BaseHealth CEO Jorge Velarde Speaks About the New Market for Genomic Health
November 7, 2014 | When a crop of enterprising startups appeared in 2006 and 2007, promising to take customers’ DNA and create personalized health reports to help us understand the medical risks lurking in our genomes, the pressures facing genomic health services seemed clear. Sequencing a human genome was prohibitively expensive, coming in at well over a million dollars — would they be able to narrow down their DNA targets enough to come in at an attractive price point, while still collecting useful information? Would the FDA and other regulators smile on these products, or regard them as unproven medical tests? Was there even a market for DNA data?
Fast forward to today, and the whole business of genomic health looks very different indeed. The genome is a commodity within reach of the middle class, coming in at the price of a cheap used car. Genetic health reports are decidedly “medical devices,” and the FDA is vocally worried that consumers could be dangerously misinformed if providers don’t go through a careful regulatory process.
And as 23andMe, the lone survivor among that first crop of companies, approaches one million customers, demand for this information is no longer in doubt.
While 23andMe works to pivot to its new regulatory demands, while keeping up the huge customer enthusiasm it has inspired with its trademark tone of empowerment, a “second wave” of genomic health companies is charting a different course. Today’s startups are preparing to work with the whole genome — and at the same time, to put DNA data on an even plane with traditional health metrics like diet, exercise, and family history. They are also toying with the idea that doctors may be their best customers, both from a regulatory standpoint, and in order to make the biggest impact on health. (For more on the trend, see “LifeMap Solutions Joins New Wave of Genetic Health Companies.”)
One second wave company is BaseHealth, whose Genophen platform Bio-IT World has previously profiled. BaseHealth has tight ties with the gene sequencing company Illumina, and this October, former Illumina Vice President for Business Development Jorge Velarde became BaseHealth’s new CEO, as the company prepares for a wider launch of its platform. Bio-IT World contributor Aaron Krol spoke to Velarde about whether the new wave of providers has finally hit on the right formula to make genomic health a reality for patients.
Bio-IT World: You previously worked as Illumina’s Vice President of Business Development, so you’ve had a front row seat to see some rapid changes in how sequencing technology is used. When did you start noticing that this was no longer just a tool for research, but that it was going to play a role in medicine sooner rather than later?
Jorge Velarde: I started [at Illumina] in 2001, back when the genome was closer to $100 million to sequence, and when I left the cost was about $4,000. During that period, it became evident that we’d reached a tipping point in the amount of information associated with the genome — to the point where you were getting very usable information, and information a consumer could potentially understand if it was put in the right context. I was very fortunate to work with a lot of companies, during that 11-year span, that were pioneering in this space: deCODEme, Navigenics, the list was long. But there was always something missing in the way that they approached it, and when I saw what BaseHealth was doing, it became evident that it was the right approach to integrating genomics into understanding your wellness.
Those kinds of companies you mentioned — Navigenics and deCODEme, and of course 23andMe — also made clear that there was a great deal of consumer interest in learning about genomic health.
Yes, absolutely. And that interest comes from a number of different angles. There’s still a very large base of consumerism around using your DNA to understand ancestry. And then there’s understanding certain genetic markers — whether they’re very predictive for Mendelian or monogenic diseases, where your outcomes are pretty much set in stone, or whether it’s a more basic understanding of your genome, which says you might have a propensity for certain things, but it isn’t deterministic… People are very engaged in wanting to know what the story is behind their DNA. I think that appetite for understanding has to be put in context, because the reality is, on average only 20% of your risk for preventable diseases is actually due to your genetics. Access to medical care is about 10%, and another 20% is from your past and present environment, and a whopping 50% of it comes from your lifestyle and your behaviors.
Is it hard to explain that relationship between lifestyle and genetics in a way that the end user will understand, and be able to take some actionable insight from?
What we do [at BaseHealth] is try to show the individual the potential risks that they might have. If, for example, you’re moving toward type 2 diabetes, your lifestyle plays a significant role in that: your eating habits, your exercise, and a lot of the standard medical practices of understanding your triglyceride levels and other aspects of your blood work. So what we do is, we put it all into perspective for the individual, so that they understand what they can do to modify their risk. It’s no different from standard practice today, except that we put it in context. And then we provide a tool that the physician can use as well, so that when [the patient] has that initial visit, they understand that baseline. And hopefully, we give them a path so that they can behave in a way that can actually address those modifiable factors.
That decision to use a physician as a mediator, or a guide to genomic health, is something BaseHealth shares with many of the newer genomic health services. Do you think that doctors have a better feel than the rest of us for how genomics is going to impact our ideas about healthcare?
[Physicians are] inundated every day in their practices by people who print things off of the Internet, who come into the office asking questions around genetics. Sometimes they get their advice from other platforms that don’t necessarily put that genetic information in context, or they’re just doing Google searches. So physicians have to deal with it in their practices, and I think they appreciate the effort that we’re making to give them a tool that allows them to better present that information to their patients, in a very comprehensive way and in a very responsible way… [At the same time], what we want to do is leave it up to the physician to decide whether he wants to use that information or not. And it really is going to be dependent on the individual.
If lifestyle is really the dominant driver of risk, why should we expect better awareness of genetics to make a difference to people’s health?
I think it’s an incredibly motivational tool. You can’t get any more personalized than your genome. It acts as a foundation for you to better understand the things that you should keep an eye out for, because if you have a higher risk for a certain preventable disease, you should always keep that in mind — and then choose a lifestyle that will help you not to progress to that disease. I think [the genetic aspect] is a foundation. It’s something important for the individual to understand, and we find that typically when they understand that, they become more engaged.
BaseHealth has the advantage of coming along a few years after companies like Navigenics and 23andMe first dipped their toes into these waters. Are there lessons learned from that first generation of companies that are driving a different approach today?
There are, and what we’re doing now is really different. We take all the information that we display, whether it’s genomics, or whether it has to do with certain blood markers, or anything in the platform, and try to give it context. We don’t look at just one factor. And in the end, I think what differentiates us is that we are not just presenting information, but we’re coming up with something that’s actionable. That’s the key, from an empowerment perspective, because everyone needs to understand what they can do to make a difference in their health. Our goal is to be incredibly actionable, and hopefully we deliver information in the most responsible way. We’re not a direct-to-consumer company. We’re working B2B with large medical groups, concierge groups, or accountable care organizations.
Do you think these care organizations and physician groups are the kinds of customers who are in a position to make genomic information a part of the standard practice of medicine?
Absolutely, and in fact, it’s happening today. There are a lot of practices where they’re using genetics every day. Maybe it’s a diagnostic test that interrogates one part of your genome, or maybe it’s pretty large screens, but they do try to incorporate that into their practices… One of the models we’ve been pursuing is working with large care organizations that have large populations, where they want to better control the risk in those populations. If we deploy the Genophen platform broadly within one of those organizations, we could, for example, identify pre-hypertensive, pre-diabetic individuals, and then work with them to make sure they don’t progress. Eighty-five percent of what’s being spent in care today is to deal with chronic diseases, so if you can catch it early, the benefit is obviously very great for some of these large organizations practicing accountable health management. It’s a natural fit for the platform.
Do you also plan to do research internally to learn more about genetic risk factors, in the vein of 23andMe, as you start getting patients on board?
Our big vision is, once we have millions of people on the platform, we’re going to be learning things about what’s best from a health management perspective. We’re collecting such a plethora of information that we can start developing our own algorithms to best understand the likelihood of someone progressing toward a preventable complex disease, and then really put those action plans into place for individuals. There’s a lot of machine learning that could go on, but obviously that will have to wait until we have a greater mass of individuals on the platform. But based on the amount of information that we track, either through biometric devices that we’re incorporating into the platform, or through self-reported data, we’ll be able to create a lot of benefit for users.
I do want to bring up the FDA, which remains a bit of a wildcard in the genomic health space since it shut down 23andMe’s health reports last year. What is your sense of how the agency feels about these services as a whole?
Obviously the FDA is still in the process of formulating all their policies and regulations. And that’s particularly true when it comes to direct-to-consumer genetic testing, which is something we’re not doing. At the same time, the company from day one has always realized that this is important, so we’re working with our outside consultants, to be within the scope of what the FDA would expect… I can’t tell you where it’s going to end up in the future, but I do feel that there’s no way you’re going to be able to stop personal genomics, and the role it plays in individual health. I feel that as long as we work hand in hand with the FDA where we need to, it doesn’t represent a huge risk for us… On a personal level, I’ve been genotyped by many different groups after spending so many years at Illumina. I think your genome is your genome. You should own it, and you should be able to make a decision as to how you’d like to use that information. But we should deliver it to you in a responsible way, so there isn’t this lack of understanding around it.
Do you have a Genophen profile? What have you learned about yourself from using it?
Yes, I do have my own profile, and I’ve been tracking myself for several months… My physician has been great. Based on my lifestyle, I’m on the track to potentially get type 2 diabetes, and so he put it in context for me, from a nutrition perspective, and going through all of the modifiable aspects of it. It’s great interacting with him at that level, and at the same time knowing that he understands many of the risk factors that I have — not just my genomics, but everything we collect, whether it’s our blood work or our lifestyle. It’s been a really interesting experience… All of us at the office are on the platform, and we tend to talk about certain aspects of our health, what we’re eating and our activities and how it relates to us personally, and it’s really a fun environment to be in. Ultimately we have to be using our product, and we have to feel that what we’re getting out of it is just as good, if not better, than what our customers and our partners will.