This Affects All of Us…

A few nights ago I hosted a fascinating dinner with a dozen CEO’s and founders from exciting diagnostics start-up’s as well as two extraordinary academics – George Church (Harvard) and David Altshuler (founder of Broad Institute).  I posed a series of questions like “What is most relevant in your field today?” and “What products and services that don’t yet exist will be available in ten years?” Some of the most engaging debate though revolved around the role of social networks in personalized medicine – an area I have been thinking a lot about recently.

First some brief background. Broadly speaking the diagnostics industry is about $100 billion in revenues (products and services) and is considered the fastest growing medtech sub-sector. In 2010 VC’s invested approximately $500 million in 60 new diagnostics companies – thus you can see why I have been saying for some time now that there is a renaissance in diagnostics underway.

The impact of new diagnostic technologies will improve clinicians’ abilities to predict, monitor and treat all of us. Given the ageing population (people over 65 test 5x more frequently than all others), the volume of tests is expected to explode. And fortunately credible diagnostic tests can avoid unnecessary treatments thereby lowering overall cost of care. Specifically, “companion” diagnostics (those tests wedded to specific therapies) are expected to reduce cost of care by $15 billion annually when fully deployed. More shockingly, drugs are only effective roughly 50% of the time they are used; in cancer the efficacy rate is around 22% (36% for surgical procedures) which means nearly $39 billion of treatment is wasted. Effective diagnostic tests will dramatically improve that.

Some of the other highlights and possible conclusions from the dialogue that night were:

  • The cost to sequence the genome is nowhere near the mythical $1,000 target – which ironically is comparable to the cost of an MRI or CAT scan – which would you rather have? The sequencing field is dominated by technologists who have over-hyped the value of unit of genomic data.
  • George Church observed that people will spend $10k per year on insurance but over a 70+ year life span are not comfortable spending ~$10k for their genome to be sequenced. Quite ironic.
  • The cost of data storage will far outstrip the actual cost of sequencing which is emerging as the real issue in this field. It may be cheaper – at some point – to simply re-sequence you every time you need your genomic data rather than storing the data! Others felt that babies will be discharged from the maternity ward with their genome on a CD at some point.
  • This means there may be some exciting business opportunities in managing one’s genetic data so that it can be interrogated in appropriate and timely ways.
  • Facebook will be very important in the field of genomics. In addition to organizing people by certain traits and diseases more efficiently and effectively, it may drive people to adopt EMR (electronic medical records). A theme I am excited about is the transition from a doctor-centric healthcare delivery system to a patient-centric one; maybe Facebook drives that?
  • Advertising – what are the opportunities as we better understand our genomes? Clearly there is a near-term direct opportunity as disease states and risk profiles are better understood – with very murky legal and political risks. But what about indirect opportunities? Will people sharing the same genetic mutation be inclined to buy red cars? Would Ford pay for that information? You bet – and probably a lot. Gets very tricky but is fortunately quite far over the horizon so we have plenty of time to sort it all out.
  • Everyone agreed that all cognitive therapies (psychologists, etc) are way undervalued.
  • And David Altshuler smartly observed that we have yet to find someone without DNA – so this will affect all of us.

My next dinner will be with this group and the search engine marketing group we convened last fall. That will be really interesting!

Thoughts? Reactions?

7 Comments

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7 responses to “This Affects All of Us…

  1. I attended an “Integrated Health” conference where all parties, from physicians to alternative health care providers to patients all bemoaned the lack of easy ability to exchange data, for a variety of reasons. The teaching hospital had its record system, but it was not coordinated (as of yet) with any other entities. The solution, as your article points out, has to be along the lines of a secure Facebook, on a patient-controlled basis. The patient would “friend” all of their health care providers, from internist to PT to optometrist to acupuncturist to faith healer to witch doctor, allowing for once an integrated health record. By having the patient at the center, giving approvals, it would become HIPAA compliant. There probably needs to be some protections or firewalls, including mental health records, but such approvals become trivial from a tech perspective.

    I’m not sure how Microsoft HealthVault or Google Health attacks the problem, but an open system, albeit with security wherein the patient authorizes level of access), seems to be the next killer health app.

    The massive use of alternative health providers (first shown by David Eisenberg) is a stumbling block, as only perhaps chiropractors have any sort of EHR capability. However, I see the ability to enter and share electronically a patient’s records becoming a sine qua non for health care practititioners, whether covered by insurance or not.

    I’m curious as to why there hasn’t been more takeup of this. With the fractured marketplace with hundreds of EHR providers, it seems natural that what’s missing is the common platform. Can someone with a better sense of history tell me why neither Microsoft nor Google’s efforts have borne fruit?

  2. Fortunato Vega

    Looking forward to hearing about the next dinner…really interesting!

    Fortunato

  3. Very interesting discussion. With respect to people paying to get their genome sequenced, I think that timing is key. Seems like current social networking platforms are already useful in the absence of genome data – I believe key would be to foster growth of this existing culture (versus forcing adoption too early of genomic data – seems like new technologies have a fairly narrow window where maturity of technology and potential for mass distribution matches with timing of awareness and demand) – perhaps key is to get as many people as possible tuned in to current benefits of social network platforms to positively impact health – then get nodes in the network to have their genome screened and discuss how it was helpful – and that may in time may prompt people to get their genome screened – i.e. show them the potential that this could have to improve their health – currently most people have no clue how genomic data could help them – so I think education through awareness is a required first step. Perhaps parallels could be drawn with the ipad or app-stores – not sure this would have been successful without global adoption of cells phones, then smart phones first (and perhaps even laptops)…which raised awareness of how mobile devices could be useful to nearly everyone.

    • great feedback Jeff. given your expertise in the field you would know how this will unfold better than most! I think your progression is how this very well might play out.

      Hope to see you soon. Think we are trying to set that up.

  4. The genetic testing company http://www.23andme.com is very interesting, as I had it done a few years ago. Started by Sergey Brin’s wife, they model genes based on likelihood of contracting various diseases and as their database enlargens, the accuracy will improve. An amazing company. John F. Gallagher, http://www.FreeHomeListingOnLine.com

  5. Matthew Udewitz

    After reading about your latest dinner focused on the genetic code I have several thoughts. First, if sequencing the genome currently doesn’t cost $1,000, how much does it cost. I know when I had a baby several years ago, I spent about $5,000 upfront to have the stem cells and cord blood properly preserved for later medicinal uses. Is there a way to possibly group this service and gathering the genetic code together? If so, there could be a method to finance this that would be reasonable. Currently, how much time from receiving DNA to running genetic tests, does it take to have the human genome of an individual in hand? What exactly are the current modalities to achieve this work? I understand that Affymetrix and Illumina are in this space. But, that is where my knowledge ends. What methods does the Gov use in the crime lab? What hurdles are there from taking the current methods offered and making the machines smaller and cost effective so that they are in an individual hospital, or are they already there? If it is not cost effective to have them in the hospital, are there any companies currently offering smart alternatives to handle genetic testing on a regional or sub-regional level? I do not see a benefit of Facebook, however, I do see the need for a more medical oriented social media network, I actually have some ideas related to these topics if anyone is interested in discussing. I am very curious about the next topic, search. In fact my group at the Rady School did our first lab to market project surrounded on the search space and focused in on what advancements could be made to Pub-Med. I would love to share this with you, please let me know if you are interested.

    I can be reached at mudewitz@gmail.com

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