The US govt pats 23andMe's back, the truth about Alzheimer's blood tests, and smoking with seniors
|Aug 3||Public post|
Aug. 3, 2019
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I'm a reporter covering health and science with insatiable curiosity. I love everything I learn, not all of which gets its own story. Each week, I'll bring you some of my favorite facts that I picked up on the job or while out living life.
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23andMe just got a ruling that makes their test even more appealing for US customers.
Found while reporting: The IRS decided that 23andMe tests aren’t just for fun—they’re medical care.
Last week when the IRS ruled that 23andMe’s medical and health package was considered medical care. It’s not totally clear what criteria it used for that definition. 23andMe is the only company cleared by the US Food and Drug Administration to give customers true direct-to-consumer information about their genetic health risks. However, that didn’t seem to come into play when the IRS made its decision, James Hazel, a biologist and lawyer at Vanderbilt University Medical Center, told me.
Regardless, it means that people with Flexible Spending Accounts or Health Savings Accounts as part of their health insurance may use some of these accounts to pay for up to nearly $118 of the $199 package.
These accounts allow people to put some of their paycheck, untaxed, into a savings account that can be used for medical and related purchases. Things like orthotic inserts for shoes, sunscreen, and prescription glasses all may be covered by the account.
But often, these accounts don’t roll over year-over-year—they have to be spent annually. So, if you were to reach the end of the year and realized you had some money left over in your FSA or HSA, there’s some pressure to spend it however you can.
As I’ve written before, companies like 23andMe play on the public’s curiosity about their DNA and impatience for actual, personalized medicine. I’d assume that if you have extra cash at the end of the year, more customers may be inclined to use it for 23andMe—especially because the full package promises to scratch that ancestry curiosity itch, too.
That said, what 23andMe can tell you about your genetic code is extremely limited—it’s like skimming the CliffNotes of Moby Dick, as my colleague Daniel Wolfe pointed out in our Gene Reading series. Medical facilities conduct separate genetic tests to confirm a 23andMe result before taking any action on behalf of your health care.
And on top of that, 23andMe is the second largest direct-to-consumer company on the market, behind AncestryDNA. A huge part of its business model is partnering with other groups who are conducting genetic research. 23andMe gives users the choice of whether they want their data to be included in this research, and a spokesperson from the company told me in March that the vast majority of customers consent to having their DNA used for scientific purposes.
I’m all about research participation, but I’m not sure I’d want to do it through 23andMe. It still feels like you’d be lacking total control over where your genetic information winds up. Even though you can always rescind your consent, you’ve still put it out there. And it’s your DNA—literally a unique identifier.
There’s one major downside to participating in early-Alzheimer’s testing research.
Found while reporting: There are a lot of promising blood tests for Alzheimer’s—here’s how to keep track.
On Thursday of this week, researchers from Washington University at St. Louis (WUSTL) published a second installment of trials looking at a blood test that accurately reflected whether they had the beginning stages of amyloid buildups in the brain, according to a PET scan (the standard Alzheimer’s diagnostics tool today). It was a solid follow up, but some outlets were calling it predictive. I wrote a thread on Twitter about why this isn’t the case (yet!).
I saw a trend in this story: for the past couple of years, news stories claiming that scientists have developed a blood test for Alzheimer’s have popped onto my radar. All of these headlines are misleading: no test is truly predictive yet and no test is ready for clinical use yet. They are only conducted on hundreds of (homogenous) individuals, and, because Alzheimer’s (and all dementias) form over decades, it will take at least that long to develop—not including the time it takes to recruit thousands of participants, plus time to get actual approval from regulatory agencies like the US Food and Drug Administration.
While these tests—and therefore research participation—is desperately needed, there’s also a tricky downside to them: at the moment, because there are no treatments for Alzheimer’s, there’s nothing researchers can really do for participants if a test indicates they may go on to develop the disease.
There’s been a lot of really promising work about the brain benefits of living a healthy lifestyle, but it’s not a guarantee of protection from the disease at all. That said, it can’t hurt—there are no negative side effects like there can be for drugs.
When Suzanne Schindler, a neuroscientists at WUSTL and co-author of the recent paper, brought that up for me, I thought about it for a long time. Personally, the harm from potentially learning I had evidence of early Alzheimer’s would be something that would deter me from participating in this kind of research. But if I’m hesitant and a fan of science, I have to imagine this is even a harder issue to wrestle with for other potential participants. I’m not sure how the field will get over this hurdle.
The proportion of seniors smoking weed has doubled in the past four years.
Found while reporting: Binge drinking among seniors is on the rise.
When I saw this study about seniors binge drinking (classified as having four or five drinks in one sitting) coming out, I thought it was a perfect example of why it’s critical that doctors ask everyone about all of their habits. And it also made me think—what about weed among those 65 and older?
It doesn’t seem like that’s something researchers have been asking for a long time, either! In the above study, 2% of adults over 65 reported using marijuana between 2015 and 2017. But when I tried to look back, there wasn’t consistently reported data. (Going through the actual results from the US National Survey on Drug Use and Health was a nightmare—I tried, I promise.)
Others have reported that same figure to be around 3%—and, it seems, largely for pain relief. And it looks like it’s doubled since 2013, when only 1.4% of seniors reported that they did.
Bonus fact: Big tobacco is deeply incestuous.
Found while reporting: The world’s largest tobacco company’s anti-smoking campaign relies on smokers.
Two of the largest tobacco companies, Philip Morris International and Altria, used to be the same company, but split up in 2008—reportedly so that Philip Morris International could evade US litigation. Now, Altria owns Philip Morris US, and licenses some of PMI’s products to sell in the US. Altria also owns a bunch of e-cigarette companies (including most of Juul) and it licenses them out to PMI to sell internationally (not including Juul).
Super bonus fact: PMI has a heated tobacco product (think, kind of like a vape lite) called IQOS. So many people call it I Quit Ordinary Smoking—even a scientific paper! But, as a rather annoyed spokesperson from PMI told me, IQOS doesn’t stand for anything. It’d be silly, he said, for an international product to have a name that only make sense in English.
Super ultra-mega bonus fact: Apparently the same is true for the SAT (h/t to Ben Daniels, this newsletter’s pro-bono copy editor.)
Stuff I learned from others:
Climate change is the latest of a growing number of threats to olive production in Palestine. Elon Musk’s brain-decoding implants require a 48-hour operation to be installed. Fitness trackers don’t work as well on people with dark skin. Banana peels used to make New Yorkers slip like cartoon characters in the early 20th century. Vets think that maybe we shouldn’t be neutering all dogs after all? Unicorns exist—kind of! Ocean spray in below-freezing air temperatures can overturn ships sailing through the Arctic. A squishy, dust-sized, asexual creature you’ve probably accidentally eaten may be the aging model researchers need. And finally, sharks pee through their skin.
Two quick programming notes:
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I am going on vacation! I am leaving next week and will be gone for the majority of August. Scrap Facts will be back in September with tales from the other side of the world. I’ll miss you! But not that much, because, you know, vacation and adventure.
That’s all for now. Stay curious, friend! <3
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Top image by E. Y. Smith, headshot drawing by Richard Howard.