Wednesday, October 3, 2007
Lots of things have transpired since Sunday. I would like to say first, sorry for no posts since Monday. I was preparing for my presentation at the Connecticut conference for the American College of Physicians. Second, I need more submissions for the Genie this weekend. I will be hosting my second and am looking forward to reviewing some great posts. Third, Navigenics is ready to unleash its technology on some unsuspecting consumers in '08. I know at Helix Health of Connecticut we are ready for the wave of "What does this mean?" "What should I do health wise?" etc.etc. etc.
We just received a call from a wonderful consumer of the so-called SNP market for nutritional supplements. The big problem here is that there are SOME SNPs which actually predict risk for disease. But what do they get for a report? Eat more broccoli...Thanks.. I am scared that they don't understand about these "genes" really being a part of your medical record. Because some are as strong as a cholesterol panel in their ability to predict risk. The even bigger problem, most are not. And what happens when Navigenics gets out over the skis and says that they are? Who will be left to pick up the mess???? The fewer than 1000 geneticists? The PMDs who don't even have the training to comment on this? This is one of the major reasons why we are reaching out to educate PMDs.
I have a concern with Whole Genome Sequencing.....it really is just a snapshot in time. I emphasize the role of continuing evaluation of expression and epigenetic effects. Luckily, USC just received a bundle of dough to research and evaluate epigenetics. This is a great reason to have a continuity of care with those who have seen and attempted to interpret your genetic data. We can't keep bouncing this reductionist idea of "If we just have your genome, then we can help you live forever and cure all disease" at the market. This is what Francis Collins would call "Overselling the technology" Please answer my poll question "How much would you pay for the oversold genome?" Oops, I mean "The cutting edge achievement know as the Human genome. You should get yours done too."
I was warned by a friend of mine. He said "Shooting from the hip and having no planning of your posts is ONE WAY to blog. Another would be to plan and deliver a message." I say, why not do both. There is more than enough foolishness going on to point out. Let me know what you think.
While giving the talk today I was asked about how we can get physicians up to speed in genomics. I stated "We cannot, we have missed the boat. We were warned in 1993 and again in 2000. Medical schools never picked up the slack. Too few clinical geneticists in the basic sciences. Less than 40 Medical schools have defined courses in genetics. Up until the last few years it wasn't even a prerequisite for medical school. See the Banbury Summit. How can we teach those who never learned the language? Only one way, complete and total immersion. Much like how an adult learns a language. I have used vignettes that have clinical applicability. Unfortunately, this takes at a minimum 2 years to see any effect. If we were to do this today we might be able to make some inroads"
But physicians will not be ready for Navigenics. Boy, it sounds like this is an argument for "Direct to Consumer and Navigenics report based medicine" Well it is not why? What physician delivers care without a physical exam? One who is looking to get sued, that's who. Good luck to all the report makers. I hope you have an army of attorneys because malpractice coverage will not be enough.
The Sherpa Says: Thank you once again to Genome Technology Online I am very happy that they enjoy my musings. I hope my CGC friends did not get the wrong ideas. I am not bashing them, I am bashing the system. A system which I hope you will join me and fix.