Friday, October 31, 2008

In the New England Journal Again! CRP genetics!

Trick or Treat..... That's Russ Altman, Disguised as a Wolf-Man!!!

First the Treat!

Ok, so I hate to say it, but I am firmly convinced that the New England Journal of Medicine has been taken over by geneticists!!! I jump for glee as I open a new edition and see genetics plastered all over it.....just like the week before......and the week before that! It is true....medicine will soon be a small sub specialty of genetics!!!!!! At least if the NEJM has their way with it!


Now for the Trick

But then I stop....pinch myself and ask "Now which company will rush to market with these findings???"""

The biggest danger to Personalized Medicine is not the lack of physician understanding. Nor is it the lack of good reimbursement systems. Nor is it the lack of education in medical school. Nor is it the lack of patient desire.

It is one thing and one thing alone.......The overselling of Genomics by corporations. 9p21! Failure to replicate!


Eager to earn a quick buck or two.....or perhaps eager to bleed cash for a few years until the tide comes in, but also willing to mend that bleed by hyping some bogus test...

This is the danger.....Why? Let me explain....


When I give grand rounds at some hospital in Connecticut I am often asked......"So do you do that 23andMe test? Isn't it bogus? Isn't most of what you do not actionable?" First I am amazed a doctor has even heard of this company...but then.....


I then have to take 10 minutes and explain what a geneticist does. I have to tell them about the several victories we have in being able to identify risk and treat disease. I have to tell him about chemotherapeutic agents targeted to tumors. I then have to tell him about the promise of gene based dosing of medications. And when I am done, they will walk away......Still thinking about these companies.....


You see, if the physician thinks that genetics is hyped up molecular tea leaves.....they are less likely to put it into practice. In fact they are even more likely to skip that article in the NEJM......By hyping, overselling genomics we are making physician skeptics. The very people we have to convince that there is great utility in personalized medicine......


When Time puts on their cover that the number one "Invention" (I say this because it wasn't invented in 2008) was the retail genomic test. I laugh because they are dead wrong and once again botched the story. You can ask Ryan Phelan, she has been selling genetic tests online since 2004. No new invention with 23andMe, just the re purposing of a research tool for clinical work....which normally takes years to happen, but in this case was rushed to market in a matter of months.....Medgadget calls this like it is TIME Magazine Panders to Google Overlords, Silicon Valley Czars, Hollywood Charlatans.......


So thank you DTC SNP testing companies.....you have set back personalized medicine about 5 years...while democratizing SNP chip data which no one can make sense of......By using celebrity and affluence you managed to convince people of the fallacy.....

But you see, doctors are pragmatic and they can smell the B.S. (Not the one issued to A.W. at Yale) from a mile away!

But the problem is, doctors aren't that nuanced and when they smell B.S. they call the whole field B.S.


So why do most geneticists speak out against DTC testing? Because it is ruining personalized medicine by lumping it in with this B.S. When will DTC learn this?

Well, one team has....That's Navigenics. They have decided to partner with Academia to study the utility of this testing. They understand it is in its infancy. Since the million dollar party in SoHo (No Navigenics doesn't have a shop in SoHo) they have realized that this is a long haul and the best way to work through this time is by proving the concept through science and an Institutional Review Board. Unlike the "Founders" of 23andMe, who instead choose to enroll children into their "study" without an independent review board to protect vulnerable children's rights....

Shout out to Coriell who has been doing the "Right Thing", since the very beginning....but I guess that's because they aren't trying to make a quick buck or 2.


So as a doctor when you skip over that Genetics article in the NEJM thinking this field is all GenoHype....stop, come see the Sherpa and we can talk about the part of genetics which is real.....



The Sherpa Says: I am dead serious. If this "it's for fun talk" keeps up, personalized medicine will be dead in the eyes of the physician....Oh and BTW, the article said that CRP polymorphsims (associated with increased CRP) alone do not increase risk of ischemic vascular disease (Heart attack or stroke), But elevated CRP levels do......Maybe genes aren't everything?????

7 comments:

Anonymous said...

Well said.

Anonymous said...

come on... "personalized medicine will be dead in the eyes of the physician"? Like alternative medicine is "dead in the eyes of the physician" until they grudgingly concede time and again that some of alternative methods are beneficial and should be integrated in conventional medicine.

Anonymous said...

Personalized medicine is not the same as alternative methods.

What these direct to consumer genetic testing companies don't seem to understand is that most of their tests are bogus and reliable(no independent replication).

Steve Murphy MD said...

First off.
1. Personalized Medicine is not Alternative Medicine.
2. DTC testing is not Alternative Medicine.......

Complementary and Alternative Medicine (Chinese and Ayurvedic) has the advantage of over a millenia of anectdotal evidence. Something PM lacks

DTC testing has NO significant Anecdotal evidence....save 2 or 3 cases.....

3. SNP tests are reliable to produce sequence....after that, you are on your own.....

4. Physicians will view DTC as PM until the proponents of PM fight against DTC taking OUR monniker....

End of story....

-Steve

Andrew said...

Alternative medicine isn't scientific. It should be treated with the same scientific skepticism and research rigor as all other methods with no bias and discredited if shown to be invalid. A Millenia of anecdotal evidence is merely, at best, a hypothesis, not an acceptable theory of medicine.

Also, if you think you can fight DTC for the "personalized medicine" title in the press and win, you are sorely mistaken, because the press is pay-to-play and you're not paying. Think of another strategy.

Steve Murphy MD said...

@ Andrew,
I agree, CAM needs to be subjected to evidence based research....and so does DTC testing...........

-Steve

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