May 31, 2012

Comment va la génomique en France ?

France has a new president and a new cabinet. An excellent reason for me to continue a series on genomics in different countries, which has already covered Japan and Germany.

In June 2000, the first draft of the human genome was completed. The contribution of France was 3% of the total. That was little, but still more than the contribution of any other country except the United States and the UK. At the time, all of the sequencing in France was done by its national sequencing centre, the Genoscope near Paris.

According to Balzac, political liberty, the peace of a nation, and science itself are gifts for which fate demands a heavy tax in blood

Since then, genomics has become even less of a national priority, and other countries have overtaken France. In terms of sequencing infrastructure, France lags behind its European peers Germany and the UK. According to Omics Maps, there are 38 sequencing machines in France, compared to Germany's 135 and the UK's 138.

There are some signs that this could change. Last year, French genomics, including the Genoscope sequencing centre, received a funding boost of €60m ($77m) as a part of a €260m package to promote research infrastructure. It is too early to tell whether this has been a one-off, or whether there is a long-term commitment by French policymakers to invest more in genomics. Doing a quick press search, I could not find any indication what the views of France's new minister of Higher Education and Research on genomics are.

How about the private sector? France has biotech giants such as Biomérieux and Eurofins that are also involved in sequencing.  However, the core business of both companies is not genomics. That is unlikely to change: In a recent interview, Eurofins senior vice president Bruno Poddevin expressed the opinion that it will take at least another 10 years until Sanger sequencing is replaced by next generation sequencing (NGS), and that until then, NGS will not be a priority for his company.

Overall, it seems that sequencing is not a priority for either the public or the private sector in France. If you have any comments that confirm or refute this view, please share them below. Please note that I will be travelling until the 19th of June and that I will not be able to reply to your messages until then.

May 25, 2012

Is it worth $61 per year?

The price tag attached to sequencing a human genome is likely to decrease to a level comparable to other complex clinical tests such as computed tomography (CT) scans, which cost around $1,000.

In an excellent article appearing together with the publication I discussed last week, Isaac Kohane and Jay Shendure argue that the cost of whole genome sequencing per year is only $13, and that any health benefits derived from it that are worth more than $13 per year would therefore make sequencing a good investment. They arrive at $13 by dividing the $1,000 that sequencing someone may cost by the life expectancy of the average American, which is 78 years.

However, this does not take into account all the other things you could do with the $1,000 you spend on sequencing, like investing it. Corrected for that, the real cost is more like $61 per year.

It is not at all obvious that for most people, and for the foreseeable future, the best way to spend $61 a year will be to get sequenced. For the same money, you could get a lot of other regular checkups that have a greater utility.

In any case, my calculation may be besides the point: Right now, it is unclear whether having your genome sequenced and analysed will eventually cost the same than a CT scan, or a multiple, or a fraction of that.

How do I arrive at $61 per year?

Like Kohane and Shendure, I assume that having your genome sequenced and analysed in a meaningful way will be around $1,000. Investing this money at a conservative rate of 6% after inflation for 78 years, which is the life expectancy of an average American, means that the equivalent of $1,000 now is $61 (plus inflation adjustments) for the next 78 years, and not $13.

May 18, 2012

How useful is it to sequence everybody?

Like everyone else, public health insurances only have a limited amount of money, and therefore constantly need to make decisions which treatments to fund, and which are too expensive. That way, some treatments, although they have a health benefit, do not get funded, because they cost too much, and the money instead goes to treatments with a higher utility.

This applies to drugs, but also to diagnostic tests. From the point of view of insurers, genome sequencing is just another such test. The question then is, is it the best way to spend health insurance money?

A new door may be a better way to spend your money

In a recent publication in the journal Science Translational Medicine, Nicholas Roberts and coworkers partially address this question. They estimate the potential of whole genome sequencing to provide clinically useful information on the disease risk of people who are currently healthy.

Their result: Even in the best of circumstances, for most people sequencing will be uninformative about their risk for the majority of common diseases.

However, they also find that there is also a good chance that sequencing will provide useful information about at least one disease. This means that if you are particularly concerned about getting a specific disease, sequencing will probably not tell you anything new. On the other hand, it might well warn you about your risk of developing a disease you never even thought of before. But even then, the predictive value is likely to be quite limited.

This is interesting, but as the authors acknowledge, it comes with some caveats. Firstly, it covers only common diseases. For diseases that are caused by single genes, sequencing is much more likely to give useful results. Also, it assumes that people are sequenced after their birth, whilst some of the value of sequencing lies with prenatal diagnosis. It also ignores the possibility of sequencing only those people who are most likely to benefit, such as those that already show certain symptoms.

In summary, Nicholas Roberts and his colleagues pour cold water on the idea that sequencing everyone is going to have a large impact on how disease risks for common diseases are assessed for asymptomatic patients. On the more important question of whether sequencing everyone will be worth the cost in clinical practice, the jury is still out.

In next week's post, I will attempt to answer the related question of what the utility of sequencing needs to be in order to offset its cost.

May 11, 2012

Who do genomics companies get their venture capital from?

This week, I take another look at venture capital (VC) investments in genomics. As suggested by Daniel, I ask which VCs invested in a panel of representative genomics companies, and what these investments looked like.

The result: The most active VCs in genomics are Alloy, Google Ventures, and Mohr Davidow, which each invested in three genomics companies from the panel. They are followed by InterWest, Invus, and OrbiMed, which each invested in two.

On average, the companies in the panel raised a total of $32m from four different investors in three funding rounds. The median individual investment was $5.8m. The median investment per round was $11.7m, which is twice the 2001-2010 VC industry average of $5.9m per round.

The panel

The panel for the above analysis consists of all those genomics companies that I mentioned on this blog in the last few months: 23andMe, BioNano, Complete Genomics, DNAnexus, Fluidigm, Foundation Medicine, GenomeQuest, Good Start Genetics, Nabsys, Natera, Oxford Nanopore, PathoGenetix, PrimeraDx, RainDance, and Verinata.

For each company, I checked which VCs invested in it using Crunchbase. Not included are companies that have gone public, did not receive VC money, or for which no data is available on Crunchbase.

Having assembled this panel, I am wondering how I could improve it and which other interesting questions I could address with it. Any suggestions?

May 3, 2012

Which VCs are most active in genomics?

Lots of venture capital firms (VCs) are active in the biotech sector, but are there any that preferentially invest in genomics companies? To find out, I looked at the portfolios of some of the most prominent biotech VCs in the world. The resulting list is below.

Most (12 out of 16) of the VCs on my list currently have at least one investment in a genomics company, but none has more than two. This implies that genomics companies form part of a healthy VC investment portfolio, but that they do not consider it sensible to invest into this area too much.

I can think of two reasons for this: Either VCs consider genomics companies risky compared to other biotechs, or there are not enough promising genomics startups out there to make such a specialisation sensible.

Does anyone have any views on this?

List of venture capital firms, by investments in genomics companies

I downloaded a list of top biotech VCs. Visiting the websites of those firms, I counted the their total number of current investments in the life sciences and healthcare, and the number of those investments that are specifically in companies that are active in genomics. I excluded firms whose main business is drug discovery, even if they use genomics-based approaches, from this definition. Obviously, I could not include investments that the VCs chose not to disclose on their websites either.