Thursday, April 30, 2009
Wednesday, April 29, 2009
Posted by Steve Murphy MD at 4:50 AM
Monday, April 27, 2009
I already wrote a little bit about it here. But if you would like I can recap for you.
Swine Flu normally doesn't spread to humans, but this type does. Even crazier is that this type can be spread between humans. To quote the CDC
"The viruses contain a unique combination of gene segments that have not been reported previously among swine or human influenza viruses in the U.S. or elsewhere. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment of infection with swine influenza viruses. The H1N1 viruses are resistant to amantadine and rimantadine but not to oseltamivir or zanamivir. It is not anticipated that the seasonal influenza vaccine will provide protection against the swine flu H1N1 viruses. "
New viruses are formed when a minimum of two viruses merge. Pigs are known to be especially efficient genetic recombinators. The new swine virus has gene segments of the bird flu, one gene segment from a human flu and two gene segments from a pig virus.
But when I hear everyone talking about bioterrorism tests I tend to chuckle nervously. Why?
Well, for one even though this may be a "Never Before Seen" Virus, we have only been surveilling very aggressively over the last few decades....
The second reason I chuckle is because it makes all this Personalized Medicine for prevention and DTC Genomics look REAL silly. As in not nearly as important as stopping a pandemic......
The Sherpa Says: If you haven't been to Mexico or in contact with the people from San Diego, Kansas, NYC, TX, or the 1 case in Ohio. Stop, take a deep breath and relax. Wash your hands and call your doctor if you feel ill......
Posted by Steve Murphy MD at 5:44 AM
Saturday, April 25, 2009
And then Kevin, in March we saw an announcement that you were handing over the CLEO Lab stuff to Navigenics. How does that change any revenues that you once had in 2008 that you won’t get in 2009?
"The CLEO Lab revenues weren’t really that significant for us. The big learning that we had here and the big reason for starting the CLEO Lab a couple years back was really to enable our partners to get to a test, right, a lab developed test and then ultimately too a path for FDA clearance. Initially we thought that this could actually be a big recurring revenue stream for us. So, we had lots of partners, 15, 20, 30 partners that we would be working on projects. Often times the projects were fairly small and when the projects were over and they had their test validated the first thing they said to us was they wanted to open their own CLEO Lab.
So, it really wasn’t much of a recurring revenue stream for us, it was more of a job shop, which was fine, because we are enabling our partners to use our consumables and so forth. But, it really wasn’t going to turn out to be the big multi-million dollar business model that I think at one point in time we thought it might be."
Posted by Steve Murphy MD at 4:59 AM
Thursday, April 23, 2009
- This bill would require an entity that provides post-CLIA bioinformatics services, as defined, to contract with a licensed clinical laboratory to process biological specimen collection kits, except as specified.
- The bill would require an entity that provides post-CLIA bioinformatics services to employ a specified expert for approval of the algorithms used in the interpretation of the biological data of a customer.
- The bill would further impose on an entity that provides post-CLIA bioinformatics services specified privacy, recordkeeping, disclosure, and audit requirements, and would impose specified duties on the State Department of Public Health in that regard.
- The bill would also subject those entities to specified provisions of existing law prohibiting unearned rebates, refunds, and discounts, a violation of which constitutes a crime.
- Because the bill would expand the scope of a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
- This bill would provide that no reimbursement is required by this act
for a specified reason.
We will see if this bill passes. But if it does, it may mean the end of Auctioning Off Genome Scans......
Which puts this technology right in line with the rest of healthcare, where it is ILLEGAL/Ethical Violation to discount, rebate, guarantee or refund.
The Sherpa Says: In my mind, this argument seems to be: "You are healthcare or you are Novelty. You cannot chose both" If this law passes it would be in line with the government of California as well as New York......
Tuesday, April 21, 2009
The Annals of Internal Medicine has a great article this week on genetic risks so does the ACMG Genetics in Medicine Journal for May.
The take home point is something which people may find interesting and it is something I feel is very real. I have begun to think that these Genomic tests act a lot like a placebo. They often don't add anything clinically. Hell, they may not even do anything to guide therapy (Pgx and high penetrance genes aside)
But they often act psychologically, either for good, or for bad.
First in the Annals of Internal Medicine; People have been arguing that perhaps testing only ONE snp and representing its risk is for disease is silly and in fact taht the REAL way to represent these risks is with a multiSNP panel. In Fact, this is what has been perhaps the selling point of some DTC genomics companies.
Even with this possibilty, the CDC and NIH are not satisfied with what the DTC companies are representing as risk.......Psychologically, that could be devastating to the would be consumer. Lack of public trust is a BIG DEAL......even in this era of lack of trust in everyone.
So let's look at what a multiSNP panel would do. The deCode/DNADirect T2 test looks at TCF7L2 (rs12255372), CDKAL1(rs7756992), PPARG( rs1801282),, CDKN2A(rs564398)
The Annals did a scientific study looking at these SNPs as well as loci including HHEX (rs1111875), IGF2BP2 (rs4402960), SLC30A8 (rs13266634), WFS1 (rs10010131), CDKN2A/B (rs564398, rs10811661) and KCNJ11 (rs5219).
What did they find?
The GRS significantly improved case–control discrimination beyond that afforded by conventional risk factors, but the magnitude of this improvement was marginal: Addition of the GRS increased the AUC by only 1%.
This is why I love science. The Journalists and Public read the word SIGNIFICANTLY different than I. In this case, statistical significance (which this word connotes) is essentially a useless guidepost. Becaue the enhanced effect was ONLY 1% better rates of prediction.....But my guess is that a crafty PR propaganda firm would USE the word Significantly in a far different way to manipulate the public.
Hence, placebo effect by hyped study results. The result? Buying more tests? Ask DeCode or DNADirect about that one.
But in this case if the results caused a patient to lose weight and exercise, that would be great. I am STILL waiting for that study.
It seems though as if the genetic risks gods have answered my request, at least with melanoma.
What if we could identify risk and the clinical or medical things we could do to prevent offered no benefit?
Hence the case with testing for Melanoma risk genes. Myriad said that Melaris testing would cause a patient to get more skin exams which would ultimately "reduce incidences and detect melanoma earlier." The data for that are not there to make any judgement on its ability to reduce disease.
But what about the psychological effects? Well, in an article to be published in May's edition of Geneitcs in Medicine it turns out that people with a family history of the skin cancer melanoma show reductions in anxiety and depression after getting tested for a high-risk gene mutation.
Over one hundred patients with a FAMILY HISTORY of melanoma were offered testing for CDKN2a, yes one of the diabetes genes.....
Myriad has this test and it is called Melaris. It turns out ONLY 25 got tested.....so this is not exactly what I call a very powerful study...nonetheless....patients who found they carried the high-risk gene had a significant reduction in scores for anxiety at two weeks after testing. Depression scores were also decreased, and remained so at one-year follow-up.
The Australians are particularly sensitive about Melanoma and it turns out it this case like to "feel" proactive.
Hence, Placebo effect, as we aren't sure if clinical exams prevent disease. But also perhaps some therapeusis if the begin to start wearing sunscreen. Something you hoped they would have done based merely on their family history...If the risk was ever conveyed to that member
The Sherpa Says: Placebo effect works, we know this in medicine. The real question is whether it is worth 99,000 USD.......or even 399?
Monday, April 20, 2009
Thursday, April 16, 2009
I was sent this article 6 times in the last 6 hours by friends and colleagues.
What's the article? "Genes Show Limited Value in Predicting Diseases"
I say deathblow to the DTC Genomics, because this article points out the issues surrounding using this limited information......
"This method, called a genomewide association study, has proved technically successful despite many skeptics’ initial doubts. But it has been disappointing in that the kind of genetic variation it detects has turned out to explain surprisingly little of the genetic links to most diseases."
What are the majority of reports you can get from 23andME or Navigenics or DecodeMe?
Reports which rely on "GENOMEWIDE ASSOCIATION STUDIES"
Not that there aren't any great genome wide associations......I think of Age Related Macular Degeneration for one.......but for every great study, there are 20 crappy studies. Which, to the unskilled observer could be made to look just as powerful. And then Silicon Valley Style Hyped, to make it to market.
I repeat, the utility of GWAS studies in Public Health NEED to be studied. Just like they are with the Coriell Personalized Medicine Collaborative.
But selling this information to people at a cost of 400 to 2500???? Sketchy at best!
From the NYT article...
"These companies are probably not performing any useful service at present, said David B. Goldstein, a Duke University geneticist who wrote one of the commentaries appearing in the journal.
“With only a few exceptions, what the genomics companies are doing right now is recreational genomics,” Dr. Goldstein said in an interview. “The information has little or in many cases no clinical relevance.”
Which is why I am aligning myself with some good People from Long Island who have been shouting this from the rooftops for about it.
A great example is this perspectives article precisely about this topic in the New England Journal of Medicine this week!!! (Only 3 this time Daniel)
Useless DTC Genomics? Not exactly. Someone is making money and has some use for it.......
The Sherpa Says: A good clinician saw this coming from a mile away. Why couldn't Venture Capital? Or the Public? Or the Scientists???? Funny, I just gave the same lecture to medical underwriters for the life insurance industry on the 14th,,,,,,
Tuesday, April 14, 2009
Monday, April 13, 2009
Monday, April 6, 2009
The risk quadrupled when family history included more than one affected member, and the relative risk soared to 64 with a positive family history and a genetic or environmental risk factor versus no family history or other factors.
Wednesday, April 1, 2009
Posted by Steve Murphy MD at 8:55 PM
I am afraid that my time here is shortly coming to an end. I am writing today to say goodbye. Why?
Like Joe Black said.....
"It will be revealed in due time."
I can no longer blog. I started this blog nearly 2 years ago to educate people on the promise of personalized medicine. I have helped point out some shortcomings in the medical system and the medical education system. I have complained about medical fraud, uneducated providers inappropriately ordering tests, malpractice, genetic counselors acting like physicians, physicians acting unprofessional and even acted unprofessional myself a time or 2.
I have pointed out impartiality in the press. I have indicated the lack of journalistic integrity that pervades the system.
That being said, my last year has been especially hard on corporate genomics. I have railed against research done on subjects without IRBs, I have complained about illegal activity with the promotion of tests in states whose laws forbid such testing, I have gotten pissed about the manipulation of vulnerable subjects and the despicable acts of using a spit kit to collect a child's sample against their will or without proper consent. I have laughed about the way in which these companies pretend to be medicine without taking any of the responsibility. I have even told you that these companies in their current incarnation will hinder personalized medicine's growth.
It is with that clarity, honesty and vigilance which I have been brought to a screeching halt.
These companies have way more money and power than I. They will continue to fill the echo chamber with platitudes of their superiority. In the end, they will convince you that they were the saviours of medicine, when in fact all that they did was pay a PR firm millions of dollars to sell you on the "next big thing"
I despise when a scientific study is hyped, but I understand why it is. The work is often the life's work of that scientist, who often has no ability to clinically translate it. But these companies took these scientists' work, they jumped the line and are using non-clinical science and making insinuations that it could be used in a clinical manner without nearly any more than 2 years of work.
It is precisely because of my warring against these tribes that I have to say goodbye to blogging. They have more money AND more lawyers......
The Sherpa Says: Goodbye blogosphere, Goodnight and Good Luck.
Posted by Steve Murphy MD at 5:54 AM