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Biobanking: Social, Advanced article

Political and Ethical Aspects Article Contents


. Introduction: Biobanking Today

Richard Tutton, ESRC Centre for Economic and Social Aspects of Genomics (Cesagen), . Governance and Legitimation of Biobanks

. Consent in the Era of Biobanking


Lancaster University, Lancaster, UK
. Ownership, Control and the
Economies of Biobanks

. Summary

Online posting date: 15th January 2010

Prospective, population-based biobanks designed for applications such as blood transfusion or organ trans-
research into genetic, environmental and lifestyle factors plantation. Biobanks are situated in a range of institutions
associated with common, complex diseases or the genetic such as hospitals, universities, pharmaceutical companies
basis of drug response have garnered significant interest and charities and vary in provenance, size, composition,
over the past 10 years from bioethicists, social scientists, methodology, economy and governance. There is dis-
agreement among academic commentators, scientists and
lawyers and other commentators. There are a series of
policymakers about what defines a biobank and whether
interrelated but distinct social, political and ethical issues
this is the best term to use, with some preferring expressions
raised by biobanking: the challenges of creating govern-
such as ‘genetic database’ instead (Corrigan and Tutton,
ance structures that win public confidence in these novel 2009; Gibbons et al., 2007). Despite such ambiguities, there
and uncertain scientific initiatives; the establishment of are strong expectations among scientists, policymakers and
appropriate systems of consent; determining the rights of others that biobanks will play an important part in
ownership, commercial exploitation and benefit-sharing improving future human health and in bringing substantial
among different stakeholders and the ways biobanks economic benefits to those who use and invest in them.
invoke ideas about human population differences and This article cannot give adequate coverage to all of the
might serve to help address the health needs of minority research and therapeutic forms of biobanking that are
groups in society. ongoing today. Given that prospective, population-based
biobanks designed for research into genetic, environmental
and lifestyle factors associated with common, complex
diseases or the genetic basis of drug response have garnered
the most interest from commentators, this article will
concentrate on this type of biobanking. It will acknow-
Introduction: Biobanking Today ledge, however, the discussions led by those who have
looked at cancer (Dixon-Woods et al., 2008) and stem-cell
In the past 10 years, a sizeable literature has been produced biobanking (Brown and Kraft, 2006) where appropriate.
on the social, ethical, legal and commercial dimensions of Prospective, population-based biobanking has become a
biobanking. Several edited anthologies have been pub- global activity, with initiatives appearing in Québec,
lished (Arnason et al., 2004; Dabrock et al., 2010; Eriksson Scotland, Japan, the United States, Newfoundland, Tai-
and Hansson, 2001; Faulkner-Sleebom, 2008; Gottweis wan, Singapore, China, Germany, the United Kingdom,
and Petersen, 2008; Häyry et al., 2007; Tutton and Corri- Iceland, Estonia, Sweden, India and Western Australia to
gan, 2004), and at least one major review of the literature list but a few places. Although most of these are ongoing
has already appeared (Hoeyer, 2008). The term biobanking concerns, some have met with local opposition or
itself describes a diverse range of research and clinical encountered difficulties related to their financing or com-
activity, ranging from research in the epidemiology of mercialization models and have either shut down or con-
common complex diseases, pharmacogenetics, rare genetic tinued in different forms (Rose, 2006).
diseases, oncology and stem cells, to therapeutic This article gives an overview of the principal social,
ethical and legal issues that commentators have debated in
relation to biobanking. Different groups of researchers
ELS subject area: Science and Society have contributed to these debates, including bioethicists,
lawyers, sociologists of science and anthropologists, as well
How to cite: as geneticists, biologists and others. This article focuses on
Tutton, Richard (January 2010) Biobanking: Social, the following clusters of issues: debates about the appro-
Political and Ethical Aspects. In: Encyclopedia of Life Sciences (ELS). priate form of consent for biobanks; questions of owner-
John Wiley & Sons, Ltd: Chichester.
ship, property and the broader economic context to
DOI: 10.1002/9780470015902.a0022083
biobanking; the way biobanks draw on and reflect ideas of

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Biobanking: Social, Political and Ethical Aspects

national identity, citizenship, and the extent to which they such as Japan appear to have been developed with little
succeed in being inclusive of racial/ethnic minorities; and, consultation with the public or the academic community
to begin with, the particular challenges to governance that (Triendl and Gottweis, 2008).
biobanks present and how they have sought their social and In addition to public engagement, it is also argued that as
political legitimation. part of their strategy to achieve legitimacy organizers of
biobanks have sought to enrol bioethicists to negotiate the
way through the political, ethical and legal uncertainties
that they face (Salter and Jones, 2005). As a group, bio-
Governance and Legitimation of ethicists have recognized expertise and competence in the
Biobanks area of biomedical governance and have an authoritative
claim to policy-relevant knowledge. It is also fair to say,
Sociologists of science and political scientists have drawn however, that other professionals with similar credentials
attention to the governance frameworks of science and such as social scientists and lawyers have also been
technology within which biobanks have appeared and the recruited to work alongside scientists, clinicians and others,
problems faced by their institutional funders and sup- including consumer or patient representatives, on the
porters to establish their social and political legitimacy. issues that biobanks face. A number of biobanks have
Biobanks emerged at a time when policymakers and com- created their own in-house oversight committees. The UK
mentators were concerned with public controversies sur- Biobank, for instance, established a semi-independent
rounding technological and scientific issues such as Ethics and Governance Council (EGC), which was per-
cloning, gene therapy, genetic testing and genetically ceived to be crucial in securing public confidence in the
modified (GM) food, and were recognizing the need ‘to project. With a bioethicist as its first chair, the EGC was
build and maintain high levels of public trust through the created long before UK Biobank began its recruitment of
effective governance of _ emerging biotechnologies’ volunteers in 2006. It has been argued that bodies such as
(Martin, 2001, p. 171). Throughout the 1980s and 1990s, the EGC represent a ‘regulation plus’ model (Haddow
networks of research and governance changed with greater et al., 2007) whereby biobanks provide an additional layer
ties between academic and commercial organizations and of scrutiny to the existing structures of governance, with
in some countries there was a move to facilitate the com- the aim of securing public confidence in them.
mercial exploitation of publicly constituted resources, Two particular issues in the governance of biobanks –
effectively blurring the lines between the private and the which have impinged directly on questions about their
public. Many biobanks are situated on these contested legitimacy – have attracted particular attention: the first
‘blurred’ lines between the public and the private in ways concerns the process by which individuals consent to
that have sometimes been controversial. In the 1990s, we deposit tissue samples and personal information with
also saw the emergence of an institutionalized ELSI (eth- biobanks; and the second relates to the rights of ownership,
ical, legal, social implications) research agenda in human, control and financial benefit that comes from the use of
animal and plant genomics in North America and Europe, these samples and data by third parties that include com-
as well as the introduction of new advisory bodies focusing mercial organizations. These will be addressed in turn in
on matters related to genetics, such as the Human Genetics the sections that follow.
Commission (HGC) in the United Kingdom, which
involved greater lay involvement. Civil society groups also
became active during this time, addressing issues related to Consent in the Era of Biobanking
animal, plant and human genetics research.
Against this background, and faced with concerns about The issue of consent has been a dominant concern of much
trust, data security, confidentiality, consent, discrimin- writing about prospective genomic or epidemiological
ation and commercial interests expressed by academic databases (see Beskow et al., 2001; Clayton, 2005; Shickle,
commentators and policy actors, the organizers of many 2006; for a review of this extensive literature see Hoeyer,
biobanks have had to build legitimation for their initiatives 2008). The prominence given to the consent question comes
(Petersen, 2006; Salter and Jones, 2005). This has been in part from what was happening in Iceland in the late
particularly important for population-based prospective 1990s. The plan developed by deCODE Genetics with the
biobanks because many receive public funding and depend support of the Icelandic Government and Parliament was
on successfully enrolling a great number of volunteers. to create the Health Sector Database – essentially an
Given this, a number of them have undertaken various electronic patient record system – that would be combined
forms of community and public engagement (Godard with a genealogical database (which was already in the
et al., 2004). Sociologists as well as policymakers have public domain) and a deoxyribonucleic acid (DNA) data-
found many of these consultative activities to be prob- base. The Health Sector Database was to operate on a
lematic, pointing to the way they are narrowly defined and presumed consent basis, with a concession that individuals
controlled to the exclusion of addressing more substantial could opt-out within a certain period to prevent their
issues (Petersen, 2007; McNamara and Petersen, 2008; medical records from being automatically included in the
Walmsley, 2009). However, biobanks in other countries database. This was seen as going against international

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Biobanking: Social, Political and Ethical Aspects

norms and faced a significant legal challenge in the be used in circumstances such as criminal investigation or
Supreme Court of Iceland that ruled against this approach for other purposes. For instance, after the tsunami in 2005,
(Palsson, 2008). However, further to this, it has been sug- the Swedish Parliament temporarily amended legislation
gested that many observers were confused about what was related to medical biobanks to permit access to identify
happening in Iceland and believed that presumed consent bodily remains (Holmlund et al., 2006).
also extended to the genetic database, which was not An alternative approach followed by a number of bio-
the case (see Hoeyer, 2008). This misunderstanding banks in Europe and Asia has been to move from informed
informed much of the critical commentary on Iceland and consent to broad consent, supplemented by two compen-
contributed to consent becoming a highly controversial satory measures: first that ethics committees approve of all
issue in relation to genomic and epidemiological databases. future research using the biobank in question and second,
See also: deCODE and Iceland: A Critique that individuals have a right to withdraw at any time
Moreover, as debates about the status, ownership and (although what this means in practice is not always clear)
control of human tissue and genetic information came to (Elger and Caplan, 2006). Those who advocate broad
the fore in the 1990s in light of its newly commercialized consent cite evidence on the views of public groups to
value, whether we were talking about things or persons, or support their case, referring to studies that indicate that
perhaps something in between became a significant point of people do not attach a similar priority to informed consent
contestation (Knoppers and Laberge, 1995). This was as ethicists (Chen et al., 2005). This point is largely sup-
especially the case because, with molecular DNA analysis, ported by empirical research on individuals’ experience of
tissue samples became a source of genetic information being participants in biobanks by anthropologists and
about individuals that was perceived to be revealing sociologists (see Hoeyer, 2008). Lunshof et al. (2008) go
something essential about them (Hoeyer, 2008). These further in their argument that the promise of privacy and
observations about the link between tissues, DNA and confidentiality is untenable in the era of genomic research
human personhood seem to be borne out by some of the that is predicated on the networking and sharing of vast
debate about the type of consent with which biobanks quantities of data. Researchers should adopt an ‘open
should operate. Given that prospective biobanks are con- consent’ model that recognizes and documents the fact that
figured as resources for multiple researchers to access and individuals will have their personal information disclosed
use over a potentially long period of time, it is not possible to third parties both now and in the future.
to tell individuals how their samples and genetic or other There are also discussions about alternative ethical
kind of information might be used in the future with any frameworks to informed consent such as those based on
degree of specificity at the time when they are enrolled. solidarity and equity in relation to biobanking. Chadwick
Some argue that seeking re-consent from individuals over and Berg (2001) observe that the rules on informed consent
time as new studies apply to use the biobank is likely to be were developed in the middle of the twentieth century and
expensive; refusals or nonresponses could undermine the argue ‘now might be the time for a fresh ethical perspective’
integrity of both the intended research and the resource (p. 321). They suggest that individuals have a duty to par-
itself and it would be burdensome to the individuals being ticipate in biobanks where the subsequent research using
recontacted on potentially several occasions. The fear is these resources could benefit wider society and future
that they might even develop negative attitudes towards generations, an act of solidarity similar to providing blood
biomedical research (Berg, 2001). This has led some to for transfusion or organs for transplantation. These ideas
speak about a crisis involving consent in the context of about solidarity and equity are not unproblematic, how-
biobanking (Lipworth et al., 2006). ever, in a time when there are significant commercial
In the United States and Europe, there have been dif- interests in banking human tissue.
ferent institutional responses to this situation: in the for-
mer, the issue of informed consent has become bound up
with the identifiability or anonymity of samples. US pol-
icymakers have broadened the category of ‘nonidentifiable’
Ownership, Control and the
samples to include those where the investigator accessing Economies of Biobanks
the biobank is unable to link that sample to a named
individual (Elger and Caplan, 2006). When samples are Recent work on the political economy of the life sciences in
rendered as ‘nonidentifiable’, informed consent is not the twenty-first century by sociologists of science and
deemed to be necessary for their continued and future use. technology points to the broader economic context in
Therefore, in the US context, informed consent is linked to which biobanks must be situated. Biobanks, whether for
questions of individual identifiability and concerns about epidemiological, pharmacogenetic, cancer or stem-cell
privacy and confidentiality. When the personal identity of research, are positioned as having a pivotal role in the
individuals is protected, informed consent is not required ‘bioknowledge economy’ (Tupasela, 2006). With their
for subsequent use of the samples. However, this expansion promise to utilize the genetic or biological characteristics of
of nonidentifiability is not without its problems, since the populations as resources for the production of intellectual
link between the sample and the individual still remains, property, biobanks are seen as key elements in the pro-
albeit in an encrypted form held by the biobank, and could duction of ‘biovalue’, by which life itself is seen as

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Biobanking: Social, Political and Ethical Aspects

productive of surplus value (Cooper, 2008). In addition to Supreme Court of California on John Moore v. Regents of the
their potential to be resources that will improve human University of California (Boyle, 1992). The plaintiff, John
health, biobanks could also provide the means for boosting Moore, claimed that he held property rights in the tissue
national or regional biotechnology and the pharmaceutical excised by doctors who performed his splenectomy and who
sectors. In countries such as Iceland, Estonia and Latvia, then used this tissue to develop a cell line, which had potential
biobank initiatives were represented as ways of establishing commercial value. The court’s decision to deny his action was
an economic resource out of the ‘raw materials’ of DNA based on the reasoning that tissue in itself could not be con-
samples, producing profit for private companies and sidered property. Only when it was turned into a cell line and
bringing inward investment in capital and jobs to these had been invested with and altered by human labour, could it
economies (Abbott, 2001; Merz et al., 2004; Mieszkowski, become property. Since Moore did not own the tissue
2003). Such expectations about the economic benefits of removed from his body, he had no claim over the cell line and
biobanks in the context of international competitiveness in no entitlement to a share of profits made from its commercial
the new ‘bioeconomy’ are important elements in the story development. The Moore case has become a touchstone for
of contemporary biobanking (Fortun, 2008). commentaries on the ethical and legal issues involved in the
As already suggested, the debate on consent is entangled use of human tissue and is a frequent point of reference for
with questions of ownership, commercial access and regulatory, advisory and ethics bodies. For some legal com-
benefit-sharing. With the exception of private cord blood mentators, the case exemplifies that ‘while property rights are
banking, where individuals pay to have tissue stored for routinely granted in respect of human material, this is usually
potential future use (see Brown and Kraft, 2006), most done to the exclusion of the one person who is central to the
types of biobanks operate on the principle that individuals entire enterprise, namely, the individual from whom the
would voluntarily and freely provide biological samples material has been taken’ (Laurie, 2002, p. 304). This is not
and personal information. The transaction between the only unjust but, as the argument goes, granting property
biobank and the volunteer or patient is, therefore, a non- rights could be a way of relegitimizing research and over-
commercial one and has sometimes been conceptualized as coming the ‘crisis in confidence’ in its governance by giving
a ‘gift relationship’ – a deliberate echo of Richard Titmuss’ people more control over what happens to their tissue
use of that expression in relation to blood donation (Tutton (Laurie, 2002). Biobanks would therefore not solely rely on
and Corrigan, 2004; Waldby and Mitchell, 2006) – to consent but incorporate a system of property rights.
emphasize that people should be acting altruistically. Such arguments have not gone unchallenged, however,
Access to and use of biobanks, however, might very well be from a number of quarters. Some social scientists have
on commercial terms, with biotechnology and pharma- questioned whether there really is a ‘crisis in confidence’
ceutical companies as well as universities as likely future and suggest that there is a range of public views on the use
users of these resources. This has led to a debate about of different types of tissue. In the context of cancer bio-
whether and on what terms such organizations should banking, the interest in controlling what is done with the
financially benefit from research conducted using samples tissue might be less important than the potential ‘pay-off’
freely provided by individuals. The dominant view in bio- from therapeutic research conducted using that tissue
ethics literature and in guidelines produced by bodies such (Sebire and Dixon-Woods, 2007). Moreover, the focus on
as the Nuffield Council on Bioethics (1995) is that to secure property and property rights detracts from the point that
the promised benefits to health in the form of new diag- much research using human tissue is conducted in charit-
nostics or drugs, commercial actors must be entitled to able, academic and clinical settings and is not driven by
intellectual property on products developed as a result of commercial interests.
research using biobank resources. However, research on Beyond the focus on property rights, others have dis-
public views on access to prospective, population-based cussed models of benefit-sharing and ways of negotiating
epidemiological biobanks points to a strong preference for public and private interests in biobanks, such as the idea
only health services and academic research organizations that biobanks should be organized as ‘charitable trusts’ to
to have use of these resources (Shickle et al., 2002). Other safeguard public interests by controlling the use made of
research reports a more variable picture of public oppos- these resources by third parties (Winickoff and Winickoff,
ition and ambivalence to commercial companies accessing 2003). Partnership rather than property is the dominant
biobanks to which individuals have freely contributed theme of such commentaries. Others have examined the
samples (Haddow et al., 2007). See also: Commercial- question of introducing systems of benefit-sharing (Berg,
ization of Human Genetic Research 2001; Simm, 2005; Wilson, 2004), including community-
The debate about ownership, commercial access and based ‘benefit-sharing’ that could involve both ‘in kind’
benefit-sharing in relation to biobanking stems in part from and monetary benefits (Haddow et al., 2007). The thrust of
broader concerns with the commodification of the human some of these contributions is that those running biobanks
body (Andrews and Nelkin, 2002), the patenting and selling should recognize the need for some form of reciprocation
of genetic information (Knoppers and Laberge, 1995) and for the free, voluntary contributions of individuals and
long-standing debates in legal theory about property in the families to biobanks and benefit-sharing could be one way
human body (Grubb, 1998). These debates are informed by in which this is achieved (Busby, 2006; Haddow et al., 2007;
case law such as the much-discussed judgement of the Winickoff, 2007).

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Biobanking, national identity and in/ scientific literature, with different approaches being advo-
exclusion of racial/ethnic minorities cated for dealing with it (see Collins, 2004). One response is
for biobanks to be designed to specifically research and
Besides raising the kinds of ethical, legal and economic issues address the health needs of defined populations, such as the
discussed in the preceding sections, across the world, the Translational Genomic Research in the African Diaspora
formation of biobanks often invoke or are entangled with Biobank that was set up at the National Human Genome
discourses of collective identity, community, nationhood or Center at Howard University in 2003 (Royal and Dunston,
ideas about racial/ethnic groups and differences. The con- 2004). The UK Biobank, by contrast, has set minimum
cern expressed by some anthropologists and sociologists is targets for the recruitment of individuals from a number of
that new genetic knowledge produced from population- specified minority racial/ethnic groups (Tutton, 2008).
based genetic research could essentialize ideas of national Although it is hoped that the inclusion of minorities in
identity and citizenship (Arnason and Simpson, 2003). Some biobanks will help identity and redress health inequalities, it
researchers have considered how those promoting these is also recognized that research on disease susceptibility
initiatives actively construct the ‘population’ of the biobank could highlight different risk profiles for such groups and
in various ways that draw on or are congruent with legal, reinforce stereotypes, leading to stigmatization or further
social and political ideas of the nation. In some cases, this is discrimination (Chadwick, 2003).
articulated in terms of claims about the homogeneity of the
national population, such as in Iceland where deCODE
Genetics and many of its supporters emphasized the genet-
ically isolated and homogeneous nature of the Icelandic Summary
population (Palsson, 2008), which was reinforced by scien-
tific and popular media reports. Although such claims did For ethicists, lawyers, social scientists and others, bio-
not go unchallenged (Arnason, 2003), they helped to make banking is a significant sociotechnical activity in the field of
the case for the Icelandic population being a ‘good popu- biomedical research that raises a wide range of issues
lation’ for genetics research at a time when inward invest- relating to the formal conditions and procedures by which
ment was needed (Fortun, 2008; Rose, 2001). In other individuals are recruited to these initiatives; how biobanks
national contexts too, such as Israel and Japan, similar dis- establish their social and political legitimacy through novel
courses of population homogeneity have been evident, governance structures; how public and private interests are
drawing on the dominant discourses of national identity (see negotiated by biobanks in a context of great commercial
Prainsack, 2008; Triendl and Gottweis, 2008). interest in human tissue and personal clinical data and how
By contrast, in countries such as the United States and biobanks reflect cultural and political discourses of
the United Kingdom, notions of diversity seem to loom national identity and might serve to address the health
larger in discourses around prospective, population-based needs of different groups in society.
biobanks. The much-discussed plans to create a national, In the past five years, there have been a number of new
prospective biobank in the United States takes place in a initiatives to set standards for biobanking at an inter-
context in which there is specific legislation to redress national level and to foster greater coordination and
under-representation or exclusion of women and minor- cooperation among different biobanks. Organizations
ities in biomedical research, emphasizing potential differ- such as the P3G (Public Population Project in Genomics)
ences among such groups (see Epstein, 2007). In the United Consortium in Quebec, Canada has been a notable actor,
Kingdom, it has been argued that UK Biobank has and the European Commission under the aegis of its
invoked an ‘imagined national community’ united around Framework Programme Seven has supported initiatives at
certain touchstones of British national identity, such as the the European level to coordinate the work of biobanks in
National Health Service, as well as drawing on more con- member and associate member states. There is an emergent
temporary discourses of innovation, global competitive- global biobanking community of scientists, technicians,
ness and multiculturalism (Busby and Martin, 2006). ethicists, lawyers and others engaged in a project of har-
The inclusion of different racial/ethnic groups in the cre- monizing scientific, technical and ethical practices and
ation, design and rationale of biobanks raises a number of encouraging greater data-sharing across national borders.
problems. Empirical studies of the scientific and social issues As these initiatives progress, they will raise further social,
of including minority racial/ethnic groups in biobanks ethical and legal issues (Knoppers, 2005). Moreover, as
highlight the potential conflict that can arise between the many existing biobanks move from the banking to the
objectives of ‘social inclusivity’ and ‘analytical acuity’ (see research phase, opening their resources for researchers to
Smart et al., 2008). Although researchers might wish to access and use, it is clear that many of the issues outlined in
include minority groups in the studies, there are concerns this article will remain pertinent for the foreseeable future.
that doing so could adversely affect the quality of their sci-
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