Monday, July 14, 2008

When you know the Books are Cooked

I finally had a chance to sit down and review Genetics in Medicine for the month of June. Yes, I am a month behind.....leave me alone. I have been doing some other things for the last few weeks........So take it easy on me.....

Have you ever had the feeling that the results of a study need replication? Especially because the results do not match up with clinical reality. What am I talking about?....Wylie Burke's study on how many PCPs have ordered a genetic test. There is an age old adage that on self-report tests for will get 2 answers.....80-85% and 15-20%.....By that I mean, most physicians don't want to say they do something all the time, or none of the time.....By that I mean, most physicians lie on self reports.....even when anonymized....

This is why I saw malarky on this study, recently published....

Methods: Survey of a random sample of 2000 primary care physicians in the United States (n = 1120,

62.3% response rate based on eligible respondents) conducted in 2002 to assess what proportion have (1) ever ordered a genetic test in general or for select conditions; (2) ever referred a patient for genetic testing to a genetics center or counselor, a specialist, a clinical research trial, or to any site of care.

Results: Nationally, 60% of primary care physicians have ordered a genetic test and 74% have referred a patient for genetic testing.

Approximately 62% of physicians have referred a patient for genetic testing to a genetics center/counselor or to a specialist, and 17% to a clinical trial.

Minority-serving physicians were significantly less likely to have ever ordered a genetic test for breast cancer, colorectal cancer, or Huntington disease, or to have ever referred a patient for genetic testing relative to those serving fewer minorities.

Conclusions: Reduced utilization of genetic tests/referrals among minority-serving physicians emphasizes the importance of tracking the diffusion of genomic medicine and assessing the potential impact on health disparities.

OK, Wylie, you are an excellent physician scientist, but you know this to be intrinsically garbage. If even 30% of PCPs referred just one patient for services, then the entirety of the genetics community would be rapidly overwhelmed.

I would bet that those tests sent off were Factor V Leiden tests for hypercoaguability work up(Now considered fairly worthless tests post clot)

There is no way 74% of PCPs even know a geneticist to refer to. This study is so flawed and I am embarassed to see it actually passing peer review. Who in there right mind would believe any of these data.

74% is awfully close to 80%....this is a fishy smelling study and I am blown away that it got published.

How did I know that they probably didn't sense the anomaly I did? Because they are all PhD's not a single community based doctor in the bunch......


The Sherpa Says:
If you believe this study, then I have a bridge to sell you.........Further proof, you can't always believe what you read....Not much has changed in 5 years since the NEJM study, so I doubt that this study is true.


Anonymous said...

I'm pretty sure wylie has an M.D. Last time I checked, anyway.

Steve Murphy MD said...

Like I said....she isn't a community PCP.

See below

The closest thing was serving as a program director at a major academic institution. She is a wonderful geneticist.....but not a community PCP. Because if she was a primary care doc, she would have known her survey results were skewed...


Steve Murphy MD said...

Think about it.....74% of all primary care doctors have referred someone to genetics????? How about we ask the geneticists why they are overwhelmed with adult patients.....oh wait.....they aren't!!


Marie Godfrey said...

Thanks, everyone. I'm seriously overloaded with nongenetic items today and enjoyed having a laugh to break the tension.