Science, Society and the Supermarket: The Opportunities and Challenges of Nutrigenomics Book

Preface     ix
Acknowledgments     xi
Nutritional Genomics: Opportunities and Challenges     1
Introduction     1
What is Nutritional Genomics?     3
Methodology and Approach of this Book     6
Opportunities and Challenges for Nutrigenomics     8
Improved health     8
Personalized dietary advice     10
Improved diet     11
More development of health-enhancing food products     12
Consumer empowerment     12
Reducing health disparities     13
Health care savings     14
Challenges and a Road Map of This Book     14
References     16
The Science of Nutrigenomics and Nutrigenet1cs     19
Introduction     19
The Scientific Context     22
Nutrigenomics     24
Nutrigenetics     27
The Case of MTHFR     30
Room for Improvement     33
Study design     34
Epigenetics     35
SNPs and haplotypes     35
Dietary intake assessment     36
Biomarkers     36
Susceptibility and predictions     37
Analyticaland clinical validity     38
Clinical utility     39
Science and Technology Assessment     39
Conclusion     42
References     43
The Ethics of Nutrigenomic Tests and Information     49
Introduction     49
Ethical Principles     52
Nutrigenomics Testing in the Clinical Setting     55
Informed consent     55
Confidentiality     56
Secondary information     56
Families     57
Genetic testing of children and adolescents     59
Use of Nutrigenomics Information for Research     61
Use of Nutrigenomics Information by Private Third Parties     63
Insurance     64
Employment     69
Legal and social responses to fears of discrimination     71
Conclusion     72
References     73
Alternatives for Nutrigenomic Service Delivery     77
Introduction     77
Considerations for Nutrigenomic Service Delivery     80
Strength of the science     80
Regulatory environment     84
Human resource capacity and professional competence     84
Funding policy      85
Professional politics and culture     86
Consumers and patients     86
Four Alternative Models     87
Consumer model     87
Health practitioner model     93
Blended models     100
Public health model     103
Conclusion     106
References     107
Nutrigenomics and the Regulation of Health Claims for Foods and Drugs     111
Introduction     111
Genetic tests, service delivery, and genetic antidiscrimination     113
Food Categories: Functional Foods, Nutraceuticals, Medicinal Foods, and Dietary Supplements     115
Functional foods     117
Nutraceuticals     118
Medical or medicinal foods     118
Dietary supplements     119
Health-Related Claims Associated with Foods Compared to Drugs     119
Structure-function claims     120
Health claims     120
Medical food claims     120
Disease risk reduction claims     121
Nutrigenomic Information and the Regulation of Foods Compared to Drugs     121
The regulation of foods     122
The regulation of drugs     123
Food and Drug Regulations in Japan, the United States, and Canada     124
Japan     125
United States     126
Canada     127
Conclusion     129
References     130
Nutrigenomics: Justice, Equity, and Access     133
Introduction     133
Industrialized Country Context     135
Individualized nutrigenomic testing     135
Population-based nutrigenomics     136
Developing Country Context     137
Individualized nutrigenomic testing     137
Nutrigenomics and Intellectual Property     143
An issue of access to scientific information     146
Conclusion     147
References     148
Conclusions and Recommendations     153
Introduction     153
Nutrigenomic science     154
Nutrigenomics and health information management     155
Nutrigenomic service delivery     155
Regulation of nutrigenomics     156
Access and equity     157
A Final Word     158
Index     161