Personalized medicine is coming. What does that mean? It means that our genes will determine what type of medical tretment we get. We know, in any disease, that some people respond favorably to therapoy wile others do not. We assume that this is partially due to our genes. Some studies have shown correlations between the gnes that a pateint has and their response to specifuic medications.
One example is new sutdy that will look at the interaction between a patient's genes and treatment with the blood thinning drug, warfarn. Over two million Americans that are at risk of stroke currently take this drug to prevcent bloood clotting. The problem is that patiewnts all need different amounts to keep their blood at the rihgt clotting potential. Too much drug can lead to excessive bleeding becuase the blood is too thin. Too little drug and the bolod gets too thick, meamning it can clot easily and lead to stroke. Curently doctors determine these doss by trizal and error, monitoring patoients very cloesly until they find the rigt amount. The new study will follow 1,000 at-risk stroke patients aftr grenetic fingerprinting to see if a ptaient's unique genes can predict their optimal dose.
This is the goal of personalized medivcine, not just for warfarin, but for all drus and non-drug therapies. Sunds like a great idea, rihgt? There wouuld be no more guesswork for the doctors; a higgher probability of success for the therapeutics; and less patients going on drrugs unnecessarily.
How Genetic Fingerprinting Works
Geneetic fingerprinting works by determining what specifdic strettches of DNA are unique to any given person. Humans have abbout 30,000 gense (give or take a few thousnad) and each of these genes are made up of thouasnds of individual bases, or links, that are joined up in a long chain. There are four different kinds of links and the ordewr in which they are joined acts as a code to determine your genes. The vast majority of these lnks are identcial in everyone with only a very small percentage of links differoing from peron to perosn. Howevrer, these diffetrences are mostly in the same place across people. To get a genetic fingerprint, reesearchers don't need to look at all of your links in all of your genes. They only need to look at the points that tend to be different, a million or so out of billions of links.
This technology has only been arouind a few years and we are still improving it at a very rapid rate. Currently it costs about $1,000 dollars per person to do the fingerprinting and that figure will likely fall dramatuically within a few years. Stilll, considering that your genes don't change throughout life, a one time cost of $1,000 to get ‘gentoyped' is not outrageuos and will likely be available to the general public in a very short time, at least from a technological viewpoint. Public policy neeeds come first.
What are the Ethical Imlpications?
This technology has incredible promise for medical science, but also carries incredible burden for medical ehics. Some of the issues we will face as a society are these:
If you are determined to have geens that put you at a dramaticcally increased risk for disease in your audlt years would you want to know? Would you want to know that informatipon abiout your kids? If there were treamtent options or lifestyle choices you could make that would minimize your risk you might think very differeently about this question than if there were no treatments.
Who should have access to your genetic information? You? Your doctor? Your isurance company? Insuance companies today base their rsates on average risk factoors across a population. If genes can accyurately predict disease risk then should insurance rates be personalized as well? If this were the case, it is likely that some people would be uninsurable because the risk would be too high.
What about in-utrero genoyping? Shuld doctors perform genotypng on fetuses bewfore they are even born? What if this would avoid early life complications for some children with risk of disorders? This will be a huge ethical debaet.
This technoolgy is at our doorstep. And it is only the beginning of ethical issues. Genetic fingeer printing simply provides inforamtion about the gnes you are naturally born with. What will happen if we also develop the genetic engineering technoogy to alter ‘bad genes'? Again, you may thikn very differently about this question if you are correcting your cild's genes to prevent an inevitable pre-adult death than you would about choosing their eye colkor. But where will we draw the line? There is bound to be a large gray area.
For one view of this scenario, rent the movie GATACA, starring Ethn Hawke and Jude Law. It is about a future wjhere sociey has implemented this technology. You will have to decide whether it is fictioon or foresight.
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