1University of Bern, Institute of Political Science, Fabrikstrasse 8, CH-3012 Bern, Switzerland. Electronic address: email@example.com.
Since Puntam's seminal work on declining levels of social capital, the question of how social trust is formed has reached unprecedented heights of critical enquiry. While most of the current research concentrates on ethnic diversity and income inequality as the main influences driving down generalized trust, we focus on opinion polarization as another potential impact factor on trust. In more detail, we investigate the extent to which polarization over morally charged issues such as homsexuality, abortion and euthanasia affects individuals' likelihood to trust others. We hypothesize that moral issues have a natural tendency to divide societies' opinions into opposing poles and, thus, to challenge social cohesion in modern civil societies. Based on hierarchical analyses of the fifth wave of the World Values Survey (WVS) - comprising a sample of 39 countries - our results reveal that individuals living in countries characterized by more opinion polarization tend to have less trust in other people.
1Skeptic Magazine, Altadena, California, and Chapman University, Orange, California.
To make the case that morality is real, objective, and natural, it will be argued, first, that morals exist in human nature as part of our evolutionary heritage; that morality involves how we think and act toward other moral agents in terms of whether our thoughts and actions are right or wrong with regard to their survival and flourishing; and that moral progress is real, quantifiable, and the result of our improved understanding of causality in the social and moral sciences in the same manner as our understanding of causality has progressed in the physical and biological sciences. A moral starting point is the survival and flourishing of sentient beings.
1King's College London and Guy's & St. Thomas' PET Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, London SE1 7EH, UK; Department of Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
2King's College London and Guy's & St. Thomas' PET Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, London SE1 7EH, UK; Department of Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Department of Radiation Oncology, National Cancer Centre Singapore 169610, Singapore.
3Lung and Mesothelioma Unit, Department of Medical Oncology, KGV Basement, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
4Department of Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Radiology Department, Guys & St. Thomas' NHS Trust, London SE1 7EH, UK.
5King's College London and Guy's & St. Thomas' PET Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, London SE1 7EH, UK; Department of Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK. Electronic address: firstname.lastname@example.org.
18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET/CT) is established for characterising indeterminate pulmonary nodules and staging lung cancer where there is curative intent. Whilst a sensitive technique, specificity for characterising lung cancer is limited. There is recognition that evaluation of other aspects of abnormal cancer biology in addition to glucose metabolism may be more helpful in characterising tumours and predicting response to novel targeted cancer therapeutics. Therefore, efforts have been made to develop and evaluate new radiopharmaceuticals in order to improve the sensitivity and specificity of PET imaging in lung cancer with regards to characterisation, treatment stratification and therapeutic monitoring. 18F-fluorothymidine (18F-FLT) is a marker of cellular proliferation. It shows a lower accumulation in tumours than 18F-FDG as it only accumulates in the cells that are in the S phase of growth and demonstrates a low sensitivity for nodal staging. Its main role is in evaluating treatment response. Methionine is an essential amino acid. 11C-methionine is more specific and sensitive than 18F-FDG in differentiating benign and malignant thoracic nodules. 18Ffluoromisonidazole (18F-FMISO) is used for imaging tumour hypoxia. Tumour response to treatment is significantly related to the level of tumour oxygenation. Angiogenesis is the process by which new blood vessels are formed in tumours and is involved in tumour growth and metastatic tumour spread and is a therapeutic target. Most clinical studies have focused on targeted integrin PET imaging of which αvβ3 integrin is the most extensively investigated. It is upregulated on activated endothelial cells in association with tumour angiogenesis. Neuroendocrine tumour tracers, particularly 68Ga-DOTA-peptides, have an established role in imaging of carcinoid tumours. Whilst most of these tracers have predominantly been used in the research environment, they offer exciting opportunities for improving staging, characterisation, stratification and response assessment in an era of increased personalised therapy in lung cancer.
1Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, 1545 Divisadero Street, San Francisco, California 94115, USA.
2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17177 Stockholm, Sweden.
3Departments of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, California 94158, USA.
4Department of Radiology, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, New Hampshire 03756, USA.
5Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Bethesda, Maryland 20892, USA.
6Departments of Surgery and Radiology, University of California, San Francisco, 1600 Divisadero Street, Box 1710, San Francisco, California 94115, USA.
Several important lessons have been learnt from our experiences in screening for various cancers. Screening programmes for cervical and colorectal cancers have had the greatest success, probably because these cancers are relatively homogenous, slow-growing, and have identifiable precursors that can be detected and removed; however, identifying the true obligate precursors of invasive disease remains a challenge. With regard to screening for breast cancer and for prostate cancer, which focus on early detection of invasive cancer, preferential detection of slower-growing, localized cancers has occurred, which has led to concerns about overdiagnosis and overtreatment; programmes for early detection of invasive lung cancers are emerging, and have faced similar challenges. A crucial consideration in screening for breast, prostate, and lung cancers is their remarkable phenotypic heterogeneity, ranging from indolent to highly aggressive. Efforts have been made to address the limitations of cancer-screening programmes, providing an opportunity for cross-disciplinary learning and further advancement of the science. Current innovations are aimed at identifying the individuals who are most likely to benefit from screening, increasing the yield of consequential cancers on screening and biopsy, and using molecular tests to improve our understanding of disease biology and to tailor treatment. We discuss each of these concepts and outline a dynamic framework for continuous improvements in the field of cancer screening.
Accurate estimation of risk and benefit is integral to good clinical research planning, ethical review, and study implementation. Some commentators have argued that various actors in clinical research systems are prone to biased or arbitrary risk/benefit estimation. In this commentary, we suggest the evidence supporting such claims is very limited. Most prior work has imputed risk/benefit beliefs based on past behavior or goals, rather than directly measuring them. We describe an approach - forecast analysis - that would enable direct and effective measure of the quality of risk/benefit estimation. We then consider some objections and limitations to the forecasting approach.
Sumi Thomas, Yaser Hussein, Sudeshna Bandyopadhyay, Michele Cote, Oudai Hassan, Eman Abdulfatah, Baraa Alosh, Hui Guan,Robert A. Soslow, and Rouba Ali-Fehmi (2016) Interobserver Variability in the Diagnosis of Uterine High-Grade Endometrioid Carcinoma. Archives of Pathology & Laboratory Medicine In-Press.
Reprints: Robert A. Soslow, MD, Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (email: email@example.com).
Context.—Low interobserver diagnostic agreement exists among high-grade endometrial carcinomas.
Objective.—To evaluate diagnostic variability in International Federation of Gynecology and Obstetrics (FIGO) grade 3 endometrioid adenocarcinoma (G3EC) in 2 different sign-out practices.
Design.—Sixty-six G3EC cases were identified from pathology archives of Wayne State University (WSU, Detroit, Michigan) (general surgical pathology sign-out) and 65 from Memorial Sloan Kettering Cancer Center (MSK, New York, New York) (gynecologic pathology focused sign-out). Each case was reviewed together by 2 gynecologic pathologists, one from each institution, and classified into the G3EC group or a reclassified group. Clinicopathologic parameters were compared.
Results.—Twenty-five WSU cases (38%) were reclassified as undifferentiated (n = 2), serous (n = 4), mixed endometrioid and serous carcinomas (n = 12), and FIGO grade 2 endometrioid adenocarcinomas with focal marked nuclear atypia (n = 7). Eleven MSK cases (17%) were reclassified as undifferentiated (n = 5), serous (n = 1), mixed endometrioid and serous carcinomas (n = 4), and mixed endometrioid and clear cell carcinomas (n = 1). Agreement rate between original and review diagnosis was 83% (54 of 65) at MSK and 62% (41 of 66) at WSU (P = .01) with an overall rate of 73% (95 of 131). There were more undifferentiated carcinomas at MSK than there were at WSU (45% [5 of 11] versus 8% [2 of 25]; P = .02). There were more grade 2 endometrioid adenocarcinomas with focal, marked nuclear atypia at WSU (28%; 7 of 25) than there were at MSK (0%) (P = .03). Mixed endometrioid and serous carcinoma was the most common misclassified subtype (44%; 16 of 36).
Conclusion.—Moderate interobserver variability exists in the diagnosis of G3EC with a significantly greater diagnostic agreement rate in gynecologic pathology–focused sign-out than in general sign-out practice.
“In North Somerset we have seen an increase in obesity in all age groups, and being overweight can seriously increase your risk of developing a number of long-term and even life-threatening health problems, these include type two diabetes, heart disease, some types of cancer, back problems, impaired fertility.
“Small changes can have a big impact and it doesn’t need to cost anything – parking 10 minutes further from the office, or getting off the bus one stop earlier, all helps.
“There’s lots of information and advice on NHS Choices and the North Somerset CCG website and you can talk to your GP for advice and support.”
There is also additional support provided by North Somerset Council through its health trainers scheme, which looks to help people to lose weight with individual assistance from professionals.
Alicia M. Schnebelen, Jerad M. Gardner, and Sara C. Shalin (2016) Margin Status in Shave Biopsies of Nonmelanoma Skin Cancers: Is It Worth Reporting?. Archives of Pathology & Laboratory Medicine In-Press.
Alicia M. Schnebelen , MD; Jerad M. Gardner , MD; Sara C. Shalin , MD, PhD
Reprints: Sara C. Shalin, MD, PhD, Department of Pathology, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot 517, Little Rock, AR 72205 (email: SCShalin@uams.edu).
Context.—The practice of reporting margin status in biopsies is relatively unique to biopsies of the skin and highly variable among pathologists.
Objective.—To address the accuracy of margin evaluation in shave biopsies of nonmelanoma skin cancers.
Design.—We collected shave biopsies of squamous and basal cell carcinomas that appeared to have uninvolved margins on routine sign out. We obtained deeper levels on corresponding tissue blocks until blocks were exhausted and examined them for tumor at biopsy margins.
Results.—Forty-seven consecutive cases were collected, including 20 squamous cell (43%) and 27 basal cell (57%) carcinomas. Eleven of 47 cases (23%) with negative margins at initial diagnosis demonstrated positive margins upon deeper-level examination. Margins of 8 of 27 basal cell carcinomas (30%) and 3 of 20 squamous cell carcinomas (15%) were erroneously classified as “negative” on routine examination.
Conclusions.—No guidelines exist regarding the reporting of margins in nonmelanoma skin cancer biopsies, and reporting practices vary extensively among pathologists. We found that nearly one-quarter of positive margins in shave biopsies for cutaneous carcinomas are missed on standard histologic examination. Moreover, reporting of a positive margin may also be misleading if the clinician has definitively treated the skin cancer at the time of biopsy. For these reasons, and as routine exhaustion of all tissue blocks is impractical, the decision to include or exclude a comment regarding the margin status should be given conscious consideration, accounting for the clinical intent of the biopsy and any known information regarding postbiopsy treatment.
1Post-doctoral Master of Science in Clinical and Translational Research (MSc) and Hispanics in Research Capability (HiREC) Endowment Programs, School of Health Professions, Medical Sciences Campus-University of Puerto Rico.
2Post-doctoral Master of Science in Clinical and Translational Research (MSc), School of Health Professions, and the Puerto Rico Clinical and Translational Research Consortium, Medical Sciences Campus - University of Puerto Rico.
3Post-doctoral Master of Science in Clinical and Translational Research (MSc) School of Health Professions, Medical Sciences Campus-University of Puerto Rico.
Personalized medicine is the development of 'tailored' therapies that reflect traditional medical approaches, with the incorporation of the patient's unique genetic profile and the environmental basis of the disease. These individualized strategies encompass disease prevention, diagnosis, as well as treatment strategies. Today's healthcare workforce is faced with the availability of massive amounts of patient- and disease-related data. When mined effectively, these data will help produce more efficient and effective diagnoses and treatment, leading to better prognoses for patients at both the individual and population level. Designing preventive and therapeutic interventions for those patients who will benefit most while minimizing side effects and controlling healthcare costs, requires bringing diverse data sources together in an analytic paradigm. A resource to clinicians in the development and application of personalized medicine is largely facilitated, perhaps even driven, by the analysis of "big data". For example, the availability of clinical data warehouses is a significant resource for clinicians in practicing personalized medicine. These "big data" repositories can be queried by clinicians, using specific questions, with data used to gain an understanding of challenges in patient care and treatment. Health informaticians are critical partners to data analytics including the use of technological infrastructures and predictive data mining strategies to access data from multiple sources, assisting clinicians' interpretation of data and development of personalized, targeted therapy recommendations. In this paper, we look at the concept of personalized medicine, offering perspectives in four important, influencing topics: 1) the availability of 'big data' and the role of biomedical informatics in personalized medicine, 2) the need for interdisciplinary teams in the development and evaluation of personalized therapeutic approaches, and 3) the impact of electronic medical record systems and clinical data warehouses on the field of personalized medicine. In closing, we present our fourth perspective, an overview to some of the ethical concerns related to personalized medicine and health equity.
Within the fields of medicine and sociology, the descriptor "profession" (along with its brethren: profession, professionalization, and professionalism) has had a rich etymological history, with terms taking on different meanings at different times-sometimes trespassing into shibboleth and jargon. This etymological journey has coevolved with the career of David Mechanic to whom this issue of the Journal of Health Politics, Policy and Law is devoted. We exploit a provocative metaphor applied to Mechanic's work on the challenges facing medicine as a profession as a playful exegesis on what we call "profession" to excavate an ensconced and encrusted domain of health jargon operating at the tensive interface of society and modern medical work.
Daniel D. Rhoads, Blaine A. Mathison, Henry S. Bishop, Alexandre J. da Silva, and Liron Pantanowitz (2016) Review of Telemicrobiology. Archives of Pathology & Laboratory Medicine: April 2016, Vol. 140, No. 4, pp. 362-370.
Daniel D. Rhoads , MD; Blaine A. Mathison , BS; Henry S. Bishop ; Alexandre J. da Silva , PhD; Liron Pantanowitz , MD
From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Rhoads and Pantanowitz);
the Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia (Messrs Mathison and Bishop and Dr da Silva);
and the Center for Food Safety and Applied Nutrition, US Food and Drug Administration, Laurel, Maryland (Dr da Silva).
Dr Rhoads is now with the Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio.
Reprints: Daniel D. Rhoads, MD, Department of Laboratory Medicine, Cleveland Clinic, 9500 Euclid Ave, LL1-123, Cleveland, OH 44195 (email: firstname.lastname@example.org).
The authors have no relevant financial interest in the products or companies described in this article.
Context.—Microbiology laboratories are continually pursuing means to improve quality, rapidity, and efficiency of specimen analysis in the face of limited resources. One means by which to achieve these improvements is through the remote analysis of digital images. Telemicrobiology enables the remote interpretation of images of microbiology specimens. To date, the practice of clinical telemicrobiology has not been thoroughly reviewed.
Objective.—To identify the various methods that can be employed for telemicrobiology, including emerging technologies that may provide value to the clinical laboratory.
Data Sources.—Peer-reviewed literature, conference proceedings, meeting presentations, and expert opinions pertaining to telemicrobiology have been evaluated.
Conclusions.—A number of modalities have been employed for telemicroscopy, including static capture techniques, whole slide imaging, video telemicroscopy, mobile devices, and hybrid systems. Telemicrobiology has been successfully implemented for several applications, including routine primary diagnosis, expert teleconsultation, and proficiency testing. Emerging areas of telemicrobiology include digital plate reading of bacterial cultures, mobile health applications, and computer-augmented analysis of digital images. To date, static image capture techniques have been the most widely used modality for telemicrobiology, despite newer technologies being available that may produce better quality interpretations. Telemicrobiology adds value, quality, and efficiency to the clinical microbiology laboratory, and increased adoption of telemicrobiology is anticipated.
"Michael Jacobson, president of the Center for Science in the Public Interest, which first petitioned the FDA to put added sugars on Nutrition Facts labels in 1999, said the new rules could prompt food makers to rethink their recipes."
"...the real but meager benefits of free drug samples are overwhelmed by the social costs, including the insidious erosion of patient trust. Half measures such as increased regulation and physician education have failed and there is no evidence adding new measures would be of any benefit. It is time to end free drug samples."
"West Virginia ranks as the heftiest state, with an adult obesity rate of 37 percent. In a close second, Mississippi has an obesity rate of 35.5 percent, and Delaware rounds out the top three with a rate of 33.8 percent.
Hawaii ranks as the leanest state, with an adult obesity rate of 18.5 percent. Hawaii and Colorado, which has the second-lowest obesity level at 19.8 percent, are the only two states that boast obesity rates below one fifth of their adult population."
Howard H. Wu, Stephen M. Jovonovich, Melissa Randolph, Kristin M. Post, Joyashree D. Sen, Kendra Curless, and Liang Cheng(2016) Utilization of Cell-Transfer Technique for Molecular Testing on Hematoxylin-Eosin–Stained Sections. Archives of Pathology & Laboratory Medicine In-Press.
A Viable Option for Small Biopsies That Lack Tumor Tissues in Paraffin Block
Howard H. Wu , MD; Stephen M. Jovonovich , MD; Melissa Randolph , CT(ASCP); Kristin M. Post , MLS(ASCP), MPH; Joyashree D. Sen , MD; Kendra Curless , MLS(ASCP); Liang Cheng , MD
Reprints: Howard H. Wu, MD, Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, 350 W 11th St, IUHPL-Room 4086, Indianapolis, IN 46202 (email: email@example.com).
Context.—In some instances the standard method of doing molecular testing from formalin-fixed, paraffin-embedded block is not possible because of limited tissue. Tumor cell–enriched cell-transfer technique has been proven useful for performing immunocytochemistry and molecular testing on cytologic smears.
Objective.—To establish the cell-transfer technique as a viable option for isolating tumor cells from hematoxylin-eosin (H&E)–stained slides.
Design.—Molecular testing was performed by using the cell-transfer technique on 97 archived H&E-stained slides from a variety of different tumors. Results were compared to the conventional method of molecular testing.
Results.—Polymerase chain reaction–based molecular testing via the cell-transfer technique was successfully performed on 82 of 97 samples (85%). This included 39 of 47 cases for EGFR, 10 of 11 cases for BRAF, and 33 of 39 cases for KRASmutations. Eighty-one of 82 cell-transfer technique samples (99%) showed agreement with previous standard method results, including 4 mutations and 35 wild-type alleles for EGFR, 4 mutations and 6 wild-type alleles for BRAF, and 11 mutations and 21 wild-type alleles for KRAS. There was only 1 discrepancy: a cell-transfer technique with a false-negativeKRAS result (wild type versus G12C).
Conclusions.—Molecular testing performed on H&E-stained sections via cell-transfer technique is useful when cell blocks and small surgical biopsy samples run out of tissue and the only available material for testing is on H&E-stained slides.
From the Department of Internal Medicine, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center and Dallas Veterans Affairs Medical Center, Dallas (Dr Wang);
and the Department of Pathology, Eugene McDermott Center for Human Growth and Development, Children's Medical Center, and University of Texas Southwestern Medical Center, Dallas (Dr Park).
Reprints: Jason Y. Park, MD, PhD, Department of Pathology, Children's Medical Center, 1935 Medical District Dr, Dallas, TX 75235 (email: firstname.lastname@example.org).
The authors have no relevant financial interest in the products or companies described in this article.
Presented at the 14th spring seminar of the Korean Pathologists Association of North America (KOPANA); March 19–21, 2015; Boston, Massachusetts.
Context.—Precision medicine is the promise of individualized therapy and management of patients based on their personal biology. There are now multiple global initiatives to perform whole-genome sequencing on millions of individuals. In the United States, an early program was the Million Veteran Program, and a more recent proposal in 2015 by the president of the United States is the Precision Medicine Initiative. To implement precision medicine in routine oncology care, genetic variants present in tumors need to be matched with effective clinical therapeutics. When we focus on the current state of precision medicine for gastrointestinal malignancies, it becomes apparent that there is a mixed history of success and failure.
Objective.—To present the current state of precision medicine using gastrointestinal oncology as a model. We will present currently available targeted therapeutics, promising new findings in clinical genomic oncology, remaining quality issues in genomic testing, and emerging oncology clinical trial designs.
Data Sources.—Review of the literature including clinical genomic studies on gastrointestinal malignancies, clinical oncology trials on therapeutics targeted to molecular alterations, and emerging clinical oncology study designs.
Conclusions.—Translating our ability to sequence thousands of genes into meaningful improvements in patient survival will be the challenge for the next decade.
Maren Y. Fuller , MD; Timothy Craig Allen , MD, JD
Reprints: Timothy Craig Allen, MD, JD, Department of Pathology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555 (email: email@example.com).
Social media use is very common and can be an effective way for professionals to discuss information and interact with colleagues. Twitter (Twitter, Inc, San Francisco, California) is a social media network where posts, termed tweets, are limited to 140 characters. Professional use of Twitter is ideal for physicians interested in both networking and education and is optimally used to facilitate in-person networking. Live-tweeting (posting real-time reactions to events) at professional meetings is also a popular and highly successful use of Twitter. Physicians report patient privacy as the top concern preventing use of social media for professional reasons, and although generally social media use is safe, it is essential to understand how to protect patient confidentially. Other social media platforms with potential for professional use include Facebook (Facebook, Inc, Menlo Park, California), Instagram (Facebook, Inc), YouTube (YouTube, LLC, San Bruno, California), and Periscope (Twitter, Inc). With Twitter and other social media options, now is the time for pathologists to increase our visibility on social media and worldwide.
Saranya Singaravel and Mohammed Abdul Aleem (2016) Hands-free: A Low-Cost Adapter for Smartphone Microscopic Photography Using a Cardboard Toilet-Paper Roll. Archives of Pathology & Laboratory Medicine In-Press.
Lynette M. Sholl, Dara L. Aisner, Timothy Craig Allen, Mary Beth Beasley, Philip T. Cagle, Vera L. Capelozzi, Sanja Dacic, Lida P. Hariri, Keith M. Kerr, Sylvie Lantuejoul, Mari Mino-Kenudson, Kirtee Raparia, Natasha Rekhtman, Sinchita Roy-Chowdhuri, Eric Thunnissen, Ming Tsao, Marina Vivero, and Yasushi Yatabe (2016) Liquid Biopsy in Lung Cancer. Archives of Pathology & Laboratory Medicine In-Press.
Lynette M. Sholl , MD; Dara L. Aisner , MD, PhD; Timothy Craig Allen , MD, JD; Mary Beth Beasley , MD; Philip T. Cagle , MD;Vera L. Capelozzi , MD, PhD; Sanja Dacic , MD, PhD; Lida P. Hariri , MD, PhD; Keith M. Kerr , MD, BSc, MB, ChB, FRCPath, FRCPE; Sylvie Lantuejoul , MD, PhD; Mari Mino-Kenudson , MD; Kirtee Raparia , MBBS; Natasha Rekhtman , MD, PhD; Sinchita Roy-Chowdhuri , MD, PhD; Eric Thunnissen , MD, PhD; Ming Tsao , MD; Marina Vivero , MD; Yasushi Yatabe , MD, PhD
Reprints: Timothy Craig Allen, MD, JD, Department of Pathology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555 (email: firstname.lastname@example.org).
Liquid biopsy has received extensive media coverage and has been called the holy grail of cancer detection. Attempts at circulating tumor cell and genetic material capture have been progressing for several years, and recent financially and technically feasible improvements of cell capture devices, plasma isolation techniques, and highly sensitive polymerase chain reaction– and sequencing-based methods have advanced the possibility of liquid biopsy of solid tumors. Although practical use of circulating RNA-based testing has been hindered by the need to fractionate blood to enrich for RNAs, the detection of circulating tumor cells has profited from advances in cell capture technology. In fact, the US Food and Drug Administration has approved one circulating tumor cell selection platform, the CellSearch System. Although the use of liquid biopsy in a patient population with a genomically defined solid tumor may potentially be clinically useful, it currently does not supersede conventional pretreatment tissue diagnosis of lung cancer. Liquid biopsy has not been validated for lung cancer diagnosis, and its lower sensitivity could lead to significant diagnostic delay if liquid biopsy were to be used in lieu of tissue biopsy. Ultimately, notwithstanding the enthusiasm encompassing liquid biopsy, its clinical utility remains unproven.
1Harris School of Public Policy, University of Chicago.
2Booth School of Business, University of Chicago.
Few biases in human judgment are easier to demonstrate than self-righteousness: the tendency to believe one is more moral than others. Existing research, however, has overlooked an important ambiguity in evaluations of one's own and others' moral behavior that could lead to an overly simplistic characterization of self-righteousness. In particular, moral behavior spans a broad spectrum ranging from doing good to doing bad. Self-righteousness could indicate believing that one is more likely to do good than others, less likely to do bad, or both. Based on cognitive and motivational mechanisms, we predicted an asymmetry in the degree of self-righteousness such that it would be larger when considering unethical actions (doing bad) than when considering ethical actions (doing good). A series of experiments confirmed this prediction. A final experiment suggests that this asymmetry is partly produced by the difference in perspectives that people adopt when evaluating themselves and others (Experiment 8). These results all suggest a bounded sense of self-righteousness. Believing one "less evil than thou" seems more reliable than believing one is "holier than thou."