CHAD

Slide 1: 

A Lancaster – Cardiff collaboration

Genes, drugs and food : 

Genes, drugs and food Ruth Chadwick Director, CESAGen Lancaster University

Outline : 

Outline New technologies have led to revisiting of the individual-collective relation in public health …and to questions of their impact on health inequalities

Issues : 

Issues Opportunity costs Access and benefit-sharing

Choice? : 

Choice? The upholding of ‘choice’ coincides with new forms of stratification No consistency in argument Examples: nutrigenetics, obesity and functional foods

Two White Papers (UK): twostrategies : 

Two White Papers (UK): twostrategies …we will learn more about the genetic features of common diseases such as heart disease and diabetes and the way external factors such as diet and smoking interact with our genes to increase the likelihood of developing a given disease

DH continued : 

DH continued There will then be the option to test people for a predisposition to disease, or a higher than normal risk. Treatment, lifestyle advice and monitoring aimed at disease prevention could then be tailored appropriately to suit each individual Our Inheritance, Our Future

Choosing Health (2004) : 

Choosing Health (2004) The White Paper sets out a strategy for action based on the principles of informed choice, personalised services and collaboration between Government, the NHS, industry and wider society. Choosing Health identifies how people can be empowered to make healthy choices. It sets out how health can be supported and improved in key environments such as retail outlets, local communities and the workplace.

Public engagement : 

Public engagement 2003 – traces of deficit model 2004 – shaped by public consultation

Key questions : 

Key questions How do these strategies relate, if at all? Impact on health inequalities? What notions of ‘personalised’ health care and ‘choice’ are at stake? 2004 White Paper talks about false dichotomy ‘nanny state’ – ‘freedom’ can imply neglect

Key example : 

Key example Food and diet Nutrigenetics Food labelling Obesity; diabetes

Nutrigenetics : 

Nutrigenetics The study of individual differences at the genetic level (SNPs) influencing response to diet

Nutrigenomics : 

Nutrigenomics The application of genomics in nutrition research, enabling associations to be made between specific nutrients and genetic factors

Information leading to applications : 

Information leading to applications Understanding of how nutrition influences metabolic pathways Understanding of how this goes awry in diet-related diseases Understanding of how individual genotypes are influencing factors

The context : 

The context Public perceptions of genetics Novel foods, e.g. gm Prevailing ethical paradigms: individualism and choice

Public health : 

Public health Will nutrigenomics have significant public health benefits? Differences between nutrigenomics and pharmacogenomics

Pharmacogenomics : 

Pharmacogenomics Avoidance of adverse reactions Genetically informed prescribing Greater safety and efficacy Patient stratification?

Testing – empowerment? : 

Testing – empowerment? Single gene disorders Huntington’s disease Susceptibility testing Identifying recessive genes Identifying genetic makeup which may increase risk of developing common diseases Pharmacogenetic testing Medicine response test Nutrigenetic testing

Screening : 

Screening Testing versus screening Criteria for introduction of screening Important condition Acceptable and reliable test Scope for action

Conditions : 

Conditions PKU Diabetes

Obesity : 

Obesity Genetic factor A – predisposition to obesity with food x A case for screening? Importance/Scope for action?

Individualism and public health : 

Individualism and public health Personal pills and personalised diets? The more individualised the promises, the more collective action is required

Acquisition of information : 

Acquisition of information Association studies Population groups Specific disorders National dietary surveys Genetic databases

WHO : 

WHO …the justification for a database is more likely to be grounded in communal value, and less on individual gain……it leads to the question whether the individual can remain of paramount importance in this context

WHO : 

WHO …the achievement of optimal advances in the name of the collective good may require a reconsideration of the respective claims so as to achieve an appropriate balance between individual and collective interests, including those of ethnic minorities, from a multi-cultural perspective

Alternative : 

Alternative ‘Environmental’ approach Healthy choices Labelling Restrictions on advertising Children as a special group

Underlying principles : 

Underlying principles Informed choice Two qualifications Children Responsibilities to others

Inequalities? : 

Inequalities? How is this approach likely to deal with health inequalities? Increase in burden of responsibility for health? Whose choice and for what?

Autonomy and choice : 

Identity INDIVIDUAL AUTONOMY Utility Responsibility Identity Autonomy and choice

Implications of information : 

Implications of information Food, the body and the self What sort of person do I want to be?

Functional foods : 

Functional foods Functional foods – specific health-promoting or enhancing foods Regulatory approach – highlights importance of freedom to market, subject to safety Case by case approach Potential problem identified with functional foods – target groups and overdosing

Functional foods : 

Functional foods Cannot be solved by labelling alone Plus or minus nutrigenetics?

Benefit-sharing : 

Benefit-sharing Turn towards sharing benefits of genomics (e.g. HUGO, 2000, 2002) What counts as a benefit? Added value? Sharing of burdens? Return to issues of class

Rights and class : 

Rights and class Ultimately, the worldwide regulatory push against smoking is being driven by a revolution not just in rights but in class….a class system is slowly being re-erected on new bases, bringing with it a new [and narrower] understanding of rights (Financial Times 20-11-04)

Conclusion : 

Conclusion Is nutrigenomics the future of public health? Bridging the genomics divide? The need for joined up thinking