DNA Is a Preexisting Condition

The din and furor of the last few days of the health care bill debate obscured a headline of potentially more importance to human health. Manufacturers of DNA sequencers announced that the cost of a complete human genome sequence had fallen to $50,000, and is on a path to $5,000 in less than two years.

Considering that the first human genome sequence cost around a hundred million dollars just a few years ago -- this is startling progress. Sequencing the genome of a single human has gone from the cost of a small space mission to the cost of a nice automobile, and will soon rival the cost a home entertainment system. Even computer technology did not advance this fast!

The first benefits show up in the pace of biology research. Labs can undertake projects that were simply too daunting in cost and time just a year ago.

Just as the drop in the cost of computing led to an explosion of applications, the drop in the cost of DNA sequencing will result in a a dizzying array of new stuff. If the history of computing is any guide, expect many of the new applications to be trivial, silly and useless. But many will be important and useful, and a few will be profound and transformative; changing science, engineering, even the way we live, forever.

Again, if history is a guide, we won't be able to tell in advance which applications will prove most important. In 1975, no one would have predicted that video games would become a bigger industry than movies, or that every business would be run by spreadsheets and relational databases.

In the early 20th Century, the microscope migrated from the scientist's laboratory to the doctor's desk and became a primary tool in the conquest of infectious disease. Until that time, infectious disease had been mankind's greatest health challenge, the leading cause of death in every human society. In the U.S. and Western Europe, life spans increased from 40 years to 70 years in just a generation. The same thing is happening in India and China today.

Now, most of us live long enough to face issues like cardiovascular disease, metabolic disorder, stroke, and cancer as our life-ending health challenges. All of these conditions are caused or heavily influenced by our genetic programming. We are beginning to identify the genetic code responsible.

What if we could do something about our sub-optimal DNA programming? I leave it to the biomedical research community to figure out exactly what this means and how it could be accomplished. But it would be a health revolution at least as profound as vaccines and antibiotics were for infectious disease. Imagine that to our grandchildren, the diseases that ravage us would seem as remote to their experience as smallpox, typhus, and cholera are to us.

The catch is that all these new therapies would start with our DNA as it is. Our DNA would be measured and analyzed. Then we would have ways to either modify the DNA itself or change the way it is interpreted in our bodies. If you think of DNA like a computer program, it would be like releasing fixes -- known in the trade as "patches" -- to a popular software product.

Our DNA is thus like a beta release of software, and every problem is a "preexisting condition" there from the moment of conception. What a field day for insurance companies! With each new discovery, millions of people would be known to have conditions that health insurance could say were there from before birth, and therefore not covered. Imagine: no coverage for diabetes, cancer, heart disease, or any of the other real killers of most Americans. Scientific progress, instead of delivering the greatest advances in health, would condemn millions to penury and even premature death, because the new therapies would not be covered because of preexisting conditions.

Fortunately, the health care bill phases out the notion that preexisting conditions can bar coverage. This was probably the least controversial part of the bill. ut had the Republican "kill the bill" effort succeeded, this obstacle would still be with us -- for perhaps a generation, if you believe the political common wisdom. And that generation would be the one in which the DNA technology revolution happens.

Now that the health care bill is law, we will see what benefits and costs really come to pass. But when we look back on this bill in a few decades, we will not remember the fuss over mandates or public options or subsidies. We will remember that we eliminated preexisting conditions, and thus removed the worst obstacle to the greatest advance in human health in a century, perhaps in all history.