Wednesday, March 24, 2010

Democratizing Scientific Research

Today, I came across a very interesting blog post by Christina Agapakis (via a GenomeWeb article). This post focuses on efforts to "democratize scientific research.” For the most part, the article discusses a post on another blog and the efforts by a group called DIYbio, which stands for “do-it-yourself biology.” She also emphasizes the need to make formal changes in the way institutions conduct scientific research, and I particularly liked some of her suggestions for improvement:

"What if there were more opportunities for high-paying technical jobs in science for people without advanced degrees? What if there were more biotech vocational programs to learn the skills you would need to work in these jobs? What if it were easier and cheaper for groups of scientists and engineers everywhere to turn ideas and hypotheses into technology and knowledge? What if there were real ways for knowledge to become power for that kid living in South Central LA?"

In regard to the issues brought up directly in her post, I think Christina is a little too harsh on DIYbio. I do agree that the organization's efforts are probably not sufficient to help intelligent individuals “[living] in a community plagued by violence and poverty” reach their full potential, and it is probably reasonable to assume that most of the participants are “white, middle class, and primarily male.” However, I think DIYbio positively contributes to the production of new ideas and products that would not otherwise be feasible. To be fair, Christina does say that DIYbio has helped promote “scientific participation and enthusiasm” and could be a useful model for developing programs for underprivileged individuals, but her opinions about DIYbio are mostly negative. She also claims that DIYbio perpetuates “the myth of the Victorian Gentleman Scientist,” who “[pursues] a 'pure' science not because of an interest in money and free of any state control but because of a deep curiosity with the power of the natural world.” I certainly agree that the Gentleman Scientist is an undesirable model for scientists that is unlikely to produce practical research and does not provide a reasonable venue for research for anyone without prior financial security. However, I honestly didn’t get that vibe from reading over the DIYbio website, although I should admit that my knowledge is limited because I hadn't heard of DIYbio before today.

In general, I am a big supporter of anything that removes politics from scientific research because I think personal and professional bias compromises the objective judgment that is so critical to good science. I think this requires fair assessment of scientific progress that emphasizes the impact of a specific result (and the effectiveness of the methods to achieve that result) and limits the role of authority as much as possible. For example, I think it would help if the peer-review process for scientific journals was a double blind process. Currently, the reviewers know the author names and institutional affiliations, but the authors do not usually know the identity of their reviewers. I know some exceptions to the latter case but not the former case (please correct my ignorance if you know of some examples). Of course, this would not be a perfect solution. Some reviewers may be able to recognize the work done by established scientists due to biological systems and methods employed in previous publications, and well-connected scientists will probably be friends with some reviewers and can give them a heads up that they have submitted an article for peer review. This is slightly tangential to the topic of DIYbio, but my ideas are relevant to the broad concept of "democratizing” scientific research by formal changes in institutional policies.

There is also a very interesting (and long) response to Christina’s post that does a good job discussing how “[it] is entirely possible to develop high level expertise outside of the formal system” and also noting that certain avenues of research (like “programming and electronics’) are much more feasible for the everyday scientist than research in biology or chemistry. Materials for biological research can be harder to acquire and more prone to regulation. For certain types of biological research, such as biomedical research, it is also relatively difficult to bring therapeutics to the market without a formal research position, in part due to the need to run clinical trails and gain FDA approval. The author of the comment specifically mentions over-regulation. I agree that some regulation is definitely unnecessary and hinders scientific progress (for example, I personally think the FDA should only limit the use of drugs due to toxicity without also considering effectiveness, and instead allow physicians to decide on the own if the treatment is effective and superior to alternative methods), but I do think that there is some rationale for not allowing everyone access to stuff like anthrax.

In short, I think informal biology research is a good thing that can benefit society (as acknowledged in Christina’s concluding paragraph), and I also think it would also benefit society to employ formal institutional changes to encourage individuals from varied backgrounds to conduct scientific research.

Wednesday, March 3, 2010

Who should be responsible for genetic counseling?

Today, I read a GenomeWeb article regarding a debate on whether Myriad Genetics’ BRCA test (BRACAnalysis) should be interpreted by primary care physicians or genetic counselors. Myriad claims that primary care physicians can and should interpret the test results, but critics claim this can result in inaccurate interpretation of test results.

Certain mutations in BRCA1 or BRCA2 genes can lead to a high risk of developing breast and/or ovarian cancer. Harmful mutations in BRCA1/2 can cause a 5-fold increase risk of developing breast cancer and greater than 10-fold increase in risk of developing ovarian cancer. Harmful mutations in BRCA1/2 “account for 5 to 10 percent of breast cancers and 10 to 15 percent of ovarian cancers among white women in the United States,” and 1% of the population is a carrier for a harmful BRCA1/2 mutation.

At least one survey from Medco indicates “most [doctors] believe that personal genomic information can be useful in their care for patients and help them make treatment decisions [but] the majority said they do not know enough about such tests.” In contrast, a different survey reports that “community-based physicians appeared to be successful incorporating BRCA1/2 testing into their practices.” However, a majority of these doctors utilized the assistance of some sort of genetics expert when making decisions about patient care. Myriad also emphasizes the paucity of genetic counselors, but critics have pointed out that Myriad fails to inform doctors that telephone-based genetic counseling is available and, in fact, required by certain insurance companies such as United Healthcare and Aetna.

I do think patients should be given the option of talking to a genetic counselor, and I think most physicians would benefit from at least informally discussing the details of a specific genetic test with a genetics expert. In general, patients should always seek out second opinions if they do not feel comfortable with their physician’s advice, and I would also advocate that patients conduct some independent research. For example, the National Cancer Institute provides a lot of useful information on BRCA1/2.

However, I do not necessarily agree with critics that recommend government oversight of these genetic tests. Although there may be a significant number of physicians who are currently misinterpreting genetic test results (it is difficult for me to assess this problem because I am neither a physician nor a genetic counselor), I think this can be improved over time with changes in medical training and public education about the role that genetic counselors can play in making medical decisions. In other words, I think legal intervention may not be necessary to improve the interpretation of medical diagnostics.
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