With consumer genomics kit sales down and layoffs recently announced at Ancestry and 23andMe, not to mention last year's major restructuring at Helix, many feel the direct-to-consumer market is in decline.
The fall is attributed in part to a tapped out market, as well as increased privacy concerns following some high-profile law enforcement cases. Yet some of the market's most influential voices believe that consumer genomics is not on the way out, but rather experiencing a period of transition.
"I think the consumer market is going to become more integrated into the healthcare experience," said Joe Grzymski, an associate research professor at the Desert Research Institute and principle investigator on the Healthy Nevada Project, a four-year-old population health study.
"Whether that occurs through your primary care doctor, your large integrated health network, or your payor, I think there will be profound changes in society's tolerance for using genetics for prevention," he said.
This general pivot toward the health market is perhaps best embodied by Helix's decision last year to refocus its efforts on partnerships with systems for population studies, such as Healthy Nevada.
The effort, now overseen by the Renown Instute for Health Innovation where Grzymski serves as CSO, initially worked with 23andMe during the first phase of the study that enrolled 10,000 people, providing them with ancestry, traits, wellness, and carrier status reports. The second phase, undertaken with Helix, involves the whole-exome sequencing of 40,000 participants.
"Anecdotally, our patients want the hospital to help them understand this information," said Grzymski.
"There's a small group of people who buy every new iPhone, every new pair of Nike shoes, and they bought 23andMe, they bought Ancestry, and they compared," he said. "But then there are those who want more out of it. That is partially driving the downturn."
Helix has also partnered with Mayo Clinic on a 100,000-participant study, and last July, Intermountain Healthcare announced a partnership with Amgen and Reykjavik, Iceland-based DeCode Genetics to sequence 500,000 patients as part of a population health study called HerediGene.
While these might look like the initial phases of a new period of making genomics available to the masses, they are similar to what pioneers in the consumer market had in mind when they launched the first services over a decade ago.
"I don't think the slowing in the sales is telling all that much about the potential of direct-to-consumer testing," said DeCode Genetics CEO Kári Stefánsson. DeCode was among the first companies to launch a consumer genomics service in 2007, entering the market roughly at the same time as other pioneers 23andMe and Navigenics with its offering.
While DeCode shuttered the service in 2013, Stefánsson said the ideas that led the company to offer DeCodeMe are more relevant than ever. "If you think about it, healthcare systems have been changing over the past two decades," said Stefánsson. He described a general empowerment of the patient within healthcare systems, who have more access to information that can help them make decisions, including genetic information obtained from DTC services.
"I wouldn't be surprised if they wouldn't yield a new kind of healthcare system where the customer of the healthcare system is a more important player in all of this," said Stefánsson. "Those who sell these tests will eventually take on the task of triaging the customer, referring people to healthcare centers and even build speciality clinics by themselves," he said.
As such, he believes that rather than signaling the end of the market, the 23andMe and Ancestry restructuring only reflects a shift in how people use the information obtained from these tests to make it more relevant and actionable.
"I think the market has a bright future and will be a significant remaker of the way in which we think about healthcare," said Stefánsson.