Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The FDA and 23andMe puts a libertarian in a dilemma

Dr. Saurabh Jha
Conditions
January 25, 2014
Share
Tweet
Share

An advantage astrologers have over genetic testing is that the prediction of astrologers are personally verifiable. An astrologer once emphatically stated that I had no chance of a career in international cricket or Bollywood. So far both claims have turned out to be remarkably accurate.

How does one personally verify a “12.5%” increased chance of lung cancer, the sort of number the vendor for genetic testing 23andMe produces? If one develops lung cancer how would one know that the chances were indeed 12.5%, not 6.25% or 25%?

We die only once. Whether one ends up with lung cancer or doesn’t, the veracity of the claim can be made only empirically. Meaning we need to see how many develop lung cancer out of 10, 000 people just like us.

Yet there is an element of scientific precision in the number, augmented by the decimal point. And it is precisely because genetic testing tends towards science not metaphysics that it falls within the dominion of the Food and Drug Administration (FDA). FDA does not regulate palm readers.

FDA has asked 23andMe to stop sales of its genomic testing.

As a libertarian seeped in the Austrian school of economics, I am generally disposed against regulations. I also share the sentiments of the monetarist Milton Friedman that the true costs of the FDA must also include the treatment opportunities foregone in their lengthy review process.

So it hurts me to be somewhat sympathetic of FDA’s stance on 23andMe, even as I think an outright ban was a tad harsh.

Genetic testing falls in that spectrum of the market where one reaps the benefits but spreads the costs. Economists call this a negative externality. Bankers are most familiar with this. Remember the adage “privatize your gains and socialize your losses.”

Who will counsel the person wondering if she should take anti-coagulants for a trans-Atlantic flight because her genomic analysis shows an 8% increase in developing blood clots over the population average?

Who will shoulder the blame for not anticipating the suicidal ideations of a man who takes his life for finding out that he is destined for Huntington’s disease within ten years?

Who will bear the costs for the overtesting and overdiagnosis that will inevitably result when people find out that they deviate from the population mean in the risk of various cancers?

Not 23andMe, which simply gets paid per Pandora’s box it opens.

The additional costs of investigation will be reflected in our insurance premium. The burden and legal risk will fall chiefly upon the already overworked primary care physicians (PCPs).

ADVERTISEMENT

How will the PCPs advise? Must they advise a woman with a 22.2% increased risk of ovarian cancer differently from someone with a 6.7% increased risk? What is the threshold of increased risk of cancer for pursuing more tests? What are the tradeoffs of such pursuit?

These questions are expected when we are dealing with imperfect information. However, these questions need to be answered rationally and scientifically if genomics truly revolutionizes patient-centered medicine.

That is not to say positive externalities cannot emerge from genetic testing. My attempt at convincing my domestic comptroller to invest in an indoor mountain climber has failed for the third year. I feel I might have succeeded if I had genomic analysis that reported “6.2% higher than average risk from procrastination-induced heart disease” (of course, it might have backfired and led to tight control of my many epicurean activities).

The point is that the ban is excessive. Instead, a sort of Pigovian tax could have been imposed on 23andMe for every $99 it collected for issuing a genomic report.

Saurabh Jha is a radiologist and can be reached on Twitter @RogueRad. This article originally appeared on The Health Care Blog.

Prev

Why psychiatrists don't take insurance

January 25, 2014 Kevin 49
…
Next

Tips to manage your seasonal allergies

January 26, 2014 Kevin 1
…

Tagged as: Genetics, Oncology/Hematology

Post navigation

< Previous Post
Why psychiatrists don't take insurance
Next Post >
Tips to manage your seasonal allergies

ADVERTISEMENT

More by Dr. Saurabh Jha

  • Masks are an effigy of American technocratic incompetence

    Dr. Saurabh Jha
  • False negative: COVID-19 testing’s catch-22

    Dr. Saurabh Jha
  • Why the Lancet’s editorial on Kashmir is unhelpful

    Dr. Saurabh Jha

More in Conditions

  • Breast cancer and the daughter who gave everything

    Dr. Damane Zehra
  • Visual language in health care: Why words aren’t enough

    Hamid Moghimi, RPN
  • Why dietary advice changes: It is not the food, it is the world

    Gerald Kuo
  • Blood in urine after a child’s injury: When to worry

    Martina Ambardjieva, MD, PhD
  • Living with vitiligo: Overcoming shame and control

    Dr. Reshma Stanislaus
  • Post-stroke cognitive impairment: the hidden challenge of recovery

    Rida Ghani
  • Most Popular

  • Past Week

    • The hidden costs of the physician non-clinical career transition

      Carlos N. Hernandez-Torres, MD | Physician
    • The gastroenterologist shortage: Why supply is falling behind demand

      Brian Hudes, MD | Physician
    • Health care as a human right vs. commodity: Resolving the paradox

      Timothy Lesaca, MD | Physician
    • Why private equity is betting on employer DPC over retail

      Dana Y. Lujan, MBA | Policy
    • Why voicemail in outpatient care is failing patients and staff

      Dan Ouellet | Tech
    • Health insurance waste: Why eliminating the middleman saves billions

      Edward Anselm, MD | Policy
  • Past 6 Months

    • Physician on-call compensation: the unpaid labor driving burnout

      Corinne Sundar Rao, MD | Physician
    • How environmental justice and health disparities connect to climate change

      Kaitlynn Esemaya, Alexis Thompson, Annique McLune, and Anamaria Ancheta | Policy
    • Will AI replace primary care physicians?

      P. Dileep Kumar, MD, MBA | Tech
    • A physician father on the Dobbs decision and reproductive rights

      Travis Walker, MD, MPH | Physician
    • What is the minority tax in medicine?

      Tharini Nagarkar and Maranda C. Ward, EdD, MPH | Education
    • Why the U.S. health care system is failing patients and physicians

      John C. Hagan III, MD | Policy
  • Recent Posts

    • Health insurance waste: Why eliminating the middleman saves billions

      Edward Anselm, MD | Policy
    • Why scale of effort matters more than ego in health care

      Ronald L. Lindsay, MD | Physician
    • End-of-life care cost substance use: When compassion meets economic reality

      Brian Hudes, MD | Physician
    • Smart design choices improve patient care outcomes [PODCAST]

      The Podcast by KevinMD | Podcast
    • Breast cancer and the daughter who gave everything

      Dr. Damane Zehra | Conditions
    • Physician wellness is not yoga: Why resilience training fails

      Tomi Mitchell, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 30 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The hidden costs of the physician non-clinical career transition

      Carlos N. Hernandez-Torres, MD | Physician
    • The gastroenterologist shortage: Why supply is falling behind demand

      Brian Hudes, MD | Physician
    • Health care as a human right vs. commodity: Resolving the paradox

      Timothy Lesaca, MD | Physician
    • Why private equity is betting on employer DPC over retail

      Dana Y. Lujan, MBA | Policy
    • Why voicemail in outpatient care is failing patients and staff

      Dan Ouellet | Tech
    • Health insurance waste: Why eliminating the middleman saves billions

      Edward Anselm, MD | Policy
  • Past 6 Months

    • Physician on-call compensation: the unpaid labor driving burnout

      Corinne Sundar Rao, MD | Physician
    • How environmental justice and health disparities connect to climate change

      Kaitlynn Esemaya, Alexis Thompson, Annique McLune, and Anamaria Ancheta | Policy
    • Will AI replace primary care physicians?

      P. Dileep Kumar, MD, MBA | Tech
    • A physician father on the Dobbs decision and reproductive rights

      Travis Walker, MD, MPH | Physician
    • What is the minority tax in medicine?

      Tharini Nagarkar and Maranda C. Ward, EdD, MPH | Education
    • Why the U.S. health care system is failing patients and physicians

      John C. Hagan III, MD | Policy
  • Recent Posts

    • Health insurance waste: Why eliminating the middleman saves billions

      Edward Anselm, MD | Policy
    • Why scale of effort matters more than ego in health care

      Ronald L. Lindsay, MD | Physician
    • End-of-life care cost substance use: When compassion meets economic reality

      Brian Hudes, MD | Physician
    • Smart design choices improve patient care outcomes [PODCAST]

      The Podcast by KevinMD | Podcast
    • Breast cancer and the daughter who gave everything

      Dr. Damane Zehra | Conditions
    • Physician wellness is not yoga: Why resilience training fails

      Tomi Mitchell, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The FDA and 23andMe puts a libertarian in a dilemma
30 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...