Jeffrey Bland argues that genomics has been framed backward: instead of using gene tests to predict disease risk, we should use them to understand how genes interact with environment to build resilience. He critiques tests like 23andMe for selling fear and calls for a shift toward mapping biological potential.
June 25, 2014.
$99.
So people are dying to know what we know. It's a double entendre. You know, it's absolutely true that the things you know are things that other people die for not knowing and not applying in their lives. So how do we make this infectious? How do we get it sticky? How do we really transform health care? So we make health as an important virtue, as disease. Now think about this for a second. What did I just say? Every marker that we have, every incentive, every social promotion, every sense of entitlement is associated with being a champion of disease. If you talk about health, you're in the public health system, you're a weak partner. You're not so strong as getting in and doing something magic to a person who's near death using heroic intervention. Think if you would about 23andMe, 23andMe, as you know, had this $99 gene test. And now the FDA has raised some questions about whether it's an unapproved medical device. But let me say something about that. One of the reasons that they got themselves into some conversation with the FDA is they're doing the same thing or were doing the same thing in the interpretation of their gene test as every other genetic testing company. And that is they were telling the owners of their genes and their report forms what diseases they were at risk for. Right? Oh, you have a risk for whatever it might be, hypertension, stroke, you know, cardiovascular disease or whatever.
And that was the message that most.
People will take away from gene testing.
They're afraid to look at their results, saying, oh, geez, what if I get a bad number here?
You know, that might be me.
I might be really in serious trouble.
Now, I want you to know that within our genome, within our genome resides not the messages for disease, but the messages for health.
What would happen if we got a.
Report back from our genetic testing saying.
Here are your resilience factors, turning it entirely around. It would be an enlightenment opportunity for an empowering population to be healthy, not to worry about disease. Disease is a fear based model. Disease is a fear based model.
And we as a culture are working.
Out of a fear based model. Because all of the concerns is our number might be pulled mysteriously in the dark of night that we didn't have any control over. We just got kind of a statistical thing because our parents gave us genes. We didn't even fill out an application card for that model. That Mendelian model is a relic. It's on the sidebar of understanding. Yet it's still dominates medical thinking today. So what's the Alternative. That's why I wrote the book. I'm trying to have people recognize that we have just crossed a threshold. Not a reversible threshold, an irreversible threshold in the last 20 years that redefines the science of human biology. This is a revolution that is equal in magnitude, a seismic intellectual understanding of the human species equivalent to when we discovered infectious disease at the turn of the last century. And we caused the mean average life expectancy to go from 44 years to 65 years in less than two decades because of sanitation, hygiene and nutrition, and then later immunization and antibiotics. Right. And that gave birth to the modern view of a pill for an ill. Because if you have a bug and you have a drug that prevents a cell wall of that bug being formed, you can selectively kill the bug without hurting the patient. And that's a magic bullet. Bullet. Right. And so we have this mentality in our minds that once we decipher the human genome, we find the gene for disease, for diabetes, the genes for heart disease, the gene for autism, the gene for bad dayism, that we will then find the molecule that will treat that gene defect, and we will have a perfect medical outcome. And lo and behold, what we find as we have deciphered the genome and we have the reports in the rose Garden in 2000, we find, gee whiz.
We can't find that any of these diseases are single genomic, they're not monogenetic. And in fact, there is no such thing as a disease, a gene for diabetes. There is no such thing as a gene for heart disease. There are associative genetic factors that in a specific environment, result in a phenotype called diabetes and heart disease. But those aren't genes for diabetes and heart disease. Those are unique characteristics carried as an advantage from the history of your race going back to time. Memorial, as a disease in the absolute. Certainly it exists in our minds because it makes it very easy to codify people that show similar signs and symptoms. But I'm telling you, if you examine 100 type 2 diabetic patients, what do you have? You have 100 individual types of diabetes. They have different etiologies, they have different treatment needs. They have different outcomes. They don't all express the condition the same. So we cluster them for convenience. What I call it makes convenience for reimbursement, right? So the CPT codes and the ICD9s are really convenient to mechanize medicine, to allow us to think we understand what's going on. But in the light of this new biology that we've just crossed over called systems network biology in which we see these things interconnected and we see genes expressing themselves as clusters in response to the environment that that person lives. This model that we grew up with looks a little bit like the barber surgeons looked to people in the 1950s Very primitive disease wasn't a requirement for living right it is an outcome of imbalances so that's kind of the message of our age I think it's a very, very powerful message and just to kind of close this is why I have been so privileged to walk this road less traveled with all of you because this is where we I think will birth the ability for people to live out to their biological potential and reduce suffering that steals from people so many years of their vital life in a time where we need the wisdom of our older age individuals to be mentors for the young in a healthy world population. So thank you very much it's been my privilege.
