Academic journal article Case Western Reserve Journal of International Law

Challenges for Implementing a PTSD Preventive Genomic Sequencing Program in the U.S. Military

Academic journal article Case Western Reserve Journal of International Law

Challenges for Implementing a PTSD Preventive Genomic Sequencing Program in the U.S. Military

Article excerpt

There is growing interest in using the quickly developing field of genomics to contribute to military readiness and effectiveness. Specifically, influential military advisory panels have recommended that the U.S. military apply genomics to help treat, prevent, or minimize the risk for post-traumatic stress disorder (PTSD) among service members. This article highlights some important scientific, legal, and ethical challenges regarding the development and deployment of a preventive genomic sequencing (PGS) program to predict the risk of PTSD among military service members.

Contents

I.   Introduction
II.  PTSD as Problem for Service Members and the Military
III. Scientific Challenges for PTSD Preventive Genomic
     Sequencing
     A. Psychiatric Genomics
     B. How are Psychiatric Genomics Addressing these Challenges?
     C. What about PTSD Genomics?
IV.  Legal Challenges for implementing a PTSD-PGS
     Program in the Military
     A. Equal Protection
     B. Invasion of Privacy: Lessons from DoD DNA Registry
     C. Unreasonable Seizure of Genomic Information
     D. Unreasonable Search of Genomic Information
V.   Ethical Challenges
     A. Unit Cohesion and Fair Distribution of Combat Risk
     B. During Active Duty, Training, or Recruitment?
     C. Genetic Essentialism and Post-Service Stigmatization
     D. Research Ethics Issues
VI.  Conclusions

I. INTRODUCTION

Technological superiority is an essential aspect of military readiness and effectiveness. To achieve this, the United States Department of Defense (DoD) invests approximately $70 billion each year in research, development, test, and evaluation programs. (4) These investments advance technologies that range from precision strike weapons and unmanned vehicles to environmental quality and medical technologies. (5) There is growing interest in using the quickly developing field of genomics to contribute to military readiness and effectiveness. (6) Specifically, influential military advisory panels have recommended that the U.S. military apply genomics to help treat, prevent, or minimize the risk for post-traumatic stress disorder (PTSD) among service members. (7) This article highlights some important scientific, legal, and ethical challenges regarding the development and deployment of a preventive genomic sequencing (PGS) program to predict the risk of PTSD among military service members.

The field of genomics examines the informational content and functional dynamics of the genes that make up the human genome. An important endeavor in genomics is the identification of genetic variants indicating that an individual is at an increased risk of developing a poor health outcome, such as different types of cancer, heart disease, diabetes, and mental health disorders. Recently, the development of massively parallel DNA-sequencing technologies (MPS) has fueled progress in genomics by allowing the sequencing of numerous genes at a time and decreasing the cost of sequencing an individual's genome. (8) MPS has made whole genome- and whole exome-sequencing (WGS/WES) more accessible to researchers and clinicians, which is quickly expanding the medical community's understanding of the genetics of certain diseases and the potential applications of genomic technologies to both the civilian and military contexts.

DoD has long demonstrated an interest in implementing genetic technologies in the military. To date, DoD has implemented a successful DNA registry for identifying human remains, and routinely screens service men and women for genetic conditions such as sickle cell anemia and Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency. (9) The recent surge in WGS/WES research has further increased DoD's interest in applying genomic technologies to the military context. In 2010, the JASON Defense Advisory Panel released a report on the opportunities and challenges of WGS/WES technologies for the military. (10) The JASON report's major recommendation was a call to action:

   The DoD should establish policies that result in the collection of
   genotype and phenotype data, the application of bioinformatics
   tools to support the health and effectiveness of military
   personnel, and the resolution of ethical and social issues that
   arise from these activities. … 
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