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ALRC-NHMRC joint inquiry: how can we best: protect privacy interests protect against unfair discrimination ensure the highest ethical standards? 144 recommendations - directed at 31 bodies, including the NHMRC Dr Francis Collins, NHGRI / NIH: 'a truly phenomenal job. Placing Australia ahead of what the rest of the world is doing'
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David Weisbrot, Ph.D “Role and Limitation of Legal Regulation for the Development of Quality Genetic Testing Services”
ALRC-NHMRC joint inquiry: how can we best: protect privacy interests protect against unfair discrimination ensure the highest ethical standards? 144 recommendations - directed at 31 bodies, including the NHMRC Dr Francis Collins, NHGRI / NIH: 'a truly phenomenal job. Placing Australia ahead of what the rest of the world is doing'
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ALRC-NHMRC joint inquiry: how can we best: protect privacy interests protect against unfair discrimination ensure the highest ethical standards? 144 recommendations - directed at 31 bodies, including the NHMRC Dr Francis Collins, NHGRI / NIH: 'a truly phenomenal job. Placing Australia ahead of what the rest of the world is doing'
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Attribution Non-Commercial (BY-NC)
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Als PDF, TXT herunterladen oder online auf Scribd lesen
Regulation for the Development of Quality Genetic Testing Services
Prof David Weisbrot, ALRC President
Kitasato International Symposium 2008 ALRC-NHMRC joint inquiry • In relation to human genetic information – and the samples from which this is derived – how can we best: protect privacy interests protect against unfair discrimination ensure the highest ethical standards • Emphasis on public engagement
Kitasato International Symposium
2 16 March 2008 Application to many contexts • Medical/scientific • Employment research • Insurance • Clinical genetics • Forensics • Systemic health • Kinship and Identity (immigration; care issues parentage; ethnicity/ • Human genetic Aboriginality?) databases, tissue • Other right, services banks, registers (eg education, aged care, sports)
Kitasato International Symposium
3 16 March 2008 Final Report – ALRC 96 (2003) • 144 recommendations – directed at 31 bodies, including the NHMRC • Dr Francis Collins, NHGRI/NIH: ‘a truly phenomenal job … placing Australia ahead of what the rest of the world is doing’. • Whole-of-Government response on 9 Dec 05 accepted almost all recommendations Kitasato International Symposium 4 16 March 2008 Genetics and public perceptions Optimism about medical breakthroughs • in diagnosis, treatment, prevention (eg, gene therapy, ‘smart drugs’) – affected families especially positive and passionate Anxiety about loss of control • ‘mad science’ unrestrained by law, ethics or morality; ‘genetic essentialism’; eugenics • commercialisation (Big Pharma = new Evil Empire?) • may intensify gap between haves and have-nots? • Australians have not lost faith in the possibility of regulating biotechnology in the public interest …
Kitasato International Symposium
5 16 March 2008 GATTACA
Kitasato International Symposium
7 16 March 2008 The policy approach Not every problem requires ‘Big Law’: • “successfully fulfilling this brief not only involves providing adequate protections against the unlawful use of genetic information, but also putting into place measures to ensure that where such information may be used lawfully, it is used properly, fairly and intelligently”
Kitasato International Symposium
8 16 March 2008 The regulatory approach Use a sophisticated mix of strategies: • legislation and regulations • official standards and codes of practice – eg NHMRC and Privacy Commissioner’s offical Guidelines, laboratory accreditation standards • industry codes and best practice standards – insurance industry’s policy on genetic testing • education and training – community, med schools, continuing/specialist ed • peer review • funding incentives/disincentives • better coordination of governmental programs Kitasato International Symposium 9 16 March 2008 Key legal recommendations • Some legal changes required – To protect/preserve inherent rights and interests – So important health choices not driven by collateral matters (“Doctor, I can’t take that genetic test because I’m worried it may affect my insurance”) • Address anti-discrimination concerns – Amend law expressly to cover unlawful discrimination based on (real or perceived) genetic status – employment, insurance, immigration, OH&S laws • Adapt privacy laws – ‘sensitive personal information’ requires strong protection … but also shared information (familial dimension) – extend law beyond data to cover genetic samples Kitasato International Symposium 10 16 March 2008 Delivering quality genetic services Preparing for when ‘all medicine will be genetic medicine’ requires a collaborative, coordinated effort: • Health Departments, hospital administrators • Clinical geneticists (and researchers) • GPs (and other specialist doctors) – diagnosis (‘gatekeeping’); patient management • Genetic counsellors (or Google?!) – expert at communicating risk and options • Genetic support groups • Human Genetics Advisory Committee Kitasato International Symposium 11 16 March 2008 Regulating access to testing • DNA testing/analysis only by fully- accredited laboratories – no Medicare payments otherwise – no evidentiary value otherwise (eg paternity tests) • Identify ‘sensitive’ genetic tests requiring restricted access, consent regimes or counselling – analogy with approach to restricted HIV-AIDS testing
Kitasato International Symposium
12 16 March 2008 Regulating illicit testing? • Decreased cost, increased availability, direct marketing, financial incentives encourage illicit testing – eg, by parents, employers, insurers, investigators, media etc
• Recommend creating a new criminal
offence: submitting another person’s DNA for testing without consent or other lawful authority (eg court order, statute) Kitasato International Symposium 13 16 March 2008 Regulating consumer curiosity? • Directly-marketed DIY ‘lifestyle’ test kits – CEO of Sciona, ‘You and Your Genes’: ‘already a lot of information out there recommending, for instance, a diet high in fruit, broccoli and grains … Consumers find this advice daunting, as they are not sure to what extent it pertains to them as individuals.’ – ‘Nutrigenomics’ has now begat ‘dermagenetics’ (the ‘5 wrinkle genes’); sporting genes; ancestry; paternity • Empowering? Worth worrying about? – Regulation? Education? Buyer beware? – (‘recreational genomics’; ‘feng shui genomics’)
Kitasato International Symposium
14 16 March 2008 www.rejuvenationplus.com/
Kitasato International Symposium
15 16 March 2008 Other serious concerns • Security – safe from hackers? • Adequacy of ethical oversight – 220+ institutional review boards in Australia • Commercialisation – intellectual property/patenting issues – undisclosed ownership, conflicts of interest • Access and equity – since genetic medicine is expensive …
Kitasato International Symposium
16 16 March 2008 Lessons/conclusions • Sensitive regulation needed to facilitate advances in genetic research and the development of quality clinical genetic services – reassure public about ethics, autonomy, legal protections, quality and integrity of system – over-regulation stifle innovation – under-(or poorly targeted-) regulation risk ‘horror stories’ that cause panic regulatory over-reaction
• Maintaining public support (and legitimacy) for
genetic medicine requires openness, transparency and honest public debate. Once trust is lost, it is very difficult to regain. Kitasato International Symposium 17 16 March 2008 For further information • ALRC website: all papers, reports available (free) at: <www.alrc.gov.au> • Email: info@alrc.gov.au • Post: GPO Box 3708 Sydney NSW 2001