Doctor's Expertise and Managing Discrepant Information from Other Sources in Genetic Counseling: A Conversation Analytic Perspective

The study examines a recurrent interactional pattern in genetic counseling. It describes clinical geneticists' responses in situations in which clients have presented information from other sources that is potentially discrepant with information given by the doctor. The data consists of 12 video-recorded sessions of genetic counseling in Finland, and the method is conversation analysis. There are two primary ways the doctors respond: either they accept the client's information as such, but show that it is not discrepant with the doctor's information, or they reject the client's information. In the latter case they mitigate the ‘wrongness’ of the client's information. The clinical geneticists seem to be working with a dilemma: they need to find a balance between ensuring correct understanding of the information and showing respect for the expertise of others. A particularly complex case is also analyzed and reflected on.     

Care of the Self and Patient Participation in Genetic Discourse: A Foucauldian Reading of the Surgeon General's “My Family Health Portrait” Program

Critics of genetic discourse are concerned that deterministic and discriminatory views of genetics are increasingly becoming adopted. These views argue that current genetic discourse becomes a source of power whereby powerful institutions harm people with so-called “bad” genes. This essay argues that current analyses of the power of genetics discourse are grounded in an improper reading that disempowers patients. Deploying Michel Foucault's concept “care of the self,” this essay claims that genetics discourse is better understood as a way that patients take on power through rhetoric rather than a force that has power over patients. Through a close reading of the “My Family Health Portrait” program, this paper argues that patients experience a process of “subjection” wherein they become agents of and objects of genetics discourse both. This alternative mode of analyzing the power of genetics discourse has implications for our collective understanding of the operations of the care of the self and the uses of genetic information that we propose.     

Differences in Individual Approaches: Communication in the Familial Breast Cancer Consultation and the Effect on Patient Outcomes

This multicenter study aimed to assess (i) whether individual clinical geneticists and genetic counselors vary in their communication skills and (ii) whether this variation in communication impacts on patient outcomes, such as anxiety, depression, genetics knowledge, and satisfaction. One hundred and fifty women from high-risk breast cancer families attending their first genetic counseling consultation completed pre and post-consultation self-report questionnaires. The consultations were audiotaped and transcribed verbatim. Univariate analyses showed highly significant differences between individual clinical geneticists and genetic counselors in: facilitating understanding (p 0.001); facilitating active involvement (p 0.001); facilitating partnership building (p = 0.003); addressing emotional concerns (p 0.001); and discussing prophylactic mastectomy (p = 0.017). Multivariate linear regressions showed that this variation in communication resulted in a greater change in patients depression 4 weeks after the counseling session (p = 0.017). These findings suggest clinical geneticists and genetic counselors have achieved some standardization in communicating information, but showed diversity in their facilitation skills. Communication skills may be a useful area to explore further in this field.     

“Hands up Who Wants to Die?”: Primoratz on Responsibility and Civilian Immunity in Wartime

The question of the morality of war is something of an embarrassment to liberal political thinkers. A philosophical tradition which aspires to found its preferred institutions in respect for individual autonomy, contract, and voluntary association, is naturally confronted by a phenomenon that is almost exclusively explained and justified in the language of States, force and territory. But the apparent difficulties involved in providing a convincing account of nature and ethics of war in terms of relations between individuals has not prevented liberal theorists from attempting this task. This paper examines a recent attempt by Igor Primoratz to sketch out the implications of a consistent liberalism for just war doctrine and, in particular, as regards the question of who may be a legitimate target of attack in wartime. Primoratz’s paper itself is a critique of Michael Waltzer’s authoritative exposition of just war theory for failing to be sufficiently and consistently liberal. The debate between these two authors is a productive site for investigating the potential and limitations of liberal theories of just war.     

An fMRI study of temporal sequencing of motor regulation guided by an auditory cue—a comparison with visual guidance

The neuronal system to process and transfer auditory information to the higher motor areas was investigated using fMRI. Two different types of internal modulation of auditory pacing (1 Hz) were combined to design a 2×2 condition experiment, and the activation was compared with that under a visual guidance. The bilateral anterior portion of the BA22 (ant-BA22) and the left BA41/42 were more extensively activated by the combined modulation condition under the auditory cue than that under the visual cue. Among the four auditory conditions with or without the two types of internal modulation, the activation in the ant-BA22 was augmented only on the left side by the combined modulation condition. The left ant-BA22 may be especially involved in integrating the external auditory cue with internal modulation, while the activation on the right side did not depend on the complexity. The role of the left BA41/42 in motor regulation may be more specific to the processing of an auditory cue than that on the right side. These two areas in the left temporal lobe may be organized as a subsystem to handle the timing of complex movements under auditory cues, while the higher motor areas in the frontal lobe support both sensory modalities for the cue. This architecture may be considered as ‘audio-motor control’, which is similar to the visuo-motor control of the front-parietal network.     

2003年诺贝尔医学奖给科学界的多重启示(上)

2003年诺贝尔医学奖授予了两位美英物理学家,劳特布尔和曼斯菲尔德,表彰他们在磁共振成像方面的发现.这些发现导致现代磁共振技术的开发,这一技术标志着医学诊断学和科学研究中的一项突破.该项发现建筑在核磁和核磁共振现象被发现的基础之上.核磁现象的发现及其应用导致了1943、1944和1952年诺贝尔物理学奖的获得.核磁共振现象的发现及其应用导致了1991年和2002年诺贝尔化学奖的获得.这意味着,2003年诺贝尔医学奖是该系列发现中第六个诺贝尔科学奖.     

Government Subsidized Academic Research: Economic and Ethical Conflicts

Justification for public funding of academic research is based on the linear model of technological advance first proposed by Francis Bacon. The model hypothesizes that government subsidized science generates new technology which creates new wealth. Mainstream economics supports Bacons model by arguing that academic research is a public good. The Bayh–Dole Act allows universities to privatize federally funded research and development (R&D) which is in direct conflict with the public good argument. Diminishing returns to university R&D, challenges to Bacons linear model and the labor exploitation of young scientists by research universities suggest that policy makers may want to reconsider the system for allocating federal R&D to universities and colleges.     

Does the right hemisphere take over after damage to Broca's area? the Barlow case of 1877 and its history

In 1877 Thomas Barlow, a London physician, published a remarkable case of functional recovery of speech following brain damage. It involved a 10-year-old boy who had lost his speech, regained it, and lost it again before he died from a disorder that affected his heart and produced embolisms that subsequently affected other organs, including his brain. Examination of the boy's brain revealed two focal regions of softening; one that affected Broca's area and the left facial-motor area, and another, which occurred weeks later, in the homologous regions of the right hemisphere. Although Barlow was most concerned with motor deficits, others at the turn of the century began to cite this case as strong evidence that the corresponding region of the right hemisphere can take over speech functions for Broca's area on the left. Whether this case really provides good support for functional takeover or vicariation theory is critically evaluated in the light of contemporary research, including PET scan studies involving damage to Broca's speech region.     

Distributed cortical networks for syntax processing: Broca's area as the common denominator

Different types of syntactic information (word category, grammatical gender) are processed at different times during word recognition. However, it is an open issue which brain systems support these processes. In the present event-related fMRI study, subjects performed either a syntactic gender decision task on German nouns (GEN), a word category decision task (WC, nouns vs. prepositions), or a physical baseline task (BASE). Reaction times in WC were faster than in GEN, supporting earlier electrophysiological results. Relative to BASE, both syntactic tasks activated the inferior tip of BA 44. In addition, BA 45 showed activation in GEN, whereas BA 47 was activated in WC. The imaging data indicate that the inferior portion of BA 44 together with type-specific prefrontal areas supports both initial word category related and later syntactic processes.