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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 to restriction of processing

The right to restriction of processing is the right of the data subject to obtain from the controller the restriction of processing of their personal data in four situations set out in Art. 18(1) GDPR: where the accuracy of the data is contested, for a period enabling the controller to verify it; where the processing is unlawful but the data subject opposes erasure and requests restriction instead; where the controller no longer needs the data but the data subject requires them for the establishment, exercise or defence of legal claims; and where the data subject has objected under Art. 21(1), pending verification of whether the controller's legitimate grounds override those of the data subject.

While restricted, data may be stored but processed otherwise only with the data subject's consent, for legal claims, for the protection of the rights of another person, or for reasons of important public interest (Art. 18(2)). The controller must inform the data subject before lifting the restriction (Art. 18(3)) and notify recipients of the restriction (Art. 19). Recital 67 suggests implementation methods such as moving data to a separate system, making it unavailable to users or flagging it in the system.

In clinical research, restriction is often the appropriate outcome of a participant's request that cannot result in erasure because of Art. 58 CTR retention and GCP integrity requirements: the sponsor flags the record so it is excluded from further analyses and secondary use while remaining archived. Member State law implementing Art. 89(2) may limit the right where it would seriously impair research objectives. EDC, safety and data warehouse systems should be able to apply and log a restriction flag, and the procedure agreed between sponsor, investigator and CRO should specify who applies it and how the participant is informed.

What does restriction of processing mean in practice?

Restriction generally preserves the data while limiting further use under the applicable conditions. For example, disputed accuracy may need to be checked before normal processing resumes. A study system should be able to flag or isolate the affected records and communicate the restriction to relevant teams, rather than treating restriction as ordinary continued use.