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Abstract
We present here a new method for bioethics: systemic modelling. In this method, the complex phenomenon being studied (e.g. personalized medicine, genetic testing, gene therapy, genetically modified organisms) is modelled as a whole, to shed light on its organization and functioning, and major (bio)ethical issues and solutions for their resolution are then identified. This systemic modelling method is ideal for use in the identification of solutions, rather than their validation, with other methods then used to test the solutions found. We provide a description and reproducible instructions for the application of systemic modelling in bioethics, together with a brief example of the application of this method to the study of the impact of personalized medicine on French society.
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Affiliation(s)
- Henri-Corto Stoeklé
- Department of Ethics and Scientific Integrity, Foch Hospital, Suresnes, France
| | - Philippe Charlier
- Laboratoire Anthropologie, Archéologie, Biologie (LAAB), Université Paris-Saclay (UVSQ), 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-Le-Bretonneux, France; Musée du Quai Branly - Jacques-Chirac, 222, rue de l'Université, 75007 Paris, France
| | - Marie-France Mamzer-Bruneel
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, Laboratoire ETRES, F-75006, Paris, France; Cancer Research for Personalized Medicine (CARPEM), Paris Descartes, APHP (HEGP, Cochin, Necker) INSERM, Paris, France; Assistance Publique-Hôpitaux de Paris AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Christian Hervé
- Department of Ethics and Scientific Integrity, Foch Hospital, Suresnes, France; Medical School, University of Paris, Paris, France; International Academy of Medical Ethics and Public Health, Université de Paris, Paris, France
| | - Guillaume Vogt
- Laboratoire Neglected Human Genetics, Inserm, Université Paris Descartes, Paris, France
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Jautrou H. [Direct-to-consumer genetic testing: a regulation by the market, or a medical regulation?]. Med Sci (Paris) 2020; 36:153-159. [PMID: 32129752 DOI: 10.1051/medsci/2019264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The direct-to-consumer genetic testing (DTC-GT) market has been developing for about twenty years now, raising various debates, even controversies. But what about the regulation of these so-called "innovative" devices, but whose medical status is ambiguous? A first regulatory aspect is depending on the market itself, since the latter is currently subjected to a strong structuring process. A second regulatory aspect, more classical, is the legal one. While the DTC-GT status has long been unclear on European scale, a new text (a Regulation, not a Directive) is modifying the situation. It encourages regulation "by the market" rather than "by the medical profession", which does not imply that the latter will have no (indirect) impact on the DTC-GT market.
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Affiliation(s)
- Henri Jautrou
- LISST-Cers (UMR 5193), Université Toulouse II, UFR Sciences Espaces et Sociétés, Département de Sociologie, 31058 Toulouse Cedex 9, France
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Stoeklé HC, Bollet M, Cobat A, Charlier P, Bloch OC, Flatot J, Draghi C, Tolyan V, Hervé C, Desvaux P, Uzan L, Grynberg M, Alcaïs A, Tolédano A, Vogt G. French-style genetics v. 2.0: The "e-CohortE" project. Clin Genet 2019; 96:330-340. [PMID: 31254389 PMCID: PMC6851966 DOI: 10.1111/cge.13595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/14/2019] [Accepted: 06/25/2019] [Indexed: 01/11/2023]
Abstract
In the digital age, a genetics cohort has become much more than a simple means of determining the cause of a disease. Two‐sided markets, of which 23andMe, Ancestry DNA and MyHeritage are the best known, have showed this perfectly over the last few years: a cohort has become a means of producing massive amounts of data for medical, scientific and commercial exploitation, and for genetic use in particular. French law does not currently allow these foreign private companies to develop on French national territory and also forbids the creation of similar entities in France. However, at least in theory, this same law does not preclude the creation of new types of cohorts in France inspired by the success of two‐sided markets but retaining features specific to the French healthcare management system. We propose an optimal solution for France, for genomic studies associated with multi‐subject questionnaires, still purely theoretical for the moment: the development, with no need for any change in the law, of France's own version of “Genetics v.2.0”: “e‐CohortE.”
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Affiliation(s)
- Henri-Corto Stoeklé
- Neglected Human Genetics Laboratory, CEA, Evry, France.,Centre National de Recherche en Génomique Humaine (CNRGH), Direction de la Recherche Fondamentale, CEA, Institut de Biologie François Jacob, Université Paris Saclay, Evry, France.,Institut Sapiens, Paris, France
| | - Marc Bollet
- Institut Rafaël, Maison de l'après cancer, Levallois-Perret, France.,Institut de Radiothérapie et de Radiochirurgie, H Hartmann, Levallois-Perret, France
| | - Aurélie Cobat
- Sorbonne Paris Cité, Imagine Institute, Paris Descartes University, Paris, France.,Laboratory of Human Genetics of Infectious Diseases, INSERM UMR 1163, Necker Branch, Paris, France
| | - Philippe Charlier
- Département de la Recherche et de l'Enseignement, Musée du Quai Branly - Jacques Chirac, Paris, France.,UVSQ (Laboratoire DANTE - EA 4498), Montigny-le-Bretonneux, France
| | - Oudy Ch Bloch
- Institut Rafaël, Maison de l'après cancer, Levallois-Perret, France.,Attorney, Paris, France
| | | | - Clément Draghi
- Institut Rafaël, Maison de l'après cancer, Levallois-Perret, France
| | - Valérie Tolyan
- Institut Rafaël, Maison de l'après cancer, Levallois-Perret, France
| | - Christian Hervé
- International Academy of Ethics, Medicine and Public Health, Paris Descartes University, Paris, France
| | - Pierre Desvaux
- Department of Urology, Cochin hospital, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | | | - Michaël Grynberg
- Service de Médecine de la Reproduction & Préservation de la Fertilité, Hôpital Antoine Béclère, Clamart, France
| | - Alexandre Alcaïs
- Sorbonne Paris Cité, Imagine Institute, Paris Descartes University, Paris, France.,Laboratory of Human Genetics of Infectious Diseases, INSERM UMR 1163, Necker Branch, Paris, France.,French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alain Tolédano
- Institut Rafaël, Maison de l'après cancer, Levallois-Perret, France.,Institut de Radiothérapie et de Radiochirurgie, H Hartmann, Levallois-Perret, France
| | - Guillaume Vogt
- Neglected Human Genetics Laboratory, CEA, Evry, France.,Centre National de Recherche en Génomique Humaine (CNRGH), Direction de la Recherche Fondamentale, CEA, Institut de Biologie François Jacob, Université Paris Saclay, Evry, France.,Institut Sapiens, Paris, France.,Neglected Human Genetics Laboratory, INSERM, Université Paris Descartes, Paris, France
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