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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.

L

Legal basis for processing

A legal basis for processing is the ground, drawn from the closed list in Art. 6(1) GDPR, that makes a processing operation lawful. The six bases are: the data subject's consent (a); necessity for the performance of a contract with the data subject (b); necessity for compliance with a legal obligation to which the controller is subject (c); protection of the vital interests of a natural person (d); necessity for the performance of a task carried out in the public interest or in the exercise of official authority (e); and necessity for the legitimate interests pursued by the controller or a third party, unless overridden by the interests or fundamental rights of the data subject (f).

Bases (c) and (e) require a foundation in Union or Member State law. The EDPB insists that the controller identify the basis before processing starts, document it in the record of processing activities and communicate it in the information notice; switching bases afterwards is not permitted. Where the data belongs to a special category, an additional exception under Art. 9(2) is required, most often explicit consent (a), health care (h), public health (i) or scientific research (j).

In life sciences the mapping is typically: legal obligation and public health for pharmacovigilance and regulatory reporting; public interest or legitimate interest with the research exception for trial conduct; contract for a patient-facing app's core service; and consent for optional features, marketing and some secondary uses. National law can change this mapping: French reference methodologies, for example, prescribe the bases to be used. A written legal-basis matrix per purpose is one of the first deliverables of a gap analysis.

Is consent to join a trial automatically the GDPR legal basis?

No. Agreement to participate and the legal basis for processing personal data answer different questions. Identify the Article 6 basis for each processing purpose, and an Article 9 condition for health or other special-category data. Explain those choices clearly instead of assuming a signed participation form resolves the data-protection analysis.