2 min read
The founders of Israel dreamed of "ingathering the exiles". It is safe to say they never realised the complex medical challenges that came with this.
With so many Jews in Israel from so many places in the world, the medical system needs to provide ultra-tailored genetic services and screening to prevent conditions that can be specific to people whose families come from a certain country, or even city.
To add to the complexity, the Israeli health system also looks after a large Arab population, which faces genetic conditions that can be specific to a single village, tribe or extended family. Marriage between cousins is still seen in this population and further complicates the challenge.
But screening programmes are succeeding. Cost has mostly been taken out of the equation. Based on the fine details of who patients are and where their families come from, doctors calculate which genetic conditions could affect their children.
They can then have free testing for any gene they have a one-in-60 chance of carrying. For genes they have a one-in-150 chance of carrying, screening is heavily subsidised.
Cost has mostly been taken out of the equation
"This is much more than is commonly offered in most of the world," says Hagit Baris Feldman, head of the Genetic Institute at Haifa's Rambam Health Care Campus.
She considers Israel to be "one of the leading centres in the world in terms of pre-natal genetic screening and testing", noting that in contrast to some countries "it is not only something taken up by higher social classes but by all population groups".
Dr Baris Feldman also notes the widespread education around screening. A lot of thought goes into maximising take-up in communities with special sensitivities. Charedim, for example, widely accept a testing programme which keeps all results secret to avoid stigmas for carriers, only stepping in if a prospective bride and groom are both carriers of the same gene.
And for Arabs, mobile clinics are taken to villages to raise awareness and motivate people to get screened.
The success of the screening is due, in part, to the confidence couples have that if they do get tested and find they are carriers, the state will help them find a solution.
State-funded testing allows fetuses to be checked at the first opportunity, and for those reluctant to consider testing and terminating - common in a society with many who are traditional or religious - there is easy access to embryo screening.
The New York Times has described Israel as the "world capital of in vitro fertilisation", with free and heavily-subsidised reatment given to couples to have several children. Labs which screen IVF embryos before transfer to the prospective mother are highly developed, the whole service is available without charge and public confidence in IVF is high.
Dr Baris Feldman believes the tackling of Tay-Sachs shows the impact of screening. "I have never seen any Ashkenazi Tay-Sachs case," she says, describing the longstanding testing to identify carriers of this disease as a "sure success".
The question now is whether this success can be replicated with other Ashkenazi conditions, with disorders affecting non-Ashkenazi Jews, and with Arabs. She is "very optimistic".
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