The End of Trial-and-Error Treatments

By Nick van Terheyden aka Dr Nick, Principal, ECG Management Consulting
Twitter: @drnic1
Host of Healthcare Upside Down#HCupsidedown

Ten years or so ago, “genotyping” and “genetics” became household terms, thanks in part to 23 and Me—a personal genomics and biotech company based in California. 23 and Me was not the first company to sequence genomes, but it was the first to offer a simple, affordable, direct-to-consumer model of genetic testing.

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What unfolded subsequently left something of a bad taste in many people’s mouths, as the company has spent many years wrangling with the FDA and other regulatory bodies concerning how their products are marketed and sold.

But for the geek and digital health fan in me, this was a new door to be opened. I obtained partial sequencing and then followed this up with more exploration and study. As the field opened up, I wondered how this data could be incorporated into general healthcare practice and decided to test this out for myself. Full exome sequencing remains a physician-ordered activity, so I persuaded my poor long-suffering general practitioner (GP) to order the test for me.

The test was easy—a blood draw and then a wait. When my GP got the results, I eagerly scheduled a visit with him to review the findings. But when the day came, I was disappointed.

The experience was a testament to how not ready the healthcare system was for any kind of genomic data. The results arrived on a USB stick, with files approaching gigabytes of data, along with a multipage summary report of findings in paper form. My GP didn’t know what to do with the mountain of data. He scanned the paper results into my record, discarded the USB digital data, and since there was no immediately actionable information, moved to his next task.

As we continue to make strides with genomic sequencing, how do we incorporate the new data and the incredible opportunities it offers into our healthcare system?

Nick Glimcher is the CEO of Blue Genes, a lab that’s using genetic data to ensure patients will be prescribed drugs that will be most effective for them. On this episode he explains how genomic sequencing can be used to achieve more personalized medicine.

Making genomic data clinically viable.

“23 and Me opened the door to the normalization of having the information available. Unfortunately, where it falls short is that the information doesn’t fit into the current clinical workflows. So it’s not applicable in the everyday clinical situation where you have a patient and provider interaction. We cannot depend on providers to apply this information, either [due to] lack of knowledge or time to review these reports. What we’re trying to do at Blue Genes is move data quickly through the system and make it clinically viable.”

Financial benefits for patients and payers.

“If a drug’s not going to work, there’s no sense in [patients] taking it. Healthcare is a trial-and-error system. That’s why they call it the practice of medicine. ‘If this doesn’t work, come back and see me and we’ll try something else.’ That’s particularly true when you talk about behavioral health—there is no rhyme or reason to how a provider may pick an SSRI. So when we can apply this information, and it doesn’t weigh down the clinical workflow process, it is ultimately going to help the patient and then protect the plan as it relates to costs.”

More targeted medication.

“We live in the most overmedicated society on the planet. We’re prescribing new medications to counter the side effects of other medications; that needs to cap out somewhere. Pharmaceutical medications, just because they’re approved by the FDA, doesn’t make them ultimately healthy for the patients. What we’re trying to do is to make sure the right drug, genetically speaking, is prescribed. Ninety-five percent of the variability between how patients react to medications is due to genetic profiling. So if we can impact a little bit of that, we’re going to help protect patients.”

This article was originally published on the ECG Management Consulting blog and is republished here with permission.

About the Show

The US spends more on healthcare per capita than any other country on the planet. So why don’t we have superior outcomes? Why haven’t the principles of capitalism prevailed? And why do American consumers have so much trouble accessing and paying for healthcare? Dive into these and other issues on Healthcare Upside/Down with ECG principal Dr. Nick van Terheyden and guest panelists as they discuss the upsides and downsides of healthcare in the US, and how to make the system work for everyone.

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