If you build it, they will come: unintended future uses of organised health data collections.
Health research increasingly relies on organized collections of health data and biological samples. There are many types of sample and data collections that are used for health research, though these are collected for many purposes, not all of which are health-related. These collections exist under different jurisdictional and regulatory arrangements and include: 1) Population biobanks, cohort studies, and genome databases 2) Clinical and public health data 3) Direct-to-consumer genetic testing 4) Social media 5) Fitness trackers, health apps, and biometric data sensors Ethical, legal, and social challenges of such collections are well recognized, but there has been limited attention to the broader societal implications of the existence of these collections.



Although health research conducted using these collections is broadly recognized as beneficent, secondary uses of these data and samples may be controversial. We examine both documented and hypothetical scenarios of secondary uses of health data and samples. In particular, we focus on the use of health data for purposes of: Forensic investigations Civil lawsuits Identification of victims of mass casualty events Denial of entry for border security and immigration Making health resource rationing decisions Facilitating human rights abuses in autocratic regimes



Current safeguards relating to the use of health data and samples include research ethics oversight and privacy laws. These safeguards have a strong focus on informed consent and anonymization, which are aimed at the protection of the individual research subject. They are not intended to address broader societal implications of health data and sample collections. As such, existing arrangements are insufficient to protect against subversion of health databases for non-sanctioned secondary uses, or to provide guidance for reasonable but controversial secondary uses. We are concerned that existing debate in the scholarly literature and beyond has not sufficiently recognized the secondary data uses we outline in this paper. Our main purpose, therefore, is to raise awareness of the potential for unforeseen and unintended consequences, in particular negative consequences, of the increased availability and development of health data collections for research, by providing a comprehensive review of documented and hypothetical non-health research uses of such data.
Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada. kieran.odoherty@uoguelph.ca.
Kieran C
KC
O'Doherty
Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.
Emily
E
Christofides
Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.
Jeffery
J
Yen
Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway.|Norwegian Research Center for Computers and Law, Faculty of Law, University of Oslo, Oslo, Norway.|Norwegian Cancer Genomics Consortium, Oslo, Norway.
Heidi Beate
HB
Bentzen
Department of Bioethics & Humanities, University of Washington, Seattle, USA.
Wylie
W
Burke
Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Nina
N
Hallowell
UCSF Bioethics, Institute for Health & Aging, University of California, San Francisco, USA.
Barbara A
BA
Koenig
Institute of Health Policy Management and Evaluation | Joint Centre for Bioethics, University of Toronto, Toronto, Canada.|Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Donald J
DJ
Willison
D003625:Data Collection; D016208:Databases, Factual / Q000941:ethics*; D000068601:Dual Use Research / Q000941:ethics*; D006806:Human Rights; D006801:Humans; D007258:Informed Consent; D018907:Privacy; D011996:Records
Biobanks; DNA; Data sharing; Discrimination; Health data; Health research; Privacy; Secondary uses