Saturday, May 10, 2008

Workman's Compensation, Stereotypes and GATTACA

Have you ever had back pain? Almost everyone has. Who has sciatica?

Sciatica a very common condition accounts for a significant amount of lost work days, medical costs and psychologic stress. Treatment failures are not uncommon, are often related to posttraumatic or work-related injuries, and may result in litigation. Although most people experience back pain during their lifetime, only a fraction experience lumbar radiculopathy or sciatica as a consequence of root compression or irritation. Almost 5% of males and 2.5% of females experience sciatica at some time in their lifetime. It is so costly to society and common that in Sweden they did a cost-benefit analysis and found the surgery to be cost effective. Although studies casting doubt on its effectiveness are now in the mainstream.

Because the majority of the cases are work related....I propose to you.......The following study:

Let's genotype everyone who had disc herniation and see what comes up......

Sounds interesting? It is. Well, it turns out in Japan that they did just that. The study entitled

What did this group find?

"A splicing-affecting SNP in THBS2 and a missense SNP in MMP9 are associated with susceptibility to Lumbar Disc Herniation"

Did it stand the Sherpa test?

Odds Ratio? It was 3.03. You betcha. This is stronger than any of the SNP chip companies SNPs. For just about anything....

Replication? Not Yet....

So why do I even bring this whole thing up? Well.....First off did anyone remember Burlington Northern Santa Fe Railroad Company? It turns out this company was secretly genetic testing their employees. You don't? Let me recap. In 2001 it was reprted that this company was testing employees who developed carpal tunnel syndrome. They tested 18 people who had filed workman's compensation claims. It turns out they had developed carpal tunnel while workin' on the rail' road.....(all the live long day)

They performed genetic testing to see if these workers were predisposed to carpal tunnel syndrome, another horrible but operable condition which costs tremendous money to society.

Guess what? Someone(Equal Employment Opportunity Commission) sued the dickens out of them and the company ended up settling out of court. They argued that company policy requiring genetic testing for all workmen's compensation claims related to carpal tunnel syndrome was genetic discrimination. In fact, this case had been used as a example of the rare times, genetic discrimination came to pass.

Here we have a very similar situation. But now that GINA is coming to pass. I would like to pose an alternative.

Young person goes to 23andME/Navigenics/ETC (They just may add this immediately)....gets predictive testing indicating that he is at a 300 fold increased risk of herniating a disc in his back. Avoids manual labor (plays video games all day) never herniates the disc. Did we do society a service? Some would argue yes....I say no.

Let's say, at birth we test the genome. Let's say we find the variants. Instantly this child is marked "High Risk for Work Related Disc Herniation" Based on the societal calculation, it is not justifiable to allow this person to work manual labor jobs. Now, I ask you. Who can tell someone what to do just because of his genetic predisposition? What if this kid wanted to be a firefighter? Should we not let him save lives? What if he wanted to be a Paramedic? A plumber? A carpenter? How far do we go?

The Sherpa Says:

We have to address this issue soon. Because more studies like this one are coming....and I am very scared with the press and marketing push going on, we may end up believing genetic predisposition is everything. The fat cats at Burlington Northern sure did...


Berci Meskó said...

One of the best articles you've written recently, Steve! Well done!

Steve Murphy MD said...

Thanks Berci!

Andrew said...

This is ridiculous, Steve. In no way does this refute the practice of using objective data to select people.

"Who can tell someone what to do just because of his genetic predisposition?"

University admissions, for one.

As for the disks, my cousin ruined his back at 23 working in a warehouse to pay for college. He could have worked another summer job, but he can't get a new back. Could he have made a better decision if he knew he was at high risk for back damage? Yes.

"Should we not let him save lives?"

Come on, Steve. Firefighters, for example, must pass physical fitness tests. Are you saying that an exception should be made because genetics scare old people?

Andrew said...

Sorry if that was a bit harsh (I am a regular reader and love your blog), I just get frustrated when educated people break out the "genetic testing is the bane of your dreams!"

The PROBLEM is that people aren't worth any potential liabilities to society, and THAT'S tragic.


I researched the specifics of the "railroad" case (I think this goes out tomorrow on Think Gene,
The employee was diagnosed with CTS, had approved surgery, returned to work in a few weeks, and then the railroad tried to dishonestly cast doubt to avoid liability.

This single case is obviously abuse, but it's just that: a single case. If it wasn't a genetic test, it'd be and has always been something else.

Steve Murphy MD said...

Sorry to hear about your cousin. My mother is getting ready for her 12th back surgery for herniated discs. She has had ray cages, fusions, BMP, rods, screws...and now needs another surgery to stabilize the others. So I understand very well the difficulty with herniated discs and chronic pain.

My point was not that we shouldn't be using objective data to quantify or predict. It is what we do with that data and how we as a society allow "What we do"

Personally, I don't believe in a big brother state. This set of data "Genomics" should not be used to limit. even if that limiting is done in the face of so-called protection. I trust you have seen Gattaca. That is the precise take home message my friend. The same is true for another all time "cheesy" movie Knight's Tale.

As for legal, all it takes is one case to have case law. 2 is a trend and 3 is written in stone. Unlike science, law is a fickle lady and we cannot allow it to land on the side of those who chose to restrict our freedoms.

We are in America. Where you can change your stars regardless of your birth right or your genome.

As for the military, firefighters, police officer...etc. I am not familiar with the firefighters' exam however, as an ex-midshipman...I am pretty familiar with the military's. That physical exam already takes genetics into account in some instances....i.e. try flying jets with sickle cell disease.

But this is only done in certain specialties of these fields. The entrance military exam does not do genomic screening to weed people out.

Genes are only the beginning my friend....Epigenomics looms large and will be so much more than faulty data points.

Trust Me,