By Che 461 students
Genetic technology has made enormous strides in the last few decades. The entire human genome has been mapped out, and heritable diseases are being linked not just to DNA in general but to specific locations on various chromosomes. On Tuesday afternoon, a group of Wabash students and faculty enjoyed a unique lunch panel discussion that highlighted the ethics, costs, and fields associated with genetic testing.
Doctors Scott Douglas and Elizabeth Colonna along with Meadow Heiman, a genetic counselor, spent time explaining the concept of genetic testing and answering the questions of those in the crowd. All of these panelists shared their experiences with genetic testing in their practices before answering questions posed by the chemistry 461 and the general public.
Doctor Scott Douglas, Wabash class of 1984, studied at the IU School of Medicine before opening a primary care family practice in Crawfordsville. Since he works in primary care, he deals with genetic testing very little, and could only think of a handful of cases in his time in which genetic testing was used. Douglas said that primary care physicians don’t see rare diseases often, so primary care physicians are usually hesitant to use genetic testing; instead, patients are sent to more specialized centers. Dr. Douglas gave an example of using genetic testing in a patient with muscular dystrophy in which he and a specialist were able to diagnose the disease clinically but used genetic testing to verify their diagnosis. He explained that genetic testing can be very expensive and that sometimes it is used to rule out other possibilities and prevent other neurological testing. Future work with genetic testing will be testing patients before giving drugs such as the blood thinner, Plavix, due to the genetic variability in response to the drug.
Meadow Heiman, who is a genetic counselor, has much more experience with genetic testing. Heiman has spent 11 years in different areas of genetic counseling including pre-natal, pediatric and research. In her profession, she spends most of her time educating patients about a particular disease and family history, assessing risk and interpreting testing. Heiman said that genetic counselors are assistants to physicians. A genetic counselor is not a general counselor, and usually only sees patients one to two times.
Doctor Liz Colonna, an obstetrician and gynecologist, did her residency in Manhattan, where genetic testing was much more prevalent than in her practice in Crawfordsville. She said that there is less interest here, usually because of religious reasons, but as a resident in New York she performed nearly 25 amniocenteses every week.
The floor was then opened to students and faculty for questions. The first question was, “What are the advantages and disadvantages of genetic screening?” Dr. Douglas said they are specific for each disease, and the problem with doing the screening is, “that we don’t know how to treat genetic problems. There are a lot of unknowns.” Dr. Colonna brought a brighter viewpoint to the question, saying if a woman has a family history of breast cancer and tests positive for BRCA, a breast cancer screening, she can have her breasts removed and receive implants which would keep her from getting breast cancer. Colonna also highlighted the amount of research that has been going into genetic testing and the exciting new information scientists are learning and publishing. Mrs. Meadow said there is a risk of genetic discrimination if a genetic test is done. While it is illegal for a health insurance company to take you off their coverage due to a genetic disorder, there are many caveats to the law. She said the advantages of genetic testing are in its ability to inform the family and let them make proper preparations and decisions for the future.
Another student asked how much a genetic test costs. The panel said it depends on the number of alleles being tested. The cheapest tests which are done on a specific allele can cost $200-400, but other tests can cost up to $7000.
It was very interesting to hear the different viewpoints that medical professionals encounter with genetic testing. Many patients leave all aspects up to God and refuse to be tested, while some soon-to-be-parents take things into their own hand with options such as termination or alternatives such as donor eggs, testing the chromosomes before implanting the egg. The professionals who spoke have the people who they serve first and forefront in their minds. They look to both the psychological and emotional well-being as well as the medical side. If a disease cannot be treated and is debilitating, there may be little reason to test for that disease. The doctors hold the right to test for things as they see fit and can refuse to test for things that may harm the patient more than simply not knowing. Overall, these professionals are simply looking to help their patients and do them no harm.