TEDMED, 23andMe and Kaiser Permanente's RPGEH

Excitement about the power of genomics was palpable at TEDMED this year as some attendees lined up to spit in DNA vials and send it off to 23andME. Unfortunately, many may be disappointed to find out how little our genomes can tell us without research that a large population-based research program, such as we are helping to build at Kaiser Permanente, can provide. Ann Wojcicki, CEO and founder of 23andMe, stated from TEDMED stage that Kaiser Permanente plans to genotype the DNA of 100K members but does not plan to provide that information to the individuals who donated their DNA, implying that valuable information was being withheld.

We asked Cathy Schaefer, executive director of the Kaiser Permanente Research Program on Genes, Environment and Health (RPGEH), to respond.

The RPGEH is designed to conduct research on populations to improve health and medical care. The information collected, including the genotyping of 100,000 individuals for our NIH-funded grant, will enable researchers to conduct population-based research that may help them understand the genetic and environmental basis of disease, treatment response, and health.

We inform all participants about the purpose of collecting genetic and other information, and they volunteer to participate — at no cost to them — to facilitate this research, knowing their individual results will not be returned to them and that all data about them will be "de-identified." We also inform participants that if we discover something in their data or samples that may be important to their health, we will contact them to learn if they want to have the information. 

Why doesn't the RPGEH restructure so that it can return results to individuals? Because genetic information obtained through today's genome-wide studies has not been designed to be useful to individuals; it is designed for use in research. In most cases, it isn’t known whether the variants tested for are actually implicated in a disease process, or are markers for variants that play a role in disease, and results from these tests are rarely actionable.

Ann Wojcicki from 23andMe misspoke at last week’s TEDMED gathering when she said that Kaiser Permanente does not return genetic results. Kaiser Permanente Health Plan members have access to genetic testing as part of their Health Plan membership and through their physicians. Kaiser Permanente physicians order genetic testing and return genetic results to thousands of patients, for numerous conditions, when information that testing will provide could help to inform the patient’s health care, disease prevention, or future childbearing. For example, members with some cancers or HIV may have genetic testing to determine the most effective treatment. Couples considering pregnancy may also be tested to determine family histories for certain diseases that may be passed on to their children.  

Individuals who have questions about their genetic risks for various health conditions should talk to their physicians, who can provide useful information about risks and options for testing.

Comments

[Anne Wojcicki]

The Kaiser Permanente Research Program on Genes, Environment and Health is an exceptional study that has the potential to transform medicine. As someone who proudly spent over 25 years as a patient with Kaiser, I would be excited to see my family's medical records used for such a worthy cause. I was disappointed, however, to learn that Kaiser will not be giving participating individuals the option to get access to the genetic data Kaiser generates in the study. Cathy Schaefer commented that the research data will not be returned "because genetic information obtained through today's genome-wide studies has not been designed to be useful to individuals; it is designed for use in research."

I strongly disagree that one's genome is currently only useful in research and not for individual use. There are a number of highly useful genetic results that may be generated. Individuals may learn that they are carriers for Mendelian disorders such as cystic fibrosis or sickle cell anemia. The genetic data might reveal that an individual is at higher risk for certain diseases such as age-related macular degeneration, blood clots, Parkinson's disease or breast cancer. Last, the genetic data may tell an individual whether or not they are likely to respond to certain drugs, like Plavix and Coumadin. Is it right for Kaiser to tell me what information I can or cannot have about my own body and my own genes?

I co-founded 23andMe, a personal genetics company, to enable individuals to access their genetic information—what we believe to be a fundamental right. We also believe this right should extend to research participants. Though the RPGEH plans to inform individuals if researchers discover something that "may be important to their health", this is not the same as an individual having their complete data in hand, and it is unlikely that researchers would continue to update 100,000 participants as genetic research progresses.

Even if genetic research is at an early stage today, having one’s genetic data will be of increasing utility as research progresses. Individuals have a vested interest in understanding what their genetic data mean in the context of new studies. They may examine their data through 23andMe, other companies, or open-source services such as SNPedia. The choices about what to do with that information are then with the individual, where they should be.

My husband, Sergey, learned through the 23andMe test that he is at substantially higher risk for Parkinson's disease. That information has had a significant impact on our lives. We eat better and we exercise more. We are motivated to follow, participate in, and fund Parkinson's research. This information is important for understanding our general health and for helping us plan our lives. Some in the medical world do not believe we should have this information. In fact, when the Parkinson's variant was discovered, we were dissuaded from being tested because "there is nothing to do." But there are things one can do, and that choice should be ours.

A growing body of evidence suggests that individuals do not suffer adverse effects from knowledge of their genetic data, and that public opinion leans strongly toward offering the return of results to research participants. For example, in a study of focus groups, the Genetics & Public Policy Center found that “focus group participants voiced a strong desire to be able to access individual research results.” And far from frightening people, returning genetic results could provide an incentive for future recruitment into these important studies. Whole-genome information would also be useful to the growing number of people interested in genealogy.

We also believe that researchers cannot know—and therefore should not dictate—what is or isn’t useful to individuals. Even for "non-actionable" variants with severe consequences such as the ApoE e4 association with Alzheimer’s disease, research from the REVEAL studies showed individuals may find personal utility in having their data. For example, they may choose to prepare their family, buy long-term care insurance, or participate in research—these are choices individuals and families have a right to make with knowledge about their own health.

Kaiser is breaking new ground with the RPGEH study but we believe they are missing a key component. Kaiser should afford the participants the respect they deserve by allowing them to decide for themselves whether they want to see their own genome.