Genetic test may refine PSA or it may not!

I am going to read this article for the seventh time and get back to you this week.

In case you missed it, the PR Firm hired by DeCode pumped out a presser (press release), which I refuse to link to directly.....which essentially said

"Analysis of Four SNPs, in Tandem With Genetic Risk Factors Detected by the deCODE ProstateCancer(TM) Test, Yields Substantial Improvement in Efficacy of PSA Screening"

OK, 4 SNPs tells us whose PSA value is a bad 2.8 vs. good 5.8?

Or at least that's what the Kari S. tells us

"This is straighforward genetics with direct clinical utility." -Kari S. (Yes they rushed the release out with the misspelling of "straightforward")

Ok, so tell me, how has this straightforward genetic test performed in a prospective analysis?

What do you mean you haven't done that yet? So how can we have you assert that there is direct clinical utility?

We can't. Maybe you meant STRAY FORWARD?

Secondly, this study was carried out on Caucasian men, leaving African Americans, who often have earlier and more aggressive prostate cancer out in the dark.......

But what really got my Ire was when respected Tweeters started parroting this presser.........

Here is some high heat for us genome critics, read the study and read the presser. If the presser hypes the study, we should tear it apart and present the true facts for all to see on the internet.

Read and analyze the study, not the presser. I know we are all busy these days, but we owe that to our readers and the public. Hell, that makes us even better than a whole host of journalists who seem to quote Kari as if his opinion is the final take.

The Sherpa Says: On seventh read I will have a take on what these "SNPs that strengthen the predictive power of PSA" really mean.

Dr Topol, I agree with you. Patient empowerment is key.

Dr. Topol, who like myself is involved in a Cohort analysis of SNP scans and their effects on health behaviors has a video blog post about the recent Bad Press that SNP scans have gotten.

More importantly, the bad press that DTC genomic companies have gotten. For full disclosure, I am not affiliated with ANY of the DTC SNP scan companies BTW, CPMC was the first study of this kind, not Scripps.

Dr Topol says that there are articles which were published in the NEJM and they were reviewed by me a week or so ago......These articles obviously have caused "consternation"

He states that he approaches this from several perspectives and addresses his research.

There is the "Nihilistic Approach" that if you have an OR of 2 or greater that it is likely that this risk science is not going to go away and he asks "When is the right time to have this information?"

He says there is no real answer to this. And that there needs to be more research on missing hereditary components.....

Then he says he has the "By having this information and Empowering patients, you help them" approach

"That may be a good thing"

Well, here's my take. There are several different data points which are much more predictive, powerful AND CLINICALLY VALIDATED than these SNP scans which can cost upwards of 2500 USD. Let's see....how about Blood pressure? Body Mass Index? CRP? Family History?

The Whole Genome SNP scan is for research, not a business plan, not for clinical medicine.........or for a Venture Investment.

The Sherpa Says: By empowering patients, we help prevent disease. But by telling patients information that may be proven wrong tomorrow, I am not so sure that helps establish patient rapport. Encouraging patients to go out and spend 2500 USD in this economy on something that is relatively useless is the specialty of silver tongued salesmen and marketers like Bernie Madoff. Isn't that what got all of us into this economic disaster in the first place????

OK for Journals but Cut From the LA Times

It is important for all of us to contribute to the literature and assure the success of new and upcoming journals. I want to point you in the direction of 2 of these journals published by Future Medicine in London.

I mention this because I just finished my manuscript for The Journal entitled Personalized Medicine. This is an excellent journal with a tremendous potential. I recently published here and intend to send a significant amount of my work its way. But what is most important about these journals, Pharmacogenomics and Personalized Medicine, is that they are giving an opportunity for younger scientists, physicians and stake holders a voice.

This is important especially because as we interview with reporters, there is no guarantees that it will end up in their article. BTW Anna, I loved the article. Anna Gosline wrote an LA Times article which she spoke with me about. Well, I guess Muin is a bigger name than me ;)

Everyone should read this article....It is excellent. And Anna, if you need some medical advice feel free to call us and you can be one of our cadre of Navigenics patients.

I have recently begun to realize the potential of pairing patient centered care with genomic medicine. By putting these two ideas together....we may have a winner. I think that these two parallel ideals may actually be synergistic. Put plainly, moving the care in a patient centered way that DOES NOT REMOVE the healthcare practitioner, but places them as the coach, enables patients to make better choices by understanding their genomic risk. First by taking a family history and secondly by using appropriate genetic testing. Just like Muin said.

Ok, now the gossip fix. Did anyone read the Sunday Times? Well Navigenics was in it. Slapping 23andMe in the face. From the article

The company has been authorized to sell the service to residents of every state except New York (Told you so), Ms. DuRoss said. New York residents must join a waiting list until state health officials license the company’s designated lab to provide services to New Yorkers.

Even if that regulatory hurdle had been cleared, Ms. DuRoss said she doubted that the company would have invited customers to provide saliva samples on the spot. “It’s a little awkward to ask people to spit in public,” Ms. DuRoss said. “It’s a very private thing.”

Woah!!! We (Navigenics) are classy and tactful, You (23andME) are classless. That's what it sounds like to me ;)

The Sherpa Says:
When my next article is published I will let you know. I hope it serves as a good compass. Speaking of compass, take a looksie at Daniel's post at Genetic Future....he seems to think these big corporate genomic companies will be fighting each other for quite some time....He may be right. Maybe they could read my article? Then they would realize what they needed to do. Differentiating themselves is definitely a start.