Genetic screening as a technique of government: The case of neonatal screening for cystic fibrosis in France

Negotiating identity at the intersection of paediatric and genetic medicine: the parent as facilitator, narrator and patient

This article identifies a significant transformation in the role and identity of parents accompanying their child to clinic. This shift is a product of the intersection between paediatric and genetic medicine, where parents play a critical role in providing information about their child, family and ultimately, about themselves. To provide a context for this matrix, two broad areas of sociological inquiry are highlighted. The first is explanations of the role a parent plays in paediatric medicine and the second is the diagnostic process in paediatric genetics and the implications for parent and child identities. Drawing from an ethnographic study of clinical consultations, attention is paid to the changing role of parenthood and the extended role of patienthood in paediatric genetic medicine.

The Reconfiguration of the Relationship to Care for a Rare Disease: Neonatal Expended Screening in a Socio-material Perspective

Neonatal Screening (NBS) is a mass screening, secondary prevention policy aimed at detecting one or several often congenital disorders in all neonates in a given country. The French CF NBS programme is completely functional since the middle of 2003. Drawing its inspiration from the socio-material approach, this article advances a description and analysis of the interactions between the biomedical technologies used in neonatal cystic fibrosis screening and the resulting changes in clinical practice, the bioethical debate and finally in the interstice between voluntary individual consent to screening and the management of a population’s health. The analysis grid focuses on four dimensions: institutional, techno-scientific, regulatory and socio-professional. Backed up by a field survey conducted in the specialised healthcare centres, this study explores two major aspects of the repercussions of NBS: first, the genesis and institutionalisation of this public policy and the impact of a more flexible form of Evidence Based Medicine (EBM) and the sustained controversy on the neonatal screening programme uniting the community of cystic fibrosis paediatrics. This study suggests that institutional stability remains fragile and in this respect constitutes a paradoxical form of production with incompleteness and uncertainty as constituting factors.

Parental support for newborn screening for cystic fibrosis

AIM

To describe the attitudes among parents towards including cystic fibrosis (CF) in the newborn screening programme and towards the potential knowledge of their own carrier status.

METHODS

A questionnaire with three to five response categories and an information leaflet was posted to 143 CF parents, 3 matched diabetes and 3 matched population parents, the response rate being 85%, 74% and 70%, respectively. Comparisons between groups were made with statistical tests for independent groups.

RESULTS

Eighty-six percent of CF, 70% of diabetes and 77% of population parents were in favour of newborn screening for CF, 47%, 45% and 50%, respectively, wished to know their CF carrier status. The parental attitude was independent of the age of the child, as well as delay of diagnosis and well-being of the CF child at the time of diagnosis. Sixty percent of the CF parents experienced the diagnosis as delayed.

CONCLUSION

Parents in Sweden support CF newborn screening. Half of the parents wanted to know their CF carrier status.

A global perspective on newborn screening for cystic fibrosis

PURPOSE OF REVIEW

Cystic fibrosis screening in newborns is occurring in an increasing number of countries, but protocols vary across regions, borders and continents. This review describes recent advances in the rationale for newborn screening and then suggests solutions to the hurdles that need to be overcome by clinicians to ensure long-term clinical outcomes can be measured robustly whilst retaining the confidence of the funding authorities who have many calls on limited budgets. The review is written to address the concerns of the sceptics.

RECENT FINDINGS

Beneficial evidence for screening for cystic fibrosis in newborns is accumulating and will be highlighted to aid those about to introduce screening for cystic fibrosis in competition with other diseases. Future approaches are described to minimize the amount of DNA-based information held but without compromising screening efficacy. Finally, guidelines for a pilot dataset of information that must be collected on each screened infant will be proposed.

SUMMARY

Standardization of international programs for newborns has not yet been achieved. Progress towards this goal is being made but many differences remain. Solutions to the practical difficulties of implementation of screening for newborns are described to help cystic fibrosis clinicians convince their colleagues of the merits of this practice.

[Neonatal screening: trends, debates and consensus]

This study focuses on the social and political implications of the substantial expansion of genetic tests and neonatal screening. The introduction of neonatal screening for cystic fibrosis is one of the significant developments that have fuelled debate on their appropriateness. It has raised a series of questions on the pros and cons, the role of evidence in biomedicine, and the articulation between the therapeutic approach and foetal selection. In this respect France provides an ideal research field as it was one of the first countries to generalize this screening, launched in January 2002. Several questions arise: What were the terms of the debate in France and their underlying logics? How was consensus reached? More generally, what does this screening tell us about policies on life forms today?