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Now why do we need genetic counselors ?

In Uncategorized on April 17, 2008 at 11:49 am

According to the National Society of Genetic Counselors, genetic counseling is:

“the process of helping people understand and adapt to the medical, psychological and familial implications of genetic contributions to disease.”

But a commentary in Science Magazine indicates that these admirable goals are unachievable. It turns out that patients given genetic information on predisposition to disease don’t really care. Consequently, they are unlikely to do any changes to their lifestyle based on the test-results. Behavioral epidemiologist Colleen McBride and human geneticist Lawrence Brody are quoted saying:

“They’re not having big emotional
responses”

And subsequently the author concludes that:

“Behavioral specialists have shifted from
worrying about the devastating effects of
learning about these new genetic risks to
wondering whether the information will
make any impression at all.”

The REVEAL study (by way of Genomeboy) modifies the picture slightly on the willingness to change lifestyle based on test results from APOE, but confirms the lack of distress or anxiety resulting from test results. The REVEAL study was designed to measure:

  • Who seeks genetic counseling and why
  • How APOE disclosure affects risk perceptions
  • The psychological impact of genetic risk assessment
  • How risk information affects participants’ subsequent health and insurance behaviors.

Where the findings included:

  • Disclosing APOE status and its association with Alzheimer’s risk to participants did not result in a significant increase in distress or depression.
  • Participants who discovered they had the high risk APOE e4 allele proved more likely to be proactive in changing their lifestyles and planning for long term care.
  • A majority of participants reported that REVEAL had made a positive impact on their lives (67% positive vs. 17% negative).
  • Participants were more likely to report lower, rather than higher, anxiety about Alzheimer’s disease as a result of being tested (43% lower vs. 11% higher)

Thus, it seems the fear of damage caused by genetic test results is unwarranted or at least highly exaggerated. So, the question is: is there still a need for genetic counselors to ease distress ?

Yes one might answer, since genetic counseling is still needed to interpret the result. … – But,

In addition to the well known test for BRCA1, genetic tests are increasingly emerging that will give clear cut answers. Additional examples are colon cancer and lung cancer if you are a smoker. Understanding the technology behind the test becomes less important when test-results leads to unambiguous recommendations. No need to know what a SNP is if having it gives you a disease risk of 80-90 %. Thus, counseling to explain the problem of uncertain statistical probabilities may soon be obsolete.

If the risk turns out to be less than 80-90 % (and consequently less reliable for a physician as a proper pre-diagnostic test), according to the piece from Science magazine: it looks like nobody will care. If this is the case, genetic counseling for tests associated with medium to low risk becomes superfluous.

As an alternative then, I would suggest that genetic counselors turn their focus towards relieving group damages from genetic testing. That may be the life saver for a group of professionals once thought to have a bright future, now facing a dim/boring one.

Richard Dawkins: an Evangelical atheist ?

In Uncategorized on April 14, 2008 at 1:07 pm

Something that should strike anyone reading, or listening to, Dawkins arguments against religion is: Being clever on hindsight is always easy.

Knowing what we know today, it is easy to see that God and religion are delusions (or faith as one might call it). Throughout history however, alternative explanations to existence has been sparse and religion has simply been the best explanation around. Consequently all known societies has had one or more Gods. Religion has been at the root of building society as we know it today, including the flaws.

Today, science builds society (including the flaws) more than religion does , – and increasingly so. Science is therefore at risk of becoming the new religion, and Dawkins may be destined for one of the new Archbishops. We should all learn from the history of religion and avoid the pitfall of discrediting and ridiculing what we cannot explain or things we currently cannot find supporting evidence for. What science cannot explain today, including any superhuman being or force, is not necessarily wrong for believers to believe in, – and who knows, evidence for some kind of a God may appear in the future when science has advanced further.

John Gray writes in “The Atheist delusion

“Zealous atheism renews some of the worst features of Christianity and Islam. Just as much as these religions, it is a project of universal conversion. Evangelical atheists never doubt that human life can be transformed if everyone accepts their view of things, and they are certain that one way of living – their own, suitably embellished – is right for everybody. To be sure, atheism need not be a missionary creed of this kind. It is entirely reasonable to have no religious beliefs, and yet be friendly to religion. It is a funny sort of humanism that condemns an impulse that is peculiarly human. Yet that is what evangelical atheists do when they demonise religion.”

Instead of concluding the obvious (that God, as explained in the bible or elsewhere, is a delusion), we should take Dawkins’ writings as strong documentation for the continuing misuse of religion to oppress and abuse. The misuse is not caused by faith or religion in itself, but rather by people claiming religious leadership and authority. Their actions are probably more a result of darwinian principles (as the struggle to excede other members of a population, – through oppression or otherwise, is a fundamental darwinian principle), than they are results of religious faith.

This last point is important to remember because science will inevitably be misused the same way, and we as conscientious scientist are obliged to fight back.

This post is an update from the previous post: Richard Dawkins being clever on hindsight

Launching SciPhu.com

In Uncategorized on April 7, 2008 at 12:55 pm

SciPhu= Science + Phusis

Phusis – An Ancient Greek word often translated as birth or nature (Wikipedia).

SciPhu.com is a blog based, open access and unrestricted publishing model. A hybrid in the spirit of Wikipedia and JustScience.

The idea behind SciPhu-publishing was to be able to publish and peer-review scientific information more efficiently than standard peer-reviewing. We wanted the reviewing process while retaining its scientific credibility, to be faster and less rigid. The answer, we found, is blogger-reviewing (which in this setting is just a fancy name for commenting on blog posts). Blogging is a good starting point since there are so many knowledgeable bloggers out there. While SciPhu may still be developed into a proper web-portal of some sort, the blog based starting point is now launched.

The end goal of SciPhu is to be able to quality control scientific information from any source, so that the twisted reality that sometimes ends up in the popular press (and ultimately in public opinion) can be promptly countered with proper accessible scientific information.

On the way towards this goal, we would like to provide a novel publishing channel for the scientific community. A way of publishing that is completely free of (any kind of) charge, less rigid, more efficient and more interactive than existing publishing models. SciPhu publishing is unlimited open-access and has the potential to reach a broad audience. At the same time, SciPhu aims be a pivotal tool to keep scientific authority intact, free and unpolitical.

Without input from (a lot of) you however, this effort will fail. Therefore, please feel free to contribute scientific content, recommend to friends and collegues or just come by to review/rate someone else’s work.

Invitation:

You are cordially invited to:

  • Write (blog) your own scientific article (or a review of a scientific topic).
  • Referee articles written by others.
  • Participate in scientific publishing in a new format.

You are invited to visit and join the SciPhu publishing community.

Combining the best of web-based medicine

In Uncategorized on April 1, 2008 at 11:35 am

It struck me while reading this article on PatientsLikeMe, ScienceRoll’s post on PharmaSurveyor and VentureBeat‘s post on health 2.0, that combining patient experiences like PatientsLikeMe with online doctors like AmericanWell must be the next step in medicine 2.0 / health 2.0. Merging the best features of these two concepts seems to me to be a killer (sic) combination. Question is how long it’s going to take the medical community to realize this.

Add this to the “uses of DNA” collection

In Uncategorized on March 28, 2008 at 7:20 pm

This post follows previous posts 10 ways to use your DNA and 9 more ways to use DNA. The collection so far: 3 blog-items containing 21 uses.

20. Will coffee make you sick ? Consumer genetics will tell you if you are likely to brake down coffein slowly or rapidly (SNP CYP1A2*1F in the CYP1A2 gene). The health implications are clearly overrated, but perhaps you would still find it interesting to know just how much coffee you have to drink in order to read DNA blogs all night.

21. Quit smoking. Nicotest analyzes two genes Cyp2A6 og DRD2. The testresult will tell the company which of its quit smoking products to sell you. However, if you look really hard you will find (faq, How does it work, section 4 second line and down), that the actual link to genetics is quite weak.

Should public health care pay for IVF-treatment ?

In Uncategorized on March 18, 2008 at 9:34 am

Some developed countries with public health care will offer in-vitro fertilization (IVF) to aid couples with their reproductive problems. Having trouble conceiving is thus regarded as a medical problem and treatment although expensive, is paid for through public health services. Now, nature news reports on a drive to extend such IVF-treatment to developing countries as well.

Why ?

Because:

“The inability to have children can create enormous problems, particularly for the woman,”

…………problems like……………….

“She might be disinherited, ostracized, accused of witchcraft, abused by local healers, separated from her spouse or abandoned to a second-class life in a polygamous marriage.”

I know perfectly well that I myself, am fortunate to have my own children. I thus, may not be able to understand the suffering that infertility can lead to (especially in the developing world).

Nevertheless, trying to be objective on this issue, isn’t it obvious that this is a misuse of health resources ?

In the developed world I find it immoral to spend public resources and money, on IVF. Adoption can help children who would otherwise suffer and in my mind, should be the alternative for infertile couples. Of course one cannot and should not, stop people if they would like to pay for assisted reproduction themselves. But, treating infertility is not a public responsibility.

In the developing world where resources are scarce, I find it even more immoral. The problem for infertile women in these countries is so clearly, a social problem, not a medical one. Put the money towards making them treat their women better, instead of giving credibility to prejudice and discrimination by treating this condition.

Also, in a world soon to be overpopulated, isn’t this just another step towards doom ?

9 more ways to use DNA

In Uncategorized on March 12, 2008 at 1:19 pm

In a follow-up to my previous post 10 ways to use your DNA, here are 9 more uses:

11. Artwork. DNA Art Forms, dna11 and DNA-Artistry all isolate your DNA from a swab-sample and subsequently chop it up to create a pattern that is unique to you (similar to the old way of determining human identity). The product is a piece of art to put on your wall. You can see examples here and here.

12. Testing for predisposition to psychiatric disorders. Three companies offer this service, NeuroMark, Psynomics and SureGene. These tests should however, under no circumstance be confused with proper diagnostic tests, as stressed in this article.

13. Genetically customized flowers. Blue roses to replace the now outdated red ones.

14. Test your athletic abilities. Although most of us are probably painfully aware of our limitations already.

15. Glow in the dark goldfish.

16. Genetally optimized SPA-treatment. This however, looks like they have just renamed a nutrigenetics test. Note that nutrigenetic testing has been heavily criticised by authorities.

17. Surname testing which is basically a tool for genealogists.

18. Another such tool is Common birthplace testing.

19. And finally we have the appalling misuse of DNA offered here. This service has rightfully been deemed nonsens….

More uses to follow in what seems to develop into a collection of DNA-use posts.

Tests that make me sad (updated)

In Uncategorized on February 29, 2008 at 10:46 am

In a previous post (“Clarifying misuse of Science“) I expressed concerns over Prenatal testing for familial hypercholesterolemia. Now it seems I should have included two more (and in my mind, – more controversial) tests approved in the UK for preimplantation testing preceding IVF. These are tests for breast cancer (BRCA1) and early onset Alzheimer.

Especially the case of BRCA1 worries me. True, the prevention (mastectomy) is a horrible ordeal for the patient, but is this sufficient grounds for excluding eggs for IVF ? Can’t you live a reasonably happy and normal life after such a procedure (see breast reconstruction) ?

Why haven’t there been more fuzz around this ? Is everyone going to be using prestested eggs in IVF now ? And what are the limits on acceptable tests, will testing for athletic performance become an exclusion criterion soon ?

I must have been naive to so strongly oppose the slippery slope argument in genetic testing discussions up until now. I wish we could restrain ourselves a bit more, but fear that we can’t.

The solution is to come up with treatments for most of these conditions (although treating athletic performance may constitute a problem in terms of the number of people needing treatment as well as treatment alternatives…..).

Treatment alternatives need to appear soon if we’re to avoid the brave new world future that critics of the genetics era have been promoting …..

The “find a cure” process however, is not going to be fast and in the 10-25 years to follow, those concerned couples that have the option of BRCA1 and Alzheimer testing will most likely not take the chance that a treatment will be found in time for their child to be cured…….., – and opt for the safer pretested egg and IVF.

Seeing that the slope is becoming slippery I have decided not to argue for genetic testing any further, and if this trend continues, – argue against, at least until treatment options appear (the next 25? years) or a sensible limit for testing is drawn (right now, – please).

On race and genetics

In Uncategorized on February 12, 2008 at 3:10 pm

In the previous post “A refreshing view on James Watson“, I referred to the website HonestThinking. The background was a post on this website pointing out the lack of scientific evidence for the unison discreditation of Watson. This has spurred a debate in some (local) newspapers about the validity of the term “race”. Race it is argued, is a social construct used to stigmatize groups. In addition there are claims that there isn’t any biological/genetic evidence to indicate that we are more different between races than within a race. Race is clearly then, a controversial term.

HonestThinking has replied to, and rejected, these arguments elegantly and has referred to the brilliant website Edge. Edge has a piece written by Mark Pagel on this issue which is very worth reading (see quote below).

As a reminder that knowledge is key to avoid prejudice, enlightened biologists do not view race as controversial. We are familiar with genetic diversity. We know that there are significant differences between ethnic groups. Our community does not associate these genetic differences with political or racist issues. James Watson on the other hand, did, – and that was hopefully, the real reason for his job-suspension. Our challenge is to communicate the scientific truth in a manner exactly opposite to Dr. Watson’s.

The scientific truth is that there are genetic differences with biological implications. These differences are larger than we previously thought. Not only are there differences in protein encoding regions of DNA, there are also differences leading to differential gene expression and in addition, there are differences in genetic insertions/deletions in the human genome. Add to this a variation in gene copy number and the multitude of ways we can be different at the genetic level becomes apparent. Altogether the 99,9 % genetic similarity we thought existed between humans is probably much lower.

On top of the genetic differences there are epigenetic differences that can contribute to phenotype variation (difference in appearance). Thus, we are all substantially different, but that does not mean we are of unequal value. It just means we’re not the same, – let’s be thankful and appreciative of that. I know I am.

Ending quote from Mark Pagel in Edge’s “The World Question Center”:

What this all means is that, like it or not, there may be many genetic differences among human populations — including differences that may even correspond to old categories of ‘race’ — that are real differences in the sense of making one group better than another at responding to some particular environmental problem. This in no way says one group is in general ‘superior’ to another, or that one group should be preferred over another. But it warns us that we must be prepared to discuss genetic differences among human populations.”

Hsp90 to end controversies in evolution theory (final chapter, blogging in Just Science 08)

In Uncategorized on February 8, 2008 at 9:42 am

Previous posts have shown Hsp90 to be a molecular buffer allowing rapid morphological changes in times of stress. As will be discussed below, such a buffering function supports the evolutionary theories of punctuated equilibria, hopeful monsters and canalization.

So…, this last post will end with the final conclusions based on the arguments presented in the previous 4 posts. But, first….Two fundamental questions:

1. Even if Hsp90 can promote rapid changes in phenotype (appearance) how is this change retained (fixed) for future generations ?

This fixation has been demonstrated to occur (see Sangster TA et al.), and the traits become independent of Hsp90. The exact mechanism(s) however remains to be elucidated.

Nevertheless, temporarily compromising Hsp90 function (either by drugs or by temperature rise) is sufficient for fixing new traits. Simulations seem to show that knocking out the genes for key proteins (not necessarily heat shock proteins) lead to increased phenotypic diversity, and thus the underlying cause may be genetic fixation. However, interplay between epigenetic and genetic mechanisms has been suggested and been backed up by experiments. Thus fixation probably happens through yet to determined genetic as well as epigenetic mechanisms, or a combination of both. A model for epigenetic fixation is given in the thumbnail below:

Epigenetic evolution through Hsp90

Models for genetic fixation follows the theory of canalization with Hsp90 functioning as the Waddington’s widget (see Semin Cell Dev Biol. 2003 Oct;14(5):301-10). This is discussed further under the next bulletpoint, the second question…..

2. Does these aspects of Hsp90-function fit into current models of evolution ?

Yes, although some of these theories are controversial. First we have the idea of punctuated equilibrium and hopeful monsters discussed in my previous post. To expand on these ideas let’s also include the theory of canalization. Canalization explains punctuated equilibrium by referring to an organisms buffering capacity (to counter the potential deleterious effects of mutations). The theory was put forward by C. H. Waddington more than 50 years ago, but is still controversial it seems. Hsp90 is a molecular explanation of the canalization concept in that organisms with different genotypes express the same phenotype until times of stress. There are also indications that other heat shock proteins or other “signaling hub”-proteins or even miRNA can serve such buffering functions (see references within this review).

Taken together, these controversial evolutionary theories and the experimental evidence on Hsp90 supports one another, and a paradigm shift in evolutionary biology is in place. Darwins theories are correct up to the point of gradual and constant evolution of traits. Evolution instead, occurs in bursts. This series of blogposts have conveyed the molecular evidence for such punctuated equlibria and canalization, which comes from studies on the molecular chaperone Hsp90. I hope I have enlightened and convinced at least some evolution biologists into believing that Darwins theories can be expanded to include these (no longer controversial) theories.

There are however, a lot to work out in terms of the underlying molecular mechanisms for Hsp90 (and/or other buffering bioactive molecules ?) in canalization. To end this blogpost-series I will therefore quote the closing remarks from Salathia N and Queitsch C‘s review in 2007:

“Clearly, organisms have succeeded in integrating multiple canalization mechanisms into robust wild-type phenotypes which can respond appropriately to environmental perturbations and evolve new shapes and functions over time. Now it is up to us to determine how molecules as diverse as a molecular chaperone, chromatin remodeling proteins, and the RNAi machinery interact coherently to achieve such synergy, a truly fascinating and worthy field of future inquiry.”