Genetic Future

The end is nigh for 23andMe?

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Over at Gene Expression, Razib suggests that trouble lies ahead for personal genomics company 23andMe. Although I’m generally a bit of a cheerleader for the Mountain View-based startup, I must admit the signs over the past year or so haven’t been good: two rounds of lay-offs, the departure of co-founder Linda Avey, and the apparent deployment of $4M from a recent funding round to pay back a loan from fellow co-founder Anne Wojcicki. 
Razib also notes some anonymous employee reviews of the company on GlassDoor suggesting poor morale among 23andMe workers; it’s hard to make too much of these given their uncertain provenance, but one of them is well worth a read.
In an economic environment where the sorts of disposable cash required for people to invest in luxury goods like personal genomics is scarce, DTC genetic testing companies were always going to have to work hard to stay afloat – and the bankruptcy of 23andMe’s competitor deCODE Genetics showed that this is no easy feat.
Razib also points to a recent entry on Avey’s blog warning of an impending NY Times article by reporter Andrew Pollack that will apparently cast a very negative light on the personal genomics industry. Avey launches a pre-emptive strike on Pollack, describing his impending piece as “a desperate attempt to make some headlines” and noting a growing number of anti-personal genomics stories in the mainstream press:

So if Andrew Pollack decides to take a swipe at this fledgling industry, he won’t be the first, or the last. It’s an easy bandwagon to jump on, along with the other nay-sayers, but there’s a growing wave of data-empowered people who won’t bat an eye, and who may just help lead us into a new age of personalized health that Andrew himself may find quite beneficial. Now that’s something to write about.

The problem is that right now there’s a very easy “failed industry” story to write, between deCODE’s demise, 23andMe’s problems, Navigenics’ bungled entry into the Australian insurance market, and so on. And to be honest, I’m finding it pretty hard to blame reporters for writing that story.
A friend of mine always likes to point out that personal genomics is transparently going through the Gartner hype cycle (see figure above), and right now we’re firmly wedged in the trough of disillusionment, following a peak of inflated expectations for which personal genomics companies themselves must take the bulk of the blame. 
It’s going to take some time before we clamber up onto that plateau of productivity; it will require major changes in technology (particularly from chip-based genotyping to sequencing) and interpretation targets (e.g. from small-effect common variants to large-effect rare variants). There’s no question in my mind that personal genomics does have a bright future ahead, but it will be in a very different form than current offerings; you can get a glimpse of it in recently-launched carrier testing company Counsyl.
Will 23andMe survive the transition? If you’d asked me a year ago I would have laughed at the possibility that a heavily Google-backed company with such an impressive collection of talent could fail to weather the storm; over the last twelve months my estimation of this probability has been somewhat revised. I would still be utterly shocked if 23andMe actually went under, but unless the company can pull a bold new move out in the next few months it does risk seriously losing its edge in the personal genomics market.
Interesting times indeed.
(image from Wikimedia Commons)

Comments

  1. #1 Russell
    March 4, 2010

    Maybe its successor will have the common sense to include ApoE status in the results.

  2. #2 Misha
    March 4, 2010

    “I buried Paul.”

  3. #3 AB
    March 4, 2010

    I am a female adult adoptee wanting to do genetic/ancestry research. Just received a gift from a family member to help pay for 23andme, but am reconsidering after reading this post and others. Would Pathway Genomics ancestry kit for way less than 23andme, give me the same information? Or would I get more and better information sticking with 23andme?

    Which one has better chance of finding relatives? I assumed 23andme had a larger database and thus would be better for my purposes. But then I only recently found out about Pathway. Can you shed some light on what might be best for an ancestral information? Thanks.

  4. #4 Debbie Kennett
    March 4, 2010

    Hi Ab

    For an ancestry test your best option is to test with a dedicated genealogy
    company where people are interested in finding genealogical connections
    rather than investigating medical conditions. The first such test, from
    Family Tree DNA, is currently in beta-testing and can only be ordered by
    project administrators and a few selected customers. The test is however due
    to launch in mid-March. It is similar to 23andMe’s Relative Finder Ancestry
    test. It looks at 550,000 SNPs (single-nucleotide polymorphisms) and will
    predict close relations up to around the fifth cousin level. You can find
    further information here on these two links:

    http://www.familytreedna.com/landing/family-finder.aspx

    http://www.familytreedna.com/faq/answers/17.aspx

    No doubt other companies will follow with similar tests in due course.

    For further advice I would recommend that you join the International Society
    of Genetic Genealogy. Our members have tested with all the different
    companies and will be able to share their experiences with you of the
    23andMe tests, and of those with other companies as well.

    http://www.isogg.org

    You might also find Dick Hill’s website of interest:

    http://www.dna-testing-adviser.com

    He is an adoptee who successfully used a variety of DNA tests to identify
    his birth father.

  5. #5 Daniel MacArthur
    March 4, 2010

    Hi AB,

    I’d argue that 23andMe is currently a better bet than Pathway for ancestry and genealogy, as it gathers information from across your genome (Pathway only looks at Y chromosomal and mitochondrial DNA, which gives you insight into a small fraction of your relatives).

  6. #6 Daniel MacArthur
    March 4, 2010

    Hey Misha,

    That’s a seriously obscure reference for us young ‘uns – thank you, Wikipedia.

  7. #7 Dan Vorhaus
    March 4, 2010

    It’s obscure to the point that, even though I’ve sourced it (thank you, as well, Wikipedia), I still don’t get it. Who is meant to be Paul here? 23andMe? Linda? This lawyer’s creative faculties, for one, are sorely taxed.

  8. #8 Steven Murphy MD
    March 4, 2010

    The NYT has a lot to do to make up for all the butt sucking they did of this industry in ’08.

    This whole field is morphing, not dying, as evidenced by the number of businesses approaching me now for advice. They, DTC Genomics, will most likely all align with some physicians/healthcare team soon.

    This is the smart play I had suggested ages (2 years) ago. Otherwise, they are playing doctor. Which, even though it may feel good, often doesn’t help the patient.

    Let’s face it, the end goal of the genome is not to just have the data, it is to use the data to live longer and prosper…..

    -Steve

  9. #9 AB
    March 4, 2010

    Thanks Daniel. 23andme it is.

    And to Steven Murphy: Aligning with doctors may be good for your pocketbook but by medicalizing everyone who wants to live long and prosper as a patient is arrogance.

    We don’t need to become a paying patient to use information – that’s the same mindset that has infantalized the population to the point they need a note from the doctor to prove they have a headache.

  10. #10 David Bachinsky
    March 4, 2010

    Interleukin Genetics has recently received some attention related to success with diets and genetic tests (http://www.businessweek.com/lifestyle/content/healthday/636647.html).
    What is the distinction between medical and non-medical testing, for example, obesity and dieting?

  11. #11 Daniel MacArthur
    March 5, 2010

    AB,

    Note that I have just released a comment by Debbie Kennett from moderation (comment #4 above) that provides an alternative approach that you might wish to consider in your case.

  12. #12 Steven Murphy MD
    March 5, 2010

    @AB

    Medicalization? That is not what I meant. You can use data all you want. But the problem here is that most of it is not of use and won’t be for another 25 years. Especially when it comes to living long and prospering.

    The only people who can put these tools to use are the people dosing medications and diagnosing disease. If you want to diagnose, go to medical school. If you want to play doctor, then, well, go find yourself someone who will let you. Because I for one will not let you play doctor on my patients or myself.

    Ancestry, sure that is one thing. Go ahead. Do that.

    But medicine is another. So is living healthy. Living health doesn’t require a genome scan or a whole genome.

    Everyone knows this and that is why these companies failed.

    Sure if you want to try and convince someone they need your proton pills because of rsIAMFULL0FBULL$H!T then you may have a “business”, but you do not have facts.

    Everyone is entitled to an opinion, but not everyone is entitled to their own facts…..

    In this case, rush to market resulted in rush to hype, which resulted in this backlash against hype and B.S.

    Everyone wanted a revolution, but what they got was the “bay of pigs”

    -Steve

  13. #13 Andrew Yates
    March 5, 2010

    @AB “We don’t need to become a paying patient to use information – that’s the same mindset that has infantalized the population to the point they need a note from the doctor to prove they have a headache.”

    Well AB, as an empowered partner in your wellbeing, all you need to do is provide proof that you probably have and maybe we’ll get back to you. Oh, you actually _do_ want to draw from your insurance and you’ve somehow forced us to respond? So you ADMIT that you are NOT empowered and a good partner in the wellbeing of the world? You do? Well… um….

    Ooops! Our risk model is based on you feeling empowered without actually having the sophistication to do anything. Otherwise, why would you continue making those small, regular payments? That’s why we spend so much on marketing. To convince you how empowered you are. You know, so empowered that you don’t actually have to do anything.

    No wait! That was the financial market. I’m sure that medical markets don’t work that way at all.

    “And to Steven Murphy: Aligning with doctors may be good for your pocketbook but by medicalizing everyone who wants to live long and prosper as a patient is arrogance.”

    There is no money in being a professional Internet asshole.

  14. #14 DTCisAlright
    March 5, 2010


    “And to Steven Murphy: Aligning with doctors may be good for your pocketbook but by medicalizing everyone who wants to live long and prosper as a patient is arrogance.”

    There is no money in being a professional Internet asshole. —
    Amen.

  15. #15 AB
    March 5, 2010

    David Bachinsky:

    I went to the link you sent about the test for genotype diet based on the work done at Stanford. Fascinating. I’ve often gone out on a limb about this and been told I was wrong, just couldn’t be. Nice to find out I wasn’t and it can be. Thank you for the link. It wasn’t a live link in your post, so I am putting it here again. http://www.businessweek.com/lifestyle/content/healthday/636647.html

  16. #16 AB
    March 5, 2010

    Debbie Kennett:

    Many thanks for the info. I went and signed up to be notified when family finder test is out. I will now compare to 23andme and decide. Options – love ‘em!

    I also went to genetic genealogy site – didn’t know about that either and also very interested. No mandatory fees! What a plus. http://www.isogg.org/ I think this is something I want to join.

    I had found Dick Hill’s story already – just yesterday morning actually. Interesting but I already found my birth parents many years ago the old fashioned way: stealing the adoption file when I was a kid and learning search techniques as I got older. If you click my name you can read my story – it’s #11 and called A Long Walk for a Lost Mother. (Never met them is the bottom line, one dead at 52, the other at 58). I have more information than many adoptees, but want more background. I go way back to the early days of adoptee search and reunion when Emma Vilardi began Soundex on file cards. DNA searches were not even in our dreams.

    Thank you for the links and the information. Very, very helpful.

  17. #17 AB
    March 5, 2010

    Andrew Yates:

    I don’t have insurance so no, no one is conning me into a false sense of empowerment.

    I have been uninsured for my entire life with one exception: when I was in grad school at Stanford where they told me I was incurable and decided I needed to be medicated for life with a bit of surgery thrown in. So, I dumped them, cured myself and haven’t looked back.

    Only one doctor has ever been intellectually curious enough to ask how I cured myself. I paid him out of my own pocket for his expertise and to dialogue with him. He encouraged me on my path of exploration and research years ago and I am thankful for that. I have continued to be my own health care provider over the years for various things which the medical community still insists there is no cure. Luckily my body can’t hear them.

  18. #18 AnneW
    March 5, 2010

    Steve Murphy’s claims cannot be understood outside of his overpowering jealousy and envy of successful businesses. 23andMe is sadly not likely to be such a business but we can all safely predict that Murphy will direct his futile vitriol towards the next market leader whoever that may be, no matter how medical they are.

    Prove us wrong Steve. How many doctors need to offer/endorse/whatever a test before you like it? How many publications in what journals? What is your criterion if anything?

  19. #19 DTCUberAlles
    March 5, 2010

    This was the first time in my memory that Steve Murphy was more coherent than Andrew Yates.

  20. #20 AB
    March 5, 2010

    Steven Murphy:

    I am 61 and doctor myself. I don’t need your permission or that of any other MD to diagnose myself or treat myself. This may not be true much longer. But for now, that freedom still exists. I don’t need a drug company based curriculum at some med school to do so. I can and do hit the stacks at Stanford Med Library when I want to, as well as the bookstore for texts and the internet for journal articles as well as google scholar. If I want a blood test done, I order it.

    I have no interest in starting a business model based on anything. But the freedom to do so should be there for those that want to. Hijacking medical care is not in the best interest of the people. Sorry, I don’t have a white coat syndrome.

    I have now cured myself of 3, maybe 4 autoimmune illnesses I was told are incurable. I use a little known (and unprofitable) off patent drug than impacts endorphin/immune system. I know there are MD’s using this, but I don’t know of any where I live and I am uninsured so I do, in fact, doctor myself. I pay for medical care myself when I want it, but since they all say, “Learn to live with it” and I refuse, there is no point in returning for more useless opinion, not fact.

    I was lucky to have grown up in a family with an MD who taught at a med school and published in many journals and liked to live in his head with “let’s think about it this way, and that way” and by osmosis this became a part of my life too. My adoptive father is dead now, but I keep the conversation going and I think about things in many different ways. I have met only one or two in the medical field with as much intellectual curiosity.

    I also had the experience of knowing Donald Kennedy when he left the FDA after running it for 2 years. From him I learned of the fraud, corruption and the revolving door that is the FDA. I have no faith in this model of medicine – drug based and corrupt and the doctors that insist they and only they can take care of me because they were trained in this system.

  21. #21 Andrew Yates
    March 10, 2010

    “This was the first time in my memory that Steve Murphy was more coherent than Andrew Yates.”

    Ouch.

    Brief: “empowerment” is marketing bullshit, and anybody who tries to convince you otherwise is probably trying to sell you “empowerment.”

  22. #22 Andrew Yates
    March 10, 2010

    @AB

    “I don’t have insurance so no, no one is conning me into a false sense of empowerment.”

    Then you don’t apply to my rant about why I distrust sales of insurance and anything that claims to provide “empowerment.”

  23. #23 Steven Murphy MD
    March 10, 2010

    AB,
    A doctor of? It sound like you have done some good work. Have you cured anyone else with you secret therapy? That you discovered in the bowels of the library? Have you written and submitted your work to a peer reviewed journal. I would be most interested in what you are doing?

    AnneW: Very funny. Seriously. Now that you pulled the 4 million out you are cool with crashing this company into the mountain? As for vitriol, I did 3 things.
    1. Point out your companies were breaking the law and practicing medicine

    2. Pointed out that the only market for your wares were spikey haired Python programmers at Google…..

    3. Point out that business people in DTC genomics were not willing to take responsibility for what they were doing nor recognize the gravity of what they were doing…..

    If that results in the public sniffing out your “Revolution” as a scam and sending some bankrupt, while others went scrambling to find physicians. Which BTW is what I said you should have done in the first place…..

    So no, the market leaders will follow the clinical path. I.E. Counsyl and others who I am speaking with…….

    Thus why would I direct vitriol towards someone doing the right thing?

    Stupid is as stupid does Anne W. Gump…..

    -Steve

  24. #24 AB
    March 14, 2010

    Steve:

    My protocol isn’t secret and I am not a doctor of medicine so I do not treat anyone.

    I didn’t learn my therapy in the bowels of the library. It was there I learned what the textbooks were saying about RA. I started at the beginning to learn what it was and went from there. That was my first (and most severe) autoimmune illness. At that time I didn’t know about what I described above and had to design a protocol based on other things. My Stanford doctors wanted to give me steroids and told me without them I would be crippled. I refused and cured myself.

    I am not doing it now because I have no symptoms. As to what I am referring to above, and what I would now use if the RA came back, is low dose naltrexone. Doctors who use it report astonishing success. Apparently it was being used for other things and it turned out to rapidly cure RA.

    It just had a very successful clinical trial at Penn State (2007) for Crohn’s disease and one at Stanford for fibromyalgia (2009). NIH is funding a new one now for kids with Crohn’s. LDN appears to work on all chronic autoimmune illnesses via endorphin/immune interaction. If I had RA now, this is what I would use. It also has dramatic success with MS. And some terminal cancer. Sound too good to be true? I promise there is science behind it.

    This is a starting point. http://www.lowdosenaltrexone.org/ You can find hundreds of pages on it, youtube videos of presentations on its use with cancer, NIH programs, researchers talking about it, etc. In England, many are trying to get it on the national formulary. It’s tricky – imagine an off patent drug with no side effects that might destroy billions in profit. I don’t have enough faith to think it will happen.

    I’d be interested in what you think of it if you look into it.

    Imagine..normalizing the immune system for under a dollar a day.

  25. #25 Steven Murphy MD
    June 26, 2010

    Well,
    I tried LDN for a patient off label and they had a horrible reaction.
    Not good. The patient knew the risks, but I am now not a fan.

  26. #26 Neil
    June 29, 2010

    Readers may also be interested in Science-Based Medicine’s:

    http://getbetterhealth.com/low-dose-naltrexone-medical-revolution-or-pseudoscience/2010.05.13

  27. #27 Sadie
    October 26, 2010

    So, Steve, regarding your patient that did not do well on LDN: Are you suggesting that they might have done well to first take the 23 and Me test to find out if they were not genetically compatible with the drug? :)