Tuesday, November 13, 2007

Updates from the Burrill Conference

Lo and Behold, the Sherpa goes looking for some updates, Epidemix and Wired deliver. My favorite line from Wired is

"Early medical testing and treatment could save patients and healthcare providers a ton of money, but nobody wants to pay for unproven and often expensive new lab work. FDA approval is not required for laboratory tests, but it is an indicator that products are actually beneficial to doctors and patients."

The best lines from Epidemix are

We’ll see about that - but there were three telling stats that came up during the day. Together, they make quite the case for personalized medicine.

1) Half of all prescriptions don’t work for the patients. Most drugs have an efficacy between 20 and 80 percent, averaging around 50 percent. Meaning that they only have their intended effect half the time. That might be awesome in baseball, but it’s hardly reassuring in medicine.

2) Chemotherapy is effective - defined as remission - in just 5 to 10 percent of breast and colon cancer cases. This is likewise startling (the stat comes from Randall Scott of Genomic Health). And factor in the fact that chemo costs about $30,000 per patient per year, and there’s a massively inefficient treatment module out there.

3) Six weeks - that’s how long it takes, give or take, for a physician to determine whether a given antidepressant is working for a patient. And given that only half of drugs work, that’s a rather long time for a patient to go effectively without a treatment for their depression or mental illness. (This from Wolfgang Sadee, chair of the pharmacology department at Ohio State).

But what is most exciting about the conference is the attention that was purported to be spent on predicition, prevention and personalization. This is what the essence of personalized medicine is.

Personalization includes face to face care and the ability to ask questions. Not questionnaires that give you incorrect guidance. No amount of computer work can give you the face to face communication. Here is an example of preposterous questionnaire results.

If I was a 40 year old woman with no first generation history of breast cancer, but had a more distant relative with breast cancer after 50, HH's position and that of the literature is that you probably shouldn't have BRCA testing as the likelihood is very low.You may ask why and spend time with us going over why we think so. But in a questionnaire the answers are often yes or no. Much like the one I just filled out. Don't believe me? Try it yourself

Direct sequencing is probably not the best "test" to detect and prevent breast cancer, a mammo is. And it certainly is tricky how this info comes up first, rather than the next screen where it says this test may not be appropriate for you. A questionnaire is only as good as the answers they provide....

The Sherpa Says: In the scramble to make money off of genetics the consumer should make sure they get what they pay for. If the cost is cheap, it probably means the same for the service....... I hope the public can understand that. Thanks to Wired and Epidemix for the great posts. I look forward to hearing the rest of the conference tid bits! Oh, and shame on those little questionnaire writers.....Did you really think someone with genetics training wouldn't pick up on that?

1 comment:

Hercules said...

What a super useful post! The Burrills conference notes were very helpful. Then Mrs. Shmoopie sat down and did DNA Direct's questionnaire (from your link), without intervention from a health professional, oooh!) She was recommended the "full blown" $3400 screening, so she will pass and stick with her mammos for now -- plus the DNADirect website blows up when she tries to save her questionnaire: not exactly a vote of confidence, perhaps someone should mention it to Hsien!