As if my conjectures weren't enough, it seems to me that the DTC genomics space is proving my theories to be correct. It turns out that the real value is in providing analysis of the genetic material, NOT testing itself. When you start giving interpretation, you begin to incur regulations that were not applied to those labs who are doing the tests.
It turns out, people don't like buying genetic tests online. In fact, one of the oldest DTC genetic testing company is NOW turning into a genetic counseling resource service.
According to the DNADirect site:
DNA Direct can help your physician practice or medical center meet this challenge by providing access to genetic expertise that can be seamlessly integrated into patient care.
It turns out that this was one of the things we did at Helix Health of Connecticut of CT about a year ago. We sat a CGC down in a busy IM practice and hoped that they would share and learn from each other. We also hoped it would lead to more referrals.
It didn't lead to too many more referrals, but it did bring the doctors up to some sort of speed. I think this is DNADirect's attempt to get physicians comfortable with genetics and I commend them for this. But I also know that they are in discussions with insurance providers to offer genetic counseling services for Insurers......much in the same light as my friend Heather Shappell.
Here's what I think. The DTC Companies will all evolve in some aspect towards providing professional services. Navigenics does, deCode is moving in this direction and NOW DNADirect is moving into this space. So much so that they are seeking out insurers to provide these services......In fact based on what I am reading they are looking to serve as a "dial a genetic counselor" for regular physicians in everyday practice.
I have thought about providing this service too, but you see physicians actually have a limitation that genetic counselors don't. Physicians have to be licensed in each and every state that they provide medical care......EVEN Telegentics care.....
Counselors don't. I think this is a good thing for counselors, but a bad thing for Pharmacogenomics and Common Adult Disease Genetics. Maybe, this is the out for 23andME????
You see, Heather had pioneered TeleGenetic Services for Cancer genetics at her company "Informed Medical Decisions"
She landed a contract with Aetna and is looking at more third party providers.....
This is a key to expanding our services. Most providers are unaware of OR improperly use genetic testing to aid health services. If you can land in every physicians office with a warm voice and some key skills, it would be very useful........rather than some discussion boards where voodoo medicine and medical misinformation is passed between patient and patient.
That being said, BRCA testing seems to be easily integrated in Internal Medicine services according to recent analysis.....so maybe doctors are starting to get at least one part of it......
What amazes me about 23andME is that a lot of their discussion boards are not proctored by healthcare providers to correct misinformation. This inevitably results in a 17 year old being scared of his prostate cancer risks and someone interjecting "Oh don't worry, more sex can help you prevent prostate cancer."
Is that really outsourcing medicine? Is that really democratizing knowledge? In my mind it is spreading misinformation under the guise of scientific authority.......
I do predict that the other DTC companies, good bad or ugly, will begin to follow Informed Medical Decisions and NOW DNADirect........which are becoming virtual extensions of things like our practice at Helix Health of Connecticut.
The Sherpa Says: Hey Dietrich, if you read this.....do you remember the "Apple Stores???" Ryan has been the leader here and it is clear......the services around the genome are the most valuable things............
4 comments:
Quote: "It turns out that the real value is in providing analysis of the genetic material, NOT testing itself."
No surprise here. I figured that out before I even went to college. Now can I give some advice for how to change the way patients are seen for genetic consults? There is a lot of time wasted in these consults and a lot of stuff is done twice over.
I wouldn't be surprised to see more companies like Informed Decisions across the country. Heck, I even told some GCs a couple of years ago (maybe my idea was stolen?) that companies like this need to be formed.
Now if these GCs really want to make headway for providing services to doctors, make contracts with specific departments where doctors can benefit from your services. Just because a clinic is located in San Fran and a GC is located in Los Angelas does not mean that a GC can't work with specific doctors at the San Fran clinic. Use the technology we have today, people. Set-up a webcam, set-up conference calls (heck, some trials in the courts are done via conference calls), etc. THINK OUTSIDE THE BOX. Just because you were trained by a method developed 40 years ago does not mean that is the way you need to operate your services today (beyond the legal stuff---like NOT providing medical advice as a GC).
N/A
*But don't listen to me, I don't know what I'm talking about. I'm just a person with a disability who can't even type names in a computer correct (just a vent from a situation a couple of years ago that still bugs the heck out of me **I'm not smart enough to be a GC..as was told by a GC herself. Vise versa my boss tells me to go medical school because I'm too smart not to.
Wasn't DNA Direct already providing pre- and post-test genetic counseling, with counselors under physician oversight, prior to this move to function more as consultants? Perhaps they could spin off a wholly owned subsidiary called DNA Indirect.
Red,
all good points. I think that Heather's model is working and that Insurers will see that advantage. I am just dubious of the physician supervision being protected as not "out of state" work. I would love to see how that is worked out...
-Steve
Why are there no DNA kits to test for a genotype (with the region dependent on the drug that needs to be given) really quickly in an emergency to see if the patient would metabolize the dose given?
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