The social dynamics of genetic testing: the case of Fragile-X

The Spillover of Genomic Testing Results in Families: Same Variant, Different Logics

Due to heritability, next-generation genetic tests have the potential to affect family members beyond the patient being tested. Geneticists and genetic counselors, in dialogue with patients and their relatives, will need to establish for whom and in what way genomic testing results matter during the communication of testing results, indicating the spillover of presumed pathological variants. On the basis of video-recorded consultations of the return of exome results in a genetics clinic, we distinguish three different logics deployed to explain the relevance of the findings for the patient, extended family members, and unborn relatives. While geneticists tend to be cautious in interpreting findings for the patient and living relatives, the findings become more deterministic in the context of reproductive decision making. The presentation of results then establishes the causal role of variants and reflects back on disability as a state to be prevented, in the process establishing genetic ties between kin.

Enacting genetic responsibility: experiences of mothers who carry the fragile X gene

A woman who carries the gene for fragile X syndrome (FXS) has a 50 per cent chance per pregnancy of passing the gene to her sons and daughters. In this paper we analyse interview data from mothers who are carriers of the FX gene, and who have at least one child with FXS, to examine how their understandings and enactments of reproductive options, obligations, and responsibilities support an expanded notion of genetic responsibility. Accounts of 108 women from across the United States show that the majority of mothers chose not to have another biological child once they learned their carrier status. They discussed genetic responsibility and reproductive agency in terms of an obligation not to risk having another child who carried the gene, although their accounts reflected the tensions that arose from managing oneself as a genetically at-risk actor. Another 22 mothers either purposely became pregnant or continued an unplanned pregnancy after finding out their carrier status. These mothers' accounts reflect an expanded version of genetic responsibility that incorporates ideas and values beyond managing risk in what it means to act responsibly in light of genetic knowledge.

The quest for the perfect baby: why do Israeli women seek prenatal genetic testing?

Since the mid-1990s, the Israeli medical scene has witnessed a real boom in elective prenatal testing for inherited diseases that has spread beyond risk groups to the general Jewish population, especially of Ashkenazi (European) origin. This study tried to identify key social influences involved in the growing range and prevalence of prenatal genetic tests as they emerged from women's own perspective. Twenty-seven women having blood tests for genetic mutations were interviewed at two types of genetic clinics, and re-interviewed after getting test results. The names of 23 women who chose not to have elective tests were obtained from testers, and these non-testers were interviewed for comparison. Women's accounts suggest that elective genetic testing is more acceptable, if not normative, among educated middle class Ashkenazi women, and is more often questioned and refused by lower class Mizrahi women, as well as religious women of any ethnic origin. The key forces that drive women's choice of prenatal genetic diagnosis include the fear of having a sick and/or socially unfit child in an unsupportive environment; strong endorsement of testing by gynaecologists; popular and professional discourse on the common Ashkenazi mutations causing genetic anxiety in this ethnic group (i.e. apprehension of multiple known and unknown dangers hidden in its genetic makeup); and the emerging social pressure for comprehensive prenatal screening as an indispensable part of good motherhood. Many women described the experience of testing as frustrating because of the long wait for results and difficulty of their interpretation and subsequent decision-making. Women who rejected elective tests explained their decision by moral/religious objections to abortion and/or eugenic aspects of prenatal screening, as well as by prohibitive costs and poor understanding of the tests' meaning and implications. Yet, few informants voiced objections to the excessive medicalisation of pregnancy as such; ethno-national motives of reproductive decisions were also uncommon in this group. More critical reflection is clearly needed from both providers and users of elective genetic screening before the more widespread uptake of this practice.

Screening for Fragile X Syndrome: Parent attitudes and perspectives

PURPOSE

This study examined the attitudes and beliefs of 442 parents of children with fragile X syndrome (FXS) regarding different screening options for FXS.

METHODS

A survey was administered to parents of children with FXS across the U.S.

RESULTS

Parents indicated their support for voluntary screening for FXS, especially carrier and newborn screening. They also thought advantages of widespread screening to be more likely than disadvantages.

CONCLUSION

Parents' support for FXS screening is at odds with current screening criteria, but as new genetic knowledge and technologies reconfigure these criteria, it will be important to take parents' perspectives into account.

Anthropological perspectives on alcohol and drugs at the turn of the new millennium

This introduction to the collection provides our thoughts on where alcohol and drug studies in anthropology are going as we enter the new millennium. After commenting briefly on each of the papers that comprise the rest of the volume, we discuss what we see as the most important and exciting issues in the future and give our views on what alcohol and drug studies can offer to medical anthropology, anthropology writ large, interdisciplinary and multidisciplinary research, and the realm of public policy and practical affairs. We call for a continued study by anthropologists of the whole array of pharmacologically active substances used by humans in different parts of the world, whether or not such studies are situated within medical anthropology. We note that many of these substances have received little attention from anthropologists to date, quite strikingly so in the cases of substances such as marijuana and methamphetamines. We emphasize that most scholars working in the anthropology of alcohol and drugs are concerned with the application of their findings to social problems, and we note that this has been especially true of research on alcoholic beverages and injection drugs. This leads us to a discussion of anthropology's involvement in public health intervention and policy work in a variety of settings. Such involvement is shown to have informed anthropological theory (notably political economic approaches) and to have enriched the methodological toolkits and forms of data analysis anthropologists use. Perhaps more importantly, we argue that such multidisciplinary involvement in applied work is most likely to eventuate in theoretical progress in alcohol and drug studies, since theory in the social sciences is not bound to singular disciplinary approaches. Thus we advocate for a "hybrid vigor" in this specialty area in the years ahead.