Wednesday, June 14, 2006

Genomics and hype   posted by JP @ 6/14/2006 11:17:00 AM

Over at Genetics and Health, Dr. Hsien Hsien Lei had an interview a little while back with Dr. David Moskowitz, Chief Medical Officer of Genomed. It's an interesting read, but I hope Dr. Lei doesn't mind if I say what at least one of the commenters on the thread was thinking: this guy is full of it. My evidence:

1. Here's a quote from near the end of the interview:
Perhaps because I'm the only genomics company CEO who sees patients, I feel that the world of genomics runs on a fuel of 99.9% hype, 0.1% clinical medicine. A clinician understands in their guts that the patient seeing them needs a practical solution right now, not 20 years from now.

Genomics needs to get real.

Fair enough. Here's a quote from near the beginning:
Q. What do you think we can expect in the genome revolution?

A. Exactly what the public has been told for the past two decades: the roadmap for preventing disease, or at least treating it better.

Like any revolution, there will be some bloodshed.

For example, being able to prevent disease is horrible news for the hospital-based medical establishment (including med schools). These folks have ruled medicine for the past two centuries. Genomics will dry up their supply of patients. Perhaps patients will choose to die again at home, at the age of 125, and boycott hospitals altogether.[my emphasis]

Pot, meet kettle.
There's nothing wrong with being ambitious; I'm all for it. But it will take a lot more basic advances in science, using technologies that don't exist now, before we can even think about getting to what he's suggesting here. Of course, Dr. Moskowitz isn't that big on technology, either...

2. Here he is talking about the X Prize-like competition to reward people who develop technologies for cheap genome sequencing:
I've spoken to them, and they're obviously hooked on technology. They have no appreciation of clinical medicine or the scarce resources available for healthcare on this planet.

In clinical medicine, you use as little resources as possible to get the maximum patient benefit. If you can predict the six most common cancers in Caucasians using only 220 SNPs, as we can already do for breast, colon, lung, ovarian, pancreatic and prostate cancer, why bother sequencing a person's entire genome? If you can already delay or even reverse atherosclerosis, as I've been able to do since 1994 without any genotyping at all, why bother sequencing for cardiovascular genes?

This is a striking example of a non sequitur: some cancers can be predicted with a limited number of SNPs, thus genome sequencing is a waste of money. It does not follow. Low cost sequencing will not only be a boon to medical researchers, who use genetic information to find new drug targets, but will lead to a sea change in our understanding of the genome, its organization, and its relationship to disease. And better understanding will have vast clinical consequences. Dr. Moskowitz probably agrees with me here; he says at one point, "you can't beat disease without knowing its pathways". Well, low-cost genome sequencing will greatly help towards that goal.

3. Did you notice he cured atherosclerosis in 1994? Well, here's something else:
I first found out how to prevent 90% of kidney failure in 1994. But I'm still the only person in the world using my protocol.

Here, I went to PubMed. What I found was a 2002 paper on preventing renal failure. The abstract (no access to the full text) claims that, "as a group, the outcomes are superior to what is available in the literature". Nothing about preventing 90% of renal failure, though perhaps that's in the full text. And note there's nothing in PubMed on artherosclerosis. Perhaps his cures haven't caught on because he's keeping them to himself (he is the CEO of a biotech company, after all).

4. Here's his last comment on genomics:
The field can continue to follow the lead of Craig Venter, Francis Collins, Eric Lander, and other pediatric geneticists who have yet to solve any adult, polygenic diseases, but who consume enormous amounts of time and money in the process, or it can focus on what needs and can be done.

This I'm going to have to chalk up to jealousy. I mean, honestly, "pediatric geneticists"? These are the people who are interested in the basic research, who sequenced the human genome, and who fund the HapMap Project. They're at the forefront of the field, and did the work that inspired his company:
It suddently became possible to scan the entire genome for disease-associated SNPs, instead of looking at one SNP at a time, as we had been doing. Since we were in a global competition to find disease-predisposition genes, I was unwilling to give up the race. I started Genomed

These people inspired his career and made his company possible, and now he thinks they're worthless?

I've definitely noticed that a "genomics is hype" meme has caught on among a lot of scientists that don't really seem to know what to do with a lot of data, but this is a particularly egregious example.