Last week I featured a recent NEJM article by Robert Green and George Annas about presidential DNA and its role in public elections. Co-author Robert Green (pictured right) agreed to share more about his views on the issue, in the following Q&A:
TPG: Both presidential candidates released information about their personal medical history during the recent election. Why do you believe genetic information should be treated differently? Why is DNA exceptional?
RG: There is a great deal of debate about whether DNA information warrants the ‘exceptionalism’ that has attached to it. The risk information provided by most genetic tests is currently less specific than family history and other risk factors can provide, putting it squarely into the domains of disease risk that health workers regularly communicate to patients. When discussing common diseases, the “exceptionalism” of genetic testing is amplified by the incorrect public perception that most genetic markers provide highly predictive information, when in fact, this is true for only a few.
Yet for some situations, there are undeniably special features to genetic testing. DNA is a highly specific identifier for forensic purposes and the occasional revelation of non-paternity can create upheaval in families. Genetic tests for highly penetrant diseases may provide reliable predictive information far in advance of symptoms, and providing such information to one family member may inadvertantly provide it to another who does not wish to receive it. And in situations where highly penetrant disease information is available far in advance of symptoms, there is greater potential for both prevention and for discrimination or unnecessary psychological distress.
Since much of the aura of ‘exceptionalism’ surrounding genetic testing is a byproduct of misunderstood notions of determinism, some of it should fade and normalize as the population learns more about genetics in the coming decade.
TPG: Both Obama and McCain have potentially serious conditions in their family medical histories (prostate cancer and heart disease, respectively). Do you believe genetic information could have helped voters in the last election evaluate the health status of the candidates?
RG: Most of us would agree that health information is relevant to a candidate’s fitness for office, particularly an office like the Presidency. Therefore, health information that could affect fitness for office seems undeniably relevant to voter decisions. So while the public does not have a right to know every detail of a candidate’s medical history, those facts relevant to fitness should be public information. Health information related to fitness may be misunderstood, exaggerated or minimized and therein lies the problem. The public is not particularly skilled or rational at sorting out the probabilities associated with health risks from whatever source… be it prior illness, lifestyle habits like smoking, cholesterol levels, family history information or genetic testing results. In the last election, I do not believe that any genetic information currently available woudl have been sufficiently predictive to warrant sharing with voters. However, if a highly predictive genetic test for recurrence of melanoma were available, that would arguably have been relevant and thus, would warrant dislosure to voters.
TPG: In your article you argued that the fierce political environment that surrounds elections, combined with our limited ability to understand genetic information, might lead to “genetic McCarthyism”. Is this a temporary circumstance?
RG: As we pointed out, there is a clear potential that someone might try to use genetic markers to smear another candidate, particularly in the realm of behavioral of psychiatric genetics. Certain conditions, such as mental illnesses, are so psychologically loaded that such smears might even be effective, even if quickly countered by experts explaining the predictive limitations of the science. But as your question suggests, as the general population becomes more familiar with genetic information and the limitations and complexities of such information, there should be less of a potential for distortion. Whether you call it “Genetic McCarthyism” or “Genetic Swiftboating”, and whether it occurs in presidential politics or in other contentious situations (lesser elections, custody cases), all of us in genetics should be prepared for it and prepared to combat it when it occurs.
Green, Robert C., Annas, George J. The Genetic Privacy of Presidential Candidates. N Engl J Med 2008 359: 2192-2193.
Dr. Robert Green is a professor in the Departments of Neurology, Medicine (Genetics), and Epidemiology at the Boston University Schools of Medicine and Public Health.