Highlights of this issue [CMAJ

Highlights of this issue

CMAJ 1999;161:1097

Perspectives on human genetics

Gene testing in the biotech century: Are physicians ready?

Gone FISHin' for genes

Second-guessing a second primary

Genetic fingerprinting in the study of tuberculosis transmission

Waiting list grows for BC's Hereditary Cancer Program

Sophie Kulaga and colleagues explain how genetic fingerprinting of Mycobacterium tuberculosis isolates using restriction fragment length polymorphism (RFLP) analysis has vastly improved our ability to detect shifts in the microepidemiology of TB. Doug Demetrick describes how fluorescence in situ hybridization (FISH) allows direct visualization of individual chromosomes or genes in tissue or cell specimens for cancer diagnosis.

As Heather Kent reports on the demand for genetic testing, Tim Caulfield foresees that physicians will inevitably be legally and ethically obligated to communicate the difficult concepts of probabilistic risk, insurance discrimination and psychological implications. He quotes L.B. Andrews as saying that "malpractice suits in this area are inevitable because physicians are unprepared for the onslaught of genetic information."

And then there are patients like Susan Harris who experience the agony of being caught between the development of new technology and its subsequent implementation.

E-psychiatry

E-psychiatry: the patient-psychiatrist relationship in the electronic age

Foreseeing e-psychiatry as inevitable in the electronic age, Mary and Bob Seeman discuss the difficult issues of liability, reimbursement and privacy using hypothetical email dialogue between patients and psychiatrists. Although physician nonresponse to patient-initiated queries might be most judicious, this may be considered negligent in the troubling case of a patient expressing suicidal intent by email.

Technology in the ICU

Life support in the intensive care unit: a qualitative investigation of technological purposes

The promise and the paradox of technology in the intensive care unit

After attending 25 rounds and 11 family meetings in which the withdrawal or withholding of advanced life support was addressed and after interviewing 25 members of the health care team, Deborah Cook and colleagues conclude that decisions are made not only on whether to use life-support technology but also on how to use it with respect to the timing, intensity and number of technologies. They question the ability of advance directives to reflect this complexity. In an editorial Deborah Cook and William Sibbald comment on the paradox that many ICU technologies, such as the pulmonary artery catheter, have never undergone rigorous evaluation before their dissemination and that others considered beneficial, such as mechanical ventilation, have demonstrated the potential to do harm.

Specialty spotlights

Several experts describe the promise and problems associated with new technologies. New ceramic bearing surfaces and improved metalmetal prostheses may prolong the durability of joint replacements. Nocturnal dialysis, conducted by the patient at home during sleep, promises quality and comfort at two-thirds the cost of in-centre hemodialysis. The Guglielmi detachable coil can be deposited through a microcatheter into an intracranial aneurysm, where it promotes thrombosis and prevents rebleeding. And these are just a few of the technologies featured.