Sunday, July 24, 2011

Genetics, Research, Health....and ethics (if there are any)

Well, the NYTimes today has a story by Mark Bittman on the toll that junk food is taking on our national health.  Bittman says that a 20% tax on sugared beverages would raise billions in revenue that could be put towards health improvement, and would prevent 400,000 people from being diabetic, would greatly reduce our national obesity problem, and would save $30,000,000,000 (that's billions) in health care costs.

These are facts so well known that it's only the specific estimates that justify a major story.  Why we haven't long ago done something about it is more complex, and not a tribute to human nature--unless it's a tribute to selfishness.  That's another subject.

For us what is relevant is that in a time when we're trying (at least some are) to make health care available to all in the US, and to curtail health care costs, the debate is about profits, HMO efficiency (that is, reducing care quality), what insurance won't have to pay for, and so on.  Meanwhile, right beneath our noses are major answers.  Of course, lots of industries, such as testing equipment makers, test labs, and Pharma don't want to see a reduction in their customers (the obese, diabetic, hypertensives, and the like).

Removing the overwhelming burden of clearly environmentally caused diseases is simple, but doesn't require lots of research grants to keep the glucose flowing through the veins of universities, so it will naturally be resisted.  But if that were done, the diseases that would remain would be those more truly genetic cases of the same diseases, cases that occur without environmental triggers.  The mask of all the non-genetic cases--most cases--would not blow away the power of GWAS and other kinds of studies as it does today.

Genetics has already under-delivered on the promise of the use genetic data to actually do something about these diseases.  Most of the decades-known genetic diseases are still here with no gene-based therapy available.  We don't think that geneticists should be faulted in this regard, except for their self-aggrandizing hype, because the problems are difficult. Still, once a gene is known, preventing or treating the disease is in a sense an engineering problem (getting an improved gene to replace a defective one or its effects), and one wouldn't want to bet against our ingenuity and technology when it comes to engineering.

So we should implement environmental measures to reduce the disease burdens, pull the plug on research that is going nowhere based on over-geneticizing disease, and intensify research on those traits that really are genetic to show that genetic knowledge and technology really can make a difference other than to the careers of geneticists (like us).

Of course, this won't solve two problems.  First, if fewer people get or die from these common environmental diseases, people will last much longer, decaying gradually, suffering more years of increasingly helpless debility and demanding resources, energy, food, and care-taking that are already in short supply.

And, second, universities not being any more willing to be good citizens than businesses are, will shift their demands for research funds to 'meta' studies: studies of social aspects of lifestyle changes, of aspects of living longer, of surveys of how people feel about all of this, and so on.  Because we'll find something to keep ourselves in business, to keep the bureaucrats' portfolios full, and the like.  Only cuts from the funding source will force universities to cut back on go-nowhere programs that exist mainly because they bring in funds.  These comments may sound rather misanthropic, but if you've lived and worked in the university setting as long as we have, you'll know that there is truth in what we say.

There are many traps in human life, real existential traps.  Curing one disease makes room for another, and worsens overpopulation and resource burdens.  Closing down useless research programs costs people jobs. But when we know how to ameliorate major problems, but spend our resources on small vested interests (like the research industry) rather than on the major problems, criticism is justified.  That there are no escapes from the existential traps is another, genuine and serious thing to think about.

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