Testing for Sports Genes Sparks Controversy. At least 2 companies have begun selling tests that claim to help match youngsters with the sports they are genetically programmed to play best.

iPads Help Reduce Pain, Anxiety for Kids in the ER. Nurses in the emergency departments of New York City hospitals are pioneering techniques — including the use of iPads — to improve the patient experience by eliminating or minimizing pain.

Pharmacy CDS Systems Miss Potentially Dangerous Interactions. Only 28% of pharmacies’ clinical decision support software systems correctly identified potentially dangerous drug-drug interactions, according to a new study.

Cockroaches May Help Explain Asthma Outbreaks. A new study shows that children in high-asthma neighborhoods have been more exposed to cockroaches than those in adjacent low-asthma neighborhoods.

NIST Event to Tackle EHR Usability. The National Institute of Standards and Technology will host a workshop on June 7 on measuring, evaluating and improving the usability of electronic health records.

Navy Calling on Gamers To Help with Security. The Office of Naval Research is rolling out the military’s first-ever online war game open to the public, crowd-sourcing the challenges of maritime security to thousands of “players” sitting in front of their computers.

California Bill Would Give Parents Access To Kids Facebook Pages. Senator Ellen Corbett has introduced legislation that would force social networks like Facebook to give parents access to their child’s account and set all privacy settings to their maximum levels by default.

Scientists Find “Master Switch” Gene for Obesity. Scientists have found a gene that controls the expression other genes which are linked to diabetes risk and cholesterol metabolism. The discovery should help in the search for treatments of obesity-related diseases.

WellPoint Shakes-Up Hospital Payments. The insurance giant announced it will cut off annual payment increases to 1,500 hospitals across the country if they fail to score high enough on a test based on 51 indicators of treatment quality.

Study: ACO Costs Higher Than CMS Says. A study commissioned by the American Hospital Association estimates that the start-up costs for establishing an accountable care organization are several times higher than estimates from the Centers for Medicare and Medicaid Services.

How Do They Know He Was Bin Laden? A US intelligence official said a DNA match, using DNA from several family members, provided virtual certainty that Osama bin Laden was killed Sunday night. 

VA-DoD joint EHR to be Commercial, Not Necessarily Proprietary. The agencies want to purchase commercially available solutions for joint use. They would adopt a Department-developed application only if an appropriate commercial solution is not available.

Court Backs Funding Embryonic Stem Cells. In a victory for the White House, a US appeals court overturned an earlier ban against taxpayer-supported stem cell research. 

UW to Punish Doctors Who Gave Sick Notes to Protesters. The University of Wisconsin will discipline physicians who wrote doctor excuse notes for protesters participating in rallies against the Governor’s union-stripping law. The discipline ranges from a written reprimand to loss of pay and leadership position.

At Least 600,000 Young Adults Join Parents’ Health Plans Under New Law. That pace is faster than the government expected. Under the new health law, health plans and employers must offer coverage to enrollees’ adult children until age 26 even if they no longer live with their parents, are not a dependent on their parents’ tax returns and are no longer students.

Today, consumers can purchase dozens of medical tests without a prescription–tests that tell them whether they are pregnant, have a urinary infection, their cholesterol is too high, and so on.

Should direct-to-consumer (DTC) genetic tests be as readily available? These are the mail-in saliva tests that tell consumers about their genetic susceptibility to Alzheimer’s disease, type 2 diabetes, heart disease and other conditions.

DTC genetic tests are different from the genetic tests that have been used for decades in prenatal and newborn screening, and more recently in predictive testing (like the BRCA test for breast cancer risk).

The difference is not the substrate being tested. In both cases, it’s DNA. Rather, it’s who owns the testing process.

For the legacy DNA tests, health professionals own the process. As per protocol, they obtain permission (informed consent) from patients before ordering the test. Then, they consult with and support the patient once the results are known.

In contrast, DTC genetic tests transfer ownership of the genetic testing process to consumers. A person can decide for herself whether to get a DTC genetic test. She doesn’t need permission from a provider, and has no obligation to share the information with her provider.

This bothers many physicians, bioethicists and consumer advocates. They point out that DTC genetic test reports can be difficult to interpret (for physicians as well, I might add, despite claims that they are universally qualified to do so). They decry the lack of regulatory oversight of testing facilities which might help assure the accuracy and reliability of the information. Furthermore, reports of “egregious…deceptive marketing” by some DTC genetic testing vendors suggest that consumers maybe harmed, they say.

These people call for regulatory oversight of DTC genetic testing. The FDA has in certain limited instances, already begun to do just that.

Physician organizations tend to support the regulation of DTC genetic testing. In particular, they favor rules that transfer ownership of DTC genetic testing to (guess who?) physicians who can then serve as custodians of the information, just as they do for the traditional genetic tests mentioned above.

Set the Data Free
I disagree. People who want access to their genetic-risk information should be free to pay their own money to obtain it, period. The only place where regulation has a role in DTC genetic testing is to assure the quality of the results being generated. That’s it.

It’s almost never a good idea for governments to impede an individual’s right to access information, no matter its source. That’s especially true when the information concerns that individual only, as is the case with DTC genetic testing. It is information that absolutely cannot be used to harm other people or ‘the national interest,’ which are 2 legitimate reasons why a government might limit the free flow of information.

In fact, the information contained in a DTC genetic test is the most intensely personal information imaginable. Beyond this, the information isn’t ‘telling’ the consumer to ‘do’ anything (as Sarah Palin did, arguably, when she said we should ’target’ politicians with views that differed from hers).

What about the argument that the information contained in these reports is so complex that only a physician can understand it? Well, health consumers deal with vague medical information all the time. The risks and benefits of screening for and treating prostate cancer is a great example, as is the ever-conflicted literature on the risks and benefits of alcohol consumption.

And you know what? Consumers have waded through muddy waters rather successfully over the years. And with so many excellent sources of health information on the Internet, it’s easier now than ever before.

There is a more fundamental issue as well. State and federal policymakers have assured that millions of people in this country have zero access to preventive services. Given this, it is absurd, perhaps even cruel, to also prevent people from accessing information about their own bodies–free and of their own will–unless they do it under the supervision of a physician.

People affected by a rare, inherited form of dwarfism virtually never get diabetes or cancer, scientists have reported. Their findings may someday open up new ways to treat or prevent both conditions.

The scientists are Jaime Guevara-Aguirre, an Ecuadorean physician, and Valter Longo, a cell biologist from USC. They collaborated to study a cohort of about 100 Ecuadoreans that had Laron syndrome, an extremely rare condition caused by a gene mutation that prevents their bodies from responding properly to growth hormone.

Guevara-Aguirre had been following the cohort for more than 2 decades. He and Longo reviewed his notes and found exactly one nonfatal case of cancer and zero cases of diabetes. By comparison, the scientists’ review of 1,600 relatives, who also resided in Ecuador, revealed that 5% of them developed diabetes and 17% developed cancer. These incidence rates matched those found in the general population.

The absence of diabetes was particularly remarkable since the Laron cohort had higher obesity rates than their non-affected relatives, and obesity is a risk factor for the disease.

To figure out why Laron dwarfs almost never got diabetes or cancer, the scientists performed genetic analyses on samples of their blood and saliva. They found that family members with the condition had lower levels of IGF-1 (insulin-like growth factor 1), a chemical that plays a central role in growth during childhood. Laron patients also had lower blood insulin levels and increased sensitivity to insulin.

In their write-up, the scientists hypothesized that low levels of IGF-1 and insulin could have reduced oxidative damage to DNA. Similar phenomena increase life expectancy in worms, yeast and mice, the scientists said. However, they could not conclude that this was the correct explanation for the observed low rates of cancer and diabetes.

If their hypothesis proves to be correct, it suggests that dietary- or drug-based strategies could be used to tackle the diseases. IGF-1 levels are known to fall in people who fast, or restrict protein intake for several days, for example.

Of course these dietary strategies are fraught with risks, but a drug that reduces the effects of growth-hormone (once a person is fully grown) might hold promise.

As it turns out, Pfizer’s Somavert does just this. The drug is now used to treat acromegaly and gigantism. Longo has approached Pfizer to explore the possibility of sponsoring clinical trials to test this drug for the new applications mentioned above.

Sad Side Note: Although the Laron dwarfs in this study never got cancer or diabetes, they did not outlive their relatives. It turns out that substance abuse and accidents are endemic in that community, and they end-up being an unfortunate equalizer when it comes to life expectancy.

Genetic factors predispose people to alcoholism. That’s why the children of alcoholics are four times more likely to develop drinking problems, and the sons of alcoholic fathers are at even greater risk. And that’s why kids who are born to alcoholic parents and then raised by non-drinking parents have the same risk for alcoholism as if they had been raised by their biologic parents.

This is not to say that one, or even a handful of genes are responsible for the disease. The number is clearly far higher than that. Genes that predispose to alcoholism affect diverse physiological functions ranging from those involved with alcohol metabolism to those governing the behavioral response to rewards and pleasure. Some genes linked primarily to depression have even been linked to alcoholism.

The explanation for this multi-gene etiology is that diverse social and environmental factors can interact with genetically programmed mechanisms in complex ways, all of which end-up precipitating the syndrome.

Gene Links to Alcoholism: A Sampler
The “Asian Flush” genes are perhaps the best understood in this regard. Fully one third of all people of East Asian descent are born with a genetic deficiency that causes their cheeks, and often their necks, arms and trunk to turn sunburn-red after consuming even small amounts of alcohol. This “Asian Flush” syndrome is often associated with nausea, headache and tachycardia, distasteful symptoms which act collectively to deter people from drinking alcohol. The result: very few affected individuals become alcoholics.

A separate, colloquially named “tipsy gene” makes affected individuals feel completely bombed after just a drink or two. As many as 20% of the US population has the tipsy gene. It too seems to protect people from becoming alcoholics.

By contrast, a gene variant for the DRD2 dopamine receptor in the brain causes people to feel downright euphoric after drinking, probably because it alters the way the brain’s reward circuits respond to alcohol. Some (but not all) studies have shown this gene variant to be present in a disproportionate number of alcoholics, drug addicts and cigarette smokers.

Where This is Headed
The breakthrough concept that dozens of genes are linked to alcoholism has fostered the idea that multiple, gene-specific drugs can be deployed to fight the disease. Moving beyond the one-drug-fits all paradigm will likely lead to more effective therapy and improved compliance, or so goes the theory.

Scientists have already made progress in this regard. For example, Bankole Johnson and colleagues at the University of Virginia recently identified a cohort of alcoholics that shared a certain gene variation involving serotonin, a neurotransmitter in the brain. They prescribed ondansetron (Zofran) for these patients. Ondansetron is a serotonin blocker that is normally used to treat chemotherapy-related nausea. Remarkably, the drug reduced alcohol consumption in alcoholics with one specific gene variation, but not in those with other types of gene variations involving serotonin. 

Similarly, scientists have shown that alcohol-dependent patients with a certain gene variation for an opioid receptor in the brain had sustained, positive outcomes when treated with the drug naltrexone. Patients with different genetic abnormalities didn’t have the same positive response to the opioid blocking drug.

“Imagine this scenario,” Johnson said in an interview. “You go to your doctor and say, ‘I’m drinking and I need help. The doctor (performs) a blood test and if you qualify, you get tablets the next day and they’re likely to be effective. If you do not qualify, you don’t waste your time with the medicine.”

Cool stuff.

Plenty of folks get a bit red in the face this time of the year. The cheeks of those who live in northern climes may take on a certain glow when they walk the dog or take out the garbage on a brisk, windy night. The same appearance bedevils folks in warmer climes should they forget to apply sunblock before settling beside the pool.

An altogether different group includes fully one third of all people of East Asian descent, who have been born with a genetic deficiency that causes their cheeks, and often their necks, arms and trunk to turn sunburn-red after consuming even small amounts of alcohol (see picture).

The condition is known colloquially as “Asian Flush” or “Asian Glow.” It is often associated with nausea, headache and tachycardia, and is caused by an inherited deficiency of aldehyde dehydrogenase 2 (ALDH2), one of 2 key enzymes involved in the metabolism of alcohol.

Unfortunately, Asian Flush isn’t as benign as once thought. Scientists have determined in recent years that ALDH2 deficiency is a risk factor for esophageal cancer, which happens to be one of the deadliest cancers humans can get.

Philip Brooks and colleagues at the National Institute on Alcohol Abuse and Alcoholism published a seminal article on this association in 2009. In it, the scientists explained that the first of those 2 key enzymes transforms alcohol into acetaldehyde, a vasodilator in the short term and a carcinogen in the long term. The second enzyme, ALDH2, converts that toxin into acetate, a harmless chemical.

People who lack ALDH2 experience a build-up of acetaldehyde in the body after they consume alcohol. The short-term effect of the build-up is the Asian Flush.

But that’s not what prompted Brooks to write that article. “People with this ALDH2 deficiency have a really high risk of getting esophageal cancer when they drink alcohol,” he explained to the LA Times. “Anyone who drinks is at risk, but the more you drink, the more your risk goes up. And when you’re ALDH2-deficient, your risk goes up much more dramatically.”

How dramatically? Brooks cites studies showing that people who inherit a deficient gene from one parent and who consume just 2 alcoholic beverages per day are nearly 10 times more likely to develop esophageal cancer than those with the same alcohol intake but who are in possession of 2 normal copies of the ALDH2 gene.

The problem is huge, because so many people are affected. Brooks and others estimate there are about 540 million ALDH2-deficient individuals in the world. That’s 8% of the world’s population.

The only good news in this story is that ALDH2 deficiency isn’t asymptomatic. People who get Asian Flush know all about their affliction, so screening tests aren’t required. If these folks can be reminded to look at their syndrome as a red flag for an increased risk of a very bad cancer, they can perhaps be convinced to avoid alcohol altogether.

Gene therapy involves replacing or altering a small part of DNA whose abnormal expression causes a disease. The new therapeutic technique has shown promise for the treatment of cystic fibrosis, hemophilia and muscular dystrophy. Now, according to scientists at Weill Cornell Medical Center, perhaps depression should be added to this list as well.

In mice that is. Perhaps someday gene therapy can be used to treat humans as well.

That’s the suggestion made by Michael Kaplitt and colleagues in their write-up summarizing the results of their recent experiments which appears in Science Translational Medicine.

Kaplitt’s team knew that abnormalities in a particular region of the brain-the nucleus accumbens-were associated with depression in humans and behaviors akin to depression in mice (specifically, murine responses to rewards and pleasurable experiences). They knew that the problem in the nucleus accumbens had to do with abnormalities in the way the neurotransmitter serotonin impacted chemical pathways that mediated mood, appetite and sleep patterns. And they knew that most antidepressant drugs acted to regulate serotonin metabolism in the brain.

Kaplitt’s group went from there to isolate the problem with serotonin metabolism in the nucleus accumbens of “depressed” mice. It turned out to be the lack of a single protein, known as p11, which normally serves to transport serotonin receptors to the surface of nerve cells. When p11 was missing or didn’t work properly, nerve cells could produce adequate amounts of serotonin receptors, but the receptors never made it to the surface of the nerve cell membrane where they could bind serotonin and thus trigger normal behavioral responses.

Kaplitt’s team then used somatic gene transfer (that is, “gene therapy”) to replace the gene responsible for producing the defective p11 protein in the nucleus accumbens of their depressed mice. They subsequently observed that the depressive symptoms disappeared.

“We potentially have a novel therapy to target what we now believe is one root cause of human depression,” Kaplitt told BurrillReport. Kaplitt’s team hopes to launch a clinical trial of gene therapy in humans with depression sometime soon.

Toronto-based scientists have found that boys with a specific DNA mutation on their X-chromosomes are at high risk of developing Autism Spectrum Disorder (ASD).

To reach these conclusions, John Vincent and colleagues at the Centre for Addiction and Mental Health compared the gene sequences of 2,000 people with ASD with a control group that had no behavioral or intellectual limitations.

The scientists found that about 1% of boys with ASD also had mutations in a gene known as PTCHD1, which is located on the X-chromosome. The scientists did not find these mutations in boys who were in the control group.

“We believe the PTCHD1 gene has a role in a neurobiological pathway that delivers information to cells during brain development–this mutation may disrupt crucial developmental processes, contributing to the onset of autism,” Vincent told BurrillReport. “Our discovery will facilitate early detection (and) increase the likelihood of successful interventions.”

ASD is a neurological condition associated with abnormal social interaction and communication, unusual behaviors, and frequently, diminished intelligence. It affects about one in 240 girls and one in 70 boys. The causes of ASD remain unknown, though scientists have long suspected that genetic factors play a role.

Boys inherit an X-chromosome from their mothers and a Y-chromosome from their fathers. If a boy’s lone X-chromosome lacks a normally functioning PTCHD1 gene, he is at risk for ASD or some other intellectual disability, the scientists explained. Girls inherit an X-chromosome from their mothers and fathers, so the effects of a PTCHD1 gene defect in one X-chromosome are masked by the normally functioning gene on the other X-chromosome. These girls will not develop ASD, but their male offspring are at risk.

The study appears in Science Translational Medicine. 

An FDA advisory panel has recommended that the agency approve a Massachusetts-based company’s plans to commercialize its genetically-engineered salmon, which grow to adult size nearly twice as fast as their natural-born counterparts.

If the FDA follows the recommendations of the Veterinary Medicine Advisory Committee, the modified salmon will be the first such animal to be marketed in the US.

The Committee is comprised largely of veterinary scientists. It concluded that the new salmon was safe to eat and that the process used to grow it would not pose a significant threat to the environment.

The FDA is not required to follow the recommendations of its advisory panels. It will probably take months before deciding the matter.

Waltham-based AquaBounty has been working on its AquAdvantage Atlantic salmon for over a decade. They grow quickly because company scientists inserted genes encoding for growth hormone from both the Chinook salmon and an eel-like creature known as the ocean pout into their DNA.

The modified fish produce growth hormone year-round. Native Atlantic salmon don’t produce the stuff, and hence don’t grow, each winter. The AquAdvantage salmon end-up being sterile females, for the most part.

AquaBounty plans to grow its genetically-modified salmon in inland tanks to prevent them from interacting with native species. “The possibility of an escape or an event with any possibility to interact with the wild population is infinitesimal,” Ronald Stotish, AquaBounty’s CEO told BurrillReport.

By the way, the Advisory Committee suggested that the FDA monitor the environmental impact of AquaBounty’s commercial operations if they are approved, and that consumers be appraised about what they are buying. Current FDA rules ban labeling that is based exclusively on how foods are produced.