Psychological and behavioural impact of returning personal results from whole-genome sequencing: the HealthSeq project

Providing ostensibly healthy individuals with personal results from whole-genome sequencing could lead to improved health and well-being via enhanced disease risk prediction, prevention, and diagnosis, but also poses practical and ethical challenges. Understanding how individuals react psychologically and behaviourally will be key in assessing the potential utility of personal whole-genome sequencing. We conducted an exploratory longitudinal cohort study in which quantitative surveys and in-depth qualitative interviews were conducted before and after personal results were returned to individuals who underwent whole-genome sequencing. The participants were offered a range of interpreted results, including Alzheimer’s disease, type 2 diabetes, pharmacogenomics, rare disease-associated variants, and ancestry. They were also offered their raw data. Of the 35 participants at baseline, 29 (82.9%) completed the 6-month follow-up. In the quantitative surveys, test-related distress was low, although it was higher at 1-week than 6-month follow-up (Z=2.68, P=0.007). In the 6-month qualitative interviews, most participants felt happy or relieved about their results. A few were concerned, particularly about rare disease-associated variants and Alzheimer’s disease results. Two of the 29 participants had sought clinical follow-up as a direct or indirect consequence of rare disease-associated variants results. Several had mentioned their results to their doctors. Some participants felt having their raw data might be medically useful to them in the future. The majority reported positive reactions to having their genomes sequenced, but there were notable exceptions to this. The impact and value of returning personal results from whole-genome sequencing when implemented on a larger scale remains to be seen

Recording therapy sessions: What do clients and therapists really think?

Aims: Recording therapy sessions has become part of routine practice amongst trainee psychotherapists. To date most research has focused on the benefits of recording sessions to support clinical supervision. There are few data about the benefits or risks for clients. This study aimed to explore the views of clients who had had their therapy sessions recorded and therapists who had recorded sessions. Design: Five clients and 25 therapists completed a qualitative survey, the results of which were analysed using thematic analysis. Findings: All clients and several therapists reported that the recording devices are soon forgotten. Both therapists and clients reported the benefits of recording as being purely for the therapist with none identified for clients. Conclusions: It was observed that clients perhaps did not always understand how recordings were used, suggesting the need for clearer practice guidance. © 2013 British Association for Counselling and Psychotherapy

Sourcing illegal drugs as a hidden older user: the ideal of ‘social supply’

Aims: At a time of growing awareness regarding the non-commercial supply of illegal drugs between friends, this article explores the significance of so-called ‘social supply’ for a group of ‘hidden’ users of illegal drugs aged 40 and over. Methodology: Semi-structured interviews were conducted with 30 users of illegal drugs aged 40 and over who were not in contact with the criminal justice system or treatment agencies regarding their use. Participants were recruited using snowball sampling. Findings: Accessing drugs through the commercial market was considered as a less attractive proposition than social supply by the participants. The majority used only socially supplied drugs, with some engaging commercial dealers when socially supplied product was unavailable. A handful sourced drugs exclusively through the commercial market. Some were home growers of cannabis, and a small number had drifted into social supply themselves. Conclusions: Social supply was seen in a far more favourable light than commercial transactions by our participants, and acted as an ideal against which all other acts of sourcing were compared. Moreover, social supply was often an integral facet of the drug using experience and served to validate and enhance that experience. The relatively benign, non-predatory nature of the social supply engaged in by the participants lends support to calls for some reform of the offence of supply in UK law

A Thousand Contradictory Ways: Addiction, Neuroscience, and Expert Autobiography

Neuroscientific accounts of addiction are increasingly influential in health and medical circles. At the same time a diverse, if equally scientifically focused, opposition to addiction neuroscience is emerging. In this struggle over the merits of addiction neuroscience are elements of a uniquely 21st-century public engagement with science. No longer trusted by the public as the unerring source of objective knowledge about the world, science is, at least in some contexts, increasingly treated as just one voice among many. Observing the difficulties this loss of faith in science poses for effective action on pressing issues such as climate change, philosopher Bruno Latour develops a different (ecological) approach to scientific knowledge, one that for the first time allows scientists (and other “moderns”) to understand it for what it really is and locate it “diplomatically” alongside other modes of knowing. In this article, I ask whether a similar innovation is needed to allow more effective understanding of addiction. I explore this question by analyzing two recent, widely discussed, popular books (Marc Lewis’s Memoirs of an Addicted Brain: A Neuroscientist Examines His Former Life on Drugs, 2011 and Carl Hart’s High Price: A Neuroscientist’s Journey of Self-discovery that Challenges Everything You Think You Know About Drugs and Society, 2013) as well as reviews of these books. Written by neuroscientists, and drawing heavily on personal memoir to illustrate and ratify their competing views on drugs and addiction, both books crystallize contemporary dilemmas about science, empiricism, and the nature of evidence and truth. How are we to understand their mix of “scientific fact” and individual self-observation, what does this mix suggest about scientific knowledge, and what are its implications for dominant notions of “evidence-based” drug policy and treatment? I argue that these books both trouble and reinforce our taken-for-granted distinctions between science and personal stories, between objectivity and subjectivity, and note the lost opportunities the books represent for a more searching and productive (Latour might say “ecological”) engagement with science

The scientific foundations and associated injury risks of early soccer specialisation

Early specialisation is characterised by formal participation in a single sport at the exclusion of others. Limited data are available to support this approach in the development of soccer players who attain elite status later in life. Of growing concern is the associated increased risk of injury and suggestions that single sport specialisation is a risk factor independent of age, growth, biological maturation and training volumes In the United Kingdom, elite soccer organisations have recently adopted an early sport specialisation approach following the introduction of the Elite Player Performance Plan. A key tenet of this programme is increased opportunities for training through a marked rise in the specified on-pitch hours per week. The accumulation of high training hours may be less of a relevant marker for success, and the impact of such a significant increase in training volume for young athletes who are experiencing a range of growth and maturational processes is currently unknown. This critical commentary includes an evidence based discussion of the effectiveness of early sport specialisation and the potential injury risks associated with such programmes placing a specific focus on elite male youth soccer players. Available data indicate that modifications to the existing EPPP framework could enhance player development and reduce injury risk. Proposed alterations include reduced volume of soccer specific training at key stages of growth and maturation and guidelines for the provision of a greater variety of physical activities that are integrated within other programme components

Not particularly special: critiquing ‘NPS’ as a category of drugs

Novel Psychoactive Substances (NPS) have been a dominant feature of drug discourse for many years now and, in academic, policy and public discourse, have become established as a new – and by implication, distinct – category of drugs. We argue that this understanding of NPS is fundamentally problematic. Differences within the category are obscured, as are similarities between NPS and more established categories of drugs. Focusing on NPS as something new, different or particularly special is misleading and counterproductive and can have serious consequences in terms of understanding the bigger picture in relation to illegal drugs more generally. This has led to overestimations of the size of the NPS problem, obfuscation of the common underlying causes of dependent drug use, and the implementation of significant and problematic policy changes. Further, a failure to see the rise in NPS as just one of a number of emerging trends in contemporary drug scenes, alongside the development of online markets or the rise in domestic drug production operations, for example, impairs our ability to understand the wider societal, cultural and theoretical underpinnings of drug use. NPS are not particularly special: treating them as such can have dangerous and far-reaching consequences

Heroin versus cocaine: opposite choice as a function of context but not of drug history in the rat

Rationale Previous studies have shown that rats trained to self-administer heroin and cocaine exhibit opposite preferences, as a function of setting, when tested in a choice paradigm. Rats tested at home prefer heroin to cocaine whereas rats tested outside the home prefer cocaine to heroin. Here we investigated whether drug history would influence subsequent drug preference in distinct settings. Based on a theoretical model of drug-setting interaction, we predicted that regardless of drug history rats would prefer heroin at home and cocaine outside the home. Methods Rats with double-lumen catheters were first trained to self-administer either heroin (25 μg/kg) or cocaine (400 μg/kg) for 12 consecutive sessions. Twenty-six rats were housed in the self-administration chambers (thus, they were tested at home) whereas 30 rats lived in distinct home cages and were transferred to self-administration chambers only for the self-administration session (thus, they were tested outside the home). The rats were then allowed to choose repeatedly between heroin and cocaine within the same session for 7 sessions. Results Regardless of the training drug, the rats tested outside the home preferred cocaine to heroin whereas the rats tested at home preferred heroin to cocaine. There was no correlation between drug preference and drug intake during the training phase. Conclusion Drug preferences were powerfully influenced by the setting but, quite surprisingly, not by drug history. This suggests that, under certain conditions, associative learning processes and drug-induced neuroplastic adaptations play a minor role in shaping individual preferences for one drug or the other

‘Because it’s fun’: English and American girls’ counter-hegemonic stories of alcohol and marijuana use

Girls’ alcohol and other drug (AOD) use are depicted culturally as problematic. In this comparative, qualitative, study the voices of 59 English and American justice-involved girls give a counter-hegemonic portrayal of their alcohol and marijuana use. In their stories we see how their AOD use is pleasurable and boundaried. AOD use involves negotiated risk within the situated context of shared experience and friendship networks that heighten and promote pleasure and fun. The findings offer the opportunity to address the ‘credibility gap’ (Measham 2006) in international health promotion policy. Our aim is to promote the adoption of policy approaches that recognize the complexity of girls’ lives and draw on strategies they have devised

Reporting bias in medical research - a narrative review

Reporting bias represents a major problem in the assessment of health care interventions. Several prominent cases have been described in the literature, for example, in the reporting of trials of antidepressants, Class I anti-arrhythmic drugs, and selective COX-2 inhibitors. The aim of this narrative review is to gain an overview of reporting bias in the medical literature, focussing on publication bias and selective outcome reporting. We explore whether these types of bias have been shown in areas beyond the well-known cases noted above, in order to gain an impression of how widespread the problem is. For this purpose, we screened relevant articles on reporting bias that had previously been obtained by the German Institute for Quality and Efficiency in Health Care in the context of its health technology assessment reports and other research work, together with the reference lists of these articles