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.     

Review of quantity and types of spirituality research in three health care databases (1962-1999): implications for the health care ministry

Using computer technology to identify the term "spiritual," these researchers present results of the 2306 citations and compare five criteria discovered with research reported in four pastoral counseling journals. The authors note the limitations of such a search and the possible implications of the findings for health care ministry.     

Sex offender community notification: managing high risk criminals or exacting further vengeance?

The current trend in dealing with convicted sex offenders is to impose long prison sentences followed by stringent release conditions. Added to this practice has been the policy of making such offenders who have been returned to society more visible to the public. In state after state, sex offender community notification laws have been passed, enabling communities to be put on notice that a convicted sex offender has become a resident. To date there has been little empirical evidence regarding the impact of these laws on managing sex offenders in the community. This study focuses on the social and psychological effects of community notification on sex offender reintegration within those communities where notification has occurred. Data are derived from face-to-face interviews with 30 convicted sex offenders, residing in various locations throughout Wisconsin, who were the subjects of community notification. The findings indicate that community notification can have a critical impact on the minimum essentials needed for the reintegration of offenders within the community. What is proposed is a reintegrative approach which suggests that stable housing and employment would mitigate the disruptive and antitherapeutic effects of community notification.     

Sex offender community notification: examining the importance of neighborhood meetings

Within the last decade, federal and state laws have been passed authorizing or requiring the notification of local residents that a convicted sex offender will be released and living in their neighborhood. The community meeting method of notifying neighborhood residents, although the subject of extensive news media attention, has been largely overlooked by empirical researchers. This study focuses on the experience of residents who attend such meetings and how that experience factors into a collective response on the part of the community. Data are derived from attendee surveys and recorded observations taken at all community notification meetings held throughout Wisconsin during a nine month period. The findings suggest that community notification meetings, if properly conducted, can perform an important role in managing the behavior of known sex offenders in the community. However the decision to notify and involve the public in an informal network of neighborhood surveillance may come at the cost of increased community anxiety. This anxiety is related to how the attendees were notified of the meeting, how clearly the purpose of the meeting was conveyed, and how organized the meeting appeared to the audience. Suggestions on how to more effectively utilize the community meeting method of notification are presented.     

The Factor Structure of the Beavers Interactional Scales

Confirmatory factor analysis and regression analyses of the Beavers Interactional Scales did not appear to support the model offered by its developers, namely, several specified family attributes contributing respectively to two global factors of Family Competence and Family Style. Moreover, regression analysis indicated that only three of 12 items predicted raters' assessments of Global Family Health, and one of seven items predicted Global Family Style. Individuals interested in the family dynamic centripetal/centrifugal might best think of that as a unitary entity and rate it accordingly.     

Plantinga’s Reformed Epistemology: What’s the Question?

Alvin Plantingas Warranted Christian Belief is without questionone of the central texts of the Reformed epistemology movement. Critiques of Plantingas defence have been both multiple and varied. As varied as these responses are, however, it is my contention that many of them amount to the same thing. It is the purpose of this paper to offer an overview of the main lines of attack that have been directed as Plantingas project, and thereafter to show how many, if not most, of these objections can be understood as versions or aspects of the same criticism, what I call the Inadequacy Thesis.     

Concordant Spiritual Orientations as a Factor in Physician--Patient Spiritual Discussions: A Qualitative Study

Objectives: To understand the impact of physicians and patients religious/spiritual orientation on discussions of spiritual issues. Methods: We performed semi-structured interviews of 10 Missouri family physicians and 10 patients of these physicians, selecting subjects nonrandomly to represent a range of demographic factors, practice types, and chronic or terminal illness. We coded and evaluated transcribed interviews for themes. Results: Respondents expressed that similar belief systems facilitate patient–physician spiritual interactions and bring confidence to their relationships. Those holding dissimilar faiths noted limited ability to address spiritual questions directly. They cited significant barriers to spiritual interaction but considered that ecumenism, use of patient-centered care, and negotiation skills lessen these barriers. Conclusions: Our respondents view spirituality similarly to other aspects of the physician–patient relationship involving differing viewpoints. Where discordance exists, cross-cultural, patient-centered, diplomatic approaches facilitate spiritual discussions.     

From <Emphasis Type="Italic">Pintele Yid to Racenjude</Emphasis>: Chaim Zhitlovsky and racial conceptions of Jewishness

The Russian Jewish intellectual, Chaim Zhitlovsky (1865–1943), a leading architect of secular Jewish culture and thought, was a central figure in the progressive Jewish intelligentsia of the late nineteenth and early twentieth century. In an essay written in 1927, Yidn un Yiddishkayt (Jews and Jewishness), he sought to define the secular essence of what he calls Yiddishkayt. This essay is not the first in Zhitlovskys long publicistic career in which he searches for new, secular definitions of Jewish identity and culture. But this essay differs, since it is marked by Zhitlovskys use of contemporary social scientific notions of race and racial traits to conceptualize what he believes constitutes Jewishness in a non-religious context, along with his adoption of the mystical Jewish concept of the pintele yid, the theory of an innate Jewishness embodied by a Jewish spark. Zhitlovskys desire to craft a truly secular theory of Jewish identity led him ironically to accept models of Jewish identity at odds with his stated larger vision. In turning to contemporary racial theory, as well as long nurtured mystical models of Yiddishkayt, Zhitlovsky reveals the wide range of ideological discourses that led him to innovative and controversial notions of modern Jewish identity.     

How bad is a 10% chance of losing a toe? Judgments of probabilistic conditions by doctors and laypeople

We presented a Web questionnaire to 139 physicians and medical researchers and 109 laypeople. The subjects made judgments of badness and importance of prevention for eight medical conditions at each of seven different probability levels. By assuming that the response to each of the 56 risks was monotonically related to transformations of the probability and of the disutility of the condition, we could assess the relative effect of probability and disutility on each subject's judgments. Physicians' judgments were more sensitive than laypeople's judgments to changes in probability. Older and female laypeople were less sensitive to probability (and correspondingly, more responsive to differences in severity among medical conditions). Laypeople varied more than physicians in their responsiveness to probability. These results point to general individual differences in the effect of probability on evaluations of medical risks. They may also provide insight into causes and noncauses of physician-patient miscommunication.