March 29, 1995 in City

Health Facts Aren’t Science Fiction

Art Caplan King Features Syndi
 

What could be worse than not knowing your future? Apparently nothing, given the huge numbers of people who eagerly ponder their horoscope every day or spend lots of money dialing the “certified” psychics who peddle their dubious skills ‘round the clock on cable television.

But would you really want to know your future if the news was bad and there was little or nothing you could do about it?

If your doctor could tell you with certainty that you would be dead of a heart attack in 10 years, would you really want to know?

What if instead of your own future it was the medical future of your son or daughter that could be predicted?

Those questions, once the stuff only of science fiction, are rapidly become real choices, as two genetic-testing reports released this month make clear.

In the March 15 issue of the American Heart Association’s scientific journal Circulation, a group of Australian researchers at the University of New South Wales led by Dr. David E.L. Wilcken report that they can identify a change in a portion of a gene that controls a chemical that regulates the body’s blood pressure.

The chemical - angiotensin converting enzyme, or ACE determines how fast and how strongly blood vessels contract. Some people, because of the way their genes are made, have a biological propensity to make more ACE, thus leaving them at higher risk of a heart attack.

The Australian researchers looked at 404 children, 214 boys and 190 girls, ages 6 to 13, to see if they had the genetic mutation associated with increased ACE production. They then checked the medical condition and history of the children’s grandparents. When they found grandparents who had heart attacks, the researchers found “a significant association between the number who had coronary events and the ACE genotype” in the children. When both grandparents had suffered heart attacks, there was a very strong link to the ACE gene marker in their grandchildren.

The researchers conclude that the ACE gene mutation is a powerful predictor of which children are at high risk of heart disease and heart attacks.

Another group of researchers, at UCLA, reported in the March 22 issues of the Journal of the American Medical Association a significant correlation between the presence of a gene known as APOE and one form of Alzheimer’s disease, the terrible curse that robs individuals of their memory and cognitive abilities.

The UCLA group reported that in 31 subjects where older relatives had suffered from Alzheimer’s disease, brain changes could be detected in those that had the APOE gene, although no obvious signs of Alzheimer’s disease were yet present.

Neither of the tests is ready for general use. But both are expected to be within a few years. When they are ready, what should doctors tell their patients and their families about using them?

There is little that can be done to stop the onset of Alzheimer’s disease. Those at risk of heart disease can try to modify their diet to make it as healthy as possible, get moderate exercise and have regular medical checkups. But that is good advice for anyone to follow.

In fact, the same is true for many diseases that appear to have a strong genetic component: breast cancer, prostate cancer, schizophrenia, colon cancer. If you are more likely than others to get the affliction, the things you need to do are no different from what a prudent person would want to be doing anyway.

As the ability to forecast our fate by knowing something about our genes advances, we will have to decide whether knowing the future even if it cannot be changed is a good thing. And we will need to decide whether burdening our children with the knowledge of their medical futures makes any sense if there is nothing that they can do to alter the risks they face.

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The following fields overflowed: CREDIT = Art Caplan King Features Syndicate

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