Pharmacogenetics: ethical issues and policy options

Pharmacogenetics offers the prospect of an era of safer and more effective drugs, as well as more individualized use of drug therapies. Before the benefits of pharmacogenetics can be realized, the ethical issues that arise in research and clinical application of pharmacogenetic technologies must be addressed. The ethical issues raised by pharmacogenetics can be addressed under six headings: (1) regulatory oversight, (2) confidentiality and privacy, (3) informed consent, (4) availability of drugs, (5) access, and (6) clinicians' changing responsibilities in the era of pharmacogenetic medicine. We analyze each of these categories of ethical issues and provide policy approaches for addressing them.     

The myth of Freud's ostracism by the medical community in 1896-1905: Jeffrey Masson's assault on the truth

The story recounted by Jeffrey M. Masson of the medical community's outraged response to the seduction theory is treated as historical fact in some of the recent literature on Freud's early psychoanalytic experiences. In this article the evidence adduced by Masson in The Assault on Truth (1984) to buttress his account of Freud's supposed ostracism is critically examined. It is concluded that this evidence fails to substantiate Masson's version of events, that there is abundant evidence that refutes it, and that he has ignored the historical research that demonstrates that the notion that Freud's early psychoanalytic writings received an irrationally hostile reception is a myth.     

Who is exaggerating cognitive impairment and who is not?

This chart review examined the effects of effort on neuropsychological assessment and test performance patterns among genuine and exaggerating patients, with and without neurological findings, as aids to diagnosing symptom exaggeration. The sample consisted of 561 consecutive patients involved in compensation claims. With a flexible neuropsychological test (NPT) battery, the claims were assessed over 2 days. The sample included 303 patients evaluated for traumatic brain injury, 55 patients with neurological disease, and 203 patients assessed for other conditions (eg, depression or chronic pain). An average of 38 ability measures per patient were used to generate an overall NPT domain score. Composite scores were also computed for symptom validity tests, self-report measures of psychiatric symptoms, and memory complaint inventory. Seven NPT cognitive subdomain scores were multiply regressed onto the symptom validity test composite, accounting for 45% of its total variance. Patients were also assigned to Genuine or Exaggerator groups based on symptom validity test performance. The NPT for Exaggerating patients averaged 1.43 standard deviations below that of Genuine patients, suggesting that NPT scores for most Exaggerating patients are underestimates of their true ability. Factor analysis results differed between these groups. As a result, clinicians might avoid falsely identifying genuine patients as exaggerating by incorporating their self-reports of psychiatric symptoms and memory complaints into the diagnostic process.     

Cross-cultural differences in tolerance for crowding: fact or fiction?

It is widely believed that cultures vary in their tolerance for crowding. There is, however, little evidence to substantiate this belief, coupled with serious shortcomings in the extant literature. Tolerance for crowding has been confused with cultural differences in personal space preferences along with perceived crowding. Furthermore, the few studies that have examined cultural variability in reactions to crowding have compared subgroup correlations, which is not equivalent to a statistical interaction. Although the authors found a statistical interaction indicating that Asian Americans and Latin Americans differ in the way they perceive crowding in comparison to their fellow Anglo-American and African American citizens, all four ethnic groups suffer similar, negative psychological distress sequelae of high-density housing. These results hold independently of household income.     

Regulation of Negative Affect During Mother–Child Problem-Solving Interactions: Adolescent Depressive Status and Family Processes

Despite recent suggestions that depression can be conceptualized as a disorder of affect regulation, relatively little research has focused on affect regulation skills in depressed individuals. This paper investigated whether depressed adolescents (N = 25) differ from nondepressed adolescents (N 25) on two indices of affect regulation (i.e., duration of negative affective states and reciprocity of maternal negative affect) as well as whether these indices are related to microsocial family interactional processes. Analyses revealed that depressed teens differed from their nondepressed peers with regard to duration of negative affective states but not in their likelihood of reciprocating negative affect. Additionally, indices of adolescent affect regulation were related to family interactional processes. Duration of depressive affect was positively associated with maternal display of facilitative behavior contingent on adolescent depressive behavior. Duration of aggressive behavior was inversely related to maternal problem-solving responses to aggressive behavior. Finally, adolescent reciprocity of maternal depressive and aggressive behaviors was strongly associated with mothers' reciprocity of adolescents' negative affective behavior.     

Commentary: A Patient's Perspective on Predictive Testing for Alzheimer Disease

Commentary

Commentary: A Patient's Perspective on Predictive Testing for Alzheimer Disease     

Seeds of discontent: Expert opinion, mass media messages, and the public image of agricultural biotechnology

Survey data are presented on opinions about agricultural biotechnology and its applications held by agricultural science faculty at highly ranked programs in the United States with and without personal involvement in biotechnology-oriented research. Respondents believed biotech holds much promise, but policy positions vary. These results underscore the relationship between opinion and stakeholder interests in this research, even among scientific experts. Media accounts are often seen as causes, rather than artifacts, of the existence of public controversy; European and now U.S. opposition to food biotechnology is often explained away in terms of such a relationship. The authors argue that where even experts are divided, public opposition cannot reasonably be attributed to poor public understanding or sensationalistic media accounts. Ethical implications for communicating science are explored.     

The role of inferences about referential intent in word learning: evidence from autism

Young children are readily able to use known labels to constrain hypotheses about the meanings of new words under conditions of referential ambiguity. At issue is the kind of information children use to constrain such hypotheses. According to one theory, children take into account the speaker's intention when solving a referential puzzle. In the present studies, children with autism were impaired in monitoring referential intent, but were equally successful as normally developing 24-month-old toddlers at mapping novel words to unnamed items under conditions of referential ambiguity. Therefore, constraints that lead the child to map a novel label to a previously unnamed object under these circumstances are not solely based on assessments of speakers' intentions.     

Turnover intentions and voluntary turnover: the moderating roles of self-monitoring, locus of control, proactive personality, and risk aversion

This article explores moderators of the relationship between turnover intentions and turnover behavior to better explain why some employees translate intentions into behavior and other employees do not. Individual differences in self-monitoring, locus of control, proactive personality, and risk aversion were examined. Results indicate that self-monitoring and risk aversion moderate the intentions-turnover link. Specifically, the relationship between turnover intentions and turnover is stronger for low self-monitors and those lower in risk aversion. Locus of control moderated the relationship in 1 of 2 samples such that the relationship was stronger for those with an internal locus of control. Proactive personality, however, did not directly moderate the relationship between intentions and turnover behaviors.