Direct to Consumer Genetic Testing

Genetic Testing Might Not Cure Everything That Ails America. So What?

Even if genetic testing is just brightly colored signage, it still has the potential to improve health outcomes.

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Genetic testing company 23andMe received FDA approval this month to resume telling customers about their predisposition to various syndromes and illnesses. Reason's Ronald Bailey, a longtime 23andMe user, is happy, though he'd be happier still if the FDA got out of the genetic information-policing business altogether.

The Mayo Clinic's Dr. Michael Joyner, meanwhile, responded to the FDA's announcement with skepticism. His beefs, in order:

  1. Genes are not destiny: "For example, people at increased genetic risk of cardiovascular disease are not at all destined to die from cardiovascular disease. Importantly, they also are at much lower risk if they follow a healthy lifestyle."
  2. Genetic info is not a necessary prerequisite for minimizing risk: "When I hear anecdotes about someone becoming more active and losing weight because they found out they are at mildly increased genetic risk for something like type 2 diabetes, it always makes me wonder why that motivated them more than all the important things we already know a healthy lifestyle can help with."
  3. Genetic testing can freak people out: "First, some people who get a score back suggesting they are at increased risk might become fatalistic and figure there is nothing they can do. Or, some people who get a score back suggesting they are at decreased risk might become cavalier about their risk and assume they are protected no matter what they do."
  4. There are cheaper tests that tell us far more about our health: "when the topic of gene scores comes up, I like to mention what I call the 'bathroom scale score.' It turns out that for many common chronic diseases, body weight, BMI or waist circumference are more predictive of future risk than a gene score."

When reading doctors on direct-to-consumer health care technology, I get the sense many of them perceive all this stuff to be a profound misallocation of resources. Yes, we are entering a truly incredible age of self-assessment on demand, and yes, those technologies have made healthy people even healthier. But middle-aged, lower-middle-class white Americans are living shorter lives and 86 million Americans have fasted glucose levels that suggest type II diabetes is not far off. What are these new technologies doing for them?

These folks currently have access to mundane technology that will tell them far more than a 23andMe report: the bathroom scale, the free blood pressure machine at the pharmacy, the fasted glucose and cholesterol panels their doctors have ordered; all these diagnostic devices are telling them they have problems right now, and should eat less, eat better, and move more. If those inputs don't inspire change, why would a genetic test–alluding only to diseases they might get–be any different? It might not be!

Genetic testing could be more like broccoli sprouts than broccoli: Broccoli sprouts are a hot "super food" right now, but most of us could stand to just eat more broccoli, the way most of us should be taking advantage of simple health assessment tools. Then again, the fact that getting people to eat more vegetables–of any kind!–would go a long way toward improving American health-care outcomes is no reason to condemn, or ban, bougie super foods (or genetic tests).

As someone who treated his body like a Superfund site for the better part of two decades, but now takes his health very seriously, I like the prospects of the direct-to-consumer healthcare market. Like many folks, I waited for a "medical trigger" to take stock and make changes. Some people don't need to develop chronic high blood pressure or sleep apnea to take their health seriously, other people don't take their health seriously until they develop one or more of those things. People in the latter category could benefit from more warning signs, particularly earlier in life. I just don't see the downside, particularly in light of what we're learning about reversing negative health trends at the individual level. As The New Yorker's Rivka Galchen reported in a piece on bariatric surgery last year, even though losing weight is literally as simple–for the vast majority of people–as "calories out must exceed calories in," rerouting the digestive tract is now considered the most effective means for treating obesity and the diseases that frequently accompany it. "I'm a dyed-in-the-wool behavioral psychologist," U. Penn's Tom Wadden told Galchen, "and even I will tell you that there's no question that bariatric surgery is going to provide a larger and more durable weight loss than life-style modification, medication, or even a combination of the two."

If genetic testing is just bigger, brighter signage warning us about the road ahead, maybe that's enough.

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30 responses to “Genetic Testing Might Not Cure Everything That Ails America. So What?

  1. So, will genetic predispositions be covered as pre-existing conditions under the (repealed and replaced) ACA or no?
    That seems like a decent way to murder the at home genetic testing market.

    Additionally, AFAICT, we have yet to go through any sort of real fraud and/or regulatory capture WRT this market. Once 23andMe gets a (few) competitors, it will be interesting to see what happens when opinions differ.

    1. Regulations bypass… PLEASE consider my worthy suggestions here! The SHORT version is simply this: Set up a “Feng Shui Molecular Fortune-Telling Analysis” branch in China. Tell you USA customers how to run a Q-Tip across the insides of their cheek linings, and where to send it in China. Your Chinese subsidiary can then email or snail-mail the results back to the USA consumer, who is anxiously awaiting the results of the (obviously non-medical) analysis of the Feng Shui sooth-sayers in China. They will examine the arrangements of the molecules on the Q-Tip, to say what they might tell of the fortunes of the USA consumer. FDA problems solved!

      1. The slightly longer version here is this: It offends me immensely that, in the names of simple freedom and religious freedom, I can pay (and get tax deductions for!) payments to the “Church” of Scientology, which will claim to help me fend off “engrams” via the use of an “E-Meter” (crude lie detector). All they’d have to do is to re-name the “engrams” to “psychoses” and the “E-Meter” to “Psychometer” and the FDA would be all over their case! You need to follow in the footsteps of the “Church” here, to give us consumers some freedom, and lower prices, please? Then of course, I am also free to consult various totally un-scientific fortune-tellers, and the FDA gives me that freedom yet again. Yet if I want to access the fruits of modern science, the FDA hinders me. So? You do the math, please!

        1. SURELY it is no crime for me to mail a dirty Q-Tip to China! SURELY it is no crime for someone in China to email or snail-mail me about my fortunes! So here is your possible, proposed verbiage to put on your flyers, web site, advertisements, etc.: “Our company regrets to inform you that the FDA has inflated the costs of our USA-based genetics testing services. If you appreciate the services of the FDA, you may purchase our well-regulated services in the USA for $700. However, if you are primarily interested in costs savings, and are a follower of Eastern Mysticism, then in the name of religious freedom, our Chinese compatriots are willing to assist you. They have meditated deeply about matters concerning the proper Feng Shui, and Chinese Buddhist, principles as they relate to the arrangements of molecules and atoms in your cheek linings. Keep in mind that our Chinese brothers and sisters are NOT addressing matters of medicine, here, they are addressing spiritual principles. So, regardless of your other spiritual beliefs, or lack thereof, if you are willing to sufficiently believe enough in Chinese Buddhism to send some of your cheek linings to China, then they will mail or email you your fortune predictions, for $400 (not $700).

          1. We do not promise any scientific or medical accuracy here; this is simply a spiritual fortune-telling operation. However, we do challenge anyone to see if they can put in two identical source samples, under different names and addresses, and get significantly different results. We DO stand by the integrity of our spiritual fortune-telling operations. Follow these instructions: ?. Blah-blah-blah.”

            Will someone PLEASE take up this business model to bypass our Overlords at the FDA?!?!?!

    2. They’re simply one more bit of information to consider when insurers are figuring out how much to price your medical insurance premiums – or if you’re simply too much of a risk.

      Even if you opt out, that doesn’t mean an insurer won’t require it anyway – same as many do with medical exams prior.

  2. When Johann Gutenberg and Martin Luther made it so regular people could read the sacred scriptures and decide for themselves what the word of the lord meant, the Pope bitched like a motherfucker, too.

    1. Interesting to think of the Popes as the ultimate Statists. Full of paternalistic thoughts and official writs, the very name is appropriate for the job.

      I wonder what Popes think their job should really be, how powerful they should be, how much they hunger for the old days when they could burn heretics at the stake and start wars. The current incarnation sure isn’t very humble.

      1. Progressive Theocracy

    2. When did Martin Luther think that people should decide for themselves what the “sacred scriptures” said? He interpreted them like a Mofo.

      1. shouldn’t the quotes be around ‘said’ in this context?

  3. It turns out that for many common chronic diseases, body weight, BMI or waist circumference are more predictive of future risk than a gene score.”

    I would like to take this opportunity to offer a more cost effective solution to those seeking a window into future health. Simply send my company your height and weight and, for a nominal fee, one of my technicians will provide for you your BMI score and a definitive answer as to whether or not you’re fat. BMI is just as much science as this so-called gene thing. Let it work for you, shaming you back to health.

    1. Thin, Sexy People never get cancer.

      Too busy dying mid-coitus.

  4. Just answer me this… can it cure what I’ve got?

    1. The Thorazine and the electroshock ain’t getting the job done?

  5. That doctor is literally saying you have no right to know what your personal property, your genes, say about you.

    1. Is that news?

      Many diagnostic tests, if not most, require a doctor’s prescription.

      No healthcare for you unless you pay your tribute to the Medical Mafia first.

      1. And a lot of them you can order over the internet.

  6. The Mayo Clinic’s Dr. Michael Joyner, meanwhile, responded to the FDA’s announcement with skepticism.

    Drop dead, slaver.

    1. Naah.
      It’s “fuck off, slaver”, like with Tony or DanO.

  7. I too like the practical arguments, but they are really beside the point: freedom is what counts. Too damned many statists who assume state control is the default condition, combined with the precautionary principle (don’t ever do anything for the first time).

    Any new tech, any new idea, method, and statists’ first reaction is “where are the regulations?”.

    Fuck ’em.

    Let victims prosecute. If there are no victims, there is no prosecution. Me, I’d like to be able to sue the statists for harming me and everybody else, becase they do, all the time, every time.

  8. Like feminists everywhere like to say “My body, my decision”

    1. But the reality too often is, “Government Almighty’s body, Government Almighty’s decision.” “Your” body does NOT belong to YOU; it belongs to Government Almighty!!!

      1. Scienfoology Song? GAWD = Government Almighty’s Wrath Delivers

        Government loves me, This I know,
        For the Government tells me so,
        Little ones to GAWD belong,
        We are weak, but GAWD is strong!
        Yes, Guv-Mint loves me!
        Yes, Guv-Mint loves me!
        Yes, Guv-Mint loves me!
        My Nannies tell me so!

        GAWD does love me, yes indeed,
        Keeps me safe, and gives me feed,
        Shelters me from bad drugs and weed,
        And gives me all that I might need!
        Yes, Guv-Mint loves me!
        Yes, Guv-Mint loves me!
        Yes, Guv-Mint loves me!
        My Nannies tell me so!

        DEA, CIA, KGB,
        Our protectors, they will be,
        FBI, TSA, and FDA,
        With us, astride us, in every way!
        Yes, Guv-Mint loves me!
        Yes, Guv-Mint loves me!
        Yes, Guv-Mint loves me!
        My Nannies tell me so!

  9. Is it just me, or did this article wander off its original topic?

  10. More important than predicting what you’re going to die of is how molecular tests will change treatment of some cancers.

    They run a DNA analysis of healthy cells then do the same for cancerous cells. The difference will be where tailored chemo will be used to attack the cancer.

    Fuck cancer

    1. “More important than predicting what you’re going to die of is how molecular tests will change treatment of some cancers.
      They run a DNA analysis of healthy cells then do the same for cancerous cells. The difference will be where tailored chemo will be used to attack the cancer.”

      No, I don’t currently have any cancer, but I have acquaintances who are MDs in the field. From them I’m pretty sure I will have cancer somewhere; comes with birthday candles.
      But this is where the current research is aimed; “cancer” isn’t a general condition, it is a specific growth in a specific organ. And the treatment is targeted as it never has been.
      No one I know is suggesting a ‘once a day pill’, but the folks I talk to are suggesting adding 10 years to current life expectancies without ‘heroic’ care.
      I’ll take it.

  11. Genetic testing and the science around it is a disaster for the Progressive State.

    Your mom and dad both have big schnozzes. So do you. Your mom and dad are good athletes, and so are you. Your mom and dad are both physicists, and you’re at least good at math. Your mom and dad have deep memories, and so do you. Your mom and dad lived without health issues into their late 70s. So will you, most likely. That’s the other side of genetic testing. Humans are not blank slates.

  12. How does the FDA justify this being within their jurisdiction to regulate to begin with?

    Genetic information is neither a food nor a drug.

    The company is in the business of providing information that it’s customers have contracted with it to provide. The company is not providing any actual product that is ingested into the human body so how is this any of the FDA’s business?

  13. “bougie”

    Godammit, don’t do that.

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