Genetic testing: Could there be unintended consequences? [PODCAST]

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“Both clinical and direct-to-consumer genetic testing have become significantly less costly and more common, providing people with access to a wealth of information about everything from their ethnicity and family lineage to their risk for certain diseases and how they will respond to medications such as blood thinners and antidepressants.

But before you decide to take the plunge into your gene pool, there are a number of issues you should carefully consider. Genetic testing can have unintended consequences, both personal and medical, so it’s wise to weigh the value of any information you may gain against the potential issues that the testing may raise.”

Miles J. Varn is chief executive officer, PinnacleCare, and can be reached on LinkedIn.

He shares his story and discusses his KevinMD article, “Genetic testing: Could there be unintended consequences?”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Miles Varn. He is a physician and chief executive officer of PinnacleCare. He wrote the KevinMD article “Genetic testing: Could there be unintended consequences?” Miles, welcome to the show.

Miles J. Varn: Thank you, Kevin. Thanks for having me.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Miles J. Varn: Yeah, absolutely. So after attending medical school at the University of Virginia, I moved up to the Northern Virginia area and did residency in family practice and then emergency medicine, and practiced in a very busy trauma center for about 14 years, part of the Inova system. So I got to see, every day, people of various backgrounds with various problems, ranging from not serious to life-threatening. And in that experience, there were quick decisions. It was, could you imagine, an ER, pretty much a windowless environment. We were kind of trapped for an entire shift. But it was thrilling. I loved going to work. And just when I thought that I’d seen everything, something new would come along, and that’s what made it interesting and different.

At the same time, when I came out of medical school and residency, I never thought that practicing medicine would be my last career. At the time, I was living on an island in the Chesapeake Bay, separated by a causeway, and I sort of became the family doctor for all kinds of problems. And the opportunity came along to work as chief medical officer for PinnacleCare. When I met our chairman initially, what I realized was this sort of family medicine, no paperwork, just help people and maybe a bottle of wine shows up, was what PinnacleCare did, but on a larger basis across the country and so forth. So I said yes, very quickly moved into that position, and I’ve worked for PinnacleCare for the last 15 years.

In this role, rather than being in a windowless room, I’m out there traveling to health systems and meeting with physicians throughout the country. So I now get to see, at my own pace and on my own schedule, health care from a holistic, macroscopic perspective. And having seen the microscopic, I now realize the differences in the value of looking around at times for care and expertise, in order to make sure that you or someone you love or work with is really getting the very best the system has. And I truly believe, in my journey around the country, that we have the greatest system in the world and that we should be proud of it. It’s not perfect, but I’ve been thrilled to meet the people that I’ve met, to know them, and to send our patients to them.

Kevin Pho: Now, I’ve had several physician CEOs on my show, and I always like to ask them: Being a physician, does it help or harm you when you put on your CEO hat?

Miles J. Varn: Yeah, that’s a good question. I think it helps. There’s a lot more credibility to having that degree, for better or worse. But honestly, a lot of my experiences in college and afterwards were leadership positions completely outside of what medicine is, president of organizations and volunteer things and so forth. So I think some of those experiences are what have helped me become a much better CEO, more so than some of the medical experiences.

Kevin Pho: Sure. So let’s get into your KevinMD article, “Genetic testing: Could there be unintended consequences?” Now, for those who haven’t read your article, can you walk my audience through it and share the story of why you decided to write it?

Miles J. Varn: Yeah, well, I think probably everyone realizes genetic testing is a big topic. People seem to want more of it. They want to know their heritage, but they also want to know their risks and other things. So some of the basis of this came from, as chief medical officer, people wanting to give me things. So I had a broad-based panel of genomic testing on myself, not because I needed it. I didn’t really want it. It was just, “Why don’t you try this so you understand the experience?” And in another opportunity, I’ve been full genome tested. So I kind of know what you learn from that.

So really, the article is: You have to look at the pros and cons. If you’re a person who embraces science and you really want data, even if that data may not be meaningful in any way, and I can assure you the vast majority of whole genome is not clinically or otherwise relevant, but if you like that, then maybe that’s a choice you should make. If you’re going to be afraid of finding out that you’re not perfect, and certainly I’m not perfect, and anyone who goes through full genome is going to find that, then maybe it’s better to consider whether or not you want that.

There are consequences that you may find that lead to anxiety, and that anxiety may be worse for you than treating the risk that you discover and doing that. But also, you may discover things about your genome that are going to impact your children or your siblings, and you have to be careful to consider that, having that knowledge of something that might impact them down the road or might explain something that they have today. You want to know that? Are you comfortable with that? Do you consider that a good thing or a bad thing?

So I think people plunge into this and ask us, our clients, all the time, “Where can I go for this? How can I get this?” But I think you really need to have a thoughtful discussion with your physician and with yourself and with your family, because there are things you’ll learn that may not be what you want to know.

Kevin Pho: So from a physician standpoint, tell me a little bit more about these tests, because a lot of doctors have patients who come to their exam rooms asking them about these home genetic tests. What are some of the issues that physicians need to know when counseling patients about these consumer tests?

Miles J. Varn: Yeah, I mean, first, they’re not perfect. I think we’ve seen this in the COVID testing era. There are errors that are just related to human frailty or fault. So samples get mixed up. You could get information that’s not accurate. So I think that’s a part of it.

I think understanding what to do with the data: It’s easy to write the order, but how do you explain the results to the patients? So you need to be comfortable as a physician understanding what it means, how to interpret it, and how to help them understand it. And then again, going back to knowing your patient, are they someone who tends to be anxious? You might learn something that’s upsetting. So I think a lot of physicians just tend to check the box, or people can get a telemedicine visit and get approved to get whatever done. I’m not sure that’s the right approach. I think it’s more thoughtful than that.

Kevin Pho: Patients can sometimes get these tests without a physician order, right? There are a lot of consumer tests. What’s your opinion on those?

Miles J. Varn: I think that the whole ancestry, where it came from, there’s not a lot of harm in that. I mean, there could be. You could learn something that you didn’t want to know, but less harm. But then when you get into predisposition to conditions like Alzheimer’s or MS, something that today and now we might not have the perfect solution for, or may not have an effective solution for at all, I think those are more hazardous for people. They don’t understand that having a genetic predisposition doesn’t mean you’re going to get the disease. It just means that you have more of a risk. So there are plenty of people who have that disposition who never get the disease.

So I think it would be better if there were more involvement of the health care industry, but, well, I’m sure that it’s going the other way. We’re becoming more consumer-focused, consumer-driven.

Kevin Pho: Now, for these genetic tests that consumers can just order online, for instance, is there any support when they get the results? Do they simply just get a paper with the results? Is there any follow-up genetic counseling? Do they simply tell patients just to go see their primary care doctor? What’s the follow-up, normally?

Miles J. Varn: Yeah, I think most that are doing clinically related offer a genetic counseling telephone call if there’s an abnormality. I’m not sure what the quality of that is. In some of the relationships we’ve worked with, I’ve actually spoken to the genetic counselor so that I can explain to the patient the significance. They want to have that conversation. So those are, I think, better approaches. Obviously, if there’s a physician and a genetic counselor and they can talk, the physician, having that relationship, can explain it to the patient. That’s better. So I think you owe it to yourself to shop around a bit and look at the ones that may be a little more expensive but provide more of a service.

Kevin Pho: We’re talking to Miles Varn. He is a family physician and CEO of PinnacleCare. He wrote the KevinMD article “Genetic testing: Could there be unintended consequences?” Miles, can you share a roadmap for genetic testing over the next, say, one, two, or three years? What do we have to look forward to?

Miles J. Varn: Yeah, I mean, the exciting thing is the cost of testing is going down, the time frame is coming down. We started maybe 10 years ago. Craig Venter first outlined the genome. It was millions of dollars and months, if not more. Now it’s pretty much down to less than $300 and a week. And I think what we’re going to see is, availability for broad-based testing is going to be cheaper and faster. And I think that has important consequences in the realm of therapeutics, so identifying genomic changes that affect which therapy you’re on. That’s going to be incredibly exciting, the availability of that to more of the population, and insurance reimbursement.

And I think we’re going to see more clinically applicable interpretation of the information. When you get a full genome report, it’s about this thick if you put it on paper, and the amount of information that’s relevant: this many paragraphs. I think we’re going to find that more and more is going to be understood in that information, and maybe there are nutritional, lifestyle, or other ways that we can change the direction of care. I think that’s the ultimate goal. If you can use that information to change someone’s behavior and make them a better patient and person over time, and keep them from getting something they might not have gotten otherwise, that’s a positive thing for all of us.

Kevin Pho: My final question: Do you have a take-home message that you want to share with the KevinMD audience?

Miles J. Varn: Yeah, I guess my message would be, in my travels and so forth, our medicine is still very much an art as much as a science, and I think it’s important for everyone to hear that, particularly physicians. It’s not just “throw all the information into Watson and spit out the answer.” I see so much more to thoughtful consideration, people laying hands on a patient, pattern recognition, and looking at a face and seeing what they’re feeling. So my message is, let’s not let the science overwhelm that personalized part of medicine that we all know is critical. And that’s why we, I think, for the most part, became physicians.

Kevin Pho: Fantastic. Miles, thank you so much for sharing your time and insight. Thanks again for being on the show.

Miles J. Varn: Thank you, Kevin. Good to be here.

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