Sunday, May 25, 2008

Living with our genes

Gene testing is becoming more popular and I expect it will become downright trendy now that Bush has signed a bill to prevent discrimination against folks with dodgy genes. When I say dodgy, I mean potentially dodgy of course. Not all genetic portents truly predict an undesirable future. The environment must also play its part. In talking to a friend from the UK last week, the topic came up around gene testing and the dilemma of insurers and employers who may see a risk the the genetic profile of prospective customers or workers but have limited ways to use that information to politely tell a prospect, no. It sounds unethical to deny insurance coverage or employment, but is it?
Our discussions was colored by the healthcare environment my friend and I are from. I live in the US, he in the UK. He has access to socialized medicine. I do not. I rely on reimbursement for all procedures and medicines from my insurance company. He never sees a medical bill. Both our worlds are governed by codes and formularies. In mine, how my doctors visit is categorized governs how much I will have to pay for services.
He put forward a view that if insurance companies take into account all risk factors including genetic ones, then the greater good will be served by providing less coverage for more risky cases. The genetic profile just helps to fill out the picture and the resulting gaps in coverage then provide an opportunity for novel approaches to insurance to entrepreneurs. In other words, the free market prevails. He has an excellent point and he comes from a country that has a basically fair health system, despite all its shortcomings. It is natural for him to think there is a fair way to deal with genetic profiles without having to resort to policies to protect those with ‘bad genes’. For me, living in the US, it seems as though gene testing provides one more level of categorization that will lead to no reimbursement or unaffordable coverage for many. The codes for risky genes have yet to be inserted to a system that leaves millions of Americans uninsured. Anit-discrimination laws do not endorse irresponsible behavior in the light of risky genes but rather give pause to those who seek to capitalize on the information for financial gain. The laws make us think. For genetic variance, our state of understanding is very immature. Genes and environment interact to place us at risk of disease in ways that are unique to each individual. It will be very difficult to say just what health outcome can be expected of a particular gene profile for many years into the future to come. In the meantime, the anti-discrimination laws will hold overzealous insurers and employers at bay. The ‘defective gene’ label is one that we can ill afford until more is understood about what it means. And boxing us into yet another categorization with a damning code to decide how we pay, is just a little before its time.

Thursday, May 8, 2008

To validate or not to validate?

I'm reading some Eckhart Tolle and loving it. It hit me today that there are three basic modes of living. First there is the ego driven life that requiree validation constantly. I used to think that validation was important for happiness and success. I though that some individuals were destined to continually seek for acceptance to fill the void created in their early years from not being vaildated by parents and caregivers. I felt validation of core identity was the key. I now think differently. Validation is still important, especially in the first half of life. We want to be seen to be successful, pretty, competent, 'identified'. After reading Tolle I realize that it is just the ego that needs the validation and will indeed continually seek it. Marketers love the ego. Fashion, smelly candles, clubs, holidays, shoes (my ego loves shoes), houses, all validate the ego and create a sense of belonging through ownership or involvement. Without the ego and its constant need for satisafaction, capitalism would struggle to survive.

The second mode of living is the conscious mode that Tolle talks about. It is akin to 'second level' stages of the Spiral. This mode develops through the second half of life (I am speaking in generalities since all lives evolve at their own pace and some people seem born into conscious existance, while others live through their ego to the bitter end). As the first mode declines, and the ego becomes more observed and therefor emore under control then conscious living takes over. It seems the two oscillate with ego winning at first, and consciousness taking over for the latter half. Perhaps the time the balance shifts from ego to consciousness is what we view as the 'mid-life crisis'. If so, I hope one day we will learn to welcome the crisis, working through and then above it, through to enlightenment. I'd recommend Tolle's books. To me they represent a fundamental truth that I have always known but not always understood.

The third mode of life is familiar to many in the US, and paid my salary for many years. It is the medicated life. This is the life that disturbs me the most, I have nothing against medications for the most part; just last week my mother's life was saved by a high dose intravneous diuretic that was in essence, a miracle cure for the acute condition she found herself in. However, we turn too readily to drugs to calm and soothe, energize and stimulate. We expect to find solace and health in a pill. If enough of us continue to live this way, our culture will hit a very real hurdle in its evolution. However, I do sense a scepticism about medicines that could lead to a more healthy application of them. Hopefully, over time we can become more conscious in the way we diagnose and treat illness, making use of all available therapies from across the traditional and complementary spectrum. I think Tolle has a unique way of expressing the duality that causes us so many problems as we wrestle a demon we often do not even know exists. I wonder if it is most usefully applied to this third mode of life where have become so disconnected from our own healing mechanisms.