Do you order genetic tests for all of your patients?

Dr. Amy Nett: No, I don’t actually. The genetic test we sometimes run is 23andMe, and I sometimes run the methylation analysis. For that, what you do is you have patients go to 23andMe.com, you have them self-order the kit, and then they collect a saliva sample, submit that to 23andMe. Once 23andMe tells them that they have the results, then they go onto GeneticGenie.org or they can use a number of different sites that sort of pull out the 23andMe data, and GeneticGenie.org, for example, has a methylation analysis that then shows you COMT, MTHFR, VDR, MAO-A, BHMT, CBS—a lot of the genes associated with methylation. But again, because we’re saying genes are associated with about 10 percent of disease but it’s really the exposome and epigenetics that affect our health, the genetic tests alone tend not to be actionable. I think we’re still ordering the methylation analysis test for most people. Again, if money is a big issue, we’re definitely going to think about if it’s going to change management, but what we might do is if we see, like, a CBS mutation and patients aren’t improving, we might consider doing downstream testing, urine sulfate, something like that, but that’s really the only genetic testing I do. I don’t actually do the BRCA1 testing—I just answered that question from Justine—and occasionally you will have patients who come to you and say, “I’ve already had this BRCA testing,” that sort of thing, so I would say it’s the minority of my patients that I order genetic testing on. Maybe 20 to 30 percent of patients I’m doing the methylation genetics, but how many people I find the genetics alone actionable for is very questionable because I tend to do the functional methylation testing.