Current scientific, ethical and social issues of biomonitoring in the European Union

The use of biomarkers in occupational health research, practice, and policy

Biomarkers are potentially useful tools for occupational health and safety research, practice, and policy. However, the full realization of this potential has not been achieved. In this paper, the progress made in these three usage areas is reviewed to identify what efforts can be taken to realize the full promise of biomarkers. Biomarker uses are described by a diverse taxonomy that builds on the categories of exposure, effect and susceptibility, and the continuum between exposure and disease prognosis. The most significant uses of biomarkers in occupational health have been in biological monitoring of workers. Other important uses have been in enhancing research and assessing mechanisms of action of occupational toxicants at low exposures. Seven critical areas will influence the extent to which the potential of biomarkers in occupational health and safety is realized. These include: (1) adequate investment in validation; (2) obtaining international agreement on exposure guidelines; (3) exploring the utility of biomarkers in regulation; (4) applying biomarkers to critical occupational safety and health questions; (5) developing the exposome; (6) utilizing biomarkers to address emerging occupational health issues; and (7) continuing to address the ethical and social justice issues related to biomarkers. Overall, if biomarkers are to make a major contribution to occupational health and safety then a more holistic approach to bringing them from the laboratory to practice will be needed.

Effectiveness of the biological monitoring of chemical exposure in the workplace: results of a survey in an area of Northern Italy

A survey of biological monitoring results from 2000 to 2008 was carried out as a part of institutional activities performed by the Workplace Prevention and Safety Service (SPSAL) of the south area of Modena district (Italy). The survey involved 18 companies employing 945 workers altogether. According to workplace exposure, routine biological monitoring had been carried out yearly or 6-monthly in private laboratories chosen by each company. Analysis of consecutive data from six plants showed fluctuating biomarker levels inconsistent with expected occupational exposure and sometimes exceeding biological exposure indices. Surveillance samplings were thus organized for comparison to be carried out in a public reference laboratory. Overall results showed systematic underestimation of marker levels by the laboratories in charge of routine biomonitoring that, together with inappropriate biomarker selection and timing of sample collection, led to insufficient and/or ineffective corrective measures. These results raise major concerns on the reliability of laboratory assessments performed for the routine biomonitoring of exposed workers. Continuous surveillance of the consistency between biological and ambient monitoring data, together with the systematic evaluation of the analytical quality of laboratory results, would be essential for a reliable assessment of health risk in the workplace.

Research on ethics in two large Human Biomonitoring projects ECNIS and NewGeneris: a bottom up approach

Assessment of ethical aspects and authorization by ethics committees have become a major constraint for health research including human subjects. Ethical reference values often are extrapolated from clinical settings, where emphasis lies on decisional autonomy and protection of individual's privacy. The question rises if this set of values used in clinical research can be considered as relevant references for HBM research, which is at the basis of public health surveillance. Current and future research activities using human biomarkers are facing new challenges and expectancies on sensitive socio-ethical issues. Reflection is needed on the necessity to balance individual rights against public interest. In addition, many HBM research programs require international collaboration. Domestic legislation is not always easily applicable in international projects. Also, there seem to be considerable inconsistencies in ethical assessments of similar research activities between different countries and even within one country. All this is causing delay and putting the researcher in situations in which it is unclear how to act in accordance with necessary legal requirements. Therefore, analysis of ethical practices and their consequences for HBM research is needed.This analysis will be performed by a bottom-up approach, based on a methodology for comparative analysis of determinants in ethical reasoning, allowing taking into account different social, cultural, political and historical traditions, in view of safeguarding common EU values. Based on information collected in real life complexity, paradigm cases and virtual case scenarios will be developed and discussed with relevant stakeholders to openly discuss possible obstacles and to identify options for improvement in regulation. The material collected will allow developing an ethical framework which may constitute the basis for a more harmonized and consistent socio-ethical and legal approach. This will not only increase the possibilities for comparison between data generated but may also allow for more equality in the protection of the rights of European citizens and establish trustful relationships between science and society, based on firmly rooted ethical values within the EU legislative framework.These considerations outline part of the research on legal, socio-ethical and communication aspects of HBM within the scope of ECNIS (NoE) and NewGeneris (IP).

Research on the socio-ethical impact of biomarker use and the communication processes in ECNIS NoE and NewGeneris IP

Current research projects using human biomarkers in their search for better knowledge on the interaction between environment and human health are facing sensitive ethical issues. Researchers may be put in situations in which it is unclear how to act in accordance with all necessary legal requirements on ethical aspects of research. As a consequence, scientific opportunities and important developments of which many individuals will benefit, may be missed. Sound scientific research in the field of environment and health may benefit from a "rethinking" of current theoretical frameworks and procedures issuing from clinical medicine, putting emphasis on decisional autonomy and the protection of the individual and to a much lesser degree taking into account the concept of "public interest". The protection of individuals participating in studies in the field of environmental health calls, e.g., new communication strategies from recruitment to debriefing, at individual as well as at societal levels. Research on the socio ethical aspects on HBM within ECNIS and Newgeneris is situated at the interface of science, ethics and law and should be considered in the context of one final goal: contributing to guidelines for a harmonized socio-ethical and legal approach of human biomonitoring activities in the EU, including procedures for effective and appropriate communication both a the individual and at the collective level, resulting in a European research atmosphere in which scientific research related to development and use of human biomarkers is promoted, and in which a simultaneous protection of the rights and dignity of the study subjects is guaranteed. A harmonized socio-ethical and legal approach not only increases the possibilities for comparison between data generated but may also allow for more equality in the protection of the rights of each citizen of the European Union.

Building informed consent for cholinesterase monitoring among pesticide handlers in Washington State

BACKGROUND

Pesticide handlers in Washington State are predominantly Mexican and, therefore, require a culturally appropriate process of informed consent. In addition, members of this occupational group are vulnerable to coercion because of poverty, lack of insurance, inability to read, and employment status

METHODS

To create a process of culturally competent informed consent for Washington State's cholinesterase monitoring program, we used focus groups to collect data about cultural beliefs, attitudes, knowledge, language, and traditions of Mexican-American pesticide handlers. With this information, we developed a final consent form and evaluated it using a 10-item test-retest questionnaire in a sample of 103 handlers.

RESULTS

Using qualitative methods, we created English and Spanish consent forms that incorporated culturally defined risk information. Both the written and audiotape formats significantly improved comprehension; but, for subjects with less than 7 years of schooling, audiotapes in Spanish yielded significantly higher scores (mean comprehension score 7.0 vs. 6.1, t = - 2.2, P = 0.03).

CONCLUSIONS

Culturally competent informed consent for particularly vulnerable populations of non-native speakers of English is possible. It requires both knowledge of specific cultural elements and the application of appropriate technology.