Genetics Interview with Dr. David Moskowitz of Genomed

Several years ago, I was an epidemiology consultant. One of my clients was Dr. David Moskowitz, a nephrologist based in St. Louis, MO, who is now the President, CEO, Chairman and Chief Medical Officer of Genomed. From the company profile:

GenoMed is a Next Generation DM^tm company that uses medical genomics to improve patient outcomes. GenoMed is working to translate knowledge of medical genomics–the study of which genes cause disease–into clinical practice. We combine biotechnology with Disease Management (DM). We develop new and better drugs, we use existing drugs for new disease indications, and we uncover disease before symptoms arise. By studying disease genes, we hope to make medicine more proactive and disease prevention more effective.

We recently got back in touch and I’m pleased to share this conversation I had with Dr. Moskowitz who talks about his experience in the biotechnology industry as well as what he expects of the genome revolution.

1. How did you get the idea for Genomed?

In 2001, I left my first company, a private company which I had founded in 1998, to start Genomed. The reason was a classic biotech dispute of business vs. science. The three other directors of my first company were all businessmen. They rightly foresaw the coming recession, and wanted to hunker down and stop doing any science. Meanwhile, the human genome was just being finished. It suddently became possible to scan the entire genome for disease-associated snps, instead of looking at one SNP at a time, as we had been doing. Since we were in a global competition to find disease-predisposition genes, I was unwilling to give up the race. I started genomed. My former company is defunct.

2. What are the challenges to starting a biotechnology company?

Money is the rate-limiting step for all science. The private sector is no exception. Because we’re doing something that no businessperson understands, namely science and its unusually high “failure” rate, money is in exquisitely short supply. The real challenge for a biotech company is to find some way to get revenues. This was another reason I started genomed: to start taking care of patients as a next generation disease management company so that we could bring in revenues.

3. How well do you think the general public as well as healthcare professionals understand genetics and genomics? How do you think we can improve upon that?

You imply that the general public doesn’t understand genetics and genomics. I think they understand the point of it perfectly well, since they’ve been told, as taxpayers, what to expect from it: the roadmap for preventing disease. They may not understand how the roadmap is constructed, but you don’t have to understand cartography to use mapquest.

4. What do you think we can expect in the genome revolution?

Exactly what the public has been told for the past two decades: the roadmap for preventing disease, or at least treating it better.

Like any revolution, there will be some bloodshed.

For example, being able to prevent disease is horrible news for the hospital-based medical establishment (including med schools). These folks have ruled medicine for the past two centuries. Genomics will dry up their supply of patients. Perhaps patients will choose to die again at home, at the age of 125, and boycott hospitals altogether.

The genomics revolution will be great for primary care physicians and, of course, for patients, especially baby-boomers, who would otherwise die as quickly as their parents.

Here’s a personal anecdote, for what it’s worth: I first found out how to prevent 90% of kidney failure in 1994. But I’m still the only person in the world using my protocol. This isn’t for lack of trying: I briefed the medical director of CMS* in October, 2004. I’ve contacted every relevant non-profit nephrology organization, as well as the American Heart Association, the American Diabetes Association, the AMA, the National Medical Association, etc. There’s even a National Kidney Disease Education Program (NKDEP) within the NIH/NIDDK that we taxpayers support to get news out about such breakthroughs.

Not a word has been whispered. Without authoritative support, no medical reporter dares stick his/her neck out about a “cure.” apparently, medical reporters are incapable of evaluating the medical literature for themselves. So there is a huge gap between the information in tens of thousands of biomedical journals, and the public. The gatekeepers turn out to be scientifically illiterate.

So I can tell you from personal experience that the medical establishment has no real interest in changing the status quo. It’s a $2 trillion a year golden goose; who would want to kill it? The hospitals, and everything they support–medical schools, and by extension, the institute of medicine–have no desire whatsoever of going the way of the TB sanitaria in the early 1950s, after streptomycin was invented.

But they will. Genomics will turn medicine upside down, exalting primary care at the expense of subspecialty care, and the outpatient clinic at the expense of the ICU. Healthcare costs will be slashed as a result. We’re already offering our state-of-the-art preventive molecular medicine to India for $12 per patient per month. Think we can’t offer the same thing to the country’s 46 million uninsured, or the Medicaid population?

What impresses me is how effectively information can still be suppressed in this day of the Internet. I published my patient outcomes data for diabetic and hypertensive renal failure in 2002, but people still haven’t heard a thing about it.

Revolutionizing medicine and giving power to primary care providers, incidentally, is exactly what managed care claimed it would do in the 1980s and 1990s. But it turns out you can’t beat disease without knowing its pathways. And managed care did no research at all.

5. Would you get your genome sequenced like Craig Venter? Why or why not?

This is not merely a question of vanity, as it first seems. There is a prize now being offered by the funders of the X Prize, recently awarded for the first commercial space flight. They’ve now decided to reward the first company that can sequence an entire human genome of 3 billion letters for under US $1,000. I’ve spoken to them, and they’re obviously hooked on technology. They have no appreciation of clinical medicine or the scarce resources available for healthcare on this planet.

In clinical medicine, you use as little resources as possible to get the maximum patient benefit. If you can predict the six most common cancers in Caucasians using only 220 SNPs, as we can already do for breast, colon, lung, ovarian, pancreatic and prostate cancer, why bother sequencing a person’s entire genome? If you can already delay or even reverse atherosclerosis, as I’ve been able to do since 1994 without any genotyping at all, why bother sequencing for cardiovascular genes?

Perhaps because I’m the only genomics company CEO who sees patients, I feel that the world of genomics runs on a fuel of 99.9% hype, 0.1% clinical medicine. A clinician understands in their guts that the patient seeing them needs a practical solution right now, not 20 years from now.

Genomics needs to get real.

The field can continue to follow the lead of Craig Venter, Francis Collins, Eric Lander, and other pediatric geneticists who have yet to solve any adult, polygenic diseases, but who consume enormous amounts of time and money in the process, or it can focus on what needs and can be done.

*Dr. Moskowitz adds that the Centers for Medicare & Medicaid Services (CMS) currently spends $25 billion on dialysis patients, so eliminating $22 billion from their budget would also mean eliminating 90% of their jobs.

Thanks, Dave, for these fantastic insights.

I’ll be doing more interviews with scientists involved in genetics research so stay tuned!

Update, June 15, 2006: JP at Gene Expression shares his opinions on this interview.