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?     

Should Europe disturb historians? On the importance of methodology and interdisciplinarity

Does the emergence of the European Union (EU) disrupt the frames of reference of the contemporary history of Europe to such an extent that historians distrust it? It would seem that methodological Euroscepticism exists. European integration arouses scepticism among some in the community of historians of contemporary Europe, since the conceptual underpinnings of that history cannot in themselves account for European integration. This billet expresses, more than a word of caution, a call for enhanced dialogue on the EU as an object of study among the different strands of historical studies and different disciplines. On the one hand, some of the analyses provided by historical studies on contemporary Europe constitute a fertile source for the study and understanding of European integration, notably in the field of history. Using them can stimulate the development in the European studies field of new concepts, new representations and new hypotheses for grasping the EU as a reality and a comparatively new object of academic interest. On the other hand, the critical study of the EU conducted in the specific field of the history of the EU questions and sheds a new light on the analytical categories of contemporary European history. In this regard, the fruitful interaction between history, political geography, law and political science can enrich contemporary European history. Interdisciplinary studies on European integration notably enable us to decentre notions of sovereignty, territory and democracy, which have classically taken the nation state as their reference in broad explanatory narratives of contemporary European history. Research mutualisation would offer all the potential interpretative and analytical benefits of the conceptual and methodological rethink of our various disciplines and of European integration as an object of study.     

The Fonds de Moscou,TICOM, and the Nerve of a Spy

Two newly available sources for World War II intelligence history consist of French pre-war mainly intelligence documents held for years in the Soviet Union and recently returned to France and of German pre-war documents, primarily cryptologic, held for years in the United Kingdom and recently restituted to the Federal Republic. In addition, a memorandum of 1930 reveals that the future spy Hans-Thilo Schmidt frequently visited the factory making the Enigma machine and coolly asked the manufacturer for basic details, which they gave him and which he later sold to the French, leading eventually to the Allied reading of Engima-enciphered messages during World War II.     

Apnea, glial apoptosis and neuronal plasticity in the arousal pathway of victims of SIDS

Of 27,000 infants whose sleep-wake characteristics were studied under the age of 6 months, 38 died unexpectedly 2-12 weeks after the sleep recording in a pediatric sleep laboratory. Of these infants, 26 died of sudden infant death syndrome (SIDS), and 12 of definitely identified causes. The frequency and duration of sleep apneas were analysed. Sleep recordings and brainstem histopathology were studied to elucidate the possible relationship between sleep apnea and neuropathological changes within the arousal system. Immunohistochemical analyses were conducted using tryptophan hydroxylase (TrypH), a serotonin synthesizing enzyme, and growth-associated phosphoprotein 43 (GAP43), a marker of synaptic plasticity. The terminal-deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) method was used for apoptosis. The pathological and physiological data were correlated for each infant. In the SIDS victims, statistically significant positive correlations were seen between the number of TrypH-positive neurons in the dorsal raphe nucleus of the midbrain and the duration of central apneas (p = 0.03), between the number of TUNEL-positive glial cells in the pedunculopontine tegmental nucleus (PPTN) and the average number of spines in GAP43-positive neurons in the PPTN (p = 0.04). These findings in the dorsal raphe nucleus of the midbrain and PPTN, that play important roles in the arousal pathway suggest a possible link between changes in arousal and SIDS.     

The Russian Bailiffs Service and the Enforcement of Civil Judgments

A lawyer and economist examines the Russian Bailiffs Service. Results of a 1999 survey of bailiffs, interviews with Bailiffs Service officials, and recent news articles are analyzed to evaluate the administrative and incentive structures of the agency. Attention is focused on the government's relationship with bailiffs and specific policy suggestions to improve the agency's effectiveness are made.     

An historical theory of intelligence

This article consists of three parts. First, ‘The past’ defines physical and verbal intelligence and maintains that intelligence, after centuries of insignificance, rose to prominence in modern times as a consequence of the increase in intelligence targets and the growth of verbal intelligence. Second, ‘The present’ explains that the function of intelligence is to optimize resources, that it is but an auxiliary element in war, and that it is necessary to the defense but is only contingent to the offense. Third, ‘The future’ articulates intelligence's two perpetual insoluble problems: foretelling everything and getting leaders to accept information that they do not like.     

Flaws in the U.S. Food and Drug Administration's rationale for supporting the development and approval of BiDil as a treatment for heart failure only in black patients

The U.S. Food and Drug Administration's (FDA) rationale for supporting the development and approval of BiDil (a combination of hydralazine hydrochloride and isosorbide dinitrate; H-I) for heart failure specifically in black patients was based on under-powered, post hoc subgroup analyses of two relatively old trials (V-HeFT I and II), which were further complicated by substantial covariate imbalances between racial groups. Indeed, the only statistically significant difference observed between black and white patients was found without any adjustment for potential confounders in samples that were unlikely to have been adequately randomized. Meanwhile, because the accepted baseline therapy for heart failure has substantially improved since these trials took place, their results cannot be combined with data from the more recent trial (A-HeFT) amongst black patients alone. There is therefore little scientific evidence to support the approval of BiDil only for use in black patients, and the FDA's rationale fails to consider the ethical consequences of recognizing racial categories as valid markers of innate biological difference, and permitting the development of group-specific therapies that are subject to commercial incentives rather than scientific evidence or therapeutic imperatives. This paper reviews the limitations in the scientific evidence used to support the approval of BiDil only for use in black patients; calls for further analysis of the V-HeFT I and II data which might clarify whether responses to H-I vary by race; and evaluates the consequences of commercial incentives to develop racialized medicines. We recommend that the FDA revise the procedures they use to examine applications for race-based therapies to ensure that these are based on robust scientific claims and do not undermine the aims of the 1992 Revitalization Act.     

MAKING THE CONNECTION: LEGAL ADVOCACY AND MENTAL HEALTH SERVICES

Recent research documenting the magnitude of mental health needs among juveniles has intensified calls for interventions that both address clinical needs and decrease recidivism. This article first examines research supporting the movement toward community mental health treatment for juveniles and argues that effective legal advocacy requires interdisciplinary coordination to identify and address mental health needs. Next, we present one jurisdiction's model for increasing access to community‐based mental health services and discuss how attorneys can apply the model to achieve this end.     

Demographic change and the demand for environmental regulation

Environmental regulation in the United States has increased pollution abatement expenditure as a percentage of gross national product from 1.7 percent in 1972 to an estimated 2.6 percent in the year 2000. This rise in regulation has coincided with demographic and economic changes that include rising educational levels, a growing minority population, an aging population, and decreasing employment in polluting industries. This paper examines whether these trends have contributed to increasing aggregate demand for environmental regulation. New evidence on voting on environmental ballots in California, local government environmental expenditures across the United States, and 25 years of congressional voting on environmental issues is examined to document the demographic correlates of environmental support. Minorities and the more educated are more pro‐green, whereas manufacturing workers oppose environmental regulation. While demographics help explain observed differences in environmental support and thus can help predict long trends in the “average voter's” environmentalism, environmentalism varies substantially year to year unrelated to population demographics. © 2002 by the Association for Public Policy Analysis and Management.