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Direct-to-participant (DTP) recruitment and enrollment via the internet has proven to be an effective way of conducting genomic research, especially research on rare diseases. Although this novel manner for researchers to interact with prospective and enrolled participants has been approved by institutional review boards (IRBs) and research ethics committees (RECs) 1 for domestic research, some IRBs and RECs have been reluctant to approve it for international research because of concerns about its legality in other countries. Thus, the threshold question is whether it is legal for a researcher in one country to recruit and enroll participants in another country when there has not been an ethics review in the participant’s country. This determination is crucial because separate ethics reviews in numerous countries to obtain a small number of participants in each country would be extremely burdensome and greatly …