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作者(中文):柯品立
作者(外文):Ko, Pin-Li
論文名稱(中文):論精準醫療政策應有的隱私保護架構
論文名稱(外文):A Study on the Privacy Protection Framework of the Precision Medicine Policy
指導教授(中文):范建得
指導教授(外文):Fan, Chien-Te
口試委員(中文):陳仲嶙
李崇僖
口試委員(外文):Chen, Chung-Lin
Lee, Chung-Hsi Lee
學位類別:碩士
校院名稱:國立清華大學
系所名稱:科技法律研究所
學號:106074501
出版年(民國):111
畢業學年度:110
語文別:中文
論文頁數:101
中文關鍵詞:精準醫療生物資料庫大數據隱私權資訊自主權基因隱私
外文關鍵詞:Precision MedicineBiobankBig DataRight to PrivacyInformation AutonomyGenetic Privacy
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精準醫療乃植基於二十一世紀基因體科學之突破,加上大數據技術的蓬勃發展與人體生物資料庫的加值應用而崛起的一種新型醫學概念與客製化的醫療模式,旨在找出對病患合適且合理的醫療照護方針與用藥指南,在正確的時間針對正確的病患獲得正確的治療,希冀能大幅提升醫療照護的效能,減少醫療資源的浪費,並增進整體醫療與公眾健康水平,造福人類社會。為此引頸期盼的新願景,世界多國紛紛投入大量資源與政策規劃來推動相關發展,台灣亦在此之列,然而社會價值觀與倫理法制的形成過程,遠遠不及科技發展的光速,因此引發不少爭議。
本文將聚焦於精準醫療的隱私保護,從個人資料的隱私保護規範為基礎,延伸至對基因隱私之保護,探討精準醫療政策之推動與既有隱私保護原則的衝突、資訊自主權之衝擊、資料揭露之疑慮,以及公共利益與個人利益之衡平等議題,並藉由參考英國與美國之隱私法制面、精準醫療實際運作之規範架構與經驗,來檢視我國在發展精準醫療之際,該如何建構出透明且值得信任的隱私保護與倫理治理框架,並提出建議。
Precision Medicine is a new concept of medicine and a medical model of customized healthcare. The breakthrough in genomics in the 21st century, the development of big data, and the value-added application of biobank are the foundation of Precision Medicine. And it aims to develop appropriate and reasonable treatment, healthcare, and drug tailored to individual patients, providing the right treatment to the right patient at the right time. Furthermore, we are looking forward to reducing the cost of medical resources and substantially improving the performance of healthcare simultaneously. Also, Precision Medicine results in enhancing the standard of overall medicine and public health, and then benefiting humankind. In order to achieve the anticipated vision, many countries, including Taiwan, have initiated Precision Medicine by devoting tremendous quantities of resources and formulating policies. However, the formation of social values, moral principles, and legal system fall behind the advance in science and technology. Therefore, it raises many controversial issues.
This article will focus on protecting the privacy of Precision Medicine. The discussions will start from the privacy protection regulations of personal information to the protection of genetic information. Then, the article will discuss issues such as the conflicts between Precision Medicine and the principles of privacy protection, the impact on autonomy, the disclosure of personal data, and the depute of balancing public good against individual interests. During the course of the Taiwan Precision Medicine Initiative, it is important to discuss how to construct the protection of privacy and ethical governance framework with transparency and trust. Hence, this article will refer to privacy laws, regulatory framework and experience of the United Kingdom and the United States Precision Medicine Initiative, and then make suggestions eventually.
第一章 緒論-------------------------1
第一節 研究動機與研---------------------1
第二節 研究方法-----------------------4
第三節 研究範圍與論文架構------------------5
第二章 精準醫療之發展--------------------7
第一節 精準醫療之背景介紹與定義---------------7
第二節 精準醫療之實踐--------------------10
第三節 精準醫療之目前進程與未來展望-------------14
第四節 小結-------------------------14
第三章 我國現行法制就實踐精準醫療相關之隱私保護規範分析---16
第一節 隱私概念源起與開展------------------17
第二節 建構我國基因資料與健康資料之隱私權法制--------21
第三節 保障隱私之主要機制------------------35
第四節 精準醫療之實踐所面臨之隱私保護問題----------39
第五節 小結-------------------------50
第四章 國際上關於精準醫療之發展與相關法律規範--------51
第一節 美國-------------------------51
第二節 英國-------------------------61
第三節 小結-------------------------73
第五章 台灣精準醫療政策應有之隱私保護架構──修正方向與建議--74
第一節 隱私保護規範之比較------------------74
第二節 基因隱私保護規範之比較----------------75
第三節 其他比較-----------------------77
第四節 國外立法例之啟示與台灣隱私架構修正之方向-------78
第五節 小結-------------------------84
第六章 結論-------------------------86
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三、學位論文
1.何建志(2011)。基因歧視與法律對策之研究。國立台灣大學法律研究所博士論文,台北市。
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四、網路資源
1.陳國維(2021)。AI算出新冠解方 陽明交大發現4款潛力藥,中央廣播電台,https://www.rti.org.tw/news/view/id/2092468。
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3.衛生福利部疾病管制署研究計畫(2020)。〈人口變遷對傳染病與慢性病合併症之流行趨勢影響評估及個案管理模式因應試辦計畫〉,https://www.grb.gov.tw/search/planDetail?id=12859381。
4.陳仁華(2021)。科技防疫難免涉隱私 陳時中:最小侵害盼取平衡,中央通訊社,https://www.cna.com.tw/news/ahel/202101060183.aspx。
5.德國之聲(2020)。「科技防疫」能凌駕隱私嗎?江明宗:台灣已過分侵犯隱私,希望疫情減緩後資料上鎖,https://www.storm.mg/article/2466171。
6.中央社(2020)。電子追蹤系統資訊全都露,防疫與隱私權的兩難,https://technews.tw/2020/04/05/covid-19-epidemic-prevention-privacy/。
7.Amazon亞馬遜利用大數據實現精準行銷,https://fetpo.org/amazon%E4%BA%9E%E9%A6%AC%E9%81%9C%E5%88%A9%E7%94%A8%E5%A4%A7%E6%95%B8%E6%93%9A%E5%AF%A6%E7%8F%BE%E7%B2%BE%E6%BA%96%E8%A1%8C%E9%8A%B7/
8.癌症,是種基因疾病,https://geneonline.news/index.php/2015/09/19/10201040/
9.全民健保資料庫應用服務,https://www.ey.gov.tw/Page/448DE008087A1971/3d272078-9709-4ce1-a8fa-9431b294444b。
10.多元應用全民健保資料庫,https://www.ey.gov.tw/Page/5A8A0CB5B41DA11E/87d0d0cd-ecb8-4035-b6e0-976eaad449b8
11.溫紹群(2020)。〈新興科技對精準醫療的決策會帶來影響嗎?〉,https://fc.bnext.com.tw/articles/view/27
12.Google《隱私權政策》,https://policies.google.com/privacy?hl=zh-TW
13.立法院法律系統網站,電腦處理個人資料保護法立法理由,https://lis.ly.gov.tw/lglawc/lawsingle?00060D1D319A0000000000000000014000000004FFFFFA00^01829084071200^00004001001
14.歐盟GDPR保護適足性審核與因應作為,https://stli.iii.org.tw/article-detail.aspx?no=0&tp=3&i=0&d=8017
15.法務部,立法院三讀通過「個人資料保護法」新聞稿,2010年4月27日,https://www.moj.gov.tw/Public/Files/201004/0427164423187.pdf
16.立法院法律系統,個人資料保護法異動條文及理由,https://lis.ly.gov.tw/lglawc/lawsingle?005B3F2E58EC000000000000000001400000000400FFFFFD00^01829099042700^0005C001001
17.法務部對個人資料保護法部分條文修正說明,https://www.moj.gov.tw/media/2813/6711114451.pdf?mediaDL=true
18.人體生物資料庫管理條例草案總說明,https://www.twbiobank.org.tw/new_web/law/20090105_%E5%A0%B1%E9%99%A2%E7%89%88%E8%8D%89%E6%A1%88%EF%BC%8820081002%E7%89%88%EF%BC%89.pdf
19.財團法人資訊工業策進會科技法律研究所(2019)。我國去識別化實務發展──「個人資料去識別化過程驗證要求及控制措施」,https://stli.iii.org.tw/article-detail.aspx?no=66&tp=3&i=158&d=8261
20.王允翬。在全民健保之外──各國健康照護制度簡介二, https://ymmedmagazine.blogspot.com/2015/04/blog-post_92.html
21.「歐盟國家個人資料保護法制因應GDPR施行之調適──以德國與英國為例」委託研究計劃結案報告,https://ws.ndc.gov.tw/Download.ashx?u=LzAwMS9hZG1pbmlzdHJhdG9yLzEwL3JlbGZpbGUvNTc0NC8zNDM1My8xMzQ5YTUxYi00NWEwLTQ1ZGEtODBiZC1jNTM5MTNkOGVkMWQucGRm&n=57WQ5qGI5aCx5ZGKLnBkZg%3d%3d&icon=..pdf
22.葉奇鑫、王慕民、吳彥欽、陳品安、廖又萱(2018)。國家發展委員會106年度「個人資料保護專責機關與資料在地化之法制研究」委託研究計劃結案報告。臺北市:達文西個資暨高科技法律事務所,https://reurl.cc/2DDx3m



英文部分
一、專書
1.Cai, W., Liu, Z., Miao, L., Xiang, X. (Eds.)(2020). Pharmacogenomics in Precision Medicine From a Perspective of Ethnic Differences. Berlin, Springer.

二、期刊論文、電子論文
1.Ayday, E., Raisaro, J.L., Hubaux, J.P., Rougemont, P. (2013). WPES '13: Proceedings of the 12th ACM workshop on Workshop on privacy in the electronic society: 95-106.
2.Barazzetti, G., Bosisio, F., Koutaissoff, D., Spencer, B. (2020). Broad consent in practice: lessons learned from a hospital-based biobank for prospective research on genomic and medical data. European Journal of Human Genetics, 28(7):915-924.
3.Biunno, Ida & Ntai, Aikaterini & Baronchelli, Simona & Pellegrino, Tatiana & Blasio, Pasquale. (2014). Biobanking shifts to “precision medicine”. Journal of Biorepository Science for Applied Medicine, 2:11-15.
4.Bruening, P., Patterson, H.M. (2016). A Context-Driven Rethink of the Fair Information Practice Principles. Legal Perspectives in Information Systems eJournal.
5.Budin-Ljøsne, I., Teare, H.J.A., Kaye, J. et al. (2017). Dynamic Consent: a potential solution to some of the challenges of modern biomedical research. BMC Med Ethics, 18(1):4.
6.Drame,I., Connor,S., Abrons, J., Chen, A. M.H.(2020) The importance of equity, ethics, and rigor in global health research. Research in Social and Administrative Pharmacy, 12: 1509-1512.
7.Favaretto M., Clercq E.D., Schneble C.O., Elger B.S. (2020). What is your definition of Big Data? Researchers' understanding of the phenomenon of the decade. PLoS one, 15(2): e0228987.
8.Ganziano, J.M., Concato, J., Brophy, M.T., Fiore, L.D., Pyarajan, S., Breeling, J., Whitbourne, S., Deen, J., Shannon, C., Humphries, D., Guarino, P., Aslan, M., Anderson, D., LaFleur, R., Hammond, T., Schaa, K., Moser, J., Huang, G., Muralidhar, S., Przygodzki, R., O'Leary, T.J. (2016). Million Veteran Program: A Mega-biobank to Study Genetic Influences on Health and Disease. Journal of Clinical Epidemiology, 70:214-223.
9.Gille, F., Vayena, E., Blasimme,A. (2019).Future-proofing biobanks’ governance. European Journal of Human Genetics, 28:989-996.
10.Goetz L.H., Schork N.J. (2018). Personalized Medicine: Motivation, Challenges, and Progress. Fertil and Steril, 109(6):952-963.
11.Hazin, R., Brothers, K.B., Malin, B.A., Koenig, B.A., Sanderson, S.C., Rothstein, M.A., Williams, M.S., Clayton, E.W., Kullo, I.J. (2013). Ethical, legal, and social implications of incorporating genomic information into electronic health records. Genetics in Medicine, 15(10):810-816.
12.Harrell, H.L., Rothstein, M.A. (2016). Biobanking Research and Privacy Laws in the United States. Journal of Law, Medicine & Ethics, 44(1):106-127.
13.Hens K., Nys H., Cassiman J.J., Dierickx K. (2011). Risks, benefits, solidarity: a framework for the participation of children in genetic biobank research. The Journal of Pediatrics, 158(5): 842-848.
14.Hoofnagle, C.J., Sloot, B., Borgesius, F.Z. (2019). The European Union general data protection regulation: what it is and what it means. Information & Communications Technology Law, 28(1): 65–98.
15.Jonkman, L.J., Nonyel, N.P., Law, M.G., Drame, I. (2020). An ethics-based approach to research in global health: a call to action for pharmacists. Research in Social and Administrative Pharmacy, 16:1569-1573.
16.Kaye, J., Whitley, E., Lund, D. et al. (2015). Dynamic consent: a patient interface for twenty-first century research networks. Eur J Hum Genet, 23:141-146.
17.Laurie, G. (2011). Reflexive Governance in Biobanking: On the Value of Policy Led Approaches and the Need to Recognise the Limits Law. Human Genetics, 130:347-356.
18.Levin, A., Nicholson, M.J. (2005). Privacy Law in the United States, the EU and Canada: The Allure of the Middle Ground. University of Ottawa Law & Technology Journal, 2(2):357-395.
19.Leitsalu, L., & Metspalu, A. (2017). From Biobanking to Precision Medicine: The Estonian Experience. In Geoffrey S. Ginsburg, & Huntington F. Willard, (Eds.), Genomic and Precision Medicine (Third Edition) (chap. 8, pp. 126-127)
20.Liu, A., & Pollard, K. (2015). Biobanking for Personalized Medicine. Advances in experimental medicine and biology, 864: 55–68.
21.Leon-Sanz, P. (2019). Key Points for an Ethical Evaluation of Healthcare Big Data. Processes, 7(8): 493-504.
22.Mayer-Schönberger, V. (2016). Regime Change? Enabling Big Data Through Europe's New Data Protection Regulation. Columbia Science & Technology Law Review, 17:315-335.
23.Meyer, M.N. (2004). Comparative Law - Genetic Privacy - Icelandic Supreme Court Holds that Inclusion of an Individual’s Genetic Information in a National Database Infringes on the Privacy Interests of His Child. Harvard Law Review, 118:810-817.
24.Miller, A.R., Tucker C. (2018). Privacy Protection, Personalized Medicine and Genetic Testing. Management Science, 64 (10): 4648–68.
25.Mikkelsen, R.B., Gjerris, M., Waldemar, G. & Sandøe, P. (2019). Broad consent for biobanks is best – provided it is also deep. BMC Medical Ethics, 20(1):71.
26.Moore, W., Frye, S. (2019). Review of HIPAA, Part 1: History, Protected Health Information, and Privacy and Security Rules. Journal of Nuclear Medicine Technology, 47(4):269-272.
27.Moore, W., Frye, S. (2020). Review of HIPAA, Part 2: Limitations, Rights, Violations, and Role for the Imaging Technologist. Journal of Nuclear Medicine Technology, 48(1):17-23.
28.Natowicz, M.R., Alper, J.K., Alper, J.S. (1992) Genetic discrimination and the law. American Journal of Human Genetics, 50(3): 465–475.
29.Noonan, K.E. (2018). Personalized Medicine and Patient Privacy Concerns in the
Telemedicine Age. DePaul Journal of Health Care Law, 19:1-20.
30.Ntai, A., Baronchelli, S., Pellegrino, T., De Blasio, P., & Biunno, I. (2014) Biobanking shifts to “precision medicine”. Journal of Biorepository Science for Applied Medicine, 2:11-15.
31.Pokorska-Bocci, A., Kroese, M., Sagoo, G.S., Hall, A.E. (2014). Personalised medicine in the UK: Challenges of implementation and impact on healthcare system. Genome medicine, 6:28.
32.Prosser, W. L. (1970). Privacy. California Law Review, 48(3): 383-423.
33.Polonetsky, J., Tene, O., Finch, K. (2016). Shades of Gray: Seeing the Full Spectrum of Practical Data De-identification. Santa Clara Law Review, Forthcoming.56(3):593-629.
34.Redekop W.K., Mladsi D. (2013). The faces of personalized medicine: a framework for understanding its meaning and scope. Value Health, 16:S4-9.
35.Rodriguez L.L., Galloway E. (2017). Bringing Genomics to Medicine: Ethical, Policy, and Social Considerations. Genomic and Precision Medicine. 283-297.
36.Rothstein, M.A. (2018). Precision Medicine and the Risk to Privacy. The SciTech Lawyer, 15(1):28-32.
37.Shu, J.J. (2017). A new integrated symmetrical table for genetic codes. BioSystems, 151:21-26.
38.Shuster, E. (1997). Fifty years Later: The Significance of the Nuremberg Code. The New England Journal of Medicine, 337:1436-40.
39.Vaszar L.T., Cho M.K., Raffin T.A. (2003). Privacy issues in personalized medicine. Pharmacogenomics. 4(2):107-112.
40.Vogenberg F.R., Barash C.I., Pursel M. (2010). Personalized medicine: part 1: evolution and development into theranostics. Pharmacy and Therapeutics, 35(10):560-576.
41.Warren, S.D., Brandeis L.D. (1890). The Right to Privacy. Harvard Law Review, 4(5):193-220.
42.Westfall, N., Coors, M., Zittleman, L., Taylor, M., Westfall, J. (2016). Biobanking for Personalized, Precision Medicine: an Annotated Bibliography. Journal of Precision Medicine, May/June: 34-47.
43.Zick, C.D., Smith, K.R., Mayer, R.N., Botkin, J.R. (2000). Genetic testing, adverse selection, and the demand for life insurance. American Journal of Medical Genetics, 93(1):29-39.

三、學位論文
1.Camposeco, A., Estheiman, J. (2017). The right to be forgotten: a descriptive overview of the right to be forgotten. (Bachelor’s final dissertation). Universitat Pompeu Fabra Barcelona.

四、網路資源
1.National Human Genome Research Institute,https://www.genome.gov/human-genome-project/What.
2.Medlineplus,https://medlineplus.gov/genetics/understanding/basics/dna/.
3.International Bioethics Committee, Report of the IBC on big data and health, https://unesdoc.unesco.org/ark:/48223/pf0000248724.
4.Collins, K., Dance G.J.X. (2018). How Researchers Learned to Use Facebook ‘Likes’ to Sway Your Thinking. https://www.nytimes.com/2018/03/20/technology/facebook-cambridge-behavior-model.html
5.Genome UK: the future of healthcare, https://www.gov.uk/government/publications/genome-uk-the-future-of-healthcare/genome-uk-the-future-of-healthcare
6.OECD Guidelines on the Protection of Privacy and Transborder Flows of Personal Data,https://www.oecd.org/sti/ieconomy/oecdguidelinesontheprotectionofprivacyandtransborderflowsofpersonaldata.htm
7.Article 29 Data Protection Working Party, Opinion 05/2014 on Anonymisation Techniques, https://ec.europa.eu/justice/article-29/documentation/opinion-recommendation/files/2014/wp216_en.pdf
8.UNESCO, International Declaration on Human Genetic Data, http://portal.unesco.org/en/ev.php-URL_ID=17720&URL_DO=DO_TOPIC&URL_SECTION=201.html
9.WMA Declaration of Taipei on Ethical Considerations regarding Health Databases and Biobanks, https://www.wma.net/policies-post/wma-declaration-of-taipei-on-ethical-considerations-regarding-health-databases-and-biobanks/
10.ICO, Big Data, Artificial Intelligence, Machine Learning and Data Protection, https://ico.org.uk/media/fororganisations/documents/2013559/big-data-ai-ml-and-data-protection.pdf UK Biobank Ethics and Governance Framework Version 3.0.(2007). https://www.ukbiobank.ac.uk/media/0xsbmfmw/egf.pdf
11.The Precision Medicine Initiative, https://obamawhitehouse.archives.gov/precision-medicine
12.FACT SHEET: President Obama’s Precision Medicine Initiative, https://obamawhitehouse.archives.gov/the-press-office/2015/01/30/fact-sheet-president-obama-s-precision-medicine-initiative
13.Precision Medicine Initiative: Privacy and Trust Principles, https://obamawhitehouse.archives.gov/sites/default/files/microsites/finalpmiprivacyandtrustprinciples.pdf
14.The White House, Precision Medicine Initiative: Data Security Policy Principles and Framework, https://obamawhitehouse.archives.gov/sites/whitehouse.gov/files/documents/PMI_Security_Principles_Framework_v2.pdf
15.U.S. Department of Health and Human Services (HHS), Precision Medicine Initiative (PMI) Data Security Principles Implementation Guide, https://www.healthit.gov/sites/default/files/pmi_security_ig_v16-clean.pdf
16.Coded Private Information or Specimens Use in Research, Guidance (2008), https://www.hhs.gov/ohrp/regulations-and-policy/guidance/research-involving-coded-private-information/index.html
17.State Genetic Privacy Laws, http://pierce.wesleyancollege.edu/faculty/hboettger-tong/docs/hbt%20public%20folder/FYS/State%20Genetic%20Summary%20Table%20on%20Privacy%20Laws.htm
18.New State Genetic Privacy Law Directed at Consumer Genetic Tests, https://www.jdsupra.com/legalnews/new-state-genetic-privacy-law-directed-1958441/
19.O’Connor, N. (2018). Reforming the U.S. Approach to Data Protection and Privacy. https://www.cfr.org/report/reforming-us-approach-data-protection
20.National Institutes of Health, All of Us Research Program Overview, https://allofus.nih.gov/about/all-us-research-program-overview
21.National Institutes of Health, What Makes All of Us Different, https://allofus.nih.gov/about/program-overview/what-makes-all-us-different
22.National Institutes of Health, Precision Medicine Initiative: Privacy and Trust Principles, https://allofus.nih.gov/protecting-data-and-privacy/precision-medicine-initiative-privacy-and-trust-principles
23.National Institutes of Health, NIH funds genetic counseling resource ahead of million-person sequencing effort, https://allofus.nih.gov/news-events-and-media/announcements/nih-funds-genetic-counseling-resource-ahead-million-person-sequencing-effort
24.Researchers Guide and Drive the Workbench's First Year, https://allofus.nih.gov/news-events-and-media/announcements/researchers-guide-and-drive-workbenchs-first-year
25.What is the Million Veteran Program? https://www.research.va.gov/pubs/docs/va_factsheets/mvp.pdf
26.About the Million Veteran Program, https://www.mvp.va.gov/pwa/about
27.Office of Research & Development, https://www.research.va.gov/MVP/research.cfm
28.The 100,000 Genomes Project, https://www.genomicsengland.co.uk/about-genomics-england/the-100000-genomes-project/
29.UK Biobank / Data Management & Sharing Plan, https://www.ukbiobank.ac.uk/media/1dypjxpt/ukbiobank-data-management.pdf
30.Learn more about UK Biobank, https://www.ukbiobank.ac.uk/learn-more-about-uk-biobank
31.The Biobanks and Health Databanks Act, https://www.government.is/media/velferdarraduneyti-media/media/acrobat-enskar_sidur/Biobanks-Act-as-amended-2015.pdf
32.Human Genes Research Act, https://archivos.juridicas.unam.mx/www/bjv/libros/5/2292/41.pdf
33.What is personal data? https://ico.org.uk/for-organisations/guide-to-data-protection/guide-to-the-general-data-protection-regulation-gdpr/what-is-personal-data/what-is-personal-data/
34.About the ICO, https://ico.org.uk/about-the-ico
35.UK Biobank Ethics Advisory Committee, https://www.ukbiobank.ac.uk/learn-more-about-uk-biobank/governance/ethics-advisory-committee
36.Article 29 Data Protection Working Party, Opinion 03/2013 on purpose limitation, https://ec.europa.eu/justice/article-29/documentation/opinion-recommendation/files/2013/wp203_en.pdf
37.Achieving the Principles through a Precision Medicine Initiative Data Security Policy Framework, https://allofus.nih.gov/protecting-data-and-privacy/precision-medicine-initiative-data-security-policy-principles-and-framework-overview/achieving-principles-through-precision-medicine-initiative-data-security-policy-framework
38.Federal Trade Commission, Protecting Consumer Privacy in an Era of Rapid Change: Recommendations for Businesses and Policymakers, https://www.ftc.gov/sites/default/files/documents/reports/federal-trade-commission-report-protecting-consumer-privacy-era-rapid-change-recommendations/120326privacyreport.pdf
39.Department for Digital, Culture, Media and Sport (2021). Data: A new direction, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1022315/Data_Reform_Consultation_Document__Accessible_.pdf



 
 
 
 
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