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.     

Ethical dilemmas in testing for late onset conditions: reactions to testing and perceived impact on other family members

This paper examines some of the ethical dilemmas that arise when testing for the late onset, untreatable condition of Huntington disease (HD) specifically now that technology allows us to test younger generations of the family for the mutant gene. Drawing on interview data from families with Huntington disease, the reactions to testing and perceived impact on other family members are considered. These are discussed in the light of the possible lowering of the age of test applicants. This potentially raises problems for a younger generation as they are confronted with reproductive decisions that the older generation did not have to face. It also means that individuals have the prospect of living with knowledge of a future illness for much longer.     

Effects of normal aging and Alzheimer's disease on emotional memory

Recall is typically better for emotional than for neutral stimuli. This enhancement is believed to rely on limbic regions. Memory is also better for neutral stimuli embedded in an emotional context. The neural substrate supporting this effect has not been thoroughly investigated but may include frontal lobe, as well as limbic circuits. Alzheimer's disease (AD) results in atrophy of limbic structures, whereas normal aging relatively spares limbic regions but affects prefrontal areas. The authors hypothesized that AD would reduce all enhancement effects, whereas aging would disproportionately affect enhancement based on emotional context. The results confirmed the authors' hypotheses: Young and older adults, but not AD patients, showed better memory for emotional versus neutral pictures and words. Older adults and AD patients showed no benefit from emotional context, whereas young adults remembered more items embedded in an emotional versus neutral context.     

Neuropsychological correlates of recollection and familiarity in normal aging

The dual-process model of recognition memory proposed by Jacoby (1991; see also Mandler, 1980) postulates the existence of two independent components of recognition memory: a conscious retrieval process (recollection) and an automatic component ( familiarity). Older adults appear to be impaired in recollection, but findings with respect to familiarity have been mixed. Studies of the brain bases of these components, using neurological patients, have also been inconclusive. We examined recollection and familiarity, using the process dissociation procedure, in older adults characterized on the basis of both their frontal and their medial temporal lobe function. Findings suggest that only some older adults, depending on their neuropsychological status, are impaired in recollection and/or familiarity: Recollection seems to involve both frontal and medial temporal lobe function, whereas familiarity appears to be dependent only on function associated with the medial temporal lobes.     

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.     

Family Processes and Treatment Outcome in the MTA: Negative/Ineffective Parenting Practices in Relation to Multimodal Treatment

To elucidate processes underlying therapeutic change in a large-scale randomized clinical trial, we examined whether alterations in self-reported parenting practices were associated with the effects of behavioral, medication, or combination treatments on teacher-reported outcomes (disruptive behavior, social skills, internalizing symptoms) in children with attention-deficit hyperactivity disorder (ADHD). Participants were 579 children with Combined-type ADHD, aged 7–9.9 years, in the Multimodal Treatment Study of Children with ADHD (MTA). We uncovered 2 second-order factors of parenting practices, entitled Positive Involvement and Negative/Ineffective Discipline. Although Positive Involvement was not associated with amelioration of the school-based outcome measures, reductions in Negative/Ineffective Discipline mediated improvement in children's social skills at school. For families showing the greatest reductions in Negative/Ineffective Discipline, effects of combined medication plus behavioral treatment were pronounced in relation to regular community care. Furthermore, only in combination treatment (and not in behavioral treatment alone) was decreased Negative/Ineffective Discipline associated with reduction in children's disruptive behavior at school. Here, children in families receiving combination treatment who showed the greatest reductions in Negative/Ineffective Discipline had teacher-reported disruptive behavior that was essentially normalized. Overall, the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practices at home; we discuss problems in interpreting the temporal sequencing of such process-outcome linkages and the means by which multimodal treatment may be mediated by psychosocial processes related to parenting.     

An experimental study of strategy development

Three experiments are reported in which the strategy usage for a compass point directions task was investigated. For this task, people may use either an efficient cancellation strategy or an inefficient spatial strategy (see Roberts, Gilmore, & Wood, 1997). Experiment 1, together with Experiment 2, showed that users of cancellation are unlikely to have explicit prior knowledge of this strategy; instead they discover it as a result of experience with the task. Experiment 1 also showed that strategy selection is unlikely to be based on stylistic preferences, and that reducing the cognitive demands of the task does not increase the discovery of cancellation. Experiment 3 showed that evaluation of strategy validity is also of importance: Unsuccessful evaluation may prevent the selection of a newly discovered strategy, even if it is the more efficient method.     

Contextual effects on word production: A lifespan study

The effect of sentence priming on picture naming was investigated across the lifespan, from age 3 to 87 years. Names that are normally acquired before 3 years of age were presented in auditory contexts that were semantically congruent, incongruent, or neutral in relation to each picture and its name. Sentential priming was present at all age levels. Facilitation (neutral vs. congruent) was significantly by 4 years of age and did not vary significantly with age. Interference (incongruent vs. neutral) was significant at all age levels, but changed nonmonotonically with age (largest in the youngest children, stable from young adulthood through age 70, with a small increase in the oldest participants). We conclude that picture naming is a useful tool for the investigation of sentential priming effects across the lifespan and that it can reveal potentially interesting developmental changes in the effects of sentential context on word retrieval.     

Accounts of the confidence-accuracy relation in recognition memory

Confidence and accuracy, while often considered to tap the same memory representation, are often found to be only weakly correlated (e.g., Bothwell, Deffenbacher, & Brigham, 1987; Deffenbacher, 1980). There are at least two possible (nonexclusive) reasons for this weak relation. First, it may be simply due to noise of one sort or another; that is, it may come about because of both within- and between-subjects statistical variations that are partially uncorrelated for confidence measures on the one hand and accuracy measures on the other. Second, confidence and accuracy may be uncorrelated because they are based, at least in part, on different memory representations that are affected in different ways by different independent variables. We propose a general theory that is designed to encompass both of these possibilities and, within the context of this theory, we evaluate effects of four variables—degree of rehearsal, study duration, study luminance, and test luminance—in three face recognition experiments. In conjunction with our theory, the results allow us to begin to identify the circumstances under which confidence and accuracy are based on the same versus different sources of information in memory. The results demonstrate the conditions under which subjects are quite poor at monitoring their memory performance, and are used to extend cue utilization theories to the domain of face recognition.     

The Role of Families and Care Givers as Risk and Protective Factors in Preventing Youth Violence

This paper reviews research which discusses the risk and protective functions that families and other caregivers provide in influencing the development of aggressive behavior in youth. Currently, there is an emphasis on providing violence prevention programs in the school environment, typically with little parental or caregiver involvement. By enhancing the role of families and caregivers in youth violence prevention programs, we assert that an unique opportunity exists to both address specific risk factors for violence while enhancing the protective features of the family. Relatedly, the risk literature on youth violence indicates that the most influential risk factors (i.e., the family, community, and peers) have their principle impact on youth aggression outside the school. We suggest a shift in the focus of violence prevention programming that is more inclusive of families as both a risk and protective agent. In support of this position, relevant theory and reviews of exemplary family-involved programs are offered. Challenges to involving youth caregivers are identified and recommendations for overcoming those challenges suggested. Last, recommendations for future research and public policy in the prevention of youth violence are offered.