A research blog from the Centre for Resarch Ethics & Bioethics (CRB)

Category: In the research debate (Page 34 of 37)

Public ethics and human morality

Is ethics universally valid or can we act differently as moral individuals than as ethical representatives of public institutions?

I just read a well-argued article in Science Policy Forum, discussing whether patients should be paid for their tissue. As their point of departure, the authors cite the (by now) famous case of Henrietta Lacks.

Contrary to the many readers and reviewers of the bestseller who thought that Henrietta Lacks was exploited by the medical establishment, the authors arrive at the following conclusion. In cases similar to that of Henrietta Lacks, patients (or their families) are NOT entitled to payment for their tissue. – Why not?

First of all, there are no property rights for human bodies, people don’t own the tissue they leave: no one has the right to demand payment for their tissue.

People should, however, be compensated for the effort of giving the tissue. But there is no such effort associated with patient samples, since the samples were taken for the sake of caring for the patients. There is no effort to compensate for.

But what about the revenue generated by the tissue? Can people make millions of dollars on patients’ cells, as in the Henrietta Lacks case, without sharing the profits with the patients (or with their families)?

Once again, the authors argue convincingly that patients have no right to demand payment or part of revenue streams. The tissues are only raw material for developing cell lines. It is the intellectual work of the investigators that creates value. Moreover, since so few donors have tissue that can be used to generate profitable medical products, the end result of trying to be fair by sharing profits with these few lucky donors would be injustice vis-à-vis the majority of donors.

What interests me here is that although I consider the ethical policy proposed in the article as well-argued and right, I can still understand if a morally concerned individual saw injustice in a case like that of Henrietta Lacks and decided to donate money to her family.

Consider this passage from the article:

  • “Christoph Lengauer, a cancer drug developer and former Hopkins faculty member, articulated this sense of inequity when he reportedly told Lacks’s daughter that he thought Hopkins had ‘screwed up’ by not sharing some of the proceeds from the HeLa cell line with the Lacks family.”

The Science Policy Forum article demonstrates that this accusation is not as reasonable as it might seem.

Still, if a concerned individual (like Lengauer) saw injustice in a destiny like that of Henrietta Lacks and personally donated money to the family, I think I could see that as a perfect moral action and not necessarily as deluded.

Can one appreciate the ethical arguments for a policy not to pay patients for their tissue, and still, as an individual, experience injustice and personally donate money?

Unless we demand that human beings should be like representatives of public institutions through and through, I think we can admit such a possibility. It would even make me uncomfortable if we didn’t acknowledge such freedom.

Pär Segerdahl

We like challenging questions - the ethics blog

LifeGene and participation of minors in biobank research

One of the issues preceding the Swedish Data Inspection Board’s decision to stop the population-based biobank LifeGene concerned participation of minors.

LifeGene had planned to collect samples from half a million Swedes, including children. A regional ethical review board, however, decided against collecting data from children. Only data collection from adults was approved of.

LifeGene saw participation of minors as essential to their purposes and therefore appealed against the decision.

Unfortunately for LifeGene, the central ethical review board took the fateful decision that LifeGene couldn’t even undergo ethical review. LifeGene’s broad purpose – “future research” – indicated that LifeGene was infrastructure for research and not a specific research project. (According to the law, only research projects are ethically reviewed.)

The broad future-oriented nature of LifeGene’s purpose later became the main reason for the Data Inspection Board to stop LifeGene.

The fact that the stopping of LifeGene was preceded by the issue of children’s participation in biobank research makes a recent publication on this problematic all the more relevant for biobankers to read.

The article by Kristien Hens, Kris Dierickx and colleagues, published in the European Journal of Human Genetics, aims towards an ethical policy for minors’ participation in biobank research.

The authors emphasize that relevant ethical concerns differ from those of adult participation in biobank studies as well as from those of children’s participation in clinical trials. There is therefore a need for principles that apply uniquely to minors’ participation in biobank research.

I will not summarize the authors’ conclusions since they are so neatly summarized at the end of the article in the form of eight principles about, for example, subsidiarity and consent.

The eighth and final principle, however, deserves special mentioning, since it introduces a new policy concerning return of individual results. If I understand it right, the principle states that parents have a limited right to decide not to receive genetic information about their children. If an incidental finding concerns a preventable or treatable early-onset disease and it has clinical validity and utility, then parents should be informed about the finding regardless of their wishes.

The right not to know is overruled in this particular case.

The article is well worth reading as a constructive discussion of concerns that need to be addressed when children are included in biobank research.

Pär Segerdahl

We recommend readings - the Ethics Blog

Drug companies as whistleblowers

Some years ago, John Ioannidis warned that most published research findings probably are false.

More recently, the drug companies Bayer and Amgen reported that their attempts to replicate scientifically published studies that could be a basis for new drug development most often fail. Amgen, for example, failed to replicate 47 of 53 oncology and hematology results that they initially deemed interesting for their purposes.

We are used to seeing drug companies under attack by right-minded critics. Now they are in the position of delivering the critique. They invalidate most scientifically published findings in the field of medicine. By going public about this embarrassing fact, they act as whistleblowers revealing emptiness in current scientific practices and ways of supporting and awarding high quality research.

A solution to the problem is now being proposed, though not by the research community, but by a company: Science Exchange. They offer researchers a new service. For a fee, they attempt to reproduce the researchers’ studies. If the studies can be successfully replicated, the company issues a certificate of reproducibility.

Can such a proposal contribute to a transformation of current scientific practices, towards an order where peers not merely read and assess papers, but practically try to validate results?

But shouldn’t validation be internal to the research work, rather than outsourced?

If I interpret Karl Popper right, a scientist should actively try to achieve negative results. Only by failing to produce negative results can she tentatively claim positive results.

Do current ways of measuring and awarding scientific quality undermine the self-critical spirit of scientific work?

Pär Segerdahl

Following the news - the ethics blog

Biobanks and alternative energy resources

Last week I participated in HandsOn: Biobanks, an interactive conference exploring the values of biobanking. The warm and collaborative atmosphere made the conference a both moving and encouraging experience.

Here is how the conference made me think about the value of biobanks:

New techniques of fundamental importance to humanity tend to appear in proportion to our needs for them. Efforts to develop efficient uses of alternative energy resources, for example, were not seriously supported until we became truly aware of how the world’s oil finds were running dry.

My impression at the conference was that biobanks could be compared to a new and much needed global energy resource. Biobanks are presently being set up all over the world as part of a new infrastructure not only for medical research, but also for health care and the pharmaceutical industry.

And the point is that efficient uses of this alternative resource of biological material appear urgently needed in our current situation.

Health care costs run amok, and so does the industry’s costs for developing new drugs. An efficient infrastructure of biobank resources would very likely help us come to terms with the problems that accumulate in the old framework.

The industry wastes billions on medical hypotheses that after years of hard work turn out to be unfeasible. Translating research results into safe and efficient drugs often is more complex and time-consuming than the research itself. Using biobanks could speed up the translation of research into drugs and make the process more predictable.

The health care sector too has problems and needs to make its practices more efficient, for example, through personalized medicine. Increasingly clever uses of biobank resources allow researchers to begin answering questions like:

  • Who is in the risk category for developing prostate cancer?
  • Who responds to which treatment?
  • Who will experience side effects?
  • Who can be given a clean bill of health after cancer treatment?

Answering such questions is revolutionary in medicine. So revolutionary in fact, that the intelligent use of biobank resources promises to generate new definitions of health and disease; new notions of diagnosis, treatment, and preventive medicine.

Developing a global infrastructure of biobank resources is a challenge for biobankers. Two challenges that were discussed at the conference were harmonization and evidence-based sampling and storing techniques. I got the impression that these challenges were manageable.

However, seeing the real significance of the biological resources that are being collected in biobanks is a challenge also for politicians, legislators and ethicists. To approach the political, legal and ethical issues in the right spirit, I believe we need a bigger picture of our situation.

Perhaps the comparison to our present need to develop intelligent uses of alternative energy resources can provide such a picture.

Pär Segerdahl

Approaching future issues - the Ethics Blog

No consent for maintaining high-quality health care?

Collecting biological samples and health information from healthy donors in the construction of biobanks and research registers obviously requires the donors’ informed consent.

But is a similar demand for consent reasonable when patients provide their doctor with samples for diagnosis, undergo medical examination and treatment, and answer the doctor’s questions? Or can patients be expected to accept that their traces in the health care system – for example, data about experienced side effects – are monitored to optimize the quality of medical diagnosis and treatment?

A recent article by Mats G. Hansson at CRB discusses the issue. The article in Theoretical Medicine and Bioethics is well-argued and challenges common assumptions.

The basic argument is that quality registers and biobanks within the health care system play such a decisive role in optimizing the quality of the care that we expect as patients, that no consent should be required for collecting and studying our traces as patients (provided that the purpose is maintenance of high-quality health care, and nothing else).

Consent is associated with costs, in the form of drop-out of data. This impairs the value of the information in quality registers and biobanks, and thereby also the conditions for optimizing medical diagnosis and treatment.

Privacy is not the only ethical concern. Quality of care carries moral weight too.

Perhaps we are prepared to accept certain access to our patient histories, if such access is a precondition to maintaining and developing high standards of health care?

Pär Segerdahl

We recommend readings - the Ethics Blog

How unspecific is broad consent?

In response to an informative article on personalized medicine and biobanking in Nature Biotechnology, a recent letter to the Editor defends broad consent for biobanking.

The three letter writers emphasize the patient and donor perspective:

  • “…patient donors actually express concern that study-specific consent can be burdensome and impede research.”

Given these donors’ desire to give so-called broad consent, I want to highlight two problematic aspects of the distinction between specific and broad consent.

The first is that the word “broad” consent may give rise to the impression that the consent is so general and vague that it cannot be seen as informed consent to anything specific at all. But broad consent is not “broad” in such an absolute sense, akin to vagueness. It is “broad” only in a relative sense: in relation to the historically more prevalent case of consenting to individual research projects.

The distinction between specific and broad consent is a distinction between two ways of being specific. One of these ways of being specific dominated the scene first. It therefore functioned as a linguistic standard. The other way of being specific had to put up with being called “broad.”

Specific consent, then, is specific only in a specific sense: one that is historically conditioned and changeable. It is not the golden standard of exactitude. Consent can therefore be “broad” without being vague.

The second problematic aspect is that when people donate samples to biobanks, the exact nature of the individual research projects that might use their samples is less relevant to them than when they consent to invasive procedures in clinical trials.

The risks are minimal in biobank research. Donors therefore look more to the practical utility of the research than to the research itself. Forcing them to consider the purposes and questions and procedures of individual research projects is forcing them to attend to a level of medical research that is less relevant to them as donors.

In short, a historically and linguistically insensitive demand for “specific consent” in biobanking may hinder donors from giving the kind of specific consent they authentically want to give in this new but more and more prevalent context.

Pär Segerdahl

Minding our language - the Ethics Blog

Research for the sake of the patient

We regularly tell strangers about sensitive aspects of our lives. We do it every time we visit the doctor. We do it without hesitating, in spite of the fact that the information won’t stay with the doctor to whom we give it.

The information is archived and will be read by health care staff in the future, when we visit a hospital again. As patients, we are satisfied with this state of affairs. Typically, we are happy that our samples are saved for future use, and that research is being done on our data to improve the quality of the care.

It is obvious to us that these actions are taken for our sake as patients, or as future patients.

However, when the same kind of data is collected for similar overall purposes, but outside of the health care sector, in the construction of biobanks and registers for future medical research, it suddenly becomes more tempting to worry about the safety of our data.

In spite of the fact that the researchers’ information about us

  1. normally is less comprehensive than in the doctor’s journal,
  2. is coded so that the connection to us is as safe as in a bank vault,
  3. isn’t used to do research on us individually, but to explore human patterns of disease,

a tendency to imagine nightmarish scenarios of surveillance appears. – Why?

One reason could be an assumption that researchers only want to answer their own questions. They don’t do research for our sake. They are curious and need our support to realize their own research goals.

Another reason could be an assumption that if medical research has commendable purposes related to health and health care, these purposes are very general and societal: Improved Public Health; Decreased Health Care Costs; A Flourishing Pharmaceutical Sector etc.

Who cares about little me?

When I visit the doctor, the connection to my own health and care is obvious. When I donate blood to the biobank for future research, on the other hand, the connection to me as a patient, or as a future patient, is less obvious.

Still, today’s health care depends on yesterday’s research.

The information I give the doctor would not help me a bit as a patient, if millions had not already provided medical research with their data. My doctor wouldn’t even be able to suggest a diagnosis, or recommend an effective treatment.

I believe we need to defuse the issue of personal data in biobanks and research registers; calm down our tendency to think that the information is collected without regard to us, and for wholly different purposes than in health care. Even in research, our data are collected for our sake: so that we, the day we visit the hospital and tell the doctor about our troubles, can expect well-founded diagnoses and effective treatments.

If you want to reflect more about our interest as future patients that there is ongoing biobank and register research, I want to recommend a coming dissertation:

  • Biobank Research – Individual Rights and Public Benefit

Author is Joanna Stjernschantz Forsberg at CRB, who defends her dissertation the 6th of October in Uppsala.

I also want to recommend the interactive conference, HandsOn: Biobanks, in Uppsala 20-21 September, which tries to illuminate the values of biobanking. You can register for the conference until the 11th of September.

Pär Segerdahl

We challenge habits of thought : the Ethics Blog

Interesting conferences

The Ethics Blog recommends three important conferences this autumn:

1.      Genomics for Healthcare and Socio-Economic Progress

This conference is organized by the Wales Gene Park. It discusses the economic potential of genomics in, for example, healthcare, agriculture and bio-energy.

  • When? 13-14 September 2012
  • Where? Radisson Blu Hotel, Cardiff
  • Website? Here

2.      HandsOn: Biobanks

This interactive conference is organized by BBMRI.se. It dicusses biobanking and the value of biobank research.

  • When? 20-21 September 2012
  • Where? Uppsala, Sweden
  • Website? Here

3.      Children’s Participation and Decision-Making in Medical Matters

This conference is organized by the Nordic Committee on Bioethics. It discusses the ethics of children’s participation in medical research.

  • When? 11-12 October 2012
  • Where? Lund, Sweden
  • Website? Here

Visit the websites to find out more about these interesting events!

Pär Segerdahl

We recommend conferences - the ethics blog

What do donors need to know about future research?

I’m reading a Scientific American Guest Blog, on the ethics of future-use DNA sampling. Donating DNA to research is described as a more lasting donation than donating organs or embryos: DNA is information and information can last longer.

That donating DNA is such a lasting donation seems to imply that the future use to which the DNA can be put to use is more open. Who knows what information future researchers might be able to obtain from DNA donated today?

The author of the guest blog, Ricki Lewis, asks how consent can be obtained for DNA sampling intended for future genetic research.

She rejects the view that researchers must know in advance where the research might lead and inform donors about it; and if research takes unforeseen directions years or decades after the donation, researchers must contact donors again for renewed consent.

This view is rejected because knowing where research might lead “is not how science works.” And renewed consent would be “confusing, disturbing, and likely expensive.” – I agree.

Ricki Lewis’s own solution is the following:

  • “…informed consent documents should state that the sample might be used in the future to get information unknown today. Participants or patients can agree, or not sign.”

Both solutions seem to operate on a level that strikes me as less relevant to DNA donors.

People who donate DNA to science probably want to contribute to research that can improve prevention, diagnosis and treatment of various diseases. That is the level at which they are concerned about the future use of their DNA: the level of the practical significance of the research.

The exact scientific path that future research takes is less relevant to donors, I believe, as long as the research has the kind of practical significance that motivates their donation. And to ask for consent to do science as science is done – without knowing in advance where it might lead – could be confusing.

I also wonder: could a consent form that emphasizes the open and unpredictable nature of scientific research be misused on the practical level that probably concern donors more?

Pär Segerdahl

Approaching future issues - the Ethics Blog

“The Route” is taking shape

Our plans for the interactive part of the conference program for HandsOn: Biobanks, in Uppsala 20-21 September 2012, are taking shape. This part of the program is called “the Route.”

During coffee and lunch breaks, participants can walk through an interactive exhibition illustrating the process of informed consent, data and sample sharing, and new legislation.

Within the Route, participants can also meet law scholars, ethicists, biobank researchers and journalists. They can listen to and participate in conversations on a broad range of issues, such as the role or trust in biobank research, handling of incidental findings, patents, and regulatory processes.

Finally, the LifeGene debate will be discussed with representatives from LifeGene, EpiHealth, the Swedish Data Inspection Board, and the Central Ethical Review Board.

Curious? Do you want to partake in the Route?

Registration is open until September 11.

Pär Segerdahl

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