genomic medicine


Should Genomic Screening Be Standard of Care? with Adam Buchanan, Geisinger

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?

Laura Hercher on the DTC Genetic Testing Landscape

"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.

The Era of the Social Genome with Rodrigo Martinez, Veritas Genetics

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.

Genomics and the 2018 Election

The last two years have had us on edge.  It had scientists marching in the street.  That was unprecedented.

So what does last week’s election mean for the genomics community?

Scientists can focus on science

A friend of mine put it this way, “When Obama was in office, I realized I’d been like a cat, relaxed and having my nap in the afternoon. When Trump was elected, I felt like a mouse, always on edge.”

Who Is Misleading Whom About Precision Medicine?

This month the New York Times put out an opinion article that was a reprint from Kaiser Health News written by Liz Szabo positing big doubts about the project of precision medicine. For the Times, it came with the title, “Are We Being Misled About Precision Medicine?” Unfortunately this piece does exactly what it warns against. It misleads.

Putting the headline in question form, rather than declaratory, reveals an insecure thesis. Why not just say it?

It’s the Social Factors, Stupid! Lisa Suennen on Healthcare, Her Career, Digital Health Investing, and . . . Just Being Herself

She's been a highly sought after venture funder and knowledge broker in the field of digital health. STAT News wrote that upwards of 1,500 pitches crossed her desk last year at GE Ventures. But as of a couple weeks ago, it's a desk at which she's no longer sitting. So what's she up to next?

No, we did not get a scoop here, though we do feel important. This interview was scheduled long before the healthcare venture capitalist, podcaster, blogger extraordinaire made her big break recently with GE. And in fact we’ve always known her for her own brand that goes beyond any employer, that of Lisa Suennen.

August 2018 Review with Nathan and Laura: The polygenic month

It’s our first show back after the summer break, and nothing has got us all buzzing about genomics again like a polygenic risk score. It even has Laura Hercher talking about the Human Genome Project doing some delivering, god forbid.

CRISPR has had a rough summer. But still . . . it is CRISPR.

Is Burning Man still cool, we were asked last weekend. Don't know. Don't care. We asked back, is 23andMe still cool?

Then we found sort of an answer in an old rag purchased last week down at the end of the street: "They rode into town on the cool train. They've been shoot'n it up out here in the Wild West makin' trouble for the sheriff. But now they've become one of the big corporations who hire their own guards to watch o'er their stage coach. They're makin' woopy with the big guys."

Surely it's talking about 23andMe.

Laura says 23andMe's heyday is past. Nathan says, no, their best is yet to come. And then he immediately gets excited about Neanderthals and Denisovan's having a love child 50,000 years ago.

Non sequitur?

An International Perspective on How to Improve Biobanking with Kirstin Goldring

For the next episode in our summer series on human tissue sample quality and biobanking, we turn to a veteran biobanker in the U.K. who managed several projects there including the U.K. Parkisons’ Disease Society Brain Bank at Imperial College.

Today we talk to Kirstin Goldring, Principal Scientist at Astra Zeneca where she’s in charge of Human Biological Sample Strategy and Governance. Kirstin is a counselor at the European Society for Biopreservation and Biobanking and also a member of ISBER or the International Society for Biorepositories.

So far, in the U.S. biobanks are not regulated. In the U.K., they have what is called the Human Tissue Authority or HTA. Kirstin explains that the HTA is really some light governance that leaves a lot open to the biobanks as to how they go about maintaining standards. Could the program be a model for us here in the U.S.?

What has been Kirstin's overall take away on the field after managing different projects in various locations? Are we getting any better at sample quality?

A Seqster Preview with Founder Ardy Arianpour

As long as we’ve been doing clinical genetics, the goal has been to marry up the genetic data with phenotypic data in the electronic medical records. This has been achieved with some success and with a few of the best genetic markers at some of the leading healthcare providers: Geisinger, Rady Children's, Brigham and Women’s—to name a few. But it hasn’t happened at scale, at least not in this country. Some of the national health services around the world are making the dream more of a reality, for example in Iceland and the U.K.

There is a movement, however, growing particularly strong in the current politics of deregulation for consumers to do it themselves by managing their own EHRs, genetic, and fitness data together in an online account similar to their financial accounts. Today we talk with Ardy Arianpour, the Co-founder and CEO of Seqster.com, a site recently out of stealth now offering such a service to early access customers.

If the business model of sites like Seqster is dependent on big pharma buying up the collected data in high numbers for their own purposes, what will make a certain platform "the one" or one of "the chosen few?" Indeed, as more and more private companies swarm to be this service and gather our private medical data, what will give us consumers the trust to take part?

“It’s already happening unidentified. So why not be fully transparent: involve the participants, the users, the patients so that they can collect, use and share their data on their own terms? All we’ve done [at Seqster] is created a technology that has that mission for its members,” says Ardy.

Followers of Mendelspod may remember hearing Ardy on the program from his days as Chief Strategy Officer at Pathway Genomics. Prior to that he served as Senior Vice President at Ambry Genetics which last year sold to Konica for $1 billion.



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