by Dr. Iain Corness
Is it all in your genes? Jeans?
Ever since we managed to crack the
genetic code and write down all the genetic sequences, many people think we
have got disease licked. Take a peek into your genetic make-up and your
(medical) future will be revealed.
After all, look at Angelina Jolie who had a bilateral mastectomy because she
has the “breast cancer gene” in her genetic sequencing. Ms Jolie didn’t wait
to see if breast cancer was just around the corner, she had an elective
mastectomy instead. Was that wise? Or was it a knee-jerk reaction?
One factor that has stopped the majority of people interested in looking at
their genetic make-up has been the cost. To do a sequencing cost many
thousands of dollars (not baht), but like many items, the costs are going
A personal DNA testing kit that gives users an insight into their genetic
make-up has gone on sale in the UK. Called the 23andMe Personal Genome
Service (PGS) costs around THB 9,000 and claims to offer access to more than
100 pieces of information about a person’s health, ancestry and family
Users spit in a tube, seal it and send it off to be analyzed in a
laboratory. After four to six weeks they can log in online to see a detailed
report of their results. The kit, which has been part-funded by Google, said
the tool is not “diagnostic” but includes results of tests for genes
associated with inherited conditions such as cystic fibrosis or sickle cell
It also tests for genes that may reveal risk factors for diseases or
conditions such as blood clotting, Alzheimer’s or Parkinson’s.
In addition to findings about their health, the firm says users can explore
the genetics behind why they may be a more frequent smoker, how they
metabolize caffeine and their body’s response to diet and exercise. They can
see information about the genetic basis of traits such as hair color,
freckling, height and hair loss.
The service also includes a “full genetic ancestry report” allowing people
to trace their family's genetic roots and “potentially discover and
communicate with new relatives”, according to 23andMe.
The firm says on its website that it is “committed to maintaining the
security and confidentiality of your personal information” and has put in
place security measures to help protect against the “loss, misuse or
alteration of information under our control”. About 10,000 UK-based
customers have already paid extra to have the kit delivered from the US.
Is this then a “good thing”? Should we all be lining up to spit in the tube,
and the future will be revealed quicker and more accurately than Gypsy
I advocate caution here, because some people who want to know, may actually
be the worst custodians of their own selves. You see, just having the
Diabetes gene, for example, does not mean that you will definitely get
Diabetes. It is better to accept this as having a “tendency” towards
Diabetes. So what should you do with this advance knowledge? Regular medical
checks and blood sugar testing is called for here.
Now let’s look at the ramifications of the “full genetic ancestry report”.
Can you live with the knowledge that your father, whom you look up to and
love so dearly may not be your father? And how does this knowledge impinge
on your relationship with your mother? In your hunger for knowledge, you
might bite off more than you can chew!
Regular readers will know that I support the notion of regular check-ups. I
promote these as giving you a heads up on what’s ahead medically. You can
plot the rise of blood sugar or cholesterol. You can see annual rises in
blood pressure, which can end up as a stroke. You can see changes in serum
creatinine, as a measure of kidney function, and evaluate the liver enzymes
for early signs of damage. You can look at serum uric acid as a precursor of
that painful condition called gout.
A check-up will show you in real time, what is happening, while DNA testing
is still a “perhaps” situation.
Turn out the pockets of your jeans, rather than those in your genes.
Doctor will be with you in a moment!
For someone lying on a stretcher, that
“moment” could feel like hours. I know I wasn’t prepared to wait many
“moments” when I broke my heel bone (called the ‘Os Calcis’ for those who
want this column to be precise and correct).
Now imagine what it is like to wait 35 hours to be seen. All I hope is that
someone gave the poor devil some anesthetic during that day and a half wait.
That figure of 35 hours was revealed at an investigation into a hospital in
Kent in the UK.
British Health watchdogs are about to issue a damning report warning of
major failings by Medway NHS foundation trust, in Kent - now branded the
worst hospital in the country - as it admitted to repeated cases of patients
waiting more than 24 hours in Accident and Emergency (EMS in Thailand).
In recent weeks, at least nine hospitals in Britain have closed their A&E
units to only the most urgent cases. The pressures came as hundreds of
thousands of NHS workers went on a four hour strike, in protest over their
pay. Having worked in the UK hospital system myself, albeit many years ago
now, it would, however, seem as if the same old problems of public hospitals
overcrowding, under-staffed, under-paid and generally just not up to the
job, has continued.
Inspectors have said that the Kent hospital is in a “state of crisis” with
patients “stacked” waiting to be treated, including children left without
assessment, and patients with potentially dangerous heart conditions left
It follows national statistics showing a doubling in the number of patients
forced to endure long trolley waits since last year, which triggered
warnings that the NHS is entering a crisis, even before the expected
increases during the cold season.
The hospital’s death rates were 17 percent higher than would be expected in
The new report follows a catalogue of failings, which in September was
responsible for almost one quarter of England’s long trolley waits.
In the same month, five patients suffered from “serious incidents,” trust
documents reveal, including a patient left with a needle in them for two
months after undergoing surgery.
Such lapses are so basic they are defined by the NHS as “never events”.
In another case, a female patient placed in a side-room without a call bell,
broke her hip after falling when she was unable to get help to go to the
The nursing side gets the flak in these sorts of situations, but I can
assure you that the nurses are not slacking. When questioned, staff were
saying they felt “under siege” as 16 ambulances queued outside. These kinds
of work loads just cannot be endured.
But the patients are also suffering, as well as waiting in silence, one
presumes. Like all enterprises there are targets to be met. Try this one for
size - Latest figures show the Kent hospital is also missing national
targets to treat urgent referrals for suspected cancer within two weeks.
So just what can be done? The government approach has always been the same -
throw money at it, but even though figures of around an extra £1.5bn in
funding are being mooted, it will be nowhere near enough.
A most senior doctor in the UK has urged patients to turn to pharmacies, to
relieve strain on the country’s A&E units.
The simple truth is that the socialist health care model just does not work
financially. In saying that, you have to compare it with the private
hospital system. While it may sound like I am just blowing a horn for my
hospital’s healthcare system, you will never hear of patients left on
stretchers for 35 hours at any private hospital in Thailand.
The times between referral and being seen for cancer patients can be
measured in hours, not weeks!
The majority of your blood test results are available in 45 minutes, though
some can take an hour.
The time between having your X-Ray and it being reviewed by the referring
doctor is measured in seconds.
So you pay for it, but if you are from the UK, you never had it so good!