Dodge Kenneth A
Center for Child and Family Policy, Duke University, Durham, North Carolina 27708-0545, USA.
Novartis Found Symp. 2008;293:87-97; discussion 97-102, 122-7. doi: 10.1002/9780470696781.ch7.
This chapter argues that implications of the gene-environment interaction revolution for public policy and practice are contingent on how the findings get framed in public discourse. Frame analysis is used to identify the implications of the ways in which findings are cast. The frame of 'defective group' perpetuates racial and class stereotypes and limits policy efforts to redress health disparities. Furthermore, empirical evidence finds it inaccurate. The frame of'defective gene' precludes the adaptive genetic significance of genes. The frame of 'individual genetic profile' offers individualized health care but risks misapplication in policies that place responsibility for disease prevention on the individual to the policy relief of industry and toxic environments. Framing the interaction in terms of 'defective environments' promotes the identification of harmful environments that can be regulated through policy. The 'therapeutic environment' frame offers hope of discovering interventions that have greater precision and effectiveness but risks dis-incentivizing the pharmaceutical industry from discovering drug treatments for 'obscure' gene-environment match groups. Can a more accurate and helpful framing of the gene-environment interaction be identified? Findings that genes shape environments and that environments alter the gene pool suggest a more textured and symbiotic relationship that is still in search of an apt public framing.
本章认为，基因 - 环境相互作用革命对公共政策和实践的影响取决于研究结果在公共话语中的呈现方式。框架分析用于确定研究结果的呈现方式所带来的影响。“缺陷群体”框架延续了种族和阶级刻板印象，并限制了纠正健康差距的政策努力。此外，实证证据表明它不准确。“缺陷基因”框架排除了基因的适应性遗传意义。“个体基因概况”框架提供个性化医疗保健，但在将疾病预防责任归咎于个体而非行业和有毒环境政策缓解措施的政策中存在误用风险。从“缺陷环境”角度构建相互作用促进了对可通过政策进行监管的有害环境的识别。“治疗环境”框架带来了发现更精确、有效的干预措施的希望，但有降低制药行业研发针对“模糊”基因 - 环境匹配群体药物治疗积极性的风险。能否确定一种更准确、更有帮助的基因 - 环境相互作用的框架？基因塑造环境以及环境改变基因库的研究结果表明存在一种更复杂、共生的关系，仍在寻找合适的公共框架。
