Archive for the ‘Education’ Category

Cytokinetics ALS Drug “Helps” Patients, but Stock is Down 22%?

Monday, December 13th, 2010

OK, I admit that I am probably too much of an idealist, but today’s news about Cytokinetics and its amyotropic lateral sclerosis (ALS) drug bugs me.

The first story I saw has the headline, “Cytokinetics, Inc. (CYTK) Stock Plunges 21% as of 10:24 AM EST After Phase II Results Released” from MarketWatch.

The next story I saw, in the same news digest, trumpeted “Cytokinetics drug helps ALS patients in small trial” (Reuters).

Is it just me or do these two news items seem incongruent?  It just bugs me.  I know that the perspective of these two news items is different.  In story one, what is likely the case is that investors were looking for a “bigger win” than the company reported (Importantly, no data were reported in either story).

In story two, the company was most likely putting their spin on the results.  I’m sure it is truthful, however, whatever the data were, investors must not have been impressed.

“Companies do what they gotta do to survive” might be the byline for story two.  I understand this, but it also highlights my chief concern with “science by press release”, a practice which is increasingly common these days.  It’s hard to tell what the real story is when the news items you read may have a pretty heavy spin on them.

Is the Internet making us intellectually shallow?

Friday, June 25th, 2010

A colleague sent around an email a few days ago that pointed to a book review that asks this question:

Is the Internet making us intellectually shallow?  http://www.csmonitor.com/Books/Book-Reviews/2010/0621/The-Shallows?sms

For me, I’ve found the internet like drinking from a firehose–way too much material to take in.  Hence, I noticed initially that I was fairly shallow in how I read material online.  Now that this resource has become the dominant one for written material that I use for my work I have learned to discipline myself to better focus on what I have chosen to read.  While this requires some extra effort on my part, the upside is that there is an amazing amount of material within easy reach to chose from.

So, my answer to that question would be, “No, the internet does not necessarily make us intellectually shallow.”  Rather, my feeling is that the internet challenges us to choose wisely.

More on Genetic Testing…

Wednesday, May 26th, 2010

Two recent developments with respect to mass genetic testing support the idea that we are not done debating how we want to handle such information as a society.

On May 19 the The House Energy and Commerce Committee and its subcommittee on oversight and investigations began efforts to collect information from Navigenics, Pathway Genomics, and 23 and Me regarding the methods, accuracy, and privacy of their tests (http://www.washingtonpost.com/wp-dyn/content/article/2010/05/19/AR2010051903079.html).  This follows on the request from the FDA to discuss with Pathway Genomics whether the company needs approval from the Agency to sell its tests at Walgreen’s.

Separately, UC Berkeley recently initiated a program in which the university is offering incoming students the opportunity to submit DNA samples for genotyping at three loci involved in alcohol, lactate, and folate metabolism.  This has raised concerns from groups, including the Council for Responsible Genetics, who would prefer to have the testing postponed, at least, until we can better address issues around misuse and privacy of this type of information.

The developments around these two events, the announcement of the imminent sale of OCT genomic tests and the testing of students at a large university, make it pretty clear that, as a society, we are not entirely OK with this type of large scale genetic testing yet.  In particular, I think that there is a feeling that we don’t really know what the true risk-benefit relationship is.

As with all situations where information is being revealed, once the cat is out of the bag there is no way to put it back in the bag.  I’m sure both of these genomic testing programs would work out just fine, but perhaps in this situation erring on the side of caution is appropriate.

More on the Future of Medicine

Thursday, March 11th, 2010

Support for Participation as a key component of the improvement of health care going forward is found in this article from the Harvard Business Review.  Important developments cited include behavioral economics, patient portals,  and checklists (for physicians, but why not patients, too?).

The Future of Medicine?

Wednesday, March 10th, 2010

Leroy Hood proposes the “P4” view of medicine in an interview in MIT’s Technology Review (http://www.technologyreview.com/biomedicine/24703/page1/). The four P’s are Powerfully Predictive, Personalized, Preventative, and Participatory. These apparently will be the underlying concepts in, as the article puts it, a “revolution in medicine”. Really? I’m not so sure.

Don’t get me wrong. Leroy Hood is one of my science heroes: he was a rising star when I was a graduate student and post-doc. Subsequently, he has offered ideas and generated energy in areas of molecular biology that I really like, having helped invent automated sequencing and started an institute to promote systems thinking around cell and molecular biology. He is one of the smartest people that I know of.

However, in my mind there is a strong case that three of these “P”s, Predictive, Personalized, and Preventative are really not new. These concepts in medicine have been the subject of discussion and goal of improved medicine for many years. The impact of genomics and informatics on these three will be, in my opinion, an extension of work that predates DNA sequencing and computers. The one “P” that I think may be revolutionary is “Participation”.

Predictive describes what we all want our tests to be. If I take a glucose tolerance test, my physician is attempting to gather information on whether I have diabetes or not. With that information in hand and armed with knowledge of the natural history of people with or without the disease of diabetes, my physician can “predict” what my health state is likely to be at some point in the future (under certain assumptions). If you think about it, there is no test that can actually predict the future. They are all educated guesses with some probability of being wrong attached. The same will hold true for genomic based tests. Sorry, 23 and Me. More on this in a future post.

Personalized and preventative are likewise extensions of long-standing trends in medicine. Physicians have been working to personalize care for eons through practices such as prescribing different doses of drugs for different size people. And, as has been discussed for the last decade, there are some very powerful disincentives for personalizing therapeutic products too much: highly targeted market = small market.

Preventative even has its own cliché (I prefer to call it “distilled wisdom”): “An ounce of prevention is worth a pound of cure”. Whether the technologies mentioned in the article will have the impact on these long-standing trends in medicine that the hype has built up for them remains to be seen.

For my money, the one “P” that does have a case for being revolutionary is Participatory. For a long time patient participation in medical decision making was pretty much discouraged. Certain shifts in social structure, along with the huge increase in the availability of medical information in the last 30 years have opened the door to patient participation in health care decisions. Now, if I am a man, I have available to me more information about prostate disease than I can possibly absorb. Similarly, women can learn all that they want to know, and more, about breast cancer if they have access to a computer with an internet connection. Whereas one used to rely on one’s physician for the required information on whatever health problem, now the patient has the capability to acquire information on their condition and the available treatment options. As a result, each of us, in most of our health care situations, is empowered to participate in the required decision making. Is this where informatics will have its greatest impact on the revolution in medicine, rather than in terabytes of sequence data?

So, perhaps the real revolution in medicine is in patient education for its ability to facilitate participation in one’s own health care. As discussed in this recent article, nearly all women who received information on their breast cancer from the Oncotype Dx test from Genomic Health, Inc. were glad they took the test. However, only 2/3 to ¾ said they understood what the test was telling them, even when explained by their physician. So, to really participate in their health care decisions, these women need to understand what breast cancer is, what genomics is and what it can tell them about their disease, and how this information can support their decisions. I believe that from a collaboration of an informed, educated patient and their physician will come the best health care decisions of all.