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Polevikov S. Advancing AI in healthcare: A comprehensive review of best practices. Clin Chim Acta 2023; 548:117519. [PMID: 37595864 DOI: 10.1016/j.cca.2023.117519] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/20/2023]
Abstract
Artificial Intelligence (AI) and Machine Learning (ML) are powerful tools shaping the healthcare sector. This review considers twelve key aspects of AI in clinical practice: 1) Ethical AI; 2) Explainable AI; 3) Health Equity and Bias in AI; 4) Sponsorship Bias; 5) Data Privacy; 6) Genomics and Privacy; 7) Insufficient Sample Size and Self-Serving Bias; 8) Bridging the Gap Between Training Datasets and Real-World Scenarios; 9) Open Source and Collaborative Development; 10) Dataset Bias and Synthetic Data; 11) Measurement Bias; 12) Reproducibility in AI Research. These categories represent both the challenges and opportunities of AI implementation in healthcare. While AI holds significant potential for improving patient care, it also presents risks and challenges, such as ensuring privacy, combating bias, and maintaining transparency and ethics. The review underscores the necessity of developing comprehensive best practices for healthcare organizations and fostering a diverse dialogue involving data scientists, clinicians, patient advocates, ethicists, economists, and policymakers. We are at the precipice of significant transformation in healthcare powered by AI. By continuing to reassess and refine our approach, we can ensure that AI is implemented responsibly and ethically, maximizing its benefit to patient care and public health.
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Tiller JM, Bakshi A, Brotchie AR, Green RC, Winship IM, Lacaze P. Public willingness to participate in population DNA screening in Australia. J Med Genet 2022:jmg-2022-108921. [DOI: 10.1136/jmg-2022-108921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/01/2022] [Indexed: 12/02/2022]
Abstract
BackgroundPopulation-based DNA screening for medically actionable conditions has the potential to improve public health by enabling early detection, treatment and/or prevention; however, public attitudes and willingness to participate in DNA screening have not been well investigated.MethodsWe presented a scenario to members of the Australian public, randomly selected from the electoral roll via the Australian Survey of Societal Attitudes, describing an adult population DNA screening programme currently under development, to detect risk of medically actionable cancers and heart disease. We asked questions regarding willingness to participate and pay, preferred delivery methods and concerns.ResultsWe received 1060 completed questionnaires (response rate 23%, mean age 58 years). The vast majority (>92%) expressed willingness to undertake DNA screening. When asked about the optimal age of screening, most (56%) favoured early adulthood (aged 18–40 years) rather than at birth or childhood. Many respondents would prefer samples and data be kept for re-screening (36%) or research use (43%); some preferred samples to be destroyed (21%). Issues that decrease likelihood of participation included privacy (75%) and insurance (86%) implications.ConclusionOur study demonstrates public willingness to participate in population DNA screening in Australia, and identifies barriers to participation, to be addressed in the design of screening programmes. Results are informing the development of a pilot national DNA screening programme.
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Butler T, Brown J, Jacobson PA, Stenehjem D. Perceptions of pharmacogenetic exceptionalism and the implications for clinical management within an electronic health record. Clin Transl Sci 2022; 15:2265-2274. [PMID: 35833242 PMCID: PMC9468565 DOI: 10.1111/cts.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/18/2022] [Accepted: 06/12/2022] [Indexed: 01/25/2023] Open
Abstract
Genetic exceptionalism refers to a concept that genetic information is distinct from other health data and therefore should have additional safety guards in place. The objective of this study was to establish perceptions of pharmacogenetic (PGx) exceptionalism and genetic information privacy and management within the electronic health record (EHR) from individuals who attended a PGx-focused conference. A 47-question survey was distributed to 370 attendees at a PGx conference in September 2020. The survey assessed demographics, professional characteristics, perceptions of PGx exceptionalism, knowledge of genetic laws and regulations, and EHR management of PGx information. Of the 370 participants invited to take the survey, 30% (n = 110) responded. Most respondents were pharmacists with postgraduate training (76.2%, n = 48). When asked whether PGx information was exceptional, 44% of respondents agreed while 32% disagreed. Agreement with PGx exceptionalism was associated most with respondents' lack of familiarity or knowledge with PGx. Over two-thirds (67%) felt that all members of the healthcare team should be able to access their patients' PGx information without restriction in the EHR. This study identified a lack of unanimity in the perception of PGx exceptionalism and the management of PGx information within the EHR across attendees of a PGx conference. Describing the perception of accessibility of PGx information within the EHR is important to ascertain for designing privacy-related technology, institutional management policies, and legal regulations as this area in genetics is increasingly being implemented into clinical care and clinical standards of care need to be established.
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Affiliation(s)
- Tiana Butler
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of PharmacyUniversity of MinnesotaDuluthMinnesotaUSA
| | - Jacob Brown
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of PharmacyUniversity of MinnesotaDuluthMinnesotaUSA
| | - Pamala A. Jacobson
- Department of Experimental and Clinical Pharmacology, College of PharmacyUniversity of MinnesotaDuluthMinnesotaUSA
| | - David Stenehjem
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of PharmacyUniversity of MinnesotaDuluthMinnesotaUSA
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Walker A. Diversity, Profit, Control: An Empirical Study of Industry Employees' Views on Ethics in Private Sector Genomics. AJOB Empir Bioeth 2022; 13:166-178. [PMID: 35435802 PMCID: PMC10194829 DOI: 10.1080/23294515.2022.2063993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Large amounts of capital are currently being invested in genomics companies across the "bench to clinic pipeline" - companies which are now shaping the future of biomedicine globally. Understanding the perspectives of people who work in such companies can contribute to shaping this industry in service of just and equitable futures of medicine. METHODS Using in-depth interviews as the primary method, this paper analyzes perspectives on ethical and social issues in private sector genomics expressed by members of the commercial genomics industry in the US. RESULTS Interviewees described a wide range of issues as pressing ethical concerns in commercial genomics. Key themes included concerns about diversity in genetic datasets, data governance and control, and pricing and profits in the industry. However, concern about diversity of datasets was not accompanied by expressions of concern about diversity in the industry workforce. CONCLUSIONS Most interviewees described concerns in the industry that are rather removed from their own work. But along with this "ethical distancing," moral concerns appeared to be the basis for competition amongst companies - to attract both employees and customers. Research in business ethics suggests that expanding moral analysis of one's own work helps improve day to day decision-making in the interest of justice. Opening space for people to examine ethics in their own subsector may provide a means for the private sector genomics industry to become a leader in ethics in the biosciences and a model for equity in our current moment of late capitalism.
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Affiliation(s)
- Alexis Walker
- Department of Medical Humanities and Ethics, Columbia University, New York, NY, USA
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Cheung R, Jolly S, Vimal M, Kim HL, McGonigle I. Who's afraid of genetic tests?: An assessment of Singapore's public attitudes and changes in attitudes after taking a genetic test. BMC Med Ethics 2022; 23:5. [PMID: 35081954 PMCID: PMC8791081 DOI: 10.1186/s12910-022-00744-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a consequence of precision medicine initiatives, genomic technologies have rapidly spread around the world, raising questions about genetic privacy and the ethics of data sharing. Previous scholarship in bioethics and science and technology studies has made clear that different nations have varying expectations about trust, transparency, and public reason in relation to emerging technologies and their governance. The key aims of this article are to assess genetic literacy, perceptions of genetic testing, privacy concerns, and governing norms amongst the Singapore population by collecting surveys. METHODS This study investigated genetic literacy and broad public attitudes toward genetic tests in Singapore with an online public survey (n = 560). To assess potential changes in attitudes following receipt of results from a genetic test, we also surveyed undergraduate students who underwent a genetic screen as part of a university class before and after they received their test results (n = 25). RESULTS Public participants showed broad support for the use of genetic tests; scored an average of 48.9% in genetic literacy; and expressed privacy concerns over data sharing and a desire for control over their genetic data. After taking a genetic test and receiving genetic test results, students reported less fear of genetic tests while other attitudes did not change significantly. CONCLUSION These findings highlight the potential of genetic education and active engagement with genetic testing to increase support and participation in genomic projects, PM, and biobanking initiatives; and they suggest that data privacy protections could potentially reduce discrimination by giving participants control over who can access their data. More specifically, these findings and the dataset we provide may be helpful in formulating culturally sensitive education programs and regulations concerning genomic technologies and data privacy.
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Affiliation(s)
- Ross Cheung
- School of Social Sciences, Nanyang Technological University, 48 Nanyang Avenue, Singapore, Singapore, 639818
| | - Shreshtha Jolly
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore, Singapore, 637551
| | - Manoj Vimal
- School of Social Sciences, Nanyang Technological University, 48 Nanyang Avenue, Singapore, Singapore, 639818
| | - Hie Lim Kim
- Asian School of the Environment, Singapore Center for Environmental Life Sciences Engineering, Nanyang Technological University, 50 Nanyang Ave, Singapore, Singapore, 637459
| | - Ian McGonigle
- School of Social Sciences, Nanyang Technological University, 48 Nanyang Avenue, Singapore, Singapore, 639818.
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Kickbusch I, Piselli D, Agrawal A, Balicer R, Banner O, Adelhardt M, Capobianco E, Fabian C, Singh Gill A, Lupton D, Medhora RP, Ndili N, Ryś A, Sambuli N, Settle D, Swaminathan S, Morales JV, Wolpert M, Wyckoff AW, Xue L. The Lancet and Financial Times Commission on governing health futures 2030: growing up in a digital world. Lancet 2021; 398:1727-1776. [PMID: 34706260 DOI: 10.1016/s0140-6736(21)01824-9] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/09/2021] [Accepted: 08/05/2021] [Indexed: 12/23/2022]
Affiliation(s)
- Ilona Kickbusch
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Dario Piselli
- Centre for International Environmental Studies, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Anurag Agrawal
- CSIR Institute of Genomics and Integrative Biology, Delhi, India; Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Ran Balicer
- Clalit Research Institute, Tel Aviv, Israel; Clalit Health Services, Tel Aviv, Israel
| | - Olivia Banner
- School of Arts, Technology and Emerging Communication, The University of Texas at Dallas, Richardson, TX, USA
| | - Michael Adelhardt
- Competence Centre Health and Social Protection, Deutsche Gesellschaft für Internationale Zusammenarbeit, Bonn, Germany
| | - Emanuele Capobianco
- International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| | | | - Amandeep Singh Gill
- International Digital Health & AI Research Collaborative, Geneva, Switzerland
| | - Deborah Lupton
- Centre for Social Research in Health, Social Policy Research Centre, Australian Research Council for Automated Decision-Making and Society, University of New South Wales, Sydney, NSW, Australia
| | | | - Njide Ndili
- PharmAccess Foundation Nigeria, Lagos, Nigeria
| | - Andrzej Ryś
- Health Systems, Medical Products and Innovation, European Commission, Brussels, Belgium
| | | | | | | | | | | | - Andrew W Wyckoff
- Directorate for Science, Technology and Innovation, Organisation for Economic Co-operation and Development, Paris, France
| | - Lan Xue
- The Schwarzman College, Tsinghua University, China
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Middleton A, Milne R, Almarri MA, Anwer S, Atutornu J, Baranova EE, Bevan P, Cerezo M, Cong Y, Critchley C, Fernow J, Goodhand P, Hasan Q, Hibino A, Houeland G, Howard HC, Hussain SZ, Malmgren CI, Izhevskaya VL, Jędrzejak A, Jinhong C, Kimura M, Kleiderman E, Leach B, Liu K, Mascalzoni D, Mendes Á, Minari J, Wang N, Nicol D, Niemiec E, Patch C, Pollard J, Prainsack B, Rivière M, Robarts L, Roberts J, Romano V, Sheerah HA, Smith J, Soulier A, Steed C, Stefànsdóttir V, Tandre C, Thorogood A, Voigt TH, West AV, Yoshizawa G, Morley KI. Global Public Perceptions of Genomic Data Sharing: What Shapes the Willingness to Donate DNA and Health Data? Am J Hum Genet 2020; 107:743-752. [PMID: 32946764 PMCID: PMC7536612 DOI: 10.1016/j.ajhg.2020.08.023] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022] Open
Abstract
Analyzing genomic data across populations is central to understanding the role of genetic factors in health and disease. Successful data sharing relies on public support, which requires attention to whether people around the world are willing to donate their data that are then subsequently shared with others for research. However, studies of such public perceptions are geographically limited and do not enable comparison. This paper presents results from a very large public survey on attitudes toward genomic data sharing. Data from 36,268 individuals across 22 countries (gathered in 15 languages) are presented. In general, publics across the world do not appear to be aware of, nor familiar with, the concepts of DNA, genetics, and genomics. Willingness to donate one's DNA and health data for research is relatively low, and trust in the process of data's being shared with multiple users (e.g., doctors, researchers, governments) is also low. Participants were most willing to donate DNA or health information for research when the recipient was specified as a medical doctor and least willing to donate when the recipient was a for-profit researcher. Those who were familiar with genetics and who were trusting of the users asking for data were more likely to be willing to donate. However, less than half of participants trusted more than one potential user of data, although this varied across countries. Genetic information was not uniformly seen as different from other forms of health information, but there was an association between seeing genetic information as special in some way compared to other health data and increased willingness to donate. The global perspective provided by our "Your DNA, Your Say" study is valuable for informing the development of international policy and practice for sharing genomic data. It highlights that the research community not only needs to be worthy of trust by the public, but also urgent steps need to be taken to authentically communicate why genomic research is necessary and how data donation, and subsequent sharing, is integral to this.
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Affiliation(s)
- Anna Middleton
- Society and Ethics Research Group, Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK; Faculty of Education, University of Cambridge, Cambridge CB2 8PQ, UK.
| | - Richard Milne
- Society and Ethics Research Group, Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK; Institute of Public Health, University of Cambridge, Cambridge CB2 0SR, UK
| | | | | | - Jerome Atutornu
- Society and Ethics Research Group, Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK
| | - Elena E Baranova
- Russian Medical Academy of Continuous Professional Education, Moscow 119049, Russia
| | - Paul Bevan
- Wellcome Sanger Institute, Cambridge CB10 1SA, UK
| | - Maria Cerezo
- EMBL-EBI, Wellcome Genome Campus, Cambridge CB10 1SA, UK
| | - Yali Cong
- Medical Ethics Program, Peking University Health Science Center, Beijing 100191, China
| | - Christine Critchley
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC 3122, Australia; Centre for Law and Genetics, University of Tasmania, Hobart, TAS 7001, Australia
| | - Josepine Fernow
- Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden
| | - Peter Goodhand
- Ontario Institute for Cancer Research, MaRS Centre, Toronto, ON M5G 0A3, Canada
| | - Qurratulain Hasan
- Department of Genetics & Molecular Medicine, Kamineni Hospitals, Hyderabad 500 068, India; SAAZ Genetics, Hyderabad 500033, India
| | - Aiko Hibino
- Faculty of Humanities and Social Sciences, Hirosaki University, Hirosaki 036-8560, Japan
| | - Gry Houeland
- Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden
| | - Heidi C Howard
- Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden; Medical Ethics, Lund Universitet, Lund SE-221 00, Sweden
| | | | - Charlotta Ingvoldstad Malmgren
- Department of Public Health and Caring Science, Uppsala University, Uppsala 751 22, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna 171 76, Sweden
| | | | | | - Cao Jinhong
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China
| | - Megumi Kimura
- Institute of Innovation Research, Hitotsubashi University, Tokyo 186-8603, Japan
| | - Erika Kleiderman
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada
| | | | - Keying Liu
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan; School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Deborah Mascalzoni
- EURAC, Institute of Biomedicine, Bolzano 39100, Italy; Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden
| | - Álvaro Mendes
- UnIGENe and CGPP (Centre for Predictive and Preventive Genetics), IBMC (Institute for Molecular and Cell Biology), i3S (Instituto de Investigação e Inovação em Saúde), Universidade do Porto, Porto 4200-135, Portugal
| | - Jusaku Minari
- Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto 606-8507, Japan
| | - Nan Wang
- Medical Ethics Program, Peking University Health Science Center, Beijing 100191, China
| | - Dianne Nicol
- Centre for Law and Genetics, University of Tasmania, Hobart, TAS 7001, Australia
| | - Emilia Niemiec
- Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden
| | - Christine Patch
- Society and Ethics Research Group, Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK; Genomics England, Queen Mary University of London, London EC1M 6BQ, UK
| | | | - Barbara Prainsack
- Department of Political Science, University of Vienna, Vienna 1010, Austria; Department of Global Health & Social Medicine, King's College London, London WC2R 2LS, UK
| | | | - Lauren Robarts
- Society and Ethics Research Group, Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK
| | - Jonathan Roberts
- Society and Ethics Research Group, Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK
| | - Virginia Romano
- Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden; EURAC, Institute of Biomedicine, Bolzano 39100, Italy
| | - Haytham A Sheerah
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - James Smith
- Wellcome Sanger Institute, Cambridge CB10 1SA, UK
| | - Alexandra Soulier
- Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden
| | - Claire Steed
- Wellcome Sanger Institute, Cambridge CB10 1SA, UK
| | - Vigdís Stefànsdóttir
- Landspitali, the National University Hospital of Iceland, Reykjavík 101, Iceland
| | - Cornelia Tandre
- Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden
| | - Adrian Thorogood
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada
| | - Torsten H Voigt
- Institute of Sociology, RWTH Aachen University, Aachen 52062, Germany
| | - Anne V West
- Indiana University Maurer School of Law, Bloomington, IN 47405, USA
| | - Go Yoshizawa
- Work Research Institute (AFI), Oslo Metropolitan University, Oslo 0130, Norway
| | - Katherine I Morley
- RAND Europe, Cambridge CB4 1YG, UK; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, Melbourne, VIC 3010, Australia
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8
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Martani A, Geneviève LD, Pauli-Magnus C, McLennan S, Elger BS. Regulating the Secondary Use of Data for Research: Arguments Against Genetic Exceptionalism. Front Genet 2019; 10:1254. [PMID: 31956328 PMCID: PMC6951399 DOI: 10.3389/fgene.2019.01254] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/14/2019] [Indexed: 12/02/2022] Open
Abstract
As accessing, collecting, and storing personal information become increasingly easier, the secondary use of data has the potential to make healthcare research more cost and time effective. The widespread reuse of data, however, raises important ethical and policy issues, especially because of the sensitive nature of genetic and health-related information. Regulation is thus crucial to determine the conditions upon which data can be reused. In this respect, the question emerges whether it is appropriate to endorse genetic exceptionalism and grant genetic data an exceptional status with respect to secondary use requirements. Using Swiss law as a case study, it is argued that genetic exceptionalism in secondary use regulation is not justified for three reasons. First, although genetic data have particular features, also other non-genetic data can be extremely sensitive. Second, having different regulatory requirements depending on the nature of data hinders the creation of comprehensible consent forms. Third, empirical evidence about public preferences concerning data reuse suggests that exceptional protection for genetic data alone is not justified. In this sense, it is claimed that regulation concerning data reuse should treat genetic data as important, but not exceptional.
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Affiliation(s)
- Andrea Martani
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | | | - Christiane Pauli-Magnus
- Department of Clinical Research, University and University Hospital of Basel, Basel, Switzerland
| | - Stuart McLennan
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Institute of History and Ethics in Medicine, Technical University of Munich, Munich, Germany
| | - Bernice Simone Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- University Center of Legal Medicine, University of Geneva, Geneva, Switzerland
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9
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Middleton A, Milne R, Howard H, Niemiec E, Robarts L, Critchley C, Nicol D, Prainsack B, Atutornu J, Vears DF, Smith J, Steed C, Bevan P, Scott ER, Bobe J, Goodhand P, Kleiderman E, Thorogood A, Morley KI. Members of the public in the USA, UK, Canada and Australia expressing genetic exceptionalism say they are more willing to donate genomic data. Eur J Hum Genet 2019; 28:424-434. [PMID: 31784701 PMCID: PMC7080803 DOI: 10.1038/s41431-019-0550-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 01/01/2023] Open
Abstract
Public acceptance is critical for sharing of genomic data at scale. This paper examines how acceptance of data sharing pertains to the perceived similarities and differences between DNA and other forms of personal data. It explores the perceptions of representative publics from the USA, Canada, the UK and Australia (n = 8967) towards the donation of DNA and health data. Fifty-two percent of this public held ‘exceptionalist’ views about genetics (i.e., believed DNA is different or ‘special’ compared to other types of medical information). This group was more likely to be familiar with or have had personal experience with genomics and to perceive DNA information as having personal as well as clinical and scientific value. Those with personal experience with genetics and genetic exceptionalist views were nearly six times more likely to be willing to donate their anonymous DNA and medical information for research than other respondents. Perceived harms from re-identification did not appear to dissuade publics from being willing to participate in research. The interplay between exceptionalist views about genetics and the personal, scientific and clinical value attributed to data would be a valuable focus for future research.
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Affiliation(s)
- Anna Middleton
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Hinxton, CB10 1SA, UK. .,Faculty of Education, University of Cambridge, Cambridge, UK.
| | - Richard Milne
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Hinxton, CB10 1SA, UK.,Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Heidi Howard
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Emilia Niemiec
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Lauren Robarts
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - Christine Critchley
- Department of Statistics and Epidemiology, Swinburne University of Technology, Melbourne, & Centre for Law and Genetics, University of Tasmania, Hobart, TAS, Australia
| | - Dianne Nicol
- Centre for Law and Genetics, University of Tasmania, Hobart, TAS, Australia
| | - Barbara Prainsack
- Department of Political Science, University of Vienna, Vienna, Austria.,Department of Global Health & Social Medicine, King's College London, London, UK
| | - Jerome Atutornu
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Hinxton, CB10 1SA, UK.,Faculty of Education, University of Cambridge, Cambridge, UK.,School of Health Sciences, University of Suffolk, Ipswich, UK
| | - Danya F Vears
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Leuven Institute for Human Genomics and Society (LIGAS), KU Leuven, Leuven, Belgium.,Melbourne Law School, University of Melbourne, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - James Smith
- Web Team, Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Claire Steed
- Web Team, Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Paul Bevan
- Web Team, Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Erick R Scott
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jason Bobe
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute for Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter Goodhand
- Ontario Institute for Cancer Research, MaRS Centre, Toronto, ON, Canada
| | - Erika Kleiderman
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Adrian Thorogood
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Katherine I Morley
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Hinxton, CB10 1SA, UK.,Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, University of Melbourne, Melbourne, VIC, Australia.,RAND Europe, Cambridge, UK
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10
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Ries N, Mansfield E, Sanson-Fisher R. Planning Ahead for Dementia Research Participation: Insights from a Survey of Older Australians and Implications for Ethics, Law and Practice. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:415-429. [PMID: 31297689 DOI: 10.1007/s11673-019-09929-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/04/2019] [Indexed: 06/10/2023]
Abstract
People with dementia have commonly been excluded from research. The adverse impacts of this exclusion are now being recognized and research literature, position statements, and ethics guidelines increasingly call for inclusion of people with dementia in research. However, few published studies investigate the views of potential participants on taking part in research should they experience dementia-related cognitive impairment. This cross-sectional survey examined the views of people aged sixty and older (n=174) attending hospital outpatient clinics about clinical research participation if they had dementia and impaired decision-making ability. Over 90 percent of respondents were agreeable to participating in a wide range of research activities, such as cognitive testing, physical measurements, imaging procedures, and blood draws. For drug studies, however, agreement dropped to 60 percent. Altruism was a strong motivator for research participation. In regard to who should be involved in decisions about their participation in research during periods of incapacity, respondents mostly preferred the person they appoint as their substitute decision-maker for healthcare matters (88%) or a doctor or health professional on the research team (78%). Over three-quarters (79%) expressed interest in making an advance research directive. The study findings are discussed in relation to law reforms in Australia that aim to strengthen respect and inclusion for people with impaired decision-making capacity, especially by providing frameworks for advance planning for research participation.
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Affiliation(s)
- Nola Ries
- Faculty of Law, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
| | - Elise Mansfield
- Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Rob Sanson-Fisher
- Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
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Beskow LM, Hammack CM, Brelsford KM. Thought leader perspectives on benefits and harms in precision medicine research. PLoS One 2018; 13:e0207842. [PMID: 30475858 PMCID: PMC6258115 DOI: 10.1371/journal.pone.0207842] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 11/01/2018] [Indexed: 01/06/2023] Open
Abstract
Precision medicine research is underway to identify targeted approaches to improving health and preventing disease. However, such endeavors raise significant privacy and confidentiality concerns. The objective of this study was to elucidate the potential benefits and harms associated with precision medicine research through in-depth interviews with a diverse group of thought leaders, including primarily U.S.-based experts and scholars in the areas of ethics, genome research, health law, historically-disadvantaged populations, informatics, and participant-centric perspectives, as well as government officials and human subjects protections leaders. The results suggest the prospect of an array of individual and societal benefits, as well as physical, dignitary, group, economic, psychological, and legal harms. Relative to the way risks and harms are commonly described in consent forms for precision medicine research, the thought leaders we interviewed arguably emphasized a somewhat different set of issues. The return of individual research results, harm to socially-identifiable groups, the value-dependent nature of many benefits and harms, and the risks to the research enterprise itself emerged as important cross-cutting themes. Our findings highlight specific challenges that warrant concentrated care during the design, conduct, dissemination, and translation of precision medicine research and in the development of consent materials and processes.
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Affiliation(s)
- Laura M. Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Catherine M. Hammack
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Kathleen M. Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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Abstract
Suppose that you have deeply personal information that you do not want to share. Further suppose that this information could help others, perhaps even saving their lives. Should you reveal the information or keep it secret? With the increasing prevalence of genetic testing, more and more people are finding themselves in this situation. Although a patient's genetic results are potentially relevant to all her biological family members, her first-degree relatives-parents, children, and full siblings-are most likely to be affected. This is especially true for genetic mutations-like those in the BRCA1 and BRCA2 genes-that are associated with a dramatically increased risk of disease. Fortunately, people are usually willing to share results with their at-risk relatives. Occasionally, however, a patient refuses to disclose her findings to anyone outside her clinical team. Ethicists have written little on patients' moral duties to their at-risk relatives. Moreover, the few accounts that have been advanced are problematic. Some unnecessarily expose patients' genetic information to relatives who are unlikely to benefit from it, and others fail to ensure that patients' most vulnerable relatives are informed of their genetic risks. Patients' duty to warn can be defended in a way that avoids these problems. I argue that the duty to share one's genetic results is grounded in the principle of rescue-the idea that one ought to prevent, reduce, or mitigate the risk of harm to another person when the expected harm is serious and the cost or risk to oneself is sufficiently moderate. When these two criteria are satisfied, a patient will most likely have a duty to warn.
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Mählmann L, Schee Gen Halfmann S, von Wyl A, Brand A. Attitudes towards Personal Genomics and Sharing of Genetic Data among Older Swiss Adults: A Qualitative Study. Public Health Genomics 2018; 20:293-306. [PMID: 29414817 DOI: 10.1159/000486588] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 12/29/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To assess the willingness of older Swiss adults to share genetic data for research purposes and to investigate factors that might impact their willingness to share data. METHODS Semi-structured interviews were conducted among 40 participants (19 male and 21 female) aged between 67 and 92 years, between December 2013 and April 2014 attending the Seniorenuniversität Zürich, Switzerland. All interviews were audio-recorded, transcribed verbatim, and anonymized. For the analysis of the interviews, an initial coding scheme was developed, refined over time, and applied afterwards to all interviews. RESULTS The majority of participants were in favor of placing genetic data to research's disposal. Participant's motivations to share data were mainly driven by altruistic reasons and by contributing to the greater good. Furthermore, several factors which might impact the willingness to share data such as sharing data with private companies, generational differences, differences between sharing genetic data or health data, and sharing due to financial incentives were highlighted. Last, some participants indicated concerns regarding data sharing such as misuse of data, the fear of becoming a transparent citizen, and data safety. However, 20% of the participants express confidence in data protection. Even participants who were skeptical in the beginning of the interviews admitted the benefits of data sharing. DISCUSSION Overall, this study suggests older citizens are willing to share their data for research purposes. However, most of them will only contribute if their data is appropriately protected and if they trust the research institution to use the shared data responsibly. More transparency and detailed information regarding the data usage are urgently needed. There is a great need to increase the engagement of older adults in research since they present a large segment of our society - one which is often underexamined in research. CONCLUSION Increased focus on general public engagement, especially of older adults, in scientific research activities known as "citizen science" is needed to further strengthen the uptake of personalized medicine.
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Affiliation(s)
- Laura Mählmann
- Psychiatric Clinics of the University of Basel, Centre for Affective, Stress, and Sleep Disorders, University of Basel, Basel, Switzerland.,United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (UNU-MERIT), Maastricht University, Maastricht, the Netherlands
| | - Sebastian Schee Gen Halfmann
- United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (UNU-MERIT), Maastricht University, Maastricht, the Netherlands
| | - Agnes von Wyl
- Psychological Institute, Zurich University of Applied Sciences, Zürich, Switzerland
| | - Angela Brand
- United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (UNU-MERIT), Maastricht University, Maastricht, the Netherlands.,Department of International Health, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Walsh K. Synchronous telecommunications in medical education. J Biomed Res 2015; 30:79-80. [PMID: 26679786 PMCID: PMC4726838 DOI: 10.7555/jbr.30.20150094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 08/13/2015] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kieran Walsh
- BMJ Learning, BMJ Publishing Group, BMA House, Tavistock Square, London WCH 9JR, UK.
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