NOT THE USUAL GENE SUSPECTS: Substance Abuse and Personality Disorders

Dr. XX: “Okay, I am ready for the line-up. Make room and send in the genes at once!”
Lab assistant XY: “Genes, front and center! Take your places next to the glass. Dr. XX will be looking closely for suspects and we have reason to believe that many of you are highly influential delinquents.”

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Suspect genes beware! New evaluation methods may identify your defiant ways long before you have time to act, conspire with environmental cronies, be influenced, or influence other genes, and before you harm the body that shelters you. Akin to criminal profiling, suspect genes will be “tagged,” put up against the “glass,” and examined closely all with the hope that they do not further express themselves and contribute to negative behaviors including substance abuse and personality disorders.1

Gene-based profiling has been used to predict and diagnose certain diseases and to tailor treatment approaches. However, these tests may be taken to another level: to identify persons more likely to become dependent on nicotine or marijuana or more susceptible to personality disorders. In the future, expressed genes may take the rap way before a person physically and negatively expresses him/herself. As described in a recent online news article, recent reports indicate that genetic tests similar to those used to manage diseases may be employed to determine those who have a greater biologic basis for engaging in substance abuse or who are prone to personality disorders.1

Data from Robert Philibert, MD, PhD (University of Iowa Roy J and Lucille A Carver College of Medicine), and colleagues suggest that gene expression in blood may determine if a person is susceptible to behavioral disorders. Yet simply having a particular gene expression alone does not predict that an individual will act in a certain manner. According to Dr. Philibert, what is paramount here is not “gene possession” but rather if the target gene is expressed and the possible influential environmental factors at work. Using samples from 6 subjects from the Iowa Adoption Studies and 9 controls, a technique termed “transcriptional profiling” was performed to examine blood. This lab method evaluates all the genes in the blood (almost 30,000) at one time. All expressed genes are labeled with fluorescent tags and changes in intensity of fluorescence are used to identify differential gene expression. Patterns of genes for specific diseases are then mapped and defined over time. Data from 94 adoption study subjects were use to identify gene pattern matches.1

The bioethical sides of our brains have to be jumping at this point. For starters, scroll back up to the opening script and replace “Dr. XX” and “Lab Assistant XY” with “Detective RNA” and “Sargent DNA”, respectively, and replace “genes” with “detainees.” Will we eventually be judged by our genes? Will employers, insurance carriers, and healthcare workers discriminate against those who have greater risk for personality disorders or substance abuse? What type of investigations will unfold when certain parties have this type of information? Are there ways to optimize the positive advantages of these types of gene-based tests while negating the negative consequences? For the bearer of “bad genes,” who will soothe their restless minds, educate them about testing methods (and their limitations), and offer preventative strategies just in case they end up in a compromising scenario and give in to temptation?

One of the study coinvestigators added that, “Just because we can look at the deep biology of the individual doesn’t automatically mean negative outcomes will follow.”1

I am going to hope for the best: additional and more thorough investigation of gene-based tests, making testing optional, conducting/using tests in an appropriate fashion, and holding results in the strictest confidence.

Reference
1. Soglin B. University of Iowa Health Science Relations. Hope and concern expressed over potential genetic testing for substance abuse. Available at: http://www.medicalnewstoday.com/medicalnews.php?newsid=64710. Accessed March 2007.