- Email: [email protected]
Getting started with handhelds
DISSECTING ROOM
Books Debating the politics of genetics
Software
he aim of this short and readable book is to provide “a general introduction to the social context of human genetics”, grounding today’s genomic revolution in the eugenics movement of the 20th century. Anne Kerr and Tom Shakespeare are social scientists, with interests in the social dimensions of biological research, and in disability issues.
future includes: much more meaningful involvement of the public in decision making; a different approach to bioethics “based on careful consideration of how morality is enacted in society”; a ban on the development of tests for minor disorders; stopping all research into behavioural genetics; and robust and effective legislation on privacy, discrimination, and patenting. After much neurotic soul searching, I find their case unproven. Pregnancy selection certainly generates problems, but it has been practised for some decades, with no evidence that it has slid down the slippery slope towards trivialisation, nor that it has inhibited adequate societal provision for those with disabilities. In any event, prenatal diagnosis is today not a dominant motif in medical genetics research or practice. For those who undergo tests in pregnancy, the process of informed decision making has certainly been faulty, in some well documented instances, but I am not persuaded that it never works, and that it is not improving. Individual behavioural geneticists have made simplistic claims, but I do not believe the specialty is so dangerous that it should be summarily curtailed. I would welcome more dialogue with social scientists and the public—but I cannot persuade myself that all bioethicists are quislings. If this all sounds a bit dismissive, I do not want to leave it thus. Kerr and Shakespeare have unearthed quotations, attributed to some of the foremost figures in modern genetics, that make me squirm. The potential parallels they draw between modern clinical genetics and pejorative eugenics are unsettling. But to see parallels does not mean that the things are the same—they are different precisely because so many of those concerned with genetics nowadays are aware of the past and make continuing efforts to keep away from it. There are those who lapse but, however eminent, they are a small minority of those currently involved in the practice of and research in genetics. Those who see biomedical research as potentially evil will find this book much to their taste. Those, like me, who are not inherently sympathetic to that view, will, I suspect, not be converted. But they will be, as I have been, provoked and irritated into thinking long and hard about what we do, how we do it, and why we do it. And if they enjoy being irritated and challenged, they will also find this, as I did, entertaining.
Getting started with handhelds
Martin Bobrow e-mail: [email protected]
Marilynn Larkin [email protected]
T
Genetic Politics: From Eugenics to Genome Anne Kerr, Tom Shakespeare. Cheltenham: New Clarion Press, 2002. Pp 211. £12.05. ISBN 1 873797 25 7.
The first half of the book is a detailed, gripping, and shaming account of social policies in the name of eugenics, in Germany and elsewhere, during the first three quarters of the 20th century. The second half discusses medical genetics as it has been practised in the past 25 years, and looks forward to the consequences of the Human Genome Project. The authors contend that modern medical genetics is not so different from past practice as it likes to think itself. It obviously differs in degree and process, but not, they suggest, in intent. Most geneticists I meet see themselves as trying to understand normal and pathological human biology, with a hope of developing preventions and treatments, whereas Kerr and Shakespeare see the subject as grounded in prenatal diagnosis and pregnancy selection allied to a “search and destroy” exercise aimed at all disability. They foresee this trend increasing towards more pregnancy selection based on ever more dubious prediction of ever less serious disorders. Kerr and Shakespeare reject the claim that today’s genetics is focused on disease rather than population characteristics. They also believe that professional, social, and peer pressure has lead to a nominal freedom of choice being exercised in a socially directed manner. Moreover, they are suspicious of a conspiracy between biomedical scientists, industry, and government, which is designing a new social order tailored to the profit motive rather than social responsibility. The intense sociopolitical introspection of geneticists, which has lead to the massive growth in bioethics of the past decades, also leaves them unimpressed—bioethics having become part of the bioscience vision of the world, which has captured and neutralised much regulatory machinery. The authors’ broad recipe for a decent
THE LANCET • Vol 361 • January 18, 2003 • www.thelancet.com
Physicians’ use of handheld computers seems set to soar in 2003 and beyond. This week’s column is aimed at new users, and looks at some free software that can help you make the most of your new device. Subsequent columns will include reviews of other freeware and shareware products, as well as commercial products that offer demo versions or trialware (time-limited programs) for all levels of users. Staying abreast of the news in health, medicine, technology, and other categories is simple with AvantGo (http://www.avantgo.com; see Lancet 2003; 361: 93) and Journal to Go (http://www.journaltogo.com), both excellent free services. Journal to Go sends current abstracts from peerreviewed journals and news articles from Reuters to your handheld when you hot synch (synchronise your handheld with your desktop computer); abstracts can be copied to your handheld’s memo program or sent via e-mail to colleagues. Numerous drug databases are also freely available, including the popular ePocrates Rx (http://www.epocrates.com). This program allows you to look up drugs by generic name, brand name, or class, and provides information on adult dosing, paediatric dosing, contraindications, drug interactions, adverse reactions, retail cost, and packaging. In addition, Skyscape (http://www.skyscape.com) offers good commercial products with trial downloads, which allow users to evaluate products by viewing the full index and 10% of the content. Users eager to test the productivity potential of their handheld will want to download a patient-tracking software such as Handheld Med’s Patient Tracker (http://www.handheldmed.com), which creates miniaturised patient charts. Once you get the hang of entering information with the on-screen alphabetical and numerical keyboards, it’s easy to add meds, labs, vitals, notes, and more. Most sites that offer software for medical professionals require a lengthy registration process with multiple steps. But the results are worth it—current content, point-of-care applications, and patient and practice management tools available at the tap of a stylus.
267
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Books Debating the politics of genetics
Software
he aim of this short and readable book is to provide “a general introduction to the social context of human genetics”, grounding today’s genomic revolution in the eugenics movement of the 20th century. Anne Kerr and Tom Shakespeare are social scientists, with interests in the social dimensions of biological research, and in disability issues.
future includes: much more meaningful involvement of the public in decision making; a different approach to bioethics “based on careful consideration of how morality is enacted in society”; a ban on the development of tests for minor disorders; stopping all research into behavioural genetics; and robust and effective legislation on privacy, discrimination, and patenting. After much neurotic soul searching, I find their case unproven. Pregnancy selection certainly generates problems, but it has been practised for some decades, with no evidence that it has slid down the slippery slope towards trivialisation, nor that it has inhibited adequate societal provision for those with disabilities. In any event, prenatal diagnosis is today not a dominant motif in medical genetics research or practice. For those who undergo tests in pregnancy, the process of informed decision making has certainly been faulty, in some well documented instances, but I am not persuaded that it never works, and that it is not improving. Individual behavioural geneticists have made simplistic claims, but I do not believe the specialty is so dangerous that it should be summarily curtailed. I would welcome more dialogue with social scientists and the public—but I cannot persuade myself that all bioethicists are quislings. If this all sounds a bit dismissive, I do not want to leave it thus. Kerr and Shakespeare have unearthed quotations, attributed to some of the foremost figures in modern genetics, that make me squirm. The potential parallels they draw between modern clinical genetics and pejorative eugenics are unsettling. But to see parallels does not mean that the things are the same—they are different precisely because so many of those concerned with genetics nowadays are aware of the past and make continuing efforts to keep away from it. There are those who lapse but, however eminent, they are a small minority of those currently involved in the practice of and research in genetics. Those who see biomedical research as potentially evil will find this book much to their taste. Those, like me, who are not inherently sympathetic to that view, will, I suspect, not be converted. But they will be, as I have been, provoked and irritated into thinking long and hard about what we do, how we do it, and why we do it. And if they enjoy being irritated and challenged, they will also find this, as I did, entertaining.
Getting started with handhelds
Martin Bobrow e-mail: [email protected]
Marilynn Larkin [email protected]
T
Genetic Politics: From Eugenics to Genome Anne Kerr, Tom Shakespeare. Cheltenham: New Clarion Press, 2002. Pp 211. £12.05. ISBN 1 873797 25 7.
The first half of the book is a detailed, gripping, and shaming account of social policies in the name of eugenics, in Germany and elsewhere, during the first three quarters of the 20th century. The second half discusses medical genetics as it has been practised in the past 25 years, and looks forward to the consequences of the Human Genome Project. The authors contend that modern medical genetics is not so different from past practice as it likes to think itself. It obviously differs in degree and process, but not, they suggest, in intent. Most geneticists I meet see themselves as trying to understand normal and pathological human biology, with a hope of developing preventions and treatments, whereas Kerr and Shakespeare see the subject as grounded in prenatal diagnosis and pregnancy selection allied to a “search and destroy” exercise aimed at all disability. They foresee this trend increasing towards more pregnancy selection based on ever more dubious prediction of ever less serious disorders. Kerr and Shakespeare reject the claim that today’s genetics is focused on disease rather than population characteristics. They also believe that professional, social, and peer pressure has lead to a nominal freedom of choice being exercised in a socially directed manner. Moreover, they are suspicious of a conspiracy between biomedical scientists, industry, and government, which is designing a new social order tailored to the profit motive rather than social responsibility. The intense sociopolitical introspection of geneticists, which has lead to the massive growth in bioethics of the past decades, also leaves them unimpressed—bioethics having become part of the bioscience vision of the world, which has captured and neutralised much regulatory machinery. The authors’ broad recipe for a decent
THE LANCET • Vol 361 • January 18, 2003 • www.thelancet.com
Physicians’ use of handheld computers seems set to soar in 2003 and beyond. This week’s column is aimed at new users, and looks at some free software that can help you make the most of your new device. Subsequent columns will include reviews of other freeware and shareware products, as well as commercial products that offer demo versions or trialware (time-limited programs) for all levels of users. Staying abreast of the news in health, medicine, technology, and other categories is simple with AvantGo (http://www.avantgo.com; see Lancet 2003; 361: 93) and Journal to Go (http://www.journaltogo.com), both excellent free services. Journal to Go sends current abstracts from peerreviewed journals and news articles from Reuters to your handheld when you hot synch (synchronise your handheld with your desktop computer); abstracts can be copied to your handheld’s memo program or sent via e-mail to colleagues. Numerous drug databases are also freely available, including the popular ePocrates Rx (http://www.epocrates.com). This program allows you to look up drugs by generic name, brand name, or class, and provides information on adult dosing, paediatric dosing, contraindications, drug interactions, adverse reactions, retail cost, and packaging. In addition, Skyscape (http://www.skyscape.com) offers good commercial products with trial downloads, which allow users to evaluate products by viewing the full index and 10% of the content. Users eager to test the productivity potential of their handheld will want to download a patient-tracking software such as Handheld Med’s Patient Tracker (http://www.handheldmed.com), which creates miniaturised patient charts. Once you get the hang of entering information with the on-screen alphabetical and numerical keyboards, it’s easy to add meds, labs, vitals, notes, and more. Most sites that offer software for medical professionals require a lengthy registration process with multiple steps. But the results are worth it—current content, point-of-care applications, and patient and practice management tools available at the tap of a stylus.
267
For personal use. Only reproduce with permission from The Lancet Publishing Group.