Posted by: brian | October 31, 2008

Genetic politics

An article in the Wall Street Journal asks “Will We Vote Against a Candidate’s DNA?

In the coming era of personal genomics — when we all can decode our genes cheaply and easily — political candidates may be pressed to disclose their own DNA, like tax returns or lists of campaign contributors, as voters seek new ways to weigh a leader’s medical and mental fitness for public office.

As it turns out, genetic testing is rapidly getting less expensive and easier to do. So, will that information make some people think twice about supporting a given candidate? I expect that ideology and party membership will continue to guide most voters. John McCain, for instance, is old and has a history of health problems including cancer, but that isn’t the major factor in most people’s decisions (although there is some evidence that people are wary of a Sarah Palin presidency, and so McCain’s health is apparently playing some part in driving independent voters toward Obama.)

“The inflammatory and prejudicial information outweighs the gain from knowing it,” [Harvard health policy analyst Dr. Aaron] Kesselheim says. “I would be reluctant to cross that bridge until the science is much more advanced than it is now.”

There is some reason to support mandatory publishing of candidates’ health records and, when feasible, the content of their DNA.

More often than not, [Dr. Kesselheim] says, [past] ailing presidents and their physicians withheld the medical data that would have allowed the public to judge the true extent of their condition and, more importantly, how it affected their decision-making ability.

The problem this assertion lies in the phrase “would have allowed the public to judge.” As an entity, the public has neither the knowledge nor the temperament to make that judgment. There are rare exceptions – Reagan’s Alzheimer’s, for instance. But even in that case, only a medical professional can make an adequate judgment about what level of impairment is worth getting worried about. Granted, when the patient is the leader of the free world, the threshold would be very low, if not non-existent. But what if someone is revealed to have a higher than average risk for Alzheimer’s, and makes a completely innocent mistake that could be symptomatic of the disease? How are we to know which it is? Does a single instance of such a slip constitute evidence that the person is slipping into dementia? Not only does the public lack the ability to properly make a medical assessment of a particular individual, but they are also bombarded by information that is often inaccurate or misleading, sometimes intentionally so.

Could this information be useful? Yes. Does the general public have the expertise to understand and analyze that information? No, and they never will. Genetics is inherently complex, and DNA != fate.

In many ways, though, our genome can be misleading. “Sometimes, there’s less to it than meets the eye,” says Stanford University biomedical ethicist Mildred Cho.

Rosalynn Gill, chief scientific officer at a consumer genetics firm called Sciona, was among those who made their genomes public last week. She was surprised to discover she carried a gene for hemochromatosis, in which abnormally high levels of iron build up in the blood, since she actually is chronically anemic. “My physical manifestation is quite the opposite of my genetic findings,” she says.

[Harvard neuroscientist Steven] Pinker says his personal genome revealed that “[he has] some susceptibility to having irregular menstrual periods.”

As in much of medical science, there are few absolutes in genomics. Rather, we rely on statistical correlations between elements. For instance, a given anti-depressant might be effective in treating 60% of a particular subset of patients diagnosed with clinical depression, and among those for whom the drug works, its effectiveness is not uniform. In the same way, genetic markers for a disease are not necessarily correlated with 100% of the occurrences of that disease.

The article cites the case of Sergey Brin, one of Google’s co-founders, who “might be at higher risk of Parkinson’s disease.” So what about that phrase “might be at higher [than average] risk”? If a disease typically affects 2 out of every thousand people, that suggests that an “average” person would have a 0.2% risk of developing that disease. What if someone carries a genetic profile that is more common to that disease, and among people who share that profile, the disease affects 4 out of every thousand people? That person is twice as likely to develop the disease! Based not on the manifestation of symptoms, but simply on that 0.4% chance that the person might develop symptoms at some unspecified future time, it is clear that they are unfit for the role of public servant!

Inevitably, analysis of any candidate’s genome will always reveal something amiss, Chicago-Kent College of Law Prof. Lori Andrews says, since we all have at least 15 or so potentially harmful mutations. “We may knock out some great candidates,” she says.

Or maybe we could knock out all the candidates, and resort to mob rule or anarchy. After all, is it really acceptable to have leaders who are prone to human failings? Wouldn’t we be better off to be governed by infallible gods, or maybe robots?


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