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Obama says technology will save health care, and it’s true that IT is quickly becoming a medical resource: Google, which recently launched an online medical records service, claims that online search is where consumers turn first for health information. Computerization can eliminate much of the 30 percent of medical costs that are due to inefficiency, according to Dr. Dean Ornish, founder of the nonprofit Preventive Medicine Research Institute. And advanced diagnostics will encourage prevention and reduce costly reactive treatment.
Two weeks ago, a small green box showed up in my mail. Inside was a “spit kit” my wife had ordered me from DNA sequencing startup 23andme. Within a few minutes, I’d completed and returned the sample. In a few weeks, I’ll be able to analyze my DNA online. What if I find something I don’t like?
Thanks to technology, such diagnostics are now within the reach of consumers. As more people test themselves, doctors and insurers may face the additional burden of just-in-case surgery and a “previvor” mentality. So, will technology cure health care, or kill it?
Normally, doctors prescribe tests when patients report symptoms. Occasionally, the U.S. Preventative Services Task Force decides to recommend blanket testing, particularly for diseases that are hard to detect until they’re fairly advanced. Sometimes the task force actually recommends against testing, partly because treating the condition is unlikely to prolong life. But increasingly, we can ignore their advice and just test ourselves.
The cost of diagnostics is dropping fast, particularly for DNA. 23andme’s service recently fell from $999 to $399. “We always knew the technology cost would drop,” said Linda Avey, the company’s co-founder. “The decline in genotyping costs surpasses that of Moore’s Law.”
Testing can get as low as $60, as Familybuilder recently showed. Founded in 2007, the company received a $1.5M Series A funding from DN Capital in February 2008. While the company only analyzes enough DNA to trace genealogy, it stores the raw samples for two years, so CEO Ilya Nikolayev hasn’t ruled out the possibility of selling additional analysis to customers in future.
By slashing prices, DNA-testing companies hope to build big databases of customers’ DNA sequences. For Familybuilder, this means more chances to find its clients’ relatives. For 23andme, it means better research. “It’s about getting statistical power,” said Avey. “As we get enough people with a certain phenotype, we can get them to enter data on when they contracted the disease and what drugs they’re on, and we can do genome-wide studies.”
But will widespread diagnostics increase the burden on healthcare? Somewhere between 10 and 50 percent of autopsies reveal diseases other than the one that killed the patient. If consumers test themselves, then tell their doctors, the medical system could wind up treating 50 percent more diseases than it does today — even those that wouldn’t have killed the patient.
Avey believes some patients will want to get tested for everything, but says she hopes that their doctor will be there to talk to them about it. “The data isn’t that definitive. Your risk [of having a disease] might be 12 percent, someone else’s 8 percent,” she points out. Understanding these finer points of diagnostic analysis is something medical professionals are trained to do, and a skill most of us lack.
DNA testing has also raised concerns that insurers or employers might use a person’s knowledge of genetic conditions against them, but recent legislation makes this illegal. According to Avey, the Genetic Information Nondiscrimination Act, passed in May, says that if you know about your genetics, your insurer and employer can’t discriminate based on that knowledge. The FDA is watching consumer diagnostics closely: It recently sent a warning to Laboratory Corporation of America that one of its customers, Ovasure, is illegally marketing a DNA test for ovarian cancer without the administration’s approval.
Anne Wojcicki, co-founder of 23andme and wife of Google co-founder Sergey Brin, says she thinks widespread DNA research will help, not harm, the medical system by encouraging prevention. “17 percent of [U.S.] GDP goes to health care but we need a radical change,” she said. “We are a country that has really been focused on reactive care; now, we’re at an inflection point where we’re transitioning to a preventative model.” She points out that DNA research can also improve treatment by showing which medication will work best for a particular genotype.
Advances in technology may well strain the healthcare system. But in the end, they may also be our best hope for fixing it.