Tip to Dr. Steven Murphy for bringing this article to my attention. He notably accompanied his email with much more profanity than I will use in this post.)

Note this excerpt from the deCODEyou blog October 20th: Customer Story: The Path To Prevention: (emphasis mine)

But because Jason’s mother had a history of strokes, Doneen wanted to dig deeper. She used deCODEme’s genetic test and searched Jason’s genome for a gene that medical studies have related to A-fibrillation. Jason was positive for the A-fib gene, so despite the fact that his heart-monitor test was negative Doneen put him on a heart monitor, but this time for a month in order to be more accurate. Sure enough, the month-long test showed that Jason was going into a-fib. Doneen immediately started treating Jason with a different course of medicine.

‘The test changed his course of treatment,’ she says enthusiastically.

Doneen cautions that just because a patient has an abnormal gene doesn’t mean that patient should be treated with medicine. In fact, she says there is no evidence to treat patients based on an abnormal gene. However, knowing that Jason had this abnormal gene, and had a family history of stroke, Doneen decided to take action, and put Jason on a heart monitor, which fundamentally altered his clinical course.

Why not just put everyone on a heart monitor for a month, instead of a week, and therefore make sure patients don’t have a false negative test?

‘Putting everyone on a monitor for a month is not feasible. But putting someone who has an abnormal gene on a monitor, that’s feasible.’

In other words, while putting everyone on a monitor for a month would catch more heart attacks, it’s not a “feasible” allocation of resources. So, the deCODEme test, which as stated has no evidence, is being used like a random number generator to justify picking some patients for additional care and not others. Why? They tested positive for the A-fib gene. Magic.

So, since there is no evidence, only “decision to take action,” you could replace the deCODEme test with a homeopathic test that produces the same ratio of positive results for the same clinical effect. I understand that people sometimes feel they need a special reason to pursue healthcare from which they could always hypothetically benefit, but there is no rational necessity to produce this impetuous prior to treatment other than the psychological comfort of rationalization.

I would like to see a study where one person gets the genetic test, and one person gets a random jibberish report recommending the same thing, and see if there is a clinical difference. Random jibberish is much cheaper to produce. Why not save your money and get a random jibberish test to help you “decide to take action?” I will put it in a leather case and have a doctor sign sign it on real parchment and read it to you in a very authoritative tone and use big words. You will be 238.8% as decided to take action as if I posted the result on your genomic Web 2.0 deCODEme profile. (there is no evidence to back this claim)

Non-casual risk testing at low-mid penetrance like deCODEme has great potential someday, but only to more optimally ration scare health resources for better net efficiacy that otherwise should be provided to everyone. However, there is no shortage of “eat healthier, reduce stress, exercise, and see a doctor if you have a problem” which is the best medical recommendation that can be produced by today’s DTC testing.

On an individual scope, one must ration personal wealth to pay for healthcare. It’s feasible that low-mid penetrance can aid in making more rational decisions. However, it’s much more likely that personal decisions to pursue which healthcare strategies are in no way rational or scientific and that “optimization” is a delusion. You can’t perform risk benefit assessment arithmetic on “your feelings.” 20% + you’re scared isn’t a number with a dollar sign.

On a social scope, low-mid penetrance risk assement can help better allocate a fixed amount of resources per person to purchase the most personally effective healthcare. However, this is assuming that the healthcare industry isn’t corrupt and would use the tests to justify whatever medically-arbitrary decision they’ve already made to benefit themselves. I don’t think that assumption is justified until the medical benefits of these tests are so obvious as to prevent such bureaucratic abuse excused as an “ongoing discussion.”

But, by all means, buy a deCODEme test. It’s the American way. But do it because you want it, not because of some magic you wish was medicine because you’re afraid of illness and death.