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A.From cancer to Alzheimer's ( 早老性癡呆病 ) to diabetes, advances in genetic sciencemean that many of us are soon going to know--or at least have the option to know--more about our risks for a wide range of illnesses than we'd ever thought possible.On the surface, that sounds like a good thing, and it is in many respects. But whileknowledge may be power, genetic testing also brings with it tremendous physical andpsychological collapse.
B.In the past two decades, the number of genetic tests available has jumped from a fewhundred to nearly 3,000. Rebecca Nagy, president of the National Society of GeneticCounselors (NSGC), recalls that when she entered the field 15 years ago, it took ayear to get the results of a BRCA ( 乳癌) test. Today, you get them back in a week ortwo.
C.As the cost of testing declines, says Lawrence Brody, an investigator with the NationalInstitutes of Human Genome ( 基因組) Research Institute. Medicine is movingtoward "multiplex testing for lots of things at once". We're at the point, he explains,where sequencing a person's entire exome 外顯子組) can be done for somewherein the neighborhood of $1,000." Whereas before it would have been really bizarre tohave someone's entire genome sequenced because it cost about the same as the GDPof several small countries. With exome sequencing, a patient may go in with questionsabout his prostate ( 前列腺 ) and come out with a report showing increased risks foreverything from bloodclots ( 凝塊 ) to kidney disease.
D. Such data points are known as "incidental findings", and they are at the heart of thehottest ethical debate now prevailing in the field, says Nagy. "What results do youdisclose to someone and what results do you withhold? And do you give patients
that choice?" One commonly cited example: what happens when a toddler'sexome is sequenced to determine the cause of a developmental delay and the labdiscovers that the child has the BRCA1 mutation ( 變異 ) ? Should the lab withholdthat information?
E. Nagy explains that "a basic principle of genetics is that patients should haveautonomy"--meaning the right to choose what they do and do not want to know.But the American College of Medical Genetics and Genomics issued a statementcontending that, in the case of certain specific harmful and active genes, doctors havean ethical obligation to alert patients to the discovered risks. Balancing this "duty towarn" with an individual's right to autonomy is tricky enough on its own. But thereare other complicating factors to consider. What if disorders are likely to impact otherfamily members? And what about all the mutations that will pop up but that we don'tyet understand? "The menu is probably more vast in terms of what you can look atthan people are prepared for, and the results will contain more uncertainty than peopleare prepared for."
F.Social worker Katie Berry has a front-row view of all the issues that this new medicallandscape is raising. Through Columbia Presbyterian Hospital in New York, Berrycounsels men and women at high risk for Huntington's ( 亨廷頓癥) , an inherited
neurodegenerative disorder ( 退行性神經紊亂 ) that typically appears in midlifewith some brutal combination of physical, cognitive, and psychiatric decline. A personwith the Huntington's gene can expect to get sick at some point down the road. Thereis no cure and, unlike with breast cancer, no preventive measures beyond maximizinggeneral health with the aim of delaying onset.
G. Berry works solely with individuals not yet experiencing symptoms. Some havealready been gene-tested. Others know that the disease runs in their family andare hesitating about whether to get tested--and when. With no preventive optionsavailable for Huntington's, the question of when to test is often dictated by loomingdecisions about marriage or parenthood. Most of the patients who come to Berry arein their 30s or early 40s. "People who are in their teens and early 20s tend not to bethinking about these things," she explains. "There's a level of denial in very youngadults."
H. But as people start pairing up and settling down, the stakes of not knowing get higher.(People with the Huntington's gene have a 50 percent chance of passing it to a child.)"They know there is this sword of Damocles hanging over their heads," says Berry.But until the test is done, they can cling to the hope that they escaped the geneticbullet. "They think, 'It's possible I'll never get it. It's possible I can continue to livethe life I'm living now,'" she says. "Knowing creates a whole other reality--a hugelydifferent reality."
I.Indeed, the news that one's genome contains a potential time bomb presentsnumerous, extremely painful psychological hurdles. Breaking the news to family canbe a particularly rough part of the process, and not simply because of the heartbreakit brings loved ones. Learning that a family member has a particular mutation can suddenly force brothers and sisters, children and parents to confront unsettling questions about their own genes--questions that many people would prefer not tohave raised at all.
J. To facilitate sharing, medical facilities are increasingly providing aid and guidance. Visvanathan's clinic invites patients to have family come in and talk with the staff. "Wetry to take some of that burden," she explains. Hospitals at places like GeorgetownUniversity and the University of Pennsylvania often provide patients with lettertemplates tailored specifically toward informing family.
K. Then there's the long-term challenge of living with a genetic ghost hiding in thebackground. At times, the anxiety can cause great damage, says Berry. "People talkfrequently about how they go through periods--and I suspect it's true of anyone whofaces a chronic illness or potentially fatal disease--periods that last days, weeks,months, or even years when there's a hyper-alertness about the body." Every twitch,twinge, or tickle spurs a raw terror that the illness has begun to take hold. "Peoplesay they're convinced they have the disease even though there's nothing obviouslysymptomatic about them," Berry says.
L. For the medical community, addressing these challenges will mean changing medical-school curricula and investing in continuing education. "It means us going out tophysicians' offices and helping them understand when it's appropriate to refer aperson to a genetic counselor," Nagy says. "It's making them feel comfortable that,once referred, their patients will come back to them for ongoing care."
M.Much more broadly, the general public is increasingly going to need a grasp ofgenetic basics to better manage their health, says Visvanathan. "Maybe the geneticaspects of health need to be brought into schools," she says. "Informing people at ayoung age would be helpful." Where and when this education should take place is,in fact, already under discussion. "I was at a conference last year in Boston wherepeople were talking about how to educate elementary school kids," Nagy recalls.
N. Equally important, there will be a need for more organizations to do the simple workof linking those facing similarly cloudy futures to one another. Having a supportnetwork of others who understand the fears, thoughts, medical peculiarities, andeven the language of your disorder makes a huge difference, says Berry. "You see apositive effect when people realize that they are not journeying alone." In some cases,just having a regular chance to vent provides a measure of relief. "We have heardfrom patients that they love the support group because it allows them to gather all thatnegative energy, worry, and anxiety and spew it out in a one- or two-hour period," shesays. "Then the rest of the month they don't have to think about it so much." But theanxiety never fades entirely, says Berry. "It's always present, always niggling."
O.Such is the burden of knowledge--and, more specifically, foreknowledge. It is aburden more and more of us are going to have to decide whether to assume and onethat our medical system is just beginning to learn how to help us shoulder. "Thisreally is a slightly different pattern for medicine," says Brody. "It's going to take a lotof work."

1.[選詞填空]According to Lawrence Brody, people can do tests with various complicated items atonce in hospitals now since it costs much less to do them.
    • 解題思路:題干意為,根據勞倫斯·布羅迪的看法,由于現在做測試的花銷大大降低,人們能夠在醫院里即刻完成對多項復雜內容的檢測。根據題干中的關鍵詞Lawrence Brody可定位到C段。該段首句提到,勞倫斯·布羅迪認為隨著測試成本的下降,醫學界正在朝著“即刻完成眾多項目的復雜檢測”的方向發展。由此可知,題干是對原文的同義轉述,故選C。
    2.[選詞填空]We have to be aware of the negative effect of genetic testing, which may do harm toour body and mind.
      • 解題思路:題干意為,我們需要注意到基因測試的負面作用,這種測試可能會對我們的身體和心理造成傷害。根據題干中的關鍵詞body and mind可定位到A段。該段末句提到,雖然知識或許就是力量,但是基因測試也會給我們的身心帶來崩潰性的后果。由此可知,題干是對原文的同義轉述,故選A。
      3.[選詞填空]

      Visvanathan suggests educating students about the basic knowledge of genes in orderto better manage their health.

        • 解題思路:題干意為,維斯瓦納坦建議教育學生掌握基因基礎知識以便促進他們更好地管理自己的健康。根據題干中的關鍵詞Visvanathan可定位到M段。該段第二、三句提到,維斯瓦納坦認為也許基因方面的健康知識需要被引入學校,在人們年輕的時候就了解此事是有好處的。由此可知,題干是對原文的同義轉述,故選M。
        4.[選詞填空]People with potential threat of Huntington's often won't decide to have a gene testuntil a decision has to be made on whether to get married or have a baby.
          • 解題思路:題干意為,有亨廷頓癥潛在危險的人經常是在不得不做出結婚或生子的決定時才會想去做基因檢測。根據題干中的關鍵詞Huntington’s可定位到G段。該段第四句提到,亨廷頓癥沒有預防性的措施,人們往往拖到必須決定是否結婚或生子時才會決定做基因檢測。由此可知,題干是對原文的同義轉述,故選G。
          5.[選詞填空]It will be good for people with genetic problems to find ways to release their pressure.
            • 解題思路:題干意為,有基因問題的人尋找方法來減輕壓力會對他們有好處。根據題干中的關鍵詞pressure可定位到N段。該段第四句提到,在某些情況下,找個正常的渠道發泄也是一種緩解措施。由此可知,題干是對原文的同義轉述,故選N。
            6.[選詞填空]People need courage to live with the fact of having a genetic problem for a longperiod and sometimes they become anxious.
              • 解題思路:題干意為,人們需要勇氣長久地面對有基因問題這個事實,有時他們會變得焦慮不安。根據題干中的關鍵詞anxious可定位到K段。該段第一句和第二句提到,和潛伏在身邊的遺傳幽靈一起生活是個長期的挑戰。有時這種焦慮會帶來巨大的傷害。由此可知,題干是對原文的同義轉述,故選K。
              7.[選詞填空]Usually when a family member is diagnosed with gene problem, other members notonly feel sad but also worry about themselves.
                • 解題思路:題干意為,通常當某個家庭成員被診斷出有基因問題時,其他成員不僅感到難過,而且也擔心自己。根據題干中的關鍵詞family和member可定位到I段。該段第二、三句提到,向家人告知某個家庭成員有基因問題的過程尤為困難。家人不僅為該成員感到傷心,而且該家庭成員的兄弟姐妹、子女及父母都得面對對自身基因產生某種特定突變的質疑。由此可知,題干是對原文的同義轉述,故選I。
                8.[選詞填空]The American College of Medical Genetics and Genomics advocates informingpatients with certain gene problems of potential risks.
                  • 解題思路:題干意為,美國醫學遺傳學和基因組學研究院主張告知基因有某些問題的病人他們面臨的潛在危險。根據題干中的關鍵詞American College of Medical Genetics andGenomics可定位到E段。該段第二句提到,美國醫學遺傳學和基因組學研究院聲明稱若病人具有某些特定的有害并活躍的基因,醫生有道德上的義務警示病人患病的風險。由此可知,題干是對原文的同義轉述,故選E。
                  9.[選詞填空]People are optimistic about their chances of being caught by an inherited diseasebefore the genetic test is done.
                    • 解題思路:題干意為,人們在做基因檢測前對自己得某種遺傳病的可能性持樂觀態度。根據題干中的關鍵詞genetic test可定位到H段。該段第四句提到,人們會守著這樣一種希望:他們可能會僥幸躲過基因的“子彈”,直到做了測試為止。由此可知,題于是對原文的同義轉述,故選H。
                    10.[選詞填空]It's difficult for us to accept the bad result of a genetic test but doctors and experts aretrying to find ways to help us.learn how to bear it.
                      • 解題思路:題干意為,我們難以接受基因檢測出的不良結果,但是醫生及專家們正努力尋找幫我們學會承受的方法。根據題干中的關鍵詞doctors and experts可定位到O段。該段第一、二句提到,這是知情——更確切地說,是預知——的負擔。我們越來越多的人將不得不決定是否要承受這一負擔,我們的醫療體系也才剛剛開始學會如何幫助我們承受。由此可知,題干是對原文的同義轉述,故選O。
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