My Path to Bioethics.

In this series of essays, The Road Less Traveled, noted bioethicists share their stories and the personal experiences that prompted them to pursue the field. These memoirs are less professional chronologies and more descriptions of the seminal touchstone events and turning points that led-often unexpectedly-to their career path.

Discrimination and anger control as pathways linking socioeconomic disadvantage to allostatic load in midlife.

OBJECTIVE: Recent evidence suggests that experiences of discrimination contribute to socioeconomic status health disparities. The current study examined if the experience and regulation of anger-an expected emotional response to discrimination-serves as an explanatory factor for the previously documented links between socioeconomic disadvantage (SED), discrimination, and allostatic load. METHODS: Data were drawn from the second wave of the Midlife in the United States (MIDUS) study and included 909 adults who participated in the biomarkers subproject. RESULTS: Results revealed that perceived discrimination was associated with higher levels of allostatic load. Furthermore, we found evidence that perceived discrimination and anger control sequentially explained the relationship between SED and allostatic load, such that greater discrimination was associated with lower levels of anger control, which, in turn accounted for the effects of discrimination on allostatic load. These results remained significant after controlling for negative affect, positive affect, other forms of anger expression, as well as demographic covariates. CONCLUSIONS: Our findings suggest that low anger control may be an important psychological pathway through which experiences of discrimination influence health.

Socioeconomic status discrimination and C-reactive protein in African-American and White adults.

OBJECTIVES: We examined the association between socioeconomic status (SES) discrimination and C-reactive protein (CRP) in a biracial cohort of middle-aged adults using an intersectionality framework. METHODS: Participants were 401 African-American and White adults from a population-based cohort in the Southeastern United States. SES discrimination was self-reported with a modified Experiences of Discrimination Scale, and CRP levels were assayed from blood samples. Linear regression analyses were used to examine the associations among SES discrimination, race, education, and CRP after controlling for age, gender, racial and gender discrimination, financial and general stress, body mass index, smoking, sleep quality, and depressive symptoms. Intersectional effects were tested using race×SES discrimination, education×SES discrimination and race×education×SES discrimination interactions. RESULTS: Adjusting for sociodemographics, racial discrimination, gender discrimination, and all relevant two-way interaction terms, we observed a significant race×education×SES discrimination interaction (p=0.019). In adjusted models stratified by race and education, SES discrimination was associated with elevated CRP among higher educated African-Americans (ß=0.29, p=0.018), but not lower educated African-Americans (ß=-0.13, p=0.32); or lower educated (ß=-0.02, p=0.92) or higher educated (ß=-0.01, p=0.90) Whites. CONCLUSIONS: Findings support the relevance of SES discrimination as an important discriminatory stressor for CRP specifically among higher educated African-Americans.

Comparative Approaches to Genetic Discrimination: Chasing Shadows?

Genetic discrimination (GD) is one of the most pervasive issues associated with genetic research and its large-scale implementation. An increasing number of countries have adopted public policies to address this issue. Our research presents a worldwide comparative review and typology of these approaches. We conclude with suggestions for public policy development.

Contrastes regionales de la discriminación laboral hacia los jóvenes en México / Contrasting regional employment discrimination towards young people in Mexico / Contrastes regionais da discriminação no mercado de trabalho em relação aos jovens no Mexico

Las condiciones de los jóvenes en México distan de ser alentadoras, máxime en situación de crisis económica y su incidencia en los mercados de trabajo, donde una de las primeras causales de despido es la poca experiencia laboral. El presente trabajo busca exponer las condiciones precarias a las que se enfrentan los jóvenes en los mercados de trabajo en México entre 2000 y 2010, comparando las diferentes regiones, utilizando los microdatos de las muestras censales de población y construyéndose índices de segregación ocupacional y discriminación salarial y educativa. Los resultados muestran el bajo reconocimiento de sus esfuerzos por adquirir formación y capacidades, reflejado en sus precarios ingresos inmediatos. Las diferencias entre los estados van en aumento, “hipotecando” su bienestar social y desaprovechando el remanente del bono demográfico.

The conditions of young people in Mexico are far from encouraging, especially in a situation involving an economic crisis and its impact on labor markets, in which one of the first grounds for dismissal is limited work experience. This article seeks to highlight the precarious conditions that young people faced in the labor market in Mexico between 2000 and 2010. The study compares the different regions using census microdata from population samples and builds indexes that cover occupational segregation and wage and educational discrimination. The results demonstrate the very low recognition of young people’s efforts to acquire training and skills, which was reflected in their low salaries. The differences between the working conditions in the different states keep increasing, “mortgaging” their social welfare and not taking advantage of what’s left of their demographic bonus.

As condições dos jovens no México estão longe de ser animadoras, especialmente em uma situação de crise econômica e seu impacto no mercado de trabalho, no qual um dos primeiros motivos de demissão é a pouca experiência de trabalho. Este artigo procura expor as condições precárias que os jovens enfrentam no mercado de trabalho no México entre 2000 e 2010, comparando as diferentes regiões, utilizando os microdados das amostras de recenseamento da população e construindo índices de segregação ocupacional e discriminação salarial e educacional. Os resultados mostram o baixo reconhecimento dos seus esforços para adquirir formação e competências refletidas em sua renda imediata precária. As diferenças entre os estados estão em ascensão, “hipotecando” o seu bem-estar social e desperdiçando o bônus demográfico remanescente.

Global trends on fears and concerns of genetic discrimination: a systematic literature review.

Since the 1990s, developments in the field of genetics have led to many questions on the use and possible misuse of genetic information. 'Genetic discrimination' has been defined as the differential treatment of asymptomatic individuals or their relatives on the basis of their real or assumed genetic characteristics. Despite the public policy attention around genetic discrimination, there is currently still much confusion surrounding this phenomenon. On the one hand, there is little evidence of the occurrence of genetic discrimination. On the other hand, it appears that people remain concerned about this theme, and this fear influences their health and life choices. This article makes use of a systematic literature review to investigate what is already known about the nature, extent and background of these fears and concerns. The 42 included studies have found considerable levels of concerns about genetic discrimination. Concerns dominate in insurance contexts and within personal interactions. The extent of concerns appears to vary depending on the type of genetic illness. Furthermore, installed laws prohibiting genetic discrimination do not seem to alleviate existing fears. This raises important questions as to the origins of these fears. Based on the findings, recommendations for future research are made. First, research on the background of fears is needed. Second, future research needs to assess more fully all different forms (for example, direct and indirect) of genetic discrimination. Thirdly, it has to be studied whether genetic discrimination is a form of discrimination that is distinguishable from discrimination based on an illness or disability. Finally, a last element that should be addressed in future research is the most recent developments in research on genomics, such as next-generation sequencing or genome-wide association studies.

La estigmatización social de la obesidad / The social stigma of obesity

Las personas con exceso de peso presentan un mayor riesgo de padecer ciertas enfermedades crónicas y muerte prematura. Sin embargo, las consecuencias fisiológicas no se limitan a los síntomas y a los signos sanitarios sino que transcienden al campo social. De hecho, la estigmatización y la discriminación que sufren las personas obesas se ha comprobado en múltiples áreas (laboral, familiar, educativa, etc.). Lo que puede contribuir a mermar la calidad de vida del paciente. Desde una perspectiva de género, en la bibliografía parece que hay evidencias de que los efectos sociales indeseables derivados de la obesidad afectan más a las mujeres que a los hombres. Para minimizar el impacto de la obesidad la población adopta de forma proactiva métodos para perder peso. No obstante la solución a este problema no se encuentra en la medicación sino en cambios de los hábitos de vida y en la propuesta de modelos estéticos no discriminatorios. Asimismo es preciso reconocer que la compleja etiología de la obesidad puede ayudar a reducir el estigma del peso y las consecuencias negativas derivadas de esta condición

People who are overweight are at increased risk of certain chronic diseases and premature death. However, the physiological consequences are not limited to health symptoms and signs but transcend the social field. In fact, the stigma and discrimination faced by obese people has been proven in multiple areas (work, family, education, etc...). This can contribute to reduce the quality of patients life. From a gender perspective, in the literature there seems to be evidence that the undesirable social effects of obesity affect women more than men. To minimize the obesity impact people adopt proactive methods to lose weight. However the solution to this problem is not on medication but changes in lifestyle and in the proposal of inclusive aesthetic models. Also it is necessary to clear that the complex etiology of obesity can help to reduce the weight stigma and the negative consequences of this condition

Sex definitions and gender practices. An update from Australia.

In recent years the Australian parliament has been considering the rights to protection from discrimination of intersex and gender identity disorder (GID) people. In 2013 such protections were made law in the amendment to the Sex Discrimination Act 1984, which in turn has influenced Senate inquiries into the medical treatment of intersex people. This year's Australian report describes the purview and the potential ramifications of the inquiry of the Senate Standing Committees on Community Affairs, published in October 2013, into the involuntary or coerced sterilization of intersex people in Australia.

Responding to discriminatory requests for a different healthcare provider.

Patient requests for a healthcare provider of a particular race or sexual orientation create a conflict of obligations. On the one hand, providers have a duty to deliver clinically indicated care consistent with patient preferences. On the other hand, providers have legal, professional, and organizational assurances that they should not suffer workplace discrimination. Protecting healthcare providers from harm while maintaining obligations to patients requires unambiguous messaging to both parties. Providers need to be clear that their organization will not be complicit in discrimination against them, instead supporting their needs and preferences for management of the situation. In a context of patient-centered care, harm principle-based boundaries of respect for autonomy must be defined. A Caregiver preference guideline developed and used at University Health Network, Toronto provides a standardized way for the organization to decide when it will honor patient requests for providers of a particular background. This process stresses dialogue, assessment of clinical feasibility, and empowerment and support for affected care providers.

Comentario Editorial: Educación y Prejuicio / Editorial Comment: Education and Prejudice

Se analiza el concepto de prejuicio desde diferentes enfoques inter e intradisciplinares así como desde una perspectiva histórica que partiendo desde el más puro universalismo ilustrado ha llegado a la globalización actual por el intermediario del relativismo cultural que caracterizó a las sociedades de los siglos XIX y XX. A continuación se analizan las implicaciones que esto tiene para la sociedad actual y se justifica el papel de la educación como instrumento para la solución de los problemas que emanan de las distintas formas de prejuicio. Esta justificación se efectúa a partir de las propuestas que emanan de DESECO para demostrar la importancia de la cooperación en la erradicación de las distintas formas de discriminación (AU)

We analyzes the concept of prejudice from different inter and intradisciplinary approaches well as from a historical perspective, starting from the purest enlightened universalism has come to today's globalization through the intermediary of cultural relativism that characterized the societies of the 19th and 20th century. Then we analyze the implications this has for society and justifies the role of education as a tool for solving problems arising from different forms of prejudice. This justification is made from DESECO's proposals to demonstrate the importance of cooperation in eradicating the various forms of discrimination (AU)

[The way out of discrimination: a process of social change]. / Sortir de la discrimination, un processus de changement social.

When dealing with stigmatisation, it is necessary to work on destigmatisation. The group as a community has social values of which "stigma" is an indicator. Psychiatry professionals have a major role to play in the process of destigmatisation.

Evolving perspectives on genetic discrimination in health insurance among health care providers.

Previous studies have documented that concerns about genetic discrimination (GD) may influence access to and participation in medically necessary care. We sought to characterize how GD issues influence current cancer genetics professional (CGP) practice, determine if their attitudes regarding GD have changed over time, and compare their knowledge and attitudes regarding laws prohibiting GD to a contemporary cohort of non-genetics clinicians. Members of the National Society of Genetic Counselors Familial Cancer Special Interest Group were invited to complete a 39 item online survey, adapted from previously published instruments. The resulting data were compared to a survey of CGPs published in 2000 and to a contemporary cohort of non-genetics clinicians (n = 1,181). There were 153 qualified respondents. Compared to the historical CGP cohort (n = 163), a significantly greater proportion said they would bill insurance for the cost of genetic testing for themselves (P < 0.0001). Most CGPs (94%) considered the risk of GD to be low to theoretical, concordant with 64% who expressed confidence in existing federal laws prohibiting GD. The mean knowledge score of CGPs regarding GD protective laws was significantly greater than that of non-genetics clinicians (P < 0.001). As barometers of change, CGPs show a migration in opinion over the past 8 years, with decreased fear of GD and greater knowledge of laws prohibiting GD compared to non-genetics clinicians. Better knowledge of GD and protective legislation, may facilitate non-genetics clinician utilization of genetics and personalized medicine.