Genomics and Immortality

Jonathan asked me the other day if I thought we could get to a point in medicine when we could make people immortal, or cure them of all disease, or at least extend life by another hundred years or so. At first I quickly dismissed those as possibilities, at least for the general population. Well, I have been in my genetics and genomics unit for the last week and now I am not so sure.

A lot of people in medicine right now are really pushing the idea of personalized care, meaning that we can sequence everyone’s DNA genome and therefore know exactly what disease they have, what kind of medication would work best, in what amount, and what kind of effect it will have. There are some great benefits to this! It means that we could know if a child has the genes for a disease that will develop later in life that could be prevented or at least lessened. It means that medication could be given effectively (a surprisingly large number of people die or are made worse due to medication complications) because doctors would know exactly how much they need, of what, and how their body will react. Treatment like this would significantly decrease a lot of health care costs, number of unneeded tests and medications, and would decrease time spent figuring out what is wrong and how to fix it.

There are also some potential drawbacks, or at least strong ethical concerns. Parents could know the exact genetics of their child while it is still in the womb, and could choose to abort if they don’t like what the genome shows. With gene therapy, parents could “fix” the genes of their in-womb child. Individuals could do that for themselves as well, though to a slightly less degree given our current technology. People could request to see the genomes of their girlfriend or boyfriend before deciding to marry and have kids. Sites like match.com could start to include a section for “genetic profile.” Ok, so that is a light-hearted example, but the point is that people who have some hidden genetic mutations, or just not “ideal genes” could be intentionally selected out of the mating pool. Here are some questions this raises for me:

-who would have access to the genomic info of another person?

-what effect would this have on insurance, if a genome showed that a person was predicted to get, or at high risk for a particular disease?

-what would the psychological impact be on society if people were able to know all of their different genetic mutations?

-what effects would this have on procreation, choosing spouses, and abortion?

-would we turn into a standardized society with a definition of “ideal” or “perfect” genes that people will preferentially select for? (ironically, diversity in the gene pool is actually considered a sign of a “healthy” population that is of low risk to severe mutation, but even that would change if you could control or fix mutations)

Right now these techniques are too expensive for the average person, but that is predicted to change over the next 10-20 years, so getting your genome sequenced could be as routine as getting your basic childhood vaccines. So this isn’t as far-fetched and distant as I initially thought.

So to return back to Jonathan’s initial questions, having your genetic sequence and using gene therapy wouldn’t definitively cure a person of all disease, but it has potential to cure a lot of the deadly illnesses.

Suddenly, an important question arrises: Is mortality an illness? If the role of scientists and doctors is to heal and cure the sick, and if we generally say that saving someone’s life is the goal of a medical procedure, then it seems to follow that trying to extend peoples’ life would be a good goal (I don’t mean just keeping old people alive forever in a state of sickness). That has certainly been the trajectory of medicine so far. One of the key methods of analyzing health of a country is to look at the average life span, and almost all countries have increased their avg. length of life over the last 100 years. But what if we have the technology to make people double their life span? No, that isn’t immortality, but it would have HUGE consequences on daily life and the core philosophy of life as we know it.

For me, this brings up the core question of what the goal of medicine and scientific research is. I think that technology has many great benefits, and I think that healing people is a good and valid life profession (or it would be hard to be in med school). I think that giving people the physical experience of going from sickness to wellness is a way of helping people experience the gospel, and a God who is all about giving health to the sick in the most holistic and eternal way possible. But I internally squirm when I think of us being immortal, or even living two or three times as long, here on Earth because of our advanced technology. I do think we are meant for eternal life. But isn't there a difference between the eternal life with God that scripture talks about and eternal life that we could give ourselves? How much does God inform and move forward our technological advances? How can we tell? The goal of life and health is similar to God and scientists/doctors, but do they move towards them in the same ways? Does God use doctors and scientists to do this? Are we even able to comprehend what God means when he talks about eternal life and health, or are our thoughts and definitions too feeble and small to really have any idea what He intends for us?

Questions that I do not have answers to, but that I think will persist thoughout med school.

"So, what brings you to the doctor today?"

I recently had to write a paper on the theories and models of the doctor-patient relationship. There is the paternalistic model, in which the doctor knows best and tells with patient what is wrong and dictates the care plan. There is the engineering model, in which the doctor gives the patient the facts and allows the patient to decide their own health plan. Then their is the collegial model, which emphasizes the need for relationship between the doctor and patient. It states that the doctors role is to listen, ask questions, advice the patient based on medical fact but all the ultimate care plan to be shaped by both the patient and the doctor, so that it takes into consideration the patient as a whole person, not just an isolated illness.

These all have different pros and cons, and (in my very limited experience) it really depends on the patient. In general, you (are supposed to) start with the collegial model, and adjust if you have to. The paper led me to think the general role or job definition that physicians have. Although the obvious answer might seem to be, "heal people/improve their health," I'm learning how debated that answer is in the medical community, both in what it means in its legitimacy as an answer to the question. A lot of the debate ends up centered around the doctor-patient relationship, and how the doctor is supposed to view the patient.

If the doctor views the patient primarily as a disease or illness, rather then a person, then the goal is simple: fix it. It might sound kind of harsh to say that these kinds of doctors don't see patients as real people, but as something to be cured, but they also get a lot more done. They see more patients a day (ie. they technically have more chances to heal), and the patient generally always receives the best care in the medical/scientific sense. Some patients seem to want this in their doctor, others don't.

If the doctor views the patient as a friend, or younger sibling, they might be really great at hearing the whole story behind the illness or injury, getting all the social/psych/family background, sympathizing or empathizing well, and maybe even sharing a personal fact about themselves. But after all of that, a lot of time has been spent and nothing has been done about the acutely medical need. Yet, a great relationship has been built, trust built, and whatever advice the doctor does give might be carried out more effectively by the patient because of that relationship. Again, pros and cons. Some patients think this is just a waste of time, others need it before they can trust the doctor.

I'm going through the gospels as my Advent reading, and its making me wonder: how would I classify Jesus' doctor-patient relationship. Sure, it gets more complicated because, well, He's the Son of God and knows people lots more intimately then I will ever know my patients. So maybe the question is more: what kind of doctor-patient relationship does Jesus teach others to have (noting the difference between following/imitating Jesus, and actually being Jesus)?

I'll let ya know what I think after I read a little more. After all, its only the second day of Advent :)

Stolen Bikes and Starbucks Seats

For the last three months, every morning on the way to school I would pass Jeffrey, who would sit outside Starbucks asking for money. After the first week, he stopped asking me for money and would just say hello, ask how I was doing, and we would chat for a few minutes. It was a small thing, but I enjoyed the regularity of seeing him every morning (although ideally he wouldn't have to beg outside starbucks). In the afternoon when I passed by, he would ask, "so what did ya learn today?" and I gave him some medical fact before going on.

As of last week, I don't see Jeffrey anymore. Starbucks put up a rail about 7 feet off the side of the building and put inside of it some more permanent tables and chairs. It looks nice. It keeps the street litter from coming in and allows people to sit and drink coffee without beeing bumped into by folks on the side walk. But it also means that Jeffrey can't sit there anymore, at least not without buying something first. Earlier today I saw him a few blocks away by CVS and said hello. He said he doesn't like sitting outside CVS as much. "The people aren't as friendly," he said. "I think coffee makes people happier, they give a little more money."

The scenario is a small picture of a much larger issue. Starbucks does something to make their store a little nicer, not in itself a bad thing at all, but it displaces Jeffrey. The same thing happens on a bigger scale when new stores and houses are built in lower class renting neighborhoods where rent prices fluxuate. What makes me frustrated is that there shouldn't be anything wrong with making a nicer store front, fixing up houses, and improving the neighborhood. These are beneficial things that don't end up benifiting the people in the neighborhood. How did the system come to be like this?!

On a related but different note, last friday a bunch of bikes were stolen from outside my apartment building. Mine had already been stolen earlier in summer. A women saw the guys doing it, yelled and said she was going to call the cops. The cops came later and asked some questions, but let's be honest...DC police have better things to do with their time then chase down bike theives. Since I live in a newly renevated building, all of the people have just recently moved into the area. As I read the responses to the bike theft (and attempted break in earlier last week) on our building listserve, I was so frustrated. These events confirm their prejudices and stereotypes and I wanted people to love the neighborhood.

It is absolutely true that stealing and breaking in are wrong. It is legitimate to feel anger and hurt in response. And if we were to look at it on the flip side, there are negative effects for our neighbors due to the fact that our building was redone, new people moved in, and it has made the block "nicer." Their feelings of powerlessness and "being moved in on" are just as legitimate (though harder to quantify).

When I think about what God's goodness looks like, I see something that doesn't discriminate. It isn't good for one person and not another. It is good, all the time and to everyone (though maybe not always felt as such). But we don't see that played out in life on earth very often. What is good for my apartment building and for starbucks was not good for the neighborhood and for Jeffrey. And what Jeffrey and the neighborhood might define as good may not feel that way to others. But God's creation was a creation of goodness. Tov! It's tov, very tov! And it's our hope that it will once again be (and is on its way to becoming) even more good. That isn't a goodness that is easy for us to see, or understand, or even to have the faith to hope for. But I think I'm learning that solid faith in God's goodness actually changes the present reality (not just my perception of it in some spiritual sense) into something that is in fact closer to the goodness of God, because it changes what I do, see, say, think, and understand. And our faith and hope in promised goodness is legitmate because "he who promised is faithful." (Heb 10:23)