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The George W.Comstock Center for Public Health Research and Prevention was established on December 12, 1962 at a joint meeting of the Washington County Health Commission (acting as the Board of Health), the Washington County Health Department, the Maryland Department of Health and Mental Hygiene, and the Johns Hopkins School of Hygiene and Public Health. The purpose of the Center was to provide a facility for encouraging and supervising student research into problems affecting the health of the citizens of Washington County.
The Center has been located in the main building(s) of the Washington County Health Department since its inception, and has functioned as the research unit of the Health Department to the extent possible. The Director of the Center has an honorary appointment as Director of Research for the Health Department. Two Health Officers have held faculty appointments in the School, and it is hoped that this relationship will continue. The Health Officer’s advice and consent is sought for any research project that involves personal contacts with county residents.
For the first years of the Comstock Center, it was supported by a training grant from the Bureau of State Services, Public Health Service. When the Bureau disappeared in the course of reorganization of the Public Health Service, funds for field research training were discontinued. Also, as the School’s General Preventive Medicine Residency Program became more formally organized, residents found it more difficult to fit short-term research projects into their schedules. Support for the training of residents in the Health Department has not been available in recent years. As a result of these changes, the Comstock Center has been supported almost entirely by research grants and contracts from the National Institutes of Health. Most student research must now be done within the constraints of funded grants. A few small research projects can be supported by funds from the Texaco Corporation and the Comstock Charitable Trust.
Community-based research must have respect for confidentiality that is above reproach. Comstock Center personnel are keenly aware of the responsibility that comes with research on persons who include relatives, friends, and neighbors; they transmit that sense of responsibility to student trainees. Several mechanisms for safeguarding confidentiality are in place.
- Only persons judged to be trustworthy are employed by the Comstock Center.
- Every employee or student with access to any records is instructed in the need for strict confidentiality and must sign a pledge to maintain confidentiality. Violation of confidentiality is grounds for dismissal.
- The Center rarely collects sensitive information. When it does, we try to code the records in such a way that it is not readily interpretable by the uninitiated.
- Whenever possible, all personal identifying information is removed from questionnaires except for a serial number. Links of serial numbers and names are filed separately from the questionnaires.
- Records are kept in rooms that are locked when not in use. These rooms are located in a wing of the Health Department accessible only by individually assigned key cards.
- Data in our computers are not accessible through outside telephone lines, thereby making it impossible for “hackers” to obtain access to our findings.
We believe we have a system that is truly confidential. To the best of our knowledge, there has been no breach of confidentiality in the 37-year history of the Comstock Center. We intend to maintain this record.
All research at the Comstock Center is designed to be ethical and to avoid the possibility of harm to any research participant. First, any proposed research must be approved by a committee of investigators at the School. This committee is composed of the major users of the Comstock Center data. It is called the “Serology Committee” because so much of our research is based on specimens in our serum bank. Second, before any project is initiated, it must be approved by the School’s Committee on Human Research. This is the official Institutional Review Board of the School. It is composed of representatives of the faculty, students, and community.
For some time, we have been concerned that the only representation from Washington County in this approval process comes from the presence on the Serology Committee of two Comstock Center personnel who live in Washington County. This concern has been heightened as medical and public health research searches for variations in genes that may affect the risk of developing a variety of diseases and for possible interaction of these genes with environmental exposures.
Any characteristics or exposure that is associated with the risk of developing or not developing a disease is called a “risk factor”. Just as unhealthy behaviors or exposures can be risk factors for disease, so too can a person’s genetic makeup. Broadly speaking, there are two classes of changes in genes that can be risk factors for disease. First there are changes in genes that substantially increase the risk of a disease. These are rare changes that confer a high risk of developing a disease. These gene changes are called mutations. Examples of this type of gene change are mutation in the BRCA1 or BRCA2 genes that are associated with a high risk of breast cancer in those rare families who carry specific mutations. While the risk is very high, not everyone who has the gene mutation will get breast cancer. Because these types of gene changes are so rare, the proportion of breast cancer in the general population that can be explained by the gene changes is very small (less than 10%).
The second class of gene changes are those that vary naturally from person to person. These variations in genes, called polymorphisms, occur more commonly than the first class of gene changes. The genes in this class tell the body how to make enzymes or proteins that have a variety of jobs. These jobs include helping to remove harmful substances or repairing bits of damage in our cells. The variations in the genes may produce more or less of an enzyme or make it work faster or slower. These differences in the enzyme function could be good, bad or indifferent for our health — it all depends on what we may be exposed to in the environment. The risks or benefits associated with the variations in these genes are generally small. The main effect of the variations is seen only in the presence or absence of the relevant exposure. While the meaning of these polymorphisms can vary considerably from person to person, in a group of people with certain exposures they could explain a large proportion of disease. By knowing who may be specifically at risk from certain exposures, we can target interventions to those who most need it. Our research in Washington County involving genes is concerned with this second class of genes.
More important than identifying variations in the genes is the search for environmental exposures (dietary, occupational, medical, or behavioral) that can modify their effects. This is the purpose of one of our recently funded grants.
Because of the potential for misunderstanding of research related to genetics and because our research deals specifically with Washington County, we desire advice from Washington Countians. To this end, we are forming a Community Research Review Committee. We are asking the following organizations to nominate one of their members to serve on this committee for a term of 2-4 years.
Nominated Member from Washington County Organizations (Voting):
- Advisory Commission to the Washington County Board of Health
(Washington County Health Department)
- Washington County Medical Society
- Washington County Bar Association
- Washington County Ministerial Association
- Washington County Council of Churches
- American Cancer Society (Washington County Chapter)
- Y-Me of Cumberland Valley
- Health Officer (Chairman)
Ex-Officio Members (Voice but no vote):
- Director, Comstock Center
- Assistant Director, Comstock Center
Although details of procedures need to be worked out with the Committee members at an organizational meeting, we envision the following. All new research projects involving the Comstock Center will be submitted to the Committee in a 2-4 page summary similar to that submitted to the School’s Committee on Human Research. For those projects that deal with genes, we will seek the advice of the Committee at a formal meeting. For others, the summaries will be considered to be for information only, with the request that any comments be submitted to the Comstock Center. If any committee member feels that a “non-genetic proposal” needs full Committee consideration, that proposal will be put on the agenda for the next meeting.
It is anticipated that after the organizational meeting, no more than three meetings a year will be needed. It is proposed that the meetings be held in the auditorium of the Washington County Health Department. It is also proposed that one-third of nominated Committee Members initially serve for two years, one-third for three years, and one-third for four years, and that this division be made according to lot at the organizational meeting. Members may be re-nominated for three-year terms at the pleasure of the organization they represent.
It is suggested that the by-laws follow the format of those for the Advisory Commission to the Washington County Board of Health and that the rules of order be those in the 1979 publication by the League of Women Voters entitled “Simplified Parliamentary Procedure based on Robert’s Rule of Orderly, Newly Revised”.
John
Hopkins Bloomberg School of Public Health Committee on Human Volunteers
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