Tuesday, June 24, 2008

Burrill Report....deCoded

Consumers are worried about developing genetic based diseases, but remain reluctant to use genetic tests that will provide early warning signs.

That is the lead statement in the executive summary from the Burrill and Company Personalized Medicine and Wellness report issued last week. Many may ask "What's this report have to do with me?" many have even doubted the validity of the report in favor of the blogosphere......In the arena of Genomic Medicine, I would say the blogosphere is pretty one sided.....IN fact, that is why the Sherpa is popular. Until I started blogging, this place was pretty much a mutual admiration society. Further proven by the backlash I received when I said that governmental regulation was coming and then came.

So let's go back to the poll.....

Second Line

Companies need to make the case for the benefits of testing, allay privacy concerns, and would be wise to work through doctors.

We have known this in Medical Genetics for a very long time. If you have counseled anyone, you know these concerns to be true.....

Only one in five consumers said it was very likely (5 percent) or likely (15 percent) that they would get a test in the next few years to measure their genetic risk for certain diseases.

This is a point of contention between Daniel and Me.......He says 20%......I say 5%....

Why? Only the very likely will get the test. It is just like a referral to see another doctor.....if you aren't feeling ill, only the very likely will ever go see that specialist.....It is called the attrition rate and is commonly understood in medical care......only 20% of your "presymptomatic ill" ever go see the referral.

So, I remain certain, the market for these tests is 5%

Just 4 percent of those surveyed said they have ever had a genetic test to determine their risk for a particular disease, but two-thirds of those who did so because it was recommended by a doctor.

My guess is that these patients received BRCA testing. What this doesn't say is who ordered the test and was it done DTC versus through a physician. Did the other one third "Ask" a physician for the test? The most likely reason a physician orders a genetic test? You Guessed it "Patient Request"

I don't believe all of this self reported survey (Physicians never like to look out of the loop) but the most likely reason to test is pretty strong.

Factors associated with ordering or referring included practice location in the Northeast [odds ratio (OR), 2.30; 95% CI, 1.46-3.63%],

feeling qualified to recommend CSTs(cancer susceptibility tests ) (OR, 1.96; 95% CI = 1.41-2.72),

receiving CST advertising materials (OR, 1.97; 95% CI, 1.40-2.78%),

and most notably, having patients who asked whether they can or should get tested (OR, 5.52; 95% CI, 3.97-7.67%).

It Trumps Feeling Qualified!!!! Even Myriad knows this!

So with this in mind, let's go back to the Burrill Report.

What About GINA????

only just over a quarter of respondents (28 percent) said the passage of GINA made it significantly more likely (7 percent) or somewhat more likely (21 percent) that they would undergo genetic testing. A total of 68 percent said the passage of the law would have no effect on their decision to get a genetic test.

Remember the rule of attrition......that to me states only 7 percent feel more likely to test.....But the physician recommendation may alter that a little bit....not alot, but a little. We saw a spike at Helix Health of Connecticut....so I know this must be influencing some....

SO Who did the report?

The survey, conducted through ChangeWave’s proprietary network between May 27 and May 30, 2008, is based upon responses from 550 consumers.


Nearly 3 out of every 5 members have advanced degrees and 93 percent have at least a four-year bachelor’s degree. This is a proprietary network of more than 15,000 highly qualified business, technology, and medical professionals in leading companies of select industries—credentialed experts who spend their everyday lives working on the frontline of technological change.


These results represent the first part of a three-pronged benchmark personalized medicine and wellness survey that is being undertaken by Burrill & Company. Companion surveys of physicians and industry professionals will be joined with this study for the final report, which will be made available this summer.

I found this article in 2007 by David Ewing Duncan very useful. The Quote from Lee Hood and then from David Altshuler both physicians.....

David asked Lee who has met with Google and has long been a maverick bridging the worlds of biology and I.T., "do Web entrepreneurs truly understand the limitations and pitfalls of this science?"

“They absolutely do not,” Hood says. “The heart of predictive medicine is in getting clinical validation and working out the fundamental biological systems—how genes and proteins and other elements interact. I don’t think that most of the Web 2.0 crowd entirely gets this.”

The he asked David what value do you see?

Critics also see little value in testing healthy people for a wide range of possible diseases. “We don’t take an M.R.I. for everything, and I don’t order every test for every person,” says Harvard geneticist and physician David Altshuler, a key figure in the Human Genome Project. “Those who do are scamming people. It’s the idea that just knowing something is useful—well, maybe, maybe not.”

I wonder what the physicians poll will show????

The Sherpa Says:

The writing is on the wall....Despite what the blogosphere says.....if these guys have 15000 members, why poll just a paltry 550? Because all they needed for an effective sampling WAS 550....We are not talking about a study to establish linkage here ladies and gentlemen...we are talking polling....much like political polling they only need a good sample....unlike(No offense) the skewed sample in the blogosphere. To Industry I say, get to know your doctors. There is a reason why Myriad is so successful......


Daniel said...


Both the blogosphere and the Burrill & Co sample are biased; they're simply biased in different ways. For the record, I've never claimed that the blogosphere is an unbiased barometer of the personal genomics market as a whole.

Anyway, I don't want to get too bogged down in this debate, but I think there is one point here that is worth discussing: the potential size of the personal genomics market. You argue:

Only the very likely will get the test [...] So, I remain certain, the market for these tests is 5%

Right now, public awareness of DTC genetic testing is pretty minimal. That's changing fast, though: any of us with the appropriate Google news alerts set up have seen the recent spikes in mainstream media coverage of the DTC industry, particularly 23andMe. As people hear more and more about genetic testing it will cease being scary and new, and (like IVF or screening for Down syndrome) become rapidly commonplace.

In the next five years two things will happen: (1) the massive decrease in the cost of sequencing will bring large-scale sequence analysis within the grasp of the average upper middle-class consumer; and (2) our understanding of the genetics of common disease will increase exponentially. The cost-to-benefit ratio of personal genomics will shrink incredibly quickly and, simultaneously, a whole host of influential early adopters will publicly discuss their genetic testing experiences. The medical and social benefits of having your genome sequenced will make this option steadily more attractive.

So, let's assume that the true size of the market right now is 5% of "upscale business professionals". That's going to be a pretty damn healthy market once Oprah starts talking about how 23andMe changed her life and the guy two cubicles down from you is bragging about his new genome sequence.

You're not getting this, though, because you keep seeing it through your clinician prism. For instance:

It is called the attrition rate and is commonly understood in medical care......only 20% of your "presymptomatic ill" ever go see the referral.

That's because standard medical testing is so boring. Genome scans and sequences, on the other hand, are cool. They're based on fancy new technology; you've read about them in Wired; and they tell you interesting things about yourself. People will want to take these tests.

And, if the medical establishment gets its act together and starts proving that clinicians can actually provide useful interpretations of genetic health data (rather than pissing people off with old-school regulations), people will want to take their test results to their doctor. That's win-win - but only if doctors do things the right way. And that, Dr Sherpa, is entirely up to you.

Anonymous said...

Myriad Genetics is a great company. They are a great company to get a job with. It also helps that the company is located in a nice area.