Genes, drugs and food doc

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Genes, drugs and food doc

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A Lancaster – Cardiff collaboration Genes, drugs and food Ruth Chadwick Director, CESAGen Lancaster University Outline • New technologies have led to revisiting of the individual-collective relation in public health • …and to questions of their impact on health inequalities Issues • Opportunity costs • Access and benefit-sharing Choice? • The upholding of ‘choice’ coincides with new forms of stratification • No consistency in argument • Examples: nutrigenetics, obesity and functional foods Two White Papers (UK): two strategies • …we will learn more about the genetic features of common diseases such as heart disease and diabetes and the way external factors such as diet and smoking interact with our genes to increase the likelihood of developing a given disease DH continued There will then be the option to test people for a predisposition to disease, or a higher than normal risk. Treatment, lifestyle advice and monitoring aimed at disease prevention could then be tailored appropriately to suit each individual Our Inheritance, Our Future Choosing Health (2004) • The White Paper sets out a strategy for action based on the principles of informed choice, personalised services and collaboration between Government, the NHS, industry and wider society. Choosing Health identifies how people can be empowered to make healthy choices. It sets out how health can be supported and improved in key environments such as retail outlets, local communities and the workplace. Public engagement • 2003 – traces of deficit model • 2004 – shaped by public consultation Key questions • How do these strategies relate, if at all? • Impact on health inequalities? • What notions of ‘personalised’ health care and ‘choice’ are at stake? • 2004 White Paper talks about false dichotomy ‘nanny state’ – ‘freedom’ can imply neglect [...]... • Increase in burden of responsibility for health? • Whose choice and for what? Autonomy and choice Utility Identity Identity INDIVIDUAL AUTONOMY Responsibility Implications of information • Food, the body and the self • What sort of person do I want to be? Functional foods • Functional foods – specific healthpromoting or enhancing foods • Regulatory approach – highlights importance of freedom to market,... metabolic pathways • Understanding of how this goes awry in diet-related diseases • Understanding of how individual genotypes are influencing factors The context • Public perceptions of genetics • Novel foods, e.g gm • Prevailing ethical paradigms: – individualism and choice Public health • Will nutrigenomics have significant public health benefits? • Differences between nutrigenomics and pharmacogenomics...Key example • • • • Food and diet Nutrigenetics Food labelling Obesity; diabetes Nutrigenetics • The study of individual differences at the genetic level (SNPs) influencing response to diet Nutrigenomics The application of genomics in nutrition research, enabling associations to be made between specific nutrients and genetic factors Information leading to applications • Understanding of how nutrition... screening • Criteria for introduction of screening – Important condition – Acceptable and reliable test – Scope for action Conditions • PKU • Diabetes Obesity • Genetic factor A – predisposition to obesity wi food x • A case for screening? • Importance/Scope for action? Individualism and public health Personal pills and personalised diets? The more individualised the promises, the more collective action... • Potential problem identified with functional foods – target groups and overdosing Functional foods • Cannot be solved by labelling alone • Plus or minus nutrigenetics? Benefit-sharing • Turn towards sharing benefits of genomics (e.g HUGO, 2000, 2002) • What counts as a benefit? • Added value? • Sharing of burdens? • Return to issues of class Rights and class • Ultimately, the worldwide regulatory... likely to be grounded in communal value, and less on individual gain……it leads to the question whether the individual can remain of paramount importance in this context WHO • …the achievement of optimal advances in the name of the collective good may require a reconsideration of the respective claims so as to achieve an appropriate balance between individual and collective interests, including those... the worldwide regulatory push against smoking is being driven by a revolution not just in rights but in class….a class system is slowly being re-erected on new bases, bringing with it a new [and narrower] understanding of rights (Financial Times 20-11-04) Conclusion • Is nutrigenomics the future of public health? • Bridging the genomics divide? • The need for joined up thinking ... have significant public health benefits? • Differences between nutrigenomics and pharmacogenomics Pharmacogenomics • • • • Avoidance of adverse reactions Genetically informed prescribing Greater safety and efficacy Patient stratification? Testing – empowerment? • Single gene disorders – Huntington’s disease • Susceptibility testing – Identifying recessive genes – Identifying genetic makeup which may . collaboration Genes, drugs and food Ruth Chadwick Director, CESAGen Lancaster University Outline • New technologies have led to revisiting of the individual-collective relation in public health • and. health care and ‘choice’ are at stake? • 2004 White Paper talks about false dichotomy ‘nanny state’ – ‘freedom’ can imply neglect Key example • Food and diet • Nutrigenetics • Food labelling • Obesity;. about the genetic features of common diseases such as heart disease and diabetes and the way external factors such as diet and smoking interact with our genes to increase the likelihood of

Ngày đăng: 27/06/2014, 03:20

Mục lục

  • Slide 1

  • Genes, drugs and food

  • Outline

  • Issues

  • Choice?

  • Two White Papers (UK): two strategies

  • DH continued

  • Choosing Health (2004)

  • Public engagement

  • Key questions

  • Key example

  • Nutrigenetics

  • Nutrigenomics

  • Information leading to applications

  • The context

  • Public health

  • Pharmacogenomics

  • Testing – empowerment?

  • Screening

  • Conditions

  • Obesity

  • Individualism and public health

  • Acquisition of information

  • WHO

  • Slide 25

  • Alternative

  • Underlying principles

  • Inequalities?

  • Autonomy and choice

  • Implications of information

  • Functional foods

  • Slide 32

  • Benefit-sharing

  • Rights and class

  • Conclusion

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