Socialized medicine + personal genomics = ?

By Razib Khan | January 28, 2012 7:02 pm

My own working assumption is that the demand side impulse toward mass adoption of human genomic technology in the USA is going to be dampened by fear of downside consequences, GINA notwithstanding. Rather, I assume that the more deregulated consumer environment in parts of Asia with very low fertility rates, as well as European states with more thorough socialized medical systems, will “punch above their weight” in this domain. It looks likes a genuine socialized medical system (i.e., the doctors are state employees), that of the UK, is preparing to step up to the plate, Genomic innovation will better target treatment in the NHS:

The independent cross-government advisory group was set up in response to the 2009 House of Lords report on genomic medicine. It draws on expertise from across Government and research institutes and makes six recommendations to Government:

The recommendations are:

• to develop a cross-cutting strategic document, to set out the direction on genomic technology adoption in the NHS;

• to develop a national central genomic data storage facility;

• that the NHS Commissioning Board should lead on developing genomic technology adoption;

• to work to develop a service delivery model for genomic technologies;

• that the NHS should continue to develop genomics education and training; and

• to raise public awareness of genomic technology and its benefits.

Many researchers believe that personal genomics will really not hit the biomedical sweet spot until you have on the order of a million people sequenced. But even then in the American system how to get a hold of all that information is going to be problematic, since it will likely be decentralized. In contrast in Britain tens of millions of people have one primary healthcare provider, their national government.

You can read the full report online (PDF). Like the “rise of China,” the “rise of genomics,” was one of those futurist predictions. Until now. It’s ridiculous to talk about the rise of something which has risen. Now it’s about maturity and ripening.

CATEGORIZED UNDER: Genomics, Personal Genomics
MORE ABOUT: Personal genomics
  • Divabiotech

    I completely agree with you. As someone who travels around the world talking about genomics in many countries, I believe that true adoption of Personalized Medicine will happen outside of the US. Countries like Korea, Saudi Arabia, China, Singapore are all investing heavily in making personalized medicine a reality and the clinicians are playing a key role in the discussions and the implementation. In addition, the ministries of health are often involved in these programs from both funding perspectives and in promoting the value. Finally the regulatory and the reimbursement systems in the US will both play a major role in stifling the adoption in the US.

  • Miley Cyrax

    I’m not intimately familiar with the nuts and bolts of retail insurance nor the laws that govern it for particular countries, but on the big picture level my hope is that personal genomics allow those with less risky health profiles to use their genomic data to bargain for cheaper policies, or that perhaps health insurance companies will use people’s genomics to determine rates. That is, I wish for greater transparency and information symmetry to result in lower costs for consumers.

    Insurance should be about the insurance-purchaser transferring risk to the insurance-writer, as the latter uses economies of scale and diversification to deal with what would otherwise be tail-risk for the insurance-purchaser. Unfortunately, in many nations, in practice it has become some insurance-purchasers subsidizing other insurance-purchasers, which for some reason some people see as desirable.

  • D Braithwaite

    In the USA, I foresee the for-profit health services using Personalised Medicine as a weapon rather than a tool. Instead of providing preventative care to at-risk patients, it will be used to discriminate against them by jacking up the cost of insurance or just outright denying cover to those who really need it.

    No health care system should have the primary goal of making money. In countries where socialised medicine is available, Personalised Medicine will provide a new level of predictive diagnostics to help catch diseases in their early stages and improve quality of life for millions of people. In America, it will be used to charge you extra or discard you as a bad investment.

  • Mephane

    @2. Miley Cyrax:

    Your assumptions about the actual intentions of many (mostly European) health insurance systems are mistaken. For example, the public system in Germany has been specifically designed so that the insurance fees are purposely independent of personal health risks, but purely on personaly income. They are based around solidarity – the strong supporting the weak, and though latest developments and the competition by private health insurance companies (and some loopholes in the laws) may undermine this, the intention is absolutely clear.

    One of the main reasons, with which I agree, is that for personal health, there are so many factors one can never control. If someone suddenly has cancer (or any similarly severe disease), possibly through no wrong doing of their own doing, would it be really fair to punish them, on top of the disease itself, with higher insurance rates?

    The end-result would be what we can observe in the USA – there are far too many people not receiving proper medical treatment just because they can’t afford it or the insurance. I strongly believe and healthcare as part of the human rights, directly implied from the right to live etc. Treating health insurance the way like car insurance works would be directly against these basic rights, if you ask me.

    And that is the reason “some people see it as desirable”.

  • Patrick

    • to develop a national central genomic data storage facility;

    I do not see the need for this “institutional” storage facility. We already share 99,9% of our genome.

    However, i can see patients storing at home (or on their mobile devices) their 0.1% and i can see socialized patients sharing their 0.1% anonimously or not, via new “medical genomics social networks”.

    Nowhere in the world, there is a standard yet for EMR, so how can you expect to setup a system to store a 3Go genome data file?

    Personalized genomic medicine will need to rely on “socialized patients” and i agree with your post title 200%.

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Gene Expression

This blog is about evolution, genetics, genomics and their interstices. Please beware that comments are aggressively moderated. Uncivil or churlish comments will likely get you banned immediately, so make any contribution count!

About Razib Khan

I have degrees in biology and biochemistry, a passion for genetics, history, and philosophy, and shrimp is my favorite food. In relation to nationality I'm a American Northwesterner, in politics I'm a reactionary, and as for religion I have none (I'm an atheist). If you want to know more, see the links at http://www.razib.com

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