Walter Neary
HS News and Community Relations
It seems like hardly a day passes by without a scientist announcing a new discovery related to genes and genetics. In spite of all the new information, the general public and health-care providers alike are still wondering how genetic advances will directly affect their own health care.
Researchers at the UW hope to help public health officials throughout the nation use advances in genetic sciences to help protect the public’s health and well-being. Public health officials form the front lines to battle communicable disease and share the credit for eliminating many common conditions of the past, such as smallpox. Today, public health officials are confronted with new questions about how to react to advances in the growing field of genetics.
The Centers for Disease Control and Prevention (CDC) is collaborating with the UW to establish a Center for Genomics and Public Health that will help public health officials to use genetic advances to prevent disease and improve health. The new center will bring together experts in science and public health with other members of the community. These experts will study how genetic discoveries can be used in the community to improve health and prevent disease. They will also examine the issues surrounding genetic discoveries. One of these issues is the use of genetic testing.
“The CDC wants a touchstone in the community to help public health get ready for this coming genetic revolution,” says Dr. Karen Edwards, director of the new center. She is an assistant professor of epidemiology and core faculty in the Institute for Public Health Genetics in the UW School of Public Health and Community Medicine.
“Local public health officials are facing a big challenge. On the one hand, they will want to understand how they can use genetic testing to provide unique opportunities for disease prevention. But they will also have to understand the limitations of testing and determine when it is not appropriate to use.”
The UW and two other universities—the University of Michigan and the University of North Carolina— were selected by the CDC’s Office of Genomics and Disease Prevention to receive $300,000 a year, for three years, to establish Centers for Genomics and Public Health. The UW center will focus its attention on asthma, diabetes, obesity, and familial hypercholesterolemia, a form of cardiovascular disease. Researchers at the University of Michigan will focus on genetic issues related to other cardiovascular conditions, while researchers at the University of North Carolina will focus on cancer.
“It’s very insightful for the CDC to start thinking about this now when we actually do have some time to carefully ponder these issues,” Edwards says. “For the most part, it will be a while before these are ready for real-life applications. Just the fact that we are gearing up and thinking about these issues is good. We have a window that allows us time to carefully consider these issues, including the ethical, legal and social implications of potential activities.”
The CDC may call upon UW researchers when local health officials ask what to do about public requests for genetic testing. One of the things public health will have to do is help inform the public about when it’s appropriate to have these tests, and when it is not. For example, it is not clear yet whether public health should use a genetic test for screening or how that information might be used to improve the public’s health.
“The question for many of these issues is, even if valid tests were available for screening, would we really change the public health message? Would you change the health message, for example, with obesity? Given the result of a positive genetic test, the health message may still be the same—exercise and watch your diet,” Edwards says.
“On the other hand, we may find that diet and exercise are not enough for a person who is genetically susceptible to gaining weight. We may find that additional interventions are needed for some people. Evaluating the scientific literature and conducting research to answer these types of questions will be important activities for the UW center.”
Public health officials already screen for what we now know are genetic illnesses. For example, newborns have been screened for many years for PKU—a condition that causes mental retardation if left untreated.
But there are many other new genetic markers coming down the scientific chute. “Public health has to be ready and has to think about their policies and programs. Public health has to think about these things now and not wait until everything is ready to incorporate genetics into practice. How does one get the public health workforce ready to incorporate this new information?” Edwards asks.
As part of their task, UW researchers will develop a database of information to keep track of how genetic developments affect the particular conditions that the UW center is studying. Via the CDC, UW researchers will also provide technical assistance to local public health agencies on these conditions. In addition, the UW is considering developing a CD-ROM that can be used to help train the public health workforce in genomics. This may include case studies designed to help guide public health workers in thinking through issues dealing with genomics.
“For example, what issues do you have to consider in a particular situation, including possible unintended consequences? Is there any scientific evidence to guide the decision and what is the quality of that evidence? What level of information do you need to have before you act,” Edwards asks. “What we’re developing, with the input of local public health officials, would become a framework for thinking through these problems.
Edwards says she is excited to be in a program where conditions will change as often as the march of scientific progress. “Public health is dealing with very real challenges right now. People are wondering how genetics will fit into the public health system. I think that is everybody’s question. It’s not clear to any of us at this point what the answer will be. ”