'DNA is not your destiny': Genetics a poor indicator of health

Nicole Bergot
Edmonton Journal
Originally posted 18 Dec 19

The vast majority of diseases, including many cancers, diabetes, and Alzheimer’s, have a genetic contribution of just five to 10 per cent, shows the meta-analysis of data from studies that examine relationships between common gene mutations, or single nucleotide polymorphisms (SNPs), and different conditions.

“Simply put, DNA is not your destiny, and SNPs are duds for disease prediction,” said study co-author David Wishart, professor in the department of biological sciences and the department of computing science.

But there are exceptions, including Crohn’s disease, celiac disease, and macular degeneration, which have a genetic contribution of approximately 40 to 50 per cent.

“Despite these rare exceptions, it is becoming increasingly clear that the risks for getting most diseases arise from your metabolism, your environment, your lifestyle, or your exposure to various kinds of nutrients, chemicals, bacteria, or viruses,” said Wishart.

The info is here.

Courage and Compassion: Virtues in Caring for So-Called “Difficult” Patients

Michael Hawking, Farr A. Curlin, and John D. Yoon
AMA Journal of Ethics. April 2017, Volume 19, Number 4: 357-363.

Abstract

What, if anything, can medical ethics offer to assist in the care of the “difficult” patient? We begin with a discussion of virtue theory and its application to medical ethics. We conceptualize the “difficult” patient as an example of a “moral stress test” that especially challenges the physician’s character, requiring the good physician to display the virtues of courage and compassion. We then consider two clinical vignettes to flesh out how these virtues might come into play in the care of “difficult” patients, and we conclude with a brief proposal for how medical educators might cultivate these essential character traits in physicians-in-training.

Here is an excerpt:

To give a concrete example of a virtue that will be familiar to anyone in medicine, consider the virtue of temperance. A temperate person exhibits appropriate self-control or restraint. Aristotle describes temperance as a mean between two extremes—in the case of eating, an extreme lack of temperance can lead to morbid obesity and its excess to anorexia. Intemperance is a hallmark of many of our patients, particularly among those with type 2 diabetes, alcoholism, or cigarette addiction. Clinicians know all too well the importance of temperance because they see the results for human beings who lack it—whether it be amputations and dialysis for the diabetic patient; cirrhosis, varices, and coagulopathy for the alcoholic patient; or chronic obstructive pulmonary disease and lung cancer for the lifelong smoker. In all of these cases, intemperance inhibits a person’s ability to flourish. These character traits do, of course, interact with social, cultural, and genetic factors in impacting an individual’s health, but a more thorough exploration of these factors is outside the scope of this paper.

The article is here.

Actuaries are bringing Netflix-like predictive modeling to health care

By Gary Gau
STAT News
Originally published on December 13, 2016

Here is an excerpt:

In today’s ever-changing landscape, the health actuary is part clinician, epidemiologist, health economist, and statistician. He or she combines financial, operational, and clinical data, such as information from electronic medical records, pharmacy use, and lab results, to provide insights on both individual patients and overall population health.

I see a future where predictive modeling helps health care companies not only suggest healthy behaviors but also convince patients and consumers to adopt them. Predictive modeling techniques can be applied to information that can influence an individual’s decision to use preventive care, accurately take prescribed medication, book a doctor appointment, lose weight, or become more physically active.

The trick will be identifying the trigger that gets him or her to act.

Insurers must understand their patient populations, including the barriers they face to achieving better health. To create solutions, insurers must first understand the psychology of motivation and what leads individuals to change their behavior. That’s where the precision approach comes into play.

The article is here.

Sex and Other Sins: Public Morality, Public Health, and Funding PrEP

Guest Post by Nathan Emmerich
BMJ Blogs
Originally posted October 5, 2016

Here is an excerpt:

Consider the following thought experiments. Imagine a drug that could be taken to significantly lessen the risk that a smoker would develop lung cancer, or a drug that would lessen the risk of ‘at risk’ individuals developing diabetes. In such cases would we be inclined to refuse public funds for such drugs merely because such individuals could lessen their risks even more by giving up smoking, or by losing weight and eating a healthy or, at least, healthier diet?

There is, certainly, something regrettable about having to spend public money on a drug that offsets risks generated by an individual’s own behaviour. Nevertheless, from an epidemiological – and therefore public health – perspective, the notion that an individual makes a choice about whether or not to smoke, or to have a bad diet, is too simplistic, even when we place the issue of addiction to one side. Thus, even when smoking cessation programmes are available and even when nutritional advice is within easy reach (as it increasingly is), plenty of people still smoke and consume a less than healthy diet.

Smoking and bad diets are correlated with a variety of demographic factors, and our choices are always made within particular cultural and socio-political contexts. Even so, some have questioned if the NHS should be funding stomach-stapling operations for those who are overweight, or if smokers and non-smokers can expect to receive the same level of treatment and care.

The entire blog post is here.

Are Biases Hurting Your Health?

By Stacey Colino
US New and World Report
Originally published October 5, 2016

It's human nature to have cognitive biases. These tendencies to think in certain ways or process information by filtering it through your personal preferences, beliefs and experiences are normal, but they can offer a skewed perspective.

"We all have these biases – they are the lenses through which we process information and they are a necessary part of the information-selection process," says Mark Reinecke, professor and chief psychologist at Northwestern University and Northwestern Memorial Hospital in Chicago. Even physicians and mental health professionals have cognitive biases when making decisions for their own health and while treating patients.

Meanwhile, certain subtle mental biases can affect the health choices you make on a daily basis – often without your realizing it. This can include everything from the dietary and physical activity choices you make to the screening tests you choose to the medications you take. Sometimes these biases are harmless while other times they could be problematic.

The article is here.