I recently wrote a piece about science and quacks, in which I made (or tried to make) the following point:

…there’s nothing New Age-y about the idea that our emotions produce physical consequences. We need look no further than adrenaline to prove a scientifically accepted and tangible mind-body connection.

Now a company called Emotiv is commercializing a product based on our ability to influence the physical world with our thoughts and emotions—and there’s no hint of quackery about it, according to the BBC News.

Gamers will soon be able to interact with the virtual world using their thoughts and emotions alone.

A neuro-headset which interprets the interaction of neurons in the brain will go on sale later this year.

“It picks up electrical activity from the brain and sends wireless signals to a computer,” said Tan Le, president of US/Australian firm Emotiv.

“It allows the user to manipulate a game or virtual environment naturally and intuitively,” she added.

The brain is made up of about 100 billion nerve cells, or neurons, which emit an electrical impulse when interacting. The headset implements a technology known as non-invasive electroencephalography (EEG) to read the neural activity.

Ms Le said: “Emotiv is a neuro-engineering company and we’ve created a brain computer interface that reads electrical impulses in the brain and translates them into commands that a video game can accept and control the game dynamically.”

Okay, so let me get this straight. We accept that emotions produce physiological responses: fear/adrenaline, stress/cortisol, etc. We accept that our thoughts can manipulate an avatar in a video game. But it’s still considered quackery to posit that our beliefs impact our DNA.

I’m sorry; I just don’t get it. Do you?

The [UK] Sunday Times ran this article today: Face it, fatty, your genes are innocent. It’s a pretty harsh piece; for example:

The fat kids you see waddling around aren’t fat because their genes just made them that way—they’re fat because they take very little exercise and are fed a great deal of fattening food which, to add insult to injury, contains very little that’s of any nutritional value. It’s not rocket science. Give your child sugar-laden “juice” and batter-covered chicken, chuck in industrial quantities of “food-product” stodge, dole out sweets as “treats” and raise them to be suspicious of vegetables, and voilà: you can start your own obesity epidemic. Especially if you blame their chafing thighs on their genes.

Here is the argument being made by author India Knight:

1. People are inclined to ignore the implications of their own actions when it comes to their weight.
2. Scientific findings indicating that genes cause obesity tend to encourage an attitude of ‘It’s not my fault.’
3. Caveats that the gene only indicates a greater likelihood of obesity—as opposed to being the cause of it—and therefore calls for greater vigilance are generally in small print and ignored by the general public.

I fully recognize the potential power offered through genetics, but it seems to me that Knight has identified a truly important problem: how do we ensure that the empowering benefit of additional information isn’t outweighed by a dismaying sense of inevitability?

This problem isn’t just related to an obesity gene—it’s related to all predictive diagnoses. You’ve got the lung cancer gene anyway, so you might as well enjoy smoking. Heart attacks are in your DNA so you probably shouldn’t do anything strenuous. You’ve got a 10% greater likelihood of getting diabetes than the general population; better take this preventative medicine with 100% chance of side effects.

The problem is also magnified through cognitive dissonance. When your behavior doesn’t square with your beliefs about yourself, one of two things happens: either you change your behavior (eat less) or you change your beliefs (it’s not the eating that makes me fat). The idea of genetic causation is a handy tool for people looking to change their beliefs.

India’s article is a slap in the face for anyone approaching a weight problem fatalistically. But is an extreme approach the only way to get people’s attention?

At any given moment, there exists a set of variables that we can control: what we choose to say, what we choose to think, what we choose to believe. People with a genetic predisposition to obesity can control what they eat and whether they exercise. We can focus on the things we can’t change and do nothing, or we can focus on the things we can change and do anything.

Do you think that genetic information is empowering? Or do you think it drives people to throw up their hands in despair? How would you react if you’d been struggling with your weight for years and suddenly were told that it was in your genes?

Summary: This is the second of a 2-part series discussing the Genetic Information Nondiscrimination Act; in it, I discuss my perspective on the U.S. health care system.

Yesterday, I wrote about the Genetic Information Nondiscrimination Act, which aims to protect people from being discriminated against because of their DNA. I suggested that, the health care system being what it is, it makes perfect sense to me for genetic information to be factored into premiums. The problem is that the health care system is what it is.

Let’s talk about insurance for a minute. The concept of insurance is simple: a group of people have some statistical likelihood of experiencing a negative event. The negative event has a financial cost associated with it. Because we don’t know who will be affected by the event, we all agree to chip in a little so that none of us will have to bear the complete cost alone.

Profit motive
The U.S. health care system takes that concept and puts a profit spin on it: they’re the house and we’re the gamblers. It is in their best interest to encourage gamblers who are likely to lose a lot of money (healthy people) and discourage gamblers who are likely to win a lot of money (unhealthy people).

Because it’s a free market system, they can adjust the rules to maximize their returns. They can actually kick the people they don’t want out of the casino altogether.

Care motive
The problem, of course, is that the purpose of health care is not money. It’s an integral part of our human existence. We may choose to fight other tribes or factions or countries, but within our community we take care of each other.

Why do we take care of each other? Partly because it’s just the way we are. Perhaps it’s an ‘evolutionary insurance’ imperative: the more we take care of each other, the more likely we are to survive as a species. Mostly, though, I think it’s because none of us knows when it’s going to be our turn.

Obviously, these two motives are in direct conflict: to be more profitable, you need to remove people who are likely to be unhealthy; to effectively care for the community, you need to take care of those same people.

Some may argue that the profit system would be set up to reward those people who take preventative measures. But I am confident that the risk of being denied insurance altogether would far outweigh the potential premium reductions available for most people.

Under the current system, people benefit more by ignoring their health than by taking care of it.

Under the current system, suppliers benefit more by not taking care of people than by taking care of them.

The issue is not whether insurance providers should be allowed to discriminate on the basis of genetic information. The issue is that insurance providers should not be allowed to discriminate at all. That’s the whole point of health care: to improve the health of our society. How can we do that by ignoring the people who need care?

Summary: The Genetic Information Nondiscrimination Act is stagnating in the Senate. But should it pass? Or should insurance companies be able to use your genetic info to calculate premiums? Today’s post is part one of a two-part series that explores the issue.

Last November, Bernadine Healy, M.D. of the US News and World Report commented on the impeded progress of the Genetic Information Nondiscrimination Act (which, as of today, is still being held up in the Senate). She describes specific benefits of genetic testing—specifically, the ability to act preventatively in risk areas:

Genes are not crystal balls. But they can be red flags signaling susceptibility to disease—and early preventive steps can be lifesaving. An example: Patients found to have genes predictive of colon cancer can cut the chances of getting the malignancy by undergoing a yearly colonoscopy that also removes any developing cancer-prone polyps.

Dr. Healy goes on to look at the real concerns about discrimination based on genetic information:

Francis Collins, director of the National Human Genome Research Institute, will tell you the worry out there is real. To protect their privacy, some patients use assumed names when tested for breast cancer genes or ask their doctors to lie for them about positive disease-related gene results so insurance companies won’t know. Lots of others don’t even seek their genetic info for this reason. NIH has shown that nearly half of family members at high risk for inheriting a cancer-producing mutation were unwilling to participate in any part of a clinical study because of a fear of genetic discrimination…

Getting a handle on such imperfection is an insurance actuary’s dream, and gene information is already being used in deciding whether to sell someone life insurance, particularly when the benefits are large. Some argue that even for health insurance, those with better genes should not be forced to pay the same high premium as those who appear to be more susceptible to disease.

There are two major issues with this situation: the health care system and the working definition of discrimination. I’ll look at discrimination today and health care tomorrow.

Discriminate: 1 recognize a distinction. 2 make an unjust distinction in the treatment of different categories of people, especially on the grounds of race, sex, or age. (Oxford English Dictionary)

Historically, legal protection against discrimination, like the Civil Rights Act, has had an overriding characteristic: membership in the group was irrelevant to the activity in question (e.g., the mental and physical ability to vote has nothing to do with the state of being black).

I’m about to propose a scenario that may surprise those of you who are familiar with my way-liberal tendencies—prepare yourselves.

Scenario A:

IF
Your genes provide specific information about your health, and
The U.S. health care system is what it is (profit-based and free market)

THEN
Of course premiums should be influenced by your genes.

Why wouldn’t they? The job of the insurance companies is to weigh probabilities. Your age, your medical history, your gender, whether you smoke… these are all legitimate criteria in determining the size of your premium. Why wouldn’t valid, predictive information about your genes qualify?

Likewise, it would make sense for insurance companies to offer premium incentives to engage in appropriate preventative activity.

Remember the requirement for legal protection: irrelevant to the activity in question. Surely your genetic information is relevant to the future state of your health.

Is it possible that our sense of ‘unjustness’ might be misguided?

What if we called it ‘reward’ instead of ‘discrimination’? People with superb genes get their premiums lowered; all others stay the same. Would that make it more palatable?

No way.

If it were, people would soon forget their baselines—all the no-good-gene people would know is that they pay more than their good-gene neighbors, and the resulting sentiment would be the same as if they had been penalized.

No, I’m afraid that, under the current health care system, it makes perfect sense to incorporate genetic information when determining premiums. But this, of course, brings me to the current health care system, which I’ll address tomorrow.

In the meantime, I’ll leave the question with you: do you think insurance companies should be able to adjust your premiums based on your genes?

I had a bit of a play on toonlet today—a fantastic toy for people like me who are missing the drawing gene

Here’s my effort:

The always intriguing Dr. Hsien-Hsien Lei wrote a piece today titled 10 Reasons NOT to Take a DNA Test. At the end, she asks, “What other reasons can you think of to convince someone NOT to take a DNA test?”

I have a couple, but first let’s approach the wording of the question. Are we trying to convince people that DNA testing is bad (i.e., it would be a lousy idea to take the test) or that they don’t need it (i.e., there’s no compelling argument for the affirmative)?

In addition, in order to truly answer the question, we need to go into some greater depth about the possible benefits of the test: why would you want to take it in the first place?

The reason to map your DNA is that information is power. Yet nobody claims that our genomes are exclusively definitive of who we are as people.

To dramatically oversimplify a complex concept, let’s say there are two factors that dictate who you are: nature and nurture. Nature is your physical DNA: what you were born with, what you inherited, the stuff you can’t control.

The historical version of nurture is how you are raised, but obviously there’s a lot more to it than that. Your diet, your environment, pollution in the air, whether you exercise: these are all the ‘nurture’ bits of the equation. They’re subject to choice, and therefore the product of human intention—my intention dictates whether I exercise, whether I drink heavily, whether I watch TV or live in a clean countryside or polluted Beijing.

The question at hand is whether to gain more information about the ‘nature’ side of the equation. What are the cards that we’ve been dealt? It’s natural to want to know more about the underlying physical drivers behind who we are.

On the other hand, even if you do the test, what are you going to do about it? One of the reasons Hsien suggests for avoiding the test is that you’re fatalistic and will let genetic information control your life. But if genetic information doesn’t control our life, why should we want to know about it? Why not just behave the way you want?

If your parents learned that genetically you’re not likely to be tall, they’re unlikely to train you in basketball. But where would that leave Muggsy Bogues?

If you knew you had the genes for testicular cancer, you might not engage in a sport that cramped your testes for hours every day. But where would that leave Lance Armstrong?

At the same time, you might think that if you knew you were at risk for certain diseases, you might choose more healthy options—but why not just choose the healthy options anyway? Why not eat healthy, whether or not your DNA indicates a propensity for heart disease? Why not quit smoking even if you’re not predisposed to lung cancer?

You can’t control the results of the test, but you can control your behavior. You can control your attitude. You can control your choices.

So what do you need the DNA for?