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Rita McWilliams, MPH; Julie Hoover-Fong, MD; Ada Hamosh, MD, MPH; Suzanne Beck, MD; Terri Beaty, PhD; Garry Cutting, MD

JAMA. 2003;290:360-366.

Context  Sequencing of the human genome provides an immense resource for studies correlating DNA variation and epidemiology. However, appropriately powered genetic epidemiology studies often require recruitment from multiple sites.

Objectives  To document the burden imposed by review of multicenter studies and to determine the variability among local institutional review boards (IRBs) in the approval of a multicenter genetic epidemiology study.

Design  A PubMed search was performed to determine the frequency of citations of multicenter studies by 5-year intervals from 1974 through 2002. A 7-question survey was sent to all participating study centers to obtain information on frequency of IRB meetings, dates for submission and approval, use/nonuse of a specific consent form, type of review performed, types of consent forms required, preparation time, and number of changes requested by the IRB at each center. Centers also provided a copy of all consent forms they generated and IRB correspondence regarding the study.

Setting and Participants  Thirty-one of 42 cystic fibrosis care centers in this single US multicenter genetic epidemiology study of cystic fibrosis replied, yielding a 74% response rate.

Main Outcome Measures  Frequency of published research studies and consistency among IRBs.

Results  The number of all published single-center studies has increased 1.3-fold since 1985, while the number of published epidemiology and genetic epidemiology multicenter studies increased by 8- and 9-fold, respectively, during this same period. Evaluation of the risk of the same genetic epidemiology study by 31 IRBs ranged from minimal to high, resulting in 7 expedited reviews (23%) and 24 full reviews (77%). The number of consents required by the IRBs ranged from 1 to 4; 15 IRBs (48%) required 2 or more consents, while 10 (32%) did not require assent for children. The most common concern (52%) of IRBs pertained to the genetic aspects of the study.

Conclusions  Review of a protocol for a multicenter genetic epidemiology study by local IRBs was highly variable. Lack of uniformity in the review process creates uneven human subjects protection and incurs considerable inefficiency. The need for reform, such as the proposed centralized review, is underscored by the ever increasing rate of genetic discoveries facilitated by the Human Genome Project and the unprecedented opportunity to assess the relevance of genetic variation to public health.

Author Affiliations: Bloomberg School of Public Health (Ms McWilliams and Dr Beaty) and McKusick-Nathans Institute of Genetic Medicine (Drs Hoover-Fong, Hamosh, and Cutting), Johns Hopkins Medical Institutions, Baltimore, Md; Department of Pediatrics, Drexel University College of Medicine, and St Christopher's Hospital for Children, Philadelphia, Pa (Dr Beck).

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