Outcomes of a Randomized Controlled Trial of Genomic Counseling for Patients Receiving Personalized and Actionable Complex Disease Reports

There has been very limited study of patients with chronic disease receiving potentially actionable genomic based results or the utilization of genetic counselors in the online result delivery process. We conducted a randomized controlled trial on 199 patients with chronic disease each receiving eight personalized and actionable complex disease reports online. Primary study aims were to assess the impact of in-person genomic counseling on 1) causal attribution of disease risk, 2) personal awareness of disease risk, and 3) perceived risk of developing a particular disease. Of 98 intervention arm participants (mean age = 57.8; 39% female) randomized for in-person genomic counseling, 76 (78%) were seen. In contrast, control arm participants (n = 101; mean age = 58.5; 54% female) were initially not offered genomic counseling as part of the study protocol but were able to access in-person genomic counseling, if they requested it, 3-months post viewing of at least one test report and post-completion of the study-specific follow-up survey. A total of 64 intervention arm and 59 control arm participants completed follow-up survey measures. We found that participants receiving in-person genomic counseling had enhanced objective understanding of the genetic variant risk contribution for multiple complex diseases. Genomic counseling was associated with lowered participant causal beliefs in genetic influence across all eight diseases, compared to control participants. Our findings also illustrate that for the majority of diseases under study, intervention arm participants believed they knew their genetic risk status better than control arm subjects. Disease risk was modified for the majority during genomic counseling, due to the assessment of more comprehensive family history. In conclusion, for patients receiving personalized and actionable genomic results through a web portal, genomic counseling enhanced their objective understanding of the genetic variant risk contribution to multiple common diseases. These results support the development of additional genomic counseling interventions to ensure a high level of patient comprehension and improve patient-centered health outcomes.     

Detecting deception: the scope and limits

With the increasing interest in the neuroimaging of deception and its commercial application, there is a need to pay more attention to methodology. The weakness of studying deception in an experimental setting has been discussed intensively for over half a century. However, even though much effort has been put into their development, paradigms are still inadequate. The problems that bedevilled the old technology have not been eliminated by the new. Advances will only be possible if experiments are designed that take account of the intentions of the subject and the context in which these occur.     

Predictive coding: an account of the mirror neuron system

Is it possible to understand the intentions of other people by simply observing their actions? Many believe that this ability is made possible by the brain’s mirror neuron system through its direct link between action and observation. However, precisely how intentions can be inferred through action observation has provoked much debate. Here we suggest that the function of the mirror system can be understood within a predictive coding framework that appeals to the statistical approach known as empirical Bayes. Within this scheme the most likely cause of an observed action can be inferred by minimizing the prediction error at all levels of the cortical hierarchy that are engaged during action observation. This account identifies a precise role for the mirror system in our ability to infer intentions from actions and provides the outline of the underlying computational mechanisms.     

Together, slowly but surely: the role of social interaction and feedback on the build-up of benefit in collective decision-making

That objective reference is necessary for formation of reliable beliefs about the external world is almost axiomatic. However, Condorcet (1785) suggested that purely subjective information--if shared and combined via social interaction--is enough for accurate understanding of the external world. We asked if social interaction and objective reference contribute differently to the formation and build-up of collective perceptual beliefs. In three experiments, dyads made individual and collective perceptual decisions in a two-interval, forced-choice, visual search task. In Experiment 1, participants negotiated their collective decisions with each other verbally and received feedback about accuracy at the end of each trial. In Experiment 2, feedback was not given. In Experiment 3, communication was not allowed but feedback was provided. Social interaction (Experiments 1 and 2 vs. 3) resulted in a significant collective benefit in perceptual decisions. When feedback was not available a collective benefit was not initially obtained but emerged through practice to the extent that in the second half of the experiments, collective benefits obtained with (Experiment 1) and without (Experiment 2) feedback were robust and statistically indistinguishable. Taken together, this work demonstrates that social interaction was necessary for build-up of reliable collaborative benefit, whereas objective reference only accelerated the process but--given enough opportunity for practice--was not necessary for building up successful cooperation.