Wednesday, October 14, 2015

"Seek, and ye shall find": Matthew 7:7

One of the interesting effects of modern medicine is that we can find things that we never thought were there. A hundred years ago one went to the physician when one had a complaint. The physician then examined the patient and considered the complaints and then made a diagnosis, if possible. The a treatment is available was prescribed.

Today we do lots of tests and find things we would never have susp[ected were there, many just the vagaies of the human. The more we look the more things we are likely to find. Kidney stones, gall stones, osteoarthritis, etc.

Now along comes a new set of tests for those who can chell out $50,000 each time, the full body MRI and full genome scan. As Xconomy reports: 

Top executives and others who come to Health Nucleus for their annual physical will receive a battery of medical tests, including many that are not FDA-approved because they are so new (and unproven), said Brar, who is the current president of the American Academy of Private Physicians. Health Nucleus was able to sidestep FDA restrictions on the clinical use of experimental tests by operating—at least initially—as a clinical research project under Institutional Research Board (IRB) protocols,

A comprehensive workup at Health Nucleus would include:

—Whole genome sequencing of all 6 billion DNA base pairs (According to Health Nucleus, most DNA tests today examine less than 2 percent of the entire human genome.)
—Genome sequencing of the microbiome—the microorganisms that live in the human gut and on the skin.
—Metabolome sequencing of the small-molecule metabolites found in the human body.
—Whole-body medical imaging with advanced MRI (medical resonance imaging) from GE that enables Health Nucleus to quantify the exact volumes of unhealthy visceral fat, the various components of the brain and other tissues that may reveal the progress of disease. 

And of course the price:

Executives and others who arrive for a Health Nucleus checkup would pay $25,000 or $50,000 each, depending on the number of people in the group  

That is just for all this data. The problem with this approach is in my opinion several fold:

1. Clearly those with the $50K get the tests, the rest of humanity do not.

2. Tests will always find something, the incidentaloma. Then what?

3. Research does not research just those people who can pay to be Lab rats, it should covera a broader base of the population.

4. When do we treat something? That is always the question. Take Prostate Cancer. If your family history is such that aggressive types was present at a close proximity, say First degree, then a good bayesian would treat. If however no one ever died in your family of the disease then perhaps one could wait.

5. The data is overwhelming, and one should have a plan and process to deal with it. Not clear here.

6. Cancer is real sneaky. Yes germ line genetic problems may be a warning, say BRCA. Yet having your genome may not be the answer for somatic cells which have become methylated. Or we have mRNAs popping up where they should not.

One suspects this type of thing will appeal to many who can afford the tests, but larger samples would be useful.