genomic medicine

“In an era where we look at these surveys about trust and everything’s going off the cliff, everyone still trusts the NHS. It’s so deep in the British psyche."

That’s today’s guest, Chris Wigley, the CEO of Genomics England, a government run company (a strange concept for us Americans), set up as a sequencing center for the UK’s NHS or National Health Service. The company also does massive bioinformatics work to bring genomics and EHR data together using the latest in machine learning methods. (Note to data scientists drooling over those legendary datasets: Genomics England is hiring.)

What many may not know is that Genomics England has finished the original 100,000 genomes it was set up to sequence and is now shooting for 500,000 genomes by 2024. Just this month the company set up a new platform that is split into two arms, one for diagnostics working with the NHS and one that is research based.

It’s our first interview with a CEO of Genomics England, and it’s a chance to ask everything. One comes away with a very optimistic picture for genomic medicine taking hold in a country where trust in a national healthcare system and rational science are just a given.

More than one in two hundred people have an inherited form of heart disease. But most don’t know it.

Often on Mendelspod we talk about cancer genomics, but in the area of cardio, too, genetic testing can save lives.

Amy Sturm is the Director of Genomic Counseling and Screening Program at Geisinger Health Systems. There she has led the effort to return the results of cardio genetic tests to over 1,000 patients.

FH, or familial hypercholesterolemia—Amy says we need to get used to saying it out to spread awareness—is the most common inherited predisposition for heart disease. Over 90% of those with the FH variant go undiagnosed.

What does it mean for one's health if one has this gene? What are Amy’s pioneering studies at Geisinger revealing as they diagnose more and more cases and report results back to patients? How does cascade testing work where family members are notified and sometimes tested? And finally, what are Amy’s thoughts on the new polygenic risk scores that are coming out in the field of cardio genetics?

It’s an area of genetics ripe for its own Anjelina Jolie moment, says Amy.

Our end-of-year special guest is one of the U.K.’s top genomicists, Ewan Birney, Co-Director of the European Bioinformatics Institute at EMBL. He is also the non-Executive Director for Genomics England.  Ewan's perhaps best known for his work with the ENCODE consortium.

We begin by following up with Ewan on a popular blog he co-wrote in October on race and genetics that responds to some of the latest trends on this topic. What does he think of “racial realism? How does he like being called “woke?” But there were issues not covered in the blog: if indeed race is cultural, what are DNA scientists doing talking about it?

We move on to general questions about genomic medicine in the UK. Ewan gives a nuanced answer on whether or not to do BRCA screening and paints a context for genomics which is different than we see in the U.S.

In a year when major genomic medicine companies have faced the chopping block in America—Human Longevity, Arrivale, UBiome— the field seems to be having a rosier time in England.  One of their health ministers just announced plans to sequence all babies at birth--a plan Ewan admits is aspirational, but "a credible aspiration."  Ewan says England and all the Nordic Viking countries enjoy strong support and interest in genomics. And in the U.K., he says, doing and believing in genomics is rooted deep in a tradition of science that goes beyond politics or any current resident of Downing Street.

Did he mean for his recent piece in the Guardian DNA is not our destiny,  it's just a very useful tool to be a correction to over hype? 

"Yes!  I'm afraid there's a very messy middle here.  It's not the case that genomics is going to somehow solve or radically alter medicine.  That's just not the way it works. But it's also not the case that it's useless.  It is a very useful tool.  It's very similar to radiology.  For certain scenarios, it is really transformative.  It's a core part of medicine.  But it's not the case that all of medicine was completely changed by X-rays."

The great promise of liquid biopsy technology is in early cancer detection. That is, it's the great future promise. Right? This past month at the annual cancer conference, ASCO, we heard about one such flagship company announcing just which technology they were going to use to do it--DNA methylation.

Well . . .it turns out there is a company, Laboratory for Advanced Medicine, that has been using DNA methylation for their liquid biopsy early cancer detection tests for a couple years already. Tests which are for sale now. On their website, they say they are "saving lives by detetecting cancer early." Presenting data for their technology back in 2017, the company offers two liquid biopsy tests commercially: one for liver cancer and the other, a broader test which confirms that a patient has a cancer, either lung, breast, colon or liver.

“This general test has clinical utility because often times the physician and the patient might have a concern about cancer because of symptoms. The physician has done other tests and eliminated other ailments, and the patient and physician have come to a working hypothesis that maybe the patient has a particular type of cancer. And so they do this test with us, and we report back with high accuracy that, yes, they do have a cancer or, no, they do not.”

Richard Brand, the CFO for Laboratory for Advanced Medicine, reviews with Theral the company’s tests, telling of several use cases over the past couple years and previews the tests on the horizon. The company looks to be ahead of the pack in a growing field.

Those of us watching every shift in the level of adoption of genomic medicine have our eyes closely glued to Geisinger Health System in Pennsylvania.

Adam Buchanan is the Co-Director of Geisinger’s MyCode Genomic Screening and Counseling program, and today we talk to him about the rationale of making genomic screening part of routine medical care.

The MyCode program—which to date includes over 200,000 participants and has returned actionable results to over 1,000 patients—is an "opt-in" program at Geisinger, so it’s not exactly like getting your cholesterol or blood sugar tests which are routine for most of us. But Adam says Geisinger has made it quite “easy” and part of the system.

What exactly is included in the screen, and what genes top the results reports? Are other health systems around the U.S. following Geisinger’s lead? Are there other nations ahead of the U.S. when it comes to genomic screening?

In the middle of the interview, we spend time on population-wide BRCA screening for women 30 and over. Is Adam for it?

At one point, Adam mentions the boom in DTC testing. Is this "self screening", and are health care providers prepared for these patients when they walk in the door?

"DTC is now too big of an arena to put everything in the same bucket.”

This was a line from Laura Hercher, one of our monthly commentators a couple shows back. The statement made its way around Twitter, so we thought we’d have Laura back to the program and ask her to come up with some more buckets.

It turns out it’s not that easy.  Direct-to-consumer genetic testing is a dynamic and complex space in 2019, a mishmash that quite defies easy categorization.

But if anyone can do it, it's Laura.  She's the Director of Research, Human Genetics at Sarah Lawrence College, a fearless genetic counselor. And she hosts our sister podcast, The Beagle Has Landed, devoted to the topic of genetic counseling.

We set up the conversation with a short history of DTC testing and end with a question about whether the consumer is becoming more savvy, more knowledgeable about genetic tests.  Yes, she says, but warns that the disinformation campaigns are becoming equally sophisticated.

With her characteristic cut-the-crap style, it’s Laura Hercher talking the world of DTC testing, past, present, and a little into the future.

Two years ago Veritas Genetics began offering whole genome sequencing for a thousand dollars. It was a significant milestone—and still is!—not only for what it means about the company providing the genomes but also what it means about the demand for such a product.

Today we talk to Rodrigo Martinez, the Chief Marketing and Design Officer at Veritas and co-author of a recent blog, Next in The Genomics Revolution: The Era of the Social Genome. The blog puts the current offer of whole genome sequencing into the larger context of the history of genomics, compares the availability of the whole genome to that of the personal computer, and anticipates how interacting with our genomic data may begin to shape our lives.

We have two core questions for Rodrigo: What does a whole genome mean to Veritas? And why should one order a whole genome test?

Rodrigo argues that the time of having single one-off genetic tests or even panels of tests has been superseded. Why not get a whole genome test at the same low price, open an online account with all of our genomic information, and have it all there ready for any future interaction?

Veritas offers their product to physicians and to consumers, giving us another perfect chance to continue our ongoing discussion here on the program about the blurring of DTC borders.

It’s our first interview with someone from Veritas. And it’s a lively and long one.  Rodrigo is a deep diver and never short of breath or ideas.  Enjoy.