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therapies could have damaging conse-
quences. Applying them inappropriately,
to illnesses where they were unlikely to
help, undermined patients' confidence in
the treatments, the doctor, and medicine
itself. It also transgressed an important
principle of the Hippocratic Oath: do
no harm. This precept is often misun-
derstood to mean that doctors must not
inflict harm in the process of care. This
is frequently impossible: we accept pain
and side e ects as the price of beneficial
treatments. What "do no harm" means,
as I interpret it, is that doctors must avoid
exposing patients to preventable risks.
The cautions expressed by the Greeks
are worth respecting in the medicine
of our own day, when technology is too
often used without regard for the ideal
of avoiding needless risk. A recent study
estimated, for example, that about four
million Americans have been exposed to
a substantial amount of radiation from
multiple imaging tests such as CT scans.
While such technologies can be impor-
tant elements of clinical care, doctors
are increasingly using them to evaluate
patients without clinical symptoms of
disease. And each new test adds to the
cumulative radiation dose that increases
a person's risk of developing cancer.
The use of imaging tests is part of a
larger trend in medicine: interrogat-
ing the body intensively and the person
minimally in trying to prevent and treat
disease. We need to pursue relationships
with patients to understand how they
live and function, not just use technol-
ogy to secure biological data about them.
To know and treat the disease fully and
the person partially is a formula that pro-
duces inadequate medical care.
STANLEY JOEL REISER IS CLINICAL PROFESSOR OF
HEALTH CARE SCIENCES AND HEALTH POLICY AT
THE GEORGE WASHINGTON UNIVERSITY SCHOOL
OF MEDICINE AND HEALTH SCIENCES.
ROBERT PLOMIN EXAMINES
THE POTENTIAL ROLE OF
GENES AND IQ IN EDUCATION.
Today, few scientists---or even mem-
bers of the wider public---question
the existence of a general cognitive
ability that is substantially influenced
by genetics. In a survey of 2,000 parents
and teachers, more than 90 percent
accepted that nature (genetics) is at least
as important as nurture (environment)
in the origins of intelligence (see "Intel-
ligence Explained," p 52).
Research on intelligence has moved
beyond the nature-versus-nurture issue
to investigate how rather than how much.
My team, for example, has discovered
that the genetic influence on IQ becomes
more pronounced during development.
In a study of 11,000 pairs of twins from
four countries, we have recently shown
that the heritability of IQ increases line-
arly from childhood (about 40 percent) to
adolescence (about 55 percent) to young
adulthood (about 65 percent). Why?
No one knows, but my guess is that the
answer involves what is called genotype-
environment correlation: as children
grow up, they increasingly select, modify,
and even create their own experiences,
partly on the basis of their genetic pro-
pensities. A child genetically inclined
toward high verbal skills might choose to
read more, enhancing those skills.
We have also found that the same set
of genes a ects di erent mental abilities.
Genes that a ect verbal abilities, such as
vocabulary and verbal fluency, are largely
the same genes that a ect nonverbal
abilities, including spatial visualization
Although these findings have far-
reaching implications for educational
policy and practice, the field of education
has scarcely begun to take the nature of
intelligence seriously. Heritability does
not imply immutability. Nonetheless, the
pervasiveness of genetic di erences sug-
gests that we must reëxamine the role of
education. Instead of thinking about it as
a way of countering genetic di erences
among children, education might profit
from accepting that children di er genet-
ically in how and how much they learn.
Understanding the nature of intelligence
is compatible with the current trend
toward personalized education.
Finding a genetic influence on intelli-
gence does not mean that we ought to put
all our resources into educating the best
learners and forget the rest. This find-
ing could be used to argue for devoting
more resources to genetically disadvan-
taged children. The relationship between
knowledge and value is complicated, but
there is nothing to be gained by pretend-
ing human di erences do not exist.
ROBERT PLOMIN IS A PROFESSOR OF BEHAVIORAL
GENETICS AT THE INSTITUTE OF PSYCHIATRY AT
KING'S COLLEGE LONDON.
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