The first course of its kind in Israel opened last week at Beilinson Hospital to train doctors from various specialties in medical genetics, a field that has moved from the laboratories where gene therapies have been developed, to clinical settings where they can help diagnose and treat diseases - if the treating physician knows how.
The first students in the four-day course are 15 doctors on staff at Beilinson, not necessarily researchers. They are taking the course during working hours at no cost to them. Tel Aviv University's Sackler School of Medicine is considering joining the project, which will mean it can be expanded to additional hospitals.
"Many doctors encounter genetics for one semester early in their studies and finish their specialization 10 years later without the up-to-date genetic knowledge that is essential today for the diagnosis and treatment of many illnesses," says Dr. Idit Maya, a senior physician at the Raphael Recanati Genetic Institute at Beilinson, who initiated the new school.
Medical genetics is a specialty that is studied for two and a half years by physicians who are already specialists in their fields. Until two years ago, the studies were open only to physicians who had already specialized in internal medicine, pediatrics or gynecology, while other specialists, such as family physicians, oncologists and opthamologists, were not eligible. Now, any specialist may further specialize in genetics.
However, this is far from the situation elsewhere in the Western world, where physicians may chose genetics as their primary specialty after only two years of working in the field, and finish their specialization after a four-year residency.
Physicians in other specialties can learn from various sources about tests and imaging pertinent to their field. But in genetics, Maya says, physicians who want to learn more about genetic tests to recommend to patients have had no organized course of studies to which they can apply.
Maya says doctors should know how genetic mutations can affect a patient's response to the medications they prescribe, a field known as pharmacogenetics. Certain mutations, some of which are common in the general population, can significantly change the way a medication acts in the body and the way the body breaks it down and secretes it. Such mutations can affect the dosage a physician prescribes, Maya adds. For example, before taking the immunosuppressive drug Azathioprine to treat autoimmune disease, a test is now recommended to determine whether the patient is one out of every 300 people in the general population whose have a defect in a gene known as TPMT and whose lives could be endangered by taking the drug.
And the livers of people with a certain genetic mutation known as polymorphism might be unable to break down certain drugs commonly prescribed for heartburn or to inhibit the activity of blood platelets, which means that the drugs not enter their bloodstream in large enough doses to be effective.
Genetics are also involved in diagnosing diseases passed down in the family. The "Ashkenazi mutation" in genes BRCA 1 and 2 is known to increase the risk of breast cancer by as much as 70 percent. Other genetic mutations have been found to be common in other population groups.
Heart disease treatment can also benefit from genetic medicine. The Israel Heart Society has recommended since 2009 that people who have a relative who died young of a sudden heart attack undergo genetic testing. If they are found to be carriers of a certain mutation that increases the risk of an early heart attack, treatment is tailored for them to ensure a healthy lifestyle and proper medical follow-up.
Genetics training is particularly important for family physicians, says Maya, because they are "responsible for the patient's connection to the entire medical network and they should know medical situations each of which is connected to a different specialist but is based on a genetic common denominator. The flood of articles on genetic connections to disease is also a reason to make sure physicians are better educated in this field.
"Some doctors get enthusiastic over an article about a new gene and make decisions based on it, even if it's a small article from which no conclusions can be drawn," Maya says. "It is important to give doctors the tools to discern the information that is relevant to their field."
The course at Beilinson will also include ethics. A candidate for inclusion in this year's "health basket" - the medications and technologies covered by HMOs - is a technology called PGD, or Preimplantation Genetic Diagnosis, which screens an embryo created by in-vitro fertilization for genetic defects to prevent passing them down to the next generation. This year it is proposed to include testing for one of the "Ashkenazi genes" that causes breast cancer as well as genes associated with Alzheimer's.
"These are issues with ethical implications in terms of medical intervention in genetics and where to limit it," Maya says.