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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.

R

Right of access

The right of access is the right of the data subject to obtain from the controller confirmation as to whether or not personal data concerning him or her are being processed and, where that is the case, access to the personal data together with information on the purposes, the categories of data, the recipients, the retention period, the other rights, the source of the data, the existence of automated decision-making and, for transfers, the safeguards applied (Art. 15(1) and (2) GDPR). The controller must provide a copy of the data free of charge, in a commonly used electronic form if the request is made electronically (Art. 15(3)).

The response deadline is one month, extendable by two further months for complex or numerous requests (Art. 12(3)). Requests can be made in any form and need not cite the GDPR; identity may be verified proportionately. The EDPB Guidelines 01/2022 stress that the right covers all data, including inferences and internal notes, and that the copy must be intelligible. The Court of Justice has held that individuals are entitled to the identity of specific recipients (C-154/21) and to a faithful copy of documents where context is needed (C-487/21). The rights of others, including trade secrets, may limit but not negate the right (Art. 15(4)).

In clinical research, access requests are usually addressed to the investigator site, which holds the identifying data and medical records, while the sponsor holds only pseudonymised data that it cannot link to the requester without the site. Art. 11 allows a controller that cannot identify the data subject to say so, but the sponsor and site should have an agreed procedure so that the participant receives a complete answer. Where Member State law implements the Art. 89(2) research derogation, access may be limited if it would seriously impair the research, but this must be documented and is not automatic. Site staff also have access rights over the data sponsors hold about them.