Star Tribune from Minneapolis, Minnesota on September 16, 2018 · A15
Get access to this page with a Free Trial

A Publisher Extra Newspaper

Star Tribune from Minneapolis, Minnesota · A15

Publication:
Location:
Minneapolis, Minnesota
Issue Date:
Sunday, September 16, 2018
Page:
A15
Start Free Trial
Cancel

“There are social responsibili- ties with what we do.” Genetic testing has become commonplace in the past decade: for relatives of patients with pancreatic, breast and other cancers; for mysterious and rare childhood diseases; and for treatment planning in cases of lung cancer and other select conditions. A rapidly growing disci- pline called pharmacoge- nomics is identifying genetic information that predicts how patients will respond to cer- tain drugs. And researchers hope that the collection of thousands, and eventually millions, of genetic samples from patients will identify the origins of common diseases in addition to the 4,700 rare diseases that have been mapped out already. One reason for optimism on all these fronts is the reduced cost of whole-genome sequencing. The process has become so cheap and repeat- able that researchers are able to conduct previously unthink- able studies, and patients can afford to have their genetic histories mapped and mined for potential defects, said Dr. Keith Stewart , director of Mayo’s Center for Individual- ized Medicine. “I can’t believe that we all won’t routinely have our genomes sequenced in the not too distant future,” he said. “It’s so cheap to do now.” Daughter avoided surgery Some doctors, though, fear that the promise of genomic medicine has been oversold, and that the stampede to genetics research has come at the expense of other pursuits in health care. “I like to tell people to drink the Kool-Aid in small doses,” said Dr. Michael Joyner , a Mayo anesthesiologist who spoke at the conference. He described a “hype-filled biomedical nar- rative” that, he argues, has led people to believe that genetic medicine has accomplished more than it really has. For example, he said, a lead- ing researcher once claimed that the dozen or so genes responsible for diabetes would be discovered by 2008. In real- ity, a much more complex com- bination of genes and lifestyle choices are responsible. Joyner worries that hype draws attention and funding to genetics research and away from public health and pre- ventive efforts that already are proven to ward off cancers and other diseases. “The promise and the ideas of what might happen have just gotten way, way out in front,” he said. Weakland is a believer — especially after losing his grandfather, an uncle and an aunt to cancer and seeing what genetic testing could accomplish for his children. His daughter was considering preventive surgeries, includ- ing a hysterectomy and double mastectomy, until the testing found that she didn’t share the family’s genetic cancer trait — specifically a mutation of the BRCA2 gene. Weakland’s son, on the other hand, carries the genetic trait and will now be moni- tored closely for physical changes that could be early warning signs. Weakland, a retired con- tractor and Vietnam War vet- eran, has outlived his doctors’ expectations when they found his aggressive pancreatic can- cer, which had already spread to his liver. The initial rounds of chemo worked so well that doctors took a follow-up tissue sample from him to learn why. Studying an NBA star Medical care is also chang- ing rapidly as doctors discover how genetics influences the effectiveness of medications on their patients. Mayo now lists 20 drugs that are suitable for pharmacogenomic tests, including common blood thinners such as warfarin and Plavix, which are taken to pre- vent heart attacks and strokes. Stewart said insurers are grad- ually covering more of these tests, but he said patients are often willing to pay the cost, around $350, in the hope that they can improve the odds of their medications working. A concern for skeptics such as Joyner is that genetic test- ing often identifies only mod- est increases in disease risks, or negligible differences in the effectiveness of drugs. He pointed to a study of the genet- ics of Shawn Bradley , a former NBA player who stands 7 feet 6 . Researchers found genetic evidence to explain his stature, but it explained only 1 centime- ter of his excess height. Stewart said he agrees that genetic medicine is some- times oversold but said that shouldn’t discourage research- ers. Instead, he said, doc- tors need to challenge their assumptions. For instance, some doctors have questioned whether a pharmacogenomic test really helps in deciding whether to prescribe Plavix for heart patients. So Mayo is participating in a national study involving 5,000 patients to determine whether the testing and medication is ulti- mately helpful. Mayo also is following 500 patients over a year to determine if spend- ing increases unnecessar- ily among those who receive whole genome sequencing. One emerging challenge is simply managing all of the genetic information being col- lected by clinics and hospitals worldwide so the profession can use it collectively to dis- cover gene types that are more prone to certain diseases or less affected by certain drugs. Mayo is participating in a study known as All Of Us, in which 100 health care organi- zations in the United States are collecting the genetic informa- tion of 1 million people. Green said there will be as many as 50 million genetic samples in the next 20 years, and that 80 per- cent of them will be collected by hospitals and clinics in the process of patient care, rather than by researchers. Another concern, Green said, is making sure these samples represent the nation’s diversity, and not just the white majority or people who can afford to pay for them. “It will be tragic if this grand vision … ends up exacerbating health disparities,” he said. David Smith , a genomics cancer researcher at Mayo, acknowledged that scientists might have made unrealistic predictions in the early years, when so much was unknown. But today, he said, predic- tions need to be more realis- tic because of the number of people counting on genetic research to save their lives. “If we continue to do this overhyping,” he said, “we’re slapping ourselves in the face.” Jeremy Olson • 612-673-7744 Doctors weigh responsibility of gene testing: Is it hype or hope? ø DNA from A1 obtained a trademark that will reserve the name for Minne- sota-grown apples. The same variety grown elsewhere will go by the name Rave, and out- of-state growers will be closely monitored. Breeding a crisper, tastier apple is a long game at the U’s Apple House, home to a rotating cast of 30,000 trees, all grown on dwarf roots in the hills south of Lake Min- netonka. The Honeycrisp was in the works for decades before its 1991 release. The first tree for the U’s next big successful apple variety, the SweeTango, was planted in 1988, with apples selected for further testing in 1999 and released to the public in 2006. And the original First Kiss tree, now a knotty matriarch in the middle of a row of younger upstarts, was planted 21 years ago. For Bedford, a trim 67-year- old with a weathered brown face and steel-gray mustache, and his crew, the work is pains- taking. They generate about 5,000 hybrid trees each year in a greenhouse. The best ones get a chance in the orchard, where their buds are grafted onto root stock in late July. A visit there is a lesson in the miracle of plant genetics and grafting. Plant the seeds from a First Kiss apple and you’ll get something akin to a First Kiss tree several years later, but the fruit is never iden- tical. Like a human child, the apple will be genetically dis- tinct from its parents. “Not a single one of them will be a First Kiss, even if we have a million seeds, and no two of them will be alike, either,” Bedford said. The hybrids Bedford grows are mostly not as good as their genetic parents, but a few — roughly 1 in 10,000 — are much better, thanks to the random- ness of nature. “We use those seeds in the beginning to generate all these lottery tickets, I call them,” Bedford said. After about six years, the trees start to bear fruit, and the real work begins, as Bedford and his colleagues work their way through the orchard, look- ing, picking, tasting, cutting and testing for the winning lot- tery ticket. About 3,000 trees that make it into the orchard are discarded every year. One afternoon last week, Bedford stood next to such a tree, hung with clusters of an unnamed, unnumbered variety of apple that will never make it to a store or commercial orchard. He picked a bright red one, sliced into it and handed out wedges. The apple was crisp, juicy, and richly tart — better than most apples ever sold at a supermarket. But it wasn’t good enough for Bedford. “It’s higher acid than I would like. That falls in the category that we’d say, ‘not so bad,’ ” he said, gently spitting out the flesh. “You throw it away. What we’re looking for is that one in 10,000 that’s a wow.” A handful of trees — about 10 every year — are “wow” enough to be tied with a blue ribbon and replicated four times in a more selective orchard closer to Apple House by grafting their buds onto root stock there. About 120 different types of apple tree are grow- ing there, and Bedford keeps careful notes on those apples, grading them over the years on a scale of one to nine each season, focusing on flavor and texture, and keeping boxes of them in cold storage to see how well they hold up over time. Even those trees are culled every year. A quartet of apple trees there was marked with orange paint last week. “Those are ones I threw away this morning,” Bedford said. Bedford’s relentless pursuit of apple perfection makes him particularly sensitive to subpar fruit that carries the name of one of the breeds he’s devel- oped. The Honeycrisp was a smashing commercial success, and generated royalties for the university until the pat- ent expired in 2008. But Bed- ford had no recourse when he thought a grower was falling down on the job. When the SweeTango was released , the university used a managed licensing system that allows Bedford to call growers and demand they do better. The next step in the U’s fruit marketing evolution is the dual naming rights for the First Kiss. “We’ve put 20 to 30 years into these things, and we want them to get out and serve the public, but we have to manage them,” Bedford said. “That’s been done in the world of commerce for many years. It’s just that it’s a newer concept in agriculture.” The First Kiss is already grown under the Rave name in Washington, where around 60,000 bushels are being picked this year. The apple is more tart than a Honeycrisp, but it retains the parent apple’s “explosive crispness” and was crossed with an unreleased variety from Arkansas, known simply as AA-44, to make it more tol- erant to hot weather and ear- lier to ripen. That makes the apple available for growers to sell a month earlier than most other apples in Minnesota. The apple is being tested at 20 sites in Europe and getting good reviews. It was a sensation at the State Fair, selling out in 48 hours at $3 an apple. “When we saw that ripen about a week before the State Fair, we knew it was going to be a hit,” said J.P. Jacobson, the grower at Pine Tree Apple Orchard outside of White Bear Lake, one of the original test sites for the apple. Jacobson said there were “frenzy-like conditions” at his booth at the State Fair. “We had 400 people in line,” he said. The First Kiss is the first national apple variety released by the university since the SweeTango , and only the sec- ond since the Honeycrisp. Jacobson said he thinks it will catch on quickly because of social media, and could wipe out cultivation of other apple varieties. It’s good for baking pies, and should make good cider, he said. “Based on how demand went this year, I ordered more trees,” Jacobson said. Most apple orchards in Minnesota are geared toward visitors, and not the wholesale market. For those, the First Kiss’ early maturity may be an obstacle to growing it. “It’s a good apple. There’s nothing wrong with the apple itself,” said Ross Nelson of Nel- son Farms near Webster, and the president of the Minnesota Apple Growers. “We will not be putting it in our orchard and the reason is it matures around the first of August and we don’t have any other apples matur- ing at that time.” Economically it doesn’t make sense for Nelson to staff the orchard for one variety for a month. Besides, he said, “Peo- ple don’t want to come out to the orchards in early August.” Nelson also said the two- name convention has been confusing to consumers in the case of another apple — the SugarBee, a grower-developed descendant of the Honeycrisp that’s known as the B51 in Min- nesota but the SugarBee else- where. “I think in the long run it will be fine,” Nelson said. Bedford said he is pleased with the plan to reserve the First Kiss name for Minnesota. “I still can’t fault the con- cept that we did it under, based on what we learned from Hon- eycrisp,” he said. The driving motivation behind all his work is partly commercial — the Honey- crisp has been a boon to the U’s horticulture department and “we’ve got to keep inventing new ones,” Bedford said. But he also said he believes a better apple has social benefits. “What’s the point of all this? More food? Don’t we have enough food?” Bedford said. “If we were just making different forms of Twinkies, I’d have more trouble answer- ing that question. But to have something that can compete with junk food that’s good for you, that’s different. “We have this category of food that’s good for you, but so is kale and broccoli. People aren’t so excited to eat those things. We fall in that weird intersection of something that’s good for you and something that people are excited to eat. There are not too many cross- over things like that, and that’s what good apples can be.” Adam Belz • 612-673-4405 Twitter: @adambelz First Kiss was long labor of love ø KISS from A1 Photos by LEILA NAVIDI • leila.navidi@startribune.com David Bedford stood back to admire the original SweeTango apple tree, a First Kiss predecessor planted in 1988. After much testing and tasting, its apples were first released to the public in 2006. Bedford demonstrated how he tastes apples in his quest to find the winning “lottery ticket.” “What we’re looking for is that one in 10,000 that’s a wow,” he said. S U N DAY, S E P T E M B E R 1 6 , 2 0 1 8 S TA R T R I B U N E • A15

Clipped articles people have found on this page

Get access to Newspapers.com

  • The largest online newspaper archive
  • 21,900+ newspapers from the 1700s–2000s
  • Millions of additional pages added every month

Publisher Extra® Newspapers

  • Exclusive licensed content from premium publishers like the Star Tribune
  • Archives through last month
  • Continually updated

Try it free