With
the U.S. Supreme Court’s decision to uphold the constitutionality of the
Affordable Care Act earlier this year and the re-election of President Obama
last month; it appears as if we are indeed on a precipice of a drastic shift in
focus with regard to how medicine is practiced in this country. In the coming
years there will be a dramatic emphasis in the area of preventative medicine
with respect to patient care. That is, rather than simply educating patients
about their disease and effectively treating their symptoms, under Obamacare,
physicians and other healthcare providers will be rewarded in the form of
financial incentives and rewards for keeping patients healthy! What a concept.
With this new focal point
however, some important discussions need to be had. Many people are unaware
that current technology exists that could in fact help identify pre-cursor
markers, or genomic “red flags” for various diseases and ailments. For example,
mutations in the BRCA family of genes could indicate that a person is more
susceptible to various breast and or ovarian cancers. The question then becomes
– do you want to know what secrets lie within your own genetic makeup? And how
can this information be best utilized for you and your family? These sorts of
questions has led to a relatively new branch of biotechnology and medicine
called “Genetic counseling”, whereby trained medical professionals help to review
potential preventative treatment options for the patient and their family.
Since
the initial completion of the Human Genome Project (HGP) in 2003, there has
been a race in the bioinformatics and related industries to learn more about
how to synthesize this vast amount of genomic data into information that can
help improve (and impact) the lives of humankind. Personal genomics groups such
as 23andMe, Illumina and others are looking to do just that. For a
not-so-nominal fee, of anywhere from $399-$499+ one could send a sample of
their saliva in order to obtain the percentage risk of the expression of
diseases and traits ranging from chronic migraines to Colorectal Cancer and
everywhere in between.
The
potential benefits of having this information at your disposal are almost
limitless. Should this technology become readily available, the growing
discussion of personalized medicine could come to fruition. The conceivable
implications of this would be that your physician could personally tailor his
or her treatment based on your personal genome in order to optimize your
results and minimize adverse reactions. Can you imagine the decrease in
healthcare costs in this country if we were able to eliminate the current
pharmaceutical cost that goes into the constant search for the next “magic
bullet” or “miracle pill” that will treat its target ailment with limited side
effects? With personalized medicine, physicians would be able to completely
sidestep this “trial and error” process and jump right into the optimization of
patient health and safety. With the seemingly endless list of benefits, there
are of course risks and concerns with regard to this process.
One
of the major concerns with regard to personal genomics is the fear that
insurers will be able to get a hold of your genetic information to determine
whether you are a financial “risk” to them. There is some legitimate concern
here as currently there are no provisions against such practice. Currently the U.S. federal legislation
has only enacted the Genetic Information Nondiscrimination Act (GINA), signed
into law on May 21, 2008, which currently only protects employee’s from their
employer using ones personal genome as a criteria for hire or salary. The
current verbiage does not address exclusion criteria afforded to health or life
insurance companies however. With
the available information however, the potential risks and benefits, I for one
am all for it.
The
Personal Genome Project (PGP) headed by Dr. George Church at Harvard’s School
of Medicine is seeking volunteers through an open-ended research project that
will collect the genomes of participants in order to better understand the
traits and characteristics that contribute to human disease. Participants agree
to have their genome sequenced and available for public viewing on the World Wide
Web. For those whom are apprehensive about this practice but wish to have their
genome sequenced, currently their best option would be to fork out the cash for
private screening.
I
for one feel that the old adage of “knowledge is power” reigns more true than
ever here. If I am at risk for Parkinson’s, Prostate Cancer or Rheumatoid
Arthritis for example, I’d like to take the necessary preventative measures and
treatments now in order to reduce my incidence of their expression. This technology can be an incredibly
useful and potentially revolutionary tool in the field of medicine and
research. It is going to be incredibly exciting to see how it is incorporated
into the new vision of preventative medicine under Obamacare going
forward.
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