Saturday, July 22, 2006

Roy: Welcome to the Monkey House


Murky Thoughts brings up a good point in the discussion about nature vs nurture as factors in personal responsibility for behavior... that genes != nature... all that is nature is not necessarily hardwired in the genes. Well, yes and no.

The frontal lobe development that occurs in adolescence and early adulthood IS directed by genes, but is also influenced by environment, some of which is by choice (marijuana, stress of half-time job while attending college, headbutting soccer balls) and some of it is not (lead in the drinking water, malnutrition due to family's poverty, head injury from accidental fall down steps).

To complicate matters, just because you have the gene(s) for, say, alcoholism, doesn't mean you will become alcoholic. If you never pick up a drink, you won't become alcoholic. Ahh, but what if you knew you have the alcoholism gene, and you knowingly drank alcohol and placed yourself at higher risk of becoming alcoholic? How is that choice viewed by society, compared with the choice of taking that first drink while not knowing of the risk?

I think it comes down to intent and risk tolerance. Do you intend to become addicted to alcohol? If so, that's either stupid or pathetic. Perhaps you are a gambler. You may decide to take a 30% risk of becoming alcoholic by taking that first drink, while others may find that a 5% risk is too high to accept.

Here's where knowing more about our defining genes, and about how they interact with environment, should increase, not decrease, our responsibility. The dystopic geneticomedicolegal future may have been foreshadowed in The Minority Report, where people are arrested before they commit the crime. It is easy to imagine being fined or taxed a higher amount if we choose lifestyles which interact with our personal genetic knowledge in a manner which increases the costs to society. We see this now with increased insurance premiums for smokers. Why not drinkers? Or, more specifically, why not folks with alcoholism genes who drink anyway... but no tax for gene-free folks who drink. Scorn the guy who knows he has the Vioxx-causes-heart-attack gene but takes it anyway due to pain, while giving a heartfelt pat on the back to the guy who inexplicably suffers the same fate. Sounds like a Kurt Vonnegut story.

I'd like to imagine a world where we can choose to learn about our genes which define our propensity to develop alcoholism, to be creative, or to develop stomach cancer... and then use that information to help make more informed decisions about where to focus our resources, take risks, avoid genetic traps.

Mind you, this does not mean that people will choose to be limited by what their G, C, A, & T-leaves tell them. Some will choose to accept our current concept of what a collection of genes mean, while others with a more oppositional bent will choose to damn the torpedoes and full speed ahead into genetically uncharted territories, in the same way that some amputees will run a marathon.

Just some food for thought.

13 comments:

Sarebear said...

I and my family once participated in a study about 9 years ago, that the University of Utah sent some grad students out to my parent's house to take blood samples from us all.

I think, even now, that people are starting to take for granted how much we know, genetically, but back then (it was only 9 years ago!!) they were still working on figuring out the genetic tendencies for prostate cancer, and the like.

My father's family has a HIGH incidence of prostate cancer, so they involved as much of the extended and extended-extended family as possible to be one of the geneaological genetic research families in the studies. (This tendency towards prostate cancer seems to have entered the family when my great great grandfather, married his second wife (polygamy), who was his first cousin. That kinda makes sense to me as that sort of semi-close genetic relationship can cause problems . . . I suspect this came from that. Then again, so did I. His first wife couldn't have kids . . . that was ancient history though, polygamy today is NOT a part of the Mormon Church and NOT accepted/acceptable).

Um, back on topic, anyway. You might wonder, why test the daughters, then again, you might have figured out that they wanted to test for transmission of the prostate cancer gene, through the daughter, to the daughter's sons (grandsons of the daughter's father who had the prostate cancer gene). Kinda disturbs me that I could pass on something like this. And also seems wierd that I could be carrying the gene for a male cancer.

I HOPE it never ever comes to the point where society goes extreme and says, HEY, you aren't allowed to have sons because you have this gene . . . (gender selection of embryos to be implanted is a whole 'nother topic . . .)

The GREATEST thing about being in this study, was that the students raised my dad's awareness even more than just the family history of it; it reminded him to go get a PSA test, and the PSA test detected the early stages of prostate cancer, and they successfully operated.

So this study saved my dad's life, too. I love medical science, even with all it's pitfalls!!!

(BTW, GO get a PSA if you are male and over forty or have a family history).

Dinah said...

Roy-- a very thought-provoking post.
This whole concept of knowing one's genetic vulnerabilities then altering our behavior...funny but I think to some extent that possibility exists already, but somehow we don't use it.

Okay, example: I know a man (ah, Roy you know him too) who is the son of a violent abusive alcoholic and he has never tasted a drop of alcohol (middled-aged and never a single beer or a drop of wine with dinner). When I heard this, I thought, wow, he knows he's predisposed, has seen the problem destroy someone and condemn him to a life of poverty, so he didn't take the risk! I've actually never heard of the child of an alcoholic who hasn't EVER tried a drink. But I asked him why, and the thought process that went into it had nothing to do with genetics and increased risk. He simply said he associated alcohol with his father who'd been violent towards him and had kept the family in poverty while his paychecks went to liquor, and he wanted nothing to do with anything having anything to do with his father. But I liked the concept, and sometimes wonder why with all our drug/alcohol education efforts we don't target young children with family histories and try to encourage total avoidance.
As it stands now, the societal pressures to drink/drug/gamble/choose your happy addiction, are not supportive of abstinence. By the way, I promised to make you a cosmopolitan so you could decide if it was a "girl" drink, but now I'll need to take a full family history first.

On the other hand, Sarebear has a very valid point here, while it might make financial sense to tax the predisposed who choose to misbehave, do we really want big brother knowing our genetics and controlling/taxing/dictating our behavior?

ClinkShrink said...

Or worse yet, what if you know your genetic predisposition and there's absolutely nothing you can do about it? As in, there's no way to avoid your fate? Thinking things like Huntington's disease here, or perhaps someday schizophrenia---there's a genetic risk but who knows what actually triggers it? If you have a genetic predisposition for schizophrenia and you chose to use PCP, would you get taxed for that? Probably, because the government would never turn down a chance for income even if you were destined to become psychotic without drug use.

Eesh, it's just too depressing to think about. (Will I get taxed for my choice to think depressogenic thoughts?)

On the Same Page said...

I once participated in a specialty clinic for diabetic adolescents, borderline diabetic adolescents, and obese adolescents. Many were children of diabetic parents and obvioulsy genetically vulnerable. But between cardiology, endocrinology, psychiatry and nutrition, it was very difficult to convience and/or influence adolescent behaviour. I use the example because, while you have no need for alcohol, drugs, or gambling, you must eat. We know the epidemic of obesity among adolescents - the staggering cost of obesity in general - but how helpful is this information in practice? I sat in a room of parents suggesting to school officials that, among the obvious reasons, soda machines should be eliminated from schools because "sugar causes diabetes."

We'll have police "checkpoints" where they stop you, weigh you, and write you a ticket if your BMI is outside the guidelines!

While I have yet to read research to support this contention, I strongly suspect I am a prodrome for no good. Can I use my credit card to pay the fine?

NeoNurseChic said...
This comment has been removed by the author.
Roy said...

I guess the 1984 version of this story has the government databases tracking and taxing (hmm, if there is a genetic basis for terrorism, we can kiss our privacy goodbye).

However, the libertarian version permits us to keep it private, learn about how it affects us, and making decisions accordingly.

I find it interesting that Clink finds these prospects depressing, while I find it liberating. If I knew that I had the gene for Huntington's, I'd make different choices in my life. I see it as giving me an edge... like being a card-counter in Vegas.

This is particularly relevant for me. My mother had four siblings, all of whom developed schizophrenia (or something close to it); she did not. There are now 8 of us in the next generation who have entered the risk period. Three of us have developed the disease. Another three (myself included) are mostly past the risk period unscathed. There are 7 so far in the third generation... so far, all are fine.

Murky Thoughts said...

Dangerous occupations (fire fighter) and sports (scuba) require prescribed training, testing and certification in the litigious post-industrial West nowadays. If you want to drink despite the fact that 30% of the carriers of your allele were alcoholics (a risk roughly six times higher than average), then arguably you ought to get special training and certification. If new laws prohibit drinking for people in this category, such programs are liable to come into being whether or not they're subsidized by taxes. Ditto if courts award millions in damages extra to the victims of drunk driving genetic carriers who got no special training and award nothing extra to those who did get it. At least, that's how society might go with this if it decided to treat this risk like certain others. But since our institutions cater to all sorts of kooky irrational views that are popular, who knows how we'll deal with it?

jw said...

I sit at the intersection of the Irish and Mennonite strains of ET. (I can't remember the gene markers or names ...) Three in five of us have the tremor and associated anxiety.

There was a lot of alcoholism in the family. I drank at first, saw that (due to the severity of the prejudice against lone fathers) I might lose my kids and made up my mind to go alcohol free. I've been straight & sober for thirty years now.

I can't make up my mind what to think about responsibility and genetic knowledge. There are good arguments on both sides.

I do think we need to be careful. We don't yet know enough about the interaction between some bad things and some good things. I'm thinking of malaria and sickle cell: Have one of the markers and you get strong resistance to malaria, have both and you get sickle cell. I'd bet everything that there are a LOT more cases exactly like that.

It might well be that the alcoholism thing is related to a strong behavior. There's plenty of good reason to believe that the traits of a great inventor are a special case of some boyhood problems.

We're playing with fire when we try to eliminate something "bad" from our genome: We simply do not know enough yet.

ClinkShrink said...

Re: "There's plenty of good reason to believe that the traits of a great inventor are a special case of some boyhood problems.

We're playing with fire when we try to eliminate something "bad" from our genome: We simply do not know enough yet."

**********

Exactly. I've often thought that even if it were possible to "cure" criminality, we probably shouldn't. We need those risk-taking, adventure -seeking genes. And talk about boyhood problems, consider this quote from an interview with Steve Jobs:

"I know from my own education that if I hadn't encountered two or three individuals that spent extra time with me, I'm sure I would have been in jail. I'm 100% sure that if it hadn't been for Mrs. Hill in fourth grade and a few others, I would have absolutely have ended up in jail."

Instead, he went on to found Apple Computer.

Dinah said...

Note to Carrie: children are so incredibly expensive, a theoretical government tax on your genes is the least of your worries.

Note to Roy: So how would genetic testing have changed your life? I doubt schizophrenia (or anything like it) is a single gene, simple you-get-it-or-you-don't transmission. So your mother had you, knowing there was a risk, and with all those relatives, you chose to have children, knowing there was a risk. Given that schizophrenia doesn't condemn everyone who has it to a life of non-stop misery (ah, you ill aunts and uncles were able to contribute some humans to the human race)would you have made a different decision about having that kid anyway?

Note to Clink: was the Bill Gates story a good thing or a bad thing? And I bought you a present yesterday.

And Foofoo, keep your thoughts about the Fat Police to yourself. One can carry a few extra pounds w/o fast food or sugary sodas.

Roy said...

I *did* make choices, knowing my increased risk. I asked my wife-to-be if there was schizophrenia in her family (if there were, I would have had to make hard choices, but it still entered the thinking). We intentionally chose not to have a child who would be born in the winter (there is a mildly increased risk of schizophrenia in winter births). I also chose to not use the fireplace during her pregnancy and to have extra carbon monoxide detectors in the house.

That is from one of my pet theories that some of the gene-environment interactional triggers for schizophrenia involve carbon monoxide exposure. Hmm, there's a blog post. I'll work on it.

Thus, I did choose alternative behaviors due to my perceived increased risk. Now, did I make similar choices as an adolescent? I would say no. I guess it's when we start thinking about the next generations that we start to pay attention to this stuff.

ClinkShrink said...

Sorry Dinah, which Bill Gates story? The one about him stealing a car in New Mexico?

On the Same Page said...

Perhaps, Roy, you should also consider the relationship between schizophrenia & influenza - "winter births" - as I recall previously reading. I found 10 separate references in the AmJPsychiatry alone. I look forward to the post.