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[IPu] Fw: [IPp] Some Gene Research Just Isn't Worth the Money



Hi All,
>From the POP List


 http://www.nytimes.com/2005/01/18/health/18essa.htmlSome Gene Research Just
Isn't Worth the MoneyBy KEITH HUMPHREYS and SALLY SATEL

 Published: January 18, 2005


How should we set priorities in medical research? Officials at the National
Institutes of Health will grapple with this question as they allocate 
billions
of dollars from the agency's budget this year.

Two geneticists, Dr. Kathleen Merikangas of the National Institute of Mental
Health and Dr. Neil Risch of Stanford University, have taken on this 
challenge
by introducing an intriguing framework for setting priorities for genetic
research.

The best candidates for genetic research, they believe, are disorders whose
emergence and course cannot be derailed by changes in personal habits or
manipulation of the environment. Examples are autism, Type 1 diabetes and
Alzheimer's disease.

In contrast, lower priority on the genetic research hierarchy should go to
conditions like Type 2 diabetes or alcohol or nicotine addiction, they 
argue.
Type 2 diabetes, after all, can be largely avoided through exercise and 
weight
loss, and teenagers will buy less beer if taxes on alcohol are high enough.
Similarly, a combination of smoking bans, social pressure and taxes have had 
an
impact on smoking.

Not surprisingly, the geneticists' proposal, published in Science, drew fire
from their colleagues who study addiction, including Dr. Nora Volkow, 
director
of the National Institute on Drug Abuse. In a published rebuttal last June, 
they
insisted that addiction deserved a much higher ranking for genetic-research
money, noting that the health and social costs of alcohol and drug addiction
exceed $500 billion a year.

No one can dispute addiction's high cost. But is genetic research the best 
way
to reduce it? Probably not.

Environmental approaches may not be as sexy as high-tech gene-based 
solutions,
but they work. In the past 20 years, California has reduced smoking to 16
percent of adults from 26 percent through higher cigarette taxes, closer
monitoring of sales outlets, restrictions of smoking in public places,
endorsement of antismoking attitudes in the general public and better 
decisions
about health by current and prospective smokers.

"Californizing" the country in a public health sense would reduce smoking to 
a
much greater extent than a comparable investment in genetics research. 
Within a
generation, most of those who continued to smoke despite every environmental
barrier would be those at high genetic risk; the rest would be a small 
cohort
who are not interested in quitting. At that point, investigating smokers' 
genes
might warrant a greater investment because they would be a more highly
genetically determined group. But for now, resources could be better 
directed
toward diseases where society has no similarly potent environmental tools.

Could genetic screening prevent addiction? Ideally, people of legal age 
could
refuse cigarettes or alcohol if they knew that their genes put them at 
higher
risk for progressing from casual to compulsive use. But screening can 
backfire:
fraternity members, for example, might be more likely to go on a drinking 
binge
if they knew their genetic risk for alcoholism was low.

In its defense, genetic research may one day improve addiction treatment. In
response to Dr. Merikangas and Dr. Risch, addiction genetics researchers 
noted
that therapeutic response of alcoholic patients to the medication 
naltrexone, an
agent first developed for heroin users, might be associated with a variant 
of a
gene that codes for a specific brain receptor. If replicated, this finding 
might
allow clinicians to use genetic information to decide whether to offer
naltrexone to a particular patient.

But future improvements in treatment from genetics research are unlikely to
have much effect because, research shows, most addicts who recover do so 
without
formal treatment. A survey by the National Institute of Alcohol Abuse and
Alcoholism, for example, found that three-quarters of adults who had once 
been
alcohol-dependent but no longer have alcohol problems never received 
treatment.

As Dr. Merikangas and Dr. Risch emphasize, addiction is malleable under the
right circumstances. Only 12 percent of American soldiers addicted to heroin 
in
Vietnam maintained the heroin habit after returning home. That is a striking
example of a physiological process (drug dependence) interrupted by
psychological and environmental processes - less need to manage the anxiety 
or
boredom of a war zone, reduced availability of inexpensive heroin and 
increased
recognition of the personal cost of continued drug use. Less startling 
examples
of environments' changing addictive behavior abound: when is the last time 
you
saw a heavy smoker light up at a religious service?

Finally, much of the harm to public health from drug and alcohol use has
nothing to do with addiction. In 1986, Len Bias, the basketball star, died 
not
because he was addicted but because cocaine can induce sudden cardiovascular
death. Improved treatments for alcoholism would not make our highways safe: 
of
the 32.3 million Americans who acknowledge driving drunk in the last year, 
most
were nonaddicted people who made bad choices after drinking too much.

Genetic research on addiction could have benefits. There is a distant
possibility of improving treatment, and it might help in understanding 
related
traits, like impulse control and anxiety. But unlike benefits from research 
into
more intractable diseases, major cuts in drug- and alcohol-related harm 
depend
not on genes but on choices by policy makers and individual citizens.

Keith Humphreys is an associate professor of psychiatry at Stanford. Sally
Satel is a resident scholar at the American Enterprise Institute and an 
unpaid
advisory board member for the Substance Abuse and Mental Health Services
Administration. 
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