Unfortunately, it appears that being slow to recognise a crisis is part of the human condition, and medical research has had its fair share. Often there needs to be a key event (or series of events) to highlight the situation and signal a turning point. Robert Hewitt, MB BS, PhD, of Biosample Hub, looks at two examples with differing outcomes.
Biobanking
A number of crises have shaped the field of biobanking. One of the most noteworthy was the UK organ retention scandal of 1999 (Bauchner & Vinci, 2001). The problem came to light because a bereaved mother investigating the death of her child, demanded a copy of her medical records. Here she found a letter revealing the fact her child’s heart had been removed at autopsy and retained without permission (The Guardian, 2003).
From the public inquiry that followed, it emerged that it was common practice in many hospitals for pathologists performing autopsies on infants to retain whole organs like the brain and heart for education and research purposes, without having the informed consent of the parents. When this information was publicised in the news media, parents who had already suffered a bereavement came to learn that their child’s organs had been retained without their knowledge. This resulted in a huge public outcry; it became obvious that major cultural change was necessary.
The report of the Royal Liverpool Children’s inquiry, published in January 2001, made many recommendations including amendment of national law to clarify the fact that informed consent is required for organ retention at autopsy. In response to these and other recommendations, the Human Tissue Act of 2004 came into force. In addition, a regulatory body called the Human Tissue Authority (HTA) was set up in 2005. The HTA serves to regulate organisations that remove, store and use human tissue for research, medical treatment, post-mortem examination, education and training, and display in public (HTA website). Its aim is to ensure that such organisations follow legal requirements and so it promotes understanding of these requirements through codes of practice and other guidance.
Biosamples
Biotech companies play a vital role in medical research. But three years ago, the annual report of a UK agency called Medicines Discovery Catapult (MDC) came up with a disturbing finding: 80% of small to medium sized biotechs found accessing samples from the National Health Service unexpectedly difficult with the result that 75% imported samples from abroad (SODN, 2018).
We need to see this for the crisis it is.
There is no shortage of samples—in the UK there are more than 150 hospital-associated biobanks—but there is a failure to share samples with biotech companies. This is partly because public sector biobanks are established by hospitals and universities to support research in academic centres rather than industry. This is not just a UK issue, it is global.
It is well-known that biotech companies around the world rely mainly on commercial tissue brokers to obtain clinical samples. Commercial brokers serve a valuable purpose in that they provide biotech companies with vital clinical samples for their research. However, in general brokers have the disadvantage that for business reasons they will not reveal the source of their samples, because to do so would risk circumvention and loss of income. This obviously means that their clients will tend to lack reliable provenance information on the samples they receive. This poses a serious problem for manufacturers of medical devices who must use samples with reliable provenance information to validate their devices in order to be compliant with the new European IVDR regulations.
It seems there are two main ways in which we can respond to this sharing crisis – both require cultural change.
1. We embrace the commercialisation of biosample procurement. This would mean that hospitals in Western Europe put aside ethical concerns and supply samples to commercial brokers, who in turn provide samples to biotech companies. This would reduce the need for brokers to source samples from other less developed parts of the world.
2. Public sector biobanks – or rather their management committees – accept it as their responsibility to share samples with biotech companies. This would be the ideal, because biotech companies must have access to high quality samples with reliable provenance information.
We need to decide which path to follow.
References
Bauchner H and Vinci, R. What have we learnt from the Alder Hey affair? British Medical Journal 322, 309-310 (2001).
Blow, N. Biobanking: freezer burn. Nature Methods volume 6, 173–178 (2009). https://www.nature.com/articles/nmeth0209-173
Compton, C. Garbage In, Garbage Out: The hidden reason laboratory test results may not be as reliable as they seem. The Pathologist 03.16.2018 https://thepathologist.com/diagnostics/garbage-in-garbage-out
Editorial: ‘Thank you for sharing’. Nature Biotechnology 38, 1005 (2020).
Human Tissue Authority website. https://www.hta.gov.uk/
Marshall, M. Why we find it difficult to recognise a crisis. BBC Future. 14 April 2020.
https://www.bbc.com/future/article/20200409-why-we-find-it-difficult-to-recognise-a-crisis
SODN. State of the Discovery Nation 2018. A report by the Medicines Discovery Catapult and the BIA.
https://md.catapult.org.uk/resources/report-state-of-the-discovery-nation-2018/
The Guardian: ‘What happened next?’ 18th May 2003.
https://www.theguardian.com/society/2003/may/18/observermagazine.theobserver
