Unsettling medical memoir by a worried-but-still-well journalist who carries a breast-cancer gene.
Gessen (Ester and Ruzya: How My Grandmothers Survived Hitler's War and Stalin’s Peace, 2004, etc.) has steeped herself in genetics lore—and conjecture—in this wide-ranging account of genetic information past, present and future. Her own story is often the focus, as she relates the deaths of her mother and other relatives from breast or ovarian cancers and traces the inheritance of the BRCA1 gene to her great-great-grandmother. The mother of one adopted and one biological child, she is considering having another baby, but the genetic counselor she consults advises an ovariectomy and perhaps a double mastectomy. As Gessen wrestles with decision-making, the text increasingly leans toward a deterministic view of genetic destiny: The BRCA genes do not simply increase the odds of cancer; they cause it, with more stubborn forms occurring at an earlier age. This pessimism colors her account as she reviews the history of genetics from the horrors of eugenics and Nazism to the discovery of the gene for the sickle-cell trait, which persists in the population because it increases protection against malaria. There is much discussion of Ashkenazi Jews and their genetic load of diseases, as well as the genetic problems of other groups. She lauds the clinicians who work with Amish and Mennonite groups in Pennsylvania, developing diets to stave off the worse effects of inherited metabolic diseases. Gessen rightly addresses such issues as the reliability of the new genome-testing firms and the value of tests in cases like Huntington’s, where the disease is inevitable but as yet untreatable in carriers. But the text is again disturbing as she moves on to discuss controversial behavior-related genes, even pondering whether her young son’s Russian heritage may make him vulnerable to alcoholism.
Credit Gessen with absorbing gobs of information, but this is a case in which a little learning may be a dangerous thing—for the author and her readers.