Pre-implantation genetic testing: decisional factors to accept or decline among in vitro fertilization patients.

PURPOSE: Embryo testing to improve pregnancy outcomes among individuals who are seeking assisted reproduction technologies is increasing. The purpose of this study was to assess decisional factors through in-depth interviews for why women would accept or decline preimplantation genetic testing for aneuploidy (PGT-A) with in vitro fertilization (IVF). METHODS: Semi-structured telephone interviews were conducted with 37 women who were offered PGT-A with IVF during the summer 2017. Interviews lasted on average 40 min and were audio-recorded, transcribed, and analyzed using a content analysis. RESULTS: Results identified a number of decisional factors related to values about conception, disability, and pregnancy termination, past pregnancy experiences, optimism toward technology, and cost. Other key issues that were identified include the use of expanded carrier screening prior to IVF, maternal age, and limited education about PGT-A due to the complexity about education for IVF alone. CONCLUSION: There is a need to develop decision support tools for the increasing choices of genetic testing options for patients seeking IVF. Including patients' values, past pregnancy experiences and attitudes toward science into the decision-making process may help promote a more informed decision.

Generative models: Human embryonic stem cells and multiple modeling relations.

Model organisms are at once scientific models and concrete living things. It is widely assumed by philosophers of science that (1) model organisms function much like other kinds of models, and (2) that insofar as their scientific role is distinctive, it is in virtue of representing a wide range of biological species and providing a basis for generalizations about those targets. This paper uses the case of human embryonic stem cells (hESC) to challenge both assumptions. I first argue that hESC can be considered model organisms, analogous to classic examples such as Escherichia coli and Drosophila melanogaster. I then discuss four contrasts between the epistemic role of hESC in practice, and the assumptions about model organisms noted above. These contrasts motivate an alternative view of model organisms as a network of systems related constructively and developmentally to one another. I conclude by relating this result to other accounts of model organisms in recent philosophy of science.

Collaborative explanation and biological mechanisms.

This paper motivates and outlines a new account of scientific explanation, which I term 'collaborative explanation.' My approach is pluralist: I do not claim that all scientific explanations are collaborative, but only that some important scientific explanations are-notably those of complex organic processes like development. Collaborative explanation is closely related to what philosophers of biology term 'mechanistic explanation' (e.g., Machamer et al., Craver, 2007). I begin with minimal conditions for mechanisms: complexity, causality, and multilevel structure. Different accounts of mechanistic explanation interpret and prioritize these conditions in different ways. This framework reveals two distinct varieties of mechanistic explanation: causal and constitutive. The two have heretofore been conflated, with philosophical discussion focusing on the former. This paper addresses the imbalance, using a case study of modeling practices in Systems Biology to reveals key features of constitutive mechanistic explanation. I then propose an analysis of this variety of mechanistic explanation, in terms of collaborative concepts, and sketch the outlines of a general theory of collaborative explanation. I conclude with some reflections on the connection between this variety of explanation and social aspects of scientific practice.

Patient perspectives and experiences with in vitro fertilization and genetic testing options.

OBJECTIVE: Decision-making and patient experiences with embryo selection during in vitro fertilization often include genetic testing options. The purpose of this study was to gain insight about the experiences and perspectives of women using in vitro fertilization and genetic technologies. METHODS: Interviews (n = 37) were conducted among female patients who had undergone in vitro fertilization, underwent expanded carrier screening, and were offered pre-implantation genetic testing for aneuploidy between July 2016 and July 2017. The interviews were transcribed and a content analysis was conducted on the transcripts. RESULTS: Categories that emerged from the data analysis included unexpected outcomes, uncertainty, unanticipated emotional consequences, too much emphasis on the woman's contributions and questions about embryo viability. Patient experiences with genetic technologies during in vitro fertilization played a significant role within these results. CONCLUSION: The emotional and psychological impacts of infertility during in vitro fertilization were the primary concerns discussed by participants. Future research is needed to identify ways to help manage unexpected outcomes and continuous uncertainty, including the increasing use of genetic technologies, to not add to the psychological burden of infertility. There is a need to explore more support options or counseling services for patients struggling with infertility during in vitro fertilization treatment.

The search for the hematopoietic stem cell: social interaction and epistemic success in immunology.

Epistemology of science is currently polarized. Descriptive accounts of the social aspects of science coexist uneasily with normative accounts of scientific knowledge. This tension leads students of science to privilege one of these important aspects over the other. I use an episode of recent immunology research to develop an integrative account of scientific inquiry that resolves the tension between sociality and epistemic success. The search for the hematopoietic stem cell (HSC) by members of Irving Weissman's laboratory at Stanford University Medical Center exhibits both the goal-oriented character of contemporary immunology and the importance of social interactions in successful achievement of those goals. This episode includes three kinds of epistemic success: characterization of HSC, formation of new interdisciplinary interfaces, and reconciliation of apparently incompatible models. All three depend on coordinating the work of diverse participants via social interactions. Together, they reveal the crucial role of social interactions within and between research groups in producing epistemic success. These features of the search for the HSC generalize to immunology as a whole, and plausibly to other disciplines. This account thus resolves the polarizing tension in epistemology of science, and complements individualistic accounts of scientific knowledge and rationality.

Stems and standards: social interaction in the search for blood stem cells.

This essay examines the role of social interactions in the search for blood stem cells, in a recent episode of biomedical research. Linked to mid-20th century cell biology, genetics and radiation research, the search for blood stem cells coalesced in the 1960s and took a developmental turn in the late 1980s, with significant ramifications for immunology, stem cell and cancer biology. Like much contemporary biomedical research, this line of inquiry exhibits a complex social structure and includes several prominent scientific successes, recognized as such by participating researchers. I use personal interviews and the published record to trace the social interactions crucial for scientific success in this episode. All recognized successes in this episode have two aspects: improved models of blood cell development, and new interfaces with other lines of research. The narrative of the search for blood stem cells thus yields a robust account of scientific success in practice, which generalizes to other scientific episodes and lends itself to expansion to include wider social contexts.

Fleck and the social constitution of scientific objectivity.

Ludwik Fleck's theory of thought-styles has been hailed as a pioneer of constructivist science studies and sociology of scientific knowledge. But this consensus ignores an important feature of Fleck's epistemology. At the core of his account is the ideal of 'objective truth, clarity, and accuracy'. I begin with Fleck's account of modern natural science, locating the ideal of scientific objectivity within his general social epistemology. I then draw on Fleck's view of scientific objectivity to improve upon reflexive accounts of the origin and development of the theory of thought-styles, and reply to objections that Fleck's epistemological stance is self-undermining or inconsistent. Explicating the role of scientific objectivity in Fleck's epistemology reveals his view to be an internally consistent alternative to recent social accounts of scientific objectivity by Harding, Daston and Galison. I use these contrasts to indicate the strengths and weaknesses of Fleck's innovative social epistemology, and propose modifications to address the latter. The result is a renewed version of Fleck's social epistemology, which reconciles commitment to scientific objectivity with integrated sociology, history and philosophy of science.