Thursday, February 5, 2009
"MDVIP doctors “are very enthused and very interested in what this is going to add clinically to their management of the patient,” MDVIP CEO Edward Goldman told Pharmacogenomics Reporter this week."
That from a report by GenomeWeb's Turna Ray yesterday. (Subscription needed...bummer)
That is a superb question to be interested in Ed.....
What will Navigenics' Annual Insight test add clinically to the care of patients?????
The short answer: We have no clue.
That being said, have doctors done things on or to patients in which they had no clue what the outcome is likely to be?
Yes, it is called medical research. What it's not, is standard of care, even more, it's not concierge care. That's for certain. The team at MDVIP should be focused on taking family histories, med-med reconciliation and med-gene interactions. They should not be trying to integrate a test which has no clinical validity.
We have been studying family history and its role in medicine for decades now......so why did they jump at this shiny bobble????
I am not certain, other than they consider this a "patch" so that they can say they are practicing personalized medicine.
Let me speak clearly to Ed Goldman. "This test is not personalized medicine" In fact it is the antithesis of that. Why? Well, you are applying a test to people who may not derive use from it, even worse you are not personalizing whether you use the test or not.......
True personalized medicine is finding a family history of heart disease, anticipating the patient's risk, getting them on a good exercise regimen, and maybe even testing CYP 2C9, 2D6 and 2C19 in anticipation of a beta blocker, warfarin and perhaps plavix......
That is what personalized medicine is ladies and gentlemen. It is hard work, and not exactly scalable, but it is what is required to carry out truly preventative medicine. Not some shiny bobble.....
IMHO, MDVIP may have sullied their name by telling patients that they don't care about what the AMA says or even that this test has no proven clinical utility.....hell, even PSA has some utility!!!!
From the article:
"Of the MDVIP physicians surveyed, more than 90 percent said that genetic risk information changed how they handled their patients and spurred them to take a more aggressive medical approach."
My point exactly, why in the hell would these test results indicate that you should manage patients more aggressively? Maybe if you have enrolled them in an experiment, and obtained informed consent, you might be able to do that.....but 9p21.3 doesn't add anything to the clinical risk profile......perhaps these 90% of doctors need a course or two in clinical genetics and biostatistics.....
What a shame, these doctors were suckered in by the razzle dazzle and now are inappropriately up-managing patients based on scientifically valid (sometimes) yet clinically invalid data......
From the article
"On the one hand, Navigenics employs state-licensed physicians and genetic counselors, but maintains in its Terms of Service that this does not constitute a doctor-patient relationship. "
Shrouded in a veil of mystery and now trying to pose as clinically valid without taking responsibility.......
Well, it is no mystery that these tests are not clinically validated, or that they even produce beneficial behavioral outcomes.......
“Our stance has always been that patients shouldn't take this information and make medical decisions on their own, that they should consult a doctor,” Navigenics’ Vanier said. “This is complex information that is often challenging for physicians.”
Is that why you picked a bunch of concierge physicians who aren't trained at all in genetics to "Beta Test" the service?
“Navigenics assumes no responsibility for any consequence relating directly or indirectly to any action or inaction you take based on our site, the services, your report, or other content,” the company says on its website. “You must evaluate and bear all risks associated with their use, including any reliance on their accuracy, completeness, or usefulness.”
Of course not, why take any responsibility for what you bring to market???
Maybe MDVIP knows this and that's why the Navigenics partnership isn't on their front page
From their site:
"The truth is, MDVIP goes far beyond the fee for access companies that are rightfully seen as Concierge Healthcare and is actually setting the new gold standard for healthcare. "
If Navigenics SNP scans without any clinically valid data are the gold standard, then get me the hell out of medicine. Maybe MDVIP, should research the subject and perhaps participate in ethical research in the field???
You would have figured these companies would have funded studies prior to forcing a non clinical test on clinicians........