Why Genetics Matters More Than Ever: Dr. Annie Hasan Explains

From the moment Dr. Annie Q. Hasan read her first high-school chapter on heredity and variation, she knew she had found her calling. “I was always interested in genetics even when genetics hardly existed in Indian medical colleges,” she says. Long before clinical genetics became a recognised super-speciality, she had already chosen it as her life’s work.Her journey began at the Centre for Cellular and Molecular Biology, one of the best places to do molecular biology in Asia, where she completed her early research and later a PhD in Genetics. What followed was nearly a decade abroad as an exchange scientist in New Zealand, working at Wellington Medical School, and later with leading institutions in the US. But even as her research career flourished, one thought persisted: genetics, she felt, belonged not just in laboratories, but in day-to-day healthcare.“I always wanted to bring genetics to the clinic,” she says. That opportunity arrived in the year 2000, when she returned to India and established genetic diagnostic and testing services across three hospitals. The more she worked with clinicians and families, the clearer it became that India needed not just more testing — but the people who could interpret it. “Medical genetics is barely covered in our curriculum,” she explains. “We needed professionals who could bridge the gap between clinicians, patients, families, policymakers and the genetic tests. That is why genetic counsellors are so important.”At the time, India had none. So she helped build the first full-time genetic counselling programme in the country, a field she continues to nurture. “Since 2001, Kamineni Hospitals has encouraged me to do everything — diagnostics, research, and training,” she says. Every year, she brings students from across India, hoping they will return to serve their states. “But as you know, most prefer the metros,” she says, matter-of-factly.Over the years, genetics has quietly moved into mainstream clinical practice — especially in paediatrics, oncology, gynaecology and neurology. And yet, patients still wonder why genetic testing is not included in routine master health check-ups. Dr. Hasan is practical: “It’s still expensive, but costs are falling. The test we did for ₹35,000 in 2014 is now under ₹15,000. As the price drops, it will become part of routine care.”Some tests, she believes, should be routine already — especially pharmacogenomics, the study of how our genes affect our response to medicines. “People take so many medicines. Why not check whether they help or harm?” she asks. At Kamineni, pharmacogenomics has guided transplant and cardiac treatments since 2006. In transplants especially, “the right dose can only be found by looking at the person’s genes,” she explains. “Too low a dose and the organ is rejected; too high and it causes toxicity.”It’s a reminder that genes silently influence much more than people assume. “The analogy is simple,” she says. “Genetics is a loaded gun; lifestyle is the trigger.” Some traits are entirely genetic — like certain forms of dwarfism, where one variant can override all other healthy genes. Others are polygenic, shaped by multiple genes and lifestyle together. She gives examples everyone relates to: families where obesity appears across generations, or individuals who eat little and still gain weight. “That’s genetics,” she says. “Some genes predispose people to require less food. Indians, in fact, are known to have ‘thrifty genes’ — we traditionally managed with less food and more physical activity.”Even common conditions like thyroid disorders have genetic components. “Excess iodine may play a role, but not everyone develops hyperthyroidism. Genes decide who is susceptible,” she explains. And what about genetic disorders appearing suddenly in a family? “It happens more often than people think. A baby develops from a single cell to billions. During cell division, errors can occur. A ‘de novo’ mutation means the child is the first in the family to have that genetic change.” One example she gives is NF1, a condition causing skin nodules. “Nobody else in the family may have it, but once the child has the mutation, it can be passed to future generations.” Cancer genetics, too, raises difficult questions. If someone carries a cancer gene, does it guarantee cancer? “Not at all,” she clarifies. “It increases lifetime risk. A person with a BRCA1 mutation may have an 80% lifetime risk of breast cancer — but lifestyle and other modifier genes may decide when or if it appears.” Knowing the risk, she believes, is powerful. “You can monitor, prevent, intervene earlier. It gives people control.”Next-generation sequencing has transformed this landscape. Earlier tests looked only at chromosomes. “NGS (Next-Generation Sequencing), allows us to look at all 20,000 genes,” she says. But it also brings complexity — because not all genetic differences are harmful. “Bioinformatics helps us separate disease-causing changes from harmless ones.” As for the right age to test? “It depends on the condition,” she explains. Pregnancy has its own panels. Infants can undergo newborn screening. Adolescents may be tested for conditions that begin in youth. Pharmacogenomics can be done at any age. And while some countries sequence newborns at birth, she believes India needs a phased, need-based approach due to its size and resources.Yet, despite these challenges, her optimism endures: “Genetics will eventually become a part of every person’s healthcare story.”



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