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The advent of the ‘unpatients’

Predictive diagnosis by molecular methods will change the scientific basis of prognostics. At the same time, it will change the ethical dimensions of the relation among patients, their doctors and other providers of care.

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References

  1. Kevles, D.J. In the Name of Eugenics: Genetics and the Uses of Human Heredity (University of California Press, Berkeley and Los Angeles, California, 1985).

    Google Scholar 

  2. Proctor, R.N. Racial Hygiene: Medicine Under the Nazis (Harvard University Press, Cambridge, Massachusetts, and London, England, 1988).

    Google Scholar 

  3. Cook-Deagan, R.M. The genesis of the Human Genome Project. Mol. Genet. Med. 1, 1–75 (1991).

    Google Scholar 

  4. Myers, M.F., Bernhardt, B.A., Tambor, E.S. & Holtzman, N.A. Involving consumers in the development of an educational program for cystic fibrosis carrier screening. Am. J. Hum. Genet. 54, 719–726 (1994).

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Tambor, E.S. et al. Offering cystic fibrosis carrier screening to an HMO population: Factors associated with utilization. Am. J. Hum. Genet. 55, 626–637 (1994).

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Fanos, J.H. & Johnson, J.P. Perception of carrier status by cystic fibrosis siblings. Am. J. Hum. Genet. 57, 431–438 (1995).

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Moseley, R., McCrary, S.V. & Allen, W.L. The Ethical, Legal and Social Implications of Predictive Genetic Testing for Health Insurance: Policy Analysis and Recommendations. A Preliminary Report of the Human Genome Insurance Project (Medical Humanities Program, University of Florida College of Medicine, 1993).

    Google Scholar 

  8. Task Force on Genetic Information and Insurance, NIH-DOE Working Group on Ethical, Legal and Social Implications of Human Genome Research. Genetic Information and Health Insurance. Report of the Task Force on Genetic Information and Insurance (National Center for Human Genome Research, National Institutes of Health, Bethesda, Maryland, 1993).

  9. Mehlman, M.J. et al. Coverage of genetic technologies under national health reform. Am. J. Hum. Genet. 55, 1054–1060 (1994).

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Marshall, E. NIH told to reconsider crime meeting. Science 262, 23–24 (1993).

    Article  CAS  Google Scholar 

  11. Hippocrates. The Art viii; Decorum, xvi (trans. Jones, W.H.S.) 204, 299 (Cambridge, Massachusetts, Harvard Univ. Press, 1923).

  12. Dunlop, M.G. Colorectal cancer genetics. Cancer Biol. 3, 131–140 (1992).

    CAS  Google Scholar 

  13. Motulsky, A.G. & Brunzell, J.D. The genetics of coronary atherosclerosis. in The Genetic Basis of Common Diseases (eds. King, R.A., Rotter, J.I. & Motulsky, A.G.) 150–169 (Oxford Univ. Press, New York, New York, and Oxford, UK, 1992).

    Google Scholar 

  14. Rotter, J.I., Vadheim, C.M. & Rimoin, D.L. Diabetes mellitus. in The Genetic Basis of Common Diseases (eds. King, R.A., Rotter, J.I. & Motulsky, A.G.) 413–481 (Oxford Univ. Press, New York, New York, and Oxford, UK, 1992).

    Google Scholar 

  15. Groop, L.C. et al. Association between polymorphism of the glycogen synthetase gene and non-insulin-dependent diabetes mellitus. N. Engl. J. Med. 328, 10–14 (1993).

    Article  CAS  Google Scholar 

  16. Miki, Y. et al. A strong candidate for the breast and ovarian cancer susceptibility gene BRCA1. Science 266, 66–71 (1994).

    Article  CAS  Google Scholar 

  17. Wooster, R. et al. Localization of a breast cancer susceptibility gene, BRCA2, to chromosome 13q12-13. Science 265, 2088–2090 (1994).

    Article  CAS  Google Scholar 

  18. Hippocrates. Epidemics I, xi. (trans. Jones, W.H.S.) 165 (Harvard Univ. Press, Cambridge, Massachusetts, 1923).

  19. Bloch, M. et al. Predictive testing for Huntington disease in Canada: The experience of those receiving an increased risk. Am. J. Med. Genet. 42, 499–507 (1992).

    Article  CAS  Google Scholar 

  20. Huggins, M. et al. Predictive testing for Huntington disease in Canada: Adverse effects and unexpected results in those receiving a decreased risk. Am. J. Med. Genet. 42, 508–515 (1992).

    Article  CAS  Google Scholar 

  21. Wiggins, S. et al. The psychological consequences of predictive testing for Huntington's disease. N. Engl. J. Med. 327, 1401–1405 (1992).

    Article  CAS  Google Scholar 

  22. Yesley, M.S. & Roth, M.J.R. ELSI Bibliography: Ethical, Legal and Social Implications of the Human Genome Project (National Technical Information Service, Springfield, Virginia, 1993).

    Book  Google Scholar 

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Jonsen, A., Durfy, S., Burke, W. et al. The advent of the ‘unpatients’. Nat Med 2, 622–624 (1996). https://doi.org/10.1038/nm0696-622

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