By Rob Stein
Washington Post Staff Writer
Tuesday, May 11, 2010; A01
Beginning Friday, shoppers in search of toothpaste, deodorant and laxatives at more than 6,000 drugstores across the nation will be able to pick up something new: a test to scan their genes for a propensity for Alzheimer's disease, breast cancer, diabetes and other ailments.
The test also claims to offer a window into the chances of becoming obese, developing psoriasis and going blind. For those thinking of starting a family, it could alert them to their risk of having a baby with cystic fibrosis, Tay-Sachs and other genetic disorders. The test also promises users insights into how caffeine, cholesterol-lowering drugs and blood thinners might affect them.
The over-the-counter test marks the first foray of personalized genomic medicine into the corner drugstore. The move is being welcomed by those who hope that deciphering the genetic code will launch a new era in biomedical science.
But it's being feared by those who worry it will open a Pandora's box of confusion, privacy violations, genetic discrimination and other issues.
The new test comes as federal regulators, bioethicists, geneticists, doctors and patients have been increasingly struggling with how to use, interpret, regulate and guard against abuse from the flood of genetic information, tests and technologies being developed because of the massive, government-sponsored Human Genome Project.
For years, companies have been hawking tests on the Internet that can analyze genes for a person's risk of some diseases, and genetic tests for paternity and ancestry have been widely available in stores.
But the plan being announced Tuesday by Pathway Genomics of San Diego to sell its Insight test at about 6,000 of Walgreens' 7,500 stores represents the boldest move yet to bring the power of modern molecular medicine to the mass market.
"It's the first widespread retail availability of genetic tests that are directed specifically at health issues," said Joan A. Scott, director of the Genetics and Public Policy Center at Johns Hopkins University.
The Food and Drug Administration questioned Monday whether the test will be sold legally because it does not have the agency's approval. Critics have said that results will be too vague to provide much useful guidance because so little is known about how to interpret genetic markers.
"It doesn't seem like a good use of resources or something people should be spending their money on yet," said Sharon F. Terry, who heads the Genetic Alliance, a Washington-based coalition of patient groups, researchers, private companies, government agencies and public policy organizations.
Others have said that the test is irresponsible and could give many buyers a dangerous false sense of security or, conversely, needlessly alarm them.
"It is reckless," said Hank Greely, director of Stanford University's Center for Law and the Biosciences. "Information is powerful, but misunderstood information can be powerfully bad."
The breast cancer test, for example, will screen for only a few of the genetic mutations associated with the malignancy, so it won't exclude the possibility of getting the disease because of other mutations or nongenetic reasons. Misunderstanding this, women whose results sound reassuring might forgo mammograms. On the other hand, a result suggesting an increased risk could prompt some to seek unnecessary follow-up tests and treatments.
The pregnancy planning test could prompt couples to decide not to get married or have children when their risk of having a baby with a disorder could be small. Or it could lead those who decide to proceed to seek genetic testing of the fetus, which could lead to more abortions.
"There's a cascade effect, potentially," said Colleen McBride, chief of the social and behavioral research branch at the National Human Genome Research Institute. "Some of these we may be able to anticipate, and some we may not."
In response to a query from The Washington Post, an FDA official said that the agency planned to investigate the test.
"We think this would be an illegally marketed device if they proceed," said Alberto Gutierrez, director of the FDA's office of in-vitro diagnostics. "They are making medical claims. We don't know whether the test works and whether patients are taking actions that could put them in jeopardy based on the test."
Company officials said the test does not require the agency's approval because the analysis will be done at the company's lab.
"Our understanding under the current regulation is, this test does not have to have FDA approval per se," said David Becker, Pathway's chief science officer. "And we do not claim that is does."
Gutierrez said the fact that the test involves sending kits to consumers for them to collect their own DNA samples raises questions about whether it requires FDA validation. He said the agency was evaluating similar tests.
Pathway officials said the test would help more people get access to potentially invaluable genetic information.
"We believe the market is ready for this," said Jim Woodman, vice president of corporate strategy. "We think there's more awareness of genetics these days."
With a $20 to $30 kit, customers will spit into a plastic vial to provide a DNA sample for analysis and ship the package to the company.
For $79, customers can get their DNA tested for how their bodies are likely to respond to 10 substances, including caffeine, cholesterol-lowering drugs called statins, the blood thinner warfarin and the breast cancer drug tamoxifen.
For $179, prospective parents can be tested to see whether they carry 23 genetic conditions, including the blood disorder beta thalassemia, diabetes and polycystic kidney disease. For the same price, they can be tested for their own risk for 23 conditions, including heart attack, high blood pressure, leukemia, lung cancer and multiple sclerosis.
For $249, they can get all of the tests.
The results, although not definitive, could encourage people to adopt more healthful lifestyles if they find they might be at increased risk for heart attack or certain forms of cancer, company officials said.
Officials said that the company has strict procedures to protect confidentiality and that it offers genetic counseling by phone, both before and after getting the test results, to make sure customers interpret them properly.
"I think there is some underestimation of the ability of the American public to understand this kind of information," Becker said. "They may not understand the exact specifics, but they do understand that these are propensities."