Lack of Antidiscrimination Law Hobbles Genomics
He said he believes genomic medicine is at a critical inflection point. “We have a lot of information. We need to exploit it to intervene, not at the most costly advanced stages of symptoms, but at early pre-symptomatic stages where we can truly prevent diseases from manifesting.”
Dr. Reed Tuckson, senior vice president for consumer health and medical care advancement at UnitedHealth Group, said there's a lot of public and physician education work that needs to be done before anyone will be able to make good on Dr. Zerhouni's vision.
“Physicians do not have time for abstract theoretical discourses on the genomics revolution. They want practical answers on how it applies to patient care and how it pertains to their daily practices. The learning systems need to meet these needs,” Dr. Tuckson said. He added that by and large, physicians and the health care system are not prepared to deal with the challenges of genomics.
“What if a doctor detects a breast cancer susceptibility gene in a patient? Does he then try to track down the patient's daughters or her sisters? This brings up some very real patient-doctor communications issues.”
The public is even further behind in terms of understanding the implications and value of genomic medicine. Dr. Tuckson called for intensive public education efforts, pointing out that the science curricula in many school systems are being decimated, leaving young people at a significant disadvantage in their ability to understand genetics. He also said that integration of genomic developments into routine practice requires many more qualified genetics counselors than are now available.
Then there's the matter of reimbursement. Dr. Tuckson noted that health plans have been slow to cover genetic testing on a wider basis because administrators have yet to be convinced that the tests, and the courses of action after testing, are ultimately cost effective.
“We need to make sure that the tests work, and then get them covered. But we really need predictive tests, not just diagnostic tests. We need a robust database to answer the question of whether this adds value, because we really need supplantive technology, not just additive technology,” Dr. Tuckson said.
The future of genomic medicine hinges on further research and development, and that requires funding. “You need to fight like hell to increase the budgets for the National Institutes of Health, the Agency for Healthcare Research and Quality, the Centers for Disease Control, the FDA, and other agencies. If we don't get the research, we can't make the choices,” Dr. Tuckson added.
