Yale's Healthcare 2009 Conference and the Sherpa

I am preparing to speak at Yale School of Management's Healthcare 2009 conference. It looks to be quite a conference. The theme this year will be

"Where is the Value? Managing Cost and Quality in a Healthcare System Facing Reform."

From the site:

The Yale Healthcare Conference is a joint effort between the School of Management and the Health Professions Schools at Yale University that aims to bring together professionals, academics, and students to engage in an instructive interdisciplinary conversation concerning current healthcare issues. This will be the 5th consecutive year and we expect the conference to continue growing to over 400 participants.

The planned title and theme for Healthcare 2009 is Where is the Value? Managing Cost and Quality in a Healthcare System Facing Reform. This conference will focus on a theme of value in the healthcare system. The conference aims to address three principle questions:

1) How do we provide better care to more patients while keeping costs under control?
2) What are innovative public and private solutions to this problem?
3) What sort of opportunities and challenges will potential healthcare reform bring?

I think that this is a timely conference. With the administration supporting reform and already a record level of Medicare Audits in the system, it is clear that America will face a drastic change in the way healthcare is provided in this country.

My breakout session is on, guess what......

Personalized Medicine!!

I will be accompanied by Dr Aidan C Power of Pfizer.

Aidan's team is at the forefront of Personalized Medicine and PGx at Pfizer. Aidan has been addressing several issues and study design for personalized medicine. One recent example is the issue of race and ethnicity in PGX.

Aidan has even been briefing the Personalized Medicine Coalition, something we at Helix Health of Connecticut are proud to be a part of.

The Sherpa Says: Healthcare IS Changing. This conference is a great way to learn about some of those changes. I hope to learn alot!

An Attorney General, A Genetic Counselor and Gap Phase

Today my phone blew up. I had five different Venture Capital firms call me to pick my brain about "The New deal with Illumina" as well as "Viability of Microarrays in Pharmaceuticals"

I must say thank you to those who called. I look forward to speaking with each of your esteemed groups.

That being said......I must say that there is a general consensus of the physician side that the time for whole genome analysis for your health is not now. I agree. An excellent scientist Dr Bettinger over at the Genetic Genealogist posed a great question.

"What is your opinion on Gap Phase?....."

"that inevitably long period of time between (1) the availability of inexpensive whole-genome sequencing, and (2) the point when the medical field produces enough specialists in genetics to handle the work load."

Well....I don't think that is what gap phase is. Currently there are less than 1300 geneticists for the WHOLE country. In addition. If we expect personalized medicine to affect things like Coumadin, a drug which is dosed by adult doctors primarily, then shouldn't we have some adult geneticists? There are less than 100 of these doctors in the US. LESS THAN 100!!!!!!! Even scarier, there were less physicians sitting for the genetics boards this year than 5 years ago.

I don't think Gap phase has anything to do with these people. I think GAP phase has to do with literature and evidence based medicine. In medicine, doctors try not to do anything without good data that shows long term outcomes. When they veer from this path you get train wrecks like drug eluting stent mishaps and Vioxx!!!! Soon to be Avandia!!

So what do we do with the gap? We mind it!! We don't jump blindly without looking out for the fall that it may cause. Overselling genomics could destroy personalized medicine's promise! I will not let some overzealous "Let's do it because the technology is there, and so cool" people ruin our future. Even for a quick set of chromosomes!

As for trained professional shortage....When we have fighting between lab companies and the people who traditionally order tests, then we have a problem. Which is the case with Myriad.

There is a great NPR spot coming up. A colleague and teacher of mine Ellen Matloff. She will be on there with Attorney General Richard Blumenthal discussing the controversial Myriad advertisement campaign that is now running in CT, MA and NY. You can listen in online Sunday Evenings at 6:00 PM http://www.wnpr.org/

Ellen is the bane of Myriad's existence and because of this the genetic counselor is notably absent from the Myriad commercials.....hmmmmmm

She has started an online petition to start asking state's attorney generals to investigate misrepresentation in genetic testing. My genetic counselor has a wonderful take on this whole thing. BRCA testing is NOT in Gap Phase, unlike whole genome sequencing for healthcare. It has significant amounts of data and studies. It is clinically useful and can be of benefit when used properly. The problem.....The Fox is watching the Hen house. Lab reps are probably not the best people to be teaching physicians about using these tests, trained counselors and Geneticists are.

I am scared for physicians and this should serve as a warning call.

MYRIAD/23andME/Navigenics/futureunnamedbiotech are saying, "if you aren't with us, then you're against us, AND WE WILL REPLACE YOU WITH COMPUTERS!!"

The Sherpa Says: When my phone blew up today, the question was not, how can we invest in a safe product and service that will benefit people's medical care. It was..."How can we make this scalable?"......The answer does not lie in training genetics professionals....that takes at least 9 years after college. The Answer......All roads lead to Google.......Too bad the data is not there and computer guys haven't been burned as bad as those Vioxx doctors......

Longevity Genetics....What's Old is New!

Today in the news there are reports of Dr. Jonathan Rothberg's plans to extract DNA from the saliva of 100 people over the age of 95. It was also posted on back in July on ABC. I would just like to bring attention to it again and compare this with the work that has already been done by one scientist.

The idea is to study those who have lived a long time. Perhaps there is something in their make up which keeps them alive despite the stressors which all of us face. This is nothing new. Nir Barzilai at Albert Einstein College of Medicine has been doing this for years. I have been at several of his lectures. There is a nice video on SAGE Crossroads about what he is and has done.

Rothberg's project is aptly named the Methselah Project after the famed biblical man who live to be 969 years of age. This is not to be confused with the "rock band" or the biblical revival (hits one and two on my google search)

What will he find. Well let's examine what Nir found. Of the findings, notable were the polymorphisms on cholesterol genes including homozygosity for the -641C allele in the APOC3 promoter as well as a markedly higher frequency of a functional CETP variant that led to increased particle sizes of HDL and LDL and thus a better health performance are some of the first examples of a phenotype and an associated genotype in humans with exceptional longevity.

The CETP example is interesting simply because of a drug that was recently pulled from trials. It was called Torcetrapib. It was designed to boost the levels of HDL by blocking the function of Cholesterol Ester Transfer Protein (CETP). The problem? Increased blood pressure, then stroke and heart attack. When they released data showing increased BP it didn't take a rocket scientist to figure that there would be increased heart attack and stroke. But they continued the trials despite this until finally the data implicated Torcetrapib in increased risk of stroke and MI.

What will Dr Jonathan's project show. Hopefully some of the same linkages. Will we "Cure" aging by figuring out these markers? Well Hsien posts on this topic over at Eye on DNA. I would be interested in what my readers and fellow bloggers have to say. Send me an email.

The Sherpa Says: Longevity genetics is a lot like nutrigenomics......As Dr Ordovas says regarding diet and genes "It is like looking through the keyhole of a door." The relationships are truly complicated and it will take a while till we can recommend measures to prevent Aging. Oh the horrors of this dreaded disease! The Buddha would say differently and so would the Sherpa.

Disturbing Drugs

In the most disgusting display of capitalism this side of the I don't know where Wired Blog posts about PharmaTV. Four companies, Johnson & Johnson, Pfizer, Novartis and Procter & Gamble are behind this disgusting "educational" television channel. The article can be found in the Guardian. I am deeply disturbed by this precedent. At least you can tell the difference between an ad and a show. True, even these days product placement, fake blogs, etc. continue to blur the lines.

The Gene Sherpa Says: What's next? DTC Gene TV? Shame on all of you.