Friday, January 23, 2009
So first off, I want to apologize to everyone. I have been out of the loop for the last 4 days. That's because I have been travelling to the Midwest and the South. I have been talking with companies that have millions of patients and companies who market to millions more.
Why? Because there is one thing and one thing alone that I have dedicated my life to.....
That is the Realization of Personalized Medicine. True my earth shattering news had to be put on hold....but it too is coming.
Second off, I want to speak to all pragmatic Internists who may have read the articles on the Annals of Internal Medicine which may have got you to believe that Personalized Medicine is not ready for prime time.........
They are dead wrong. You see, the Annals are the journal published by the same people that brought you the ACP scientific meeting without a single iota of personalized medicine or even genetics for that matter.....So it is no surprise that when the study a model, they don't actually know the price for pharmacogenetic testing.
Which BTW, I am proud to announce is being covered by insurance companies. Yes, that is absolutely correct! Genelex is getting coverage for these tests by several carriers! No if I only could get those bastards (insurance) to actually pay us for interpreting the results and caring for those patients!
So why is the Annals wrong? Recently an article was published which hinted that perhaps testing for CYP 2C9 genotype and VKORC1 genotype was only likely to be cost effective at 200 dollars per set assay. But alas, their model studied this data through MEDLINE searches and Markov state transition decision model....hardly the best way to evaluate cost effectiveness. Certainly a cheap way to do it, but I always thought case control would be a cleaner way to go rather than retrospectively.
That being said, the authors publish this well written article with some faulty assumptions.
1) Cost of testing at 400 USD. I know some doing this for under 200 USD
2) Meta analysis of 3 studies is ideal to make proclamations
3) That this testing is best for those who have a low risk of hemorrhage (bleeding from warfarin)
4) They used the rates CYP genotypes and VKORC1 genotypes of Caucasians!
So they instead selected criteria which likely would fail....Why did they do this?
We could ask Dr. Gage, who has received grants from BMS. The people who make Coumadin.
One thing is for sure.....the sticks in the mud will use this data to hide behind the fact that they don't know genetics. Even when they do this the authors suggest that PgX dosing could be effective....just like it was in the 3 studies the "meta-analyzed"
I am glad the authors note the limitations in their study......so when you read about it in "the news" remember, a limited study produces results of limited value......which is why....
Pharmacogenomics is here to stay and the case for it will only get stronger this year!
The Sherpa Says: Brother Cotherman I look forward to seeing you again. Next time with a way to show pharma how they can truly benefit from good data! We are getting ready for our next part of the ascent.....Somehow I don't see how DTC Genomics is going to make this climb...
Posted by Steve Murphy MD at 3:43 AM