Researchers into genetic surgery in Philadelphia developing a technique to eliminate HIV from cells. Photo: Getty
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Why DNA testing isn’t always best for customising medical treatment

Greater understanding of the genetic causes of illness suggests that this method of categorisation might not be the most accurate.

If doctors discovered you had a 30 per cent chance of developing colon cancer, would you want to know? What if that probability was only 10 per cent, or perhaps as high as 50? Maybe it would depend on what you could do to improve your prognosis – or whether the information would be confidential.

These ethical issues are becoming increasingly relevant following the announcement this month of a landmark £300m project to sequence the genomes of 100,000 NHS patients. The programme, which will last four years, is part of the developing field of personalised medicine and it aims to use genetic data to customise medical treatments.

Currently, many diseases are defined by their symptoms or the site of occurrence. Greater understanding of the genetic causes of illness suggests that this method of categorisation might not be the most accurate. For instance, scientists now believe that cancer is better understood as a plethora of diseases rather than a single one because of the variety of underlying genetic mutations.

Improved awareness of these genetic factors raises the potential of new treatment options. Up to one in four cases of breast cancer is caused by a mutation in the gene that encodes the HER2 protein. As such, Herceptin, the drug used to target the protein, is given only to breast cancer patients with this genetic abnormality. It is hoped that further research will allow more drugs to be optimised in a similar way.

Personalised medicine could also be safer. Genetic variation among patients has been linked to dangerous reactions to drugs. In 2004, a British Medical Journal report estimated that each year in the UK, more than 10,000 deaths result from adverse reactions to drugs. By predicting how patients will respond to medication, genetic screening could help avoid these cases.

There is also the possibility of disease prevention. If we know which diseases we are most susceptible to, that allows us to take precautions. For instance, a patient might choose to have surgery to remove her ovaries after discovering that she has a genetic predisposition to ovarian cancer. These changes can also be more subtle. Health advice can often seem overwhelming; genetic testing could personalise dietary guidelines or fitness regimes for individuals.

These exciting developments bring challenges. A 2001 study found that genetic testing had certain severe psychological implications, with a group of adults reporting clinical levels of anxiety and depression after learning that their genes predisposed them to colon cancer. Especially when it comes to conditions for which effective treatment isn’t available, it’s worth asking yourself how much of your genome you wish to explore.

Another concern often raised is the legal status of genetic data. In 2008, the US government introduced the Genetic Information Nondiscrimination Act to prevent employers and health insurers requesting genetic records. In the UK the government relies on a voluntary agreement with the Association of British Insurers. This expires in 2017 and a review is due this year.

That said, if you wish to discover your medical fate you needn’t wait for the NHS project. Private companies already offer genotyping services for less than £100.

George Gillett is a freelance journalist and medical student. He is on Twitter @george_gillett and blogs here.

This article first appeared in the 13 August 2014 issue of the New Statesman, A century of meddling in the Middle East

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The decline of the north's sporting powerhouse

Yorkshire historically acted as a counterweight to the dominance of southern elites, in sport as in politics and culture. Now, things are different.

On a drive between Sheffield and Barnsley, I spotted a striking painting of the Kes poster. Billy Casper’s two-fingered salute covered the wall of a once-popular pub that is now boarded up.

It is almost 50 years since the late Barry Hines wrote A Kestrel for a Knave, the novel that inspired Ken Loach’s 1969 film, and it seems that the defiant, us-against-the-world, stick-it-to-the-man Yorkshireness he commemorated still resonates here. Almost two-thirds of the people of south Yorkshire voted to leave the EU, flicking two fingers up at what they saw as a London-based establishment, detached from life beyond the capital.

But whatever happened to Billy the unlikely lad, and the myriad other northern characters who were once the stars of stage and screen? Like the pitheads that dominated Casper’s tightly knit neighbourhood, they have disappeared from the landscape. The rot set in during the 1980s, when industries were destroyed and communities collapsed, a point eloquently made in Melvyn Bragg’s excellent radio series The Matter of the North.

Yorkshire historically acted as a counterweight to the dominance of southern elites, in sport as in politics and culture. Yet today, we rarely get to hear the voices of Barnsley, Sheffield, Doncaster and Rotherham. And the Yorkshire sporting powerhouse is no more – at least, not as we once knew it.

This should be a matter of national concern. The White Rose county is, after all, the home of the world’s oldest registered football club – Sheffield FC, formed in 1857 – and the first English team to win three successive League titles, Huddersfield Town, in the mid-1920s. Hull City are now Yorkshire’s lone representative in the Premier League.

Howard Wilkinson, the manager of Leeds United when they were crowned champions in 1992, the season before the Premier League was founded, lamented the passing of a less money-obsessed era. “My dad worked at Orgreave,” he said, “the scene of Mrs Thatcher’s greatest hour, bless her. You paid for putting an axe through what is a very strong culture of community and joint responsibility.”

The best-known scene in Loach’s film shows a football match in which Mr Sugden, the PE teacher, played by Brian Glover, comically assumes the role of Bobby Charlton. It was played out on the muddy school fields of Barnsley’s run-down Athersley estate. On a visit to his alma mater a few years ago, David Bradley, who played the scrawny 15-year-old Billy, showed me the goalposts that he had swung from as a reluctant goalkeeper. “You can still see the dint in the crossbar,” he said. When I spoke to him recently, Bradley enthused about his lifelong support for Barnsley FC. “But I’ve not been to the ground over the last season and a half,” he said. “I can’t afford it.”

Bradley is not alone. Many long-standing fans have been priced out. Barnsley is only a Championship side, but for their home encounter with Newcastle last October, their fans had to pay £30 for a ticket.

The English game is rooted in the northern, working-class communities that have borne the brunt of austerity over the past six years. The top leagues – like the EU – are perceived to be out of touch and skewed in favour of the moneyed elites.

Bradley, an ardent Remainer, despaired after the Brexit vote. “They did not know what they were doing. But I can understand why. There’s still a lot of neglect, a lot of deprivation in parts of Barnsley. They feel left behind because they have been left behind.”

It is true that there has been a feel-good factor in Yorkshire following the Rio Olympics; if the county were a country, it would have finished 17th in the international medals table. Yet while millions have been invested in “podium-level athletes”, in the team games that are most relevant to the lives of most Yorkshire folk – football, cricket and rugby league – there is a clear division between sport’s elites and its grass roots. While lucrative TV deals have enriched ruling bodies and top clubs, there has been a large decrease in the number of adults playing any sport in the four years since London staged the Games.

According to figures from Sport England, there are now 67,000 fewer people in Yorkshire involved in sport than there were in 2012. In Doncaster, to take a typical post-industrial White Rose town, there has been a 13 per cent drop in participation – compared with a 0.4 per cent decline nationally.

Attendances at rugby league, the region’s “national sport”, are falling. But cricket, in theory, is thriving, with Yorkshire winning the County Championship in 2014 and 2015. Yet Joe Root, the batsman and poster boy for this renaissance, plays far more games for his country than for his county and was rested from Yorkshire’s 2016 title decider against Middlesex.

“Root’s almost not a Yorkshire player nowadays,” said Stuart Rayner, whose book The War of the White Roses chronicles the club’s fortunes between 1968 and 1986. As a fan back then, I frequently watched Geoffrey Boycott and other local stars at Headingley. My favourite was the England bowler Chris Old, a gritty, defiant, unsung anti-hero in the Billy Casper mould.

When Old made his debut, 13 of the 17-strong Yorkshire squad were registered as working-class professionals. Half a century later, three of the five Yorkshiremen selec­ted for the last Ashes series – Root, Jonny Bairstow and Gary Ballance – were privately educated. “The game of cricket now is played in public schools,” Old told me. “Top players are getting huge amounts of money, but the grass-roots game doesn’t seem to have benefited in any way.”

“In ten years’ time you won’t get a Joe Root,” Rayner said. “If you haven’t seen these top Yorkshire cricketers playing in your backyard and you haven’t got Sky, it will be difficult to get the whole cricket bug. So where is the next generation of Roots going to come from?” Or the next generation of Jessica Ennis-Hills? Three years ago, the Sheffield stadium where she trained and first discovered athletics was closed after cuts to local services.

This article first appeared in the 19 January 2017 issue of the New Statesman, The Trump era