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Cluley V, Burton JO, Quann N, Hull KL, Eborall H. Biographical dialectics: The ongoing and creative problem solving required to negotiate the biographical disruption of chronic illness. Soc Sci Med 2023; 325:115900. [PMID: 37084703 DOI: 10.1016/j.socscimed.2023.115900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/03/2023] [Accepted: 04/08/2023] [Indexed: 04/23/2023]
Abstract
Here we propose the term 'biographical dialectics' as a sister term to 'biographical disruption' to capture the ongoing problem solving that characterises the lives of many people living with life limiting chronic illnesses. The paper is based on the experiences of 35 adults with end-stage kidney disease (ESKD) in receipt of haemodialysis. Photovoice and semi-structured interviews showed that ESKD and the use of haemodialysis was widely agreed to be biographically disruptive. In talking about and showing disruption through photographs the participants' ongoing problem solving was universal across their diverse experiences. 'Biographical disruption' and Hegalian dialectical logic, are drawn on to make sense of these actions and to further understand the personal and disruptive experience of chronic illness. Based on this, 'biographical dialectics' captures the work that is required to account for and manage the enduring and biographical impact of chronic illness that follows the initial disruption of diagnosis and continues as life progresses.
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Affiliation(s)
- Victoria Cluley
- School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham, UK.
| | - James O Burton
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicester, UK; John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Niamh Quann
- Leicester Clinical Trials Unit, College of Life Sciences, University of Leicester, Leicester, UK; John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Katherine L Hull
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicester, UK; John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Helen Eborall
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
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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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Löwy I. How diseases became "genetic". CIENCIA & SAUDE COLETIVA 2019; 24:3607-3617. [PMID: 31576991 DOI: 10.1590/1413-812320182410.19102019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/23/2019] [Indexed: 11/21/2022] Open
Abstract
This article examines the origins of the term "genetic disease." In the late 19 and early 20th century, an earlier idea that diseases that occur in families reflect a vague familiar "predisposition" was replaced by the view that such diseases have specific causes, while Mendelian genetics provided then clues to the patterns of their transmission. The genetictisation of inborn pathologies took a decisive turn with the redefinition, in 1959, of Down syndrome as a chromosomal anomaly, then the development of tests for the diagnosis of other hereditary pathologies. At that time, geneticists distinguished "hereditary" diseases that run in families, from "genetic" conditions that are the result of new mutations during the production of egg and sperm cells. In the latter case, the inborn impairment is produced by an anomaly in the genetic material of the cell, but is not hereditary, because it is not transmitted from one or both parents. In the late 20th and early 21st century, new genomic technologies blurred the distinction between hereditary and genetic impairments, extended the concept of genetic disease, and modified the experience of people living with such a disease.
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Affiliation(s)
- Ilana Löwy
- CERMES 3 Paris & visiting professor - Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro. R. Francisco Xavier 524/bl. D/7º, Maracanã. 20550-013. Rio de Janeiro, RJ, Brasil.
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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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Ankeny RA. Geneticization in MIM/OMIM®? Exploring Historic and Epistemic Drivers of Contemporary Understandings of Genetic Disease. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2017. [DOI: 10.1093/jmp/jhx013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Arribas-Ayllon M. After geneticization. Soc Sci Med 2016; 159:132-9. [DOI: 10.1016/j.socscimed.2016.05.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 11/24/2022]
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Tong A, Rangan GK, Ruospo M, Saglimbene V, Strippoli GFM, Palmer SC, Tunnicliffe DJ, Craig JC. A painful inheritance-patient perspectives on living with polycystic kidney disease: thematic synthesis of qualitative research. Nephrol Dial Transplant 2015; 30:790-800. [PMID: 25637642 DOI: 10.1093/ndt/gfv010] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/24/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is a life-threatening genetic disorder and has multiple complications including, infection, pain, intracranial aneurysm and kidney failure leading to significantly impaired quality of life and reduced survival. These outcomes are well described, but patient perspectives and experiences of living with ADPKD are under-recognized. METHODS MEDLINE, Embase, PsycINFO and CINAHL were searched to August 2014. Studies were analyzed using thematic synthesis. RESULTS From 21 studies (n = 247), we derived five themes: unvalidated pain (medical trivialization, inadequacy of pain management); persisting uncertainties and ambiguities (lacking diagnostic clarity, disempowerment in self-care, unpredictable daily disruptions, inability to plan ahead, financial discrimination); genetic guilt and resentment (blaming parents, self-blame, constant burden of guilt); precariousness in pursuing parenthood (prognostic uncertainty, owning the decision, needing directive counselling); and defining parental responsibility for genetic testing and disclosure (preserving normality, doubting necessity of genetic testing, respecting the child's autonomy and hope in future technologies, facilitating preparedness). CONCLUSIONS The erratic onset of pain contributes to the substantial unpredictability of daily living and prevents patients from establishing long-term life goals. Decisions about family planning, genetic testing of children and disclosure involves making profoundly difficult judgments about ethical parental responsibility. Patient engagement in pain management, strategies for self-care, counselling to reduce the burden of 'genetic guilt' and specific family planning decision support tools may be priorities for care to improve patient-centred outcomes in ADPKD.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Gopala K Rangan
- Centre for Transplant and Renal Research, Westmead Millennium Institute, The University of Sydney, Westmead, NSW 2145, Australia
| | - Marinella Ruospo
- Medical Scientific Office, Diaverum Academy, Diaverum, Lund, Sweden Department of Translational Medicine, Division of Nephrology and Transplantation, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | | | - Giovanni F M Strippoli
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia Medical Scientific Office, Diaverum Academy, Diaverum, Lund, Sweden Department of Translational Medicine, Division of Nephrology and Transplantation, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - David J Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia
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Bitsch L, Stemerding D. The innovation journey of genomics and asthma research. SOCIOLOGY OF HEALTH & ILLNESS 2013; 35:1164-1180. [PMID: 23551185 DOI: 10.1111/1467-9566.12028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article concerns the transformative potential of medical genomics for common disease research. We analysed 13 review articles in asthma research in the period 1999 to 2008. Our aim was to understand how genomics has emerged in this research field, and the attendant changes. Motivated by Lippman's geneticisation thesis, we use the concept of an 'innovation journey' to trace how expectations of improved understanding, prevention, diagnosis and treatment structure a dynamic co-evolutionary process through which a genome-based discourse emerges. We show how the asthma researchers involved continuously struggle to define their contribution to asthma research, as well as to clinical practice. Along the way, the researchers propose changes to both the definition and the aetiological model of asthma, thus highlighting gene-gene and gene-environment interactions. It is, however, difficult to characterise this discourse as one of geneticisation. With increasing attention being given to epigenetics, metabolomics, proteomics and systems biology, the emerging picture suggests an important, but much less deterministic, role for genes.
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Affiliation(s)
- Lise Bitsch
- Department of Science, Technology and Policy Studies (STePS), University of Twente, The NetherlandsTechnology Assessment, The Rathenau Institute, The Hague, The Netherlands
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Exploring genetic responsibility for the self, family and kin in the case of hereditary raised cholesterol. Soc Sci Med 2011; 72:1760-7. [DOI: 10.1016/j.socscimed.2010.03.053] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 01/11/2010] [Accepted: 03/08/2010] [Indexed: 11/22/2022]
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Genetic unexceptionalism: Clinician accounts of genetic testing for familial hypercholesterolaemia. Soc Sci Med 2010; 71:910-7. [DOI: 10.1016/j.socscimed.2010.05.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 04/28/2010] [Accepted: 05/20/2010] [Indexed: 11/20/2022]
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Pickersgill MD. Psyche, soma, and science studies: New directions in the sociology of mental health and illness. J Ment Health 2010; 19:382-92. [DOI: 10.3109/09638230903531092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cox SM, Kazubowski-Houston M, Nisker J. Genetics on stage: public engagement in health policy development on preimplantation genetic diagnosis. Soc Sci Med 2009; 68:1472-80. [PMID: 19233530 DOI: 10.1016/j.socscimed.2009.01.044] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Indexed: 10/21/2022]
Abstract
Arts-based approaches to public engagement offer unique advantages over traditional methods of consultation. Here we describe and assess our use of theatre as a method of public engagement in the development of health policy on preimplantation genetic diagnosis, a controversial method for selecting the genetic characteristics of embryos created through in vitro fertilization. Funding from the Canadian Institutes for Health Research and Health Canada supported 16 performances of the play Orchids in Vancouver, Toronto, and Montréal and post-performance discussion in English and French (with Hubert Doucet) in 2005. A total of 741 individuals attended. The methods used to assess audience engagement and elicit policy-relevant dialogue included in-theatre observation of audience responses, moderated post-performance large audience discussion and focus groups, audience feedback forms and researcher fieldnotes. Emphasizing process and context over emerging outcomes, we reflect on the distinctive contributions of theatre in stimulating public engagement and the need to utilize multiple methods to adequately assess these contributions. We suggest continued dialogue about the possible uses of theatre in health policy development and conclude that greater clarity is needed with regard to citizens' (as well as specific stakeholders, policy makers' and sponsors') desired outcomes if there is to be a suitably nuanced and reflexive basis for assessing the effectiveness of various strategies for public engagement.
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Affiliation(s)
- Susan M Cox
- University of British Columbia, The W. Maurice Young Centre for Applied Ethics, Vancouver, BC, Canada V6T 1Z2.
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Abstract
This paper is concerned with changing conceptions of genetic disease. It is based on an analysis of biomedical literature and focuses on the treatment of coronary heart disease (CHD) in four published commentary papers. The aim of this analysis is to explore the ways in which CHD is constructed as genetic and the place of genetic discourses in the wider set of ideas that circulate about the disease. This analysis is then used to consider some of the claims of the geneticisation thesis (Lippman 1991, 1992). The analysis suggests that a genetic vision for understanding and managing CHD has emerged, which has many of the hallmarks of the geneticisation imagined by Lippman. However, a number of alternative and competing models of CHD are also supported within the biomedical discourse. These are related to the different disciplines with a stake in the field of CHD, and their struggles for authority. In conclusion, it is suggested that the geneticisation thesis, as a universal claim, is at odds with the diffuse and distributed nature of biomedical knowledge and practice. Rather than analysing geneticisation in a literal way, it may be more fruitful to see the thesis, itself, as a form of boundary work (Gieryn 1983).
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Affiliation(s)
- Kate Weiner
- Institute for Science and Society, University of Nottingham, UK.
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Shostak S, Conrad P, Horwitz AV. Sequencing and its consequences: path dependence and the relationships between genetics and medicalization. AJS; AMERICAN JOURNAL OF SOCIOLOGY 2008; 114 Suppl:S287-S316. [PMID: 19569408 DOI: 10.1086/595570] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Both advocacy for and critiques of the Human Genome Project assume a self-sustaining relationship between genetics and medicalization. However, this assumption ignores the ways in which the meanings of genetic research are conditional on its position in sequences of events. Based on analyses of three conditions for which at least one putative gene or genetic marker has been identified, this article argues that critical junctures in the institutional stabilization of phenotypes and the mechanisms that sustain such classifications over time configure the practices and meanings of genetic research. Path dependence is critical to understanding the lack of consistent fit between genetics and medicalization.
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Affiliation(s)
- Sara Shostak
- Department of Sociology, Brandeis University, MS 071, Waltham, Massachusetts 02454-9110, USA.
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Smith RA. Picking a frame for communicating about genetics: stigmas or challenges. J Genet Couns 2007; 16:289-98. [PMID: 17476468 DOI: 10.1007/s10897-006-9075-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2006] [Accepted: 11/03/2006] [Indexed: 11/26/2022]
Abstract
Currently, one may describe awareness of genomics as limited, but growing in the US. Although awareness is limited, the US public expresses great concern that genomics could result in stigmatization and discrimination (Reproductive genetic testing: What America thinks. Washington, DC: Genetics and Public Policy Center, 2004). This situation provides a rare opportunity to think carefully about how to design communication to a general public in ways that galvanize positive sentiments around genomics instead of stimulate stigmas. This manuscript provides a synthesis of communication theories relevant to framing genomics in stigma and challenge formats, the details necessary to understand what such messages look like, and an illustration of the two frames. Many people in different roles are engaging in these conversations in many different contexts. Through the growing exposure and interest in genomics, the opportunity to proactively script messages to form beliefs and attitudes about genomics, instead of managing pre-existing ones, may disappear quickly.
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Affiliation(s)
- Rachel A Smith
- Department of Communication Studies, University of Texas, Austin, 1 University Station A1105, Austin, TX 78712-0115, USA.
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Lock M, Cox S, d'Agincourt-Canning L. Social, political, and epistemological aspects of genetics and genomics. Public Health Genomics 2006; 9:137-41. [PMID: 16741342 DOI: 10.1159/000092649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The papers in this special issue were first given at a conference in Toronto, Canada, in April 2004 entitled 'Genomics, Genetics, and Society: Bridging the Disciplinary Divides'. The papers fall into four intersecting themes. (1) The introduction of genetic and genomic technologies into communities. (2) Governance, the morals of scientific discourse and policy making. (3) What is a gene? (4) Public knowledge, public trust and improved dialogue between the public and scientists.
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Affiliation(s)
- Margaret Lock
- Department of Social Studies of Medicine and Department of Anthropology, McGill University, Montreal, Canada.
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Cox SM, Yew S, Nisker J. Prenatal diagnosis for late-onset disease--always room for discussion. Fertil Steril 2005; 83:1887-8; author reply 1888. [PMID: 15950678 DOI: 10.1016/j.fertnstert.2005.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Indexed: 10/25/2022]
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