RESUMO
Widespread use of medical records for research, without consent, attracts little scrutiny compared to biospecimen research, where concerns about genomic privacy prompted recent federal proposals to mandate consent. This paper explores an important consequence of the proliferation of electronic health records (EHRs) in this permissive atmosphere: with the advent of clinical gene sequencing, EHR-based secondary research poses genetic privacy risks akin to those of biospecimen research, yet regulators still permit researchers to call gene sequence data 'de-identified', removing such data from the protection of the federal Privacy Rule and federal human subjects regulations. Medical centers and other providers seeking to offer genomic 'personalized medicine' now confront the problem of governing the secondary use of clinical genomic data as privacy risks escalate. We argue that regulators should no longer permit HIPAA-covered entities to treat dense genomic data as de-identified health information. Even with this step, the Privacy Rule would still permit disclosure of clinical genomic data for research, without consent, under a data use agreement, so we also urge that providers give patients specific notice before disclosing clinical genomic data for research, permitting (where possible) some degree of choice and control. To aid providers who offer clinical gene sequencing, we suggest both general approaches and specific actions to reconcile patients' rights and interests with genomic research.
Assuntos
Centros Médicos Acadêmicos/organização & administração , Redes Comunitárias/organização & administração , Comitês de Ética em Pesquisa , Pesquisa Translacional Biomédica/legislação & jurisprudência , Centros Médicos Acadêmicos/legislação & jurisprudência , Comportamento Cooperativo , Credenciamento , Humanos , Relações Interprofissionais , Responsabilidade Legal , Imperícia , Papel do Médico , Risco , Pesquisa Translacional Biomédica/tendências , Estados UnidosAssuntos
Pesquisa Biomédica/legislação & jurisprudência , Regulamentação Governamental , Imageamento por Ressonância Magnética , Mapeamento Encefálico , Health Insurance Portability and Accountability Act/legislação & jurisprudência , Experimentação Humana , Humanos , Neurociências , Segurança , Estados Unidos , United States Food and Drug Administration/legislação & jurisprudênciaAssuntos
Pesquisa Biomédica/ética , Encefalopatias/diagnóstico , Encéfalo/fisiologia , Diagnóstico por Imagem , Achados Incidentais , Imageamento por Ressonância Magnética , Revelação da Verdade/ética , Protocolos Clínicos , Custos e Análise de Custo , Comitês de Ética em Pesquisa , Guias como Assunto , Humanos , Consentimento Livre e EsclarecidoAssuntos
Pesquisa Biomédica/legislação & jurisprudência , Confidencialidade/legislação & jurisprudência , Health Insurance Portability and Accountability Act/legislação & jurisprudência , Prontuários Médicos/legislação & jurisprudência , Pesquisa Biomédica/ética , Prova Pericial , Fidelidade a Diretrizes/legislação & jurisprudência , Humanos , Estados UnidosRESUMO
Humans subjects research entails significant legal and ethical obligations. Neuroimaging researchers must be familiar with the requirements of human subjects protection, including evolving standards for the protection of privacy and the disclosure of risk in "non-therapeutic" research. Techniques for creating veridical surface renderings from volumetric anatomical imaging data raise new privacy concerns, particularly under the federal medical privacy regulation. Additionally, neuroimaging researchers must consider their obligation to communicate research results responsibly. The emerging field of neuroethics should strive to raise awareness of these issues and to involve neuroimaging researchers in the legal, ethical, and policy debates that currently surround human subjects research.