BMC Medical Ethics | |
Ethical challenges for the design and conduct of mega-biobanking from Great East Japan Earthquake victims | |
Shimon Tashiro1  Kenji Matsui2  | |
[1] Office for Promoting Medical Research, Showa University, Hatano-dai 1-6-8, Shinagawa-ku, Tokyo 142-8555, Japan;Office of Personal Information Protection, the National Cerebral and Cardiovascular Center Biobank, Fujishiro-dai 5-7-1, Suita, Osaka 565-8565, Japan | |
关键词: Declaration of Helsinki; Justice; Exploitation; Biobank; Research ethics; Disaster; | |
Others : 863126 DOI : 10.1186/1472-6939-15-55 |
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received in 2014-02-17, accepted in 2014-06-20, 发布年份 2014 | |
【 摘 要 】
Background
Amid continuing social unrest from the Great East Japan Earthquake and subsequent Fukushima nuclear accident of 2011, the Japanese government announced plans for a major biobanking project in the disaster-stricken areas, to be administered by the ‘Tohoku Medical Megabank Organization’ (ToMMo). This project differs from previous biobanking projects in that it 1) was initiated mainly to boost post-disaster recovery and reconstruction; and 2) targets the area’s survivors as its primary subjects. Here, we review the ethics of the ToMMo biobanking project within the wider context of disaster remediation.
Discussion
Private citizens in the Tohoku region have criticized the project proposal, asking for further review of the ethics of targeting disaster survivors for this study. They claim the project violates the Declaration of Helsinki’s ethical provisions in that (1) government and university researchers initiated it without consulting any Tohoku survivors; (2) survivors already suffering extreme losses may view study involvement as meaningless or even undesirable, yet feel forced to participate in exchange for tenuous promises of future assistance, thus exploiting those most in need.
Although the ToMMo has promised certain future social benefits for the target population in exchange for participating in its biobanking research, it is questionable whether such research can address the immediate health needs of the Tohoku disaster survivors in any significant fashion. The ethics of recruiting still-struggling survivors is also questionable.
Summary
This case analysis demonstrates that conducting a post-disaster biobanking project on survivors poses issues concerning potential exploitation and the just distribution of benefits and burdens. Though the ToMMo emphasizes the project’s importance for individual survivors and regional recovery, it is questionable whether such research can justly respond to the survivors’ immediate health needs and whether truly voluntary participation can be ensured in such a crisis. Our society must enhance this nationwide debate and reexamine our priorities for recovery in the disaster-stricken regions. We should evaluate both whether and how this project can truly contribute to the survivors’ quality of life.
【 授权许可】
2014 Matsui and Tashiro; licensee BioMed Central Ltd.
【 预 览 】
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20140725025315389.pdf | 270KB | download |
【 参考文献 】
- [1]Research Promotion Bureau Life Sciences Division, the Ministry of Education, Culture, Sports, Science and Technology-Japan: A Notice: About Surveys and Research in the Disaster-stricken Regions (in Japanese). Tokyo; 2011. [http://www.mhlw.go.jp/seisakunitsuite/bunya/hokabunya/kenkyujigyou/hisaichi/jimurenraku.html webcite]
- [2]Kashima H, Japanese Society of Psychiatry and Neurology: An Emergency Statement Concerning Surveys and Research in the Great East Japan Earthquake-hit Regions (in Japanese). Tokyo: The Japanese Society of Psychiatry and Neurology; 2011. [http://www.higherbrain.gr.jp/07_osirase/img/shinsai.pdf webcite]
- [3]Cyranoski D: Genomics ace quits Japan. Nature 2012, 482:18-19.
- [4]The Miyagi Residents Center of the Post-Great East Japan Earthquake Recovery and Reconstruction Supports: A Letter of Opinion: We require thoughtful re-consideration among the parties concerned about the grand design of the ToMMo-BbP (in Japanese). Miyagi; 2012. [http://blog.canpan.info/miyagikenmin/monthly/201202/1 webcite]
- [5]Imai Y, Satoh H, Nagai K, Sakuma M, Sakuma H, Minami N, Munakata M, Hashimoto J, Yamagishi T, Watanabe N, Yabe T, Nishiyama A, Nakatsuka H, Koyama H, Abe K: Characteristics of a community-based distribution of home blood pressure in Ohasama in northern Japan. J Hypertens 1993, 11:1441-1449.
- [6]Tamakoshi A, Sato K, Matsui K, Masui T, Maruyama E: Some suggestions for establishing a genome-cohort study in the genome era: based on population-based cohort studies on middle-aged and elderly in Japan (in Japanese). J Natl Inst Public Health 2012, 61:155-165. [http://www.niph.go.jp/journal/data/61-2/201261020012.pdf webcite]
- [7]World Medical Association the 59th WMA General Assembly: WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects. Seoul: Ferney-Voltaire: World Medical Association; 2008.
- [8]Emergency Disaster Countermeasures Headquarters: Damage Situation and Police Countermeasures Associated With 2011 Tohoku District – off the Pacific Ocean Earthquake (in Japanese). Tokyo: National Police Agency of Japan; 2013. [http://www.npa.go.jp/archive/keibi/biki/higaijokyo_e.pdf webcite]
- [9]Reconstruction Agency: The Number of Evacuees Across the Country (in Japanese). Tokyo; 2013. http://www.reconstruction.go.jp/topics/main-cat2/sub-cat2-1/20130730_hinansha.pdf webcite]
- [10]The Ministry of Health, Welfare, and Labours- Japan: The damage situation of the disaster key hospitals after the Great East Japan Earthquake (in Japanese). Tokyo; 2011. [http://www.mhlw.go.jp/stf/shingi/2r9852000001uo3f-att/2r9852000001uo7y.pdf webcite]
- [11]Terada A: The Great East Japan Earthquake Report (the 11th report): Damage and reconstruction situations and challenges of medical facilities (in Japanese). NKSJ-RM Report 2011, 57:1-9. [http://www.sjnk-rm.co.jp/publications/pdf/r57.pdf webcite]
- [12]Anonymous: Wearing Memories of the Disaster, Declined Health, and no Prospect of Dwellings: A Survey of 100 Evacuees Living in Temporary Housing (in Japanese). Tokyo: Sankei News; 2013.
- [13]Anonymous: A survey by the Japan Medical Association Research Institute of the three disaster-hit prefectures found 3.5 times higher prevalence than before of ill-health doctors in Fukushima (in Japanese). Miyagi: Kahoku Shinpo; 2013.
- [14]Eguchi N, Degushi M: A Survey on Attitudes Toward Medical Services Among Physicians in the Three Disaster-hit Prefectures (in Japanese). The Japan Medical Association Research Institute Working Paper 2012, 273:1-90.
- [15]Yonezawa K: Shortages of Doctors and Nurses (in Japanese). Gerontol J 2012, 11–027:1-12. [http://www.nli-research.co.jp/report/gerontology_journal/2011/gero11_027.pdf webcite]
- [16]Anonymous: More Than 1,200 Doctors Left from Coastal Areas of the Three Disaster-hit Prefectures Because of the Disaster and the Nuclear Accident (in Japanese). Miyagi: Kahoku Shinpo; 2011.
- [17]The Tohoku Medical Megabank Project Advisory Committee: The Official Record of the Proceedings of the 1st Meeting (in Japanese). Tokyo: Research Promotion Bureau Life Sciences Division, the Ministry of Education, Culture, Sports, Science and Technology-Japan; 2012.
- [18]Organization TUTMM: Leaflet (Sep 2013 version) (in Japanese). Miyagi: Tohoku University Tohoku Medical Megabank Organization; 2013. [http://www.megabank.tohoku.ac.jp/file/leaflet01.pdf webcite]
- [19]Kubota A: The Tohoku Medical Megabank Organization has Detached the First Team of 4 Doctors to a Disaster-hit Region (in Japanese). Tokyo: Nikkei Medical Online; 2012. [http://medical.nikkeibp.co.jp/leaf/mem/pub/hotnews/int/201210/527034.html webcite]
- [20]Komatsu H: Ethical Flaws of the Grand Design of the Tohoku Medical Megabank (in Japanese). Medical Governance Association Mail Magazine 2011, 268. [medg.jp/mt/2011/09/vol268.html]
- [21]Mitobe H: The Grand Design of the Tohoku Medical Megabank: Genetic Research and ICT Utilization are in Progress on the Pretense of Recovery from the Disaster (in Japanese). In Hyogo Medical Practitioners Association News Paper. Hyogo: Hyogo Medical Practitioners Association; 2012:1699. [http://www.hhk.jp/hyogo-hokeni-shinbun/backnumber/2012/1005/070200.php webcite]
- [22]Annas GJ, Grodin MA: Research forum: ethics and studies of HIV: human rights and maternal-fetal HIV transmission prevention trials in Africa. Am J Public Health 1998, 88:560-563.
- [23]Participants in the 2001 Conference on Ethical Aspects of Research in Developing Countries: Fair benefits for research in developing countries. Science 2002, 298:2133-2134.
- [24]Participants in the 2001 Conference on Ethical Aspects of Research in Developing Countries: Moral standards for research in developing countries. From “reasonable availability” to “fair benefits”. Hastings Cent Rep 2004, 34(3):17-27.
- [25]Emanuel EJ, Wendler D, Killen J, Grady C: What makes clinical research in developing countries ethical? The benchmarks of ethical research. J Infect Dis 2004, 189:930-937.
- [26]The Tohoku Medical Megabank Project Advisory Committee: Recommendations by the Tohoku Medical Megabank Project Advisory Committee (in Japanese). Tokyo: Research Promotion Bureau Life Science Division, the Ministry of Education, Culture, Sports, Sciences and Technology-Japan; 2012. [http://www.mext.go.jp/b_menu/shingi/chousa/shinkou/026/gaiyou/1321811.htm webcite]
- [27]The Tohoku Medical Megabank Project Advisory Committee: The Official Record of the Proceedings of the 2nd Meeting (in Japanese). Tokyo: Research Promotion Bureau Life Sciences Division, the Ministry of Education, Culture, Sports, Science and Technology-Japan; 2012. [http://www.mext.go.jp/b_menu/shingi/chousa/shinkou/026/gijiroku/1321745.htm webcite]
- [28]The Tohoku Medical Megabank Project Advisory Committee: The Official Record of the Proceedings of the 3rd Meeting (in Japanese). Tokyo: Research Promotion Bureau Life Sciences Division, the Ministry of Education, Culture, Sports, Science and Technology-Japan; 2012. [http://www.mext.go.jp/b_menu/shingi/chousa/shinkou/026/gijiroku/1323277.htm webcite]
- [29]The Tohoku Medical Megabank Project Advisory Committee: The Official Record of the Proceedings of the 4th Meeting (in Japanese). Tokyo: Research Promotion Bureau Life Sciences Division, the Ministry of Education, Culture, Sports, Science and Technology-Japan; 2012. [http://www.mext.go.jp/b_menu/shingi/chousa/shinkou/026/gijiroku/1323278.htm webcite]
- [30]The Tohoku Medical Megabank Project Advisory Committee: The official record of the proceedings of the 5th Meeting (in Japanese). Tokyo: Research Promotion Bureau Life Sciences Division, the Ministry of Education, Culture, Sports, Science and Technology-Japan; 2012. [http://www.mext.go.jp/b_menu/shingi/chousa/shinkou/026/gijiroku/1323280.htm webcite]
- [31]Tagajo City Council: The official record (No. 3) of the proceedings of the 2nd Tagajo City Council in 2013 (in Japanese). Miyagi; 2013. [http://www.city.tagajo.miyagi.jp/gikai/hanasi/mae/kaigiroku/h2506t/250618t-hon.html webcite]
- [32]Qureshi KA, Gershon RRM, Smailes E, Raveis VH, Murphy B, Matzner F, Fleischman AR: Roadmap for the protection of disaster research participants: findings from the World Trade Center Evacuation Study. Prehosp Disaster Med 2007, 22:486-493.
- [33]London AJ, Zollman KJS: Research at the auction block: problems for the fair benefits approach to international research. Hastings Cent Rep 2010, 40(4):34-45.
- [34]Council for International Organizations of Medical Sciences: International Ethical Guidelines for Biomedical Research Involving Human Subjects. Geneva; 2002.
- [35]Anonymous: Reconstruction from the Great East Japan Earthquake and Training New Physicians (in Japanese). In Nikkei Medical Appendix Special Edition. Tokyo: Nikkei Business Publications; 2011:1-6. [http://medical.nikkeibp.co.jp/all/info/mag/express/data/nmexpress1112.pdf webcite]
- [36]Sakai T, Aizawa T, Ishii E, Shiotani T: 2012 new year discussion meeting: toward resumption of medical services (in Japanese). Jpn Hosp 2012, 59(1):12-38. [https://www.hospital.or.jp/mag/data/03_20120100_01.pdf webcite]
- [37]Council for Science and Technology Policy: The Official Record of the Proceedings of the 93th Meeting of the Expert Panel on Evaluation (in Japanese). Tokyo: Cabinet Office, Government of Japan; 2012. [http://www8.cao.go.jp/cstp/tyousakai/hyouka/haihu93/giji93.pdf webcite]
- [38]Hachiyama K: Toward the Development of Japan-Originated Medical Innovations (in Japanese). In Digital Government & Financial Topics. Tokyo: NTT Data; 2012. [http://e-public.nttdata.co.jp/topics_detail2/id=697 webcite]
- [39]Kubota F, Toyokawa T: Transmission of Advanced Research from the Disaster-hit Regions, and Placing Stress on Human Resource Development of Disaster Medicine. A Special Report: Glimmering Hopes in Medicine in Tohoku (Part 2). Reproduction from Nikkei Medical Extra Edition – The Great East Japan Earthquake: How Medicine Changed? – (in Japanese). Tokyo: Nikkei Business Publications; 2012. [https://medical.nikkeibp.co.jp/leaf/all/report/t188/201212/527931.html webcite]
- [40]Hara N: We Have a Historical Mission for Achieving Reconstruction of Tohoku and Leading the Recovery of Japan (in Japanese). Miyagi: Miyagi-no-shinbun Field and Network; 2013.
- [41]Tohoku Medical Megabank Organization: Informed Consent Form (17 May 2013 Version) (in Japanese). Miyagi; 2013. [http://www.megabank.tohoku.ac.jp/chco/details/pdf/doi_setsumei_20130517.pdf webcite]
- [42]Mitsubishi Research Institute: Reconstruction After Hanshin-Awaji Great Earthquake Through Establishing R&D Sites (in Japanese). In A Survey Report: Governmental Promotion of R&D: the Current Status of Universities and Public Research Bodies. Tokyo: National Diet Library Research and Legislative Reference Bureau; 2012:281-289. [http://dl.ndl.go.jp/view/download/digidepo_3487171_po_20110223.pdf?contentNo=1 webcite]
- [43]Biomedical Innovation Cluster KOBE: The strategy of Kobe Medical Industry Development Project: Creating a future out of a heap of rubble (in Japanese). Kobe: Foundation for Biomedical Research and Innovation; 2011.
- [44]Kobe City Council: The Official Proceedings of Kobe City Council (the 3rd Regular Assembly, the Second day: The Express Version) (in Japanese). Kobe; 2012.
- [45]Millum J, Emanuel EJ: The ethics of international research with abandoned children. Science 2007, 318:1874-1875.
- [46]Aono Y: Science After 3.11.: An Interrogation Point About Genetic Analysis in Fukushima (in Japanese). Tokyo: The Mainichi Newspapers; 2012.
- [47]Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology: The Report of the Survey Concerning Early Diagnosis of Potential Dementia Patients in Local Communities (in Japanese). Tokyo; 2012. [http://www.tmghig.jp/J_TMIG/extra/pdf/h23_kokkohojo_result/report_awata.pdf webcite]
- [48]Anonymous: The Elderly People Totaled 53,696 in the Evacuation Areas: Forced to Take Prompt Measures Against Increasing Population Aging Rate (in Japanese). Fukushima: Fukushima-Minpo; 2012.
- [49]The House of Representatives: The Record of the 183rd Diet: The House of Representatives’ Special Committee on Reconstruction After Great East Japan Earthquake No. 6. (in Japanese). Tokyo; 2013. [http://www.shugiin.go.jp/internet/itdb_kaigiroku.nsf/html/kaigiroku/024218320130425006.htm webcite]
- [50]Matsuyama Y: A Large Scale Social Welfare Facility is Needed for Reconstruction of the Disaster-Stricken Regions (in Japanese). Tokyo: CB NEWS; 2011.
- [51]Mogami M: The Tohoku Medical Megabank Project got Severe Criticism in the 2nd Commission: An Illusory Recruitment Plan of 150,000 People in the Disaster-Stricken Regions, but no Research Subjects Without the Return of the Residents (in Japanese). Tokyo: Nikkei Medical Online; 2012.
- [52]London AJ: Justice and the human development approach to international research. Hastings Cent Rep 2005, 35(1):24-37.
- [53]Maschke KJ: Returning genetic research results: considerations for existing no-return and future biobanks. Minn J Law Sci Technol 2012, 13:559-573.
- [54]Terry SF: The tension between policy and practice in returning research results and incidental findings in genomic biobank research. Minn J Law Sci Technol 2012, 13:691-736.
- [55]The Ministry of Education, Culture, Sports, Science and Technology-Japan: The Official Proceedings of the 4th Tohoku Medical Megabank Project Commission (in Japanese). Tokyo; 2012. [http://www.mext.go.jp/b_menu/shingi/chousa/shinkou/026/gijiroku/1323278.htm webcite]
- [56]Research Promotion Bureau Life Sciences Division: The Proposal by the Tohoku Medical Megabank Project Commission (in Japanese). Tokyo: The Ministry of Education, Culture, Sports, Science and Technology-Japan; 2012. [http://www.mext.go.jp/b_menu/shingi/chousa/shinkou/026/gaiyou/1321811.htm webcite]
- [57]Murphy J, Scott J, Kaufman D, Geller G, LeRoy L, Hudson K: Public expectations for return of results from large-cohort genetic research. Am J Bioeth 2008, 8(11):36-43.
- [58]Matsui K, Lie RK, Kita Y, Ueshima H: Ethics of future disclosure of individual risk information in a genetic cohort study: a survey of donor preferences. J Epidemiol 2008, 18:217-224.
- [59]Clayton EW, Ross LF: Implications of disclosing individual results of clinical research. JAMA 2006, 295:37.
- [60]Wolf SM, Crock BN, Van Ness B, Lawrenz F, Kahn JP, Beskow LM, Cho MK, Christman MF, Green RC, Hall R, Illes J, Keane M, Knoppers BM, Koenig BA, Kohane IS, Leroy B, Maschke KJ, McGeveran W, Ossorio P, Parker LS, Petersen GM, Richardson HS, Scott JA, Terry SF, Wilfond BS, Wolf WA: Managing incidental findings and research results in genomic research involving biobanks and archived data sets. Genet Med 2012, 14:361-384.
- [61]Levine RJ: Ethics and Regulation of Clinical Research. 2nd edition. New Haven and London: Yale University Press; 1986:79.
- [62]Macklin R: Double Standards in Medical Research in Developing Countries. Cambridge: Cambridge University Press; 2004:102.
- [63]Tohoku Medical Megabank Organization: News (in Japanese). Miyagi; 2013. [http://www.megabank.tohoku.ac.jp/news/detail.php?id=472&c1=2 webcite]
- [64]Hozawa A, NakaYa N, Nakamura T, Tsuchiya N, Kikuya M, Metoki H, Obara T, Osumi N, Kiyomoto H, Sugawara J, Suzuki Y, Tomita H, Tominaga T, Nakaya J, Fuse N, Minegishi N, Tsuji I, Yaegashi N, Yamamoto M: A progress report of the population-based cohort study of the Tohoku Medical Megabank [abstract]. J Epidemiol 2014, 24(Suppl 1):67.
- [65]The Expert Panel on Evaluation of the Council for Science and Technology Policy: The Official Record of the Proceedings of the 2nd Meeting of the Tohoku Medical Megabank Project Evaluation Panel (in Japanese). Tokyo: Cabinet Office, Government of Japan; 2012. [http://www8.cao.go.jp/cstp/tyousakai/hyouka/kentou/tohokummb/haihu2/giji2.pdf webcite]
- [66]Tohoku Medical Megabank Organization: The ToMMo has sequentially hold seminars and briefing on ethical issues (in Japanese). ToMMo News Letter 2013, 4:3. [http://www.megabank.tohoku.ac.jp/guidance/file/Newsletter4.pdf webcite]