U.K. House of Lords Issues Report on Genomic Medicine
On July 7, the Science and Technology Committee of the United Kingdom’s House of Lords issued its report on genomic medicine (pdf). The Report is optimistic about the potential long-term benefits of translating advances in genetics into substantial improvements in medical care but determines that the National Health Service (NHS) is not currently equipped to take advantage of this scientific revolution. The Report identifies existing institutional deficiencies and makes a variety of recommendations for improving the U.K.’s current system.
The following first summarizes key features and recommendations of the Report and then considers how the Report may influence legislative and regulatory developments in the United States, as well as in the U.K.
Part I: Recommendations for Genomic Medicine
At a hefty but still manageable 126 pages, the full Report is recommended reading for those interested in the field of genomic medicine in any country with a developed healthcare system. But for the sake of convenience, some of the highlights of the Report are summarized below.
Betting on the Next 20 Years of Genomic Science
Without a doubt, the Human Genome Project produced some of the most significant advancements in genomic science of the past two decades, from seismic improvements in genomic sequencing technologies to the first ever “map” of the human genome. In 2000, as the Human Genome Project was marching toward completion, Ewan Birney of the European Bioinformatics Institute wound up in an argument with Francis Collins (then head of the National Human Genome Research Institute and today the Obama administration’s nominee for head of the NIH) over the number of genes in the human genome. What resulted was a friendly competition — dubbed GeneSweep — between some of the world’s preeminent genomic researchers to predict the final tally which, in 2003, was announced at a mere 21,000 genes. The winner, Lee Rowen from the Institute of Systems Biology in Seattle, collected more than $1,000 and a signed copy of The Double Helix for her prediction of 25,947 genes.
Now a pair of prominent scientists have placed a new wager on the course of the next two decades of genomic research. As described in the New Scientist, a case of fine port hangs in the balance of this sentence:
By May 1, 2029, given the genome of a fertilised egg of an animal or plant, we will be able to predict in at least one case all the details of the organism that develops from it, including any abnormalities.
Genomic Research Goes DTC
The first generation of Direct-to-Consumer genetic testing and sequencing was populated by companies such as 23andMe, Navigenics and deCODEme that offered genotyping for a limited set of conditions, focusing primarily on genealogy and monogenic traits.
As the cost of generating genetic data continued to decline new companies brought new commercial offerings to the table, including whole-genome sequencing from Knome and, more recently, Illumina, and an increasing focus on the genetics underlying complex diseases and traits.
Recruiting Customers as Research Subjects
Even more recently a new dimension to the field of DTC genetics has emerged: Direct-to-Consumer research. In May of 2008 23andMe’s founders laid out their vision for customer-driven research. 23andWe, as the company’s research arm is known, launched its first significant project in March of this year when, aided by financial support from Sergey Brin, the co-founder of Google and the husband of 23andMe co-founder Anne Wojcicki, 23andMe announced a large-scale study aimed at the genetic bases of Parkinson’s disease. The study aims to recruit 10,000 patients with Parkinson’s disease to enroll. Participants in the study will receive 23andMe’s services for $25, a steep discount from the going rate of $399.
And on Tuesday, 23andMe announced what it is terming the “Research Revolution, a community outreach program that empowers people to drive the direction of genetic research.” In some ways this Research Revolution is genomic research meets American Idol, with the general public invited to vote by participating in the project and choosing from a list of 10 diseases to support. (Participation costs $99 for a stripped-down version of 23andMe’s service that does not include several key features, including ancestry information, carrier testing and access to the underlying raw genetic data).
A Closer Look at Biobanking of Newborn Blood Spots
Under established state public health programs, hospitals nationwide collect blood samples from the majority of the more than 4 million U.S. newborns each year to screen for genetic and metabolic disorders. This is widely viewed as a valuable program that can lead to early diagnosis and treatment of potentially serious conditions and is normally controversial only when the parents object to testing.
At present, although there is some national coordination of newborn screening programs, there is no uniform policy governing the disposition of newborn blood samples after screening is complete. Some states store the samples for a limited period of time and then discard them. Others, including Minnesota and Michigan, permit researchers to use the samples, including to conduct pilot studies designed to develop additional newborn screening tests. Michigan is even facilitating (although not funding) the development of a “Neonatal BioTrust” in the hopes of drawing biomedical companies to the state.
And additional guidance from the federal government is likely forthcoming. Late last year the National Institute of Child Health and Human Development, a division of the National Institutes of Health (NIH), awarded the American College of Medical Genetics (ACMG) a $13.5 million, 5-year contract for the development of a National Newborn Screening Translational Research Network. One of the network’s many aims is to facilitate the creation of a “reliable repository of residual dried bloodspots that is either virtual or physical and comprised of those stored by state newborn screening programs and other resources.”
