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Klitzman R, Bezborodko E, Chung WK, Appelbaum PS. Impact of Receiving Genetic Diagnoses on Parents' Perceptions of Their Children with Autism and Intellectual Disability. J Autism Dev Disord 2023:10.1007/s10803-023-06195-0. [PMID: 38158539 PMCID: PMC11213829 DOI: 10.1007/s10803-023-06195-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 01/03/2024]
Abstract
To assess whether genetic test results identifying the cause of a child's autism, when accompanied by other neurodevelopmental disorders (NDD), including intellectual disability, alter how parents perceive and treat their child. 28 parents of 22 individuals with autism (mean age: 15 years), usually with other NDDs, were interviewed after receiving genetic diagnoses indicating a de novo mutation through the Simons Foundation Powering Autism Research for Knowledge study. Diagnosis of a de novo genetic variant can alter parental perceptions of offspring with autism and other NDDs. Parents often blamed their child less, saw their child as less in control of symptoms, and developed more patience, framing expectations accordingly. Parents had mixed feelings about receiving genetic diagnoses, with sadness sometimes accompanying reframed expectations. Genetic diagnoses could change views of the child among extended family members, teachers, social service agencies, insurers, and broader communities and society. Genetic testing might also reduce delays in diagnoses of autism among African American, Latino and other children. These data, the first to examine several critical aspects of how parents and others view children with autism and other NDDs after receiving genetic diagnoses, highlight vital needs for education of multiple stakeholders (including geneticists, other physicians, genetic counselors, parents, individuals with autism, social service agencies, insurers, policymakers, and the broader public), research (to include perspectives of extended family members, insurers, social service agencies and teachers) and practice (to increase recognition and awareness of the potential benefits and effects of genetic testing for such children).
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Affiliation(s)
- Robert Klitzman
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Joseph L. Mailman School of Public Health, Columbia University, 1051 Riverside Drive; Mail Unit #15, New York, NY, 10032, USA.
| | | | - Wendy K Chung
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul S Appelbaum
- Department of Law Ethics and Psychiatry, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA
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Lane AS, Lynch KE, Arnold M, Dar-Nimrod I, Morandini J, Gawronski SA, Griffiths PE. The undue influence of genetic information on senior medical students' treatment decisions. BMC MEDICAL EDUCATION 2023; 23:938. [PMID: 38066555 PMCID: PMC10709879 DOI: 10.1186/s12909-023-04895-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Knowledge of the genetic basis of health conditions can influence how the public perceives their own and others' health. When there are known genetic associations for such conditions, genetic essentialist biases facilitate deterministic thinking and an over-emphasis of genetic causality. This study investigates the role that genetic essentialist biases play in medical decision-making. METHODS Senior postgraduate medical students (N = 102) read a scenario in which a patient presents with gastroenterological symptoms. Half of the students were told that the patient tested positive for HLADQ2 - a gene implicated in, but not deterministic of, coeliac disease. The other half received no genetic information. Students were assessed on their recommendations for investigation and management using a multiple-choice questionnaire. Twenty-two of these students participated in a qualitative follow-up which used focus groups and semi-structured interviews to explore the reasoning behind students' responses. RESULTS Management recommendations differed between the two groups, with those receiving genetic information more likely to recommend a gluten free diet. Recommendations for further investigation did not differ significantly between groups. Interviews suggested that these findings arose despite the students' good understanding of the common non-deterministic nature of genes, such as HLADQ2. CONCLUSION Differences in management recommendations suggest that the inclusion of genetic information unduly biased students towards a premature diagnosis of a serious health condition, coeliac disease. Follow-up interviews introduced the possibility that observed manipulation-based differences may have been based on anticipated expectations of examiners, rather than perceived future clinical practice. Based on the present results it is unclear whether intentional exam-taking strategies fully account for medical students' decisions, or if they contribute in addition to the activation of genetic essentialist biases. Further research in clinical settings may ascertain whether genetic essentialist biases would truly influence medical student and doctors within their clinical practice environment.
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Affiliation(s)
- Andrew Stuart Lane
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.
| | - Kate E Lynch
- Department of Philosophy, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Department of History and Philosophy of Science, The University of Melbourne, Victoria, 3010, Australia
| | - Mark Arnold
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Western New South Wales Health District, Dubbo, NSW, 2830, Australia
| | - Ilan Dar-Nimrod
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, 2006, Australia
- School of Psychology, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - James Morandini
- School of Psychology, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Stefan A Gawronski
- Department of Philosophy, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, 2006, Australia
- School of History of Philosophy of Science, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Paul E Griffiths
- Department of Philosophy, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, 2006, Australia
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Malinowska JK, Żuradzki T. Reductionist methodology and the ambiguity of the categories of race and ethnicity in biomedical research: an exploratory study of recent evidence. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:55-68. [PMID: 36352325 PMCID: PMC9646278 DOI: 10.1007/s11019-022-10122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
In this article, we analyse how researchers use the categories of race and ethnicity with reference to genetics and genomics. We show that there is still considerable conceptual "messiness" (despite the wide-ranging and popular debate on the subject) when it comes to the use of ethnoracial categories in genetics and genomics that among other things makes it difficult to properly compare and interpret research using ethnoracial categories, as well as draw conclusions from them. Finally, we briefly reconstruct some of the biases of reductionism to which geneticists (as well as other researchers referring to genetic methods and explanations) are particularly exposed to, and we analyse the problem in the context of the biologization of ethnoracial categories. Our work constitutes a novel, in-depth contribution to the debate about reporting race and ethnicity in biomedical and health research. First, we reconstruct the theoretical background assumptions about racial ontology which researchers implicitly presume in their studies with the aid of a sample of recent papers published in medical journals about COVID-19. Secondly, we use the typology of the biases of reductionism to the problem of biologization of ethnoracial categories with reference to genetics and genomics.
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Affiliation(s)
- Joanna K. Malinowska
- Faculty of Philosophy, Adam Mickiewicz University, Ul. Szamarzewskiego 89C, 60-568 Poznań, Poland
| | - Tomasz Żuradzki
- Institute of Philosophy & Interdisciplinary Centre for Ethics, Jagiellonian University, Ul. Grodzka 52, 31-044 Kraków, Poland
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The dubious precision and utility of heritability estimates. Behav Brain Sci 2022; 45:e164. [PMID: 36098431 DOI: 10.1017/s0140525x21001527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Uchiyama et al. question heritability estimates in a convincing manner. We offer additional arguments to further bolster their claims, highlighting methodological issues in heritability coefficients' derivation, their misuse in various contexts, and their potential contributions to exacerbating common erroneous intuitions that have been shown to lead to deleterious social phenomena. We conclude that science should move away from using them.
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Hammack-Aviran C, Eilmus A, Diehl C, Gottlieb KG, Gonzales G, Davis LK, Clayton EW. LGBTQ+ Perspectives on Conducting Genomic Research on Sexual Orientation and Gender Identity. Behav Genet 2022; 52:246-267. [PMID: 35614288 PMCID: PMC9132750 DOI: 10.1007/s10519-022-10105-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 05/03/2022] [Indexed: 11/30/2022]
Abstract
We conducted in-depth, semi-structured interviews with LGBTQ+-identified individuals (n = 31) to explore the range of LGBTQ+ perspectives on genomic research using either sexual orientation or gender identity (SOGI) data. Most interviewees presumed that research would confirm genetic contributions to sexual orientation and gender identity. Primary hopes for such confirmation included validating LGBTQ+ identities, improved access to and quality of healthcare and other resources, and increased acceptance in familial, socio-cultural, and political environments. Areas of concern included threats of pathologizing and medicalizing LGBTQ+ identities and experiences, undermining reproductive rights, gatekeeping of health or social systems, and malicious testing or misuse of genetic results, particularly for LGBTQ+ youth. Overall, interviewees were divided on the acceptability of genomic research investigating genetic contributions to sexual orientation and gender identity. Participants emphasized researchers' ethical obligations to LGBTQ+ individuals and endorsed engagement with LGBTQ+ communities throughout all aspects of genomic research using SOGI data.
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Affiliation(s)
- Catherine Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End Ave., Suite 400, Nashville, TN, 37203, USA
| | - Ayden Eilmus
- College of Arts and Sciences, Vanderbilt University, Nashville, TN, USA
| | - Carolyn Diehl
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End Ave., Suite 400, Nashville, TN, 37203, USA
| | | | - Gilbert Gonzales
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lea K Davis
- Department of Medicine, Health and Society, Vanderbilt University, Nashville, TN, USA
| | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End Ave., Suite 400, Nashville, TN, 37203, USA.
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Aspinwall LG, Drummond DM, Stump TK, Kohlmann WK, Leachman SA. Interactive Beliefs about Genes and Behavior Predict Improved Sun Protection Following Melanoma Genetic Counseling. Ann Behav Med 2022; 56:816-829. [PMID: 35179177 PMCID: PMC9345182 DOI: 10.1093/abm/kaab117] [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: 11/14/2022] Open
Abstract
BACKGROUND Little is known about how members of cancer-prone families think about genetic determinism and whether personal behavior can amplify or counter genetic risk for disease. PURPOSE Understanding how people think about the impact of personal behavior on disease risk may inform communications about genetic risks and their management. METHODS We assessed three sets of beliefs about the impact of behavior on genetic risk-interactive (unhealthful behaviors can amplify genetic risk), subtractive (healthful behaviors can reduce genetic risk), and deterministic (genes primarily determine health outcomes)-among 114 unaffected members of melanoma-prone families receiving genetic counseling (51.6% men, average age = 35.3). We examined whether these beliefs predicted changes in perceived control, motivation to manage melanoma risk, and sun-protection behavior one year later. RESULTS Participants strongly endorsed interactive and subtractive beliefs, but not deterministic beliefs. These beliefs generally did not change, even among those who received positive CDKN2A/p16 genetic test results conferring up to 76% lifetime melanoma risk. Controlling for age, sex, education, skin type, and genetic test result, interactive beliefs predicted sustained increases in perceptions of personal control, motivation to reduce sun exposure, use of multiple sun-protection methods, and reduction in objectively assessed tanning at the wrist one year following genetic counseling. Subtractive beliefs predicted increased personal control, motivation to manage risk, and sunscreen use, while deterministic beliefs were generally unrelated to outcomes. CONCLUSIONS Among people at highly elevated hereditary cancer risk, beliefs that unhealthful behaviors can amplify genetic risk seem to be especially motivating of behavioral risk-reduction efforts.
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Affiliation(s)
- Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | | | - Tammy K Stump
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Wendy K Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Sancy A Leachman
- Department of Dermatology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
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Morosoli JJ, Barlow FK, Colodro-Conde L, Medland SE. Genetic and Environmental Influences on Biological Essentialism, Heuristic Thinking, Need for Closure, and Conservative Values: Insights From a Survey and Twin Study. Behav Genet 2022; 52:170-183. [DOI: 10.1007/s10519-022-10101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 03/19/2022] [Indexed: 11/24/2022]
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Kelly-Irving M, Ball WP, Bambra C, Delpierre C, Dundas R, Lynch J, McCartney G, Smith K. Falling down the rabbit hole? Methodological, conceptual and policy issues in current health inequalities research. CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2036701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Michelle Kelly-Irving
- Centre for Epidemiology and Research in Population Health (CERPOP), Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Institut fédératif de recherche et d’études interdisciplinaire santé société, Université de Toulouse, Toulouse, France
| | | | - Clare Bambra
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, UK
| | - Cyrille Delpierre
- Centre for Epidemiology and Research in Population Health (CERPOP), Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Julia Lynch
- Department of Political Science and Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, U S.A
| | - Gerry McCartney
- College of Social Sciences, University of Glasgow, Glasgow, Scotland
| | - Katherine Smith
- School of Social Work & Social Policy, University of Strathclyde, Glasgow, UK
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