Sunday, June 6, 2010

Not DTC and not even DTMD? – Genetichub announces itself

There is a new “old” kid on the block – announced last week at the Consumer Genetics Conference by Dr Stephen Murphy, aka @genesherpas, http://genetichub.com/

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This is just a short note about the site and service because it seems likely that it was finalised in a rush to get it ready for the CGC announcement. It’s too early to judge what it is and what it will become. Steve Murphy is of course very well known as an outspoken critic of most DTC genomics via his blog. I am wondering whether his now official status as a fully commercial genetics service provider, beyond his own medical practice, will affect the tone of his future posts. I doubt it…but it’s a fact that the situation is now different, the opposition is now the competition and a potential conflict of interest has to be acknowledged, at least. One thing is certain though – his blog history means that he has set himself very high standards regarding the delivery of genetic testing

So what is the Genetic Hub? At the moment the site has little content, most of it consisting of links to external sites or content:

  • What are Genes links to an embedded YouTube video of Francis Collins talking about…genes (DNA Day 2005)
  • Genetic Disorders links to University of Utah pages
  • Genetic Laws links to the excellent Genomics Law Report of Dan Vorhaus et. al
  • Genetics Blog looks to be the Sherpa blogs repackaged in GeneticHub clothes

As I said, it may have been a rush to get it ready in time. Anyhow, the hub of GeneticHub is of course business, selling products and services. The first (currently only, more coming soon for Coumadin and Tamoxifen) product is the CYP450 2C19 (PlavixTM) Gene Test together with a genetic physician consult. Clicking on the Buy Now link takes you to the pages of mymedlab.com who sell the test – the websites have similar designs but the relationship between mymedlab and genetichub is not clear. The test price includes 15 minutes with a “board-certified Genetic Physician across our secured platform”. Is that a phone call or a webchat? Expertise provided by “Dr. Steven Murphy and his Personalized Medicine Group”.

You can purchase the test straight away via the website so this IS actually a genetic test sold DTC. The difference between this and 23andme, decode, etc (but maybe not navigenics) is that 15 mins consult is included (and of course it is a declared clinical diagnostic test, not just for “educational use”). As I said, this is not a critical review, just an overview of a new provider of personal genetics services. There are a few questions and I am sure all will be cleared up by Dr Murphy in due course:

  1. 1. Does customer get the results before the consult?
  2. 2. If not can the customer get them before and choose to forgo the consult?
  3. 3. Is a medical prescription required (seems not, no mention on the site).
  4. 4. Can we see a sample results – what SNPs, what are the interpretations, etc? (I have no doubt that this service is high quality, but the next MD that comes along and sets up a company may be less knowledgeable – so transparency is, as always, a key requirement, for any provider).
  5. 5. Does insurance cover the costs?

Genetichub is actually entering into quite a competitive field. Pharmacogenetic testing has always been less controversial than the so-called predictive personal genetics and has been on offer, DTC and via MD, for several years. Among the the other offerings are

Genelex – they have a wide range of Pgx tests that are sold direct but only if customer has a medical prescription. I couldn’t find pricing, they say the test is billed direct to the insurer. They also give you 90 days access to their GeneMedRX “drug and gene interaction software so healthcare providers can see the effect of the genotype on all of your medications, herbals, and over-the counter medicines” Actually they will give a 30day free demo to anyone, even without any purchase. Does not appear to include a personal consult. Website provides a lot of information and a guide on how the results are interpreted.

DNAdirect test CYP2C19, plus many others. The CYP2C19 costs $199 with “toll free support” – not clear what this consists of as they also advertise Pre-test & Post-test Consultation for $250 per hour

The 23andme $429 health edition includes the CYP2C19 SNPs plus an interpretation of the results specifically for Plavix – recently announced partnership with Informed Medical Decisions provides genetic counselling consult for $99 or $375 for “Comprehensive Clinical Genetic Counseling” which they say will be reimbursed by insurance making the net cost just $35

Decodeme include the same SNPs but don’t seem to have a specific Plavix interpretation, they seem to have priced themselves out of the market at $2000 for the complete scan.

Pathway have a specific Plavix report in their $249 scan and access to Counselors but no indication of costs of this part of the service. (Still very unimpressed by the information available on their website).

Navigenics complete scan is $999, it specifically includes Plavix, among many other drugs and “Our counselors are available at any time to answer your questions, at no additional charge – even before you have signed up. You can call us any time at (866) 522-1585 to set up an appointment at your convenience.”

So with Genetichub and last weeks Existence Genetics it’s getting more and more crowded – bring on the NIH genetic testing registry please…(NIH is canvassing opinions, go here and give them yours, help them to get it right from the start).

4 comments:

  1. Hi Keith,
    Great questions. You are spot on correct. I didn't give the website in the presentation for a reason. We are just putting things together, I just wanted to let everyone know what we are working on.

    1. Test is MD ordered. We follow prescriptive authority
    2. No test without consultation. Via MD.
    3. GeneticHub is the meetup place where you get Expert genetics opinion from my physicians

    It is a place where Lab meets Consumer meets Physician and we exist in a space together.

    The first test is 2C19. I will not talk about genetichub on GeneSherpas in any way any more.

    I even thought about dismantling TGS, but I won't. However, more refined commentary will be coming from a GeneticHub blog soon.

    If you want Howard Stern, see the Gene Sherpa.

    Our service is not DTC Genetics it is DTC Genetic expertise and consultation, with or without test. Much different.

    On to the questions
    1. No Test without consultation
    2. No results without scheduling consultation
    3. Yes, prescriptive authority is respected here
    4. OK, SNP list, will get it on the site. We currently use AmpliChip and recognize it shortfalls. However am in Discussion with Montreal and others about their panel. Trust me when I say this, this will be the most robust testing experience possible.
    5. You can always submit the 99444 code via your insurer to obtain reimbursement. We won't.

    -Steve

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  2. Thanks Steve

    As said in the post, there is no doubting the expertise and robustness of your services, the doubts regard those companies that will follow. Of course it's in your interests to clearly show that yours is "the most robust testing experience possible". The Plavix test is relatively simple and I guess we already know the SNPs, but you will develop more complex panels, best to start off as you mean to go on with full disclosure. It's a strange business this one - where the more "secrets" you can give away, the better for keeping a distance from the competition.

    Regarding TGS, hmmm, I think that there would be a whole range of reactions to the possibility of it being closed. Despite, or because of, various disagreements I would miss it...except for the posts where you drift from Stern to Rush Lumbaugh (you can leave that to your attack-dog Rottweiler at Think[sic]gene...which blog, to be honest, I would not miss).

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  3. Update - just come across this company which also offers Plavix for $299 and no consult - http://www.matrixgenomics.com/Plavix-Activation.php

    Don't know much about them - Matrix Genomics. DTC for various risks inc Alzheimers (co-founder published original APOE e4 connection) - pretty opaque website and they use "their proprietary risk analysis methodology" - but at least they don't appear to claim to be able to help prevent Alzheimers

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  4. I am glad Steven Murphy and others are re-educating folks about DTC genetic tests. Althouse those companies promote themselves as personalized medicine they fall short in my mind. I am a part of a start up (www.dynemobiosystems.com) that we believe offer truly personalized medicine. Our technology can successfully predict patient response to therapy. We believe that the ability to predict therapy response is one of the key pillars of personalized medicine.

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