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Madden EB, Hindorff LA, Bonham VL, Akintobi TH, Burchard EG, Baker KE, Begay RL, Carpten JD, Cox NJ, Di Francesco V, Dillard DA, Fletcher FE, Fullerton SM, Garrison NA, Hammack-Aviran CM, Hiratsuka VY, Hildreth JEK, Horowitz CR, Hughes Halbert CA, Inouye M, Jackson A, Landry LG, Kittles RA, Leek JT, Limdi NA, Lockhart NC, Ofili EO, Pérez-Stable EJ, Sabatello M, Saulsberry L, Schools LE, Troyer JL, Wilfond BS, Wojcik GL, Cho JH, Lee SSJ, Green ED. Advancing genomics to improve health equity. Nat Genet 2024; 56:752-757. [PMID: 38684898 PMCID: PMC11096049 DOI: 10.1038/s41588-024-01711-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/08/2024] [Indexed: 05/02/2024]
Abstract
Health equity is the state in which everyone has fair and just opportunities to attain their highest level of health. The field of human genomics has fallen short in increasing health equity, largely because the diversity of the human population has been inadequately reflected among participants of genomics research. This lack of diversity leads to disparities that can have scientific and clinical consequences. Achieving health equity related to genomics will require greater effort in addressing inequities within the field. As part of the commitment of the National Human Genome Research Institute (NHGRI) to advancing health equity, it convened experts in genomics and health equity research to make recommendations and performed a review of current literature to identify the landscape of gaps and opportunities at the interface between human genomics and health equity research. This Perspective describes these findings and examines health equity within the context of human genomics and genomic medicine.
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Affiliation(s)
- Ebony B Madden
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA.
| | - Lucia A Hindorff
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
| | - Vence L Bonham
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
| | - Tabia Henry Akintobi
- Department of Community Health and Preventative Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Esteban G Burchard
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | | | - Rene L Begay
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John D Carpten
- Comprehensive Cancer Center, City of Hope, Duarte, CA, USA
| | - Nancy J Cox
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA
| | | | - Denise A Dillard
- Department of Medical Education and Clinical Sciences, Washington State University College of Medicine, Seattle, WA, USA
| | - Faith E Fletcher
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | | | - Nanibaa' A Garrison
- Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA, USA
- Institute for Precision Health, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Vanessa Y Hiratsuka
- Center for Human Development, University of Alaska Anchorage, Anchorage, AK, USA
| | | | | | - Chanita A Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Michael Inouye
- Department of Public Health and Primary Care, University of Cambridge Victor Phillip Dahdaleh Heart and Lung Research Institute, Cambridge, UK
| | - Amber Jackson
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
| | - Latrice G Landry
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jeff T Leek
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Nita A Limdi
- Department of Neurology, University of Alabama, Birmingham School of Medicine, Birmingham, AL, USA
| | - Nicole C Lockhart
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
| | - Elizabeth O Ofili
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Maya Sabatello
- Center for Precision Medicine and Genomics, Columbia University, New York, NY, USA
- Department of Medical Humanities and Ethics, Columbia University, New York, NY, USA
| | - Loren Saulsberry
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | | | - Jennifer L Troyer
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
| | | | - Genevieve L Wojcik
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Judy H Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sandra S-J Lee
- Department of Medical Humanities and Ethics, Columbia University, New York, NY, USA
| | - Eric D Green
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
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Benedetti DJ, Hammack-Aviran CM, Diehl C, Beskow LM. Corrigendum: Landscape of pediatric cancer treatment refusal and abandonment in the US: a qualitative study. Front Pediatr 2024; 12:1386784. [PMID: 38468872 PMCID: PMC10925743 DOI: 10.3389/fped.2024.1386784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/13/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fped.2022.1049661.].
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Affiliation(s)
- Daniel J. Benedetti
- Division of Hematology and Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Catherine M. Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Carolyn Diehl
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Laura M. Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
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Chen S, Park BC, Makhoul AT, Perdikis G, Hammack-Aviran CM, Drolet BC. Patient Perspectives on Selecting an Academic Aesthetic Surgeon: A Qualitative Analysis. Ann Plast Surg 2023; 91:674-678. [PMID: 38079315 PMCID: PMC10746295 DOI: 10.1097/sap.0000000000003699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Growth of the aesthetic surgery marketplace has increased patient choice in provider selection. This study aimed to characterize how patients choose an aesthetic surgeon, identify knowledge gaps in this decision-making process, and understand why patients select academic aesthetic surgeons. METHODS A qualitative interview study of aesthetic surgery patients from an academic center was conducted. Purposive sampling maximized representation regarding surgeon, surgery type, and patient demographics. An interview guide was developed in collaboration with content and methodology experts, then refined through pilot testing. Emergent themes were identified using a codebook constructed by grounded theory. RESULTS Thematic saturation was achieved with 24 patients. When selecting a surgeon, participants valued bedside manner (24 of 24) and past patients' satisfaction (18 of 24). Most participants (16 of 24) ascribed low importance to board certification. Reasons given for choosing an academic practice included the institution's reputation (13 of 24) and the availability of medical records and other specialties if complications arise (8 of 24). Participants demonstrated knowledge gaps regarding medical training and licensure. No participant (0 of 24) was aware that any licensed physician can offer aesthetic surgery, and nearly all participants (23 of 24) expressed discomfort with this. CONCLUSIONS Patients prioritize subjective elements when selecting an aesthetic surgeon, relying less on objective and meaningful qualifications like board certification and training background. Academic aesthetic practice is valued because of reputation and ability to function as a medical home. Given the lack of public understanding regarding physician training, initiatives promoting transparency are needed to ensure that patients can make safe, informed decisions.
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Affiliation(s)
| | | | | | - Galen Perdikis
- Department of Plastic Surgery, Vanderbilt University Medical Center
| | - Catherine M. Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center
- Department of Health Policy, Vanderbilt University School of Medicine
| | - Brian C. Drolet
- Department of Plastic Surgery, Vanderbilt University Medical Center
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center
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Harris KW, Hammack-Aviran CM, Brelsford KM, Kavanaugh-McHugh A, Clayton EW. Mapping parents' journey following prenatal diagnosis of CHD: a qualitative study. Cardiol Young 2023; 33:1387-1395. [PMID: 35942903 PMCID: PMC10152984 DOI: 10.1017/s1047951122002505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To better understand parents' accounts of their prenatal and postnatal experience after prenatal diagnosis of CHD - particularly emotional processing and coping mechanisms - to identify strategies to improve support. METHODS This single-centre, longitudinal qualitative study included pregnant mothers and their support persons seen in Fetal Cardiology Clinic at Vanderbilt Children's Hospital from May through August 2019 for probable complex CHD. Twenty-seven individuals from 17 families participated in 62 phone interviews during pregnancy and postpartum: 27 conducted after the initial prenatal cardiology consultation, 15 after a follow-up prenatal visit, and 20 after birth. Applied thematic analysis approach was used to code and analyse transcribed interviews. Coding and codebook revisions occurred iteratively; intercoder reliability was >80%. RESULTS Patients included mothers (16 [59%]), fathers (8 [30%]), and other support persons (3 [11%]). Initial fetal diagnoses included a range of moderate to severe CHD. Prenatally, parents sought to maintain hope while understanding the diagnosis; planning for the future rather than focusing on day-to-day was more common if prognoses were better. Postnatally, with confirmation of prenatal diagnoses, parents' sense of control expanded, and they desired more active engagement in clinical decision making. CONCLUSIONS To enhance effective communication and support, understanding how parents conceptualise hope in relation to diagnosis and how that may evolve over time is critical. Expectant parents whose child has a significant risk of mortality may demonstrate hope by focusing on positivity. As prognostic uncertainty diminishes postpartum, the parental role on the team may shift, requiring clinicians to provide different support.
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Affiliation(s)
- Kelly W. Harris
- Division of General Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
- Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Kathleen M. Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ann Kavanaugh-McHugh
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ellen Wright Clayton
- Division of General Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
- School of Law, Vanderbilt University, Nashville, TN, USA
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Liu Y, Chen S, Hammack-Aviran CM, Drolet BC, Perdikis G. Overlapping Surgeries From the Patient's Perspective. J Surg Res 2023; 286:85-95. [PMID: 36803878 DOI: 10.1016/j.jss.2022.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/11/2022] [Accepted: 10/16/2022] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Overlapping surgery (OS) occurs when a single surgeon is concurrently caring for patients in multiple operating rooms (OR) but is present for all critical portions of each surgery. Although this is common practice, most studies have found public disapproval of OS. This study aims to better understand attitudes toward OS of patients who gave informed consent for OS. METHODS Participant interviews covered topics including trust, OR personnel roles, and attitudes toward OS. Four representative transcripts were distributed among researchers for independent code identification. These were aggregated into a codebook, applied by two coders. Iterative and emergent thematic analyses were done. RESULTS Twelve participants were interviewed to reach thematic saturation. Three themes shaped how participants felt about OS: trust in their surgeon, worries about OS, and understanding of OR personnel roles. Factors contributing to trust included personal research and the surgeon's experience. Frequently cited concerns were unpredictability of complications during operations and the surgeon's divided attention. Two participants inaccurately understood personnel roles, believing the surgeon did most or all the hands-on work while trainees were observers. Most participants felt a high or neutral level of comfort toward OS and indicated trust as the reason. CONCLUSIONS In contrast to prior research, this study found that most participants had a neutral or positive view of OS. This suggests that a trusting relationship with their surgeon and informed consent are important factors in increasing comfort for OS. Participants who misunderstood OR roles felt less comfortable toward OS. This highlights an opportunity for patient education on trainee roles.
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Affiliation(s)
- Yangzi Liu
- Vanderbilt University School of Medicine, Nashville, Tennessee.
| | - Shirley Chen
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Brian C Drolet
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Galen Perdikis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Benedetti DJ, Hammack-Aviran CM, Diehl C, Beskow LM. Landscape of pediatric cancer treatment refusal and abandonment in the US: A qualitative study. Front Pediatr 2023; 10:1049661. [PMID: 36699305 PMCID: PMC9869139 DOI: 10.3389/fped.2022.1049661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To describe United States (US) pediatric oncologists' experiences with treatment refusal or abandonment, exploring types and frequency of decision-making conflicts, and their impact. Study design We conducted exploratory qualitative interviews of pediatric oncologists (n = 30) with experience caring for a pediatric patient who refused or abandoned curative treatment. Interviewees were recruited using convenience and nominated expert sampling, soliciting experiences from diverse geographic locations and institution sizes across the US. We analyzed transcripts using applied thematic analysis to identify and refine meaningful domains. Results Many oncologists reported multiple experiences with refusal and abandonment. Most anticipated case frequency would increase due to misinformation, particularly on the internet. Interviewees described cases of treatment refusal and abandonment, but also a wider variety of cases than previously described in existing publications, including cases involving: non-adherence; negotiations for different treatments; negotiations for complementary and alternative medicine; delayed treatment initiation; and refusal of a component of recommended therapy. Cases often involved multiple stages or types of conflicts. Recurring patient/family behaviors emerged: clear opposition to treatment from the outset; hesitancy about treatment despite initiating therapy; and psychosocial circumstances becoming an obstacle to treatment completion. Oncologists revealed substantial professional and personal repercussions of these cases. Conclusion Oncologist interviews highlight a broad range of conflicts, yielding a taxonomy of treatment refusal, non-adherence and abandonment (TRNA) that accounts for the heterogeneity of situations described. Cases' complexity and interrelatedness points to a functional model of TRNA that includes families' behaviors. This preliminary taxonomy and model warrant further research and examination to refine the model and generate strategies to prevent and mitigate TRNA.
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Affiliation(s)
- Daniel J. Benedetti
- Division of Hematology and Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Catherine M. Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Carolyn Diehl
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Laura M. Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
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Naguib MM, Day RT, Hammack-Aviran CM, Brelsford KM, Langerman A. Patient Perceptions of Resident Involvement in Surgery: A Qualitative Study Using Surgical Video. J Surg Educ 2022; 79:974-982. [PMID: 35396187 DOI: 10.1016/j.jsurg.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/01/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To improve patient-centered perioperative informed consent, this study used real surgical footage to identify key topics which might be discussed with patients regarding resident involvement in surgery. DESIGN We conducted semi-structured qualitative interviews with 27 participants. The interviews included a video showing an attending and resident performing a procedure together. Questions focused on comfort with resident involvement and preferences regarding preoperative informed consent. Participants also described residents' participation in their own words. SETTING Participants were recruited from the infusion room of the allergy clinic and the treatment room of the dialysis clinic at a tertiary care facility in Nashville, TN (Vanderbilt University Medical Center). PARTICIPANTS Adult medical patients were recruited via periodic verbal announcements by the interviewer in the waiting rooms. Purposive sampling was used to increase demographic diversity. Participants with training in the clinical health professions (i.e., physicians, nurses, and medical assistants) were excluded. RESULTS Before watching the video, roughly half of participants imagined the resident to have a passive, bystander role, while the remaining imagined a more active role. Despite these differences, most participants found the video of attending-resident teamwork to be a reassuring depiction of resident involvement. When asked the best way to describe resident participation depicted in the video to patients, participants emphasized the need to focus on attending supervision, teamwork, reassurance, as well as resident presence, specific activities, and experience. CONCLUSION Although patients have varying perceptions regarding the role of trainees in surgery, most participants were comfortable with teamwork between an attending and resident, as depicted in the video. Our participants provided multiple practical ways to transparently articulate resident involvement for testing in future research.
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Affiliation(s)
- Mark M Naguib
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - R Thomas Day
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Catherine M Hammack-Aviran
- Program on Surgical Ethics, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathleen M Brelsford
- Program on Surgical Ethics, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexander Langerman
- Program on Surgical Ethics, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee; Departments of Otolaryngology-Head and Neck Surgery and Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
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Makhoul AT, Day RT, Walker JC, Hammack-Aviran CM, Al Kassis S, Winocour JS, Drolet BC. Perioperative Experiences of Transgender Adults Seeking Gender-Affirming Surgery: A Qualitative Interview Study. Transgend Health 2022. [DOI: 10.1089/trgh.2021.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alan T. Makhoul
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - R. Thomas Day
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jasmine C. Walker
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Salam Al Kassis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Julian S. Winocour
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian C. Drolet
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Abstract
The authors surveyed hospitals across the country on their policies regarding overlapping surgery, and found large variation between hospitals in how this practice is regulated. Specifically, institutions chose to define "critical portions" in a variety of ways, ultimately affecting not only surgical efficiency but also the autonomy of surgical trainees and patient experiences at these different hospitals.
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Abstract
Biomedical research is increasingly capitalizing on an array of data to illuminate the interplay between "omics," lifestyle, and health. Leveraging this information presents opportunities to advance knowledge but also poses risks to research participants. In interviews with thought leaders, we asked which data type associated with a hypothetical precision medicine research endeavor was riskiest: 42% chose ongoing access to electronic health records, 17% chose genomic analyses of biospecimens, and 15% chose streaming data from mobile devices. Other responses included "It depends" (15%), the three types are equally risky (8%), and the combination of data types together is riskiest (3%). When asked to consider the hypothetical study overall, 60% rated the likelihood of the risks materializing as low, but 20% rated the potential consequences as severe. These results have implications for study design and informed consent, including placing appropriate emphasis on the risks and protections for the full range of data.
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Affiliation(s)
- Laura M Beskow
- Ann Geddes Stahlman Chair in Medical Ethics and a professor of health policy at the Center for Biomedical Ethics and Society at the Vanderbilt University Medical Center
| | - Catherine M Hammack-Aviran
- Associate in health policy at the Center for Biomedical Ethics and Society at the Vanderbilt University Medical Center
| | - Kathleen M Brelsford
- Research assistant professor at the Center for Biomedical Ethics and Society at the Vanderbilt University Medical Center at the time of this work
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Beskow LM, Hammack-Aviran CM, Brelsford KM. Developing model biobanking consent language: what matters to prospective participants? BMC Med Res Methodol 2020; 20:119. [PMID: 32414333 PMCID: PMC7227271 DOI: 10.1186/s12874-020-01001-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/30/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Efforts to improve informed consent have led to calls for providing information a reasonable person would want to have, in a way that facilitates understanding of the reasons why one might or might not want to participate. At the same time, advances in large-scale genomic research have expanded both the opportunities and the risks for participants, families, and communities. To advance the use of effective consent materials that reflect this landscape, we used empirical data to develop model consent language, as well as brief questions to assist people in thinking about their own values relative to participation. METHODS We conducted in-person interviews to gather preliminary input on these materials from a diverse sample (n = 32) of the general population in Nashville, Tennessee. We asked them to highlight information they found especially reassuring or concerning, their hypothetical willingness to participate, and their opinions about the values questions. RESULTS Consent information most often highlighted as reassuring included the purpose of the biobank, the existence and composition of a multidisciplinary oversight committee, the importance of participants' privacy and efforts to protect it, and controlled access to a scientific database. Information most often highlighted as concerning included the deposition of data in a publicly accessible database, the risk of unintended access to data, the potential for non-research use of data, and use of medical record information in general. Seventy-five percent of participants indicated initial willingness to participate in the hypothetical biobank; this decreased to 66% as participants more closely considered the information over the course of the interview. A large majority rated the values questions as helpful. CONCLUSIONS These results are consistent with other research on public perspectives on biobanking and genomic cohort studies, suggesting that our model language effectively captures commonly expressed reasons for and against participation. Our study enriches this literature by connecting specific consent form disclosures with qualitative data regarding what participants found especially reassuring or concerning and why. Interventions that facilitate individuals' closer engagement with consent information may result in participation decisions more closely aligned with their values.
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Affiliation(s)
- Laura M Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 400, Nashville, TN, 37203, USA.
| | - Catherine M Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 400, Nashville, TN, 37203, USA
| | - Kathleen M Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 400, Nashville, TN, 37203, USA
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Hammack-Aviran CM, Brelsford KM, McKenna KC, Graham RD, Lampron ZM, Beskow LM. Research Use of Electronic Health Records: Patients' Views on Alternative Approaches to Permission. AJOB Empir Bioeth 2020; 11:172-186. [PMID: 32338567 DOI: 10.1080/23294515.2020.1755383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: The increased use of electronic health records (EHRs) has resulted in new opportunities for research, but also raises concerns regarding privacy, confidentiality, and patient awareness. Because public trust is essential to the success of the research enterprise, patient perspectives are essential to the development and implementation of ethical approaches to the research use of EHRs. Yet, little is known about patients' views and expectations regarding various approaches to seeking permission for research use of their EHR data. Methods: We conducted semi-structured interviews with 120 patients in four counties in diverse regions of the southeastern United States: Appalachia, the Mississippi Delta, and the Piedmont area of North Carolina. We asked participants to consider, from multiple stakeholder perspectives, the advantages and disadvantages of three approaches to notifying patients of, or obtaining permission for, research use of their EHR data; whether they believed it would be acceptable if their healthcare organization used each approach; and which approach would be most appropriate. Results: Nearly all participants said General Notification, Broad Permission, and Categorical Permission would each be acceptable approaches to notification of, or permission for, EHR research. Over half identified Broad Permission as the most appropriate approach. Across all of these discussions, major themes included the importance of clarity, simplicity, and usability of patient-facing materials, as well as the level of transparency, trustworthiness, and respect for patients the approach conveys. Conclusions: Our findings help to inform the development and implementation of ethical approaches to the research use of EHRs by identifying key patient considerations regarding various approaches to permission and suggesting potential actions for healthcare organizations and researchers.
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Affiliation(s)
- Catherine M Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathleen M Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin C McKenna
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ross D Graham
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zachary M Lampron
- Department of Pragmatic Health Systems Research, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Laura M Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Beskow LM, Hammack-Aviran CM, Brelsford KM, O’Rourke PP. Expert Perspectives on Oversight for Unregulated mHealth Research: Empirical Data and Commentary. J Law Med Ethics 2020; 48:138-146. [PMID: 32342753 PMCID: PMC7783510 DOI: 10.1177/1073110520917039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In qualitative interviews with a diverse group of experts, the vast majority believed unregulated researchers should seek out independent oversight. Reasons included the need for objectivity, protecting app users from research risks, and consistency in standards for the ethical conduct of research. Concerns included burdening minimal risk research and limitations in current systems of oversight. Literature and analysis supports the use of IRBs even when not required by regulations, and the need for evidence-based improvements in IRB processes.
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Affiliation(s)
- Laura M. Beskow
- Center for Biomedical Ethics and Society at Vanderbilt University Medical Center (Nashville, TN)
| | | | - Kathleen M. Brelsford
- Center for Biomedical Ethics and Society at Vanderbilt University Medical Center (Nashville, TN)
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Rothstein MA, Wilbanks JT, Beskow LM, Brelsford KM, Brothers KB, Doerr M, Evans BJ, Hammack-Aviran CM, McGowan ML, Tovino SA. Unregulated Health Research Using Mobile Devices: Ethical Considerations and Policy Recommendations. J Law Med Ethics 2020; 48:196-226. [PMID: 32342752 DOI: 10.1177/1073110520917047] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Mobile devices with health apps, direct-to-consumer genetic testing, crowd-sourced information, and other data sources have enabled research by new classes of researchers. Independent researchers, citizen scientists, patient-directed researchers, self-experimenters, and others are not covered by federal research regulations because they are not recipients of federal financial assistance or conducting research in anticipation of a submission to the FDA for approval of a new drug or medical device. This article addresses the difficult policy challenge of promoting the welfare and interests of research participants, as well as the public, in the absence of regulatory requirements and without discouraging independent, innovative scientific inquiry. The article recommends a series of measures, including education, consultation, transparency, self-governance, and regulation to strike the appropriate balance.
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Affiliation(s)
- Mark A Rothstein
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine. John T. Wilbanks is Chief Commons Officer of Sage Bionetworks. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Megan Doerr, M.S., L.G.C., is Principal Scientist, Governance at Sage Bionetworks. Barbara J. Evans, J.D., Ph.D., is Mary Ann and Lawrence E. Faust Professor of Law, Professor of Electrical and Computer Engineering, and Director of the Center for Biotechnology and Law, University of Houston. Catherine M. Hammack-Aviran, M.A., J.D., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Michelle L. McGowan, Ph.D., is Associate Professor, Department of Pediatrics and Department of Women's, Gender, and Sexuality Studies, Cincinnati Children's Hospital Medical Center. Stacey A. Tovino, J.D., Ph.D., is Judge Jack and Lulu Lehman Professor of Law at the William S. Boyd School of Law, University of Nevada-Las Vegas
| | - John T Wilbanks
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine. John T. Wilbanks is Chief Commons Officer of Sage Bionetworks. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Megan Doerr, M.S., L.G.C., is Principal Scientist, Governance at Sage Bionetworks. Barbara J. Evans, J.D., Ph.D., is Mary Ann and Lawrence E. Faust Professor of Law, Professor of Electrical and Computer Engineering, and Director of the Center for Biotechnology and Law, University of Houston. Catherine M. Hammack-Aviran, M.A., J.D., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Michelle L. McGowan, Ph.D., is Associate Professor, Department of Pediatrics and Department of Women's, Gender, and Sexuality Studies, Cincinnati Children's Hospital Medical Center. Stacey A. Tovino, J.D., Ph.D., is Judge Jack and Lulu Lehman Professor of Law at the William S. Boyd School of Law, University of Nevada-Las Vegas
| | - Laura M Beskow
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine. John T. Wilbanks is Chief Commons Officer of Sage Bionetworks. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Megan Doerr, M.S., L.G.C., is Principal Scientist, Governance at Sage Bionetworks. Barbara J. Evans, J.D., Ph.D., is Mary Ann and Lawrence E. Faust Professor of Law, Professor of Electrical and Computer Engineering, and Director of the Center for Biotechnology and Law, University of Houston. Catherine M. Hammack-Aviran, M.A., J.D., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Michelle L. McGowan, Ph.D., is Associate Professor, Department of Pediatrics and Department of Women's, Gender, and Sexuality Studies, Cincinnati Children's Hospital Medical Center. Stacey A. Tovino, J.D., Ph.D., is Judge Jack and Lulu Lehman Professor of Law at the William S. Boyd School of Law, University of Nevada-Las Vegas
| | - Kathleen M Brelsford
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine. John T. Wilbanks is Chief Commons Officer of Sage Bionetworks. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Megan Doerr, M.S., L.G.C., is Principal Scientist, Governance at Sage Bionetworks. Barbara J. Evans, J.D., Ph.D., is Mary Ann and Lawrence E. Faust Professor of Law, Professor of Electrical and Computer Engineering, and Director of the Center for Biotechnology and Law, University of Houston. Catherine M. Hammack-Aviran, M.A., J.D., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Michelle L. McGowan, Ph.D., is Associate Professor, Department of Pediatrics and Department of Women's, Gender, and Sexuality Studies, Cincinnati Children's Hospital Medical Center. Stacey A. Tovino, J.D., Ph.D., is Judge Jack and Lulu Lehman Professor of Law at the William S. Boyd School of Law, University of Nevada-Las Vegas
| | - Kyle B Brothers
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine. John T. Wilbanks is Chief Commons Officer of Sage Bionetworks. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Megan Doerr, M.S., L.G.C., is Principal Scientist, Governance at Sage Bionetworks. Barbara J. Evans, J.D., Ph.D., is Mary Ann and Lawrence E. Faust Professor of Law, Professor of Electrical and Computer Engineering, and Director of the Center for Biotechnology and Law, University of Houston. Catherine M. Hammack-Aviran, M.A., J.D., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Michelle L. McGowan, Ph.D., is Associate Professor, Department of Pediatrics and Department of Women's, Gender, and Sexuality Studies, Cincinnati Children's Hospital Medical Center. Stacey A. Tovino, J.D., Ph.D., is Judge Jack and Lulu Lehman Professor of Law at the William S. Boyd School of Law, University of Nevada-Las Vegas
| | - Megan Doerr
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine. John T. Wilbanks is Chief Commons Officer of Sage Bionetworks. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Megan Doerr, M.S., L.G.C., is Principal Scientist, Governance at Sage Bionetworks. Barbara J. Evans, J.D., Ph.D., is Mary Ann and Lawrence E. Faust Professor of Law, Professor of Electrical and Computer Engineering, and Director of the Center for Biotechnology and Law, University of Houston. Catherine M. Hammack-Aviran, M.A., J.D., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Michelle L. McGowan, Ph.D., is Associate Professor, Department of Pediatrics and Department of Women's, Gender, and Sexuality Studies, Cincinnati Children's Hospital Medical Center. Stacey A. Tovino, J.D., Ph.D., is Judge Jack and Lulu Lehman Professor of Law at the William S. Boyd School of Law, University of Nevada-Las Vegas
| | - Barbara J Evans
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine. John T. Wilbanks is Chief Commons Officer of Sage Bionetworks. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Megan Doerr, M.S., L.G.C., is Principal Scientist, Governance at Sage Bionetworks. Barbara J. Evans, J.D., Ph.D., is Mary Ann and Lawrence E. Faust Professor of Law, Professor of Electrical and Computer Engineering, and Director of the Center for Biotechnology and Law, University of Houston. Catherine M. Hammack-Aviran, M.A., J.D., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Michelle L. McGowan, Ph.D., is Associate Professor, Department of Pediatrics and Department of Women's, Gender, and Sexuality Studies, Cincinnati Children's Hospital Medical Center. Stacey A. Tovino, J.D., Ph.D., is Judge Jack and Lulu Lehman Professor of Law at the William S. Boyd School of Law, University of Nevada-Las Vegas
| | - Catherine M Hammack-Aviran
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine. John T. Wilbanks is Chief Commons Officer of Sage Bionetworks. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Megan Doerr, M.S., L.G.C., is Principal Scientist, Governance at Sage Bionetworks. Barbara J. Evans, J.D., Ph.D., is Mary Ann and Lawrence E. Faust Professor of Law, Professor of Electrical and Computer Engineering, and Director of the Center for Biotechnology and Law, University of Houston. Catherine M. Hammack-Aviran, M.A., J.D., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Michelle L. McGowan, Ph.D., is Associate Professor, Department of Pediatrics and Department of Women's, Gender, and Sexuality Studies, Cincinnati Children's Hospital Medical Center. Stacey A. Tovino, J.D., Ph.D., is Judge Jack and Lulu Lehman Professor of Law at the William S. Boyd School of Law, University of Nevada-Las Vegas
| | - Michelle L McGowan
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine. John T. Wilbanks is Chief Commons Officer of Sage Bionetworks. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Megan Doerr, M.S., L.G.C., is Principal Scientist, Governance at Sage Bionetworks. Barbara J. Evans, J.D., Ph.D., is Mary Ann and Lawrence E. Faust Professor of Law, Professor of Electrical and Computer Engineering, and Director of the Center for Biotechnology and Law, University of Houston. Catherine M. Hammack-Aviran, M.A., J.D., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Michelle L. McGowan, Ph.D., is Associate Professor, Department of Pediatrics and Department of Women's, Gender, and Sexuality Studies, Cincinnati Children's Hospital Medical Center. Stacey A. Tovino, J.D., Ph.D., is Judge Jack and Lulu Lehman Professor of Law at the William S. Boyd School of Law, University of Nevada-Las Vegas
| | - Stacey A Tovino
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine. John T. Wilbanks is Chief Commons Officer of Sage Bionetworks. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Megan Doerr, M.S., L.G.C., is Principal Scientist, Governance at Sage Bionetworks. Barbara J. Evans, J.D., Ph.D., is Mary Ann and Lawrence E. Faust Professor of Law, Professor of Electrical and Computer Engineering, and Director of the Center for Biotechnology and Law, University of Houston. Catherine M. Hammack-Aviran, M.A., J.D., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Michelle L. McGowan, Ph.D., is Associate Professor, Department of Pediatrics and Department of Women's, Gender, and Sexuality Studies, Cincinnati Children's Hospital Medical Center. Stacey A. Tovino, J.D., Ph.D., is Judge Jack and Lulu Lehman Professor of Law at the William S. Boyd School of Law, University of Nevada-Las Vegas
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Hammack-Aviran CM, Brelsford KM, Beskow LM. Ethical Considerations in the Conduct of Unregulated mHealth Research: Expert Perspectives. J Law Med Ethics 2020; 48:9-36. [PMID: 32342756 PMCID: PMC7789882 DOI: 10.1177/1073110520917027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
To assist in resolving ethical questions surrounding unregulated mHealth research, we conducted in-depth qualitative interviews with experts from four key stakeholder groups: patient/research advocates, researchers, regulatory professionals, and mobile app/device developers. They discussed challenges and potential solutions in the context of two hypothetical scenarios involving unregulated mHealth research, including notifications/permissions for research use of mHealth data, data access procedures, new primary data collection, offering individual research results, and data sharing and dissemination.
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Affiliation(s)
| | - Kathleen M. Brelsford
- Center for Biomedical Ethics & Society at Vanderbilt University Medical Center (Nashville, TN)
| | - Laura M. Beskow
- Center for Biomedical Ethics & Society at Vanderbilt University Medical Center (Nashville, TN)
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Rothstein MA, Zawati MH, Beskow LM, Brelsford KM, Brothers KB, Hammack-Aviran CM, Hazel JW, Joly Y, Lang M, Patrinos D, Saltzman A, Knoppers BM. Legal and Ethical Challenges of International Direct-to-Participant Genomic Research: Conclusions and Recommendations. J Law Med Ethics 2019; 47:705-731. [PMID: 31957580 DOI: 10.1177/1073110519898297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Mark A Rothstein
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine. Ma'n H. Zawati, Ph.D. (D.C.L.), is Executive Director of the Centre of Genomics and Policy and Assistant Professor, Department of Human Genetics, McGill University Faculty of Medicine. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Catherine M. Hammack-Aviran, J.D., M.A., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. James W. Hazel, J.D., Ph.D., is a Post-Doctoral Fellow at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Yann Joly, Ph.D. (D.C.L.), is Research Director of the Centre of Genomics and Policy and Associate Professor, Department of Human Genetics, McGill University Faculty of Medicine. Michael Lang, B.C.L., LL.B., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Dimitri Patrinos, B.Sc., LL.B., J.D., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Andrea Saltzman, B.S.N., M.A., is Director, Office of Research Subject Protection, Broad Institute of Massachusetts Institute of Technology and Harvard University. Bartha Maria Knoppers, Ph.D. (Comparative Medical Law), is Canada Research Chair in Law and Medicine, Professor and Director of the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine
| | - Ma'n H Zawati
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine. Ma'n H. Zawati, Ph.D. (D.C.L.), is Executive Director of the Centre of Genomics and Policy and Assistant Professor, Department of Human Genetics, McGill University Faculty of Medicine. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Catherine M. Hammack-Aviran, J.D., M.A., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. James W. Hazel, J.D., Ph.D., is a Post-Doctoral Fellow at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Yann Joly, Ph.D. (D.C.L.), is Research Director of the Centre of Genomics and Policy and Associate Professor, Department of Human Genetics, McGill University Faculty of Medicine. Michael Lang, B.C.L., LL.B., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Dimitri Patrinos, B.Sc., LL.B., J.D., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Andrea Saltzman, B.S.N., M.A., is Director, Office of Research Subject Protection, Broad Institute of Massachusetts Institute of Technology and Harvard University. Bartha Maria Knoppers, Ph.D. (Comparative Medical Law), is Canada Research Chair in Law and Medicine, Professor and Director of the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine
| | - Laura M Beskow
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine. Ma'n H. Zawati, Ph.D. (D.C.L.), is Executive Director of the Centre of Genomics and Policy and Assistant Professor, Department of Human Genetics, McGill University Faculty of Medicine. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Catherine M. Hammack-Aviran, J.D., M.A., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. James W. Hazel, J.D., Ph.D., is a Post-Doctoral Fellow at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Yann Joly, Ph.D. (D.C.L.), is Research Director of the Centre of Genomics and Policy and Associate Professor, Department of Human Genetics, McGill University Faculty of Medicine. Michael Lang, B.C.L., LL.B., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Dimitri Patrinos, B.Sc., LL.B., J.D., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Andrea Saltzman, B.S.N., M.A., is Director, Office of Research Subject Protection, Broad Institute of Massachusetts Institute of Technology and Harvard University. Bartha Maria Knoppers, Ph.D. (Comparative Medical Law), is Canada Research Chair in Law and Medicine, Professor and Director of the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine
| | - Kathleen M Brelsford
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine. Ma'n H. Zawati, Ph.D. (D.C.L.), is Executive Director of the Centre of Genomics and Policy and Assistant Professor, Department of Human Genetics, McGill University Faculty of Medicine. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Catherine M. Hammack-Aviran, J.D., M.A., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. James W. Hazel, J.D., Ph.D., is a Post-Doctoral Fellow at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Yann Joly, Ph.D. (D.C.L.), is Research Director of the Centre of Genomics and Policy and Associate Professor, Department of Human Genetics, McGill University Faculty of Medicine. Michael Lang, B.C.L., LL.B., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Dimitri Patrinos, B.Sc., LL.B., J.D., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Andrea Saltzman, B.S.N., M.A., is Director, Office of Research Subject Protection, Broad Institute of Massachusetts Institute of Technology and Harvard University. Bartha Maria Knoppers, Ph.D. (Comparative Medical Law), is Canada Research Chair in Law and Medicine, Professor and Director of the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine
| | - Kyle B Brothers
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine. Ma'n H. Zawati, Ph.D. (D.C.L.), is Executive Director of the Centre of Genomics and Policy and Assistant Professor, Department of Human Genetics, McGill University Faculty of Medicine. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Catherine M. Hammack-Aviran, J.D., M.A., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. James W. Hazel, J.D., Ph.D., is a Post-Doctoral Fellow at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Yann Joly, Ph.D. (D.C.L.), is Research Director of the Centre of Genomics and Policy and Associate Professor, Department of Human Genetics, McGill University Faculty of Medicine. Michael Lang, B.C.L., LL.B., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Dimitri Patrinos, B.Sc., LL.B., J.D., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Andrea Saltzman, B.S.N., M.A., is Director, Office of Research Subject Protection, Broad Institute of Massachusetts Institute of Technology and Harvard University. Bartha Maria Knoppers, Ph.D. (Comparative Medical Law), is Canada Research Chair in Law and Medicine, Professor and Director of the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine
| | - Catherine M Hammack-Aviran
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine. Ma'n H. Zawati, Ph.D. (D.C.L.), is Executive Director of the Centre of Genomics and Policy and Assistant Professor, Department of Human Genetics, McGill University Faculty of Medicine. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Catherine M. Hammack-Aviran, J.D., M.A., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. James W. Hazel, J.D., Ph.D., is a Post-Doctoral Fellow at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Yann Joly, Ph.D. (D.C.L.), is Research Director of the Centre of Genomics and Policy and Associate Professor, Department of Human Genetics, McGill University Faculty of Medicine. Michael Lang, B.C.L., LL.B., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Dimitri Patrinos, B.Sc., LL.B., J.D., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Andrea Saltzman, B.S.N., M.A., is Director, Office of Research Subject Protection, Broad Institute of Massachusetts Institute of Technology and Harvard University. Bartha Maria Knoppers, Ph.D. (Comparative Medical Law), is Canada Research Chair in Law and Medicine, Professor and Director of the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine
| | - James W Hazel
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine. Ma'n H. Zawati, Ph.D. (D.C.L.), is Executive Director of the Centre of Genomics and Policy and Assistant Professor, Department of Human Genetics, McGill University Faculty of Medicine. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Catherine M. Hammack-Aviran, J.D., M.A., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. James W. Hazel, J.D., Ph.D., is a Post-Doctoral Fellow at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Yann Joly, Ph.D. (D.C.L.), is Research Director of the Centre of Genomics and Policy and Associate Professor, Department of Human Genetics, McGill University Faculty of Medicine. Michael Lang, B.C.L., LL.B., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Dimitri Patrinos, B.Sc., LL.B., J.D., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Andrea Saltzman, B.S.N., M.A., is Director, Office of Research Subject Protection, Broad Institute of Massachusetts Institute of Technology and Harvard University. Bartha Maria Knoppers, Ph.D. (Comparative Medical Law), is Canada Research Chair in Law and Medicine, Professor and Director of the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine
| | - Yann Joly
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine. Ma'n H. Zawati, Ph.D. (D.C.L.), is Executive Director of the Centre of Genomics and Policy and Assistant Professor, Department of Human Genetics, McGill University Faculty of Medicine. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Catherine M. Hammack-Aviran, J.D., M.A., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. James W. Hazel, J.D., Ph.D., is a Post-Doctoral Fellow at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Yann Joly, Ph.D. (D.C.L.), is Research Director of the Centre of Genomics and Policy and Associate Professor, Department of Human Genetics, McGill University Faculty of Medicine. Michael Lang, B.C.L., LL.B., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Dimitri Patrinos, B.Sc., LL.B., J.D., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Andrea Saltzman, B.S.N., M.A., is Director, Office of Research Subject Protection, Broad Institute of Massachusetts Institute of Technology and Harvard University. Bartha Maria Knoppers, Ph.D. (Comparative Medical Law), is Canada Research Chair in Law and Medicine, Professor and Director of the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine
| | - Michael Lang
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine. Ma'n H. Zawati, Ph.D. (D.C.L.), is Executive Director of the Centre of Genomics and Policy and Assistant Professor, Department of Human Genetics, McGill University Faculty of Medicine. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Catherine M. Hammack-Aviran, J.D., M.A., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. James W. Hazel, J.D., Ph.D., is a Post-Doctoral Fellow at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Yann Joly, Ph.D. (D.C.L.), is Research Director of the Centre of Genomics and Policy and Associate Professor, Department of Human Genetics, McGill University Faculty of Medicine. Michael Lang, B.C.L., LL.B., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Dimitri Patrinos, B.Sc., LL.B., J.D., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Andrea Saltzman, B.S.N., M.A., is Director, Office of Research Subject Protection, Broad Institute of Massachusetts Institute of Technology and Harvard University. Bartha Maria Knoppers, Ph.D. (Comparative Medical Law), is Canada Research Chair in Law and Medicine, Professor and Director of the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine
| | - Dimitri Patrinos
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine. Ma'n H. Zawati, Ph.D. (D.C.L.), is Executive Director of the Centre of Genomics and Policy and Assistant Professor, Department of Human Genetics, McGill University Faculty of Medicine. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Catherine M. Hammack-Aviran, J.D., M.A., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. James W. Hazel, J.D., Ph.D., is a Post-Doctoral Fellow at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Yann Joly, Ph.D. (D.C.L.), is Research Director of the Centre of Genomics and Policy and Associate Professor, Department of Human Genetics, McGill University Faculty of Medicine. Michael Lang, B.C.L., LL.B., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Dimitri Patrinos, B.Sc., LL.B., J.D., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Andrea Saltzman, B.S.N., M.A., is Director, Office of Research Subject Protection, Broad Institute of Massachusetts Institute of Technology and Harvard University. Bartha Maria Knoppers, Ph.D. (Comparative Medical Law), is Canada Research Chair in Law and Medicine, Professor and Director of the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine
| | - Andrea Saltzman
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine. Ma'n H. Zawati, Ph.D. (D.C.L.), is Executive Director of the Centre of Genomics and Policy and Assistant Professor, Department of Human Genetics, McGill University Faculty of Medicine. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Catherine M. Hammack-Aviran, J.D., M.A., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. James W. Hazel, J.D., Ph.D., is a Post-Doctoral Fellow at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Yann Joly, Ph.D. (D.C.L.), is Research Director of the Centre of Genomics and Policy and Associate Professor, Department of Human Genetics, McGill University Faculty of Medicine. Michael Lang, B.C.L., LL.B., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Dimitri Patrinos, B.Sc., LL.B., J.D., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Andrea Saltzman, B.S.N., M.A., is Director, Office of Research Subject Protection, Broad Institute of Massachusetts Institute of Technology and Harvard University. Bartha Maria Knoppers, Ph.D. (Comparative Medical Law), is Canada Research Chair in Law and Medicine, Professor and Director of the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine
| | - Bartha Maria Knoppers
- Mark A. Rothstein, J.D., is Herbert F. Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine. Ma'n H. Zawati, Ph.D. (D.C.L.), is Executive Director of the Centre of Genomics and Policy and Assistant Professor, Department of Human Genetics, McGill University Faculty of Medicine. Laura M. Beskow, M.P.H., Ph.D., is Professor and Ann Geddes Stahlman Chair in Medical Ethics at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kathleen M. Brelsford, Ph.D., M.P.H., is Research Assistant Professor at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Kyle B. Brothers, M.D., Ph.D., is Endowed Chair of Pediatric Clinical and Translational Research, University of Louisville School of Medicine. Catherine M. Hammack-Aviran, J.D., M.A., is Associate in Health Policy at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. James W. Hazel, J.D., Ph.D., is a Post-Doctoral Fellow at the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center. Yann Joly, Ph.D. (D.C.L.), is Research Director of the Centre of Genomics and Policy and Associate Professor, Department of Human Genetics, McGill University Faculty of Medicine. Michael Lang, B.C.L., LL.B., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Dimitri Patrinos, B.Sc., LL.B., J.D., is a Research Assistant at the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine. Andrea Saltzman, B.S.N., M.A., is Director, Office of Research Subject Protection, Broad Institute of Massachusetts Institute of Technology and Harvard University. Bartha Maria Knoppers, Ph.D. (Comparative Medical Law), is Canada Research Chair in Law and Medicine, Professor and Director of the Centre of Genomics and Policy, Department of Human Genetics, McGill University Faculty of Medicine
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