It's All Relative
So your second toe is longer than the first, and you have 17 freckles across the bridge of your nose—your grandpa does too. And those gray flecks in your hair and your nearsightedness may indicate much more than a passing resemblance to your mom or dad. The hodgepodge of traits inherited from your parents and grandparents help make up your physical identity. Unfortunately, your ancestors may have passed along some unhealthy traits as well. Discovering what those are could one day save your life.
The fact that your grandmother died from complications of diabetes or your father suffered from high blood pressure from the time he was 22 is part of the complex network of information that makes up your family medical history. Both conventional and holistic doctors place a high value on this information, but not necessarily for the same reasons. While Western docs focus on your disease history to help with a diagnosis and perhaps get a jump on certain conditions, integrative physicians view that information in the context of your current physical, mental, and emotional health as well as your lifestyle choices (past and present).
Family background should be just one consideration among many other physical and emotional clues that help a doctor determine what is happening in a patient’s body, says Jerry Kantor, LAc, an acupuncturist and homeopath in Wellesley, Massachusetts. “I can learn something from a mole on your skin that I can’t find out from your genes,” he says. “Something from a family history may suggest [a propensity for a certain illness], but it’s not the only determining factor.”
As a means of early diagnosis or prevention, many conventional doctors endorse advanced screenings for patients with a family medical history of diseases like heart disease. Unfortunately, some doctors go one step further and prescribe cholesterol-lowering drugs, known as statins, to patients with a family history of high cholesterol—just in case.
Kantor disagrees. He doesn’t believe in prescribing preventative medication or even screening for genetic diseases strictly because a patient’s family medical history indicates a risk. “Everyone is an individual in integrative medicine. We don’t believe disease trumps the individual,” he says. “If there were diseases independent of the person, I would never have to see anyone in my office.”
Despite their differing philosophies on how to use family medical history, most doctors encourage their patients to gather as much information as they can on the diseases and conditions their parents, siblings, aunts and uncles, and grandparents may have faced in their lives.
“From an integrative standpoint, I definitely value family medical history—it alerts me to the connection [the patient has] to certain conditions like diabetes,” says Robert Weissberg, MD, who runs two holistic medical practices in New York State. Integrative and conventional doctors look for single-gene disorders, such as cystic fibrosis or sickle cell anemia, which have a clear pattern in a family. They also check for chronic conditions such as heart disease and diabetes, which don’t have clear patterns but may show a trend among family members.
Catching diseases before they become advanced has always increased a patient’s chance of survival, and a family history may help doctors diagnose a disease faster and start treatment earlier. It can also encourage patients to create a healthier lifestyle. If a patient is concerned about diseases lurking in her family tree, Weissberg will advise her to modify her eating habits, exercise routine, and environment. People should focus on what they can do to control their health and future, says Weissberg, rather than dwell on the likelihood of contracting a specific disease.
Not everyone feels safe sharing, however, because insurance companies and employers have sometimes discriminated based on genetic information. Luckily, that’s all changing. Just last May, Congress passed a long-awaited measure called the Genetic Information Nondiscrimination Act (GINA), which protects Americans against such discrimination.
Whether or not family medical history has any impact on your lifestyle decisions, just talking to your doctor about it can strengthen the patient-doctor relationship, according to Weissberg, because it helps him or her learn about your physical makeup as well as what’s going on in your mind.
Tree of knowledge
Even though 96 percent of Americans believe they should know their family history, just one-third have ever tried to gather and write it all down. To help motivate them to start, the surgeon general declared Thanksgiving Day as National Family History Day in 2004.
While you don’t want to put a damper on a happy occasion, using part of family holidays or gatherings to ask questions about your family’s medical history makes sense, says Thomas Shawker, MD, author of Unlocking Your Genetic History: A Step-by-Step Guide to Discovering Your Family’s Medical and Genetic Heritage (Thomas Nelson, 2004). “A lot of people don’t like to talk about what runs in the family out of the blue,” says Shawker. “So the government picked Thanksgiving when relatives traditionally come together.” But choose any time that feels comfortable for you and your family to talk openly about health habits and illnesses. Use this five-step approach to gather, record, and interpret your family medical history.
1. Ask the right people. It may seem quite daunting to interview all 400 of your relatives, but there’s no need to do that. The most important information comes from your first-degree relatives—parents and siblings—and second-degree relatives—grandparents, aunts, and uncles, Shawker says. If you discover, for example, that your aunt had a
particular illness, ask your family how old she was when the diagnosis was made and, if applicable, when she passed away.
2. Ask the right questions. Find out as much detail as you can. “Your father might tell you that his mother died of cancer. But that doesn’t really help you,” Shawker says. “You need to know what type of cancer and how old she was when she died.” It can also help to know the health habits his mother maintained. What was
her diet like? How often did she see a doctor? Did she exercise regularly?
3. Write it all down. You can do it the old-fashioned way and draw out your family tree on paper, although with a large family, that can become unwieldy and impractical. Dozens of online options can help you compile a personalized family medical history within a matter of minutes (see “Virtual Pedigree” on page 50).
4. Share your work with your doctor. Whether you see an acupuncturist, a homeopath, or a conventional doctor, share your research with her. Even if your findings turn up very little, she may see something you do not. Or if you have turned up a significant history of disease in your family, your doctor may put your mind at ease by suggesting specific changes you can make to your diet, your environment, or your lifestyle to circumvent your genetic makeup.
5. Put it away. After you’ve recorded your family medical history and shared it with your doctor, don’t dwell on it, no matter what you find. If you spend time and energy worrying about a disease you might get, it could become a self-fulfilling prophecy.
“Sometimes people see themselves as being fated to contract a particular disease, so they talk themselves into it,” Weissberg says. “If people prepare themselves for that, they can help produce conditions through their own worry without realizing it.” Other times, patients think they need to be overly aggressive to avoid disease. “You could just say, ‘I’m going to have my breasts taken off so I don’t get breast cancer because my mother and aunt had breast cancer,’” he says. “Or maybe you can look at changing the way you live and act to move in a healthier, more positive direction.”
Your family and your genetics give your body building blocks, but ultimately, you play the role of architect—envisioning and constructing your health to its best potential.
Jessica Downey is a freelance writer in Doylestown, Pennsylvania, who hopes she doesn’t inherit her mom’s neuroses or her dad’s hairline.
Not Just a Phone Call Away
Family medical history doesn’t become less important when you can’t reach your family—just more challenging. If you are adopted, estranged from your family, or have relatives who are deceased, these steps can get help.
Find people to help you. If you need to start from scratch, especially in the case of adoption, start with the Child Welfare Information Gateway (childwelfare.gov). They may be able to locate your birth family’s medical records or point you in the right direction. If the agency can’t unseal your records because of state laws or can’t locate the information, a lawyer can help you gain access to adoption papers or medical records.
Become an amateur genealogist. “Start by finding out where your parents (or grandparents) lived and when they died. You just have to dig,” says Thomas Shawker, MD, author of Unlocking Your Genetic History (Thomas Nelson, 2004). “Usually you can find the cause of death on the death certificate. It may list cause of death as one thing, but it may also list a secondary cause like diabetes.”
Create your own history. Sometimes you may run up against insurmountable obstacles, says Robin L. Bennett, author of The Practical Guide to the Genetic Family History (Wiley-Liss, 1999). If that happens and the search becomes too frustrating or emotional, don’t worry. Instead, she says, “let the family history begin with you.”
Want to start building your family health tree? These online resources make it easy
My Family Health Portrait. Using this site, you can specify the conditions you want to track and answer the questionnaire one family member at a time to get a customized pedigree. If you have the information at your fingertips, you can create a complete family tree in less than five minutes. This site also lets you view your data as a chart, a drawing, or a PDF. familyhistory.hhs.gov
The Generations Network. With links to a number of sites, including myfamily.com, ancestry.com, and genealogy.com, the Generations Network provides comprehensive information on creating a pedigree, software downloads for building one online, and valuable advice for finding and storing information. Ancestry.com offers a DNA search engine, which helps you search for potential relatives and answers some of your questions regarding DNA testing. tgn.com
My Heritage. A group of people with a passion for genealogy created this site that gives users access to family tree–building software, the ability to create a public or private family website, and a photo-archiving component that lets you attach images to your family tree. myheritage.com