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Term of the Day

Natural history study

A natural history study is a preplanned observational study intended to track the course of a disease over time, identifying demographic, genetic, environmental and other variables that correlate with its development and outcomes in the absence of intervention, or under standard of care. Designs may be retrospective (chart review of existing records) or prospective (longitudinal follow-up of a cohort or registry).

Natural history data is particularly important in rare and paediatric diseases, where randomised placebo-controlled trials may be infeasible or unethical. The FDA (guidance on rare disease natural history studies, 2019) and the EMA accept well-designed natural history studies to define endpoints and biomarkers, identify patient subgroups, estimate sample sizes and, in some cases, serve as external or historical control arms for single-arm trials supporting orphan products.

Because they are non-interventional, natural history studies fall outside the CTR and are governed by national law (for example France's MR-003 or MR-004 reference methodologies) and by the GDPR. They typically involve secondary use of medical records, long-term follow-up, genetic data and small populations in which anonymisation is rarely achievable, so pseudonymisation, a DPIA and a robust research legal basis under Art. 9(2)(j) are essential. Registries maintained by patient organisations or academic consortia raise additional questions of joint controllership and data access governance.

K

Key (cryptographic key and pseudonymisation key)

In data protection and information security, a key is a piece of secret information that controls the transformation of data. Two senses matter in practice. A cryptographic key is the parameter used by an encryption algorithm to convert readable data into ciphertext and back; symmetric algorithms (AES) use the same key for both operations, while asymmetric algorithms (RSA, elliptic curves) use a public-private key pair. A pseudonymisation key, or code key, is the additional information, typically a mapping table or a keyed hash secret, that allows a pseudonym such as a subject number to be linked back to the identity of the data subject.

Both senses are central to the GDPR. Art. 4(5) defines pseudonymisation as processing such that data can no longer be attributed to a specific person without the use of additional information, provided that this additional information is kept separately and protected by technical and organisational measures. The EDPB Guidelines 01/2025 on pseudonymisation stress that the security of the key and the definition of who may access it determine whether the measure is effective. Similarly, Recommendations 01/2020 accept encryption as a supplementary measure for transfers only where the keys are held exclusively by the exporter or a trusted party in the EEA.

In a clinical trial, the investigator holds the code key linking subject numbers to patients, which is why the sponsor's dataset is pseudonymised rather than anonymous. Key management (generation, storage in hardware security modules or key vaults, rotation, access logging and destruction) is therefore a governance question to document in the DPIA, not only a technical one.