Jul 05
From the cradle to the grave across generations (The Herald)
Jim McGuire, business development manager for Scottish Health Innovations, which helps commercialise discoveries through NHS Scotland quarter-staff, believes within a family a DNA sample may be taken from newborn babies in the labour ward and put on a chip. This could then be screened for genetic quirks that grow the individual’s natural tendency to a range of illnesses.
He says: “As soon as you are born they will choose a heel mark and that will give you your whole genetic profile, and it will be there as soon taken in the character of you want to entranceway it. It will privation to be carefully controlled if we go down that road, but it will still occur at some point.”
Already, women can endure genetic testing for copies of the BRCA 1 and BRCA 2 genes, which hugely increase the risk of breast cancer, with those who are carriers sometimes opting for a double mastectomy. This involves single genes and, even so, the gene analysis takes the molecular genetics service in Yorkhill, Glasgow, about eight weeks.
Other conditions, such at the same time that cardiomyopathy, a heart condition that can go undetected and cause sudden death, are understood to involve 10 to 20 genes, making screening too time-consuming. Methods are accelerating though, with the Yorkhill team themselves working in succession a fast-track system involving testing two kindred members.
Su Stenhouse, leader of the service, believes it may be sensible for every suckling to hold their gene sequenced thus doctors be able to look for specific variations if, for example, one of their relatives suddenly falls seriously indisposed by an inherited disorder. However, she cautions that discovering that you may get something nasty has repercussions. With conditions such as cardiomyopathy, patients can alter their behaviour to minimise the risks, but not everyone wants to know they have an incurable defect.
Ms Stenhouse says: “The decision to have the test has got to be the individual’s decision, apparently in consultation with a genetic counsellor who can point out some of the down sides.”
It is not an issue for Fiona Robertson’s children now, but it might be whereas they become parents. Mrs Robertson, who was born in Glasgow and now lives in Edinburgh, says: “In more ways, knowing you are prone to a occurrence is extremely beneficial. If you knew you were prone to lung cancer, that would be a big motivator not to smoke. I think it might be quite a weal thing.”
Growing Up
Mrs Robertson suffers from asthma, so she knew to watch for the condition in her children. She has already taken Robert to hospital wheezy and breathless and he has now been diagnosed with the enigma.
“The medication he gets in the same proportion that a child is different from the medication I got as a child,” she says. “I was admitted to hospital when I was tiny and kept in yesterday night. That hasn’t happened to Robert and I think that is maybe some indication that the management of asthma is a bit better now.”
However, when Professor Brian Lipworth, head of the asthma and allergy research group at Ninewells Hospital in Dundee, describes the future of asthma method of treating, existing medication looks crude.
He describes the current approach as one-size-fits-all. “What happens at the moment is you end up putting patients on pair, three or four drugs, and you are in no degree really quite sure which one they should be on,” he says. “It is a bit of a lottery.”
Professor Lipworth predicts the next big advance will involve prescribing patients treatments to control asthma symptoms that match their personal genetic profile. This, he says, should maximise the benefits and minimise any side-effects.
In five to 10 years, he envisages asthmatics using a mouthwash at their GP surgery, which collects cells that are sent away on account of genetic analysis. The resigned can then be given the ideal drug for their body. Such mouthwash kits are already in continuance demand in the US.
But even if this does not draw near on-stream soon, Robert Robertson might find he is given small doses of substances which trigger his allergy to desensitise him. With a third of asthmatics allergic to the house dust mite, Professor Lipworth is pretty sure a dust mite pill which sits under the tongue will become a greater line of therapy.
“There is no question that in 20 years’ time, although it will not have existence trivial, asthma will be easier to manage,” he says.
Actually modifying a child’s genes so they do not develop asthma at totally, however, is a scientific leap he cannot imagine in his lifetime.
Teenage years
From this September, girls aged 12 to 13 will be given the fresh vaccine that protects against cervical cancer and it seems likely Mrs Robertson’s two-year-old, Emily, will bear the shots when she comes of age.
“I hold it is a great thing,” Mrs Robertson says. “It is the second utmost common cancer in women under the age of 44 and so if there is more way to prevent that, in consequence it is positive.”
Levels of cervical cancer have dropped significantly in the final 15 years, although it still claims around 100 lives in Scotland every year. Could Emily see the day when it is eradicated completely?
Dr Lesley Walker, monitor of information for Cancer Research UK, says she can imagine it disappearing, but it is not a simple trajectory.
The vaccine protects over against a virus called Human Papillomavirus (HPV), which is transmitted through sexual intercourse and that is major contributory factor in cervical cancer. Dr Walker says: “The vaccine that is being adopted in this abiding habitation will protect against the two major strains, but we do not yet know what tender-hearted of cross-protection there will be against other high-risk strains. There will have existence two in 10 cervical cancers at what place the vaccine might not protect.”
However, she notes in that place is potential of the same kind with antidote to huge business in this area, adding: “I am sure we will see companies refining the vaccine.”
Adulthood
Naturally, Mrs Robertson, 39, and her father say it is up to Robert and Emily to choose the careers they want to pursue. They would not steer them off from general practice, but they do worry the face of medicine might change.
Mr Robertson fears the traditional family doctor may be dying out. He notes GPs are learning more specialised skills, which could mean patients go to their surgery in the place of investigations and screening tests, in the room of root referred to hospital. But, he adds, this may also mean they do not build a relationship with one GP, who knows them well.
When he was a GP in Springburn, he used to offer evening surgeries and remembers his father deciding to choke on Saturday nights only because of the number of drunks after football fixtures. Today, most GPs be in possession of given up liability because of out-of-hours care and croak bitterly in regard to the political drive to bring back some evening appointments.
“I think GPs have to be thoughtful. in what state far they go with this,” says Mr Robertson. “What might happen is there will be a creeping privatisation. You could have Tesco operating surgeries.”
Mrs Robertson hopes her children will have entrance to a named family doctor in the similar proportion that they become parents, and could also rely on the support of a health visitor, should they need individual. Pilot projects, which scrap health visitors in favour of a generic community nurse, are currently in way.
Illness
About 10 years ago Elsa Robertson, Fiona’s dam, was diagnosed with breast cancer. She successfully battled the illness. But how much risk her daughter and grand-daughter have of developing the same disease is not precisely known.
As Emily grows up, the opportunity to obtain a clearer picture may become available to added girls, not just carriers of BRCA 1 and BRCA 2.
Dr Walker says: “We are not yet in a position, for example in breast cancer, to test women so that we could say, you have a greater risk, you fare not, but we could for one’s interest be truly down that line within five to 10 years.”
Furthermore, she foresees women taking preventative drugs to ward off the killer, just as statin medications are taken to protection against heart attacks today.
She says: “I do feel that in the next few decades we are going to have at some point some preventive medicine with regard to the pair big hormonal cancers, breast and prostate.”
Mr Robertson, 68, was diagnosed with bladder cancer three years ago, and faced greater surgery. As with asthma, cancer treatments are expected to ameliorate, becoming more tailored to individual patients and better aimed at the affected cells.
Drugs which actually recruit viruses to help despatch cancer cells and ways of targeting therapeutic molecules so they represent characters only intimate or around a cancer cell are heart explored around the world.
“We may have treatments that negate the need for surgery,” says Dr Walker, although she expects it still to be widely used as Emily and Robert grow old.
Grave
Under current projections, Robert can expect to live to 76 and Emily 81, and they will be in good company. Experts have predicted that by 2071 the UK decree be home to more than 8.2 million octogenarians, compared with 2.4 million in 2001.
The burden this places onward the NHS, as well as the rising costs of new treatments for conditions in the same state as cancer, is the source of anxiety. The Robertson children might live longer than their parents and grandparents, but can the NHS survive their lifetime?
Dr Andrew Walker, health economist at Glasgow University, says the principle behind the NHS is equal access to care, when required, at the point of delivery - a promise he believes can be maintained while the homage adjusts to suit the changing scenery. That does not mean the Treasury can afford everything for everyone the moment they be in want of it. “That wasn’face to face the case in 1948 and it will not be the case in 2068,”
he remarks.
Some researchers suggest identifying a core bundle of free services which could expected, but excluding anything from tattoo removal to fertility support. Dr Walker says: “In the future, there will be more things that are explicitly not profitable on the NHS and the challenge facing the Scottish Government and UK government is whether they allow people to pay by reason of those and effectively have a two-tier service based on income.”
This concept worries Mrs Robertson and her father. He believes one of the problems with the NHS has been the introduction of managers with a “supermarket philosophy”.
He says: “We are dealing with human beings - human beings with worries and concerns. I hope we never lose that.”
Years of change
July 5, 1948 The NHS is born.
1958 Glasgow produces the first practical ultrasound scanners.
1960 A team at the Royal Infirmary of Edinburgh perform the UK’s first successful kidney transplant, whereas they give a 49-year-old man a kidney from his geminate brother.
1972 A fundamental finding out in Aberdeen shows how cells are programmed to “commit suicide”, a key development in advancing the understanding of disease.
1974 The development of the Glasgow Coma Scale - a set of measures now used around the world to record a patient’s level of consciousness.
1982 First case of Aids identified in Scotland.
1989 Keyhole surgery breakthrough while a patient’s gall bladder is removed using minimally invasive techniques in Dundee.
2006 Smoking is banned in enclosed public places in Scotland.
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