Medgadget: Thanks for taking some time to speak with us today. Can you give our readers a little summary about the history and mission of Navigenics?

Dietrich: Its a pleasure, thank you for agreeing to be involved in our beta testings. Navigenics was started by myself (a human geneticist) and David Agus (a clinical oncologist) in 2006. We both recognize that all human disease has a genetic component and that the most effective cure is prevention. Take the case of melanoma - by seeing a dermatologist and removing skin lesions before they metastasize we are actually curing melanoma. It is much more difficult to cure melanoma when it has metastasized throughout the body. The same concept is almost universally true for every disease. The major goal of Navigenics is to use risk information embedded within the genome to drive prevention strategies early in life.

The goal of Navigenics is ultimately to provide an individual (and their physician) with a holistic assessment of their genetic predispositions to disease. The vast majority of disease burden in the world is caused by chronic diseases - also called complex genetic diseases - which have a genetic and an environmental component. By learning of predispositions to complex genetic diseases early in life, an individual should be able to focus their prevention efforts on specific environmental toxins that they are more susceptible to, engage in early screening in a focused way, and also achieve a diagnosis earlier and go on therapy earlier which generally results in better clinical outcomes. If we can deliver this information in a broad-based fashion, and motivate individuals to act on the risk information, it is reasonable to assume that we can reduce the burden of chronic disease for some individuals and have a public health impact. We hope that in the next decade we can nucleate a shift from reactive medicine to preventive medicine.

Medgadget: Currently you screen for about 21 diseases, but your promotional video mentions that eventually Navigenics will offer access to "hundreds of different conditions." How soon do you think Navigenics clients will have access to this broad of a genetic screening exam?

Dietrich: Yes, we are proud to announce the recent addition of 3 new conditions (Atrial Fibrillation, Abdominal Aneurysm, and Lung Cancer) to bring current total to 21 medical conditions. Our number of conditions and the number of SNPs for each condition will keep pace with the quality associations that are published in the public domain. We commit to minimal lag time in updating our members with new medical risk information. We anticipate a continued linear increase in association findings over the next 5 years, with researchers addressing less common disorders, prognosis, and drug response/adverse effects as alternative questions in the coming years.

Medgadget: After reviewing the detailed patient and physician educational packets, we were curious as to why has Navigenics decided not to include clinically significant genes like BRCA for breast cancer?

Dietrich: First of all, I'm pleased that you found the educational packets helpful. We are dedicated to ensuring that our clients are well educated about the clinical significance of their results. However, today we are screening an individual's genome for common variants that raise risk. DNA sequencing for monogenic disease (such as sequencing for BRCA1/2 mutations) is currently not supported by our company.

Medgadget: Will clients be able to update their genetic sample as your technology improves? Will this be necessary?

Dietrich: Members will obtain updated information regarding the common variants that predispose to common complex genetic disease over time based on the archived genotype file that they provided. At any point in time an individual can terminate membership and their data will be purged from the Navigenics systems. If a member would like to take advantage of various other types of risk factor screening services in the future, a new DNA sample may be necessary.

Medgadget: We think many clients, especially from our reader population, would be interested in having more (unlimited) access to their genetic information. Will clients be able to freely 'browse' their genetic code?

Dietrich: That's an excellent question, thank you for asking. We firmly believe that an individual owns their genome, and is the only person who should ever have access to that information freely. To this end, we will always allow an individual to obtain the complete sequence file from us. There will be an educational component associated with this information transfer that explains that most sources of information regarding correlations between sequences within the genetic code and disease predispositions are incorrect, and that by freely "browsing" their genome, an individual is assured of being misinformed. There is a critical role for expert interpretation of sequence variants and Navigenics prides itself on the quality of its interpretations.

Medgadget: Absolutely. I think many of our readers would be interested to learn a little more about the Affymetric tecnology...Can you give us a brief overview?

Dietrich: Sure thing, its a bit technical but I'm sure your many of your readers will appreciate the details. Our scan, performed by a CLIA-certified laboratory, uses the Affymetrix Genome-Wide Human SNP Array 6.0 (R). It tests for nearly 2 million genetic markers, including more than 900,000 SNPs, or single nucleotide polymorphisms. The arrays sequence specific regions of the genome by taking advantage of the natural tendency for DNA to form a double helix and specifically align with sequences that match itself and are perfectly complementary. The Affymetrix array has short single-strands of DNA that are grown on the surface of the array and match very specific regions of the human genome. The person who is being tested then submits a DNA sample which is fragmented, labeled, and poured onto the array in single-stranded form. The individual's DNA fragments will hydrogen bond to the exact sequences on the array when there is a perfect match, and allow the sequence of that person to be read out. If there is no match, then there will be no binding and that sequence is not present in the individual's genome.

Medgadget: What do you feel is the most significant genetic marker you currently screen for?

Dietrich: Of course, depending on an individual clients results, the "most significant" marker will be the one that affects their health the most. However, in objective terms, the single strongest marker we test for (if an individual opts in to receive this information) is the APOE gene related to Alzheimer's disease. That being said, there are combinations of markers that together have even stronger predictive power - for example the SNPs for age-related macular degeneration.

Medgadget: How does your service compare with that of your competitors? What differentiates Navigenics from the similar services?

Dietrich: We focus only on actionable medical conditions. We present the highest possible caliber of curation of our variants. We are completely transparent with our risk scoring. We guarantee 100% complete data - no missing SNPs. We capture SNPs that are correlated with disease and meet our quality criteria even if they do not reside on the Affymetrix platform using secondary technologies. We present risk in an intuitive fashion. We provide guidance for an individual and their physician so that they may easily understand the information and decide on a prevention plan. We have partnered with the best medical institutions in the world as collaborators, such as the Mayo Clinic and Harvard University.

Medgadget: Its hard to argue with a commitment to quality like that. Its clear that you've handpicked the most accurate variations, but if I had a specific interest in emerging research for "disease x" will I ever be able to search my info for those alterations?

Dietrich: We will only provide interpretations for those variants and diseases that we feel are of the highest quality.

Medgadget: Mr. Stephan, thank you very much for allowing to participate in the beta testing of the Navigenics. As clinicians, it will be extremely exciting to see what the future holds for individual genetic analysis and its role in clinical medicine.

Dietrich: Absolutely, it was a pleasure to work with you...and sorry to break the bad news about you not being a member of some super-human race...

More from Navigenics...

So we registered the domain, installed a user-friendly publishing software, and gave it some testing. The site is now ready to go, all without any significant investments (except for our time) or outside funding. In other words, 100% independent political network for doctors.

Some features of the website: WYSIWYG (What You See Is What You Get) blog editor, drag and drop picture uploading, social networking (make friends, establish contacts), bookmarking, event announcements, polls creation, and much more. The publishing on Medpolitics is as easy as writing an email: no knowledge of HTML is necessary. Again, the site is open for blogging to US physicians only, and everyone else can follow the debate and comment. We have a person on staff to treat everyone who signs up the old fashioned way, "like a doctor." That means continuous support, a phone number to call for help or to explain how to do something, and the utmost attention to all your requests. What blogging platform will do that for you?

We are not looking for thousands of members, but just for some of you that care for the future of our profession and have the desire to have your opinions heard. So let's see if the experiment will work, and whether we can get some of the quiet voices out. Sign up now, and if you have that Blogger account that gets drowned in a sea of chatter, move it and join other physicians. A few voices together are definitely louder than individuals scattered all over.

If you have any questions, please get in touch with us via this contact form.

See you in the debate halls of Medpolitics.com!

We'd like to note and to give credit to the AMA for not officiating this discussion, for not setting limits or requesting in advance the questions we were planning to ask.

Medgadget: Dr. Rohack, my name is Michael Ostrovsky. Welcome to Medgadget, I think everything is working very well now.

Dr. Rohack: Great, very good.

Medgadget: We really appreciate you giving us this opportunity to interview the president-elect of American Medical Association. It's a great opportunity for us. Just to let you know about Medgadget. We are a physician edited blog, and we've been discussing the AMA a little bit among ourselves, and would like to ask a couple questions about the AMA and its future. First question would be.. Can you give us a little summary of the mission of the AMA at the present time, in these turbulent for physicians political times.

Dr. Rohack: From a historical perspective, as well as right now, our mission is to promote the art and science of medicine, and the betterment of public health. Our three major areas of focus, however, that we are trying to accomplish is to make sure that the 47 million Americans that are uninsured do now have health insurance. And it is through a process of changing the Federal tax code so that those that can't afford health insurance can get tax credits to purchase their own health insurance. The second is to fundamentally reform the Medicare system. Medicare was created 40+ years ago, [it] is still siloed as far is its payments, it is still backwards as far as how the system works, in that it took almost 37 years to finally get a drug benefit, and we still see that Congress, having to go to Congress to say "We need to cover immunizations" is kinda backwards. And the third thing we're focusing on is improving the quality and safety, and that's through not only continuation of our involvement in standard setting for medical education, both at the medical school, the graduate medical education, and continuing education, but more importantly taking a look at tools that we can help physicians in their offices how care is being provided in different ways, to reduce the duplication that maybe out there that maybe unnecessary, that physicians may not have the tools to help them. So, clearly there are many other areas we're involved with, but those are the top three.

Medgadget: Also, I'm sure you know that there is a lot of disagreement among doctors, some would even say discontent among doctors, with the AMA, with the organization itself. Do you feel this is a time when the AMA is having more difficulty reaching physicians with its message. Specifically, are you seeing any evidence of this discontent among physicians in your membership numbers?

Dr. Rohack: Well, certainly our historical process that we've had for getting feedback from physicians has been tied to our house of delegates that assembles twice a year with physicians representing every state and specialty. However, it's also a recognition that the technology has changed. We've also looked at weblogs and other venues where physicians are being engaged for us to get an experience if that's something we should be more involved with, to interact with our members. A few years ago we started to do what's called 'Member Connect surveys', where we sent electronically to our membership individual questions, that they could respond to, to help shape our annual agenda that we put together. So I think that one of the things that the American Medical Association has done over the last decade is recognize that the historical past of how communication occurred with doctors... that is doctors coming to the AMA twice a year, the doctors then returning back to their community, and then those doctors being responsible for communication, has left the average AMA member, in fact has left the average doctor, completely unaware of what the AMA is doing. The other recognition that we have, our house of delegates which meets twice a year, is a very open, deliberative, democratic body. We don't bar the press from those deliberations. And it is so democratic, that any individual can bring a resolution to that debate, so that any time the resolution that is introduced happens to be on social policy, where the country hasn't come up with a consensus, unfortunately sometimes the press, that becomes the headlines, and it really distorts all the things the AMA does to help the actual practice and doctor in their every day life.

Thankfully, there are innovative companies that hope to drag help bring medical professionals into the 21st century with secure, affordable, seamless solutions. Recently, we had an opportunity to sit down with Scott Finlay, CEO of Max.MD, and chat about how this company hopes to do just this.

Medgadget: What is Max.MD?
Scott: Max.md is a US based Registry and an innovative internet technology company committed to the idea that physicians, practices and the healthcare industry in general would benefit from the establishment of a Top Level Domain (TLD) for the Healthcare industry. .md Because Medicine is your Domain.

Max.md owns the exclusive rights to create sub domain names in the .md TLD and to register, market, maintain, publicize, promote, distribute, and license such domain names and provide related services to any and all customers in over 90 countries around the world. Max.md has developed a secure communication platform (patent pending) for physicians, practices and covered healthcare organizations in the United States so that they may communicate securely over the internet in compliance with The Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Max.md registration bundle offers healthcare organizations an ability to communicate securely with each other via .mdEmail® and .mdSecureIM™ for pennies per user per day. Max.md is located in Jersey City, New Jersey and maintains Secure Server locations in Texas, Virginia and New Jersey.

Grand Rounds started at GruntDoc this week...

But he lost steam and asked Dr. Val to pick up...

She thought the submissions were beneath her and asked David E Williams to continue...

But he was humbled by the excellent writing and asked us to step in.

Very well, then. On to the links, Medgadget-style -- with an appropriate emphasis on well-conducted research, verifiable findings, and sound conclusions. Our motto: Just because we're bloggers, it doesn't mean we can't be evidence-based.

Well, this sample of links certainly made for interesting reading, but didn't produce any scientific breakthroughs. However, we do have one milestone to report:

We are pleased to announce that artificial intelligence has come far enough to allow virtual blog carnival hosting. Behold, Dr. Anonymous, an entirely official construct. This so-called 'blog host,' who seems to have real opinions, feelings, and even a 'sense of humor,' is nothing more than a complex array of heuristic algorithms and pre-programmed responses. What you see inside the black & white box when you press play (a color version is said to be forthcoming) is pretty much all there is to "Dr. Anonymous" -- yet the effect is so lifelike, the hosting experience is so complete, that much of his audience has been fooled, despite multiple encounters.

See for yourself, as Dr. A continues with the hosting of this week's Grand Rounds....

Undoubtedly, as was pointed out in the Reuters article, things aren't so simple. In reality the situation is that politicians are leaning towards controlling pharmaceutical prices as a method to keep already skyrocketing healthcare (Medicare, really) costs down, and medical devices are naturally next in line.

Of course the nominee plans call for more spending on top of a system that is already generating debt everyday. Given that the healthcare industry is already close to capacity, an infusion of approximately another 100 million people should, if the free market exists, drive through the roof the already high cost of medicine. This last sentence assumes that additional patients are actually additional consumers creating extra demand within the old supply/demand charts. In reality, instead of creating additional individual consumers that participate in the mechanics of the free market, the tendency, at least from the Democrats, is to lump these people and insure them through the government, creating the dreaded "single payer" entity that exists the world over. Just like a monopoly supplier that can set prices, the monopoly consumer has almost universal mandate powers to make manufacturers submit to its whim.

Moreover, a monopoly consumer in the form of an indebted state, where the legislation-writing individuals fear no personal loss (being neither patients receiving care, nor the ones that directly pay for it), have a much easier time of demanding cheap supplies, while having no scruples of limiting provided care. The result, given enough time, is a system where neither the patients nor medical suppliers are making any decisions anymore, but are mandated by the state to produce so many syringes at given prices for a stated population, and for the patient to receive this or that treatment and no more.

We believe there is a reason why the pages of Medgadget are dominated by American medical technology. We believe that is thanks to a multitude of independent manufacturers and suppliers, as well as the millions of unique individuals with different conditions, calculations of cost/benefit, and individually suited health insurance plans from hundreds of competing companies.

American healthcare is indeed going through an important period that requires specific changes, and yet one must keep in mind the strong, unyielding forces that come to life when bureaucrats take over and a critical industry such as healthcare is taken from the civilian world to the political. Perhaps Reuters will consider long term consequences of more interest to ponder than short term results provided on borrowed terms.

After a careful analysis of the vote, we are pleased to announce that ScienceRoll takes the top honor in the Best Medical Technologies/Informatics Category. ScienceRoll's readers and many bloggers respect this website's consistent coverage of the latest internet medical news, genetics developments, and more. Well deserved!

2007 was an eventful year for the world of medical blogs. We saw old favorites disappear, like Medpundit and Dr. Flea, and heard from provocative new voices. Last year, the mainstream media and Wall Street invested more in medical blogs and forums -- but from our perspective the most insightful, passionate medical writing keeps coming from independent bloggers: doctors, nurses, students and healthcare professionals that venture online to share their thoughts.

We salute all the medical bloggers, but to draw attention to the best of the bunch, we let readers weigh in. That's right -- the same people that inspire and cajole bloggers to write their best got to nominate their favorites. After our editorial board (plus some esteemed guests) narrowed down the list of reader-selected nominees, we once again put it to an open vote.

And the readers have spoken! So, without further ado -- the WINNERS of the 2007 Medical Weblog Awards!

BEST MEDICAL BLOG: This was a wide-open race featuring many "must-read" blogs that readers nominated repeatedly in other categories. Kevin, MD is a perennial favorite, an aggregator of interesting (and provocative) medical news. Surgeonsblog is a lyrical look back at a career in surgery. Respectful Insolence is a fountain of opinions on the scientific establishment and its enemies. DiabetesMine is chock-full of nuggets and news on an increasingly prevalent disease. All these blogs are expertly crafted and worthy of acclaim.

But the readers have chosen another: Running a Hospital, the blog by Paul Levy, CEO of Beth Israel-Deaconess in Boston, Massachusetts. Levy has lifted the veil on hospital administration at one of the world's premier institutions -- he writes openly about his salary, his hospital's infection rates, controversial partnerships and upcoming plans. His candor and openness, and willingness to respond to commenters and critics has inspired readers and bloggers alike. Alone among an excellent field of nominees, Running a Hospital is a blog that might actually change the way healthcare works in this country. For this reason, and many more, readers have chosen Paul Levy's site as the Best Medical Blog.

BEST NEW MEDICAL BLOG: There were a lot of promising nominees in this category, and we enjoyed exploring the merits of these emerging new voices. The readers, however, favored one voice: Dr. Val, and the Voice of Reason. Part of the Revolution Health Network, Dr. Val brings a very human approach to medicine, balancing news and research with anecdotes and humor. A very reasonable choice!

BEST LITERARY MEDICAL BLOG: This is the kind of blog readers turn to when they want a well-written tale or rumination on the art of medicine. This year's winner should be familiar to longtime fans -- it's Random Acts of Reality by Tom Reynolds of the London Ambulance Service. Tom's gripping tales from the frontlines of the human condition are what won him this category in 2005 (the year he also took top honors for Best Medical Blog). Other nominees included Dr. Hébert's Medical Gumbo, intueri, A Chronic Dose, and Surgeonsblog.

BEST HEALTH POLICIES / ETHICS BLOG: This topic featured some really interesting websites, including cardiologist Dr. Wes, The Physician Executive, Respectful Insolence, and the Carlat Psychiatry blog (Dr. Cartlat's writing has been featured in the NYTimes). But readers once again gravitated to Running a Hospital, CEO Paul Levy's insightful attempt to make hospital administration transparent.

BEST MEDICAL TECHNOLOGIES / INFORMATICS BLOG: Hmm... We've got a bit of a dilemma here. In fact, we're going to hold off on naming a winner in this category, until we review the voting data, and consult an ethicist (perhaps one of the nominees in the previous category...)

BEST CLINICAL SCIENCES WEBLOG: This was a tight contest between a young upstart resident and a seasoned vet. Sumer's Radiology Site, which won in 2005, narrowly lost out to New York Emergency Medicine, the innovative new blog that features interviews with leading figures in EM, quizzes with cash prizes, and interesting medical and legal case discussions. Other notable nominees included Clinical Cases and Images and Aetiology.

BEST PATIENT BLOG: The winner here was Chronic Babe, a site created for young women by Jenni Prokopy. Her positive outlook in the face of debilitating chronic illness is infectious -- and readers agreed. The other stellar nominees included Six Until Me, Billy Bob's Wild Ride, The biopsy report, and the aforementioned DiabetesMine, which was nominated for best blog -- a remarkable accomplishment!

This year's Medical Weblog Awards has been sponsored by ScrubsGallery.com. They've graciously donated an Amazon Kindle portable reader, which will go to the winner of the Best Medical Blog, Paul Levy. Other category winners will receive the Cambridge Illustrated History of Medicine.

The 2007 Medical Weblog Awards Nominees ...

The 2007 Medical Weblog Awards announcement...

Your favorite medical bloggers, and some of Medgadget's own staff, will be appearing on a special edition of the Doctor Anonymous radio show this Sunday night (tonight!), as the polls close for the Medical Weblog awards. We envision this as a kind of red-carpet preview event, but, you know, instead of making snide comments on people's attire, we'll be speculating on the awards race, and rehashing some of our favorite (and not so favorite) medblog events and trends over the past year.

If you're new to Dr. Anonymous' BlogTalkRadio format, it's easy. Point your browser here to listen to archives or wait for the Sunday night event to appear, at 9 PM EDT on 1/20/08. Another way of listening (or participating) is to call in -- just dial (646) 716-9514 and you'll hear the chatter. There's also a chat room for the peanut gallery.

Some of our regular readers may not be familiar with the shadowy Dr. Anonymous. He has, of course, been active as a nominee in the past, and is providing coverage on this year's awards.

So come, have a listen, and get to know some of your favorite bloggers better!