Comercializació de pruebas genéticas: un enfoque biééticos / Markting geneticc tests: a bioethical approach / Comercalização dde provas genéticas: um enfoque bioético

Los grandes avances biotecnológicos en genética humana brindan la oportunidad de realizar un diagnóstico predictivo de múltiples enfermedades monogénicas así como la identificación de diversos genes que contribuyen a la presencia de enfermedades complejas. El problema bioético que ha surgido con esta tecnología es que muchas de esas pruebas se ofrecen directamente al consumidor y, en ocasiones, sin indicación médica, lo cual ocasiona que las personas que reciben los resultados los malinterpreten o generen falsas expectativas de los mismos, como es el caso de las enfermedades complejas, lo cual impide tomar decisiones informadas. Por tanto, es fundamental crear las condiciones adecuadas para que los laboratorios comerciales se apeguen a las normas éticas y legales establecidas en cada país, y que los consumidores estén bien informados.

The major biotechnological advances in human genetics provide an opportunity for pre-symptomatic diagnosis of several monogenic diseases, as well as the identification of many genes that contribute to presence of complex illnesses. The bioethical problem that has emerged with this technology resides in the fact that many of these tests are offered directly to consumers, sometimes without a doctor's orders. In such cases, people who request and receive the results are apt to misunderstand them or to generate false expectations, as in the case of complex diseases. This prevents informed decisions. Therefore, the appropriate conditions must be created for commercial laboratories to adhere to the ethical and legal standards established in each country and to ensure the consumer is well informed.

Os grandes avanços biotecnológicos em genética humana oferecem a oportunidade de realizar um diagnóstico preditivo de múltiplas doenças monogênicas bem como a identificação de diversos genes que contribuem para a presença de doenças complexas. O problema bioético que surge com esta tecnologia deve-se a que muitas dessas provas são oferecidas diretamente ao consumidor e, em ocasiões, sem indicação médica, o que faz com que as pessoas que recebem os resultados os mal interpretem ou gerem falsas expectativas sobre eles, como é o caso das doenças complexas, o que impede a tomada de decisões informadas. Portanto, é fundamental criar as condições adequadas para os laboratórios comerciais se apegarem às normas éticas e legais estabelecidas em cada país, e que os consumidores estejam bem informados.

The contribution of chronic diseases to the prevalence of dependence among older people in Latin America, China and India: a 10/66 Dementia Research Group population-based survey.

BACKGROUND: The number of older people is set to increase dramatically worldwide. Demographic changes are likely to result in the rise of age-related chronic diseases which largely contribute to years lived with a disability and future dependence. However dependence is much less studied although intrinsically linked to disability. We investigated the prevalence and correlates of dependence among older people from middle income countries. METHODS: A one-phase cross-sectional survey was carried out at 11 sites in seven countries (urban sites in Cuba, Venezuela, and Dominican Republic, urban and rural sites in Peru, Mexico, China and India). All those aged 65 years and over living in geographically defined catchment areas were eligible. In all, 15,022 interviews were completed with an informant interview for each participant. The full 10/66 Dementia Research Group survey protocol was applied, including ascertainment of depression, dementia, physical impairments and self-reported diagnoses. Dependence was interviewer-rated based on a key informant's responses to a set of open-ended questions on the participant's needs for care. We estimated the prevalence of dependence and the independent contribution of underlying health conditions. Site-specific prevalence ratios were meta-analysed, and population attributable prevalence fractions (PAPF) calculated. RESULTS: The prevalence of dependence increased with age at all sites, with a tendency for the prevalence to be lower in men than in women. Age-standardised prevalence was lower in all sites than in the USA. Other than in rural China, dementia made the largest independent contribution to dependence, with a median PAPF of 34% (range 23%-59%). Other substantial contributors were limb impairment (9%, 1%-46%), stroke (8%, 2%-17%), and depression (8%, 1%-27%). CONCLUSION: The demographic and health transitions will lead to large and rapid increases in the numbers of dependent older people particularly in middle income countries (MIC). The prevention and control of chronic neurological and neuropsychiatric diseases and the development of long-term care policies and plans should be urgent priorities.

Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based survey.

BACKGROUND: Disability in elderly people in countries with low and middle incomes is little studied; according to Global Burden of Disease estimates, visual impairment is the leading contributor to years lived with disability in this population. We aimed to assess the contribution of physical, mental, and cognitive chronic diseases to disability, and the extent to which sociodemographic and health characteristics account for geographical variation in disability. METHODS: We undertook cross-sectional surveys of residents aged older than 65 years (n=15 022) in 11 sites in seven countries with low and middle incomes (China, India, Cuba, Dominican Republic, Venezuela, Mexico, and Peru). Disability was assessed with the 12-item WHO disability assessment schedule 2.0. Dementia, depression, hypertension, and chronic obstructive pulmonary disease were ascertained by clinical assessment; diabetes, stroke, and heart disease by self-reported diagnosis; and sensory, gastrointestinal, skin, limb, and arthritic disorders by self-reported impairment. Independent contributions to disability scores were assessed by zero-inflated negative binomial regression and Poisson regression to generate population-attributable prevalence fractions (PAPF). FINDINGS: In regions other than rural India and Venezuela, dementia made the largest contribution to disability (median PAPF 25.1% [IQR 19.2-43.6]). Other substantial contributors were stroke (11.4% [1.8-21.4]), limb impairment (10.5% [5.7-33.8]), arthritis (9.9% [3.2-34.8]), depression (8.3% [0.5-23.0]), eyesight problems (6.8% [1.7-17.6]), and gastrointestinal impairments (6.5% [0.3-23.1]). Associations with chronic diseases accounted for around two-thirds of prevalent disability. When zero inflation was taken into account, between-site differences in disability scores were largely attributable to compositional differences in health and sociodemographic characteristics. INTERPRETATION: On the basis of empirical research, dementia, not blindness, is overwhelmingly the most important independent contributor to disability for elderly people in countries with low and middle incomes. Chronic diseases of the brain and mind deserve increased prioritisation. Besides disability, they lead to dependency and present stressful, complex, long-term challenges to carers. Societal costs are enormous. FUNDING: Wellcome Trust; WHO; US Alzheimer's Association; Fondo Nacional de Ciencia Y Tecnologia, Consejo de Desarrollo Cientifico Y Humanistico, Universidad Central de Venezuela.