Genetic Testing Might Not Cure Everything That Ails America. So What?
Even if genetic testing is just brightly colored signage, it still has the potential to improve health outcomes.
Genetic testing company 23andMe received FDA approval this month to resume telling customers about their predisposition to various syndromes and illnesses. Reason's Ronald Bailey, a longtime 23andMe user, is happy, though he'd be happier still if the FDA got out of the genetic information-policing business altogether.
The Mayo Clinic's Dr. Michael Joyner, meanwhile, responded to the FDA's announcement with skepticism. His beefs, in order:
- Genes are not destiny: "For example, people at increased genetic risk of cardiovascular disease are not at all destined to die from cardiovascular disease. Importantly, they also are at much lower risk if they follow a healthy lifestyle."
- Genetic info is not a necessary prerequisite for minimizing risk: "When I hear anecdotes about someone becoming more active and losing weight because they found out they are at mildly increased genetic risk for something like type 2 diabetes, it always makes me wonder why that motivated them more than all the important things we already know a healthy lifestyle can help with."
- Genetic testing can freak people out: "First, some people who get a score back suggesting they are at increased risk might become fatalistic and figure there is nothing they can do. Or, some people who get a score back suggesting they are at decreased risk might become cavalier about their risk and assume they are protected no matter what they do."
- There are cheaper tests that tell us far more about our health: "when the topic of gene scores comes up, I like to mention what I call the 'bathroom scale score.' It turns out that for many common chronic diseases, body weight, BMI or waist circumference are more predictive of future risk than a gene score."
When reading doctors on direct-to-consumer health care technology, I get the sense many of them perceive all this stuff to be a profound misallocation of resources. Yes, we are entering a truly incredible age of self-assessment on demand, and yes, those technologies have made healthy people even healthier. But middle-aged, lower-middle-class white Americans are living shorter lives and 86 million Americans have fasted glucose levels that suggest type II diabetes is not far off. What are these new technologies doing for them?
These folks currently have access to mundane technology that will tell them far more than a 23andMe report: the bathroom scale, the free blood pressure machine at the pharmacy, the fasted glucose and cholesterol panels their doctors have ordered; all these diagnostic devices are telling them they have problems right now, and should eat less, eat better, and move more. If those inputs don't inspire change, why would a genetic test–alluding only to diseases they might get–be any different? It might not be!
Genetic testing could be more like broccoli sprouts than broccoli: Broccoli sprouts are a hot "super food" right now, but most of us could stand to just eat more broccoli, the way most of us should be taking advantage of simple health assessment tools. Then again, the fact that getting people to eat more vegetables–of any kind!–would go a long way toward improving American health-care outcomes is no reason to condemn, or ban, bougie super foods (or genetic tests).
As someone who treated his body like a Superfund site for the better part of two decades, but now takes his health very seriously, I like the prospects of the direct-to-consumer healthcare market. Like many folks, I waited for a "medical trigger" to take stock and make changes. Some people don't need to develop chronic high blood pressure or sleep apnea to take their health seriously, other people don't take their health seriously until they develop one or more of those things. People in the latter category could benefit from more warning signs, particularly earlier in life. I just don't see the downside, particularly in light of what we're learning about reversing negative health trends at the individual level. As The New Yorker's Rivka Galchen reported in a piece on bariatric surgery last year, even though losing weight is literally as simple–for the vast majority of people–as "calories out must exceed calories in," rerouting the digestive tract is now considered the most effective means for treating obesity and the diseases that frequently accompany it. "I'm a dyed-in-the-wool behavioral psychologist," U. Penn's Tom Wadden told Galchen, "and even I will tell you that there's no question that bariatric surgery is going to provide a larger and more durable weight loss than life-style modification, medication, or even a combination of the two."
If genetic testing is just bigger, brighter signage warning us about the road ahead, maybe that's enough.