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"We have just begun to tap the potential for toxicogenomic
technologies to improve risk assessment," said David Christiani, chair
of the committee that wrote the report, and professor of occupational
medicine and epidemiology at the Harvard School of Public Health. "To
harvest public health benefits requires both greater investment in
research and coordinated leadership."
Toxic substances and drugs can potentially disrupt gene processes
within cells, thus disturbing the cells' healthy functioning. In
addition, an individual's genetic variations can leave him or her
particularly susceptible to the effects of chemicals or side effects
of medications. For example, studies have shown that certain inherited
gene variations may make some people more prone to symptoms such as
nausea and impaired muscle function when exposed to a common pesticide,
the report notes.
Using new toxicogenomic technologies, researchers can identify toxic
processes as they unfold at an early, molecular stage, long before
symptoms appear. This knowledge will support the development of tests
that can more accurately predict whether a chemical will be hazardous,
and at what dose. The tests' sensitivity also could lead to better
prediction and prevention of damage to fetuses at critical stages of
development. Finally, toxicogenomic studies can inform individuals
about their particular genetic vulnerabilities.
Given the potential of toxicogenomics to reduce and prevent health
risks, regulatory agencies should expand their research and enhance
efforts to use these methods to aid risk assessments, the report says.
It also calls on the National Institute of Environmental Health
Sciences and other stakeholders in government, academia, and industry
to explore the feasibility of implementing a concerted human
toxicogenomics initiative.
A crucial part of this effort will be the creation of a single public
database to collect toxicogenomic data and integrate it with data on
health effects generated by traditional toxicology studies, the report
says. Such a database will let scientists see connections between
activity at a molecular level and the symptoms that result, and
decipher how multiple genetic reactions at the cellular level can
combine to cause adverse outcomes. New studies will also be needed to
generate data on the genomic effects of chemicals for which
traditional toxicity data already exist. And a national "biorepository"
for physical samples - human blood and tissue, for example - will be
useful for future toxicogenomic studies. Every effort should be made
to use samples already being collected for other research, the report
urges.
The generation of data from such studies, and toxicogenomic research
in general, raises a host of social, legal, and ethical questions that
the new initiative needs to address - including protecting the privacy
of genetic and health data, the report says. Individuals might decide
against genetic testing if there is a danger that health insurers or
employers could access their information and use it to deny them
insurance or work. Safeguarding the privacy of this data will be
increasingly challenging as the use of electronic medical records
grows.
Improved legislation is needed to protect the privacy, confidentiality,
and security of health information anywhere it is collected, stored,
and transmitted - not just at organizations already subject to privacy
rules under the Health Insurance Portability and Accountability Act.
The decision to learn about one's genetic vulnerabilities should rest
with the individual, the report says. And except in rare circumstances,
people who choose to get tested to learn about their particular
genetic susceptibilities to a workplace chemical should be allowed to
decide for themselves whether to accept the risks involved in
employment.
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