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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Our union backed Brexit, but that doesn't mean scrapping freedom of movement

We can only improve the lives of our members, like those planning stike action at McDonalds, through solidarity.

The campaign to defend and extend free movement – highlighted by the launch of the Labour Campaign for Free Movement this month – is being seen in some circles as a back door strategy to re-run the EU referendum. If that was truly the case, then I don't think Unions like mine (the BFAWU) would be involved, especially as we campaigned to leave the EU ourselves.

In stark contrast to the rhetoric used by many sections of the Leave campaign, our argument wasn’t driven by fear and paranoia about migrant workers. A good number of the BFAWU’s membership is made up of workers not just from the EU, but from all corners of the world. They make a positive contribution to the industry that we represent. These people make a far larger and important contribution to our society and our communities than the wealthy Brexiteers, who sought to do nothing other than de-humanise them, cheered along by a rabid, right-wing press. 

Those who are calling for end to freedom of movement fail to realise that it’s people, rather than land and borders that makes the world we live in. Division works only in the interest of those that want to hold power, control, influence and wealth. Unfortunately, despite a rich history in terms of where division leads us, a good chunk of the UK population still falls for it. We believe that those who live and work here or in other countries should have their skills recognised and enjoy the same rights as those born in that country, including the democratic right to vote. 

Workers born outside of the UK contribute more than £328 million to the UK economy every day. Our NHS depends on their labour in order to keep it running; the leisure and hospitality industries depend on them in order to function; the food industry (including farming to a degree) is often propped up by their work.

The real architects of our misery and hardship reside in Westminster. It is they who introduced legislation designed to allow bosses to act with impunity and pay poverty wages. The only way we can really improve our lives is not as some would have you believe, by blaming other poor workers from other countries, it is through standing together in solidarity. By organising and combining that we become stronger as our fabulous members are showing through their decision to ballot for strike action in McDonalds.

Our members in McDonalds are both born in the UK and outside the UK, and where the bosses have separated groups of workers by pitting certain nationalities against each other, the workers organised have stood together and fought to win change for all, even organising themed social events to welcome each other in the face of the bosses ‘attempts to create divisions in the workplace.

Our union has held the long term view that we should have a planned economy with an ability to own and control the means of production. Our members saw the EU as a gravy train, working in the interests of wealthy elites and industrial scale tax avoidance. They felt that leaving the EU would give the UK the best opportunity to renationalise our key industries and begin a programme of manufacturing on a scale that would allow us to be self-sufficient and independent while enjoying solid trading relationships with other countries. Obviously, a key component in terms of facilitating this is continued freedom of movement.

Many of our members come from communities that voted to leave the EU. They are a reflection of real life that the movers and shakers in both the Leave and Remain campaigns took for granted. We weren’t surprised by the outcome of the EU referendum; after decades of politicians heaping blame on the EU for everything from the shape of fruit to personal hardship, what else could we possibly expect? However, we cannot allow migrant labour to remain as a political football to give succour to the prejudices of the uninformed. Given the same rights and freedoms as UK citizens, foreign workers have the ability to ensure that the UK actually makes a success of Brexit, one that benefits the many, rather than the few.

Ian Hodon is President of the Bakers and Allied Food Workers Union and founding signatory of the Labour Campaign for Free Movement.