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MacUalraig
07-04-2017, 12:16 PM
England's chief medical officer is calling for WGS to become routine in cancer diagnosis/treatment, citing UKP680 as the cost to carry it out in the NHS (tumour and non-tumour site WGS and comparison).

http://www.bbc.co.uk/news/health-40479533

Afshar
07-05-2017, 08:44 AM
WGS - which costs about £700 - can reveal these errors by comparing tumour and normal DNA samples from the patient.
I don't think that is a lot of coverage

DMXX
07-05-2017, 12:39 PM
A noble and forward-thinking proposal, but...

1) The NHS is struggling to meet pre-existing targets in spite of increased funding as it is. It's actually doing worse than before. To finance this and other such futuristic initiatives in the current socialised medical framework, further cuts will have to be made to pre-existing services (mental health and social care are struggling), or the budget will have to be increased through other means (tax increase).

2) The conditions crippling the service (hypertension, ischaemic heart disease, obesity, hyperlipidaemia, diabetes) are all complex diseases (mixed inherited and environmental risk factors). Diabetes alone costs 14 billion pounds per year. From a financial perspective, WGS for cancer patients is a waste of money. Particularly as some of these conditions (obesity, diabetes) increase the overall risk of cancer.

3) Given the numbers involved, more people with an abysmal quality of life will have the combination of the above conditions than patients with a recognised malignant neoplasm. From a maximum-beneficence-to-treat perspective, whatever hypothetical budget is drawn up for oncological WGS will be better spent on addressing those chronic diseases.

4) If introduced today, you will see an increase in the numbers of patients taking up unhealthy (but inherently enjoyable) habits due to the perception that their recovery from cancer is guaranteed. I'm embedded within this system and see it on a weekly basis (patients awaiting limb amputations with gangrenous appendages going out of the wards for regular smokes!). The welfare mentality is present already in an unacceptably large number. Proposals like this will worsen it, in the current environment.

If readers take issue with the finance-driven decision making process shown above, this is precisely how senior figures running the NHS have to decide what treatments are made available at present.

Focusing on cancer genomics when certain predisposing factors are on the rise? Washing the horse when the cart's wheels are disintegrating.

AJL
07-05-2017, 04:21 PM
To expand on DMXX's second point, most health authorities don't do nearly enough for the awareness/prevention of the chronic diseases that would lower costs massively later on.

Metabolic syndrome is already and will only continue to be a major issue through the western world, for example, as we rely increasingly on desk jobs, vehicle commuting, and high caloric diets.

MacUalraig
07-06-2017, 07:49 PM
I don't think that is a lot of coverage

not sure - this doc mentions 75x for cancer and 30x for germline

https://ukgtn.nhs.uk/fileadmin/uploads/ukgtn/Documents/Resources/Library/Presentations/UKGTN_4th_Biennial/Genomics%20England%20Caulfield%20UKGTN.pdf

Afshar
07-06-2017, 08:47 PM
not sure - this doc mentions 75x for cancer and 30x for germline

https://ukgtn.nhs.uk/fileadmin/uploads/ukgtn/Documents/Resources/Library/Presentations/UKGTN_4th_Biennial/Genomics%20England%20Caulfield%20UKGTN.pdf

Ah I see. Illumina is a partner.

TŠltos
07-06-2017, 11:01 PM
To expand on DMXX's second point, most health authorities don't do nearly enough for the awareness/prevention of the chronic diseases that would lower costs massively later on.

Metabolic syndrome is already and will only continue to be a major issue through the western world, for example, as we rely increasingly on desk jobs, vehicle commuting, and high caloric diets.

Sadly most do not even realize they have metabolic syndrome (at least in my neck of the woods).
P.S. I am so happy to leave my desk job!

Saetro
07-09-2017, 04:23 AM
Agree with the previous commentators.

This is not joined-up thinking.
Philippines has many health challenges, but attacked one of these head on.
Am not sure of current status, but with everybody from top parliamentarians down promoting healthy lifestyle action to combat conditions contributing to Type 2 Diabetes, the news a few years ago (after about 15-20 years of the program) was quite positive.

That is the sort of action that is needed.

Any technical fix of this nature needs to be backed by a money-back guarantee that certain performance targets will be met.
Oh, wait. That is something that governments often are not good at. So that's a "no" then.

As usual, excellent solutions to improve societal health and well being are known, but:
1) They are not exciting enough (or politicians lack the fortitude or nous to back them).
2) Who can make money from them? No-one. OK. They are out, then.
3) Some people will actually lose money.
And so on.

The fact that we have a massively successful recent anti-smoking history only seems to undermine any other similar health program for the future.

Nachobou
07-31-2017, 06:41 PM
It will as soon as the cost becomes closer to 100$

Judith
08-10-2017, 08:36 PM
As usual, excellent solutions to improve societal health and well being are known, but:
1) They are not exciting enough (or politicians lack the fortitude or nous to back them).
2) Who can make money from them? No-one. OK. They are out, then.
3) Some people will actually lose money.
And so on.

The fact that we have a massively successful recent anti-smoking history only seems to undermine any other similar health program for the future.

Several people have recently asked my husband what his secret was on how to loose weight, which he has sucessfully done. His answer was eat less by portion control and exercise more. Their response has been a disappointed, even bored, flat "Oh". The trouble is we all know the answer but do not want to accept that it applies to me as well.
So like Saetro comments the answer was not exiting enough, no instant answers, no money to be made, just need to do it.

What I notice from old family photos such as my parents wedding, just how VERY slim everyone was in the late 1950s (rationing was only just finishing in the UK), and now we are all much fatter.

Saetro
08-11-2017, 08:05 AM
What I notice from old family photos such as my parents wedding, just how VERY slim everyone was in the late 1950s (rationing was only just finishing in the UK), and now we are all much fatter.

Looking back over many old photos, the people who are carrying a bit more weight are often those who have retired, but have not adjusted their eating habits enough to compensate. Their children who are still working are usually much thinner.
I have never seen images of people on average as large over history as in the past few years.