Sanford Health is making a major bet on genetic testing in primary patient care, despite uncertainties about the reliability of some tests and whether they actually help people improve their health.
Through a $125 million gift from benefactor T. Denny Sanford, announced Tuesday, the sprawling South Dakota-based medical network will be one of the first in the nation to place genetic counselors in internal medicine clinics and to certify primary care doctors in genetic testing.
The investment comes at a time when consumer interest in tests that can detect genetic mutations or predict elevated risks for certain diseases is surging. Nationally, spending on genetic and molecular diagnostic testing grew to $5.5 billion in 2011, a 13 percent increase from 2010, and is expected to grow at a similar pace for the next five years, according to a recent report from the Minnetonka-based UnitedHealth Center for Health Reform & Modernization. The U and its clinical affiliate, Fairview Health Services, are in the process of expanding genetic testing.
Proven forms of genetic testing — such as determining how patients tolerate and metabolize certain drugs — could show up soon as this spring at Sanford internal-medicine clinics in Bemidji and Fargo, along with clinical research that could bring other tests into the mainstream. Ultimately, Sanford executives say, genetic testing can become a path to "precision medicine" by which patients receive the care they need and avoid care that is unnecessary or could cause complications.
"In the long run, I really am a believer that all patients will benefit from a broad survey of genetic markers that will give their physicians a picture of the diseases that they are at risk for," said Dr. Gene Hoyme, president of Sanford Research, based in Sioux Falls, S.D.
Tests for a set of genetic mutations known as BRCA, which predict a heightened risk of breast cancer, are now well known, and other tests can similarly predict elevated risks for certain cancers, some types of cardiovascular disease and other conditions. And the use of genetic testing to evaluate drug tolerance — a specialty known as pharmacogenetics — can warn patients of risks with many everyday medications, such as statins to lower cholesterol and blood thinners.
Limited value right now?
At the same time, controversy over genetic testing has arisen over expensive, mail-order tests that analyze segments of patients' DNA to provide broad assessments of their disease risks. A New York Times reporter recently sent away blood or saliva samples to three testing agencies and received conflicting results and analysis about her risks for arthritis, psoriasis and diabetes.
Tests of a patient's entire genome could unlock more reliable information, but they are expensive, and the ability of doctors to interpret them is limited, according to Kristin Niendorf, a genetic counselor and program manager for cancer risk management at the University of Minnesota Medical Center.
"We don't really in all cases understand the results completely or know how to use them clinically," Niendorf said. "That's the problem." There is limited value, for example, in providing an obese person with genetic information about his or her risk of obesity, she said.
In Minnesota, patients cannot consent to genetic tests without first consulting experts or genetic counselors, who are trained to communicate the pros and cons of such tests.
Test results can lead patients and their doctors to anguishing medical choices, as well as psychological consequences that can come with learning about family or personal disease risks.
Confusion and inconsistency over ordering genetic tests have recently drawn the concern of officials at the Institute for Clinical Systems Improvement (ICSI) in Bloomington, which advises health care providers and insurers in Minnesota on best medical practices.
The organization hopes to create a "decision support" tool to guide doctors and patients on whether to pursue genetic tests based on clinical research and expert opinion — just like an existing tool that has reduced the number of unnecessary imaging scans in Minnesota.
"We must learn how to approach genomics so we get better health, better costs and better care at the same time," said Dr. Sanne Magnan, ICSI's president and chief executive officer.
The gift announced Tuesday is the latest in a philanthropic sprint by T. Denny Sanford, who made a fortune in high-interest consumer credit, that has transformed Sioux Falls-based Sanford Health into the nation's largest rural nonprofit chain of hospitals and clinics. Sanford made an unsuccessful bid last year to join forces with Twin Cities-based Fairview Health Services and the University of Minnesota hospital.
Pharmacogenetics will be one of the first target areas for genetic testing at the Sanford internal medicine clinics in Bemidji, Fargo, Bismarck, N.D., and Sioux Falls, S.D., said Dr. Dan Blue, president of Sanford Clinic.
"This technology and the information from your DNA can help really guide better decisions on what we prescribe and what to expect from these medications," Blue said.
In addition to improving clinical care, Sanford's new program, named Sanford Imagenetics, aims to improve the understanding and reliability of genetic tests.
The health care system also is working with Augustana College and the University of South Dakota to expand training programs for doctors, nurses, researchers in genomic medicine.