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.     

The interaction of payoff structure and regulatory focus in classification

This report brings together research on motivation and learning by exploring how fit of regulatory focus affects people's ability to acquire new categories. Perceptual categories were learned by people with a promotion focus (a situationally determined sensitivity to gains) or a prevention focus (a sensitivity to losses). Classification performance was closest to optimal (as determined by models fit to individual subjects' data) when the regulatory focus matched the structure of the payoffs for the categories. Promotion-focus subjects performed best when the payoffs consisted of all gains. Prevention-focus subjects performed best when the payoffs consisted of all losses.     

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.     

Competition between endogenous and exogenous orienting of visual attention

The relation between reflexive and voluntary orienting of visual attention was investigated with 4 experiments: a simple detection task, a localization task, a saccade toward the target task, and a target identification task in which discrimination difficulty was manipulated. Endogenous and exogenous orienting cues were presented in each trial and their validity was manipulated orthogonally to examine whether attention mechanisms are mediated by separate systems and whether they have additive and independent effects on visual detection and discrimination. The results showed that each orienting mechanism developed its typical and independent effect in every case except for the difficult identification task. A theoretical framework for understanding the relationship between endogenous and exogenous orienting of attention is proposed, tested, and confirmed.     

Adjustment, social skills, and self-esteem in college students with symptoms of ADHD

Many studies of ADHD have shown that the problems associated with the disorder continue into adolescence and beyond for 10% to 60% of patients. The present study assesses several aspects of college adjustment, social skills, and self-esteem in a nonreferred sample of college students meeting criteria for a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnosis of ADHD. Twenty-one undergraduate students with symptoms of ADHD are compared to 20 students without significant ADHD symptoms, who match the ADHD students on age, gender, and grade point average. Students with ADHD symptoms show decreased functioning in several areas of college adjustment as well as lower levels of self-reported social skills and self-esteem. The results also suggest that the relation between ADHD and college adjustment is partially mediated by self-reported levels of self-esteem.     

Negative mood, self-focused attention, and the experience of physical symptoms: the joint impact hypothesis

A joint impact hypothesis on symptom experience is introduced that specifies the role of negative mood and self-focus, which have been considered independently in previous research. Accordingly, negative affect only promotes symptom experience when people simultaneously focus their attention on the self. One correlational study and 4 experiments supported this prediction: Only negative mood combined with self-focus facilitated the experience (see the self-reports in Studies 1, 2a, & 2b) and the accessibility (lexical decisions, Stroop task in Studies 3 & 4) of physical symptoms, whereas neither positive mood nor negative mood without self-focus did. Furthermore, the joint impact of negative mood and self-focused attention on momentary symptom experience remained significant after controlling for the influence of dispositional symptom reporting and neuroticism.     

Relationships between physical activity and motor skills in middle school children

The purpose of this study was to examine the relationships between physical activity measured as pedometer steps and performance on three motor skill tests. A secondary purpose was to determine if middle school children are meeting the recommendation for the number of daily steps. A sample (n =217) of 6th, 7th and 8th grade students participated. Each subject wore a Digi-Walker pedometer for three consecutive days. Subjects additionally recorded their pedometer steps in two 45 min.-physical education classes. There were strong significant correlations between daily steps taken by boys and girls, pedometer steps during physical education class and the AAHPERD Passing Test and the Bass Stick Balance. Similar correlations were weaker for the Side-Step Agility Test. Multivariate analysis of variance was utilized to examine variability of the three skills test by sex and year in school. Differences between students in Grades 7 and 8 on the AAHPERD Passing Test were significant. In addition, significant differences between daily pedometer steps and steps during physical education between Grades 6 and 7 were observed. Boys and girls had similar means on the AAHPERD Passing Test and Bass Stick Balance Test, but not on the Side-Step Agility Test. Scores on the three movement skills tested in this study were not strongly related to physical activity of the entire sample. Steps taken by middle school children appear not to be related to these measures of motor skills.     

Increasing implicit self-esteem through classical conditioning

Implicit self-esteem is the automatic, nonconscious aspect of self-esteem. This study demonstrated that implicit self-esteem can be increased using a computer game that repeatedly pairs self-relevant information with smiling faces. These findings, which are consistent with principles of classical conditioning, establish the associative and interpersonal nature of implicit self-esteem and demonstrate the potential benefit of applying basic learning principles in this domain.