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.     

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.     

Key Word Index Volume 4

Other Index

Key Word Index Volume 4     

Treatment for sexually abused children and adolescents

The authors review research demonstrating the variable effects of childhood sexual abuse, the need for intervention, and the effectiveness of available treatment models. The well-controlled treatment-outcome studies reviewed do not focus on sensationalistic fringe treatments that treat sexually abused children as a special class of patients. Instead, studies demonstrate empirical evidence for extending and modifying treatment models from mainstream clinical child psychology to sexually abused children. The authors propose a continuum of interventions to meet the needs of this heterogeneous group. Interventions range from psychoeducation and screening, to short-term, abuse-focused cognitive-behavioral therapy with family involvement, to more comprehensive long-term plans for multiproblem cases. Last discussed are gaps in the research and suggestions for future research to address the pressing dilemmas faced by clinicians and policymakers.     

Asymmetries in a unilateral flanker task depend on the direction of the response: the role of attentional shift and perceptual grouping

Four experiments were conducted using a flanker task with 1 distractor appearing either on the left or right side of a central target. Responses were made on a keyboard aligned parallel to the displays. A larger flanker effect was obtained when the distractor was on the same side as the response. Two factors account for this asymmetry. First, when the flanker and target are identical, the 2 form a group that is assigned a spatial tag, creating a form of the Simon effect on the basis of the compatibility between the response keys and the group. Second, preparation of a lateralized response appears to entail a shift of visual attention in the corresponding direction, thus enhancing processing of the flanker on the response side. Consistent with the 2nd hypothesis, participants were more likely to correctly recognize letters that were briefly presented at the distractor position on the same side as the response.     

Group Psychotherapy as the Century Turns: Toward a Philosophy of Care

A futuristic essay should be written by two persons so as to invoke Bion's basic assumption pairing (Bion, 1964) with its connotations of hope, no matter how irrational. Accordingly, I split my self in two parts, one, the hard-headed realist, and the other, the prophetic visionary. As idealized identities, neither comes easily to me. But, perhaps heeding the two has permitted the articulation of some presentable notions about group psychotherapy and its evolving fate.     

Attributional Style, Self-Esteem, and Human Immunodeficiency Virus: A Test of the Hopelessness and Self-Esteem Theories of Depression

Research on the hopelessness and self-esteem theories of depression (Abramson, Metalsky, & Alloy, 1989; Metalsky, Joiner, Hardin, & Abramson, 1993) suggests that HIV-infected persons with depressotypic attributional style (AS) and low self-esteem (SE) may be at risk for onset of a syndrome referred to as hopelessness depression (HD). In a prospective study conducted to test these theories, measures of anxiety and depression, AS, and SE were administered to 85 HIV+ and 43 HIV– men; symptoms were reassessed 6 months later. Results indicated that: (1) The interaction of AS, SE, and HIV status predicted change in HD symptoms, but not overall depression or anxiety symptoms; (2) HIV+ men with depressotypic AS and high SE had increased HD symptom levels while other men with high SE had decreased HD symptom levels; (3) HD symptoms remained stable over the 6-month interval among men with low SE; and (4) High SE predicted decreases in anxiety symptoms among HIV– men, but not among HIV+ men. Contrary to the study hypothesis, these findings suggest that among individuals with life-threatening illnesses such as HIV infection, those with depressotypic AS and high SE may be at highest risk for onset of HD.     

The role of reinforcement contingencies in chronic alcoholism: An experimental analysis of one case

investigators have questioned chronic alcoholics and round that some of them have returned to normal social drinking (Davies, 1962; Lemere, 1953; Nørvig and Nielsen, 1956; Selzer and Holloway. 1957; and Shea, 1954). These findings would seem inconsistent with such notions as loss of control or craving as the basis of compulsive drinking. Moreover, antecedents and consequences of these explanatory constructs, have not been elucidated. The purpose of this research was to make an intensive study of a single subject to see if specific conditions could be identified under which a chronic alcoholic's drinking could be controlled, in a setting in which environmental variables could be systematically varied and drinking behavior documented.