| Personalized medicine is coming. What does that | | | | do the fingerprinting and that figure will likely fall |
| mean? It means that our genes will determine what | | | | dramatically within a few years. Still, considering that |
| type of medical treatment we get. We know, in any | | | | your genes don't change throughout life, a one time |
| disease, that some people respond favorably to | | | | cost of $1,000 to get 'genotyped' is not outrageous |
| therapy while others do not. We assume that this is | | | | and will likely be available to the general public in a |
| partially due to our genes. Some studies have shown | | | | very short time, at least from a technological |
| correlations between the genes that a patient has | | | | viewpoint. Public policy needs come first. |
| and their response to specific medications. | | | | What are the Ethical Implications? |
| One example is new study that will look at the | | | | This technology has incredible promise for medical |
| interaction between a patient's genes and treatment | | | | science, but also carries incredible burden for medical |
| with the blood thinning drug, warfarin. Over two | | | | ethics. Some of the issues we will face as a society |
| million Americans that are at risk of stroke currently | | | | are these: |
| take this drug to prevent blood clotting. The problem | | | | If you are determined to have genes that put you at |
| is that patients all need different amounts to keep | | | | a dramatically increased risk for disease in your adult |
| their blood at the right clotting potential. Too much | | | | years would you want to know? Would you want to |
| drug can lead to excessive bleeding because the | | | | know that information about your kids? If there |
| blood is too thin. Too little drug and the blood gets | | | | were treatment options or lifestyle choices you could |
| too thick, meaning it can clot easily and lead to | | | | make that would minimize your risk you might think |
| stroke. Currently doctors determine these doses by | | | | very differently about this question than if there |
| trial and error, monitoring patients very closely until | | | | were no treatments. |
| they find the right amount. The new study will follow | | | | Who should have access to your genetic information? |
| 1,000 at-risk stroke patients after genetic | | | | You? Your doctor? Your insurance company? |
| fingerprinting to see if a patient's unique genes can | | | | Insurance companies today base their rates on |
| predict their optimal dose. | | | | average risk factors across a population. If genes can |
| This is the goal of personalized medicine, not just for | | | | accurately predict disease risk then should insurance |
| warfarin, but for all drugs and non-drug therapies. | | | | rates be personalized as well? If this were the case, |
| Sounds like a great idea, right? There would be no | | | | it is likely that some people would be uninsurable |
| more guesswork for the doctors; a higher probability | | | | because the risk would be too high. |
| of success for the therapeutics; and less patients | | | | What about in-utero genotyping? Should doctors |
| going on drugs unnecessarily. | | | | perform genotyping on fetuses before they are |
| How Genetic Fingerprinting Works | | | | even born? What if this would avoid early life |
| Genetic fingerprinting works by determining what | | | | complications for some children with risk of disorders? |
| specific stretches of DNA are unique to any given | | | | This will be a huge ethical debate. |
| person. Humans have about 30,000 genes (give or | | | | This technology is at our doorstep. And it is only the |
| take a few thousand) and each of these genes are | | | | beginning of ethical issues. Genetic finger printing |
| made up of thousands of individual bases, or links, | | | | simply provides information about the genes you are |
| that are joined up in a long chain. There are four | | | | naturally born with. What will happen if we also |
| different kinds of links and the order in which they | | | | develop the genetic engineering technology to alter |
| are joined acts as a code to determine your genes. | | | | 'bad genes'? Again, you may think very differently |
| The vast majority of these links are identical in | | | | about this question if you are correcting your child's |
| everyone with only a very small percentage of links | | | | genes to prevent an inevitable pre-adult death than |
| differing from person to person. However, these | | | | you would about choosing their eye color. But where |
| differences are mostly in the same place across | | | | will we draw the line? There is bound to be a large |
| people. To get a genetic fingerprint, researchers don't | | | | gray area. |
| need to look at all of your links in all of your genes. | | | | For one view of this scenario, rent the movie |
| They only need to look at the points that tend to be | | | | GATACA, starring Ethan Hawke and Jude Law. It is |
| different, a million or so out of billions of links. | | | | about a future where society has implemented this |
| This technology has only been around a few years | | | | technology. You will have to decide whether it is |
| and we are still improving it at a very rapid rate. | | | | fiction or foresight. |
| Currently it costs about $1,000 dollars per person to | | | | |