E-mail updates
Follow on Twitter
Subscribe to RSSShould high school kids get a genetic test for the risk for Alzheimer’s disease before they’re allowed to play football? Two prominent scientists who study both Alzheimer’s and the traumatic brain injury suffered by some football players raise that ethically charged question in an editorial out Wednesday in the journal Science Translational Medicine.
We all carry a gene called APOE which comes in three forms. If we carry one copy of the form called E4, it triples our lifetime risk for Alzheimer’s. About 10 percent of the U.S. population falls in that category. If we have two copies of E4, the lifetime Alzheimer’s risk is 15 times greater. About 2 percent of us have that genetic makeup.
Although the connection between APOE E4 and Alzheimer’s risk has been known for years, few have suggested it as a screening tool because there’s no known way to prevent the mind-robbing disease. But, now as scientists want to test drugs as early as possible as potential methods of preventing Alzheimer’s, APOE is getting more attention, as are brain scans and other techniques that might determine who is at risk.
At the same time, scientists have been finding that football players, boxers and soldiers suffering blast injuries are more likely to develop chronic traumatic encephalopathy (CTE), the form of dementia that can follow a brain injury -- if they have one or two copies of the E4 version of APOE.
The U.S. government has launched a new website and is pouring millions of dollars into two large studies examining whether or not a drug can slow the progression of Alzheimer's among patients who are predisposed to the devastating disease. NBC's Robert Bazell reports.
Neurologist Dr. Sam Gandy of Mt. Sinai Medical Center in New York and Alzheimer’s researcher Dr. Steven DeKosky of the University of Virginia School of Medicine, Charlottesville, conducted a poll of 49 colleagues. By a 2 to 1 decision their fellow scientists said it is not yet appropriate to test high school students, and by a 3 to 1 ratio they opposed testing military recruits. But few of the scientists dismissed the ideas out of hand.
As the evidence of a connection mounts, testing may become more of an imperative.
There are obvious, enormous ethical difficulties. Telling a 14-year-old that he or she faces an increased lifetime risk of Alzheimer’s could lead to unknowable future strains on individuals and families, as well as a lifetime of difficulty in getting health and life insurance. But if scientists learn how to intervene to prevent the Alzheimer’s, or if the evidence of increased risk from sports or on the battlefield becomes overwhelming, the question may be asked more often.
Robert Bazell is NBC's chief science and medical correspondent. Follow him on Facebook and on Twitter: @RobertBazellNBC.
More from Robert Bazell:
- US assurances on mad cow case may be 'gross oversimplification'
- Out-of-whack sleep habits can cause diabetes
- Dental X-rays linked to brain tumor risk
Related:
Leave a Comment:
As if getting concussions playing football would turn the gene on? If the gene is present then your probably going to get Alzheimer's and concussions. Studies have shown effects of severe concussions to be about as bad as Alzheimer's so Im not real sure what the entire point of this is unless you are trying to say concussions are not causing Alzheimer's like effects later on in life like ex pro players exhibit.
It would be stupid and needlessly harmful to a person to try and prevent them from taking part in sports just because of a gene they may carry anyways.
"As if getting concussions playing football would turn the gene on?"
yeah, as if smoking cigarettes is going to turn on the lung cancer gene. yeah right.
I got smacked in the head with a baseball bat in the 3rd grade, pretty badly...that resulted in life long migraines. Im only 33 and every now and then walk into a room and wonder what the heck I was going there for...or turn onto auto pilot and go right past my intended destination.
it scares the crap out of me that I might have the genetics for alzheimers, and that swing of one bat and one crack of my head, was all it needed to activate.
but whatever will be will be...and I cant worry about it, because it wont help.
I can only hope I dont burden too many people should I end up with dimentia.
and I would never go in for testing, not because the knowledge would be too much.
but rather, I know insurance would kick me to the curb. no thanks, i'll just drain the system of every penny I can in hopes that some CEO has to forgo an extra yacht or vacation home that year.
Don't panic, that is not what they are saying. Evidence suggests that the E4 mutation in the APOE gene cause some change in the brain that makes it more susectable to Alzheimer's and concusions. So, having the will increase the risk of concusions and Alzheimer's, but getting a concusion will not alter the gene, nor will it change the likelyhood of getting Alzheimer's (well, it might, but not via genetics).
Our healthcare system doesn't know ANYTHING about preventive medicine. Drugs are not 'preventive' in any sense of the word. Of course, they're much more profitable than the steps it would take to improve our nutrition and remove the toxins in our food and environment that cause alzheimers in the first place.
Amen! I wholeheartedly agree!
And how do your propose we prevent something caused by genetics? Alzheimer's is not caused by environmental toxins, at leas not in the majority of cases. It has a VERY strong genetic component. As for drugs not having preventive properties, how about aspirin (heart attack)? Antibiotics (infection)? Potassium iodide (radiation poisoning)?
Why not ban football? They want to ban everything else, just ban it, or make them play touch.
What's next?
This article, and the scientific debate it is about, has nothing to do with banning anything. Nobody is even considering that (well, somebody probably is, but nobody anyone is going to take seriously). The point of this is to see if we can reduce the risk of Alzheimer's by removing the effects of one of the risk factors. Football comes into it because that risk factor (the E4m version of the APOE gene) also increases the risk of concussions. If the drug eliminates the effects of E4, it will reduce the risk of concussions. To test this, they need a group that has a high risk of concussion (football players), and they need to know which individuals have the E4 gene (hence the testing). That football leads to concussions is actually beneficial in this case.
Add a little curcummin to your diet.
Well here is the thing if they are tested for it then before they are requiring treatment we can almost guarantee an insurance change and guess what then it is a preexisting condition and will not be covered. They will be screwed.
Sorry to break it to all of you but medicine works in the manner whereby if a disease (single gene defects) can be slowed or prevented then genetic testing is recommended. This can be seen with BRCA1/2 testing for breast cancer and if testing is positive then the woman can have prophylactic surgery to remove all of her breast tissue. There is nothing crazy about offering a genetic test if something can be done about it. No one is saying that you cannot do something, the ultimate choice is up to the individual. However, knowing the risks can help a person make informed choices about the course of their lives.
As another example, individuals being treated with 6-mercaptopurine (anti-cancer drug) should be tested for a genetic variation in the metabolism of this drug. If they are not tested and they have a variation then they can have serious bone marrow suppression. All of these examples are trying to point out that medicine is moving towards individualized care. Health insurance companies would appreciate this fact because it limits adverse side effects (and thus the cost of treating complications) and limits the use of ineffective treatment options.
It should also be stated that what scientists and doctors try to accomplish when tackling a disease does not necessarily tackle the bureaucratic/social issues surrounding it. Issues of privacy and policy are up to society to decide as a whole.
I would like such a test. I would like to know. As for my insurance, I assume that if I pay for the test myself they don't need to know. Of course, the cost might be prohibitive. Anyone know?
23andme does it over mail for $250.00
Even a high end, reliable genetic test (no offense, 23andme) should be pretty cheap (well, relativly cheap) once it becomes common. It isn't all that difficult of a process from a technical point of view.
Why in the Hell is school all about training junior gladiators for a black mafia numbers game???? So much THE REST OF THEIR LIVES, THEIR BODIES WILL NEVER BE THE SAME???? WHEN is authority going to ALLOW or legalize Fighting to the Death, for entertainment, for money???