Commercialism Before Evidence

It is yet another striking example of commercial interests superseding patients' best interests: the lure of "personalized medicine."

What is "personalized medicine" as defined by the business community? Is it really up-close and personal attention to your health care needs?

Of course not.

No, to the business community, "personalized medicine" is the deceptive claim that genetic testing can decide what tests you'll need or drugs to take to prevent a heart attack - with business interests telling us so.

Unfortunately, with the exception of some very well-defined and rare genetic diseases - not one shred of data exists that obtaining these heart attack-predicting genetic tests can do what they claim: prospectively predict your risk of getting a heart attack.

That's because all of the data they have obtained is based on retrospective correlational analysis rather than prospective outcomes data.

And yet that's how the headlines are construed:

"Gene Variant Is Said to Be Linked To Heart Attack and Prevention" - Wall Street Journal 22 Jan 2008

"Gene Test Can Identify Heart Disease, Spur Cholesterol Drug Use" - Bloomberg.com 22 Jan 2008

So what are these headlines about?

Well it seems another genetics company feels that they've found a gene called KIF6 (short for "kinesin-like protein family member 6") that correlates (thats the important verb here) with people who got a heart attack and lo and behold they could correlate that patients in their group that took statins did better than those who didn't. Funny how another "correlation genetics company" deCode Genetics, failed to identify the same gene! Gosh, how come? I mean, shouldn't these genetics companies be finding the same genes important to the development of heart attacks?

Or could it be that the business community has found a means to create new blockbuster gene-screening companies as varied as the galaxy? I mean, think of the potential - there are so many genes out there that the number of companies devoted to screenings will soon be just like naming a star after yourself!

But there's another troubling issue here.

It is telling when these sensationalist headlines are published before those of us who paid for journal subscriptions are leaked to the press before they are published "on-line before print." (My statements are made here before reading the publications, since they were not available for my review at the time of this writing). Here was this fine-print disclaimer from the Journal of the American College of Cardiology available to me this AM:

FOR THE MEDIA: THESE ARTICLES ARE TO BE CONSIDERED UNDER EMBARGO UNTIL OTHERWISE NOTIFIED BY ACC MEDIA STAFF. EACH ARTICLE BELOW WILL APPEAR IN AN UPCOMING PRINT ISSUE OF JACC AND WILL BE HELD TO THE STANDARD JACC EMBARGO POLICY, WHICH IS ONE WEEK PRIOR TO THE PUBLICATION DATE. IF YOU HAVE QUESTIONS REGARDING A PARTICULAR ARTICLE, PLEASE CONTACT AMY MURPHY IN THE ACC MEDIA RELATIONS OFFICE AT 202-375-6476. THANK YOU.

You see, it's important to all medical journals that they release these studies to the media before the general public or paid physician subscribers. Why? Corporate interests, of course.

I can hear the back halls of the publishing medical journals' halls now: "Hey guys, this arrangement with media we have is great! We can get the media to interpret the studies before the doctors to assure we help out those nice companies that pay for advertising in our journals! And if we leak it early enough, heck, they'll have time to interview those researchers who's work was supported by the company while really boosting our journal's impact factor! And then our advertisers will have to pay us even more! Damn, I love this business!"

It is a sick game but early leaks to the press can make or break a company eager to generate a buzz for investors.

Just look at the Transcatheter Cardiovacular Therapeutic conference held annually in Washington DC. New start-ups can show-case their wares internationally, and if received well, sky-rocket in value. If they are poorly received, die.

International medical conferences are the same way. Journals now commonly have their on-line publications held for release until the precise second a presentation concludes and shows the slide that says "This publication can be found on-line at http://www.theworldsbestjournal.com" - just so the conference advertisers can draw attendees and can get the (very) short-term buzz before the media hacks into it.

So before going out and dropping $200 into one of these companies' unproven tests promoted by the media, why not do the obvious: lose weight, eat right, spend time with your kids and put the money in an interest-bearing health savings account for when you'll really need it.

Like when you get sick.

-Wes

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