Norway Brings DNA Sequencing To National Healthcare

ananyo writes "Norway is set to become the first country to incorporate genome sequencing into its national health-care system. The Scandinavian nation, which has a population of 4.8 million, will use 'next-generation' DNA sequencers to trawl for mutations in tumors that might reveal which cancer treatments would be most effective. In its three-year pilot phase, the Norwegian Cancer Genomics Consortium will sequence the tumor genomes of 1,000 patients in the hope of influencing their treatments. It will also look at another 3,000 previously obtained tumor biopsies to get a better idea of the mutations in different cancers, and how they influence a patient's response to a drug. In a second phase, the project will build the laboratory, clinical and computing infrastructure needed to bring such care to the 25,000 Norwegians who are diagnosed with cancer each year. Similar projects are under way in the United Kingdom and at research hospitals in the United States, France and elsewhere. But Norway's will be among the first to look for tumor mutations using next-generation DNA sequencing rather than conventional genetic testing."

Comments

Too early?

[backslashdot]

I'm not sure with current technology this will be very useful. Better than nothing? As I have said in the past, http://slashdot.org/comments.pl?sid=1408231&cid=29781469 -this is the way forward .. but I hope it's not at the expense of long term. I mean look how long it is taking for us to wean of incandescent lightbulbs and gasoline.

We really need a way to do long reads, coupled with single cell sequencing technology. That's the proper way to attack cancer. Hmm, also we may need a way to find out chromatin structure on a single cell basis too. Get on it.

Re:Too early?

[gringer]

I agree that it's perhaps not the best idea for cancer genome sequencing, but current 2nd-generation sequencing should be beneficial for the standard human genome. Even at a cost of $10,000 per person, you may be able to substitute a single expensive drug for a substantially cheaper generic when knowing that a person has (or doesn't have) a particular mutation. As long as the sequencing is high enough quality (as you should get from a long paired-end Illumina run), it only needs to be done once, and then can be re-used for whatever new genetic discoveries come your way.

I've wondered for a couple of years now why drug companies aren't already doing this (or at least subsidising the cost of sequencing). Some drugs have been brought back from the brink of rejection via genetic tests, and given the high cost of drug research it makes sense to do a relatively cheap genome sequencing if it hasn't been done on a person previously. The cost of whole-genome (and whole-transcriptome) sequencing is now in the range where research institutes are starting to consider it as a routine operation, and it won't be long before it falls into the price range of a cost-conscious consumer.

Re:Too early?

[Daniel Dvorkin]

(Short reads * massive coverage) + better sequence assembly algorithms = whole genomes, cheap. I agree that longer reads would be nice to have, but we're reaching the point where as long as read length is "long enough," we can do the rest computationally.

Also, job security for bioinformaticists. ;)

Re:Too early?

[Anonymous Coward]

I know the VA (United States Venterans Administration) is evaluating the storage costs for DNA sequencing; they've recently looked into pricing as they don't have to pay the patent fee's since the federal government funded much of the research. From what I hear, they want to DNA sequence all military personnel as it would lead to better treatment in the field. Currently, they think they'll do a little better then breaking even, but long term they are anticipating huge savings. If it saves them money and leaves to better treatment, it sounds like a win-win for us as it'll help lower the cost of the technology.

As for the patent-fees, I've heard that's 90% of the cost of DNA sequencing; when I commented how sad that was, they commented just wait a decade for our health system to collapse and then people will be begging for a centralized medical system and we'll all be exempt from patent fees due to the government covering the bill.

Re:Too early?

[biodata]

Clever assembly can only bridge repeats shorter than the fragment lengths. Coverage is not enough, you need fragments longer than the longest repeat unit, however long the reads are. MiSeq are quoting paired end reads in the 250bp per end class now, so as long as you can get them to sequence both ends of a long enough fragment then, yes, coverage can solve it, but I think the bottleneck might be in getting the fragments long enough while still being able to pair the ends.

Re:Too early?

[Anonymous Coward]

Mate-paired reads are getting long enough (~ 40 kbp). They are still sub-optimally used by current assembly algorithms (specifically scaffolding).

In Soviet America

[cosm]

DHS sequence your DNA. Come here comrade, we keep tabs on your DNAs. For your safety comrade. For your safety.

Socialized Medicine

[global_diffusion]

It's sad to think that we can't do these kinds of massive human genome sequencing projects in America. Anybody who got their DNA sequenced would be at immediate risk of losing their healthcare or seeing their premiums triple.

Re:Socialized Medicine

[Fuzzy Viking]

Land of the free - where anyone having health problems are FREE to live in a cardboard box... But then any attempts to socialize medicine gets voted down over there so I guess they have the system they deserve.

Re:Socialized Medicine

[JaredOfEuropa]

Socialised healthcare has similar issues as well, make no mistake. If we all pay for our collective well-being, it stands to reason that we all have a duty to avoid health issues that incur costs, right? That means no alcohol, chocolate, fatty foods: these are bad for your health. No more dangerous sports like skiing. And since we're already working towards mandatory helmets while riding a bicycle, why not wear a helmet while walking? Anything might happen and then society would be out of pocket again on account of your carelessness.

Insurers of private healthcare love to quantify risk factors and charge a premium according to risk; DNA sequencing would be a dangerous tool in their hands. Socialised medicine on the other hand equalises risk and cannot discriminate on genetic or behavioral health risks, but it does want to reduce factors that increase that risk, by modifying our behaviour. So you could end up with a government that literally tells you when to pee, for health reasons. With private healthcare at least you'll have the insurers vs. the government (at least if your government doesn't kowtow to those insurers); in socialised medicine you have insurers and government openly on the same side, with the same goals. That scares me, and it already resulted in a number of creepy and far-reaching ideas for health-related laws in my country. Thankfully most got shot down, but with the cost burden increasing in these crappy economic times, that might change.

Don't get me wrong, I think it's good that everyone has access to healthcare over here, but socialised healthcare is not without its problems, and those problems are not all about costs.

Re:Socialized Medicine

[Daniel Dvorkin]

So you could end up with a government that literally tells you when to pee, for health reasons.

You could, but do you? I haven't seen any evidence that countries with socialized medicine, on the whole, put any more restrictions on people's health habits than those without.

Re:Socialized Medicine

[Luckyo]

This is one of the most insane claims I've read on slashdot. Government that tells you when to pee? (Obvious concern troll, but I'll bite).

I think you're talking about things like making a law to ensure people wear helmets when riding bikes. Of course, being from a nordic, free and socialist... excuse me, communist, freedom hating degenerate land of free sex as your types likes to put it, we also trust that people understand that it's for their own good, and there is no punishment associated with it. You can ride a bike without a helmet, and police can legally stop you and tell you to get a helmet. But no fine.

Because people around here aren't batshit insane and imagine that hurting themselves on purpose is somehow sticking it up to the Man.

P.S. Nice concern troll.

Re:Socialized Medicine

[JaredOfEuropa]

There are not many such restrictions as yet, but the pressure is on to somehow punish unhealthful behaviour, and it's not just coming from the crackpot politicians. Our government has traditionally been very active making suggestions for leading healthy and safe lives, and I think that's good, but with the economic squeeze and the looming long-term demographic issues around the corner, they are starting to sound less and less like suggestions. I don't think it will ever be nearly as bad as in my exaggerated example, but looking at the current economic situation and political landscape in my country, I think there's a good chance of at least some of these suggestions making it into the law books.

Re:Socialized Medicine

[JaredOfEuropa]

Yes, I was exaggerating of course. But you're not all that far from the Netherlands; come visit sometime, and put your ear to the ground around parliament. I think you'll find that the notion of these suggestions for healthy living being turned into laws or rules isn't all that far-fetched. The idea of a "socially engineered society", the idea that managing many aspects of people's behaviour and society as a whole through laws and taxes is not only possible but desirable, is deeply rooted in our country.

Re:Socialized Medicine

[anyanka]

Actually, you get too little of this (in Norway, at least).

Prevention (in the form of getting people to eat healthier, exercise more, etc.) is typically paid from a different budget than the health care budget, and it's a lot easier to cut the prevention budget than the health care budget. So in practice the health care budget gets fatter, and little attention is paid to things that could have made people healthier. This also goes for things like welfare; if you'd used health care a bit more sensibly in some cases, you could get more people back to work and earn more taxes and pay less in disability benefits. But that would require a holistic view of spending, across departments and different levels of local and national government.

And, of course, you can't cut the tax on fruit and vegetables without the dairy and meat industry complaining and wanting cuts too. Overall, eating healthy is a lot more expensive than eating junk food (assuming you're educated enough to *know* what food is healthy).

You *do* have campaigns against smoking, though, and restrictions on alcohol (but that's more due to morals/puritanical tradition). But it's almost impossible to get treated for drug addiction, particularly if you life and health isn't already ruined by drugs...

Re:Socialized Medicine

[Anonymous Coward]

America has a higher drinking age, more restrictive alcohol sales laws, and harsher anti-smoking laws than any Western European country. Your country already punishes or restricts unhealthful behaviour very strongly, and you aren't even getting the benefit of universal healthcare.

Re:Socialized Medicine

[Luckyo]

One of the key aspects of our societies (and by our I mean that of relatively small, wealthy European countries) has typically been openness to new. This means that suggestions that you and I find stifling, or even crazy should be allowed to be suggested.

And when it's clearly against our ethics or culture, such suggestions should be shot down. As they do. To suggest stifling debate about those things on political level is to attempt to control the very freedom of speech we so cherish.

Re:Socialized Medicine

[Kjella]

They might be surprised if they expect their costs to be significantly reduced. The top graph here shows the average contribution in taxes/expenses for people of a certain age. What can you say from that graph? Mostly that the very healthy and long-lived are very expensive to the government, in fact if you've worked a few decades and die at 50 you're not actually a net expense. Note that the graph doesn't add to zero since this is per person and obviously there's rather few 100 year olds, but if you multiply by population at that age it ought to be roughly balanced.

Here's the thing, everybody dies the only question is how. A long, protracted decline with failing health is far more expensive than the people that, sorry to be blunt, drop dead. Middle-aged people, even if they've attracted something serious like lung cancer from smoking or heart attacks from obesity tend to either die or recover, either way it's not that expensive. Meanwhile your 90 year old that's been in and out of hospital and made his slow recoveries has been a big expense, never mind the pensions, retirement homes, nursing homes and various other forms of aid. At least on average.

We've been able to have a retirement age because the cost of carrying people to the end of their lives haven't been all that big. But now more and more people are having sunset decades instead of sunset years and they don't want to work longer just because they live longer. And with longer education, work life is possibly even getting shorter. Study until you're 25, work until you're 65, live until you're 85 - that's more than half your life not working. Top that off with people that are unfit to work - or perhaps more relevant today, out of work - and society is struggling.

At the current predictions, I'd have to work until I'm 70. It's great that maybe we've added five years to the average lifespan so I'll be 90 instead of 85. But to make up for it you will have to take three year from 67 to 70 and turn retirement years into working years. Like so many countries in Europe are finding out now, the government can't make that money for nothing. The cost to keep me alive is coming out of my own hide, one way or the other. If I were to stuff myself full of things to I choke at 70 instead of 90, I should be rewarded not punished.

Re:Socialized Medicine

[rmstar]

The idea of a "socially engineered society", the idea that managing many aspects of people's behaviour and society as a whole through laws and taxes is not only possible but desirable, is deeply rooted in our country.

What you are describing is precisely what a society with a government is. Anyone who thinks that a "socially engineered society" is not desirable at all is a libertarian. And, IMO, also deluded. You will get a socially engineered society anyway, the question is, who will engineer it to the benefit of whom.

Personal freedom, and the right to be a fool, are things that a well engineered society allows. Within bounds.

The idea of attacking cancer by a massive data mining exercise is probably a very good one, as almost all other approaches have essentially failed. Only a very healthy society can afford the risk this approach represents, though. I sincerely wish Norway good luck with that.

Re:Socialized Medicine

[Tsingi]

I guess they have the system they deserve.

They deserve to have health care just as much as you or I do. The government in the US no longer represents the people. That's a problem for all of us.

Re:Socialized Medicine

[SomethingOrOther]

So you could end up with a government that literally tells you when to pee, for health reasons.

Nice troll.
Norway significantly outranks the US on the Democracy Index.
As do all the Nordic countries for that matter..... all with the strong Nordic healthcare & welfare systems in place.

Re:Socialized Medicine

[stephanruby]

Health Insurance Companies are not allowed to discriminate based on dna information. I believe that bill was signed by W Bush.

Thought, this law doesn't protect against this type of discrimination for Life Insurance. Life Insurance is a little bit more tricky than Health Insurance, because if insurance companies are told not to discriminate on dna for Life Insurance, then people who have deadly genes will play the odds and load up on as much Life Insurance as they can just before their number comes up.

Re:Socialized Medicine

[TheGratefulNet]

blaming the voters and lack of turn-out? really?

if 100% of the population showed up and voted, the politicians would STILL vote based on which corp gave them the most.

stop thinking that we still have a stay in things.

we do not have a 'say' in things. corporations have 100% total rule right now. this is what the occupy guys were primarily angry about and what most of the younger generation does know, but no one in power is willing to break from the financial gains you get by sucking corporate cock.

Re:Good for Norway but not current patients.

[semi-extrinsic]

In the words of Napoleon: "If it will take that long, we must start at once!"

Re:Dammit Norway

[hxnwix]

They're not that cold considering their latitude.

Very true. Compare Trondheim's average daily temperatures to those of inland cities at the same latitude, such as Yakutsk. Due to the ocean and the gulf stream, Trondheim is something like 35C warmer in January than you might expect. Even a ways inland here in Skreia, Oppland, my outdoor thermometer is reading -13C, which is still a bit lower than average for this time of year. This is fine for working outside and skiing; grade school recess is outdoors and some kids around here walk 1km to their bus stop in these temperatures.

There's a world of difference between Norwegian and Russian winter temperatures. -10C isn't any sort of problem; -40C is trees exploding, frostbite to your dick if you pee outside.

Re:Slashbias

[Anonymous Coward]

Because Norway's governments (both right and left wings) have, repeatedly, demonstrated an ability to not fuck over the citizenry. Both sides are jockeying for positions, obviously, but where your politicians are downright evil, the worst people we have are merely incompetent.

Re:Good for Norway but not current patients.

[damn_registrars]

thousands will die before any usefull data will be discovered from such research.

That simply isn't true. Sure, some will die before advancements are made from sequencing their tumors, but they would still receive standard oncology care during the process same as they would have without the sequencing initiative - in other words, they didn't die from the sequencing.

Even more so, new treatment modalities have already come online in the past decade or so that have come from genomic identification of tumors. Genomics has changed what we know about cancer progression and has allowed for much better tailoring of treatment already. You don't need to necessarily sequence the entire genome of a tumor to know quite a bit about it; most tumors fall into a few genetic classifications rather quickly and that information is tremendously valuable in treatment decisions.

Norway is full of atheists

[Anonymous Coward]

They do not like to pray cancer away like the civilized world.

Biomarkers

[garthsundem]

I write science part-time for the University of Colorado Cancer Center -- biomarkers are totally the way of the future. In lung cancer, we discovered that a ALK-EML4 gene rearrangement predicts great response to the drug crizotinib; we know about PSA in prostate cancer; we test for hormone dependence in breast cancer. Hopefully the Norway sequencing will add to this list of biomarkers that allow us to find cancer early and give doctors clues to its treatment. (Now, the next-gen is *protein* sequencing.)

Re:Biomarkers

[biodata]

The other angle I have heard on biomarkers for cancers is not to look for individual ones, but to look at hundreds or thousands at once, and relate 'biomarker configurations' with disease. Genome sequencing will help this approach a lot too.

Re:Biomarkers

[garthsundem]

Yes! In many cancers a whole "panel" of biomarkers are affected -- researchers are dialing in the algorithms that recognize these biomarker signatures of disease. For example, maybe one biomarker isn't predictive, but in combination with 5, 15, or 100 others, the panel as a whole becomes predictive. An example is Dan Thoedorescu's COXEN panel, which looks for a host of biomarkers to predict bladder cancer: http://www.ucdenver.edu/academics/colleges/medicalschool/departments/Pathology/academicprograms/cancerbiology/Pages/theodorescu_canbio.aspx Researchers are even using gold nanoparticles to detect biomarkers in exhaled breath, to predict lung cancer. The tech's not quite there yet, but soon you might be able to breathe into a bag at the grocery store and it would screen your breath for the signatures of lung cancer.

Re:real school

[Samantha Wright]

The drug design process takes too long for this approach to yield profitable results: first you have to do a genetics workup on all of the mutations to find out which ones are important and which ones are spurious; some may even have novel mutations that aren't fluff either. Drug companies don't generally fly into action until medicine is sure of what they need to target; it's far easier to justify that sort of spending to their shareholders, as there is less risk involved (and drug design is an extremely risky business, as it is.)

For the time being, I imagine they have their hands full with enough other projects and approaches—although you can be sure they'll be interested in the data and results this endeavour generates. At any rate, the patients will be long dead before anything based on their genomes hits the market.

Re:And if the TSA did this?

[Samantha Wright]

And? What's your point? This is a medical procedure. It belongs in a medical process. Relatedly—and you may want to hold onto your knickers for this onepeople would also get upset about the TSA asking them to strip naked, but not a doctor asking them to do the same. Is your mind boggled yet?

Re:Just at the right time

[Samantha Wright]

Actually, blonde hair went extinct over a hundred years ago. Didn't you hear? It was in all the newspapers.

Re:And if the TSA did this?

[19thNervousBreakdown]

I know this is a troll, but...

Yes, when somebody is trying to save my life, I'm happy to provide them with as much information as they need, and when somebody is trying to ruin my life to justify their worthless job, I'll do everything I can to be unhelpful.

Hint: It's not a privacy invasion if I volunteer the information. And, "if you don't want to share you're obviously hiding something" is the very definition of coercion.