基因工程药物发展的历史及启示

基因工程诞生20余年,运用于医药行业,研制和开发工程药物,已取得长足进展,迄今为止,已有近100个基因工程新药上市,并有数百种正在研制和开发中,可以预计,基因工程药物的发展具有无比强大的生命力。就基因工程药物发展史进行概述,会从中得到许多启示。     

Re‐examining Human Dignity in Literary Texts: In Seeking for a Continuous Dialogue Between the Conceptual and the Empirical Approaches

The article deals with the treatment of human dignity in three novels: The Ballad of Narayama (1956) by Shichiro Fukasawa; Never Let Me Go (2005) by Kazuo Ishiguro; and Still Alice (2007) by Lisa Genova. The article argues for a rich understanding of human dignity, an understanding that cannot be reduced to rigid principles. Cultural forms, imagination, and fantasy employed in literary fiction allow us to see this richness.     

Genetic Engineering,Virtue-First Enhancement,and Deification in Neo-Irenaean Theodicy

This article seeks to provide a unified explanation to two profound challenges to Christian belief: the existence of evil and Darwin’s theory of natural selection. It is argued that an understanding of the full implications of our evolutionary past in conjunction with the Irenaean theodicy provides us with the best answer to these challenges. The traditional Irenaean theodicy emphasizes the importance of education for soul building. Soul building can benefit from technologically enhancing the biological superstructure of our humanity. In particular, genetic engineering can enhance human virtue. The biological basis of our moral natures can be improved using genetic technologies, including (possibly) somatic and germline engineering. To plan for virtue-first enhancement—the Genetic Virtue Project, which focuses on genetic improvements to our moral natures—is of paramount importance for the neo-Irenaean theodicy.     

抗体工程研究中几点思维启示和策略

本文以近几年非常活跃的抗体基因工程研究的几个方面为素材,回顾性地阐述了人们在对深邃的自然界认识过程中认识的逐步深化以及科学的创造性思维对研究工作的设计和结局的重大影响,并地未来抗体工程研究方面几个战略性问题提出了商榷性看法和建议。     

Family Communication Following BRCA1/2 Genetic Testing: A Close Look at the Process

This study examines the process of communicating BRCA1/2 genetic test results to family members, and the factors influencing disclosure. Twenty-nine semi-structured telephone interviews with BRCA1/2 tested individuals, 4 to 9 years post-notification, were conducted. Our results suggest that individual, familial, relational and socio-medical factors influence the decision to disclose/not disclose genetic test results to family members. These factors are at play in all three communication phases: the Decision-making phase, in which the individual ponders various factors before deciding to disclose test results to family members; the Disclosure phase, in which communication per se takes place; and the Reaction phase, which shapes the participant’s subsequent disclosure/non-disclosure decisions. We propose a guiding framework to assist in identifying and evaluating significant factors that might shape the course and outcome of the transmission of genetic information to family members.     

Probability Biases in Genetic Problem Solving: A Comparison of Undergraduates, Genetic Counseling Graduate Students, and Genetic Counselors

Heuristics are mental shortcuts that aid people in everyday problem-solving and decision-making. Although numerous studies have demonstrated their use in contexts ranging from consumers’ shopping decisions to experts’ estimations of experimental validity, virtually no published research has addressed heuristics use in problems involving genetic conditions and associated risk probabilities. The present research consists of two studies. In the first study, 220 undergraduates attempted to solve four genetic problems—two common heuristic problems modified to focus on genetic likelihood, and two created to study heuristics and probability rule application. Results revealed that the vast majority of undergraduates used heuristics and also demonstrated a complete misuse of probability rules. In the second study, 156 practicing genetic counselors and 89 genetic counseling students solved slightly modified versions of the genetic problems used in Study 1. Results indicated that a large percentage of both genetic counselors and students used heuristics, but the counselors demonstrated superior problem-solving performance compared to both the genetic counseling students and the undergraduates from Study 1. Research, training, and practice recommendations are presented.     

Genetic Influence Helps Explain Variation in Human Fertility: Evidence From Recent Behavioral and Molecular Genetic Studies

To search for genetic influence on human fertility differentials appears inconsistent with past empirical research and prior interpretations of Fisher's fundamental theorem of natural selection. We discuss Fisher's theorem and give reasons why genetic influences may indeed account for individual differences in human fertility. We review recent empirical studies showing genetic influence on variance in fertility outcomes and precursors to fertility. Further, some of the genetic variance underlying fertility outcomes overlaps with that underlying fertility precursors. Findings from different cultures, different times, different levels of data, and both behavioral and molecular genetic designs lead to the same conclusion: Fertility differentials are genetically influenced, and at least part of the influence derives from behavioral precursors that are under volitional control, which are themselves genetically mediated.     

Gene therapy: ethical issues

To discern the ethical issues involved incurrent gene therapy research, to explore theproblems inherent in possible future genetherapies, and to encourage debate within thescientific community about ethical questionsrelevant to both, we surveyed American Societyof Human Genetics scientists who engage inhuman genetics research. This study of theopinions of U.S. scientific experts about theethical issues discussed in the literature ongene therapy contributes systematic data on theattitudes of those working in the field as wellas elaborative comments. Our survey finds thatrespondents are highly supportive of thepotential use of somatic cell gene therapy tocure serious diseases in adults and children aswell as prospective offspring. A clearmajority, however, believe that using suchgenetic techniques for enhancement purposes isunacceptable. Delineating the line betweendisease/disorder and improvement/enhancementposes a problem not easily resolved and oneconducive to the growth of slippery-slopeapprehensions. The majority of respondents alsoadvocate germ-line therapy, in theory at least,and under similar restrictions, but theyrecognize the roadblock that the existence ofunanticipated negative consequences currentlypresents. Another complex matter involvestrying to determine appropriate reasons forchoosing target diseases for research, forwhich the dichotomy between rare single-geneand common multifactorial diseases reveals anongoing dilemma.     

The Prophylactic Mastectomy Dilemma: A Support Group for Women at High Genetic Risk for Breast Cancer

The goal of this pilot study was to test the usefulness of a six session psychoeducational support group for women at high genetic risk for breast cancer who were considering prophylactic mastectomy. The themes of the group sessions included overestimation of and anxiety about risk; desire for hard data; the emotional impact of watching a mother die of breast cancer; concerns about spouse reactions; self- and body image; the decision-making process; and confusion over whom to trust in decision making. Both the participants and the multidisciplinary leaders concluded that as a supplement to individual counseling, a support group is a beneficial and cost-effective treatment modality. Recommendations for the optimal format for such a group are described.     

美国对受试者研究中特殊挑战的观点:遗传研究中的伦理问题

虽然基因研究比其他任何时候更有望了解人类疾病及其在世界各类人群中的表现形式,并且对预防和治疗疾病产生了深远影响,但是它的应用也会极大地改变我们对个体及群体特征。从个体属性及群体意识的角度来看,特别是关于知情同意这个议题,我们会非常清楚地看到遗传研究所面临的挑战。阐述了在美国遗传研究所面临的挑战,讨论了遗传研究进行过程中出现的一系列伦理问题,如：如何正确执行知情同意;研究中可能对受试者产生的标签和歧视行为;遗传流行病研究中出现的伦理问题以及需要关注的社区和民族的伦理问题;对人类组织样本的储存和使用中所出现的伦理问题。强调了知情同意和社区参与遗传研究及在研究中社区代表性的重要性;强烈主张在遗传研究中建立多民族的合作是确保研究的顺利进行的基础。     

A Different Look at Assessment Centers: Views of Assessment Center Users

This study aims to shed light on possible problems of assessment center users and designers when developing and implementing assessment centers. Semi-structured interviews with a representative sample of assessment center users in Flanders revealed that, besides a large variability in assessment center practice, practitioners experience problems with dimension selection and definition, exercise design, line/staff managers as assessors, distinguishing between observation and evaluation, and with the content of assessor training programs. Solutions for these problems are suggested.     

Preconception Genetic Counseling: Three Years of Experience at a Community-Based Health Center

In the United States, access to genetic education and services is not equally available to all segments of the population, especially to women of minority backgrounds and low incomes. In response to this issue, the Preconception Genetic Health Education Program (PGHEP) was implemented in September of 1993 at the Woodlawn Maternal and Child Health Center in south side Chicago. The goal of this program is to provide access to genetic services to a previously underserved population. Women attending the family planning clinics are offered free, confidential preconception genetic screening and counseling on-site. As of January 1, 1997, 1300 women have participated in the program. The development and implementation of the PGHEP, client self-reports of family histories and beliefs, and implications for future delivery of genetic services are discussed.     

Psychosocial Genetic Counseling in the Post-Nondirective Era: A Point of View

For three decades nondirectiveness has served as the central ethos for genetic counseling. It has evolved from narrow definitions defining what should not be done to broad definitions that promote active counseling skills in support of client autonomy and informed decision making. As broad definitions have been formulated, the term nondirective has become largely irrelevant to their content; it persists primarily as a historic relic. It has thus become an impediment to creative theory and clinical practice. I propose that nondirectiveness be replaced as the central ethos, while relevant components (providing balanced information, not imposing the counselor's values) are retained as elements of practice and ethics. This raises the question of what principle(s) should be adopted as a new guiding ethos. To promote a discussion of that issue I propose that the central ethos of genetic counseling should be to bring the psychosocial component into every aspect of the work.     

Environmental Contributions to Adolescent Delinquency: A Fresh Look at the Shared Environment

Few genetically-informative studies have attempted to explicitly identify the shared environmental (i.e., those environmental influences that contribute to sibling similarity) factors now known to contribute to adolescent delinquency. The current study therefore examined whether the parent-child relationship served as one source of these shared environmental influences. Participants were 610 adoptive and biological families from the Sibling Interaction and Behavior Study (SIBS). Parents and adolescents reported on their parent-child conflict and parental involvement with child, and adolescents reported on their own delinquent behaviors. We employed structural equation modeling and supplementary multilevel modeling, finding consistent evidence that the association between delinquency and the parent-child relationship is at least partially shared environmental in origin. Such findings provide an important extension of previous twin studies, as they suggest that passive genotype-environment correlations do not explain earlier findings of shared environmental influences on this association.     

The Mind and the Book: A Long Look at Psychoanalytic Literary Criticism

This immense field can be summarized by recognizing that the psychoanalytic critic must address one or more of three minds: the author's, the reader's, or a mind derived from the text. The critic can then address them from any theoretical point of view. The future of psychoanalytic criticism, and indeed of psychoanalysis, lies in integrating the discoveries of brain and cognitive science with those of psychoanalysis. In the present, psychoanalytic critics need to recognize that their function is to delight and enlighten. Hence, no more pathography, no more id-analysis, no more symbol-mongering, no more jargon. Only that way, will psychoanalytic critics keep open psychoanalysis' royal road into the human possibilities offered by great literature.     

The Importance of Cartesian Triangles: A New Look at Descartes's Ontological Argument

In this paper, I argue that commentators have missed a significant clue given by Descartes in coming to understand his 'ontological' proof for the existence of God. In both the analytic and synthetic presentations of the proof throughout his writings, Descartes notes that the proof works 'in the same way' as a particular geometrical proof. I explore the significance of such a parallel, and conclude that Descartes could not have intended readers to think that the argument consists of some kind of intuition. I argue that for Descartes the attribute of existence is a 'second-order' attribute that is demonstrated to belong to the idea of God on the basis of 'first-order' attributes. The proof, properly understood, is in fact a demonstration. Having brought to light the geometrical parallels between the ontological and geometrical proofs, we have new evidence to resolve the 'intuition versus demonstration' controversy that has characterized much of the discussion of Descartes's ontological argument.     

Case Report: A Systems Approach to Genetic Counseling for Albinism

A systems approach to family therapy assumes that a person and his/her problems do not operate in a social vacuum but instead are imbedded in a social context. This context includes fairly small social systems such as a nuclear family and larger social systems such as school systems and cultural beliefs. A case of a girl with albinism born to a couple from India will be used to discuss how a systems approach might be useful in a genetic counseling setting.     

The Relationship of Nondirectiveness to Genetic Counseling: Report of a Workshop at the 2003 NSGC Annual Education Conference

Nondirectiveness has been a guiding principle for genetic counseling since the founding of the profession. However, its efficacy and appropriateness in this role have been frequently questioned. A workshop at the 2003 Annual Education Conference of the National Society of Genetic Counselors provided audience participation in a discussion of these issues. Participants presented arguments for and against nondirectiveness as a central ethos. They described complex personal transitions in adapting what they had learned about nondirectiveness during training to the realities of the workplace. There was support for flexible approaches to genetic counseling, with varying adherence to nondirectiveness, based on client and family needs and values, clinical circumstances, and desired counseling outcomes. The discussion supports the use of clinical experience, outcomes research, and the experience of other professions to move beyond nondirectiveness and more accurately identify the theoretical bases that underlie genetic counseling in the variety of circumstances in which it is currently practiced.