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Submission from CMF to the Medical Research Council on 'Genes and the Mind'

Published: 1st May 1997

Introduction

Christian Medical Fellowship has made a Submission to the Nuffield Council on Bioethics Working Party on Mental Disorders and Genetics: the Ethical Context. A copy of this submission is attached. It sets out at some length CMF's status and basis, our theological position on genetics and on mental disorders and on the complex relations between the two, and makes some specific and detailed practical comments.

We intend this Submission to be seen as a Supplement to that one, focusing on your specific interest in behavioural disorders, and these brief comments should therefore be seen in that perspective.

These comments on behavioural disorders come from the Chairman of the CMF Specialist Standing Committee on Genetics, who retired this year as a consultant clinical geneticist, and from the CMF General Secretary, an experienced former general practitioner with a particular interest in psychiatry.

The MRC's Booklet and the Need for Educating the Public

May we begin by commending the MRC for an excellent attempt in Genes and the Mind at conveying the vitally important but difficult concept that individuals may be genetically 'at risk' of developing a problem without being predetermined to one.

Where genetics apply to mental disorders it is far more about predisposition than about prediction, as might be the case with physical disorders, and this principle of predisposition is even more true where 'behavioural disorders' are concerned than with the classical psychotic illnesses. Our experience is that the general public makes the mistake of assuming that if you've got the gene you get the condition. As scientific doctors and as Christians, we are opposed to this crude determinism.

Educating the public about genetics is therefore essential, and sensitive use needs to be made of all the available media. We believe the 'road signs' motif of the booklet is a good start.

'The Testing Question'

As amplified in our attached Submission, we believe that the research suggested should be performed, with full professional and public recognition of the 'possible pitfalls' and the 'potential benefits'. Subsequent use of any knowledge obtained should be subject to conclusions reached after the widest possible discussion, and some of these conclusions might need the force of law behind them.

We would reiterate our strong concern about the resource implications. We cannot afford to divert limited funds from care.

We have no other general comments to make here, and will therefore address specifically the two clinical conditions suggested for further study.

Depression

We note the proposal to mount 'nature-nurture studies' on mild depression. Our only comment is to wonder when low mood moves from being a normal part of the rich tapestry of life to being abnormal and requiring treatment, be it pharmacological or psychotherapeutic. Whilst recognising the real misery that 'mild' depression can bring, we do need the spiritual insights we find for example in the Bible book of Job or in some of the Psalms. We must beware any tendency to medicalise real life, and the booklet does not give adequate weight here to this 'possible pitfall'.

Attention Deficit-Hyperactive Disorder (AD-HD).

We recognise one very specific and entirely genetic disorder (Smith Magenis Syndrome) where gross hyperactivity leading to severe psychosocial consequences is a feature, and where knowledge of the diagnosis can bring great relief to families, but are concerned that there may currently be cultural pressures to make the diagnosis of AD-HD too often. There may be other causes of the phenomenon such as social deprivation and poor parenting. Perhaps the phenomenon illustrates the general 'nature-nurture' conflict well.

However, regarding genetic elements, we think there are 'possible pitfalls' associated with the potential results of this proposed research:

1. Pressure to perform genetic testing on disruptive children in school, miscreants such as joyriders, prisoners, and maybe their siblings.
2. Unreasonable pressure for treatment of those affected or perhaps even those genetically predisposed. We recognise the beneficial effects of Ritalin properly used, but know for example of a family with a child suffering from Smith Magenis Syndrome where the school insisted the child was treated and the parents refused to 'have our child drugged'.
3. A positive test result could be used unreasonably as a criterion when decisions are taken, for example, about whether a child should go into care or not. 'This child is likely to be too difficult for you to handle.'
4. Problems with adoption - see (8) in the Submission
5. The risk of diverting funds from education, social support etc - see above and (7) in the Submission attached.

Conclusion

These 'possible pitfalls' we have suggested regarding the two behavioural disorders you propose studying underline the concern you have mentioned and which we endorse about the dangers of deterministic thinking. Education of the professions and the public is going to be essential if we are to keep the possible results of research in their proper perspective.

For further information:

Steven Fouch (CMF Head of Communications) 020 7234 9668

Media Enquiries:

Alistair Thompson on 07970 162 225

About CMF:

Christian Medical Fellowship (CMF) was founded in 1949 and is an interdenominational organisation with over 5,000 doctors, 900medical and nursing students and 300 nurses and midwives as members in all branches of medicine, nursing and midwifery. A registered charity, it is linked to over 100 similar bodies in other countries throughout the world.

CMF exists to unite Christian healthcare professionals to pursue the highest ethical standards in Christian and professional life and to increase faith in Christ and acceptance of his ethical teaching.