The chromosome 22q11.2 deletion: From the unification of biomedical fields to a new kind of genetic condition

Strategies of stratification: Regulating market access in the era of personalized medicine

Personalized medicine raises the stakes of pharmaceutical market regulation. Drawing on pragmatist valuation studies and science and technology studies literature on personalized medicine and pharmaceutical markets, this article demonstrates how complex negotiations about the value of a pharmaceutical can constitute a market in various ways, while also shaping the concerned patient populations. Tracing the path of a pharmacogenetic treatment, Spinraza, from its approval by the European Medicines Agency to its adoption in the publicly funded Danish healthcare system, we show how the market was formatted through particular stratifications of the patient population. We conceptualize these seemingly technical moves as strategies of stratification, that is, the application of techniques to assemble and divide data - and what data are meant to represent - into groups delineated by certain characteristics. We argue that stakeholders' use of strategies of stratification has important implications not only for market access, but also for the delineation of diseases and patient populations. Hence, it is crucial to make intelligible the mutual constitution of pharmaceutical markets and patient populations and the political efforts of delineating and connecting the two.

Humangenetik

Genetische Erkrankungen haben in der Kinderheilkunde eine größere Bedeutung erlangt. Durch Weiterentwicklung zytogenetischer, biochemischer und molekulargenetischer Diagnostik ist das Spektrum der bekannten genetischen und genetisch mitbedingten Erkrankungen größer geworden: im Katalog monogener Erkrankungen von McKusick stehen inzwischen über 8.500 Erkrankungen. Die häufigsten genetischen Erkrankungen werden in diesem Kapitel ebenso beschrieben wie die Aufgaben der humangenetischen Beratung, pränataler Diagnostik sowie des „next generation sequencing“.

The nuanced negative: Meanings of a negative diagnostic result in clinical exome sequencing

Genomic sequencing technology is moving rapidly from the research setting into clinical medicine but significant technological and interpretive challenges remain. Exome sequencing (ES) in its recent clinical application provides a genetic diagnosis in about 25 per cent of cases (Berg 2014). While this diagnostic yield is substantial, it also indicates that in a majority of cases, patients are receiving negative results (i.e. no explanatory genetic variant found) from this technology. There are a number of uncertainties regarding the meaning of a negative result in the current context of ES. A negative result may be due to current technological limitations that hinder detection of disease-causing variants or to gaps in the knowledge base that prohibit accurate interpretation of their pathogenicity; or it may indicate that there is not a genetic etiology for the disorder. In this paper we examine the uncertainties and nuances of the negative result from genome sequencing and how both clinicians and patients make meaning of it as revealed in ethnographic observations of the clinic session where results are returned, and in interviews with patients. We find that clinicians and patients construct the meaning of a negative result in ways that are uncertain, contingent, and multivalent; but invested with optimism, promise, and potentiality.

Scientific consensus, the law, and same sex parenting outcomes

While the US Supreme Court was considering two related cases involving the constitutionality of same-sex marriage, one major question informing that decision was whether scientific research had achieved consensus regarding how children of same-sex couples fare. Determining the extent of consensus has become a key aspect of how social science evidence and testimony is accepted by the courts. Here, we show how a method of analyzing temporal patterns in citation networks can be used to assess the state of social scientific literature as a means to inform just such a question. Patterns of clustering within these citation networks reveal whether and when consensus arises within a scientific field. We find that the literature on outcomes for children of same-sex parents is marked by scientific consensus that they experience "no differences" compared to children from other parental configurations.

What binds biosociality? The collective effervescence of the parent-led conference

Questions of community are central to many research settings in the social sciences. Rabinow argued that, in the wake of the Human Genome Project, an increasingly important form of collectivity would be biosociality. Biosociality recognises a central role for biomedical knowledge in constructing genetic identities and producing and reproducing social relationships. Accordingly, it is often imagined as a new form of social solidarity. We draw on observations of parent-led conferences to explore the way in which biosociality is expressed at events organised around a particular genetic syndrome - 22q11 deletion syndrome. The parent-led conferences took place within the United Kingdom between 2007 and 2010 and were observed as part of a multi-sited ethnographic study. By bringing together a geographically dispersed group of people together within the same physical location, conferences offer an ideal platform to empirically examine sociality. Durkheim used the term collective effervescence to describe the collective expression of heightened emotion. We suggest that in the case of the 22q11 deletion syndrome activities discussed in this paper, collective effervescence is a mechanism through which individuals become a collective. We argue that parent-led conferences gather individuals in one location on the basis of common biological factors, but it is the shared emotional experience of being together that consolidates and renews the connection between members.

Mood disorders in youth: exercise, light therapy, and pharmacologic complementary and integrative approaches

The therapeutic value of physical exercise, bright light therapy and dawn simulation, and several pharmacologic treatments, including hypericum (St. John's wort), S-adenosylmethionine, and 5-hydroxytryptophan, are reviewed, with a focus on their use for treating major depressive disorder in children and adolescents and also for alleviating depressed mood in the general (nonclinical) population of youth. For each treatment discussed, all published randomized, double-blind, placebo-controlled trials are summarized, along with some additional selected studies. Nutritional psychopharmacology and several other approaches to treating depression will be presented in an upcoming volume in the Child and Adolescent Psychiatric Clinics of North America.