Genetic tests could actually increase the price of medical care
It’s exactly 62 years since James Watson and Francis Crick described the structure of DNA and 12 years since the first sequence of the genome and as I write this blog I’m sitting in the ‘supposed’ pub where it was discovered in Cambridge.
The first time scientists sequenced a person’s entire genome, it took more than a decade and cost hundreds of millions of dollars. Currently, such sequencing takes less than twenty-four hours and costs less than $5,000 (see figure below).
To put that into perspective, Myriad Genetics charges $3,000 to test for mutations in just two genes associated with breast cancer. The days of affordable genomic sequencing are rapidly approaching. But will such testing bankrupt us?
In most consumer markets, lower prices are a boon to consumer budgets. In the 1950s, for example, Americans spent over 30% of their income on food. But with food production becoming more efficient, that percent has been cut in half.
The decreasing cost of sequencing genomes is becoming so inexpensive that even Joe Public can now get their genome sequenced via 23andme.
The Healthcare Paradigm – Effective and Safer Tests Cost us More?
But that straightforward economic truth does not necessarily hold when it meets the weird logic of the American healthcare system. Consider what happened to healthcare costs when old-fashioned gallbladder surgery was overtaken by laparoscopy cholecystectomy. In the old-fashioned approach, the surgeon would make a sizeable incision in the patient’s upper belly and remove the gallbladder, leaving the patient with impressive scars and several days in the hospital before he or she recovered enough to go home. With the newer laparoscopic approach, surgeons make a few tiny incisions, sneak a laparoscope through one of the openings to remove the gallbladder, leaving patients with a few butterfly Band-Aids and a quick return home. By substantially shortening the hospital stay, this laparoscopic approach was much cheaper than its predecessor. So we must have saved money on gallbladder surgery, right?
Because the new procedure was safer, many patients who were previously too risky to operate on were now fair surgical game, as well as those with mild gallbladder disease who had previously been treated with a “wait and watch” approach. As a result of the safety of this procedure, the rate of gallbladder surgery skyrocketed more than 20% after physicians adopted laparoscopy, more than wiping out the cost savings of the new approach.
So am I advocating that we should abandon personalized medicine? Absolutely not, and in the words of Watson and Crick (at the Eagle Pub perhaps?)
Almost all aspects of life are engineered at the molecular level, and without understanding molecules we can only have a very sketchy understanding of life itself.