A long time ago I had a post entitled "Beware Doctors Bearing Genetic Tests" back in April of 2007. It was an interesting post where I point out that this wonderful GI doctor who was IVY league trained completely hashed genetic testing for HNPCC.
I went on to explain the shortcomings with Internists in interpreting APC testing for familial adenomatoid polyposis coli. 1 in 3 misinterpret tests.....Wait till you see the DTC interpretation!
Everyone who gets all in a huff when I say that these DTC genetic tests should be regulated. But I am here to say there is a good reason for it, and it has nothing to do with the people getting the tests.......There is now threat of public harm.....
But first let me explain my frustration. Saturday I was on Twitter and Daniel MacArthur and I had a conversation, which he lead off by saying:
"@helixhealthct Just shows how arbitrary most medical care is anyway; not like it'll change the outcomes much.Which was in response to a PHG report on an article published in Genetic In Medicine [Kolor K et al. (2009) Genet Med 11(8):595].
Among the 1880 physicians sampled, 42% were aware of the tests(DTC Genetic tests) and, over the past year, 15% had at least one patient bring the results of such a test to them for discussion. Interestingly, of this latter group, 75% (212 physicians) indicated that the results had changed some aspect of their patient’s care.
Holy Crap! Really? 75% changed the care?
So it had me begging several questions.
1. Did the physician read the Terms of Service for the DTC test? "Not to be used to make medical decisions"
2. Did the patient read the Terms of Service when they brought this test to the physician.
3. How is the physician supposed to know that this is not a clinically validated genetic test?
4. How is the busy clinician to differentiate this test from other clinically valid tests?
5. Why did the patient bring the test to the doctor? Was it due to DTC marketing efforts?
I was pissed at Daniel. How dare he say what we as physicians do changes no health outcomes!
In some instances he may be right. In others I wondered how complaints may actually be neglected based on this "genetic test"
Did these 212 doctors know something I don't about the utility of this DTC testing?
I doubt it.
I am seriously concerned that the 3/4ths of the 18% had actually changed care based on a non-clinical based test. That, to me is Scary AS HELL!!!!!
Think on this for a second.....How many of these doctors will ignore chest pain complaints based on a low genetic risk?
Now think on this. How many doctors will unnecessarily order stress tests for patients who have no complaints and are "High Risk"?????
Either way you slice it, 3/4 of these doctors are acting incorrectly, or at least not according to evidence base.
This survey proved one thing to me. Doctors have no F^CK!n& Clue what they are doing with genomics!
Why should these tests be regulated?
1. Patients aren't following the terms of service, likely due to deceptive advertising
2. Doctors can pose a threat based on inaccurately using these tests
3. Over use of resources could end up being a big problem because of these tests.
4. The potential for public harm has now gone from silly consumer, to trained medical professional inflicting damage.......
The Sherpa Says: Like I said, beware doctors bearing genetic tests........and patients too.