This NBC story uses the narrative of a woman who struggled to find an effective medication to treat her severe depression to talk about the potential benefits of using genetic testing to identify which drugs may be most effective in treating depression, with the fewest side effects, for specific patients.
Unfortunately, it lacks discussion of any rigorous research supporting the clinical utility of such genetic testing, the potential harms patients might experience as a result of genetic testing, or how the specific genetic test discussed in the story differs from others currently in use.
As the story notes, the Centers for Disease Control report that about one of every 20 Americans 12 and older cope with depression and some of them (not “many more,” as the story claims) experience severe side effects from the drugs used to treat depression.
Finding the correct drug and the correct dosage for a specific patient can require a sometimes extended process of trial-and-error, with depression sufferers sometimes enduring multiple trials of different drugs before they find one that is effective and has an acceptably low level of negative side effects. Thus, a test or tests that would effectively enable doctors to determine ahead of time which patients are likely to respond well or poorly to specific types of drugs would offer substantial benefits.
The story notes that the genetic test touted costs $179 and says it is often covered by insurance.
The article is nominally about the Genefolio test that’s offered by the Avera Institute for Human Genetics. But the only specific numbers provided in the story pertain to a different test called GeneSight. That’s misleading, since it suggests that the two tests are interchangeable. These are two different products looking at different genetic profiles to make recommendations. It’s like using data from the AT&T cell network to show how great T-Mobile’s coverage is.
The story also doesn’t do enough to explain what the numbers provided mean. Does the 70% reduction mean that patient symptoms went from a 10 out of 10 to a 3 out of 10? Or from 2 out of 10 to 0.6 out of 10? Both are possible and the story should have clarified the difference between relative and absolute numbers.
There is no discussion of any potential harms of genetic testing, and the article also does not discuss the fact that some genetic tests may focus only on a single genetic marker, making them far less useful. Tests that are inaccurate may falsely suggest that patients will or will not respond to a specific drug, delaying effective treatment. Moreover, genetic test results can have significant negative social, emotional and financial consequences for patients, including the possibility of employment and insurance discrimination based on the test results.
The article offers no information whatsoever about the one study that was cited, other than to say it was “conducted by the Mayo Clinic,” so it’s impossible to tell whether that study was rigorous and therefore trustworthy or not. In any case, one study of one genetic test–no matter how rigorous–cannot produce evidence supporting the use of a range of similar tests.
The single patient profiled who took 23 different combinations is not representative of typical person with depression. Also, the story said that “many” people with depression experience severe side effects, but offers no data to back up such a claim.
The only three sources in the story are two employees of different branches of the Avera medical organization, which developed the specific genetic test (Genefolio) discussed in the article, and a depression patient whose doctors used that test to help identify why the patient was responding so poorly to previously described drugs.
The article mentions that other organizations are “exploring the role of pharmacogenomics,” and it mentions one other specific test, GeneSight Psychotropic, which it describes as “similar to many used in hospitals.” This is enough to merit a marginal Satisfactory score.
It does not say how similar the Genesight Psychotropic test is to the Genefolio test developed by the Avera Institute for Human Genetics, as we note above in the quantified benefits criterion. Thus, the article provides no data whatsoever about the clinical utility of Genefolio or of any other genetic tests other than GeneSight Psychotropic; instead, it focuses on the anecdotal story of how the Genefolio test helped a patient’s doctor decide to prescribe for her a lower dose of an older antidepressant and on the positive results that produced.
It says Avera is “offering” the test and that there are others used in hospitals. It’s pretty clear that they are available, at least to some people. This is sufficient for a Satisfactory rating, though the story would have been stronger if it had explained this more thoroughly.
The story includes no information about how the Genefolio test differs, if at all, from any other genetic tests currently available.
The story does not appear to be based entirely on a news release; there does appear to be enough original reporting to rate the story Satisfactory on this criterion.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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