Keith Grimaldi of Eurogene writes in response to a comment thread at Daniel MacArthur’s Genetic Future:

@AndrewYates
“Is there a law in the UK about providing medical advice without a medical license?”

I don’t understand your (and Sherpas) issues with what is medicine and what is not. Is it actually against the law to give medical advice if you are not a medical doctor? Is it against the law to give it DTC widely and freely as many government sites do (NHS, CDC, NIH, etc)? What about the pharmacist who advises me on medicines? What about buying ranitidine DTC in the supermarket? Where does medicine begin and end? What are the terms that define what has to be limited to a medical doctor and transmitted by the doctor directly to the patient? It seems that a lot of what you and Steve talk about as “doing medicine” apply to a whole load of stuff that is routinely done by non-medics, with no particular problems.

What makes 23andme with their (non-invasive) test “doing medicine” compared to say the NCI Breast Cancer Risk Assessment Tool? Especially as we are often reminded that classic risk assessments are more accurate than genetic tests. If that is the case then why is it not a problem that there are so many sites offering risk assessments with these more accurate algorithms, why are they OK DTC but genetic testing is not? What is the fundamental difference?

As far as I can see none of the DTC companies are making diagnoses or actually advising treatment – that I would agree is generally the realm of the medical doctor, but not always, unless it’s against the law for my pharmacist to advise me to take a ‘flu medication).

The lines are blurry and the regulation is poor but it’s not clear why DTC is being singled out for your collective attacks. You may not like the marketing methods (I would say that you certainly don’t), you might not think them useful as tests, on these I can understand your reasons. I don’t understand your reasons for thinking that it’s an illegal activity and that only medical doctors should be allowed to do it.

“why DTC is being singled out for your collective attacks”

Because genomics belongs as common medical practice, and the way to achieve that is to shed the groupies and get serious about how to actually apply genomic medicine in actual practice.

“Is it actually against the law to give medical advice if you are not a medical doctor?”

Yes.

Think: law. Can you give legal advice if you are not a juris doctor? That depends on how you represent yourself and what kind of contracts you solicit for the advice you “give.”

“Is it against the law to give it DTC widely and freely as many government sites do (NHS, CDC, NIH, etc)?”

• Medical science itself is not medical advice. An analogy is that a law citation is not a court order.
• It’s not unlawful for an agency of law to publish medical science —even if edited for “layperson’s consumption.”
• Merely “publishing public medical science on a website” does not constitute a patient relationship between the reader and the publisher.

“What about the pharmacist who advises me on medicines?”

What a pharm tech can tell you over the counter is more aggressively regulated than anything in a medical office. Further, (and I’m going to get in trouble for this someday but) Pharmaceutical salespeople are specifically selected for their complicit ignorance so that they don’t accidentally disclose protected information about the drug. If you want to amuse yourself, pull out wikipedia in front of a drug rep and start telling them about their own drugs in front of a medical doctor.

“What makes 23andme with their (non-invasive) test “doing medicine” compared to say the NCI Breast Cancer Risk Assessment Tool?”

“Invasive” is a matter of relationship, not necessarily physical contact. “Information” itself cannot form a relationship with an individual to produce medical advice in the same way that the source code of software itself cannot to produce results. Note: “non-invasive” actually means “less invasive” with the implication being “less invasive than traditional surgery.”

Also: It’s not unlawful for an agency of law to publish medical science —even if edited for “layperson’s consumption.”

Commentary:

I am receptive to learn how 23andMe and Navigenics actually intended genetics for real application in medicine when they explicitly forbid that practice in their contract.

Yah, I got the memo: Everybody just chill, this is for the greater good.

Yah, well: I didn’t see any greater good. I just saw new people telling me what I should be “free” to think. I just saw celebrities gorging on cake while everyone else scrambled for bread. And I saw the same pharma psyops and the same condescending licensing games —just new people, and this time, they had the gall to tell me that “this is freedom.”

Now we all can see that the dream is dying, and we all can see you just wanted to buy horses and play tin soldiers. Hurry up and die so next generation can step on your corpse without tripping. Nice website.