Surgeons gain a huge advantage by using genetic sequencing, which allows them to learn more about a patient than ever before. (Courtesy photo)

Genes and joints: Learning more about your patients

Our world has changed. The recent TED talk by physicist Riccardo Sabatini dramatically demonstrates our growing ability to decipher the Human Genetic Code. The high likelihood that this information will be successfully used to modify this code to prevent and cure disease changes the way we look at life. But let’s just take a peek at how it affects the world of orthopedic injuries and arthritis.

When patients come into my clinic with an injury, I don’t know if their genetic makeup makes them more or less likely to develop arthritis as a result of their injury. I don’t know if they are sensitive to preventive supplements such as glucosamine or to injections of hyaluronate to lubricate their joints. If they are hypersensitive to donor ligament or meniscus tissues, I may need to transplant to rebuild their knee. I give my patients statistics based on “the best available evidence” and on my own patient data. Soon, however, this method will look like something out of the Dark Ages.

It used to cost tens of thousands of dollars to interpret one’s genetic code. But when the cost drops to $100 and is available at most diagnostic laboratories, everyone will have to have it done — like it or not.

Why? Because a requirement to have your code read is already percolating amongst insurance companies. Though you can still buy health insurance without it, you can no longer buy life or disability insurance from many of the major insurance providers. They realize that the actuarial tables of the past — those mathematical predictions that guessed how long you would live — are old-school compared to the predictions made by your genetic code.

While this might be viewed as yet another step in the loss of privacy, for a surgeon, it is a huge advantage.

When we work together in the near future, I will have more than a history, physical exam, X-ray and MRI of your injured knee; I will also have an in-depth insight to your genome. I’ll be able to choose therapies that are likely to work specifically for you. The coming age of personalized medicine will mean that your entire care will be customized — from the drugs I prescribe to the surgical tissues I use. Even the rehabilitation exercises I assign will be tailored to the testosterone receptors in your muscle groups.

As long as the genetic code is available, the letters of code are properly translated and the therapies accurately targeted, the likelihood of you having a successful treatment in your surgeon’s hands increases dramatically. Hopefully government, politics and fear of this new world will not get in the way.

So in this spirit, let’s celebrate the efforts of HumanCode.org and others like them. Let’s guide the conversation and action around the growing wealth of genomic information toward positive outcomes. If we can avoid the misuse, misunderstanding and abuse that this deep predictive knowledge can bring, it can serve us well. With the right attitude, we can all look forward to a future in which our genetic code is a roadmap, not a verdict.

Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco.

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