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

  • The hidden epidemic of orthorexia nervosa

    Sally Daganzo, MD
  • Why early diagnosis of memory loss is crucial

    Scott Tzorfas, MD
  • Rethinking stimulants for ADHD

    Carrie Friedman, NP
  • Why young people need to care about bone health now

    Surgical Fitness Research Pod & Yoshihiro Katsuura, MD
  • Why health care needs empathy, not just algorithms

    Muhammad Abdullah Khan
  • A doctor’s story of IV ketamine for depression

    Dee Bonney, MD
  • Most Popular

  • Past Week

    • Rebuilding the backbone of health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why you should get your Lp(a) tested

      Monzur Morshed, MD and Kaysan Morshed | Conditions
    • The paradox of primary care and value-based reform

      Troyen A. Brennan, MD, MPH | Policy
    • Why CPT coding ambiguity harms doctors

      Muhamad Aly Rifai, MD | Physician
    • Reimagining medical education for the 21st century [PODCAST]

      The Podcast by KevinMD | Podcast
    • A pediatrician’s reckoning with behavior therapy

      Ronald L. Lindsay, MD | Physician
  • Past 6 Months

    • Rebuilding the backbone of health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The dangerous racial bias in dermatology AI

      Alex Siauw | Tech
    • When language barriers become a medical emergency

      Monzur Morshed, MD and Kaysan Morshed | Physician
    • The dismantling of public health infrastructure

      Ronald L. Lindsay, MD | Physician
    • The high cost of PCSK9 inhibitors like Repatha

      Larry Kaskel, MD | Conditions
    • A neurosurgeon’s fight with the state medical board [PODCAST]

      The Podcast by KevinMD | Podcast
  • Recent Posts

    • The hidden epidemic of orthorexia nervosa

      Sally Daganzo, MD | Conditions
    • A question about maternal health and the rise in autism [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why early diagnosis of memory loss is crucial

      Scott Tzorfas, MD | Conditions
    • Rethinking stimulants for ADHD

      Carrie Friedman, NP | Conditions
    • Why young people need to care about bone health now

      Surgical Fitness Research Pod & Yoshihiro Katsuura, MD | Conditions
    • What burnout does to your executive function

      Seleipiri Akobo, MD, MPH, MBA | 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

    • Rebuilding the backbone of health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why you should get your Lp(a) tested

      Monzur Morshed, MD and Kaysan Morshed | Conditions
    • The paradox of primary care and value-based reform

      Troyen A. Brennan, MD, MPH | Policy
    • Why CPT coding ambiguity harms doctors

      Muhamad Aly Rifai, MD | Physician
    • Reimagining medical education for the 21st century [PODCAST]

      The Podcast by KevinMD | Podcast
    • A pediatrician’s reckoning with behavior therapy

      Ronald L. Lindsay, MD | Physician
  • Past 6 Months

    • Rebuilding the backbone of health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The dangerous racial bias in dermatology AI

      Alex Siauw | Tech
    • When language barriers become a medical emergency

      Monzur Morshed, MD and Kaysan Morshed | Physician
    • The dismantling of public health infrastructure

      Ronald L. Lindsay, MD | Physician
    • The high cost of PCSK9 inhibitors like Repatha

      Larry Kaskel, MD | Conditions
    • A neurosurgeon’s fight with the state medical board [PODCAST]

      The Podcast by KevinMD | Podcast
  • Recent Posts

    • The hidden epidemic of orthorexia nervosa

      Sally Daganzo, MD | Conditions
    • A question about maternal health and the rise in autism [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why early diagnosis of memory loss is crucial

      Scott Tzorfas, MD | Conditions
    • Rethinking stimulants for ADHD

      Carrie Friedman, NP | Conditions
    • Why young people need to care about bone health now

      Surgical Fitness Research Pod & Yoshihiro Katsuura, MD | Conditions
    • What burnout does to your executive function

      Seleipiri Akobo, MD, MPH, MBA | 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...