Of Nanochips and Persons: Toward an Ethics of Diagnostic Technology in Personalized Medicine

This paper proposes an ethical reflection on personalized medicine and more precisely on the diagnostic technology underlying it, including nanochips. Our approach is inspired by a combination of two philosophical frames of reference: first, John Dewey’s distinction between intuitive valuation and reflexive evaluation, second, John Rawls’ reflective equilibrium. We aim at what we call a ‘reflexive equilibrium’, a mutual adjustment between on the one hand, the intuitive beliefs scientists have about the ethics of the technologies they work on (‘valuations’ in Dewey’s vocabulary) and, on the other hand, the reflexive ethical assessment of these technologies (‘evaluations’). Our goal, in this paper, is to provide the first step of this process through a philosophical analysis of some valuations on individualized medicine. In order to apprehend the ethical values shaping the development of biochips, we present and analyze qualitative interviews with scientists involved in the conception and the development of biochips involving nanotechnologies. We then propose a critical assessment of the role of ethics in these scientific practices. Last, we suggest two distinct and complementary ways to solve some of the issues brought to light by the interviews, without aiming at any dogmatic or “ready-made” answer. The first of these perspectives gives a central role to the capability individuals could achieve through personalized medicine; the second approach analyses the ethical disruptions entailed by personalized medicine with a special focus on care.     

Understanding the executive functioning heterogeneity in schizophrenia

Schizophrenia is characterized by heterogeneous brain abnormalities involving cerebral regions implied in the executive functioning. The dysexecutive syndrome is one of the most prominent and functionally cognitive features of schizophrenia. Nevertheless, it is not clear to what extend executive deficits are heterogeneous in schizophrenia patients. Furthermore, it is still unknown if the executive impairments observed in schizophrenia are better characterized as specific or as reflecting generalized cognitive factors. The four executive processes (i.e. updating, inhibition, shifting and divided attention) described in Miyake et al.'s (2000) theoretical model were examined in 62 individuals with schizophrenia and 49 healthy controls. At group level, impairments in all four executive processes confirmed the marked impairment in executive functioning in patients with schizophrenia. Statistical analysis indicated that executive performances in schizophrenia patients were more heterogeneous than in healthy controls. Compared with standardized norms, 94% of patients exhibited impairment in at least one of the executive tasks. Twenty-one percent of patients exhibited impairment in one executive task, 27% in two tasks, 23% in three executive tasks and 23% exhibited impairments in the four executive tasks. Six percent of patients had normal executive profile. Regression analysis indicated that only premorbid intellectual quotient and a general slowing in processing speed predicted the executive dysfunction severity. Executive functioning was not affected by age, duration of illness, psychotic status, or by antipsychotic dosage. Our results emphasize the heterogeneity of the dysexecutive syndrome in schizophrenia when individual profile analysis is considered, and extend the view that individual cognitive differences in schizophrenia are largely underlined by general cognitive factors such as intellectual level and general processing speed.     

Unerwünschte Wirkungen, Nebenwirkungen und Fehlentwicklungen

This paper is based on the observation that side effects, unwanted effects and undesirable developments in psychotherapy are still rarely discussed. Following an attempt to classify the phenomena some instruments which allow their assessment are described. Finally, studies indicating results about the frequency of the individual phenomena and their correlates are summarized. Focusing on side effects and unwanted effects of psychotherapy should start early and persist continuously throughout psychotherapeutic training.     

Under what conditions would people be willing to make a living organ donation?

The aim was to examine the factors involved in people's willingness to make a living organ donation. A convenience sample of 200 people in southern France rated willingness to be a living donor in 48 scenarios consisting of all combinations of five factors: recipient's identity (close family member and city resident); donor's surgical risk (little and some); donor's possible long-term health consequences (none, some lessening over time, and durable); transplant success ("generally durably successful" and "durably successful one time out of two"); and likelihood of other donors (subject is one of the rare compatible donors or one among others). Cluster analyses showed the existence of three distinct organ donation philosophies. For the largest cluster (49% of participants), willingness to donate was very high to a family member, but low to a city resident. For the second cluster (37%), willingness was high to family, but also moderately high to a city resident. For the third cluster (14%), willingness was always low. Thus, most participants judged themselves ready to make a living organ donation to a family member and many even to a stranger.     

A randomised trial of the effect of appearance versus health-framed messages on engagement with an online brief screening and alcohol reduction intervention

Objectives: To compare the impact of appearance versus health-framed messages on engagement in a brief web-based risk screening and alcohol reduction intervention.

Design: Randomised trial delivered via Drinkaware’s website. Visitors were exposed to appearance (n?=?51,588) or health-framed messages (n?=?52,639) directing them towards an AUDIT-C risk screening questionnaire. Users completing this questionnaire were given feedback on their risk level and extended frame-congruent information.

Outcomes: The primary outcome is completion of the AUDIT-C questionnaire. The secondary outcome is whether the participant accessed any of four further resources.

Results: The appearance-framed message led to a small but significant increase in the number of users completing the AUDIT-C compared to the health-framed message (n?=?3,537, 6.86% versus n?=?3,355, 6.37%, p?<?0.01). Conversely, following subsequent risk feedback, users exposed to extended health-framed information were more likely to access further resources (n?=?1,146, 2.17% versus n?=?942, 1.83%, p?<?0.01).

Conclusions: Physical appearance-framed messages increased the likelihood of engagement with an online alcohol screening and brief intervention tool, whereas health-framed messages increased the likelihood of accessing further resources. This highlights the potential for the use of multi-level approaches in alcohol reduction interventions.     

Involuntary and voluntary demotion: employee reactions and outcomes

ABSTRACT

Demotion has received little attention from scholars and practitioners alike. The purpose of this study was to assess empirically the reaction to, and outcomes of, both involuntary and voluntary demotion. Drawing on 49 semi-structured in-depth interviews with 28 involuntarily demoted workers and 21 voluntarily demoted workers, we develop a conceptual model using organizational justice theory and person-job fit of the reaction to and outcomes of demotion. We show that involuntarily demoted individuals might react by expressing turnover intentions and lower motivation and commitment, indicating that the demotee’s reaction is related to perceptions of fairness. Voluntary demotion is related to a better work-life balance, greater satisfaction, less stress and burnout and is perceived to be a viable phased retirement option by older workers. In addition, the findings highlight the role of demotion-related stigma, status loss, identity threat, and age in the way employees react to the experience of demotion.     

Less is more: The availability heuristic in early childhood

This study examined whether young children are influenced by the subjective experience associated with an easy or difficult recall when making memory decisions. Seventy‐one children, aged 4, 6, and 8 years, were asked to generate either a small (easy condition) or large (hard condition) number of first names. Statistical analyses revealed that participants in the hard condition were more likely to infer that they did not know many names than participants in the easy condition, contrary to what would be expected if children based their memory judgement on the objective number of recalled items. Overall, our results support the hypothesis that children as young as 4 years old rely on the subjective experience of ease to regulate their decision‐making processes. Theoretical implications of these findings are discussed.     

Breaching the contract? Using social contract theory to explain individuals’ online behavior to safeguard privacy

ABSTRACT

This study applies social contract theory to examine whether perceptions of a social contract explains adaptive behavior to safeguard online privacy. We (1) identify and (2) estimate the prevalence of subgroups that differ in their perceived “social contract” (based on privacy concerns, trust, and risk), and (3) measure how this perceived social contract affects adaptive online behavior. Using a representative two-wave panel survey (N = 1,222), we distinguished five subgroups of internet users; the highly-concerned, wary, ambivalent, neutral (the largest group), and carefree users. The former three were more likely to adapt their behavior than the latter two subgroups. We argue that the implied social contract represents an important construct that helps to identify whether individuals engage in privacy protection behavior.