Genomics and the Power of Public Health

On a bad day in the lab, we sometimes joke that if we really wanted to help save lives, we’d forget about molecular biology and go help people quit smoking. Relatively simple public health efforts – clean water, washing your hands before moving from one sick patient to another, basic vaccines – generally save many more lives that the cures that come out of the high tech stuff we do in the lab. Cancer immunotherapy may turn out to be a major advance in cancer treatment, but we’d reduce cancer even more if we could get everyone to quit smoking, lose weight, and stay physically active.

Genomics, whose near-term medical benefits have been the subject of a lot of hype, may turn out to be a high-tech, scientifically complex effort that actually does to have a big impact on people’s lives. As I discuss in my Pacific Standard column this week, part of that will be the long-term medical benefits that grow out of a better understanding of biology. But a more dramatic – and more near-term – impact may be how genomics changes public health. As some sort of genome analysis becomes a routine part of normal medical care, genetics will be integrated with other public health screenings (like testing your cholesterol), which, as two recent studies show, could have a big impact on avoiding preventable consequences of common diseases. Once exome sequencing is cheap enough, there could be a possible benefit of combining genomic screenings using existing medical knowledge – we don’t need to wait for distant future discoveries.

The takeaway is that policy and the infrastructure of the healthcare system, and not science, may soon be the rate-limiting step for realizing the medical benefits of genomics in some cases. Physicians, insurers, hospitals, and the health care system in general is utterly unprepared to handle the kinds of genomic data that could, in the near future, improve routine medical care.

A Long View of the Scientific Revolution

wotton Been eager to get this doorstop of a book, which sat on my shelf for most of 2016:  David Wotton’s The Invention of Science. I’ll have more to say later, but for now, a few pages in, it’s clear that Wotton really takes the long view on science. “It is far too soon to say” how the Scientific Revolution will turn out:

But since 1572 the world has been caught up in a vast Scientific Revolution that has transformed the nature of knowledge and the capacities of humankind. Without it there would have been no Industrial Revolution and none of the modern technologies on which we depends; human life would be drastically poorer and shorter and most of us would live lives of unremitting toil. How long it will last, and what its consequences will be, it is far too soon to say; it may end with nuclear war or ecological catastrophe, or (though this seems much less likely) with happiness, peace and prosperity.

More Science is Always a Winning Bet

Eric Lander in The Boston Globe on hype and hope in medical research is well worth reading:

Science is the most powerful force in the world for improving human health and well-being. It consistently pays enormous returns on society’s investment, transforming the way we live and work.

This is a case we need to keep making, to society and our political leaders as we head into a new Congress, new administration, and new state governments in 2017. As Nature also argues this week, scientists need to stay politically engaged. And that doesn’t just mean partisanship; it means engaging with the party in power, even if it’s not yours.

My year in writing (but not on this blog.)

I did a lot of writing in 2016… just not on this blog, in spite of my good intentions. Aside from a personal record in grant proposals and our latest paper, I continued to write over at Pacific Standard. In case you missed them, here are four favorite picks from the year:

Scientists Can Now Genetically Modify Organisms in the Wild (Feb 17)

Compared to the controversies over GMO foods, gene drives have flown under the radar, but not for long.

Why the National Institutes of Health Should Replace Peer Review With a Lottery (April 8)

There are limits to the fine-scale resolution of peer review; a lottery  to fund grants would openly acknowledge that.

How Slavery Changed the DNA of African Americans (July 19)

Genetic history is about sex and migration, and both were dramatically affected by the slave trade and its racist aftermath.

How Our Environment Affects Our Genes (Nov 15)

We tend to think genetics is destiny, but the real story is gene by environment interactions.

Sciencesplaining Won’t Solve All Our Problems

I am as guilty of this as any other scientist: we think that by simply informing people about the scientific facts of something – climate change, evolution, GMOs – we’ll resolve our disagreements. People, currently misinformed, will come around to seeing issues from the proper scientific perspective if we just lay out the evidence.

It generally doesn’t work out that way, because not understanding the evidence on an issue like climate, while common, is almost always not the primary barrier. Public skepticism about the science, about whether evolution happens, whether climate change is real, whether GMO foods as safe as conventional foods, is a manifestation of an unarticulated, deeper concern that has less to do with the science – faith in one’s religion, concerns about regulating business, or the impact of Big Ag.

So if scientists want to clear up misunderstood science, we need to do more than sciencesplain* – we need to clarify what the argument is really about, and engage on the unstated issues that are the real barriers to agreement.

This is long-winded lead-in to my latest column in Pacific Standard, about a weird piece of sciencesplaining published in Genetics. The Genetics pieces describes how rates of cancer and other diseases among survivors of the Hiroshima and Nagasaki atomic bombings and their offspring are not as high as you might expect. It accurately summarizes results of the still-running epidemiological study of the survivors, and indeed, most bomb survivors did not get cancer, and there is no evidence of higher rates of genetic disease among their offspring.

But the weird thing about the piece is the framing: its premise is that the public has a wildly exaggerated view of the harmful effects of radiation. By informing people about the actual data on bomb survivors, we can have a less irrational discussion about, say, the place of nuclear energy in our efforts to cut carbon emissions.

In my Pacific Standard article, I explain why this is misguided – irrational fears about radiation are the least of the nuclear industry’s problems: Economics, security, and the fact that, while accidents are extremely rare, they are enormously consequential, probably play a much bigger role than irrational fears.

* Yes, the whole “X-‘splaining” fad is annoying but sometimes effective.