Rachel Lehmann-Haupt writes about Counsyl

I’d like this to sit on the Internet for the next fifty years —just in case Rachel feels like it is ever personally expedient for her to pretend this article was never published should fashions and politics in reproductive medicine ever shift like they tend to do…

Title: Want a Perfect Baby? Counsyl Says: Just Spit

Translation: Eugenics is bad, but Counsyl isn’t Credible

Breakdown: Spitting is considered crude in all cultures, but especially European cultures. The idea of a “Perfect Baby” is taboo because it is an allusion to eugenics. However, all parents want “perfect babies.” Thus, Rachel allusion is that Counsyl promises something both impossible and taboo —but as immature upstarts who need gentle correction and merit little actual attention.

1: Counsyl is a me-too scam

Every expecting parent wants to have a perfect kid. Counsyl, a new Redwood City, Calif.- based genetics company, hopes to profit off this fantasy by selling a cheap(er) genetic test that claims to screen out 100 dangerous genetic anomalies.

Breakdown: [everybody wants something perfect but that's impossible.] Counsyl: “new” “hopes” “profit” “fantasy” “cheap(er)” (even less credible than other already low-value tests) “claims” [something vague, dubious, but scary].

Photo: Little Child Spitting Water

flickr for “Spit”

Caption:

“Water play in my bathroom. -Homage to rebekka’s “talk” series

Translation: First word Rachel associated with “Counsyl” is “spit.” What a buccal DNA sample has anything to do with “water play in my bathroom” is: nothing. Rachel doesn’t care because she doesn’t take Counsyl seriously. She didn’t even bother to post a picture of the logo, company, or product. Flickr “spit,” copy-paste… next!

2: Counsyl is Heterodox

Even with the creepy Gattaca undertones, Counsyl’s technology could potentially save lives and health care dollars as a kind of preventative medicine. But the accuracy of the new technology is still in question, and it’s unclear if the masses really want to know these answers to such questions — even if insurance is willing to pay. Accuracy and large-scale adoption is the formula Counsyl needs to make its business model work.

Breakdown:

Even with the creepy Gattaca undertones,

First: “creepy” is intelligentsia for “heterodox.” Also: a movie reference. Pop culture. Not serious.

Counsyl’s technology could potentially save lives and health care dollars as a kind of preventative medicine.

[dubious... unrecognized technology] “could” “potentially” [dubious... impossible promise] [dubious... includes profit motive] “kind of” [dubious] [dubious].

Also: there is no such thing as “saving health care dollars.” YOU DON’T PAY FOR HEALTH CARE! There is only “insurers not paying claims with money they’ve already collected from your employer.” Any “savings” is money already paid by you to pay the margin calls for your big broke investment bank medical insurer (Aside: Medicare of Connecticut flat refused to pay providers for all claims this month. Your “cost saving initiatives” in action.)

But the accuracy of the new technology is still in question

This is a baldfaced lie so astounding that it breaks my concentration just to read it. The Counsyl “technology” is extremely accurate —especially by medical standards —and you can rerun tests if necessary. It’s the immediate clinical application of this extremely accurate data which is not well understood —which is not especially problematic considering the low cost and immutability of your genotype. I don’t expect Rachel to understand the distinction —in fact, she would probably be insulted if you challenged her casual dismissal of the entire core substance of the product —because “she’s more about the people-side” and “I don’t ‘do’ math.” I’m not an idiot, but the shear sophistication behind Counsyl humbles me, and I’m a complete asshole. Calling Counsyl “inaccurate” is like calling Idaho “the Moon.”

and it’s unclear if the masses really want to know these answers to such questions — even if insurance is willing to pay.

1) the masses don’t care about rs230492384, but they do care such questions including “how I not have retard baby?” 2) the opinion of the masses is irrelevant because first, even if 99% of people didn’t want this test, that shouldn’t restrict the remaining 1%, and second, the masses don’t have any coherent or useful medical opinion, and third, the masses don’t pay for health care — insurers do— but Rachel doesn’t consider that relevant because she already has decided that genetic testing is heterodox in the same way that I have already decided that homeopathy is heterodox —your insurer’s reimbursement policy be damned.

Accuracy and large-scale adoption is the formula Counsyl needs to make its business model work.

No. All Counsyl needs to do is

1. Not be 23andMe
2. Not engage in expensive lawsuits
3. Have more money than they spend —which largely amounts to: 1) sales higher than debt service 2) not hiring anybody who ever expects to participate normal salaryman society, or really, to ever work at any other company ever again, and probably will (should) kill themselves if the company catastrophically fails (not official medical recommendation) 3) unix, which is apparently cheap in dollars but impossibly expensive in humans

Large-scale adoption is the EXACTLY WRONG formula, because a dozen 30-somethings cannot compete dollar for dollar with big providers which have almost unlimited credit and a monopoly on distribution. All a Labcorp would have to do would be add checkbox to their superbill —as so goaded by an army of blueshirt blabbermouths screaming about “widespread adoption” in the press, and… whoops! Counsyl just missed one payment on its “world domination sales numbers” to service all that pushed debt to buy “widespread adoption.” Knock knock! Hello! It’s me! Your friendly pharma VC bagman! I would like to sit on your board now. Would you like an Xbox to play while you sit out this forced acquisition?

The market point for a generic genetic test is about the cost of a vaccine. You may as well try to compete in the medical gauze market —at least cotton has a longer shelf life. Go for the impossible-to-replicate speciality test in public, while building a local vertical for complete medical testing in private. What’s the big difference between a genetic test and all other medical labs? Another machine? It’s not the technology that makes a medical test: it’s the distribution! Your own single-internist medical center can be bought for about $200,000 if you already know a doctor who’d work there. Why would you want to know about that terrible business? Because you know which test the doctor orders in real practice? The one on the superbill. You know who puts which labs on which superbills? I do. (actually, Steve uses Google Docs to make his own forms) The risk is: which is more expensive, the liability of launching a medical practice (probably illegal, as in “American in China” illegal), or the liability of missing the market for your product (certain death)?

to be continued…