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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Leader: Mourning in Manchester

Yet another attack shows we are going to have to get to used to the idea that our liberalism and our freedoms can only be preserved by a strong state.

Children are murdered and maimed by a suicide bomber as they are leaving a pop concert in Manchester. As a consequence, the government raises the terror threat to “critical”, which implies that another attack is imminent, and the army is sent out on to the streets of our cities in an attempt to reassure and encourage all good citizens to carry on as normal. The general election campaign is suspended. Islamic State gleefully denounces the murdered and wounded as “crusaders” and “polytheists”.

Meanwhile, the usual questions are asked, as they are after each new Islamist terrorist atrocity. Why do they hate us so much? Have they no conscience or pity or sense of fellow feeling? We hear, too, the same platitudes: there is more that unites us than divides us, and so on. And so we wait for the next attack on innocent civilians, the next assault on the free and open society, the next demonstration that Islamism is the world’s most malignant and dangerous ideology.

The truth of the matter is that the Manchester suicide bomber, Salman Ramadan Abedi, was born and educated in Britain. He was 22 when he chose to end his own life. He had grown up among us: indeed, like the London bombers of 7 July 2005, you could call him, however reluctantly, one of us. The son of Libyan refugees, he supported Manchester United, studied business management at Salford University and worshipped at Didsbury Mosque. Yet he hated this country and its people so viscerally that he was prepared to blow himself up in an attempt to murder and wound as many of his fellow citizens as possible.

The Manchester massacre was an act of nihilism by a wicked man. It was also sadly inevitable. “The bomb was,” writes the Mancunian cultural commentator Stuart Maconie on page 26, “as far as we can guess, an attack on the fans of a young American woman and entertainer, on the frivolousness and foolishness and fun of young girlhood, on lipstick and dressing up and dancing, on ‘boyfs’ and ‘bezzies’ and all the other freedoms that so enrage the fanatics and contradict their idiot dogmas. Hatred of women is a smouldering core of their wider, deeper loathing for us. But to single out children feels like a new low of wickedness.”

We understand the geopolitical context for the atrocity. IS is under assault and in retreat in its former strongholds of Mosul and Raqqa. Instead of urging recruits to migrate to the “caliphate”, IS has been urging its sympathisers and operatives in Europe to carry out attacks in their countries of residence. As our contributing writer and terrorism expert, Shiraz Maher, explains on page 22, these attacks are considered to be acts of revenge by the foot soldiers and fellow-travellers of the caliphate. There have been Western interventions in Muslim lands and so, in their view, all civilians in Western countries are legitimate targets for retaliatory violence.

An ever-present threat of terrorism is the new reality of our lives in Europe. If these zealots can murder children at an Ariana Grande concert in Manchester, there is no action that they would not consider unconscionable. And in this country there are many thousands – perhaps even tens of thousands – who are in thrall to Islamist ideology. “Terror makes the new future possible,” the American Don DeLillo wrote in his novel Mao II, long before the al-Qaeda attacks of 11 September 2001. The main work of terrorists “involves mid-air explosions and crumbled buildings. This is the new tragic narrative.”

Immediately after the Paris attacks in November 2015, John Gray reminded us in these pages of how “peaceful coexistence is not the default condition of modern humankind”. We are going to have to get used to the idea that our liberalism and our freedoms can only be preserved by a strong state. “The progressive narrative in which freedom is advancing throughout the world has left liberal societies unaware of their fragility,” John Gray wrote. Liberals may not like it, but a strong state is the precondition of any civilised social order. Certain cherished freedoms may have to be compromised. This is the new tragic narrative.

This article first appeared in the 25 May 2017 issue of the New Statesman, Why Islamic State targets Britain

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