Wednesday, October 27, 2010
Thursday, October 21, 2010
Thursday, October 14, 2010
As the FDA debates what they should do, Barbara Evans at the University of Houston Law School and Amy L. McGuire of the Center for Medical Ethics and Health Policy at Baylor College of Medicine in Houston, also includes, Canadian legal expert Timothy Caulfield and Wylie Burke, M.D., of the University of Washington School of Medicine post some guidelines for regulation of DTCG/LDT genetic testing.
I love this sort of handicapping.
You have absolutely brilliant people posing ideas for regulations. I have read a ton. There are those from industry insiders, Ones from industry "Advisors", Ones from politicians who receive funding from industry, Ones from academic centers that do LDT testing. Ones from bioethicists...
But I have paid attention to the mixed group that includes pragmatist Wylie Burke and Barb Evans
In an article I just read from Science published October 8th. They propose rules for DTCG, but I am certain they also would work for LDT.
What they propose is a "sliding scale of potential harm"
Which is sort of what I had been saying for years, which perhaps is why it rings true.
If this is for earwax type, let it go to market, if it is for medically related decision making, probably needs some regulation.
The proponents for a wild west DTCG (WWDTCG), which BTW includes a "registry" say
"Well, there is no proof of harm or risk"
I say, well, this is not about psychologic risk.
Instead, it is about medically actionable risk.
I say this because recently, Kif6 testing has fallen into question, despite a company promoting these tests to physicians.
The test is marketed as a "Statin response" genetic test.
Can you imagine how many people were started on statins? Well, 250,000 tests had been ordered. Even if 10% were started it would be nearly as many people as DCTG 23andMe have tested.
The real problem here: Pharmacogenomics tests are not something you hide, you ask your doctor to use these results. Unless you are a doctor, you can't use these results to dose medications.......
That is a real risk. Despite what WWDTCG proponents say.
Another risk, BRCA testing. I cringe at the thought that a doctor would use 23andMe results and only those results to infer carrier status of BRCA 1/2
The same goes for CF carrier status.
These DTCG medical tests aren't recreational. These companies added these tests because NO ONE wanted to pay hundreds, hell thousands of dollars to find out these risks.....
In a business decision, they fell short of looking at the medical risks.
So yes, a sliding scale of regulation is likely coming. But not because of Wylie, because of the FDA.
It is obvious. Again, medical testing will be regulated as medical. Ear Wax as ear wax. Will LDT be forced to go through pre-market review? Probably not if they can only be ordered by licensed professionals.....
It's not a form a rent seeking, it is a form of guidance and protection for consumers. That's why physicians are licensed and malpractice covered.
Yes, yes. Someday everyone will have these genomes done and everyone will be educated enough to know what they mean. And all humans will have medical education and we can replace the oligarchy of physicians and the tyrannical healthcare system once and for all........
But until that day, we will have to rely on trained professionals who don't have their retirements tied to their company's new genetic test......
The Sherpa Says: Handicapping of the FDA by the Sherpa. If it has any medical utility it will be regulated as either Class II or III. If only ordered via physician it will more likely be Class II. If not, will need Class III.
Posted by Steve Murphy MD at 6:51 PM
Friday, October 8, 2010
Wednesday, October 6, 2010
I have a lot of friends and readers who have emailed me over the month.
The recurring comments: "Has the DTCG field run you off of your blog?"
The answer: "Uh No"
Why I have I stopped blogging so much? For multiple reasons.
1. DTCG has been put on the Radar of the FDA and Government. I have nothing more to say about that.
2. Journalists and Genomics aficionados have been correctly pointing out the hype behind some tests. Most notably lately with the ADHD stuff, which BTW should not have been put out there in the press....Maybe, I need to blog more.....
3. My practice and patients have really taken up my time. I am working to apply personalized medicine daily. Because that is what is needed. We need to show the public and the press how it is done on a daily basis.
I will be back soon, to dissect shotty science and poor clinical studies. But for now, our boots are on the ground and we are climbing the mountain....
See you soon!
Posted by Steve Murphy MD at 6:44 PM