Genetic background of patients from a university medical center in Manhattan: implications for personalized medicine

What are our AIMs? Interdisciplinary Perspectives on the Use of Ancestry Estimation in Disease Research

BACKGROUND

Ancestry estimation serves as a tool to identify genetic contributions to disease but may contribute to racial discrimination and stigmatization. We sought to understand user perspectives on the benefits and harms of ancestry estimation to inform research practice and contribute to debates about the use of race and ancestry in genetics.

METHODS

Key informant interviews with 22 scientists were conducted to examine scientists' understandings of the benefits and harms of ancestry estimation.

RESULTS

Three main perspectives were observed among key informant scientists who use ancestry estimation in genetic epidemiology research. Population geneticists self identified as educators who controlled the meaning and application of ancestry estimation in research. Clinician-researchers were optimistic about the application of ancestry estimation to individualized risk assessment and personalized medicine. Epidemiologists remained ambivalent toward ancestry estimation and suggested a continued role for race in their research.

CONCLUSIONS

We observed an imbalance of control over the meaning and application of ancestry estimation among disciplines that may result in unwarranted or premature translation of ancestry estimation into medicine and public health. Differences in disciplinary perspectives need to be addressed if translational benefits of genetic ancestry estimation are to be realized.

Knowledge and attitudes regarding expanded genetic carrier screening among women's healthcare providers

OBJECTIVE

To determine women's healthcare providers' knowledge and attitudes regarding genetic disorders and expanded genetic screening.

DESIGN

Survey of American Society for Reproductive Medicine 2010 and American College of Obstetricians and Gynecologists 2011 Annual Meeting attendees. The survey included 60 items (12 demographic, 10 knowledge, and 38 attitude). Attitudes were assessed with a 5-point Likert scale. Chi-square or t tests determined significance.

SETTING

American Society for Reproductive Medicine 2010 and American College of Obstetricians and Gynecologists 2011 Annual Meeting.

PATIENT(S)

A total of 203 participants completed the survey. Of these, 48% were male, 61% were physicians, 73% were Caucasian, and 42% were aged 35-50 years.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

None.

RESULT(S)

Physicians had better knowledge scores than other participants (87% vs. 79%). Knowledge was not influenced by prior personal/family experience with genetic screening. Fewer correct answers were observed for the probability of a positive test (65.2%), the risk of transmitting a gene mutation (62.2%), and the risk of having an affected child (56.2%). Very few participants (18.3%) disagreed with the notion of carrier screening as socially responsible behavior. Some had concerns about test result confidentiality (40.1%) and resulting insurance rate increases (37.0%). Assuming equal costs, most participants preferred to be tested for a larger number of diseases (77.7%) and believed posttest counseling to be helpful (83.7%).

CONCLUSION(S)

Women's healthcare providers generally had good knowledge and positive attitudes about genetic disorders and expanded genetic screening. Specific misperceptions, both medical and legal, require education.

Inclusion of racial and ethnic minorities in genetic research: advance the spirit by changing the rules?

Genetic research aimed at understanding human health and disease is grounded in the study of genetic variation. The inclusion of research subjects with diverse ancestral backgrounds is essential for genetic and genomic research that fully explores human diversity. Large-scale cohort studies and biobanks in Europe and the United States often do not include the breadth of ethnic and racial diversity observed in their countries' citizens. This article explores the findings of a qualitative study of U.S. scientists' understanding and views of the NIH Policy and Guidelines on the Inclusion of Minorities as Subjects in Clinical Research. The findings suggest that the policy restricts how scientists use racial and ethnic categories to define and report their study populations and does little to motivate their efforts to increase the inclusion of non-European ancestral populations in genetic and genomic research.