Genetic Future

This seems like pretty interesting news:

23andMe, Inc., an industry leader in personal genetics, and Palomar Pomerado Health
(PPH), the largest public health district in California, today
announced that PPH will be offering the 23andMe Personal Genome Service
for sale to San Diegans at its outpatient health centers. As an
innovator in preventive health care, PPH encourages its communities to
understand their genetic information in order to make more informed
decisions about their health. This partnership marks the first time
that a healthcare organization has provided the Personal Genome Service
to members of its community, and the first time that 23andMe has made
the service available for purchase outside of its Website.

Starting today, PPH
will be offering the Personal Genome Service for $399 at two of its
expresscare retail health centers in Escondido and Rancho Penasquitos,
as well as the Pomerado Outpatient Pavilion (POP) in Poway. PPH
patients who purchase the service at those locations also will receive
a live, 30-minute Personal Education Session with a PPH nurse
practitioner who can help answer questions they may have about the
process and provide a tour of the Personal Genome Service.

Shrewd move – by diversifying the ways it provides its tests to
consumers, 23andMe will be well-placed to respond to changes in the
regulatory environment (such as, for instance, the possibility of a
complete ban on online direct-to-consumer genetic testing). This is
also a good opportunity to test an alternative business model to the
purely-online system 23andMe currently uses.

The medically relevant predictive information provided by a genome scan is still pretty marginal for most of us, due to the currently limited understanding of genetic risk factors for the most common diseases (e.g. heart disease and type 2 diabetes). However, that information will dramatically increase over the next few years – and it’s clear that 23andMe intends to be poised to play a key role in the translation of genetic information into clinical practice.

The crucial unanswered question here is, of course: does receiving genetic information about the risk of diseases like type 2 diabetes actually have an impact on medical outcomes, for instance by encouraging people to avoid risky behaviour?

I’ll be posting on this in more detail soon, but there’s actually very little information out there about the impact of genetic risk data on behaviour – and what evidence does exist suggests that the impacts are surprisingly small. Thus, if PPH genuinely wants to use genetic data to “help members make more educated lifestyle and healthcare decisions”, as its medical director claims, it almost certainly won’t be enough to simply provide the results of a genome scan back to consumers. However, the most effective ways to use genetic information to produce healthier behaviour are yet to be determined; 23andMe and other personal genomics companies have a lot of work to do before they can show that their products genuinely provide a medical benefit to the majority of consumers.

Anyway, I’d be very interested to hear how accurately the benefits of a genome
scan are explained by a nurse practitioner – so if there’s anyone in
the San Diego area who ends up purchasing a 23andMe kit through one of these places, drop me a line to let me know what you thought of the consultation.



  1. #1 Steven Murphy MD
    April 27, 2009

    Interesting news that 23andMe now sees the writing on the wall. I wonder how long the clinicians will sell out for PR. It is not like they can clinically justify using the tests to other clinicians.

    Vamos a Ver.

  2. #2 Dan Vorhaus
    April 27, 2009

    Very interesting, and I agree that it’s a strategically wise move to partner with a clinic. It’s only a short step from having the test ordered in consultation with a nurse practitioner to doing so at the direction of an MD. And the general regulatory trend at the moment certainly seems to be placing gatekeepers (likely MDs) in between DTC and consumers.

    It is interesting, though, how quickly 23andMe has moved to ramp up its emphasis in the (purported) clinical utility of its service. I’d be more concerned about that emphasis if individuals weren’t picking up the full tab for the service, but there doesn’t seem to be any indication that PPH is subsidizing the cost here (which they might be more inclined to do if there were true clinical/preventative value).

    – Dan

  3. #3 Daniel MacArthur
    April 29, 2009

    Hi Dan,

    It certainly has been fascinating to watch 23andMe switch its focus – remember the cartoonish figures on its front page when it first came out? They’ve been banished now to the genetics 101 section. The site is still visually appealing, but it’s far less whimsical than it used to be: preparation for an ever-increasing emphasis on serious medical information?

  4. #4 Steven Murphy MD
    April 30, 2009

    Agent Smith has spoken,

    This technology will fall in the medical space. That much is for certain.


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