Healthcare Goes ‘Designer’

Posted on August 4, 2010


When Craig Venter’s Human Genome Project research successfully mapped the human genome, genetic engineering officially went mainstream.  That was the turn of the millennium. The achievement appeared to be the beginning of healthcare optimized on a new plane.  Understanding the body on the molecular level of DNA, the control panel that drives each of our individual biological destinies, seemed like something greater than a breakthrough; it would be a scientific epiphany with implications for all of humanity. We could snipe the killers of modern society from a genetic perch, altering our futures by delaying death, or at least be able to pick the sex of our babies.

Yet more than ten years later, genetic engineering is not as successful as expected from a healthcare perspective.  Genomics, or ‘gene therapy’, still has some promise and proteomics was a buzzword for some time. Yet no magical drugs, no immensely successful predictive powers, no ability to turn on and off genetic markers like light switches.  Some of the reasons are covered well in a Fast Company article from November of last year.

For a different perspective on why genetic engineering is not more successful and what it means, I read a little bit of David Shenk, who approaches the topic from a different perspective. Mr. Shenk’s research focuses on our performance and abilities in relation to our genetics.  In his book The Genius in All of Us, with excerpts in a WSJ article, “The Success Myth”,  Shenk says it is not our genetics which limit our achievement, but our inability to tap our potential.  This is not the message healthcare and scientific experts wanted to hear; they wanted to play God and control futures.

Like many other things, humans have oversimplified the assignment, and underestimated the complexity of the human body.  Schenk notes the work of geneticists Eva Jablonka and Marion Lamb:  “The gene cannot be seen as an autonomous unit—as a particular stretch of DNA which always produces the same effect.”

Genes interact with their surroundings, getting turned on and off all the time, and we have no way of knowing what triggers what. Perhaps just as interestingly, our unique traits are based a great deal on the environment in which our genes developed, which can never be replicated:  “From the moment of conception, genes constantly interact with nutritients, hormones, sensory input, and other genes to produce a unique human being custom-tailored for his/her own unique circumstances.” Much like cancer is caused from both a genetic predisposition and an environmental trigger that initiate the rogue cell replication, we have no idea what the trigger is on any of our genetic material. As it was described:  “Many of those knobs and switches [that express a trait] can be turned on and off at any time— by another gene or by any tiny environmental input.”

Upon a closer inspection of our genetic material, some very crucial insights were gained. The most significant overlap between the Fast Company and Schenk book is the role of RNA. It turns out RNA, which was mostly ignored in the genetic quest, is incredibly important, and its controls hard to solve:

“DNA’s transcription into RNA, a stage in protein formation, turned out not to be a pure photo-copy process, but one influenced by many things happening inside and outside the cell. Different hormone levels, for example, could influence precisely how the DNA was interpreted. Our biology turns out to have a built-in system for individual adaptation.”

For what it is worth, Shenk’s main conclusions about our abilities in relation to our genetics:  “Fixed abilities are not biologically possible. Instead, all abilities (while strongly genetically influenced) are dynamic skills that get developed over time….Everything that we are, from the first moment of conception, is a result of this nature-nurture interactivity. Genes guarantee that differences will exist, but the actual end-result will emerge from a dynamic developmental process.”

The good news from Shenk’s perspective is that we control our destiny in relation to what we can achieve (whew!), keeping in mind we have propensities for some things over others. In the end, our environment (how we develop and what we do with what we have) is at least as important as what we genetically inherit.

What this means to me from a healthcare treatment standpoint is humans have identified the parts of our DNA, but we have a long way to go to figure out how the genetic material works together—and it may never happen.  The human body is that complex. So no worries yet about rolling out genetic treatment service lines at your local hospital or ASC. And for me, no sweating the chance of becoming a genetics clinic design expert. At least not for a few more years.