Genetic research

pangbotommy

How to lead a healthy life? How to lead a sustainable life?
These questions affect us all and are accordingly discussed
with much gusto. Strangely enough, however, the combin-ation
of sustainability and health has been rather neglected
in this discussion. Sustainability in the healthcare system
and in health research presupposes an integrated health
policy which is geared to a responsible handling of the limited
resource “health“ in both the individual and the collective
sense and gives rise to a transdisciplinary approach to the
prevention and alleviation of disease.
How can genetic research, i.e. the investigation of human
hereditary factors, contribute to sustainable health research?
What are the opportunities it presents and what are the risks?
Genetic technology is spreading to more and more areas
of medicine at such speed that it would appear advisable
for the purposes of this article to concentrate on just three
important areas of application that relate to sustainable
health research and a viable healthcare system for the future:
genetic diagnostics, pharmacogenetics, and drug develop-ment.
GENETIC DIAGNOSTICS
In the past there were many cases in the field of clinical
medicine where therapeutic action could not be taken until
the first symptoms of a disease became manifest. Genetic
tests, however, are capable of identifying the predisposition
to a particular disease years before it breaks out – if not with
absolute certainty then at least with varying degrees of
probability. In the future, with the aid of genetic diagnostics,
it will even be possible to take preventive measures for many
diseases by changing the patient’s lifestyle or prescribing a
different drug.
PHARMACOGENETICS
A patient has a common disease, there is a good drug for
it – but the patient does not respond to that drug. Why is
that? Up until now drugs have been designed for “average
patients“, and there has been no possibility to consider an
individual’s genetic make-up in their development. So doc-tors
treating patients with high blood pressure, for example,
often have to try at least three or four different drugs before
they find one that works satisfactorily. And patients with
breast cancer undergo a course of chemotherapy with
major side effects as a safeguard against relapse, and yet
many patients do not respond to that therapy. And then
there are the 100,000 patients or so that die every year in the
United States alone from the adverse side effects of drugs.
The reason for all this is that minute differences in individual
genes decide on how well or how badly a drug is absorbed,
distributed, and then metabolized in the body. Researchers
are tracing these variations in the genetic material in order
to develop milder therapies geared to individual patients.
This relatively new branch of research, which aims to
make therapies more effective and more reliable, is called
pharmacogenetics. It could also shorten the development
and approval phases of drugs substantially. Some pharma-ceutical
companies have announced that within a matter
of years they will be introducing drugs which will require a
genetic test before being taken.
DRUG DEVELOPMENT
Since the very beginnings of the pharmaceutical industry,
chemists have identified only 500 molecular targets,
around which they have developed the entire spectrum of
drugs. This spectrum is now considered to be more or less
exhausted. On the basis of the human genome project,
genetic research will provide thousands of new targets,
which will in turn reveal the principles of how new drugs
work and will thus point the way to new opportunities
for recovery from disease. Of the US$ 40bn that is spent on
drug research throughout the world each year, US$ 10bn
already goes into genetic technology – and its share is rising.
These are three of the areas of application from which
decisive impulses for sustainable health research are to be
expected. A further area is the development of vaccines.
Genetic technology could help to repress such infectious
diseases as malaria or tuberculosis, which have hardly
been touched by vaccines up to now. Gene therapy, on
the other hand, is a completely new method of treatment,
involving the introduction of “healthy genes“ that are
supposed to attack diseases at their molecular roots. In the
1990s, however, a whole series of clinical gene therapy tests
were a major disappointment. The much discussed stem
cell therapy initially presupposes that the ethical issues will
be straightened out. Its potential for the future lies in the
induction of regeneration processes in organs with a chronic
impairment, the generation of replacement organs and
tissue, the gaining of insight into the origins of diseases
(e.g. cancer), and the avoidance of animal testing in that
new drugs can be tested on stem cell lines rather than on
animals.
Genetic research will make an increasing contribution to
medical progress. In order to show what that will mean to
health research and finally to insurance companies, we
shall look at four aspects: the perception of the patient and
the role of the physician, the meaning of the term “health“,
preventive medicine, and cost development in the health-care
system..Munich Re ENVIRONMENTAL MAGAZINE 2001 – Genetic research

A CHANGE IN THE PERCEPTION OF THE PATIENT AND
THE ROLE OF THE PHYSICIAN
Genetic research will change the way patients see themselves.
It will reveal individual predispositions and show patients
where and how their health is threatened. Genetic research
will also make it possible to individualize the type of treat-ment
adopted. Both will give patients more responsibility
for themselves. However better informed and more educated
patients have become as a result of new information
technologies like the Internet, they will still need competent
counselling on health matters. And this will lead to a change
in the role of the physician. Doctors will increasingly have to
assume the role of mediator and counsellor between genetic
technology, data interpretation, and health science.
A CHANGE IN THE CONCEPT OF HEALTH
Genetic research will make a decisive contribution towards
our healthcare system shifting its orientation from treating
disease to preserving health. The greater the number of
molecular mechanisms we understand, the more obscure
the boundaries between “healthy“ and “sick“ will become.
The identification of a predisposition to certain diseases
at an early stage will show “not-yet“ patients ways in
which they can prevent or at least delay their development.
It must be remembered, however, that human beings also
have the right not to know what their predispositions are.
Preventive medicine should not be forced through by any
kind of coercion, which includes any kind of social coercion
that could be generated, for instance, by the pressure of
costs. It is also important to prevent arbitrary offers of mass
genetic testing by, for instance, profit-oriented firms on the
Internet.
A PARADIGM SHIFT IN THE DIRECTION OF
PREVENTIVE MEDICINE
Even if healthcare management is already widely practised,
health insurance systems have mainly focused on the
reimbursement of costs for treatment. Health education and
disease prevention have not been extensively developed.
The medicine of the 21st century, on the other hand, will
focus on the prevention of diseases. Genetic technology can
play a decisive role in this. There will be a transformation
in the idea of what disease really is, for instance. The tongue-in-
cheek saying that health is only a “badly performed
medical examination“ will acquire new meaning, since even
today geneticists presume there to be dozens of more or
less pathogenic mutations in each and every individual’s
genetic make-up.
COST DEVELOPMENT IN THE HEALTHCARE SECTOR
Medical progress (particularly in the area of genetic tech-nology),
the ageing of the population, and growing health
awareness are leading to costs increasing steeply in the
healthcare sector. In the future we will also have to expect
additional expenses for preventive measures emerging as
a result of genetic research. The state’s ability to finance all
this is limited, so that we must expect to see an increasing
share being carried by patients making their own provisions
and by covers provided by private insurance companies.
Whether rigorous and wide-ranging preventive medicine
will help to relieve the healthcare budget in the long run
remains to be seen.
MUNICH RE’S ROLE
These examples show that our healthcare system is due
for far-reaching changes in the medium term, changes
which will require new approaches and new solutions (e.g.
structural improvements) and new insurance and financing
concepts. Particular attention will have to be paid to a re-sponsible
and sustainable handling of each person’s limited
health resources and each national healthcare system’s
limited financial resources. Sustainable approaches will
only be found in the dialogue between the users of genetic
technology, the risk carriers, and the insureds. They will
also depend on an ethical discussion and social acceptance.
This will require giving earnest thought to the problem areas
of genetic research. Progress in the life sciences is acceler-ating,
with the result that specialist knowledge will become
a more significant competitive factor for insurers too.
Munich Re has responded to this development by founding
a centre of competence for the life sciences. Supported by
numerous sources of information, this unit critically monitors
the progress of research in the field of genetic technology
and examines it in terms of its significance for insurance
companies. Munich Re is thus implementing one of the
aspects of its guiding principles in this area too: to further
develop our competence with regard to the issues affecting
society now and in the future and to develop our own
position.