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Haddad Y. The epistemic harms of direct-to-consumer genetic tests. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:559-571. [PMID: 37488418 DOI: 10.1007/s11019-023-10164-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/26/2023]
Abstract
In this paper, I provide an epistemic evaluation of the harms that result from the widespread marketing of direct-to-consumer (DTC) genetic tests. While genetic tests are a valuable accessory diagnostic tool when ordered by a medical practitioner, there are different implications when they are sold directly to consumers. I aim to show that there are both epistemic and non-epistemic harms associated with the widespread commoditization of DTC genetic tests. I argue that the epistemic harms produced by DTC genetic tests have been disregarded in discussions on the topic. Drawing on the notion of contributory epistemic injustices, I highlight two pertinent epistemic harms: (1) a failure to uptake an individual's articulations about their identity and (2) the presiding reductionist framework dismisses useful hermeneutical resources. I then propose ways to mitigate these harms.
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Affiliation(s)
- Yasmin Haddad
- Department of Philosophy, Department of Biochemistry and Molecular Biology, Dalhousie University, Marion McCain Arts and Social Sciences Building, 6135 University Avenue, Halifax, NS, B3H4P9, Canada.
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Rahimzadeh V, Knoppers BM, Bartlett G. Ethical, Legal, and Social Issues (ELSI) of Responsible Data Sharing Involving Children in Genomics: A Systematic Literature Review of Reasons. AJOB Empir Bioeth 2020; 11:233-245. [PMID: 32975491 DOI: 10.1080/23294515.2020.1818875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Progress in precision medicine relies on the access to, use of, and exchange of genomic and associated clinical data, including from children. The ethical, legal, and social issues (ELSI) of such data access, use, and exchange may be accentuated in the pediatric context due in part to the highly sensitive nature of genomic data, children's consent-related vulnerabilities, and uncertain risks of reidentification. Systematic analyses of the ELSI and scientific reasons for why and how genomic data may be shared responsibly are, however, limited. Methods: We conducted a modified systematic review of reasons according to Sofaer and Strech to examine the ELSI and scientific reasons for "responsible" sharing of children's genomic and associated clinical data. Empirical articles, commentaries, and data-sharing policies indexed in Medline, Scopus, Web of Science, and BIOSIS were included in the analysis if they discussed ELSI and were published between 2003 and 2017 in English. Results: One hundred and fifty-one records met our inclusion criteria. We identified 11 unique reasons and 8 subreasons for why children's genomic data should or should not be shared. Enhancing the prospect of direct and indirect benefits and maximizing the utility of children's data were top reasons why data should be shared. Inadequate data privacy protection was the leading reason why it should not. We furthermore identified 8 reasons and 30 subreasons that support conditional data sharing, in which recontact for the continued use of children's data once they reach the age of majority was the most frequently endorsed condition. Conclusions: The complete list of ELSI reasons and responsible conditions provides an evidentiary basis upon which institutions can develop data-sharing policies. Institutions should encourage the sharing of children's data to advance genomic research, while heeding special reconsent and data protection mechanisms that may help mitigate uncertain longitudinal risks for children and families.
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Affiliation(s)
- Vasiliki Rahimzadeh
- Center for Biomedical Ethics, Stanford University, Stanford, California, USA
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Leadbeater BJ, Dishion T, Sandler I, Bradshaw CP, Dodge K, Gottfredson D, Graham PW, Lindstrom Johnson S, Maldonado-Molina MM, Mauricio AM, Smith EP. Ethical Challenges in Promoting the Implementation of Preventive Interventions: Report of the SPR Task Force. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:853-865. [PMID: 29936579 PMCID: PMC6182388 DOI: 10.1007/s11121-018-0912-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Prevention science researchers and practitioners are increasingly engaged in a wide range of activities and roles to promote evidence-based prevention practices in the community. Ethical concerns invariably arise in these activities and roles that may not be explicitly addressed by university or professional guidelines for ethical conduct. In 2015, the Society for Prevention Research (SPR) Board of Directors commissioned Irwin Sandler and Tom Dishion to organize a series of roundtables and establish a task force to identify salient ethical issues encountered by prevention scientists and community-based practitioners as they collaborate to implement evidence-based prevention practices. This article documents the process and findings of the SPR Ethics Task Force and aims to inform continued efforts to articulate ethical practice. Specifically, the SPR membership and task force identified prevention activities that commonly stemmed from implementation and scale-up efforts. This article presents examples that illustrate typical ethical dilemmas. We present principles and concepts that can be used to frame the discussion of ethical concerns that may be encountered in implementation and scale-up efforts. We summarize value statements that stemmed from our discussion. We also conclude that the field of prevention science in general would benefit from standards and guidelines to promote ethical behavior and social justice in the process of implementing evidence-based prevention practices in community settings. It is our hope that this article serves as an educational resource for students, investigators, and Human Subjects Review Board members regarding some of the complexity of issues of fairness, equality, diversity, and personal rights for implementation of preventive interventions.
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Affiliation(s)
- Bonnie J Leadbeater
- Department of Psychology, University of Victoria, Cornett Building A241, 3800 Finnerty Road (Ring Road), Victoria, BC, V8P 5C2, Canada.
| | - Tom Dishion
- Department of Psychology, REACH Institute, Arizona State University, 900 S. McAllister Rd, Tempe, AZ, 85287-1104, USA
| | - Irwin Sandler
- Department of Psychology, Arizona State University, 900 S. McAllister Rd, Tempe, AZ, 85287-1104, USA
| | - Catherine P Bradshaw
- Curry School of Education, University of Virginia, 112-D Bavaro Hall, 417 Emmet Street South, PO Box 400260, Charlottesville, VA, 22904-4260, USA
| | - Kenneth Dodge
- Sanford School of Public Policy, Duke University, 222 Rubenstein Hall, Durham, NC, 27708, USA
| | - Denise Gottfredson
- Department of Criminology and Criminal Justice, University of Maryland, 2220 LeFrak Hall, College Park, MD, 20742, USA
| | - Phillip W Graham
- Drugs, Violence, and Delinquency Prevention Program, Center for Justice, Safety, and Resilience, RTI International, 3040 Cornwallis Rd, Raleigh, NC, USA
| | - Sarah Lindstrom Johnson
- School of Social and Family Dynamics, Arizona State University, PO Box 873701, Tempe, AZ, 85287, USA
| | - Mildred M Maldonado-Molina
- University of Florida, Institute for Child Health Policy and Family Data Center, College of Medicine, Gainesville, FL, 32608, USA
| | - Anne M Mauricio
- REACH Institute, Department of Psychology, Arizona State University, P.O. Box 876005, Tempe, AZ, 85287-6005, USA
| | - Emilie Phillips Smith
- Human Development and Family Science, University of Georgia, 305 Sanford Drive, Athens, GA, 30602, USA
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Meagher KM, Master Z. Fostering a prevention mindset for responsible gene editing. Account Res 2019; 26:251-256. [PMID: 31074637 PMCID: PMC6545880 DOI: 10.1080/08989621.2019.1617140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In this special issue, we solicited three commentators to discuss issues specific to the responsible conduct of research as it relates to the birth of gene-edited children. We explore the ethics of prevention and its ties to the responsible conduct of gene-editing research to introduce three commentaries addressing: (1) the relevance of cultural and regulatory context in China, (2) how to actualize calls for greater public engagement, and (3) where we might improve graduate education of genomic researchers.
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Affiliation(s)
- Karen M Meagher
- a Biomedical Ethics Research Program , Health Sciences Research, Mayo Clinic , Rochester , MN , USA
- b Center for Individualized Medicine, Mayo Clinic , Rochester , MN , USA
| | - Zubin Master
- a Biomedical Ethics Research Program , Health Sciences Research, Mayo Clinic , Rochester , MN , USA
- c Center for Regenerative Medicine, Mayo Clinic , Rochester , MN , USA
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Fisher CB, Layman DM. Genomics, Big Data, and Broad Consent: a New Ethics Frontier for Prevention Science. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 19:871-879. [PMID: 30145751 PMCID: PMC6182378 DOI: 10.1007/s11121-018-0944-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Emerging technologies for analyzing biospecimens have led to advances in understanding the interacting role of genetics and environment on development and individual responsivity to prevention and intervention programs. The scientific study of gene-environment influences has also benefited from the growth of Big Data tools that allow linking genomic data to health, educational, and other information stored in large integrated datasets. These advances have created a new frontier of ethical challenges for scientists as they collect, store, or engage in secondary use of potentially identifiable information and biospecimens. To address challenges arising from technological advances and the expanding contexts in which potentially identifiable information and biospecimens are collected and stored, the Office of Human Research Protections has revised federal regulations for the protection of human subjects. The revised regulations create a new format, content, and transparency requirements for informed consent, including a new mechanism known as broad consent. Broad consent offers participants a range of choices regarding consent for the storage and future use of their personally identifiable data. These regulations have important implications for how prevention scientists and oversight boards acquire participant consent for the collection, storage, and future use of their data by other investigators for scientific purposes significantly different from the original study. This article describes regulatory changes and challenges affecting traditional informed consent for prevention research, followed by a description of the rationale and requirements for obtaining broad consent, and concludes with a discussion of future challenges involving ongoing transparency and protections for participants and their communities.
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Affiliation(s)
- Celia B Fisher
- Department of Psychology, Fordham University, Dealy Hall 441, East Fordham Road, Bronx, NY, 10458, USA.
| | - Deborah M Layman
- Department of Psychology, Fordham University, Dealy Hall 441, East Fordham Road, Bronx, NY, 10458, USA
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Scott MS. Commentary: Perspectives on alcohol-related gene and environment interplay in diverse populations. Am J Addict 2018; 26:526-531. [PMID: 28745447 DOI: 10.1111/ajad.12584] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/26/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Racial/ethnic groups comprise more than 20% of the U.S. population, but many experience disproportionately high risk for alcohol misuse, often resulting in higher rates of alcohol-associated consequences. Completion of mapping the human genome has launched rapidly evolving research methods aimed at improved understanding of genetic contribution to disease. Despite decades of research on the influence of genetic and environmental risks on alcohol use disorders and outcomes, few studies have included racial/ethnic subpopulations in sufficient numbers to allow for proper statistical analysis. METHODS The papers in this special issue help to elucidate current knowledge on the etiology of genetic and environmental contributors and potential moderators of alcohol use and associated problems among racial/ethnic populations. The lack of racial/ethnic diversity across many genetic studies contributes to challenges in interpretation of findings and eventually applications to precision medicine. RESULTS Proposed approaches to overcome disparities in racial/ethnic participant recruitment in genetic studies include methods to address population stratification in allele frequency, improve transparency in subjects' consenting to participate, and engaging interdisciplinary research teams and community involvement to improve recruitment of racial/ethnic minorities. DISCUSSION AND CONCLUSIONS The reviews presented underscore various gaps in our knowledge of the genetic influences on alcohol use disorders due to the failure to include racially and ethnically diverse populations in genetic and epigenetic study samples. New directions are suggested to overcome the resulting research challenges and ultimately to inform future personalized intervention approaches for racial/ethnic populations. SCIENTIFIC SIGNIFICANCE Inclusion of heterogeneous populations in genomic research will provide a better comprehension of possible unique genetic factors in the broader general population that may be missed due to exclusion of unique and common variants that may be present in racial/ethnic populations. (Am J Addict 2017;26:526-531).
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Affiliation(s)
- Marcia S Scott
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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Nouri N, Nouri N, Tirgar S, Soleimani E, Yazdani V, Zahedi F, Larijani B. Consanguineous marriages in the genetic counseling centers of Isfahan and the ethical issues of clinical consultations. J Med Ethics Hist Med 2017; 10:12. [PMID: 29416832 PMCID: PMC5797678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/04/2017] [Indexed: 12/02/2022] Open
Abstract
Consanguineous marriage, which is common in many regions in the world, has absorbed much attention as a causative factor in raising the incidence of genetic diseases. The adverse effects may be attributed to the expression of the genes received from common ancestors and mortality and morbidity of the offspring. Iran has a high rate of consanguineous marriages. In recent years genetic counseling has come to be considered in health care services. This cross-sectional study was conducted in order to determine the prevalence and types of consanguineous marriages in the genetic clinics in Isfahan. We aimed to define the different types of marriages, specific categories of genetic disorders associated with consanguineous marriages, and mode of inheritance in the family tree. We also narratively reviewed the ethical aspects of the issue. The data were collected using a simple questionnaire. A total number of 1535 couples from urban and rural areas formed the study population. The marriages were classified according to the degree of the relationship between couples, including: double cousin, first cousin, first cousin once removed, second cousin and beyond second cousin. The SPSS software version 16 was used for data analysis. Data obtained through genetic counseling offered during a 5-year period revealed that 74.3% had consanguineous relationships, 62.3% were first cousins, 1% were double cousins and 7.8% were second cousins. In addition, 76% of the couples had at least one genetic disease in their family tree. Related ethical issues were also considered in this study, including autonomy and informed decision making, benefit and harm assessment, confidentiality, ethics in research, justice in access to counseling services, financial problems ethics, and the intellectual property of scientific success.
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Affiliation(s)
| | - Nayereh Nouri
- Genetic Laboratory of Al- Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Samane Tirgar
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Faculty of Sciences, Isfahan University, Isfahan, Iran.
| | | | - Vida Yazdani
- Medical Genetics Laboratory of Genome, Isfahan, Iran.
| | - Farzaneh Zahedi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bagher Larijani
- Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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De Laet S, Colpin H, Van Leeuwen K, Van den Noortgate W, Claes S, Janssens A, Goossens L, Verschueren K. Transactional Links Between Teacher-Student Relationships and Adolescent Rule-Breaking Behavior and Behavioral School Engagement: Moderating Role of a Dopaminergic Genetic Profile Score. J Youth Adolesc 2016; 45:1226-44. [PMID: 27013478 DOI: 10.1007/s10964-016-0466-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 03/10/2016] [Indexed: 12/14/2022]
Abstract
Throughout adolescence, there is an increase in rule-breaking behavior and a decrease in behavioral school engagement. The role of teacher-student relationship quality in the development of these adjustment problems remains understudied. This study examined how adolescent-reported teacher-student affiliation and dissatisfaction and parent-reported rule-breaking behavior and behavioral engagement impact one another throughout adolescence. In addition, we examined the moderating effect of genes by means of a Biologically Informed Multilocus genetic Profile Score (BIMPS), a composite score reflecting the cumulative effect of multiple dopaminergic genes, with a higher score indicating higher dopamine signaling in the adolescent brain. We used three-year longitudinal data from 1111 adolescents (51 % boys; M age = 13.79), and their parents. Cross-lagged analyses revealed a transactional process in which adolescents who display more rule-breaking behavior and less behavioral engagement experienced increased subsequent dissatisfaction with their teachers, which in turn further increased their adjustment problems. Also, adolescents with more adjustment problems experienced decreased subsequent affiliation with their teachers. The other way around, adolescents' behavioral engagement also benefitted from positive relationships with teachers. Multi-group analyses revealed genetic moderation for behavioral engagement, but not for rule-breaking. Specifically, adolescents who had a BIMPS score coding for moderate levels of dopamine signaling (instead of high or low signaling) were most affected in their behavioral engagement when they experienced dissatisfaction with their teachers. Our study findings may guide schools in implementing interventions to create a supportive class and school environment including positive, supportive teacher-student relationships and indicate that providing a such a supportive school environment is important for all adolescents.
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Affiliation(s)
- Steven De Laet
- Research Group for School Psychology and Child and Adolescent Development (SCAD), University of Leuven, Tiensestraat 102, box 3717, 3000, Louvain, Belgium.
| | - Hilde Colpin
- Research Group for School Psychology and Child and Adolescent Development (SCAD), University of Leuven, Tiensestraat 102, box 3717, 3000, Louvain, Belgium
| | - Karla Van Leeuwen
- Research Group for Parenting and Special Education, University of Leuven, Louvain, Belgium
| | - Wim Van den Noortgate
- Research Group for Parenting and Special Education, University of Leuven, Louvain, Belgium
| | - Stephan Claes
- Research Group for Psychiatry, Department of Neurosciences, University of Leuven, Louvain, Belgium
| | - Annelies Janssens
- Research Group for School Psychology and Child and Adolescent Development (SCAD), University of Leuven, Tiensestraat 102, box 3717, 3000, Louvain, Belgium
| | - Luc Goossens
- Research Group for School Psychology and Child and Adolescent Development (SCAD), University of Leuven, Tiensestraat 102, box 3717, 3000, Louvain, Belgium
| | - Karine Verschueren
- Research Group for School Psychology and Child and Adolescent Development (SCAD), University of Leuven, Tiensestraat 102, box 3717, 3000, Louvain, Belgium
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De Laet S, Colpin H, Van Leeuwen K, Van den Noortgate W, Claes S, Janssens A, Goossens L, Verschueren K. Teacher-student relationships and adolescent behavioral engagement and rule-breaking behavior: The moderating role of dopaminergic genes. J Sch Psychol 2016; 56:13-25. [PMID: 27268567 DOI: 10.1016/j.jsp.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 11/18/2015] [Accepted: 02/17/2016] [Indexed: 12/31/2022]
Abstract
This study examined whether the dopamine transporter DAT1 and the dopamine receptor DRD4 genes moderate the effect of student-reported teacher-student relationship affiliation or dissatisfaction on parent-reported adolescent rule-breaking behavior and behavioral engagement. The sample included 1053 adolescents (51% boys, Mage=13.79) from grades 7 to 9. Regression analyses were conducted using Mplus while controlling for multiple testing and nested data. Adolescents who experienced stronger affiliation with their teachers were more engaged in school, whereas greater dissatisfaction predicted more rule-breaking behavior. In addition, a significant gene-environment interaction was found for both genes examined. The link between low teacher-student affiliation and low engagement was more pronounced for DAT1-10R homozygotes. The link between high teacher-student dissatisfaction and more rule-breaking was stronger for DRD4 non-long carriers. Implications for understanding the role of teacher-student relationships in adolescence and suggestions for future research are outlined.
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Affiliation(s)
- Steven De Laet
- Research Group for School Psychology and Child and Adolescent Psychology (SCAD), University of Leuven, Belgium.
| | - Hilde Colpin
- Research Group for School Psychology and Child and Adolescent Psychology (SCAD), University of Leuven, Belgium
| | - Karla Van Leeuwen
- Research Group for Parenting and Special Education, University of Leuven, Belgium
| | | | - Stephan Claes
- Research Group for Psychiatry, Department of Neurosciences, University of Leuven, Belgium
| | - Annelies Janssens
- Research Group for School Psychology and Child and Adolescent Psychology (SCAD), University of Leuven, Belgium
| | - Luc Goossens
- Research Group for School Psychology and Child and Adolescent Psychology (SCAD), University of Leuven, Belgium
| | - Karine Verschueren
- Research Group for School Psychology and Child and Adolescent Psychology (SCAD), University of Leuven, Belgium
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Nagle E, Kažoka D. Ethical challenges in teaching genetics for medical students. JOURNAL OF MICROBIOLOGY & BIOLOGY EDUCATION 2014; 15:181-5. [PMID: 25574275 PMCID: PMC4278474 DOI: 10.1128/jmbe.v15i2.776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Although inclusion of ethics as a study course in medical students' curricula is a common practice, special approaches in teaching ethics in the context of genetics should be considered. In the realm of genomics, there are several ethically sensitive topics such as diagnosis of genetic diseases, in vitro fertilization, and identification of genetic susceptibility to common diseases. In addition, in communication with the general public, genetic terms should be used with caution. Demonstration of the phenotypes of affected individuals should be regarded as a particular aspect of teaching genetics. In a description of a patient's phenotype, not only is it necessary to provide scientifically precise characteristics of a patient; voice timbre, facial expression, and body language should also be carefully controlled. Furthermore, in medicine, the theory-practice gap is a problematic aspect, and students often find it difficult to apply knowledge on ethical issues to real situations in clinics. For this purpose, clinical cases are presented during classes and their analysis requires a very respectful attitude on the part of both students and lecturers. For many genetic diseases, evaluation of minor anomalies such as a curved fifth finger, low situated ears, or missing of some teeth is required. Some minor anomalies are found in healthy individuals too, and interpretation of such features must therefore be considered carefully. This article describes our experiences in teaching genetics at Riga Stradinš University, ethical problems faced while teaching genetics, and their solutions.
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Affiliation(s)
- Erika Nagle
- Department of Biology and Microbiology, Riga Stradinš University, Riga, Latvia
| | - Dzintra Kažoka
- Institute of Anatomy and Anthropology, Department of Morphology, Riga Stradinš University, Riga, Latvia
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Fishbein DH, Ridenour TA. Advancing transdisciplinary translation for prevention of high-risk behaviors: introduction to the special issue. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2013; 14:201-5. [PMID: 23579566 PMCID: PMC4020239 DOI: 10.1007/s11121-013-0394-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Diana H Fishbein
- RTI International, 5520 Research Park Drive, Suite 210, Baltimore, MD 21104, USA.
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