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23andMe Gets FDA Authorization for Consumer Genetic Health Risk Reports

The big news about 23andMe’s FDA approval came out last week when I was holed up at a conference.

That’s right. 23andMe can now directly offer consumers a genetic health risk report that’s FDA approved. This is a big step for 23andMe when you consider that they’d previously gotten their hand slapped by the FDA.

23andMe got what’s called a de novo authorization from the FDA. This is something we’re likely to see more of and something that I’m sure many people aren’t familiar with. Here’s a description of what a de novo authorization is from the 23andMe announcement:

What does it mean to be granted a de novo authorization?
The Food and Drug Administration Modernization Act of 1997 (FDAMA) added the de novo classification option, which provides an alternate pathway to classify novel devices of low to moderate risk. The de novo process is used by the FDA to grant marketing authorization for devices that are new and unlike any other on the market. In addition de novo marketing authorization means that 23andMe met the FDA’s premarket requirements to demonstrate the following: accuracy, validity and user comprehension.

I’m glad that the FDA has created this new form of authorization for companies like 23andMe. This story also stands in stark contrast to other FDA related stories like Theranos. I’m sure that 23andMe would hate the comparison. However, there are some similarities. They both got slapped by the FDA. However, their response to the FDA’s notices was completely different. That’s why 23andMe seems to still be thriving and now have FDA approval. Theranos is floundering with reports that their founder now owes the company $25 million.

Needless to say, if you’re a healthcare startup, make sure you know the FDA regulations that apply to your startup.

April 11, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

23andMe Testing Shut Down by FDA

I’ll admit that I’m not an expert on FDA clearance, but I found this notice from the FDA to 23andMe really interesting. As stated in the notice, “23andMe must immediately discontinue marketing the PGS until such time as it receives FDA marketing authorization for the device.”

The letter does specify that 23andMe has been working with the FDA since July 2, 2012, but something has gone wrong in 23andMe’s clearance process. It does offer the following explanation of the issues the FDA has:

This product is a device within the meaning of section 201(h) of the FD&C Act, 21 U.S.C. 321(h), because it is intended for use in the diagnosis of disease or other conditions or in the cure, mitigation, treatment, or prevention of disease, or is intended to affect the structure or function of the body. For example, your company’s website at www.23andme.com/health (most recently viewed on November 6, 2013) markets the PGS for providing “health reports on 254 diseases and conditions,” including categories such as “carrier status,” “health risks,” and “drug response,” and specifically as a “first step in prevention” that enables users to “take steps toward mitigating serious diseases” such as diabetes, coronary heart disease, and breast cancer. Most of the intended uses for PGS listed on your website, a list that has grown over time, are medical device uses under section 201(h) of the FD&C Act. Most of these uses have not been classified and thus require premarket approval or de novo classification, as FDA has explained to you on numerous occasions.

Some of the uses for which PGS is intended are particularly concerning, such as assessments for BRCA-related genetic risk and drug responses (e.g., warfarin sensitivity, clopidogrel response, and 5-fluorouracil toxicity) because of the potential health consequences that could result from false positive or false negative assessments for high-risk indications such as these. For instance, if the BRCA-related risk assessment for breast or ovarian cancer reports a false positive, it could lead a patient to undergo prophylactic surgery, chemoprevention, intensive screening, or other morbidity-inducing actions, while a false negative could result in a failure to recognize an actual risk that may exist. Assessments for drug responses carry the risks that patients relying on such tests may begin to self-manage their treatments through dose changes or even abandon certain therapies depending on the outcome of the assessment. For example, false genotype results for your warfarin drug response test could have significant unreasonable risk of illness, injury, or death to the patient due to thrombosis or bleeding events that occur from treatment with a drug at a dose that does not provide the appropriately calibrated anticoagulant effect. These risks are typically mitigated by International Normalized Ratio (INR) management under a physician’s care. The risk of serious injury or death is known to be high when patients are either non-compliant or not properly dosed; combined with the risk that a direct-to-consumer test result may be used by a patient to self-manage, serious concerns are raised if test results are not adequately understood by patients or if incorrect test results are reported.

The 23andMe website doesn’t say anything about the FDA letter, but the company did put a statement for the media on their Facebook page. I guess Facebook is the new media hub for organizations (although, I found it from this tweet)

We have received the warning letter from the Food and Drug Administration. We recognize that we have not met the FDA’s expectations regarding timeline and communication regarding our submission. Our relationship with the FDA is extremely important to us and we are committed to fully engaging with them to address their concerns.

That’s a pretty vague statement. It is interesting that they chose to acknowledge that they haven’t met the FDA’s expectations. You can be sure there’s a whole lot more to this story and 23andMe’s interactions with the FDA.

Considering the big name people behind 23andMe, it will be really interesting to see this battle play out. It could certainly set precedent for many other healthcare applications in the future.

November 25, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.