Trisomy 18 - A Bibliography and Dictionary for Physicians, Patients, and Genome Researchers
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A positive test result means the laboratory found a variance in a particular gene, chromosome, or protein of interest. Depending on the purpose of the test, this result may confirm a diagnosis, identify an increased risk of developing a disease in the future, indicate the person is a carrier of a particular genetic mutation, or suggest a need for further testing.
In some situations, positive test results are simply uninformative or indeterminate because everyone has common, natural variations in their DNA that do not affect health.
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This explains why health professionals cannot and should not use a positive test result to predict the course or severity of a condition. A negative test result, on the other hand, means the laboratory did not find a variance in the gene, chromosome, or protein under consideration. A negative result may indicate the person is not affected by a particular disorder, does not have an increased risk of developing a certain disease, or is not a carrier of a specific genetic mutation. Or, a negative result may mean the test failed to detect genetic changes that could cause a particular disorder.
The complexity of test results and the complicated interaction between genes and the environment e. Specifically, in , the American College of Medicine Genetics ACMG issued a policy statement opposing DTC genetic testing and stating that genetic testing should be provided to the public only through the services of appropriately qualified health care professionals, who would be responsible for both ordering and interpreting the genetic tests, as well as pre-test and post-test counseling regarding the medical significance of the test results and the need, if any, for follow-up.
Potential harms could include inappropriate test utilization, misinterpretation of test results, and lack of necessary follow-up. These policy statements, which oppose DTC genetic testing and collectively call for qualified health care professionals to order, supervise, and interpret genetic tests, impliedly raise the question of whether the practice of DTC genetic testing falls within the scope of the practice of medicine? If so, should the practice of ordering and interpreting genetic tests be limited to the confines of the physician-patient relationship?
There has been little case law defining what constitutes a medical diagnosis. No state has directly addressed this issue. Hence, determination of whether genetic testing constitutes medical practice is a matter of interpretation that has not yet come before the courts. It could be argued that testing asymptomatic persons for disease risk does not constitute a diagnosis and is not within the scope of the practice of medicine precisely because no disease or pathology exists.
If a DTC genetic test company is exercising medical judgment by rendering health care advice on the basis of genetic test results then it is probably engaged in the unlicensed practice of medicine. After receiving the 14 written test results, the GAO concluded the results contained health-related predictions that a consumer could potentially interpret as diagnoses.
Although the Internet genetic testing companies provided disclaimers stating the information was not intended to diagnose disease or a pre-disposition to disease, the GAO found the results misleading because they indicated the fictitious consumers were at risk for developing a myriad of medical conditions. A survey of the web sites for several current Internet genetic test companies reveals disclaimer language consistent with that found in the GAO report.
At a minimum, this requires stricter regulation to ensure truth-in-marketing and to prevent fraud. The objective of CLIA is to ensure quality laboratory testing which, in theory, should include test validity through a laboratory certification process. Several companies have responded by hiring a physician to order and interpret tests for all consumers. For example, Navigenics, a popular DTC personal genome testing company, provides consumers with an opportunity for pre- and post-test counseling with a board-certified genetics counselor.
Physicians have a fiduciary obligation to act competently and to use their expert knowledge and skills primarily for the benefit of their patient. Company-employed physicians can be utilized for this purpose as long as they are able to appropriately manage real and perceived conflicts of interest that might arise. However, if a physician is employed by the company to act for the benefit of the patient, neither the company nor the physician can avoid the establishment of a physician-patient relationship by simply declaring it not to exist.
The question of whether a DTC company physician establishes a physician-patient relationship with on-line consumers is complex. Ultimately, it is a matter of state law and will be left to individual state legislators or courts to decide. Typically, the question of whether a physician-patient relationship has been formed arises in the context of medical malpractice lawsuits and when analyzing whether the physician owes a duty to the patient.
Absent this relationship, there is no duty. The physician does not have to establish direct physical contact or deal directly with the patient to establish a physician-patient relationship. There is no clear case law directly on point to suggest that a DTC genetic testing company-based physician and an on-line consumer have an implied physician-patient relationship.
This duty should supersede any economic interest or benefit the physician could potentially receive from the company. Sound clinical principles dictate that, before genetic tests can be generally accepted in clinical practice, data must be collected to demonstrate the benefits and risks that accrue from both positive and negative effects. Usually, a screening or diagnostic test alone does not have utility; rather, it is the therapeutic and preventive interventions that influence health outcomes.
The utility of a test should be defined as the balance between the benefits and harms clinical as well as personal of testing and the ensuing follow-up evaluation, treatment, or prevention. Currently, the degree to which clinical utility is established for different genetic tests varies widely and often depends on the type of test offered and the populations or conditions with which they are associated. The current state of complexity and uncertainty surrounding DTC genetic testing suggests that physicians have a limited but important role to play.
The advantage of using a company-employed physician is that he or she will be familiar with the test products and can provide accurate and detailed information about them. Consumers should be free to purchase information, whether it is predictive information regarding their astrological future or their biological future, in a free market economy.
If consumers understood and could fully appreciate the limitations of this information then minimal regulation may be justified. However, the little available evidence suggests that, despite disclaimers of DTC genetic test companies, consumers are likely to misinterpret the clinical significance of test results and to make misinformed and potentially harmful health care decisions on the basis of those results.
Medical licensure laws were originally created to protect patients from unscrupulous and untrained providers.
Recent Activity. The snippet could not be located in the article text. This may be because the snippet appears in a figure legend, contains special characters or spans different sections of the article. J Law Med Ethics. Author manuscript; available in PMC Dec PMID: Cynthia Marietta and Amy L. Copyright notice.
The publisher's final edited version of this article is available at J Law Med Ethics.
See other articles in PMC that cite the published article. Benefits and Risks of DTC Genetic Testing Proponents of DTC genetic testing believe that it will empower consumers to take more personal responsibility for their health by providing them risk assessment information and allowing them to proactively search for specific genetic variants of interest. Acknowledgements Dr. References 1. All About the Human Genome Project. Genetics and Public Policy Center. Genetic Testing Quality Initiative.
Javitt GH, Hudson K.
Federal Neglect: Regulation of Genetic Testing. Issues in Sciences and Technology. Langreth R. California Orders Stop to Gene Testing. Jun 14 [last visited on April 9, ]. Direct-to-Consumer Genetic Testing Companies.
Trisomy disorders - Better Health Channel
Prainsack B, Reardon J. Misdirected Precaution. Genetic Alliance. American Journal of Bioethics. General Medicine. See Genetic Alliance, supra note 7. See Federal Trade Commission, supra note 12; see also U. National Library of Medicine, supra note See U. New England Journal of Medicine. However, polysomy can be transmissible through both the male and female parents through nondisjunction. Heterochromatin contains a small number of genes and densely staining nodules in or along chromosomes. In the fruit fly, Drosophila , one X chromosome in the male is almost the same as two X chromosomes in the female in terms of the gene product produced.
A karyotype rearrangement of individual chromosomes takes place when polysomy in plants in observed. The mechanism of this type of rearrangement is "non-disjunction, mis-segregation in diploids or polyploids; mis-segregation from multivalents in interchange heterozygotes. Few fungi have been researched so far, possibly due to the low number of chromosomes in fungi, as determined by pulsed field gel electrophoresis.
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Chromosome 13 contains loci, specifically the ADH2 and ADH3 loci, which encode for the isozymes of alcohol dehydrogenase. These isozymes play a primary role in the biological aging of wines via ethanol oxidative utilization. Fluorescence in situ hybridization FISH is a cytogenetic technique that has proven to be useful in the diagnosis of patients with polysomy.
Spectral karyotyping SKY looks at the entire karyotype by using fluorescent labels and assigning a particular color to each chromosome. SKY is usually performed after conventional cytogenic techniques have already detected an abnormal chromosome.
FISH analysis is then used to confirm the identity of the chromosome. Karyotypes are commonly analyzed using Giemsa banding G-banded karyotyping. Each chromosome shows unique light and dark bands after they are denatured with trypsin and polysomies can be detected by counting the stained chromosomes. Several cells have to be analysed to detect mosaicism.
Submicroscopic chromosomal abnormalities that are too small to be detected via other means of karyotyping, may be identified by chromosomal microarray analysis. Maternal blood sampling for fetal cells, often used to identify risk of trisomies 18 or 21, poses less risk as compared to amniocentesis and chorionic villous sampling CVS. It was first performed in and became standard practice in the s.