[IPu] Fw: [IPp] Some Gene Research Just Isn't Worth the Money
>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
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
by introducing an intriguing framework for setting priorities for genetic
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
In contrast, lower priority on the genetic research hierarchy should go to
conditions like Type 2 diabetes or alcohol or nicotine addiction, they
Type 2 diabetes, after all, can be largely avoided through exercise and
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
impact on smoking.
Not surprisingly, the geneticists' proposal, published in Science, drew fire
from their colleagues who study addiction, including Dr. Nora Volkow,
of the National Institute on Drug Abuse. In a published rebuttal last June,
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
to reduce it? Probably not.
Environmental approaches may not be as sexy as high-tech gene-based
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
about health by current and prospective smokers.
"Californizing" the country in a public health sense would reduce smoking to
much greater extent than a comparable investment in genetics research.
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
who are not interested in quitting. At that point, investigating smokers'
might warrant a greater investment because they would be a more highly
genetically determined group. But for now, resources could be better
toward diseases where society has no similarly potent environmental tools.
Could genetic screening prevent addiction? Ideally, people of legal age
refuse cigarettes or alcohol if they knew that their genes put them at
risk for progressing from casual to compulsive use. But screening can
fraternity members, for example, might be more likely to go on a drinking
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
that therapeutic response of alcoholic patients to the medication
agent first developed for heroin users, might be associated with a variant
gene that codes for a specific brain receptor. If replicated, this finding
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
formal treatment. A survey by the National Institute of Alcohol Abuse and
Alcoholism, for example, found that three-quarters of adults who had once
alcohol-dependent but no longer have alcohol problems never received
As Dr. Merikangas and Dr. Risch emphasize, addiction is malleable under the
right circumstances. Only 12 percent of American soldiers addicted to heroin
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
boredom of a war zone, reduced availability of inexpensive heroin and
recognition of the personal cost of continued drug use. Less startling
of environments' changing addictive behavior abound: when is the last time
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
because he was addicted but because cocaine can induce sudden cardiovascular
death. Improved treatments for alcoholism would not make our highways safe:
the 32.3 million Americans who acknowledge driving drunk in the last year,
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
traits, like impulse control and anxiety. But unlike benefits from research
more intractable diseases, major cuts in drug- and alcohol-related harm
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
advisory board member for the Substance Abuse and Mental Health Services
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