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遗传学、表观遗传学和环境:精准医学、医疗提供者的同情心和社会公正是否是减轻疾病风险和严重程度的有效公共卫生措施?

Genetics, Epigenetics, and the Environment: Are Precision Medicine, Provider Compassion, and Social Justice Effective Public Health Measures to Mitigate Disease Risk and Severity?

机构信息

Departments of Pathology and Pediatrics, Northwestern University, Evanston, IL 60611, USA.

Department of Biomedical Sciences, Rocky Vista University, Englewood, CO 80112, USA.

出版信息

Int J Environ Res Public Health. 2024 Nov 16;21(11):1522. doi: 10.3390/ijerph21111522.

Abstract

Environmental forces impacting public health include exposure to toxic substances, adverse childhood experiences (ACEs), diet, and exercise. Here, we examine the first two of these forces in some detail since they may be amenable to correction through cultural, medical, and practitioner intervention. At the same time, changing people's dietary and exercise routines are likely more resistant to these interventions and are referred to only incidentally in this review. That is, societal efforts could prevent exposure to toxicants and ACEs-not necessarily requiring cooperation by the affected individuals-whereas changing diet and exercise practices requires an individual's discipline. Toxic substances considered in this review include endocrine disruptors, arsenics, 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD), the organic solvent, Trichloroethylene (TCE), and the Benzo[]pyrene (B[]P) produced from incomplete combustion of tobacco and other organic materials. Exposure to each of these toxic substances may have serious adverse health effects, especially in genetically more susceptible individuals. For example, children of mothers exposed to the endocrine disruptor, Atrazine, have significantly lower birth length, weight, and head circumference. Moreover, male offspring exhibit genital abnormalities, and all of these effects may be transgenerational. However, analyses of interactions among genes, the environment, and epigenetic modifications have already revealed distinctive individual risks of adverse reactions to toxic exposure. So, interventions through precision medicine might improve the health of those exposed individuals. Adults previously exposed to more than one ACE (e.g., child abuse and inter-parental violence) are more likely to develop anxiety, cancer, and diabetes. Detecting ACE exposures in children in the general population is fraught with difficulty. Thus, the risks of ACEs to our health remain even more insidious than exposures to toxicants. Nevertheless, higher provider compassion is associated with significantly better clinical outcomes for patients with these afflictions. For all these reasons, the first major aim of this review is to recount several of the major forces contributing to or impairing public health. Our second major aim is to examine mitigating influences on these forces, including social justice and provider compassion in the setting of precision medicine. Idealistically, these mitigators might eventually lead to the development of more cooperative and compassionate cultures and societies.

摘要

影响公众健康的环境因素包括接触有毒物质、不良的儿童经历 (ACEs)、饮食和运动。在这里,我们详细研究了前两个因素,因为它们可能可以通过文化、医疗和从业者干预来纠正。与此同时,改变人们的饮食和运动习惯可能更难抵抗这些干预,并且在本综述中仅附带提及。也就是说,社会努力可以防止接触有毒物质和 ACEs——不一定需要受影响的个人合作——而改变饮食和运动习惯需要个人的自律。本综述中考虑的有毒物质包括内分泌干扰物、砷、2,3,7,8-四氯二苯并对二恶英 (TCDD)、有机溶剂三氯乙烯 (TCE) 和不完全燃烧烟草和其他有机材料产生的苯并 [] 芘 (B[]P)。接触这些有毒物质中的每一种都可能对健康产生严重的不良影响,尤其是在遗传上更易受影响的个体中。例如,接触内分泌干扰物莠去津的母亲所生的孩子出生时的长度、体重和头围明显较低。此外,雄性后代表现出生殖器畸形,所有这些影响都可能具有代际效应。然而,基因、环境和表观遗传修饰之间相互作用的分析已经揭示了对有毒暴露产生不良反应的独特个体风险。因此,通过精准医学进行干预可能会改善暴露个体的健康状况。以前接触过多种 ACE(例如,虐待儿童和父母间暴力)的成年人更有可能患上焦虑症、癌症和糖尿病。在普通人群中检测儿童的 ACE 暴露存在困难。因此,ACE 对我们健康的风险比接触有毒物质更加阴险。尽管如此,更高的医疗服务提供者同情心与这些疾病患者的临床结果显著改善相关。出于所有这些原因,本综述的主要目的之一是回顾导致或损害公众健康的几个主要因素。我们的第二个主要目的是研究这些因素的缓解影响,包括精准医学背景下的社会公正和医疗服务提供者同情心。理想情况下,这些缓解因素最终可能导致更具合作性和同情心的文化和社会的发展。

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