The human genome as public: Justifications and implications

Since the human genome was decoded, great emphasis has been placed on the unique, personal nature of the genome, along with the benefits that personalized medicine can bring to individuals and the importance of safeguarding genetic privacy. As a result, an equally important aspect of the human genome – its common nature – has been underappreciated and underrepresented in the ethics literature and policy dialogue surrounding genetics and genomics. This article will argue that, just as the personal nature of the genome has been used to reinforce individual rights and justify important privacy protections, so too the common nature of the genome can be employed to support protections of the genome at a population level and policies designed to promote the public's wellbeing. In order for public health officials to have the authority to develop genetics policies for the sake of the public good, the genome must have not only a common, but also a public, dimension. This article contends that DNA carries a public dimension through the use of two conceptual frameworks: the common heritage (CH) framework and the common resource (CR) framework. Both frameworks establish a public interest in the human genome, but the CH framework can be used to justify policies aimed at preserving and protecting the genome, while the CR framework can be employed to justify policies for utilizing the genome for the public benefit. A variety of possible policy implications are discussed, with special attention paid to the use of large‐scale genomics databases for public health research.     

Defining Ourselves: Personal Bioinformation as a Tool of Narrative Self-Conception

Where ethical or regulatory questions arise about an individual’s interests in accessing bioinformation about herself (such as findings from screening or health research), the value of this information has traditionally been construed in terms of its clinical utility. It is increasingly argued, however, that the “personal utility” of findings should also be taken into account. This article characterizes one particular aspect of personal utility: that derived from the role of personal bioinformation in identity construction. The suggestion that some kinds of information are relevant to identity is not in itself new. However, the account outlined here seeks to advance the debate by proposing a conception of the relationship between bioinformation and identity that does not depend on essentialist assumptions and applies beyond the narrow genetic contexts in which identity is customarily invoked. The proposal is that the identity-value of personal bioinformation may be understood in terms of its instrumental role in the construction of our narrative identities, specifically that its value lies in helping us to develop self-narratives that support us in navigating our embodied existences. I argue that this narrative conception provides useful insights that are pertinent to the ethical governance of personal bioinformation. It illuminates a wider range of ethical considerations in relation to information access; it accounts for variations in the utility of different kinds of information; and it highlights that the context in which information is conveyed can be as important as whether it is disclosed at all. These arguments are illustrated using an example drawn from psychiatric neuroimaging research.     

Proposed guidelines to evaluate scientific validity and evidence for genotype-based dietary advice

Nutrigenetic research examines the effects of inter-individual differences in genotype on responses to nutrients and other food components, in the context of health and of nutrient requirements. A practical application of nutrigenetics is the use of personal genetic information to guide recommendations for dietary choices that are more efficacious at the individual or genetic subgroup level relative to generic dietary advice. Nutrigenetics is unregulated, with no defined standards, beyond some commercially adopted codes of practice. Only a few official nutrition-related professional bodies have embraced the subject, and, consequently, there is a lack of educational resources or guidance for implementation of the outcomes of nutrigenetic research. To avoid misuse and to protect the public, personalised nutrigenetic advice and information should be based on clear evidence of validity grounded in a careful and defensible interpretation of outcomes from nutrigenetic research studies. Evidence requirements are clearly stated and assessed within the context of state-of-the-art ‘evidence-based nutrition’. We have developed and present here a draft framework that can be used to assess the strength of the evidence for scientific validity of nutrigenetic knowledge and whether ‘actionable’. In addition, we propose that this framework be used as the basis for developing transparent and scientifically sound advice to the public based on nutrigenetic tests. We feel that although this area is still in its infancy, minimal guidelines are required. Though these guidelines are based on semi-quantitative data, they should stimulate debate on their utility. This framework will be revised biennially, as knowledge on the subject increases.     

Current status of regulating biotechnology-derived animals in Canada: animal health and food safety considerations

Development of an effective regulatory system for genetically engineered animals and their products has been the subject of increasing discussion among researchers, industry and policy developers, as well as the public. Since transgenesis and cloning are relatively new scientific techniques, transgenic animals are 'novel' organisms for which there is limited information. The issues associated with the regulation of transgenic animals pertain to environmental impact, human food safety, animal health and welfare, trade and ethics. It is a challenge for the developers to prove the safety of the products of biotechnology-derived animals and also for regulators to regulate this increasingly powerful technology with limited background information. In principle, an effective regulatory sieve should permit safe products while forming a formidable barrier for those posing an unacceptable risk. Regulatory initiatives for biotechnology-derived animals and their products should be able to ensure high standards for human and animal health, a sound scientific basis for evaluation; transparency and public involvement, and maintenance of genetic diversity. This review proposes a regulatory regime that is based on scientific risk based assessment and approval of products or by-products of biotechnology-derived animals and its application in context to Canadian regulations.     

Editorial

This special section of Genes and Nutrition presents a baseline analysis of ethical and legal issues undertaken within the EU FP7 research project Food4Me, which investigates the feasibility today of the vision for delivering personalized nutrition. Four major topics are addressed: Do we know enough for offering personalized nutritional advice? How can personal, cultural, and scientific perspectives on food and health be integrated? How does personalized nutrition affect individual autonomy? Which urgent ethical and legal matters stand out when personalized nutrition is commercialized?     

Values at stake: autonomy, responsibility, and trustworthiness in relation to genetic testing and personalized nutrition advice

Personalized nutrition has the potential to enhance individual health control. It could be seen as a means to strengthen people’s autonomy as they learn more about their personal health risks, and receive dietary advice accordingly. We examine in what sense personalized nutrition strengthens or weakens individual autonomy. The impact of personalized nutrition on autonomy is analyzed in relation to responsibility and trustworthiness. On a societal level, individualization of health promotion may be accompanied by the attribution of extended individual responsibility for one’s health. This constitutes a dilemma of individualization, caused by a conflict between the right to individual freedom and societal interests. The extent to which personalized nutrition strengthens autonomy is consequently influenced by how responsibility for health is allocated to individuals. Ethically adequate allocation of responsibility should focus on prospective responsibility and be differentiated with regard to individual differences concerning the capacity of adults to take responsibility. The impact of personalized nutrition on autonomy also depends on its methodological design. Owing to the complexity of information received, personalized nutrition through genetic testing (PNTGT) is open to misinterpretation and may not facilitate informed choices and autonomy. As new technologies, personalized nutrition and PNTGT are subject to issues of trust. To strengthen autonomy, trust should be approached in terms of trustworthiness. Trustworthiness implies that an organization that develops or introduces personalized nutrition can show that it is competent to deal with both the technical and moral dimensions at stake and that its decisions are motivated by the interests and expectations of the truster.     

Functional Foods — Lebensmittel der Zukunft?: Maßgeschneiderte Ernährung

Functional foods might be helpful in improving the nutritional status and preventing certain diseases. In order to inform the consumer about the benefit of a product it will be necessary to enable scientifically proved health claims. These health claims have to be supported by studies and should make clear how a product can influence health. Only if there are proven facts, functional foods could establish on the market as foods of the future in the longer term beside the naturally healthful products. It will be of no use neither to the consumer nor to the food industry to promote these product group with exaggerated promises as a kind of miracle cure which can help against all diseases. The acceptance of the consumer will depend on credible product concepts. Another important precondition for functional foods is that there are absolutely no health risks associated with the consumption of these products. Recommendations regarding fortification and intake of functional foods must consider this aspect. Side effects by excessive doses or imbalances are to be avoided. The consumer should know that the point is not to take as much as possible of potentially healthful single substances but to show clearly that physiological dosages, which can also be attained by a higher intake of traditional food are associated with the best benefit‐risk relation, i.e. show the greatest benefit and minimal risk. In general functional foods do not resolve any nutritional problem. The effects are limited, especially if the nutrition is imbalanced (e.g. hyperenergetic, high fat). In these cases the addition of functional foods offers no or only small corrective effects. Functional foods represent no substitute for a fully balanced nourishment with a high amount of naturally healthy foods such as vegetables, fruits, whole grain products as well as milk and milk products.     

Do we know enough? A scientific and ethical analysis of the basis for genetic-based personalized nutrition

This article discusses the prospects and limitations of the scientific basis for offering personalized nutrition advice based upon individual genetic information. Two divergent scientific positions are presented, with an ethical comment. The crucial question is whether the current knowledge base is sufficiently strong for taking an ethically responsible decision to offer personalized nutrition advice based upon gene–diet–health interaction. According to the first position, the evidence base for translating the outcomes of nutrigenomics research into personalized nutritional advice is as yet immature. There is also limited evidence that genotype-based dietary advice will motivate appropriate behavior changes. Filling the gaps in our knowledge will require larger and better randomized controlled trials. According to the second position, personalized nutrition must be evaluated in relation to generally accepted standard dietary advice—partly derived from epidemiological observations and usually not proven by clinical trials. With personalized nutrition, we cannot demand stronger evidence. In several specific cases of gene–diet interaction, it may be more beneficial for individuals with specific genotypes to follow personalized advice rather than general dietary recommendations. The ethical comment, finally, considers the ethical aspects of deciding how to proceed in the face of such uncertainty. Two approaches for an ethically responsible way forward are proposed. Arguing from a precautionary approach, it is suggested that personalized dietary advice should be offered only when there is strong scientific evidence for health effects, followed by stepwise evaluation of unforeseen behavioral and psychological effects. Arguing from theoretical and applied ethics as well as psychology, it is also suggested that personalized advice should avoid paternalism and instead focus on supporting the autonomous choice of each person.     

Specialty products made from goat milk

Although it may not be important in certain parts of the world, the contribution of goat milk to the economic and nutritional wellbeing of humanity is undeniable in many developing countries, especially in the Mediterranean, Middle East, Eastern Europe and South American countries. Goat milk has played a very important role in health and nutrition of young and elderly. Goat milk has also been known for its beneficial and therapeutic effects on the people who have cow milk allergy. These nutritional, health and therapeutic benefits enlighten the potentials and values of goat milk and its specialty products. The chemical characteristics of goat milk can be used to manufacture a wide variety of products, including fluid beverage products (low fat, fortified, or flavored) and UHT (ultra high temperature) milk, fermented products such as cheese, buttermilk or yogurt, frozen products such as ice cream or frozen yogurt, butter, condensed/dried products, sweets and candies. In addition, other specialty products such as hair, skin care and cosmetic products made from goat milk recently have gained a further attention. Nevertheless, high quality products can only be produced from good quality goat milk. The quality milk should have the potential to tolerate technological treatment and be transformed into a product that satisfies the expectations of consumers, in terms of nutritional, hygienic and sensory attributes. Taste is the main criteria used by consumers to make decisions to purchase and consume goat milk and its products. Typical goat taste is considered as a quality component in certain goat cheese products. Farmers can produce more value-added products for the economic sustainability of their business and the dairy goat industry in general.     

DNA testing and domestic dogs

There are currently about 80 different DNA tests available for mutations that are associated with inherited disease in the domestic dog, and as the tools available with which to dissect the canine genome become increasingly sophisticated, this number can be expected to rise dramatically over the next few years. With unrelenting media pressure focused firmly on the health of the purebred domestic dog, veterinarians and dog breeders are turning increasingly to DNA tests to ensure the health of their dogs. It is ultimately the responsibility of the scientists who identify disease-associated genetic variants to make sensible choices about which discoveries are appropriate to develop into commercially available DNA tests for the lay dog breeder, who needs to balance the need to improve the genetic health of their breed with the need to maintain genetic diversity. This review discusses some of the factors that should be considered along the route from mutation discovery to DNA test and some representative examples of DNA tests currently available.     

Twin registers across the globe: what's out there in 2002?

Twin research offers the greatest power for the genetic analysis of complex multifactorial traits and diseases in humans. Modern twin analyses extend beyond the classical twin study for estimating the heritability of a trait. The human genome project can fulfil its promises only after functional characterisation of single genes in the context of genetic background and environment. Twin research can make a major contribution in that regard. Twin research is greatly facilitated by the willingness, motivation, cooperation, and generosity of the participants and their families. A second important aspect is the availability of twin registries that serve as a resource for genetic epidemiology. Currently, there is no systematic overview of the twin collections worldwide. This special issue will help to overcome the limited accessibility of this resource by providing basic information on most of the existing twin registers. Furthermore, an additional goal is to facilitate collaboration between registers. Some basic principles, potentials, and problems will be exemplified by my personal experience in the Berlin Twin Study.     

Sharing the benefits of genetic resources: from biodiversity to human genetics

Benefit sharing aims to achieve an equitable exchange between the granting of access to a genetic resource and the provision of compensation. The Convention on Biological Diversity (CBD), adopted at the 1992 Earth Summit in Rio de Janeiro, is the only international legal instrument setting out obligations for sharing the benefits derived from the use of biodiversity. The CBD excludes human genetic resources from its scope, however, this article considers whether it should be expanded to include those resources, so as to enable research subjects to claim a share of the benefits to be negotiated on a case-by-case basis. Our conclusion on this question is: 'No, the CBD should not be expanded to include human genetic resources.' There are essential differences between human and non-human genetic resources, and, in the context of research on humans, an essentially fair exchange model is already available between the health care industry and research subjects. Those who contribute to research should receive benefits in the form of accessible new health care products and services, suitable for local health needs and linked to economic prosperity (e.g. jobs). When this exchange model does not apply, as is often the case in developing countries, individually negotiated benefit sharing agreements between researchers and research subjects should not be used as 'window dressing'. Instead, national governments should focus their finances on the best economic investment they could make; the investment in population health and health research as outlined by the World Health Organization's Commission on Macroeconomics and Health; whilst international barriers to such spending need to be removed.     

Practical guidelines for assessing patients positive for hepatitis B surface antigen.

In assessing the patient the hepatitis B surface antigen (HBsAg) the physician must decide on the basis of physical findings, results of laboratory tests and biopsy, when indicated, whether the patient is an asymptomatic carrier or has acute or chronic hepatitis. Asymptomatic carriers of HBsAg must be educated in personal hygiene and the possibility of transmission, should not be allowed to donate blood or breast-feed and should not work with blood products for human use or pharmaceutical products designated for intravenous use. However, it is otherwise not necessary to advise these individuals to change their profession.     

Human senescence

Human life expectancy has increased dramatically through improvements in public health, housing, nutrition and general living standards. Lifespan is now limited chiefly by intrinsic senescence and its associated frailty and diseases. Understanding the biological basis of the ageing process is a major scientific challenge that will require integration of molecular, cellular, genetic and physiological approaches. This article reviews progress that has been made to date, particularly with regard to the genetic contribution to senescence and longevity, and assesses the scale of the task that remains.     

Molecular biology and the control of viral vaccines

The live attenuated vaccines against poliomyelitis developed by Sabin are among the safest and most effective antiviral vaccines in current use and have eliminated poliomyelitis as a public health problem in many countries. They form the main basis of the WHO intention to eliminate poliomyelitis from the world by the year 2000, and the molecular basis of their attenuated phenotype and some of its virological consequences are increasingly clear. Nonetheless, the data reviewed here show how poorly understood their mechanism of action is in use. Our studies raise the possibility of in vitro neurovirulence tests and may help to identify features of particular importance in the attenuation of the virus for human rather than simian recipients. On the other hand it is clear that when a live virus is used as a vaccine it is not possible to control it in the same way that genetically engineered products may be controlled in so far as replication in the recipient makes it possible for the live vaccine strain to alter in ways which may or may not be undesirable.     

What research participants want to know about genetic research results: the impact of "genetic exceptionalism"

The disclosure of individual genetic results has generated an ongoing debate about which rules should be followed. We aimed to identify factors related to research participants' preferences about learning the results of genomic studies using their donated tissue samples. We conducted a cross-sectional survey of 279 patients from the United States and Spain who had volunteered to donate a sample for genomic research. Our results show that 48% of research participants would like to be informed about all individual results from future genomic studies using their donated tissue, especially those from the U.S. (71.4%) and those believing that genetic information poses special risks (69.7%). In addition, 16% of research participants considered genetic information to be riskier than other types of personal medical data. In conclusion, our study demonstrates that a high proportion of participants prefer to be informed about their individual results and that there is a higher preference among those research subjects who perceive their genetic information as riskier than other types of personal medical data.     

Special Issue Editor’s choice: Global child health from birth to adolescence and beyond

Caitlin Moyer discusses PLOS Medicine’s Special Issue on Global Child and Adolescent Health.

In a new PLOS Medicine special issue, entitled “Global Child and Adolescent Health: From Birth to Adolescence and Beyond”, guest editors Zulfiqar Bhutta, Quique Bassat, and Kathryn Yount bring to the forefront new research to illuminate global challenges for achievement of child and adolescent health and survival goals, and novel ways to address these challenges. The research articles in this special issue cover a broad range of current threats to child and adolescent health and wellbeing around the globe, shining a spotlight on the health impacts of pollutions, climate change, injury, violence, infectious diseases, undernutrition, and adolescent pregnancy. It is important to identify the gaps in knowledge that stand in the way of ensuring that all children and adolescents have the opportunity to survive, grow, and achieve developmental, social, and academic milestones. These studies further this goal by investigating new strategies that may be adopted to address these areas of need.     

Understanding the nutrigenomic definitions and concepts at the food-genome junction

The marked differences in individual response to dietary factors have led to major controversies in nutrition and puzzled nutrition scientists over the last century. The emerging field of nutrigenomics helps us to understand the basis for some of these differences and also promises us the ability to tailor diet based on individual genetic makeup. Great advances in Human Genome Project, documentation of single nucleotide polymorphisms (SNPs) in candidate genes and their association with metabolic imbalances have gradually added new tests to the nutrigenomic panel. Studies based on ethnopharmacology and phytotherapy concepts showed that nutrients and botanicals can interact with the genome causing marked changes in gene expression. This has led to the commercial development of nutraceuticals and functional foods that can modify negative health effects of individual genetic profile bringing the field to the "food/genome" junction. Despite the promise of nutrigenomics to personalize diet, there is skepticism whether it can truly bring about meaningful modification of the risk factors connected to chronic diseases, due to the lack of large scale nutrition intervention studies. Several intervention studies currently underway in the United States and abroad (Israel, Spain, and France) will further help validate nutrigenomic concepts. France has already introduced a National Nutrition and Health Program to assess nutritional status and risk of major metabolic diseases. As the field(s) related to nutritional genomics advance in their scope, it is essential that: (a) strict guidelines be followed in the nomenclature and definition of the subdisciplines; and (b) the state/federal regulatory guidelines be updated for diagnostic laboratories, especially for those offering tests directly to the public (without a physician's request) to help protect the consumer.     

Epistasis and Its Implications for Personal Genetics

The widespread availability of high-throughput genotyping technology has opened the door to the era of personal genetics, which brings to consumers the promise of using genetic variations to predict individual susceptibility to common diseases. Despite easy access to commercial personal genetics services, our knowledge of the genetic architecture of common diseases is still very limited and has not yet fulfilled the promise of accurately predicting most people at risk. This is partly because of the complexity of the mapping relationship between genotype and phenotype that is a consequence of epistasis (gene-gene interaction) and other phenomena such as gene-environment interaction and locus heterogeneity. Unfortunately, these aspects of genetic architecture have not been addressed in most of the genetic association studies that provide the knowledge base for interpreting large-scale genetic association results. We provide here an introductory review of how epistasis can affect human health and disease and how it can be detected in population-based studies. We provide some thoughts on the implications of epistasis for personal genetics and some recommendations for improving personal genetics in light of this complexity.