Monday, July 13, 2009

Breakthroughs in DNA medicine to revolutionise doctors’ training

Doctors are to be given more specialised training in genetics to prepare the NHS for a revolution in DNA-based medicine, The Times has learnt.
A review of medical education in genetics is to examine what doctors need to know about the influence of DNA on common diseases and patients’ response to drugs, so they can exploit science’s growing understanding of the human genome in clinical practice.
In an interview with The Times, Professor Peter Farndon, director of the National Genetics Education and Development Centre, said recent advances in genetic science made it essential for doctors to have more access to information.
Though the last genetics syllabus for medical students and junior doctors was introduced in 2006, so much has changed since then that the centre was already working to update it, he said. It was also developing guidelines for professional education in the field.
Over the past three years, costs of reading DNA have fallen so sharply that many scientists predict that it will be possible to sequence any individual’s entire genetic code for less than £1,000 within a year or two. Research has also revealed hundreds of genetic variations that affect an individual’s risk of disease or response to medicines.
Companies such as 23andMe and deCODEme have started to sell genome scans directly to consumers, assessing their genetic risks of developing a range of diseases for between £300 and £600.
Last week a report from the House of Lords Science and Technology Committee said that these developments required urgent reforms to medical training and NHS infrastructure so they could be translated into benefits for patients. The importance of genetic tests was “placing strain on the expertise of doctors, nurses and healthcare scientists, who at present are poorly equipped to use genomic tests effectively and to interpret them accurately, indicating the urgent need for much wider education of healthcare professionals and the public in genomic medicine”, the report said.
While doctors learn about genetics in undergraduate and postgraduate training, the focus is on rare disorders caused by mutations in single genes, such as Huntington’s disease and cystic fibrosis.
More recent genetic research has identified hundreds of DNA variants with more complex and subtle effects on a wide range of much more common conditions, such as heart disease, cancer and rheumatoid arthritis. Each raises or lowers a patient’s predisposition to disease only slightly, but can combine to create a significantly raised risk, and their influence can be difficult to interpret.
Family doctors, in particular, need an understanding of this area so that they can give appropriate advice to patients, Professor Farndon said.
Scientists have also started to discover genetic variants that affect whether drugs are likely to be effective, or the safe dose that a patient can take. This practice, known as pharmacogenomics, is forecast to become increasingly important to more personalised medicine, but currently it is not highlighted as an important teaching subject.
“It definitely needs to go into the main syllabus now, absolutely,” Professor Farndon said. “Suppose there’s a set of eight DNA variants that predispose a woman to a high risk of breast cancer. Even though she has no family history, you might target her for screening much sooner than the current recommended age.”

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