Natural Settings Trials — Improving the Introduction of Clinical Genetic Tests

Approaches to genetic testing differ in the research setting and the clinical setting. More data are needed to develop approaches that will best facilitate the use of new genetic tests in the clinical setting, especially settings where genetic testing has not been widely used, such as in primary care. Furthermore, data are needed to establish the clinical utility of new genetic tests in the general practice setting. Natural setting trials are proposed as a strategy to develop this information. While natural setting trials are clinical research studies and will expose participants to some degree of risk, the risks are different, and arguably less than the risks those same individuals would otherwise face if the test went directly into clinical practice. Ultimately, clinical practice and safety of new genetic tests can be improved by adding the evaluation provided by natural setting trials.     

The Rise of Committees

Committees are of increasing importance in the process of EC policy-making, particularly in regulatory fields which touch upon politically sensitive issues. This article discusses the problems which have arisen due to the unforeseen emergence of committees within the institutional framework of the Community. It examines the main institutional conflicts in relation to committees and argues that parliamentary disdain for Comitology notwithstanding, the use of committees in the area of social regulation may be explained through a 'Member State-oriented' understanding of the institutional balance of powers. Committees may thus not only contribute to more effective decision-making, but may also secure a degree of subsidiarity. The increasing reliance on committees, however, might nonetheless be argued to detract from the general legitimacy of Community decision-making, especially since committees remain creatures of pragmatism. This article accordingly argues that the lack of transparency within committees, and the absence of general procedural rules upon the activities and composition of committees, should now be compensated for through the evolution of formal and generalisable procedural rules.     

Child abuse and chronic pain in a community survey of women

This study examined the relationship between a self-reported history of child physical and sexual abuse and chronic pain among women (N = 3,381) in a provincewide community sample. Chronic pain was significantly associated with physical abuse, education, and age of the respondents and was unrelated to child sexual abuse alone or in combination with physical abuse, mental disorder (anxiety, depression, or substance abuse), or low income. Number of health problems and mental health disorders did not mediate the relationship between physical abuse and chronic pain. Despite considerable evidence from the clinical literature linking exposure to child maltreatment and chronic pain in adulthood, this may well be the first population-based study to investigate this relationship for child physical and sexual abuse independently. The significant association between childhood history of physical abuse and pain in adulthood calls for a greater awareness of the potential for chronic pain problems associated with this type of maltreatment. Further research is needed to understand the mechanism for this complex relationship.