By Kirell Lakhman
A show of hands: Who among you would watch a reality TV show that follows a platoon of Harvard pathology residents as they get their DTC genotypes interpreted?
Neither would I. But I did enjoy reading the Boston Globe article yesterday describing Harvard Medical School’s plan to immerse its pathology residents into the world of DTC genomic services.
The program, which started last week at Beth Israel Deaconess Medical Center in Boston, is the first of its kind in the US and puts the hospital “in the vanguard of preparations to guide patients through the dawning Wild West age of personalized medicine,” according to the Globe.
“This has always been our role: blood tests, cultures, urine, those samples come to pathology, where the test is done,” Jeffrey Saffitz, chairman of the pathology department at Beth Israel Deaconess, was quoted as saying in the article. “We see this personalized genomic analysis as a modern extension of our traditional role.”
The program, which will use the DCT genomic services offered by Navigenics in Foster City, Calif., is also sure to intensify the debate that has been on a rolling boil between the clinical lab community, paternalistic regulators, DTC genomic test vendors, and the platform companies whose technologies they use.
Acknowledging that “today, the results [of DTC genomic tests] can be hard to interpret and can mislead patients — and scientific understanding of the genetics of common diseases is still evolving,” the Globe said “doctors are realizing they need to be ready to assess the information and assist their patients.”
“We can bury our head in the sand and pretend it’s not happening, we can suppress the information and tell patients not to go near it, or we can figure out strategies to play a constructive role as this new era of genomic and personalized medicine rolls out,” Mark Boguski, an associate professor of pathology at Harvard Medical School and a program instructor, told the Globe. “That’s what we’re trying to do: prepare our trainees — not because the technology is ready for prime time today, but people are using it, and it’s clear it’s going to play a role in the future.”
The course will require MDs in their second and final years of pathology residency training to “attend lectures and research the science behind the test,” the Globe reports. Undergoing the test is optional.
“I’m curious to see what’s there,” said Thomas Gage, a resident who said he would participate in the testing. “A lot of this stuff can be interpreted too easily sometimes. . . . So I think that’s where you have to be a little bit skeptical. Still, it’s information.”
Gage’s skepticism if not curiosity is shared by the ACMG, which in April issued “a cautionary statement” about DTC genomics tests, and the ACCP, which in July said ads marketing the tests should be regulated by the federal government or risk slowing advances in clinical pharmacogenomic testing.
The Beth Israel program may counterbalance calls for greater regulation — which I oppose — in an important way: by proving to prescribing docs that the tests are not harmful — indeed that they may improve medical outcomes
Other efforts may likely reach the same ends: The National Human Genome Research Institute is making efforts “to increase genetic competency among medical professionals, including nurses, physician assistants, and specialists,” according to the Globe, and ACMG President Bruce Korf said efforts “like the one at Beth Israel Deaconess are essential to give doctors the ability to evaluate genetics information, even though most of it is not useful now.”
“My personal view is we have relied way too much on lectures and not enough on innovative models based on case teaching or other simulations that are much more real than … hearing someone talk about something," he told the Globe.
