1. Choose a Topic

Possible “Big Themes” and Questions for Your Café

1) The Impact of Genomic Science on Medical Research and Clinical Practice 

Francis Collins, the geneticist who helped pioneer the Human Genome Project and who now heads the National Institutes of Health, has witnessed how genomics is revolutionizing medicine. “Genomics,” Collins says, “offers us the chance to look, in the most precise way, at the causes of illness and how to prevent and treat illnesses with that information.” Your café can explore this revolution in greater depth.

Possible subtopics and questions include:

  • The history of advances in genomic science and where it is heading
  • Specific diseases that can now be diagnosed more readily
  • New paths of drug discovery and highly targeted drugs
  • How can clinicians best integrate new genomic knowledge in their practices?

2) Direct-to-Consumer (DTC) Genetic Testing: the Benefits and Potential Pitfalls

An ever-growing number of companies offer genetic tests directly to consumers, bypassing physicians. Proponents of such testing argue that it is a boon to individuals, allowing them to identify risk factors for dozens of health conditions and take preventative measures. Critics assert that such tests are generally inconclusive and misleading. Your café can tackle this controversial topic.

Possible subtopics and questions include:

  • Given the complex determinants of most diseases, how accurate are current commercial tests?
  • Is the information offered by DTC testing more informative than family medical histories?
  • What are some best-case scenarios for individuals using these tests?
  • Should physicians and/or genetic counselors always be intermediaries in interpreting genetic tests for patients?

3) Would You Want to Know? The Potential Burdens of Genetic Information

If you could peer into a crystal ball foretelling the diseases that lie in your future, would you? What if you saw Alzheimer’s disease, for which there is no reliable means of prevention? What if the crystal ball were cloudy, offering only a sense of probabilistic risks rather than clear-cut diagnostics? Your café can help sort through such perplexing issues.

Possible subtopics and questions include:

  • Different types of genetic tests and what they reveal
  • How well do individuals grasp and interpret probabilistic risk data?
  • The impact of genetic test results on family members
  • When are genetic tests most warranted?

4) Will Genomic Science Usher in a New Era of “Designer Babies?”

The film Gattaca painted a disturbing picture of how genetic testing and engineering could be used in the future to create an elite class of genetic superiors. With the growing use of prenatal genetic testing, are we headed toward such a future of so-called “designer babies”? Your café can explore the use of prenatal genetic testing today and how it might be used in the future.

Possible subtopics and questions include:

  • How do advances in reproductive technologies enable more prenatal genetic testing?
  • What, if any, genetic traits should be screened out through prenatal genetic testing?
  • Who decides what screening is warranted? Should there be legal limits?
  • How might such testing impact the relationships between parents and children?

5) Protecting Your Privacy in the Genomic Age

Almost everywhere you go, you leave evidence of your genetic makeup—in strands of hair, shed dry skin, and traces of saliva. As the cost of genome sequencing plummets, the risk of what has been termed “genomic hacking” increases. Genomic hacking could become an illicit strategy for screening potential employees or marriage partners or used in other nefarious ways. Your café can envision such dark scenarios and discuss safeguards.

Possible subtopics and questions include:

  • How does the 2008 Genetic Information Nondiscrimination Act (GINA) provide protection against discrimination in health coverage and employment based on genetic information? Why does it not cover life or long-term care insurance?
  • Does DTC genetic testing today put a person at risk of jeopardizing his or her genetic privacy?
  • If genomic testing of newborn children becomes routine, how will it impact their future genetic privacy?
  • Will a black market for genetic information develop, and what can be done to stop it?