Healthcare, medicine & pharmaceuticals

A genetic test to predict psychological traits

In 2015, a study found that children of Holocaust survivors had an epigenetic tag on a gene related to stress. These people had literally inherited a trauma that occurred before they were born.

If you think this is far-fetched, Professor Robert Plomin, from the Institute of Psychiatry at King’s College London, says that in the future a simple blood test will be able to tell your fortune. In short, when you are born, a cheap neonatal blood test will be able to forecast whether you will suffer from heart disease 40 years into the future, or for that matter whether you will do well at school, suffer from depression, have ADHD, be thin, work in advertising, or go to prison. (Those last two are a stretch, but you never know.)

This, of course, is controversial because it goes to the very heart of the “nature vs. nurture” debate and questions many of society’s deepest-held assumptions and beliefs. For example, if a blood test revealed that it was highly unlikely that you would do well at school, what should a school do: invest heavily in you or simply cast you aside? It can get more controversial too. If a parent knows that a child will struggle with mental illness before they are born, should they be born at all? This harks straight back to the Nazis and the practice of eugenics, although if you think about it, many parents do much the same thing already, by choosing mates that they believe will result in their offspring having certain traits.

The bright side of this, of course, is that such genetic data — especially when married with lifestyle data — is fertile territory for the development of personalised niche treatments tailored to very specific conditions or inherited traits. Mind you, it’s still an ethical minefield.

Ref: Times magazine (UK) 29.8.18, ‘Isabella is 11 months old. In 40 years, she’ll be a shy divorcee with a history of addiction and weight issues’ by D. Aaronovitch.

A growing problem

Obesity costs the NHS £5.8 billion every year in the UK. Globally, 650 million adults and 124 million children are clinically obese. Meanwhile, back in the UK, half of children at primary school are overweight or obese by the age of eleven. As a result, we’re seeing record levels of heart disease, type-3 diabetes and circulatory illnesses.

Despite this, we seem unable even to talk about obesity. Labelling someone as “fat” is now classed as a hate crime in the UK. Even the Weight Watchers organisation has dropped the word “weight” on the basis that it might offend someone or put people off (it’s now rebranded as ‘WW’). But why? Why are we using jargon designed to obfuscate? Why can’t we use direct honesty to make people take responsibility for what they eat? This is what Weight Watchers used to do when they used group weigh-ins, but these have been replaced with private scales so as not to harm people’s confidence and self-esteem.

There are plenty of explanations for why obesity is becoming such a problem, not only in places like the US, UK and Australia, but globally, especially across the poorest sections of society. Cheap food (usually crap food) is readily available and convenient, especially in poor areas. It’s quick to prepare, which helps if you believe (often wrongly) that you are too busy to shop and cook properly, and supermarkets load convenience foods with fat, sugar and salt, because they know that’s what people crave on one level.

Sedentary, screen-based lifestyles are another factor, as is the historically low cost of many foods. But one other reason why people eat too much and get fat is surely a lack of purpose or anxiety. They aren’t called “comfort foods” for nothing.

Ref: Financial Times (UK) 28.9.18 ‘why are we so afraid to talk about obesity? By J.Ellison. See also Daily Telegraph (UK) date? ‘Primary school has highlighted the huge scale of the obesity crisis’ by Henry Bodkin and Patrick Scott.

A purposeful sleep

Modern life isn’t very sleep friendly. There’s light and noise pollution, especially in urban areas, while the blue light emitted from smartphones and tablets is well known to disturb sleep patterns.

The average adult needs between 7 and 9 hours’ sleep per night to function properly and avoid various physical and mental problems, but less than a third of adults generally get this amount. However, in what appears to be a twist on the old adage that a good conscience makes the softest pillow, scientists in the US (at the Feinberg School of Medicine at North-Western University) have found that people, especially elderly people, sleep better at night if they have something to get up for the next morning. People who feel their lives have meaning, or purpose, are 63 per cent less likely to have sleep apnoea, for example.

Lost hours caused by people not having enough sleep is estimated to cost the UK economy £40 billion annually.

Ref: Daily Telegraph (UK) 10.7.17, ‘For a good night’s sleep, have something to get up for’ by S. Knapton.

Key disrupters for healthcare and medicine

It’s been said that the two sectors yet to be really disrupted by digital technology are healthcare and education. Personally, I’m somewhat sceptical about education, but healthcare certainly seems ready for change. So, what are the key areas that we should be thinking about in terms of being beneficiaries?

The first broad area to impact healthcare, not surprisingly, is AI. Healthcare generates data and AI is one of the best ways to look for patterns and make some sense of huge amounts of data. AI can spot things that medics can overlook, but used alongside human expertise it could be a formidable weapon for both disease prevention and cure. AI could also enable faster and more convenient access to high-end healthcare regardless of location, for example with robotic surgeons in one country guided by human hands in another.

The second disruptor is Big Data, which is closely aligned with AI. It’s now possible to collect vast amounts of healthcare data using existing tests or bio- and nano-sensors, either from wearable tech or connected devices. In the future, we’ll see nano-sensors that can be swallowed or even permanently implanted under the skin, leading to 24/7 monitoring and modelling.

Next there’s virtual healthcare, especially virtual doctors for virtual or remote diagnosis and care (what is often termed “telemedicine”). Given problems with access, especially waiting lists, surely it can't be too long before a trip to the doctor is replaced with an app or avatar on a smartphone.

The fifth disruptor is 3D printing, which can be affordably used to print drugs or, potentially, even human body parts. Finally, there are genetics and the human genome, which amongst other things promise more personalised treatments for disease.

Ref: Time (UAE) 12.18, ‘Six key disruptors to the healthcare sector’ by M. Al Kasimi.

A future with fewer children

If things aren’t bad enough at the moment, there’s now news that developed countries are facing a new threat. Israeli scientists at the Hebrew University in Jerusalem recently found that reported male sperm counts had fallen by over 50 per cent over the last 40 years in richer developed countries and continue to fall at a rate of 1.6 per cent per year. As a result, one in ten couples now have trouble conceiving.

If this sounds like the plot from yet another dystopian novel, it is. PD James’s The Children of Men, set in the year 2021, was conceived on just this premise. In the book, no child had been born in 25 years and the human species was heading for extinction. In the novel, the cause of this was a disease. In real life, nobody knows what the cause is.

Ref: New Scientist (UK) 18.11.17, ‘Inconceivable truth’ by M. Sarner.

Why all the pain?

According to NHS figures, prescriptions for opiate painkillers have doubled over the past ten years in the UK. Prescriptions rose from 12 million in 2006 to 24 million in 2014.

But that’s small beer compared to what’s been happening over in the US, where opiate overdoses are now responsible for killing more Americans than the Vietnam war, automobile accidents, gun deaths, and the peak of HIV deaths. At the moment, the main response to this, in the US at least, has been law enforcement, along with tougher prescribing. However, this has only made users switch from prescribed opioids to illicit ones (often found on the internet). Treatment centres help, but they cost money to run and require a shift in attitudes.

Clearly, another key question alongside effective treatment is: Why are people becoming addicted in the first place? Obviously, these are addictive substances, but does the rise in addiction signal something else? Is this, along with rising obesity and eating disorders, representative of a society, or culture, that is without purpose or meaning?

Meanwhile, there could be a breakthrough on the horizon. Synthetic oxytocin-like compound (SOC-1) is a small molecule that appears to reverse substance addiction by switching the brain away from drug-chasing mode to social mode. In short, people prefer hanging out with people to chasing a hit, especially by themselves.

SOC-1 appears to address not only the need for a hit, but also the common triggers that cause relapse. The problem, though, is that drug addicts and substance abusers are not exactly popular when it comes to the research and development funded by pharmaceutical companies, so it remains to be seen how things will develop.

Ref: New Scientist (UK) 3.2.18, ‘Emergency in name only’ by J. Hamzelou. See also ‘A helping hand’ by A; Klein. (same publication and date).