Sorry so long away

I haven't been blogging for sometime lately, this is for several reasons. The biggest of which is personal. I apologize to my readers, but we have had some family health issues.

When I come back, and I will, I am going to bring you some very exciting updates and also be posting on things VERY, VERY relevant to the Personalized Medicine Revolution taking place.

But until then, Family First. I hope you all understand.

Keep Climbing,
-The Sherpa

This Just In. 23andMe to go to GPs. I love my readers!!

That's correct. 23andSergey are going to offer GPs deep discounted SNP scans to General Practitioners in England.

As she is interviewed by The Times!!!

This comes just DAYS after I said that their market is in England, NOT the United States.....

"After listening closely to Timothy Aitman of the Imperial College of London, it seems to me that the market for DTC is not in the United States.

It is in Jolly 'Ol England. "

One of my readers sent this to me today and I laughed and laughed.

Why?

I am filling out an abstract that I will present to the GAPPNET meeting in Michigan.

It is about media response and attitudinal change to these companies correlated to my blog posts......

So what does Jolly 'Ol Anne and Bloody Sergey plan to do for Londoners????

"Ms Wojcicki said that it would be especially important for companies like hers to work with doctors to interpret genomic information, as the costs of DNA sequencing fall further. It is widely predicted that it will be possible to sequence anybody’s entire genome for less than £1,000 within a year or two, to reveal genetic variations that influence disease risk and response to drugs."

Ahhh, now you want to work with doctors Eh? Maybe listening to Mari Baker a little???? Physician distribution centers......

OMG, Dietrich, did you tell them our plan????

Well, count me in. As long as you come on bended knee. I will hear what you have to say. But then you have to hear what I am to say as well........

I have been getting CPMC data, this is no different, except the lack of IRB, the potential of bankruptcy sales of my data, the pootential of google linking this data to my gmail account etc.

The Sherpa Says: After trying to replace doctors with algorithms and getting bashed up against a brick wall, I would be more than happy to help you do this the right way.....Unless of course, you eat pain for breakfast!!!!!

Tell Me, How do you feel now? Sherpa's RX

One thing is for sure. In a recent poll of members of the AMA, granted a pretty skewed poll as tons of AMA members cut up their cards this year........random sample of 6000 physicians from the American Medical Association (AMA) Physician Masterfile, which includes current data on all U.S. physicians.

Excluded were, residents and doctors in US territories. From this data in the New England Journal of Medicine, Keyhani et al found some interesting things. The biggest of these is that a majority of physicians are for a governmental option WITH private options.

Not a surprise, this is what ALREADY EXISTS.

From the study......

"Survey respondents were asked to indicate which of three options for expanding health insurance coverage they would most strongly support:
1. public and private options, providing people younger than 65 years of age the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans

2. private options only, providing people with tax credits or subsidies, if they have low income, to buy private insurance coverage, without creating a new public plan.

3. a public option only, eliminating private insurance and covering everyone through a single public plan like Medicare.

We also assessed the level of physician support for a proposal that would enable adults between the ages of 55 and 64 years to buy into the current Medicare program — a strategy that the Senate Finance Committee has proposed."

But what pisses me off about the article is how it is written....take a listen....

"Physicians in every census region showed majority support for a public option, with percentages in favor ranging from 58.9% in the South to 69.7% in the Northeast. Practice owners were less likely than nonowners to support a public option (59.7% vs. 67.1%, P<0.001),>majority still supported it."

No caveats for the fact that DOCTORS ONLY SUPPORT A PUBLIC OPTION IFF there exists a private industry as well.

What these jokers don't say is precisely that point. Which is why, the press will publish "A majority of doctors support a Public Plan" which may sound like they support single payer.....

They don't. In fact, 3 times as many support a private only plan than a public only plan!!!!

They do acknowledge limitations

"Some limitations of our study deserve comment. First, our response rate was 43.2%, which is modest, though typical of the most recent national physician surveys and surveys in general.

There were no significant differences between survey respondents and nonrespondents in important characteristics, such as specialty, practice location, and practice type.

Second, physicians’ opinions about strategies for expanding health insurance coverage may have evolved during the period of data collection, given the intensive press coverage of the issues."

But in the end, they never, ever mention the fact that a near THIRD of physicians support a private ONLY system and that this number is 3 times the physicians who support a government ONLY plan like Canada or the UK. Thus placing those progressives who demand such, clearly outside of the mainstream of most physicians.....

The only true way to save costs is to start using science and personalized medicine. You will not save costs by covering more people. In fact, I argue that there is no science which truly extols the benefit of enhanced coverage. What should be enhanced is catastrophic coverage.

What bankrupts people? Catastrophe, not a URI.

If you want to nationalize/universalize coverage, stick with catastrophic care. That would make sure everyone was covered when HUGE bills hit.

I am certain this plan would be extremely useful. Enroll everyone in this system and pay out when catastrophe strikes. It works for life insurance. Leave the small time players alone and focus on hospitalization costs, etc.

Continue funding HPSA and increase the loan repayment to 300k over 3 years rather than 85 over 3 years. Watch the doctors come then.......

Give tax subsidies for people who pay for URIs etc or traditional health insurance, which now should cost less as the government/taxpayer absorbs the catastrophic costs.........

That should keep everyone covered and help out with the uninsured. We all know that the major cost to hopsitals is the "self pay" patient with disseminated echinococcus or HIV or esophageal cancer or heart attack.

As for the government and medicare, if you just had a huge boost in revenue by new people coming on board for catastrophic care (To be read as, not pay out for most, and pay out later for some) you could help that insolvency thingy........

The Sherpa Says: Personalized Medicine is a key, rational thinking is the LOCK! I know, my wife just had an ER visit, the hospital charged 6168.00 USD, the insurance paid 800 USD. If she didn't have an insurer protecting her from gouging, she would have had to pay 6168.00 USD. I see it both ways....

Adrienne Carlson's Personalized Medicine.

Why Personalized Medicine?

There’s no doubt that mankind is advancing in leaps and bounds in all spheres, and when it comes to medicine, advancement is absolutely imperative if we are too keep ahead of the new diseases that are constantly plaguing us. If we consider it on a deeper level, personalized medicine is something that would benefit each of us, if we had the wherewithal to pay for the expense that it entails. In essence, it boils down to analyzing our gene sequence and deciding on the best treatment that our bodies are likely to respond to.

Personalized medicine will pave the way for the more effective treatment of diseases like diabetes and coronary issues, illnesses that are based on hereditary factors and our gene sequence. If we were to explain it in layman’s terms, it’s like going to an exclusive tailor and getting a suit custom-made for your size and shape without having to resort to buying one off the shelf, one that is often ill-fitting either over the shoulders or around the waist and hips. We don’t have too much control or say in what we buy directly from the store – the closest we can get to control is to buy a size that we think is right for us, one that does not really fit the way we would like it to.

Personalized medicine is good because it is preventive in nature; it helps prevent hereditary conditions rather than try to maintain and cure them after they manifest in our bodies. While it may be expensive initially, if personalized medicine advances through continued research, the healthcare industry will be able to save a huge amount of dollars in money spent on treating diabetes and other hereditary diseases that cripple and even kill.

Some forms of personalized medicine are already here to stay – drugs that attempt to change your genetic predisposition to certain diseases are already on the market and come with warning tags that are supposed to prevent other people, those without these genetic markers, from taking them.

It’s a nascent field, one that holds much promise, and if allowed to grow, will prove to be a boon to mankind.

By-line:

This guest article was written by Adrienne Carlson, who regularly writes on the topic of nurse practitioner schools . Adrienne welcomes your comments and questions at her email address: adrienne.carlson1@gmail.com

The Sherpa Says: Be kind, she is a nice lady.

Crazy Night of Emails to Government

So I was up watching President Obama deliver his speech with his usual eloquence and charisma when I began really paying attention to him. Not just his looks or his mannerisms, but instead to the words he was saying.

Why? Because what he was saying may have an impact on

1. My patients
2. My future as a physician
3. My family

I began to realize, OMG this issue can either affect every person, or just those who don't have insurance.

Most people who have insurance don't want it taken away. Most people who don't have insurance are young people, those who don't care about their health or those who can't afford it.

Why are people freaking out at town halls, because they could be affected negatively and are scared of this. Should they be? Well, maybe.

Medicare for example has a fee schedule for each state, you can look at CT here It is traditionally the lowest PAYOR OF ALL!!!

I am sick of hearing "Medicare is a popular program"

What is the alternative for someone greater than 65? Free or pay out the nose for medical insurance? I am SURE that this is why the program is popular.

Let me tell you a little secret. You mess up and miscode for an Insurer, you get audited and pay them back.

You mess up and miscode for the Government Plan, you have effectively committed a felony that could ruin your career forever.

Make sense? Not really.

Ask the doctors who do the coding if Medicare is popular. They will vehemently say no. Doctors everywhere are dropping Medicare because it

1. Doesn't pay enough
2. Exposes you to legal risk
3. Can punish you for not doing what they say

Corporate Insurance does Number 1 and Number 3. But they do not put you into number 2.

Why should we be felons? Any other governmental plan is likely to have the same statutes..

But, I did like the speech. I just hope he can back up the words.

But the answer here is simple. Someone takes other people's money and then takes some for themselves and their administration, then they pay for other people's healthcare.

Take less for administration. My guess is most of what is done could be automated by technology.

I got so fired up I emailed, Jim Himes, My congressman, from Greenwich.

I was in such a frenzy that I decided to comment on the Human Genetic Commission at the British Department of Public Health. This too was a diatribe. So I wish the UK all the best.

Why the UK? Timothy Allistar made me do it. After watching him brief the National Academies I began to say, here is a really smart guy, who thinks DTC Genomics is Not medicine.

I needed to get my point across. Now granted I am no Muin Khoury, but I wonder if Muin has commented on the site....

So I took this as my task as well. Needless to say, I am extremely exhausted. My points for DTC Genomics you have heard.

My Points to Jim Himes are as follows.

1. If you want to cover the uncovered, make it mandatory and give subisidies (Nice job Obama)
2. If you want insurances to stop being profit centers, create a NON Governmental Not For Profit like a Mutual of Omaha, etc. Fast track credentialing for them, but don't subsidize.
3. Don't cut payments to physicians, they already are getting killed by your lack of pay raise
4. You have to focus on a few things at a time. Play your hand wisely, or we won't vote for you again.

The Sherpa Says: True, no genetics today, other than the UK commentary (HT David)

The problem with nonclinicians.......

There is a huge set of people involved in the clinical DTC genomics game who are arguing that what they do is not medicine. Some of these people aren't even employees for these companies.

There is a fantastic comment string over at Daniel MacArthur's Blog Genetic Future.

Basically, from what I gather, Sigmund who is assume is a PhD Geneticist is telling me about clinical value and utility. He also is scolding me for using SNPs for the BRCA genes as clinical tests

"The fact that you see 23andme snps as valid for confirming a BRCA1 or 2 mutation status is, frankly, disgraceful."

What he doesn't know is that the DNA are not really SNPs per se.....they are mutations

i4000377, i4000378, and i4000379

5382insC

185delAG

6174delT

Look familiar?

These the Ashkenazi BRCA1/2 Founder mutations which are often tested for FIRST in people of Ashkenazi Jewish Ancestry....... PRIOR to Full SEQUENCING.

These 23andMe Mutations are precisely at the heart of what I argue is a silicon valley company trying to practice medicine without a medical license.

But the problem with Non-Clinicians is that they don't know clinical medicine, so how could they argue that something IS NOT clinical medicine?

Does that make any sense to you. Maybe if they could say, "Yes, I know clinical medicine by studying for 12 years" But if they do that, then they become clinicians in some regards......

But in usual Gene Sherpa fashion, I quickly disqualify people who do not know clinical medicine from arguing once they demonstrate their lack of knowledge in the clinical space.


@Sigmund,
Are you serious? The standard of care for ASHKENAZI jewish people with a high likelihood of carrying a BRCA mutation is to start with these SNPs.

You sir are officially disqualified from learned discourse in the clinical realm. Rather than address my questions about what you define a clinical test to be, you try to play straw man by stating something I did not argue all the while not answering the question.....

You are wrong. I am correct. This IS a clinical test, used ALL the time via a CLIA certified lab. Whether it be Myriad or Yale.

They check for the same biological sample and the presence of the same DNA......

I am an excellent clinician and don't need to defend myself to someone who obviously doesn't know the clinical standards of care in cancer genetics.....

God Speed in your quest to endanger the public.

-Steve
www.thegenesherpa.blogspot.com

So if you want to watch a fiery debate about who is doing medicine tune in to Daniel's Blog

Re-Reviewing the National Academies

After listening closely to Timothy Aitman of the Imperial College of London, it seems to me that the market for DTC is not in the United States.

It is in Jolly 'Ol England.

Timothy seems to be very Pro-DTC and Dr. Khoury(CDC), Dr. Ganz (UCLA) and Dr Korn (HARVARD) seem to firmly believe that regulations are needed and that they should be treated as one in the same with "Any other Clinical Laboratory that is offering similar services"

Frederick Anderson asks, "How far does this go? Does this go to the interpretation or the testing? Or Both?"

It seems to me that this panel is Pro-Regulation.

Timothy BTW is just a presenter, not a member.

My guess, National Academies will conclude that the regulation of these companies currently is not up to par. In fact, they may conclude it is an area in dire need of further regulation. What will that mean?

The business models of these companies will shift towards research focus. OR, they will start medical practices. Which is sad that they run away from regulation as opposed to actually sacking up, taking the charge and doing it the best they can. Ah, such is the fickle problem with Venture Capital......why take that risk of regulations with other people's money. Understandable.

The Sherpa Says: I will cover the Alzheimers stuff later. It is not as exciting as you may think.....