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Jeske M, Vasquez E, Fullerton SM, Saperstein A, Bentz M, Foti N, Shim JK, Lee SSJ. Beyond inclusion: Enacting team equity in precision medicine research. PLoS One 2022; 17:e0263750. [PMID: 35130331 PMCID: PMC8820610 DOI: 10.1371/journal.pone.0263750] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/25/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To identify meanings of and challenges to enacting equitable diversification of genomics research, and specifically precision medicine research (PMR), teams. METHODS We conducted in-depth interviews with 102 individuals involved in three U.S.-based precision medicine research consortia and conducted over 400 observation hours of their working group meetings, consortium-wide meetings, and conference presentations. We also reviewed published reports on genomic workforce diversity (WFD), particularly those relevant to the PMR community. RESULTS Our study finds that many PMR teams encounter challenges as they strive to achieve equitable diversification on scientific teams. Interviewees articulated that underrepresented team members were often hired to increase the study's capacity to recruit diverse research participants, but are limited to on-the-ground staff positions with little influence over study design. We find existing hierarchies and power structures in the academic research ecosystem compound challenges for equitable diversification. CONCLUSION Our results suggest that meaningful diversification of PMR teams will only be possible when team equity is prioritized as a core value in academic research communities.
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Affiliation(s)
- Melanie Jeske
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, United States of America
| | - Emily Vasquez
- Department of Sociology, University of Illinois, Chicago, Illinois, United States of America
| | - Stephanie M. Fullerton
- Department of Bioethics & Humanities, School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Aliya Saperstein
- Department of Sociology, Stanford University, Stanford, California, United States of America
| | - Michael Bentz
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY, United States of America
| | - Nicole Foti
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, United States of America
| | - Janet K. Shim
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, United States of America
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY, United States of America
- * E-mail:
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2
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Affiliation(s)
- Chandrasekar Gopalakrishnan
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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3
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Knapp E. "Somatic" Tumor Genomic Profiling and Potential Germline Implications: Ethical Considerations for Children with Cancer. J Law Med Ethics 2020; 48:778-783. [PMID: 33404327 DOI: 10.1177/1073110520979389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Esther Knapp
- Esther Knapp, M.D., M.B.E., is with the Division of Pediatric Hematology/Oncology, Department of Pediatrics at University of Louisville/Norton Children's Hospital
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4
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Abstract
BACKGROUND Precision medicine (PM) research and clinical application is moving forward at a rapid pace. To ensure ethical inclusion of all populations in PM, in-depth understanding of diverse communities' views of PM research and PM implementation is necessary. METHODS Semi-structured interviews were conducted to explore perspectives on PM in a tribally managed healthcare organization. Thematic analysis was used to analyze data from 46 interviews. RESULTS Participants described gains in diagnostic efficiency, risk identification for preventable disease, and the advancement of population-specific biomedical research as key benefits of PM. Concerns expressed related to privacy risks associated with data-sharing, overpromising on PM, and managing patient expectations related to PM. Stakeholders encouraged PM implementation to be preceded by health education activities that leverage a range of communication strategies. CONCLUSION Perspectives described in this study may aid in and should be considered prior to implementation of PM in this and other healthcare systems, especially those serving diverse populations.
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Affiliation(s)
| | | | | | | | - Paul Spicer
- Department of Anthropology, University of Oklahoma, Norman, Oklahoma, USA
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5
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Nau JY. [Not Available]. Rev Med Suisse 2020; 16:1722-1723. [PMID: 32936560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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6
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Affiliation(s)
- Hala T Borno
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco
| | - Jennifer R Rider
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
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7
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Abstract
"Big Data represents a challenge that points to the need for collective and political approaches to self-protection rather than solely individual, atomistic approaches."- Anita Allen, "Protecting One's Own Privacy in a Big Data Economy".
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Abstract
The CRISPR-based genome editing holds immense potential to fix disease-causing mutations, however, must also handle substantial natural genetic variations between individuals. Previous studies have shown that mismatches between the single guide RNA (sgRNA) and genomic DNA may negatively impact sgRNA efficiencies and lead to imprecise specificity prediction. Hence, the genetic variations bring about a great challenge for designing platinum sgRNAs in large human populations. However, they also provide a promising entry for designing allele-specific sgRNAs for the treatment of each individual. The CRISPR system is rather specific, with the potential ability to discriminate between similar alleles, even based on a single nucleotide difference. Genetic variants contribute to the discrimination capabilities, once they generate a novel protospacer adjacent motif (PAM) site or locate in the seed region near an available PAM. Therefore, it can be leveraged to establish allele-specific targeting in numerous dominant human disorders, by selectively ablating the deleterious alleles. So far, allele-specific CRISPR has been increasingly implemented not only in treating dominantly inherited diseases, but also in research areas such as genome imprinting, haploinsufficiency, spatiotemporal loci imaging and immunocompatible manipulations. In this review, we will describe the working principles of allele-specific genome manipulations by virtue of expanding engineering tools of CRISPR. And then we will review new advances in the versatile applications of allele-specific CRISPR targeting in treating human genetic diseases, as well as in a series of other interesting research areas. Lastly, we will discuss their potential therapeutic utilities and considerations in the era of precision medicine.
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Affiliation(s)
- Junjiao Wu
- National Clinical Research Center for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Beisha Tang
- National Clinical Research Center for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan 410008, China
| | - Yu Tang
- National Clinical Research Center for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
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Sleigh J, Schneider M, Amann J, Vayena E. Visualizing an Ethics Framework: A Method to Create Interactive Knowledge Visualizations From Health Policy Documents. J Med Internet Res 2020; 22:e16249. [PMID: 31934866 PMCID: PMC6996733 DOI: 10.2196/16249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Data have become an essential factor in driving health research and are key to the development of personalized and precision medicine. Primary and secondary use of personal data holds significant potential for research; however, it also introduces a new set of challenges around consent processes, privacy, and data sharing. Research institutions have issued ethical guidelines to address challenges and ensure responsible data processing and data sharing. However, ethical guidelines directed at researchers and medical professionals are often complex; require readers who are familiar with specific terminology; and can be hard to understand for people without sufficient background knowledge in legislation, research, and data processing practices. OBJECTIVE This study aimed to visually represent an ethics framework to make its content more accessible to its stakeholders. More generally, we wanted to explore the potential of visualizing policy documents to combat and prevent research misconduct by improving the capacity of actors in health research to handle data responsibly. METHODS We used a mixed methods approach based on knowledge visualization with 3 sequential steps: qualitative content analysis (open and axial coding, among others); visualizing the knowledge structure, which resulted from the previous step; and adding interactive functionality to access information using rapid prototyping. RESULTS Through our iterative methodology, we developed a tool that allows users to explore an ethics framework for data sharing through an interactive visualization. Our results represent an approach that can make policy documents easier to understand and, therefore, more applicable in practice. CONCLUSIONS Meaningful communication and understanding each other remain a challenge in various areas of health care and medicine. We contribute to advancing communication practices through the introduction of knowledge visualization to bioethics to offer a novel way to tackle this relevant issue.
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Affiliation(s)
- Joanna Sleigh
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Manuel Schneider
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Julia Amann
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Effy Vayena
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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Abstract
Scholars have shown that promoting diversity and inclusion in precision medicine research is important for ethical and scientific reasons. The processes for classifying the populations that enroll in biomedical research, however, are often unclear, inconsistent, and poorly justified. Precision medicine research promises increasingly meticulous approaches to defining research cohorts and assessing the multivariate factors at the root of racial health disparities. Insofar as precision medicine is promoted to members of historically underrepresented populations as a tool for illuminating these factors, the use of race-based classifications is fraught with risks for society and medicine. This article examines the drivers and limitations of the ongoing use of race by investigators juxtaposed with recent efforts to enroll underrepresented populations in precision medicine research.
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Affiliation(s)
- Shawneequa L. Callier
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, DC
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
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11
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Scheper A. AMA Policies and Code of Medical Ethics Opinions Related to Human Genome Editing. AMA J Ethics 2019; 21:E1056-1058. [PMID: 31876469 DOI: 10.1001/amajethics.2019.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Recent research using gene editing technologies has made such tools more accessible and easier to use, fueling the promise of their therapeutic capacity. However, development of gene editing tools reminds professionals and the public that these technologies' potential use extends beyond treating somatic disease to germline editing, with consequences yet unknown. This article canvasses AMA Code of Medical Ethics' opinions and policies relevant to gene editing.
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Abstract
BACKGROUND Novel precision oncology trial designs, such as basket and umbrella trials, are designed to test new anticancer agents in more effective and affordable ways. However, they present some ethical concerns referred to scientific validity, risk-benefit balance and informed consent. Our aim is to discuss these issues in basket and umbrella trials, giving examples of two ongoing cancer trials: NCI-MATCH (National Cancer Institute - Molecular Analysis for Therapy Choice) and Lung-MAP (Lung Cancer Master Protocol) study. MAIN BODY We discuss three ethical requirements for clinical trials which may be challenged in basket and umbrella trial designs. Firstly, we consider scientific validity. Thanks to the new trial designs, patients with rare malignancies have the opportunity to be enrolled and benefit from the trial, but due to insufficient accrual, the trial may generate clinically insignificant findings. Inadequate sample size in study arms and the use of surrogate endpoints may result in a drug approval without confirmed efficacy. Moreover, complexity, limited quality and availability of tumor samples may not only introduce bias and result in unreliable and unrepresentative findings, but also can potentially harm patients and assign them to an inappropriate therapy arm. Secondly, we refer to benefits and risks. Novel clinical trials can gain important knowledge on the variety of tumors, which can be used in future trials to develop effective therapies. However, they offer limited direct benefits to patients. All potential participants must wait about 2 weeks for the results of the genetic screening, which may be stressful and produce anxiety. The enrollment of patients whose tumors harbor multiple mutations in treatments matching a single mutation may be controversial. As to informed consent - the third requirement we discuss, the excessive use of phrases like "personalized medicine", "tailored therapy" or "precision oncology" might be misleading and cause personal convictions that the study protocol is designed to fulfill the individual health-related needs of participants. CONCLUSIONS We suggest that further approaches should be implemented to enhance scientific validity, reduce misunderstandings and risks, thus maximizing the benefits to society and to trial participants.
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Affiliation(s)
- Karolina Strzebonska
- REMEDY, Research Ethics in Medicine Study Group, Department of Philosophy and Bioethics, Jagiellonian University Medical College, ul. Michałowskiego 12, 31-126 Krakow, Poland
| | - Marcin Waligora
- REMEDY, Research Ethics in Medicine Study Group, Department of Philosophy and Bioethics, Jagiellonian University Medical College, ul. Michałowskiego 12, 31-126 Krakow, Poland
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Abstract
The digital revolution is disrupting the ways in which health research is conducted, and subsequently, changing healthcare. Direct-to-consumer wellness products and mobile apps, pervasive sensor technologies and access to social network data offer exciting opportunities for researchers to passively observe and/or track patients 'in the wild' and 24/7. The volume of granular personal health data gathered using these technologies is unprecedented, and is increasingly leveraged to inform personalized health promotion and disease treatment interventions. The use of artificial intelligence in the health sector is also increasing. Although rich with potential, the digital health ecosystem presents new ethical challenges for those making decisions about the selection, testing, implementation and evaluation of technologies for use in healthcare. As the 'Wild West' of digital health research unfolds, it is important to recognize who is involved, and identify how each party can and should take responsibility to advance the ethical practices of this work. While not a comprehensive review, we describe the landscape, identify gaps to be addressed, and offer recommendations as to how stakeholders can and should take responsibility to advance socially responsible digital health research.
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Affiliation(s)
- Camille Nebeker
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA.
- Research Center for Optimal Digital Ethics in Health, Qualcomm Institute and School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA.
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
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14
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Abstract
Precision medicine research is rapidly taking a lead role in the pursuit of new ways to improve health and prevent disease, but also presents new challenges for protecting human subjects. The extent to which the current "web" of legal protections, including technical data security measures, as well as measures to restrict access or prevent misuse of research data, will protect participants in this context remains largely unknown. Understanding the strength, usefulness, and limitations of this constellation of laws, regulations, and procedures is critical to ensuring not only that participants are protected, but also that their participation decisions are accurately informed. To address these gaps, we conducted in-depth interviews with a diverse group of 60 thought-leaders to explore their perspectives on the protections associated with precision medicine research.
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Affiliation(s)
- Catherine M Hammack
- Catherine M. Hammack, M.A., J.D., is an Associate in Health Policy in the Center for Biomedical Ethics & Society at Vanderbilt University Medical Center (Nashville, TN). Kathleen M. Brelsford, M.P.H., Ph.D., is a Research Assistant Professor in the Center for Biomedical Ethics & Society at Vanderbilt University Medical Center (Nashville, TN). Laura M. Beskow, M.P.H., Ph.D., is a Professor of Health Policy and Ann Geddes Stahlman Chair in Medical Ethics in the Center for Biomedical Ethics & Society at Vanderbilt University Medical Center (Nashville, TN)
| | - Kathleen M Brelsford
- Catherine M. Hammack, M.A., J.D., is an Associate in Health Policy in the Center for Biomedical Ethics & Society at Vanderbilt University Medical Center (Nashville, TN). Kathleen M. Brelsford, M.P.H., Ph.D., is a Research Assistant Professor in the Center for Biomedical Ethics & Society at Vanderbilt University Medical Center (Nashville, TN). Laura M. Beskow, M.P.H., Ph.D., is a Professor of Health Policy and Ann Geddes Stahlman Chair in Medical Ethics in the Center for Biomedical Ethics & Society at Vanderbilt University Medical Center (Nashville, TN)
| | - Laura M Beskow
- Catherine M. Hammack, M.A., J.D., is an Associate in Health Policy in the Center for Biomedical Ethics & Society at Vanderbilt University Medical Center (Nashville, TN). Kathleen M. Brelsford, M.P.H., Ph.D., is a Research Assistant Professor in the Center for Biomedical Ethics & Society at Vanderbilt University Medical Center (Nashville, TN). Laura M. Beskow, M.P.H., Ph.D., is a Professor of Health Policy and Ann Geddes Stahlman Chair in Medical Ethics in the Center for Biomedical Ethics & Society at Vanderbilt University Medical Center (Nashville, TN)
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Abstract
In this issue of the Hastings Center Report, Maya Sabatello and Paul Appelbaum explore the assumptions about community embedded in the U.S. Precision Medicine Initiative, which aims to recruit donor-partners who reflect the United States' racial and ethnic diversity. As Sabatello and Appelbaum discuss, the initiative is like other national biobanking efforts in bringing to life an imagined genetic community in need of critical attention, and given the public-private forms of partnership at the heart of the PMI, such efforts could become avenues to deepen existing inequalities rather than to alleviate them. The notion of justice has underwritten debates about genomic medicine, informed consent, citizenship, benefit sharing, and profit making since the first national biobanking project emerged at the dawn of the twenty-first century. In a paradigmatic case, the creation, by an Icelandic company, of the deCODE genomic biobank opened up fierce debates about the proper relationship between public good and private gain and became the first global example of the economic and political implications that imagined genetic communities could have in our shared future. In Mexico, in 2001, the Icelandic case fueled a policy agenda to deal with global health justice and the prospects of a future market-based colonialism predicated on the intimate knowledge of DNA.
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Abstract
The goal of this article is to examine the intersections of precision health and rare diseases. Specifically, we propose 3 lessons from the last decade of applying genomics to rare diseases: (1) precision can end one odyssey and start another; (2) precise interventions can exacerbate health disparities and create other ethical dilemmas; and (3) democratization of data will transform research and translation. By studying experiences of patients with rare diseases, researchers, clinicians, and policymakers can anticipate similar challenges in precision medicine and hopefully mitigate potential harms or injustices.
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Affiliation(s)
- Holly K Tabor
- An associate professor in the Stanford University Department of Medicine and the associate director for clinical ethics and education at the Stanford Center for Biomedical Ethics in Stanford, California
| | - Aaron Goldenberg
- An associate professor of bioethics and the associate director of the Center for Genetic Research Ethics and Law at Case Western Reserve University School of Medicine in Cleveland, Ohio
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Wouters RHP, Bijlsma RM, Voest EE, Bredenoord AL. [Unsolicited genomic findings in daily clinical practice]. Ned Tijdschr Geneeskd 2018; 162:D2087. [PMID: 30040258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Whole genome sequencing (WGS) is increasingly being used in clinical practice. As a result, various healthcare professionals now encounter ethical dilemmas that were formerly confined within the genetics clinic. In addition to autonomy and well-being of both patients and their family members, which need to be balanced carefully, a societal perspective is also vital to ensure the ethically sound introduction of whole genome sequencing into daily practice. Important choices to be made are: who is eligible for whole genome sequencing; how can informed consent be sensibly obtained, when dealing with such vast quantities of genomic information; which type of information should be offered to patients; should professionals actively search for pathogenic mutations. The rise of WGS has an impact on the moral responsibilities incumbent on healthcare professionals and necessitates a comprehensive societal debate on the advent of personalized medicine.
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Affiliation(s)
- Roel H P Wouters
- UMC Utrecht, afd. Medical Humanities, Julius Centrum
- Contact: R.H.P. Wouters
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Wouters RHP, Bijlsma RM, Voest EE, Bredenoord AL. [Ethical dilemmas in a general practitioner's clinic due to incidental findings resulting from whole genome sequencing]. Ned Tijdschr Geneeskd 2018; 162:D2087. [PMID: 31035742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Whole genome sequencing (WGS) is increasingly being used in clinical practice. As a result, various healthcare professionals now encounter ethical dilemmas that were formerly confined within the genetics clinic. In addition to autonomy and well-being of both patients and their family members, which need to be balanced carefully, a societal perspective is also vital to ensure the ethically sound introduction of whole genome sequencing into daily practice. Important choices to be made are: who is eligible for whole genome sequencing; how can informed consent be sensibly obtained, when dealing with such vast quantities of genomic information; which type of information should be offered to patients; should professionals actively search for pathogenic mutations. The rise of WGS has an impact on the moral responsibilities incumbent on healthcare professionals and necessitates a comprehensive societal debate on the advent of personalized medicine.
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Affiliation(s)
- Roel H P Wouters
- UMC Utrecht, afd. Medical Humanities, Julius Centrum
- Contact: R.H.P. Wouters
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19
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Affiliation(s)
- Maya Sabatello
- Department of Psychiatry, Columbia University, New York, New York, USA
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20
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Hewitt JE. The Ethical, Legal and Regulatory Issues Associated with Pharmacogenomics: Systematically Quantifying the Literature. J Law Med 2018; 25:782-793. [PMID: 29978667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Since the human genome was successfully mapped much academic attention has been given to ethical, legal and regulatory issues associated with the integration and application of genomics in health care. In line with the recent political commitment to promoting precision medicine that relies heavily on omic knowledge, it is timely to review the issues that this body of literature has addressed. Focusing on pharmacogenomics, this review quantifies the issues identified in this body of academic work. It reveals that, after nearly two decades, interest in the regulatory and legal issues associated with pharmacogenomics continues to generate significant attention. The ethical issues, while not as predominant, also persist. The analyses highlights that there is a dearth of empirical research exploring the impact that these issues have had.
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Boers SN, de Winter-de Groot KM, Noordhoek J, Gulmans V, van der Ent CK, van Delden JJM, Bredenoord AL. Mini-guts in a dish: Perspectives of adult Cystic Fibrosis (CF) patients and parents of young CF patients on organoid technology. J Cyst Fibros 2018. [PMID: 29523474 DOI: 10.1016/j.jcf.2018.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Organoid technology enables the cultivation of human tissues in a dish. Its precision medicine potential could revolutionize the Cystic Fibrosis (CF) field. We provide a first thematic exploration of the patient perspective on organoid technology to set the further research agenda, which is necessary for responsible development of this ethically challenging technology. METHODS 23 semi-structured qualitative interviews with 14 Dutch adult CF patients and 12 parents of young CF patients to examine their experiences, opinions, and attitudes regarding organoid technology. RESULTS Four themes emerged: (1) Respondents express a close as well as a distant relationship to organoids; (2) the open-endedness of organoid technology sparks hopes and concerns, (3) commercial use evokes cautiousness. (4) Respondents mention the importance of sound consent procedures, long-term patient engagement, responsible stewardship, and stringent conditions for commercial use. CONCLUSIONS The precision medicine potential of organoid technology can only be realized if the patient perspective is taken adequately into account.
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Affiliation(s)
- Sarah N Boers
- Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Center Utrecht, Internal post Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Karin M de Winter-de Groot
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Internal post KH.01.419.0, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
| | - Jacquelien Noordhoek
- Dutch Cystic Fibrosis Foundation (NCFS), Dr. A. Schweitzerweg 3A, 3744 MG Baarn, The Netherlands.
| | - Vincent Gulmans
- Dutch Cystic Fibrosis Foundation (NCFS), Dr. A. Schweitzerweg 3A, 3744 MG Baarn, The Netherlands.
| | - Cornelis K van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Internal post KH.01.419.0, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
| | - Johannes J M van Delden
- Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Center Utrecht, Internal post Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Annelien L Bredenoord
- Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Center Utrecht, Internal post Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
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22
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Affiliation(s)
| | | | | | | | - John Lantos
- e Children's Mercy Hospital and University of Missouri at Kansas City
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23
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Abstract
Inclusion of children in medical decision making, to the extent of their ability and interest in doing so, should be the default position, ensuring that children are routinely given a voice. However, optimizing the involvement of children in their health care decisions remains challenging for clinicians. Missing from the literature is a stepwise approach to assessing when and how a child should be included in medical decision making. We propose a systematic approach for doing so, and we apply this approach in a discussion of two challenging clinical cases. The approach is informed by a literature review, and is anchored by case studies of teenagers' refusal of clinical care, regulatory requirements for research assent, and the accepted approach to involving cognitively impaired adults in medical decisions.
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Lin JC, Fan CT, Liao CC, Chen YS. Taiwan Biobank: making cross-database convergence possible in the Big Data era. Gigascience 2018; 7:1-4. [PMID: 29149267 PMCID: PMC5774504 DOI: 10.1093/gigascience/gix110] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/29/2017] [Accepted: 11/07/2017] [Indexed: 11/30/2022] Open
Abstract
The Taiwan Biobank (TWB) is a biomedical research database of biopsy data from 200 000 participants. Access to this database has been granted to research communities taking part in the development of precision medicines; however, this has raised issues surrounding TWB's access to electronic medical records (EMRs). The Personal Data Protection Act of Taiwan restricts access to EMRs for purposes not covered by patients' original consent. This commentary explores possible legal solutions to help ensure that the access TWB has to EMR abides with legal obligations, and with governance frameworks associated with ethical, legal, and social implications. We suggest utilizing "hash function" algorithms to create nonretrospective, anonymized data for the purpose of cross-transmission and/or linkage with EMR.
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Affiliation(s)
- Jui-Chu Lin
- National Taiwan University of Science and Technology, No. 43, Keelung Rd., Sec. 4, Dayan District, Taipei, Taiwan 10607 (ROC)
| | - Chien-Te Fan
- Institute of Law for Science and Technology National Tsing Hua University, No. 101, Sec. 2, Kuang-Fu Rd., Hsinchu, Taiwan 30013 (ROC)
| | - Chia-Cheng Liao
- Saint Island International Patent & Law Offices, 11F-1, No. 248, Sec. 3, Nanking E. Rd., Taipei, Taiwan 10595
| | - Yao-Sheng Chen
- National Taiwan University of Science and Technology, No. 43, Keelung Rd., Sec. 4, Dayan District, Taipei, Taiwan 10607 (ROC)
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Shoaib M, Rameez MAM, Hussain SA, Madadin M, Menezes RG. Personalized Medicine in a New Genomic Era: Ethical and Legal Aspects. Sci Eng Ethics 2017; 23:1207-1212. [PMID: 27896605 DOI: 10.1007/s11948-016-9828-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 09/12/2016] [Indexed: 06/06/2023]
Abstract
The genome of two completely unrelated individuals is quite similar apart from minor variations called single nucleotide polymorphisms which contribute to the uniqueness of each and every person. These single nucleotide polymorphisms are of great interest clinically as they are useful in figuring out the susceptibility of certain individuals to particular diseases and for recognizing varied responses to pharmacological interventions. This gives rise to the idea of 'personalized medicine' as an exciting new therapeutic science in this genomic era. Personalized medicine suggests a unique treatment strategy based on an individual's genetic make-up. Its key principles revolve around applied pharmaco-genomics, pharmaco-kinetics and pharmaco-proteomics. Herein, the ethical and legal aspects of personalized medicine in a new genomic era are briefly addressed. The ultimate goal is to comprehensively recognize all relevant forms of genetic variation in each individual and be able to interpret this information in a clinically meaningful manner within the ambit of ethical and legal considerations. The authors of this article firmly believe that personalized medicine has the potential to revolutionize the current landscape of medicine as it makes its way into clinical practice.
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Affiliation(s)
- Maria Shoaib
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Syed Ather Hussain
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohammed Madadin
- Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Kingdom of Saudi Arabia
- Victorian Institute of Forensic Medicine, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Ritesh G Menezes
- Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Kingdom of Saudi Arabia.
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Abstract
The United States' ambitious Precision Medicine Initiative proposes to accelerate exponentially the adoption of precision medicine, an approach to health care that tailors disease diagnosis, treatment, and prevention to individual variability in genes, environment, and lifestyle. It aims to achieve this by creating a cohort of volunteers for precision medicine research, accelerating biomedical research innovation, and adopting policies geared toward patients' empowerment. As strategies to implement the PMI are formulated, critical consideration of the initiative's ethical and sociopolitical dimensions is needed. Drawing on scholarship of nationalism and democracy, we discuss the PMI's construction of what we term "genomic citizenship"; the possible normative obligations arising therefrom; and the ethical, legal, and social challenges that will ensue. Although the PMI is a work in progress, discussion of the existing and emerging issues can facilitate the development of policies, structures, and procedures that can maximize the initiative's ability to produce equitable and socially sensitive outcomes. Our analysis can also be applied to other population-based, precision medicine research programs.
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Kohler JN, Turbitt E, Lewis KL, Wilfond BS, Jamal L, Peay HL, Biesecker LG, Biesecker BB. Defining personal utility in genomics: A Delphi study. Clin Genet 2017; 92:290-297. [PMID: 28218387 DOI: 10.1111/cge.12998] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Individual genome sequencing results are valued by patients in ways distinct from clinical utility. Such outcomes have been described as components of "personal utility," a concept that broadly encompasses patient-endorsed benefits, that is operationally defined as non-clinical outcomes. No empirical delineation of these outcomes has been reported. AIM To address this gap, we administered a Delphi survey to adult participants in a National Institute of Health (NIH) clinical exome study to extract the most highly endorsed outcomes constituting personal utility. MATERIALS AND METHODS Forty research participants responded to a Delphi survey to rate 35 items identified by a systematic literature review of personal utility. RESULTS Two rounds of ranking resulted in 24 items that represented 14 distinct elements of personal utility. Elements most highly endorsed by participants were: increased self-knowledge, knowledge of "the condition," altruism, and anticipated coping. DISCUSSION Our findings represent the first systematic effort to delineate elements of personal utility that may be used to anticipate participant expectation and inform genetic counseling prior to sequencing. The 24 items reported need to be studied further in additional clinical genome sequencing studies to assess generalizability in other populations. Further research will help to understand motivations and to predict the meaning and use of results.
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Affiliation(s)
- J N Kohler
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, Maryland
| | - E Turbitt
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, Maryland
| | - K L Lewis
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, Maryland
| | - B S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - L Jamal
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland
| | - H L Peay
- RTI International, Research Triangle Park, Durham, North Carolina
| | - L G Biesecker
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, Maryland
| | - B B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes Health, Bethesda, Maryland
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Abstract
In engaging critically with personalised medicine and mapping pitfalls which mark its progress this project aims to stimulate conversations which deal intelligently with controversies for the sake of consensus. We aim to ask the ethical questions which will lead to the improvement of healthcare and we take an open-minded approach to finding answers to them over time. What is or should be meant by 'personalised medicine' is a major theme of this issue. It is a debate bound up with question of both values in the sense of ethical reflection and value in the sense of economic return. This editorial discusses and interrelates the articles of the issue under four headings: the promise and the hype of personalised medicine; the human person and the communication of risk; data sharing and participation; value, equity and power. A key intention throughout is to provoke discourse and debate, to identify aspirations which are more grounded in myth or hype than reality and to challenge them; and to identify focussed, practical questions which need further examination.
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Abstract
Artificial Intelligence (AI) is a general term that implies the use of a computer to model intelligent behavior with minimal human intervention. AI is generally accepted as having started with the invention of robots. The term derives from the Czech word robota, meaning biosynthetic machines used as forced labor. In this field, Leonardo Da Vinci's lasting heritage is today's burgeoning use of robotic-assisted surgery, named after him, for complex urologic and gynecologic procedures. Da Vinci's sketchbooks of robots helped set the stage for this innovation. AI, described as the science and engineering of making intelligent machines, was officially born in 1956. The term is applicable to a broad range of items in medicine such as robotics, medical diagnosis, medical statistics, and human biology-up to and including today's "omics". AI in medicine, which is the focus of this review, has two main branches: virtual and physical. The virtual branch includes informatics approaches from deep learning information management to control of health management systems, including electronic health records, and active guidance of physicians in their treatment decisions. The physical branch is best represented by robots used to assist the elderly patient or the attending surgeon. Also embodied in this branch are targeted nanorobots, a unique new drug delivery system. The societal and ethical complexities of these applications require further reflection, proof of their medical utility, economic value, and development of interdisciplinary strategies for their wider application.
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Affiliation(s)
- Pavel Hamet
- Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada, H2X 0A9; Department of Medicine, Université de Montréal, Montréal, Québec, Canada, H3T 3J7.
| | - Johanne Tremblay
- Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada, H2X 0A9; Department of Medicine, Université de Montréal, Montréal, Québec, Canada, H3T 3J7.
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Salari P, Larijani B. Ethical Issues Surrounding Personalized Medicine: A Literature Review. Acta Med Iran 2017; 55:209-217. [PMID: 28282721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 06/06/2023] Open
Abstract
More than a decade ago, personalized medicine was presented in modern medicine. Personalized medicine means that the right drug should be prescribed for the right patient based on genetic data. No doubt is developing medical sciences, and its shift into personalized medicine complicates ethical challenges more than before. In this review, we categorized all probable ethical considerations of personalized medicine in research and development and service provision. Based on our review, extensive changes in healthcare system including ethical changes are needed to overcome the ethical obstacles including knowledge gap and informed consent, privacy and confidentiality and availability of healthcare services. Furthermore social benefit versus science development and individual benefit should be balanced. Therefore guidelines and regulations should be compiled to represent the ethical framework; also ethical decision making should be day-to-day and individualized.
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Affiliation(s)
- Pooneh Salari
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical
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Abstract
Nanomedicine offers remarkable options for new therapeutic avenues. As methods in nanomedicine advance, ethical questions conjunctly arise. Nanomedicine is an exceptional niche in several aspects as it reflects risks and uncertainties not encountered in other areas of medical research or practice. Nanomedicine partially overlaps, partially interlocks and partially exceeds other medical disciplines. Some interpreters agree that advances in nanotechnology may pose varied ethical challenges, whilst others argue that these challenges are not new and that nanotechnology basically echoes recurrent bioethical dilemmas. The purpose of this article is to discuss some of the ethical issues related to nanomedicine and to reflect on the question whether nanomedicine generates ethical challenges of new and unique nature. Such a determination should have implications on regulatory processes and professional conducts and protocols in the future.
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Affiliation(s)
- Irit Allon
- Chief Scientists Office, Ministry of Health, 39 Yirmiyahu St., Jerusalem, Israel.
- Department of Oral Pathology and Oral Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Ahmi Ben-Yehudah
- Chief Scientists Office, Ministry of Health, 39 Yirmiyahu St., Jerusalem, Israel
| | - Raz Dekel
- Head of Occupational Medicine Services, Ministry of Health, Tel Aviv, Israel
| | - Jan-Helge Solbakk
- Centre for Medical Ethics Faculty, Medicine University of Oslo, Oslo, Norway
| | | | - Gil Siegal
- University of Virginia School of Law, Charlottesville, VA, USA
- Gertner Institute of Public Policy, Ministry of Health, Ono Academic College, Kiryat Ono, Israel
- Center for Health Law, Bioethics and Health Policy, Ono Academic College, Kiryat Ono, Israel
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Abstract
In our time of genome-based personalized medicine, clinical research and clinical medicine are accelerating at a quick pace. Faster and cheaper DNA sequencing and protein profiling, microfluidic devices for capturing blood biomarkers, nanoparticles for precise drug delivery and enhanced imaging, rapid computational analysis of massive data inputs, and other technological wonders coalesce to create a kind of Moore's Law for medicine. Needs are obvious, knowledge grows, capital becomes available, but these factors are not entirely sufficient to make health more achievable. Personalized medicine also requires social acceptability, not only for accuracy and efficacy but also because medicine is a moral domain. This chapter deals with medical ethics that determine the choices a society makes regarding healthcare; and it has not always been a steady, morally correct course of progress. Indeed, medical ethics has largely derived from socio-scientific calamities in the past. Personalized medicine, with its enhanced capacity to access the individuality of illness, must have a continuously evolving feedback mechanism-the most important element being the physician-patient relationship-which is its ethical footing.
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Affiliation(s)
- G Terry Sharrer
- Retired Surator of Health Sciences - Smithsonian Institution, Washington, DC, USA.
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Vos S, van Delden JJM, van Diest PJ, Bredenoord AL. Moral Duties of Genomics Researchers: Why Personalized Medicine Requires a Collective Approach. Trends Genet 2016; 33:118-128. [PMID: 28017398 DOI: 10.1016/j.tig.2016.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/21/2016] [Accepted: 11/28/2016] [Indexed: 12/30/2022]
Abstract
Advances in genome sequencing together with the introduction of personalized medicine offer promising new avenues for research and precision treatment, particularly in the field of oncology. At the same time, the convergence of genomics, bioinformatics, and the collection of human tissues and patient data creates novel moral duties for researchers. After all, unprecedented amounts of potentially sensitive information are being generated. Over time, traditional research ethics principles aimed at protecting individual participants have become supplemented with social obligations related to the interests of society and the research enterprise at large, illustrating that genomic medicine is also a social endeavor. In this review we provide a comprehensive assembly of moral duties that have been attributed to genomics researchers and offer suggestions for responsible advancement of personalized genomic cancer care.
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Affiliation(s)
- Shoko Vos
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Johannes J M van Delden
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annelien L Bredenoord
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht, The Netherlands
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Zacharias RL. Skepticism in the Genomic Era. Hastings Cent Rep 2016; 46:inside front cover. [PMID: 27875644 DOI: 10.1002/hast.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
I joined The Hastings Center this past summer, after graduating from Duke University, where I researched advancements in neuroscience and genomics and their import for law, ethics, and policy. This research required, to an extent, faith in the idea that researchers can identify pathways by which genes combine with epigenetic and environmental factors to affect neuronal activity and influence behaviors. Throughout my first months here, I have puzzled over broad critiques of "genomic hype" in recent literature, which clash with the optimistic rhetoric found in the Human Genome Project and the Precision Medicine Initiative.
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Blasimme A, Vayena E. Becoming partners, retaining autonomy: ethical considerations on the development of precision medicine. BMC Med Ethics 2016; 17:67. [PMID: 27809825 PMCID: PMC5096300 DOI: 10.1186/s12910-016-0149-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 10/18/2016] [Indexed: 11/10/2022] Open
Abstract
Precision medicine promises to develop diagnoses and treatments that take individual variability into account. According to most specialists, turning this promise into reality will require adapting the established framework of clinical research ethics, and paying more attention to participants' attitudes towards sharing genotypic, phenotypic, lifestyle data and health records, and ultimately to their desire to be engaged as active partners in medical research.Notions such as participation, engagement and partnership have been introduced in bioethics debates concerning genetics and large-scale biobanking to broaden the focus of discussion beyond individual choice and individuals' moral interests. The uptake of those concepts in precision medicine is to be welcomed. However, as data and medical information from research participants in precision medicine cohorts will be collected on an individual basis, translating a participatory approach in this emerging area may prove cumbersome. Therefore, drawing on Joseph Raz's perfectionism, we propose a principle of respect for autonomous agents that, we reckon, can address many of the concerns driving recent scholarship on partnership and public participation, while avoiding some of the limitations these concept have in the context of precision medicine. Our approach offers a normative clarification to how becoming partners in precision is compatible with retaining autonomy.Realigning the value of autonomy with ideals of direct engagement, we show, can provide adequate normative orientation to precision medicine; it can do justice to the idea of moral pluralism by stressing the value of moral self-determination: and, finally, it can reconcile the notion of autonomy with other more communitarian values such as participation and solidarity.
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Affiliation(s)
- Alessandro Blasimme
- Health Ethics and Policy Lab, University of Zurich, 84 Hirshengraben, 8001 Zurich, Switzerland
- U1027 Inserm – Université Paul Sabatier, Toulouse, France
| | - Effy Vayena
- Health Ethics and Policy Lab, University of Zurich, 84 Hirshengraben, 8001 Zurich, Switzerland
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Callier SL, Abudu R, Mehlman MJ, Singer ME, Neuhauser D, Caga-Anan C, Wiesner GL. Ethical, Legal, and Social Implications of Personalized Genomic Medicine Research: Current Literature and Suggestions for the Future. Bioethics 2016; 30:698-705. [PMID: 27767224 DOI: 10.1111/bioe.12285] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/27/2016] [Accepted: 05/16/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE This review identifies the prominent topics in the literature pertaining to the ethical, legal, and social issues (ELSI) raised by research investigating personalized genomic medicine (PGM). METHODS The abstracts of 953 articles extracted from scholarly databases and published during a 5-year period (2008-2012) were reviewed. A total of 299 articles met our research criteria and were organized thematically to assess the representation of ELSI issues for stakeholders, health specialties, journals, and empirical studies. RESULTS ELSI analyses were published in both scientific and ethics journals. Investigational research comprised 45% of the literature reviewed (135 articles) and the remaining 55% (164 articles) comprised normative analyses. Traditional ELSI concerns dominated the discourse including discussions about disclosure of research results. In fact, there was a dramatic increase in the number of articles focused on the disclosure of research results and incidental findings to research participants. Few papers focused on particular disorders, the use of racial categories in research, international communities, or special populations (e.g., adolescents, elderly patients, or ethnic groups). CONCLUSION Considering that strategies in personalized medicine increasingly target individuals' unique health conditions, environments, and ancestries, further analysis is needed on how ELSI scholarship can better serve the increasingly global, interdisciplinary, and diverse PGM research community.
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Abstract
Over the last decade, personalized medicine has become a buzz word, which covers a broad spectrum of meanings and generates many different opinions. The purpose of this article is to achieve a better understanding of the reasons why personalized medicine gives rise to such conflicting opinions. We show that a major issue of personalized medicine is the gap existing between its claims and its reality. We then present and analyze different possible reasons for this gap. We propose an hypothesis inspired by the Windelband's distinction between nomothetic and idiographic methodology. We argue that the fuzzy situation of personalized medicine results from a mix between idiographic claims and nomothetic methodological procedures. Hence we suggest that the current quandary about personalized medicine cannot be solved without getting involved in a discussion about the complex epistemological and methodological status of medicine. To conclude, we show that the Gadamer's view of medicine as a dialogical process can be fruitfully used and reveals that personalization is not a theoretical task, but a practical one, which takes place within the clinical encounter.
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Affiliation(s)
- Camille Abettan
- Center of Interdisciplinary Researches in Human and Social Sciences (CRISES, EA 4424), Paul-Valéry University, Rue du Professeur Henri Serre, 34090, Montpellier, France.
- Espace Régional de Réflexion Éthique du Languedoc-Roussillon, Hôpital La Colombière, 39 Avenue Charles Flahault, 34295, Montpellier Cedex 5, France.
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Juengst E, McGowan ML, Fishman JR, Settersten RA. From "Personalized" to "Precision" Medicine: The Ethical and Social Implications of Rhetorical Reform in Genomic Medicine. Hastings Cent Rep 2016; 46:21-33. [PMID: 27649826 PMCID: PMC5153661 DOI: 10.1002/hast.614] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Since the late 1980s, the human genetics and genomics research community has been promising to usher in a "new paradigm for health care"-one that uses molecular profiling to identify human genetic variants implicated in multifactorial health risks. After the completion of the Human Genome Project in 2003, a wide range of stakeholders became committed to this "paradigm shift," creating a confluence of investment, advocacy, and enthusiasm that bears all the marks of a "scientific/intellectual social movement" within biomedicine. Proponents of this movement usually offer four ways in which their approach to medical diagnosis and health care improves upon current practices, arguing that it is more "personalized," "predictive," "preventive," and "participatory" than the medical status quo. Initially, it was personalization that seemed to best sum up the movement's appeal. By 2012, however, powerful opinion leaders were abandoning "personalized medicine" in favor of a new label: "precision medicine." The new label received a decisive seal of approval when, in January 2015, President Obama unveiled plans for a national "precision medicine initiative" to promote the development and use of genomic tools in health care.
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Goodman D, Johnson CO, Wenzel L, Bowen D, Condit C, Edwards KL. Consent Issues in Genetic Research: Views of Research Participants. Public Health Genomics 2016; 19:220-8. [PMID: 27376949 PMCID: PMC4996754 DOI: 10.1159/000447346] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/02/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND With the arrival of large-scale population-based genomic research studies, such as the Precision Medicine Initiative (PMI), the question of how to best consent participants is significant, and in an era of patient-centered research, few studies have evaluated participants' preferences about re-consent and broad consent. Using quantitative methods, this study evaluates participants' views regarding the acceptability of re-consent and broad consent in subjects from the Participant Issues Project. METHODS A total of 450 participants were recruited from a cancer genetics registry, including cancer patients, their relatives, and controls. Participants completed a secure online survey. RESULTS Most participants endorsed re-consent when investigating an unrelated health condition or sharing their de-identified data with an investigator at a different institution. Notification rather than re-consent was preferred when studying a different gene but the same disease. Over 80% of respondents endorsed re-consent when parents of a child gave the original consent and the child has now reached adulthood. Preferences for some scenarios varied by history of cancer at baseline, gender, stage of cancer, or case versus control group. The large majority of participants preferred the option to select broad consent categories of research. CONCLUSION Understanding research participants' preferences, including their views on the need for re-consent, are critical to the success of the PMI.
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Abstract
In recent years, it has become almost axiomatic that biomedical research and clinical practice should be 'innovative'-that is, that they should be always evolving and directed towards the production, translation and implementation of new technologies and practices. While this drive towards innovation in biomedicine might be beneficial, it also raises serious moral, legal, economic and sociopolitical questions that require further scrutiny. In this article, we argue that biomedical innovation needs to be accompanied by a dedicated 'bioethics of innovation' that attends systematically to the goals, process and outcomes of biomedical innovation as objects of critical inquiry. Using the example of personalised or precision medicine, we then suggest a preliminary framework for a bioethics of innovation, based on the research policy initiative of 'Responsible Innovation'. We invite and encourage critiques of this framework and hope that this will provoke a challenging and enriching new bioethical discourse.
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Hey SP, Barsanti-Innes B. Epistemology, Ethics, and Progress in Precision Medicine. Perspect Biol Med 2016; 59:293-310. [PMID: 28479573 DOI: 10.1353/pbm.2016.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The emerging paradigm of precision medicine strives to leverage the tools of molecular biology to prospectively tailor treatments to the individual patient. Fundamental to the success of this movement is the discovery and validation of "predictive biomarkers," which are properties of a patient's biological specimens that can be assayed in advance of therapy to inform the treatment decision. Unfortunately, research into biomarkers and diagnostics for precision medicine has fallen well short of expectations. In this essay, we examine the portfolio of research activities into the excision repair cross complement group 1 (ERCC1) gene as a predictive biomarker for precision lung cancer therapy as a case study in elucidating the epistemological and ethical obstacles to developing new precision medicines.
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Zarate OA, Brody JG, Brown P, Ramirez-Andreotta MD, Perovich L, Matz J. Balancing Benefits and Risks of Immortal Data: Participants' Views of Open Consent in the Personal Genome Project. Hastings Cent Rep 2015; 46:36-45. [PMID: 26678513 DOI: 10.1002/hast.523] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
An individual's health, genetic, or environmental-exposure data, placed in an online repository, creates a valuable shared resource that can accelerate biomedical research and even open opportunities for crowd-sourcing discoveries by members of the public. But these data become "immortalized" in ways that may create lasting risk as well as benefit. Once shared on the Internet, the data are difficult or impossible to redact, and identities may be revealed by a process called data linkage, in which online data sets are matched to each other. Reidentification (re-ID), the process of associating an individual's name with data that were considered deidentified, poses risks such as insurance or employment discrimination, social stigma, and breach of the promises often made in informed-consent documents. At the same time, re-ID poses risks to researchers and indeed to the future of science, should re-ID end up undermining the trust and participation of potential research participants. The ethical challenges of online data sharing are heightened as so-called big data becomes an increasingly important research tool and driver of new research structures. Big data is shifting research to include large numbers of researchers and institutions as well as large numbers of participants providing diverse types of data, so the participants' consent relationship is no longer with a person or even a research institution. In addition, consent is further transformed because big data analysis often begins with descriptive inquiry and generation of a hypothesis, and the research questions cannot be clearly defined at the outset and may be unforeseeable over the long term. In this article, we consider how expanded data sharing poses new challenges, illustrated by genomics and the transition to new models of consent. We draw on the experiences of participants in an open data platform-the Personal Genome Project-to allow study participants to contribute their voices to inform ethical consent practices and protocol reviews for big-data research.
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Abstract
The quantified self community brings together enthusiasts who are using technological devices to monitor their health and social media to share their personal data with others online. In light of the growing popularity of this movement, self-trackers are challenging the health-care system by raising important questions about data ownership and risk-taking. As we enter a new era of consumer genomics, a significant number of quantified self (QS) individuals are now interested in the monitoring of their microbiome and performing personal interventions. In this paper, we discuss the scientific validity of experiments involving serial observations of a single individual as opposed to randomized clinical trials. We look at self-tracking from an ethical standpoint by questioning the risks and assessing the potential benefits for personalized medicine in general and for microbiome research in particular.
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Affiliation(s)
- Carine Gimbert
- Département de sciences biologiques, Université de Montréal, CP. 6128, Succursale Centre-ville, Montréal, QC, H3C 3J7, Canada.
| | - François-Joseph Lapointe
- Département de sciences biologiques, Université de Montréal, CP. 6128, Succursale Centre-ville, Montréal, QC, H3C 3J7, Canada.
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Sing CW, Cheung CL, Wong ICK. Pharmacogenomics--how close/far are we to practising individualized medicine for children? Br J Clin Pharmacol 2015; 79:419-28. [PMID: 25855823 DOI: 10.1111/bcp.12338] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The translation of pharmacogenomics into clinical practice is a key approach for practising individualized medicine, which aims to maximize drug efficacy and minimize drug toxicity. Since the completion of both the Human Genome Project and the International HapMap project, the development of pharmacogenomics has been greatly facilitated. However, progress in translating pharmacogenomics into clinical practice, especially in paediatric medicine, is unexpectedly slow. Many challenges from different areas remain. This paper discusses the existing applications and the limitations to the implementation of paediatric pharmacogenomics, as well as possible solutions for overcoming these limitations and challenges.
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Flugelman A. [ETHICS, MORALS AND SOCIETY IN PERSONALIZED MEDICINE]. Harefuah 2015; 154:599-606. [PMID: 26665754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Following the completion of the human genome project, genomic medicine including personalized medicine, widely based on pharmacogenetics and pharmacogenomics, is rapidly developing. This breakthrough should benefit humankind thanks to tailoring the most appropriate prevention, interventions and therapies to each individual, minimizing adverse side effects, based on inter-personal genetic variety and polymorphism. Yet wide spectrum ethical, legal and social issues carry significant implications regarding individuals, families, society and public health. The main issues concern genomic information and autonomy, justice and equity, resources allocation and solidarity, challenging the traditional role of medicine and dealing with unlimited boundaries of knowledge. Those issues are not new nor exceptional to genomic medicine, yet their wide unlimited scope and implications on many aspects of life renders them crucial. These aspects will be discussed in light of Beauchamp and Childress' four principles: non-maleficence, beneficence, autonomy and justice, and main moral philosophies, Kant's autonomy, Utilitarianism which promotes the common good, and Rawls' Theory of Justice.
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Radermecker RP. [PERSONALIZED MEDICINE AND EBM: ETHICAL ASPECTS]. Rev Med Liege 2015; 70:343-346. [PMID: 26285464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
More patients are actually treated due to the incredible improvements of medical care, especially in the field of pharmacotherapy. Medical guidelines are based on the results of controlled trials. This kind of medicine, also called Evidence Based Medicine (EBM), is actually the cornerstone of good clinical practice. Nevertheless, it remains a lot of patients disappointed by the fact that they have no medical gain of their treatment. The reason is that each patient has his/her own metabolic characteristics. Better is, the characterization of such patients, better will be the treatment targeting them. It is what is called the personalized medicine. To reach this challenge, pharmacogenetic advances would be helpful. From an antagonism between EBM and personalized medicine, this new medical paradigm has to consider these approaches as partners. To reach this goal, medical doctors, legal authorities and pharmaceutical companies have to be responsible in front of these new ethical challenges.
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Chadwick R. Selfies, personalization and bioethics. Bioethics 2015; 29:ii. [PMID: 25655575 DOI: 10.1111/bioe.12159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Agustí A, Antó JM, Auffray C, Barbé F, Barreiro E, Dorca J, Escarrabill J, Faner R, Furlong LI, Garcia-Aymerich J, Gea J, Lindmark B, Monsó E, Plaza V, Puhan MA, Roca J, Ruiz-Manzano J, Sampietro-Colom L, Sanz F, Serrano L, Sharpe J, Sibila O, Silverman EK, Sterk PJ, Sznajder JI. Personalized respiratory medicine: exploring the horizon, addressing the issues. Summary of a BRN-AJRCCM workshop held in Barcelona on June 12, 2014. Am J Respir Crit Care Med 2015; 191:391-401. [PMID: 25531178 PMCID: PMC4351599 DOI: 10.1164/rccm.201410-1935pp] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/21/2014] [Indexed: 12/29/2022] Open
Abstract
This Pulmonary Perspective summarizes the content and main conclusions of an international workshop on personalized respiratory medicine coorganized by the Barcelona Respiratory Network ( www.brn.cat ) and the AJRCCM in June 2014. It discusses (1) its definition and historical, social, legal, and ethical aspects; (2) the view from different disciplines, including basic science, epidemiology, bioinformatics, and network/systems medicine; (3) the bottlenecks and opportunities identified by some currently ongoing projects; and (4) the implications for the individual, the healthcare system and the pharmaceutical industry. The authors hope that, although it is not a systematic review on the subject, this document can be a useful reference for researchers, clinicians, healthcare managers, policy-makers, and industry parties interested in personalized respiratory medicine.
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Affiliation(s)
- Alvar Agustí
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Josep Maria Antó
- Centre for Research in Environmental Epidemiology, Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra, Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Barcelona, Spain
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, Lyon, France
| | - Ferran Barbé
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Esther Barreiro
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Pulmonology Department, Hospital del Mar-Hospital del Mar Medical Research Institute, CEXS, Universitat Pompeu Fabra, Barcelona Biomedical Research Park, Barcelona, Spain
| | - Jordi Dorca
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Hospital University Bellvitge, University Barcelona, El Institut d’Investigació Biomèdica de Bellvitge, Hospitalet Ll., Spain
| | - Joan Escarrabill
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University Barcelona, Spain
| | - Rosa Faner
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Laura I. Furlong
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, University Pompeu Fabra, Barcelona, Spain
| | - Judith Garcia-Aymerich
- Centre for Research in Environmental Epidemiology, Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra, Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Barcelona, Spain
| | - Joaquim Gea
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Pulmonology Department, Hospital del Mar-Hospital del Mar Medical Research Institute, CEXS, Universitat Pompeu Fabra, Barcelona Biomedical Research Park, Barcelona, Spain
| | | | - Eduard Monsó
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Hospital University Parc Taulí, Sabadell, Spain
| | - Vicente Plaza
- Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, University Autonoma de Barcelona, Barcelona, Spain
| | - Milo A. Puhan
- Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Josep Roca
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Juan Ruiz-Manzano
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Hospital University Germans Trias i Pujol, University Autónoma Barcelona, Badalona, Spain
| | - Laura Sampietro-Colom
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University Barcelona, Spain
| | - Ferran Sanz
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, University Pompeu Fabra, Barcelona, Spain
| | - Luis Serrano
- European Molecular Biology Laboratory/Centre for Genomic Regulation Systems Biology Research Unit, Centre for Genomic Regulation, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - James Sharpe
- European Molecular Biology Laboratory/Centre for Genomic Regulation Systems Biology Research Unit, Centre for Genomic Regulation, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Oriol Sibila
- Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, University Autonoma de Barcelona, Barcelona, Spain
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Peter J. Sterk
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; and
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