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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Andy Burnham and Sadiq Khan are both slippery self-mythologisers – so why do we rate one more than the other?

Their obsessions with their childhoods have both become punchlines; but one of these jokes, it feels to me, is told with a lot more affection than the other.

Andy Burnham is a man whose policies and opinions seem to owe more to political expediency than they do to belief. He bangs on to the point of tedium about his own class, background and interests. As a result he’s widely seen as an unprincipled flip-flopper.

Sadiq Khan is a man whose policies and opinions seem to owe more to political expediency than they do to belief. He bangs on to the point of tedium about his own class, background and interests. As a result he’s the hugely popular mayor of London, the voice of those who’d be proud to think of themselves as the metropolitan liberal elite, and is even talked of as a possible future leader of the Labour party.

Oh, and also they were both born in 1970. So that’s a thing they have in common, too.

Why it is this approach to politics should have worked so much better for the mayor of London than the would-be mayor of Manchester is something I’ve been trying to work out for a while. There are definite parallels between Burnham’s attempts to present himself as a normal northern bloke who likes normal things like football, and Sadiq’s endless reminders that he’s a sarf London geezer whose dad drove a bus. They’ve both become punchlines; but one of these jokes, it feels to me, is told with a lot more affection than the other.

And yes, Burnham apparent tendency to switch sides, on everything from NHS privatisation to the 2015 welfare vote to the leadership of Jeremy Corbyn, has given him a reputation for slipperiness. But Sadiq’s core campaign pledge was to freeze London transport fares; everyone said it was nonsense, and true to form it was, and you’d be hard pressed to find an observer who thought this an atypical lapse on the mayor’s part. (Khan, too, has switched sides on the matter of Jeremy Corbyn.)

 And yet, he seems to get away with this, in a way that Burnham doesn’t. His low-level duplicity is factored in, and it’s hard to judge him for it because, well, it’s just what he’s like, isn’t it? For a long time, the Tory leadership’s line on London’s last mayor was “Boris is Boris”, meaning, look, we don’t trust him either, but what you gonna do? Well: Sadiq is Sadiq.

Even the names we refer to them by suggest that one of these two guys is viewed very differently from the other. I’ve instinctively slipped into referring to the mayor of London by his first name: he’s always Sadiq, not Khan, just as his predecessors were Boris and Ken. But, despite Eoin Clarke’s brief attempt to promote his 2015 leadership campaign with a twitter feed called “Labour Andy”, Burnham is still Burnham: formal, not familiar. 

I’ve a few theories to explain all this, though I’ve no idea which is correct. For a while I’ve assumed it’s about sincerity. When Sadiq Khan mentions his dad’s bus for the 257th time in a day, he does it with a wink to the audience, making a crack about the fact he won’t stop going on about it. That way, the message gets through to the punters at home who are only half listening, but the bored lobby hacks who’ve heard this routine two dozen times before feel they’re in the joke.

Burnham, it seems to me, lacks this lightness of touch: when he won’t stop banging on about the fact he grew up in the north, it feels uncomfortably like he means it. And to take yourself seriously in politics is sometimes to invite others to make jokes at your expense.

Then again, perhaps the problem is that Burnham isn’t quite sincere enough. Sadiq Khan genuinely is the son of a bus-driving immigrant: he may keep going on about it, but it is at least true. Burnham’s “just a northern lad” narrative is true, too, but excludes some crucial facts: that he went to Cambridge, and was working in Parliament aged 24. Perhaps that shouldn’t change how we interpret his story; but I fear, nonetheless, it does.

Maybe that’s not it, though: maybe I’m just another London media snob. Because Burnham did grow up at the disadvantaged end of the country, a region where, for too many people, chasing opportunities means leaving. The idea London is a city where the son of a bus driver can become mayor flatters our metropolitan self-image; the idea that a northerner who wants to build a career in politics has to head south at the earliest opportunity does the opposite. 

So if we roll our eyes when Burnham talks about the north, perhaps that reflects badly on us, not him: the opposite of northern chippiness is southern snobbery.

There’s one last possibility for why we may rate Sadiq Khan more highly than Andy Burnham: Sadiq Khan won. We can titter a little at the jokes and the fibs but he is, nonetheless, mayor of London. Andy Burnham is just the bloke who lost two Labour leadership campaigns.

At least – for now. In six weeks time, he’s highly likely to the first mayor of Greater Manchester. Slipperiness is not the worst quality in a mayor; and so much of the job will be about banging the drum for the city, and the region, that Burnham’s tendency to wear his northernness on his sleeve will be a positive boon.

Sadiq Khan’s stature has grown because the fact he became London’s mayor seems to say something, about the kind of city London is and the kind we want it to be. Perhaps, after May, Andy Burnham can do the same for the north – and the north can do the same for Andy Burnham.

Jonn Elledge edits the New Statesman's sister site CityMetric, and writes for the NS about subjects including politics, history and Daniel Hannan. You can find him on Twitter or Facebook.