Memorandum by the Science and Technology
Section of the British Embassy, Tokyo
HUMAN GENETIC DATABASES IN JAPAN
1. SUMMARY
1.1 Following adoption of the Japanese government's
1999 "Basic Strategy towards the Creation of Biotechnology
Industry" the government has sought to expand the breadth
of activity through new initiatives aimed at consolidating work
within the area of genome exploration and pushing forward into
the period of post genome sequencing.
1.2 Underpinning the new drive is the Japanese
Government's "Millennium Projects" initiative with its
priorities of analysing full length cDNA and undertaking SNPs
research; the results of which will supplement the databases of
earlier initiatives, including amongst others GenomeNet and the
DDBJ (DNA Database of Japan).
1.3 As part of the effort to fully exploit
genetic information, Japan is actively seeking to expand its collections
of human cells, genes and tissues and to exploit the resources
of historical collections. Associated with this expansion is increased
emphasis on the key issue of consent and anonymity. Both the Ministry
of Health and Welfare (MHW) and the Council have produced guidelines
for Science and Technology. A "Basic Law for Personal Data
Protection" is currently under discussion.
1.4 Although none of the public databanks
are understood to contain information from which DNA profiles
could be generated, measures to prevent linkage of data with individuals
have not to date been universally employed and some databases
with the ability to generate DNA profiles do exist.
1.5 The exact reason(s) for assembly of
the latest databases is not entirely clear. The databases will
benefit studies of gene function, studies of drug response, prediction
of side-effects, and the study of the Japanese population's genetic
characteristics. Whether or not use of the data will eventually
extend to the development of new drugs is a point for discussion.
1.6 MHW considers ethical issues to be amongst
the main constraints to development. Discussion of hereditary
diseases is anathema to the Japanese.
1.7 To date the majority of databases are
the responsibility of government and have been assembled with
public money. There is however some private activity, such as
that of the Japan Pharmaceutical Manufacturers Association and
its 43 member companies.
1.8 In the post-sequencing era, researchers
are well aware of IP value accrued through the identification
of useful genes and those causing disease. Rights to the IP will
be shared between the government and all those having had an input,
including, where appropriate, universities, research institutes
and companies.
1.9 Human genetics research in Japan is
currently in a transitional stage and wide-ranging decisions on
ethics and the acceptability of working practices are currently
under discussion. Few principles have been fully determined and
little information is available on the current profile of Japanese
activity.
2. INTRODUCTION
2.1 The Japanese Government's 1999 "Basic
Strategy towards the Creation of Biotechnology Industry"
expects Bioinformatics to play a major role in the post genome
sequencing period. Since its adoption, the government has sought
to expand the breadth of activity through new initiatives aimed
at consolidating work within the area of genome exploration and
pushing forward into the period of post genome sequencing. Ranging
from work relating to SNPs through to Genome information on Protein
Structures and Protein Analysis and Function, initiatives are
encompassing both public and private sectors.
2.2 A number of the current bioinformatics
activities, such as GenomeNet and DDBJ (DNA Database of Japan)
are clearly the product of earlier initiatives. Yet there is no
doubt that under the latest initiative, bioinformatics has been
a major beneficiary of additional resources and increased attention,
in anticipation of post genome sequencing activity.
2.3 Underpinning the new bioinformatics
drive is the Japanese Government's "Millennium Projects"
initiative with its priorities of analysing full length cDNA and
undertaking SNPs research. In support of this work, five government
ministries proposed the building of four new databases, encompassing
"Healthy SNPs and Polymorphism Networks", "Biological
System Information Integrated Database" (including non-human),
"Disease SNP database" and a "Comprehensive Database"
for the private sector. Along with the development of these and
other new databases, Bioinformatics in Japan, as in Europe and
the US, is evolving to take account of the new challenges involved
in "post genomic informatics".
2.4 As part of the effort to fully exploit
genetic information, Japan is actively seeking to expand its collections
of human cells, genes and tissues and to exploit the resources
of historical collections. Driven by the Government's Millennium
Project, consideration of the degree to which information in current
and future databases can/should be linked with individuals has
precipitated guidelines from both the Ministry of Health and Welfare
and the Council for Science and Technology. Although these set
the parameters for future information collection, they are not
retrospective. Measures to prevent linkage of data with individuals
have not to date been universally employed and some databases
with the ability to generate DNA profiles do exist. These are,
however, as far as can be ascertained, principally restricted
to research institutes and to the hospitals with which they are
collaborating and are neither made generally available nor integrated
into broader databases.
2.5 None of the public databanks are understood
to contain information from which DNA profiles could be generated.
In the main, profile generation should only be possible where
donors have made a request to be informed of the outcome of the
research. Many of the databanks containing linkable data are in
the public sector (University/hospital/research institute). However,
before data is passed to central databanks, any opportunity for
linkage is removed.
2.6 Human genetics research in Japan is
currently in a transitional stage and wide-ranging decisions on
ethics and the acceptability of working practices are currently
under discussion. Few principles have been fully determined and
little information is available on the current profile of Japanese
activity. Enquiries by the leading practitioners, in the Human
Genome Diversity Forum, into the range, diversity and application
of databases in Japan proved inconclusive and much additional
work is required before a reliable picture can be produced.
2.7 Within these limitations the following
provides an outline of the major genetic databases under consideration
or construction and through examples gives an insight into the
activities of the estimated 40 to 50+ centres with privately constructed
databases.
3. CURRENT ACTIVITIES
3.1 By no means have Japan's efforts in
Bioinformatics only just materialised. A number of databases have
been developed and operated since the early part of the 1990s
when Monbusho set up the Human Genome Project; the foundation
of today's much expanded activity. These databases include:
3.2 GenomeNet
Since 1991, the Ministry of Education have,
as part of their Human Genome Project "Genome Science",
undertaken Genome Bioinformatics Research. Led by Professor Minoru
Kanehisa, the GenomeNet Database has been developed and jointly
operated by the Institute of Chemical Research (ICR) of the University
of Kyoto, the Human Genome Centre, University of Tokyo and the
Japan Advanced Institute of Science and Technology in Hokuriku.
It provides an integrated database search facility and access
to the Kyoto Encyclopaedia of Genes and Genomes (KEGG), with services
for base arrangement analysis, including homology search, protein
motif search, pathway search and other analytical tools.
3.3 Kyoto Encyclopaedia of Genes and Genomes
(KEGG)
Constructed by Professor Kanehisa's group, KEGG
contains comprehensive data on metabolic Pathways, Enzyme Reaction
Compounds (LIGAND), Inter-reaction amongst molecules (BRITE) and
Gene and Genomes catalogues. From an early stage KEGG aimed to
undertake the analysis of interactions among genes and proteins.
New funding from the Science and Technology Agency (STA) and Japanese
Society for the Promotion of Science (JSPS) will facilitate a
scaling up of activity in readiness for post-sequencing genome
analysis. Additional information on KEGG can be found at http://www.genome.ad.jp.
3.4 Laboratory of Genome Database
Led by Professor Takagi of the Human Genome
Centre, as part of the GenomeNet activity, work is ongoing into
(1) the investigation of database technologies such as deductive,
object-orientated databases that are suitable for complex and
huge genome-related data; (2) Re-arrangement, re-organisation
and integration of databases; (3) Development and construction
of database tools, based on new database technologies and networks
and (4) Providing supporting services by developing specialised
databases and software tools for the operation of GenomeNet.
3.5 DNA Databank of Japan (DDBJ)
Funded by the Ministry of Education, DDBJ, the
sole DNA data bank in Japan, began its activities in 1984 at the
Ministry's National Institute of Genetics (NIG). It had been collaborating
internationally with the European Bioinformatics Institute responsible
for EMBL databases and with the National Centre for Biotechnology
(NCBI), responsible for GenBank databases in the US. Information
on links to other databases developed by NIG, other Japanese institutes
and foreign organisations may be accessed at http://www.ddbj.nig.ac.jp.
3.6 KDRI-DB Kazusa DNA Research Institute
KDRI-DB is a collection of biological information
mainly derived from the sequencing data from the research institute.
Genome sequences include human, full-length cDNA data.
3.7 RIKEN Genome Science Centre (GSC), Science
and Technology Agency
"Human Genome Research Group"/"Protein
Research Group". Having, along with the US and UK, completed
sequencing chromosome 21 and 22 genes, the Human Genome Research
Group are currently working on chromosomes 11 and 18. The recently
established "Howdy" database has been developed to retrieve
human genome information from different data sources that are
available to the public. At the same time, Dr Shigeyuki Yokohama
has started work on building a "Protein Folding Catalogue/Encyclopaedia"
using NMR.
3.8 PRF/LITDB and PRF/SEQDB, Protein Research
Foundation
The Protein Research Foundation funds the Protein
Research Institute in Osaka University and holds Japan's major
peptide sequence database.
3.9 Private Sector
Unlike US genomic venture firms, there is little
known of the current databases compiled by private sector companies,
outside of two compiled by Otsuka Pharmaceutical Co Ltd's Tokushima
Genome Research Institute, who in collaboration with Professor
Yusuke Nakamura's group of the Institute of Medical Science, University
of Tokyo, have produced open access databases, including "GENOTK",
a human cDNA database.
4. NEW INITIATIVES
4.1 Following commencement of Japan's Bioinformatics
research in 1991, the country is now entering a new phase in its
commitment to this discipline. A raft of new initiatives is either
underway or in the final stages of planning. These include:
"New Development of Genome Information
Science" Monbusho.
RIKEN's Genome Science Centre.
Single Nucleotide Polymorphisms Project.
The Bioinformatics Research Centre,
MITI.
4.2 "New Development of Genome Information
Science"
4.2.1 Succeeding the "Genome Science"
initiative, Monbusho has this year started a "Specially Promoted"
informatics orientated research programme, led by Professor Takagi
of the Human Genome Centre, University of Tokyo. Work is focused
in the following four areas:
Advanced Database Systems and Systemisation
of Biological Knowledge.
Knowledge Discovery from Databases.
Genome Information on Protein Structures;
and
Modelling and Simulation of Gene
Networks.
4.2.2 Alongside this programme Monbusho
and the Japan Society for the Promotion of Science will, under
the leadership of Professor Kanehisa, be developing a "Biological
Systems Database and Genome Information Science" programme,
aimed at taking a central role in the "Academic consortium
of bioinformatics".
4.3 RIKEN Genome Science Centre
4.3.1 The RIKEN Genome Science Centre is
due for completion in October this year. Emphasis will be given
to five main areas, including the Human Genome (Chromosome Nos
11 and 18). From this year, a sixth group, "Genome Information
Science", will be set up to undertake research into the areas
of:
"Gene Network Modelling";
comparative expression research focusing
on colour, hand, foot and internal organs; and
signalling transaction mechanism
modelling research for effective molecular analysis of proteins.
4.3.2 This group will be responsible for
bioinformatic analysis of all data produced by the Genome Science
Centre.
5. PLANNED DATABASES
UNDER THE
MILLENNIUM PROGRAMME
5.1 SNPs Single Nucleotide Polymorphisms
The Millennium human genome research programmes
focuses on the analysis of human complementary DNA (cDNA) and
single nucleotide polymorphisms (SNPs). The Japanese healthy SNPs
database is the only one already being constructed and opened
to the public. Professor Y Nakamura, Director of the Human Genome
Centre (HGC) of the Institute of Medical Sciences, Tokyo University
(IMST) is undertaking the project in collaboration with the Japan
Science and Technology Corporation (JST), an organ of the Science
and Technology Agency (STA). Other databases being planned are
listed below.
5.2 Normal SNPs
| Project name
| Organisations | Notes
|
| Healthy SNP database | Institute of Medical Sciences, Tokyo University (IMSUT) and JST
| Sample collections are from two 24 people groups
|
| Allele frequency SNP database | JBiC (Japan Bioinformatics Consortium)-IMSUT
| Under planning |
5.3 Disease SNPs database being planned
| Disease | Implementing research organisations
|
| Cancer | National Cancer Centre Research Institute (NCCRI), MHW, in which a Centre for Medical Genomics is under construction and a central disease database will be set up; IMSUT, Japanese Foundation for Cancer Research, Japan Medical College, Kyushu University, Osaka University, Kumamoto University, Tohoku University; Tokyo Institute of Technology, Molecular Cell Biology Institute of Tokyo University.
|
| Dementia | National Centre of Neurology and Psychiatry (NCNP), MHW Tokyo University, Niigata University.
|
| High blood pressure | National Cardiovascular Centre Research Institute, MHW Asahikawa Medical College, Ehime University, Tsukuba University.
|
| Asthma/allergy | National Children's Medical Research Centre (NCMRC), MHW Tsukuba University, Juntendo Medical College, IMSUT.
|
| Diabetes | Research Institute of the International Medical Centre of Japan, MHW Gunma University, Chiba University, Kobe University, Tokushima University.
|
Myocardial Infarction, chronological joint rheumatoid arthritis
and osteoarthritis are also the target of work at RIKEN. The numbers
of samples collected are 650, 311 and 194 respectively. From 2001,
Diabetes and interferon's side effects work will commence. Osaka
University, IMSUT and Kyushu University will collaborate with
the centre.
5.4 Drug responder SNPs
There are two major initiatives to study Japanese drug responder
SNPs; one by the National Institute of Health Sciences (NIHS),
MHW and the other by the "Pharma SNPs Consortium" (PSC);
involving 43 Japan Pharmaceutical Manufacturers Association (JPMA)
member companies.
5.4.1 National Institute of Health Sciences (NIHS), MHW
project involving drug categories and their metabolic action points,
including cytochrome p540 and transporter related molecules and
receptors.
5.4.2 The "Pharma SNPs Consortium" (PSC) was
set up in September 2000 to investigate SNPs within the Japanese
population, to determine individuals differences and thereby facilitate
the production of tailor-made pharmaceuticals with less side effects.
Forty three Japanese pharmaceutical companies will participate
in the project, which will start from October, collecting blood
samples from a target number of 1,200 volunteers. Research themes
include: the identification of SNPs involved in pharmaco-kinetics,
frequency and functional analysis and standardisation of sample
donation. A database will be built to accommodate research results
and after filing of patents, the data will be open to the public.
The research period will be for three years with a total investment
of 1 billion Yen. PSC has commissioned the work to Professor Y
Nakamura of IMSUT.
6. OTHER HUMAN
RELATED GENETIC
DATABASES
6.1 Some other human-related databases are:
Osaka UniversityBodyMap (Human and Mouse
Gene Expression Database).
Otsuka GEN Research Institute, Otsuka PharmaceuticalHuman
cDNA Database.
Kazusa DNA Research InstituteHUGE: Human
Unidentified Gene-encoded large proteins.
6.2 Keio Mutation Database (KMDB)
Keio Mutation Database (KMDB) is a database of mutations
in human disease-causing genes, which was constructed by Professor
Nobuyoshi Shimizu's group. As of July 2000, KMDB accommodates
mutation data for 64 different genes involved in 72 different
diseases of the eye, heart, ear, brain, auto-immunity and syndrome
(Table 1).
Table 1
MUTATION DATA IN THE KMDBs AND MUTATIONVIEW (AS OF JULY
2000)
|
| Category | No of diseases
| No of genes | No of mutation
entries
| No of literatures
compiled
|
|
| Eye | 27 |
20 | 591
| 129 |
| Heart | 7 |
7 | 80
| 20 |
| Ear | 16 |
12 | 188
| 34 |
| Brain/Nerve | 5
| 6 | 212
| 71 |
| Cancer-related | 5
| 5 | 1,046
| 133 |
| Auto-immunity | 2
| 2 | 96
| 13 |
| Syndrome | 10
| 12 | 312
| 83 |
| Total | 72
| 64 | 2,525
| 483 |
|
7. HUMAN CELL,
GENE AND
TISSUE COLLECTIONS
7.1 There are three kinds of collections; namely:
(1) Public banks which distribute samples to researchers.
(2) "Private collections" among researchers
of universities and medical research institutes who have been
pooling samples while undertaking research programmes funded by
Monbusho and the Ministry of Health and Welfare (MHW). They don't
distribute their samples beyond their groups or institutes.
(3) Envisaged massive "collections" obtained
through clinical practices by hospitals, which are not formally
available for medical research unless patients give their consent
for the use of medical research.
7.2 Principles governing the collection of samples
Following an increasing awareness of patients' rights over
the last several years, "informed consent" has been
introduced. The MHW in May this year introduced guidelines governing
the way in which research under the human genome projects was
to be undertaken and in June the Council for Science and Technology
(CST) announced the "Fundamental Principles of Research on
the Human Genome". Both require strict adherence to good
practice during the collection of human tissues.
7.3 How to deal with existing collections
7.3.1 Many samples collected before the introduction
of the MHW guidelines are now being considered for use in genetic
studies. The question therefore is how should these be treated
within the context of the new guidelines?
7.3.2 These materials have been assigned to one of the
following three categories, dependent upon the level of consent
given at the time the samples were obtained. Alongside each category
are conditions to be met before the sample can be used in genetic
research.
| Category | Imposed requirements
|
| A group: Collected with donors' consent for the use of genetic analysis
| None |
| B group: Collected with donors' consent for research purposes but no explanation of the use of genetic analysis
| To obtain informed consent or where this is not possible to anonymise such that the sample donor cannot be linked with the sample and thereafter to submit to the research organisation's ethical committee to decide whether or not the use of the sample in this way is reasonable.
|
| C group: Collected without donors' consent
| To obtain informed consent or where this is not possible to anonymise and to submit to the ethical committee for a more broadly considered decision on whether or not use of the sample is reasonable.
|
7.3.3 How this will work in practice is yet to be seen;
particularly in respect of the ethical committees granting permission
to use materials for which consent has not been given. To do so
may give rise to the risk of public opposition and an aversion
to providing samples for research.
7.4 Public cell, gene and tissue banks in Japan
The major public bank in Japan is the Japanese Collection
of Research Bioresources (JCRB). This comprises cell and gene
banks, operated by the National Institute of Health Sciences (NIHS)
and the National Institute of Infectious Disease (NIID) respectively.
Both institutes belong to the Ministry of Health and Welfare (MHW).
7.5 Since 1995, with NIHS and NIID acting as master banks,
MHW's Japan Human Science Foundation (JHSF) has distributed samples.
Of the cell and gene collections, roughly 59 per cent of the cells
are human derived cells and 55 per cent of the genes of human
derivation. Those using the banks must follow sound ethical principles
in conducting their research.
7.6 In response to a MHW report in May this year, Japan's
biomedical research infrastructure is to be consolidated, with
JHSF setting up the Health Science Research Resources Bank (HSRRB)
in Osaka. This will be the first public tissue bank in Japan.
Tissues within HSRRB will be confined to those removed during
operations. Conditions to be met include:
(1) The institutional ethical committees of donor organisations
must approve the taking of samples.
(2) Full information should be provided to donors, including
the intention to put the sample into the HSRRB and to use the
sample in private sector research.
(3) Donor institutes should anonymise samples (Fig 1).
Fig 1.Anonymisation of Donor Information

7.7 RIKEN Gene Bank (Tsukuba), set up 1987, is another
major bank, including a human Cell Bank, human DNA Bank and Bio
Info Bank.
7.8 Other banks include:
Medical Cell Resources Bank Institute of Development, Ageing
and Cancer, Tohoku University, http://www.idac.tohoku.ac.jp/idac/HomePages/ccr/Set
up in 1984 as a Tumour Bank, based on knowledge accumulated by
Professor Yoshida and Professor Sato under Monbusho 10-year cancer
research programme.
Institute for Fermentation, Osaka (IFO), http://village.infoweb.or.jp/Set
up in 1994 under the auspices of Monbusho. Animal cell and micro-organisms
cell lines, of which 47 per cent is human derived.
Hayashibara Fujisaki Cell Centre, http://cellbank.nihs.go.jp/jtca/book/Set
up in 1985. Specialising in human leukaemia, lymphoma.
7.9 Private collections by medical research institutes
and university research groups
It is difficult to identify which groups have what kinds
of human tissue collections potentially available for genetic
research. For the past 20+ years genetic studies have been conducted
mainly in Japanese universities. Some collections related to genetic
study may have until recently been known only to the scientists.
Whilst these are currently kept by individual researcher groups,
there is a prospect in the long term of integration into public
tissue banks in order to consolidate resources. Examples of such
banks are thought to include:
The National Children's Hospital "Tonsil Lymph Tissue
Bank"Xeroderma Pigmentosum.
Dr Furuichi and Dr Makoto GotoWerner's syndrome genes,
causing early ageing.
Professor Katsushi Tokunaga, Tokyo UniversitySample
collections for Japanese population HLA study.
Professor Tsuji, Niigata UniversityBrain specimens.
National Centre of Neurology and PsychiatryCentre's
"Child Brain Bank" keeps about 1,200 brain specimens,
50 Alzheimer disease patients' brain specimens, and 700 DNA samples
of Alzheimer patients.
National Cardiovascular Centre Research InstituteBlood
samples.
National Cancer CentreCancer related tissues.
National Children's Medical Research CentreSamples
involved in allergy.
7.10 Anonymity
7.10.1 In meeting the requirements of MHW's guidelines,
research organisations are required to safeguard information with
the potential to link donors to research data generated from donated
samples. Donors also have an opportunity to withdraw their consent
for use of donated samples, or resultant research data, at any
time. Upon transferring research data to the central data bank,
the linkage between the donor of the sample and the research data
generated from the sample will be irrevocably broken. At the time
of providing consent, the donor is made aware that once within
the central data bank, the data can no longer be linked and cannot
therefore be withdrawn.
7.10.2 The guidelines provide for two stages in anonomysing
donor data. In the first stage, samples taken and used in research
by the medical institution remain linkable to the donor (Figure
2). Managers appointed to supervise the protection of donor information
provide each sample with a unique bar code, containing donor information.
Details of the coding are kept on a stand-alone workstation, protected
by fingerprint operated mouse controls and a hard disc drive password
entry system. Paperwork relating to the donors is kept in a high
security safe. The bar-coded sample is then passed (along with
the age of the donor) to the research team. The adequacy of this
level of security is currently under debate.
7.10.3 At the conclusion of the research (second stage),
and at the point of transfer of research data to a central database,
the data along with the age of the donor is fed into an online
computer connected to the central database (Figure 2). Linkable
now only by age and under normal circumstances amongst an array
of data for similar aged donors, the data and donor should no
longer be unequivocally linkable. Transfer to the central database
further diminishes the probability of being able to link data
to the sample donor.
7.10.4 All MHW national research institutes are required
to follow this procedure.
7.10.5 Under conditions yet to be fully determined and
with the agreement of the Research Institute ethical committee,
Director Generals of the Institutes have the authority to link
research data to the sample donor. However, in the event that
confidentiality is broken in a way judged not to be acceptable,
the public funds supporting the research may be withdrawn from
the Institute and legal proceedings instituted against those considered
responsible.
7.10.6 It is accepted by MHW that there is value in certain
circumstances (when disease related) in being able to link research
data to the sample donor; the value varying dependent upon which
disease is involved. Determining the best ways of exploiting these
benefits whilst still retaining the principles of consent is currently
being considered. Where the disease is a hereditary one and beneficial
medical intervention is not possible, a decision on whether or
not to permit linkage under these circumstances is also currently
under consideration by MHW.
7.11 It is broadly accepted that it is difficult to construct
patient linkable databases in Japan, principally due to the fear
of discrimination and sensitivity to information linking the patient
to genetic diseases. Linkable information is also recognised to
be of limited value where additional essential information such
as environmental conditions is not routinely collected.
8. OTHER ASPECTS
8.1 Reasons behind data assembly
The exact reason(s) for assembly of some of the databases is not
entirely clear. Views to some extent differ between those constructing
the databases and between these groups and the MHW. What is agreed
is the benefit that the databases will have in studies of drug
response and prediction of side-effects and in the area of gene
function and the study of the Japanese population's genetic characteristics.
Whether or not use of the data from the Millennium project will
eventually extend to the development of new drugs, is a point
for discussion. In the case of the JPMA database (one of the very
few private databases), both the side effects resulting from the
level of drug metabolising enzymes and the identification of target
drugs will form the focus of the database assembly. The MHW suggested
that the information collected as part of the Millennium projects
might ultimately feed into drug development work, but that this
was not the present focus. Others expressed doubts of extending
the scope and suggested that the schemes were not drawn up in
a way that would readily connect to drug discovery.
8.2 Constraints to development
MHW considers ethical issues to be amongst the main constraints
to development. Historically, discussion of hereditary diseases
has been shunned by Japanese society. The prospect of compiling
databases containing information of this type is therefore anathema
to many Japanese.
8.3 Consciousness of the potential effects that information
on hereditary disorders might have on prospects for employment,
marriage and insurance, is likely to dissuade many prospective
donors from giving consent. To address this, MHW is currently
working on how to best protect private information and how to
legislate in support of this.
8.4 Integration of research across the responsibilities
of the Japanese Ministries is not fully developed. In circumstances
where hospitals are likely to have insufficient patients for a
satisfactory association study and study methods between researchers
varies considerably, useful comparisons of research data will
be difficult to make.
8.5 The ability to fund consolidation of medical infrastructures,
to provide genetic counselling and to meet the stringent standards
of informed consent will require considerable additional funds.
Providing the funds may produce strain on budgets.
|