Sunday, July 13, 2008

Do I have the right to know my own genetic makeup?

I took a little time yesterday (July 12) to attend a panel discussion on direct to consumer genetic testing at the Genetic Alliance annual conference. Panelists were Sue Friedman, from FORCE; Trish Brown, from DNA Direct; Joanna Mountain, from 23andMe and Sean George, from Navigenics. Francis Collins, Director of the National Human Genome Research Institute, moderated. Once each of the panelists had made their opening remarks, Collins started the discussion by asking why, if personalized genetics is so wonderful, the states of California and New York have issued cease and desist orders to several personalized genetics companies (story). The response was conciliatory, echoing statements on the 23andMe blog (the spittoon):
We agree that this evolving field of personal genomics is in need of proper regulatory oversight. While our mission to provide accurate and contextual information to our customers about their genetic information is aligned with the regulatory mandate to protect the public health, we also want to ensure that efforts to rein in our industry do not hamper the potential benefit of genetic knowledge to our health.
Many relevant issues were brought up, by panel members, or by those in the audience. Can people deal appropriately with uncertainty? Do they understand the relationship between genotype, the environment and phenotype? What about genetic information with predictive value, but about which the consumer can do nothing? The case of APOE was discussed at length.

I do feel that we have a right to obtain information about our own genetic makeup without having to justify ourselves, to a physician, to an insurance company, or to the state of California. I am also skeptical of the perception that "most people are incapable of grasping the relevance of provisional, statistical information." In any case, an enterprise that feeds users with 500,000 bits of information, most of which have no significance, seems more likely to help people understand that genotype is not fate than to have the opposite effect.

Giving people genetic information can be separated from giving them advice, and it seems to me that providing information about genotype should be regulated only to the extent that technical standards are met. This is analogous to surveyors giving me information about the elevation of my house. That information, by itself, is not advice about flood risk, and I would be surprised if surveyors were required to provide accurate assessments of that risk in order to operate, or forbidden from providing consumers with data that a third party judged to be of little value.

The panel helped me to understand the risk of consumer fraud, but, ultimately, I feel, strongly, that I have a right to know my own genetic makeup. Furthermore, I find it insulting to say that consumers are incapable of understanding uncertainty. There is certainly room for regulation, but I hope that my right to pay someone to tell me about my own genes is not infringed. Perhaps it is most important to prevent companies from taking money for tests without providing portable genotype data whose implications can be evaluated by a third party in the light of new information, which could be information about the implications of that specific information, other genetic information that might influence how it is interpreted, or information about the interactions between that bit of genotype and other factors such as one's diet or medical history.

Links for this article:
  • NHGRI (National Human Genome Research Institute), with news, links to research, funding opportunities, fact sheets, and career opportunities, including such tidbits as a Catalog of genome-wide association studies.


  • "Should Personal Genomics Be Regulated" Tim O'Reilley's blog on the subject (with interesting comments and discussion).


  • DNA Direct. DNA Direct's services focus on personalized test result interpretation and supportive materials and services.


  • Genetic Alliance. The Genetic Alliance works to eliminate obstacles and limitations within the genetics community through novel partnerships among stakeholders and integration of individual, family, and community perspectives to improve health systems and inform decisions.


  • "Getting up close and personal with your genome," a news summary for the scientist written by Laura Bonetta and published in Cell (2008 May 30;133(5):753-6)

2 comments:

Steve said...

From today's New York Times:
"California has decided to grant licenses. Two closely watched companies that offer consumers information about their genes have received licenses that will allow them to continue to do business in California, a state official said Tuesday. The licenses, granted to Navigenics and 23andMe, should help defuse a controversy that began in June when the California Department of Public Health sent “cease and desist” letters to the two companies and 11 others that offer genetic testing directly to consumers."

Andrew Yates said...

I agree, though my (albeit minor) contention is the implied confidence from risk presentation. Do we really have the confidence to report risk to the tenth decimal place? No, of course not. Yet, that's what the calculator says...

I strongly support scientific rigor, and I think companies like 23andMe are making great strides to provide the best information they can. However, significant digits is high school chemistry, and I would appreciate some more honesty regarding the story the numbers tell.