The Wall Street Journal's article today about the existence of "alcoholism genes" and what the future might bring ("imagine you go to your doctor and say 'I'm drinking I need help.' and they do a blood test and, if you qualify [based on genetic markers], they give you medicine the next day.") is a part of a larger trend that will radically change the world's health care system. With a nod to my friends at Hubspot, I'll refer to this future phenomenon as "inbound marketing comes to health care".
First, some background. The cost of mapping your genes is falling rapidly. Today, you can get your genes mapped and analyzed for $10k. In 3-5 years, that price will fall to $1k. Harvard Medical School Professor George Church, one of the great pioneers in this field, observed recently to one of my partners that, "people will spend $10k per year on insurance but over a 70+ year lifespan are not yet comfortable spending $10k for their genome to be sequenced." As the process gets cheaper and the data and analytics gets better, that will change. I'd be shocked if you, dear reader, did not have an analytical report in your files somewhere in 5 years about your personal genome and insight into its health implications.
And that gets me to the concept of inbound marketing. Inbound Marketing (as captured nicely in the book by Dharmesh Shah and Brian Halligan), is the notion that the new era of marketing is about pull, not push. Rather than producers pushing their products onto consumers, consumers have the tools and means to show up at the producer's door "inbound" and identify their needs and interests.
It's become very clear how this technique applies to products – consumers research their needs by searching this huge information database in the cloud called "Google" and find what products and services might serve their needs and proactively contact and, eventually, purchase those products. This technique is why many companies invest so much money in search engine optimization (SEO) and search engine marketing (SEM) – a business that has grown to tens of billions of dollars and fueled Google's meteoric rise as one of the most successful companies and global brands in business history. Businesses are redirecting their tens of billions of "push" marketing dollars into other mechanisms that set themselves up to be found by intelligent, informed consumers.
Now, let's go back to health care. Imagine that in 5-10 years that tens or even hundreds of millions of people have their genomic data stored in the cloud. Imagine that this data can be indexed, analyzed, parsed, sliced and diced. And imagine that it is very, very secure.
What might happen with that kind of large-scale genomic data available in that format? Inbound marketing. Rather than pharmaceutical companies pushing drugs through their large sales force, they can access this database and alert consumers as to what drugs might fit what genomic profile. Rather than hunt for clinical trial candidates in hospitals throughout the world, drug companies can email the relevant 1000 patients that precisely fit the indication they would like to test.
Let's make this very personal. My father-in-law recently died of ALS. His older brother also died of ALS a number of years ago. Thus, there is a reasonable chance that my wife's family has some genetic predisposition to ALS. In today's health care environment, where genomic information is expensive and sitting in silos, there is nothing much we can do about it but wait and worry. But someday in the future, perhaps as soon as 10 years from now, we will have the opportunity to opt-in to a service that will alert us via email or text when ALS drugs that might address this particular issue enter clinical trials. Or perhaps even approved by the FDA. We might all register our genomic data into this service so that we can receive alerts and information about any range of insights or treatments that might be relevant to our personal make-up. This is "personalized medicine" in the extreme.
One of our portfolio companies, Predictive BioSciences, is pioneering a urine biomarker technique – pee in a cup, and Predictive will tell you if you have cancer. In the future, we might all be swabbing our cheeks, peeing in cups, and pricking our fingers to tell us much, much more. And when that information is available to our trillion-dollar health care infrastructure, imagine the possibilities.
SEEING BOTH SIDES 
The concept of “personalized medicine” sounds interesting if it’s commercially viable.
LikeLike
I like this great post. I think it’s only a matter of time before we’re able to tap this data set en masse and start seeing the personalized medicine that you’re talking about.It will be a big help for us. This was supposed to happen much sooner. Thanks share this good think at this site.
LikeLike
You’re right Marybelle, it is trust indeed that people need to have. Medicare security is very important for confidentiality precautions and to protect a person’s reputation in a community. Before we reach the retirement stage we should know how reliable our healthcare company is, so we would not be worrying at the age of 70, instead enjoy the life in PA.
LikeLike
I do think that trust, security and privacy need to be worked out carefully coz’ a lot of people now worry about the confidentiality of their Medicare records or medical records. I am happy to know that your software can supplement high sense of security and I think all insurance company should plan to have one like this.
LikeLike
I’m looking forward that it will be happen sooner. It will be a big help for us. I’m hoping also for more discoveries will be implemented because it is also for our own good. Government should help also those persons who engage with science because they are help out also on the progress of a country.
LikeLike
Unfortunately you do not understand DNA. Sequencing ones DNA is almost meaningless. It tells you nothing of what is “turned on and off”, how much each gene is express, how its processed, decorated with carbohydrates, and then presented and placed in the right place. It tell you nothing about how it interacts with 100’s or 1,000’s of other gene products. Our genome is littered with ancient code and viral code. Its as worthless as reading all our legal documents and thinking that now you can understand how people behave and interact. Ps its illegal to give someone a cold in Wyoming – pretty sure that does not reflect reality. Biology is WAY more complex than most people understand. Those of us in the industry know we are walking around blind in a cave system. Do not make the assumption that human created systems like tech or math can be examples of how non-man made systems like biology work.
LikeLike
Girls spent more time than boys on social networking sites, listening to music and reading.
LikeLike
TypePad HTML Email
Thanks for raising this issue, Michael. The
insurance implications and the impact on pre-existing conditions is definitely
a concern that is worth inserting into the debate.
LikeLike
TypePad HTML Email
Very interesting, Saul. Thanks for
sharing.
LikeLike
It seems likely that genome testing is not the extreme frontier of personalized medicine. Someday we might be able to combine knowledge about the genome together with other personal data to go beyond “what might be relevant” to a level of even greater certainty.
And I suppose that there may be other data with even greater predictive value than the genome. For example, we might be able to take a sample of cancerous tissue and measure its response to particular chemotherapies before treating the patient. (I am aware of a startup working on exactly that.)
LikeLike
I wish I could share your enthusiasm over this issue but so long as health care is a for-profit enterprise there are going to be far too many people willing to game the system for their benefit and not yours. When an insurer gets a baby with a suspicious gene, that child is already burdened with a pre-existing condition. Maybe that means no coverage or it means coverage at a much higher premium.
They may insist on a particular treatment or drug. That treatment or drug may turn out to be more dangerous than the condition, but the demand to meet quarterlies will trump patient safety. This has already played out countless time in a reactive form after diagnosis. There’s no reason to think the proactive form would be any safer.
You have seen what ALS can do and I understand how that can drive your hope for a better life for others. I really think ready access to a genome is a tremendous profit opportunity. Not health. Profit. And like a lot of drugs and surgeries that have a neutral or negative impact on mortality, the profit will come at the cost of a lot of carnage.
LikeLike
TypePad HTML Email
Our current security software can handle it, after all, think of all the financial transactions happening over the public pipes. That said, trust, security and privacy will all need to be worked out very carefully.
LikeLike
Great post Jeff. What’s your take on people not wanting to pee, prick, or swab because they don’t want their genetic info “out there” vis-a-vis insurers, employers, etc.? Can our current system digest and protect that info, or does it need to change first?
LikeLike
TypePad HTML Email
Great question, Mike. I'm not super well-informed here, but am under the impression that insurance payments for these test are a long, long way off…if ever.
LikeLike
Great post, Jeff. Thanks.
In the example you cited, a patient can choose to pay $10,000, or soon, $1,000. How soon before insurers cover these tests?
My wife does genetic counseling in oncology in addition to traditional treating of cancer patients, and insurers aren’t yet sure what to make of the proactive stuff yet.
LikeLike
TypePad HTML Email
Thanks for the comments, David, and the
added pointers.
LikeLike
I couldn’t agree with you more. What’s fascinating to me is the tremendous amount of similarity between the advent of personalization on the web and that in health care – I think it’s definitely a leading indicator of what’s to come.
You talk about the data being ‘locked up.’ It’s mostly because the diagnostics just aren’t good enough yet. But if you look to the web – there’s been a tremendous amount of innovation around ‘diagnostic’ tools that measure your digital personality (i.e. music you like, books you read, food you eat, where you party, and who your friends are) all incredibly valuable datasets for advertisers looking to make a personalized pitch.
With George Church’s help and guys like Jonathan Rothberg at Ion Torrent leading the way, I think it’s only a matter of time before we’re able to tap this data set en masse and start seeing the personalized medicine that you’re talking about.
http://supplydemanded.com/post/3148821768/hackinggenomics
LikeLike
TypePad HTML Email
We shall see, Lucaino. With advances in
compute power, storage, and the cloud infrastructure, I am optimistic.
LikeLike
This was supposed to happen much sooner. People have been predicting personalized medicine since the human genome project mapped the genome. Unfortunately, it may be one of those trends that are much farther away into the future than we expect…
LikeLike