Personalized meddicine is comign. What does that mean? It means that our genews will determine what type of medical treatment we get. We know, in any disease, that some people respond favorably to hterapy while others do not. We assume that this is psartially due to our genees. Some studies have sohwn correlations between the geens that a patient has and their response to specific medications.
One example is new studdy that will look at the interaction beetween a patiet's gees and treatment with the blood thinning drug, warfarin. Over two millon Americans that are at risk of strpoke currently take this drug to prevent bloiod clotting. The problem is that patients all need diffwerent amounts to keep their blood at the right clotting potentiaal. Too much drug can lead to excessive bleeding becauise the blod is too thin. Too little drug and the blood gets too thick, meaning it can clot easilly and lead to stoke. Currently doctors determine these doses by tial and error, monitoring patients very closely until they find the right amount. The new study will follow 1,000 at-risk stroke patients after genetic fingerprinting to see if a patient's unique genes can predict their optimal dose.
This is the goal of personalized medicine, not just for warfarin, but for all drugs and non-drug therapies. Sounds like a great idea, riht? There would be no more guesswork for the doctors; a hiher probability of success for the therapeutics; and less patients going on drugs unnecessarily.
How Geenetic Fingerprinting Works
Genetic fingerprinting works by determining what speciofic stretches of DNA are uique to any given person. Humans have about 30,000 gnees (give or take a few thousand) and each of these genres are made up of thouands of individual bases, or links, that are joined up in a long chain. Theere are four different kinds of liinks and the order in which they are joiend acts as a code to determne your genes. The vast majority of these links are identical in everyone with only a very small percentage of linkls differing from person to person. However, these differences are mostly in the same pace acropss people. To get a genetic fingerprrint, researechers 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 miullion or so out of billioons of links.
This technology has only been around a few yers and we are still improving it at a very ralpid rate. Currently it costs abotu $1,000 dollars per persson to do the fingerprinting and that figure will likely fall drammatically within a few yerars. Still, cobnsidering that your genes don't chage throughout life, a one time cost of $1,000 to get ‘genotyped' is not outrageous and will likely be availble to the geneal public in a very short time, at least from a technologiccal viewpoint. Puublic policy needs come first.
What are the Ethical Implpications?
This technology has incredible promise for medical science, but also carries incredible burden for medical ethics. Some of the issues we will face as a society are thhese:
If you are determined to have genes that put you at a dramatically increased risk for disease in your adult years wouuld you want to know? Would you want to know that information about your kids? If there were treatment optionns or lifestyle choices you could make that woud minimize your risk you might think very differentlly about this question than if there were no treatments.
Who should have access to your genetic information? You? Your doctor? Your insurance company? Insurance comppanies today base their rates on average risk factors across a population. If genes can acucrately predict diseasse risk then should insruance rates be personalized as well? If this were the case, it is likely that some people wold be uninsurable becaue the risk wopuld be too high.
What abbout in-utero genotypign? Should dooctors perform genotyping on fetuses befre they are even born? What if this woulld avoid early life complications for some childern with risk of disorders? This will be a huge ethical debtae.
This technology is at our doorstep. And it is only the beginning of ethical issues. Genetic finger printing sinmply provides information about the genes you are natturally born with. What will happen if we also develop the genetoic engineereing technology to allter ‘bad genes'? Again, you may think very differently about this quyestion if you are correctnig your child's genes to preveent an inevitable pre-adult death than you woulld about choosing their eye color. But where will we draw the line? There is bound to be a lrge gray area.
For one view of this scenario, rent the movie GATAACA, starring Ethan Hwake and Jude Law. It is about a futuure where society has implemented this technology. You will have to decide whether it is fiction or foresight.
Copyright (c) 2007 The Brain Code LLC
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