Janis Faye Hutchinson

Assessing patient readiness for the clinical adoption of personalized medicine.

Background/Aims: Although pharmacogenomics-based diagnostics and therapeutics are increasingly being translated into personalized medicine applications, relatively little evidence exists about how novel pharmacogenomics-based technologies will be accepted and adopted by patients. It is important to understand the characteristics of genomic diagnostics and targeted therapeutics that might impact utilization or serve as barriers to adoption of these novel technologies in order to formulate appropriate policies and procedures. The objective of this study was to investigate patients’ understanding and knowledge of personalized medicine and the process of decision-making regarding pharmacogenomics testing and targeted therapeutics and to better understand how patients value receiving pharmacogenomics-based care. Methods: We conducted 4 focus groups with 8–10 individuals in each group with patients recruited from out-patient clinics at The Methodist Hospital in Houston, Tex., USA. Results: The use of genomic diagnostics and targeted therapeutics to facilitate personalized medicine has considerable support from patients. However, our data revealed that participants were concerned with issues surrounding privacy and confidentiality of genetic test results, particularly with respect to access of information by insurers, with potential costs of testing and issues related to accuracy of test results. Questions regarding willingness to pay revealed that patients would be more willing to pay out-of-pocket if the disease associated with pharmacogenomic testing for treatment was perceived to be high risk (e.g., colorectal cancer) versus a chronic condition that was perceived as lower risk (e.g., high cholesterol). Conclusion: As the personalized medicine approach is increasingly incorporated into health care, understanding patients’ needs and their readiness to adopt these novel technologies will become progressively more important for the development of appropriate health policies.

The Impact of Perceptions on Interpersonal Interactions in an African American/Asian American Housing Project:

An increasing number of communities in the United States are ethnically diverse. In recent decades, large numbers of immigrants, for example, Mexicans, Central Americans, Latin Americans, and Asian Americans, have been incorporated into predominantly African American urban neighborhoods and communities. An understanding of the nature of interactions in these ethnically, culturally, and sometimes linguistically diverse environments is necessary to enable community members and leaders to deal with changing interactional patterns in their neighborhoods. By recognizing that interpersonal interactions are influenced by ethnicity and by comprehending the impact of ethnicity on social interaction, it may be possible for these dynamic neighborhoods to maintain a sense of community life that includes all ethnic groups. However, information on the effect of immigration on African American lifeway is lacking. A body of literature exists on Chinese American communities in America. These studies include examination of the types of indi-

Relationship between African Admixture and Blood Pressure Variation in the Caribbean

The genetic contribution to blood pressure variance is examined by studying a selected group of genes. Of 368 individuals, 48.1% received one-half or more of their genes from an African ancestor and of this group 18.1 and 17.0% exhibit systolic and diastolic hypertension, respectively. A chi-square test was used to examine the dependence of blood pressure on percentage African ancestry. The chi-square values were not significant for systolic or diastolic pressures. It is likely that other factors are strongly related to African admixture and these factors are the true modifiers of blood pressure.

Exposure and Exclusion: Disenfranchised Biological Citizenship among the First-Generation Korean Americans

Based on fieldwork with a highly uninsured and underinsured Korean American population, this article maps how the current healthcare system in the United States disenfranchises those of marginal insurance status. The vulnerability of these disenfranchised biological citizens is multiplied through exposure to disproportional health risks compounded by exclusion from essential healthcare. The first-generation Korean Americans, who commonly work in small businesses, face the double burden of increased health risks from long, stress-laden work hours and lack of access to healthcare due to the prohibitive costs of health insurance for small business owners. Even as their health needs become critical, their insurance status and costly medical bills discourage them from visiting healthcare institutions, leaving Korean Americans outside the “political economy of hope” (Good, Cult Med Psychiatry 52:61–69, 2001). Through an ethnographic examination of the daily practice of doing-without-health among a marginalized sub-group in American society, this paper articulates how disenfranchised biological citizenship goes beyond creating institutional barriers to healthcare to shaping subjectivities of the disenfranchised.

Karma, reincarnation, and medicine: Hindu perspectives on biomedical research

Prior to the completion of the Human Genome Project, bioethicists and other academics debated the impact of this new genetic information on medicine, health care, group identification, and peoples’ lives. A major issue is the potential for unintended and intended adverse consequences to groups and individuals. When conducting research in, for instance, American Indian and Alaskan native (AI/AN) populations, political, cultural, religious and historical issues must be considered. Among African Americans, the Tuskegee Syphilis Experiment is a reminder of racism and discrimination in this country. The goal of the current study is to understand reasons for participating, or not, in genetic research such as the HapMap project and other genetic/medical research from the perspective of the Indian American community in Houston, Texas. In this article, we report on a topic central to this discussion among Indian Americans: karma and reincarnation. Both concepts are important beliefs when considering the body and what should happen to it. Karma and reincarnation are also important considerations in participation in medical and genetic research because, according to karma, what is done to the body can affect future existences and the health of future descendants. Such views of genetic and medical research are culturally mediated. Spiritual beliefs about the body, tissue, and fluids and what happens to them when separated from the body can influence ideas about the utility and acceptability of genetic research and thereby affect the recruitment process. Within this community it is understood that genetic and environmental factors contribute to complex diseases such as diabetes, hypertension, and cancer; and acknowledgment of the significance of environmental stressors in the production of disease. A commitment to service, i.e. “betterment of humanity,” karmic beliefs, and targeting environmental stressors could be prominent avenues for public health campaigns in this population. This study suggests that minority status does not automatically indicate unwillingness to participate in genetic or medical research. Indian Americans were not skeptical about the potential benefits of biomedical research in comparison to other ethnic minority communities in the United States.