|
The
Ethical, Legal and Social Issues (ELSI) Core of the Center for
Ecogenetics and Environmental Health was convened to evaluate
when and how ecogenetics research, which focuses on identifying
genetic polymorphisms that influence responses to hazardous substances
in the environment, can be applied to public health. Specific
objectives include the development of educational case studies
that illustrate the ethical, legal, social and scientific challenges
surrounding use of genetic susceptibility testing for particular
gene-environment interactions that adversely impact health; consideration
of the research agenda needed to address these implications; and
evaluation of other ways in which ecogenetics research can contribute
to improvements in public health.
An important potential application of genetic susceptibility testing
is in the hazardous workplace. Occupational illness resulting
from workplace chemicals and other toxic substances is an important
public health problem, and genetic testing holds the promise of
mitigating risk for those workers who are predisposed to react
adversely to the work environment. However, historical experience
with the use of genetic susceptibility testing in the workplace
illustrates that this technology can also discriminate, stigmatize,
and unnecessarily exclude workers (Draper, 1991; 1998; Schill,
2000). In this case study we explore the ethical, legal and social
implications of the application of genetic susceptibility testing
to prevent or minimize occupational disease from pesticide exposure.
The case study focuses on the interaction between environmental
exposure to chlorpyrifos, an organophosphate pesticide (OP), and
polymorphisms in the paraoxonase PON1 gene. The PON1 gene regulates
the activity and expression of PON1, an enzyme involved in the
metabolism of certain organophosphate (OP) pesticides, including
chlorpyrifos. Chlorpyrifos was selected as the environmental agent
of interest because a substantial body of research in genetics,
ecogenetics, and environmental health suggests that polymorphisms
in the PON1 gene could mediate individual susceptibility to chlorpyrifos
toxicity. Because chlorpyrifos is a widely used agricultural pesticide,
genetic testing to identify farm workers who are predisposed to
react adversely to this particular environmental exposure could
play a significant role in efforts to reduce the disease burden
associated from pesticide toxicity among agricultural workers.
In conjunction with this first case study we designed a template
for analysis that can be used with other ecogenetic case studies
(see Appendix in full report). Consistent with the template, this
case study begins by reviewing the environmental risk, the susceptibility
genotype and the specific scientific, legal, ethical and social
policy parameters that set the stage for a case specific analysis.
Next, potential public health interventions are identified, with
a particular focus on genetic susceptibility testing. The case
study concludes with an ELSI analysis and recommendations for
further research.
top
of page
|
