Is It Time to Retire the Concept of Deidentification?

December 12, 2024 @ 9:00 am 11:30 am

Virtual Event

In the US, research with data only qualifies as human subjects research and triggers protections, such as ethics board review and informed consent, when those data are identifiable, defined as “information for which the identity of the subject is or may readily be ascertained by the investigator or associated with the information” (45 CFR 46.102(e)(5)). The process of deidentification of data involves removing explicit identifiers such that the data cannot be readily linked to an individual; deidentified data is no longer considered protected health information subject to the protections of the Privacy Rule, implemented in response to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Deidentified data, therefore, can be used without consent, without review by an IRB or ethics committee, and without oversight by a Privacy Board.

In the approximately 30 years since the passage of HIPAA and even in the 5 years since the issuance of the Common Rule, technology has advanced. The concept of deidentification may no longer be relevant. Numerous studies have demonstrated that it is relatively easy to re-identify individuals from seemingly deidentified data sets, particularly when these data are triangulated with publicly available data sources. The increasing use and sophistication of Artificial Intelligence (AI) further exacerbates this situation, raising questions about whether any types of data are beyond re-identification or fail to meet the regulatory definition of “identifiable.” Other countries (e.g., EU/EEA, China, India, and others) and even US States (e.g., California) have adopted this position and, unlike the US, have substantiated data protections and personal rights to privacy through the law.

Eliminating the concept of deidentification[1] (a concept that the HHS Office of Human Research Protections promises to review periodically) would have profound effects on clinical research, including impact on IT infrastructure, data repositories, secondary use of data, consent paradigms, and scientific discovery. But given the current ease of reidentification, might it be time to retire the concept of deidentification in the service of privacy, autonomy, and respect for persons?


[1] The HHS Office of Human Research Protections promises to review the concept of identifiability periodically, although that has not yet occurred in the five years since the effective date of the 2019 Final Common Rule. If OHRP changes its definition, FDA is likely to reconsider its interpretation of identifiability. 


 This meeting is open to sponsors of the Bioethics Collaborative. For more information about the Bioethics Collaborative and how to become a sponsor, click here.

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Impact of Dobbs on Reproductive Health: Unintended Consequences for/on Research 

September 10, 2024 @ 10:00 am 12:30 pm

Hybrid: In-person (Boston) and Virtual (Zoom)

800 Boylston St.
Boston, MA 02199

Topic: Impact of Dobbs on Reproductive Health: Unintended Consequences for/on Research 

In 2022, the United States Supreme Court ruled, in Dobbs vs. Jackson Women’s Health Organization, against a federal right to abortion. The effects of this ruling continue to reverberate across the research ecosystem. Clinical trials often involve the administration of investigational therapies that pose reproductive risks. Because of this, participants are routinely asked to undertake measures that could pose privacy risks to them in states where elective termination of pregnancy is illegal. These measures include documentation of the results of pregnancy tests and reporting of incidental pregnancies and their outcome, among others. These risks may also extend to site staff in states where providers are prohibited from advising or facilitating elective termination of pregnancy. In addition, research on various aspects of pregnancy is itself at risk of being stifled for similar reasons. What should the research community’s response be to this situation? Is there an obligation to educate participants about these risks as part of the informed consent process? Who should bear this responsibility? What mechanisms are available to help shield participants and other stakeholders from undue risk while permitting the collection of important pregnancy data? To what extent, if any, do Certificates of Confidentiality provide sufficient legal protections? Will this ruling impact innovation in reproductive health research in the US more generally? At the next Bioethics Collaborative, we will focus on these and other questions related to the ongoing effects of the Dobbs rulingon clinical research. 

This meeting is open to sponsors of the Bioethics Collaborative. For more information about the Bioethics Collaborative and how to become a sponsor, click here.

Reciprocity in Research: Does Justice Support Community Investment?

June 18, 2024 @ 9:30 am 12:00 pm

Virtual Event

Topic: Reciprocity in Research: Does Justice Support Community Investment?

Abstract:  It is generally agreed that sponsors and other entities undertaking research in limited-resource settings incur certain duties of reciprocity. These obligations ensure that host communities are treated fairly and not exploited, given the burdens and risks of research undertaken by community members. However, the expectations, content, and limitations of these obligations are not defined. The next Bioethics Collaborative will be devoted to understanding and assessing different approaches to satisfying the ethical contorts of reciprocity for research undertaken in these settings.

Click here to view the Meeting Summary.


This meeting is open to sponsors of the Bioethics Collaborative.

For more information about the Bioethics Collaborative and how to become a sponsor, click here.

Comment on the NPRM Request of the Office for Civil Rights (OCR) re: Discrimination on the Basis of Disability in Health and Human Services Programs or Activities

Public Comment

Submitted on: November 11, 2023

Comments provided to: Office of Civil Rights, U.S. Dept. of Health and Human Services

The MRCT Center submitted a response to the Notice for Proposed Rulemaking (NPRM) request of the Office for Civil Rights (OCR) for comments on the draft, “Discrimination on the Basis of Disability in Health and Human Service Programs or Activities. The MRCT Center applauds OCR’s considerations of the rights of people with disabilities and OCR’s effort to clarify and strengthen Section 504 of the Rehabilitation Act of 1973. The MRCT endorsed several key areas in the proposed rule Center presented some suggestions for further clarification.

Comment on the American Community Survey SOGI Test

Public Comment

Submitted on: November 10, 2023

Comments provided to: U.S. Census Bureau

The MRCT Center commented on the Census Bureau’s proposed American Community Survey Sexual Orientation and Gender Identity Test (the ‘Test’) as part of its ongoing American Community Survey Methods Panel Tests. The MRCT Center thanked the Bureau for its commitment to bringing Sexual Orientation and Gender Identity (SOGI) data collection to the foreground. In our response, we asked specific questions about the design of the ‘Test’ and the reliability and privacy of proxy reporting by one household member about the sexual orientation and gender identity of other household members.

Accessibility by Design (AbD) Toolkit

Toolkit

Date: May 4th, 2023

Description: The Accessibility by Design (AbD) in Clinical Research Toolkit is a comprehensive resource intended to be used by sponsors, institutions, investigators, ethics committees/IRBs, participants, and patient advocacy groups to support greater inclusion of people with disabilities in clinical research. It was developed by the MRCT Center in collaboration with people with disabilities, family caregivers, allies, disability rights advocates, and stakeholders working in clinical research, and aligns with the MRCT Center’s Achieving Diversity, Inclusion, and Equity in Clinical Research Guidance Document and the Equity by Design in Clinical Research Metrics Framework.

Toolkit

Related Resources:
Accessibility by Design (AbD) Toolkit

Webinar Slides

Excluding People with Disabilities from Clinical Research: Eligibility Criteria Lack Clarity and Justification (Publication)

Supported decision-making can advance clinical research participation for people with disabilities (Publication)

Integrating Supported Decision-Making into the Clinical Research Process (Publication)

MRCT Center Leaning In Webinar Series: Driving Inclusion in Clinical Research – June 9, 2021: Improving Inclusion of Persons with Disabilities in Clinical Research (WEBINAR)

MRCT Center Diversity, Inclusion, and Equity in Clinical Research Guidance Document and Toolkit

Equity by Design in Clinical Research: The EbD Metrics Framework (FRAMEWORK)

Health Literacy Month Spotlight

Thinking about Numeracy

When crafting patient-facing materials, focusing on health literacy best practices such as plain language, intuitive design, cultural awareness, and usability testing are expected. Numeracy and the clear presentation of numeric data demand additional attention.

In clinical research, understanding risk, percentages, probabilities, and other numerical concepts undergirds participant choice, voluntariness, and autonomy. While some studies might offer the possibility of benefit, no study guarantees success, and risks are always present. Participants are asked to comprehend ideas like risk assessment, risk-benefit ratios, and randomization. Numeracy also underlies interpreting dosages, medication instructions, schedules, and study calendars. As with health literacy, numeracy skills are generally low in the US and globally. Knowing this, communicators are responsible for helping patients, participants, and caregivers comprehend and apply the numeric data shared with them.

Barbara Bierer, MD, and Sylvia Baedorf Kassis, MPH, explored this topic in their June 2023 Frontiers in Communication publication entitled, “Communicating complex numeric information in clinical research” and suggested several steps for communicators to consider when explaining and visualizing numeric information:

  • What numeric information do you need to present and explain?
  • Determine the intent – How should the information be used? Is it informational? Helpful for decision-making?
  • Know the audience – Is there anything about this audience that should be considered?
  • Understand the context – In what setting will the information be presented?  Will the person be stressed, receptive, supported, or alone in a new environment?
  • Develop presentation options – What are some ways to present the info? Which are most clear?
  • Review for biases – Could the information be misunderstood or be inappropriately influential?
  • Consider accessibility – Can the information be accessed and used by people with different abilities?
  • Conduct usability testing – Is the information understood as intended?

Data Literacy: Leveraging PHUSE Videos to Advance Understanding

Participants’ understanding of how their data are collected and used in research is important for empowering value-concordant decision-making. The MRCT Center is actively focused on developing educational materials for the public on the significance of data in clinical trials, to complement the exemplary PHUSE Global Healthcare Data Science Community video series on data privacy and data-sharing. This work expands our ongoing commitment to improve health literacy. We welcome additional collaborators to the data literacy initiative. 


Health Literacy On-Demand Webinar: Amplifying Participant Voices: Crafting Respectful, Inclusive, and Understandable Patient Materials

Learn how to incorporate patient perspectives in crafting participant-facing materials that are accessible, culturally competent, and easy to understand.

Click here to view the webinar resources, including the recording, slides, and related materials.


Advancing Inclusion: Integrating Pregnant and Lactating People in Research

March 8, 2024 @ 11:00 am 2:00 pm

Hybrid: In-person (Boston) and Virtual (Zoom)

800 Boylston St.
Boston, MA 02199

Click here to view the Meeting Summary.

Abstract:

There is widespread recognition, including among pregnant and lactating people, of the need for better evidence on which to base medical treatment decisions during pregnancy and the post-partum period. Despite this, pregnant and lactating people continue to be left out of clinical trials that test drugs, vaccines, devices, and other medical products for safety and efficacy. Study eligibility criteria routinely exclude both pregnant and lactating individuals, even though the biological bases for exclusion of the two populations differ; the effects of exposure of medicinal products to the fetus at the varying stages of development differ from the effects on the neonate or newborn of medicinal products possibly transferred through breast milk Eligibility often requires negative pregnancy tests prior to enrollment and effective methods of contraception for the duration of the study. Further, people who become pregnant while on an interventional trial protocol are typically withdrawn from further participation. Explanations for this are likely to involve perceived ethical, regulatory, and/or legal considerations, reflecting primarily a concern to avoid harming the developing fetus. In the United States, the regulatory framework requires special protections that must be met before pregnant people may participate in clinical research, including limits on the risks they may be asked to undertake. And there are no federal regulations on the exclusion of or additional safeguards for lactating people, despite their common exclusion. In addition, concerns about potential liability and negative public perception are likely to loom large for sponsors, funders, and investigators, motivating them toward the perceived safer strategy of excluding pregnant people from research in many situations.    

At the next Bioethics Collaborative, we will examine ethical issues that bear on determining the proper scope of efforts to further the inclusion of people who are pregnant or lactating in clinical research. Discussion will seek to build on prior workshops and recommendations asking such questions as: Is the current default of excluding pregnant and lactating people from interventional clinical trials justifiable? Do pregnant people have the right to autonomously choose what level of risk is acceptable for themselves and the fetus they carry? How do clinical research entities circumscribe a reasonable range of, and limits on, risk for pregnant people in research, and does this definition align with the views of pregnant and lactating people? Are there alternatives to including pregnant people in clinical trials that can yield the data needed to improve the care of pregnant and lactating people and avoid the well-known problems that arise with seeking to protect groups by excluding them? What are the justice-based implications of placing restrictions on pregnancy? Might requirements for effective contraception, for example, inadvertently function to discourage or even preclude participation from people who are unable to afford contraception? Could these requirements, which are likely to be perceived as burdensome by some, hinder the participation of people of childbearing potential generally and further exacerbate gender inequities in clinical research? We will seek to examine these questions and others on March 8. 

Bioethics Collaborative events are open to sponsors. For more information about the Bioethics Collaborative and how to become a sponsor, click here.

Deliverables