Thursday, December 31, 2009
Posted by Steve Murphy MD at 6:14 AM
Thursday, December 24, 2009
I unwrapped the NEJM this week and to my surprise it has a Lp(a) stuff in it. One of the things we do to prevent heart disease is take family histories. We also check cholesterol levels and include something called a Cardio-CRP. One thing we haven't been including is a Lp(a). Why? The only data I see that is good on this is on women.
Posted by Steve Murphy MD at 5:30 AM
Wednesday, December 23, 2009
Ho Ho Ho!
As I begin to enter year 3 of this blog I have refined my thinking and working to effect change. Personalized medicine delivery will change soon, so will personal genomics. I hope to create some of this next year. Until then, Merry Christmas everybody!
The Sherpa Says: And to All a Good Night!
Posted by Steve Murphy MD at 4:52 PM
Thursday, December 17, 2009
Yes, That is correct. As if this stuff couldn't get any cheaper. It does.
"Happy, healthy holidays! Holiday offer: Our #genetic service for $499 (half off). Use code naviholiday2009 at checkout. http://bit.ly/roe95"
That straight from the mouths of the Navigenics Babes, Seriously. Do you know Katie Kihourany?
Everyone including Daniel MacArthur is yelping about the DeCodeMe free analysis offer, but I have yet to hear anyone screming about the 500 USD drop in price of Navigenics service. Ladies and Gentlemen, this is a 50% price cut.
In what world do you cut your service cost in half? This didn't even happen with the iPhone. Seriously?
This is a bad, bad sign coming from the team at Navigenics. Nearly a year ago they launched Annual Insight for 499.....Now the whole ship is up for 499........
I have yet to see how this market is the market for Whole Genome Testing. In fact, my assessment is that whole genome sequencing will not be used widely until it costs less than 300 USD.
Why? Can your genome data play crazy videos of Will Smith? What about making a phone call and downloading songs? No?
Well, what can a whole genome do for you? Good question. The iPhone wins because in it's ads it shows you what it can do......
These tests and the whole genome have not shown that utility. That's why they are cutting their costs.....because the can't show that they have use........
And that is precisely why deCode is offering its analysis service for free. They want to show you what they do........
The Sherpa Says: Like I said before, climbing Everest with one Crampon a windbreaker and a map is not what most rational people want to do......
Posted by Steve Murphy MD at 5:47 PM
Thursday, December 10, 2009
Posted by Steve Murphy MD at 10:29 AM
Tuesday, December 8, 2009
Remember this? From GenomeWeb
“After extensive fact-finding, consultation, and analysis, the committee found significant gaps in the US system of oversight of genetic testing that can lead to harms,” SACGHS states in the report. “The committee also identified novel opportunities that would enhance oversight.”
What are these novel opportunities to enhance oversight?
"As reported by Pharmacogenomics Reporter in February, the establishment of a mandatory, web-based registry for all laboratory-developed tests is one of the main vehicles the committee is proposing in order to improve how the federal government regulates genetic tests [see PGx Reporter 02-20-2008]. "
The 21st Meeting of SACGHS will occur in February of 2010. I wonder if this recommendation has gone on deaf ears. With all the turmoil surrounding health reform, will HHS take genetic test regulation up? One of 3 or 4 things may happen.
1. Health reform happens, billions flow into HHS and they form a committee to set the SACGHS recommended registry up.
2. Health reform happens, they are so busy that this gets queued.
3. Health reform doesn't happen. Nor does the Registry.
4. Health reform doesn't happen, thus the HHS has the time and attention to set up this registry.
But what I really want to know is: "Will the HHS including DTC genomic testing give these companies a perceived seal of approval?"
Better yet, will these companies be listed?
PWC has said Personalized Medicine will grow at 11% (How the hell they come up with that figure g-d only knows) Do I think DTC genomics will be included in the growth? Probably not. This type of testing will not grow until it is less than 100 USD.
The Sherpa Says: Like I said before, unless PM can cure cancer or prevent HIV it is likely to be difficult to sell. No matter how many meetings Harvard/Scripps/Etc has. What needs to happen is promotion of physicians (like my group) who are actually implementing PM.
Posted by Steve Murphy MD at 4:43 PM
Tuesday, December 1, 2009
"Although there appears to be a clear relationship between UGT1A1 genotype and severe neutropenia (and some evidence of a relationship with severe diarrhea) there is no evidence to support or refute the hypothesis that a modified initial and/or subsequent dose of irinotecan will change the rate of these severe adverse drug reations." -EGAPP working group analysis of UGT1A1 testing
That is where most of personalized medicine (PM) is at today.
Why is this important? Because this precise clinical set of questions will be worked out over the next 10 years.
While I have been taking a break from posting some things have become crystallized.
The first thing: In an economic downturn, your genomic/PM product better have intrinsic value.
Chances are, if you have to have big celebrities and open bars to launch, you need to rethink the product.
The second thing: If you think you can take science to market in less than 5 years, then you need to do one of 3 things.
1. Immediately Cure Cancer
2. Prevent HIV infection
3. No, there are just 2 PM things that will work here.
Do I think there are products that don't involve direct basic science that will help personalize medicine which CAN go to market quicker than the 10 year revolution we are about to undergo?
Yes. But none involve PhD geneticists. They involve computer scientists, automation, email, etc.
This latest bubble of DTC Genomics existed just so the SV could cut their teeth on genetics for the big bite 5 years from now.
Why is the Sherpa such a naysayer?
I am not. I am a realist planning the ascent of the next tier.
That Tier is clinical utility. Yes we still have the missing heredity here. But let's say that will come in the next 5 years.....maybe We still have 5 to go.
Those 5 will be used for clinical studies, for outcome and guidance of therapies. But that is only the next tier.
Pragmatic physicians and scientists will demand replication, some will fail, ultimately casting doubt on the field as a whole.
This will further driving pragmatism and encourage naysayers.
Don't believe me. You have heard the new mammographic guidelines from USPSTF, right? Pragmatists have always said we don't need so many mammos....
Now so does Consumer Reports !!!
Many people place their trust in Consumer Reports. It is clear, they too see a case for overspending.
In an economic environment a savvy entrepreneur will look for targets like Asia.
As a doctor, I know most PM tools are on the horizon, so I pragmatically pick up my pen and pedigree.....
I am at my ICOB meeting today and am posting this from there. We will be going over several genes and variants. I am excited because OSUMC has now partnered with CPMC......there is no doubt this project will continue to grow in strength and importance as we have quite a cohort.
The Sherpa Says: Poor PM, attacks on every front. But don't worry, in the end, we win.
Posted by Steve Murphy MD at 5:23 PM