Fifteen percent of Americans still smoke. Seventy percent of Americans are obese or overweight. Many Americans engage in risky health behaviors that negatively affect their overall wellness.
However, my grandparents were not among these. I can remember hiking in the woods with my grandfather and trying to keep up with him. I also remember a doctor’s office and how, for the first time, it was my grandfather who was the one falling behind. Among these memories are the last times I saw my grandparents, each in a hospital bed before they passed away. Despite their sharp contrast, these memories are not spaced years apart. They happened over a matter of months. As a child, I often struggled with the question of why my grandparents had to be taken away from me long before the ripeness of old age. Looking for ways to better understand what happened, I volunteered at the cancer research center where they had received their care. It was during my time there that I learned about the unlikely, often sinister, partnership between genes and behavior.
Because of these experiences, I underwent genetic testing and learned that I am predisposed to several cancers as well as other illnesses including heart disease — as a matter of fact, if can you name a disease, I am probably at high-risk to develop it. This grave revelation, along with the painful memories of my grandparents’ valiant struggles against a mysterious and ultimately fatal illness, has beckoned me to make modifications to my lifestyle to mitigate the risk of my genetic baggage. A simple saliva test that is available on Amazon for less than the cost of most vitamins has forever changed my outlook on life, health and fate.
Meanwhile, in my work in the lab and clinic, I have seen firsthand the suffering caused by a health care system that treats effects instead of causes and relinquishes any semblance of personal responsibility. We spend $3.3 trillion a year on health care, more than any other nation (absolute and per capita), and yet we still suffer worse life expectancy and health outcomes than other developed countries. For all the political posturing in the news, the entirety of recently proposed health care reforms essentially amounts to reshuffling the deck chairs on the Titanic. We must fundamentally reconsider the reactive nature of health care.
Recent research shows that as many as 50 percent of the nearly three million annual deaths in this country are entirely preventable. Heart disease, the number one killer of Americans, is a function of lifestyle in the great majority of cases. Cancers, rather surprisingly, could be prevented in 50 percent of cases. Many crippling malignancies that seem predetermined by our genes might be entirely avoided if we would safeguard our health. One relevant example is tobacco use. Just a few decades ago, with tobacco use the leading cause of preventable death, smoking rates were as high as 30 percent. Today, this rate has reached a record low, largely due to effective advertising campaigns and cigarette taxes. This success story demonstrates that people do respond to appropriate incentives and education. However, we have not been as successful in addressing other threats to public health. Obesity is a leading contributor to morbidity and mortality. It constitutes among the worst public health crises we have ever faced, and the solution is not as simple as taxing a Big Mac. Obesity is not merely a function of diet, but also exercise and genetic factors. There is no panacea.
One promising approach to encourage healthy living involves financial incentivization of lifestyle modifications. Such proposals could resemble programs already in practice, such as safe driving rewards from car insurers. This idea is gaining traction in certain industries. John Hancock, one of the largest life insurers in the country, has already begun offering discounted Apple Watches to encourage healthy living. However, similar campaigns have hit a snag; critics argue that it may be discriminatory to reward consumers based on metrics like weight loss because such achievements have a genetic component.
Fortunately, the recent revolution in personal genetics has offered insights into the human body that were once thought impossible. The first sequencing of the human genome, in 2001, took decades in the making and cost billions of dollars. Today personal genetic testing is available from services like 23andMe for as low as $50, with results available within six weeks. Though limited, our present understanding of human genetics could be used to help resolve today’s health care challenges. Taking genetics into account when incentivizing lifestyle changes would allow people to compare progress to their own potential rather than that of others. With genetic differences under consideration, people with the same changes in weight could be appropriately awarded — or penalized — on an individual scale.
While most patients are already aware of the benefits of exercise and healthy eating habits, personal genetic profiles could also offer personalized preventive lifestyle recommendations. For instance, I learned that I have a MTHFR mutation that predisposes me to high homocysteine levels, which in turn greatly increases my risk of developing heart disease. Research shows that I can reduce that risk by supplementing my diet with folate or folate-rich foods. This gene does not doom me to developing heart disease, but it does indicate an area of greater risk against which I can take concrete actions. Despite the seemingly ubiquitous stories of fatal genes, research shows that a major determinant of our health is just not our genetics but also our behavior. Our genes do not define our fate — rather, they can offer us clues as to how we can most effectively be the masters of our own health.
Implementing genetic testing as a tool to improve public health does present its own challenges on both political and economic levels. Genetic testing does not have to take hold as a nation-wide reform — all citizens can seize this opportunity to improve their abilities to take care of themselves. Such tests are no longer cost-prohibitive, and, thanks to the Genetics Information Nondiscrimination Act, insurers and employers cannot hold the results against those undergoing testing. However, the genetic test is the easiest step. Making the lifestyle modifications indicated by test results requires resolve and sacrifice. We live in a world rife with temptation from fast food and sedentary entertainment. I am intimately aware of the challenges associated with making the changes that I preach. For me, remembering my grandparents carry on with their lives despite their painful treatments has helped me maintain my resolve.
Personal drive and a passion to live well are essential, but to love life is unfortunately not enough. My grandfather, the only religious member of our household, passed away weeks before my Bar Mitzvah. My grandmother, who valued my education above all else, died days before my high school graduation. Time is an undeniably valuable commodity — arguably, it is the most valuable. Fortunately, countless others are winning their battles against illness, cancer and death due to advances in genetic testing and preventive medicine. Such innovations allow us to peer into a better future, one in which people live healthier lives and countless families like mine stay together longer. It is a future in which we are empowered by information to surpass the limitations of our own makeup — a future in which we are more than our genes.