What every patient should know before taking a consumer genetic test.

Today, there are hundreds of companies offering to analyze your DNA, or parts of it to let you know everything from your health risks and ancestry to very specific traits such as your favorite smells or athletic ability. Before you embark on this genetic journey of self- discovery, here is what you should know:

1. Consumer genetic testing may provide you with valuable information at the price of your privacy.

Companies such as 23andme make efforts to disclose their policies before you take their test. However, this does not apply to all companies. Many companies have very vague and lengthy privacy statements. An analysis of the privacy policies written by 30 consumer genetic testing companies found that most did not meet international transparency guidelines related to confidentiality, privacy, data use. This analysis was completed by public health researchers at the University of Wisconsin- Milwaukee reported in 2017 in Genetics in Medicine. Patients must also understand that once you click “agree.” You are consenting to the company’s terms even if the terms change down the line and they often do. Take time to read and understand consents.

2. Your genetic information may be online, and you may not even know it.

Websites such as GEDmatch allow users to upload their genetic codes to databases in hopes of discovering their relatives and ancestors. This database was recently used to identify the suspect in a murder case from 20 years ago after matching the genetic fingerprint with the genetic code of the suspect’s family member. The suspect, known as the “Golden State Killer” was a man who killed 12 people and raped 45 women across California between 1976 and 1986. Even though, the suspect was not in this database, a distant relative of his was. Using this genetic information with the fingerprint from the crime scene, investigators were able to narrow down the suspect to one family. Using traditional crime investigation, there were able to narrow down the suspect to James James DeAngelo, a retired police officer who lived very close to the crime scene. This technique has been used to crack other cold cases from around the world. It’s a triumph for the crime world but has invoked criticism from genetic experts.

3. Your health insurance or your employer can not use this information against you.

Several laws at the federal and state levels help protect you against genetic discrimination. A federal law called the Genetic Information Nondiscrimination Act (GINA) protects you from genetic discrimination. GINA has two parts: Title 1 makes it illegal for insurance providers to use or require genetic information to make decisions about a person’s insurance eligibility or coverage. Title II makes it illegal for employers to use a person’s genetic information when making decisions about hiring, promotion and other terms of employment.

GINA and other laws do not apply when an employer has fewer than 15 employees. GINA does not protect against genetic discrimination in your disability, life or long-term care insurance.

Have no fear! Some states offer more protection! California and Alaska have the strongest consumer genetic privacy protections. California’s law called CalGINA has expanded its protections to include housing, mortgage lending, education, and public accommodations. The law allows victims of genetic discrimination to seek monetary damage. Other states have developed regulations concerning genetic non-discrimination and insurance, health insurance coverage, genetic privacy, and research.

4. If you are unsure about your results, consult your doctor.

Companies such as 23andme use saliva samples or inner cheek swabs sent in by customers to test for your ancestry and various factors related to your health. These tests can be estimates rather than definitive results. If you take the test and your ancestral data, is unlike anyone profile, the algorithms that assign ancestry usually make a “best guess” which is usually close but imperfect.

The accuracy of your test depends on how many people have taken that test with your similar background. A test for “Irish” versus “French” ancestry is very sensitive to the exact method and data used. However a test for “East Asian” may give the same results no matter the method or data used.

If you receive unexpected health information from a home genetic test, please consult your doctor and consider a genetic blood test to confirm the results.

Disclaimer: Opinions are my own and do not reflect that of my institutions. These are articles are not meant to provide medical advice only to educate.

The newest medication on the market is not found in a bottle. It’s not always prescribed by a doctor but is believed to treat many medical conditions from mental illness, to depression, anxiety, and chronic pain! It has taken a cult status in the business world.

What’s this treatment? It’s called mindfulness.

Mindfulness is the psychological process of bringing one’s attention to experiences occurring in the present moment. The most common way to develop this practice is through meditation. Thanks to technology, you can now click on the app on your phone and have access to hundreds of meditation exercises depending on your emotions, your activity and the allotted time available. It’s like a monk on demand.

There are several thousand meditation apps now available on your phone. Headspace, the app that has dominated the market is an English-American online healthcare company specializing in meditation. It was established in 2010 by the writer, public speaker, and health advocate Andy Puddicome and partner Richard Pierson. Andy is the soothing British voice on the app that many will recognize.

And by many, I mean millions.

In June of 2018, 31 million people had downloaded the app with the company surpassing more than 1 million users. More than 250 companies including Nike, Goldman Sachs, and Dane-Farber Cancer Institute have bought bulk subscriptions to headspace for their employees. According to Forbes, it has an estimated annual revenue worth $50 million and annual revenue estimated by Forbes of $250 million. Headspace has called themselves the “gym membership for the mind.”

Mindfulness is everywhere in the business world. The World Economic Forum in Davos opens with daily meditation sessions, companies like General Mills, General Motors and Target offer their employees meditation programs. Goldman Sachs and the Dane-Farber Cancer Insititute have bought bulk subscriptions to Headspace for their employees. Of course, when you have celebrities like Arianna Huffington and Richard Branson preaching the benefits of meditation, you begin to wonder maybe that’s why he owns a private island, and you don’t!

All jokes aside, in medicine mindfulness and meditation, have a minimal presence in traditional practices. However, there is increasing data to show benefit as a complementary or integrative health practice. There is evidence that it may reduce blood pressure as well as symptoms of irritable bowel syndrome and flare-ups in people who have had ulcerative colitis. It may ease symptoms of anxiety and depression and may help people with insomnia. (NOTE) All of these treatments should not replace conventional care or act as a reason to postpone seeing a healthcare provider about a problem.

Headspace truly believes in its benefits that it is conducting researching with the app to validate the Headspace approach to meditation scientifically. It is partnered with over 35 scientific research institutions and organizations such as NYU, Harvard, and USC to conduct these third-party investigations. They are investigating whether the headspace meditation platform on clinical conditions such as efficacy in improving asthma, cancer patient quality of life, sleep quality and pain management. Through this research, they plan to develop the world’s first prescription meditation app as an FDA-cleared treatment for chronic disease.

What does this mean?? Well move over Google, Apple and Amazon, Headspace wants a piece of the pie. By clinically validating the app, they are solidifying the presence of Headspace as a clinical tool in healthcare, meaning that insurance companies may choose to cover the app in the future. Headspace will be used in homes, hospitals and doctors offices. Headspace will not only have you, but they will also have you as a user and YOUR DATA! The clinical validation of meditation through this research will also encourage certain specialists to integrate the use of meditation in their treatment of chronic disease, cancer treatments, chronic pain, and even obstetrics and gynecology! I am so excited by the future, now its time for me to meditate.

• Brook RD, Appel RJ, Rubenfire M, et al. Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the American Heart Association. Hypertension. 2013;61(6):1360–1383.
• Gaylord SA, Palsson OS, Garland EL, et al. Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. American Journal of Gastroenterology. 2011;106(9):1678–1688.
• Goldstein CM, Josephson R, Xie S, et al. Current perspectives on the use of meditation to reduce blood pressure. International Journal of Hypertension. 2012;2012:578397.
• Jedel S, Hoffman A, Merriman P, et al. A randomized controlled trial of mindfulness-based stress reduction to prevent a flare-up in patients with inactive ulcerative colitis. Digestion. 2014;89:142–155.

Today I was actually grateful for my son’s nosebleed.

We were sitting on the floor of the bathroom, watching YouTube Kids to distract him from the bleed, when I saw it.

It was a simple, innocent cartoon — until it happened.

Four minutes and forty-five seconds into the video, a man quickly walked onto the screen, held his arm out, and taught the children watching this video how to properly kill themselves. What did I just see? Did I really just see that? I immediately turned off the video. My son’s nose stopped bleeding, and I further investigated the video in private while he went to play. I watched it again, certain that I had dreamt it up. I know YouTube had some sick videos, but I thought YouTube Kids was safe. They sure make it seem like it is.

But — no. There it was again. Four minutes and forty-five seconds into the video. The man quickly walked in, held his arm out, and tracing his forearm, said, “Kids, remember, cut this way for attention, and this way for results,” and then quickly walked off.

Not much shocks me. I’m a physician, I work in the emergency department. I’ve seen a lot.

But this did.

This video was intentionally planted on YouTube Kids to harm our children. He waited until parents’ guards were down, thinking their kids were just watching a harmless cartoon when he made his entrance four minutes and forty-five seconds into this video.

How can anyone do this?

How can YouTube Kids trick parents into thinking their content is safe?

What else do our children seen on these apps?

I reported the video and asked my friends and family to report. Hours later though, it is still up, and I wonder how many children have seen this video since. Those apps are all now deleted and will never return to our household.

I am disturbed, I am saddened, I am disgusted. But I am also relieved that I was there to see this video with my own eyes, so that I could take the appropriate actions to protect my family. I would recommend everyone reading this to take these same steps as well.

Today I was grateful for my son’s nosebleed.