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Simon Dee
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Office of Biobank Education and Research (OBER), University of British Columbia, Vancouver, Canada
| | | | | | - Sheila O'Donoghue
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Office of Biobank Education and Research (OBER), University of British Columbia, Vancouver, Canada
| | - Stefanie Cheah
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Office of Biobank Education and Research (OBER), University of British Columbia, Vancouver, Canada
| | - Peter Watson
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Office of Biobank Education and Research (OBER), University of British Columbia, Vancouver, Canada
- BC Cancer Agency, Victoria, Canada
| | - Suzanne M. Vercauteren
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, BC Children's Hospital, Vancouver, Canada
| |
Collapse
|
27
|
Kesserwan C, Friedman Ross L, Bradbury AR, Nichols KE. The Advantages and Challenges of Testing Children for Heritable Predisposition to Cancer. Am Soc Clin Oncol Educ Book 2017; 35:251-69. [PMID: 27249705 DOI: 10.1200/edbk_160621] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The increased application of germline genetic testing is expanding our understanding of the risk factors associated with childhood cancer development, and, in some cases, such testing is also informing clinical management. Nonetheless, the incorporation of genetic testing into the pediatric oncology setting is complex and associated with many ethical and practical challenges. The decision as to whether to pursue clinical genetic testing for hereditary cancer predisposition for children should always be guided by the best interest of the child. Despite this fundamental ethical principle, patients, parents, and health care providers may differ in their opinions. Clinical genetic testing to detect the presence of predisposition syndromes associated with childhood-onset cancers, particularly those for which surveillance and preventive measures have proven to enhance outcome, is currently well accepted. On the other hand, clinical genetic testing of children for syndromes associated with adult-onset cancers has raised many concerns about the potential for psychological harm and disrespect of patient autonomy. As a consequence, such testing is not encouraged. The challenges surrounding germline genetic testing are further complicated when testing is done in the research setting and/or when it involves whole-exome or whole-genome sequencing approaches, which can uncover genetic variants that may or may not be associated with the disease under study. Accordingly, there is great debate around these processes and the most appropriate approaches regarding the return of test results. Future research is needed to enhance knowledge about how best to incorporate genomic information into clinical practice.
Collapse
Affiliation(s)
- Chimene Kesserwan
- From the Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN; Departments of Pediatrics, Medicine, and Surgery, MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL; Department of Medicine, Department of Medical Ethics and Health Policy, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Lainie Friedman Ross
- From the Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN; Departments of Pediatrics, Medicine, and Surgery, MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL; Department of Medicine, Department of Medical Ethics and Health Policy, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Angela R Bradbury
- From the Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN; Departments of Pediatrics, Medicine, and Surgery, MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL; Department of Medicine, Department of Medical Ethics and Health Policy, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Kim E Nichols
- From the Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN; Departments of Pediatrics, Medicine, and Surgery, MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL; Department of Medicine, Department of Medical Ethics and Health Policy, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
28
|
Vos S, van Delden JJM, van Diest PJ, Bredenoord AL. Moral Duties of Genomics Researchers: Why Personalized Medicine Requires a Collective Approach. Trends Genet 2016; 33:118-128. [PMID: 28017398 DOI: 10.1016/j.tig.2016.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/21/2016] [Accepted: 11/28/2016] [Indexed: 12/30/2022]
Abstract
Advances in genome sequencing together with the introduction of personalized medicine offer promising new avenues for research and precision treatment, particularly in the field of oncology. At the same time, the convergence of genomics, bioinformatics, and the collection of human tissues and patient data creates novel moral duties for researchers. After all, unprecedented amounts of potentially sensitive information are being generated. Over time, traditional research ethics principles aimed at protecting individual participants have become supplemented with social obligations related to the interests of society and the research enterprise at large, illustrating that genomic medicine is also a social endeavor. In this review we provide a comprehensive assembly of moral duties that have been attributed to genomics researchers and offer suggestions for responsible advancement of personalized genomic cancer care.
Collapse
Affiliation(s)
- Shoko Vos
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Johannes J M van Delden
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annelien L Bredenoord
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
29
|
O'Doherty KC, Christofides E, Yen J, Bentzen HB, Burke W, Hallowell N, Koenig BA, Willison DJ. If you build it, they will come: unintended future uses of organised health data collections. BMC Med Ethics 2016; 17:54. [PMID: 27600117 PMCID: PMC5011895 DOI: 10.1186/s12910-016-0137-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 08/25/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Health research increasingly relies on organized collections of health data and biological samples. There are many types of sample and data collections that are used for health research, though these are collected for many purposes, not all of which are health-related. These collections exist under different jurisdictional and regulatory arrangements and include: 1) Population biobanks, cohort studies, and genome databases 2) Clinical and public health data 3) Direct-to-consumer genetic testing 4) Social media 5) Fitness trackers, health apps, and biometric data sensors Ethical, legal, and social challenges of such collections are well recognized, but there has been limited attention to the broader societal implications of the existence of these collections. DISCUSSION Although health research conducted using these collections is broadly recognized as beneficent, secondary uses of these data and samples may be controversial. We examine both documented and hypothetical scenarios of secondary uses of health data and samples. In particular, we focus on the use of health data for purposes of: Forensic investigations Civil lawsuits Identification of victims of mass casualty events Denial of entry for border security and immigration Making health resource rationing decisions Facilitating human rights abuses in autocratic regimes CONCLUSIONS Current safeguards relating to the use of health data and samples include research ethics oversight and privacy laws. These safeguards have a strong focus on informed consent and anonymization, which are aimed at the protection of the individual research subject. They are not intended to address broader societal implications of health data and sample collections. As such, existing arrangements are insufficient to protect against subversion of health databases for non-sanctioned secondary uses, or to provide guidance for reasonable but controversial secondary uses. We are concerned that existing debate in the scholarly literature and beyond has not sufficiently recognized the secondary data uses we outline in this paper. Our main purpose, therefore, is to raise awareness of the potential for unforeseen and unintended consequences, in particular negative consequences, of the increased availability and development of health data collections for research, by providing a comprehensive review of documented and hypothetical non-health research uses of such data.
Collapse
Affiliation(s)
- Kieran C O'Doherty
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| | - Emily Christofides
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Jeffery Yen
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Heidi Beate Bentzen
- Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian Research Center for Computers and Law, Faculty of Law, University of Oslo, Oslo, Norway
- Norwegian Cancer Genomics Consortium, Oslo, Norway
| | - Wylie Burke
- Department of Bioethics & Humanities, University of Washington, Seattle, USA
| | - Nina Hallowell
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Barbara A Koenig
- UCSF Bioethics, Institute for Health & Aging, University of California, San Francisco, USA
| | - Donald J Willison
- Institute of Health Policy Management and Evaluation | Joint Centre for Bioethics, University of Toronto, Toronto, Canada
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| |
Collapse
|
30
|
Roach AN, Braithwaite T, Carrington C, Marcellin E, Sharma S, Hingorani A, Casas JP, Hauser MA, Allingham RR, Ramsewak SS, Bourne R. Addressing ethical challenges in the Genetics Substudy of the National Eye Survey of Trinidad and Tobago (GSNESTT). Appl Transl Genom 2016; 9:6-14. [PMID: 27556007 PMCID: PMC4986520 DOI: 10.1016/j.atg.2016.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The conduct of international collaborative genomics research raises distinct ethical challenges that require special consideration, especially if conducted in settings that are research-naïve or resource-limited. Although there is considerable literature on these issues, there is a dearth of literature chronicling approaches taken to address these issues in the field. Additionally no previous ethical guidelines have been developed to support similar research in Trinidad and Tobago. METHODS A literature review was undertaken to identify strategies used to address common ethical issues relevant to human genetics and genomics research in research-naïve or resource-limited settings. Strategies identified were combined with novel approaches to develop a culturally appropriate, multifaceted strategy to address potential challenges in the Genetics Substudy of the National Eye Survey of Trinidad and Tobago (GSNESTT). RESULTS Regarding the protection of study participants, we report a decision to exclude children as participants; the use of a Community Engagement and Sensitization Strategy to increase the genetic literacy of the target population; the involvement of local expertise to ensure cultural sensitivity and to address potential comprehension barriers in informed consent; and an audit of the informed consent process to ensure valid consent. Concerning the regulation of the research, we report on ethics approvals from relevant authorities; a Materials Transfer Agreement to guide sample ownership and export; and a Sample Governance Committee to oversee data use and data access. Finally regarding the protection of the interests of scientists from the host country, we report on capacity building efforts to ensure that local scientists have access to data collected through the project and appropriate recognition of their contributions in future publications. CONCLUSION This paper outlines an ethical framework for the conduct of population-based genetics and genomics research in Trinidad and Tobago; highlights common issues arising in the field and strategies to address these.
Collapse
Affiliation(s)
- Allana N. Roach
- Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies (UWI), St. Augustine, Trinidad and Tobago
- Corresponding author at: University of Trinidad and Tobago, O'Meara Road, Arima, Trinidad and Tobago.University of Trinidad and TobagoO'Meara RoadArimaTrinidad and Tobago
| | | | - Christine Carrington
- Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies (UWI), St. Augustine, Trinidad and Tobago
| | - Elysse Marcellin
- Research Assistant, Faculty of Medical Sciences, The University of the West Indies (UWI), St. Augustine, Trinidad and Tobago
| | - Subash Sharma
- Optometry Programme, Faculty of Medical Sciences, The University of the West Indies (UWI), St. Augustine, Trinidad and Tobago
| | - Aroon Hingorani
- Institute of Cardiovascular Sciences, University College London (UCL), UK
| | - Juan P. Casas
- Institute of Health Informatics, University College London, UK
| | - Michael A. Hauser
- Department of Medicine, Duke Institute of Molecular Physiology, Duke University, Durham, NC, USA
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - R. Rand Allingham
- Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies (UWI), St. Augustine, Trinidad and Tobago
| | - Samuel S. Ramsewak
- Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies (UWI), St. Augustine, Trinidad and Tobago
| | - Rupert Bourne
- Vision and Eye Research Unit, Anglia Ruskin University (ARU), Cambridge, UK
| |
Collapse
|
31
|
Holm IA, Iles BR, Ziniel SI, Bacon PL, Savage SK, Christensen KD, Weitzman ER, Green RC, Huntington NL. Participant Satisfaction With a Preference-Setting Tool for the Return of Individual Research Results in Pediatric Genomic Research. J Empir Res Hum Res Ethics 2016; 10:414-26. [PMID: 26376753 DOI: 10.1177/1556264615599620] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The perceived benefit of return of individual research results (IRRs) in accordance to participants' preferences in genomic biobank research is unclear. We developed an online preference-setting tool for return of IRRs based on the preventability and severity of a condition, which included an opt-out option for IRRs for mental illness, developmental disorders, childhood-onset degenerative conditions, and adult-onset conditions. Parents of patients <18 years of age at Boston Children's Hospital were randomized to the hypothetical scenario that their child was enrolled in one of four biobanks with different policies for IRRs to receive (a) "None," (b) "All," (c) "Binary"--choice to receive all or none, and (d) "Granular"--use the preference-setting tool to choose categories of IRRs. Parents were given a hypothetical IRRs report for their child. The survey was sent to 11,391 parents and completed by 2,718. The Granular group was the most satisfied with the process, biobank, and hypothetical IRRs received. The None group was least satisfied and least likely to agree that the biobank was beneficial (p < .001). The response to the statement that the biobank was harmful was not different between groups. Our data suggest that the ability to designate preferences leads to greater satisfaction and may increase biobank participation.
Collapse
Affiliation(s)
- Ingrid A Holm
- Boston Children's Hospital, MA, USA Harvard Medical School, Boston, MA, USA
| | | | - Sonja I Ziniel
- Boston Children's Hospital, MA, USA Harvard Medical School, Boston, MA, USA
| | - Phoebe L Bacon
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Elissa R Weitzman
- Boston Children's Hospital, MA, USA Harvard Medical School, Boston, MA, USA
| | - Robert C Green
- Harvard Medical School, Boston, MA, USA Partners Personalized Medicine, Boston, MA, USA
| | | |
Collapse
|
32
|
Abstract
In this commentary on Karla Stroud and Kieran O'Doherty's 'Ethically Sustainable Governance in the Biobanking of Eggs and Embryos for Research' (2015) I call into question the need for good governance to overcome the challenges facing biobanking of eggs and embryos. I argue that the principles of good governance for biobanking that Stroud and O'Doherty outline come up short in providing concrete normative guidance to resolve the challenges associated with a biobank for eggs and embryos.
Collapse
Affiliation(s)
- Katharine Browne
- Novel Tech Ethics, Dalhousie University, 1379 Seymour Street, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| |
Collapse
|
33
|
Abstract
Biobanks are designed with particular purposes in mind. These purposes are reflected in the governance frameworks that define the conditions for participation and access by researchers. In this paper, I analyse two different models: the commercially aligned deCODE biobank and the 'public good' framework of UK Biobank. These diametric models have both featured 'the public interest' as pivotal to their achievements. However, if properly understood, the public interest rhetoric of deCODE actually conflicts with any professed community interest. The reasons why are explained, and the effects this has on conditions for participation are critiqued, before reflecting on how each model might have an impact on reproductive health research.
Collapse
|
34
|
Stroud K, O'Doherty KC. Ethically sustainable governance in the biobanking of eggs and embryos for research. Monash Bioeth Rev 2016; 33:277-94. [PMID: 26712609 DOI: 10.1007/s40592-015-0047-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Biobanking of human tissues is associated with a range of ethical, legal, and social (ELS) challenges. These include difficulties in operationalising informed consent protocols, protecting donors' privacy, managing the return of incidental findings, conceptualising ownership of tissues, and benefit sharing. Though largely unresolved, these challenges are well documented and debated in academic literature. One common response to the ELS challenges of biobanks is a call for strong and independent governance of biobanks. Theorists who argue along these lines suggest that since fully informed consent to a single research project is often not feasible, research participants should be given the additional protection of being allowed to consent to the governance framework of the biobank. Such governance therefore needs to be transparent and ethically sustainable. In this paper we review the governance challenges of establishing and maintaining human tissue biobanks. We then discuss how the creation of a biobank for eggs and embryos, in particular, may introduce additional or unique challenges beyond those presented by the biobanking of other human tissues. Following previous work on biobank governance, we argue that ethically sustainable governance needs to be participatory, adaptive, and trustworthy.
Collapse
Affiliation(s)
- Karla Stroud
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Kieran C O'Doherty
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| |
Collapse
|
35
|
Azuma K, Yamanaka S. Recent policies that support clinical application of induced pluripotent stem cell-based regenerative therapies. Regen Ther 2016; 4:36-47. [PMID: 31245486 PMCID: PMC6581825 DOI: 10.1016/j.reth.2016.01.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 01/07/2016] [Accepted: 01/28/2016] [Indexed: 02/04/2023] Open
Abstract
In Japan, a research center network consisting of Kyoto University to provide clinical-grade induced Pluripotent Stem Cells (iPSC) and several major research centers to develop iPSC-based regenerative therapies was formed for the clinical application of iPSCs. This network is under the supervision of a newly formed funding agency, the Japan Agency for Medical Research and Development. In parallel, regulatory authorities of Japan, including the Ministry of Health, Labour and Welfare, and Pharmaceuticals and Medical Devices Agency, are trying to accelerate the development process of regenerative medicine products (RMPs) by several initiatives: 1) introduction of a conditional and time-limited approval scheme only applicable to RMPs under the revised Pharmaceuticals and Medical Devices Act, 2) expansion of a consultation program at the early stage of development, 3) establishment of guidelines to support efficient development and review and 4) enhancement of post-market safety measures such as introduction of patient registries and setting user requirements with cooperation from relevant academic societies and experts. Ultimately, the establishment of a global network among iPSC banks that derives clinical-grade iPSCs from human leukocyte antigens homozygous donors has been proposed. In order to share clinical-grade iPSCs globally and to facilitate global development of iPSC-based RMPs, it will be necessary to promote regulatory harmonization and to establish common standards related to iPSCs and differentiated cells based on scientific evidence.
Collapse
Key Words
- AMED, Japan Agency for Medical Research and Development
- BLA, Biological License Approval
- CFR, Code of Federal Regulations
- CiRA, Center for iPS Cell Research and Application
- DMF, Drug Master File
- ESC, embryonic stem cell
- FDA, Food and Drug Administration
- FY, fiscal year
- GAiT, Global Alliance for iPS Cell Therapies
- GCTP, Good Gene, Cell, Cellular and Tissue-based Products Manufacturing Practice
- GMP, good manufacturing practice
- HLA, human leukocyte antigen
- Haplobank
- IBRI, Institution of Biomedical Research and Innovation
- ICH, The International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use
- IND, Investigational New Drug
- INTERMACS, Interagency Registry for Mechanically Assisted Circulatory Support
- IRB, Institutional Review Board
- J-MACS, Japanese Registry for Mechanically Assisted Circulatory Support
- JST, Japan Science and Technology Agency
- Japan
- LVAD, left ventricular assist device
- METI, Ministry of Economy, Trade and Industry
- MEXT, Ministry of Education, Culture, Sports, Science and Technology
- MHLW, Ministry of Health, Labour and Welfare
- NEDO, New Energy and Industrial Technology Development Organization
- NIBIO, National Institute of Biomedical Innovation
- NIHS, National Institute of Health Science
- PAL, Pharmaceutical Affairs Law
- PIC/S, The Pharmaceutical Inspection Convention and Pharmaceutical Inspection Co-operation Scheme
- PMD Act, Pharmaceuticals and Medical Devices Act
- PMDA, Pharmaceuticals and Medical Devices Agency
- Policy
- R&D, research and development
- RM Act, the Act on the Safety of Regenerative Medicine
- RMP, regenerative medicine product
- Regenerative medicine
- Regulation
- Riken CDB, Riken Center for Developmental Biology
- U.S., United States
- WHO, World Health Organization
- iPS cells
- iPSC, induced pluripotent stem cell
Collapse
Affiliation(s)
- Kentaro Azuma
- Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan
| | - Shinya Yamanaka
- Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan
- Gladstone Institute of Cardiovascular Disease, San Francisco, California 94158, USA
| |
Collapse
|
36
|
Wallace SE, Gourna EG, Laurie G, Shoush O, Wright J. Respecting Autonomy Over Time: Policy and Empirical Evidence on Re-Consent in Longitudinal Biomedical Research. BIOETHICS 2016; 30:210-7. [PMID: 25960157 PMCID: PMC4762535 DOI: 10.1111/bioe.12165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Re-consent in research, the asking for a new consent if there is a change in protocol or to confirm the expectations of participants in case of change, is an under-explored issue. There is little clarity as to what changes should trigger re-consent and what impact a re-consent exercise has on participants and the research project. This article examines applicable policy statements and literature for the prevailing arguments for and against re-consent in relation to longitudinal cohort studies, tissue banks and biobanks. Examples of re-consent exercises are presented, triggers and non-triggers for re-consent discussed and the conflicting attitudes of commentators, participants and researchers highlighted. We acknowledge current practice and argue for a greater emphasis on 'responsive autonomy,' that goes beyond a one-time consent and encourages greater communication between the parties involved. A balance is needed between respecting participants' wishes on how they want their data and samples used and enabling effective research to proceed.
Collapse
|
37
|
Árnason E. Commentary on models of biobanks and implications for reproductive health innovation. Monash Bioeth Rev 2016; 33:258-64. [PMID: 26809668 DOI: 10.1007/s40592-016-0054-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Einar Árnason
- Institute of Biology, University of Iceland, Reykjavik, Iceland.
| |
Collapse
|
38
|
Sasongko TH, Zabidi-Hussin Z, Othman NH, Van Rostenberghe H. Informed Consent Template and Guidelines on the Ethical Practice in Human Genetics and Human Genomic Research; Initiatives of the Universiti Sains Malaysia. Malays J Med Sci 2015; 22:47-53. [PMID: 28223885 PMCID: PMC5295757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/21/2015] [Indexed: 06/06/2023] Open
Abstract
Malaysia is advancing and nearly on pace with the international scientific community in human genetics and human genomics research. However, this research poses unique challenges. Although Malaysia already regulates medical genetic services, these regulations are insufficient for coping with the ethical issues emerging from recent genomic technologies. The Universiti Sains Malaysia recently created in-house guidelines and an informed consent template for genetic and genomic research. This article presents these guidelines and the informed consent template and discusses the justification and the background of the initiative. We also propose recommendations pertaining to local social studies and regulatory arrangements.
Collapse
Affiliation(s)
- Teguh Haryo Sasongko
- Human Genome Center, School of Medical Sciences, Health Campus, Universiti Sains Malaysia,16150 Kubang Kerian, Kelantan, Malaysia
- Universiti Sains Malaysia Human Research Ethics Committee, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zamh Zabidi-Hussin
- Department of Pediatrics, School of Medical Sciences, Health Campus, Universiti Sains Malaysia,16150 Kubang Kerian, Kelantan, Malaysia
| | - Nor Hayati Othman
- Department of Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia,16150 Kubang Kerian, Kelantan, Malaysia
- Universiti Sains Malaysia Human Research Ethics Committee, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Hans Van Rostenberghe
- Department of Pediatrics, School of Medical Sciences, Health Campus, Universiti Sains Malaysia,16150 Kubang Kerian, Kelantan, Malaysia
- Universiti Sains Malaysia Human Research Ethics Committee, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| |
Collapse
|
39
|
Chanda-Kapata P, Kapata N, Moraes AN, Chongwe G, Munthali J. Genomic research in Zambia: confronting the ethics, policy and regulatory frontiers in the 21st Century. Health Res Policy Syst 2015; 13:60. [PMID: 26510898 PMCID: PMC4625443 DOI: 10.1186/s12961-015-0053-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/09/2015] [Indexed: 11/10/2022] Open
Abstract
Genomic research has the potential to increase knowledge in health sciences, but the process has to ensure the safety, integrity and well-being of research participants. A legal framework for the conduct of health research in Zambia is available. However, the ethical, policy and regulatory framework to operationalise genomic research requires a paradigm shift. This paper outlines the current legal and policy framework as well as the ethics environment, and suggests recommendations for Zambia to fully benefit from the opportunity that genomic research presents. This will entail creating national research interest, improving knowledge levels, and building community trust among researchers, policymakers, donors, regulators and, most importantly, patients and research participants. A real balancing act of the risk and benefits will need to be objectively undertaken.
Collapse
Affiliation(s)
- Pascalina Chanda-Kapata
- Directorate of Disease Surveillance Control and Research, Ministry of Health, Lusaka, Zambia.
| | - Nathan Kapata
- National TB/Leprosy Programme, Ministry of Community Development, Mother and Child Health, Lusaka, Zambia.
| | - Albertina Ngomah Moraes
- Directorate of Disease Surveillance Control and Research, Ministry of Health, Lusaka, Zambia.
| | - Gershom Chongwe
- Department of Public Health, University of Zambia, Lusaka, Zambia.
| | - James Munthali
- School of Medicine, University of Zambia, Lusaka, Zambia.
| |
Collapse
|
40
|
McVeigh TP, Sweeney KJ, Kerin MJ, Gallagher DJ. A qualitative analysis of the attitudes of Irish patients towards participation in genetic-based research. Ir J Med Sci 2015; 185:825-831. [DOI: 10.1007/s11845-015-1373-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/10/2015] [Indexed: 11/29/2022]
|
41
|
Oberg JA, Glade Bender JL, Cohn EG, Morris M, Ruiz J, Chung WK, Appelbaum PS, Kung AL, Levine JM. Overcoming challenges to meaningful informed consent for whole genome sequencing in pediatric cancer research. Pediatr Blood Cancer 2015; 62:1374-80. [PMID: 25832998 DOI: 10.1002/pbc.25520] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 02/19/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Introducing whole genome sequencing (WGS) into pediatric cancer research at diagnosis poses unique challenges related to informed consent. WGS requires tissue obtained prior to initiating treatment, when families may be overwhelmed with uncertainty and fear. Motivation to participate may be high without fully understanding the range of possible results, including secondary findings. Little is known about parental knowledge, attitudes, and beliefs about this type of research. PROCEDURE A qualitative study was conducted to investigate parental knowledge about genetic concepts and WGS, thoughts about the informed consent process, and preferences for secondary findings. Focus groups were conducted with parents/guardians of children with cancer and semi-structured interviews were conducted in a control group without cancer. All transcripts were analyzed using content analysis. RESULTS Four focus groups included 15 participants; eight semi-structured interviews included 10 participants. Basic knowledge about genetics was limited to heredity. Some knowledge of genomic analysis was present in 3/15 focus group participants. Major factors related to participation in WGS research were: (i) hope for their child and future children; (ii) no additional procedures; (iii) and protection of privacy. All favored a two-step consent process, first to store extra tissue from a diagnostic biopsy/resection, followed by consenting to WGS research, one-to-two months later. The desire to receive secondary findings was high among both groups, but there were individuals who did not want these results, fearing increased anxiety. CONCLUSIONS Parents/guardians of children with cancer have limited knowledge about WGS. A two-step consent process may improve their ability to provide meaningful informed consent.
Collapse
Affiliation(s)
- Jennifer A Oberg
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation, Columbia University Medical Center, 161 Fort Washington Avenue, IP7, New York, New York
| | - Julia L Glade Bender
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation, Columbia University Medical Center, 161 Fort Washington Avenue, IP7, New York, New York
| | - Elizabeth G Cohn
- School of Nursing, Division of Academics, Columbia University Medical Center, 161 Fort Washington Avenue, IP7, New York, New York
| | - Marilyn Morris
- Department of Pediatrics, Division of Pediatric Critical Care, Columbia University Medical Center, 161 Fort Washington Avenue, IP7, New York, New York
| | - Jenny Ruiz
- College of Physicians and Surgeons, Columbia University Medical Center, 161 Fort Washington Avenue, IP7, New York, New York
| | - Wendy K Chung
- Department of Pediatrics and Medicine, Division of Pediatric Molecular Genetics, Columbia University Medical Center, 161 Fort Washington Avenue, IP7, New York, New York
| | - Paul S Appelbaum
- Department of Psychiatry, Division of Law, Ethics, and Psychiatry, Columbia University Medical Center, 161 Fort Washington Avenue, IP7, New York, New York
| | - Andrew L Kung
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation, Columbia University Medical Center, 161 Fort Washington Avenue, IP7, New York, New York
| | - Jennifer M Levine
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation, Columbia University Medical Center, 161 Fort Washington Avenue, IP7, New York, New York
| |
Collapse
|
42
|
Parker M, Bull S. Sharing Public Health Research Data: Toward the Development of Ethical Data-Sharing Practice in Low- and Middle-Income Settings. J Empir Res Hum Res Ethics 2015; 10:217-24. [PMID: 26297744 PMCID: PMC4547199 DOI: 10.1177/1556264615593494] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
It is increasingly recognized that effective and appropriate data sharing requires the development of models of good data-sharing practice capable of taking seriously both the potential benefits to be gained and the importance of ensuring that the rights and interests of participants are respected and that risk of harms is minimized. Calls for the greater sharing of individual-level data from biomedical and public health research are receiving support among researchers and research funders. Despite its potential importance, data sharing presents important ethical, social, and institutional challenges in low-income settings. In this article, we report on qualitative research conducted in five low- and middle-income countries exploring the experiences of key research stakeholders and their views about what constitutes good data-sharing practice.
Collapse
|
43
|
Family decision maker perspectives on the return of genetic results in biobanking research. Genet Med 2015; 18:82-8. [PMID: 25856669 PMCID: PMC4600004 DOI: 10.1038/gim.2015.38] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/17/2015] [Indexed: 02/06/2023] Open
Abstract
PURPOSE There are many ethical considerations regarding the return of genetic results to biobanking participants, especially when biobanks collect samples from deceased organ and tissue donors that require the authorization of a family decision maker (FDM). This article explores FDM knowledge and opinions regarding return of genetic results in the context of the Genotype-Tissue Expression (GTEx) Project, which does not return results to participants. METHODS Data collection included a survey completed by Organ Procurement Organization requesters (n = 22) and semistructured telephone interviews with FDM (n = 55). RESULTS Nearly every FDM wanted some form of genetic results returned. Information regarding treatable diseases (94.3%) and diseases that could affect their children (84.9%) were more desirable than that regarding untreatable diseases (71.7%). Sixty percent of FDMs understood that GTEx would not return genetic results. FDMs were four times more likely to have correct knowledge of the GTEx policy when their GTEx requester reported discussing the topic with them. CONCLUSION FDMs from the GTEx project were interested in receiving genetic test results. Marked changes in the infrastructure of the GTEx would be required to alter the policy. Regardless, care must be taken to ensure that the return policy is clearly communicated with FDMs to dispel misconceptions.Genet Med 18 1, 82-88.
Collapse
|
44
|
Critchley C, Nicol D, Otlowski M. The impact of commercialisation and genetic data sharing arrangements on public trust and the intention to participate in biobank research. Public Health Genomics 2015; 18:160-72. [PMID: 25790760 DOI: 10.1159/000375441] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/22/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The necessity for biobanks to share their resources with third parties poses potential risks to public trust and the intention to participate in genetic research. We explore the effects of data sharing and the type of third-party access (public vs. private) on public trust and, in turn, the intention to participate in biobank research. METHODS An experimental design was used to assess a national sample of 1,701 Australians via a computer-assisted telephone interview. RESULTS The results revealed that trust and the intention to participate significantly decreased in relation to private compared to public biobanks, and when access to third-party researchers was allowed compared to when it was not. Somewhat surprisingly, no differences were found in relation to the third party being international compared to Australian, but trust and the intention to participate were significantly eroded when private third parties were allowed access. Those with a university education were particularly distrustful of private biobanks and biobanks that allowed access, while those who were more aware of genetic databases appeared more confident with biobanks sharing with private-sector third parties. CONCLUSION The pattern of results suggests that public awareness of the need for biobanks to share their resources widely needs to be increased to maintain public trust and support.
Collapse
Affiliation(s)
- Christine Critchley
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Vic., Australia
| | | | | |
Collapse
|
45
|
Budin-Ljøsne I, Burton P, Isaeva J, Gaye A, Turner A, Murtagh MJ, Wallace S, Ferretti V, Harris JR. DataSHIELD: an ethically robust solution to multiple-site individual-level data analysis. Public Health Genomics 2014; 18:87-96. [PMID: 25532061 DOI: 10.1159/000368959] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/08/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND DataSHIELD (Data Aggregation Through Anonymous Summary-statistics from Harmonised Individual levEL Databases) has been proposed to facilitate the co-analysis of individual-level data from multiple studies without physically sharing the data. In a previous paper, we investigated whether DataSHIELD could protect participant confidentiality in accordance with UK law. In this follow-up paper, we investigate whether DataSHIELD addresses a broader range of ethics-related data-sharing concerns. METHODS Ethics-related data-sharing concerns of Institutional Review Boards, ethics experts, international research consortia and research participants were identified through a literature search and systematically examined at a multidisciplinary workshop to determine whether DataSHIELD proposes mechanisms which can address these concerns. RESULTS DataSHIELD addresses several ethics-related data-sharing concerns related to privacy, confidentiality, and the protection of the research participant's rights while sharing data and after the data have been shared. The data remain entirely under the direct management of the study that collected them. Data processing commands are strictly supervised, and the data are queried in a protected environment. Issues related to the return of individual research results when data are shared are eliminated; the responsibility for return remains at the study of origin. CONCLUSION DataSHIELD can provide an innovative and robust solution for addressing commonly encountered ethics-related data-sharing concerns.
Collapse
Affiliation(s)
- Isabelle Budin-Ljøsne
- Division of Epidemiology, Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Kleiderman E, Avard D, Besso A, Ali-Khan S, Sauvageau G, Hébert J. Disclosure of incidental findings in cancer genomic research: investigators' perceptions on obligations and barriers. Clin Genet 2014; 88:320-6. [PMID: 25492269 DOI: 10.1111/cge.12540] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 01/24/2023]
Abstract
Although there has been significant research surrounding incidental findings (IFs), the guidelines and information provided to investigators remain unspecific, unclear, and often generalize the course of action to everyone in the field. We explored the perceptions and experiences of investigators regarding the return of IFs in genetic research. Researchers and clinician-researchers were invited to participate in semi-structured telephone interviews in Quebec and Ontario. Twenty professionals participated, and thematic analysis was used to analyze the transcriptions. Four contextual elements emerged: (i) degree of significance of results, (ii) respect for persons, (iii) infrastructure implications, and (iv) professional responsibilities. Our findings demonstrate that all investigators raised similar contextual elements surrounding the return of IFs. However, some nuances in participants' experiences of the understanding of professional responsibilities also emerged. Because of the existing nuances, a one-size-fits-all approach is inappropriate, suggesting that context ought to be considered in decisions about IFs.
Collapse
Affiliation(s)
- E Kleiderman
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - D Avard
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - A Besso
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - S Ali-Khan
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - G Sauvageau
- Institute for Research in Immunology and Cancer, Université de Montréal, Montreal, Quebec, Canada.,Leukemia Cell Bank of Quebec and Division of Hematology-Oncology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada.,Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - J Hébert
- Institute for Research in Immunology and Cancer, Université de Montréal, Montreal, Quebec, Canada.,Leukemia Cell Bank of Quebec and Division of Hematology-Oncology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada.,Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
47
|
Minari J, Shirai T, Kato K. Ethical considerations of research policy for personal genome analysis: the approach of the Genome Science Project in Japan. LIFE SCIENCES, SOCIETY AND POLICY 2014; 10:4. [PMID: 26085440 PMCID: PMC4646883 DOI: 10.1186/s40504-014-0004-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 01/17/2014] [Indexed: 06/04/2023]
Abstract
As evidenced by high-throughput sequencers, genomic technologies have recently undergone radical advances. These technologies enable comprehensive sequencing of personal genomes considerably more efficiently and less expensively than heretofore. These developments present a challenge to the conventional framework of biomedical ethics; under these changing circumstances, each research project has to develop a pragmatic research policy. Based on the experience with a new large-scale project-the Genome Science Project-this article presents a novel approach to conducting a specific policy for personal genome research in the Japanese context. In creating an original informed-consent form template for the project, we present a two-tiered process: making the draft of the template following an analysis of national and international policies; refining the draft template in conjunction with genome project researchers for practical application. Through practical use of the template, we have gained valuable experience in addressing challenges in the ethical review process, such as the importance of sharing details of the latest developments in genomics with members of research ethics committees. We discuss certain limitations of the conventional concept of informed consent and its governance system and suggest the potential of an alternative process using information technology.
Collapse
Affiliation(s)
- Jusaku Minari
- />Department of Biomedical Ethics and Public Policy, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871 Japan
| | - Tetsuya Shirai
- />Research Administration Office, Kyoto University, Kyoto, Japan
| | - Kazuto Kato
- />Department of Biomedical Ethics and Public Policy, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871 Japan
- />Institute for Integrated Cell-Material Sciences (iCeMS), Kyoto University, Kyoto, Japan
| |
Collapse
|
48
|
Jaitovich Groisman I, Egalite N, Godard B. Consenting for current genetic research: is Canadian practice adequate? BMC Med Ethics 2014; 15:80. [PMID: 25410958 PMCID: PMC4247628 DOI: 10.1186/1472-6939-15-80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/05/2014] [Indexed: 01/08/2023] Open
Abstract
Background In order to ensure an adequate and ongoing protection of individuals participating in scientific research, the impacts of new biomedical technologies, such as Next Generation Sequencing (NGS), need to be assessed. In this light, a necessary reexamination of the ethical and legal structures framing research could lead to requisite changes in informed consent modalities. This would have implications for Institutional Review Boards (IRBs), who bear the responsibility of guaranteeing that participants are verifiably informed, and in sufficient detail, to understand the reality of genetic research as it is practiced now. Current literature allowed the identification of key emergent themes related to the consent process when NGS was used in a research setting. Methods We examined the subjects of secondary use, sharing of materials and data, and recontacting participants as outlined in the Canadian Informed Consent templates and the accompanying IRB instructions for the conduct of genetic research. The research ethics policy applied by the three Canadian research agencies (Tri-Council Policy Statement, 2nd Edition) was used to frame our content analysis. We also obtained IRB-approved consent forms for genetic research projects on brain and mental health disorders as an example of a setting where participants might present higher-than-average vulnerability. Results Eighty percent of documents addressed different modalities for the secondary use of material and/or data, although the message was not conveyed in a systematic way. Information on the sharing of genetic sequencing data in a manner completely independent of the material from which it originated was absent. Grounds for recontacting participants were limited, and mainly mentioned to obtain consent for secondary use. A feature of the IRB-approved consent documents for genetic studies on brain and mental health disorders using NGS technologies, offered a complete explanation on sharing material and data and the use of databases. Conclusions The results of our work show that in Canada, many NGS research needs are already dealt with. Our analysis led us to propose the addition of well-defined categories for future use, adding options on the sharing of genetic data, and widening the grounds on which research participants could consent to be recontacted.
Collapse
Affiliation(s)
| | | | - Beatrice Godard
- Omics-Ethics Research Group, Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, C,P, 6128, succ, Centre-ville, Montreal H3C 3 J7, Canada.
| |
Collapse
|
49
|
Management and return of incidental genomic findings in clinical trials. THE PHARMACOGENOMICS JOURNAL 2014; 15:1-5. [PMID: 25348616 DOI: 10.1038/tpj.2014.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 08/21/2014] [Accepted: 08/28/2014] [Indexed: 01/04/2023]
|
50
|
Bahassi EM, Stambrook PJ. Next-generation sequencing technologies: breaking the sound barrier of human genetics. Mutagenesis 2014; 29:303-10. [PMID: 25150023 PMCID: PMC7318892 DOI: 10.1093/mutage/geu031] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Demand for new technologies that deliver fast, inexpensive and accurate genome information has never been greater. This challenge has catalysed the rapid development of advances in next-generation sequencing (NGS). The generation of large volumes of sequence data and the speed of data acquisition are the primary advantages over previous, more standard methods. In 2013, the Food and Drug Administration granted marketing authorisation for the first high-throughput NG sequencer, Illumina's MiSeqDx, which allowed the development and use of a large number of new genome-based tests. Here, we present a review of template preparation, nucleic acid sequencing and imaging, genome assembly and alignment approaches as well as recent advances in current and near-term commercially available NGS instruments. We also outline the broad range of applications for NGS technologies and provide guidelines for platform selection to best address biological questions of interest. DNA sequencing has revolutionised biological and medical research, and is poised to have a similar impact on the practice of medicine. This tool is but one of an increasing arsenal of developing tools that enhance our capabilities to identify, quantify and functionally characterise the components of biological networks that keep us healthy or make us sick. Despite advances in other 'omic' technologies, DNA sequencing and analysis, in many respects, have played the leading role to date. The new technologies provide a bridge between genotype and phenotype, both in man and model organisms, and have revolutionised how risk of developing a complex human disease may be assessed. The generation of large DNA sequence data sets is producing a wealth of medically relevant information on a large number of individuals and populations that will potentially form the basis of truly individualised medical care in the future.
Collapse
Affiliation(s)
- El Mustapha Bahassi
- Department of Internal Medicine, Division of Hematology/Oncology, UC Brain Tumor Center, University of Cincinnati, 3125 Eden Avenue, Cincinnati, OH 45267-0508, USA, Department of Molecular Genetics, Biochemistry and Microbiology, University of Cincinnati, 3125 Eden Avenue, Cincinnati, OH 45267-0508, USA
| | - Peter J Stambrook
- Department of Molecular Genetics, Biochemistry and Microbiology, University of Cincinnati, 3125 Eden Avenue, Cincinnati, OH 45267-0508, USA
| |
Collapse
|