find evidence to indicate that anticonvulproduce multiple congenital malfor¬ mations in the offspring when taken by expectant mothers. We concluded that we did not regard them as a high risk couple, but that we might be wrong. The couple subsequently had a miscar¬ riage, and about a year later a child who died at birth with a nonpatent trachea, cleft palate, ambiguous genitalia, six fingers on one hand and four on the other, club feet, deformed ears and imperforate anus. The delivery room nurse and the obstetrician obtained cord blood for chro¬ mosome analysis. Cytogenetic evaluation revealed a normal male chromosome com¬ sants
plement. The couple again requested genetic coun¬ seling. They felt that their case was different from that of other couples with congenitally malformed offspring since ...
of their defective children had lived. The children had not been a great burden to them. They both felt a strong need to have children. Even if we told them that their risk was high, for example as high as 50 per cent, they would elect to accept that risk. Thus, they planned to have another none
pregnancy.' While our article was being edited, I saw a report in The Lancet on trime¬ thadione embryopathy by James Ger¬ man. When the galley proofs arrived, I added a footnote:
Since the completion of this paper, two similar mothers have been described. They were receiving trimethadione or paramethadione for the control of seizures and had a total of nine pregnancies, all of which ended either in spontaneous abortion or in the birth of an abnormal child. When the drugs were withdrawn, all three subse¬ quent pregnancies ended with the birth of a normal child. (German et al, Lancet 2:261,
1970).' So much for medical history!
FREDERICK HECHT, MD Southwest Biomedical Research Institute The Genetics Center 123 E University Dr Tempe, AZ 85281
1. Hecht F, Lovrien EW: Genetic diagnosis in the newborn: A part of preventive medicine. Pediatr Clin North Am 17:1039-1053, 1970.
Heredity
and the
Family
Sir.\p=n-\LawrenceFisher in his article titled "On the Impossibility of Overriding the Influence of the Family," which appeared in the Journal (132:1075-1076, 1978) carefully skirts an issue that almost immediately comes to mind. Far be it from me to become an apologist for B. F. Skinner, yet the role of heredity cannot be
in the present discussion. It is well known that in the case of out-and-out mental deficiency, the person in a supportive environment does better than does the neglected person. Nevertheless, the total person remains "substandard" owing to anatomical defects, physiological deficiencies, or both. In short, "heredity," in the sense that only from his biological ancestors could the person have acquired his anatomical and physiological building blocks, is responsible for the differences that are manifest in these cases. In view of the fact that it is an unacceptable posture, one can understand the reluctance of Dr Fisher to mention heredity. Since I am not shackled by the academic community, I can suggest that serious considera¬ tion be given to heredity in connection with performance. Let no one accuse me of indiffer¬ ence to, say, a victim of Down's syndrome. The mere fact that I cannot "cure" him completely does not mean that I will not try to improve his lot. On the other hand, my understanding of disease will not be helped by denial of the facts, no matter how unpalata¬ ble they are. PAUL DER. KOLISCH, MD Cuba Memorial Hospital Main Street Cuba, NY 14727
ignored
In Reply.\p=n-\DrKolisch's response to my review of the Firkowska et al paper1 suggests that genetic influences may underlie the powerful effect of family life on a child's IQ, as presented in the study. His comments are, I believe, quite relevant and they raise several fundamental points of interest. First, one must ask whether or not IQ implies a genetic linkage and if so to what extent does this genetic influence carry over to a child's performance. I believe that it can be safely concluded, based on a large number of studies, that undoubtedly bright parents have bright offspring and that such correspondence in functioning across generations cannot be solely accounted for by family environment. However, the questions arise as to (1) how much is nature and how much is nurture, and (2) of the proportion that is nurture, what amount is amenable to extrafamilial remediation or influence. Fortunately, there is a substantial body of literature in this area that can
Downloaded From: http://archpedi.jamanetwork.com/ by a University of Pittsburgh User on 06/19/2015
be cited in general terms without getting into the old philosophical hairsplitting of predicting exact per¬ centages. The line of reasoning attempting to sort out the two notions of causation goes something like this. First, parental education and occupa¬ tion, the two measures composing "family variables" in the article under discussion, are correlated with each other, as one would assume, and are also highly correlated with IQ. It would stand to reason that bright people rise to the upper classes of society and achieve higher educational levels. Second, parental IQ and child IQ have been found to correlate within the general range of 0.50, accounting for roughly 25% of the variance. This means that at maximum, in some areas of behavior, roughly 25% of the variance in some forms of child behav¬ ior might be attributable to a geneti¬ cally transmitted intellectual compo¬ nent. It should be recalled, however, that Firkowska et al reported that from 85% to 97% of the covariation was attributable to family variables, leaving a great deal of variance unac¬ counted for by the supposed genetic overlay alone. Although this line of reasoning is in no way intended to dismiss the possi¬ ble influence of genetic factors, it does serve to point up that at best genetic factors, while contributory, are not conclusive in and of themselves. If this were not the case, efforts to alter or remediate given behaviors would surely be wasted since behavior would be fixed at birth, providing a pessi¬ mistic view to improving human exis¬ tence. In this sense, my review did not in any way skirt the issue of genetic influence. It merely permitted the review of a variable that has been documented to account for a substan¬ tially greater proportion of variance. Perhaps at times the academic com¬ munity does not shackle its members to the point of skirting issues of science, but rather expands the mind by permitting the inclusion of alterna¬ tive or equally meaningful concepts based on empirical data. LAWRENCE FISHER, PHD Department of Psychiatry University of Rochester Medical School 300 Crittenden Blvd Rochester, NY 14642 A, Ostrowska A, Sokolowska M, Cognitive development and social policy. Science 200:1357-1362, 1978. 1. Firkowska
et al:
plement. The couple again requested genetic coun¬ seling. They felt that their case was different from that of other couples with congenitally malformed offspring since ...
of their defective children had lived. The children had not been a great burden to them. They both felt a strong need to have children. Even if we told them that their risk was high, for example as high as 50 per cent, they would elect to accept that risk. Thus, they planned to have another none
pregnancy.' While our article was being edited, I saw a report in The Lancet on trime¬ thadione embryopathy by James Ger¬ man. When the galley proofs arrived, I added a footnote:
Since the completion of this paper, two similar mothers have been described. They were receiving trimethadione or paramethadione for the control of seizures and had a total of nine pregnancies, all of which ended either in spontaneous abortion or in the birth of an abnormal child. When the drugs were withdrawn, all three subse¬ quent pregnancies ended with the birth of a normal child. (German et al, Lancet 2:261,
1970).' So much for medical history!
FREDERICK HECHT, MD Southwest Biomedical Research Institute The Genetics Center 123 E University Dr Tempe, AZ 85281
1. Hecht F, Lovrien EW: Genetic diagnosis in the newborn: A part of preventive medicine. Pediatr Clin North Am 17:1039-1053, 1970.
Heredity
and the
Family
Sir.\p=n-\LawrenceFisher in his article titled "On the Impossibility of Overriding the Influence of the Family," which appeared in the Journal (132:1075-1076, 1978) carefully skirts an issue that almost immediately comes to mind. Far be it from me to become an apologist for B. F. Skinner, yet the role of heredity cannot be
in the present discussion. It is well known that in the case of out-and-out mental deficiency, the person in a supportive environment does better than does the neglected person. Nevertheless, the total person remains "substandard" owing to anatomical defects, physiological deficiencies, or both. In short, "heredity," in the sense that only from his biological ancestors could the person have acquired his anatomical and physiological building blocks, is responsible for the differences that are manifest in these cases. In view of the fact that it is an unacceptable posture, one can understand the reluctance of Dr Fisher to mention heredity. Since I am not shackled by the academic community, I can suggest that serious considera¬ tion be given to heredity in connection with performance. Let no one accuse me of indiffer¬ ence to, say, a victim of Down's syndrome. The mere fact that I cannot "cure" him completely does not mean that I will not try to improve his lot. On the other hand, my understanding of disease will not be helped by denial of the facts, no matter how unpalata¬ ble they are. PAUL DER. KOLISCH, MD Cuba Memorial Hospital Main Street Cuba, NY 14727
ignored
In Reply.\p=n-\DrKolisch's response to my review of the Firkowska et al paper1 suggests that genetic influences may underlie the powerful effect of family life on a child's IQ, as presented in the study. His comments are, I believe, quite relevant and they raise several fundamental points of interest. First, one must ask whether or not IQ implies a genetic linkage and if so to what extent does this genetic influence carry over to a child's performance. I believe that it can be safely concluded, based on a large number of studies, that undoubtedly bright parents have bright offspring and that such correspondence in functioning across generations cannot be solely accounted for by family environment. However, the questions arise as to (1) how much is nature and how much is nurture, and (2) of the proportion that is nurture, what amount is amenable to extrafamilial remediation or influence. Fortunately, there is a substantial body of literature in this area that can
Downloaded From: http://archpedi.jamanetwork.com/ by a University of Pittsburgh User on 06/19/2015
be cited in general terms without getting into the old philosophical hairsplitting of predicting exact per¬ centages. The line of reasoning attempting to sort out the two notions of causation goes something like this. First, parental education and occupa¬ tion, the two measures composing "family variables" in the article under discussion, are correlated with each other, as one would assume, and are also highly correlated with IQ. It would stand to reason that bright people rise to the upper classes of society and achieve higher educational levels. Second, parental IQ and child IQ have been found to correlate within the general range of 0.50, accounting for roughly 25% of the variance. This means that at maximum, in some areas of behavior, roughly 25% of the variance in some forms of child behav¬ ior might be attributable to a geneti¬ cally transmitted intellectual compo¬ nent. It should be recalled, however, that Firkowska et al reported that from 85% to 97% of the covariation was attributable to family variables, leaving a great deal of variance unac¬ counted for by the supposed genetic overlay alone. Although this line of reasoning is in no way intended to dismiss the possi¬ ble influence of genetic factors, it does serve to point up that at best genetic factors, while contributory, are not conclusive in and of themselves. If this were not the case, efforts to alter or remediate given behaviors would surely be wasted since behavior would be fixed at birth, providing a pessi¬ mistic view to improving human exis¬ tence. In this sense, my review did not in any way skirt the issue of genetic influence. It merely permitted the review of a variable that has been documented to account for a substan¬ tially greater proportion of variance. Perhaps at times the academic com¬ munity does not shackle its members to the point of skirting issues of science, but rather expands the mind by permitting the inclusion of alterna¬ tive or equally meaningful concepts based on empirical data. LAWRENCE FISHER, PHD Department of Psychiatry University of Rochester Medical School 300 Crittenden Blvd Rochester, NY 14642 A, Ostrowska A, Sokolowska M, Cognitive development and social policy. Science 200:1357-1362, 1978. 1. Firkowska
et al:
