Navigenics vs 23andMe: drawing the battle-lines

Well, the debut of Navigenics has certainly been a lot more interesting than I anticipated. Far from being just another genome-scan product limping along in the wake of 23andMe (like, say, SeqWright's rather depressing effort), Navigenics is brazenly attempting to re-define the entire industry in a way that suits them.

At the very least, the company is staking a solid claim over the lucrative well-paid over-30 non-geek market niche, which has been surprisingly poorly tapped by the current players. But Navigenics seems to want to go further than this: in fact, they appear to be trying to reshape the personal genomics industry as being first and foremost about the sober provision of evidence-based health information, and simultaneously position themselves as the most respectable provider of this information. If in the process they can create a perception of their competitors (particularly 23andMe) as frivolous and over-hyped, so much the better.

Over at Genetics and Health, Elaine Warburton has a long interview with Navigenics' Medical Director Michael Nierenberg. This is by no means a probing critique - in fact, it reads suspiciously like an extended advertisement for the company - but there are some interesting snippets from Nierenberg about the image Navigenics wishes to present:

Navigenics is no way a ‘recreational’ genomics company and does not wish to contemplate entering any ‘recreational’ field. It is a company focusing on the wellness and prevention aspects of health. Our service focuses on actionable entities and things of substance such as cardiac disease, not eye colour or such like. We welcome regulation and make heavy use of genetic counseling.

The sub-text is abundantly clear: we'll give you accurate information about the really important stuff like cancer and heart disease, whereas our competitors (they know who they are!) mess about with trivial information about athletic performance and ear-wax consistency.

Navigenics' well-orchestrated marketing campaign revolves around this central theme of seriousness and competence, and I'm sure the message is sinking in with their apparent target audience (well-paid, highly-educated, time-poor executive types old enough to start fretting about their long-term health); having the reliably earnest Al Gore spruik the company certainly didn't hurt. To emphasise their trustworthy seriousness, Navigenics has launched a joint study with the Mayo Clinic into the effects on patients of receiving genetic information, is partnering with Medscape to provide physician education, and proposed a set of standards for personal genomics companies (a clear attempt to re-define the industry in their own image, while simultaneously seizing the moral high ground).

Through these activities, as well as their use of CLIA-certified genotyping facilities and provision of 24-hour access to genetic counselling, the company no doubt hopes to avoid many of the criticisms thrown at other personal genomics companies.

This all seems quite admirable, on the whole. However, the Navigenics model is also deeply regressive: they are taking the currently exciting, somewhat anarchic but intrinsically empowering field of personal genomics (in which individuals are free to explore their own genetic data however they wish) and cramming it back into the tightly-regulated, paternalistic environment of the standard medical framework. Where 23andMe talks about guiding customers through their own journey of genetic discovery, Navigenics appears to be more about giving clients the information that Navigenics thinks is medically relevant, and protecting them from all the non-essential details that might overwhelm or confuse them.

Nowhere is this regressive paradigm more evident than in Navigenics' refusal reluctance to give their customers access to more than a tiny fraction of their own genotyping results. Unlike 23andMe and deCODEme, who both freely provide clients with access to their complete, raw genotyping data, Navigenics customers must sign a waiver to receive their results on an encrypted disk (presumably without an easy-to-navigate interface); Navigenics ominously warns that "without our blessing, the potential for misinformation is extremely high" (updated thanks to Hsien). Elaine puts a positive spin on this reluctance:

Imagine the confusion and furore if Navigenics were to provide its members with their full 1 million marker analysis! Navigenics’ (and others) sensible, if somewhat patriarchal approach of ‘drip feeding’ results to members as and when the research is robust enough to bring the SNP into the public domain, is one that should be applauded not derided.

In other words, customers shouldn't need to worry their pretty little heads over all these confusing As, Cs, Gs and Ts - they can just let Navigenics decide what they need to know. Ouch.

I can only assume that Navigenics' focus group research suggests that their target audience finds this attitude reassuring rather than profoundly insulting; either way, it's both patronising and unnecessary. After all, it's not like 23andMe simply punt any old genetic association out there for their customers to sift through - they carefully code the associations to indicate how reliable they are (based on a pretty reasonable set of criteria [PDF], I might add). Customers are allowed to analyse their own data for both gold-standard and lower-reliability associations, but are given information to help them decide how much weight they should place on each. In my opinion this sort of informed freedom is a far more enlightening (and vastly less insulting) model that the constrained "need-to-know" approach of Navigenics.

Anyway, it will be interesting to see how Navigenics alters the long-term tone of the personal genomics market. Perhaps the early pioneering feel of personal genomics was just a temporary aberration, and we are now seeing the beginning of a general regressive shift towards the standard medical model. More optimistically, I suspect these early battle-lines mark the beginning of a diversification of the industry, with some products targeting the individualistic and curious spirit of a younger, information-savvy generation, and others appealing to the more serious health-centered focus of individuals moving towards middle age.

Either way, it will be fascinating to watch 23andMe, Navigenics and their current and upcoming competitors struggling to define an entire industry as they battle for market share.

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