Consent for medical gift, 62 years later

Carl Zimmer / New York Times News Service /

Published Aug 8, 2013 at 05:00AM

Henrietta Lacks was only 31 when she died of cervical cancer in 1951 in a Baltimore hospital. Not long before her death, doctors removed some of her tumor cells. They later discovered that the cells could thrive in a lab, a feat no human cells had achieved before.

Soon the cells — nicknamed HeLa cells — were being shipped from Baltimore around the world. In the 62 years since — twice as long as Lacks’ own brief life — her cells have been the subject of more than 74,000 studies, many of which have yielded profound insights into cell biology, vaccines, in vitro fertilization and cancer.

In the journal Nature on Wednesday, a team of scientists from the University of Washington described the HeLa genome, which they recently sequenced. The project is a tour de force of DNA analysis, befitting the best-studied human cells in the world.

But the research is exceptional for another reason. Henrietta Lacks, who was poor, black and uneducated, never consented to her cells being studied. For 62 years, her family has been left out of the decision-making about that research.

Now, over the past four months, the National Institutes of Health has come to an agreement with the Lacks family to grant them control over how Henrietta Lacks’ genome is used.

“In 20 years at NIH, I can’t remember something like this,” Francis Collins, the institute’s director, said in an interview.

Though the agreement, which was announced on Wednesday, is a milestone in the saga of Henrietta Lacks, it also draws attention to a lack of policies to balance the benefits of studying genomes with the risks to the privacy of people whose genomes are studied — as well as their relatives.

As journalist Rebecca Skloot recounted in her 2010 best-seller “The Immortal Life of Henrietta Lacks,” Lacks’ cells were removed without her consent. She gave no permission for scientists to rear them. Compounding that injustice, the scientists studying the cells and developing lucrative medicines from them did not inform her family or share any profits. Her family discovered that their mother was, in effect, scattered across the planet in 1973, only when a scientist called to ask for her children’s blood to study genes inherited from her.

For the Lacks family, this March brought an intense feeling of déjà vu. Scientists at the European Molecular Biology Laboratory published the genome of a line of HeLa cells, making it publicly available for downloading. Another study, sponsored by the National Institutes of Health at the University of Washington, was about to be published in Nature. The Lacks family was made aware of neither project.

“I said, ‘No, this is not right,’” said Jeri Lacks Whye, one of Henrietta Lacks’ grandchildren, in an interview. “They should not have this up unless they have consent from the family.”

When the University of Washington researchers had originally applied to the NIH for a grant to sequence the HeLa genome, no red flags went up about contacting the Lacks family.

“I don’t think we would have anticipated this had we looked at the grant,” Kathy Hudson, the National Institutes of Health deputy director for science, outreach and policy, said in an interview. “Hindsight is 20/20.”

Once reports of the controversy emerged, the European researchers took down their public data, and the publication of the University of Washington paper was stopped. Collins and Hudson made three trips to Baltimore to meet with the Lacks family to discuss the research and what to do about it.

“The biggest concern was privacy — what information was actually going to be out there about our grandmother, and what information they can obtain from her sequencing that will tell them about her children and grandchildren and going down the line,” said Lacks Whye.

The Lacks family and the NIH settled on an agreement: the data from both studies should be stored in the Institutes’ database of genotypes and phenotypes. Researchers who want to use the data can apply for access and will have to submit annual reports about their research. A so-called “HeLa Genome Data Access working group” at the NIH will review the applications. Two members of the Lacks family will be members.

With this agreement in place, the University of Washington researchers were then able to publish their results. Their analysis goes beyond the European study in several ways. Most important, they show precisely where each gene is situated in HeLa DNA.

A human genome is actually two genomes, each passed down from a parent. The two versions of a gene may be identical, or they may carry genetic variations setting them apart.

“If you think of the variations as beads on a string, you really have two strings,” said Jay Shendure, who led the Washington genome study. “The way we sequence genomes today, for the most part we just get a list of where the genes are located, but no information about which ones are on which string.”

Shendure and his colleagues have developed new methods that allow them to gather that information. By reconstructing both strings of the HeLa genome, they could better understand how Lacks’ healthy cells had been transformed over the past 60 years.

For example, they could see how Lacks got cancer. Cervical cancer is caused by human papillomavirus infections. The virus accelerates the growth of infected cells, which may go on to become tumors.

Shendure and his colleagues discovered the DNA of a human papillomavirus embedded in Lacks’ genome. By landing at a particular spot, Lacks’ virus may have given her cancer cells their remarkable endurance.

“That’s one of the frequent questions that I and the Lacks family get whenever we talk about this stuff,” said Skloot. “The answer was always, ‘We don’t know.’ Now, there’s at least somewhat of an answer: Because it happened to land right there.” (Skloot is a friend of the writer, who supplied an endorsement for her book.)

Richard Sharp, the director of biomedical ethics at the Mayo Clinic, said he thinks the agreement “was pretty well handled.” But he warned that it is only a “one-off solution,” rather than a broad policy to address the tension between genome research and the privacy of relatives, now that recent research has demonstrated that it is possible to reveal a person’s identity through sequencing.

Sharp considered it impractical to set up a working group of scientists and relatives for every genome with these issues.

“There’s absolutely a need for a new policy,” he said.

Eric Lander, the founding director at the Broad Institute of Harvard and MIT, said resolving these issues was crucial to taking advantage of the knowledge hidden in our genomes.

“If we are going to solve cancer, it’s going to take a movement of tens of thousands, or hundreds of thousands, of patients willing to contribute information from their cancer genomes towards a common good,” said Lander. “We are going to need to have ways to have patients feel comfortable doing that. We can’t do it without a foundation of respect and trust.”