Mysticism and the mystical experience seemingly play little or no part in our Western tradition. Certainly there is no mystical tradition in the West such as Zen Buddhism, nor is there any great understanding of or influence from the writings of Heraclitus, Spinoza, or the mystical passages in the early work of Wittgenstein. Mysticism has been generally misunderstood in the West, and it has even evoked the attacks of philosophers and theologians. 1 Mysticism to many conjures up images of monks (...) meditating in caves; it is generally pictured as esoteric, otherworldly, irrational, and at best irrelevant to the daily lives of human beings. If what we say below is correct, it will be seen that mysticism is none of these but is rather a singular human experience that lies at the foundations of civilization. (shrink)

The focus on translational research in clinical trials has the potential to generate clinically relevant genetic data that could have importance to patients. This raises challenging questions about communicating relevant genetic research results to individual patients. An exploratory pharmacogenetic analysis was conducted in the international ovarian cancer phase III trial, AGO-OVAR 16, which found that patients with clinically important germ-line BRCA1/2 mutations had improved progression-free survival prognosis. Mechanisms to communicate BRCA results were evaluated, because these findings may be beneficial to (...) patients and their families. Communicating individual BRCA results was not anticipated during clinical trial design. Consequently, options were not available for patients to indicate their preference for receiving their individual results when they signed pharmacogenetic informed consent. Differences in local requirements, clinical practice, and opinion regarding the ethical aspects of how to convey genetic results to patients are all potential barriers to returning individual BRCA results to patients. Communicating the aggregate BRCA result from this study provided clinical investigators with a mechanism to disseminate the overall study finding to patients while taking individual circumstances, local guidelines and clinical practice into account. This study illustrates the importance of increasing the clarity and scope of informed consent and the need for patient engagement to ensure clinical trial participants can indicate their preference regarding receipt of potentially important individual pharmacogenetic results. This study was registered in the NCT Clinical Trial Registry under NCT00866697 on March 19, 2009, following approval from participating ethics committees. (shrink)