This is my first post for a while as I’ve been pretty snowed under with coursework (and I’m still feeling my way with this blogging malarky to be honest) but I went to an event at the Royal Society of Medicine recently that I think deserves a post.
It was a debate on using biomarkers – indicators such as genes or brain activity – to treat, detect and predict mental illness. It’s quite a personal issue for me as my Mum has had chronic bipolar since her early 20s, which she’s had some really rough times with, and having seen her living with this I feel strongly about what the speakers were saying.
One potential use of psychiatric biomarkers they were discussing was using them to personalise drugs, predicting whether a treatment is likely to work for a patient. This I’m all for, at the moment patients often have to go through rounds of trial and error to find what suits them or what doesn’t cause them severe side-effects, as I well know from my Mum. Biomarkers could also shed light on the cause and processes involved in these diseases and again this all sounds good to me.
But I feel really uneasy about using them to predict risk of getting these conditions. Derek Bolton, a professor of philosophy and psychopathology at King’s College, said that anyone with a close relative with bipolar – so me and my sister – had a one in ten chance of developing it too. Even this was too much information for me, and if it was possible to screen for bipolar genetic markers there’s no way I’d want to know this. I think it would be really difficult information to deal with, especially as it would be something tied to my personality. I’d maybe want my doctor to know, but I’d definitely not want to.
I’ve written a piece on it for a competition (which I didn’t win, boo) so thought I’d give it an airing here. It’s another fiction piece, have just finished a module on narrative and creative writing! It’d be good to hear if anyone feels the same way.
Marked for life
Genetics is set to revolutionise healthcare, and psychiatry is on the cusp of this sea change. Our knowledge of mental disorders is broadening as scientists build a picture of biomarkers – indicators such as genes or brain activity which can predict or measure illness or response to treatment1,2. This research is already nearing clinical practice: Vilazodone is an antidepressant being developed alongside understanding of biomarkers which predict its efficacy in individuals, enabling targeted prescription3. Parallel to this the cost and speed of genomic decoding is plummeting, and a public healthcare-intended ‘lab-on-a-chip’ able to sequence DNA using nanolitre- (billionths of a litre) scale samples has been created4,5. The NHS is poised to exploit these developments, wanting to use genetics for personalised treatment6. It also plans to prescribe information in much the same way drugs currently are7. However fears about the use of psychiatric biomarkers are being aired. These include how best to communicate results, the effects on children of predicting life trajectories, and the commercial targeting of individuals based on their DNA8.
I nervously flip the prescription card over and over, running my finger over its magnetic strip. It’s so every-day looking; a simply, white bank-card shape with the NHS logo and my details. Ugh gross, my hands are so clammy they’re smearing the spotless plastic. Ok here goes, I’m ready. I’ve got to be.
I type in nhs.uk. Here we go, ‘Personal prescription’ tab. Enter name, date of birth, prescription number…Click. It’s loading. I stretch my fingers to try and stop them shaking and wipe some of their dampness onto my jeans. “Welcome. Please read the information below before looking at your personal prescription”. Don’t think so, not now. I scroll down, yup, yup, agree, accept, click, click. Next. Deep breath. There it is.
“Diagnosis: Mild panic disorder”. Wow. I freak out over a GCSE maths exam and now I’ve got ‘mild panic disorder’. Dr Oliff told me after they read my DNA and looked at my brain scan results, but it’s shocking reading it. “The most important news of your life”, Dr Oliff said in the consultation as I was spitting into the cup. “The secrets to who you really are”. She pipetted it into this small device, it looked almost like a pregnancy test. And then five minutes later she downloaded the whole lot.
There’s a list of numbers and letters on the screen too. They’re the Bad Genes I guess: what’s wrong with me, why, what might be wrong with me later. The most important news of my life.
Except it wasn’t exactly news. The first thing my Dad did after the school rang, and got him to pick me up, was get me to gob in a test tube so he could send it off. “It’s the rest of your life, your education, your success, your career. We have to find out what’s wrong and sort it, ok? Who knows where it might lead? I’m sorry”. And then he wouldn’t let me read the report when it did come, just said we’d discuss it at the doctors! I’m old enough to drive and have sex but I’m clearly too immature to talk about what’s in my own cells. I’ve got to have this Vilazodone now. Dad insisted Dr Oliff prescribe it, kept saying how I’d have an “enhanced response” to it, and that my “side effect profile” suited it. Dr Oliff was well unpleased he’d got the genetic health analysis from the internet, but she prescribed it anyway, saying her results agreed Vilazodone was the one for me. There was a list of other stuff the internet said I should have but she wasn’t on board. Maybe he feels guilty, my Dad, like it’s half his fault.
I check the rest of the treatment section. A cognitive behaviour therapy site, a support forum, a relaxation exercises site. Right, ok. Onto the next stage of the prescription. My mental health for the rest of my life. My hands are properly shaking. Prognosis. Dr Oliff went through this with me and Dad but I couldn’t take it in then. She explained the percentages and what it all meant but my head was spinning too much. “Genetic biomarkers”: another list of Bad Genes. “fMRI results”: more confusing numbers and letters. “Risk of chronic panic and anxiety disorder: 75% – high”. Fuck. “Risk of clinical depression: 65% – moderate-high”. Double fuck. Wow. I try and stretch my fingers again. 65%? That’s fairly certain right? It’s my entire body that’s shaking now. I mean, much more likely to happen than not? I always knew it was in my family but I hadn’t thought what that could mean for me. What does 65% mean for me?
I thought I had just my exams to worry about.
1. Donati, R. J. and Rasenick, M. M. (2008) Lipid rafts, G proteins and the etiology of and treatment for depression: progress toward a depression biomarker. Future medicine, Vol 3, No 5, 511-514, doi: 10.2217/14796708.3.5.511.
2. McMahon, Francis J. et al. (2010) Meta-analysis of genome-wide association data identifies a risk locus for major mood disorders on 3p21.1. Nature Genetics, Vol 42, No 2, 128-131. doi: 10.1038/ng.523.
3. Rickels, K., Athanasiou, M. & Reed, C. (2009) Vilazodone, a novel, dual-acting antidepressant: current status, future promise and potential for individualized treatment of depression. Personalised Medicine, Vol. 6, No. 2, 217-224. doi: 10.2217/17410518.104.22.168
4. Blazej, R. G., Kumaresan, P. and Mathies, R. A 92006). Microfabricated bioprocessor for integrated nanoliter-scale Sanger DNA sequencing. PNAS, 103, 7240-7245.
5. De Mello, Andrew. (2009) HYPERLINK “http://royalsociety.org/Prize-lectures-events/”The Lilliput laboratory: chemistry & biology on the small scale. Royal Society Clifford Paterson Prize Lecture. Webcast. [Online] Available from: HYPERLINK “http://royalsociety.org/Prize-lectures-events/”http://royalsociety.org/Prize-lectures-events/# [Accessed 26 February 2010].
6. Department of Health. (2008) Our inheritance, our future: realising the potential of genetics in the NH. Progress review. [Online] Available from: HYPERLINK “http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4019346.pdf”http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4019346.pdf [Accessed 24 February 2010].
7. Stilgoe, Jack and Farook, Faizal. (2008) The talking cure: why conversation is the future of healthcare. Demos. Page 11. [Online] Available: HYPERLINK “http://www.demos.co.uk/files/Talking%20cure%20final-web.pdf?1240939425″http://www.demos.co.uk/files/Talking%20cure%20final-web.pdf?1240939425 [Accessed 24 February 2010].
8. Singh, I. and Rose, N. (2009) Biomarkers in psychiatry. Nature, Vol 460, 202-207.