1
|
Moreno PG, Knoppers T, Zawati MH, Lang M, Knoppers BM, Wolfson M, Nabi H, Dorval M, Simard J, Joly Y. Regulating cancer risk prediction: legal considerations and stakeholder perspectives on the Canadian context. Hum Genet 2023:10.1007/s00439-023-02576-8. [PMID: 37365297 DOI: 10.1007/s00439-023-02576-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023]
Abstract
Risk prediction models hold great promise to reduce the impact of cancer in society through advanced warning of risk and improved preventative modalities. These models are evolving and becoming more complex, increasingly integrating genetic screening data and polygenic risk scores as well as calculating risk for multiple types of a disease. However, unclear regulatory compliance requirements applicable to these models raise significant legal uncertainty and new questions about the regulation of medical devices. This paper aims to address these novel regulatory questions by presenting an initial assessment of the legal status likely applicable to risk prediction models in Canada, using the CanRisk tool for breast and ovarian cancer as an exemplar. Legal analysis is supplemented with qualitative perspectives from expert stakeholders regarding the accessibility and compliance challenges of the Canadian regulatory framework. While the paper focuses on the Canadian context, it also refers to European and U.S. regulations in this domain to contrast them. Legal analysis and stakeholder perspectives highlight the need to clarify and update the Canadian regulatory framework for Software as a Medical Device as it applies to risk prediction models. Findings demonstrate how normative guidance perceived as convoluted, contradictory or overly burdensome can discourage innovation, compliance, and ultimately, implementation. This contribution aims to initiate discussion about a more optimal legal framework for risk prediction models as they continue to evolve and are increasingly integrated into landscape for public health.
Collapse
Affiliation(s)
- Palmira Granados Moreno
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Terese Knoppers
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montréal, Québec, Canada.
| | - Ma'n H Zawati
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Michael Lang
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Bartha M Knoppers
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Michael Wolfson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Hermann Nabi
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Michel Dorval
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada
- Faculty of Pharmacy, Université Laval, Québec City, Québec, Canada
- CISSS Chaudière-Appalaches Research Centre, Lévis, Québec, Canada
| | - Jacques Simard
- Genomics Center, CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada
- Department of Molecular Medicine, Université Laval, Québec City, Québec, Canada
| | - Yann Joly
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| |
Collapse
|
2
|
Abstract
Technological innovations including risk-stratification algorithms and large databases of longitudinal population health data and genetic data are allowing us to develop a deeper understanding how individual behaviors, characteristics, and genetics are related to health risk. The clinical implementation of risk-stratified screening programmes that utilise risk scores to allocate patients into tiers of health risk is foreseeable in the future. Legal and ethical challenges associated with risk-stratified cancer care must, however, be addressed. Obtaining access to the rich health data that are required to perform risk-stratification, ensuring equitable access to risk-stratified care, ensuring that algorithms that perform risk-scoring are representative of human genetic diversity, and determining the appropriate follow-up to be provided to stratification participants to alert them to changes in their risk score are among the principal ethical and legal challenges. Accounting for the great burden that regulatory requirements could impose on access to risk-scoring technologies is another critical consideration.
Collapse
Affiliation(s)
- Bartha M. Knoppers
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, 740 Avenue Dr. Penfield, Suite 5200, Montreal, QC H3A 0G1, Canada; (A.B.); (P.G.M.)
| | - Alexander Bernier
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, 740 Avenue Dr. Penfield, Suite 5200, Montreal, QC H3A 0G1, Canada; (A.B.); (P.G.M.)
| | - Palmira Granados Moreno
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, 740 Avenue Dr. Penfield, Suite 5200, Montreal, QC H3A 0G1, Canada; (A.B.); (P.G.M.)
| | - Nora Pashayan
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 7HB, UK;
| |
Collapse
|
3
|
Alarie S, Hagan J, Dalpé G, Faraji S, Mbuya-Bienge C, Nabi H, Pashayan N, Brooks JD, Dorval M, Chiquette J, Eloy L, Turgeon A, Lambert-Côté L, Paquette JS, Walker MJ, Lapointe J, Granados Moreno P, Blackmore K, Wolfson M, Broeders M, Knoppers BM, Chiarelli AM, Simard J, Joly Y. Risk-Stratified Approach to Breast Cancer Screening in Canada: Women's Knowledge of the Legislative Context and Concerns about Discrimination from Genetic and Other Predictive Health Data. J Pers Med 2021; 11:jpm11080726. [PMID: 34442372 PMCID: PMC8398750 DOI: 10.3390/jpm11080726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/17/2021] [Accepted: 07/26/2021] [Indexed: 12/16/2022] Open
Abstract
The success of risk-stratified approaches in improving population-based breast cancer screening programs depends in no small part on women’s buy-in. Fear of genetic discrimination (GD) could be a potential barrier to genetic testing uptake as part of risk assessment. Thus, the objective of this study was twofold. First, to evaluate Canadian women’s knowledge of the legislative context governing GD. Second, to assess their concerns about the possible use of breast cancer risk levels by insurance companies or employers. We use a cross-sectional survey of 4293 (age: 30–69) women, conducted in four Canadian provinces (Alberta, British Colombia, Ontario and Québec). Canadian women’s knowledge of the regulatory framework for GD is relatively limited, with some gaps and misconceptions noted. About a third (34.7%) of the participants had a lot of concerns about the use of their health information by employers or insurers; another third had some concerns (31.9%), while 20% had no concerns. There is a need to further educate and inform the Canadian public about GD and the legal protections that exist to prevent it. Enhanced knowledge could facilitate the implementation and uptake of risk prediction informed by genetic factors, such as the risk-stratified approach to breast cancer screening that includes risk levels.
Collapse
Affiliation(s)
- Samuel Alarie
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| | - Julie Hagan
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
- Correspondence: ; Tel.: +1-(514)-398-8155
| | - Gratien Dalpé
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| | - Sina Faraji
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| | - Cynthia Mbuya-Bienge
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Hermann Nabi
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Université Laval Cancer Research Center, Quebec City, QC G1R 3S3, Canada
| | - Nora Pashayan
- Department of Applied Health Research, Institute of Epidemiology and Healthcare, University College London, London WC1E 6BT, UK;
| | - Jennifer D. Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada; (J.D.B.); (M.J.W.); (A.M.C.)
| | - Michel Dorval
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Faculty of Pharmacy, Université Laval, Quebec City, QC G1V 4G2, Canada
- CISSS de Chaudière-Appalaches Research Center, Lévis, QC G6V 3Z1, Canada
| | - Jocelyne Chiquette
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- CHU de Québec-Université Laval, Quebec City, QC G1S 4L8, Canada
- Département de Médecine Familiale et de Médecine D’urgence, Université Laval, Quebec City, QC G1V 4G2, Canada;
| | - Laurence Eloy
- Québec Cancer Program, Ministère de la Santé et des Services Sociaux, Quebec City, QC G1S 2M1, Canada;
- Department of Social and Preventive Medicine, CISSS de Lanaudière-Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Annie Turgeon
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
| | - Laurence Lambert-Côté
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
| | - Jean-Sébastien Paquette
- Département de Médecine Familiale et de Médecine D’urgence, Université Laval, Quebec City, QC G1V 4G2, Canada;
| | - Meghan J. Walker
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada; (J.D.B.); (M.J.W.); (A.M.C.)
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada;
| | - Julie Lapointe
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
| | - Palmira Granados Moreno
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| | | | - Michael Wolfson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada;
| | - Mireille Broeders
- Radboud Institute for Health Sciences, Radboud University Medical Center, 525 EZ Nijmegen, The Netherlands;
- Dutch Expert Centre for Screening, 6538 SW Nijmegen, The Netherlands
| | | | - Bartha M. Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| | - Anna M. Chiarelli
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada; (J.D.B.); (M.J.W.); (A.M.C.)
- Department of Social and Preventive Medicine, CISSS de Lanaudière-Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Jacques Simard
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 4G2, Canada
| | - Yann Joly
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| |
Collapse
|
4
|
Mbuya-Bienge C, Pashayan N, Brooks JD, Dorval M, Chiquette J, Eloy L, Turgeon A, Lambert-Côté L, Paquette JS, Lévesque E, Hagan J, Walker MJ, Lapointe J, Dalpé G, Granados Moreno P, Blackmore K, Wolfson M, Joly Y, Broeders M, Knoppers BM, Chiarelli AM, Simard J, Nabi H. Women's Views on Multifactorial Breast Cancer Risk Assessment and Risk-Stratified Screening: A Population-Based Survey from Four Provinces in Canada. J Pers Med 2021; 11:jpm11020095. [PMID: 33540785 PMCID: PMC7912955 DOI: 10.3390/jpm11020095] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 12/03/2022] Open
Abstract
Risk-stratified screening for breast cancer (BC) is increasingly considered as a promising approach. However, its implementation is challenging and needs to be acceptable to women. We examined Canadian women’s attitudes towards, comfort level about, and willingness to take part in BC risk-stratified screening. We conducted an online survey in women aged 30 to 69 years in four Canadian provinces. In total, 4293 women completed the questionnaire (response rate of 63%). The majority of women (63.5% to 72.8%) expressed favorable attitudes towards BC risk-stratified screening. Most women reported that they would be comfortable providing personal and genetic information for BC risk assessment (61.5% to 67.4%) and showed a willingness to have their BC risk assessed if offered (74.8%). Most women (85.9%) would also accept an increase in screening frequency if they were at higher risk, but fewer (49.3%) would accept a reduction in screening frequency if they were at lower risk. There were few differences by province; however, outcomes varied by age, education level, marital status, income, perceived risk, history of BC, prior mammography, and history of genetic test for BC (all p ≤ 0.01). Risk-based BC screening using multifactorial risk assessment appears to be acceptable to most women. This suggests that the implementation of this approach is likely to be well-supported by Canadian women.
Collapse
Affiliation(s)
- Cynthia Mbuya-Bienge
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Nora Pashayan
- Department of Applied Health Research, Institute of Epidemiology and Healthcare, University College, London WC1E 6BT, UK;
| | - Jennifer D. Brooks
- Dalla Lana School of Public Health Science, University of Toronto, Toronto, ON M5S 1A1, Canada; (J.D.B.); (M.J.W.); (A.M.C.)
| | - Michel Dorval
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Faculty of Pharmacy, Université Laval, Quebec City, QC G1V 4G2, Canada
- CISSS de Chaudière-Appalaches Research Center, Lévis, QC G6V 3Z1, Canada
| | - Jocelyne Chiquette
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- CHU de Québec—Université Laval, Quebec City, QC G1S 4L8, Canada
- Département de Médecine Familiale et de Médecine d’Urgence, Université Laval, Quebec City, QC G1V 4G2, Canada;
| | - Laurence Eloy
- Québec Cancer Program, Ministère de la Santé et des Services Sociaux, Quebec City, QC G1S 2M1, Canada;
| | - Annie Turgeon
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
| | - Laurence Lambert-Côté
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
| | - Jean-Sébastien Paquette
- Département de Médecine Familiale et de Médecine d’Urgence, Université Laval, Quebec City, QC G1V 4G2, Canada;
| | - Emmanuelle Lévesque
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (E.L.); (J.H.); (G.D.); (P.G.M.); (Y.J.); (B.M.K.)
| | - Julie Hagan
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (E.L.); (J.H.); (G.D.); (P.G.M.); (Y.J.); (B.M.K.)
| | - Meghan J. Walker
- Dalla Lana School of Public Health Science, University of Toronto, Toronto, ON M5S 1A1, Canada; (J.D.B.); (M.J.W.); (A.M.C.)
- Ontario Health, Cancer Care Ontario, Toronto, ON M5G 2L3, Canada;
| | - Julie Lapointe
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
| | - Gratien Dalpé
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (E.L.); (J.H.); (G.D.); (P.G.M.); (Y.J.); (B.M.K.)
| | - Palmira Granados Moreno
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (E.L.); (J.H.); (G.D.); (P.G.M.); (Y.J.); (B.M.K.)
| | | | - Michael Wolfson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada;
| | - Yann Joly
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (E.L.); (J.H.); (G.D.); (P.G.M.); (Y.J.); (B.M.K.)
| | - Mireille Broeders
- Radboud Institute for Health Sciences, Radboud University Medical Center, 525 EZ Nijmegen, The Netherlands;
- Dutch Expert Centre for Screening, 6538 SW Nijmegen, The Netherlands
| | - Bartha M. Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (E.L.); (J.H.); (G.D.); (P.G.M.); (Y.J.); (B.M.K.)
| | - Anna M. Chiarelli
- Dalla Lana School of Public Health Science, University of Toronto, Toronto, ON M5S 1A1, Canada; (J.D.B.); (M.J.W.); (A.M.C.)
- Ontario Health, Cancer Care Ontario, Toronto, ON M5G 2L3, Canada;
| | - Jacques Simard
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 4G2, Canada
| | - Hermann Nabi
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Université Laval Cancer Research Center, Quebec City, QC G1R 3S3, Canada
- Correspondence: ; Tel.: +1-418-682-7511 (ext. 82800)
| | | |
Collapse
|
5
|
Granados Moreno P, Ali-Khan SE, Capps B, Caulfield T, Chalaud D, Edwards A, Gold ER, Rahimzadeh V, Thorogood A, Auld D, Bertier G, Breden F, Caron R, César PM, Cook-Deegan R, Doerr M, Duncan R, Issa AM, Reichman J, Simard J, So D, Vanamala S, Joly Y. Open science precision medicine in Canada: Points to consider. Facets (Ott) 2019. [DOI: 10.1139/facets-2018-0034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Open science can significantly influence the development and translational process of precision medicine in Canada. Precision medicine presents a unique opportunity to improve disease prevention and healthcare, as well as to reduce health-related expenditures. However, the development of precision medicine also brings about economic challenges, such as costly development, high failure rates, and reduced market size in comparison with the traditional blockbuster drug development model. Open science, characterized by principles of open data sharing, fast dissemination of knowledge, cumulative research, and cooperation, presents a unique opportunity to address these economic challenges while also promoting the public good. The Centre of Genomics and Policy at McGill University organized a stakeholders’ workshop in Montreal in March 2018. The workshop entitled “Could Open be the Yellow Brick Road to Precision Medicine?” provided a forum for stakeholders to share experiences and identify common objectives, challenges, and needs to be addressed to promote open science initiatives in precision medicine. The rich presentations and exchanges that took place during the meeting resulted in this consensus paper containing key considerations for open science precision medicine in Canada. Stakeholders would benefit from addressing these considerations as to promote a more coherent and dynamic open science ecosystem for precision medicine.
Collapse
Affiliation(s)
- Palmira Granados Moreno
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Sarah E. Ali-Khan
- Centre for Intellectual Property and Policy, Faculty of Law, McGill University, Montreal, QC H3A 1W9, Canada
| | - Benjamin Capps
- Department of Bioethics, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Timothy Caulfield
- Health Law Institute, Faculty of Law and School of Public Health, University of Alberta, Edmonton, AB T6G 2H5, Canada
| | - Damien Chalaud
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Aled Edwards
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
- Structural Genomics Consortium, University of Toronto, Toronto, ON M5G 1L6, Canada
| | - E. Richard Gold
- Centre for Intellectual Property and Policy, Faculty of Law, McGill University, Montreal, QC H3A 1W9, Canada
| | - Vasiliki Rahimzadeh
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Adrian Thorogood
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Daniel Auld
- McGill University and Genome Quebec Innovation Centre, Montreal, QC H3A 0G1, Canada
| | - Gabrielle Bertier
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Felix Breden
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Roxanne Caron
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Priscilla M.D.G. César
- Centre for Intellectual Property and Policy, Faculty of Law, McGill University, Montreal, QC H3A 1W9, Canada
| | - Robert Cook-Deegan
- School for the Future of Innovation in Society, Barrett & O’Connor Washington Center, Arizona State University, Washington, DC 20006, USA
| | | | - Ross Duncan
- Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada
| | - Amalia M. Issa
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada
- Personalized Medicine & Targeted Therapeutics, Philadelphia, PA 19803, USA
- Health Policy & Pharmaceutical Sciences, University of the Sciences in Philadelphia, Philadelphia, PA 19104, USA
| | | | - Jacques Simard
- Genomics Center, Centre Hospitalier Universitaire de Quebec-Laval University, Quebec City, QC G1V 4G2, Canada
| | - Derek So
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Sandeep Vanamala
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Yann Joly
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| |
Collapse
|
6
|
Granados Moreno P, Joly Y, Knoppers BM. Public-Private Partnerships in Cloud-Computing Services in the Context of Genomic Research. Front Med (Lausanne) 2017; 4:3. [PMID: 28164085 PMCID: PMC5247451 DOI: 10.3389/fmed.2017.00003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/06/2017] [Indexed: 11/13/2022] Open
Abstract
Public–private partnerships (PPPs) have been increasingly used to spur and facilitate innovation in a number of fields. In healthcare, the purpose of using a PPP is commonly to develop and/or provide vaccines and drugs against communicable diseases, mainly in developing or underdeveloped countries. With the advancement of technology and of the area of genomics, these partnerships also focus on large-scale genomic research projects that aim to advance the understanding of diseases that have a genetic component and to develop personalized treatments. This new focus has created new forms of PPPs that involve information technology companies, which provide computing infrastructure and services to store, analyze, and share the massive amounts of data genomic-related projects produce. In this article, we explore models of PPPs proposed to handle, protect, and share the genomic data collected and to further develop genomic-based medical products. We also identify the reasons that make these models suitable and the challenges they have yet to overcome. To achieve this, we describe the details and complexities of MSSNG, International Cancer Genome Consortium, and 100,000 Genomes Project, the three PPPs that focus on large-scale genomic research to better understand the genetic components of autism, cancer, rare diseases, and infectious diseases with the intention to find appropriate treatments. Organized as PPP and employing cloud-computing services, the three projects have advanced quickly and are likely to be important sources of research and development for future personalized medicine. However, there still are unresolved matters relating to conflicts of interest, commercialization, and data control. Learning from the challenges encountered by past PPPs allowed us to establish that developing guidelines to adequately manage personal health information stored in clouds and ensuring the protection of data integrity and privacy would be critical steps in the development of future PPPs.
Collapse
Affiliation(s)
| | - Yann Joly
- Centre of Genomics and Policy, McGill University , Montreal, QC , Canada
| | | |
Collapse
|
7
|
Murdoch B, Ravitsky V, Ogbogu U, Ali-Khan S, Bertier G, Birko S, Bubela T, De Beer J, Dupras C, Ellis M, Granados Moreno P, Joly Y, Kamenova K, Master Z, Marcon A, Paulden M, Rousseau F, Caulfield T. Non-invasive Prenatal Testing and the Unveiling of an Impaired Translation Process. Journal of Obstetrics and Gynaecology Canada 2017; 39:10-17. [DOI: 10.1016/j.jogc.2016.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/29/2016] [Indexed: 12/15/2022]
|
8
|
Shin SS, Laniado-Laborin R, Moreno PG, Novotny TE, Strathdee SA, Garfein RS. Dose-response association between salivary cotinine levels and Mycobacterium tuberculosis infection. Int J Tuberc Lung Dis 2014; 17:1452-8. [PMID: 24125450 DOI: 10.5588/ijtld.13.0311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Tijuana, Mexico. OBJECTIVE To describe the association between salivary cotinine levels and interferon-gamma (IFN-γ) release assay results. DESIGN We conducted a cross-sectional study among injection drug users. Salivary cotinine levels were measured using NicAlert, a semi-quantitative dipstick assay. QuantiFERON©-TB Gold In-Tube (QFT-GIT) was used to determine Mycobacterium tuberculosis infection. RESULTS Among 234 participants, the prevalence of QFT-GIT positivity for NicAlert cotinine categories 0 (non-smoking), 1 (second-hand smoke exposure or low-level smoking) and 26 (regular smoking) were respectively 42.1%, 46.4% and 65.2% (Ptrend 0.012). We found increasing trends in QFT-GIT positivity (Ptrend 0.003) and IFN-γ concentrations (Spearman's r 0.200, P 0.002) across cotinine levels 0 to 6. In multivariable log-binomial regression models adjusted for education, cotinine levels were not associated with QFT-GIT positivity when included as smoking categories (1 and 26 vs. 0), but were independently associated with QFT-GIT positivity when included as an ordinal variable (prevalence ratio 1.09 per 1 cotinine level, 95%CI 1.021.16). CONCLUSION Our findings suggest that a dose-response relationship exists between tobacco smoke exposure and M. tuberculosis infection. Longitudinal studies that use biochemical measures for smoking status are needed to confirm our findings.
Collapse
Affiliation(s)
- S S Shin
- Joint Doctoral Program in Public Health (Global Health), San Diego State University/University of California San Diego, San Diego, California, USA
| | | | | | | | | | | |
Collapse
|