Thursday, December 5, 2013

23andMe: A Company Worth Supporting

23andMe is a company worth supporting, and it's in trouble with the government for regulatory issues for all the wrong reasons. Individual patients are now able to take control of their medical outcomes and overall fitness to a greater extent than was possible in the past when this technology didn't exist. 

The disruption this company may be causing is:
1) misunderstood by doctors who write scripts for tests that may not be required out of caution because of their own ignorance and panic, not that doctors can be expected to keep up with all the advances in genomics.
2) misunderstood by all those, including government regulators, who haven't been tested or used the company or benefited from the information the company provides.
3) understood by those who have been tested and can begin to understand the impact of the technology to the future of medicine. 

It amazes me to hear that doctors supposedly advocate full mastectomies on the basis of the 23andMe saliva test when the company explicitly states that further tests should be made in the service of accuracy.

One example I can report concerns my former gastroenterologist. This gastroenterologist recommended an endoscopy which she could give me (and profit from) after I mentioned (verbally) that my 23andMe test results showed I had three times greater than average chance of having celiac disease. I know I have a chance only, and that results from 23andMe were not diagnoses, but I asked for the doctor's advice. The doctor looked at the statistics from 23andMe, admitted she’d not ever heard of the company before, and based her appeal for an endoscopy on the 23andMe score while I was with her in her office.

Endoscopy, for those unfamiliar, is an invasive test requiring the same preparation as for colonoscopy. The patient's digestive tract must be entirely emptied of food before the surgery. The patient can't drive away from the center outside of the hospital after the surgery because of having endured general anesthesia, and then a whopping charge arrives in the mail like a sonic boom after the fact if all goes as planned. Add to that the risk of fatal complications and a possibly expensive stay in the hospital. None of it is pleasant. Worse, it wasn’t necessary.

Trying to avoid this surgery, I asked for a second opinion from another gastroenterologist about my chances of having celiac disease, and this second one said that a simple non-fasting blood test should also rule it out, and indicated I could have an invasive endoscopy if necessary after the blood test. In fact, the blood test did rule out the endoscopy, if the blood test is to be believed. The biopsy gained in an endoscopy supposedly gives a more trusted result than a blood test, but I'm not going to have the procedure.

It's clear to me that most of my doctors in New Jersey haven't heard of 23andMe, and so far I haven’t had one who’s taken the test. The founder of 23andMe wanted to be disruptive, and she can be sure that the disruption has already started as this article claims. I don't think critics should comment on 23andMe without using the product being sold, unless they don't believe their weigh scales, home blood pressure kits, or blood test results from LabCorp. The 23andMe homepage says it uses Labcorp, one of the two nationwide competitors in America trusted for blood tests (the other is Quest). I also read LabCorp and 23andMe use Illumina for testing. 

Some people try hard to escape medical truths, and disparage the company without having facts on which to base their remarks.

Perhaps the company could distribute kits free to doctors as a service. And perhaps the company should change its name, but defintely keep the service. I love it. One of my doctors asked me, "Did you say 22 and me?"

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