ELSI Publications and Products Database

This project will develop knowledge about health care provider and patient perceptions of breast cancer, to guide the clinical use of DNA-based tests to measure inherited susceptibility for this condition. Information about inherited susceptibility to breast cancer could stigmatize individuals with positive test results and alter concepts of personal responsibility for health. As a new and highly sophisticated technology, DNA-based genetic susceptibility testing may also have potential for over-use, thus representing a new threat to cost-effective clinical care. The study will address these issues with questionnaires and interviews to determine: (1) how women receiving routine health care and primary care (PC) providers think about breast cancer risk, and their receptiveness to the use of a test for inherited susceptibility to breast cancer; (2) how women react to receiving risk information about breast cancer based on their family history; and (3) whether PC providers differ from genetics professionals in their approach to counseling concerning genetic risk for breast cancer. In addition, a Policy Group, comprising study investigators and experts in genetics, ethics and health services delivery will be formed and will meet regularly during the course of the project, to review study data and to identify the major policy considerations applicable to the use of the genetic susceptibility testing for breast cancer.

The overall goals of this project are to develop relevant, evidence-based clinical practice guidelines for genetic testing for BRCA1/2 through a consensus process involving community care practitioners and oncologists, and to evaluate the effect of the guidelines on clinical practice. The project will convene a Guidelines Group. Educational materials will be developed based on the guidelines, to aid clinicians in pedigree assessment, interpretation of the risks and benefits of BRCA1/2 testing, and use of cancer surveillance or other individuals with increased cancer risk. Educational seminars based on these materials will be presented to community physicians. These materials will be assessed using standardized patient encounters.

Genomic research is rapidly producing new opportunities for understanding disease biology, and promises to enhance health care and health outcomes significantly through improved strategies for prediction and prevention, targeted drug treatment, and innovative molecular-based therapies. As with other seminal developments in biomedicine and technology, successful clinical translation requires a careful evaluation of the benefits and harms of specific interventions, in order to encourage uses that improve health outcomes and minimize applications that cause harm or accelerate health care expenditures without commensurate benefit. This challenge is matched by the need to reduce health care disparities. A major concern in the era of genomic health care is to insure that the medically underserved can benefit fully from genome technology, while at the same time not experiencing additional disparities due to genetic discrimination. Yet these groups often experience significant barriers to health care, including limited access to services and culturally inappropriate care. In addition, minority groups may view genomic health care with suspicion, because of historic associations between genetics and racism or because genetic science is viewed as threatening core cultural values. These perceptions, which challenge the acceptability of clinical uses of genetics, need to be taken into account in determining the benefits and appropriate uses of genomic technology. This Center of Excellence in ELSI Research will be dedicated to addressing two overarching themes accompanying the clinical integration of genomics: the need to define criteria for clinical integration that lead to clinically and socially appropriate applications of genomic health care; and the need for a translational pathway that incorporates the goal of reducing health care disparities among the medically underserved. A major product will be the identification and assessment of policy options for addressing these challenges. The specific aims of the Center are to: 1) Identify strategies for assessing the clinical utility of a range of different genomic applications to health care; 2) Assess the implications of different genomic health care applications for medically underserved populations; 3) Describe policy options for the clinical integration of genomes into health care, and their implications for addressing health and health care disparities; 4) Engage ELSI researchers and genetic scientists in on_going conversations about the interacting contributions of the environment, social structural factors, and genetics to health outcomes; 5) Provide training opportunities to encourage the participation of researchers from underrepresented minorities in the Center's research agenda and other ELSI research; and 6) Stimulate collaborative partnerships that result in additional funded research addressing these and related questions.

This program will develop a model project, aimed at increasing the likelihood that persons affected by genetic conditions receive quality family-centered and culturally sensitive medical care. This will be accomplished by: 1) implementing a model for the program in conjunction with three regions of the Council of Regional Networks for Genetic Services (CORN) and evaluating the effectiveness of the model's design: 2) identifying and defining key components of a consumer perspective on quality genetic services: 3) integrating 30 genetics consumer educators in classes at approximately 15 medical schools, internship and residency programs, representing approximately 5,000 students: 4) bringing together 20 genetics consumer educators and clinical genetics providers with PCPs and managed care administrators at four, managed care pilot organizations - representing approximately 14,000 primary care providers to enhance genetic services to the approximately 768,000 plan members who receive their care within these settings: and 5) developing, employing and evaluating multimedia educational materials for genetic consumer educators to use in support of case-based learning interventions with medical students and primary care providers.

The Human Genome Project and the International HapMap Project have produced significant resources for understanding the genetic bases for health and disease, including identifying genetic variations, genetic mutations, and genomic functions. The interpretation and reporting of findings from these resources have direct and immediate implications for researchers, the news media, and the general public. Knowledge gaps and low health literacy limit how well many people understand health and genetic information and can therefore influence their decisions and actions. Compared to other racial and ethnic population subgroups, African Americans are more likely to have limited and or inaccurate health information and lower levels of health literacy. With increasing and complex genetic information, recommendations, and products being reported to the public, the news media play an important role in reporting and interpreting new discoveries from genetic studies. Although recent studies have explored media reporting of genetic information and public perceptions of those reports, no studies have examined such coverage or its effects in media outlets specifically serving minority populations. Currently, Black newspapers reach a large proportion of the U.S. Black population-estimates range from 6 to 15 million African Americans in total circulation-and are the most trusted media source for health information among African Americans. This application proposes the first national study of news coverage of genetics in a national sample of Black newspapers plus experimental testing of three African American-centric approaches to reporting on genetics. The study consists of two parts: (1) describing differences between African American and general population newspapers in reporting genetics-related information; and (2) conducting a randomized experiment to determine which characteristics of news stories about genetics are most appealing to and understood by African American adults. First, using an existing database of 17,172 health stories we created from 24 Black newspapers and 12 general population papers published from 2003-2008, we will identify and content analyze all genetics-related health stories (n=370) and use this information to characterize current newspaper coverage of genetics. Second, in a randomized experiment, 296 African Americans ages =21 years will read mock news headlines and news articles about genetic risk that apply findings from prior studies of culturally based health communication in African Americans. The study will test effects of: (A) headlines using the term "family history" vs. "genetics"; (B) news reports that include personal stories ("narratives") vs. none; and (C) news reports that include local and race-specific information vs. none. By characterizing current journalistic practices in Black newspapers and identifying optimal strategies for presenting genetics-related information to African American audiences, this study takes the first step toward improving understanding and enhancing perceptions of genetics and genetic research among African Americans. PUBLIC HEALTH RELEVANCE - This two-part exploratory study uses a current and one-of-a-kind database of health stories from Black and general population newspapers to characterize current coverage of genetics-related health news stories, and improves upon this coverage by identifying characteristics of genetics-related stories that maximize interest, comprehension, and trust in those stories by African Americans exposed to this coverage.

This project is designed to support a conference on the implications for our understanding of health and moral responsibility of the Genome Project. The purpose of the conference will be to better anticipate the cultural impact that knowledge generated by the Genome Project will have on society. The conference will be held on the campus of the University of California, Berkeley in March or April of 1991. It will draw together speakers from the fields of medicine and genetics, philosophy, history, and the social sciences. The four major themes of the conference will encompass: cultural understandings of diseases and illness, moral responsibility, the political implications of genetic classifications, and the moral imperative to seek a cure for disease in general and genetic disease in particular. The program will be open to the public but will particularly be aimed at the researchers and others involved in the Genome Project in Northern California and the Bay Area. A conference report designed for wide circulation will help to assure wide distribution of the conference results.

This study will focus on setting priorities in the screening, testing, counseling, and treatment of pre-symptomatic and contingent genetic conditions. Under the assumption that unlimited resources will not be immediately available for smoothly introducing genome research into the clinical arena, this project will develop an ethically sound set of priorities to guide this process. In order to structure the introduction of novel technologies in ways appropriate to individual and societal notions of health and well-being, The Hastings Center will develop, analyze, and assess strategies for responding to these practical concerns. We are asking: What clinical priorities, if any should be established from information arising out of genetic research? Should there be any relative priority among disease groups and population served? and What should be the relative priority of clinical resources directed toward genetics compared to other clinical endeavors? To provide a context for these efforts, the Center will also formulate a theory of the goals of medicine designed to accommodate changing understandings of genetic health and simultaneously point to priorities that can direct rational implementation of clinical services.

The purpose of the proposed investigation is to explore the phenomenon of Academic-Industry Relationships (AIRs) in the life-sciences, with an emphasis in the field of genetics. This study seeks to update previous work and explore how the prevalence and magnitude of AIRs have changed over the last two decades. Qualitative data from focus groups and personal interviews with investigators in research intensive medical schools and teaching hospitals will be used to refine existing and develop new survey items and hypotheses. The quantitative data will involve an anonymous mailed survey of a random sample of up to 3,000 faculty researchers in genetics, other basic life sciences, and clinical departments. Survey responses will be analyzed to show how individual, departmental, institutional, and national policies and characteristics affect the propensity, scale, length, and type of industry affiliation, including research, consulting, licensing, equity, training, and gift relationships. Results will be disseminated through publications in peer-reviewed journals and presentations at scientific meetings.

The overall purpose of this grant is to explore the nature, extent and consequences of data-sharing and data- withholding in academic genetics and the other life sciences. The specific aims are: (1) to empirically examine the frequency of various forms of the data sharing and withholding in genetics and the other life sciences and to compare these findings with the results from 2000; (2) to examine factors that are associated with data sharing and withholding in genetics and the other life sciences and to compare these findings with the results from 2000; (3) to explore using survey data to the functioning of existing federal policies related to data sharing and withholding in the life sciences. Our investigative team has significant experience conducting studies of science policy in general and data-sharing and withholding in particular. The study will employ qualitative and quantitative methods. The qualitative methods will include focus groups and individual interviews which will be used primarily to inform the revision of existing survey items and the development of new ones. The quantitative component will involve a large national survey of 3000 academic life scientists chosen to adequately represent both genetics researchers and other life scientists. The survey of scientists will provide data on the frequency of data-sharing and withholding behaviors, attitudes towards these behaviors and the factors that are associated with such attitudes and behaviors. The analyses will use univariate, bivariate and multivariate methods test several hypotheses as well as explore the changes the frequency of data-sharing and withholding behaviors and attitudes since our previous ELSI funded study in 2000. Results from this research will be disseminated in publications in scientific journals as well as presentations at scientific meetings and will be used to inform government policies. PUBLIC HEALTH RELEVANCE: Openness in data sharing (defining data to include the full range of research results, including materials useful for future investigation) is, or perhaps was, a major ideal in the conduct of academic science. Failure to share data is believed to have negative effects on the efficiency of science, the accuracy of the scientific record, the development of new scientific fields and on the education of the next generation of scientists. The results of this study are intended to inform institutional and national policies and procedures designed to limit data-withholding in the life sciences.

The centerpiece of this Center for Biomedical Ethics project is a meeting to be held in Minneapolis on April 19-20, 1991. The topic of the meeting is 'Genetics Counseling: Ethics, Values, and Professional Responsibilities'. The meeting will be an invitation only 'working conference' involving 12 experts from outside Minnesota and 5 Minnesotans who will meet, present papers and engage in discussions with an interdisciplinary and interprofessional group of approximately 210 scholars and professionals, the majority of whom are affiliated with the University of Minnesota. The objectives of the meeting are: to identify and critically assess current normative stances in genetic counseling; to examine the nature and adequacy of the norms of 'value neutrality' and 'non-directiveness' for genetic counseling practice; to help identify those issues in genetics counseling most likely to be affected by the human genome project; to present the best thinking about the ethical issues current in the field of genetics counseling to a 'core' group of individuals at the University of Minnesota so that they will be in a better position to undertake a more systematic inquiry into these issues under the aegis of a long-term systematic study of the area; and to produce a book of scholarly papers based on the conference which will help advance academic and public understanding of the ethical and value issues facing providers and patients in the area of genetic counseling.

How do ordinary Americans make sense of genetic research? How might they decide whether or not to participate in such research? The proposed study aims to address these questions, in a two-year panel study unfolding in three broad phases: —> an initial, general-population baseline survey of relevant knowledge, attitudes and opinions; —> a structured series of web-based group deliberations, whereby a random subset of survey participants meet three times over several months to respond to and discuss decision scenarios highlighting basic ethical and social issues implicated in genetics research; and —> a series of concluding public opinion surveys, gathered from participants in the deliberative groups as well as from a fresh sample of the U.S. population. Key goals of the project include: —> obtaining high-quality and representative public opinion data, of both a qualitative and quantitative nature, on beliefs and opinions about issues surrounding genetics research; —> constituting deliberative forums known to produce diverse, informed, and representative opinion; —> examining the changing nature of public opinion as it takes shape through public discourse and deliberation; —> testing the impact of information framing on opinions about uses of genetic data, privacy, data sharing, and on willingness to participate in research; and —> moving beyond conventional opinion-survey responses, by examining public decision making in the context of authentic choice scenarios related to participation in genetics research.

This project will examine the moral basis of, and legal and policy framework for, health and life insurance in light of the increase that the HGP is expected to generate in genetic screening capacity to predict disease, disability, and premature death. A core group of 12 experts from ethics, law, regulation, business economics, actuary science, medicine, and genetics has been assembled. The group will first analyze the numerous unresolved issues in this field, and each member will prepare a paper on an aspect of the topic. Through a discussion of these and other sources of information and evaluation, the group will draft guidelines for the insurance industry and policy makers on the appropriate use of genetic screening in health and life insurance, balancing the needs of insurers with individual's interests in affordable insurance, right to privacy, etc. The research papers and guidelines will be presented and discussed at a national meeting, then modified and disseminated.

The New York State Task Force on Life and the Law will analyze the appropriate role for state government in issues of genetics policy, identify specific issues involving genetic testing and screening most suited to legislation or regulation at the state level, and devise concrete recommendations for legislation and/or regulation to serve as a model for adoption by states nationwide. The project will be carried out by the Task Force's standing membership, which includes prominent physicians, nurses, bioethicists, lawyers, community advocates, and religious leaders, in conjunction with the Task Force's professional staff and a diverse group of specialist consultants. A Working Group, made up of selected Task Force members and consultants, will identify the issues raised by developments in genetic testing and screening most in need of prompt attention by state lawmakers and policy makers. In a series of meetings, the Task Force members and consultants will determine the goals that policy in these areas should seek to achieve, analyze the range of policy vehicles available to realize those goals, and formulate specific recommendations for state legislation and regulation.

This project will assemble persons of diverse religious commitments to study the religious and ethical implications of genome research. Four regional inter-disciplinary study groups will produce preparatory papers for an international, ecumenical conference, in March 1992. The papers will be supplemented by several addresses with respondents, interpretations of case studies on recent genetic research, and by presentations on diverse religious points of view. Topics addressed include: the impact of prevailing theologies of human life and new knowledge of molecular biology; modifying human nature by genetic manipulation; defining the limits of scientific inquiry and technology; religious organizations as educators on genetics; the role of women in science and the impact of the genome project on reproductive decisions; and concerns about screening, confidentiality, and factors affecting genetic counseling. The corpus of addresses, reports, case studies and discussions will be published in book form.

The purpose of this study is to provide empirical data on effects of intellectual property (IP) and commercialization on clinical translation of noninvasive prenatal genetic testing (NIPT) and identify potential barriers to clinical adoption and patient access. Advances in technologies for genetic analysis of cell-free fetal DNA could make NIPT routine. Early clinical trials indicate that sequencing-based NIPT tests for chromosomal aneuploidies are more accurate than currently used noninvasive screening tests. A commercial NIPT test for Down Syndrome recently became available and tests for common genetic conditions are in prospect. It is still too early to know the clinical utility and cost effectiveness of these tests. Nevertheless, NIPT could significantly change the paradigm of prenatal testing and screening and potentially even lower costs. Intellectual property (IP) and commercialization promise to be important components in the emerging debate about when and how such technologies should enter clinical practice. IP could induce commercial investment in R&D, in regulatory approval, and in securing third-party payment. But exclusive IP rights could also hamper innovation, increase transaction costs for test developers and providers, and decrease patient access, especially if monopolies emerge. Indeed patents on foundational NIPT technologies have been exclusively licensed to companies, raising such concerns. The commercial landscape is quickly evolving and companies are already involved in patent litigation. The disposition of these patents could determine who can offer the tests and the business models that will prevail, which in turn can impact clinical adoption and patient access. The IP landscape for NIPT appears complex and is unclear. Few if any data are also available on stakeholders' views about effects of IP vs non-IP factors on clinical adoption, and patient access to NIPT.. This study will address these gaps with the following specific aims: 1) map IP relevant to NIPT and assess potential IP effects on development of new NIPT genetic tests; 2) identify and rank IP versus non-IP barriers to clinical adoption and patient access based on stakeholders' views; and 3) identify ethical and policy implications of potential barriers to patient access. A multidisciplinary team of researchers with expertise in genetics, IP law, health policy, bioethics, health economics, maternal and fetal medicine and health law will use established qualitative research methods combined with legal, ethical, and policy analysis. One outcome of this study will be a careful empirical analysis of whether and how IP can affect patient access to NIPT genetic testing. This analysis will be enabled by a publicly available IP and commercialization landscape for NIPT technologies that we will create. Another expected outcome is a forecast of barriers to clinical adoption and patient access ranked by stakeholders. A workshop at the conclusion of the study will include stakeholder representatives groups and experts from relevant domains to identify approaches and policy priorities for reducing barriers to clinical translation and promoting patient access to NIPT. PUBLIC HEALTH RELEVANCE: Noninvasive prenatal genetic tests could significantly impact public health by aiding reproductive decision- making, improving pregnancy management and neonatal health care. The proposed research will find and analyze empirical data on the effects of intellectual property (IP) and commercialization on development, clinical adoption and patient access to noninvasive prenatal genetic tests. This study will also identify and compare how non-IP barriers such as FDA regulation, reimbursement, and quality control of these tests, could affect patient access and clinical adoption. The results of this study will ground and enrich ongoing debates about implementation and clinical integration of noninvasive prenatal genetic tests.

The Secret of Life is a series of eight, 60-minute programs for PBS broadcast with extensive educational and outreach materials. The goal of the program is to make molecular biology intelligible to the audience, to demonstrate the extent to which it has transformed the biological and medical sciences, and to explore the pressing issues it raises. The materials will debunk tabloid images of laboratory-created monsters and headlines of miracle cancer cures, and bring subjects to life through tales of discovery, personal case studies, and engaging histories. The project aspires to prepare viewers to act as informed citizens in debates that demand the widest possible participation. It is a collaborative effort between the WGBH Educational Foundation, the British Broadcasting Corporation, the Chedd-Angier Production Company, and an international panel of scientific advisors.

Modern genetic research gives us unprecedented ability to understand and manipulate fundamental biological processes. Our growing potential to understand and shape the world in genetic terms also seriously challenges basic beliefs and ethical norms. At the same time, values and norms affect the way genetic research is designed and conducted. Despite the significant ethical and societal implications of emerging genetic research, there are few venues for geneticists to participate in interdisciplinary research and to discuss these issues. The overall goal of this proposal is to create a Center for Integrating Ethics and Genetic Research (CIEGR) to develop and test new models of deliberative, interactive processes that integrate ethical, legal and social considerations into the design and conduct of current and emerging genetic research. CIEGR will achieve these goals through a number of innovative programs and products: 1) The Program for Integrated ELSI Research (PIER), which will identify and conduct research on ethical, legal and social issues, focusing on two areas of genetic research (human genetic variation and neuro- and behavioral- genetics), and develop educational materials and policy guidance; 2) a Benchside Consultation Program BCP) for genetic researchers seeking real-time consultation to anticipate and develop policy guidance to address ethical, legal or social issues that could arise from current or future research and that are not addressed by other institutional mechanisms; 3) a Training and Education Program that will train four postdoctoral scholars in both genetic and ELSI research, and use the ethical issues identified by PIER and BCP as the basis for producing educational materials for genetic and ELSI researchers. These will include two documentary training films on research ethics, issue briefs, policy guidance, and webcasts of a series of Interactive Dialogs. The new models will be widely adoptable and will enable unprecedented consideration of genetic research ethics issues among the research community and the public.

It is recognized that research on the human microbiome is important for its potential scientific and medical impact. The complexity of microbiome research, however, could change the way that genetics is studied and understood because it calls for a more complex, nuanced framework for defining and demonstrating causality. The understanding of the human microbiome could also disrupt traditional assumptions about definitions of species, self, disease and normality. It is also recognized that microbiome research can raise ethical, legal, and social issues. The mandate to study the ELSI issues of human microbiome research at this stage implicitly embraces the concept of preventive or prophylactic bioethics. While useful, such an approach can be less effective than desired at identifying ethical and social issues and minimizing harm if it occurs separately from the scientific community, or is conducted in the abstract and general rather than linked to actual features of planned or ongoing research. Our overall goal is to devise an approach to examine the ELSI issues associated with microbiome research. We propose to use the frameworks of Constructive Technology Assessment and Value-Sensitive Design because they are designed to evaluate research specifically incorporating social context and values, and are well suited to evaluating rapidly-moving and boundary-challenging technologies such as those used in microbiome research. We propose to use a dual concept of risk as a tool to link discussions of abstract questions about values and social implications with specific features of research. This analysis will be used to identify potential research design alternatives that could minimize value conflicts and could potentially be generalized to other genomic and biomedical research more broadly. Our specific aims are: AIM 1. To analyze how risk and benefit are conceptualized in research contributing to the understanding of the human microbiome and its applications, through: A) content analysis of scientific articles about microbiome-related research B) content analysis of microbiome articles in the lay media AIM 2. Determine the relationship between microbiome research questions or design, concepts of risk and benefit, and societal values, in order to inform research conduct, through: A) extended, structured interdisciplinary dialog with experts in microbiome research, technology assessment, and ethical and social analysis B) writing and disseminating white papers and articles PUBLIC HEALTH RELEVANCE: Our overall goal is to devise an approach to examine the ELSI issues associated with microbiome research. We propose to use the frameworks of Constructive Technology Assessment and Value-Sensitive Design because to evaluate research specifically incorporating social context and values and the concepts of risk and benefit as a tool to link discussions of abstract questions about values and social implications with specific features of research.