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Anne Wojcicki Speaks Out About the F.D.A. Crackdown on 23andMe
- tokenadult 13y agoOne of the comments on the submitted article on its website nails it: "What 23 and me is saying is not accurate. The reason why the FDA has a problem with them is not the fact that they are decoding DNA for people, it is the fact that they are interpreting the results to diagnose specific medical conditions direct to the public. "This is against FDA regulations unless it is waived (CLIA waived). In order for a test to be CLIA waived it has to be 'simple laboratory examinations and procedures that have an insignificant risk of an erroneous result.' Examples include glucose tests and pregnancy tests. DNA testing is FAR from that. "I am a member of 23 and me and they scour scientific research papers to assign medical conditions to certain genomes. They rate the quality of the research from 1 to 4 stars based on how established the research is. How they determine this is unknown. Genomics is rapidly expanding and it is often hard to determine disease correlation with a genetic marker." Hear. Hear. I have a local friend whom I grew up with who is an electrical engineer who works on medical devices. By any reasonable reading of the FDA regulations adopted under statutory authority from Congress, the product and service combination on offer from 23andMe falls within the scope of FDA's regulatory authority, and the company's consumer-facing product claims are extraordinary claims for which the company has not provided evidence. That's bad. An article from Fast Company previously submitted to HN and discussed here points out that 23andMe's business model is basically to gather a lot of cell samples and a lot of personal health data from consumers, and then gradually infer genetic relationships to disease risk that might be valid and actionable. But that's not how it is marketing itself to consumers today. http://www.fastcompany.com/3018598/for-99-this-ceo-can-tell-you-what-might-kill-you-inside-23andme-founder-anne-wojcickis-dna-r http://www.fastcompany.com/3018598/for-99-this-ceo-can-tell-...
- kefka 13y agoFine. Then label it for "Entertainment purposes only".
- carbocation 13y agoAccording to the FDA's letter of action, they spent years discussing the company's marketing of their product with 23andme. Surely the company, in that time, could have chosen to rebrand. Instead, it is plastered with quasi-medical advice. Not that I think this is even bad—but I do think that this puts the company's marketing claims justifiably under the FDA's purview.
- spikels 13y agoAll they need to do is slap a disclaimer all over the place and instead of mentioning specific diseases say something non-specific like "this test result indicates your heart/lung/bone/etc is unhealthy/risky/bad/etc". The completely bullshit vitamin/herbs/supplements/alternatives industry has been making similar claims without a peep from the FDA. You gotta know the rules to the game even if they are arbitrary.
- carbocation 13y ago> "this test result indicates your heart/lung/bone/etc is unhealthy/risky/bad/etc" It's pretty unlikely they would escape the FDA's review simply by making their medical diagnoses slightly more vague.
- spikels 13y agoFrom the FDA letter to 23andMe describing why they have regulatory oversight: "because it is intended for use in the diagnosis of disease or other conditions or in the cure, mitigation, treatment, or prevention of disease, or is intended to affect the structure or function of the body."[1] No mention of disease (or structure or function) then there would be no problem. The FDA makes many arbitrary distinctions because of the long and twisted legal and political history of "health" industry regulation[2]. [1] http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2013/ucm376296.htm http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2... [2] http://www.fda.gov/NewsEvents/Testimony/ucm112576.htm http://www.fda.gov/NewsEvents/Testimony/ucm112576.htm
- specialp 13y agoI posted that comment on NYT then submitted this article to HN. I used to work in the medical laboratory business before getting into software development. I do not think 23 and me is going to escape enforcement from the FDA. The comments they made to NYT were about the fact that the FDA has to look at each test individually to determine if it can be CLIA waived. They imply that this is an archaic way of doing things as they are testing millions of correlations, and compare it with the challenges in the tech community with slow regulatory change. They are wrong about this. The FDA does have to evaluate every diagnosis that they are making as it is that.. a diagnosis. Diagnoses that are going straight to the consumer have an even higher bar to meet not unlike a drug becoming OTC. Medical laboratories are not allowed to perform direct to patient testing for non waived tests. The purpose of this is that they do not want patients to interpret tests incorrectly where there is gray area, and possibly make adverse decisions based on the diagnosis. http://wwwn.cdc.gov/CLIA/Resources/WaivedTests/default.aspx http://wwwn.cdc.gov/CLIA/Resources/WaivedTests/default.aspx
- EpicEng 13y agoI was just popping in to post essentially the same thing. I have worked on two class III medical devices (systems work with a focus on software) over the past eight years (lead developer and project manager). It is obvious to anyone who has an ounce of experience dealing with the FDA that the interpretation is the problem and that such a product should be regulated in some way. Honestly, their comments come off as a bit flippant, and really, they should be a bit more fearful. Right or wrong, the FDA is not to be trifled with.
- btian 13y agoIt's wrong. 23andme does not diagnose disease. It links DNA to published research papers and provides confidence level based on a number of factors.
- EpicEng 13y ago...provides confidence level based on a number of factors You have just described a medical diagnosis.
- potatolicious 13y agoIn the same way that Lyft rides are paid with "donations" and not "fares", yes? Fortunately corporate doublespeak does not make a duck stop waddling or quacking.
- derefr 13y agoSimple patch, in my mind: 1. Drop all interpretation of the results from the results pages. Instead, just spew out a bunch of semantically-tagged gene tables. 2. Take all the interpretation map-data they have so far, and dump that into a FOSS Github project for a Firefox/Chrome Extension, which parses the results page and re-renders it into... exactly what it is now. Bam. "23andMe" is no longer giving medical advice; some FOSS project is. (Even though the developers, individually, could be ongoing contributors to the very same FOSS project.) This is actually probably for the better, either way. Other front-ends could make use of 23andMe's genetic-data "API", and the FOSS interpretation-map could be maintained by people (doctors!) all over the world.
- LogicX 13y agoBut you've just open sourced their entire value-proposition, which is that correlation part based on all the data. Mapping your DNA is now the 'easy' part, and offers them no differentiation and competitive advantage. (Ok, they still have lots of data to use to do their own lookups of all customers using the FOSS and improve that project, but again, they're adding value outside their company)
- derefr 13y agoI think that could still be tenable, if the marketing was rearranged so that the FOSS project was the initial point-of-contact for people looking for gene mapping (picture it as a whole app, rather than just an extension), and then it does lead-gen for "23andMe, the premium gene mapping service compatible with our gene explorer." The FOSS project still might get forked, of course... but as long as the 23andMe people are actually the leading experts in doing those correlational studies, their fork will stay the canonical/preferred one. Seems more honest. (Of course, no company wants to have to be "honest" in that way, but if the only other option being legislated out of existence, it might still be a profitable strategy.)
- cromwellian 13y agoCreating hyperlinks between genes and research papers is not what I'd call diagnosing. You find evidence of ABCD gene, you search all research papers that cite ABCD, you curate and rank papers by quality, summarize related conditions with statistical correlations. This is just a high-tech version of me using WrongDiagnosis.com, typing in 5 or 6 symptoms, and having it return all possible articles that cite those symptoms, ranked by number of simultaneous occurrences. The potential hack to defeat the FDA here is to simply split the company in 2 parts. Company #1 sells a $99 service which gives does the test. Company #2 is a partner of Company #1 through an API. Consumers can elect to OAuth access of their gene data from Company #1 to Company #2. Company #2 takes gene data over an API and sells you linked and ranked reports on it. Company #2 sells no devices, performs no tests. They are pure software bioinformatics. They take standard file formats and produce reports. Consumers can elect not to use Company #2's services, get their own private data in raw format and write their own python scripts if they want. Or, consumers can buy Company #2's services, but supply their own data from any company that offers personal genomics raw-data dumps. The idea that me reading ranked reports to research papers linked to my personal health data is 'extraordinary claims' and a danger to me is frankly offensive. I would hope that a company offering software that parsed and processed genetic data and turned it into linked reports from crawled research papers could be considered a first amendment right. But if not, the github approach is certainly a worthwhile approach. Again, as I said in other posts, the FDA doesn't regulate supplements, doesn't regulate Dianetics/Scientology, didn't stop "The Secret" from killing people with heat-stroke therapy. It's enormously offensive to me that the government spends so much time going after stuff like this, pot smokers, et al, instead of massively beefing up enforcement over the hundreds or thousands of hucksters selling harmful bullshit health products on radio and late night TV ads. Does no one remember http://en.wikipedia.org/wiki/HeadOn http://en.wikipedia.org/wiki/HeadOn ? Coldeze? Five Hour Energy, which may have actually killed people, and still gets away with deceptive ads. What about Hoodia? Yeah, the FDA advises people not to purchase it, but does nothing to stop consumers from buying it based on false claims of efficacy. People don't like this style of reasoning, but in my opinion, the government regulatory agencies have limited resources. I want the SEC going after big banks and investment firms, not small time insider traders. I want the IRS auditing people who avoided millions or billions in taxes, not the guy who owes $1000. I want the FDA going after things which are much much more likely to be ripping off and harming consumers, either financially, or physically, and on the scale of possible things that can harm you, this is way way down the list based on a really loose theory of someone avoiding treatment by false negative, when in reality, if anything, the majority of people are going to be having more conversations with their doctor over this product. It's like complaining about the people who lost under Obamacare and ignoring the fact that tens of millions more couldn't get any health insurance in the first place.
- kevinh 13y agoHow long before 23andMe sells your personal DNA information up the river to advertisement corporations? Don't trust corporations with your personal information because, with few exceptions, they are more than willing to sell you out to make a quick buck. And then they claim that their slogan is 'Don't be evil.'
- specialp 13y agoI believe one of their goals is to crowd source medical information and possibly sell the results. Right now they have a "23 and We" research program where you can voluntarily opt in. Even if you don't when you go on their site they try to get you to answer questions about yourself from time to time. I have never answered them and they seem very innocuous such as is your earwax wet?. I am not sure if they dig deeper if you answer those questions in future questions
- diydsp 13y agoSome interesting perspectives in this article: First, calling the FDA "a very important partner" is overly glib. The FDA is not a "partner" in the sense that they will accompany you or assist you on your journey. They are only there to put the brakes on you. They are not merely "important," they are _vital_. Second, the article is skewed to make it sound like people aren't entitled to our own DNA information. That's not what is contested. Of course, you can have access to your own DNA data, as long as the proper checks are made to ensure you're actually getting an accurate reading. The issue is whether telling you have a disease with life-scale consequences requires validation of these claims. There is something to be said for their tactic of giving a large number of answers instead of validating single tests, but it still requires a thorough level of validation to protect people from exploitation and it wouldn't hurt their cause to present themselves more respectfully to the authorities. Perhaps they're trying to fake casualness, that's certainly my reading, but I hope they don't screw this all up but not thinking it through and throwing around lots of bullshit. For example, comparing themselves to Google is ludicrous. First, google's indexing search engine HAD been doing before, by altavista, webcrawler, etc., etc. Second, there was no question that whether what they were doing could negatively influence people's health and well-being. Perhaps the scholar/books scanning was a bit controversial. Perhaps some were surprised at Streetview, but that was actually legal and in both cases, they took several key measures, voluntarily, to keep themselves well inside the law. BTW, I'm no google fanboy, but to compare their IT stunts and magic tricks with potentially delivering low-quality information about life-threatening health conditions "isn't in the same ballpark. It isn't even the same goddamn sport." -Jules.
- sanxiyn 13y agoIs anyone actually contesting that 23andMe doesn't get an accurate enough reading of DNA? I thought the problem was all with interpretation. https://www.23andme.com/more/science/ https://www.23andme.com/more/science/ states "Data quality starts with the laboratory that processes your DNA. Our contracted laboratory is licensed by the federal government to perform clinical testing. It uses standardized processes and procedures that ensure highly accurate genetic data." and so far I haven't seen anyone contesting this. That is, DNA reading part is already regulated.
- mentat 13y agoYou really trust a large government bureaucracy that's been beholden to large pharmaceuticals to get this right? Really? The danger of the information is that great? I'm just not buying it and the comments in this thread so pure "anti-disruption" bias which apparently is the new hipster anti-hipster sentiment. 23andme provides information that can be used in conversation qualified professionals. You might was well shut down every medical related forum, Yahoo Answers, WebMD and the rest if you really think that information or misinformation is the danger. Really people take a step back the current memeset at look at the facts.
- carbocation 13y agoI think this comment is conflating "regulation" with "shutting down". As a society, in the USA, we have created the FDA and empowered it to cast a watchful eye over certain types of marketing and manufacture. Regulation limits the rate of innovation in exchange for attempting to limit harm.
- mentat 13y agoExcept that that function has been completely perverted by economic dynamics.
- wiT0 13y agoPhilip Greenspun (of the famous "tenth rule of programming"!) had an interesting question [1]: Question: would it be illegal for 23andme to relocate to Singapore, for example, and have people mail DNA samples to Singapore and then email them the results? The company’s web site indicates that customers in Singapore (and a bunch of other countries) can send their DNA to have it tested. Would the FDA have jurisdiction to prevent a Singapore-based company from accepting packages from consumers in the U.S.? [1] http://blogs.law.harvard.edu/philg/2013/11/25/good-example-of-regulatory-risk-23andme/ http://blogs.law.harvard.edu/philg/2013/11/25/good-example-o...