Genetic Testing and the Future of Disability Insurance: Ethics, Law & Policy

Predictive genetic testing poses fundamental questions for disability insurance, a crucial resource funding basic needs when disability prevents income from work. This article, from an NIH-funded project, presents the first indepth analysis of the challenging issues: Should disability insurers be permitted to consider genetics and exclude predicted disability? May disabilities with a recognized genetic basis be excluded from coverage as pre-existing conditions? How can we assure that private insurers writing individual and group policies, employers, and public insurers deal competently and appropriately with genetic testing?     

CT‐Guided,Minimally Invasive,Postmortem Needle Biopsy Using the B‐Rob II Needle‐Positioning Robot

CT‐guided, minimally invasive needle biopsy techniques can be used to retrieve tissue or body fluid samples for histologic tissue diagnoses in forensic investigations. The purpose of this study was an evaluation of CT‐guided needle‐positioning robot B‐Rob II. To operate under CT guidance, we adopted the B‐Rob II robotic needle placement system and its workflow. The accuracy and speed of the procedure were tested on a gelatin phantom in a series of 21 biopsies. We achieved an average needle placement accuracy of 1.8 mm (±1.1 mm) using robotic assistance. The procedure required an average of 2 min 21 s. The needle placement accuracy for minimally invasive needle biopsies using the B‐Rob II biopsy robot is sufficiently accurate and fast for forensic postmortem examinations of focal organ changes. Further tests will be performed to test the feasibility of the robot for performing biopsies of focal organ changes in human bodies.     

Switzerland and the EU: the puzzling effects of Europeanisation without institutionalisation

Switzerland is not a member of the EU and in 1992 refused to join the European Economic Area (EEA) treaty in a popular vote. A conservative majority preferred to keep utmost national autonomy, and consequently, relations between the EU and Switzerland are regulated by a series of bilateral treaties. This process of Europeanisation without institutionalisation has led to profound changes of Swiss politics over the last two decades. While many effects of economic liberalisation and internationalisation are similar to those found in EU countries, some specific problems like the acceleration of immigration present rising social conflict. Social cleavages between urban and rural regions, and between capital and labour are deepening. The continuous rise of the conservative nationalist Swiss People's Party and the growing polarisation between the political Right and Left have put the traditional political culture of accommodation and power sharing at risk. Twenty years after the No-vote on the EEA-treaty, Switzerland is a divided country. Why do Swiss politicians still practice consensus democracy, and what does the divide mean for the future relations between the EU and Switzerland?     

Correspondence

‘Machiavelli's solitude’ is a new English translation by Ben Brewster of a lecture delivered by Louis Althusser in 1977, so far unpublished in French. O'Hagan presents it as exemplifying a side of Althusser which is often neglected: his skill as lecturer and stylist. He compares the content of this 1977 lecture with that of an earlier series of lectures on the same theme, delivered by Althusser at the École Normale Supérieure in 1972. He suggests that there is a striking shift in emphasis in Althusser's political and philosophical position between the two, in particular a move towards a more negative view of the role of the law in a popular democracy. In passing O'Hagan reflects on changing fashions in the writing of intellectual history.     

Academic freedom 1979: The West German case

Abstract

Given the continued significance of ideology as a social and political phenomenon, political science must consider the important contributions made to ideology theory made over the last thirty years by Louis Althusser. In this essay, I offer a critical exegesis of Althusser's views, focusing on the concept of reading, on the various conceptions of ideology held by Althusser, on the distinction Althusser made between ideology and science, and on his theory of the subject. This study of his thought makes three claims: (1) that Althusser's views, billed as a radical break with bourgeois thought, can be assimilated easily into social scientific understandings about ideology; (2) that Althusser's theory has internal difficulties rooted in the tension between positive and negative conceptions of ideology; and, (3) that Althusser left unanswered the key question of the means to ideological liberation.     

Cops,Teachers, and the Art of the Impossible: Explaining the Lack of Diffusion of Innovations That Make Impossible Jobs Possible

In their 1990 book Impossible Jobs in Public Management, Erwin C. Hargrove and John C. Glidewell argue that public agencies with limited legitimacy, high conflict, low professional authority, and weak agency myths have essentially impossible jobs. Yet some such positions have proven operationally possible. For example, over a 17‐year period, the New York City Police Department achieved dramatic reductions in crime. A second impossible job discussed by James Q. Wilson, the urban school superintendent, has also proven possible, with Washington, D.C., having considerable success educating disadvantaged children. However, these successes in urban crime control and public schooling have not been widely copied. Building on the work of Manuel P. Teodoro, the authors use these cases to discuss how the inflexibility of personnel systems and political costs of disruptive reforms combine with the professional norms and progressive ambition of agency leaders to limit the diffusion of innovations in law enforcement and schooling. The article concludes with hypotheses for future testing.     

Independence day explosion on lovers key

The display of fireworks is a popular holiday celebration in the United States. Because injuries due to recreational fireworks-related explosions among private consumers are relatively common, the sale of fireworks is regulated by the federal government and is also limited by state and local laws. In contrast, because fireworks display companies are under tight safety regulations, explosions in the professional pyrotechnics industry are uncommon occurrences, and the literature contains rare reports of injuries and fatalities resulting from such explosions. We report the 2003 Fourth of July commercial fireworks explosion on Lovers Key in southwest Florida that resulted in five fatalities. Events occurring during the investigation of the scene of this explosion illustrate the unique considerations and hazards for medicolegal death investigators, law enforcement and other investigative agencies. Additionally, this case demonstrates unusual aspects of the postmortem examinations performed on victims of fireworks-related incidents.     

Recovery and detection of urea nitrate in traces

Urea nitrate (uronium nitrate, UN) is a powerful improvised explosive, frequently used by terrorists in the Israeli arena. It was also used in the first World Trade Center bombing in New York in February 1993. It is difficult to identify UN in postexplosion debris, because in the presence of water it readily decomposes to its original components, urea and nitric acid. A method for the recovery and detection of urea nitrate in traces is described. The residues are extracted with hot acetone, and the extract chromatographed on chromosorb G-HP. The eluent is analyzed by liquid chromatography mass spectrometry using atmospheric pressure chemical ionization (APCI). By applying this technique, we were able to identify urea nitrate in actual exhibits. It was found that UN can be also formed during the analytical procedure, by certain combinations of urea, nitrate ions, and a source of protons and, hence, the presence of the characteristic adduct ion does not necessarily indicate an "authentic" urea nitrate. Several solutions are suggested to overcome this ambiguity.     

Sudden cardiac death due to giant cell inflammatory processes

Granulomatous inflammation of the myocardium may occur in a number of systemic disease processes including those with infectious etiologies such as fungal, mycobacterial and parasitic infections, as well as hypersensitivity reactions, and rarely autoimmune disorders. In many of these disorders, giant cells are components of the inflammatory infiltrate. Systemic granulomatous processes of unknown pathogenesis, most notably sarcoidosis, may also be associated with involvement of the myocardium. Occasionally, these disorders are associated with sudden death due to pathologic involvement of the heart. In contrast, giant cell myocarditis, also known as idiopathic myocarditis, a rare, frequently fulminant and fatal disorder of unknown etiology, is isolated to the heart and lacks systemic involvement. This disorder is most commonly diagnosed at autopsy. We present two cases in which sudden death resulted from a giant cell inflammatory process affecting the myocardium. Both individuals lacked antemortem diagnoses and collapsed at their respective places of employment. These cases compare and contrast the clinical and pathologic issues involved in the differential diagnoses of the subgroup of sudden cardiac deaths resulting from giant cell inflammatory processes that affect the myocardium, as well as the value of histologic examination and immunohistochemical studies.     

Is breast really best? Risk and total motherhood in the National Breastfeeding Awareness Campaign

From June 2004 to April 2006, cosponsored by the U.S. Department of Health and Human Services and the Ad Council, the National Breastfeeding Awareness Campaign (NBAC) warned women that not breast-feeding put babies at risk for a variety of health problems. "You'd never take risks before your baby is born. Why start after?" asked televised public service announcements over images of pregnant women logrolling and riding a mechanical bull. The NBAC, and particularly its message of fear, neglected fundamental ethical principles regarding evidence quality, message framing, and cultural sensitivity in public health campaigns. The campaign was based on research that is inconsistent, lacks strong associations, and does not account for plausible confounding variables, such as the role of parental behavior, in various health outcomes. It capitalized on public misunderstanding of risk and risk assessment by portraying infant nutrition as a matter of safety versus danger and then creating spurious analogies. It also exploited deep-seated normative assumptions about the responsibility that mothers have to protect babies and children from harm and was insufficiently attentive to the psychological, socioeconomic, and political concerns of its intended audience. Critical analysis of the NBAC suggests that future health campaigns would benefit from more diverse review panels and from a greater focus on providing accurate risk information about probabilities and trade-offs in order to enable informed decision making.