Finally, what you all have been eagerly anticipating.
The Sherpa's Predictions for 2009.
Mind you they come in 3 groups. Highly likely, Possible and Ridiculous
1. Francis Collins will become the director of the NIH and collaborate with Kari from Iceland to create a national database of genomes. This is the only way to jumpstart personalized medicine. My feeling is that Kari knows how to do this, is a friend of Francis, and Obama is likely to give him the greenlight on this, despite public sentiment....
2. We will see our first lawsuit for a pharmacogenomic cause. My colleague over at ASU, Gary Marchant says it will only take one and the flood gates will open. The lawsuit will be based on something called "Loss of Chance" doctrine. The theory goes, "did you cause the patient to lose a chance at a better health outcome?" If the answer is yes, well then you can be sued. This recently has been the case for delayed diagnoses in several states (24 to be precise). All it takes is one smart, enterprising, hungry attorney to go after this....I can see it now.
Plantiff's attorney(PA) "Doctor, who is the FDA?"
Doctor(MD): "The US Food and Drug Administration"
PA "and what do they do?"
MD: "FDA provides safety information on drugs and other FDA-regulated products, and allows for adverse event reporting."
PA: "Would you use a drug that was not approved by the FDA?"
PA: "Doctor, would you mind reading this label?"
MD: "…genetic variations in the CYP2C9 and VKORC1 enzymes may influence the response of the patient to warfarin.” In the “Dosage and Administration” section, it states that lower initial doses should be considered for patients with genetic variations in CYP2C9 and VKORC1."
PA: "Doctor, what is the genotype of the defendant Mr. X?"
MD: "I do not know"
PA: "Doctor, why do you not know everything you need to know about a patient PRIOR to giving this deadly rat poison"
PA: "Doctor, is there evidence showing that patients with poor metabolism would need a lower dose than the one you prescribed Mr. X?"
MD: "Yes, but......"
PA: "But what doctor? Why would the FDA put something on the label if there wasn't solid evidence behind it?"
PA: "furthermore, if you knew your patient had a liver problem with metabolizing the medication, would you give the dose you gave to Mr. X?"
MD: "Well, hepatic dysfunction is (cut off by attorney)
PA: "CYP2C9 genetic mutations ARE hepatic dysfunction doctor"
I think you get where I am headed. In economic lean times, people will try anything....and this sure is like the Statue of Liberty play. It WILL score a touchdown, that's why people still run it.
3. We will see George Church's Exome project results and they will certainly confuse all of us as to what it really means. We may even see a broken ladder?
1. We will have an X-Prize winner. If PacBio and the black box known as Complete Genomics work out, this will be ready by November 2009. Seriously.....now, to sort out what the hell it means......We need a database, someone to actually take liability (Unlike the chickeSh!^ companies today), and someone to counsel on this.....do you really think 2700 people is enough???? That is only a cool 111,533 people per provider......at 2 hours per evaluation that is only 223,066 hours of work, only 9294 days of straight work, or 25 years straight!.....give me a freakin break NSGC/ABMG/ABGC/ACMG!
2. Mr. Stoicescu sues KNOME for a 345,000 USD refund. It could happen, the oligarchs lost a ton of money last year. I am sure he could use the money back in exchange for Complete Genomics Genome evaluation.
1: Mark Cuban will buy the rights to 23andMe's database. If I have at least one thing, it is tenacity.....this one will happen
2: A new technology called next-next-next-next gen sequencing will debut and have your genome done in 15 minutes. They will say the technology will be ready for prime time in 2 years.
The Sherpa Says: Happy New Year! May the new year be as good for you as it already has been for me. Here's to personalized medicine in 2009!!!!!