Should I consider genetic screening for my kids?

By thaas / August, 28, 2018 / 0 comments

With answers from Medcan’s Child & Youth Team and genetic specialists at The Hospital for Sick Children (SickKids)

Posted April 6, 2018By Tania Haas, Staff Writer

During the 2018 Winter Olympics’ commercial breaks, families watching the Games may have seen a Warren Buffett-voiced advertisement for a test to identify the “speed gene”. Olympic athletes were also featured in the ‘DNA of a Champion’ campaign by the company 23andme, which was promoting its direct-to-consumer genetic tests: one related to athletic performance; others identified risk for certain diseases.

Elite athletes and a finance guru promoting a product? Sign me and my kids up, pronto! Right? Well, like so many aspects in medicine and technology, the answer seems to be: it depends. I approached five health-care professionals with questions from parents. Here’s what they said:

Should I order the “speed gene” test for my athletic child?

Have you ever had a parent ask for your guidance or perspective on direct-to-consumer genetic testing for their child? What would be your response?

What is pharmacogenomics (PGx)? Why would parents be interested in knowing about pediatric PGx research?

What does the current landscape of pediatric PGx testing look like? Where are we now, and where are we going?

Should I order the “speed gene” test for my athletic child?

The Psychologist
Mark Rothman, Registered Psychologist, PsyD, C. Psych.

I am not a genetic specialist; but issues come up like this a lot when I work with kids and their parents. I think we can make a parallel between an athletic genetic test and psych-ed (psychological-educational) testing.

If you find out that your child is intellectually gifted, what does it tell you? It tells you that they have a very strong intellectual potential, but does not tell you what they should exactly do with that. Should they be in a gifted program to optimize their intellectual strengths? Or would they be better off in a regular academic program, which will give them better opportunities for socialization?

Getting a classification like “gifted” or having the “speed gene” does not necessarily mean that a child will be high achievers in academics or athletics. In many cases, with kids that are gifted, they find school discouraging or uninteresting.  For some gifted teens, the biggest conflict can be with parents who are upset that the teen is not living up to his potential.  If the child is found to be genetically prone for athletic excellence, which you may not need a test for, does that then give license to parents to push the child in that direction?

I see some pretty gifted athletes in my practice. Take the 16-year-old teen girl on the pre-professional swim circuit. For her, all she wants to do is swim. If her test results confirmed the speed gene, would those results reassure her? Maybe, if it was a yes. But what if it were a no? If someone has a passion towards a sport, and the genetic test says they don’t come out strong, would the parents say, ‘we aren’t going to support you in this sport because you aren’t likely to be one of the highest performers’?

What makes people successful is their work ethic. It is not their natural competencies, but rather the work they put into something that usually leads to success, regardless of what the genetic test says. If you are one of those people lucky enough to have natural competencies and the work ethic, yes, you can be pretty remarkable.

Dr. Mark Rothman is a registered psychologist and marriage counsellor at Medcan. To book, call (416) 350-5949 or email MentalWellbeing@medcan.com

The Family Physician
Janice Weiss, MD, CCFP

Regarding genetic tests that offer insight into possible future athletic performance, I would advise parents to consider a different question: ‘Are we doing this for us or for them?’

I think children need to be listened to and understood.  Patents shouldn’t be imposing their hopes, based on genetic potential, onto their children unless it is something that is equally important to the child. And when that’s the case, parents can support them on their own journey. Children respond best when they feel understood and when their own passions and interests are respected and encouraged.

Pharmacogenomics is a scientifically validated method of determining how some medications interact with one’s genes. For some children this has tremendous health benefits. SickKids has an excellent program (see related answer below from one of the field’s leading researchers).

Dr. Janice Weiss is the Director of the Child & Youth Program at Medcan. To learn more about the program, contact (416) 350-3621 or email childandyouth@medcan.com

The Fitness Trainer
Tim Evangelista

The current state of genetic screening for physical fitness is still in its infancy. These tests are information, but not prescriptive. Genetic results won’t predict who the next Usain Bolt or Michael Phelps will be or what one would need to become them. It is simply additional information that may or may not help you in your goals.

I would encourage parents — who are thinking about this test for themselves or their children — to consider these questions before pressing the “order test” button:

  • What utility will this information have?
  • Where are you currently in your athletic or health journey now? And what do you want to improve on?
  • How will this change what you, or your child, does now?
  • Will this information be motivating?

Genetic results shouldn’t drive exercise prescription. The results from physical fitness tests as well as your goals are what should dictate the exercise program.

The psychological motivation is the tricky part. If the data will motivate you to get out of your chair and exercise, hey, go for it. But it shouldn’t determine the exercise prescription. For children, they may actually be pre-dispositioned to be good at endurance or power, but not like it.  The risk is that some people could rely too much on this information. Sure genetics may be a limiting factor if you are a sprinter without the speed gene variant competing in the upper echelons of athletics.

Even for elite athletes, we all know of underdog stories where many factors were against an athlete — height, social status, illness — and yet they still succeeded. If you base decisions only on genetics, you may be overlooking others aspects: effort, determination, environmental factors.

Your genes respond to messages from its environment- in this case exercise or lack there of. Your genes will encode the proteins that will help you get better at whatever you are doing. If you’re strength training your genes will encode for proteins that will make you stronger. Our biology is never static or pre-determined.

Tim Evangelista is the Assistant Head Fitness Trainer at Medca. He has a keen interest in the role of genetics on human health and performance. You can reach Tim by email TimothyEvangelista@medcan.com  or (416) 350-5900 ext. 3644

Have you ever had a parent ask for your guidance or perspective on direct-to-consumer genetic testing for their child? What would be your response?

The Pediatric Genetic Counsellor
Cheryl Shuman, MS, Director, Genetic Counselling at SickKids

This is a complicated question that is currently being discussed by genetic counsellors and geneticists across Canada.

If a child has a health concern for which genetic testing is available, that testing could be organized by a health-care provider to guide health management. If parents are pursuing direct-to-consumer testing on their healthy child, we would suggest waiting until the child is old enough to decide about testing and learning about the potential implications of the results as this pertains to his/her own genetic information.

In future, we will likely all have our genomes sequenced and this information will be used to manage our health and well-being.

What is pharmacogenomics (PGx)? Why would parents be interested in knowing about pediatric PGx research?

The Pharmacist practising pediatric pharmacogenomics
Iris Cohn, MSc., RPh, Clinical Research Pharmacogenetic Advisor

The Hospital for Sick Children (SickKids) has launched the Clinical Pharmacogenetics Research Pilot study: CPS pilot, which is available for both ambulatory and inpatient consultations within SickKids for up to 200 children.

Children at SickKids may be eligible to enroll in the study if they meet certain criteria:

  • They have a family history of medication hypersensitivity
  • They fail to react to certain medications even in high doses
  • They are being prescribed a medication with drug-gene guidelines.
  • They have complex issues and will be put on several medications at once

At SickKids, we use a clinically validated targeted PGx test, where variants associated with 11 pharmacogenes with known drug-gene interactions are analyzed. PGx test results are explained and discussed in detail to the participant and coordinated with the treating healthcare team.

The overall goal of the pilot project is to examine the clinical utility and feasibility of implementing such a test into routine paediatric care.

Can you describe the current landscape of pediatric PGx testing? Where is the research now, and where are we going?

Regulatory authorities such as Health Canada and the US Food and Drug Administration (FDA) recognize that we all carry genetic variants that can have significant effects on our responses to various drugs. This has led to warning labels on more than 140 medications about PGx variants associated with side effects, adjustments of drug dosing or different treatment choices.

Some PGx tests are already standard of care in specific paediatric settings, such as tests used for paediatric oncology patients to prevent severe side effects to certain kinds of chemotherapy. However, there are significant barriers to the use of PGx data in daily clinical care for both children and adults. These barriers include limited availability of clinically validated laboratories and a general lack of knowledge of PGx in the healthcare community. If and when PGx testing is widely available to the public through the healthcare system, pharmacists should be at the forefront of delivering these services to patients.

To learn more about this topic, read more of the genetic-related content created by Medcan

 

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