Tuesday, March 26, 2013

Genetic Testing and You

From James Beck, Ph.D., Director of Research Programs

The genetic testing company 23andMe recently announced that it had reached its goal of enrolling 10,000 people with Parkinson's into its genetic testing program. I personally think that is fabulous.

While genetic abnormalities that lead to Parkinson's disease are rare, finding these cases has been a boon to understanding PD for all. From the location and then discovery of the first PD gene by PDF’s first supported fellow, Roger Duvoisin, M.D., and his colleagues in 1996 to the more recent genetic discoveries of today, PDF steadfastly supports research into understanding how genetics and PD interact.

As we move forward, genetic testing is becoming more sophisticated and cheaper too as the cost drops faster than comparable advances made in computing technology. This is akin to buying the original IBM PC desktop one day and then next year being able to bring home the latest iPad. 

Low costs are making genetic testing more ubiquitous and that is causing some problems. For scientists, the problems are a bit academic—they are drowning in data. For the PD community, these problems hit closer to home. Genetics testing has the potential to bring forth knowledge that before was unknowable—the future. The question now is are we ready?

Deciding to voluntarily undergo genetic testing is a very personal decision; and, like many other endeavors, it is not always happy sailing. This is why, in response to the many questions and concerns PDF has received about genetic testing, PDF tasked our Medical Policy Committee to provide guidance for those interested in gene testing.  

Why does this matter? Let me tell you the story I heard about a person with PD who decided to buy a gene test kit  This person wanted to see if he had a genetic cause to his disease.  Not surprisingly, the answer was no; he did not have a mutation in the few PD genes that are examined on a consumer level. However, he got more than he bargained for and what he did find out was not good. In his DNA were two copies of the bad variant of the APOE gene. He now knew he was at a 10-fold increased risk of developing Alzheimer’s disease—information he did not want nor was he prepared to know.

Fortunately, most scientific studies involving gene testing do not reveal the results to those who participate. Providing a blood sample for PD research remains a very easy way for everyone to become participants in the research process, moving us all closer to finally tackling this disease. 

As it stands today, nearly 90 percent of the people with PD do not have a clearly attributable genetic cause to their disease. Since consumer testing only looks at a handful of the known PD genes, the odds of using a consumer test to unveil a personal PD-genetic link are rare. And for those who do, that knowledge will not affect their current medical care. The bottom line with genetic testing is to look before leaping. Take the time to understand what you are buying and deciding what that knowledge is worth to you.

Tuesday, March 12, 2013

Are You a Driver and a Partner? Notes on ASENT and Patient Collaboration

Two Saturdays ago, in a Washington DC hotel, PDF pulled off an interesting little coup in its long-term bid to bring people with Parkinson’s (and other neurological disorders) into the center of conversations about the process of clinical research and drug development.

 The occasion was the plenary session on the last day of the annual scientific conference of the American Society for Experimental Neurotherapeutics (ASENT), and the title of the session was: New Models for Collaboration: Patients as Drivers and Partners in Neurological Research. I have served on the Board of Directors of this very worthwhile organization for three years now, and they asked me to help put together an expert panel on this important topic.

Note that the title of the panel referred to patients and clinical research participants as Drivers, and Partners.  Not as Research Subjects, or Attentive Audience Members – important as these roles are in the right context – but as Drivers, and Partners.  In other words, as full players in the process, shouldering their way up against the other weighty and recognized players in clinical research such as the scientists, the government regulators, and the industry collaborators (e.g., drug companies and biotech firms).

Why is this so important?  The answer is that the needs, opinions and requirements of people who live with neurological disorders have an absolutely crucial role to play in the way clinical research in the United States is organized, conducted and evaluated.  What should we be measuring in a clinical trial (often described as “outcome measures”)?  How should participants in trials be treated – from the information that is shared with them to the reimbursement for necessary travel expenses that is provided to them?  And how can recruitment be accelerated, and retention secured, so as to assure that each trial is initiated and completed in the shortest possible time – for the benefit both of the participants’ well-being and the company’s pocketbook?  On these and related issues, patients/participants have important things to say, and important opinions and needs to be accommodated.

Members of the panel, who were assembled and directed by my colleague Veronica (Ronnie) Todaro, PDF’s Director of National Programs, were diverse, interesting and eminently well qualified for the task.  Two presentations in particular stood out for me: Dr. Petra Kaufman, M.D., M.Sc., Associate Director for Clinical Research at NIH/NINDS, who presented a brilliant and comprehensive overview of how patient organizations can be involved in recruitment and retention for clinical trials of new treatments in brain disorders; and Dr. Russell Katz, M.D., the long-time Director of the Division of Neurology Products at the US Food and Drug Administration, who listed the many ways in which patients can be involved in the process of drug approval.

There were three things that I found most exciting about the panel.

  1. First – this was most evident in the presentations of Drs. Kaufman and Katz - it gave an encouraging and convincing picture of the many ways that patients can get involved in the clinical research process.
  2. Second, the experience filled me with hope that the health care system is at last ready to consider how patients can be integrated into the clinical research process, to the benefit of all the major partners and to the lasting assurance of the people who live with Parkinson’s and other neurological disorders.  (One reflection of this was the healthy size of the audience of doctors and scientists that we attracted – on a Saturday morning, no less, at the very end of the meeting!).
  3. And third, it gave me a great sense of pride to see how my own organization, the Parkinson’s Disease Foundation, was playing such an important role in this process -- not only in behalf of Parkinson’s community, but of all groups that are committed to solve brain disorders.  (A sparkling reflection of this was the masterly performance as moderator of Linda Morgan, a talented MBA pharmacist who is a leader of PDF’s national People with Parkinson's Advisory Council and one of the first advocates active with our Parkinson's Advocates in Research program).

ASENT will soon be making available the slide-decks of our speakers to a wider audience.  We will keep you posted on this blog when they do.

What are your suggestions and opinions? Are there additional ways in which patients can be usefully involved in the clinical research process?  Do you feel as if you have the opportunity to be a driver and a partner?