Navigenics Announces Clinical Partnership with Toronto’s Medcan Clinic
Genetic testing provider Navigenics has announced a partnership with the Medcan Clinic, a preventive healthcare clinic located in Toronto, Canada. According to the press release, Medcan will use a version of the Navigenics genotyping service, in combination with family history information, to offer patients an analysis of those “genetic risks that are clinically actionable, allowing patients to lower their risk through prevention strategies and more personalized screening.” The focus on clinically or medically actionable strategies is consistent with the approach taken by the Coriell Personalized Medicine Collaborative (CPMC), which is studying the effect of providing information on “medically actionable” genetic risk factors to its participants. (Interestingly, one of the conditions highlighted by the MedCan-Navigenics release is Alzheimer’s disease, which is not a medically actionable condition in the eyes of the CPMC.)
Assessing the clinical utility of direct-to-consumer (DTC) genetic or genomic testing services (including the Navigenics Health Compass service, the price of which was just reduced from $2,500 to $999) has proven to be a thorny issue for the DTC genetics industry. While many DTC companies, including 23andMe, deCODEme and Navigenics, initially positioned themselves not as providers of clinical or medical information but as personal genetic information services, the recent trend has been toward a focus on distinctively clinical features, including genetic carrier screening and medical research. And the regular integration of genetic data with existing patient health data, particularly family histories, is often singled out as a key step in the translation of genetic or genomic data to clinically useful information.
Partnering with a clinical service provider typically has the effect of placing a healthcare provider, usually a physician, in between the consumer/patient and the genetic testing service provider. While Medcan is not the first clinical partnership for Navigenics it remains to be seen whether this is a model that will merely supplement or ultimately replace the direct-to-consumer offerings of companies such as Navigenics.
I would like to comment on your question regarding the inclusion of markers for Alzheimer’s Disease (AD) in the Navigenics / Medcan Clinic screening program. The fact that AD is a devastating disease for patients and their families, for which there is no cure or well defined treatment options, is precisely why it should be part of the screening. While there is no one drug or surgery that can be used to treat AD, there are numerous studies that indicate that some foods, specialty nutrients, even physical and cognitive exercise may slow disease progression for some patients.
Knowledge that one may be afflicted with AD can allow those potential AD patients to take steps early to perhaps delay onset. Knowledge of predisposition to the disease could allow people to make informed decisions regarding long term care, estate planning, etc. Furthermore, people who learn they are genetically predisposed to AD may be able to ease the disease for those who may be afflicted in the future by participating in clinical studies.
Thanks for your comment, Evelyn. Whether or not AD is “actionable” is certainly a topic that has generated a fair bit of discussion. One important distinction is whether or not a condition such as AD is “actionable” in the sense that a physician or other healthcare professional would take some medical or clinical action on the basis of a positive diagnosis. In this sense I think that the general consensus is, at least at this time, that AD is not medically or clinically actionable. Discussions with researchers in this field, including one this afternoon with one of the authors of the recent REVEAL paper in the NEJM (http://content.nejm.org/cgi/content/short/361/3/245), have confirmed this to me.
That said, you are quite right to point out there are still steps that individuals diagnosed with AD can take that, although perhaps not medically significant, are nevertheless significant for the individual and his or her family. Estate planning, provision for long term care and other actions would all fall into this category, as would a decision to participate in future AD clinical research.
Thank you again for the excellent comments.