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Nomura A, Okada H, Nohara A, Kawashiri MA, Takamura M, Tada H. Impact of providing genetics-based future cardiovascular risk on LDL-C in patients with familial hypercholesterolemia. J Clin Lipidol 2023; 17:622-632. [PMID: 37673778 DOI: 10.1016/j.jacl.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is an autosomal dominant monogenic disease characterized by high low-density lipoprotein cholesterol (LDL-C) levels. Although carrying causative FH variants is associated with coronary heart disease (CHD), it remains unclear whether disclosing its associated cardiovascular risk affects outcomes in patients with FH. OBJECTIVE We aimed to evaluate the efficacy of providing future cardiovascular risk based on genetic testing in addition to a standard FH education program. METHODS We conducted a randomized, wait-list controlled, open-label, single-center trial. In the intervention group, we reported a future cardiovascular risk based on the genetic testing adding to standard FH education at week 0. In the wait-list control group, we only disseminated standard FH education according to the guidelines at week 0; they later received a genetic testing-based cardiovascular risk assessment at week 24. The primary endpoint of this study was the plasma LDL-C level at week 24. RESULTS Fifty eligible patients with clinically diagnosed FH, without a history of CHD, were allocated to the intervention group (n = 24) or the wait-list control group (n = 26). At week 24, the intervention group had a significantly greater reduction in LDL-C levels than the wait-list control group (mean changes, -13.1 mg/dL vs. 6.6 mg/dL; difference, -19.7 mg/dL; 95% confidence interval, -34 to -5.6; p = 0.009). This interventional effect was consistent with FH causative variant carriers but not with non-carriers. CONCLUSIONS In addition to standard FH care, providing future cardiovascular risk based on genetic testing can further reduce plasma LDL-C levels, particularly among FH causal variant carriers. REGISTRATION Japan Registry of Clinical Trials (jRCTs04218002). URL: https://jrct.niph.go.jp/latest-detail/jRCTs042180027.
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Affiliation(s)
- Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University (iCREK), Kanazawa, Japan (Dr. Nomura); Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 9208641, Japan (Drs. Nomura, Okada, Takamura and Tada); College of Transdisciplinary Sciences for Innovation, Kanazawa University, Kanazawa, Japan (Dr. Nomura); Frontier Institute of Tourism Sciences, Kanazawa University, Kanazawa, Japan (Dr. Nomura)
| | - Hirofumi Okada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 9208641, Japan (Drs. Nomura, Okada, Takamura and Tada)
| | - Atsushi Nohara
- Department of Clinical Genetics, Ishikawa Prefectural Central Hospital, Kanazawa, Japan (Dr. Nohara)
| | - Masa-Aki Kawashiri
- Department of Internal Medicine, Kaga Medical Center, Kaga, Japan (Dr. Kawashiri)
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 9208641, Japan (Drs. Nomura, Okada, Takamura and Tada)
| | - Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 9208641, Japan (Drs. Nomura, Okada, Takamura and Tada).
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Peretti N, Vimont A, Mas E, Ferrières J, Tounian P, Lemale J, Boccara F, Di Filippo M, Charriere S, Moulin P, Poinsot P, Cottin Y, Ducluzeau PH, Dourmap C, Cariou B, Farnier M, Paillard F, Pradignac A, Yelnik C, Gallo A, Bruckert E, Beliard S. Factors Predicting Statin Initiation During Childhood in Familial Hypercholesterolemia: Importance of Genetic Diagnosis. J Pediatr 2023; 253:18-24.e2. [PMID: 36049522 DOI: 10.1016/j.jpeds.2022.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify childhood and parental factors associated with initiation of statin therapy in children with heterozygous familial hypercholesterolemia (HeFH), including underlying genetic diagnosis or parental premature atherosclerotic cardiovascular disease (ASCVD). STUDY DESIGN This multicenter cohort study included 245 HeFH child-parent pairs from the REFERCHOL national register (2014-2020). Demographic and clinical characteristics at the last visit were collected. Vascular disease in parents was defined as a history of ASCVD, and/or a coronary artery calcium score >100, and/or stenosis of >50% in at least carotid artery. Statistical analyses included descriptive analysis, logistic regression for univariate and multivariate effects of statins, and a sensitivity analysis combining the characteristics of children and parents. RESULTS Among the 245 children in the study cohort, 135 (58%), with a mean age of 14 ± 3 years, were treated with a statin. In multivariable analysis, the predictive childhood factors associated with statin treatment were genetic diagnosis (OR, 2.5; 95% CI, 1.3 to 4.9; P = .01), older age (OR, 4.4; 95% CI, 1.8-10.6; P = .01), more than 2 visits (OR, 2.36; 95% CI, 1.18-4.73; P = .015), and longer duration of follow-up (OR, 1.3; 95% CI, 1.1-1.6; P < .001). The predictive parental factor associated with childhood treatment was the presence of vascular disease (OR, 2.4; 95% CI, 1.0-5.7; P = .04). CONCLUSIONS HeFH confirmed by DNA testing during childhood and a history of vascular disease in parents were independently associated with statin treatment in children with HeFH. Genetic diagnosis may be useful for cardiovascular prevention in children.
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Affiliation(s)
- Noel Peretti
- Hospices Civil de Lyon, Pediatric Hospital Femme Mere Enfant HFME, Department of Pediatric Gastroenterology-Hepatology and Nutrition, Bron, France; Lyon University, Claude Bernard Lyon-1 University, Lyon Est Medical school, Place d'Arsonval, Lyon, France; INSERM, CarMeN laboratory, U1060, Oullins, France
| | - Alexandre Vimont
- Real World Evidence, Department of Public Health Expertise, Paris, France
| | - Emmanuel Mas
- CHU of Toulouse, Children Hospital, Department of pediatrics, Unit of Gastroenterology, Hepatology, Nutrition, and Inborn Errors of Metabolism, Toulouse, France; Toulouse University, Institute of Research in Digestive Science IRSD, INSERM U-1220, Team 6, Toulouse, France
| | - Jean Ferrières
- CHU of Toulouse, Toulouse Rangueil University Hospital, Department of Cardiology, Toulouse, France; INSERM UMR 1295, Toulouse University School of Medicine, Toulouse, France
| | - Patrick Tounian
- Assistance publique - Hôpitaux de Paris AP-HP, Trousseau Hospital, Department of Pediatric Nutrition and Gastroenterology, Paris, France; Sorbonne University, Paris, France
| | - Julie Lemale
- Assistance publique - Hôpitaux de Paris AP-HP, Trousseau Hospital, Department of Pediatric Nutrition and Gastroenterology, Paris, France
| | - Franck Boccara
- Assistance Publique - Hôpitaux de Paris AP-HP, Saint Antoine University Hospital, Department of Cardiology, Paris, France; Sorbonne University, Clinical Research Group No. 22, Cardiovascular and Metabolic Complications in People Living with HIV, Inserm UMR-S 938, Saint Antoine Research Center, Cardiometabolic and Nutrition Institute of Research (ICAN), Paris, France
| | - Mathilde Di Filippo
- INSERM, CarMeN laboratory, U1060, Oullins, France; Hospices Civil de Lyon, Department of Biochemistry and Molecular Biology, Laboratory of Medical Biology, Bron, France
| | - Sybil Charriere
- INSERM, CarMeN laboratory, U1060, Oullins, France; Hospices Civil de Lyon, Cardiologic Hospital Louis Pradel, Department of Endocrinology and Nutrition, Bron, France
| | - Philippe Moulin
- INSERM, CarMeN laboratory, U1060, Oullins, France; Hospices Civil de Lyon, Cardiologic Hospital Louis Pradel, Department of Endocrinology and Nutrition, Bron, France
| | - Pierre Poinsot
- Hospices Civil de Lyon, Pediatric Hospital Femme Mere Enfant HFME, Department of Pediatric Gastroenterology-Hepatology and Nutrition, Bron, France
| | - Yves Cottin
- CHU of Dijon, Department of Cardiology, Dijon, France
| | | | - Caroline Dourmap
- CHU of Rennes, Rennes University, Center of Cardiovascular-Prevention, Department of Cardiology, Rennes, France
| | - Bertrand Cariou
- CHU of Nantes, Laennec Hospital, Department of Endocrinology, Metabolic and Nutrition, Nantes, France; INSERM, UMR-C 6291, Thorax Institut, Nantes, France
| | - Michel Farnier
- University of Bourgogne Franche-Comté, PEC2 Team, Dijon Cedex, France
| | - François Paillard
- CHU of Rennes, Rennes University, Center of Cardiovascular-Prevention, Department of Cardiology, Rennes, France
| | - Alain Pradignac
- CHU of Strasbourg, University Hospital of Hautepierre, Department of Internal Medicine, Endocrinology and Nutrition, Strasbourg, France
| | - Cécile Yelnik
- CHUR of Lille, Department of Internal Medicine and Immunology, Lille, France; INSERM, UMR 1167 RID-AGE, Lille, France
| | - Antonio Gallo
- Assistance Publique, Hôpitaux de Paris AP-HP, Pitié-Salpêtrière Hospital, Department of Nutrition, Lipidology and Cardiovascular Prevention Unit, Paris, France; INSERM, Sorbonne University, Research Unit on Cardiovascular and Metabolic Diseases, ICAN, Paris, France
| | - Eric Bruckert
- Assistance Publique, Hôpitaux de Paris AP-HP, Pitié-Salpêtrière Hospital, Department of Nutrition, Lipidology and Cardiovascular Prevention Unit, Paris, France; Assistance publique - Hôpitaux de Marseille APHM, La Conception Hospital, Nutrition, Metabolic Diseases and Endocrinology Department, Marseille, France
| | - Sophie Beliard
- Assistance publique - Hôpitaux de Marseille APHM, La Conception Hospital, Nutrition, Metabolic Diseases and Endocrinology Department, Marseille, France; INSERM, INRAE, Aix Marseille Université, Department C2VN, Marseille, France
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Mwale S, Farsides B. Imagining genomic medicine futures in primary care: General practitioners' views on mainstreaming genomics in the National Health Service. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:2121-2140. [PMID: 34773708 DOI: 10.1111/1467-9566.13384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 05/24/2023]
Abstract
Genomic medicine has captured the imaginations of policymakers and medical scientists keen to harness its health and economic potentials. In 2012, the UK government launched the 100,000 Genomes Project to sequence the genomes of British National Health Service (NHS) patients, laying the ground for mainstreaming genomic medicine in the NHS and developing the UK's genomics industry. However, the recent research and reports from national bodies monitoring genomic medicine's roll-out suggest both ethical and practical challenges for health-care professionals. Against this backdrop, this paper, drawing on qualitative research interviews with general practitioners (GPs) and documentary analysis of policy, explores GPs' views on mainstreaming genomic medicine in the NHS and implications for their practice. Analysing the NHS's genomic medicine agenda as a 'sociotechnical imaginary', we demonstrate that whilst sociotechnical imaginaries are construed as collectively shared understandings of the future, official visions of genomic medicine diverge from those at the forefront of health-care service delivery. Whilst policy discourse evokes hope and transformation of health care, some GPs see technology in formation, an unattainable 'utopia', with no relevance to their everyday clinical practice. Finding space for genomics requires bridging the gap between 'work as imagined' at the policy level and 'work as done' in health-care delivery.
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Affiliation(s)
- Shadreck Mwale
- Brighton and Sussex Medical School, Division of Clinical and Experimental Medicine, Brighton, UK
| | - Bobbie Farsides
- Brighton and Sussex Medical School, Division of Clinical and Experimental Medicine, Brighton, UK
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Turrini M, Bourgain C. Genomic susceptibility in practice: The regulatory trajectory of non-rare thrombophilia (NRT) genetic tests in the clinical management of venous thrombo-embolism (VTE). Soc Sci Med 2020; 304:112903. [DOI: 10.1016/j.socscimed.2020.112903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 01/23/2023]
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5
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Milne R. The rare and the common: scale and the genetic imaginary in Alzheimer's disease drug development. NEW GENETICS AND SOCIETY 2019; 39:101-126. [PMID: 32256202 PMCID: PMC7077363 DOI: 10.1080/14636778.2019.1637718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/03/2019] [Indexed: 06/11/2023]
Abstract
In this paper I examine how the promissory value of genetics is constituted through processes of scale and scaling, focussing on the relationship between "rare" and "common" forms of disease. I highlight the bodies and spaces involved in the production of post-genomic knowledge and technologies of Alzheimer's disease and the development of new disease-modifying drugs. I focus on the example of the development of a monoclonal antibody therapy for Alzheimer's disease. I argue that the process of therapeutic innovation, from genetic studies and animal models to phase III clinical trials, reflects the persistent importance of a genetic imaginary and a mutually constitutive relationship between the rare and the common in in shaping visions of Alzheimer's disease medicine. Approaching this relationship as a question of scale, I suggest the importance of attending to how and where genomic knowledge is "scaled" or proves resistant to scaling.
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Affiliation(s)
- Richard Milne
- Wellcome Genome Campus – Society and Ethics Research Group, Cambridge, UK
- Institute of Public Health, University of Cambridge, Cambridge, UK
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7
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Berberich AJ, Hegele RA. The role of genetic testing in dyslipidaemia. Pathology 2019; 51:184-192. [DOI: 10.1016/j.pathol.2018.10.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 01/28/2023]
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8
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Keenan KF, Finnie RM, Simpson WG, McKee L, Dean J, Miedzybrodzka Z. Parents' views of genetic testing and treatment of familial hypercholesterolemia in children: a qualitative study. J Community Genet 2018; 10:129-141. [PMID: 29949065 PMCID: PMC6325044 DOI: 10.1007/s12687-018-0373-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/01/2018] [Indexed: 01/06/2023] Open
Abstract
Familial hypercholesterolemia (FH) is a serious inherited disorder, which greatly increases individuals’ risk of cardiovascular disease (CVD) in adult life. However, medical treatment and lifestyle adjustments can fully restore life expectancy. Whilst European guidance advises that where there is a known family mutation genetic testing is undertaken in early childhood, the majority of the at-risk population remain untested and undiagnosed. To date, only a small number of studies have explored parents’ and children’s experiences of testing and treatment for FH, and little is known about interactions between health professionals, parents, and children in clinic settings. In this study, in-depth interviews were undertaken with parents who had attended a genetics and/or lipid clinic for FH with their children (n = 17). A thematic analysis revealed four main themes: undertaking early prevention, postponing treatment, parental concerns, and the importance of the wider family context. The majority of parents supported genetic testing for FH in childhood. However, although some were very supportive of following early treatment recommendations, others expressed reluctance. Importantly, some parents were concerned that inappropriate information had been shared with their children and wished that more time had been given to discuss how, when, and what to tell in advance. Future research is needed to explore the long-term outcomes for children who undertake genetic testing and early treatment for FH and to trial interventions to improve the engagement, follow-up, and support of children who are at risk, or diagnosed, with this disorder.
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Affiliation(s)
- Karen Forrest Keenan
- Epidemiology Group, University of Aberdeen, First Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK. .,Medical Genetics Group, University of Aberdeen, Polwarth Building, Aberdeen, AB25 2ZD, UK.
| | - Robert M Finnie
- Department of Medicine/Care of the Elderly, St. Johns Hospital, Howdon Road West, Livingston, UK.,Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William G Simpson
- Department of Clinical Biochemistry, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Lorna McKee
- Health Services Research Unit, University of Aberdeen, Third Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - John Dean
- Medical Genetics Group, University of Aberdeen, Polwarth Building, Aberdeen, AB25 2ZD, UK.,Department of Medical Genetics, Ashgrove House, NHS Grampian, Aberdeen, UK
| | - Zosia Miedzybrodzka
- Medical Genetics Group, University of Aberdeen, Polwarth Building, Aberdeen, AB25 2ZD, UK.,Department of Medical Genetics, Ashgrove House, NHS Grampian, Aberdeen, UK
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Paul JL, Leslie H, Trainer AH, Gaff C. A theory-informed systematic review of clinicians' genetic testing practices. Eur J Hum Genet 2018; 26:1401-1416. [PMID: 29891880 DOI: 10.1038/s41431-018-0190-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/13/2018] [Accepted: 05/08/2018] [Indexed: 11/09/2022] Open
Abstract
This systematic literature review investigates factors impacting on clinicians' decisions to offer genetic tests in their practice, and maps them to a theoretical behaviour change framework. Better understanding of these factors will inform the design of effective interventions to integrate genomics tests into clinical care. We conducted a narrative synthesis of empirical research of medical specialists' perspectives on and experiences of offering genetic tests to their patients. This review was based upon the PRISMA statement and guidelines for reviewing qualitative research. Four electronic data sources were searched-MEDLINE, EMBASE, CINAHL, PubMed. Studies were independently assessed by two authors. Content analysis was applied to map the findings of included studies to a framework validated for behaviour and implementation research, the Theoretical Domains Framework (TDF). The TDF describes 14 factors known to influence behaviour and has been applied in diverse clinical settings to understand and/or modify health professional behaviour. Thirty-four studies published in 39 articles met inclusion and quality criteria. Most studies were published after 2011 (54%), Northern American (82%), quantitative in design (68%) and addressed familial cancer genetic tests (53%). Of the 14 TDF factors, 13 were identified. The three most common factors were: Environmental Context and Resources (n = 33), Beliefs about Consequences (n = 26), and Knowledge (n = 23). To support the adoption of genomic tests beyond specialist services, nuanced interventions targeting considerations beyond clinician education are needed. For instance, interventions addressing organisational constraints which may restrict clinicians' ability to offer genomic tests are required alongside those targeting factors intrinsic to the clinician.
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Affiliation(s)
- Jean L Paul
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Hanna Leslie
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia.,Paediatric & Reproductive Unit, SA Clinical Genetics Service, Adelaide, South Australia, Australia
| | - Alison H Trainer
- Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Parkville integrated Familial Cancer Centre and Genomic Medicine, Peter McCallum Cancer Centre and Royal Melbourne Hospitals, Melbourne, VIC, Australia
| | - Clara Gaff
- Murdoch Children's Research Institute, Melbourne, VIC, Australia. .,Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia. .,Melbourne Genomics Health Alliance, Melbourne, VIC, Australia.
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Weiner K, Martin P, Richards M, Tutton R. Have we seen the geneticisation of society? Expectations and evidence. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:989-1004. [PMID: 28271518 DOI: 10.1111/1467-9566.12551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Abby Lippman's geneticisation thesis, of the early 1990s, argued and anticipated that with the rise of genetics, increasing areas of social and health related activities would come to be understood and defined in genetic terms leading to major changes in society, medicine and health care. We review the considerable literature on geneticisation and consider how the concept stands both theoretically and empirically across scientific, clinical, popular and lay discourse and practice. Social science scholarship indicates that relatively little of the original claim of the geneticisation thesis has been realised, highlighting the development of more complex and dynamic accounts of disease in scientific discourse and the complexity of relationships between bioscientific, clinical and lay understandings. This scholarship represents a shift in social science understandings of the processes of sociotechnical change, which have moved from rather simplistic linear models to an appreciation of disease categories as multiply understood. Despite these shifts, we argue that a genetic imaginary persists, which plays a performative role in driving investments in new gene-based developments. Understanding the enduring power of this genetic imaginary and its consequences remains a key task for the social sciences, one which treats ongoing genetic expectations and predictions in a sceptical yet open way.
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Affiliation(s)
- Kate Weiner
- Department of Sociological Studies, University of Sheffield, UK
| | - Paul Martin
- Department of Sociological Studies, University of Sheffield, UK
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Hallowell N, Jenkins N, Douglas M, Walker S, Finnie R, Porteous M, Lawton J. A qualitative study of patients' perceptions of the value of molecular diagnosis for familial hypercholesterolemia (FH). J Community Genet 2017; 8:45-52. [PMID: 27866366 PMCID: PMC5222760 DOI: 10.1007/s12687-016-0286-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/02/2016] [Indexed: 12/27/2022] Open
Abstract
For many years, familial hypercholesterolemia (FH), an inherited disorder, has been diagnosed using phenotypic features plus family history of early onset cardiovascular disease (CVD), and has been successfully treated using statin therapy. DNA testing is now available and this has been incorporated into familial cascade screening programmes in many parts of Europe. Little is known about patients' perceptions of the value of undergoing molecular diagnosis for FH. In-depth interviews were carried out with patients (n = 38) being treated for FH who were the first in their family to undergo DNA testing for FH. Data were analysed thematically. While interviewees regarded DNA testing as an unexceptional event, it was seen as a positive innovation because it confirmed that their family carried a particular disorder, offered an aetiological explanation for their hypercholesterolemia and provided information about their own and family members' future risks. From the patient perspective, the main benefit of molecular diagnosis lies in its ability to provide information which allows (younger) family members to access genetic screening and, thus, timely treatment. The implications for future developments in genetic services and the need to investigate further the provision of molecular testing in mainstream specialties are briefly discussed.
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Affiliation(s)
- Nina Hallowell
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Nicholas Jenkins
- School of Media, Culture and Society, University of the West of Scotland, Edinburgh, UK
| | | | - Simon Walker
- Clinical Biochemistry, Division of Reproductive and Developmental Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | - Julia Lawton
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Screening for Familial Hypercholesterolaemia: Universal or Cascade? A Critique of Current FH Recognition Strategies. CURRENT CARDIOVASCULAR RISK REPORTS 2015. [DOI: 10.1007/s12170-014-0434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Jenkins N, Lawton J, Douglas M, Hallowell N. Inter-embodiment and the experience of genetic testing for familial hypercholesterolaemia. SOCIOLOGY OF HEALTH & ILLNESS 2013; 35:529-543. [PMID: 22897600 DOI: 10.1111/j.1467-9566.2012.01510.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this article we explore the concept of inter-embodiment and its potential for advancing sociological research into illness biography and genetic identity. Inter-embodiment theory views embodied knowledge as produced through relations between bodies, as opposed to originating from within the body or as the product of relations between disembodied selves. Drawing on a qualitative study in which we interviewed 38 individuals about their experiences of discovering they had high cholesterol and undergoing genetic testing for familial hypercholesterolaemia (FH), we discuss how their narratives may be understood from an inter-embodiment perspective. The participants frequently talked at length about their family histories of high cholesterol and cardiovascular disease. Through these accounts, we develop the concept of the family corpus in order to highlight the role body networks play in shaping lay constructions of genetic identity and a familial disease biography. The notion of a family corpus, we argue, is useful in understanding why genetic testing for FH was experienced as either biographical re-enforcement or as biographical disruption. We conclude by discussing the implications of our findings for future sociological research into illness biography and genetic identity.
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Affiliation(s)
- Nicholas Jenkins
- Centre for Population Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG.
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Jenkins N, Lawton J, Douglas M, Walker S, Finnie R, Porteous M, Hallowell N. How do index patients participating in genetic screening programmes for familial hypercholesterolemia (FH) interpret their DNA results? A UK-based qualitative interview study. PATIENT EDUCATION AND COUNSELING 2013; 90:372-377. [PMID: 21962872 DOI: 10.1016/j.pec.2011.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 08/31/2011] [Accepted: 09/04/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore patients' interpretations of their DNA results for familial hypercholesterolemia (FH). METHODS In-depth interviews were conducted with patients from two lipid clinics in Scotland, who were offered genetic testing as part of a nationwide cascade screening service. RESULTS Patients were receptive to taking part in genetic screening and most expected a positive result. Receiving a molecular diagnosis of FH could provide reassurance to patients that diet and lifestyle factors were not the primary causes of their condition. Patients who received inconclusive results tended to interpret this as meaning that their high cholesterol was not genetic, which could induce feelings of uncertainty and self-blame. With the exception of newly diagnosed patients, for whom a positive result could provide a useful rationale for initiating statins, most perceived DNA screening to be of little relevance to their own medication use or their own approaches to lifestyle management. CONCLUSIONS Index patients are likely to view DNA screening for FH as non-threatening. Receiving a positive DNA result can be reassuring for patients. Patients may not, however, interpret inconclusive DNA results correctly. PRACTICE IMPLICATIONS Health professionals need to ensure FH index patients are prepared to receive, and fully understand, inconclusive DNA results.
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Affiliation(s)
- Nicholas Jenkins
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Hollands GJ, Armstrong D, Macfarlane A, Crook MA, Marteau TM. Patient accounts of diagnostic testing for familial hypercholesterolaemia: comparing responses to genetic and non-genetic testing methods. BMC MEDICAL GENETICS 2012; 13:87. [PMID: 22994377 PMCID: PMC3495051 DOI: 10.1186/1471-2350-13-87] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 07/11/2012] [Indexed: 12/13/2022]
Abstract
Background Continuing developments in genetic testing technology together with research revealing gene-disease associations have brought closer the potential for genetic screening of populations. A major concern, as with any screening programme, is the response of the patient to the findings of screening, whether the outcome is positive or negative. Such concern is heightened for genetic testing, which it is feared may elicit stronger reactions than non-genetic testing. Methods This paper draws on thematic analysis of 113 semi-structured interviews with 39 patients being tested for familial hypercholesterolaemia (FH), an inherited predisposition to early-onset heart disease. It examines the impact of disease risk assessments based on both genetic and non-genetic information, or solely non-genetic information. Results The impact of diagnostic testing did not seem to vary according to whether or not genetic information was used. More generally, being given a positive or negative diagnosis of FH had minimal discernible impact on people's lives as they maintained the continuity of their beliefs and behaviour. Conclusions The results suggest that concerns about the use of genetic testing in this context are unfounded, a conclusion that echoes findings from studies in this and other health contexts.
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Affiliation(s)
- Gareth J Hollands
- Health Psychology Section, Department of Psychology (at Guy's), King's College London, 5th Floor Bermondsey Wing, Guy's Campus, London SE1 9RT, UK
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Extending the reach of public health genomics: What should be the agenda for public health in an era of genome-based and “personalized” medicine? Genet Med 2010; 12:785-91. [DOI: 10.1097/gim.0b013e3182011222] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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