Decoding FDA DTC Policy: Part 5 – Final Thoughts

by | Nov 16, 2018 | FDA User Experience Study, Genetic Testing

Finding this post on or after Friday, November 16, 2018? This is part of a 5-part series on DTC genetic testing, which you can now find in its entirety as one post here. Feel free to read on, however, if you prefer to read it in daily chunks.

Authors:

Scott D. Crawford, M.A., Shawn Fayer, M.Sc., M.S., C.G.C., Robert C. Green, MD, MPH

Note:  See Part 1 for further details about these authors.


Commentary: Final Thoughts on DTC Genetic Testing

Over the course of this week, we have covered a variety of related topics that arose from the recent FDA activity around direct-to-consumer (DTC) genetic testing.  Because this is so new, much is yet unknown, so the best we can do today is speculate. However, we thought we would wrap up today with a few parting ideas to consider.

  1. If you are in the DTC genetic test business, get familiar with these rulings.

    The big news for you this week is that there is now a pathway to pharmacogenetic reports.  While this presents an obvious pathway for others, do pay attention to the small differences that seem to be emerging.  They may well be significant.

  2. The FDA has come to maturity with a regulatory journey that started in 2010.

    With the Personal Genome Service Pharmacogenetic Reports (PGSPR) authorization, the FDA has now completed what it started in 2010 when it issued its Warning Letter to 23andMe after they went to market with hundreds of tests.  Eight years later, the FDA now has regulations in place to provide test manufacturers with a pathway to go to market with these tests.

  3. Consider using the FDAs guidance as a set of best practices in the development of genetic testing reports.

    Whatever your role is in genetic testing, there now exists a framework that can be considered as a “best practice” for reducing risk to consumer/patients with these tests.  Even if you do not currently fall under the FDA with what you are doing – it may not be a bad idea to use this framework to help guide what you do.

    Even physician ordered (non-DTC) test manufacturers may find it useful to conduct user comprehension studies – to ensure that once the report is in the hands of the patient and away from the medical professionals – the consumer is not mistaken when they pick the report up weeks or months later.
  4. If you are involved in providing software designed to interpret genetic data, start paying attention to this FDA space.

    This is a new and growing field — and the FDA has not raised it in previous DTC related rulings.  But now that they have, expect it to be an area of focus. If you do provide such a platform, you may want to consider significant legal warnings about the platform being an entertainment or education only environment — or consider proceeding through the DTC protocols to obtain FDA authorization.

  5. If you are in the healthcare profession, these letters may cause an inconvenience and potentially some confusion for you.

    Patients will now be receiving more personal genetic tests than ever before, and the pharmacogenetic test will have warnings that indicate that the test cannot be used for any medical purpose. Get familiar with them and consider how you will respond when they show up.  

By the way, for those who are really interested in this topic – which probably means you if you got to this final paragraph of the series – the FDA has a growing and well-stocked page that details all of their actions and positions pertaining to DTC genetic testing (see it here).  


The contents of this post are not intended as, nor should be considered legal, regulatory, health, or any other form of advice for any specific situations – they simply represent the opinions of these authors.

Currently, the FDA only regulates true direct-to-consumer (DTC) genetic tests, which have no health care provider involved either before or after testing. Consumer-initiated, physician-mediated genetic tests are considered lab developed tests (LDTs), which currently do not require FDA oversight. 

 

Our Study Design

Our study was designed to simulate the experience of an everyday person who is considering doing a health-related genetic test. For this reason, we only reviewed website contents presented to a consumer before ordering a test. By limiting our data collection to pre-test content, instead of digging around or contacting the companies to fill in missing data points, gaps in public-facing information that consumers use to make ‘informed’ decisions were revealed.  

Also, while a genetic counselor supervised the project, a research assistant (RA) conducted most of the website investigations. The RA was familiar enough with genetics and genetic testing to understand and identify the information presented on the websites, but has not had the clinical exposure that might create bias from knowing how specific tests work “behind-the-scenes”. 

 

To Sum Up

We set out to understand the landscape of health-related consumer genomics testing from the public perspective. By limiting our research (by design) to public-facing pre-test website content, we could not complete our data collection as set out in the protocol. However, this uncovered an important observation: consumer genomics websites are highly variable in content, readability and ease of use. 

This begs the question, if we can’t find basic test information on a consumer genomics website, how does a consumer have enough information to make an informed choice about testing? 

Stay tuned for Part 2 in this series, where we will dig into our study findings and reveal our most interesting observations.  

 

 

As experts in FDA user comprehension studies for consumer genomics companies seeking 510(k) clearance, we are interested in how everyday people access and understand health content that is meant for them. If you need help optimizing your consumer-directed health communications, we’ve got the in-house expertise and experience to meet your needs. Let’s chat

About the Author

Scott D. Crawford

Scott D. Crawford is the Founder and Chief Vision Officer at SoundRocket. He is also often found practicing being a husband, father, entrepreneur, forever-learner, survey methodologist, science writer & advocate, and podcast lover. While he doesn’t believe in reincarnation, he’s certain he was a Great Dane (of the canine type) in a previous life.