There are very few readers of this article who haven’t, at some point or another, had some of their blood or tissue (a portion of a tumour, perhaps) collected as part of their medical care. What you may not know is that in the great majority of instances, not all of that material was needed for medical purposes. Some of it almost always ends up being thrown away—in more technical terms, disposed of as “biological waste.” And yes, this has surely happened to you: some of your biospecimens, perhaps some leftover drops of blood in a test tube, have been thrown away. Junked. Ended up as bio-trash.

But there is an important second sense in which the notion of “waste” comes into play here: when we dispose of these materials, we are losing the opportunity to learn important new medical knowledge from them. This is the more meaningful way in which waste is taking place. Given our technological capabilities in molecular characterisation and techniques such as genome sequencing, metabolite profiling, microbiome characterisation, and more, every bit of blood or tissue can help researchers gain valuable insights into human biology.

To do that, researchers need to combine the information they extract from analysis of biospecimens from many, many people, involving hundreds of thousands or more specimens. Yet each year, it is estimated that millions of biospecimens—ranging from routine blood samples to surgical tissues—are discarded after clinical use, representing an immense untapped resource that could otherwise accelerate scientific discovery and improve healthcare outcomes.

There are numerous examples of breakthroughs from the biomedical analysis of biospecimens:

We could list many more such breakthroughs. Given the potential benefits from this research, you might well ask: why are we still disposing of—wasting!—most of this excess blood and tissue? Why are we not saving every single drop of blood, every piece of excess tissue, for research purposes?

The failure to use or store these biospecimens occurs due to well-intentioned rules that are designed to protect the interests of the people whose biospecimens might otherwise be used in this research. The usage of human bio-specimens in research is a highly regulated practice worldwide. In Singapore, the Human Biomedical Research Act (HBRA), passed in 2015, forms the rulebook for the ethical conduct of human biomedical research. In appropriately protecting privacy and confidentiality, these biospecimens are only given to researchers after they have first been stripped of information that would allow the researchers to know the names of the people whose biospecimens they are getting.

But the major barrier to using more of these biospecimens in research—the barrier that leads to so many of them ending up in the trash—is a HBRA requirement for generally obtaining the consent of each person before their biospecimen can be used, or even before it can be saved and stored for possible future research. Researchers must usually obtain either consent for the specific study in which the biospecimen will be used, or a “broad” consent to the types of future research studies (such as their general purposes) for which it might be saved.

The need for consent aims to respect your autonomy: after all, it is your biospecimen, it comes from your body, so surely it is a good thing to allow you to control its use.

Maybe not. There are several reasons to question the appropriateness of the current Singapore consent requirements. Indeed, there appears to be a recent trend around the world of public support for the removal of mandatory informed consent procedures as societies become increasingly aware of the harm caused by overly strict consent rules. It is time for Singapore to look at the arguments in favour of relaxing consent requirements and perhaps reach the conclusion that it would be a good thing to join that movement.

First, in balancing the interests of any person in preventing the use of their biospecimens in research against the benefits to society from allowing that use, the latter interest greatly outweighs the former. Assuming that appropriate protections for privacy and confidentiality are built into the rules for conducting medical research—and stringent protections of that type already are the law in Singapore—the use of a person’s biospecimen for research has almost zero impact on a person’s life. In contrast, as described above, by combining the biospecimens from many thousands of patients, the amount of new medical knowledge that can be generated is almost limitless.

Secondly, the need for consent taking can actually end up, surprisingly, harming racial minorities and other groups of patients who are less well represented in traditional medical research. Historically, a great deal of research has taken place on Western populations, with the result that there is much less knowledge available about the specific ways that medical treatments need to be shaped for Southeast Asian populations—including, of course, Singaporeans. To counter that long-standing problem, we need to be doing everything possible to accelerate the growth of biomedical research about Southeast Asians. Putting consent barriers in the way of doing that is going in exactly the other direction.

Thirdly, having a consent-taking procedure does not actually directly minimise the risks of re-identification or other privacy breaches. Paradoxically, it increases the risks to participants. It makes it a requirement for anonymised bio-specimens to be tied to the consent forms for verification purposes, creating an unnecessary linkage between the biospecimen and the donor, thus making re-identification (and thus breaches of confidentiality) easier.

There actually exists a much better model for dealing with consent issues relating to biospecimen research in Singapore than the one that is currently mandated by the HBRA. And that model comes from Singapore’s own laws: namely, the Human Organ Transplant Act (HOTA), which created an “opt-out” system for organ donation. In Singapore, you have the right to specifically put yourself on a list saying that you do not want your organs to be used for transplantation purposes after your death. But if you fail to take that action, the default is that your organs then will indeed be available for transplantation.

A similar rule could be used in the case of research with biospecimens. It would allow anyone who objects, for whatever reason, to the research use of their biospecimens to put their name on a list of people whose biospecimens could not be used for such research. But for the great majority of us, who would tend not to object to the use of our own tissues in research, our biospecimens will otherwise automatically become available to be anonymised, stored and used for research. Far fewer biospecimens will be inappropriately trashed. And a great deal of the time, effort and money spent in obtaining consent will be saved, freeing it up to pay for the actual conduct of research. There will be minimal impact on the rights of Singaporeans to prevent biospecimen research with their tissues if they object to that. But it would be a huge win for the people of Singapore in terms of dramatically increasing the number of specimens that would be available for medical research on the unique aspects of the Singaporean population. This would go far in fostering a much more conducive environment for our biomedical research landscape, without offending key bioethical pillars that define medical practice here in Singapore.

A version of this article was first published on CNA and is reproduced with edits.

The authors thank other members of the team who co-authored a prior publication on which this shorter piece was based. These members are Gini W. W. Wong, Athena Ham, Aaron D’Sa and Mayank Dalakoti. That prior publication, “Your Tumour Can Save Lives” was in the Asian Bioethics Review.

Click here to read the published paper.