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Will Technology Cure Health Care — Or Kill It?

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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.

11 Responses to “Will Technology Cure Health Care — Or Kill It?”

  1. Giving your genome to a for-profit corporation for testing today is a very dangerous act for the following reasons:

    1) Americans NO longer have the right to health privacy! Today, your rights to health privacy in electronic health systems are nil. You have no control over personal electronic health information. Federal bureaucrats eliminated our rights to control the use and disclosures of personal health information in electronic systems in 2002. The media has not reported on this drastic elimination of every Americans’ privacy rights. See:

    2) Once you reveal your genome, you will never be able to delete it from the private corporation’s data bases or make it private again. Why on earth would you pay someone to take and use the most personal health data that exists about you and your family for whatever purposes they choose? Think about Paris Hilton’s sex video, once it was out in cyberspace, it can never be private again. It will live for millenia on the Internet.

    3) Why pay a private corporation like 23andMe or any other for-profit genetic testing lab to take your extremely valuable and sensitive personal health data and give it to them as a CORPORATE asset—to sell, to disclose to researchers for studies you might not want to be part of, to sell as an asset to employers or insurers or financial institutions, or even to sell to the US Government as part of the data profiles they are building on every American in Fusion Centers.

    4) The legal duties of coporations are to stockholders, not to patients or people who buy genetic tests. Genetic testing labs like 23andMe can be bought by Google or the Bank of America or to a business that sells employers genetic snapshots of future employees’ potential illnesses. Even if you trust a genetic lab—-you have no control over whether that corporation is sold to another corporation that you would never want to own your DNA.

    5) Today’s health IT systems are notoriously insecure and hackable. An industry study of 850 electronic health records systems found ALL of them could easily be hacked. See:,289142,sid182_gci1273006,00.html

    What assurances do you have that the lab’s database is secure enough to prevent your genome or genetic tests from being stolen?

    6) It is crtical to understand that giving ownerhsip of a critical personal asset like your DNA or genome to a corporation is a very bad idea. Not only do you put your future opportunities at risk, you endanger your entire family’s futures at the same time.

    As a practicing physician who has spent over 30 years listening to patients whose sensitve medical records were used against them by employers or used to humiliate them or harm them in public, I am very well aware of how personal health information is used to harm people and ruin lives. I founded Patient Privacy Rights because health information should never be used except to help you get well or for research WITH your informed consent. No one should be denied a job or a promotion because of fears about their future health.

    Because of the lack of privacy, 600,000 people refuse to seek treatment or early diagnosis for cancer and 2,000,000 refuse treatment for mental illness. 150,000 Iraqi vets refuse treatment for PTSD because they fear their treatment will not be private. The result is the highest rate of suicide among active duty military in 30 years. The lack of health privacy kills.

    Current law is just not enough to protect health privacy. GINA is not enough. We need Congress to restore our longstanding Constitutional, legal, and ethical rights to control personal health information. Without that right firmly re-established in Federal law, giving ANYONE your sensitive genomic or health information is a very bad idea.

    Check out our website. You can sign up for e-alerts about health privacy in the Digital Age. If we are able to restore control over our personal digital health information, then we have a powerful model for building personal control over ALL our personal electronic data (financial, email, phone records, purchases, etc). If you do not fight for your privacy rights, who will?

    If EVERYTHING about you is for sale and can be seen by everyone, will you continue to have your precious liberties and freedoms?

    Deborah C. Peel, MD
    Chair, Patient Privacy Rights

  2. Dude,

    You are mixing many things here. When Obama or people generally talk about Healthcare IT, its about making electronic medical records available to doc/patients. And connecting the existing systems. Hopefully towards reducing the cost and improving the care. Google Health and Microsoft HealthVault are big strides in the direction.

    The DNA diagnostics is simply like any other laboratory test. IF made available, docs ll prescribe it to make their decisions. Nothing changes as much in terms of healthcare costs. May be they increase a bit more. And help early detection to save lives.

    Healthcare is complex. Technology will only solve a part of the problem. There has already been too much of mess. We’ve to be very careful going forward.

  3. Oh if it were just that simple.
    Or, why don’t identical twins get the same illnesses?
    Health care cost are partial that high because people do self diagnoses. Based on some TV commercial or some web site woodoo.
    Based on the twin studies we can say, DNA is maybe a 30-50% marker, in other words just flip a coin a few times.
    So I agree with Stephanie. Life style changes if you are over weight for example and nutrition are way better to bring health care cost down then DNA sampling.

  4. Stephanie

    An additional angle on this is the whole prevention side of the equation. Just because you have a certain gene sequence doesn’t mean you will actually get the disease. Many of the body’s systems controlled by genes are modifiable via nutrition and supplementation that can reduce the risk or prevent the condition from becoming disease. What if more people used the genetic testing data to focus on changing their lifestyles and nutrition habits to prevent disease?

  5. A supplemental thought to the “cure” side of this equation is the growth that will happen in the area of decision support and autonomous treatment solutions. Sure, perhaps we’ll be treating 50% more diseases than we do today, but we won’t be treating them the same way. The potential for technology to develop in-pace with the advances in diagnostics will meet the need of that potential 50% increase in treatment. The point is that treatment, too, won’t look like it does today.