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.     

The Double Life of Double Effect

The U.S. Supreme Court's majorityopinion in Vacco v. Quill assumes thatthe principle of double effect explains thepermissibility of hastening death in thecontext of ordinary palliative care and inextraordinary cases in which painkilling drugshave failed to relieve especially intractablesuffering and terminal sedation has beenadopted as a last resort. The traditionaldoctrine of double effect, understood asproviding a prohibition on instrumental harmingas opposed to incidental harming or harming asa side effect, must be distinguished from otherways in which the claim that a result is notintended might be offered as part of ajustification for it. Although double effectmight appropriately be invoked as a constrainton ordinary palliative care, it is not clearthat it can be coherently extended to justifysuch practices as terminal sedation. A betterapproach would reconsider double effect'straditional prohibition on hastening death as ameans to relieve suffering in the context ofacute palliative care.     

The placebo effect in popular culture

This paper gives an overview of the placebo effect in popular culture, especially as it pertains to the work of authors Patrick O’Brian and Sinclair Lewis. The beloved physician as placebo, and the clinician scientist as villain are themes that respectively inform the novels, The Hundred Days and Arrowsmith. Excerpts from the novels, and from film show how the placebo effect, and the randomized clinical trial, have emerged into popular culture, and evolved over time. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

The concept of placebo

This paper attempts to define the concept of placebo as it is used in the clinical context The author claims that X is a placebo if and only if X has such a property d_p, that whenever in a therapeutic situation T a stimulus S appears, then in attending conditions A, it will cause a beneficial reaction R in the patient. Formally, the same structure may be used to define any pharmacologically active drug. The main difference between the drug and a placebo is in the range of possible substitutions for X and the property d. For the active drug there is only one possible substitution for X and property d and it can be scientifically explained why, and how the drug works. In the case of a placebo a set of possible substitutions for X and d is open, and so far it is impossible to offer any scientifically valid explanation of the action mechanism of placebo.     

A holistic account of the own-race effect in face recognition: evidence from a cross-cultural study

A robust finding in the cross-cultural research is that people's memories for faces of their own race are superior to their memories for other-race faces. However, the mechanisms underlying the own-race effect have not been well defined. In this study, a holistic explanation was examined in which Caucasian and Asian participants were asked to recognize features of Caucasian and Asian faces presented in isolation and in the whole face. The main finding was that Caucasian participants recognized own-race faces more holistically than Asian faces whereas Asian participants demonstrated holistic recognition for both own-race and other-race faces. The differences in holistic recognition between Caucasian and Asian participants mirrored differences in their relative experience with own-race and other-race faces. These results suggest that the own-race effect may arise from the holistic recognition of faces from a highly familiar racial group.     

Developmental dyslexia in different languages: language-specific or universal?

Most of the research on developmental dyslexia comes from English-speaking countries. However, there is accumulating evidence that learning to read English is harder than learning to read other European orthographies (Seymour, Aro, & Erskine, 2003). These findings therefore suggest the need to determine whether the main English findings concerning dyslexia can be generalized to other European orthographies, all of which have less irregular spelling-to-sound correspondences than English. To do this, we conducted a study with German- and English-speaking children (n=149) in which we investigated a number of theoretically important marker effects of the reading process. The results clearly show that the similarities between dyslexic readers using different orthographies are far bigger than their differences. That is, dyslexics in both countries exhibit a reading speed deficit, a nonword reading deficit that is greater than their word reading deficit, and an extremely slow and serial phonological decoding mechanism. These problems were of similar size across orthographies and persisted even with respect to younger readers that were at the same reading level. Both groups showed that they could process larger orthographic units. However, the use of this information to supplement grapheme-phoneme decoding was not fully efficient for the English dyslexics.     

The Relation Between Coordinated Interpersonal Timing and Maternal Sensitivity in Four-Month-Old Infants

The relation between mother–infant coordinated interpersonal timing, an automated microanalytic measure of dyadic vocal coordination, and maternal sensitivity was explored. Thirty-five mothers and their developmentally normal 4-month-old infants were audio-recorded during a 20-min laboratory vocal interaction session, that was later analyzed for degree of vocal coordination. Maternal Sensitivity ratings (Ainsworth & Bell, 1969) were based on a video-taped 45-min unstructured laboratory interaction period. A significant curvilinear relation between the degree to which mother coordinated her noninterruptive co-occurring speech to that of her infant was found and revealed that mothers highest in sensitivity were characterized by moderate levels of coordination. Examining mother-infant interaction at the specific behavioral level, while incorporating tests of nonlinear trends, may provide important information about the nature of sensitive parenting.     

Responding for sucrose and wheel-running reinforcement: effects of sucrose concentration and wheel-running reinforcer duration

Six male albino rats were placed in running wheels and exposed to a fixed-interval 30-s schedule of lever pressing that produced either a drop of sucrose solution or the opportunity to run for a fixed duration as reinforcers. Each reinforcer type was signaled by a different stimulus. In Experiment 1, the duration of running was held constant at 15 s while the concentration of sucrose solution was varied across values of 0, 2.5. 5, 10, and 15%. As concentration decreased, postreinforcement pause duration increased and local rates decreased in the presence of the stimulus signaling sucrose. Consequently, the difference between responding in the presence of stimuli signaling wheel-running and sucrose reinforcers diminished, and at 2.5%, response functions for the two reinforcers were similar. In Experiment 2, the concentration of sucrose solution was held constant at 15% while the duration of the opportunity to run was first varied across values of 15, 45, and 90 s then subsequently across values of 5, 10, and 15 s. As run duration increased, postreinforcement pause duration in the presence of the wheel-running stimulus increased and local rates increased then decreased. In summary, inhibitory aftereffects of previous reinforcers occurred when both sucrose concentration and run duration varied; changes in responding were attributable to changes in the excitatory value of the stimuli signaling the two reinforcers.     

The unification of mind: Integration of hemispheric semantic processing

Seventy-six participants performed a visual half-field lexical decision task at two different stimulus onset asynchronies (50 or 750 ms). Word targets were primed either by a highly associated word (e.g., CLEAN-DIRTY), a weakly associated word (e.g., CLEAN-TIDY), or an unrelated word (e.g., CLEAN-FAMILY) projected to either the same or opposite visual field (VF) as the target. In the short SOA, RVF-left hemisphere primes resulted in high associate priming regardless of target location (ipsilateral or contralateral to the prime) whereas LVF-right hemisphere primes produced both high and low associate priming across both target location conditions. In the long SOA condition, contralateral priming patterns converged, demonstrating only high associate priming in both VF locations. The results of this study demonstrate the critical role of interhemispheric transfer in semantic processing and indicate a need to elaborate current models of semantic processing.     

Beyond the Obvious: Chronic Vividness of Imagery and the Use of Information in Decision Making

The authors investigate two competing hypotheses about how chronic vividness of imagery interacts with the vividness and salience of information in decision making. Results from four studies, covering a variety of decision domains, indicate that chronic imagery vividness rarely amplifies the effects of vivid and salient information. Imagery vividness may, in fact, attenuate the effects of vivid and salient information. This is because, relative to nonvivid imagers, vivid imagers rely less on information that appears obvious and rely more on information that seems less obvious. This tendency is so robust that vividness of imagery may amplify the effects of vivid information only when this information is the only information available in the decision field. The findings seem to reflect vivid imagers' tendency to totally immerse themselves in a decision problem and scrutinize the available information creatively.