He doesn't think that a 23andMe test is going to change that. However, from what he sees treating people with diabetes, “the killer problem is that knowledge does not change human behavior.” It’s just too hard to get off the couch and put down the fries. Meigs gives 23andMe points for educating the public and thinks the approach is well thought out. Selecting for lower risk in real life is not as easy. More or fewer of these turn dark blue (for diabetes) depending on factors the users can select with a drop-down menu, including age, weight, and frequency of eating fast food.
Once they have their scores, customers of 23andMe will be able to dig into the data with an interactive widget, which shows 100 human figures representing people with genes like theirs. In a statement, 23andMe says its test is “accurate” for African-American, Latinos, and Asians. If you are a black person doing this test, it’s not giving the right answer.”įor that reason, some companies offering polygenic tests have restricted them to people of European ancestry. “These risk scores do not perform in blacks, disease after disease. “I don’t believe the African-American results,” says James Meigs, an endocrinologist at Massachusetts General Hospital who specializes in diabetes prevention. The result is that the predictions perform less well for other populations. The company developed its model using DNA from white people of European ancestry, who make up most of its database. The genetic predictions are also especially spotty for African-Americans. Overall about 9.5% of American adults have diabetes That is because many Americans are overweight. A bathroom scale, for example, would be about three times as effective in identifying people with diabetes risk as 23andMe’s $199 genetic test. Some doctors said genetic prediction has questionable benefit in diabetes, a disease strongly shaped by age, diet, and weight. “Although it is way too early to share this kind of information, 23andMe thinks as long as they are honest about the shortcomings, who cares.” “It’s totally expected they are going this route,” says Cecile Janssens, an epidemiologist at Emory University. The FDA did not respond to questions about whether polygenic risk scores for common diseases would be exempt from regulation.
That is because it falls into an exemption for low-risk tests and phone apps that offer only “general wellness” suggestions, not real medical advice or diagnoses. According to 23andMe, the current diabetes report needs no regulation at all. Since then, however, the science of prediction has improved and regulations have loosened. With the DNA from enough people, it’s now become possible to create statistical models that can predict, from any single individual’s DNA, what traits that person is likely to have, including the chance of getting diabetes or breast cancer, as well as the likelihood of being particularly short or having a higher IQ than average. Underlying the report is some razzle-dazzle new science.
It then encourages him to check out a $19.99-a-month health coaching app, called Lark, sold by a 23andMe partner. Jamie learns his genes predict he’s got a very high chance of getting diabetes.
“You’re rolling it out to millions of people, but there is a lot we don’t know.”Īn example report, provided by 23andMe to the media last week, is for an imaginary Latino customer named Jamie. “I think it’s a huge experiment,” says Peter Kraft, an epidemiologist at Harvard University’s school of public health. Only those in the high-risk category will be provided exact odds (for instance, a 3-in-5 lifetime chance) of developing the disease.Įxperts questioned the introduction of such a report, saying that while polygenic scoring systems look promising, they are not highly accurate and don’t have proven health benefits. About 80% of customers will learn that their DNA puts them at average risk, and 20% will learn they have an increased likelihood of getting diabetes.
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