NN°°2314 8I -q24au9 Ir StEePrTlEyBMR I ocEt-oObCTerO BR201E3 2010 RubFroiqcues | 21 w diagnosis (see p. 24) and rare hereditary diseases (as in Jolie’s case), the clinical applications of gene-based predictive medicine are extremely limited,” notes Anne Cambon-Thomsen,1 a geneticist and expert associated to the COMETS, CNRS’s ethics committee. THE RIGHT NOT TO KNOW Given that most diseases are multifactorial (see box), predictive medicine may never fully live up to its ambition, unlike the related field of pharmacogenetics, which can already predict the effectiveness of certain treatments. Regardless, the genetic testing underlying these approaches exacerbates the issues already raised by other early diagnosis techniques. These issues could become even more critical if tests that cover the entire genome—whose price has now fallen to around $1000—become common practice. First of all, the risk of getting more than bargained for, only an occasional occurrence with medical imaging or simple blood tests, would become systematic. The ethical question of the “right not to know,” either for patients or family who might have the same predispositions, would regularly come up, with ever more complex implications. Everyone would need to learn how to handle more uncertainty—which of course already arises from conventional biological examinations. “In fact, differentiating the normal from the pathological largely depends on the physician’s opinion, especially in the assessment of certain ‘precancerous’ cells,” comments Ilana Löwy, a medical historian at Cermes32 and former biologist at the Pasteur Institute. “If everyone has access to extensive data on genetic predispositions, an important educational effort will be needed to explain to patients what the figures really mean,” warns CNRS senior researcher Hervé Chneiweiss, director of a neurobiology unit3 and chairman of the Inserm4 Ethics Committee. Lastly, within a few years, as genetic sequencing becomes faster and less expensive, a single hair brushed from someone’s shoulder will yield an entire DNA profile. How will we protect our genetic privacy from insurance companies, employers, and bank loan officers who might be tempted to resort to DNA-based discrimination? The future benefits of predictive medicine are difficult to assess, but whatever its merits, the social issues it raises will need to be addressed. C. Z. 01. Unité Épidémiologie et analyses en santé publique: risques, maladies chroniques et handicaps (Inserm / Université de Toulouse / Université Paul-Sabatier Toulouse-II). 02. C entre de recherche, médecine, sciences, santé, santé mentale, société (CNR S / Inserm / EHESS / Université Paris-Descartes). 03. Plasticité gliale et tumeurs cérébrales (Inserm). 04. Institut national de la santé et de la recherche médicale. Future in our Genes What Does Genetic Testing Tell us?
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