by Ronnie S. Stangler, M.D.
Imagine a seemingly healthy 35-year-old family member assumes the CEO position of a core global family enterprise. On the second day of his tenure, he sustains a cardiac arrest and dies immediately. Could the risk of his tragic death have been mitigated using currently available actionable DNA science of genomics?
The answer is resoundingly YES.
In a recent new year’s letter to family and friends, Bill Gates stated: “the promise and perils of genomics is the single most important public conversation we are not having today.” I would posit that genomics is also the single most important conversation wealthy families are not universally having today.
We have entered the “Age of the Genome”. Over the next decade, global families, family offices and family enterprise will gain increasing access to clinical applications of the cutting-edge sciences of genomics and epigenetics. These sciences will be critical in assisting early adopter families and their advisors to make informed decisions which enhance health, mitigate risk, and promote enduring family legacy. A few key definitions may be helpful.
Genetics is the study of heredity and individual genes which have long been understood to be a major determinant of health and well-being. Many of us learned about genetics in high school biology, studying Mendel’s pea plant experiments of the early 1860s.
Epigenetics is the unseen biological process by which our genes are turned “on” and “off”. It involves changes in our biology caused by modifications in gene expression, rather than the underlying genetic code itself. Factors that influence our epigenetics include diet, physical activity, alcohol consumption, psychological and spiritual well-being, stress, and environmental toxins.
Genomics is the study of all our genetic information. Today, we can map and analyze the entirety of an individual’s genome through a process called whole genome sequencing. This technology is redefining our approach to health fostering precision medicine and disease prevention.
Introducing DNA Sciences to Families of Wealth
Genes have always influenced family health and well-being. However, today, we can see our genes, understand them and take positive action
The importance of studying all of our genes through genomic analysis is that most inherited traits (e.g., height, intelligence and athletic ability), most common medical disorders (e.g., heart disease, diabetes and obesity) and most emotional and psychiatric conditions (e.g., anxiety, depression and mood disorders) are a function of many genes acting together in conjunction with their surrounding environment. Increasingly, we are able to recognize these clusters, generate “polygenic risk scores” which dictate specific medical and lifestyle interventions.
Many wealthy families have preliminary familiarity with DNA sciences through investments in biotechnology and the like. However, for many families and the systems that support them, the introduction and personal application of complex DNA sciences presents a compelling but confusing puzzle. Genetics, genomics and epigenetics are fast-moving, technical fields with powerful implications affecting families now and across generations.
In the late fall of 2020, Harvard Business School presented in its Executive Education Program for Family Offices the first case study of “Genomics in the Family Office”, co-authored by Lauren Cohen, Ph.D. and Dr. Stangler. The case profiled a prominent Israeli family challenged by a rare genetic disorder and addressed its impact on family dynamics, health planning, and philanthropic strategy. The novel concept of a Family Genomics Charter was introduced and served as stimulus for provocative group discussion.
Genomics absolutely belongs in today’s boardroom – not merely as an investment vehicle. Genomics offers critical actionable information to protect family health, enhance human capital, and support success of family enterprise, so inextricably linked to family health.
Wealthy Families Face Unique Challenges
The wealthy represent a population with the same concerns about health and genes as all others. Yet, factors in their environment additionally generate unique concerns. The terms “family office”, “family enterprise” and “family legacy” convey the requisite focus on all that is “family” – and genomics permeates and influences all aspects of family.
In the past, traditional family offices have typically focused on matters related to wealth preservation, succession planning and growth of financial capital. Today’s modern family offices have evolved to serve families in more diverse, multifaceted, high-touch and personal ways, including the protection of family health. In the end, “health is wealth” (Emerson, 1860).
As genomics infuses and guides all aspects of health and well-being, reproduction, and relationships, even the most traditional domains of family advising will be affected by this science. Knowledge of genomics and epigenetics and its impact on families is now part of an essential toolkit for the trusted family advisory.
Enhancing Family Health
The human capital of a family is the totality of health, well-being, reproductive vitality, and longevity of its family members. Understanding one’s genes and their interaction with the environment has been shown to spur better life choices and planning, inform personalized medical care, radically alter reproduction options and extend healthy lifespan.
Proactive sequencing of family members to identify risk factors is proliferating exponentially, as the cost of sequencing continues to decrease over time, and as the population moves to shift focus from treatment to prevention.
Risk mitigation is a core responsibility of family advisors. But risk must be recognized as not only a threat to financial capital, but to human capital, as well. If it is discovered through genetic testing that a family member has a significant likelihood of imminent disease, reconsideration of future planning may be profoundly affected (e.g., financial projections, trusts, even business roles). Others in the family may be unknowingly affected, as well. Genomics is not a solo sport. One small example of many actionable risk mitigation strategies: pharmacogenomic profiles may reveal an increase or decrease of adverse response to particular medications (e.g., aspirin, for instance, increases, rather than decreases, cardiovascular risk for some known genetic variants).
Promoting Enduring Family Legacy
Genomics is already becoming an essential component of family philanthropy portfolios in highly individual ways. Catalyzed by new knowledge of personal genetic vulnerability, families of wealth are choosing to devote significant resources to support bench science to treat and even eliminate disease.
When Sergei Brin, Co-Founder of Google, learned about his vulnerability to Parkinson’s disease, he radically altered his philanthropic strategy to support bench science within the field. Having changed the way the world searches the internet for information, he has literally changed how science approaches this terrible disease.
With financial resources and moral compass, the wealthy have the potential to become transformative hyperagents of change, fundamentally reshaping the world.
Knowledge of genomics and epigenetics and its impact on families is now part of an essential toolkit for the trusted family advisory.
Six Ways Families Can Start Engaging Safely with DNA Sciences
Promote education and buy-in
• Family education and buy-in are essential components for any new project. Create conditions for frank, informative dialogue about genomics at your next family meeting. Begin a basic education about fundamental scientific principles and, most importantly, convey the reality of a shared family destiny. Identify real opportunities to enhance health, mitigate risk and promote legacy within your family ecosystem.
Spearhead discovery projects
•. Nominate someone within the family or family advisory to spearhead new projects related to genetic discovery. Ideally, this would be someone with a purview of all family health matters. Consider what external resources might be necessary at the onset for ongoing medical/scientific counsel and updates in real time.
Create a family genomics charter
• Consider what necessary ingredients might form part of a Family Genomics Charter to guide ethical decision-making now and in the future. Each family’s ethical considerations should be guided by family values, culture, religious preferences and family traditions.
Conduct due diligence
• Reject the use of inferior and high-risk direct-to-consumer genetic testing products and partner with trusted medical professionals to conduct whole genome sequencing in a safe and controlled manner.Education about options and value of genetic analysis
Education about options and value of genetic analysis
•. Empower family members to nurture their genes for a lifetime of greater health fostered by an understanding of science carefully translated into practical terms they can understand. Employ biological age testing to assess cumulative rate of aging and measure improvements in health and function over time.
Investigate stem cell banking
•. Investigate banking of stem cells of family members as early as possible so they can avail themselves of radically new medical treatments that are yet to be fully developed. Consider that “real” insurance for ultimate protection.
Towards an ethical blueprint
Families of wealth, family offices and family enterprise are already benefiting from the gifts of genomics and epigenetics. These disruptive, deeply intimate human sciences offer us a pathway to an extraordinary future through elimination of malignant disease, enhanced well-being, healthy longevity and human optimization.
With new knowledge and opportunity comes new fiduciary responsibility to protect the lives of our family and of those we serve. Empowering families with actionable knowledge of genomics and epigenetics, and co-creating a blueprint for its ethical application, allows us to shape our most powerful legacy and future.
This article was written by Ronnie S. Stangler, M.D., for &Simple, published on January 21, 2021.