Emerging genomic technologies and the concept of personalized medicine: An overview of ethical,legal and social implications

With the completion of the Human Genome Project in May 2006, genetic testing for every American is rapidly becoming a reality. As the advanced technology fuels the path towards personalized medicine, genetic nondiscrimination legislation follows closely behind. It seems that the 2007 Genetic Information Nondiscrimination Act (GINA) will finally pass through both chambers of Congress and will be signed by the President, but questions remain. On May 1, 2008, the House passed GINA by a vote of 414 to 1. Why is this the year that genetic nondiscrimination legislation could finally become the reality? Is this the beginning of a new relationship between science and policy, where policy is finally catching up? We examine the answers to these questions through a look at the history of genetic nondiscrimination legislation and where it stands today, including arguments for and against the bill. We conclude by discussing how we can achieve a future of safe personalized medicine for the populous, which would require continuous productive interactions between policymakers and scientists.     

Developing drugs for the developing world: an economic,legal, moral,and political dilemma

This paper discusses the economic, legal, moral, and political difficulties in developing drugs for the developing world. It argues that large, global pharmaceutical companies have social responsibilities to the developing world, and that they may exercise these responsibilities by investing in research and development related to diseases that affect developing nations, offering discounts on drug prices, and initiating drug giveaways. However, these social responsibilities are not absolute requirements and may be balanced against other obligations and commitments in light of economic, social, legal, political, and other conditions. How a company decides to exercise its social responsibilities to the developing world depends on (1) the prospects for a reasonable profit and (2) the prospects for a productive business environment. Developing nations can either help or hinder the pharmaceutical industry's efforts to exercise social responsibility through various policies and practices. To insure that companies can make a reasonable profit, developing nations should honor pharmaceutical product patents and adhere to international intellectual property treaties, such as the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement. To insure the companies have a good business environment, developing nations should try to promote the rule of law, ethical business practices, stable currencies, reliable banking systems, free and open markets, democracy, and other conditions conducive to business. Overall, this paper advocates for reciprocity and cooperation between pharmaceutical companies and developing nations to address the problem of developing drugs for the developing world. In pursuing this cooperative approach, developing nations may use a variety of other techniques to encourage pharmaceutical companies to act responsibly, such as subsidizing pharmaceutical research, helping to design and implement research protocols, providing a guaranteed market, and bulk buying.     

German law on circumcision and its debate: How an ethical and legal issue turned political

The article aims to illuminate the recent debate in Germany about the legitimacy of circumcision for religious reasons. The aim is both to evaluate the new German law allowing religious circumcision, and to outline the resulting conflict between the surrounding ethical and legal issues. We first elucidate the diversity of legal and medical views on religious circumcision in Germany. Next we examine to what extent invasive and irreversible physical interventions on infant boys unable to given their consent should be carried out for non‐medical reasons. To this end, the potential benefits and harms of circumcision for non‐medical reasons are compared. We argue that circumcision does not provide any benefits for the ‘child as a child’ and poses only risks to boys. We then set out to clarify and analyse political (rather than ethical) justifications of the new circumcision law. We demonstrate through this analysis how the circumcision debate in Germany has been transformed from a legal and ethical problem into a political issue, due at least in part to Germany's unique historical context. Although such a particular political sensibility is entirely comprehensible, it raises particular problems when it comes to framing and responding to medical ethical issues – as in the case of religious circumcision.     

The interface between medically assisted reproduction and genetics: technical, social, ethical and legal issues*

¹⁹ To whom correspondence should be addressed at: Department of Medical Genetics, University of Turku, Kiinamyllykatu 10, FIN-20520 Turku, Finland. E-mail: hkaaria{at}utu.fi^* Reprinted from European Journal of Human Genetics (2006) 1–58 with permission. The views expressed in this study do not necessarily reflect those of the European Commission (EC). The interface between assisted reproductive technologies (ART)and genetics comprises several sensitive and important issuesthat affect infertile couples, families with severe geneticdiseases, potential children, professionals in ART and genetics,health care, researchers and the society in general. Geneticcauses have a considerable involvement in infertility. Geneticconditions may also be transmitted to the offspring and hencecreate transgenerational infertility or other serious healthproblems. Several studies also suggest a slightly elevated riskof birth defects in children born following ART. PGD has becomewidely practiced throughout the world for various medical indications,but its limits are being debated. The attitudes towards ARTand PGD vary substantially within Europe. The purpose of thisarticle was to outline a framework for development of guidelinesto be issued jointly by European Society of Human Genetics (ESHG)and European Society of Human Reproduction and Embryology (ESHRE)for the interface between genetics and ART. Technical, social,ethical and legal issues of ART and genetics will be reviewed.     

The ethical and social implications of exploring African American genealogies

In June 2002, the University of Minnesota hosted a conference to explore the implications of using genetic technologies and genealogical methods to reconstruct African identity. This paper includes transcribed remarks from that conference by Annette Dula, Marian Gray Secundy and Charmaine Royal.     

Consumers on the Internet: ethical and legal aspects of commercialization of personalized nutrition

Consumers often have a positive attitude to the option of receiving personalized nutrition advice based upon genetic testing, since the prospect of enhancing or maintaining one’s health can be perceived as empowering. Current direct-to-consumer services over the Internet, however, suffer from a questionable level of truthfulness and consumer protection, in addition to an imbalance between far-reaching promises and contrasting disclaimers. Psychological and behavioral studies indicate that consumer acceptance of a new technology is primarily explained by the end user’s rational and emotional interpretation as well as moral beliefs. Results from such studies indicate that personalized nutrition must create true value for the consumer. Also, the freedom to choose is crucial for consumer acceptance. From an ethical point of view, consumer protection is crucial, and caution must be exercised when putting nutrigenomic-based tests and advice services on the market. Current Internet offerings appear to reveal a need to further guaranty legal certainty by ensuring privacy, consumer protection and safety. Personalized nutrition services are on the borderline between nutrition and medicine. Current regulation of this area is incomplete and undergoing development. This situation entails the necessity for carefully assessing and developing existing rules that safeguard fundamental rights and data protection while taking into account the sensitivity of data, the risks posed by each step in their processing, and sufficient guarantees for consumers against potential misuse.     

Why there are no objective values: A critique of ethical intuitionism from an evolutionary point of view

Using concepts of evolutionary game theory, this paper presents a critique of ethical intuitionism, or non-naturalism, in its cognitivist and objectivist interpretation. While epistemological considerations suggest that human rational learning through experience provides no basis for objective moral knowledge, it is argued below that modern evolutionary theory explains why this is so, i.e., why biological organisms do not evolve so as to experience objective preferences and obligations. The difference between the modes of the cognition of objective and of valuative environmental attributes is explained with reference to different modes of natural selection acting on the cognitive apparatus of the organism. The negative implications are pointed out which the observable diversity of intraspecific behavioural adaptations and of cultural values has for the cognitivist, objectivist foundation of ethics. Eventually a non-cognitivist alternative to ethical intuitionism is outlined in terms of empirical authority relations, with the ritualisation of dominance-submission patterns as the evolutionary origin of human charismatic authority.     

D-Aspartate--an important bioactive substance in mammals: a review from an analytical and biological point of view

It was long believed that D-amino acids were either unnatural isomers or laboratorial artifacts and that the important functions of amino acids were exerted only by l-amino acids. However, recent investigations have shown that a variety of D-amino acids are present in mammals and that they play important roles in physiological functions in the body. Among the free d-amino acids that have been identified in mammals, D-aspartate (D-Asp) has been shown to play a crucial role in the neuroendocrine and endocrine systems as well as in the central nervous system. Here, we present an overview of recent studies of free D-Asp, focusing on the analytical methods in real biological matrices, expression and localization in tissues and cells, biological and physiological activities, biosynthesis, degradation, cellular transport, and possible relevance to disease. In addition to frequently used techniques for the enantiomeric determination of amino acids, including high-performance liquid chromatography and enzymatic methods, the recent development of analytical methods is also described.     

Ethical,legal and social implications of forensic molecular phenotyping in South Africa

Conventional forensic DNA analysis involves a matching principle, which compares DNA profiles from evidential samples to those from reference samples of known origin. In casework, however, the accessibility to a reference sample is not guaranteed which limits the use of DNA as an investigative tool. This has led to the development of phenotype prediction, which uses SNP analysis to estimate the physical appearance of the sample donor. Physical traits, such as eye, hair and skin colour, have been associated with certain alleles within specific genes involved in the melanogenesis pathways. These genetic markers are also associated with ancestry and their trait prediction ability has mainly been assessed in European and North American populations. This has prompted research investigating the discriminatory power of these markers in other populations, especially those exhibiting admixture. South Africa is well known for its diversity, and the viability of these particular SNPs still needs to be assessed within this population. South African law currently restricts the use of DNA for molecular phenotyping, and there are also numerous ethical and social considerations, all of which are discussed.     

Plant intelligence: an alternative point of view

The concept of plant intelligence has been advanced by Trewavas as a potentially useful framework to guide those seeking to understand plant growth and development. In this short critique, the validity of this concept is critically assessed. Central to this critique is the proposition that the concept of the individual, to which intelligence and behaviour are intimately linked, cannot usefully be applied to plants. It is argued that the adaptive responses of plants are best appreciated if the importance of the autonomy of the individual organs is acknowledged. Although Trewavas does acknowledge the autonomy of organs by describing an individual plant as being 'a democratic confederation', that terminology implies a complexity to the interaction between organs which would demand a cogitative ability beyond that actually demonstrated in plants. It may be more appropriate to consider a plant as operating normally as a simple economic federation of many specialized economies (organs and cells). Occasionally, there can be a dramatic, and sometimes complex, reshaping of the economic balances, with the result that the fate of some or many of the individual cells will change. However, such major changes in growth and development are driven by a few simple events in an individual organ and cells. These driving events are more akin to small local revolutions in individual states than they are to democratic decisions in a sophisticated confederation.     

Development and application of ovine reproductive technologies: an Indian experience

Sheep play an important role in the Indian economy by providing employment to a large population of marginal and landless farmers. The production from native breeds is relatively low due to their poor reproductive efficiency. Embryo transfer technology can be utilised for faster multiplication of elite animal to increase the genetic gain. A great deal of research is involved to overcome the constraints in the technology, i.e. expensive and complicated nature of the technology and low success rate. In order to avoid surgical involvement, procedures of laparoscope aided embryo collection and transfer have been developed. Although the use of FSH of ovine origin has given more consistent superovulatory response, but it is still too low to get sufficient numbers of progeny from a donor ewe. The progress made in cryopreservation of ram semen has opened the possibility for conservation and utilisation of frozen semen of elite rams in sheep improvement programme. The lambing rate obtained after laparoscope aided intrauterine artificial insemination with frozen semen is encouraging but the impetus is now to develop the non-invasive transcervical insemination technique.