Coming soon: home test kits as simple and cheap as a pregnancy-test dipstick. Then will come dipsticks for the genes that control hormone levels, brain chemistry, nerve functions and metabolic rates–which, in turn, affect stress, pleasure, irritability, aggression, impulsive behavior, suicidal tendencies, alcoholism and sexual proclivities. And then, finally, the dipstick that reveals all. And Google wants to be in the middle of all this.
What will Paris Hilton expose next? The sure-to-be stunning contents of her ovaries. Your barely legal children will follow her lead, posting their genetic profiles as casually as they post faces, graphic descriptions of what’s hot and what’s not, and closeups of "strategically placed" tattoos. They will post because they want to be seen, and because a genome is worth a thousand pictures. Private types will recoil, but if the Web has taught us anything, it’s that many people like to flaunt it.
Politically delicate though the fact may be, genetic differences play quite a role in determining beauty, health, intelligence and character. Ordinary people care about these things a lot, and genetic knowledge can be put to good use as well as to bad. The worst is yet to come, but so is the best.
Routine lab tests using cells swabbed from the inside of a cheek can already expose genetic variations associated with cholesterol, cancer and hundreds of other traits and diseases, both common and rare. Coming soon: home test kits as simple and cheap as a pregnancy-test dipstick. Then will come dipsticks for the genes that control hormone levels, brain chemistry, nerve functions and metabolic rates–which, in turn, affect stress, pleasure, irritability, aggression, impulsive behavior, suicidal tendencies, alcoholism and sexual proclivities. And then, finally, the dipstick that reveals all. A $10 million prize has been offered for development of technology that can sequence 100 human genomes in ten days, with another $1 million tossed in for sequencing 100 named celebrity volunteers. Within a few decades at most, imaging your entire personal genome onto your hard drive–a mere 3 gigabytes of code currently stored on 6 tightly folded feet of your DNA–will be as easy as imaging your face.
Then you can post it on Craigslist. "SWM (HNPCC-free) seeks SWF, no BRCA1/BARD1." (Translation: "Your breasts had better be as good cancer risks as my colon.") If you doubt people would ever go there, you don’t know where they’ve already been.
Ugly? Yes. But prenatal genetic testing is already quite routine, and premarital genetic testing is increasingly common. If you are among the one in 500 Americans with a bad cholesterol gene, you might prefer to marry one of the 499 who have two good ones, otherwise you’ll face a 1-in-4 chance of having a child who could well have a heart attack in his teens. Why shouldn’t the lovelorn consider such things long before they get to the dark chocolate and champagne? People already engage in genetic discrimination every time they search for a prospective partner by sex, race, or eye color on Match.com. If they check the "want children" box today, they’ll be checking genetic boxes tomorrow.
And it isn’t all ugly–far from it. The nonprofit Kinsearch Registry allows adopted children, egg and sperm donors and biological parents to submit DNA in the hope of connecting with a biological mother, father or sibling who has opted to do the same. Genealogy sites are already beginning to use the same tools to fill in the gaps. One touts itself as the place "where genealogy meets DNA testing." But genes and genealogy have met before, on the site called sex. Mutations aside, genes are just cut-and-paste ancestry, and descendants are just cut-and-paste genes. The day will come when interconnected databases will tell us exactly how each one of 6.5 billion genetically unique individuals emerged from 4 billion years of file-swapping on the DNA network.
But things get really interesting long before that. If Paris exposes her genes, she tells us a good bit about sister Nicky’s, too. And if the two sisters both flash, they expose their parents, however little Rick and Kathy may wish to go public with them. Genes and genealogy can fill in each other’s blanks, by way of the simple arithmetic that Gregor Mendel discovered 140 years ago.
Genetic networking, in other words, is way beyond viral–it’s viral squared, it’s the power you get when a network gets networked. You logged on to the genetic network when you were conceived, and if your family tree goes public, which you can hardly stop, others will quite easily be able to get an excellent fix on your genes. Law enforcement officers have already used genetic fingerprints to locate a suspect who wasn’t on file himself, by finding a partial match with a relative who was.
That brings us to medicine. One of the first things a good doctor always asks you is what ails your parents and siblings. Pretty soon you’ll be telling him what cocktail of drugs helped two of your third cousins beat the same rare cancer that just hit you.
Drug companies have been scrutinizing genes for quite some time already, to guide their development of drugs to treat genetically linked disease. Decode genetics was established in Reykjavik in 1996 specifically to mine Iceland’s exceptionally comprehensive genealogical and health records for genetic causes of disease. But how well a patient responds to a drug often depends also on other genes that shape metabolism, liver function and much else. So drug companies are interested in that angle, too. The UGT1A1 genetic test kit, for example, identifies patients who react badly to a drug routinely used in treating advanced colon cancer. But Iceland’s records don’t help here–Ing????lfur wasn’t on Lipitor when he landed on the island in the year 874.
Until patients and doctors take direct charge, the third leg of pharmacology–how the drug interacts not with the disease but with all the rest of the body–can progress only as fast as drug companies can plod their way through clinical trials that are robust enough to convince federal regulators. But drug-gene interactions can be highly idiosyncratic. Iressa is a very good treatment for one form of lung cancer–if you happen to be a nonsmoking Japanese woman. Drug companies and regulators can never hope to scrutinize even a tiny fraction of every combination of disease, drug and patient-specific genes that might be medically important.
With the rise of genetic networks, patients and their doctors will soon have what they need to do pharmacogenomics far better than Big Pharma and the FDA. Doctors are free to prescribe drugs off label and do so all the time, especially when treating the seriously ill. And desperate patients try everything, including unlicensed drugs imported easily (if often illegally) from abroad. Many desperate patients are also already sharing everything they know via online sites dedicated to beating what’s killing them. Sharing relevant genetic information is the inevitable next step. Simply naming close relatives will often suffice; DNA-based genealogical trees can take care of the rest. The rules of genetic arithmetic make some things certain, rule out others completely and often supply probabilities that are good enough for what you need. And however cheap it may get to decode your own genes, it will always be cheaper to let Dad, Mom and your annoyingly rich kid brother pay instead.
This kind of networking will of course spawn lots of self-prescribed quackery, but it will also suggest tantalizing new possibilities that later crystallize into rock-solid new medicine. One amateur alone is far more likely to be a rotten scientist than the next Pasteur, but the wisdom of crowds is quite another matter. Networked crowds have already proved themselves smarter than Dan Rather, and the science in their Wikipedia is on a par with the Encyclopedia Britannica‘s. Assisted by accommodating doctors and compliant pharmacies both here and abroad, networked patients will also have one huge research advantage over all the official medicos–the freedom to experiment in ways that lawyer-shy drug companies and lawyer-clogged regulatory agencies can never risk.
Best of all, genetic networks will help you see far enough into your medical future to dodge bullets before they even leave the genetic gun. The perils of asbestos and bathhouses might well have been exposed years earlier if people suffering from two very rare cancers–mesothelioma and Kaposi’s sarcoma–had been communicating as freely in the 1960s and 1970s as they can today. Quite a few genes seem to have much the same power for mischief as toxic chemicals and viruses, but the genetic mischief is often more tractable. A smart diet is a highly effective antidote for a dumb cholesterol gene–and quite a number of other ones, too.
Most of medicine is a search for common biochemical ground. Toxic chemicals and infectious microbes usually expose themselves first as unusual clusters of disease among the healthy. Drugs prove themselves safe and effective by delivering unusual clusters of health among the sick. Discovering what ails us and how to beat it is a statistical game. It has traditionally been left to the gnomes in Washington, because they had the best access to the most data. The networked masses, however, have far better access to their private genes, and are always the first to know what hanky-panky they’ve been up to, what pills they’ve been popping, and whether they feel better or worse. What Google medicine will lack in discipline and traditional rigor, it will more than make up for in speed and scope.
Nature is a blind watchmaker, but humans added sight and thought to their eugenic scheming a long time ago. However unconsciously we may do it, we search for hardy genes whenever we gaze and sigh; for similar genes when we search for ancestors, relatives and rapists; for good genetic matches when we search for safe, effective drugs; and for vulnerable genes when we search for healthier lifestyles. Genes will make the leap from carbon to silicon and fiber-optic glass because they can organize, refine and accelerate these searches, and many others, too, as never before. Count on it–you are going to end up searching for genes on Google.