Saturday, May 10, 2008
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
"A Functional Polymorphism in THBS2 that Affects Alternative Splicing and MMP Binding Is Associated with Lumbar-Disc Herniation" was just published in the American Journal of Human Genetics.
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...