Q: Before we discuss predictive genetic testing, can you explain what is meant by personalized medicine?
PVH: Personalized medicine takes a person’s unique genome or DNA into consideration when making health care decisions. The genome includes our entire genetic material, which is stored in 20,000 encoding genes. Most of these genes are inherited, but some are genetic mutations caused by environmental toxins or lifestyle factors — smoking, alcohol use, or obesity, for example.
Swami Kriyananda explained that our genes reflect the karma of our current lifetime, including the karma of illness. In other words, neither our genetic makeup nor our illnesses happen by chance. They are the product of our karma.
Genetic testing for medications
Q: How is genetic information being used in the field of medicine?
PVH: Genetic testing is now being used to determine how well a person will respond to certain medications. For behavioral health issues, for example, we send the laboratory a list of possible medications together with a swab of cells from inside the patient’s cheek. There is a copy of our genome in the nucleus of all our cells, and mouth cells are easy to sample.
When the testing relates to a behavioral health issue, the laboratory only needs to look at ten genes. We can also now test for how specific cholesterol and blood pressure lowering medications will work for a specific individual.
Q: How long have you been doing genetic testing for medications?
PVH: This kind of testing has been commercially available for about five years, but low-cost tests and easy sampling techniques have only just become available. This kind of simple genetic testing now costs only about $200.00.
Genetic testing and cancer treatment
Q: Has genetic information proved useful in other areas of medicine?
PVH: Yes, it has. The other major area involves cancer treatment. Some cancers are inherited through specific genes, for example the BRCA gene which influences the development of breast cancer. However, many cancers are caused by genetic mutations.
For cancers caused by common genetic abnormalities some treatments already exist. With other cancers, researchers are developing treatments which target specific genes in an individual. However, because we need to examine a person’s entire genome to develop these individualized treatments, this kind of testing is much more expensive for the patient. Creating a specific medication for the patient would be an additional expense.
Q: How effective are these new cancer treatments?
PVH: Very effective, especially for cancers that normally would be difficult to treat with traditional radiation and chemotherapy. For example, melanoma is a very serious skin cancer with poor survival rates in advanced cases. Physicians have had very good success recently in treating this disease with a new drug developed through genetic testing.
Q: Are there any other cancer treatments that target genes?
PVH: Yes. For some cancers we’ve been able to identify the specific genetic dysfunction that causes the cell overgrowth that creates cancer. For these cancers, we’ve developed treatments known as “nano-particle technology” — treatments that target the cell’s cancer-producing genes and eliminate the genetic abnormality directly. In some instances, doses of these incredibly minute particles can be administered as an oral medication with no side-effects.
Q: “Nano-particle technology” sounds like a very hopeful development for cancer treatment?
PVH: Yes, it is, and I think we’re going to see many more ground-breaking treatments for cancer. The ultimate goal is to be able to genetically sequence any kind of cancer that’s not easily removed by surgery, and then make a unique medication for that specific cancer. Once created, the medication would ideally cure the cancer within months with no side-effects.
Future genetic-based treatments
Q: What genetic-based approaches to cancer treatment are we are likely to see in the future?
PVH: In the near future, the main approaches will involve 1) targeting the genetic material as we’ve discussed or 2) stimulating the patient’s immune system to create antibodies to fight off the cancer.
Q: How would you stimulate a person’s immune system in this way?
PVH: By careful genetic manipulation. We would create an “immune scavenger” to go after the cancer cells and destroy them. This would involve growing a cell in a dish that could make the particular antibodies the patient needs. Already science is synthetically creating many different kinds of antibodies to fight various diseases or toxins.
Q: I read that approximately 40,000 articles are published on cancer each year, and that most of these articles discuss personalized medicine which, as we’ve discussed, is focused on genetics. This suggests that personalized medicine is an especially fast-growing area of medicine? Is that correct?
PVH: Yes, that’s exactly what it means. What will dramatically change the field of cancer treatment is the focus on the genetics of the cancer.
Q: Wouldn’t a focus on genetics positively affect all medical treatments?
PVH: Absolutely. I think it would revolutionize medicine. Medical diagnosis and treatment are often a trial-and-error process, and that’s particularly true with behavioral health medications. With predictive genetic testing, we can make much better medication choices for each individual patient.
More informed health care decisions
Q: As we move more in the direction of personalized genomic medicine, wouldn’t health education become more important?
PVH: Yes. The good news is that a person’s genome tells us whether he or she has a high risk for certain illnesses, information which is very important for making health care decisions. And even though many common illnesses are not controlled by a single gene, by looking at the genome, we can determine whether a disease is likely or unlikely.
Even knowing the likelihood of some diseases can help us make more focused lifestyle recommendations for our patients. Previously, for people with a family history of diabetes or heart disease, our advice was essentially the same for all our patients: keep your weight at a good level, exercise regularly, and eat a healthy diet. Now, based on an analysis of the genome, we might tell a patient, “For you, the specific key to not developing diabetes or heart disease is keeping your weight down.”
A database of pooled information
Q: As genetic research increases medical science’s predictive ability, what other benefits do you see?
PVH: There are a number of illnesses known as “orphan diseases,” characterized by unusual symptoms that don’t fit any known type of disease. In the past, I would have contacted colleagues or people famous in the field, to get their opinions. Now it’s possible to send that person’s genome and a description of their symptoms to a much larger network of physicians to ask for help.
Q: To be able to practice genetically-based medicine in the best possible way, having a database of pooled information from the widest possible group of physicians would be necessary, would it not?
PVH: That’s correct, and we are very close to having such a database. The Personal Genome Project, which began in 2005, is a long-term study to 1) sequence and analyze the genomes of over 100,000 people throughout the world and to 2) make that pool of information available both as a research tool and to individual physicians to use in their practices. At points along the way, as useful things are learned, the project will publicize that information and make it available. Though originally just a 10-year study, it now appears to be ongoing with that original group.
Studies like this are very important. Most of what we now know about how to help people at risk for cardiovascular disease came from the Framingham Study begun many decades ago. That study looked at a huge group of people and evaluated cardiovascular risk factors such as smoking and blood pressure. Often it takes decades of information to understand specific disease risks.
The Personal Genome Project involving 100,000 individuals is not only similar but much more comprehensive. It’s looking not only at cardiovascular disease but at all known diseases. And it’s a long-term project. It not only gives us a snapshot of the participants’ health at the start of the study, we will also be able to observe what happens to the participants’ unique genomes as they age.
Genetic researchers are also working toward a point at which we will be able to get a complete analysis of a person’s encoding genes through a simple blood test or mouth swab.
Determining the risk for certain illnesses
Q: Does medical science now know which genes to look at to determine a person’s risk for certain illnesses?
PVH: For some illnesses we have that knowledge, but certainly not for all. We had hoped that Type 2 diabetes would involve only one gene but it’s turning out that many different genes are involved. Five people with diabetes could all have different genetic markers for the disease. The same dilemma is true for cardiovascular disease.
Q: Does that mean that ideally we would need to understand the function of each one of our 20,000 encoding genes? Obviously science does not yet have that knowledge.
PVH: That’s correct. However, I would not be surprised that if we had in-depth knowledge of the function of 200 or 300 encoding genes we could, in most instances, make accurate predictive guesses. I suspect there’s a core of genes that have a disproportionately large impact.
The relevance of the teachings of yoga
Q: In this highly individualized world of predictive genetic medicine do the teachings of yoga have any relevance?
PVH: Yes, they most certainly do. We already know that much of what Paramhansa Yogananda generally recommended as healthful is proving to be beneficial at a genetic level for everyone. For example, meditation has been shown to affect the robustness of our DNA and to limit risk for DNA mutations as we age. Meditation has also been shown to reduce the “biological age” of our DNA and keep it more youthful despite our chronological age. I will continue to use Yogananda’s teachings as the ultimate guide in pursuing health.