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Song R. Waiving the consent requirement to mitigate bias in observational precision medicine research. Int J Equity Health 2024; 23:142. [PMID: 39026212 PMCID: PMC11256561 DOI: 10.1186/s12939-024-02221-4] [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: 10/21/2022] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
Consent bias is a type of selection bias in biomedical research where those consenting to the research differ systematically from those not consenting. It is particularly relevant in precision medicine research because the complexity of these studies prevents certain subgroups from understanding, trusting, and consenting to the research. Because consent bias distorts research findings and causes inequitable distribution of research benefits, scholars propose two types of schemes to reduce consent bias: reforming existing consent models and removing the consent requirement altogether. This study explores the possibility of waiving consent in observational studies using existing data, because they involve fewer risks to participants than clinical trials if privacy safeguards are strengthened. It suggests that data protection mechanisms such as security enhancement and data protection impact assessment should be conducted to protect data privacy of participants in observational studies without consent.
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Affiliation(s)
- Ruifeng Song
- Faculty of Law, The University of Hong Kong, Pokfulam, Hong Kong, China.
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2
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Ganeson K, Tan Xue May C, Abdullah AAA, Ramakrishna S, Vigneswari S. Advantages and Prospective Implications of Smart Materials in Tissue Engineering: Piezoelectric, Shape Memory, and Hydrogels. Pharmaceutics 2023; 15:2356. [PMID: 37765324 PMCID: PMC10535616 DOI: 10.3390/pharmaceutics15092356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Conventional biomaterial is frequently used in the biomedical sector for various therapies, imaging, treatment, and theranostic functions. However, their properties are fixed to meet certain applications. Smart materials respond in a controllable and reversible way, modifying some of their properties because of external stimuli. However, protein-based smart materials allow modular protein domains with different functionalities and responsive behaviours to be easily combined. Wherein, these "smart" behaviours can be tuned by amino acid identity and sequence. This review aims to give an insight into the design of smart materials, mainly protein-based piezoelectric materials, shape-memory materials, and hydrogels, as well as highlight the current progress and challenges of protein-based smart materials in tissue engineering. These materials have demonstrated outstanding regeneration of neural, skin, cartilage, bone, and cardiac tissues with great stimuli-responsive properties, biocompatibility, biodegradability, and biofunctionality.
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Affiliation(s)
- Keisheni Ganeson
- Institute of Climate Adaptation and Marine Biotechnolgy (ICAMB), Kuala Nerus 21030, Terengganu, Malaysia;
| | - Cindy Tan Xue May
- Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, Kuala Nerus 21030, Terengganu, Malaysia;
| | - Amirul Al Ashraf Abdullah
- School of Biological Sciences, Universiti Sains Malaysia, Bayan Lepas 11800, Penang, Malaysia;
- Malaysian Institute of Pharmaceuticals and Nutraceuticals, National Institutes of Biotechnology Malaysia, Gelugor 11700, Penang, Malaysia
- Centre for Chemical Biology, Universiti Sains Malaysia, Bayan Lepas 11800, Penang, Malaysia
| | - Seeram Ramakrishna
- Center for Nanofibers and Nanotechnology, Department of Mechanical Engineering, National University of Singapore, Singapore 117581, Singapore
| | - Sevakumaran Vigneswari
- Institute of Climate Adaptation and Marine Biotechnolgy (ICAMB), Kuala Nerus 21030, Terengganu, Malaysia;
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Patrinos D, Knoppers BM, Laplante DP, Rahbari N, Wazana A. Sharing and Safeguarding Pediatric Data. Front Genet 2022; 13:872586. [PMID: 35795212 PMCID: PMC9251179 DOI: 10.3389/fgene.2022.872586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/30/2022] [Indexed: 11/21/2022] Open
Abstract
Data sharing is key to advancing our understanding of human health and well-being. While issues related to pediatric research warrant strong ethical protections, overly protectionist policies may serve to exclude minors from data sharing initiatives. Pediatric data sharing is critical to scientific research concerning health and well-being, to say nothing of understanding human development generally. For example, large-scale pediatric longitudinal studies, such as those in the DREAM-BIG Consortium, on the influence of prenatal adversity factors on child psychopathology, will provide prevention data and generate future health benefits. Recent initiatives have formulated sound policy to help enable and foster data sharing practices for pediatric research. To help translate these policy initiatives into practice, we discuss how model consent clauses for pediatric research can help address some of the issues and challenges of pediatric data sharing, while enabling data sharing.
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Affiliation(s)
- Dimitri Patrinos
- Centre of Genomics and Policy, School of Biomedical Sciences, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- *Correspondence: Dimitri Patrinos,
| | - Bartha Maria Knoppers
- Centre of Genomics and Policy, School of Biomedical Sciences, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - David P. Laplante
- Lady Davis Institute (LDI), Montreal, QC, Canada
- Centre for Child Development and Mental Health, Jewish General Hospital, Montreal, QC, Canada
| | - Noriyeh Rahbari
- Lady Davis Institute (LDI), Montreal, QC, Canada
- Centre for Child Development and Mental Health, Jewish General Hospital, Montreal, QC, Canada
| | - Ashley Wazana
- Lady Davis Institute (LDI), Montreal, QC, Canada
- Centre for Child Development and Mental Health, Jewish General Hospital, Montreal, QC, Canada
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Patrinos D, Knoppers BM, Kleiderman E, Rahbari N, Laplante DP, Wazana A. Re-contact Following Withdrawal of Minors from Research. CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1087202ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Kohlschütter A. Ethical Issues in Care and Treatment of Neuronal Ceroid Lipofuscinoses (NCL)-A Personal View. Front Neurol 2021; 12:692527. [PMID: 34248829 PMCID: PMC8267169 DOI: 10.3389/fneur.2021.692527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
The management of Neuronal Ceroid Lipofuscinoses (NCL), a group of genetic neurodegenerative disorders mainly affecting brain and retinas, raises difficult questions for physicians and other professionals in research, pharmaceutical industry, and public health. Ethical problems in medicine cannot be solved by rational deliberation or by following formal rules. Two topics of ethical issues in the field of NCL are presented here. One group relates to the care of individual patients and centers on a life with dementia at a young age. Advanced care planning for the end of life and the use of life-prolonging measures require challenging assumptions in the best interest of a patient. A second group of questions relates to new treatments. Impressive novel putative causal therapies, such as enzyme replacement for CLN2 disease, may be only disease-modifying and carry the risk of changing a deadly disease of short duration into one with prolonged survival and poor quality of life. The wish for better therapeutic interventions in life-limiting diseases has to take such risks, but more experience is needed before definite conclusions can be drawn. The appropriateness of presymptomatic screening for a severe disease, e.g., must be carefully evaluated to avoid the disastrous experience made with the rash start of newborn screening for Krabbe disease. The ethical issues described and commented in the article reflect the personal experience of a pediatrician who has studied clinical and research questions in NCL for four decades. They should alert various professionals to the necessity of taking their own decisions in situations that are caused by rare progressive brain diseases of young persons, as typified by the NCL.
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Beauvais MJS, Knoppers BM. Coming Out to Play: Privacy, Data Protection, Children's Health, and COVID-19 Research. Front Genet 2021; 12:659027. [PMID: 33936177 PMCID: PMC8080022 DOI: 10.3389/fgene.2021.659027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/19/2021] [Indexed: 12/29/2022] Open
Abstract
The COVID-19 pandemic has underscored the need for new ways of thinking about data protection. This is especially so in the case of health research with children. The responsible use of children's data plays a key role in promoting children's well-being and securing their right to health and to privacy. In this article, we contend that a contextual approach that appropriately balances children's legal and moral rights and interests is needed when thinking about data protection issues with children. We examine three issues in health research through a child-focused lens: consent to data processing, data retention, and data protection impact assessments. We show that these issues present distinctive concerns for children and that the General Data Protection Regulation provides few bright-line rules. We contend that there is an opportunity for creative approaches to children's data protection when child-specific principles, such as the best interests of the child and the child's right to be heard, are put into dialogue with the structure and logic of data protection law.
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Affiliation(s)
- Michael J. S. Beauvais
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Bartha Maria Knoppers
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Canada Research Chair in Law and Medicine, Montreal, QC, Canada
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Beauvais MJS, Thorogood AM, Szego MJ, Sénécal K, Zawati MH, Knoppers BM. Parental Access to Children's Raw Genomic Data in Canada: Legal Rights and Professional Responsibility. Front Genet 2021; 12:535340. [PMID: 33868358 PMCID: PMC8044527 DOI: 10.3389/fgene.2021.535340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
Children with rare and common diseases now undergo whole genome sequencing (WGS) in clinical and research contexts. Parents sometimes request access to their child's raw genomic data, to pursue their own analyses or for onward sharing with health professionals and researchers. These requests raise legal, ethical, and practical issues for professionals and parents alike. The advent of widespread WGS in pediatrics occurs in a context where privacy and data protection law remains focused on giving individuals control-oriented rights with respect to their personal information. Acting in their child's stead and in their best interests, parents are generally the ones who will be exercising these informational rights on behalf of the child. In this paper, we map the contours of parental authority to access their child's raw genomic data. We consider three use cases: hospital-based researchers, healthcare professionals acting in a clinical-diagnostic capacity, and "pure" academic researchers at a public institution. Our research seeks to answer two principal questions: Do parents have a right of access to their child's raw WGS data? If so, what are the limits of this right? Primarily focused on the laws of Ontario, Canada's most populous province, with a secondary focus on Canada's three other most populous provinces (Quebec, British Columbia, and Alberta) and the European Union, our principal findings include (1) parents have a general right of access to information about their children, but that the access right is more capacious in the clinical context than in the research context; (2) the right of access extends to personal data in raw form; (3) a consideration of the best interests of the child may materially limit the legal rights of parents to access data about their child; (4) the ability to exercise rights of access are transferred from parents to children when they gain decision-making capacity in both the clinical and research contexts, but with more nuance in the former. With these findings in mind, we argue that professional guidelines, which are concerned with obligations to interpret and return results, may assist in furthering a child's best interests in the context of legal access rights. We conclude by crafting recommendations for healthcare professionals in the clinical and research contexts when faced with a parental request for a child's raw genomic data.
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Affiliation(s)
- Michael J S Beauvais
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Adrian M Thorogood
- ELIXIR-LU, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Belvaux, Luxembourg
| | - Michael J Szego
- Centre for Clinical Ethics, Unity Health, Toronto, ON, Canada.,Departments of Family and Community Medicine and Molecular Genetics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Ma'n H Zawati
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Bartha Maria Knoppers
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, QC, Canada
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Villanueva AG, Majumder MA. Hashtag who's missing? Lessons for genomic databases. Disabil Health J 2020; 14:100945. [PMID: 32788131 DOI: 10.1016/j.dhjo.2020.100945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
Genomic databases support research intended to advance understanding, diagnosis, and treatment of disease. Utility is linked to diversity, and initiatives are seeking to enroll traditionally underrepresented groups such as people with disabilities. Commentators have called for adoption of a participant-centric approach to build trust and address barriers to inclusion. Complexities emerge, however, when minors are enrolled and whose perspective on their condition may with time diverge from their parents' perspective. Public response to MSSNG, a genomic database focused on autism, and public discourse regarding neurodiversity reveal division regarding autism as a difference or identity versus a disease. We explore what it means for genomic databases enrolling individuals, particularly minors, with disabilities to be participant-centric when affected individuals disagree about the nature of their condition and research priorities, offering recommendations for participant engagement and measures when enrolling minors with conditions that are the subject of difference-disease debates.
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Affiliation(s)
- Angela G Villanueva
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 310D, Houston, TX, 77030, USA.
| | - Mary A Majumder
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 310D, Houston, TX, 77030, USA.
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Bak MAR, Ploem MC, Ateşyürek H, Blom MT, Tan HL, Willems DL. Stakeholders' perspectives on the post-mortem use of genetic and health-related data for research: a systematic review. Eur J Hum Genet 2020; 28:403-416. [PMID: 31527854 PMCID: PMC7080773 DOI: 10.1038/s41431-019-0503-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/07/2019] [Accepted: 08/27/2019] [Indexed: 01/20/2023] Open
Abstract
The majority of biobank policies and consent forms do not address post-mortem use of data for medical research, thus causing uncertainty after research participants' death. This systematic review identifies studies examining stakeholders' perspectives on this issue. We conducted a search in MEDLINE, CINAHL, EMBASE and Web of Science. Findings were categorised in two themes: (1) views on the use of data for medical research after participants' death, and (2) perspectives regarding the post-mortem return of individual genetic research results. An important subtheme was the appropriate authority and degree of control over posthumous use of data. The sixteen included studies all focused on genetic data and used quantitative and qualitative methods to survey perspectives of research participants, family members, researchers and Institutional Review Board members. Acceptability of post-mortem use of data for medical research was high among research participants and their relatives. Most stakeholders thought participants should be informed about post-mortem research uses during initial consent. Between lay persons and professionals, disagreement exists about whether relatives should receive actionable genetic findings, and whether the deceased's previous preferences can be overridden. We conclude that regulations and ethical guidance should leave room for post-mortem use of personal data for research, provided that informed consent procedures are transparent on this issue, including the return of individual research findings to relatives. Future research is needed to explore underlying causes for differences in views, as well as ethical and legal issues on the appropriate level of control by deceased research participants (while alive) and their relatives.
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Affiliation(s)
- Marieke A R Bak
- Section of Medical Ethics, Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - M Corrette Ploem
- Section of Health Law, Department of Social Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hakan Ateşyürek
- Faculty of Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke T Blom
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Thorogood A. International Data Sharing and Rare Disease: The Importance of Ethics and Patient Involvement. Rare Dis 2020. [DOI: 10.5772/intechopen.91237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Suver CM, Hamann JK, Chin EM, Goldstein FC, Blazel HM, Manzanares CM, Doerr MJ, Asthana SJ, Mangravite LM, Levey AI, Lah JJ, Edwards DF. Informed Consent in Two Alzheimer's Disease Research Centers: Insights From Research Coordinators. AJOB Empir Bioeth 2020; 11:114-124. [PMID: 32175821 DOI: 10.1080/23294515.2020.1737982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Informed consent (IC) is critical to performing ethical research. Unfortunately, the IC process and supporting IC forms are frequently burdensome and do not necessarily meet the informational needs of participants. The intersecting legal and ethical challenges of obtaining IC from individuals with memory or cognitive deficits further exacerbate existing IC shortcomings. For this reason, study coordinators play a critical role in facilitating the IC process in Alzheimer's disease (AD) research. To identify opportunities to improve how IC is obtained in AD research, we examined the IC process from the perspectives of study coordinators at two Alzheimer's Disease Research Centers (ADRC). Methods: We performed semi-structured interviews with 15 study coordinators from two ADRC sites detailing their experience obtaining IC. Interviews were conducted in private, recorded, transcribed, and independently coded using the constant comparative method of grounded theory. Key themes were explored as they emerged. Results: Coordinators reported overall satisfaction with the IC process. However, many reported difficulties maintaining participant attention, explaining complex procedures, and addressing medical misinformation. Although the centers use site-specific consent forms, coordinators at both centers stressed that their IC is too long and the supporting IC forms are too complicated. Coordinators indicated modifying the IC process to the perceived needs of individual participants. Adaptations reported include altering the cadence and vocabulary they employ, using supplemental materials, varying the order of IC topics, and limiting the depth of information presented. Conclusion: A qualitative analysis of interviews with study coordinators reveals opportunities to improve how we obtain IC in AD research. These insights will be used to create an electronic informed consent (eConsent) designed to boost engagement, enhance trust, and improve understanding by supporting participants' direct agency in the IC process.
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Affiliation(s)
| | | | - Erin M Chin
- University of Wisconsin-Madison Alzheimer's Disease Research Center, Madison, WI, USA
| | - Felicia C Goldstein
- Emory University Goizueta Alzheimer's Disease Research Center, Atlanta, GA, USA
| | - Hanna M Blazel
- University of Wisconsin-Madison Alzheimer's Disease Research Center, Madison, WI, USA
| | | | | | - Sanjay J Asthana
- University of Wisconsin-Madison Alzheimer's Disease Research Center, Madison, WI, USA
| | | | - Allan I Levey
- Emory University Goizueta Alzheimer's Disease Research Center, Atlanta, GA, USA
| | - James J Lah
- Emory University Goizueta Alzheimer's Disease Research Center, Atlanta, GA, USA
| | - Dorothy F Edwards
- University of Wisconsin-Madison Alzheimer's Disease Research Center, Madison, WI, USA
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