Research ethics and Indigenous Peoples: Repercussions of returning Yanomami blood samples

This work presents the case of the Yanomami indigenous people from Brazil that were the object of US ethnography initiated in the 1960s. The research brought harmful repercussions to the life of the Indigenous people of Brazil for several decades, and it took more than 40 years until the beginning of a process of reparation involving the Brazilian government and American universities. Objective: to discuss the meaning of the return of Yanomami blood samples, as well as contributions from the epistemologies of traditional Indigenous knowledge to the debate about research ethics and the structuring of means for the social control of researchers and the protection of participants in scientific studies, having as an example the Yanomami indigenous people from Brazil, subjected to noxious ethnography in the 1960s and the 1970s. This work used data reports recorded in secondary sources. In this article we argue that Bioethics needs to further diversify its epistemological foundations and to consider epistemologies and cosmologies beyond the frontiers of Western science, as the case of the abusive research involving the Yanomami indigenous people in Brazil reveals. We argue that traditional knowledge, such as those of indigenous and quilombolas, with their epistemologies and cosmologies, are fundamental for the election of less colonized and more efficient principles of research ethics, regarding the protection of the participants' rights in scientific studies. Traditional indigenous populations can teach us a great deal about doing research.

Not the usual suspects: addressing layers of vulnerability

This paper challenges the traditional account of vulnerability in healthcare which conceptualizes vulnerability as a list of identifiable subpopulations. This list of 'usual suspects', focusing on groups from lower resource settings, is a narrow account of vulnerability. In this article we argue that in certain circumstances middle-class individuals can be also rendered vulnerable. We propose a relational and layered account of vulnerability and explore this concept using the case study of cord blood (CB) banking. In the first section, two different approaches to 'vulnerability' are contrasted: categorical versus layered. In the second section, we describe CB banking and present a case study of CB banking in Argentina. We examine the types of pressure that middle-class pregnant women feel when considering CB collection and storage. In section three, we use the CB banking case study to critique the categorical approach to vulnerability: this model is unable to account for the ways in which these women are vulnerable. A layered account of vulnerability identifies several ways in which middle-class women are vulnerable. Finally, by utilizing the layered approach, this paper suggests how public health policies could be designed to overcome vulnerabilities.

Governing biological material at the intersection of care and research: the use of dried blood spots for biobanking

A series of governance issues currently surrounds the multiple uses and multiple users of dried blood spots (DBS) for research purposes. Internationally there is a discussion on storing DBS resulting from newborn screening for public health and using them as the basis for large biobank-like collections to facilitate biomedical research. If such a transformation were to be formalized, then DBS would sit at the intersection of care (ie, public health) and research, with the mechanisms through which such a collection could be managed not totally self-evident. What is more, a DBS collection raises questions about the fuzzy boundaries between privacy and anonymity; how to control or define quality control uses of DBS; medical vs nonmedical uses; as well as benefit sharing and stakeholder involvement. Our goal here is to explore some of the key questions relating to DBS governance by way of the bio-objects and bio-objectification concepts. By embracing - rather than resisting to - the blurring of boundaries and problems in categorization that have come to characterize bio-objects and bio-objectification processes recently described in this journal, we attempt to highlight some issues that might not be currently considered, and to point to some possible directions to go (or avoid). Building from our knowledge of the current DBS situation in the Netherlands, we outline questions concerning the uses, management, collection, and storage of DBS.

Sugaring the pill: ethics and uncertainties in the use of sucrose for newborn infants

Sucrose is widely used for the management of procedural pain in newborn infants, including capillary blood sampling, venepuncture, and vascular cannulation. Multiple randomized controlled trials have demonstrated that sweet-tasting solutions reduce behavioral responses to acute painful stimuli. It has been claimed that sucrose should be a standard of care in neonatal units and that further placebo-controlled trials of sucrose are unnecessary and unethical. However, recently published data cast doubt on the analgesic properties of sucrose. We review this new evidence and analyze the philosophical and ethical questions that it raises, including the "problem of other minds." Sugar may be better understood not as an analgesic, removing or relieving pain, but as a compensating pleasure. There is a need for further research on the mechanism of sucrose's effect on pain behavior and on the long-term effects of sucrose treatment. Such trials will require comparison with placebo or with other interventions. Given uncertainty about the benefit of sucrose, it may be wise to use alternative analgesics or nonpharmacological interventions where these are available and appropriate. Sucrose may not be the answer to procedural pain in newborns.

Assessing public attitudes on the retention and use of residual newborn screening blood samples: a focus group study

This paper discusses attitudes and opinions of a diverse group of participants toward the retention and use of residual newborn blood samples for research. Data were drawn from focus groups based in six states in the USA, and results provide support for the retention and use of residual newborn blood samples for research when parental permission is asked beforehand. However, there were a number of concerns that also warrant attention for the development of policy and maintaining trust with the public, such as timing of permission, use of samples already stored, level of personal control of sample use and education. The results demonstrate the complexity of the topic and the ethical ambiguities associated with the retention and use of residual newborn blood samples.

Policy issues and stakeholder concerns regarding the storage and use of residual newborn dried blood samples for research

Newborn screening is an important public health programs in the United States. Over 4 million infants are screened each year for a number of conditions. There is a growing need for more explicit state policies governing the storage and research use of residual newborn samples. This paper provides an overview of newborn screening and issues related to policies of residual newborn samples as well as attitudes and opinions from stakeholders. Three groups (n = 21) were conducted with stakeholders: an African American group, a Pediatrician group and a Mothers of young children group. Despite the differences between these groups, consistent themes emerged from all groups that may be relevant for policy development governing the storage and use of residual newborn samples. The data from this exploratory study suggest that future policy developments with the newborn screening program warrant further public input on these topics.

Collection of fetal blood for stem cell research and therapy

Stem cell research has generated novel therapeutic opportunities at the expense of new ethical and legal problems. Its promoters recommended early clamping of the umbilical cord to maximize the amount of acquired fetal blood. Fear has been expressed, therefore, that the donor could be compromised by this approach. Actually, the problem is more complex than generally assumed. In certain clinical situations the neonate may benefit from or become harmed by additional blood volume. Gravity influences the direction of umbilical blood flow and, thus the consequences of early or delayed cord clamping. Therefore, vaginal birth promotes blood flow from the placenta to the fetus, whereas delivery by cesarean section usually has the opposite effect. Largely ignored in the course of the relevant debates, the above facts require consideration. The controversy may be beneficial in the long run by drawing attention to this relatively neglected aspect of perinatal medicine.

Potential clinical impact of taking multiple blood samples for research studies in paediatric oncology: how much do we really know?

Pharmacological studies of anti-cancer agents in children are essential to determine their clinical safety and efficacy, both of which can differ considerably from that observed in adults. However, the potential clinical impact of taking blood samples, in addition to those required for standard clinical practice is commonly a concern for both medical and allied staff and parents. Frequently quoted 'safe limits' of 3%-5% of total blood volume taken on any one study day are not based on published data and may not be acceptable for all patients. This article reviews some of the reasons why clinical pharmacology data for anti-cancer drugs is often lacking in a paediatric patient population, summarises data from a retrospective study investigating the potential impact of repeated blood sampling for research purposes and discusses how this issue may be more systematically addressed in future studies. Research involving children with cancer should be limited to those studies addressing key scientific questions and should be designed to limit both the number and volume of blood samples required.

Ethical and practical problems in blood sampling for research purposes during pre-hospital emergencies

BACKGROUND

Research in the pre-hospital phase of emergencies involves certain ethical and practical challenges. Severely ill or injured patients are not able to give informed consent in the immediate stressful situation. The aim of this pilot study was to find an ethically acceptable method to carry out research in acutely ill or injured patients before any treatment was given in order to be able to study the acute and unmodified systemic inflammatory response to trauma.

METHODS

Younger physicians were assigned to the mobile emergency care unit (MECU) on a volunteer basis. They drew blood samples 'at the scene' from patients exposed to accidental injury or from patients with acute medical emergencies. The ethical committee accepted that informed consent to blood analyses could be postponed until later or given by relatives. Pro- and anti-inflammatory cytokines, catecholamines and cortisol were measured.

RESULTS

During 6 months, the study group accompanied the MECU on approximately 500 call-outs. Blood samples were drawn from 42 patients. Consent to the analysis of blood samples was obtained in 30 cases. In 20 cases, it was not possible to draw the blood sample before medication.

CONCLUSION

This pilot study showed that it was possible to conduct blood sampling from acutely ill patients 'at the scene'. However, the present legislation on informed consent makes this type of research very time consuming. When patients die in hospital and no relatives can be found, consent cannot be obtained, and information from these severely affected patients is lost.

The Harvard case of Xu Xiping: exploitation of the people, scientific advance, or genetic theft?

A unique history and make-up of a population may make it an attractive research target for population geneticists and pharmaco-genomic investors. The promise of pharmaceutical profits and advances in medical knowledge attracted Harvard researchers and the company Millennium Pharmaceuticals to remote areas in Anhui Province, Central China, leading to international diplomatic disagreements about issues such as the ownership of genetic material and informed consent (IC). This article discusses the role of genomics and genetic sampling in China, the way it is related to population policies (the new eugenics), the national importance of genetic materials and the conflicts it led to between the Chinese government and Harvard University. Here many consider the Xu Xiping case as textbook example of ruthless Western exploitation of development countries, illustrating the cold rationality of science in the process of globalisation. Ten perspectives on this case show that this view is simplistic and contributes little to an understanding of bioethical issues important to the population actually donating the samples. Viewing the Xu Xiping case as the nexus of the intertwinement of international, transnational, national, and local interest groups shows how different interest groups make use of different units of analysis. It also clarifies why the same practice of genetic sampling continues under a different regime, and why the discussion about genetic sampling has shifted from a concern with health care of the poor to an issue of international exploitation, terrorism and development.

The humane collection of fetal bovine serum and possibilities for serum-free cell and tissue culture

Fetal bovine serum (FBS) is a common supplement to in vitro culture media. A workshop was organized to discuss whether or not fetuses might suffer when blood is withdrawn, and to discuss serum replacement methods. When bovine fetuses are exposed after slaughter of the dam, they can suffer only if they inflate their lungs with air and increase their blood oxygen to levels compatible with awareness. Preventing fetuses from breathing air or killing them by an efficient method, according to clearly defined safeguards, ensures that fetal blood collection is humane. Since serum is a supplement of unknown composition, which could be contaminated with unwanted factors, there are scientific and safety reasons for omitting FBS from culture media. Several media have been developed in which minimal or no animal derived components are present. Also, different cell types have been adapted to serum-free media. As yet, no standard serum free media are present, and each cell type requires its own medium composition. Among other recommendations, the establishment of a public database with information on cell types and their serum-free medium composition is proposed.

[Genetic research on blood samples stored for years in biobanks. Most people are willing to provide informed consent]

Genetic research involving biobanks has been the subject of numerous declarations, recommendations and guidelines produced by professionals, administrators, legislators and other decision-makers. Yet, there is little published empirical information on people's willingness to participate in genetic studies on blood samples that they donated many years ago, at a time when the informed consent did not include the possibility of genetic research. We here report on our experiences of obtaining informed consent for academic and as well as commercial genetic research on blood samples collected more than a decade ago. Participants in a population-based risk factor survey who had donated blood to a biobank in 1990 were contacted eleven years later (in 2001) and asked for informed consent for genetic studies. A total of 1,311 out of 1,409 participants (93%) gave their consent to use blood samples for academic genetic research, provided that an Ethics Committee had approved the research. Thirty-one participants (2.2%) did not give their consent for academic genetic research. Another 35 subjects (2.5%) did not consent to industrial genetic research even if their blood samples were anonymized. Sixty-four individuals did not reply or provided incomplete answers (together 4.8%). Of the 1,311 individuals that agreed to participate, 292 (22.3%) wanted to be informed and give their concent to every new specific project. All the others gave a general concent provided that an Ethics Committee had approved the research.

Biosamples, genomics, and human rights: context and content of Iceland's Biobanks Act

In recent years, human DNA sampling and collection has accelerated without the development of enforceable rules protecting the human rights of donors. The need for regulation of biobanking is especially acute in Iceland, whose parliament has granted a for-profit corporation, deCODE Genetics, an exclusive license to create a centralized database of health records for studies on human genetic variation. Until recently, how deCODE Genetics would get genetic material for its genotypic-phenotypic database remained unclear. However, in May 2000, the Icelandic Parliament passed the Icelandic Biobanks Act, the world's earliest attempt to construct binding rules for the use of biobanks in scientific research. Unfortunately, Iceland has lost an opportunity for bringing clear and ethically sound standards to the use of human biological samples in deCODE's database and in other projects: the Biobanks Act has extended a notion of "presumed consent" from the use of medical records to the use of patients' biological samples; worse, the act has made it possible--perhaps likely--that a donor's wish to withdraw his/her sample will be ignored. Inadequacies in the Act's legislative process help account for these deficiencies in the protection of donor autonomy.

Governing population genomics: law, bioethics, and biopolitics in three case studies

Existing scholarship on population genomics has only superficially addressed issues of power and political process. Accordingly, questions of politics and governance pervade the analysis of three population genomics case studies that follow: the Human Genome Diversity Project, Iceland's Health Sector Database, and "Clinical Genomics" as defined by the Beth Israel-Ardais collaboration. An examination of these case studies reveals that the common law, U.S. regulatory law, and international law have not developed the political sophistication to make the traditional promises of biomedical ethics--respect for autonomy, justice, and beneficence--come to fruition. Further, comparisons of these projects illuminate three areas ripe for reframing--informed consent, expert ethical oversight, and commercial benefits. Four avenues of reform are suggested.