500 Hospitals want to know....

Lots of stuff happening online today. I just left a conference call where I was the invited guest panelist along with Robert Resta CGC. The Advisory Board Company and The Innovations Center presented an Issue Brief entitled-The Genetic Testing Frontier: Impact on Clinical Care, Market Opportunities. Hundreds of hospitals were online wondering how they too can get a piece of the action.....

Also....did anyone read the Washington Post today? Genetic Testing Gets Personal again another article on this "revolution" non subscription link here

"We call it consumer-enabled research," said Linda Avey, co-founder of 23andMe, based in Mountain View, Calif. "It's about changing the paradigm of how research is done."

Well Said.......You could also call it uninformed cohort analysis...."Free Kits?" Come-On....nothing is free. Davos, you sold your DNA for some fancy flash animation and trinkets....I am guessing the Belmont Report is not required reading in MBA schools...Hey guys don't worry, here are the Cliff Notes

The Belmont Report explains the unifying ethical principles that form the basis for the National Commission’s topic-specific reports and the regulations that incorporate its recommendations.

The three fundamental ethical principles for using any human subjects for research are:

(1) respect for persons: protecting the autonomy of all people and treating them with courtesy and respect and allowing for informed consent;

(2) beneficence: maximizing benefits for the research project while minimizing risks to the research subjects; and

(3) justice: ensuring reasonable, non-exploitative, and well-considered procedures are administered fairly (the fair distribution of costs and benefits.)

These principles remain the basis for the HHS human subject protection regulations.

Paradigm of how research is done???? Isn't that why we developed IRBs? To protect from those who want to change the paradigm and injure the patients? IMHO these companies need to immediately develop research protocols and IRBs. End of story....nothing less. The consumer should be allowed to at least ask questions to another person.

It can be entertaining, Venter said, to learn one has a gene for soggy earwax. "But if you're on the receiving end of one of these tests and are told your probability of having a serious problem is 62 percent, what the hell does that mean?"

And that is assuming the results are correct. As it turns out, many gene tests today search for DNA patterns that have been linked to a disease or trait in only one or two studies. Such findings are often overturned by later research.

Enter the trained professional.....This is precisely why we need more Sherpas!!!

Dr Venter is completely correct....the brick and mortar where professionals exist is the transition point. Even 500 hospitals online today acknowledged that. Now where do we get these individuals?

Exacerbating the problem is that virtually no one is watching over the industry. The Food and Drug Administration does not regulate most gene-based tests, and there is no federal proficiency-testing system for companies offering them.

Enter the SACGHS and EGAPP...2 organizations devoted to helping best practices....In addition, the ICOB at the Delaware Valley Personalize Medicine Project will also help shape this future.

"It creates an air of charlatanism that doesn't help the field," Venter said.
All told, concluded a study in this month's issue of the American Journal of Human Genetics, "There is insufficient scientific evidence to conclude that genomic profiles are useful in measuring genetic risk for common diseases or in developing personalized diet and lifestyle recommendations for disease prevention."

That is my number one concern. Here's why...geneticists and genetic counselors require referrals from physicians who don't speak genetics, but watch the national news and read the New York Times...If they link Medical Geneticists with Scientific Match.....There Ain't no way in hell any self-respecting, butt-covering, good physician will refer patients to such "Qwacks" simply due because of the confusion. All press is good press? Don't think so...especially when the NEJM posts such a confusing article failing to clarify the difference.

"I very much worry that all this emphasis on a 'gene for this' and 'gene for that' raises the risk that people will conclude that that's the whole story," Collins said. Instead of empowering people to make healthful changes in their lives, that could simply make them "more fatalistic," he said, "in which case, what's the point?"

Me too Francis...Me Too....

The Sherpa Says:

To climb the mountain we need unreasonable people that won't quit....Corporate and Academic can exist together...provided they do the right thing. Do it yourself surgery is probably just as "Revolutionary" so why isn't anyone on that money train? BTW the pic is of do it yourself LASIK.....I bet that is a best seller.

KIF6, Jarvik and You

Ok, so today I want to bring up a set of studies which I just finished reviewing extensively. I have to admit, we have some nice trends for genetic and genomic medicine here.

First, KIF 6 is identified as a risk for heart attack. Not super impressive with and Odds Ratio of 1.5. But it is replicated as well.

Second, the "Polymorphism in KIF6 Gene and Benefit From Statins After Acute Coronary Syndromes Results From the PROVE IT-TIMI 22 Study"

This is a good sequencing study of the bigger PROVE IT-TIMI22 study. More importantly it is a great representative of the retrospective analysis we can do on these great pharma based studies. The major limitation is the statistical flaws introduced by the method. So what is the major crux of this study.

The study population for this genetic study was derived from the PROVE IT-TIMI 22 trial, which has been described previously (14). Briefly, the trial comprised 4,162 patients who had been hospitalized for an acute coronary syndrome within 10 days preceding enrollment and who were enrolled while in stable condition and after any planned revascularization.

How well is this patient population a representative?

Because only 10.3% of the patients were nonwhite, which did not provide sufficient power for a separate analysis of ethnic groups, we included only the white patients in this genetic analysis.

If you are not caucasian, these results may not apply to you. The big problem I have with these studies is precisely their lack of diversity. This limits their applicability. But this is still an ok study.

Here is what makes this a good revisit. This study demonstrates a certain population at risk AND a benefit of therapy provided to that group. This is the essence of what pharmacogenomics and personalized medicine will bring to the table. The theory is nice, we will see if it stands


Carriers and noncarriers of KIF6 719Arg received significantly different benefit from high-dose atorvastatin therapy compared with standard-dose pravastatin therapy. Specifically, in carriers of the 719Arg allele, high-dose atorvastatin therapy 80mg, compared with standard-dose pravastatin therapy, reduced the risk of death or major cardiovascular events by 41% (adjusted HR 0.59, 95% confidence interval [CI] 0.45 to 0.77; p <>


This is a pretty good result. Funny how all the cardiologists I know pooh pooh'd the Coumadin genetic testing because there was no clinical outcomes(Not true BTW). Here we have some solid data coming from a cardio study. I maintain that these huge pharma sponsored cardiac studies will be the low-hanging fruit here. They have reams and reams of patients and their data already available, the genotyping should be the easiest part.

So sorry my cardiologist buddies, you got some learin' to do. It's ok, I will help you.

So here's a question. If this benefit is genetically mediated, will the non-carriers of KIF6 719Arg variant have a similar benefit?

In contrast, high-dose atorvastatin, compared with standard-dose pravastatin, was of no significant benefit in noncarriers (adjusted HR 0.94, 95% CI 0.70 to 1.27; p = 0.70) (Table 2). This difference in benefit between carriers and noncarriers was significant (p = 0.018 for interaction between KIF6 719Arg carrier status and treatment)

NOPE. So there you have it, the death knell to one drug fits all! If it stands....

"You hear that Mr Anderson?" (Hat tip Matrix)


Carriers of the 719Arg allele are at increased risk of fatal or nonfatal coronary events when not treated with statins ([8], [9] and [10]), and they clearly benefit from statin therapy, whether it be standard-dose pravastatin compared with placebo (8) or high-dose atorvastatin therapy compared with standard-dose pravastatin. In contrast, noncarriers not only were at lower risk than carriers in the ARIC and WHS trials and in the placebo groups of the CARE and WOSCOPS trials, but noncarriers also received less benefit from statin treatment than did carriers in the CARE, WOSCOPS, and PROVE IT-TIMI 22 trials.


There are some limitations, I agree. Despite the limitations it is the blueprint that matters most. This is the start of the new model! We shall see more of these redux studies shortly.

The Sherpa Says:

One of the biggest sellers in the pharma world, now has a target group that receives maximal benefit. Hey Hank, send me the check in the mail please.....You gotta love Personalized Medicine. Now we need 10 minute genotyping for those patients with chest pain. Or maybe they could use their NAVIGENICS or 23andME screen which their PMD pooh pooh'd? But you would need a geneticist to interpret that!

Nice Commercial, Bogus Advertisement.

Has anyone seen a company named Navigenics....Unless I have been sleeping and missed my daily rss feeds searching pubmed for pharmacogenomics, personalized medicine, genomics, and GWAS I feel they are lying.......

They have partnered with Affymetrix and plan to NAVigate GENomICS.

The way the Navigenics process works is that you submit a saliva sample and.......

They present your future!!!

Please take a look at the commercial!

What blew me away was this quote......after a misleading commercial where you think that a simple report, delivered in your email, describing your genome will alter your life......

"Now is the time when people should be getting this information(their genome). The Science is there, The Information is there....and Now Navigenics is there"

Even more disturbing is the fact that this was a quote by Greg Simon JD.....Their Chair for the Policy and ETHICS Task Force. Mr Simon is the president of FasterCures an "actiontank" committed to "saving lives by saving times" Mr Simon was the Chief Domestic Policy Advisor to Al Gore from 1993-1997

I don't think saying "The Science is Here" is an ethical statement. In fact it is misleading. He could mean the science to obtain a genome is here.....which is true......He could mean that the science to hold your genome and store it is here....true again.....but the commercial gives you the feel that the SCIENCE IS HERE TO APPLY THE WHOLE GENOME TO YOUR HEALTH. Especially when the tag line is "My genes....My health....My life....My Guide" Perhaps it depends on what your definition of is is......

The Sherpa Says:

Unless I have been asleep at the wheel, the science to send a report via mail and deliver meaningful contribution to you health care ethically and with some validity is not here. Perhaps Mr Simon missed the Bio 200 class where they talked about evidence based medicine???? Oh wait....there wasn't a lecture on that.....