What is the real issue?

So I'm in a meeting of Laboratory Quality and Organisation Committee of the Cancer Genetics club the other day, and we're going over what some other committee has estimated as the price to put on the different steps involved in doing a genetic test. It's very hard to tag each item independently with a number of centimes (including reagents, plasticware, amortisation of the equipment, and the salaries of the staff), and even then you have to remember it's an average price for labs all across the country.

Add up all the steps from when a sample lands in your in-box to sending the result, and, on average, BRCA testing comes out to about twice what Myriad charges to do it in the States*. Looking at my own lab, we calculated that our price was about on par with Myriad or slightly less. The thing is, how expensive the test is depends entirely on the throughput of samples you have and the level of automation you use.

This tedious exercise is in preparation for such testing to enter into the domain of medical analyses that are reimbursed by social security here. Up to now, the work is classed as 'research' and the national cancer institute pays the labs according to their annual output. Codification will transfer financing to a different arm of government.

The upshot is that you'll get paid so much for the test, and if you can do it for less good for you; if it takes you more, you'll go bankrupt. That's not much different than what happens now, but right now as researchers we have access to funding that industry does not. The change will put us into competition with them. The danger is that if the test is very well paid relative to its cost, private industry will take over. And that, in the thinking of the group, is Evil.

All agreed that the proposed payment was too much, and looking around the room, you could see who was from one of the small labs with few patients and little automation - they saw themselves being wiped out of the game right away, being swallowed not so much by industry as by the bigger lab in the next town. A consolidation into major centers that everyone has been trying to avoid.

To keep this diagnostic work in the academic/hospital labs, it was agreed to rely on our collective and collaborative expertise. We're not just doing some labwork, we've got the biological and medical background to know what to do with the different variants we find. Our value is in the analysis.

Fine. I agree completely. But if our value is in the analysis, why should the benchwork not be consolidated into a smaller number of labs, or even be contracted for? I think the answer is that once a test goes into routine production, it is in fact more economical for private enterprise to deal with it, as long as there is no loss in the quality of the work.

What we're really talking about is the fact that our local, semi-academic labs depend on that reliable income to make up the deficit in funding of real research. With grants harder and harder to get, it's the diagnostic arm that allows the research arm to live. And if research were to wither on the vine, we're all in trouble for the future of health care.

Screening for mutations in BRCA1 and BRCA2 is not, after all, the end of the story of hereditary breast cancer risk. It's 17 % of the story, and the rest is research.

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* before crying foul, let me state that Myriad's patent on mutation detection for the BRCA genes has been limited in France to concern only the detection of specific mutations known to be present in a given family. De novo analyses are not covered.

Doesn't even require a microscope

I was just sitting around, doing some writing I'd rather not be doing, and it came over me to go get a cup of coffee.
Whoa, too fast there. I had one of those before-lunch moments of stars in the eyes. Or more like little squiggles that dart like fireflies and disappear.
I love that phenomenon. What you're seeing is actually the red cells moving through the capillaires of the retina. Really. Pay attention, and you can tell they repeat the same tracks. And that their appearance is in sync with your pulse. That's what that is: watching your own blood go around.

Cat of the Month. Number Three: Errnestine

Ernie!
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Errnestine (yes, with two r’s, let’s lean into that Errrrrrrr) was one of the best. On the football team of cats she gets her number retired.
The replacements to Mitten & Brand X were Errnestine and Rhubarb. American shorthair tabbies. Ernie was about 1/3 black spots on a white body. Stubby and solid, she stood up to all that three kids and a dog could dish out. She’d wrestle. She’d chase strings. She’d let you dress her up in dolls’ clothes.

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Ernie was also my first writing project: the fifth grade Errnestine Files, which recounted all the notable doings of the favorite cat. Like when she was a kitten and my dad had this huge handlebar moustache, and she would get up onto his chest while he was sleeping and play with it like it was a mouse or something. How’s that for a wakeup.

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Or the time she was hiding out between the fences that separated our yard from the neighbor’s and I was walking the dog in the Little League baseball fields behind our house. I had the dog off the leash (as usual if I was taking my time), and he flushed a jackrabbit out of its hiding place. Bassets are made to hunt rabbits! Such fun! The rabbit headed right for the gap between the fences, a dog-safe space about five inches wide. Right into the cat. So it was that Errnestine caught a rabbit nearly as large as herself. She ate it, too. Well, about half. I had to bury the rest.

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And the time that the neighbor’s malamute caught her. Blackie and I were out back on a walk, and the other dog had escaped from its yard. The two dogs didn’t really get along so I quickly got the leash back on mine to head home. Blackie didn’t usually go after Knute, but Knute somehow surprised Errnestine, and Blackie was off like a shot. The cat escaped in the ensuing fight, and the huge ruff of loose skin around my basset’s neck served its purpose keeping him from injury. We didn’t find the cat for three days. She holed up somewhere secret to nurse her wounds, and by the time we got her to the vet there wasn’t much more to do. Knute had bitten her through the thigh, which afterwards always bothered her in bad weather.

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Ernie takes the record for the cat I had the longest. With our house on the edge of coyote territory, and several years where it was rumored that pet cats were being rounded up for medical research, most cats didn’t last long. She was only caught that once, and survived, succumbing to an infection at the age of 10.

Rugby scores

The spring semester is really heating up, so I'm getting behind in the things I want to say!
From the weekend's 6-Nations games: new prizes. It's not just about winning or losing (though, frankly, it is mostly); it's how you play the game. So play it in style.
Looks most like Vlad Putin: Italy's Sergio Parisse
Most buff Scot: Chris Paterson
Most dashing Italian: McLean
Most handsome: Ireland's Ronan O'Gara
Best butt: Scotland's Mike Blair
Best move: passing the ball to nobody (so many players did this that it's useless to list them all)
Most astonishingly short: Ireland's Peter Stringer (Stringer will of course win this every single time he plays, but it's worth noting that many of his teammates and opponents would actually have to lean down to rest their chin on his head.)
As pale as his uniform: England's Mike Tindall (The 15 for the Rose playing in white)
Best nose: England's number 13, whatever his name.

Fabrie, suite et fin

Just a few more pictures from last weekend in the snow. In just the last few days most of the remaining white stuff has disappeared, and yesterday it got up to 18°C, quite spring-like. So I'm lucky we didn't put off the weekend once again, because it may well have been the last chance this year.

These are from a stroll around the fields surrounding La Fabrie, up to the hamlet of Anglard. I was going to take some pictures of the big fat chickens wandering around the farmyards, but the farmers going about their business all around made me a little too self-concious for that.

Then in the afternoon Jerome and I stopped by a local waterfall that we had never been to, in spite of passing by the parking spot many times. William always said it was nothing much, but if we didn't see for ourselves we'd never know. You get used to things you're always around, and inured to the beauty of surroundings that become ordinary. For people who live here, making a special trip to see, and spending hours tramping around, taking pictures of stupid trees and empty fields, seems rather a strange thing to do.