Your patient’s asking about her 23andMe results. Now what?

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Precision health has been signaling a paradigm shift in how physicians address disease prevention, diagnosis and treatment. But to what extent are these approaches to health new, and what are the clinical and ethical implications for distinguishing between care and research?

The September issue of AMA Journal of Ethics® (@JournalofEthics) explores ethical questions surrounding novel clinical applications, public policy questions about stewardship of patient information, and questions about how to justly distribute these efforts’ risks and benefits.

Articles include:

How Should Primary Care Physicians Respond to Direct-to-Consumer Genetic Test Results? In this case, a primary care physician is presented with direct-to-consumer genetic test results, and asked to provide counseling and order follow-up diagnostics. To deal effectively with this situation, authors suggest physicians need to look no further than practice principles that guide more routine clinical encounters.

In the article, authors examine the rationale behind two major clinical ethical considerations: Physicians have obligations to help their patients achieve reasonable health goals, but are not obligated to perform procedures that are not medically indicated; and primary care physicians do not need to know everything, just how to get their patients appropriate care.

Should Genetic Testing for Variants Associated with Influenza Infection Be Mandatory for Health Care Employees? Scientists are beginning to understand more about the role of host genetics in individuals’ responses to influenza virus exposure.

This case commentary responds to a fictional situation in which a health care organization proposes requiring all health care practitioners with direct patient care responsibilities to undergo mandatory genetic testing for genetic variants used to predict individuals’ responses to the influenza vaccine, determine individual susceptibility to influenza infection and identify individuals at increased risk.

Justice in CRISPR/Cas9 Research and Clinical Applications.” Gene editing with CRISPR/Cas9 raises concerns about equitable access to therapies that could limit research participation by minority group members. These concerns can be addressed through public education, transparency, and stakeholder partnerships.

What Precision Medicine Can Learn from Rare Genetic Disease Research and Translation.” Rare genetic disease research has something to teach precision medicine about addressing some patients’ limited access to treatment. Health disparities exacerbated by high costs and limited availability of drugs can, perhaps, be mitigated when patient activism accelerates drug development.

Listen and discuss

In the journal’s September podcast, Katie Johansen Taber, PhD, an expert on precision health issues, and Ysabel Duron, a community representative on the All of Us Institutional Review Board, discuss strategies for protecting participants and ensuring that diverse communities are represented. Listen to previous episodes of the podcast, “Ethics Talk,” or subscribe in iTunes or other services.

Conley Contests

The Conley Art of Medicine and Conley Ethics Essay contests for medical students, residents, and fellows are now open through Sept. 25. Each has a $5,000 prize for the winning entry.

Submit manuscripts and artwork

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.

Call for papers and theme issue editors

The AMA Journal of Ethics call for papers is now open. The journal invites original submissions for peer review consideration on themes that will be explored in 2019 issues.

A call for theme issue editors is also now open through Oct. 1, 2018. The journal invites medical students, residents and fellows (MDs or DOs) in United States-based programs to apply to serve as theme issue editors for monthly issues to be published from December 2019 through November 2020.

A look ahead

Upcoming issues of the AMA Journal of Ethics will focus on health and food ethics, and false beliefs in health care. Sign up to receive email alerts when new issues are published.

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Sep 14, 2018
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