Sixteen European Union countries have signed up to a European genome project to collaborate on DNA research and, regrettably, Ireland is not yet one of them. This, as an Irish GP, concerns me, as this failure has profound implications for the health of the nation. An Irish genome project is crucial if we are to develop a modern and effective health system.
I, like the blue whale, the fruit fly and the foxglove, have a genome which is my genetic make-up. We Irish also have our own variant of the human genome, the characteristic make up of our DNA as a people. Dr Gianpiero Cavalleri in the Royal College of Surgeons of Ireland has shown that those of Irish descent have a distinctively homogenous make-up, which makes it comparatively easy to map our susceptibility to disease, as well as our reaction to medication. When you consider that there are about 50 million people on Earth who claim Irish descent, this is important work, not just for Ireland but for the world. Dr Cavalleri and his fellow geneticists would like to start off by taking samples from 10,000 people from the island of Ireland.
Many of us have had our DNA mapped for the fun of it by such methods and several private companies will gladly map our individual genomes for us. It is a painless process, and when samples are taken from a sizeable chunk such as 10,000 people in the population, it gives a basis for years of valuable research.
I recently attended a fascinating lecture given by Dr Eimear Kenny, a New York-based, Irish-born geneticist about such a project among the Latino population in Harlem. Although those from Puerto Rico and the Dominican Republic look much the same, live in the same areas of New York City and speak the same language, they have significantly different types of disease and reactions to medications. So if, for instance, a child has a cough, their doctor will know that if they belong to one genetic background and not the other they are far more likely to have severe asthma and, furthermore, which inhaler is more likely to work, neatly reducing morbidity and saving time and money.
Ancestry
As I listened to Dr Kenny, it all seemed pleasantly familiar. After all, every family doctor knows that conditions run in families, and consideration of ancestry, regions and timely interventions are part of our everyday work. So it is no surprise that the Irish College of General Practitioners CME tutors, as always up to date and innovative, are taking a lively interest in the Irish genome project. They are holding meetings and workshops about the explosion of knowledge in genetics and the implications for future medicine. This is logical, for the GP consulting room would be the logical place to start testing, if general practice could be properly resourced to do it. If a doctor knows the genetic make-up of her patients, she could accurately predict their reactions to drugs such as warfarin, their reaction to cancer treatments and which medications are likely to be hazardous to their DNA type.
Like digital cameras, mobile phones and electric cars, the genome is on the way, and it could yet save the Health Service Executive a fortune. Our Nordic cousins in Finland estimate that if they could identify those likely to develop diabetes, and prevent it before it develops, it could save them tens of millions, year after year. In Ireland we spend 10 per cent of our health budget on diabetes care; so we should be aiming to make similar savings here.
We are at a fork in the road. The decision-makers in Government, the Dáil health committee and the policymakers in the HSE have a clear choice. They can choose to endorse the Irish genome project and go down in as politicians with Lemass-like vision. They will have ensured that ownership of the Irish genome stays with the Irish people, they will have saved the health budget money, they will have benefited the health of the nation and they will have created thousands of sustainable jobs.
Or they can do nothing.
If Ireland becomes the 17th country to sign up to the international agreement on genome research in the EU, it would be a good start. If we could listen to the geneticists and start planning for the future, like Britain, Finland and Estonia, who are quickly leaving us behind, it would be even better.