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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.11.015 Byline: Fiona Alice Miller, Catherine Ahern, Christopher A. Smith, Erin A. Harvey Keywords: Genetic medicine; New genetics professionals; Metaphors; Attitudes; Science media Abstract: Developments in genetics are expected to have a profound impact on health and health care, yet much remains to be learned about how leaders of the research and clinical communities view and frame these expectations. We conducted a comprehensive review of editorials about developments in genetic medicine published in scientific journals, to understand what this elite group of commentators anticipate. Editorials are an important resource for understanding how the new genetics is understood and portrayed. They allow leaders of the research and clinical communities to communicate to each other and informed publics, and are a forum for the expression of widely shared elite beliefs and opinions. We analyzed selected editorials for content and metaphoric language to explore attitudes and expectations concerning developments in genetic science and technology. Our analysis suggests that a diverse group of leaders of the research and clinical communities are remarkably uniform in their discourse about the future of genetic medicine. Editorialists have great expectations for developments in basic science and in the comprehension and management of disease. They also anticipate important effects on health care, notably the health care professions, and on wider society. Yet editorialists do not discuss these prospects in a consistently positive or optimistic manner, and they utilize metaphoric imagery that emphasizes the inexorable nature of progress, and the sometimes ominous manner in which developments emerge. The dominant discourse of editorialists claims authority for clinicians and researchers and asserts a broad sphere of expertise, but it also positions these leaders as handmaidens of a science they do not control, and insists that their ultimate contribution is to prepare themselves and others for the inexorable march of progress. Author Affiliation: McMaster University, Hamilton, Ontario, Canada

We report on a qualitative analysis of interviews with 14 genetic counsellors in Ontario, Canada about the implications of developments in molecular genetic knowledge for disease definition and classification. Genetic counsellors express a restrained set of hopes and expectations about the utility of genetic diagnoses. They identify several limitations faced by available genetic tests, limitations that constrain the significance of genetic information in disease identification and clinical management. Yet they also emphasize the fundamental nature of genetic information, its decisive role in specifying disease causation, and its significance for disease classification. The decisive nature of genetic information means that, in some cases, genetic tests foster change in disease categories. Diseases are redefined by the 'ruling in' of atypical cases demonstrating a broader spectrum of clinical effects, or the 'ruling out' of typical cases with classic clinical presentations that are better assigned to other (or no) causes. These redefinitions can be profoundly consequential, producing several kinds of uncertainty: What do we call this state of being? How do we manage it clinically? And, what are the social entitlements of individuals in this state? Though limited today, such complex effects can be expected to increase, alongside the growing diagnostic power of molecular genetics. Keywords: Canada; Genetics; Disease classification (nosology); Diagnosis; Genetic counsellors