And just to be clear, by profitable, I do mean money. Jim Golden describes the problems with using genomics to directly combat cancer (i.e., not basic research; boldface mine):
Every year there are 1.4 – 1.7 million new diagnoses of cancer in the US. Many of those cancer patients are familiar with the latest advances in healthcare technology reported in the media, including insights derived from medical data and personalized medicine. Here’s the challenge facing the treating physician: It costs a lot more than $1000 to sequence a genome. Sure, costs continue to fall but the price today to sequence [minimally] two genomes – from tumor and normal tissue, to analyze the data and have an oncologist interpret that data in terms of clinical recommendation – is between $25K and $100K. That cost is not covered by insurance. And most importantly, you have to know someone. If we set the total current sequencing capacity in the US against the number of new cancers each year we can only sequence a few percent of those patients. To get your cancer genome sequenced you have to have a friend at a genome center who can do the work, perform the analysis and work with a clinical oncologist to optimize therapy. This isn’t going to change any time soon.
On the other hand, microbial genomes are cheap, fast, and you can provide epidemiological relevant information to clinical laboratories, hospital networks, and public health departments. I’m not arguing that we will or should sequence everything–and today that’s not feasible–but in two or three years, I don’t see any technical hurdles to routine microbiological surveillance in hospitals. This is something already being done, just with mid-20th century technology.
Then again, I’m an expert, so there’s a good chance I’m wrong….
I’m not sure that the genomic sequence of your tumor is going to provide an oncologist with any useful information that couldn’t have been determined by a far less expensive but more focused experiment.
I couldn’t agree more. Also, microbial sequencing could be useful outside of the clinic, with the added (business) benefit of less stingent regulation
Let me first say I 100% agree with you; microbial sequencing will be far more immediately useful on several levels, the most important of which you aptly pointed out.
However, I have a question about the limited usefulness of tumor sequencing. Are you saying that Clarient’s buy of Seq Wright will not yield them fruit any time soon? Am I misunderstanding what this buy enables Clarient to do?
Curious on your thoughts, I am not feeling like I know enough about the details here to disagree with you on this level.
I think it could be useful, but there’s a long way to go, especially in terms of a viable cost model. It’s one thing to demonstrate in an academic clinical setting that something could work, versus making it a production ‘turnkey’ system. There is, as Golden notes, a long way to go (though I hope I’m wrong about this).
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