Ir­ish ab­sence from EU genome project could cause harm

The Irish Times - Tuesday - Health - - Health Lifestyle - Pat Har­rold

Six­teen Euro­pean Union coun­tries have signed up to a Euro­pean genome project to col­lab­o­rate on DNA re­search and, re­gret­tably, Ire­land is not yet one of them. This, as an Ir­ish GP, con­cerns me, as this fail­ure has pro­found im­pli­ca­tions for the health of the na­tion. An Ir­ish genome project is cru­cial if we are to de­velop a mod­ern and ef­fec­tive health sys­tem.

I, like the blue whale, the fruit fly and the fox­glove, have a genome which is my ge­netic make-up. We Ir­ish also have our own vari­ant of the hu­man genome, the char­ac­ter­is­tic make up of our DNA as a peo­ple. Dr Gian­piero Caval­leri in the Royal Col­lege of Sur­geons of Ire­land has shown that those of Ir­ish de­scent have a dis­tinc­tively ho­moge­nous make-up, which makes it com­par­a­tively easy to map our sus­cep­ti­bil­ity to dis­ease, as well as our re­ac­tion to med­i­ca­tion. When you con­sider that there are about 50 mil­lion peo­ple on Earth who claim Ir­ish de­scent, this is im­por­tant work, not just for Ire­land but for the world. Dr Caval­leri and his fel­low ge­neti­cists would like to start off by tak­ing sam­ples from 10,000 peo­ple from the is­land of Ire­land.

Many of us have had our DNA mapped for the fun of it by such meth­ods and sev­eral pri­vate com­pa­nies will gladly map our in­di­vid­ual genomes for us. It is a pain­less process, and when sam­ples are taken from a size­able chunk such as 10,000 peo­ple in the pop­u­la­tion, it gives a ba­sis for years of valu­able re­search.

I re­cently at­tended a fas­ci­nat­ing lec­ture given by Dr Eimear Kenny, a New York-based, Ir­ish-born ge­neti­cist about such a project among the Latino pop­u­la­tion in Har­lem. Although those from Puerto Rico and the Do­mini­can Repub­lic look much the same, live in the same ar­eas of New York City and speak the same lan­guage, they have sig­nif­i­cantly dif­fer­ent types of dis­ease and re­ac­tions to med­i­ca­tions. So if, for in­stance, a child has a cough, their doc­tor will know that if they be­long to one ge­netic back­ground and not the other they are far more likely to have se­vere asthma and, fur­ther­more, which in­haler is more likely to work, neatly re­duc­ing mor­bid­ity and sav­ing time and money.

Ances­try

As I lis­tened to Dr Kenny, it all seemed pleas­antly fa­mil­iar. Af­ter all, ev­ery fam­ily doc­tor knows that con­di­tions run in fam­i­lies, and con­sid­er­a­tion of ances­try, re­gions and timely in­ter­ven­tions are part of our ev­ery­day work. So it is no sur­prise that the Ir­ish Col­lege of Gen­eral Prac­ti­tion­ers CME tu­tors, as al­ways up to date and in­no­va­tive, are tak­ing a lively in­ter­est in the Ir­ish genome project. They are hold­ing meet­ings and work­shops about the ex­plo­sion of knowl­edge in ge­net­ics and the im­pli­ca­tions for fu­ture medicine. This is log­i­cal, for the GP con­sult­ing room would be the log­i­cal place to start test­ing, if gen­eral prac­tice could be prop­erly re­sourced to do it. If a doc­tor knows the ge­netic make-up of her pa­tients, she could ac­cu­rately pre­dict their re­ac­tions to drugs such as war­farin, their re­ac­tion to cancer treat­ments and which med­i­ca­tions are likely to be haz­ardous to their DNA type.

Sav­ings

Like dig­i­tal cam­eras, mo­bile phones and elec­tric cars, the genome is on the way, and it could yet save the Health Ser­vice Ex­ec­u­tive a for­tune. Our Nordic cousins in Fin­land es­ti­mate that if they could iden­tify those likely to de­velop di­a­betes, and pre­vent it

‘‘ If a doc­tor knows the ge­netic make-up of her pa­tients, she could ac­cu­rately pre­dict their re­ac­tion to cancer treat­ments

be­fore it de­vel­ops, it could save them tens of mil­lions, year af­ter year. In Ire­land we spend 10 per cent of our health bud­get on di­a­betes care; so we should be aim­ing to make sim­i­lar sav­ings here.

We are at a fork in the road. The de­ci­sion-mak­ers in Gov­ern­ment, the Dáil health com­mit­tee and the pol­i­cy­mak­ers in the HSE have a clear choice. They can choose to en­dorse the Ir­ish genome project and go down as politi­cians with Le­mass-like vi­sion. They will have en­sured that own­er­ship of the Ir­ish genome stays with the Ir­ish peo­ple, they will have saved the health bud­get money, they will have ben­e­fited the health of the na­tion and they will have cre­ated thou­sands of sus­tain­able jobs. Or they can do noth­ing. If Ire­land be­comes the 17th coun­try to sign up to the in­ter­na­tional agree­ment on genome re­search in the EU, it would be a good start. If we could lis­ten to the ge­neti­cists and start plan­ning for the fu­ture, like Bri­tain, Fin­land and Es­to­nia, who are quickly leav­ing us be­hind, it would be even bet­ter.

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